set down to the which I refer the Reader The End of the first Part. BARBETTY'S CHIRURGERY The Second Part. Which treats of Tumors Wounds and Ulcers In three Books The First Book of the Second Part of Chirurgery Of Tumors CHAP. I. Of Tumors in general A Tumor besides Nature is a Disease in which the Parts of the Body are indecently inlarlarged and extended so that they are rendred unfit to perform its Actions The Differences of Tumors are taken 1. From the Part affected as an Inflammation of the Eyes Jaws c. 2. From the Causes The Causes are 1. The Parts of the Body removed out of their Natural place 2. The Four Humors as well Natural as Preternatural viz Blood Choler Phlegm Melancholy to which likewise we add Serum and Wind. Tumors for the most part are generated from the Humors and that either by Congestion or Fluxion They come by Congestion when the Natural heat of the Part being diminished the good Humors are ill concocted or the vicious are not sufficiently evacuated By Fluxion from a two-fold Cause External viz. a Fall Blow External Heat too great Motion c. Internal viz. Pain Superabundancy Thinness Acrimony of Humors c. The Signs of Tumors are an Extention of the Part Pain Redness Heat Hardness c. But these are better explained in particular Tumors than in general The times of Tumors for all curable Tumors have four are as followeth Beginning when the Part begins to swell Increase the swelling pain and other Symptoms are augmented State the Symptoms stand at a stay and grow not worser Declination when the Symptoms are diminished Prognostick Tumors produced from Phlegm or Melancholy are hard of Cure Those are dangerous which are generated from corrupt Blood or Choler which seizeth the Internal Parts which shew themselves about the greater Vessels Joynts Nerves and the Membranous or Noble Parts Those that are of great bigness and that happen in Cacochymick Bodies They are Terminated four ways 1. By Dissipation which the lessening of the Symptoms do declare 2. By Suppuration wherein the Pain and Pulsation is increased together with a Fever 3. By Induration which the too often and immoderate use of Repelling and Dissipating Medicines hath caused 4. Degenerating into a Gangrene from the defect of Natural Heat The Cure is performed two ways 1. By hindering any further Flux to the Part. 2. In removing that which is already gathered in the Part. We stay the Flux of Humors 1. By Intercepting 2. By Repelling 3. By Revelling 4. By Derivation 5. By Corroborating the Part it self The Matter already gathered is taken away 1. By Astringing and Repelling Medicines to wit when 't is thin and sticks not too firm to the Parts 2. By Resolvents when it is thick and adheres more firmly to the Part. 3. By Suppuratives when the other are too weak 4. By Fire and Cutting when other means effect nothing CHAP. II. Of Inflammation A Phlegmon or Inflammation is a Tumor besides Nature from Blood thrown forth into the Skin or Subjacent Muscles causing Heat Redness Pain Pulsation and Tension Difference 'T is Perfect when from Blood alone Imperfect when Choler Phlegm or Melancholy is mix'd with the Blood and then 't is called Phlegmone Erysipelatodes Oedematodes Schirrhodes The Cause is sometimes Blood alone sometimes mixt with other Humors Signs are Heat Redness Pain Pulsation Shining Tension Hardness Renitency Prognosticks An Inflammation of the External Parts frees the Internal from many Diseases always wholesome except from its too great Extention it produceth a Gangrene dangerous and of hard cure is that which seizeth on the Eyes Jaws Penis Pudendum Muliebre and Joynts In a young Person and in Summer soon cured longer of Cure in a fat than a lean Body The Cure hath four Indications The first of these respects a good Diet let him chuse a clear Air his Meat and Drink little and that cooling all hot sweet and fat things as Pepper and Ginger are hurtful as also the motion of the Body especially of the Part affected Sleep is very convenient All Costivenefs Anger and Venery are noxious Second that stops the further Flux of the Humor which may be performed by Revulsion Derivation Repelling and Interception therefore let a Vein be opened as soon as possible it being most necessary Revulsion is made in the Opposite and most Remote part Derivation in the nearest If you may not open a Vein you must use Leeches and Scarifications Whilst these things are done seeing the Body is seldom clean but that always there are ill Humors mixt with the Blood by Purging rightly used and often repeated as also Bleeding we effect much In the mean time the Part affected requires Repelling Medicines from which we must abstain Where 1. The Noble Parts send the Humors to convenient