the other to doe his part example if an vlcer bée with hollownesse verie filthie there is a thrée fold affect against nature the vlcer the hollownesse the filth the order of curing in purging the filth because the vlcer cannot be anie thing adglutinated or filled with flesh before it be cleane the cure of the hollownesse hath the second place for if we shal either adglutinate or incarnate or to speak briefly cure the vlcer we cannot fill the hollownesse imagine therefore that not onely these thrée do infect the part but also inflamation or Erisipelas or Gangrena or some intemperatiues either simple or compound whether or no it is manifest that the vlcer cannot be filled with flesh before that this be taken awaie it is before saide that generation of flesh commeth of that which is sound vnder but new flesh cannot grow of that which inflamation infesteth is intemperate to conclude that which is sick therfore there is of them to be considered a thrée fold end in all such coniūctions one as it were taken of the cause which is to come after another hath the reason without which not the third is named such as do inforce and accelerate For the iust temperature of the flesh is as it were the cause which maketh that is vlcerate to growe with it and filleth the hollownesse The purenesse cléernesse of the vlcer hath the place without which not for the filth letteth this doeth prolong the cure the hollownesse hath the place to the vlcer without which not for if the hollownesse be not filled the vlcer cannot be cicatrised therefore if thou doest regard these thou shalt finde the order of curing as if inflamation hollownesse an vlcer filth be found together in the part we must first cure the inflammation secondlie the filth thirdly the hollownesse last the vlcer And truelie in the rehearsed both the order and the inuention of things to be done is taken of these but the indication of that which enforceth or accelerateth is not héere reckoned in other truly it is for that affect is first of all to be cured whereof there first followeth perill to the man yea not onely first but onely it as if the head of a muscle be prickt there followeth conuulsion which cannot be remitted by the helpe of conuenient medicines for thou shalt heale the conuulsion the muscle being cut ouerthwart notwithstanding thou hast corrupted some motion of the part in like manner when ther immoderatlie floweth bloud out of a veine or arterie if thou cuttest the whole vessell ouerthwart although thou canst not cure the Vlcer yet thou hast taken awaye the perill which should haue come through the fluxe of bloud Now we are constrained after to cut a nerue ouerthwart as often as we sée either conuulsions or madnesse or both being great and hardlie curable to follow after wounding In like sort where luxation chaunceth in anie of the greater ioyntes we cure the vlcer but leaue the luxation incurable for if we wold cure also this conuulsions would follow The third end to put before our eies of curing is vnto that which enforceth accelerateth and is contrarie to the other two rehearsed neither is it all one to consider anie thing as the cause or as that which hath the place with out which not or as that which enforceth and accelerateth But we haue said that which enforceth is such sometime that it leaueth the other affect vncurable and also that both we make the affect partly in the pūcture of a nerue or tendon or profusion of bloud of the vessels and partlie in the muscle whose head is wounded for wheras the luxation is with the vlcer we make not the affect but leaue onelie that vncured which is made But we shall speake more exactlie of these héereafter The tenth Chapter AT this present it pleaseth vs to go to the difference and to comprehend brieflie our propounded talke that we ouerpasse not anie indication of inuēting remedies if anie yet remaine Therfore they doe call as differences of vlcers an vlcer without inflamation a rotten vlcer and a deuouring or corrosiue vlcer an vlcer with Gangrena and Erisipelas and a Cancerous vlcer an vlcer with paine an vlcer voide of paine such like if anie cōming forth setteth out the emperike curatiō thinking no other thing nameth them differences of vlcers we wil not contend with him for we haue said a thousand times that it behoueth not to contend about names but if he goeth about as it were to shew anie artificiall thing of indications he is to be taught that all the rehearsed affects be compound that ther are other differences of a simple and sole vlcer to which there is no other affect ioyned for if there be diuision with anie edged thing if the forme of that which did wound be imprinted in the part diuided there shal truly be so many differences of vlcers of oblique right retort like a bristle crooked like an hooke and so being euerie waie and all these differences be of the figure Againe there are a thousand other differences of the magnitude for an vlcer both is and is also sayde to be bigger or lesser than another also great little also a short a long a shallow and a déepe and in euerie of these both that it is more or lesse such a one whether it be in the differēce of space or magnitude or quantitie or call it after what manner you will but if this so be then trulie an vlcer equall or inequall shall be with the profunditie of diuision for if it chaunce that the thing being cut in length the higher parte of the diuision may go in déeplie the lower part to be in the vpper part of the bodie or contrarie the higher part of the wound to bée in the vpper part the lower to bée déeper also these that is to saie to bee diuulsed in some part or totall and to haue bene cut and where that wound went ouerthwart vnder the skinne the one part of the vlcerate parte to be séene the other to be hidden vnder the skinne and that to be in the higher partes or lower or sides all these be differences of vlcers Againe of the time there are other differences of vlcers taken as an olde or new vlcer of small or long time and in all these the reason of more lesse is to be numbred And these differences are taken of the nature of the vlcer most proper which are taken of the substance of the thing for those that are taken of the figure and magnitude of diuision and that either in length or déepnesse or in both dimensions also in these with equalitie or inequalitie these that come outwardly and hath the place of that without which is not also of the time in which the vlcer is made for so one is called a new another an old vlcer Also of that that either part
