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
a top is to be taken off with a speon and whatsoever sinke to the bottom throw it away Then afterwards Take of Earth worms washed in Wine or Water two sextaries let them be put for a while into the Bakers oven in an Earthen pot covered where as they must be baked so you must have a great care that they be not burnt and after this beat them into a pouder Take Of this Pouder the dryed brains of a Brawner Red Saunders that smells sweet Mummie and the Haematites or Blood stone as he calls it of each one ounce After this Take Vsnea or Moss from the skul of one that died a violent death let this Moss be cut off from the skul in the increase of the Moon and she being then in a good house as that of venus if it be possible but not of Mars or Saturn the weight of two filberds or thereabout And all of them being bruised together and well mingled with the fat let there be an unguent made according to art and then in a Glass vessel stopt or if you think good in a Box let it be carefully kept for use If after long time the unguent happen to be over dry it may be a new moystened and softened with the aforesaid fat or virgin hony Let the Vnguent be made the Sun being in the sign Libra The Vse of this Ungruent Now as touching the Efficacy and use of it he thus writeth This cure is performed by the Magnetick attractive virtue of this Medicament caused by the constellations which thorow the medium of the Air is brought unto the wound and Joyned therewith that so the spiritual operation may be drawn forth into effect It s wrought I say by means of the Astral and Elementary conjunction There are therefore three things that by this unguent cause so admirable an Effect 1. The Sympathy of Nature 2. The influence of the heavenly Bodies perfecting their operations by the Elements 3. The Balsam which being endued with a virtue of healing is naturally applyed unto any man without any difference With this unguent are cured all Wounds by what weapon soever they be inflicted and whatsoever the sâ—x he and yet so notwithstanding that neither the Nerves Arteries nor yet any one of the three more principal members be hurt so that the Weapon may but possibly be had although the patient be many miles distant from us And in regard that it is of a Couglutinating Suppurating and renewing Nature it doth not permit if it be rightly applyed any hurtful symptom to follow upon it The manner of applying the Unguent or Weapon salve First Let the Weapon wherewith the man is Wounded be anoynted every day once if necessity require it and the wound be great but otherwise it will be sufficient if the Weapon be anoynted every other or third day and then let it be kept in a Clean Linen Cloth and in a place a little warm but not over hot lest that any damage should thereby be brought upon the Patient We must likewise be very careful that the Weapon fall not down from on high neither that the wind blow upon it in a cold place for if this should happen the Patient wil run mad Secondly Before you anoynt the Weapon Consider whether the Wound were made with the point by pricking and if it were let the Weapon be first anoynted upwards and not below and so descending toward the point thereof for otherwise much hurt may be brought upon the Patient Thirdly But if thou canst not certainly know how deep or in what manner the Weapon entered into the flesh thou mayst then anoynt it all over but otherwise it will be sufficient to anoynt that part of the Weapon wherewith any one is hurt Fourthly There is no Necessity of sewing the wound together after the manner of Barber Surgeons but every day only to bind it up with a clean linen Cloth first wet in the Patients Vrine Fifthly That day that any one anoynts the Weapon let him abstain from Venery Sixthly Before the anoynting of the Weapon let the Wounded persons blood be with al speed stanched Seventhly In fractures and ruptures of bones you may add unto the unguent some of the powder of the greater comfry or the roots of black Hellebor Having the weapon wherewith the Patient was hurt if thou be desirous to know whether the Patient be likely to live or to die of his Wound thou art to make the trial in this manner Take the weapon and make it hot over the coals so hot that thou can hardly endure thy hand upon it and then sprinkle upon it some powder of Red Sanders and the blood stone and if the Weapon then sweat drops of blood the patient will die but if not he wil escape it But if we would know whether the Patient order himself aright in his drink and other Requisites this may thus be known if there be in the weapon spots of blood he is disordered but if no such spots then the Patient ordereth himself aright We are moreover to take notice first that if we have not the Weapon or instrument whatsoever it were yet nevertheless that any violent opening of the Skin and hurting of the flesh by which any Blood goeth forth may be Cured with this unguent so that a little piece of Sallow Wood be moystened in the bloody opening and after that the Blood sticking thereto be dryed not by the heat of the Sun or the fire but of it self and own accord it be then put into the above mentioned Vnguent kept close covered in the Box and there left Secondly If the Wound should be great and deep it may then be cleansed every morning and bound up with a new Linen Cloth without any other use of Extraneous Oyls Vnguents and the like and then this wound how ever it were inflicted will heal of it self and it sufficeth that the little piece of Wood once only moystened in the opening of the Bloody wound be then put into the Box of Vnguent as aforesaid and there left to remain until the Wound be perfectly Cured Thirdly But yet notwithstanding as oft as any new Wound is to be healed there is alwaies required a new piece of Wood. Fourthly But if it be so that the Wound wil not bleed it is then with the Wood so long to be scarified until the blood flow forth and so likewise in the curing of the Tooth-ach the pained Tooth is so long to be scraped with a Pen-knife until it bleed and then the Pen-knife after the blood is dryed up it to be anoynted with this Vnguent and so the pain is presently asswaged If a Horse be prickt with a Nail in his Foot let the Nail be first of all drawn forth and anoynted with this Vugment and the Horses Foot shall immediately be cured without any suppuration at all And so in this same manner all living Creatures having flesh and Bones may be Cured The description
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
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
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
body inflicted with the wound sticketh therein we wil therefore together and at once treat of the removal of them But now as we said before the common indication of a simple wound is union as Galen teacheth us in his Art Medic. Chap. 90. And as the same Galen hath it in his third Book of the Meth. of Physick Chapt. 4â— a simple Wound only requireth agglutination Now this Agglutination and union is the work of Nature alone and by her operation only the wounded parts as likewise those parts that are broken Hand disjoyned do again grow together and are conglutinated But then since that there is required for this purpose a certain medium and a glew as it were nature for this purpose maketh use of that very matter by which the parts are nourished to wit the blood For this blood being attracted unto the part for nutrition and sticking in the pores of the sides and the lips of the wound is converted into a substance like unto the wounded part to wit flesh and so by the benefit thereof what was disjoined now groweth together again and so of two becometh one And this in the flesh the Sarcopoietick faculty performeth in the skin the cutifique or skin-breeding faculty and so in every part Nature generateth a Medium of the same kind for the Agglutinating of that which was disjoyned And this inded albeit that it be solely Natures work yet the Physitian in the furtherance of this work is a Servant unto Nature and the truth is that unless the Physitian strike in for Natures assistance she is in many things frustrated of her end neither can she effect the intended Conglutination But now those things that in this case are to be done by the Physitian are reduced by Galen in Art Medic. Ch. 90 unto four heads Nature her self saith he causeth to unite and grow together again those things that stood at distance one from the other and she it is that restoreth the pristine Vnity but now it is our part and work actually to apply and put together the extreams of the distant parts and being thus brought together into one so to keep and preserve them and thirdly to beware of this that nothing fall into the Lips of the wound and fourthly our work it is to preserve safe and unhurt the substance it self of the part And so in the Cure of Wounds there are especially four offices belonging to the Physitian specified by Galen in the place alleadged First of all the Physitian is to see and take care that nothing fal into the part affected which may hinder the Conglutination Secondly That the Extreams in Unity dissolved may again be rightly conjoyned and put together in a due and fit manner the one to the other and the extreams thus Joyned together are so to be kept until Nature hath done her work Thirdly That so the temperament and the innate heat of the part it self may the better be preserved he is during the time of Agglutination to afford unto Nature all the necessary help and assistance that he can by the best of his skill and diligence Unto which We may not unfitly add a fourth to wit that those Symptoms which may and are wont to supervene may be prevented and corrected and all those things taken away which may be any the least impediment to Nature in the Conglutinating of the Wound But now in regard that there may be a very great difference in the solution of Unity these Scopes are not alwaies to be performed alike in one and the same manner in all parts And first of all for what concerneth the wounds we are now treating of if there be any thing extraneous as Clods of Blood or Haires or any thing of the Nature of any sort of Weapons or smal pieces of bones or any thing else whatsoever from without shall chance to stick in the Wound that is to be taken forth and extracted For they cannot possibly become one between which somthing lieth that is of a different kind And indeed we are not only to draw forth of the wound at the very first all things that are extraneous but we must likewise afterward take great Care lest that any thing from without fal into the wound When once all extraneous things if any such there were are drawn forth the lips of the Wound are then to be brought together and Joyned close the one to the other the which how it ought to be performed we shal by and by shew you The parts that stood at distance being thus Conjoyned all the rest of the work to wit that they may be united and grow together in one is the work of Nature alone For it is she only that Conglutinateth these parts when they are disjoyned But seeing that Nature in this Agglutination maketh use both of the temper of the part and the innate heat thereof we must therefore do our endeavour that the temper and innate heat of the part may be preserved or if it hath been by any means weakned that it may be again restored And seeing likewise that the matter of the flesh by which the parts are Conjoyned is the Blood we must therefore take especial care and use the very utmost of our endeavours that the Blood that floweth unto the part affected may not offend either in quantity or quality For if the Blood be vitious it cannot generate good flesh And again if there be too great abundance thereof the flesh then becometh over Luxuriant and proud and there are many Excrements generated if there be less thereof then is requisite it doth not then generate and make a supply of sufficient matter And whereas the wounded part is made much the weaker both by the pain and by the wound therefore in the wounded part of necessity there must be produced store of Excrements and corrupt filthy mattier and if the Sanies and Excrements intervene in the midst of the Lips when they are drawn together or if that also there shall be any middle place between which though it be indeed void of filth and Excrements yet is ful of Air such a like Ulcer I say cannot possibly be Conglutinated by the sole Conjunction of the disjoyned and distant parts but that it may unite and grow together again there is a necessity that it be first filled up with flesh And therefore in such like case as this there wil be need of a sarcotick Medicament And so in the performing of the cure of Wounds our first office and work is 1. To endeavor that nothing extraneous and coming from without may stick in the wound and betwixt the Lips thereof and that nothing be left remaining therein 2. That the Gaping parts of the wound may be again conjoyned 3. That being conjoyned they may be so kept 4. That they sodder and grow together again each to other 5. The performing of which seeing that it is the work of nature it is especially requisite that the temper and strength
of blood and the matter of the inflammation may be withdrawn and kept back And indeed by how much the danger in the wound is the greater by so much the more spare ought his diet to be but so soon as the danger of the wound is diminished then his diet may be by degrees augmented so that he may feed somwhat more fully but yet stil with a due moderation And therefore albeit that Hippocrates in his B. of Affects saith that Wounded persons ought to be pinched and afflicted with hunger this is not simply so to be taken but that we are alwayes to heed the danger of the wound and especially of the inflammation conjoyned therewith and according as this danger shal be greater or less so the diet prescribed may be more ful or ought to be more sparing as we may see out of the same Hippocrates in his Book of Fractures comment â— Text. 44. and Comment 3. Text. 12. as also out of Galen in his Commentary upon those Texts of Hippocrates But yet notwithstanding there is some consideration and respect to be had unto the Age time of the year Region Custome and Temperature according to that 17. Aphorism of the first Section As touching the Patients drink in our Regions Beer may fitly and conveniently enough be drunk His Drink I mean that drink that is made either of Barly or of Wheat and this is to be made somtimes weaker and somtimes stronger according to the state and condition of the wounded party and the wound it self Wine is not allowable in those wounds that are dangerous and where there is present or the danger of an Inflammation threatened and neer at hand in regard that it may by reason of its heat and thinness be a vehicle or means to convey the humors unto the part affected And therefore Hippocrates in his Book of Ulcers text 1. writeth in this manner A small and moderate quantity of Meat and the drinking of water is mostly fit and requisite in all Wounds whatsoever but yet rather in those that are new and fresh then in those that are old and of a long standing and then especially when in the wound there is present an Inflammation or if there shal be any feared or when there is any danger lest that any thing may be vitiated or when the wounds of a joynt are attempted by an inflammation or when there is any fear of a convulsion at hand and lastly when the Belly hath received a Wound And therefore for those that have been long accustomed to drink water and where there is no great plenty of beer either simple and pure water may be administred unto the patient or else a Medicate water destilled out of the juice of Pomgranates Coriander seed Citron rinds of Barley water or the water destilled out of the whol Citron When the danger of the inflammation as past then that wine that is thin and weak may be allowed the patient how and then In wounds that are more grievous and ful of danger Medicate drinks may be provided and made of vulnerary herbs As for what Concerns the motion and rest of the body Motion and rest which of them fittest for those that are wounded Rst is most convenient for wounded persons but more especially for the wounded part For motion moveth and scattereth the humors and rendereth them apt to flow and the moving of the wounded Member exciteth a pain in it and yet nevertheless for the Patient to walk casily and gently his leggs being sound unhurt it wil be no way amiss but very good for him so to do touching which Celsus in his fifth Book and Chapt. 26. thus gives us his opinion The best Medicament likewise saith he is Rest and quietness and to More and walk unless for those that are sound and in health is not so fit and convenient but yet nevertheless it is least dangerous in those that are wounded in their head or Arms but more unto such as are wounded in their inferior parts But motion or walking is then least of all convenient when the wound is either in the Thigh or the Leg or the Foot The Commotions likewise and all perturbations of the mind are carefully to be avoyded Affects of the mind how they are to be ordered and more especially wrath and Anger And therefore those persons that may be an occasion of incensing and provoking to anger the sick person are not to be permitted to come where he is nor so much as any mention to be made of them in his hearing But the Patient ought rather to be moved and stirred up unto a moderate and fitting mirth and cherefulness and all possible tranquillity and calmness of Mind And of all other things that are prejudicial unto the Patient at this time the use of Venus and the company of women is the most hurtful Immoderate and overlong watchings are also very offensive in regard that they inflame and cause a commotion in the humors The sick persons belly must be kept open and soluble and if it chance at any time to be stopt and shut up it is then again to be opened and loosened with mild and gentle Clysters Chap. 13. Of keeping the flux of humors from the Wounded part And thus much touching the general cure of Wounds which yet notwithstanding is somtimes to be varyed according to the variety of the subjects the Nature of the wounded part and the condition of the diseases and the symptoms that flow thereupon and of this we shall now speak And first of all indeed it oftentimes happeneth that the body that is wounded may not be exactly and perfectly sound but that it may be either Plethorical or cacochymical so that there may be great cause to fear lest that either great abundance of blood or the vitious humors that have been long treasuring up in the body may by occasion of the wound rush unto the affected part and there excite various evils And therefore we are to use our utmost endeavour to hinder and prevent the afflux of the humors unto the wounded part Now this flux is especially prevented if care be taken to hinder all those causes that may excite the said flux and moreover al those things that may overmuch and prâ—ternaturally heat the wounded part excise a pain therein or render the same soft loose and so consequently the more apt to receive the flux or overheat the humors disperse them and so render them the more fit for motion are wholly to be removed and taken quite away And such a care and orderly course there ought also to be taken in point of dyet that it may not in any wise generate either too great abundance of blood or had and corrupt humors And furthermore we are likewise to succour and help the weak and infirm part by those things that corroborate and strengthen it the pain if there shall be any is to be mitigated if there be present any heat it is to be
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
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
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
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
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
Veins are to be opened whiles the blood flows with greater violence and as we may say with a more impetuous motion and the lesser when the Fluxion of the blood is less forcible and impetuous For it is behoveful that the Remedies should be such as may by their celerity or swiftness contend with the over hasty motion of the matter And therefore we acknowledg Fernelius to be in the right in his second Book of the Method of Physick Chap. 7. where he writes That the opening of the Shoulder Vein in the Elbow doth very conveniently draw back al the affects of the Head as wel internal as external arising from fulness if they be on the right side the right Vein but if on the left side the left Shoulder Vein is in the Elbow to be opened But if this be to be done more deliberately and slowly as to instance when the intention and main drift is only to anticipate and prevent future Diseases then that Vein in the Hand which runs directly unto the Thumb and fore Finger is to be opened unless haply it take its original from elswhere and not from the Shoulder Vein But for those distempers which are seated betwixt the Channel bone and the Kidneys the more inward Vein in the Elbow being opened doth more speedily and with greater force draw back from them but more slowly and dully that Vein in the branch of the Hand which is extended and stretched forth between the Ring-finger and the little finger Repulsion or driving back is used to follow revulsion Repulsion or driving back For Repulsion and Revulsion as it were mutually assist each other and hence it is that both these Remedies are to be administred in great Inflammations yet notwithstanding Revulsion ought alwaies to have the precedence For Repelling Remedies that drive back may not safely be administred while the body continues full since that the Vessels yet remaining ful wil hardly give way unto the Humor that is driven back but if Revulsion be first made use of where there is occasion for it afterwards those things that drive back may with more safety be administred For Repellers both drive back the flowing humor unto some other part and so permit not the passage thereof into the distempered part and they also likewise repress the humor which is newly flown into it and which sticks in the Capillary Vessels and so by this means they free the part affected from that overgreat abundance of blood But albeit the benefit arising from these Repelling Remedies be very great and evident as that whereby the fluxions even in their beginning by the alone use of these Repellers are stopped and the part which began to be lift up into a Tumor again fals down from its Swelling yet notwithstanding these ought not evermore in al cases to be administred For that we may not again repeat what we said before to wit that driving back benefits nothing in a full and foul body but that likewise it cannot then be so much as attempted without danger When Remedies that drive back are not to be made use of it is altogether improper and unfit to administer those things that drive back when a far greater discommodity and inconvenience may be feared from the repulsion or driving back of the blood than from the Inflammation it self which may very wel be first if the humor be malignant venemous and pestilent the which if Nature shal thrust forth from the inward parts unto the outward we ought not to drive it back again unto the internal parts lest that it should peradventure make its retreat back unto those inward parts and thereby encrease the disease and indanger the choaking of the man Which very Caution is likewise to be observed in every other humor be it what it wil that Nature rightly acting in a critical way rejects and casts forth into any some one part For Nature while it is rightly imployed and busied is by no means to be impeded in her operation Secondly Those things that drive back are not safely to be administred in the parts which we term ignoble or less considerable being such as Nature hath ordained to receive the superfluities of the more noble Parts unto which she is oftentimes wont to thrust out the Humors with which the more noble parts are burdened and even loaded and such are the Glandules or Kernels in the Groins Arm-pits and behind the Ears For if repelling Medicaments be applied unto these parts there will be great cause to fear lest the matter should again retire to the more noble and principal parts Furthermore thirdly There are other places and other parts likewise unto the which Repellers may not commodiously be applied and such are al those that in their scituation too neerly neighbor upon the noble parts For the very same thing as before said is to be feared lest that the matter being driven back should invade some of the nobler parts and create a greater mischief In the fourth and last place Repelling Remedies are not then to be tampered with when the parts are scituated in a place too profound or over deep For neither doth the vertue as we cal it and strength of the Repelling Medicaments reach unto such parts neither can it wel be prevented but that those parts are hereby rather made more ful than any waies emptied For while by Repelling Remedies the exterior parts are contracted and from out of them the Humors are driven inwards they are after a sort thrust and obtruded upon the affected part the which by this means becomes more replenished The time when Remedies that drive back are to be administred But then again For the time and season when these Repellers are to be administred it is easily discernable To wit seeing that the main end and scope of driving back is this That the flowing humor should be prohibited its passage and rejected therefore they are to be prescribed in the very beginning and that most rightly and properly whilest the matter is yet flowing But this notwithstanding ought evermore carefully to be observed as we said before that the body be not ful For if the body yet remain ful drivers back are not safely administred whenas the blood hath not any free passage for its retreat and so by this means becomes either more impacted into the part or else rusheth into some more noble part and so create a greater danger But when indeed even whilest it is in its augmentation there is yet some of the blood in flowing even then repelling Medicaments may be administred yet not alone whereupon we judg it not amiss that unto these we add and mingle therewithal some kind of Digestives to the end that by the heat somwhat may together also be attenuated and converted into exhalations How Medicaments that drive back are to be mingled with those that digest Now after what manner Repellers are to be mingled with Digestives Galen instructs us in his sixth Book of
be contained in the intervening middle spaces And in his second Chapter of a Tumor he thus writes It is saith he by Physitians found to be expedient in the case aforesaid not only to discuss by the means of heaters but likewise sensibly to evacuate at least some part or portion of the blood it self by making scarifications in the Skin But here then we are to know that great heed and circumspection ought to be taken and had whether or no the matter may be turned into Pus as we term it being the snotty fetid matter ensuing upon maturation For if we may probably hope for the said suppuration then the above mentioned scarifications have not any the least place But then on the other hand if the matter may not be changed into the said Pus or matter and that notwithstanding likewise there be little or no hope that possibly it may be wholly discussed or scattered by the application of Medicaments then in this case both Scarifications and Cupping-glasses may nay ought to be administred For these two are a very effectual and prevalent Remedy for the evacuation of the matter whatever it be that sticks and is deeply scituated and which seemeth forthwith to be in the ready way of conversion into a Scirrhus And therfore they are by no means to be administred in the beginning or first appearance of the Inflammation but at length after that the body is sufficiently emptied and that the Phlegmone is at a stay that so there may be further cause to fear that a new fluxion should be excited by that pain which originally proceeds from scarification and then only when we have a purpose to extract that which remains over and above after the use of other convenient Remedies Yet notwithstanding Scarification hath place only in those parts which in other cases likewise are fit to undergo and suffer the said Scarification For if an Inflammation happen unto any part unto the which in any other case scarification ought not to be administred I conceive that there wil be found no man so rash and unadvised as that he dare be so adventurous as after a Phlegmone for the evacuation of the residue of the matter to apply Cupping-glasses and administer scarifications unto the part affected But very rare it is that scarifications are admitted and allowed of for the use and purpose aforesaid But the safest and most usual way of curing an Inflammation is that the matter which hath flown in unto the part be discussed by the Medicaments before propounded But if thereby it may not be effected Suppuration we must then have recourse unto some other means for the curing of the Phlegmone and that is by Suppuration Now all this that hath been said must be understood as spoken of a pure and simple Phlegmone But if the Inflammation be not pure but that it rather decline unto the nature of an Erysipelas or an Oedema or a Scirrhus then those Medicaments that are proper and convenient for these and such like Tumors are to be intermingled with the other yet evermore with this Proviso that such of them as relate unto the Phlegmone be alwaies predominant The Cure of an Inflammation degenerating into an Impostume The generation of an Impostume If therefore there be no hope that the Inflammation may be compleatly cured by the helps and means hitherto propounded which will appear from the more intense signs of the Inflammation to wit grievous pain that encreases day after day a manifest Pulsation or beating and an evident discernable extension or stretching out of the part then we ought instantly to use our utmost endeavor that the matter that is the cause of the Inflammation may with all possible speed be concocted and brought unto suppuration that is converted into Pus For neither can the matter yet unconcocted and as yet not turn'd into matter be in a due manner evacuated and then again if any one open the inflamed part before the said Pus be compleated he shal thence draw forth nothing and shal encrease and add unto the Malady rather than relieve and cure it But if that same part shal be opened the purulent matter being already elaborated and thereby brought to a due perfection then all whatever is superfluous in the inflamed part may most commodiously be evacuated And therefore we conclude that the matter is first of al to be concocted and so far forth as possible may be digested by the native radical heat For although that matter which is conteined in a Phlegmone can never be so far forth concocted and elaborated that it may be rendred any waies useful and profitable to Nature and in any sort fit to nourish the parts Yet notwithstanding since that there are therein certain qualities which are to Nature very offensive and burdensome those may be taken away and a certain kind of equality and moderation of the qualities may be instituted and a separation of the corrupt humors from those that are good and such as are meet to nourish the Body may be wrought which said elaboration of the humor is here termed concoction and suppuration And when that that is superfluous and corrupt in the part inflamed is separated from what is useful good and serviceable and that the vitious qualities are now hereby corrected and amended and the very proper substance of the blood it self shal be changed into an equal whitish and smooth matter and gathered together into its proper and peculiar place so that now without any difficulty at all it may upon the opening of the part be evacuated then and not til then the Pus is said to be now already perfectly concocted and that same collection or gathering together of the snotty filth termed Pus or matter into some one particular place is by the Grecians called Apostema and by the Latines Abscessus with us in English it is named an Apostem or Impostume as hath been said before in the first Chapter Now that concoction in mans Body is Natures work alone the which by the help and assistance of the native heat digests the humors takes pains with them and as it were leads them along until it hath brought them unto that perfection which they ought to receive which said heat if it be strong and vigorous then we use to say that the Pus or matter thereby bred is good and laudable and it is as we may find in the first Prognostick Tom. 42. white equal smooth and not very sâ—â—nking and noysom But if the innate heat be weak then it wil be quite and clean contrary unto what was in the former case And therefore the Physitians office is and his main care must be to cherish or preserve and encrease the native or natural heat in the inflamed parts that so by means of it the generating and breeding of the said Pus may the better succeed and the more easily attain unto its perfection The innate heat is conserved and augmented if