places and to the Glandules 2. Where the Humors are Malignant 3. When Critical 4. When the Body is very impure 5. When the part affected is very weak or painful 6. Where the Inflammation is about some Noble Part. Repelling Medicines The Roots of Bistort Tormentil the Leaves of Cyprus Mirtles Plantain and Oak the Flowers of Balaustians and Roses Quince-seeds Red Sanders Galls Acacia Dragons Blood Whites of Eggs Vinegar Red Wine Allum Bole Oyl of Roses Myrtles Empl. de Spermate Ranarum Take Rose-Vinegar two ounces Whites of Eggs beat together No. 2. Bole-Armenick three drams Lap. Hematitis a dram Mix them Take the Juice of Housleek Purslane and Plantane of each an ounce Rose-Vinegar sowr Red Wine of each an ounce and half Oyl of Myrtles an ounce Stir them together in a Leaden Morter adding to them of the Powder of Pomegranate Rinds and Bistort of each a dram Make it into a Linament 3. Indication requires the taking away the Humor already in the Part. Here Resolvents are first to be used but they not effectual then Suppuratives Resolvents or Discussives Roots of Galangal Orrise Dill Southernwood Rue Savin Flowers of Camomil Melilot Elder 2 Aniseeds Carraways and Cummin Ammoniacum Bdellium Sagapenum Tacamahac Oyl of Dill Nard Rue Bays Ointment of Agrippa Martiatum Emplaisters of Betony Oxicroceum Diachilon Leaven the Dung of Beasts Spirit and Lees of Wine Take Roots of Orrise Marsh-Mallows of each an ounce and half the tops of Wormwood Flowers of Camomile Melilot of each one Pugil Herbs of Pellitory of the Wall Mullein of each one handful Meal of Barley and Fenugreek as much as is sufficient Boil them in White Wine then being beaten together add of Oyl of Orrise and Camomile of each an ounce Make it into a Cataplasm Or Take Cows-dung three ounces Juice of Hemlock one ounce Oyl of Camomile half an ounce Castor two drams Bole-Armonick half a dram Red Myrrhe two drams Saffron one dram Meal of Lupines as much as sufficeth to make it into a Poultice Suppuratives Marsh-Mallow Roots Mallows Camomile-Flowers Figs Galbanum Bdellium Sagapenum Ammoniacum Fat of Hogs Geese Ducks Hens Oyl of White-Lillies Ointment of Marsh-Mallows both
the Arteries to be conveyed through the whole Body every part of this Blood nourisheth those parts which are of the like temperament with it self the Hot part of it nourisheth the Hot the Dry the Dry the Moist the Moist c. that which is here not well concocted must be brought back again to be perfected Why we say that the Veins are not sufficient and the passages not commodious enough to perform the same whose Office we know is to bring back to the Heart the Blood not sufficiently concocted the Reason is that the Water always remaining in the Vessels rendered the Blood too thin so deprived it of its natural consistence and strength From all those so clearly and distinctly laid down it sufficiently appears what the CIRCULATION OF THE BLOOD is to wit a continual motion of the Blood out of the Arteries into the Vena Cava and Porta to the Liver and Heart that in them it may be fitted for the Nutrition and the life of the whole Body Out of the subtilest part of the Blood are the SPIRITS produced which are two-fold 1. Vital which begotten in the Heart carry life to the parts of the Body 2. Animal who out of the Vitals elaborated in the Brain impart Sense and Motion to the Body The Natural at the same time that the Circulation of the Blood was found out vanished Chirurgical Considerations 1. The Ductus Salivales when the string of the Tongue is to be cut or the Ranine Vein to be opened or any other Disease of the Tongue that is to be cured by Manual Operation warn you to have great care of those little Glandules in which they end that they might not be hurt with the Launcet lest there follow a continual spitting The great Glandule also of the Neck from whence these Ductus's take their rise when it is inflamed admits not of the use of Mercury for from hence a dangerous Salivation may very easily be raised 2. The Lacteal Veins either the greater or the lesser are oftentimes from a Contusion or Wound so greviously hurt that they cannot carry the Chile to the Heart and though the wound be cured with great diligence care and speed yet the Patient will fall into a Consumption whence follows Death inevitably This Truth will defend Chirurgeons from many Calumnies In Children and older People is often perceiv'd an induration and inflamation of the Abdomen the cause of which is the hardness of the Mesaraic Glandules which allow not passage for the Chile to the great Lecteal Vein except the very thinnest of it whence the flesh of the Muscles wasts the Body becomes heavy and weary and at length a Feaver and a wasting of the whole Body