greatly delighting them selues in the onely dignitie of the Arte not knowing what it meaneth which doe oftentimes let bloud their poore patients without any IndicatioÌ„ or councel of one learned in the same arte or of some graue and learned Phisition but also they will geue inward medicines a gods name a matter truely most worthie of publike punishment For as much as I haue séene many by such their rash and bold enterprises brought into daunger yea and some haue I séene miserably languished and depriued of lyfe Therefore let not that young Chirurgion which would be estéemed worthie of his arte presume to take in hande these thinges without the councell of an auncient maister learned in the same arte or else a graue Phisition such a one which is learned in the arte of medicine the matter it selfe geuing also such libertie or time But otherwise if there be no learned maister present or that any present necessitie doe constraine the same then truely the younger Chirurgions may boâ—…t bloud and also if néede bée minister a medicine so that he haue good erudicion iudgement and experience Moreouer the Vnguentes where with the Chirurgion ought to be furnished and the same to haue alwayes in his saluetorie as these Vnguentum Basilicum Vnguentum Apostolorum Vnguentum Aureum Vnguentum Album and Vnguentum de Althea as Basilicon to superate and materate and Apostolicon to mundifie and clense Vnguentum Aureum to incarnate and to fill Vnguentum Album to cicatrise Vnguentum de Althea to cease dolour and paine and to make soft Moreouer as for emplaisters pouders fomentations and such like the expert Chirurgion doth prescribe of them very many sortes according to the reason of curing And these are the medicinall instruments pertaining to the art of Surgerie By the manual instrumeÌ„ts ye shal chiefely vnderstaÌ„d instrumeÌ„ts of yron very méete most necessarie to the ChirurgioÌ„s vse wherof some are to make incisioÌ„ to cut of a thing other some are to draw out certaine are to search also some be properly to stitch or sowe and other some to make adustion to cut or make incision Forfices Nouacula rasorius scalpellum Chirurgicum for Phlebotomie seu lancetam forsipes to draw out called commoÌ„ly Tenaculae volcellae seu volcellae which in French they call pinsettas the crooked hooke vncus seu vncinus and that Yron instrument which the Grecians call Diocleum graphiscum is apt as Celcus writeth to draw out arrowes For to serch we doe fitly vse a probe for to sow a néedell and a quill are properly vsed and to adustion diuerse kindes of cauteries commonly called actuall are occupied and for the variable meanes of their vse they haue diuerse figures and diuers names for some be sharpe at the point and other be not and other cauteris they call myrtea oliuaria dactilica cultellaria so called of the similitude of thinges which these instrumentes doe represent for the cauteris called Mirtia doe imitate the figure of the leaues of Mirtills Oliuaria of an Oliefe dactilica of the Date as Cultellaria doth represent the forme of a knife these are the common instruments necessarie for Chirurgions There are certaine other instruments proper and appointed to certaine partes of the bodie as modioli which the common Chirurgions call Trepans malleus scalpri and the same are conuenient to scrape cut or pul out bones as well of the head as other parts euen as Falx is proper to the fundament speculum oris to the mouth and speculum matricis to the matrise there are innumerable other sorts of instrumentes conuenient to drawe out dartes gunshots other infixed things whereof to speake I doe now cease and will prepare my selfe to set out a Chirurgion what maner a man the best ChirurgioÌ„ should be which thing I often times haue declared to be the chefe effect of the matter for wée know what Galen hath saide of the Phisition aswell in his booke De institutione artis medicinalis as also in the third booke de naturalibus facultatibus and in his third fourth de methodo medendi Galen calleth him that cureth woundes and vlcers medicus that is to say a Phisition he saith that the Phisition ought to be prudent and well exercised and also he ought to be of quicke nature and of pregnant wit that he may promptly obtaine all thinges and verie well instructed in learning and moreouer appointed to the best maisters to learne of and one induring labor paine a great louer of the truth studious and most déeplie vnderstanding his art approoued by much vse and long experience and all this saie I must be applied to the Chyrurgion which will bée most excellent estéemed for an vndoubted Artist but beside these there be certaine things which doe pertaine priuatlie to a ChyrurgioÌ„ as to the manual Artist do not so much pertaine to the ancient maister of the art of Medicine for a Chyrurgion ought to be a young man or els but little past youth that is betwéene the same and auncient mans estate for the age flourisheth most in sense strength to exercise rightlie whatsoeuer belongeth to his art wherfore they which are aged men cannot so aptlie bring things to passe which arte requireth for the imbecilitie of their senses for they follow them rather by counsaile Furthermore he must haue a sure and strong hand and steadfast to all workes that hée shall doe whether it be to make incision adustion also for the cutting awaie of a member Also it behooueth him to haue a quicke and cléere eie and he must not be fearefull of mind but rather without pittie if he do intend to cure him that he taketh in hand Furthermore neither let him make the more hast neither let him cut Canteries or cut off lesse than néede requireth for the clamor or crying out or for the tendernesse of the sicke Patient but let him doe all things as though he heard not the clamors of the sicke neither let his minde be therwith anie thing troubled And wée haue declared that a Chyrurgion ought to excell in learning for therein chiefelie doth his erudition manifestly appeare if he vnderstand exactlie both the Theorike and the Practike parts that is to saie to know things naturall and not naturall and also those that are against nature Also if hée know what be the causes of wounds vlcers fractures and luxations with their accidents and also what be their conuenient remedies and how to remoue the same In lyke manner he shall excell in practise if hée haue had much and good exercise in the operations of his Arte by working spéedelie trimlie and readilie consulting with the auncient maisters of the same arte in those things that pertaine to Pharmaceuticen Diateticen And although he vse those things which be searched out by reason confirmed by frequent vse wherein truelie the faith and honestie of a Chyrurgion séemeth chieflie to consist The Chyrurgion ought to
be these Dogmatists which are not able by reason to vnderstand the naturall principles of bodies but of these Thessalions voide of method what doest thou yet speake Therefore those which cure by right method doe finde apt remedies for euerie kinde of vlcers as also conuenient diet they do most apparantlie declare by the things it self how much it profiteth and how great light it doth bring to the arte of curing the Treatise of nature it selfe declareth for I haue not once declared vnto you how that sometime they which goe from one medicine to another doe let slip and neglect that which is profitable and that with some one of their remedies which they haue vsed the same vlcers haue béene cured therefore they haue worthilie despised the facultie of such remedies which because of the vntimelie vse they haue séene not onelie the profite but much for to hurt and that in the first vse it hath done no euident thing Furthermore thou hast séene no lesse the grieuous pains of the eies to be healed either with bath either with drinking of wine either with foments either with letting of bloud eyther with purging vnto which these common sort of Phisitions haue applied no other thing than these medicines which are made of Opium and Mandrake and Henbane bringing great daunger vnto the eies inasmuch as they taking no other thing awaie for the present but the paines it selfe these doe kill the sence as thou hast knowen many by the vse of these medicines when they haue bene too much applied neuer after to haue come to their naturall state and that first their eyes were dim and they haue hardly séene after to be vexed with suffusion which is called Hipochysis or with too