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
an Erysipelas in his left Hand and by the advice of a Barber-Chirurgeon for some daies anoynting his Hand and Arm with Oyl of Roses a Pain an Inflammation and other symptoms were from day to day more and more augmented insomuch that at length the whol Hand was corrupted and altogether rendred incurable by a Gangrene Chap. 8. Of a Bubo A Bubo likewise appertains unto Inflammations For a Bubo as Galen defines it in his Book of the Difference of Feavers Chap. 5. and in his second to Glauco Chap. 1. is an Inflammation of the Glandules in the Groyns For the Glandules being by Nature ordained and appointed that unto them the superfluous Humors should be expelled from the principal parts if they and together with them the blood shal chance to be thrust forth altogether and as it were by heaps unto the Glandulous parts then an Inflammation is excited and this happens most an end and especially in the Groins and somtimes also under the Arm-pits and behind the Ears which latter Inflammations behind the Ears are commonly termed Parotides But now The Humors that stir up and provoke Nature unto the aforesaid expulsion being very various hence it is that the differences arising from Bubo are likewise exceeding various and different For one while the Humors are said to be simply vitious or vitiated so that they have no malignity conjoyned with them and from these originally proceed those Bubo's that are not malignant but then again otherwhiles the matter is malignant and thence the malignant Bubo is produced and this again according to the variety of the malignant matter is either pestilent or else that which we call venereal But in regard that we have already treated of the Pestilent Bubo in our Book of Feavers and that the other which we call Venereal belongs unto the Tract touching the French Pox therefore we wil discourse of the Bubo at large only and handle it as it is in the general The Causes Now every Bubo whatsoever hath its original from a preternatural effusion of the blood into the Glandules in the Groyns or the Arm-holes the which notwithstanding hath evermore conjoyned with it some certain vitious and corrupt humor of what sort soever it be that excites and stirs up Nature into the aforesaid excretion or as we usually term it expulsion From whence also the antecedent yea and the external causes likewise which make for the generation of that humor are very various Notwithstanding the strength of the principall parts is for the most part evermore conjoyned therewith which expel forth whatsoever is offensive and burdensom unto themselves unto these ignoble parts and to the Emunctories Hieronymus Fabricius ab Aquapendente determines that some kind of Bubo's have their beginning and original only from the store of Blood and that certain of them by the way of expulsion are bred from the vitious blood and that the other Diseases follow and are excited at the time and Instant of the Crisis But in very truth I cannot think that a Bubo may be excited from the abundance of blood only but that it hath evermore conjoyned vitious humors which provoke Nature to the expulsion This notwithstanding is most true and certain that one while a Bubo doth follow upon another Disease and is excited by the Crisis whether perfect or imperfect and as soon again without any other Disease preceding it For although only those Tumors which follow upon other Diseases may properly be said to be caused by the Crisis yet notwithstanding even those likewise thâ— arise without any other Diseases are excited by Nature in her expulsion of the depraved and buâ—densome humors The Signs Diagnostick The Bubo is known by this to wit that in the Groyns or under the Arm-holes there appears a Swelling or Tumor with a certain kind of renitency or resistance with a redness of color and likewise with pain and for the most part also a gentle Feaver accompanieth it And this is most certain and sure if the Bubo happen to be by the Crisis that then a Feaver or some o her Disease went before which upon the appearing and breaking forth of the Bubo is lessened and abated and then the signs of a good and hopefull Crisis preceded the which if so be they are absent then the Bubo is to be accounted for symptomatical And then truly if there appear no signs at all of the Pestilence or of the French Disease then it is a single and simple Bubo and not malignant and contagious But if there be conjoyned the signs of the Plague the Bubo is then to be accounted for malignant and contagious and evermore Bubo's are to be suspected where the Pestilence invades the Patient In like manner if the sick Person be infected with the French Pox commonly termed likewise the Neopolitane Disease the Bubo is then also to be held for and esteemed Venereal Malignant and Contagious Prognosticks 1. Bubos that are not malignant and those likewise that are not contagious are not in the least dangerous since that they are resident in the external parts and are caused by Nature in her expelling forth the vitious and corrupt blood unto the weak and ignoble parts and especially if they be forthwith suppurated and then opened 2. But if they belong delaied and that their maturation be not speeded there may be great danger in regard that they very easily pass and degenerate into dangerous Fistula's 3. Those Bubo's that are bred or excited under the Arm-holes are sooner maturated since that they arise from a hotter kind of blood such as is that which the greater Vessels neer neighboring unto the Heart do extrude and thrust forth for as much as that part by reason of the Hearts vicinity hath more than ordinary heat which is altogether necessary and requisite for maturation 4. But Bubo's that have their original in the Groyns are longer ere they come to a supputation in regard that they are excited by a blood that is lets hot and thick and likewise because they are scituatâ— in a place more remote from the heart and which is but meanly hot 5. The slowest of them all in their maturation are those Bubo's that are behind the Ears upon this account namely that they proceed from a colder kind of matter and have their residence in a colder place 6. What we are to think and judge of Pestilential and Venereal Bubo's hath been already shewn in its own proper place The Cure When a Bubo that neither is Pestilent nor Venereal is excited Nature unburdening her self of that whatever it be that is offensive and troublesome unto her and expelling it unto the external ignoble parts Natures operation and endeavor is by no means to be hindred nor the matter to be driven back again unto the internal parts And first of al we must duly weigh whether or no Nature hath excited the Bubo by the Crisis and that a perfect one and that thereupon the sick Person be discharged of the
2. Among these Tubercles or little Swellings they of them are the more hopeful and least to be feared which bunch forth externally in the outward Skin and are sharp-pointed and equally maturate and wax ripe and are not hard neither divided and cleft in two parts or such as have their tendency downwards For so saith Hippocrates in the sixth of his Epidemicks and first Section The Cure We must use our utmost Skil and endeavor that so the matter that is the cause of the Furunculus may be most speedily turned into Pus for which end and purpose those Medicaments that have been already described and propounded in an Inflammation are here likewise very requisite and necessary Now those things that convert the matter into Pus or purulent matter are Wheat masticated and imposed upon the place Raisons of the Sun Figs bruised and laid upon the part and Diachylum simple or without Gums Or Take of Linseed meal pouder of Marsh-mallow roots of each half an ounce of dried fat Figs in number four Raisons of the Sun stoned an ounce boyl them all and then add of fresh or unsalted Butter two ounces make therewith a Cataplasm Or if the pain be more vehement and violent Take Roots of white Lillies one ounce the leaves of Mallows and violets of each a large handful boyl them to a softness and pass them through an hair sieve then add of Barley meal Wheaten meal and flour of Linseed of each half an ounce the Yelks of two new laid Eggs the fat of a Cock and fresh Butter of each one ounce and make a Cataplasm Or Take Turpentine the marrow of an Hart the fat of a Calf the fat of a Goose Wax fresh Butter the best Honey Oyl of Roses of each half an ounce and mingle them for a Cataplasm This Tumor when it is maturated unless it break of its own accord is to be opened And so soon as it is opened it ought to be cleansed Take the juyce of Smallage half an ounce Barley meal two drams Frankincense a dram and half Turpentine one ounce the Yelk of one Egg Honey of Roses as much as wil suffice mingle and make them into the form of a Liniment After it is cleansed it is to be filled up with flesh and shut up with a Cicatrice or scat like as we are wont to do in other Impostumes Chap. 10. Of the Tumor Phyma UNto an Inflammation there appertains likewise the Tumor Phyma which aâ— Galen acquaints us in his second Book to Glauco Chap. 1. and his third Book of the Method of Physick Chap. 3. is a Tumor or Swelling of the Glandules which forthwith is augmented and hasteneth unto a suppuration The place affected are the Glandules The Cause The Cause or Humor exciting the Phyma is blood yet not that which is pure but that which is Phlegmatick and thereupon the Inflammation is not altogether so great and intense and this kind of Tumor appertains unto the Inflammation Oedematodes as we usually term it and appeareth most an end in Children seldom in Youths and most rarely in those that are of ful age Signs Diagnostick It is known by a round Tumor of Swelling and which is much elevated little or nothing red and almost void of pain and in a glandulous or kernelly part Prognosticks 1. This kind of Tumor is altogether free from danger it is likewise instantly augmented and for the most part it is suppurated and healed without the help and assistance of Medicaments 2. The Cure is more easily accomplished in Children more difficultly in Youths and such as are of ful growth and perfect age The Cure We must endeavor that it may be suppurated with al possible speed And to this end Natures attempt and operation is to be furthered al that may be by maturative Medicaments imposed on the part of which we have already spoken enough where we treated of an Inflammation and a Furunculus which yet notwithstanding in this case by reason of the coldness both of the part and cause ought to be somwhat more strong and forcible Wheat chewed and laid on is here very useful as likewise Raisons of the Sun stoned and also the Diachylum Plaister both the simple and that likewise with Gums As Take pouder of the Roots of Marsh-mallows Wheaten meal the meal of Lupines of each one ounce of dried fat Figs six in number Leaven half an ounce then boyl them and add thereto one Onion roasted in the Embers Oyl of white Lillies as much as wil suffice and so make a Cataplasm Or Take Turpentine the Honey found at the entrance of the Bee-hive of each one ounce Ammoniack dissolved in Vinegar half an ounce Oyl of white Lillies as much as will suffice and make an Vnguent For to tel you the truth there are some that conceive that a Phyma is not presently to be cut and opened so soon as it is suppurated but they rather are of opinion that an assay should be made that it may appear whether or no the matter may possibly be dissipated and scattered by discussives and therefore Galen in his eighth Book of the faculty of simple Medicaments commends Southernwood Parietary commonly known by the name of Pellitory of the Wall and by others likewise called Feverfew Nettles Marsh-mallow roots and Ammoniacum softened with Honey but this happeneth but very seldom And therefore the safest course is unless it break of its own accord that it be artificially opened lest that the long detaining of the matter should cause and produce much danger Chap. 11. Of the Tumor Phygethlon IN the self same Glandulous parts of the Body there is likewise another kind of Tumor excited which the Greeks name Phygethlon but the Latines cal it Panus or rather as Celsus in his fifth Book and Chap. 28. Panis from the similitude and resemblance of its figure But here the cause is more hot and like as Phyma hath its original from pituitous or flegmatick blood so a Phygethlon or Panis hath its rise from cholerick blood as Galen instructs us in his second Book to Glauco Chap. 1. But most an end this kind of Tumor chanceth after Feavers or else after the pains of some one or other part and chiefly those torturing pains which invade and afflict the belly The Signs Diagnostick The Signs of a Phygethlon are a Tumor or Swelling hardness heat distension and greater pain than might probably be expected in regard and reference unto the magnitude of the dimension of the Tumor There is likewise somtimes a Feaver to accompany it But very frequently notwithstanding there is not any one of al the aforesaid perceived outwardly to wit when and where the matter lieth deeper rooted and is there kept concealed but only at least some certain prickings are inwardly perceived This sort of Tumor is long ere it come to a maturation neither is it fitly and properly converted into Pus Prognosticks 1. That Phygethlon which becomes not more hard than ordinary al on a sudden
and which albeit it waxeth not red is yet notwithstanding otherwise of a changed color this Phygethlon I say is of the better sort and there is little of danger in it Thus Celsus in his fifth Book Chap. 28. 2. That Panus which ariseth from an Ulcer Pain stroke or from any external cause is altogether void of danger But that which follows upon Feavers like as it is especially wont to fall out in a Pestilential and contagious season or else proceeds from Swellings either under the Arm-pits or in the Neck is the worst and most dangerous species of this Tumor And so Paulus Aegineta in his fourth Book Chap. 22. The Cure If a Phygethlon shal happen to arise from an Ulcer pain contusion or stripes or from any other Procatarctick cause then like as in other Inflammations its increment and growthâ—s to be impeded by coolers and Repellers But if it be in Feavers or that otherwise it be excited from some internal provision and storing up of Humors then in this case Repellers have not any place allowed them neither are they at al to be made use of but those Medicaments that discuss and resolve are alone to be administred and if the matter have any thing of hardness in it then softeners are therewithal to be added such as are Marsh-mallows common Mallows Orach Chickweed Parietary dried Figs Ammoniack But if the matter cannot be discussed then we ought to use our utmost endeavor that it may be maturated i. e. brought to a ripeness and turned into Pus by the application of those Medicaments that have hitherunto been propounded And at length unless it be opened of its own accord the Impostume is otherwise to be broken and opened Chap. 12. Of the Tumor Parotis UNto the Inflammations of the Glandules appertaineth likewise Parotis a Tumor so called from the Greek words Para and otos because its scituation is nigh unto the Ears Hippocrates in the sixth of his Epidemicks Comment fifth Title first and elswhere terms these Tumors Eparmata For a Parotis is an Inflammation of the Glandules neer unto the Ears The Causes Whereas then that a Parotis is an Inflammation it must necessarily follow that the neerest and containing cause thereof is the blood But this blood notwithstanding is very seldom pure but most an end Choler Phlegm or Melancholy yea oftentimes also there are malignant and pestilential humors therewith mingled from whence it is that there are malignant and pestilent Parotides proceeding therefrom And it is a most rare thing that blood that is faulty in nothing but that there is too great store thereof should stir up and provoke Nature so far forth that it should attempt such a kind of excretion or separation but it happeneth from the vitious and depraved Humors by which Nature being irritated and stirred up is wont to thrust forth unto the external parts such like Humors together with the blood For like as in critical bleedings which Physitians usually term Haemorrhages it is not the blood alone that is principally faulty and peccant but likewise the vitious humors the which when that Nature cannot easily expel without the blood she thereupon assays and institutes this Excretion or as we commonly term it separation of the blood and this she doth in such a manner to the end that she may avert and turn away the vitious humors from the principal unto the more ignoble parts that she makes use of the blood like as of a Vehicle or Conduit pipe Now these humors are transmitted and sent either from the whol body or at least from the Brain And in good truth we have discovered that these kind of Tumors which we cal Parotides may not only happen from vitious Humors bred in the body but also from poysons that shal by any accident be drunk or taken into the body as for instance I remember the like done here at Wittenberg For a certain Servant Maid when she was to boyl fish unwillingly drawing water out of Vessels into which a Bat or Dormouse had accidentally fallen and was therein suffocated and choâ—ked by the water and boyling the fish therein there were if my memory fail me not ten Students that together with their Hostess fel sick and some of them died And for those of them that recovered in two of them at least even these Parotides brake forth behind the Ears The Differences The principal Differences of these Parotides are taken from the matter and from the manner of their Generation From the matter because that the blood which exciteth the Parotis is either Cholerick or Phlegmatick or Melancholick or in regard also that it hath malignant and pestilent humors mingled together with them From the manner of their beginning or generation in regard that some of them have their original without Feavers or as Celsus speaks in his sixth Book and Chap. 16. some of them in good and perfect health Nature thrusting forth unto those places some certain vitious humors either from out the whol body in general or else more particularly and principally from the head but then others of them appear upon Feavers and those again such as are either long or acute and lastly such as are either benign and inoffensive or otherwise malignant and pestilential And this happeneth in the state or declination thereof Nature by the Crisis driving forth the digested humor the cause of the Feaver unto these more ignoble places or else they arise symptomatically in the very beginning or augmentation of Feavers Signs Diagnostick These Parotides are known from the place affected from the swelling the pain and for the most part from the redness that appeareth behind the Ears But then what kind of Humor it is that is mingled with the blood is known out of the several signs of the Humors that have been elswhere propounded If there be present a malignant or pestilential humor then there is evermore conjoyned therewith a Feaver of the like Nature If it be only transmitted from the Head then there are not present any signs of a Cacochymy throughout the whol body and there went before a pain of the head the which upon the breaking forth of the Parotis either altogether vanisheth or at least is in great part diminished Now whether the eruption or breaking forth of it be critical or symptomatical the time of the Disease and the signs of the Crisis whether they be present or absent wil sufficiently instruct us Prognosticks 1. These Parotides that have their being without a Feaver are less malignant and have less of danger in them than those that have a Feaver to accompany them 2. They also are less dangerous which follow upon Feavers of a long duration than those that ensue upon acute Feavers and especially if they be malignant and pestilential 3. Those of them likewise that break forth critically are more safe and hopeful more easily cured and such as free the sick persons from danger But as for those of them that happen in the
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
there is not somthing of malignity and therefore the malignant matter is with more safety thrust forth unto the superficies of the body by those Medicaments we term Alexipharmaca then drawn to the more inward parts by Medicaments that purge That fervent heat also of the adust blood is to be altered and the malignity to be opposed by convenient Medicaments as the juyce of Citron of Pomegranates Sorrel Borrage Bugloss Water Germander Succory and the like with which in a pestilent Carbuncle other Alexipharmaca may also be firly mingled As Take Conserve of Sorrel Borrage Bugloss of each one ounce and half the species of Diamargarit frigid Confection of Hyacynth Elect. de Gem. of each half a dram of candied Citron rind six drams the candied roots of Scorzonera or Vipers Grass half an ounce with the juyce of Citron make an Electuary Unto which in a Pestilent Carbuncle we may add Bole-armenick Terra Sigillata or sealed Earth Harts horn Bezoar stone and the like Very many there be that in a Carbuncle do much commend Scabious and they conceive that it never ought to be passed by and they write that either the Juyce or the Water or the Decoction thereof is of singular use and benefit in a Carbuncle It wil not likewise be amiss to fence and guard the Heart with Topicks by Epithems that are otherwise known applied to the Region of the Heart and the Pulses that so by all manner of means the Heart may be preserved safe and sound from all the malignity Afterward as for what concerns the conjunct cause or the Tumor it self the way and means of curing a Carbuncle is not altogether the same as in other Inflammations unless haply there appear to be in it very little of an offensive quality Neither must we make use of Repellers but the malignant and poysonous matter is rather to be attracted from the more inward unto the external parts unless perhaps they may be administred for the mitigating of the vehemency of the pain touching which more hereafter And therefore so soon as Venesection hath been administred the part affected is forthwith to be scarified and that likewise with lancings that go deep enough that so the corrupt malignant and poysonous blood which unless it be instantly emptied forth of the part affected corrupteth the parts neer adjoyning may be quite drawn forth Immediately upon this the part affected is to be cleansed and throughly washed with warm salt water or with some other convenient liquor lest that the blood should clod and so grow together in the part Now if the corrupt blood seem not as yet to be sufficiently evacuated the scarifications ought then to be repeated We are likewse allowed when the place is scarified to apply thereto Cupping-glasses or Leeches Yet notwithstanding iâ— with great violence the humor flow unto the part then Atrractives may not safely enough be administred since there is cause to fear lest that the matter flowing thereto in great abundance the pain should be made the more vehement which may possibly excite and cause watchings augment the Feaver and deject the Natural vigor but rather if the matter flow thereunto over hastily and with too great force we are then to make use of those Medicaments which by moderate repressing and driving back may likewise digest And such is the following Cataplasm Take Arnogloss we commonly term it Lambs-tongue or Way-bread Lentiles Bread that is neither wholly purged from its bran neither yet such as is altogether branny of all these a like proportion let them boyl in Water or Wine and so make a Cataplasm which is to be applied twice or thrice every day But now this said Medicament that we have mentioned or such like is not to be imposed and laid upon the very Carbuncle it self but only neer about it some three fingers distance from it For by this means the malignant matter it self is not driven back but only the extream heat and pain is mitigated the flux of matter is somwhat retarded and hereby is prevented the retreating back again of the matter unto the more inward parts But yet neither must this be passed over in silence that it is not evermore requisite to fence the Carbuncle with such a guard but notwithstanding this for the most part iâ— necessary to wit That that part which hath a neer relation with a noble Member should be wel guarded forasmuch as it is no way hurtful but indeed profitable that some of the matter should be derived and evaporated unto the other ignoble parts Moreover the place being scarified there are not to be applied those Medicaments that otherwise are wont to be laid on in regard that they promote and further the Pus or purtilent matter and by this means may encrease the putrefaction and rottenness since that a Carbuncle in putrefying evermore creepeth and spreadeth so that very often a Mortification chanceth unto such parts but rather those Medicaments that are drying and such as resist putrefaction For which end and purpose we may administer the Pastils or Pomanders of Andro Musa Polyidas and Pasio which are to be dissolved first of al in Wine and then also afterward in Vinegar touching which see Galen in his Composition of Medicaments in general the fifth Book Chap. 11 and 12. They commonly likewise make use of the Aegyptiack Unguent There may also be made a Cataplasm of the Meal of the Pulse Orobus with Oxymel Morsus Diaboli or Devils-bit is likewise very much commended if while it is yet green and wel bruised it be laid on or else boyled in Wine and drunk There be many likewise that here make use of those things that are experimentally found to be helpful by the propriety of their substance among which Scabious is especially commended as also Morsus Diaboli or Devils-bit they take to wit the Scabious whilest it is green and bruise it wel and then they add thereto the Yelk of an Egg Hogs grease that is old and a little Salt and herewith they make a Cataplasm which is often to be renewed Some likewise take the Herb Comfry for the same use and with it they prepare and make such a Medicament as this that followeth Take of the Juyce of the greater Symphytum or great Comfrey Scabious Cranes-bill or Doves-foot of each one ounce of Barley Meal two ounces and an half and mingle them for a Cataplasm Others there are who if there be present an extream heat and pain commend this Viz. Take Plantane Leaves and Sorrel Leaves of each two handfuls boyl them to a softness then let them be bruised when they are throughly bruised add to them the Yelks of four Eggs Treacle two drams Barley meal a sufficient proportion and so make a Cataplasm Many likewise there are that commend those Wallnuts that are old and Oyly being bruised of the which some make such a Cataplasm as this that followeth Take the Kernels of Walnuts such as are old and rancid or mouldy in
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