This evil I use to remedy without any great trouble with this External Liniment Take compound Oyntment of Marshmallows Ointment of Sow-bread of Martiaton of each two drams Oyl of white Lillies of Camomile of each three drams Mix it into an Ointment Inwardly the following Troches are excellent being continually used the whole time of the Cure Take prepared Steel prepared Crabs-Eyes of each a scruple Vitriolated Tartar half a dram Sal Prunella xvj grains Species Aromatici Rosati a scruple white Sugar two ounces Make them into Troches according to Art In this case Purging is not to be used but with Cassia Cream of Tartar and Laxative Syrups for the Glandules will not bear strong Purges 3. The Blood taken out upon the opening a Vein oftentimes after some few hours space appears very dry and destitute of all Serum which for the most part is ascrib'd to its too great Heat and Adustion but this Argument is very invalid for if the same day the same or another Vein be again opened there will be found a great quantity of Serum in the Blood therefore the true Cause is to be deduc'd from the Circulation of the Blood but especially in the Lymphatick Vessels which at that time draws the Serum and Humidity and so leaves the Blood dry It very often also happens that the Body becomes Tumid Turgid and Languid upon which the fearful Physitian forthwith pronounces nought but dangers When with the use of Internal and External Sudorificks the Patient in a short time may be cured The Cause of this Disease is not from the intemperature and debility of those parts the Ancients call'd Noble for it may easily be distinguished from the Dropsie which these parts occasion for although the sick persons are very dull and weary yet are they not anxious but breath free and the Belly swells not much In the Face and Joynts especially is a watry Matter collected but if the swell'd parts are compressed by the Finger we perceive much less Serum to be contained in the parts than in a true Dropsie from whence those that understand not the true Cause are wont to ascribe this Inflammation to wind But the Lymphatick Vessels when comprest broke or by any other way obstructed so that the natural motion of the Lympha is hindred occasions this evil 1. The Circulation of the Blood requires all venomous and deprav'd Humors which are thrown out either by Nature it self or that outwardly happen to the Body at the very first instant forthwith to be expelled out of the Glandules and the Skin by the means of attractive Medicines lest that the whole Blood in a very short time be infected and the Heart it self opprest and suffer under it The which doth sufficiently declare how dangerous it is to open a Vein and to purge in a Venereal and Pestilential Bubo nay in all venomous Wounds as on the contrary how necessary it is to cast forth the offending matter by the use of Sudorifick and Attracting Medicines As moreover how that the invention of the Circulation of the Blood is of very great use in the Art of Physick CHAP. XV. The Division of the Body MAn's Body is most conveniently divided into the Venters or Regions and Joynts There are three Venters 1. The Head or the supream Region or Cavity to it is joined the Neck which is its prop. 2. The Thorax Breast or middle Region 3. The Abdomen lower Belly or lower Region The Joynts are the two Arms and the two Legs Chirurgical Considerations We divide the Body after this manner that it may be known what place each part of the Body ought to keep to those that read the following every thing will become more manifest But there is so great consent of all the Parts so great concord that no part may be by it self consider'd without a consideration of the whole therefore I think it necessary that in a few words the foundation of this mutual consent be here declar'd 1. In every part is required a natural temper for the Liver being too hot the Stomach too cold the Brain too dry c. the whole Body must be out of order 2. A sufficient number for in the Hand if the least Bone Tendon or Artery c. be wanting forthwith its