greate dilatation of the ball of the Eie named Mydriasis or with Tabes or Corrugation called Rhetiosm Thou hast knowen also being with me from sixtéene yéeres of age neuer to haue seene vnder anie maister this worke but to haue excogitated it by reason and how long time I did consider that Aphorisme of vnalayde wine or bath or foment or letting bloud or purging taketh away the paines of the eyes And what trust I had by the rest of Hippocrates laborers that there was nothing in this Aphorisme either false or might not be brought to passe that was it which stirred mée to search vntill going Hippocrates way I found by what meanes I should discerne when and how euery of the forenamed should be vsed By which reason I made manifest to many which haue séene the like things of how great force the medicinall methode is and how great occasion of euill they are which haue not obserued the olde arte of Phisicke haue builded new sectes and now truely although from the beginning I haue refused it yet by entreating you haue compelled mée to take al this whole worke in hand which I pray the gods may be profitable by others truely I haue small hope aswell for the contempt of good letters which now do raigne as also for the admiration of riches estimation and ciuill power vnto which whosoeuer doe turne himselfe is not able to finde the truth in any thing But these things shall be determined as pleaseth the gods and we now for our power shal restore the Methode of curing which was found of the auncient Phisitians being now neglected repeting againe the disputation which we haue begunne of the hollow vlcer and of the first inuention of those things which doth fill an vlcer with flesh let that suffise which hitherto we haue saide and let vs graunt if they will vnto the Empericks all that they say And for the vse of things foūd out I haue often shewed to thée in themselues and now nothing lesse I will go about to demonstrate by reason how these Empericks cannot by certaine reason go vnto another medicine whē they haue nothing profited with the first and that rightly chaunceth for when as they know not the cause of the vnhappie successe of the first medicine neither can declare the lyke in the second and when they are ignorant of the cause wherefore the first medicine doth not his affect neither are able to vnderstād why it taketh no place this thing truely being not knowen they cannot reasonably go to another when as they cannot in the same medicine perceiue the like cause The third Chapter NOw therfore let vs set out Hyppocrates waie and the true method of curing an hollow vlcer surelie it behoueth to begin thus that is of the substance of the thing therefore séeing that an hollow vlcer that is our scope that the flesh which is lost may be restored it is néedfull to knowe that the thing which engendereth flesh is good bloud nature as I may tearme it being the workman and author notwithstanding it is not sufficient to name simplie Nature vnlesse we consider also whose nature and where For it is manifest that Nature it selfe is the ingenderer of flesh of those bodies that be subiect whereas flesh is to be made and surelie it is declared that the nature of euerie bodie doeth consist of the temperament of hot cold moist and drie therefore it is manifest that the iust temperament of these in those parts whereas we shall restore the lost flesh is as it were the workman And first of all in euerie hollow vlcer these two things are to be considered whether the bodie being subiect be in iust temperature that is to saie whether it be according to nature For we haue declared that health of similer bodies is the iust temperature of the foure qualities and whether the bloud that floweth to the part be good or else but indifferent for if either of these doe offend there are trulie many affects against nature notwithstanding there is now put to vs but onlie the hollownesse in the fleshie parts Therefore let vs imagine the part to be sound and the bloud which floweth to the parte to be frée from fault either in qualitie or quantitie surelie these thinges béeing as is sayde there is no impediment but that flesh shall prosperouslie growe and that without the helpe of anie outwarde medicine for both causes which ingender flesh béeing present and nothing outwardlie hindering then it cannot bée but that flesh must bée ingendered But in the first engendering of flesh there must of force spring a double excrement as we haue shewed in our commentaries of Nature that there followeth euerie mutation of the qualitie of the nourishment an excrement grose and thicke and another thin And these excrementes chauncing euer through the whole bodie that which is thinner is inuisible by persperation notwithstanding it is forthwith visible as often as the naturall heate diminisheth or that hée vseth more large diet than is méete or that there happeneth to the creature more vehement motion The other excrement is the filth that is sent to the skin Furthermore in vlcers the thinner excrement is called Sanies in Gréeke Icor the groser is named Sordes and the
beginnings thou shalt not néede either stitching or hookes but if thou wilt otherwise binde it vse thou either stitching or hookes Few stitches shall in this suffice And thou shalt cure greate vlcers with vehement desiccatiue medicines if thou remembrest that which before is spoken The medicines which doe moderatly drye will abundantly heale small vlcers Déepe vlcers be euer also great therefore they must be rolled with two beginnings and the lippes of it be spedely adglutinated and those which are both verye déepe and also long as they are great two wayes so doe they shew a double indication therefore they require vehement siccatiues Neither ioyne thou the lippes to soone together and rolle it with two beginnings and take déepe stitches In like sort if there come many differences together of which euery one hath his indication it is expedient to vse them all so that they be not contrary But if they be contrary among themselues wée haue heretofore shewed how it behoueth them to be denied of these but wée will more largely set it out hereafter And now it séemeth good in this place to ende this third booke In the fourth which shall follow we will dispute of those affectes which for the more part accustome to follow vlcers and with these there shall be set out the curations of inward causes FINIS THE FOVRTH Booke of Galen called in Greeke 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and in Latine Methodus Medendi The effect of the same 1 The right method of curing malignant stubburne Vlcers 2 What Vlcers be hard to be cured 3 The method of curing an vlcer difficill to be cured by the reason of the intemperancie of the flesh 4 The curation of an vlcer when as the part is exulcerate with a tumour against nature 5 The method of curing another affect when as ill humours doe flow to the particle 6 How a man may know in certaine diseases the originall cause 7 The opinion of Thessalus in the curation of malignant vlcers 8 That of time no indication ought to be taken contrarie to the opinion of Thessalus 9 The curation of malignant vlcers according to the sentence of Hippocrates 10 That an ill affect comming to the vlcer ought first to be cured before the vlcer be taken in hand 11 The curation of those affects that flow to the vlcer according to the sentence of Hippocrates 12 What indication ought to be taken of the scituation and figure of the parts The first Chapter