Barley Lentiles Beans of each one handful Arnogloss or Lambs Tongue two handsuls Pomegranate flowers Roses the grains of Myrtle Sumach of each half an ounce Let all except the Barley be grossly poudered and then boyl them in Wine until the Barley be soft and make hereof a Cataplasm Or Take the Rinds of the Pine tree burnt and washed a dram and half Ceruss three drams Frankincense one dram Goats fat six drams Oyl of Myrtle two ounces Wax at much as wil suffice make herewith an Vnguent But if we have a mind to dry more than ordinarily we may ad the prepared file-dust of Iron the flower of Brass and Lime washed This is likewise commended Take the spume or froth of Silver half an ounce the juyce of Leeks and Beets of each sive ounces Mingle them c. Hieronymus Fabricius writeth that with very good success he made use of this following Remedy Take the juyce of Tobacco three ounces green or Citron-coloured Wax two ounces Rosin of the Pine tree an ounce and half Turpentine one ounce Oyl of Myrtles as much as wil suffice for the making and forming of a soft Seoer-cloth But if the Ulcer be already putresied we must then betake our selves to the Remedies that are stronger and more forcible such as are the little sweet Bals of Andro Musa and Polyidas a for example Take Litharge and Ceruss of each two ounces the Rinds of Pomegranates half an ounce Myrrh one dram Frankincense a dram and half the flower of Brass and Allum of each a dram and with the Oyl of Myrtle and Waie a sufficient quantity of each make an Vnguent But if these wil not serve the turn and that the Ulcer and putrefaction creep further and become broader we must then have recourse unto the stronger sort of Remedies They refer likewise unto choletick Tumors those that we cal Phlyctaenae Impetigines Lichenes Sudamina and Epinyctides But because that these little risings or swellings proceed not from pure Choler but from Choler mingled with serous and salt Humors we wil therefore treat of them below with the rest of the Tumors of this kind Chap. 18. Of the Tumor Oedema LIke as those Tumors that we have already hitherto handled have their original from hot Humours so there are likewise some certain peculiar Tumors that arise from cold Humors and in the first place Oedema that hath its original from Flegm For although Hippocrates and other ancient Physitians under the name of Oedema understand al other Tumors whatsoever in general yet notwithstanding those of latter times by Oedema do understand some one certain kind of Tumor only and this they specially term Oedema being a Tumor that is lax or loose soft without pain yielding unto the touch and compression of the singers having its original from thin flegm or else from the more cold and moist part of the Mass of blood The Causes The containing Cause of this Tumor is that flegm that is contained in the blood to wit if it be so increased that it irritate and stir up the Expulsive Faculty For then Nature being stirred up and provoked thrusteth forth the matter out of the greater Vessels unto the less and expelleth it from the more noble parts unto the weaker until at length it be received and retained by the most weak and infirm part The cold and heavy Humor it self likewise very often by its own weight tendeth downwards and also unto the extream parts And thereupon it it that although the Oedema may be excited in al parts whatsoever of the body yet notwithstanding it chiefly and more especially ariseth in the Hands and the feet as it evidently appeareth in Persons that are Hydropical Cachectical and Phthisical in regard that those parts are more remote from the fountain of heat But now this Oedema is not suddenly generated but by degrees and by little and little For why the Humor is thick and therefore altogether unfit for any speedy and sudden motion Galen in his second Book to Glauco and third Chapter determineth that the Oedema is caused by a Pituitous or flegmy substance or else by the Spirits when they are ful of vapors and such a like Tumor or swelling happeneth in dead Carkasses From which place as likewise from the 14. of his Method of Physick Chap. 4 Johannes Philippus Ingrassias in his Book of Tumors the first Tome page 113. endeavoreth to prove a twofold kind of Oedema the one from thin flegm the other from a vaporous spirit and that to wit the former he asserteth to be a Disease and the latter a Symptom only that followeth upon Phthisis and the water betwixt the Skin one species of the Dropsie and the Cachexy But yet although it be not to be denied that Carkasses in the very first beginning of there putrefying and as it were a certain kind of fermentation swel up in some sort yet that in the Cachexy or Phthisis the Oedematose swellings of the Feet should in this same manner be caused I cannot easily beleeve in regard that such a like putridness doth not then happen but it is far more credible that such like Tumors are caused from a serous wheyish Humor abounding in the body and descending unto the Feet and there abiding and sticking fast as in a part more cold than the other parts of the Body And be it indeed granted and admitted that in the similar parts there may be some kind of slatulent Spirit collected and that it may lift up the part into a Tumor yet notwithstanding this Tumor is not properly Oedema but is rather to be termed Empneumatosis or Emphysema And albeit such a like Tumor is by Galen in his 14. Book of the Method of Physick Chap. 4. called a Symptom yet we say that Galen then useth the name of a Symptom in the general for every Affect preternatural that followeth another But if we wel weigh and consider what this Tumor properly is we affirm that it is altogether and in al respects a Disease in regard that it is magnitude augmented and for the most part an impediment and hindrance unto men in their walking And although such an Oedema doth not indeed requite a peculiar Cure yet notwithstanding it is not for al that to be razed out of the number of Diseases and placed among the Symptoms For those Diseases that simply depend upon other Diseases require not any proper and peculiar kind of Cure but those being removed these likewise are taken away But now that very Humor that is the cause of Oedema is generated by an error and default in the sangnification touching which we have spoken in the third Book of our Practice third Part second Section and first Chapter The Signs Diagnostick Oedema is known in this manner The Tumor is soft and loose and if it be pressed down with the singer it easily yieldeth and giveth way by sinking and so there is a little pit and print of the singer left behind For the moist
known because that at first it is scarcely so big as a Vetch or a Bean but then afterwards when it is grown and hath gotten so much augmentation and enlargement that it is now lift up into a greater bulk it hath with it then signs and symptoms so evident and so grievous that it by any one may be most easily known For this Tumor is hard it hath a leaden or wan or blackish color and yet notwithstanding this is more or less such according to the diversity of the matter There is present likewise a pain to attend it the which although it may indeed be sometimes greater and somtimes less yet notwithstanding the Cancer is never wholly without it There is likewise present an heat pulsation or beating and round about as it were in a Circle it hath Veins distended and strutting out with black Blood Now although the Scirrhus arising from a melancholly humor hath some kind of likeness and affinity with a Cancer yet notwithstanding by the aforesaid and other signs it may easily be discerned from it For a Cancer hath evermore a pain and pulsation conjoyned therewith together with an heat more than ordinary and most commonly it beginneth of it self and suddenly getteth encrease so that from a very smal and inconsiderable bigness it becometh exceeding great and bulky and there is for the most part a humor residing in the Veins which said Veins being therewith filled very full resemble the Feet and Claws of Crevish or Craw-fish But now in the Scirrhus there is no pain appearing and for the most part it hath its original from the Change and alteration of other Tumors and the humor that produceth the Scirrhus doth not chiefly and principally reside in the Veins but in the spaces and Pores of the Parts from whence also it is that the Veins are not ample wide and large neither turgid and strutting out and the increasing and growth thereof is much more slow than that of a Cancer But now if the Cancer be already Ulcerated then the Ulcer is nasty and stinking the lips are swoln thick and pale or wan The Prognosticks 1. In the general every Cancer is a most grievous and a dangerous Disease and such as is seldom or never cured For the Cause thereof being over thick is obstinate and malignant and oftentimes it seizeth and surprizeth even those Veins also that lie low and deep insomuch that it cannot be removed and taken away either by the purgation of the Body or by Repellers or Discussives or cutting and lancing or lastly even by actual Cauteries and burning for as for the milder sort of Remedies it sleights and contemns them and as for the stronger sort of Medicaments it is by them exasperated 2. Where there are secret and hidden Cancers there it is best not to cure them For they that are cured die within a very short time after but those that are not cured of these aforesaid Cancers live a longer time so saith Hippocrates in the sixth of his Aphorisms Aphor. 38. For why those Cancers that before were not exulcerated when they have Medicaments applied to them may and do easily become exulcerated 3. They likewise that have Cancers in the Cavity of the Body or in the palate of the mouth or in the Buttocks or in the Womb if they be either cut or burnt the Ulcers cannot by any means be healed up and covered over with a Cicatrice But those that are thus affected while they lie under Cure are tortured and tormented even to death by the afflicting pain they undergo whereas without a Cure and if they shall not at all submit themselves unto the means tending thereunto they may live a longer time and with far less trouble and grievance as Galen hath it iâ— his Commentary upon the aforesaid Aphorism of Hippocrates 4. Those Cancers only therefore are to be attempted in the way of Cure which are and appear in the outward part of the Body and there likewise it will be more safe to attempt the Curing of them by Medicaments in the very first rise of them while they are yet but smal and inconsiderable than when they are grown and become great for then they are not to be cured without the help of the Hand which we term the Manual operation neither indeed so unless they have their residence and situation in those parts that may without danger be lanced and burnt together with the very Roots that is to say the Veins in them that are full of burnt of adust blood 5. For when the Cancer hath once gotten possession of a great part or when it sticketh fast in a more noble part or any other that may not safely and conveniently be cut or burnt it is then altogether incurable 6. Yea moreover in the general there are very many and indeed the most Physitians that are of opinion that no Cancer confirmed and exulcerated can possibly be cured And it is oftentimes observed That although Cancers be cut out and now and then cured in the external parts Yet notwithstanding that the same have returned again either in the very same part or else even in some other parts as for instance when the Cancer hath been cured in the paps or breasts another hath soon after risen and sprung up in the Womb. And therefore we ought rather so far forth and no further to cure those Cancers that are already inveterate and of the greater size that their further growth and augmentation may be impeded and hindered Whether an exulcerated Cancer be contagious Zacutus Lusitanus will have it to be contagious he proveth it 1. From Reason Cardanus in his first Book of Poysons and 12. Chapter affirmeth that the Cancer is not contagious and yet he giveth us no reason at al for this his Assertion but presupposeth and taketh it for granted as a thing apparent and manifest Neither to my best remembrance do I know any one who accounteth and esteemeth the Cancer to be in the number of contagious Diseases excepting only Zacutus Lusitanus in the first Book of his Practice and Administr of Physick and 124. Observat who doth it and endeavoreth to prove it both by Reason and Experience His Reasons are 1. Because that in an exulcerated Cancer there is present a certain putridness and noysom stench as it were of a dead Carkass that by its purulency infecteth the body that is nigh unto it His second Reason is Because the Cancer is the same Disease with an Elephantiasis and Leprosie of one only Member but now the Elephantiasis is most contagious An Answer thereto But these his Reasons do not sufficiently conclude any thing For first Al things that are putrid and ill favoured and noysom are not contagious For in a Gangrene and Sphacelus there is an extraordinary putridness and stench and yet notwithstanding the stander by is not therewith infected And moreover although a Cancer hath some kind of similitude and resemblance with an Elephantiasis they are
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
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
Physitians understand hereby al kind of Scabies whatsoever Now albeit the next cause of Scabies be a humor sharp and salt yet notwithstanding Avicen doth not altogether absurdly assert that blood is the matter of the Scabies For seeing that Scabies is an Univerversal Affect of the whol Body it cannot therefore easily proceed from any other humor unless that blood be likewise therewith mingled and yet notwithstanding the blood cannot properly be said to be simply the cause of Scabies to wit so long as it retaineth its benign and tempeperate Nature For whilest it continueth benign and good it can in no wise excite and cause the itching neither yet those Ulcerous Tumors or Swellings Wherefore before such time as the blood can possibly produce and breed the said Scabies it must of necessity be corrupted and other humors that are sharp and biting there with mingled And true it is indeed that yellow Choler is sharp and corroding but then it scarcely floweth in so great abundance or is of that thickness as to excite such like Tumors But black Choler and salt Flegm are Humors very fit and most apt to produce the said Scabies For these Humors being thick hot and dry and withal biting and corroding if they chance to be thrust forth unto the Skin there they stick fast in it and there they excite a hot and dry distemper an itching a swelling and an exulceration But now as for the primitive Causes and more especially for the generating and breeding of those salt biting and sharp humors the kind and ordinary course of Diet that is kept doth exceedingly advance and further the same Meats to wit of a bad juyce and that afford an unwholsom and corrupt aliment such as are salt sharp and that are easily corrupted And hence it is that the poorer sort of people who live upon these kind of unwholsom corrupt meats are most frequently infested with the Scabies or Scabbiness as likewise Children and yong people in general in regard that these are altogether careless and heedless in their Diet whereupon they contract great store of excrements that being retained in the outward part of the body are there corrupted and so they get an acrimonious quality But then from these bad and naughty meats those sharp and salt humors are the more easily bred if there be present a hot and dry distemper of the Liver And hitherunto likewise relateth the uncleanness and nastiness of the body to wit when there is altogether a neglect in the keeping it sweet and clean and if the foulness and impurities of the Skin be not duly washed off or the garments not shifted and changed often enough whereupon it is that filth and impurities sticking in the superficies of the body do not permit so free a passage forth unto the excrements and by this means the said excrements acquire a certain acrimony and so corrupt the other humors The Scabies ariseth likewise somtimes after a Crisis and after Diseases both acute and those also that are of a long continuance to wit when Nature expelleth forth unto the Skin those naughty and depraved humors which it is not able any other way to discuss and evacuate And lastly Congium is likewise accounted and reckoned up among the principal causes of Scabies which cause Galen also acknowledgeth in his first Book of the Differences of Feavers Chap. 2. and Book 4. of the Differences of Pulses Chap. 3. For in the Superficies of the Skin of those that are Scabby there is a certain viscous and clammy moisture gathered together which being either by the Apparel oâ— by some other means communicated to the body corrupteth the humors therein after the like manner and produceth the like Affection and that especially in these bodies that are now already disposed unto the Scabies And indeed the humid or moist Scabies is the more contagious in regard that in this there is generated more of the aforesaid viscid and clammy humidity The Differences Some there are that reckon up very many Differences of Scabies as that one is new another old and inveterate and that one seizeth upon the whol Body another upon the Hands only and the Thighs but the main and special Difference is that which is taken from the Difference of the Humors that one ariseth from a black and melancholy humor and this is called a dry Scabies in which although there be a concurrence of other humors yet notwithstanding the greatest part thereof is of this last mentioned humor from whence it is that out of the parts affected with this Scabies either there is nothing at all sent forth or if there be any thing issuing our it is thick dry and the Ulcers themselves as likewise the prints and footsteps as we may so term them of these Ulcers are wan and pale and somtimes black another is humid and moist in which there aboundeth a salt flegm out of which there plentifully floweth forth much moist filth and corruption that is thin and subtile sharp and now and then likewise it wil be thick Signs Diagnostick The Scabies or Scabbiness is an Affect very wel known and it may easily be discerned as may also its Differences and from those signs and tokens especially that we but even now mentioned And yet notwithstanding those signs do now and then vary and are somthing changed according as the aduition of the other humors is greater or less Prognosticks 1. Now although the Scabies be in this respect troublesom to wit in regard of the foulness and deformity that it causeth in the Skin rather than that it bringeth with it or threateneth any other danger nigh at hand and that in youth it oftentimes preserveth and likewise freeth from other Diseases yet notwithstanding it is not alwaies secure and safe For if it be of any long continuance it may and somtimes doth turn into the Lepra or Leprosie and in Ancient persons it is contumacious and stubborn and hard to be cured 2. And among the several species and kinds of them the dry is more difficult in curing than the moist And therefore whatever kind or sort it be of it is not at any hand to be neglected but by a due and fit Cure even for the very deformities sake if there were no other cause speedily to be taken away and removed Of the Scabies retiring inwardly That Scabies that hath its rise and original not from any contagion but from some internal default of the humors for the most part breaketh forth as it were critically and ariseth from some internal vice of some one or other of the Bowels in which so soon as any vitious humors are generated they are immediately by Nature thrust forth unto the outward part of the body the which motion if Nature be not able to perfect and accomplish it or in case she be by Medicaments administred unseasonably hindered in her operation divers Diseases are from hence excited Many Diseases proceeding
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
Leuca or the inveterate Alphus hath continued white From what hath hitherto been said it is apparent and manifest that by reason of the color there is truly an alliance and neer relation between these two Affects Leuca and Alphus and yet notwithstanding in other respects they much differ the one from the other since that in Leuce there is a change not only in the color of the Skin but of the flesh likewise yea also a change in the very substance whereas in Alphus only the Skin or rather indeed the Scarf-skin is changed in color The Causes For touching the generation of Leuca Galen in his third Book of the Causes of Symptoms and Chap. 2. thus writeth When the flesh saith he hath for some long time been nourished with blood both flegmatick and withal glutinous and clammy the flesh indeed as yet remaineth but yet notwithstanding its form it changed and turned into another species and it becometh in a certain mean betwixt flesh that hath blood and that that is altogether bloodless But when it is become such it then so beâ—alieth it that for the nutriment that is brought unto it from the rest of the body it doth no more so much as attempt the converting thereof into the red species of flesh but rather into the likeness of the flesh of Locusts And so it cometh to pass that very speedily it is rendered and becometh both white and flegmatick and that not only in part but wholly in regard that it cannot convert the nutriment into a redness and because that withal that flegmatick humor continually floweth thereunto And therefore what kind of flesh even from the beginning the Locusts have and almost al kind of Oysters the like from this transmutation have they that are defiled and fouled with Leuca For so they cal this vice of the flesh imposing to wit the name from the white color like as they give the name unto black and callous flesh from the Elephant But as touching the generating of the Alphi Galen immediately subjoyneth that the generation of them together with the vices aforesaid are of the like kind but yet so notwithstanding that under them the whol flesh is not vitiated but only in the superficies of the body there are as it were certain scales fixed and fastened But now Alphus is twofold the white that proceedeth from flegm and by the Arabians it called the white Morphaea and the black that it generated from a melancholy humor and is called the black Morphaea But yet notwithstanding some there are that constitute other colors also and they say that the Skin is somtimes changed unto a citrine yellowish color and somtimes likewise unto a red according unto the diversity of the corrupt humor And indeed what they say is not altogether â—rivolous and to no pupose for the Skin true it is is changed oftentimes no only noâ—◠〈◊〉 â—â—â—re color or a black color alone but also 〈…〉 unto a citrine and yellowish color The Antecedent causes of these Vices are Humors of the same kind heaped up in the Veins and by Nature driven forth unto the circumference and superficies of the Body But now those humors proceed from a default and error in the sanguification which happeneth either by reason of an ill course of Diet or else from some sickness and distemper of the Liver And yet notwithstanding unto the black Alphus there concurreth likewise and that more especially the vice and distemper of the Spleen But now with this malady men are more usually surprized and set upon than women Foe in women those vitious humors are wont to be evacuated together with the monthly or menstrual purgation Children are likewise less infested with this malady in regard that their bodies are hot and moist and therefore the less apt to breed these kind of Humors their bodies are likewise open and permeâ—ble and consequently most sit for insensible transpiration Signs Diagnostick Those Diagnostick Vices are known by the change of the color of the Skin And indeed the signs of the black Alphus are manifest in regard that there are broad blackish spots scaly as it were here and there spread and dispersed up and down throughout the Skin But because in Leuce and the white Alphus there is every where and on al sides a white color these two vices are therefore to be distinguished In the white Alphus the hairs in the place affected retain their natural color but in Leuce there arise white hairs like unto the soft and tender woolly hairs in yong Children And likewise in Leuce the Skin is more depressed Moreover in the Alphi if the Skin be pricked with a Needle there issueth forth blood but in Leuce that which floweth forth is not altogether blood but a certain waterish and white humor And lastly in the Alphus the spots are not continued but disjoyned but in Leuce they are altogether continued by reason of the equal vice of the Skin underneath and the flesh Prognosticks 1. The Vitiligo to tel you the truth hath in it no danger of death and yet notwithstanding it is a very filthy and loathsom affect 2. If it be cherished by any default of the Liver or the Spleen the Malady is then the harder to be cured 3. Leuce is more difficult to be cured than Alphus and the Alphus likewise that hath been of long continuance is more easily cured than Leuce that is but newly beginning 4. That Leuce which waxeth not red when it is rubbed and being pricked doth not bleed is incurable 5. That Leuce likewise is incurable which seizeth upon and possesseth a large and spacious room is of long continuance and groweth and encreaseth every hour and also when all the Aliment that floweth thereunto is corrupted 6. On the contrary that Leuce that hath yet some kind of redness left in it and is but smal is curable 7. That Leuce that is in the hand or the foot is of difficult Cure 8. The white Alphus is likewise more easily cured than the black And in the general look by how much the color recedes from the Natural color of the body by so much the more is the Malady the harder to be cured The Cure This Malady is cured if the Humor that exciteth it be wasted and consumed and if a course be taken to hinder the further afflux of the like humor unto the skin and this is done if care be taken that the humor that is already present in the body may be evacuated and such a course likewise taken that may preveâ—t the generating of any new humor for the future In Leuce and the white Alphus there is no need at al of Venesection For the blood doth not here superabound but that which too much aboundeth is the thick and cold humors which are to be prepared by those Medicaments that heat cut and cleanse and such as these are made and provided of Hysop Betony the opening Roots Steechas and others of this kind and they are
something omitted by the carelessness and overfight of the Writers which appeareth even from this that he altogether omitteth the Signs of Atheroma And therefore without all doubt it is thus to be read the omissions being supplied out of Aetius Steatoma is harder then the other and resisteth upon the touch and having the bottom thereof more solid But Atheroma yieldeth when it is touched as it were a certain loose body and returneth back but slowly but Meliceris giveth place speedily unto the touch and then it is very suddenly again collected And although Steatoma be hard yet notwithstanding it differeth from Strumae because it is nothing so hard as Strumae neither hath it an unequal Tumor like as Strumae hath But what these Tumors have within as it may be guessed at by conjecture so true it is that it cannot be certainly known unless it be when they are cast forth as Celsus tels us in his seventh Book Chap. 6. Prognosticks 1. The truth is that these Tumors have no danger at all conjoyned with them and yet notwithstanding they oftentimes continue long are without any hurt carried about and neglected 2. Yet notwithstanding they often of their own accord end in an Impostume Which if they do not they are not so difficultly cured as Scrofulae and Scirrhi 3. Those of them that are elevated and exposed unto motion and the touch are easily curable But such of them as are seated and fixed more deeply and not exposed to the Touch are more difficultly cured and in Chirurgical attempts they require the greatest care and diligence by reason of the imminent eruptions of Blood and the pricking of the Nerves For very many Chirurgeons there be that for want of skil together with these like Tumors cut away those Nerves that lie under them The Cure Although these Tumors differ in their names and each of them contein a peculiar Matter yet notwithstanding they have almost one and the same way of curing For Universals and generals being premised and the Body throughly purged from the vitious humor the matter that is the cause of the Tumor is together with the Tunicle to be taken away which is done if the matter be either discussed or if that may not conveniently be done suppurated or else if the Tumors be cut forth In Meliceris this threefold kind of Remedy hath its place Atheroma is Cured by Discussives and Suppuratives and for the most part hath no need at all of Section As Take Laudanum Bdellium Galbanum Ammoniacum Propolis and Turpentine equal parts of them all and mingle them Very useful likewise is the Emplaster made of Ammoniacum Pellitory and the Oyl of the Juyce therof by which I have seen such a Tumor cured in the Jaw-bone broken and long white strings like threads such as are somtimes found in Cancers drawn forth Unslaked Lime also mixed with Grease or Oyl is very useful and of singular benefit Or Take Ship-pitch one ounce Ammoniacum and Sulphur of each half an ounce Mingle c. Take of the Root of Sowbread and Swines Grease and a little Sulphur and of these make an Empaster If the Tumor open not of its own accord then Section is to be ordained that so the little Bladder whether it contein a Substance like Honey like a Pultise or a fat substance or any other may be pulled forth and taken away But the Skin is not to be cut transversly or overthwart but strait forward or else somwhat obliquely like unto the figure and form of a Myrtle Leaf and the Membrane conteining the humor is to be freed from the Skin and the part lying under it great care and caution being had lest that the said Membrane or Bladder be hurt which wil most certainly be if the Skin be not dissected and opened with one touch of the Instrument and so the humor that is conteined therein flowing forth all abroad hinder the operation and by this means there be some of it or somthing of the humor left remaining behind And yet if this should chance and somwhat should be left behind it is to be consumed by these Remedies that we call Cathaereticks For if there be any part of that Tunicle left to remain the Tumor wil again return If these kind of Tumors be in the Head the little Bladder being taken forth let the Pericranium be cut and the Skul shaven lest that there be any Root that may be able to generate a new Tumor left remaining behind But if the sick person wil at no hand admit of this said Section or if otherwise it may not conveniently be done by reason of the Veins then the Skin is to be broken through by Caustick Medicaments The little bladder being taken forth the Ulcer is to be consolidated and if the Skin be more loose and extended than it ought to be so that it cannot conveniently be drawn together in this case whatsoever is superfluous is to be cut away Chap. 36. Of Testudo Talpa or Topinaria and Natta ANd hither likewise belong those Tumors which to speak truth are referred to Melicerides Atheromata and Steatomata But because they privily happen unto the head therefore they have peculiar names imposed on them which yet notwithstanding we find no where extant in the more Ancient Greek or Latine Authors but they have been invented and hammered out by the more modern and barbarous Latines to wit such as are these Testudo Talpa or Topinaria and Natta Testudo what it is To wit Testudo is a great Tumor soft or at least not very hard in the Head of a broader form like unto and after the manner of the Tortoise from the likeness whereof it hath taken its name growing forth at the first in the form and fashion of a Chesnut but afterwards in the figure of an Egg in the which there is contained a soft kind of matter a certain Tunicle being drawn over it from whence it is by Authors referred to Melicerides which sticketh so fast in the Skul that for the most part it vitiateth and defileth it and bringeth upon it a polluting rottenness Neerly allied unto this is the Tumor Talpa Talpa so called because that look as the Mole by the Latines called Talpa runneth under ground just so this Tumor under the Skin feedeth upon the Cranium or Skul Some of those aforesaid Latine Barbarous Authors comprehend this Tumor under the name of Testudo neither do they make any peculiar mention of Talpa But others of them have their peculiar Tracts touching this Tumor Talpa and Vigo in his second Book Tract 3. and Chap. 1. doth expresly distinguish Talpa from Testudo and the truth is they differ in their matter which in Talpa is more thick and gross than in Testudo And therefore like as we have said that Testudo may be referred unto Meliceris so may Talpa be referred to Atheroma Some cal it Topinaria But others notwithstanding say that Topinaria is a