30 hours or more been troubled with the Spots at length after exceeding great pain accompanied with a Delirium he voided first Blood and after that a purulent matter through his Yard by which means he was restored to his health I conjectured that there was a Carbuncle in the case which seized not on the Membranous part of the Bladder but on the Neck thereof As to the Cure Blood-letting is very prejudicial to those that already have the Plague and dangerous to such that would prevent it The Poison oftentimes lies hid within the Bâ—dy for some dayes weeks or months before â—â— discovers it self by seizing on the conveyances of the Blood Wherefore I would advise you seriously to consider if by opening a Vein you invite it immediately to the Heart whether the diminution of Blood Spirits and Strength which is effected by this means be not the Cause why the Heart is suffocated and deprived of that vigour which it should make use of to repulse the Enemy I confess some Experienced Physitians of good credit have reported that in hot Countries there is no better means for restoring a Patient visited with the Plague unto his health than that of opening a Vein provided it be done cautiously and at the beginning of the Disease but whosoever have attempted it in colder Climates have quickly learnt by experience that it ought to be forborn Purging which is oftentimes very necessary in other gentle Diseases is excluded by the Malignity of this But every one is not quick-sighted enough to discern when it is requisite to be done and when to be forborn Moreover it is evident that in a Malignant Disease the Physick which is administred to a Patient ought to be more mild and gentle than at other times for besides that the Body cannot then bear strong purgations a Dysentery is oftentimes the consequence of them I have when I have been fully perswaded that there was no Malignity in the Disease oftentimes used this or some such like Potion with good success viz. Take Rhubarb a dram and half Senna two drams Cream of Tartar a dram Scorzonera-Roots half an ounce Aniseeds half a dram Boil them in Holy-Thistle-Water and to three ounces of the strained Liquor and Syrup of Succory with Rhubarb six drams Spirit of Salt a little Confection of Alkermes a scrupel Make it into a Potion I never adventured to prescribe any thing Purgative to such as have been taken with the Plague before the fourteenth day at which time the Fever and the other Symptoms of the Disease would be abated There are some who have attempted it while the Carbuncles remain purulent and before the Bubo is perfectly cured But I dare not advise any one to follow that Method whatsoever Remedies they administer at the same time which may be intended specifically against the Plague But if it happen that the Patient for several days be very costive and troubled with a pain at his heart and hopes to be relieved by Purgation It is to be considered that the Venom of the Disease and not the Costiveness is the cause of the pain at the Heart it is therefore most requisite to make use of Sudorificks to corroborate the Heart and not to concern your self for the costiveness of the Body but if you desire to open it a little it is better to make use of a Suppository than a Glyster which is not altogether so safe but hath been prejudicial to many on this occasion and to others it hath done but little good and not at all opposed the Malignity of the Disease But to such as will not take this advise which hath been very confirmed by experience and several good Reasons and will still persist to make use of Glysters it is fit however that they forbear to prescribe Scammony as an Ingredient especially to Women in the time of their Flowers Juleps are in this case very necessary but all persons may not make use of them nor any at all times I am never wont to prescribe them without joyning with them some Sudorificks which will appear hereafter and this I take to be the safest course for if the sick person should make use of such things only as refrigerate while he sweats freely the Sweat would oftentimes strike inward and the Venom would be conveyed to the Heart from whence would follow sudden Death There is no means more requisite than that of Diaphoreticks and Cordials especially those that are acid which produce such effects as are certain and therefore the more laudable for they rectifie the Mass of Blood and free it from the venom which infects it They dissolve the pituitous Matter which is lodged in the Stomach and the Entrails and correct the Choler which in this Disease is the cause of much mischief Nevertheless the several disguises of this Disease and the vanity of the Symptoms which attend it do require that they should be often changed since when the Disease is more gentle those things are not to be used which would do good service in an accute one Medicaments against the Plague Roots of Zedoary Butter-Bur Angelica Ditamny Galangal Vipers-grass Gentian Master-wort Lovage Burnet Orrise Florentine and ours China Sarsaparilla Leaves of Rue Scordium Sage Holy-Thistle Swallow-wort Wormwood Southern-wood Centuary the lesser Valerian Sorrel Fluellin Balm Marjoram Rosemary Thyme Mint Flowers of Borage Bugloss Violets Roses Marrigolds St. John worts Rosemary Indian-Spikenard Jesamy Seeds of Citrons Oranges Rue St. Johns wort Anise Coriander Lovage Fruits Citrons