WE haue said that there is one kind of disease that is called solution of continuitie which cōmeth into all the parts of the bodie of mankind howbeit it hath not one name in them all For solution of continuitie in the fleshie part is called an vlcer in the bone a fracture the Gréekes call it Catagma in the nerue a conuulsion the Gréekes call it Spasma There be of the same kindes of Solutions which the Gréekes call Apospasma Regma Thlasma Thlasma in the ligament Apospasma Regma in the veines and muscles because of anie violent stroke or grieuous fall or anie other great motion The solution of continuitie called Ecchimosis in the Gréeke commeth most often with concussion and ruption Sometime solution of continuitie commeth by opening the orifices of the veines in Gréeke named Anastomasis Also it commeth of that which is called of many Diapedisis Other solutions of continuitie happen of Erosion in Gréeke called Anabrosis But it is a disposition alreadie medled and composed with an other kinde of disease that consisteth in the quantitie of the partes as before hath bene shewed when as we did intreate of hollow vlcers which doe procéede of two causes that is to saie of Exition and Erosion It is manifestlie knowen by what meanes exition commeth And if erosion abound inwardlie it commeth of Cachochimia if outwardlie it is done either by strong medicine or fire it behoueth then as is said before to take diligent héede and discerne the simple diseases from the compound for to a simple disease a simple remedie is conuenient and to a compound disease a compound medicine Also we haue said before what method must be kept to cure cōpoūd diseases yet notwithstāding it is not inough to know the generalitie of the said method but to be exercised in all parts thereof Séeing then that in the same is néede by manner of speaking of sundrie perticular methods because that euerie kinde of disease hath his owne methode then that which resteth of the curation of vlcers must bée performed in this booke taking the beginning héere Euerie vlcer is simple and alone without other dispositions and affects with it or it is with some other disposition or diuerse whereof some haue not onelie stirred vp the same vlcer but hath augmented it The other are without which the said vlcer cannot be cured Of thē we haue spoken héere before we shal speake in this present booke of the dispositions which augmenteth the vlcer in the which lyeth double counsaile of curation that is to saie either to take the said dispositions all wholie out of the bodie or to surmount the incommoditie that aboundeth in it The which thing may be easilie done if the dispositiō be little but if it be great the vlcer may not be cured vntill the same disposition be taken awaie Wherefore we must diligently consider what the said affects and dispositions be and how many in number in taking our beginning as is sayd before Euerie vlcer is by it selfe alone or with hollownesse the the flesh being subiect be natural and that there be nothing betwixt the ioyning of the lips that may let the conglutination therof which oftentimes happeneth either by haire a Spiders web mattier oyle or such lyke things that may let the ioyning together And these things are as Symptomata and accidents of the sayd wound which if they be present maye hinder the curation but if they be not they let not but the disposition of the flesh is cause of that which followeth For with the same flesh and by the same lips that were asunder are closed and the hollownesse filled It behoueth then that the sayd flesh be naturall because that these two things may be wel and commodiously made perfect Then it is naturall if it kéepe his owne temperament which thing is common to all other partes for it behoueth that the flesh subiect be wholie temperate as well to close the vlcers as to fill them with flesh But is that enough I praie you Must not the bloud that commeth to it be good also and moderate in quantitie I thinke this trulie to be true For that bloud which is corrupt doeth so differ from adglutination and filling the flesh as also somtime to exulcerate and erode the bodie And if it be ouermuch in quantitie it engendereth excrements in the vlcers as we haue before spoken and hindereth the curation And also there be thrée kindes of vlcers which are difficill and hard to be cured The first aboundeth by the
manifestly that they haue no regarde of other things that appeare in the affected part for to come to such euacuation But I doe not say thus that purgation is euacuation the which is no indication of the course of the bloud but for bicause wée must sometime haue consideration to the letting forth of bloud although there be no course of bloud present which may flow to the greued part for when the disease is very strong there is none which vnderstandeth the arte of medicine but will let bloud And truely the Emperickes themselues let bloud when any is fallen from an high place or when there is any part sore brused hurt with any wound though the pacient were whole and sound before and without superfluitie of bloud By the which it appeareth that it is not the flowing of the bloud to the affected parte which giueth indication but the magnitude and vehemēcie of the disease the force of the strēgthes excepting yet from our talke children As for example If a man be whole and sound and without any maner of hurt and hauing abundance of bloud it is not necessarie because of his abundance to take his bloud from him For there is no indication to be taken of the bloud for because the man is whole for to such men fasting doth profit small eating and sometime Purgation or bathing and Frications may suffise Letting of bloud is not necessary to such as the Emperickes say Likewise Purgation is not good in the onely abundāce of humours for euen as letting of bloud is done either for abundance of bloud or for the magnitude of the disease so is purgation giuen either for the abundaunce of ill humours or for the force of the disease As touching letting of bloud we haue spoken of in another booke and shall doe againe hereafter But in this present booke I will speake of purgatiōs for they that be diseased require them not onely because it doth euacuate the noysome and superfluous humours with the which the bodie is grieued but also putteth foorth and clenseth the excrements within the bodie And for this cause Hyppocates as well in his other works as in that he hath written of Vlcers considereth the vehemencie and strength of the disease whereof he taketh Indication of purging and sayth thus Purgations of the bellie is profitable to many Vlcers and also to woundes of the head of the bellie and of the ioynts and where there is daunger of the rottennesse of the bones or where stitching behoueth in woundes or where erosions bée or where Herpis other affects be which hindereth the curation of Vlcers and also where rolling must be vsed By these words it is apparant truelie that Purgations are profitable both to wounds and Vlcers at all times when they be great and grieuous For not onelie the sayd affects but other bée made great and grieuous thrée manner of waies that is either through the excellencie of the afflicted part either else through the greatnesse of the affect or else because the said affects are Cacoethae that is to saie hard to be cured Hyppocrates hath made mention of all these thinges perticularlie when he dyd intreate of woundes of the head and bellie and of the excellencie and