different Affect and such as is familiar and common unto Children and that it is bred out of sweet flegm which is manifestly declared by the viscousness and clamminess of the rotten filthiness as also by the whiteness thereof and somtimes from a flegm mingled with Blood as the color declareth which is not very red and it soon cometh to a maturity and somtimes likewise from Melancholy or Choler as Gulielmus Placentius writeth of this same Affect in the first Book of his Chirurgery and Chap. 5. Johannes Philippus Ingrassias in his Book of Tumors Tract 1. Chap. 1. without any the least scruple conceiveth that this Tumor is to be referred to Hydrocephalus But in regard that Hydrocephalus is bred of Water and hath no blood at al mingled therewith neither may be suppurated this therefore cannot be granted unto the said Ingrassias nor by any means allowed of And lastly there is another Tumor which they cal Nata Natta Natta and Napta being great and soft without any pain and color growing forth especially in the back and somtimes notwithstanding breaking forth in the shoulders and other parts hanging by a smal slender Root but yet so greatly encreasing that it weigheth some pounds and is in bigness equal unto a Melon or Gourd which because it hath not alwaies one and the same form and figure it hath likewise therefore by Authors divers and several names conferred upon it The matter that is therein contained doth indeed now and then seem to be fleshy but in truth it is no flesh but like unto fat and therefore it may not unfitly be referred unto Steatoma The Causes They refer the cause of these Tumors unto a salt flegm or else a flegm mingled with Choler But in regard that these Tumors may be referred to Melicerides Atheromata and Steatomata it may therefore most fitly be determined and asserted That these Tumors have the very self same cause that those said Tumors have only here lieth the difference That in these there is greater store of matter and thereupon it is likewise that these Tumors arrive at a greater bulk and bigness than the former Signs Diagnostick These Tumors are easily known from the descriptions before declared for they are soft Tumors or at least such as are not very hard broad and large and shut up in their peculiar Membrane Prognosticks 1. If these kind of Tumors be in the Head they then are dangerous by reason of the vicinity and neerness of the Skull in regard that they corrode the Skul and corrupt it especially about the Sutures 2. If there be present a great corruption of the Skul it is then far better to let this Tumor alone and not meddle with it than to cure it 3. Those of them that are without any corruption of the Skul are cured with more safety 4. Like as it was in the Tumors mentioned in the former Chapter so it is likewise in these unless the whol Tunicle be drawn forth together with the humor there is no perfect health and soundness to be expected or hoped for since that if there be any thing left behind there wil from it a new Tumor arise and break forth The Cure Universals and generals being first premised and the body sufficiently evacuated the matter constituting the Tumor is to be taken away which is done by digestive and resolving Medicaments or by those that suppurate or by Chirurgery And therefore if the Tumor be without any Ulcer and corruption of the bone then let discussing Medicaments be administred Now the Discussives are such as are wont to be used in Scrofulae and Tumors But it is somwhat rare that these Tumors are cured by Discussives If therefore they cannot be so taken away and removed to wit by Discussives alone then Maturatives and Suppurating Medicaments are likewise to be administred such like as have been already propounded in the foregoing Chapter Or Take Onions roasted under the Embers the Yelks of Eggs hard boyled of each three in number Swines Grease or unsalted Butter half a pound the Root of Marsh-mallows boyled to a softness and bruised very smal one pound and make a Cataplasm And yet notwithstanding we are not to expect and wait for a perfect Concoction and generation of Pus in regard that Pus easily and soon gets a sharp and malignant quality and so corrodeth the Skul And therefore so soon as any signs of Suppuration shal appear the Tumor is maturely to be opened The Incision is to be either simple and downright or else it is to be made in the form and figure of a Cross according to the bigness of the Tumor The Pus being wholly evacuated the Ulcer is to be throughly cleansed by convenient Medicaments as for example with such as this Take Barley Meal two ounces Myrrh half an ounce Sarcocol one ounce Honey as much as will suffice mingle c. The Ulcer when it is throughly cleansed is to be filled up with Flesh and consolidated If the bone be corrupted it is then to be shaven and to be cured in like manner as it is wont to be in the rottenness of the bones But as for the Cure by Chirurgery it is to be ordained and instituted in like manner as was declared in the Chapter foregoing Chap. 37. Of Verrucae or Warts THere are moreover other Tumors likewise that are said to have their original not from humors but from a solid substance But since that these same humors take their original either from a vitious and luxuriant juyce nourishing the parts or else from excrementitious humors mingled together with them we wil therefore subjoyn this kind of Tumors unto those that were but even now explained and treated of And first of al there are indeed certain smal Tumors that arise in the Skin like unto little hillocks Verrucae which are called Verrucae or Porri For with the Latines Verruca is properly the higher and more eminent part of a Mountain or Hil and according to Gellius in his third Book and Chap. 7. the rough part thereof whereupon it is that those places are termed Verrucosa that are unequal and have divers eminent parts But now these Verrucae from their several forms have gotten divers and several appellations For one is called Sessilis by the Greeks Myrmecion Verruca sessilis and by the Latins Formica which is fixed and fastened with deeper roots broad beneath and slender above and this thrusteth forth it self in the Skin less than the other kinds of them and it is likewise stable and permanent and not altogether so movable as the rest Now they conceive that it is so named either from their blackish color such as there is in Ants or Pismires or else because that when it is hard pressed it exhibiteth a sense of pain like unto the bitings of those aforesaid Pismires and it is for the most part bred in the Hands or likewise in the Feet neither is it altogether without pain and in this
Ulcer was healed of its own accord and covered over with a Cicatrice Nodi And hither without al question belong and are to be referred the Nodi of Platerus touching which we spake above in the thirty fourth Chapâ—er which are the hardest sort of Tumors sticking firm and fast in the bones that lie under them and which cannot be made to remove their place from the said bones as if some new bone were now grown unto the former which kind of Tumors are bred about the Temples and the Forehead and also about the length of the Ankles in those naked Regions And these Tumors either begin of themselves or else they accompany other Diseases as the French Pox and one certain kind of the Cephalaea Affect The Cure These Cornua and Nodi are very hard to cure and they often continue al the whol life time And yet notwithstanding if they be neer unto the Joynts so that they hinder the motion of them or if they cause continual pain by pressing upon them they are then to be amputated and cut off which may be done the more safely in regard that they consist in the naked bones that are only covered with the skin The skin is first of al to be opened and the Cornu or Nodus to be made naked and bare and after that it is to be cut away from the bone with a sharp Iron Knife and the Wound to be cured in a fit and convenient manner Chap. 39. Of Fungi THat Affâ—ct which the Latines cal Fungus the Arabians cal Fater and Fatera and they refer them unto the Tumors of the Brain Galen by the way and cursorily maketh mention hereof when in his first Book of the place affected Chap. 1. he thus writeth And now saith he even likewise of those things that spring up and grow unto other things the notes and marks of the place or seat affected are to be sought for For why such things as adhere and cleave unto others obtain the propriety of Essence like as do Fungi which the Greeks cal Mycete if upon the breaking of the Head the Meninx or Membrane chance to be broken Avicen likewise makeâ—h mention hereof in the fifth of his fourth Book Tract 3. Chap. 2. where he saith thus And when the Cramum or Skull is broken and the Vail or covering goeth forth there is then also caused an Impostume that is named Fatera And we treated of this Tumor in the first Book of our Practice Part 1. Chap. 25. But as somtimes we wrote unto that eminent and worthy man Gulielmus Fabricius as is to be seen in the second Century of his Observations Observat 25. this kind of Tumor as indeed it may arise very frequently from the Membranes of the Brain so it may also be bred in other parts as you may there find two Histories by me produced for the further confirmation thereof The former whereof is this A History A certain Youth there was about ten yeers old that in leaping hit his left foot hard against the ground and by this vehement stroke he hurt the sole thereof over against the little toe Upon this a Tumor began by little and little to increase insomuch that it had soon gotten over al the foot and exceedingly distended the skin so that the toes â—y reason of the tumor or swelling coming betwixâ— stood at too great a distance the one from the other And yet notwithstanding the skin in color was like unto the found part There were by divers Physitians as the manner is divers means aâ—tempted and different Remedies put in practice but al in vain At length his Friends went unto a Chirurgeon for his assistance who when he saw the place very soft and found that the pain encreased conceived that there was now already a suppuration made and thereupon without any more ado he opened the place out of which there issued forth a little blood but no Pus at al. And in a short time after there ran forth as it were a certain kind of fatness by the which the Wound was quite shut up Within a few daies following there began to break forth these Fungi in great abundance ful of black wheyish blood And in the sole of the foot neer unto the little toe one night there happened as it were a benummedness and deadness as large and broad as half a Rix Doller This being opened yet notwithstanding there fel forth no putrid and corrupt matter neither could any of the dead flesh be separated but the flesh was in appearance like unto a burnt spunge al bloody swelling â—nd strutting with blood and destilling it They began likewise to shew themselves in other places to wit at the sides of the foot and above the ankles most loathsom and frightful to look upon insomuch that that part of the foot did equal or indeed exceed in bigness a childs head At length he proceeded to Section and the middle part of the foot even to the Navicular bone and the heel bone was cut off That which was thus cut off was wholly a hollow spungy flesh partly putrid and corrupt and partly curdled thick and like unto a clammy porous fatness and weighing wel neer four pound But on the following daies a Spungy flesh brake forth again with great violence and look how much there was taken away in the day time there grew again as much in the night And lastly there arose a great swelling in the Thigh nigh unto the left Groyn in the place where the Glandules are in shape much resembling that which at first was seen to appear in the midst of the foot which afterward brake of its own accord out of which there grew forth great store of spungy flesh And so not long after the Boy died The other History is this A Boy twelve yeers old was greatly troubled with the pain of his teeth Another History At length it came to this That they must be drawn One of the upper teeth is accordingly drawn forth Upon which there afterward arose a Tubercle in the Palate neer unto that Tooth as big as a Prune stone This being soft and not opening of its own accord it was conceived that there lay some Pus or purulent matter under it whereupon it was opened and at first there flowed forth nothing but some few drops of blood but then afterward there brake forth a spungy and blackish flesh which so far encreased that it did not alone hang forth at the mouth but grew forth likewise by the Nostrils and at length brought death upon the Child And Gulielmus Fabricius in his second Century Observ 199. relateth likewise an History of a Fungus that had its original from Gurgulio that wholly filled up the Palate and reached welnigh unto the fore teeth And another he mentioneth in the following Observation that arising from Gurgulio was altogether as big as an Hen Egg and it so stopped up the little holes of the Nostrils that end in the
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
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
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
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
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
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
may throughly purge it Of such like Potions Tragaultius hath described two the former whereof is this Take Agrimony three parts Plantane two parts Olive Leaves one part Cut them smal and bruise them wel and then boyl them in white Wine let the sick Person drink hereof a small Cup full three or four ounces every day Or Take Osmund or Water-Fern three parts Gentian two parts Centaury one part boyl them in the same manner as aforesaid in white Wine which Potion expelleth and driveth forth likewise Bones that are corrupted Others there are that commend this Potion Take Sanicle i. e. Bears Ears or French Couslips Mugwort Speedwel Saracen Consound Winter-green of each one ounce Savine one ounce and half Hors-tail half an ounce boyl them in white Wine and make a Potion which if we wil at any time make stronger and more operative we may then in the drinkng of it unto each Dose add and mingle therewith half a scruple of Oculus Cancri or the Crabs Eye prepared For Savine and Crabs Eyes are of singular use and benefit in the expelling and driving forth of corrupted Bones Pus putrified Veins and the like Or Take Saracen Consound Sanicle Speedwel of each one ounce Tormentil Root half an ounce Avens and Carduus Benedictus of each an ounce and an half boyl them in Wine Afterward before any thing else be done we must do the utmost of our endeavor that the callous hardness and brawnishness may be removed But now whenas the narrowness of the orifice of the Fistula doth for the most part hinder the application of those Medicaments that are to be administred for the removal of the callous hardness it is therefore to be dilated which may be done either by fire or by an Iron Instrument or else more commodiously and without pain likewise by long sharp tents that are made of Sea-Spunge the pithy substance of the Elder-tree the Roots of Gentian Aristolochy Briony or even likewise of the wild Rape throughly dried For these things being formed into a Pyramidal figure and put into the Fistula the sharp-pointed end downward they soak up the humidity of the Fistula and by this means they are rendered the thicker and so by little and little they dilate and widen the orifice without any pain at al. Which things are somtimes likewise soaked and anointed over with such Medicaments as are in their own nature fit to take away the callous hardness when the callus hindereth the dilatation For there ariseth a callousness especially in the external orifice of the Fistula to wit in the very skin it self it being such as easily becometh hard and such as is made thicker than the flesh that is softer and easily receiveth in the excrements and the humors that flow thereunto Yet nevertheless the very flesh it self somtimes likewise getteth a callous hardness in the cavity of the Fistula The callousness that is in the orifice of the Fistula is sufficiently apparent both unto the touch and to the sight But now whether there be any callousness likewise in the Sinus it self this may be discovered by the searching Instrument For when the Instrument is put into it there is then perceived very little or no pain and there is no blood at al issueth forth but there is a certain hardness perceived if a Callus be present Which if it be absent then there is a great pain excited the blood floweth forth and there is no hardness at all perceived But now wheresoever this Callus is it is to be removed which is done either by Medicaments or by Cutting or by the Fire But then likewise Medicaments are to be administred somtimes such as are mild and moderate and such are Emollients and Digestives and somtimes again those that are stronger and such are Detersives or Cleansers and lastly now and then also the strongest sort of al and such are Causticks In those that are but young and in their youthful age and that have their flesh soft and tender here Emollients and Digestives only are sufficient which do dissipate the said Callus and the matter that is impacted and stuffed into the part that constituteth and causeth the Callus unto which we may likewise if there be occasion add and mingle therewithal some of the Abstersive and Cleansing Remedies And such are the ashes of Figs mingled with the fat of a Goose the Decoction of Fern Root of Agrimony of Olive leaves the great Diachylon and the Unguent Apostolorum But for the most part there wil be need of the stronger and more forcible Remedies which by cleansing or likewise by burning do waste and consume the aforesaid Callus The stronger sort of Medicaments are the Root of Spondylima we usually cal it Cow-parsnep or Meadow-parsnep peeled and pared round about Asphodel Root Snakeweed Briony the Decoction of Lupines and especially above al the lesser Centaury There are some likewise that make use of the Root of black Hellebor and this they put for three daies into the Fistula But Antonius Chalmeteus pre-admonisheth us touching this Root and he tels us that it is a very unsafe and dangerous Remedy and especially if the Fistula be in any part of the Thorax or Chest For when on a time he himself as he saith had once and but once filled with Hellebor a Fistula that was in the Spina Dorsi neer unto the Region of the Heart the sick person very often fel into fainting and swounding fits Those things that are yet stronger are the Aegyptiack Unguent Vitriol burnt Vitriol precipitate the Oyl of Sulphur Trochisques of Minium Chalcitis and that which by the Apothecaries is called Misy and Sory out of which there may be made Compositions for the present use Celsus in his fifth Book writeth that this following is found by good trial and experience to be of singular use and Paulus Aegineta doth the like also in his fourth Book and Chap. 49. in which place we may see more hereof Take of the Rust and soil of Brass twelve drams Ammoniacum two drams Let the Ammoniacum be dissolved in Vinegar and the aforesaid Soil of Brass therewith mingled Or Take strong Ley four ounces the Decoction of Lupines one ounce Honey of Roses strained one ounce and half Allum half an ounce and mingle them If we mind to add any further virtue and strength thereto to make it the more operative we may then add half a dram of Precipitate Mercury Or Take the best Wine Vinegar three parts of the oldest Oyl two parts Litharge one part let the Litharge be bruised in a Mortar with Vinegar and afterward let them boyl al together until they have gotten both the color and consistence of Pitch of which we are then to form long sharp Tents for the present purpose Or Take Litharge half a pound boyl it in Vinegar and Rose water and then strain and filtrate it Afterward Take Calcined Tartar as much as wil suffice dissolve it in destilled Vinegar Mingle the Waters and make
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
a wollen Cloth be wee therein and so imposed upon the place affected it hath likewise been happily and successfully administred in the Gangrene of the Cods of which we have spoken above Take Vitriol one ounce the tops of the Oake one handful Frankincense half an ounce Camphyre two drams Vrine two pints and half boyl them to the Consumption of a third part and then strain them But the Aegypriack Unguent is not alone to be applied but upon the Unguent that Cataplasm is also to be imposed which resolveth drieth and hindreth putrefaction such an one as Johannes de Vigo in his second Book first Tract and seventh Chapter describeth and commendeth and which many other Physitians and Chirurgeons now a daies likewise make use of And all these are to be applied blood-warm and they are so long to be continued untill the putridness be removed But if the Malady wil not yield unto these Remedies then we are to have recourse unto those that are stronger to wit Causticks such as those Trochisques of Andro Polyidas Musa and Pafio which dissolved in Vinegar and Wine may be imposed upon the part Many indeed do here commend and prefer Arsenick before all other Remedies but Gulielmus Fabricius doth and not without good Cause reject and altogether disallow of it in the Cure of a Gangrene as that that not only hath in it a Septick and putrefying faculty and a quality of melting the flesh as it were but that likewise produceth very great and grievous Symptoms vehement pain Dotings Syncope's and the like the malignant vapours being communicated unto the principal part It is therefore more safe to make use of an actuall Cautery as that which hindereth and preventeth putridness drieth and corroborateth the part This is also much commended Take Mercury dissolve it in Aqua fortis when it is dissolved precipitate it the Oyl of Tartar after it is precipitated wash it Or Mercury alone dissolved and mingled with the Water of the Trinity Flowers and wollen Cloaths wet in this Liquor may be imposed on the part The Crust in what manner soever it be produced is to be taken away by those Medicaments that have been above declared in the first Part and Chap. 13. touching a Carbuncle Neither are we to wait so long til Nature shal altogether have separated the Corrupt from the Sound but the highest part of the Crust is with the edge of a Knife or a Penknife to be cut even unto the sound part that so there may be a way made for the Medicaments unto the deeper parts and the rest that are corrupted For if we expect until the Crust shal be freed of its own accord it may possibly happen that under the Crust a new putridness may be contracted The rest of the Cure is in the same order to be proceeded in as is fit to be done in Ulcers Fourthly If the Gangrene happen from overmuch heat A Gangrene from too much heat then a Cold Diet being prescribed and the hot humors being duly qualified and evacuated if the Malady take its original from an internal Cause the Member affected is to be scarified and then washed with such a Decoction as this Take the Water of Endive Sorrel Lettice Nightshade and Vinegar of each one pint Syrup of Sorrel two pound of Lupines half an ounce Water Germander half a handful Salt three ounces boyl them till a third part be consumed After this the Aegyptiack Unguent and the Cataplasm but even now mentioned is to be imposed and the rest which were before prescribed are speedily to follow Where notwithstanding this is to be observed that unless in case of urgent necessity we must not have recourse unto the actual Câ—utery lest that hereby to wit by the power and force of the fire the extraneous heat which is the Cause of the Gangrene be augmented Fifthly and lastly If the Gangrene arise from the defect of Aliment and Blood and Spirits A Gangrene by reason of an Atrophy in the part and chiefly in truth if it be by reason of a Driness and an Atrophy necessaâ—ry Nutriment being denied unto the part then meats that are hot and moist easie of Digestion and such as generate much and good blood are to be given unto the sick Person and outwardly the body is likewise to be moistened with Oyntmentâ— of sweet Oyl or with Oyl of sweet Almonds and all things are carefully to be avoided that exsiccate and dry the body And unto the part it self that is already affected with the Gangrene the Aliment is by all manner of means to be attracted And therefore here there is no place left for Defensives in regard that they shut and stop up all passage of the blood and Spirits unto the part affected And therefore we are not only to anoynt the part affected and the other members with the Juyce of Earth-worms which is made of the said Earth-worms first washed in Water and then in Wine so put into a great Vessel with good store of the Oyl of sweet Almonds Violets and melted by a gentle and moderate heat over hot Embers and afterwards strained which is a sprecial and soveraign Remedy in the Atrophy and extenuation of the parts but the part affected is therwith likewise gently to be rubbed and chafed unto which also Cupping-glasses not scarified are to be applied But it wil be most fit and requisite if there be already present a putridness to administer those things that do alike both attract and resist putridness such as are Salt Water boyled with Water-Germander Liquid Pitch with the meal of Lupines of the bitter Vetch Orobus Myrrh and the like But if the Gangrene hath already made any progress the part is then to be scarified and the Aegyptiack Unguent and that likewise that is compounded of Pitch and those other things a little before mentioned are to be laid thereon A Gangrene from the interception of the blood spirits Moreover If the Gangrene happen from the interception of the Blood and the Spirits likewise whatsoever the Cause then be that thus intercepteth the blood and the spirits it is immediately to be taken away as if the said interception be from the binding of the part it is forthwith to be loosened and withal those Medicaments that resist putridness as likewise those that discuss that that is corrupted such as are those that are made of the Meal of Beans of the bitter Vetch Orobus of Lupines Aloes Water-Germander and the like are to be imposed And if the Gangrene hath already gotten unto any heighth the place is to be scarified and those other things that are required in al Gangrenes are to be done If an astringent and repelling Medicament be the Cause the said Medicament being removed the heat is to be recalled by Frictions Lotions and Anointings And so we must also proceed in the Gangrene that hath its original from other Causes that intercept the Spirits For the Cure of the Gangrene