dignitie of hurt parts I thinke it is manifest to all men that he must bée vnderstoode not onelie the lower bellie but also the superiour for in diuiding the Trunke of mannes bodie which is betwixt the necke and the legges is two greate capacities The first is contained vnder the Thorax and aboue Diaphragma and the second vnder Diaphragma vnto Os Pubi or to Peritoneum which couereth the inwarde parte of the bellie And for certaine those woundes which hath pearced within the Thorax or within Peritoneum is verie dangerous chiefelie if anie of the inward parts bée wounded Likewise there are verie fewe but they doe know that the woundes of the ioyntes are Cachoethae and are harde to bée cured Which thinges the Emperikes vnderstand onelie by experience and they that haue studied and haue attained to the knowledge of mannes bodie vnderstand these thinges by the nature of the hurt parte For in tendonie and sinnowie parts where bones are void of flesh there is great daunger of paine waking and priuation of rest and also of conuulsion Such woundes as these be and such as be stitched that is to saie those that are so great that they néed stitching or at the lest of binding or rolling requireth purgation We haue declared in the last booke that all the greater wounds ought to be ioyned together either by stitching or by binding Likewise the vlcers where there is daunger of corruptiō of the bones are oftentimes ioyned with great inflamations Also they that procéede of ill humours bée Cachoethae and with erosion Also Herpetes come of cholerike humours and all other olde vlcers come of such like cause Wherefore in all the vlcers before especified Hyppocrates commandeth to purge by the bellie and afterward he addeth these wordes In all vlcers whereto Erisipel as is come the bodie must be purged in that part most profitable for the vlcer so that the purgation be made either by the vpper partes or else by the lower which difference hée hath set forth in the booke of Humours where he commandeth to tourne awaie the humour to the contrarie parte As for example There is a great flux that commeth to one part of the bodie where there is an vlcer it behoueth to make another in the contrarie parts and thereof he speaketh in the said booke Wherefore if there be as yet a great fluxe which dooth runue to the sore part we shall make reuulsion to the contrarie part that is to saie if the vlcer be in the vpper parts by purging downward and if it be in the neather partes by purging the vpper ventricle But if the fluxe bée newe stopped in such sorte that is fixed in the member it is expedient to driue it out by the next partes séeing that the passages be the next places séeing that the accesse and attraction of purging medicines is more easie and prompt to remoue those things that be néere rather than those thinges that be farre of the which reason belongeth to another part of the art which entreateth of purging medicines therfore hereafter it shall be declared and made perfect Now I will shew the force or if you will call it the magnitude of the disease to be appointed for a certaine indication of taking away bloud or giuing purgation And also that Hippocrates was the first inuenter of the sayd indication I will speake in the bookes following of diseases and in this booke I will speake of vlcers I haue alreadie spoken of Purgations For séeing that euery disease is greuous thrée maner of wayes it is either for the excellencie and noblenesse of the part or for the magnitude of the affect or for the frowardnesse of the same affect called in Gréeke Cacoethia Hippocrates hath made
bloud came gushing out and much in quantitie being red and hot manifestly shewing that it came not farre of Surely the transsumption of the bloud from the brest into Aspera Arteria bringeth a great doubt but of those Phisitions who suppose that it cannot be sent out by the cote which inuesteth the lunges And peraduenture they would haue affirmed that the bloud could neuer be voyded by the mouth out of the brest Many of those that were affected felt present dolour other hauing an inflammation which after dyd supperate shewed a manifest token that the affect was in the brest But now being confounded by these signes they graunt that it commeth from the brest But while they séeke another way yea by the cote of the lungs they are constrained to bring out many and that absurde things although as I suppose they sée most euidently in them whome the Gréekes call Empios the mattier it selfe which they confesse to be in the middest space betwixt the lungs the brest to be spyt out from the lungs We verely haue vsed to them Melicratum which was iniected into the brest to be spyt out from the lungs in those where was so great an Apostume that part of the bones was putrified Surely at Rome we haue séene such affects amongst the Romans to haue after remained in the brest so that of force we were faine to cut out the affected bone and in many also the Pannickle which within is ioyning to the ribbes This being found putrified with the corrupt ribbes we are accustomed in this cure to vse Melicratum to be put in by the vlcer the paciēt inclining himselfe on the affected part to cough and sometime hastely to blow his nose and in the meane time with an instrument that draweth out matter the Gréekes call it Pyulcon to bring out the Melicratum that remained this being done when as we trusted that we had voyded out both all the mattier and also the Sanies by by wée iniected Medicines so that in these affects if thou leauest in the cured space betwene the breast the lungs any moisture thou shalt presently cause the same to be cast out with coughing Truely wée doe maruaile of those that doubt of the waye by the lungs why they doe not rather doubt how grosse bloud issueth out of the Callus of a fractured bone for the bloud which issueth is more grosser thā that which is natural and the substance of the skinne is a great deale thicker than the pannickle inuesting the bones Therefore as we saide when as any vessell of the lungs is broken either with falling or with loude crying and that without griefe there gusheth out much bloud hot and fresh by coughing you may vnderstand that the wound is in the lungs the cure must be taken in hande after the manner that we often haue done and that many tymes with good successe Therefore we must commaund the pacient that he vse not great respiration and furthermore that he alwayes vse silence Furthermore the inwarde veine of the Cubite must be opened from which twice or thrise afterwarde thou shalt take bloud because we may diuert it then rub and binde all the the ioyntes as we are wont These thinges being done thou shalt first giue him to drink Oxicratum delayed and bloud warme that if in the inward part there be any congeled bloud being resolued it may be spit out and thus doe twice or thrice in thrée houres then giue him some medicine which both hath an Emplastique vertue and is also astringent and that first with delayed Oxicratum or with the decoction of Myrtiles or such lyke astringent Againe at night giue him this medicine in like sorte suffering him not to eate any thing if the affect be vehement but else giue him of some supping that shal be sufficient and it shall chiefely profit if the pacient be strong if that the next day a little bloud be taken out of the deuided veine and so to continue in diet and medicines as is aforesaid vnto the fourth daie the breast in the meane time if it be in Summer being moistned with oyle of Roses in Winter with Vnguento Nardino And if thou wilt vse an Emplastique medicine thou hast an excellent one of our making which boldly thou maist also vse to other wounds it is made of Aspaltum and Vineger and other which are accustomablie mixed to those medicines which Phisitions call Enaema Barbara But if thou cure a woman with childe or him that hath soft flesh the medicine that is called Diachalciteos is verie conuenient whose vertues I haue declared in the first booke of Composition of medicines And by this waie we haue cured many vnto whome wée came presentlie as they felte paine for this is the greatest thing vnto which it behooueth thée to be greatlie attendant whether presentlie vpon the rupture of the vessell thou beginnest the curation that thou dost adglutinate the gréene wounde before there that bée inflamation for if inflamation flowe there is after small hope of adglutination but yet you may prolong the time And the cause that such vlcers can hardlie or not at all bée cured is that when the inflamation is cured the mattier and Sanies of the vlcer are to be taken awaie but in the matrix or bladder they are voide of their owne accorde when as the Patient lyeth groueling and also we maye cleanse them But in the lungs neither of these are to be done Therefore in all vlcers which are in it all the purging that is made is onelie by coughing But if we commaund all quietnesse and small respiration and to speake little that the wound maye adglutinate what hope can there be of curation to thē that cough but the cure is to be dispaired of for that through respiration this member doeth continuallie moue and those that haue bene before our time do iudge it so by the vacuation of the mattier and Sanies But if anie is presentlie cured by this waie the wound wil close and if inflamation do come the cure is both hard and vncertaine when as the mattier Sanies cannot be expelled out of the places of the lungs and that the cough doe stretch the parts affected But those that are brought out of the breast haue a triple aduantage more than that which is euacuated out of the lungs For the substance of Aspera Arteria which is altogether drie voide of flesh is not found in anie parte of a liuing creature These that falleth in the like are wont to be broken if anie other veine or arterie be ruptured the Aspera Arteria remaining sound the translation of the bloud is by opening of the mouths called in Gréeke Sunanastomasis so that in such the bloud which commeth out is neither hot nor red nor yet much and these affectes at the first séeme small not inducing feare through the great euacuation but trulie they are héereby the more perilous for the bloud coniealed about the
from the Sea or somewhat more the place it selfe toward the Sea for Tabia is in the lowest straight which is betwixte Surrentum and Naplis but more one the side toward Surrentum Furthermore all that side of the hill is of good bignesse stretching in length to the Sea Tirrhenum this hill doeth a little bend towarde the West neither goeth it wholie towarde the South therefore this Hill doth kéepe the straight frée from the winde which bloweth from the East Eurus subsolanus and Boreas there is ioyned to this in the lowest of the straight another bigge Hill which the auncient Romanes in their Hystories and those also that bée now diligent call Vesuuium now Vesuuium is a a famous and new name and knowen to all men for the fire sent out of the earth in it which thing doth not as I thinke helpe to the drynesse of the aire and that beside the fire there is not in all the straight either standing water marrish or floud of anie account this Vesuuius Hill is toward all those windes which blowe from the North toward the Eastuall setting of the Sunne and much ashes commeth from it euen to the Sea béeing the ashes of that burnt in the hill and of that which yet is burned all these make the aire drie surelie there may bée the like drie hill in other partes of the earth found that is not farre from the Sea neither yet so bigge that it is subiect to the violence of windes nor yet so lowe that it shall receiue easilie the vapours of the fieldes Beware also that it bée not toward the North so shoulde it bée auerted from the Sunne and if it may bée in a temperate place of the world as that is which is at Tabias it should so much profite let the hearbes in the Hill be these Agrostus and Lotus and Poligonon and Melissofillon the shrubbes also Lentiscus Arbutus and Rubus and Hedera and Cetisis and such lyke and so hast thou the hill prepared The Cattell that doe féede on the Hill at Tabias are Kine and the milke of these beastes is as thicke as the milke of Asses is thin and I truelie least there shoulde bée anie kinde of milke that might profite wanting of Kine thicke milke of Asses thinne and of Goates that which is a meane I did put in to féede both Kine Asses and Goates the olde Phisitions would haue a woman giuing milke to those that are consumed with Pthoe to stande and giue them sucke vnto whose minde I agrée both for that it is naturall and also for that they would haue it taken before it were refrigerated of the ambient aire Furthermore let this bée to thée a great precept that those that shall haue néede to drinke milke that the beast standing present they drinke it presentlie as it is milked putting Honie into it whereas it curdeth in the stomacke or if thou wilt haue it spéedelier to passe into the bellie adde some salt And the young man that had an vlcer through the Pestilence in Aspera Arteria was cured of it and manie other after him Another young man of xviij yeares in age when as he was vexed with Catarrhus many daies first with the cough he voided bloud fresh but not much after that a péece of the pannicle which outwardlie couereth all Aspera Arteria ascending vnto Larinx it séemed to me coniecturing both by his thicknesse and féeling of the patient to be the inward tunicle of Larinx but this hurt not his voice and this also though in longer time it was perfectlie cured but those which come to this affect through the Pestilence séemed to bée verie easilie cured for that his whole bodie was héere purged and dried for that many of them did vomite and all were made laxatiue so that those which escaped wer purged they had blacke Pustules aboundantlie through the whole bodie In many they were vlcerous but in all they were drie and it was manifest to many that beheld them that they were the dregges of the bloud which putrified in the Feauer which as it were lyke certaine ashes Nature did thrust out to the skinne lyke as it thrust out manie other superfluities but there is no néede of Medicines for these Exanthemata when they fall off by themselues in this sorte those that had the vpper parte of the skinne vlcerate the crust of the vlcer fell off and the parte vnder it was almost whole and after a daie or two was ciccatrized others whose skinne was not vlcerate the Exanthemata it selfe was rough and scabbie and fell awaie like a certaine scale and after were cured therefore it is no meruaile though those that haue Exanthemata in the lungs be cured because of the drinesse of the Vlcers the which before wée haue shewed that the purposed scope of curation in all Vlcers that in these Vlcers springing through the pestilence was héere present for they were all drie and rough and many of them like to a scab and many like Lepria therfore séeing that Experience testifieth with reason and that the