it self doth scarcely at al differ the difference lying only in the removal of the Causes But if the Malady become to that that the Member is now already altogether mortified and dead and that it be sphacelated from whatsoever cause it be that the Malady hath its original there is then one only way of curing it For seeing that what is altogether dead in the body cannot possibly recover life again and that it hath now altogether the nature of a thing that is preternatural there is this one only Indication to wit that it is to be taken and amputated from the body Which if by reason of the unfitness of the place it cannot conveniently be done then the case is wholly desperate For some parts are much more fitly scituated for amputation than others as for instance the fingers the feet the hands the genitals may be cut off with less danger But if the Malady be in the Thorax or Chest or in the Belly the parts cannot then be cut out and especially if there be many particles of the Member at Once infected For it somtimes so falleth out that the whol Member is not to be taken away but only some part thereof But oftentimes indeed the whol Member is wholly to be amputated and cut off to wit when the putridness hath seized Upon and corrupted al the parts thereof round about which in some may be speedily done and without any great danger as in the Scrotum or Cods but in other parts the amputation is ful of difficulty and peril as in the Feet Army and Hands But after what manner the said amputation and the taking away of that which is corrupted is to be performed we wil now acquaint you Now this may be done divers waies some there be that having first applied a Defensive upon the sound part they then with many straight and oblique Sections scarifie the dead flesh that lieth neer unto the sound and this they do very deep even unto the very bone And afterward upon the Wounds they strew the pouder of Arsenick and Sublimate that so the mortified part may be separated from the sound But in this way of extirpating the corrupt flesh Arsenick as we lately gave you notice is suspected and therefore in the stead thereof we are to administer other burning Medicaments of the ashes of Vine-sprigs and unslaked Lime The Crust that is al over the part affected is to be taken away with a Pen-knife neither must we expect til it be separated of its own accord Yet nevertheless that the dead part may be dried and be easily separated from the sound Fallopius applieth this Sparadrape Take Aloes Myrrh Acacia Gallia Moschata Alipta Moschata al the Saunders Lign Aloes Cumin Allum of each one dram make a Pouder Of which Take one ounce Ship-pitch Rosin of the Pine-tree Colophony of each two ounces Frankincense Mastick Styrax liquid of each one ounce and half Gum Arabick and Tragacanth of each half an ounce Let them be all melted put a Linen cloth into the Liquor until it be throughly soaked in the Medicament And afterwards let al other things be done as it useth to be in other Ulcers There are others that with an actual Cautery burn that that is corrupted even until there be a pain perceived in the part and al other things are afterward to be done according to art But now Fallopius doth advise us if much dead flesh be to be taken away not to make use of an actual Cautery alone in regard that from the said burning there wil be caused a most abominable loathsom stench Others there are that by Section and the Razor amputate that that is corrupted and afterwards to avoid the Hemorrhage and to dry up and consume the reliques they apply likewise an actual Cautery if need require But what hath hitherto been spoken touching this way and method of Curing is to be understood only of that Sphacelus wherein the whol Member is not corrupted and when there is no cause of taking away the Bone likewise For if the whol Member be corrupted The cutting off the corrupted Member when to be done and therefore to be amputated this cannot be effected either with an actual Cautery or a Potential neither yet with a Razor but there is a necessity of cutting off the whol entire Member the Foot the Hand c. But in what manner this amputation ought to be performed Authors differ much in their opinions concerning it Celsus in his seventh Book and Chap. 33. perswadeth us to make the Section between the sound flesh and the dead and rather to take away some of the sound than to leave any of the dead flesh remaining left the Malady that is left corrupt that that is sound Which way of curing most of our late Physitians disapprove of by reason of those dangers that follow the Section in the sound part to wit an immoderate profusion of the blood and an extraordinary great pain and the faintings and swoundings that depend upon these And therefore that these may be avoided they advise us to make the Section in the corrupted part alone Fallopius indeed with a Razor cutteth into the dead flesh even unto the bone a fingers breadth distant from the sound part and then after this he forthwith taketh away the bone with the saw and then again with Irons red hot he burneth the greater Vessels and the flesh even unto the causing of pain Hieronymus Fabricius also leaveth a portion of the sound flesh as much as one fingers breadth and appointeth the Section likewise to be made with a Razor in the dead flesh and he afterwards burneth the part with fire-hot Irons after the same manner to hinder and restrain the Hemorrhage and to waste and consume the reliques of the putrefaction But here in this place we are to advertise you that somtimes the putridness wil yet creep further and infect the neer neighboring parts but then again that somtimes the putridness ceaseth neither doth it creep any further unto the parts neer adjoyning which whensoever it happeneth then round about the corrupted part there appeareth a Circle that is exactly red and of an exquisite sense In the latter case indeed that way of curing seemeth not altogether improper and unfit in a part that is corrupted and dead For by this means those many dangers which accompany that Section that is made in that part that is alive are prevented to wit the profusion of blood pain and faintings since that through the corrupted part the blood cannot pass and because that the said part hath no sense at al. But if there be any of the dead flesh left remaining this when the putridness shal cease any longer to creep although there shal not be any Cauteries administred wil afterwards divide it self of its own accord and then it wil be separated by Nature upon the administring of fit and proper Medicaments But if as yet the putridness be creeping forward and that Nature hath not
as yet of her own accord begun to separate the sound from the corrupt then the Section cannot be instituted in the corrupted part alone without present danger For it oftentimes falleth out that in the interior parts and in the bottom of a Member the corruption penetrateth far deeper and further than in the skin it appeareth to do For the Muscles and their Vessels in the interior parts in regard that they are there hotter than they are without do easily receive the putridness Wherefore if any wil yet be instituting the incision in the mortified part seeing that he leaveth behind much putridness in the interior parts either he wil hasten sudden death upon the sick person by leaving the said putridness that wil be alwaies creeping further deeper and broader or else by reiterating and renewing of the Section he must needlesly and unadvisedly again exeâ—uciate and torture the Patient Neither maketh it any thing at al to the matter that the pain is excited in the sound part For as Celsus saith in the place before alleadged it is little or nothing material whether that guard and defence be sufficiently strong and safe that is but one alone And as Hippocrates hath it Vnto extream Diseases the Remedies that are to be administred must likewise be extream But in very truth the pain may in a manner be moderated and the sense obscured by the fastening on of the Ligatures intercepting the passage of the Animal Spirits for a certain time as we shal afterward shew you and likewise how with a very sharp Razor the Section shal be almost quite finished before ever the sick Person shal perceive what it is in doing But yet they themselves who make the Section in the the Corrupted part cannot notwithstanding hereby prevent all manner of pain For so soon as the bone is cut asunder with the Saw then there happen very sharp and most acute pains because of the Periostium or that Membrane that encompasseth the bones which pain if any would avoid then of necessity he must make the Incision with the Saw in that part wherein the said Membrane it self is dead which if he should do without all doubt even there likewise the bone it self is corrupted and there would be so great a putridness left remaining in the Vessels and in the Muscles which are very apt ready to receive the said putridness that it cannot possibly be afterwards all of it extinguished no not with the Cautery it self Neither do those Cauteries themselves take away all that is corrupt without much pain of which there ought indeed many to be applied and administred if all the dead flesh that there remaineth be to be taken away And moreover Cauteries have likewise in them these inconveniencies that by their vehement beat they melt the fat and the humors and they so vehemently heat the parts that thereupon in those parts that have their sense and feeling there is an extraordinary pain excited and the flesh for the most part is so consumed by the force of the Fire and withall contracted and wrinkled that a great part of the bone sticks forth naked and bare which very often requireth a new Section The Hemorrhage likewise is not so greatly to be feared For if the Vessels be intercepted by Ligatures as we shall shew you there wil not then flow forth much of the blood And if the blood should chance to flow forth in somwhat a greater abundance then ordinary yet this would make rather for the benefit of the sick Person then be any waies prejudicial and hurtful unto him For by this means the blood in the Vessels that haply hath received some putridness is evacuated and so by this means al the danger is taken away and prevented lest that the putridness should creep any broader and by spreading it self any further should again prevail and get strength That we may therefore briefly declare unto you after what manner the said Section ought to be performed Universals if the malady wil admit of any respite and delay are not to be neglected and especially there is a due regard to be had to the strength of the Patient Let the sick Person therefore first of all eat a porcht Egg with a piece of Bread toasted and throughly soaked in Wine and let him be strengthened with Perfumes Epithems and other Cordial medicaments Some there are that before they set upon the Section do prescribe some kind of Narcotick Medicament to dull and stupefie the Sense but Fallopius much blameth these for as he saith gentle and sleight stupefiers benefit little or nothing and as for those that are strong they are very dangerous After this the sick Person being fiâ—ly placed and held fast by the standers by or if need be fastned by tying and the Muscles being drawn upwards towards the sound part upon that part in which the section ought to be made the Member is most strictly and very hard to be tied down with Ligatures By which binding first of all the overgreat flux of blood is prevented secondly the sense of the part by the shutting up of the Animal Spirits is somwhat dulled and thirdly the Muscles that are by this means drawn upwards the Section being ended and the bands loosned do again devolve and move downward that they may cover the extream and naked parts of the bones The place of Amputation As concerning the place of Amputation in the Fingers and Toes the Section is most fitly made in the very Joynt For in the Joynt if at least the Malady will admit thereof the Amputation is made with the least danger and likewise with the least pain For the Nerves and the Tendons so soon as they are cut assunder they are instantly contracted upwards and covered with flesh neither doth there follow any Convulsion hereupon But if in the Feet the Sphacelus transcend the Ankle then the Leg is to be cut off a little below the Knee so that the Patient may be the better fitted and accommodated with a wooden Leg. For which cause in the Leg the amputation is not alwaies to be made in that part that is neerest unto the dead part but there is oftentimes also much of the sound part to be amputated For if much of the Leg be left this wil be very burdensome unto the sick Person and a great impediment to him in his motion But then on the Contrary in the Arm as little as may be of the sound part is to be amputated but the Section ought to be instituted as neer as may be unto the corrupted part And therefore when we have made choyce of the most convenient place then with a very sharp Razor the Section is to be made even unto the very Bone and if it may be done the very Periostium is likewise to be cut in sunder and if there be any smal portion of the flesh left behind or if there be any of the flesh hid betwixt two Bones lest it should afterwards
hinder that Section that is made with the Saw that flesh is likewise to be cut off with a Knife that is fit for the purpose And then instantly and with as much speed as possibly may be the Bone is to be amputated with the Saw unless the Section be in the Joynt for then the Member may be amputated with the Razor alone The amputation of the Member being finished the next thing to be done is the stopping of the flux of blood after that it hath flown forth sufficiently Most Practitioners burn the Vessels with a Cantery But Paraeus much disliketh this course for he conceiveth it indeed to be very cruel and barbarous in regard that it causeth an extraordinary great pain if the Section be made as it ought to be in the quick and live flesh and very bad and dangerous Symptoms happen unto the Nervous parts unto which we may add that by the said burning very much of the sound flesh is consumed whereupon the bones are left bare and the flesh together with the Cicatrice either it is not at all brought over the naked part or if it be it is not without much difficulty And therefore he Practiseth another way of stanching the Hemorrhage to wit with a Crows-bil he laieth hold upon the Vessels and draweth them altogether then bindeth them as close as may be The Vessels being thus straitly tied together with a Ligature or if you judg this more fit shut up close with a Cautery the bonds are then to be loosened and the courser part of Flax or Hemp we cal it Hurds after it hath been throughly soaked in the White of an Egg and sufficiently besprinkled with a Pouder that hath in it a virtue and faculty of stanching the blood is to be laid upon the Member And yet nevertheleless for the most part without any such Ligature or Cautery the blood may likewise be stopped and stanched after this manner As Take the finest Flour three ounces Dragons blood Frankincense Aloes of each two drams Bole armenick Terra Sigillata Parget or Plaister of each one dram Water Frogs prepared though there be some that for this use and purpose do rather commend those of them that live among Trees one ounce the Flix of a Hare cut very small a thin Spunge torrefied by the Fire of each two drams and make a Pouder Upon the Vessels likewise that pour forth blood there may very fitly be applied and laid on that Mushrom so much used by Câ—iturgeons to stanch blood which they cal Crepitus Lupi Others there are that make up Emplasters of Dragons blood Bolearmenick Terra Sigilata and the finest Volatile flout and the like with Pitch Afterwards the Trunk of the amputated Member is to be safe guarded with those Defensives or such like as we have above mentioned the like unto which is this also that followeth which is to be applied with Hurds and Swathe-bands having been first wel and throughly soaked in Oxycrate Take Bolearmenick Terra Sigillata Dragons blood Mastick Parget Oyl of Roses and Oyl of Myrtle of each one ounce Whites of three Eggs Vinegar as much as wil suffice and make an Vnguent And this is the first dressing or the first binding up which is not to be loosened in the Summer time before the second or third day but in the Winter not before the fourth day at the soonest unless in case of urgent necessity And in the mean time the Member is to be placed in a direct middle posture or figure in Pillows stuffed with the hairs of Harts or Wheaten meal The first binding being loosened and the first Provision taken away again with the White of an Egg as before the Pouder stanching the blood is to be applied and the excremities of the bones to be covered with a piece of the dry Liniment and in the end the Wound to be bound up with some kind of Digestive And this Cure is so long to be continued until there be now no cause of further fear that any mischief may follow upon the Hemorrhage and that the Wound be now become Purulent For then these Medicaments being laid aside we are to make use of Cleansers Gulielmus Fabricius commendeth tins Unguent following of the Juyce of Smallage not only for the Gangrene but likewise for other sordid foul and Malignant Ulcers Take the Juyce of Smallage of Water-Germander of Waybred or Plantane and of Rue of each two ounces Honey of Roses strained one pound boyl them to the Consistence of a Syrup and afterwards mingle therewith the meal of Lupines the Pouder of round Aristolochy root of Angelica root of Swallow-wort and of Treacle of each half an ounce Aqua vitae one ounce make an Vnguent In the mean time we must do our endeavor that the Lips of the Wound may be drawn together and afterwards that flesh may cover the bones and nay be unto them in stead of the Pillows Paraeus and others saw together the lips of the wound in the form of the letter X but a Suture which they cal the dry Suture seemeth to be far more convenient or else by a Glew which is done after this manner A Linen Cloth of a convenient figure and bigness moistened throughly in a Glew of Astringent Emplastick and viscous Medicaments such as are Bolearmenick Dragons blood Gum Tragacanth Sarcocol Mastick the White of an Egg and the like is to be laid upon the place As Take Mastick Dragons blood Bolearmenick Sarcocol and the finest Volatile flour of each half an ounce Rosin of the Pine Tree two drams mingle them with the White of an Egg. Of this Linen Cloth let there be made Emplasters which are to be applied unto the extremity of the Wound on both sides So soon as the Emplasters are become dry so that they begin to stick too fast unto the Skin then we use to annex unto them little handles to hold by of Thread twice or thrice doubled and with them we contract the lips and this may likewise be done in a suture that is more thin sewed And then at length we must do to the utmost of our endeavor that the excremities of the bones which were hurt by the touch of the Iron and the Air may fal off For which end some there be that burn the utmost parts of them with a red hot Iron yet stil taking great heed lest that the flesh and other of the sensible parts be hurt thereby Others make use of the Emplaster of Becony and other Catagmatick or Fracture Medicaments And so within thirty or fourty daies whatsoever there is of the bone corrupted wil fall off If the flesh be luxuriant or proud as we sometimes term it it is then to be repressed and kept under by the Pouder of Alum and the like and at length the Cicatrice is to be brought over it But whereas pains do in the mean time much infest and disquiet the sick Person and that there is cause to fear lest that Convulsions
while somthing reddish and as soon again of a color inclining to black and which are generally wel known are more fitly to be referred unto the Alphus Niger or the black Alphus And he the aforesaid Rudius doth likewise ill in calling the Ephelis by the name of Panus and his determining that Ephelis and Panus are one and the same Affect is altogether false since that out of Celsus his fifth Book Chap. 18. Pliny his twenty fourâ—h Book Chap. 4 9. and likewise from other Physiâ—ians it is very cleer that Panus is the Greeks Phygethlon and that somtimes likewise Phymata are comprehended under the name of Panus But there are some others also that neglecting the Authority of the Ancients cal those spots in the Face especially in Women by the name of Pani Hippocrates in his Book of Women that bear not Children page 245. in Foesius his Book writeth that this kind of spots is called Ephelis when he saith That those women that are with child if they have a spot in their Face as it were from the Suns burning for the most part bear female Children Where for the most part is wel added in regard that it is often observed also that Women great with Child which have born Males have had their Faces defiled with these k nd of spots so that these spots may rather be said to be a sign and token of the Conception in general than particularly of the Sex that is conceived whether it be Male or Female Whence it is that the Germans likewise cal it Kinds flecken But now whereas there is a twofold Ephelis one from causes external another from internal Causes of the latter of these we intend to treat in the Chapter following but of the former we wil speak in this present Chapter And indeed the first kind of these Ephelides is that wel known Affect Blackness from the Sun to wit that blackness which the Germans cal Sommerbradt in the Face the Hands and those other parts that are exposed unto the Sun-beams contracted from the heat of the Sun And as wel men as women are subject unto this affect but yet nevertheless more especially women as having their Skin more tender and chiefly in the Spring time For whereas in the Winter the Face was not accustomed to much heat if in the Spring it be suddenly exposed unto the Sun-beams the Skin that before was white now beginneth to wax red with a certain kind of blackness The Affect is of it self known from the Cause foregoing And the Face is not only deformed with some certain spots but the whol color thereof is changed But now this burning and blackness from the Sun may be prevented Preservation from it if the Suns Beams be turned away from the Face by Shades and other Coverings and the Hands kept covered with Gloves or both the Face and Hands anointed with the white oâ— an Egg shaken together with Rose-water or with the Mucilage of the Seeds of Quinces or of Fleawort extracted with Rose-water or Gum Tragacanth dissolved in Rose-water or else let the face be anointed with the Emulsion of the four greater cold seeds or let it be anointed with this Unguent Take Vnguent Pomarum two drams Ceruss dissolved in Rose-water one dram Mastick half a dram the Mucilage of the seeds of Fleawort one ounce Make hereof a Liniment And of these kind of Medicaments there is need most especially in the Spring time when the tender Face can very hardly be sufficiently guarded from the heat of the Sun and of the Air. The Cure But if the Face be already as it were burnt and a blackness be contracted Nature indeed of her own accord is wont in process of time to change this deformity when it draweth a new Scarf-skin upon the burnt place if in the mean time the Face be covered from the Beams of the Sun But these delaies being for the most part tedious unto women they must in al haste have their pristine color again restored unto them by the help of Medicaments And commonly women are wont to cleanse their Faces with the Leaves of the Cherry Tree while they are yet fresh and green Others of them there are that use Rose-water wherein Camphyre hath been dissolved and others of them make use likewise of the Cherry-tree Gum dissolved in Vinegar whereunto they put a little Oat-meal And here likewise there is much use made of the Water of Bean flowers of Mallows and white Lilies and those that are made of the four greater cold seeds destilled with Milk Bitter Almonds are also here very useful Or Take the juyce of Plantane and of Nightshade of each one ounce Litharge of Gold and of Silver of each one dram burnt Lead half an ounce Tutty prepared six drams Camphyre half a dram Oyl of Roses and Wax as much as wil suffice and make an Vnguent Take Roots of white Lilies rosted under the Embers two drams the Root of the Herb Dragon-wort and Solomons Seal and Melons seed of each two drams the Mucilage of Fleawort seed one ounce of the Citrine Vnguent half an ounce and make an Vnguent according to art Chap. 2. Of the Ephelides in Women with Child THere is another kind of these Ephelides that happeneth more especially unto Women with Child and it hath its original from the Menstruous blood retained which in regard that for the most part from the said retention it contracteth a great deal of vitiousness is wont to excite in Women great with Child divers symptoms as likewise these spots in the Face bred from a vitious humor thrust forth thither But now and then notwithstanding Virgins and Women that are not with Child have these kind of spots breaking forth in their Faces if in the time of their monthly Menstruous flux they eat those kind of meats that as they say have in them a power of coloring such as are the Carrot Roots and the red Beets and the like which as we are taught by Experience do breed and bring forth these kind of Spots Signs Diagnostick These Ephelides in Women with Child are known in that they are dark and duskish spots appearing more especially in the Forehead and deforming it and spreading themselves both in length and breadth and oftentimes they equal in length the palm of the hand but they are void of al kind of roughness The Prognostick The Ephelides in Women are a sign of their Conception as we told you before out of Hippocrates his Tract of Women that never have Children and they are seldom or never cured and if haply they be taken away yet they soon return again and with some they continue even unto the time of their Delivery and after that they vanish and in some they likewise continue after their Delivery and in some others they also vanish before they are delivered when the Child is now become strong and vigorous like as do other symptoms that usually infest Women with Child in the beginning of
and the Skin it self For albeit while the place of the Itch be scratched there is perceived a certain seeming pleasure yet nevertheless this pleasure doth not belong to the Nature of the Itch but it followeth only upon the scratching whilst that the parts that were gnawn by a sharp matter do suddenly return unto their natural state and their wonted smoothness For like as there is a pain excited from that sudden motion unto a preternatural state so in like manner there is a certain pleasure felt from this sudden motion and return unto their Natural state Now the truth is the Itch it self ceaseth after scratching because that the matter which was the cause of the Itching is evacuated and because also that the solution of Continuity that exciteth the pain is again brought unto an Union and quietness if the scratching be any thing strong The Causes The neerest cause of the Itch is a salt Excrement that is biting and sharp to wit either meer pure Choler or else black Choler commonly called Melancholy or else a salt flegm Which excrement albeit that it be present also in the scabby Affect yet in the Itch it is more thin and insinuateth it self through the least particles But it sticks between the true skin and the scarf-skin and thereupon by its acrimony it goadeth as I may so say and pricketh the sensible particles in the skin and provoketh them unto scratching And indeed like as the Nature of the excremens it self maketh much for the sticking of the said Excrement in the Skin this Excrement although it be thin yet having in it a certain kind of clamminess and glewishness by the which it sticketh very close and pertinaciously unto the parts so doth likewise the thickness of the skin it self by reason of which it cannot exhale But now that excrement is collected by reason of the heat and driness of the Liver the use of sharp meats and many Spices And hence it is that old men those especially of them that in their youth had a hot Liver and such of them as then used a hot kind of Diet in their meat and drink are in their old age so sensible of the Itch and at length come to be troubled with scabbiness See further hereof in Galen his second Book of the Causes of Symptoms and the sixth Chapter The Differences Now according to the variety of the humor and the nature of the places affected there is a certain difference likewise of the Itch. For look how the matter is more or less sharp so the Itch that is excited is more or less contumacious and troublesom And somtimes there is felt an itching in the skin of the whol body and somtimes in some parts only Prognosticks 1. The Itch is for the most part the forerunner of Scabbiness shortly to follow For if the Itch be of any long continuance there is then at the length collected a greater abundance of the matter and this receiving a putridness is rendered more sharp and it corrodeth the Scarf-kin and exciteth Pustules 2. By how much the worse the humor is that exciteth the Itch by so much the worse is the malady also To wit the Itch that is excited from burnt blood or Choler is sooner ended and gone but that which proceedeth from salt slegm lasteth longer and longest of al that which hath its original from burnt Melancholy 3. The Itch in which there is great pleasure taken in the scratching thereof is evil because that it ariseth from a sharp Choler 4. The Itch in old people is seldom cured especially in those that are decrepit For since that old age is fit for the treasuring up of these salt humors that disposition of the body is hardly changed and brought unto a better state And yet notwithstanding if diligence and care be shewn it is somtimes healed And Mercurialis in his Tract of the Diseases of the skin Chap. 3. relateth that Leonellus Pius a man fourscore yeers old was freed from an extraordinary great Itch by the benefit of Medicaments 5. Hippocrates in Coacis writeth that the Itch in those that have Consumptions if it succeed the suppression and binding of the Belly is not only dangerous but deadly For by reason of the trouble and disquiet of the Itch those in Consumptions can neither sleep nor take any restr whereupon there is little or no Conconction and therefore they have their death hastened upon them The Cure The Itch seeing that it is a pain if it be extraordinary great and vehement and cause watchfulness thereby decaying the strength sheweth that mitigation by Anodynes is to be procured but the Cause that it dependeth upon calleth for evacuation And indeed the next Cause since that it is a sals humor sticking in the Skin this is likewise to be evacuated from the Skin And in regard that this said next cause is nourished by a like humor contained in the Veins therefore this is likewise to be evacuated And because that this humor is generated from a distemper and vitious disposition of the Bowels it is therefore to be anointed and so the generating of such like humors is to be prevented Those Moisteners take away the Itch that mitigate the sharp matter that is the Cause of the Itch. Now those things that evacuate these excrementitious humors from the Skin are those Medicaments that Cleanse Mollifie and make thin Purgers take away the Antecedent Cause Alterers amend the vitious disposition of the Bowels but more especially a good course of Dier And therfore in the first place the Salt Nitrous and sharp humor is to be prepared and evacuated The humor is prepared by such Medicaments as have in them a power of Cooling and Moistening and such as withall attenuate the Thick Clammy humor such as are Succoâ—y Endive Borrage Bugloss Fumitory Hope Maidenhair Asparagus Roots Polypody Mother of Time and Syrups made out of these and more especially that oâ— Hops Fumitory Succory the Byzantine Syrup and the Syrup of Maidenhair Now the Humors are evacuated by the Leaves of Sene Polypody black Hellebor Jalap the compound Syrup of Polypody the Electuary Dracatholicon Confection of Hamech Extract of black Hellebor the Melanagoge Excract The forms oâ— these are elsewhere propounded and so they are also in the Chapter of the Scabs And sometimes also Venesection if the Age and strength wil bear it is to be instituted and because that it often falleth out that either the Haemorrhoids or the Courses suppressed and kept it may afford matter and occasion unto this Evil it wil therefore not be amiss to provoke and draw forth these Haemorrhoids or Courses But for the tempering and allaying the heat of these Adust humors as also of the Bowels themselves there is nothing that doth it sooner then the Whey of Goats Milk which may be given from one pint to three But it wil be better for use if there be added some Juyce or Syrup of Fumitory But that which more especially correcteth the