curation of vlcers haue this one end that is to saie to be exiccated you may saue many of those that casteth forth bloud from the lungs as we our selues haue done The thirteenth Chapter NOw we haue before declared how those shall be cured that haue broken anie great vessell of the lungs either through falling frō high or that they immoderatly did strain them in crying or did beare a burthen aboue their strength or any hard or waightie thing outwardly haue fallen on their brest but how they may be cōueniently cured which putteth forth bloud through Catarrhus we shall now declare putting for more manifest doctrine a like example of that the curation which was done to a noble woman at Rome when as she heard such like talke as we right now had of those that reiecteth bloud out of the lungs that she had spit out in the night somewhat either through Catatrhus or through coughing presently she sent for mée promising her selfe to be obedient to all thinges I would commaund her for she had heard before that time some that if one applyed not presently strong medicines and that before the Vlcer was inflamed all was in vaine and that this was the cause of their destruction which reiected bloud therefore we thought not good to let hir bloud because through the drienesse of hir bodie she had abstained foure dayes from meate But commaunded that she should vse sharpe clisters then with some hot medicine to rubbe much the thighes and handes and after to shaue the head on which I layd the medicine that is made of Stockdoues dung and after thrée houres I bathed hir not touching the head with any fat things thus I couered the head with a conuenient cap and for that time I nourished hir with supping after which I gaue hir some of the Auster fruites of Autumne and when she went to bed I gaue hir of Triakle foure monthes olde and being
if they shall exiccate without mordication That is also an healthfull medicine which is made of Honie Plaister wise béeing made of the best Honie and this be resolued in oyle of Roses which in all respectes is the best and voide of Salt yea and the Waxe also which is put into such medicines must be washed in like sort If thou puttest in anie Turpentine it behooueth that thou wash it and so much the sooner if thou put anie other Turpentine in for the sharpe and biting Sanies is washed and purged awaie by all medicines which thou doest wash But if hée that is wounded bée strong in bodie and voide of superfluous excrements in him it is requisite to vse more strong medicines As I once did whē as a young man studious in Philosophie was wounded in the breast hauing a good strong bodie and burnt with the Sun in the Summer season The Trochifce of Polida dissolued in Sope and afterward made warme beeing put ouer hot water I applyed it as a Liniment For that first of all we must haue regarde that nothing bée colde which toucheth the wound For because the affected part is most sensible and also the chiefe of the principall partes are continuall and of temperament cold by which all occasions that is grieued is with cold sendeth also his greiefe to the braine But if it be of these that come into the muscles it causeth also conuulsiō For we haue shewed in our Anathomie that the muscles are the instruments of voluntarie motion and the like conuulsion shall be looked for in the tendons by the same causes but when as I had applied the foresaid medicine to the wound of this young man and had couered much of the partes aboue the wound with the same I did continuallie foment with hot oyle the partes about the arme pits neck and head and opening a veine the first daie I tooke some bloud from him and the fourth daie this young man also was well insomuch as the vlcer looked wrinkled small and shrunke together notwithstanding I thought good to continue with the same medicines vntill the seauenth daie after which daie he was perfectlie well Trulie you may foment this wound with oyle and chieflie as we haue saide when it is cured for oyle is of contrarie nature to the Trochisce and maketh the Vlcer filthie neither is there small difference to applie oyle to a bare nerue where the skin couereth it Therefore the mattier is to be wiped awaie from the wound with a probe hauing soft lint rolled about it You may if you will wet your Lint in Sapa least that thou touch the Vlcer with drith with Sapa that is Sirium called also with vs and in Asia Hepsama therefore dipping thy lint in this and after pressing it out thou shalt mundifie the Vlcer and let this Sapa bée warme the first daies chiefly but if all things doe prosperously succéed thou maist wet it also without daunger with swéete Wine for all swéete wine is void of all biting qualitie such is the wine called Thereum and Scybelites And next these is Carginum what Wines so euer are swéete and yeolowish such is Falcrun being vnprofitable for all these are sharpe and vnmeasurable hot And the vlcer comming now to ciccatrize white and thin Wine and that which will not abide the mixture with water neither swéete smelling is better than swéete wine and thou shalt eschue the vse of water to a wounded nerue and also a relaxing Cataplasme next vnto the vse of these Trochisces is the vse of Diachalciteos which we openlie vse this must be molten in Sūmer with oyle of Roses but in winter with the Oyle of Sauine we haue described this medicine in the first booke of compounding medicines the Pastilles or Trochisces or call them how you lyst of Polyda are knowne to all men which if you haue not you may take the Trochisce of Andro or Pasio or else our owne which is stronger than the rest And we haue declared that to strong bodies strong medicines are conuenient as to tender bodies gentle medicines this right Methode haue I inuented and experience doth confirme it but Thessalaus with his Sophistes sitting in his high throne shall be had in reputation among brute people as Cercidas saith While he confirmeth by his reasons that there is one curation of gréene wounds neither this to require any Indication to the nature of the parts yet one of so great same in his learning hath excogitated a marueilous cure of wounded Nerues for presently he cutteth them a sunder geuing the wounded man no warning thereof although in this he goeth from his secte for it had bene better to cut a sunder the wounded muscles and arteries veines or any other thing but not the Nerue otherwise that thing which they flie they are found to doe that they may take a contrary indication for the difference of the parts but let vs leaue them and intreate of a Nerue wounded ouerthwart in which there is greater feare of conuulsion inflammation comming of Feuers which are not cut but those which pertaine to the cure of the Vlcer are like also to these Yet it behoueth more largely to take away bloud and vse more thinne diet and to kéepe him altogether quiet in a soft bed and to foment largely with hot Oyle the arme pits necke tendons ligaments and head if the wounded Nerue be in these that are in the legges like as we vsed Oyle to the arme pittes when the wound was in the hand so in these the flankes are largely to be fomented with Oyle and so to ascend by the whole spine to the necke and head And the contused Nerues whereas the skinne also is contused and wounded require the same medicines which is vsed in drying the wounds of the Nerues But yet such medicines as may further draw constringe or binde the parts diuided by contusion but those which are contused without the like affect of the skinne ought to be fomented often with hot Oyle which haue power to euaporate and to haue like regard to the whole bodie as I saw this to happen and dyd spedely cure it fomenting it with oyle but haue often séene the Nerues to be contused with the skinne and the wrestlers for the custome of the accident being taught by vse haue a Cataplasme made of Oximell and Beane floure which truely is an healthfull medicine but if dolour also commeth with contusion it doth behoue to put in molten pytch and boyle them well together and so to apply the medicine hot and if thou wilt make it more drying put in the floure of Eruum and if thou wilt haue it yet more drying put in Iris ilirica the regard to be had to the whole bodie it is common to these as if the Nerue be all cut there resteth after no perill of conuulsion but yet the part shal be weake it hath the same cure that the other Vlcers haue although the Thessalians know
Furthermore Callus in Gréeke or Poron shal so luckely follow when it behoueth to the generation of it as it is afore declared some of the proper norishment of the bone to be gathered together and grow Therefore this is now to be cōsumed away from the lips of the fracture or else to be euapored for else truely it shall make solution of continuitie neither shalt thou let it slip so long time that thou knowest not how the fracture goeth forward for we haue often séene that when the bones were vehemently dryed Callus hardly dyd grow Wherefore it is méete to poure vpon these a little warme water the third or fourth daye leauing when as the flesh riseth in a red tumor and wée must leaue herein before it beginneth to asswage Contrarywise when as we will digest any thing we shall not leaue of before all the tumor be vanished which sprong of the perfusion and whereas the aboundant moisture is and let that Callus doth not better grow there we shall go about with cōuenient ligature to exicate as is before saide and with perfusion of water which must be altogether little or much for it shal be but little when it ceaseth and before any thing floweth to it the humors which be about be digested and doth dissolue those which are déepe fixed For it is expedient so to lose dissolue these which are to be expelled by rolling for a great deale of water doth more digest than attract Surely it is euident that in that ligature which doth expell the endes of the rolles are lesse to be coarcted but wheras we must nourish there the endes must be straiter and the other inuoluings more lose Now séeing we haue founde out not onely what time we must helpe the generation of Callus but also by what maner now there resteth to set out the vniuersall order of diet For in the beginning they ought to vse most thinne dyet as we will proue when we take in hand the proper curation of inflammations Furthermore we will declare that sometime it shal be expedient to let bloud and also to purge but what time Callus is ingendred the bodie is to be nourished with good iuyse which may much nourish of which there accustometh to follow not onely good iuise but that which is also tough of which principally Callus is made for séeing that it cannot grow of a serous and thin moisture that it can spedely grow of that which is grose and brickle and voide of fatnesse but yet in time waxeth drye it is made friable and apt to breake The bignesse of Callus shal be such as it were a safe band to the bones yet not compresse the muscles for that Callus which is to little is not sufficiēt for the bones that which is to great bringeth dolor to the muscles so that diligent hede must be had to encrease it if it groweth to little and to let it if that it doth increse to much And thou shalt doe these both by the quantitie of the perfusion and also qualitie and quantitie of meates and also the faculties of medicines which are to it outwardly applyed but we haue before spoken of perfusion and order of dyet of medicines and such as haue an emplastike substāce do moderately heat they doe both bring forth Callus and also increaseth them But such medicines as haue a digestiue facultie doe deminish those Callus which are now great but if thou studiest that neither Callus shal be encreased or deminished but art content to let it grow further vse thou some of those medicines which are applyed to gréene wounds which because they doe moderately drye they cause Callus moderately to coagulate and grow and this is sufficient touching ouerthwart fractures Now of those that are in length the cure is in all points as the other but yet the ligature must be straiter made in the fractured place and that which is a sunder must be inwardly thrust to those which are diuersely fractured and chiefely with a wound as it doth cōmonly happen to these Hippocrates willeth that splents bowed like a sawe and dipped in redde and auster wine chiefely in sommer be put about it For if any doth vse either Oyle or Serot they doe putrifie because the affect being goeater than the rest doe more drye than they require to be dryed And let all the medicines as he commaundeth be drying but yet considering the meane of excication he willeth such medicines to be of the kinde of Enema But if any shall at the beginning vse an Enemon medicine let it be such a one as is apt to be poured in and all other thinges are to be done after his precepte not onely in these rehearsed but also if the bare bone requireth to be cut with a saw or that thou shalt take away some fragment or that it behoueth to minister to nature expelling it what so euer Hippocrates doubted of those instruments which the legges are to be layde in called Solenas whether they are to be vsed or not all men doe know that I iudge the reasons laudable and Glosconum which is inuented of the later Phisitions we doe account it as worthie of praise as anie other doe vse it when in the time of engendering flesh Yet it séemeth that Hyppocrates knew not that although otherwise he was not negligēt in excogitating instruments which should be profitable but the instruments in which the legs are placed was rightly deuised of them that by one axiltrée which was placed in the end of the instrument at the lower parte caused by a double extension a contrarie indeauour to the whole member the one of thē which extendeth the member right out is called in Gréeke Eutigporos the other which extendeth it first vpward afterward backward is called Translatiue in Greeke Metaleptice both are done by bands or cordes that band is most aptest to this vse that hath two ends for this being put about the member the armes being put about the axiltrée of it maketh the first extension called Eutigporos and when as the band is put about the parts of the broken member it maketh the translatiue extension called Metaleptice the armes of him being moued first vpward after backward for these are also to be put about the axiltrée Furthermore the armes with the bands being put about as it were bowed the extention which is made frō the higher parts to the lower ought to be done by the pulley or vice which are placed in the sides of Glottocomon thou maist call this instrument Solena with his adiection Solena Machanicum or Glottocomon Mechanicum but we shal more largelie speake of instruments whē we set out the cure of luxations where also we will no lesse speake of the varietie of ligatures which are to be put about Now séeing I haue made mention of Solena Mechanicū which doth much profit the leg but when it is reposed otherwise put or whē as the