take care that by appointing a due meet course of Diet there may be generated sufficient store of good blood But for the drawing of this unto the place affected frictions are more especially to be made use of Yea indeed almost before the use of any Topicks the frictions or rubbing of the head are to be administred as Galen teacheth us in his first Book of the Composition of Medicaments according to the places Chap. 2. For Friction doth both attract the Aliment unto the head and also strengthen and thicken the skin If this falling of the hair proceed from the pravity of the humors then universal purgations if need require being first premised the head is often to be rubbed and discussives are to be administred but yet let the Discussers be moderate especially if there be a concurrence of an abundant aliment left that by the excessive and overmuch use of them the aliment be likewise dissipated and the skin rendered over thin and therefore Ladanum is very fitly mingled together with the Unguents If the Defluvium depend wholly upon the thinness of the skin then we ought to apply those things that condense and thicken the skin Galen commendeth especially Ladanum the Oyl of Mastick and the Oyl of Myrtle mingled together Or else let Ladanum be dissolved in Wine and so made use of And Ladanum is also very fitly administred in almost every falling off of the hair But in regard that it is of too thick consistence in it self to be anointed with it is therefore to be dissolved in somthing that is liquid Wine or Oyl and indeed such an Oyl is to be made choyce of that may satisfie and answer the cause But seeing that Unguents and Oyls are troublesom unto many who wil not endure that their heads should be anointed with Oyntments or Oyls therefore for these we must provide Lotions for the head that please them better which are to be made or Southernwood Maidenhair Golden Maidenhair Mastick Roses Rosemary Ladanum And we must here again repeat what we gave you notice of about the end of the foregoing Chapter to wit That there are some who appoint and not without good reason such kind of Medicaments to be made for the recovery of the hair that do not only by a manifest quality take away the cause of the shedding of the hair but such as also by an occult and peculiar faculty do conduce unto the breeding of hair and such as these are only known by experience And these are al the Capillary Herbs Southernwood Reed root sharp-dock root the root of the greater Bur Asarabacca Ladanum Honey and Water destilled from it Bees beaten together with the Honey-combs or the pouder and ashes of them aâ— also of Wasps Flyes Moles Mice the Land Urchin Bears fat and Serpents fat Of which there are made many Compositions As for instance Take the Rind of the Reed root burnt Bees ashes of each two drams Southernwood burnt one dram Ladanum two drains Honey half an ounce Oyl of sweet Almonds and Bears fat of each as much as wil suffice and make a Liniment For the shedding of the hair after sicknesses this following is found to be good Take Maidenhair Southernwood Golden Maidenhair of each half a handful the Leaves of Myrtle of Roses and of Wormwood of each two pugils boyl them in a sufficient quantity of common Oyl and red Wine until the Wine be wasted then strain and squeeze them hard Take of the aforesaid Oyl four ounces Ladanum one ounce Mastick half an ounce and mingle them according to art Or Take Root of the Bur-dock six ounces Maidenhair three handfuls Southernwood one handful Pour thereunto as much white Wine as wil suffice and let them be destilled in a bladder Vnto what is thus destilled if you please you may add the Water of Honey Or else let the Roots of the Bur-dock be boyled in Ley and the head washed therewith Chap. 4. Of Alopecia and Ophiasis Alopecia THat which is called Alopecia and Ophiasis is a peculiar kind of the falling of the Hair Alopecia is so termed from Foxes because that this kind of shedding of the Hair is familiar unto them But Ophiasis is so called from its figure Ophiasis because that the bald and smooth parts destitute of their Hair and writhed seem like unto Serpents It is common unto both these Affects that in them the Hairs fall off areatim as they term it and hence it is likewise that this Malady is in the general called Area And Celsus in one and the same Chapter treateth of Area Area Alopecia and Ophiasis Now the name of Area is imposed upon this Affect from Country Garden-plats For as there the Beds or quarters are distinct and in certain places only and as these Beds when they are void of Plants are Naked and bare so it is likewise in these Areae for here in certain places the Skin appeareth smooth bare and slippery These Affects differ only in their figure For Alopecia hath no certain figure but as Celsus saith is dilated under any kind of figure But the Ophiasis creepeth up and down writhingly like unto a Serpent and one while being extended from the hinder part of the Head it creepeth along on both sides the Head even unto the Ears the breadth almost of two fingers and as soon again being carried beyond the Ears it creepeth forward Serpent-like even unto the very Forehead it self And moreover there is in the Ophiasis far more hurt and danger in the Cause thereof so that not only the roots of the Hair but even the Skin it self also is eaten and gnawn thorow to wit as far as the roots of the Hair reach The definition of Alopecia and Ophiasis And so Alopecia and Ophiasis may be thus defined that they are a falling off of the Hair after the aforesaid manner areatim having its Original from a corrupt and depraved humor gnawing assunder the roots of the Hair The Author of the Book of Medicaments soon provided referreth the Alopecia and Ophiasis unto those Affections that vitiate and marr the Colour of the Hair But we are to know that this is not proper unto the said Areal falling off of the Hair but that this change of Color in the Hair doth either precede the Alopecia and Ophiasis to wit when from a vitious Nutriment the Hair first becometh white but afterwards they fall off or else the colors of the Hair are changed after the Alopecia and Ophiasis For when after the Areae Hairs are again bred they are then either white or yellow like as it is in Horses after that the hair is fallen off by reason of some Ulcer caused by attrition or gauling there is wont in the place thereof to appear and grow again white hairs which happeneth from a vitious Nutriment and the weakness of the Skin And of this Celsus gives us notice in his sixth Book Chapter 1. to wit that the Ophiasis is extended unto the Hair
the natural bowels somtimes the Liver by its heat elevating many vapors and somtimes the stomack naturally cold and affected likewise with an Adventitious humidity corrupting with a more crude juyce the aliment of the whol body and filling the head and then withall the Spleen and obstructed Mesentery sending upwards many fumes So that the flegm heaped up in the head partly by its great plenty and its own weight maketh it self a way and passage unto the parts lying underneath and partly thrust forth by the strength and act of the expulsive faculty it rusheth unto the mouth and stomach looseneth the teeth in the Gums and besides exciteth and causeth very much trouble and pain in the swallowing The same being much encreased in the stomach by reason of its own proper distemper causeth in him the loss of his Appertite and from the agitation and weakness of the heart it produceth extream windiness as also a pain of the Intestines with a Costiveness of the belly by reason especially of the hindered contraction of the transverse fibres distended by windiness by which said Contraction the descent of the Dreggs is very much furthered But the hotter habit of the adust blood and both the Cholers arising from the Liver and the obstructed places greatly disturbeth his sleep especially in the night time by which it cometh to pass that from the retâ—â—ing of the Spirits and the blood unto the internal parts the Evaporations become so much the greater Neither it is any wonder at al that somtimes likewise there is kindled a Feaver not only an every day Feaver by reason of the vehemency of the pain but also a Periodical Feaver resembling the Nature of a spurious Tertian in regard that the obstructions being somtimes augmented great store of excrements and those very different one from the other of al sorts miâ—gled together one with another are very easily corrupted And moreover also the smal sand and gravel may very wel happen to grow together from this manifold filth communicated unto the over hot Kidneys and there retained by the wasting of the more thin parts by the ex raordinary great heat and the Nephritick pain may likewise be generated by the abundant matter impacted in the Uterers and not having an easie and speedy motion But of the occult and hidden Diseases some of them are simply such touching the existence whereof we may very wel doubt and others of them are occult only in regard of their Essence and Nature since that it is not in the least to be controverted whether or no this illustrious Lord be afflicted with them a truth so obvious and manifest Simply occult is that Witchcraft of which this illustrious person hath very rational and probable grounds to suspect that it hath been practised upon him in regard that as he relateth there have been often found in his bed strange and admirable Magical Figures of Bones of Wax and of other matter as also such like Signs and Characters as Enchanters and Wizards are wont to abuse in destroying those they bewitch and in regard likewise that he had most powerful and most implacable Enemies by whom he doubteth not but that his ruine and destruction hath by al kinds of wiles wicked arts and inventions been attempted Since therefore it is confessed by al that by Witchcraft bodies may in a various manner be changed and that thereby there often happen the very same effects that are wont to follow likewise upon the natural motions of the humor in the body ill affected hence it iâ— that Physicians can have no proper signs whereby they may constantly discover and absolutely determine whether there be any Witchcraft practised or not And this is now altogether the case of this most illustrious person For there is non I suppose unless he be eiâ—her a mere Dolt or one that hath no good opinion of Christian Philosophy that will dare to doubt whether or no the related suspicions may not frequently accompany Witchcraft so that hereupon that there is in this present case no practice of Magick and Enchantment can by no evident Argument possibly be convinced But if haply any one shal object and say That the aforesaid doubt is altogether needless and impertinent since that al those Accidents that the Patient suffereth may very wel be referred unto the various and those likewise sufficiently manifest vices of the humors let such a one know that such as are variously affected from a supernatural Cause although the effects proceeding therefrom may seem to be natural yet notwithstanding they cannot by the aid and assistance of the Physitians so easily be corrected and kept under as those may that are vitiated and derive their depraved power and violence from some Natural and sensible Cause so that albeit the knowledg of Witchcraft maketh not much for the attaining of the next and immediate Cause of the Disease yet nevertheless it helpeth very much in foretelling the facility of the Cure and presaging the issue and event of the Disease I would to God that this noble person were altogether free from this infection which doth indeed render the Cure of the Disease most pertinacious in al respects and most intricate and difficult But there are two other occult Maladies with the which I plainly affirm that this noble person is affected to wit the Scurvey and the Plica the Nature of which Maladies as it is abstruse and hitherunto never sufficiently demonstrated by any so the accidents therein happening are most manifest And in very deed that so for brevities sake I may pass over the many other notes and signs al men generally acknowledg and confess that the Plica ariseth from the inexplicable and intangled Locks of the Hair but yet they are altogether ignorant of the proper Cause thereof although they speak somwhat that is probable touching the common Cause which yet nevertheless cannot be sufficient for the constituting of the perfect Cure of the said Malady But certain it is that their hairs are conglutinated frizled and entwiâ—ted from some dull and sluggish excrement of the third Concoction of the head sweating through the Sutures and Pores which being restrained and kept in by the cutting off the hair the Air more freely getting into the said open pores there ensue thereupon most grievous Accidents It is also certain that by the drinking of vitious Waters or else from exhalations mingled together with the Air after a long abode and continuance therein this Malady may at length be contracted and therefore it is that this evil is almost Epidemical unto the Inhabitants of those places that abound so much with these like Fountains and Rivers that are so wel known unto this noble person Neither can it be doubted that such as have weaker heads are sooner and more grievously infected But of what kind that excrement is and with what poyson infected that seemeth a thing altogether occult and hidden as likewise for what reason it doth infest the head rather than
made long but they likewise become thick unequal and rugged And this happeneth from strong and hard labor by which the Nails about the roots of them are as it were moved together and so they attract the aliment in greater abundance This Vice cannot easily be amended unless that the external Cause cease But if the said external Cause be removed then in process of time those thick and unequal Nails being by degrees cut off other that are better wil succeed in the stead of them The Roughness of the Nails Moreover the Nails also become rough and ill colored and thick Scabrities and Lepra of the Nails which Vice is called the Scabrities and Lepra of the Nails in which Vice not only the magnitude but likewise the figure and Conformation of them is vitiated This Vice is generated from the vitious and excrementitious humors mingling themselves with the aliment of the Nails Now those humors are more especially Melancholick which is shewn even from the color it self of the Nails they having in them somthing of Tartar from whence the said hardness proceedeth This Vice is manifest unto the Eyes and bringeth along with it rather a deformity than any dang r and yet nevertheless it may hurt and hinder the laying hold upon any thing which is wont to be done by the Nails and it likewise sheweth withal that there is some vitious humor lying hid and concealed in the body that Nature thrusteth forth unto the Nails like as we have before told you that those who are affected with Plica Polonica have also this evil befalling them This Vice is cured if what cannot be amended be by degrees pared away and the excrementitious humor discussed If the Vice be but new begun then the Decoction of the Vetch Orobus and Lentiles wil be very convenient or else a Cataplasm formed of their meal or else let Sulphur with Oyl and Vinegar be laid upon them Pliny writeth that Orach or Arrach wil take away the Nails without any Ulcer as we find it in his 20. Book and Chap. 20. And the lesser Celandine with Pitch doth perform the very same Or else let an Unguent be imposed or an Emplaster made of Pitch Wax Rosin Mastick Burgony Pitch or else lay on Raisins with Opopanax or Cresses with Lin-seed stronger are the Roots and Leaves of Crowfoot Or Take Rosin half an ounce Turpentine two drams new Wax and Goats Suet of each five drams Mastick one dram and half Frankincense two drams Make an Emplaster See more of these in Paulus Aegineta his second Book and 81. Chapter And in Avicen in the seventh part of his fourth Book last Tract and 14. Chapâ— The color of the Nails changed But somtimes only the color of the Nails is vitiated so that they become leaden colored yellow and black Which Vice happeneth nor only by reason of the change of the color of the flesh lying underneath as some have thought but because the very aliment of the Nails is vitious and endued with such a color And now and then likewise the Nails ar here and there marked wi h certain smal white spots especially in the younger sort of people which arising for the most part about the Roots of them together with the growing Nail they change their place until at the length they are pared off with the Nail and they have their original from the thick juyce that mingleth it self with the aliment In Curriers also by reason of their handling of Lime and Ley and in Dyers by means of their handling their Dying stuff the Natural color of the Nails is frequently changed into another which oftentimes lasteth and continueth long This Vice indeed bringeth with it no danger at al but yet it causeth a deformity and is very offensive and troublesom unto Men but especially unto Women But now that this Vice may be taken away the vitious humors if they lie hid in the whol body are to be evacuated and then after they are to be taken away out of the Nails themselves This may be done if the new growing nails be very often pared until al that is viciated be quite taken away And unto the Nail it self that Emplaster that ere while we mentioned in the Lepra of the Nails is to be applied But there is then a peculiar change of the color of the Nails when by reason of a Contusion there is blood shed forth under the Nail and when shining through the Nail it produceth a red or a blackish color as it is wont to happen in Suffusions Which if it chance Avicen adviseth to make a hole through the same and so to let out the blood that lieth underneath the Nail And yet nevertheless there is in thus doing great care to be had lest that in the perforation the nervous skin lying underneath be hurt and so a pain be thereby excited The Nail having a hole made through it or if it hath not it maketh no matter lay upon it Candy Dittany with the Glue or Gelly of fish Or the Basilick Emplaster of the Root of Solomons Seal wel bruised Or Take Sagapenum as much as you please mingle it in a Mortar with the Oyl of Nuts that an Emplaster may be made and laid thereon The Crooking of the Nails There are some likewise that make mention of the crooking of the Nails among the Vices of the Nails and indeed it is of that crooking wherein the Nails in their extremities are rendered crooked and as it were hooked lâ—ke as we see it to be in Birds and this crooking they say proceedeth from a driness that doth overmuch contract the substance of the Nails But this Affect is very rare neither when any such there is doth it proceed from driness but from a vitious matter by reason of the abundant flowing of which the Nails come to grow in that vitious and uncouth manner and this as we have already told you happeneth in the Plica Polonica And therefore there is no other way or method of Curing of this Evil than that of Rough and Leprous Nails This is not unusual especially in the Feet that the Nails grow forth too much at the sides and make a hole through the skin lying underneath upon which the flesh there in that place beginneth to grow luxuriant and to become proud and proveth a very great impediment both in putting on of the shoos and also in going Which if it happen we are then to sprinkle upon the place burnt Alum which taketh away whatsoever of the flesh is superfluous and afterwards the Nail that hath grown forth too long is to be pared off The Cleaving of the Nails And now and then likewise solution of Unity happeneth unto the Nails so that they are cleft either longwaies or else transversly and as it were cut into two thin plates And this cometh to pass either from Causes external as Wounds or else from the vitiousness of the Humor which somtimes falleth out in the French Disease
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
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
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
part of their ends on both sides somwhat shorter then the Swathing lying under it lest that they press together the part beyond the Swathing Now they are imposed upon the Fracture on every side round about so that they may not stand distant one from the other less then a Fingers breadth and they are so to be fitted that the ends of the said Ferulae be not placed above the Heads of the Joynts that stick forth or the Nerves nigh unto the Joynts or that they touch upon the naked Skin See Hippocrates touching those things that are to be done in the Curing of Wounds Tit. 11. and in his 1 B. of Fract Text 40. and in his 2 B. of Fract Text 5. 7. 11. 64. 69. 71. And Galen in his Comment And Paulus Aegineta in his Sixth B. Chapter 99. And unto the extream parts also that are grievously wounded or broken or disjoynted the Hands especially there are somtimes applied little Coffers or Chests of smooth Wood so wrought that they may answer unto the Figure of the Member or else such as are made of thin plates of Iron or a hard Skin or paper glewed together that so they may hold together the parts united and conjoyned that so they stir not neither move to and fro and so again start fort and fal out of their places Of Laquei or Binders Unto the binding up of Wounds there likewise belongeth the injection of Laquei as they term them which we may fitly cal Illaqueation Now this Laqueus is properly a bond so knit and tied that what is drawn together or pressed down by weight may be shut up and closed And the use thereof is for the extending of bones broken and out of Joynt for the keeping of them in their places when they are set and for the streightening and close binding of the parts The differences of these Laquei are very various taking their Names either from the inventors or from their use or from the similitude and Figure of some thing or other or from their manner of knitting or from then effect which since that they cannoâ— well be perceived nor understood without a manifest Delineation and very hardly from a bare description therefore touching this Particular Consult that B. de Laqueis that is commonly ascribed unto Oribasius Of the due placing of the Member after it is bound up After that the affected Member is rightly bound up it remaineth that it be likewise fitly placed Now the due and fit placing of it consisteth in this that the part have that position which conserveth the Natural figure thereof such as is without pain and fit for the cure of the disease Now the member shall thus be placed if all its parts Bones Muscles Nerves Veins and Arteries have that situation that they are neither distended nor pressed together if the Member be softly and equally situated if in a hollow ulcer or wound the Orifice as much as may be look downward that so the Sanies may be purged forth and lastly if in the placing there be a mean kept in regard of the binding up and that the binding be neither too loose nor yet over streight and hard And indeed that there may in the placing be an apt and meet figuration of the Member we must especially have respect unto two things unto the Joynts and unto the Muscles to wit in respect of the Joynts That the Member have a middle figure as Galen very often calleth it which is without pain to wit that in which we are both born and accustomed to keep all our Members when we are out of Action and in which no Muscles at all do act and such as is equally distant from the extream motion of the Joynts or their extensions and inflections and in regard of the Muscles to wit that on one part it hath Muscles and the whole entir fibres thereof and that neither a whole Muscle neither its fibres be distorted Now placing Consisteth either in reposition or suspension A member is then fitly put back when by certain props and stayes as feathers fleeces of Wool or soft Clothes it is so born up that it is made quiet and rising upwards lie alwaies equally and softly so that it be neither shaken by any motion nor assaulted by any flux or that any Sanies or Ichor be therein retained And from hence it is that if the thigh be broken and bound up Hippocrates supporteth it with somthing like a Counduit pipe the ham being stretched forth from the hip even unto the foot Our Chirurgeons use to apply some certain props of straw or of paper rolled together like a Counduit pipe and within filled up with hurds and so involved and wrapt up in the extreme part of the linen cloathes by which the whole Member is firmly held together lest that it should unawares be moved But the Member is hung in a string and supported thereby when the sick person either lieth down or now beginneth to walk abroad For although that while the sick party lyeth in his bed it sufficeth if that while he is awake he have his hand softly inclining upwards yet lest that when he is asleep he should unawaers move it therefore it is not amiss for him to have it hung in a sling of a swathband But it is especially requisite when the sick party beginneth now to walk that he carry his Arm wrapt up and hung in a swathe which the Greek Physitians call Taenia and Celsus Mitella the narrow heads wherof let them be cast about the neck and for the breadth of it in that part wherein the Arm is enwrapped and born up let it be so broad that it may contain the whol arm that so there may be no part thereof that is not equally supported And here for the more fit underpropping of the hands there is oftentimes great need of those little Coffers or Chests of which but even now mention was made upon which the Hand when it is bound up is to be placed and then wich the said Capsula or little coffer it is to be put upon the swathband Chap. 8. Of the swathing of wounded parts ANd that we may apply unto Wounds all that hath hitherto been said of swathing in general the Chirurgeon when he is ready to bind up the wound must in the first place be very careful in stanching of the blood if it flow forth over abundantly But since that there happeneth not unto all Wounds any such extraordinary and remarkable hemorrhage but only when the greater vessels are Wounded of the stopping and stanching of the hemorrhage we wil speak more below in the fourtâ—enth Chapter And now at the present as for what concerneth the very swathing it self of wounds the lips of Wounds when they are disjoyned are to be drawn together conjoyned when they are thus brought together they are then to be kept conjoyned which without the solution of continuity may be done two waies either by swathing or Glew or
without any Cicatrice and Deformity such as is wont to be caused by the Needles point the Lips of the wound are drawn together and being thus brought together and united they are so kept and preserved a longer time then by that sewing or stitching that is done with the Needle The aforesaid kind of sewing seemeth to have in it this one only inconvenience and discommodity to wit that it is of little or no use until after six or seven hours for sooner then this it will not be dryed so as to stick fast unto the Skin whereupon it is that many do first administer the sewing and then afterwards the glew But the aforesaid delay can bring no great danger and detriment along with it And if any danger be feared instead of the aforesaid Glue an emplaster may be provided which sticketh immediatly such an one as is described by Caesar Magatus in his first B. of Wounds Chap. 59. As Take The Gum of the Fir Tree four ounces the Liquor of the Elme-Tree three ounces Rosin of the Pine Greek Pitch and Ship-Pitch and Wax of each one ounce Ammoniacum Mastick Tacamahaca of each ten drams Sarcocol Dragons blood Gum-Juniper and Gum-Hedera of each six drams the Root of the greater Consound of round Aristolochy Bistort and Tormentill of each two drams The Gums that will away with melting are to be dissolved over the Fire with a portion of that which sweateth out of the Fir-Tree and then the rest that are wont to melt at the Fire being dissolved according to art let them be added and then let them be well and diligently mingled together that so they may be reduced into one Body and then after cast them altogether into an Alembick and by the heat of the Balneum draw forth the Liquor and when you conceive that the feces are freed from al their Watery Humor unto these when they are again melted by the heat add the rest of the powders and mingle them together with al care and diligence and then again destil them until that all the Humor be wholly evaporated and then withdrawing the Fire suffer the Balneum to cool For so it is that the matter which is conteined in the Vessel will become solid like unto a Cerote and it will be very tenacious neither is it by the heat of a mans Body so to be melted and made thin that it forget its office and what it hath to do I my self also am wont to use this following which may be provided with far less labour Take Bole-Armenick Mastick Dragons Blood Frankincense of each one dram Gum Tacamahaca two drams And make a powder which with a hot Pestle you may spread upon Leather that an Emplaster may be made thereof Caesar Magatus hath likewise a peculiar manner of applying this future by Gluing He extendeth and spreadeth a part of such a like Cerote upon a new thin Linen cloth and then with a pair of Cizers from this linen Cloth he cutteth off so many parts of a Fingers length or somwhat longer and as broad as an ordinary point that we use to truss with but in the ends of them somthing broader as the stitches that seem to be requisite in a Wound or not many fewer and the first he applyeth in the middle of the Wound and yet so that it may stick only unto one side of the Wound in the half part of it and that the rest be free Unto this at the side but yet opposite unto it he applieth another and so by turns he proceedeth applying one on the right part and another on the left and after this he layeth hold on the parts that are free and that as yet stick not unto the Skin one with his right hand and the other with the left and draweth them both together toward the opposite Lip until that the Lips be so drawn together that they touch one the other and afterwards he applieth both the parts that he held in his hand unto the opposite lip unto which they did not stick and here he is very Curious and takes a great deal of pains to make them stick right on all parts and so likewise he proceedeth in the rest of them so that betwixt one and another there is left as much space as is otherwise wont to be between the stitches And indeed the well experienced Chirurgeon who by his long practise knows well how by such like Emplasters that stick close unto the Skin of which there are many sorts of them to be made to conjoyn the Lips of Wounds this Chirurgeon I say in almost all Wounds Yea even in the very first dressing knows how very well to be without the said sewing or stitching made with the Needle which is both cruel Bloody and painful And certainly it were far better that the Chirurgeons should accustom themselves unto this manner of sewing Wounds together in regard that in the other which is performed with the Needle after a kind of Barbarous fashion they oftentimes commit many Errors whiles that in stitching of the wound they excite more pain then was caused by the wound it self and using Needles that are too thick they take in more of the Skin then is requisite and so often leave the Lips of the Wounds writhed and pleited insomuch that the Skin is not Joyned close unto the Skin neither the Flesh to the Flesh but the Skin is sewed in the midst between the Flesh or if they do their endeavor to avoid this evil they fal into another as great by taking so little hold of the Skin that the Wound is left hollow and the stitches within a very short time break out again Of the Suture and Buttons And al these Conjunctions and drawings together of the fleshy and soft parts are performed without any wounding of the said parts There is yet another also which is done by dissolving of continuity For not only the Ancient Chirurgeons but those likewise of our daies in Wounds transverse and great and altogether in those wherein Swathing only will not suffice for the drawing together the Lips of the Wounds use sewing and Buttons Unto the stitching or sewing of Wounds there are required three things What is required unto sewing of Wounds a Needle a Thread and the little hollow Instrument having holes through one end of it The Needle that is required for its more easie penetration ought to have a Triangular point A Needle which the Curriers most commonly make use of indifferently thick that so it be not broken or pass through the more difficultly and a little hollowed in the Tayl thereof that the Thread hinder it not in its passage forth Most Artists require a Thread of Silk yet nevertheless others reject this Thread in regard that it easily breaketh the Skin and they take one of Flax doubling it that it may be firm and not easily broken And this they will have not to be over much writhed but waxed equal and of a mean
hold together the gaping superficies of the Wound until the rest of the wounded parts to wit the Flesh and the Nerves be sufficiently purged and yet so that they may not by any means hurt the Nervous parts And that therefore the depth of the Wound is diligently to be observed and great care to be taken that the edge of the Tent and more especially if either a Nerve or any thing Nervous be discovered and laid open press not together the bottom of the Wound But now in those Wounds that are so narrow that they will not receive in any Tent that is thick and that that is slender and weak as that which is over flexible is turned this way and that way and therefore cannot reach unto the very bottom of the Wound in this Case he tels us that his custom was to impose a piece of a Gold or Silver thread as long as the Wound was deep wrapt up in fine Linen and anointed with some Anodyne and Digestive Unguent When the Lips of the Wound shall in this manner be conjoyned they are wont commonly and indeed not amiss to impose the white of an Egg well shaken together and put into hurds with this following powder Take Frankincense two parts and Dragons Blood one Part And make a Powder Or Take Bole-Armenick and Terra Sigillat of each six drams Frankincense Mastick Sarcocol of each two drams and half Myrrh and Aloes one dram and half Tragacanth Dragons Blood of each one dram Barley Meal and Bran Meal of each half a dram Make hereof a Powder and mingle the same with the white of an Egg shaken together and put upon hurds and so imposed upon the wound upon which also other hurds that is only wet with the white of an Egg is to be imposed Neither is this Medicament administred but for very good Reason since that it suppresseth the Flux of Blood asswageth pain and preventeth Inflammation But now if there be no fear at all of any such excessive Flux of the Blood or of any afflux of the Humors we shal not then need to make any such provision against it seeing that the Hurds and those Medicaments stick so Tenaciously unto the part that being throughly dried on they contract the said part causing great trouble unto the same and when they come to be removed they excite much pain And now although that what we have already said might suffice Other waies of Sewing of Wounds as touching the stitching or sewing of Wounds yet nevertheless we think it not amiss here further likewise to add some other waies of the Sewing of Wounds as we meet with them in several Authors For there is moreover another manner also of sewing of Wounds which is indeed performed altogether in like sort as Leather-dressers are wont to sew their Skins together and this is then only fit when the Intestines are wounded and the Veins and Arteries cut assunder There is yet another way of Sewing them which is done with two Needles and this way Celsus used and describeth it in his 7. B. and 16. Chap. where you may see it fully set down There is among the Ancients mention made likewise of Buttons The Buttons of VVounds For as Celsus writeth in his 5. B. and 26. Chap. if the Wound be in the Flesh so that it gape and that the sides thereof cannot easily be drawn together into one then fewing is improper and in this case buttons are to be imposed the Greeks call them Agcterae that may only a little contract the sides to the end that afterwards the Cicatrice may be the less broad And because that the way and manner of Uniting the sides of the Wound by buttons was generally so wel known unto them from thence it was that neither the matter of these buttons neither the form of them was ever sufficiently described by the Ancients Guido whom many follow writeth that these buttons were made of Iron Circles as it were or Semicircles a little crooking on either part the hooks whereof being on both sides fixed and fastened within the Lips of the Wound did answer exactly the one to the other But seeing that in this manner to fasten in such hooks as these and being so fastened there to keep them in the Skin and especially the Flesh that is so sensible was nothing else but a keeping there of so many pricking sharp-pointed Needles as it were with an intolerable pain it it not therefore Credible that the Ancients by Buttons do understand any such Iron Instrument to be fastened within the Skin and there exciting pains that were not to be endured The Opinion of Gabriel Fallopius is far more probable who in his Tract of Wounds in General Chap. 12. tels us that the Button was that kind of sewing that above we called Intercisa and which at this day is in very frequent Use in the which both the Lips of the Wound are by a Needle drawing after it a double Thread thrust through and upon the Wound with three turnings in both the Heads of the Thread are drawn together and tied up into a knot And although that in Authors there be mention made of Gold and Iron Buttons yet notwithstanding we are here to know that the Word Button is a general word and signifyeth every Instrument whatsoever that Joyneth and keepeth together any things unto which they are applied And so Caesar in the 4. B. of his Warrs in France speaketh of Beams or Rafters conjoyned with Buttons There was yet as we read another way among the Ancients of sewing and stitching of Wounds but this they thought not so convenient and therefore it soon ceased as to the use thereof in the which they on both sides thrust through the Lips of the Wound so many Needles drawing Threads as they thought necessary for the Conjunction of the Wound and then after this above the Wound they woon'd a Thread about both ends of the Needle in the very same manner as Women when they intend to keep their Needles in the Garments they are making rowl together their Threads about both the ends thereof As touching the binding up of wounds this is likewise to be observed that we make an exact enquiry whether the Wound be a simple or single one or else whether it be reduplicated and manifold For it somtimes so happeneth that although there be but one Wound in the Skin yet notwithstanding in the Muscles under the Skin there are two or three For if this should so chance and that the Chirurgeon should Cure only one of the Wounds and altogether neglect the other that lieth hid then will Pus get together in that other wound and there cause great pain Inflammation Feaver and other grievous Symptoms Of the truth of which Gulielm Fabricius in his 4. Cent. Observat 84. and 85. giveth us two remarkable Histories Where he likewise teacheth us that the hollow nook that lieth hid may be opened and there he also describeth and plainly delineateth
unto our view those Instruments that are fit and requisite for this purpose Chap. 8. Of those Medicaments that are necessary for the Curing of VVounds ANd these are the offices of the Chirurgeon which he ought to perform in and about the Curing of Wounds but the very uniting and sodering together of the wounded parts is the Work and Task of Nature which oftentimes likewise without any help from Medicaments and this especially happeneth in inward Wounds agglutinateth those things that are disjoyned And therefore since that Nature is the Efficient Cause of Conglutination and Blood the matter thereof it is necessary that these two be rightly disposed and in a due temper For first of all the truth is since that the faculty is not indeed hurt in it self and yet notwithstanding may be frustrated of its end unless the instrument which here is the temperament of the part and the innate heat be as it ought therefore we are to take care that the wounded part have its due and natural temper And moreover in the next place our endeavour must be that the Blood that floweth thereto exceed not its just quantity neither be less then what it ought and likewise that it be good and pure For the viâ—ious and bad Blood that floweth thereto is so far from being fit to Conglutinate that oftentimes it exciteth many dangerous Symptoms And therefore if it be impure it is to be corrected and the vitious Humors all of them to be evacuated And there is also a due and right Course of Diet to be instituted and all sort of meats to be avoided that afford a naughty and unwholsome Juyce from which the Blood that is generated must needs be vitious When we have thus taken care in these things then afterward in the curing of the Wound there are also two Offices of Nature The first whereof is that the Pus she generateth be in a due proportion and Secondly That she Conglutinate those parts that are disjoyned For first of al and although that Galen make no express mention thereof whiles that he treateth of the curing of Wounds in the general yet Rhaser in his 13. B. and 14. Chap. and Avicen in his 4 Sect. and 4 B. Tract 3. Chap. 2. and Celsus in his 5 B. Chap. 26. tel us that there is a certain Pus or Purulent mattier flowing forth of the Ulcer so soon as it once begins to give any hopes of recovery and therefore this Pus must in the first place be furthered in its motion and that then the Ulcer is to be Cleansed and filled up and at length after this is done the wound is to be closed up with a Cicatrice And happy experience hath indeed approved of that kind of curing and those Medicaments that are for this end applied are commonly called Digestives Neither is this without Reason For whenas even out of the smallest Veins when they are cut assunder in the wounded part there sloweth forth some of that Blood that by Nature is destined to flow unto the part for its nourishment this sticking in the pores of the part and it being so that it cannot be carried unto the part whither it tendeth it is by Nature converted into Pus And furthermore the very wounding it self hath Joyned with it some kind of Contusion and the part dissected is altered by the Ambient Air. And therefore there is a necessity that what is altered should impostumate and be turned into Pus And therefore in this the Physitian ought to succour Nature and to administer those Medicaments that help forward that generating of Pus these Medicaments they commonly cal Digestives and afterwards to apply Sarcoticks or such as Agglutinate But here notwithstanding Authors seem a little to differ in their practise For some of them the said Digestives and Suppuratives being wholly neglected presently administer those Medicaments that dry much to wit Balsams either Natural or Artificial of which we shal speak more hereafter with the which they both anoint the wound al over and instill it likewise unto the very bottom of the wound and by Tents also impose it upon the same Others there are that in the first place make use of those Medicaments that further help on the Pus which they call Digestives And Hippocrateâ— himself seemeth to have approved of both these wayes when in his Book of Ulcers he thus writeth Al the newer Wounds saith he as well themselves as the parts situate round about them are but little or not at all infested with an inflammation if they be with al speed suppurated and if that the pus of the wound be no waies suppressed by some small bone as being intercepted thereby or if we take care to prevent that nothing may come unto the pus but what is necessary and that in as small a quantity as possibly may be but that we dry it as much as may be with a Medicament that is not at al troublesome And experience hath taught us that in both these waies of curing the Chirurgeon hath attained unto his end and what he desired And yet nevertheless it seemeth not that both these Medicaments are to be made use of without any kind of difference For in regard that those Digestive Medicaments so commonly made use of are more moist if they be without great caution and overlong administred the matter beginneth not only to be digested but also to putrefy and the Wound degenerateth into a sordid Ulcer For seeing that Nature is the author both of Concoction and also of the generating of flesh the native heat and the temper of the part Natures instruments are to be preserved and we must endeavor that the medicaments may answer unto the temperament of the part And therefore although that the former way of curing may have its place in those parts that are fleshy as being such as are more moist and in which there is much of the blood that is to be turned into pus sticking in the pores of the part which that so the pain and the inflammation may be prevented ought as soon as may be to be converted into pus which work of Nature those drier kind of Medicaments might more easily hinder yet in the parts that are more dry those drier Medicaments seem to be more commodious and proper which as they may preserve the temperament of the part so they themselves may likewise help forward the necessary generation of the Pus or purulent matter And therefore the safest way is not alwaies to confide in one Medicament alone but rather to compound them according to the Nature and temper of the part 3 and to mingle Digestives with Sarcoticks and those that Agglutinate since that experience testifieth that such are used with far better success then meer Suppuratives as Franciscus Arcaeus writeth that with his Balsam or Unguent which we shall anon acquaint you with applied forthwith in the very beginning he himself most happily cured the greatest and most grievous Wounds
the use whereof I my self have likewise very often experienced with very happy success And therefore I will now subjoyn such Digestives which are not meer Suppurative There may then be provided Digestive Medicaments Digestives or those things that further the Pus or such as further the purulent mattier of the yelks of Eggs Butter Oyl of Roses Oyl of Mastick Rosin of the Turpentine or Fir-Tree Wheat flour Frankincense and Mastick As Take Turpentine washed in white Wine two ounces the yelk of one Egg Barley Meal and Honey of each a sufficient quantity And make an Unguent Or Take Turpentine washed in Wine May Butter unsalted of each one ounce Frankincense and Mastick of each a like sufficient quantity Mingle them Or Take Turpentine half an ounce Frankincense one dream fresh Butter one ounce the yelk of one Egg And mingle them Or Take Citrine Wax one ounce Oyl four ounces Frankincense and Mastick of each two drams fresh Butter as much as will suffice the yelks of two Eggs Mingle them Or Take Oyl of Roses half an ounce Turpentine one ounce the yelk of one Egg And mingle them So soon as ever there is any appearance of good Pus the next thing we are to do is that we Conglutinate that which is wounded and disjoyned Now we are taught by Galen in the 91. Chap. of his Art of healing The Union of the Parts how caused and in the 3. B. of his Meth. of Physick Chap. 4 that the Union of the Parts disjoyned in Wounds is wrought in a twofold manner to wit either by a true Union which is by a Medium of the same kind and not by the intervening of any other substance or else by a Medium of a different substance The former Union they cal a Union according to the first Intention because that such a Union is intended both by the Physitian and also by Nature her self The other they term a Union according to the Second intention because that both the Physitian and Nature when they cannot attain unto what they primarily intend they then do what they can In the former manner the soft parts and the flesh are united and grow together but the hard parts in the other manner to wit the bones and the Skin of which those are united by a Callus but these by a Cicatrice Unto the former Union is required a substance of the same kind and a strong Active faculty which in the other are wanting For in the Fleshy and soft parts there is present abundance of Blood and in these the heat is strong and thereupon the Blood by a very smal alteration may be changed into Flesh whereby the wound may grow together But in those parts that we call spermatick and the harder parts the Nature of which parts being at a far greater distance from blood and the Native heat of these parts being much weaker it is not the very same that is generated anew but some thing like thereunto For instead of a Skin there is bred a Cicatrice most like indeed unto the Skin but harder and thicker then it and instead of a bone there is a Callus produced And this distinction of Galen as being that which is generally and commonly received I my self have likewise followed in the 5 B. of my Institut Part 2 Sect. 2. Chap. 4. and even in his very manner But it seemeth altogether to stand in need of some kind of Explanation Now this especially consisteth in the division of the part into parts Spermatick and parts proceeding from Blood by which it is determined that certain parts are generated from the Seed and certain of them from the blood Yea some certain Physitians there are among whom Caesar Magatus in his 4. B. and 15. Chap. who deny that the blood is the immediate Aliment of the Spermatick parts but they write that there is a necessity that if the blood ought to nourish the Spermatick parts that then the seed must first be made But it is not my purpose here in this place in many words to discuss that Question the which as others so Andr. Laurentius in his 1 B. of Anatomy Chap. 21. Quaest 7. hath so largely and fully controverted I conceive this to be the truer Opinion that the first delineation of all the parts in the Womb is wrought by the Formative faculty from and out of the Seed Whereupon Hippocrates in his little B. of Originals writeth that the Conception hath in seven daies all whatsoever it ought to have all the Members the Regions of the Eyes the Ears the Hands the Fingers the Thighs the Feet the Toes the Privities c. But now seeing that the Mass of the Seed is but little it is impossible that the Bulk of the whole Body should from the Seed acquire that magnitude that it ought to have And therefore afterward the parts take nourishment and increase from the Mothers Blood in the Womb and afterward the Child being brought â—oâ—th into the light the parts are augmented from the Blood and so even unto the end they are nourished with the blood Which manifestly appeareth even from this that the very bones when they are at any time shaved yield forth Blood which is their Aliment But now that which some affirm touching those parts we cal Spermatick that they are nourished by the Seed is a thing most false For how can so great a bulk of the Body be formed nourished and augmented from so smal a Mass of Seed And then again the Seed is no where else generated but in its own proper Vessels Yea moreover Children whose bones nevertheless are nourished and augmented do not generate any Seed Neither is it sufficient what Laurentius saith that the blood variously changed and suffering many alterations made white and thickned is nothing else but Seed For this is most false For neither is the Seed any where else generated but in its own Organs neither are other substances Seed although that in whiteness they are like unto Seed And therefore albeit that those white and more dry parts which they commonly cal Spermatick be generated and nourished from the Blood suffering many Changes yet nevertheless in very truth they are generated and nourished from the Blood And therefore it is true indeed that the flesh that is generated for the agglutinating of the Fleshy part of the Wound is altogether like unto the former as being such into which the blood by reason of the neer alliance of the matter and the strength of the Fleshy parts is most easily changed but yet I shall not rashly affirm neither easily beleeve that the Skin and the bones and the rest of the Spermatick parts may be united by any thing Heterogeneous and yet without any absurdity I think it may be said that the Cicatrice is a Skin and the Callus a bone For although there appeareth some kind of difference between a Cicatrice and the Skin and between a Callus and bone yet nevertheless they
each two ounces and half Mastick one ounce Saffron one dram Wax half a pound Common Oyl one pound and half Make hereof an unguent according to Art Or Take the Juice new drawn of Ladies Mantle of Sanicle of Saracen Consound of each alike as much as you think good set them to the fire and then add of old Swines fat and May Butter of each alike as much as wil suffice and make an Vnguent Or Take White Rosin three ounces May Butter six ounces Juice of Ladies Mantile one ounce Sanicle Wintergreen of each an ounce and half Goats beard Oyl of Olive of each two ounces Let the Juices be first boyled with the Oyl until the moisture be consumed then add the Rosin and after that the Butter then let them be strained and stirred well together until they be cold Or. Take the Herb Wintergreen Adders tongue Sanicle Speedwell of each one ounce flowers of St. Johns Wort and Centaury the less of each six drams let them be cut very smal and shut up in a Glass bottle Add Oyl Olive one ounce the fat of a Hog three ounces unsalted Butter four ounces let them stand in a hot place or in Balneo Mariae for eight days afterwards boyl them till the humidity be consumed and then strain them after this add Turpentine one ounce Mastick Frankincense Myrrh of each half an ounce Aloes Hepatick one ounce and make an unguent The Unguent likewise of Caesar Magatus is very useful As Take our Oyl of St. Johns Wort one pound Wax washed in Balsam water three ounces Let them melt together in a narrow mouthed Glass vessell when they are melted ad unto them of our Balsam one pound Gum Elemi three ounces Balsam of Peru Tacamahaca Caranna of each two ounces all these Gums are to be dissolved severally and apart with our oyl of St. Johns Wort Ammoniacum and Galbanum in like manner dissolved of each half an ounce Myrrh Frankincense Aloes Gum hedera of each two drams the Roots of Consound Birthwort Bistort and Tormentil of each one dram and half Cretan Dittany three drams Water Germander two drams Mans fat prepared two ounces Swans fat one ounce mingle them and make an Vnguent and keep it carefully in a narrow mouthed vessel of Glass or Silver Oyls and Balsams natural as the Balsam of Tolu Balsams of Peru and the like and Artificial as Take Oyl of Bayes two ounces Mastick Olibanum Goats sewet of each one ounce and Mingle them or Take the yellow that is in the middle of red and white Roses and white Lilyes of each as much as wil suffice pour in unto them Oyl Olive a sufficient quantity and then set them in the Sun in a Glass close stopped for fourteen daies or Take Turpentine and Oyl of Bayes of each four ounces the Oyl of the yelks of Eggs two ounces Oyl of Roses half a pound mingle them and set them in the Sun until they shall have gotten a yellowish colour or Take Turpentine one pound Galbanum Gum Elemi Gum Hedera Frankincense Mastick Myrrh of each two ounces Aloes Xyloaloes Galangal Cloves Cinamom Nutmeg Cubebs of each one ounce Aqua vitae three ounces Let them be macerated together for a day and a night and afterward let them be twice destilled and keep that destilled oyl as a pretious Balsam Or Take the Liquor of the bladders of the Elm defecated and prepared one pint the best hony purified three ounces Juice of Tormentil of the greater Consound and of the mean Consound of each four ounces mingle them boyl them over a gentle fire to the consumption of the Juices and then ad the following powders Take Dragons Blood Oriental Bole-armenick Manna thuris Horse Tayl Mastick of each two drams Mingle them and make a very fine pouder and ad it unto those things above mentioned The preparation of the liquor of the Elm-bladders is thus in the moneth of May these kind of bladders are to be gathered before there breed any Worms in them and with this liquor a glass vial is to be filled up and stopt with a linen cloth after this a hole is to be made in the earth two or three hand breadths in heigth and in the bottom of the hole we are to put common salt three fingers high upon which the vial is to be placed and then the hole to be filled up with earth so that the vial appear not and so it is to stand for twenty five daies then the dreggs are to be separated from the cleer substance and that which is cleer is to be kept for use which if you put of it self alone unto the disjoyned parts it agglutinateth them Another Balsam Take Frankincense Myrrh Sarcocol Gum Junip Gum Arabick Gum hedera Gum Elemi Mastick Dragons blood Balsam of Peru Tacamahaca Caranna of each one ounce and half The tears or sweat of the Fir tree the liquor of the little leaves of the Elm of each one pinte Rosin of the pine half a pound Tormentil roots Roots of Bistort of Orace Birthwort Consound white Dittany of each half an ounce Juniper berries and Bay berries of each six drams spirit of the best wine three pints mingle them together and destill them and receive the water the spirit and the oyl severally and apart All of them are excellent good for the agglutinating of any Wound Another Balsam Take the oldest oyl you can get four ounces Venice Turpentine ten ounces and half whol Wheat two ounces St. Johns Wort two ounces and half the roots of Carduus Benedict and valerian of each ten drams the finest smal dust or pouder of Frankincense two ounces Hypocistis or the excrescence of Cystus half a dram Bolearmenick and Dragons blood of each half an ounce the ponder of Earth-Worms two drams the greater Consound one handful Horse Tail half a handful let the roots and herbs be bruised after a gross manner and then put up into a vessel and then pour in white Wine unto them and after they shall for a while be thus infused let the oyl and the wheat be added and all boyled unto the consumption of the Wine After this pressing and squeezing forth the Liquor with al your strength ad the powders and the Turpentine and then suffer it again to boyl a little and so keep it in a Glass vessel for your use Or Take Turpentine two pound Common oyl three pints Oyl of Bayes six ounces Oyl of Cinnamom two ounces Oyl of Euphorbium oyl of Cloves and oyl of Bay berryes Gum hedera Ammoniacum Sagapenum Opopanax Galbanum of each one ounce Frankincense Mastick of each two drams Let them be together destilled and make a Balsam for the Wounds of Nerves or Take Clear Turpentine two pound oyl of Linseed one pint Rosin of the Pine six ounces Frankincense Myrrh Aloes Mastick Sarcocol of each three ounces Mace Ligne Aloes of each two ounces Saffron half an ounce put al these into a Reâ—ort and first of al let them be
lucid and lightsom body is the greater also is its sphere of Activity and hereupon it is that the starrs of all other bodies do scatter and disperse their light from them furthest in distance and widest in breadth We are now therefore to make enquiry in regard that it is of a certainty that the Weapon salve with which the Weapon is anoynted is in body absent and distant from the wounded party whether the weapon-salve touch the Wounded body either of these two waies for a third way there is none Neither can this be done by Accident some quality since that an Accident doth not pass from one subject to another neither diffuse it self at a distance and unto any other body Now I say that this is not done neither indeed can be either of these wayes The Weapon-salve doth not Act by sending forth any small bodies For first of all those Atomes or Effluvious bodies that flow forth having no certain motion of their own but moving inordinately hither and thither this way and that way how can these possibly directly and in a straight line tend unto the wounded person Neither is there any Cause that we should here fly unto and plead the likeness of Substance For although that those smallest bodies do at the length apply themselves unto others of their own kinds as we may plainly see in thunder and lightning yet notwithstanding when they at first exhale out of the body they wander up and down inordinately this way and that way And much less may we have recourse unto the spirit of the World by whose carrying and conveying whereof these smallest bodies may from the weapon anointed at length come unto the wounded person and the wound it self For those things are indeed spoken of the spirit of the world but they are not proved yea but rather they are opposed by reasons strong and weighty And furthermore since that this cure extends it self very far in length and as they wil have us beleeve at the distance of some miles if this were done by the effusion of those small bodies seeing there is so very little of the Unguent and yet much less of that natural Balsam that sticketh unto the Weapon that Unguent with the Balsam would easily fly abroad into the Air and there vanish and so the very foundation of the cure being taken away and gone the cure it self must needs cease The Weapon salve doth not Act by any species But if they wil say that his Action is performed by the species or Magnetick action they ought first of all to prove that there are such species in this Unguent for indeed Nature hath given unto some simples and things natural not compounded by art a virtue of sending forth such like species as these we speak of and then they must shew us what the nature of them is and what their sphere of Activity For it is no way credible that the virtue of this Unguent should extend it self for twelve miles round about and so orbicularly As for what concerns the Loadstone from which they are wont to term these magnetick actions the Load-stone doth indeed attract the Iron although it be at some distance from it but if very far removed and beyond the sphere of its Activity it doth not attract and the very same is likewise well known to be done in other such like occult and magnetick Actions For the Loadstone and other the like bodies do put forth their virtues in a straight and direct line which yet nevertheless are not extended in infinitum as we say and they are oftentimes likewise intercepted by the interposing of other things So the Sun-beams by the coming between of an opacous body are excluded Who then can believe that from so smal a pittance of the Unguent and so little of the blood there should break forth so many of these small bodies or species thorow the chest in which the anoynted weapon is shut up and that they should thence be carried so great a distance even twelve miles that they should penetrate thorow Mountains and Walls and tend directly unto the wounded person close shut up within his Chamber or in bed and that there they should pass throw those many double swathes wherein the wound is wrapped and so insinuate themselves at length into the wound it self The Loadstone is moved unto the Iron but this unguent is not anoynted upon the Wound but upon the Weapon And the Loadstone indeed being but only moved toward the Iron draweth it but now in the right using of this unguent what a company of Ceremonies and superstitious practises there are used we have shewn you before And in other respects also there appeareth a very vast difference between the Loadstone and this Weapon salve The Loadstone is a natural body and so hath its Natural Effect wh ch it evermore worketh in one and the same manner The Weapon salve is a Composition out of many things and by some it is made one way and by others after a different manner and of other things as before we have shewn you And the Unguent ought also to effect many things to wit perform all those things that are Necessary for the curing of the wound preserve the Wound free from pain and likewise bring pain upon it if it be not rightly preserved or if it chance to be defiled For if it ought to perform all that that is otherwise the work of Nature in the curing of Wounds there will be then altogether a necessity that it perform many things to wit that it concoct whatsoever is to be concocted that it expel the Pus and excrements and that it generate flesh Yea moreover it ought to perform the office both of the Physitian and also of the Medicaments which is indeed very various For neither are all those bodies that are Wounded a like disposed some of them being sound bodies others Plethorick and a third sort Cacochymical the parts likewise are various as flesh Nerves Membranes which require Medicaments of a different kind the virtues of all which this unguent ought to sustain And if a man shall at one and the same time as it very often happeneth receive dvers wounds in different parts of his body and from different weapons the question then wil be whether it be sufficient to anoynt one of the Weapons only and whether or no the virtue thereof wil be conveyed unto al these several wounds or whether or no all the weapons are to be anoynted and whether each particular unguent wil do its own office and this tend straight and directly unto that wound that was inflicted by this weapon and that unguent likewise unto another wound made by that other weapon A reason should likewise be rendered why the unguent should not perform the same while it is in the box which they say it performs when it is anoynted upon the weapon For they have no ground to say that by the benefit of that balsam
that is in the blood the virtue of the Medicament is carried and conveyed unto the wound For if all that whol blood were resolved into Atomes it would not be sufficient to fil up all that so great a space Neither have they as yet proved that the blood can send forth out of it self any such species And if by the benefit of the blood the virtue of the Medicament may be carried unto the wound why should it not then likewise carry to the wound the virtues of other things into the which out of wounded persons the blood is oftentimes abundantly poured out which yet we see that it doth not But now as for those things that they alleadg in special touching the Secundines and the first menstruous blood of Virgins and as for their asserting that if this blood be not rightly handled there is much hurt and damage brought unto those maydens these things are to be imputed unto the superstition of these young Women And if in woman kind the Secundines being cast forth into some unclean places bring damage unto these women from whom they came why is not the like done in bruit Creatures whose Secundines or after births being cast forth and buried in dung do oftentimes putrefy And in what place soever you dig and bury these secundines they yet notwithstanding rot and putrefy And why also do not the Molae or false conceptions which women use to burn bring any hurt and damage unto the Woman from whom it proceeded And why should the first menstruous blood if it be burnt bring damage unto the virgin and none of the rest These things being as we have said and the case thus standing there is no need of any further tedious dispute touching those virtues that this unguent is said to have in curing the Wound seeing that it is hitherto sufficiently proved that there cometh no virtue at all from this Unguent unto the Wound And if this Unguent had indeed any virtue at all in it either of preserving and cherishing the temperament or the innate heat of the part they commonly cal it the Balsam or of drying up the Excrements it would better and more commodiously exercise and put forth this virtue being anoynted upon the wounded part it self then upon the Weapon And besides all this if as some will have it the virtue and strength of this Medicament consist in the Blood and fat of Man why then do some of them likewise apply it unto the Wounds of other living Creatures to wit of Horses c. For how great is the Difference between a Man and a Horse But that Crollius and some others that I may not here altogether omit the mentioning of this also derive the vertue of this Medicament from the Heaven and therefore command the preparing of it in such a certain position of the Heavens Neither will that at al patronize this Cause For they have not as yet proved that there is in the Heavens or any of the Stars any virtue at all to heal Wounds or that if there were any such virtue in these that it doth so mingle it self with this Unguent that as if it were in a manner bound and shut up it may be carried up and down about with us and drawn forth into use and Act when we please And so likewise as touching the manner of using this Medicament this also hath no Foundation to uphold it neither doth it want for superstition For first of al seeing that they place the whole Cause of the Cure in this that the virtue of the Medicament is derived unto the Wound by the benefit of the natural Balsam that is in the Blood why then do they anoynt only the Weapon with the which the man was wounded or some other Weapon or a piece of Wood bloodied with the Blood of the Wound and why do they not as well anoynt his shirt or the other Garments of the wounded party or a Stone or any thing else what ever it be upon which the Blood hath been spilt or poured out and if not there is then some implicite underhand compact with the Devil to be suspected And moreover why if the wound be made with the pricking of a Sword do they anoynt the Sword in the point therof towards the hilt but if the wound be made by the Cut of a Sword then they anoynt it from the edge towards the back and if it appear how far and deep the Sword penetrated into the wound so far they anoynt it and no farther but if it doth not appear how far it pierced they then anoynt the Sword all over all which are no better then Superstitious Ceremonies and of which no Reason can be rendered For if the power and faculty of the Medicament be Natural what doth this or that manner of using it in the anoynting make to the thing it self and whether or no doth it add any new virtue and quality thereto If the vertues be Natural there is no need of any such Ceremonies as it plainly appeareth in all Natural things whatsoever The Load-stone draweth the Iron and the Iron being touched with the Load-stone is moved unto the North-pole without any of the aforesaid Ceremonies And furthermore some there are that anoynt the Weapon once every day others every Second or Third day and some content themselves with once only anoynting And some there are who that so they may not Erre in the anoynting wholly dip and plunge the Weapon or Sallow Wood that now and then serves in stead thereof into the Unguent kept in along Box or little Chest until the Wound be perfectly healed but they altogether neglect the Weapon it self that dip the Arms or that they make use of in their stead all over in the Unguent But others there are that keep the anoynted Weapon in any temperate place what ever it be and others likewise shut it up in a little Chest But al of them generally are exceeding Cautious in this that the Weapon be never kept in any place that is over hot or over cold and that it be not polluted with filth and impurities for if this should happen the Cure will by this means be hindered and a most grievous pain in the Wound procured unto the sick person All which are meerly frivolous and superstitious For seeing that as it is before sufficiently proved there cannot possibly be any action of the Weapon-Salve upon the wound at a far distance and interval of place from the Wound so likewise we say that it cannot possibly excite any pain And therefore we conclude that if this at any time happen it is then caused and procured by the help and assistance of some evil spirit And most certain it is that the Blood of wounded persons is not alwaies poured forth into clean places but oftentimes into places very noysom and unclean and that in the Winter time it is frozen and that the Bloody Linen Clothes are washed with warm Water and the wood be sprinkled
in the end of the boyling add of the best White Wine three pints and then making a strong expression of the liquor and strayning it make thereof with hony or sugar a sweet and pleasant drink for the Patient But if the Wounded person should have a fever hanging upon him you must then leave out the Wine in the aforesaid decoction The following Potion likewise of the Nobles of Berine is very much commended by which al one as it is commonly reported the most grievous wounds are oftentimes cured of which mention is likewise made by Guilhelm Fabricius in his 4 Century Observat 84. Take Wintergreen Golden rod Mugwort Sanicle Red Beets of each as much as you think good the Plants are to be gathered in the Month of August then dryed in the shade and afterwards beaten into a pouder take equal parts of the powder and mingle them then Take Of this pouder one spoonful let it boyl in one measure of White Wine give the wounded person a draught of this blood-warm thrice a day and so continue it until the consolidation of the Wound Give the Patient if he be weak two spoonfuls hereof Aanother Potion Take Clary Wintergreen Periwinkle Sacracennical Consound Ladies bedstraw Sanicle Speedwel Ladies Mantle tree Ivy Mugwort of each three handfuls Album Graecum or if you will white Dogs-tird pickt up in the month of March two ounces and half old beer a little tart and sourish the proportion of one little earthen Cup let them stand digesting for fourteen daies and afterwards let them be destilled and reserve it for use in glasses wel and close stopped of this you are to give three spoonfuls at a time thrice every day And for this use and purpose there are likewise powders to be provided Pouders Take Nutmegs one ounce Crabs Eyes one ounce and half make a pouder and give half a dram or a dram at one time with wine or Take Red Corral three drams Margarites Spodiums of each six drams Crabs eyes two ounces Mingle and make a powder Give unto the wounded person of this powder one dram at time in Wine or Water And such like Electuaries may be provided likewise As Electuaries Take Conserve of Red Roses and Betony of each two ounces Tormentil and Consound of each one ounce Mace two drams Red corral one dram Crabs Eyes prepared half a dram and with the syrup of sorrel make an Electuary or Take Juice of Plantane Horstayl Sanicle Mouseare Speedwel of each two ounces the greater Consound roots rosted under the embers and passed thorow a hayr sieve one ounce white Sugar one pound boyl them to the Consistence of an Electuary and in the end ad Conserve of Roses one ounce Tormentil half an ounce and mingle them And yet nevertheless we are not so to trust and conside in those potions as to neglect al other Topical Medicaments For if we should thus do the Wounded person may possibly fall into some great danger and hazard of which we have a very remarkable history in Guilhelmus Fabricius his 4 Cent. Observ 83. Chap. 12. Of the Dyet of Wounded persons The Diet of wounded persons And thus much may suffice to have been spoken touching the Chirurgical part and the Medicaments Necessary in general for the curing of Wounds It remaineth now that we speak some what of the Dyet that is to be observed by wounded persons Let the Air be temperate or a little inclined to Warmth touching which Celsus in his fifth Book Chapt. 26. thus the Place saith he in which the wounded person shal lie it ought ta be somewhat warm But a cold Air is greatly hurtful and an enemy unto all Wounds And although that a hot Air be convenient enough for the wound yet in regard that it heateth the body moveth much the humors and rendereth them fit and apt for motion and so may easily give an occasion for fluxions which are otherwise too apt to happen in Wounds therefore it is not fit and allowable for wounded persons touching which Celsus thus in his fifth Book and Chapt. 26. The most opportune time saith he for the cure is the spring or at least that time that is neither fervently bâ—t neither yet over cold For the truth is that both overmuch beat and too much cold they do both of them infest and offend Wounds But now if such an Air may not be had that is naturally such it is to be made such by the help of art Let the Air be likewise pure and that which is stinking or any ways impure is carefully to be avoyded The food of the Patient And as for the meat and drink of the Patient since that from the blood both the flesh and whatsoever else is Necessary for the agglutination of the wound is generated they ought to be such from which good and pure blood may be bred and such as may not afford the least occasion and matter for many excrements and dangerous Symptoms But meats of an ill Juice must heedfully be eschewed such as Garlick Onyons Swines flesh Pease and the Patient myst altogether abstain from meats that are hot sharp tart and biting and of an ill Juice and he may only feed upon those meats that yield a good Juice and are of easy concoction And let the food he takes be such for the quantity thereof that it may be concucted by Nature and such as may supply a moderate quantity of blood For if too great abundance of blood be generated it supplyeth matter fit for fluxion inflammation and other symptoms And indeed his food that he taketh ought to be in such a quantity that there may flow unto the wounded part so much blood as was wont to flow thither while the part was sound and without any distemper seeing that the wounded part if it be rendered weak and infirm is not able to concoct and assimilate so great a quantity of blood as it did before whereupon there wil be generated either an inflammation or great store of excrements and so the wound wil be made over moyst Let his meats likewise in the general be so ordered that they may restrain the flux of humors rather then excite it they ought to be altogether such that if there be any thing amiss in the blood and humors it may rather correct then further augment the same And if any evil accident shal befal the Wound all indeavour ought to be used that so the food may oppose and with stand the same And yet nevertheless it is not one and the same kind of dyet that is fit and proper in all wounds For if the wound be in a fleshy part and that there be no danger of an Inflammation then a more plentiful dyet may be allowed but if the wound be in the Nervous parts and that there be danger at hand of an inflammation then a more spare diet is to be prescribed that so there may flow unto the wounded part the less store
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
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
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
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
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
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
Corpulent and his Shoulder that he had broken being not possibly to be bound up in a right manner and hard enough and he in the night time sleeping very unquietly and continually turning himself in his bed and moreover by reason of his extraordinary sweating in his Shoulder the Medicaments applied thereto being continually kept so wet and moist that they could not stick close enough to put forth their virtue the bones could not be consolidated nor brought to grow fast and firm together but they lay at a certain distance one from the other But now such Fractures as these are afterward very hardly to be cured unless it be so that they are new and of no long standing in which the usual way of Curing is to be administred and the Osteocolla Stone to be given the Patient as we have already shewn you how and in what manner of which very thing we finde an example in Guilhelmus Fabricius his third Cent. Observat 90. in regard that a Callus is drawn over the extremities of the broken bones by reason of which the bones can no more be brought to grow together Yet some there are that think that such inveterate Fractures as these may likewise be Cured And Cornelius Celsus in his 8. B. and 10. Chapt. writeth of them in these very words If saith he the Fracture to wit of the bones that grow not well together be inveterate the Member is then to be extended that it may be somthing hurt The bones are with the Hand to be divided one from the other that by coming together again they may be exasperated so that if there be any thing fat it may by this means be taken away and that it may wholly become new as it were and yet great care ought here to be had that the Nerves and Muscles be not hurt And then the Member is to be fomented with Wine in which Pomegranate Rinds have been boyled and the same is likewise to be laid on mingled with the white of an Egge The third day it is to be loosened and fomented with Water in which Vervein hath been boyled On the fifth day the like is to be done and Splinters are to be placed round about it And as for all the rest that is to be done both before and after it is the very same that we wrote before But this way of Curing is very dangerous and which Celsus himself likewise feareth by thus doing the Nerves and Muscles may easily be hurt and thereupon an Inflammation or Convulsion excited Chap. 8. Of the Fracture of the Arm. ANd thus much in general may suffice to have been spoken touching Fractures But now because that the bones which are broken are various and in regard that according to the variety of the broken bones the Cure doth somthing differ we shal now therefote speak somthing of Fractures in their species and particularly But as for the rest of the differences in regard that they make very little or nothing at all either for the knowledg or Cure and that all that may be said of them is conteined in those things which we have hitherto spoken of Fractures in general we shall therefore pass them over and shall treat only of those differences that are taken from the subject and the diversity of those broken bones And because that very frequently the Arm Shoulder Leg and Thigh are broken we shall therefore in the first place speak of them and afterwards we intend to treat likewise of the Fractures of the rest of the bones And indeed as touching the Fracture of the Arm The Fracture of the Arm in regard that the Arm together with the Hand is the Organ or Instrument of laying hold on things and of many labors and is likewise exposed unto external injuries it is wont to be often broken Now the Arm or that part which is from the Shoulder to the Wrist consisteth of two bones of which the greater that lieth lowermost is called Cubitus or Vlna but the less which lieth above the Elbow is termed Radius Now somtimes both these bones are broken and somtimes but only one of them Prognosticks 1. The Fracture of the Arm is more easily Cured when but only one of the bones is broken then when they are both broken as we told you above in the first Chapt. and sixth Prognost 2. If only one of these Arm-bones be broken the Cure is more easie if the upper bone or Radius then if the lower bone or Cubitus be broken for the upper needeth less extension then the lower and if the lower to wit the Cubitus be preserved sound it serveth instead of a Basis and prop as it were to keep the broken bone from being moved out of its place And Secondly Because that it is more easie to be set in its place again unless it be in that part next the Hand And thirdly Because that the Elbow bone being kept safe and sound it is carried more safely in the Scarf or Linen Swathe 3. But the worst Fracture of all is if both the bones be broken together For first of all they have no prop nor any thing at all to sustain them And then again Secondly They need a greater Extension since that the Nerves and Muscles are more contracted toward the place from whence they spring in regard that there is nothing whereby when they are extended they may be so kept And Thirdly because that the neer neighbouring parts aâ—e more hurt 4. But now the bones of the Arm are for the most part made to grow together within thirty daies although as we said before there may be great difference in the Age and Nature of the Patients The Cure Whatsoever things they are that are required unto the Curing of the Fractures of the other parts they are here likewise necessary But as for the Extension there is less need of strength and force when the Radius is broken then when the Cubitus or Elbow is broken but the greatest need of all when both the bones are broken And indeed if both the bones are broken the Extension that is made ought to be equal but if only one of the two bones be broken the greatest and strongest Extension ought to be in that part where the bone is broken The Extension being made the broken bone is again to be directed into its proper place and there set fast The broken bone being thus replaced the Fracture as we told you before is in a convenient manner to be bound up and rowled about with Swathes and all other things are here to be performed that were before spoken of in the Cure of a Fracture in general and then at length the Arm is to be fitly placed and Scituaced And indeed as Hippocrates adviseth in his first B. of Fractures Text 22. in the placing thereof there is great care to be had that the Hand be not lower then the Elbow lest that if the Arm hang down the Blood should flow toward
the Shoulder be broken a Linen ball is then to be bound under the Wing thereof and the binding is not to be loosened before the seventh day unless there happen somthing else Let the sick person lie on the opposite side and let him all he can keep the part in quietness Chap. 16 Of the Fracture of the Sternum or Breast-bone THe Sternum or Breast-bone it self is somtimes broken either by a fal or by a blow Signs Diagnostick Which is known from the pain and especially from the inequality which is discovered by the touch and at the compression of the Fingers the broken bone retireth inwardly and there is a certain sound or noise heard and there where the bone is broken there may be notice taken of a Cavity And there is also difficulty of breathing the Cough and spitting of Blood that for the most part follow thereupon Prognosticks 1. The Fracture of the Stern is very dangerous in regard that by reason of the Pleura Membrane which is easily hurt together with the Stern and the noble parts that lie under it it is wont to attract sad and grievous Evils 2. But yet it is consolidated in twenty or twenty four daies in regard that it is spungy and thin The Cure Now that this bone when it is broken and depressed may be restored again unto its own seat the sick person being laid flat upon his Back a Pillow is to be put under the Spina or Back bone over against the Fracture and by some Servant of the Chirurgeon the Shoulder is on both sides to be pressed down but let the Chirurgeon himself with his Hand press together the Ribbs on both sides and so let him bring back the broken bones into their places And after this those Medicaments that are wont to be administred in other Fractures and which prevent Inflammation and serve for the Conglutination of the Fracture are to be imposed and the binding is to be instituted with fit Swathes above the Shoulders in the Cross Figure of the letter X and this binding must not be over hard lest it hinder the breathing Chap 17 Of the Fracture of the Ribbs ANd sometimes also the Ribbs are broken from violent causes as a fall a blow or the like But now the Ribbs are sometimes so cleft as Celsus writeth in his 8 B. and Chapt. 9. that indeed not the top of the bone but the inward part thereof which is thin may be hurt and sometimes so that this fal hath wholly broken them And indeed the broken bones do sometimes decline inwardly and sometimes they stick forth outwardly and sometimes notwithstanding that they are wholly broken yet they are not moved out of their proper places and sometimes likewise the flesh about the Ribbs is battered and bruised Signs Diagnostick If the Whole Ribb be not broken then neither is there any blood spit forth neither any fever following thereupon nor any thing suppurated or but very rarely neither is there present any great pain and yet nevertheless this place is lâ—ghtly pained even upon the very touch But if the Ribb be wholly broken and yet the broken extremityes thereof not moved out of their places by being either driven inwardly or forced into the Exterior part there are but very few that are hereupon taken with a fever And many there are also that do not at all spit blood neither is there any Pus contracted in the Chests of some and those indeed not a few But if the Ribb be both wholly broken and the extremityes thereof moved out of their places there is then a certain inequallity or unevenness and Cavity that may be both discovered by the sight as also by the touch and there is likewise a certain ratling noyse heard unto which also there are divers other symptoms Joyned There is present a very great and grievous pain and especially if the internal part of the Ribb be broken and this pain much resembleth the pain of such as have the Pleurisy the breathing is very difficult the Cough extremely troublesom and now and then likewise spitting of blood followeth thereupon the Lungs soaking in the blood flowing forth of the broken vessells and a feaver is also herewithall joyned and accompanyeth the same But more especially two evills there are that usually attend the Fracture of the Ribbs The first whereof is the puffing up of the flesh lying upon the Ribb which is discovered both by the touch and sight and if the place be pressed together with the hand there is heard a certain noyse and sound of the Air going forth thereof Unto which unless timely Remedies be administred in the second place an Inflammation and a fever and an Impostume are wont to succeed The cause of which thing is the separation of the flesh from the bone and a weakness brought upon the part with the blow which cannot therefore sufficiently concoct the Aliment that by reason of the pain is more abundantly attracted and flowerh thereunto which remayneth thereupon partly crude and is partly resolved into vapours and flatulencies or windiness And somtimes the Corruption of the Ribbs is wont likewise to follow this Malady For when the flesh is separated from the bone the Air getteth in in the place thereof by the contact and impression whereof the bone is offended and corrupted Prognosticks 1. If the Fracture be single without any Contusion or bruising of the parts lying neer thereunto there is then little or no danger at all and the Ribbs will grow together again within twenty days 2. But if the flesh about the Ribbs be battered and bruised then the evil is very dangerous by reason of those symptoms that as we have before told you do happen herupon somtimes deadly Touching which Hippocrates in his 3. B. of the Joynts Text. 65. if the Contusion sayth he or the bruising that is caused about the Ribbs be neglected although upon this a worse Mischief doth not follow yet notwithstanding it hath the flesh more soft and spungy in the bruised place then it was before and where such flesh is so left and not by curing thereof restored unto a good habit the thing is so much the worse if filth and snottiness be left about the bone itself in regard that the flesh wil now no more fasten unto the bone in like manner as formerly and in regard that the bone it self is rendered more apt and ready for diseases and for this very cause many have their bones vitiated because that the evil is a long while protracted ere it can be Cured 3. And thirdly likewise the Fracture is ful of danger if the Ribb be driven inward and there prick or wound the Pleura Membrane and then almost al those symptoms that are wont to infest those that have a pleurisy do follow upon the sayd fracture and the Cure is scarcely ever perfectly accomplished in less then fourty days The Cure If the whole Ribb be not broken or if wholly broken yet not removed out of