Oranges Walnuts Figs sharp Cherries Pippins Ribes sowre Pomegranates Barberries Spices Musk Ambergreece Civet Benjamin Storax Calamita Cinamon Mace Nutmegs Cardamums Camphire Animals or their parts Flesh of Vipers Mummy Serpents Quails Thrushes Harts-horn Unicorns-horn Bezoar Stone of an Indian Hog Ivory Castor Precious Stones and Earths the Jacinth Granate Emerald Ruby Carbuncle Pearls Coral Bolearmenick Earth of Lemnos and Seal'd Gold Silver Salts Common brought lately from the River Nile which moveth Sweat most powerfully of Scordium of Wormwood Rue Self-heal Holy-Thistle Vitriolated Tartar Bezoarticum Minerale Threacle of Andromacus's Diatesseron Mithridate of Damocratis Diascordium of Fracastorius Confection of Alkermes of Hyacinth Species Liberantis Electuaries of the Egg Rob. of Currans of Barberies Conserves of Balm Mint Rosemary-Flowers Borage Bugloss Marigold-Flowers Troches of the Juice of Barberries of Citrons Out of all which you may make choice of such as you judge most fit for the purpose The Writings of Authors who have treated of this Disease will give you an account of other Compounds out of which you may chuse such as please you best I shall here propound such only as I have found to be most efficacious and which I shall constantly make use of till by experience I shall discover some others whose nature is more excellent and that the use of them may the more plainly appear I shall premise some Medicaments that some years since were prescribed by my self and those Learned Men Dr. Francis Sylvius
it well observing here that the Arm during the whole time of Cure must remain in that posture in which it was extended otherwise the Fracture will upon the least change of its posture slip out again Where yet 't is to be understood that the Chirurgeon after the second or third dressing as often as after that he dresseth the Patient must stretch out his Arm strait to the end that the Tendons which run from the Arm and are inserted below the Elbow shrinking by the long lying still may not cause a troublesome stiffness However this shrinking of Tendons which are by pretenders to Chirurgery ridiculously call'd Nerves may yet conveniently be cured in two or three months if you make the Patient to carry every day some weight and endeavor to relax and mollifie the Tendons with Fomentations and Embrocations abstaining from the use of any Brandy or any other corroborating and astringent Medicines I have always found successful the following Unguent Take Man's and Duck's Grease of each one ounce Oyntment of Marsh-mallows half an ounce Oyl of Earth-worms white Lilly and Camomile of each two drams Make an Oyntment This broken Bone is cured in forty days The restoring of the broken Thigh-bone hath nothing different from this 12. The Elbow hath two Bones of which the greater is called Radius the lesser Ulna both Fociles The small Focile being broken 't is easie to restore it The Cure is harder when the great one is broken and yet harder when both are broken In which case the extention is to be made the stronger When they be well set and bound up then must the hand be placed a little higher upon the Chest than the Elbow and afterwards every second or third day without pain or violence the Arm is gently to be stretch'd out to the end that the Humors flowing thither and there staying too long may not cause a concretion in the Bones and a stiffness in the Arm as not extensible any more It is cured in thirty days 13. The Leg hath also two Bones the greater called Tibia and the lesser Fibula Their Cure had nothing different from the next foregoing 14. If the Patella or Knee-pan break cross-ways the Patient commonly remains lame If it break long-ways then by the Muscles that draw upwards without any great help of the hands it is almost of it self restored and cured in twenty days CHAP. V. Of the Nature Difference Signs Causes Prognosticks and Cure of Dislocations in general A Dislocation is a forcing of the Bone out of its cavity and natural place into another hindering voluntary motion The Differences are taken 1. From the manner for sometimes the Bone is altogether forced out of its place and that is properly called Luxation or Dislocation Sometimes it is got out but a little or half which is called Sub-laxation or Elongation 2. From the Cause for sometimes it is from an external accident as by wrestlings Falls or Blows c. Sometimes from internal Causes by the afflux of Humors The Causes are of two sorts 1. External Such as are Falling Beating Running Wrestling and vehement extention as it often happens to Women in Labour through the unskilfulness of Midwives yea by a violent stroke or fall even the Bones of the Infant in the Womb may be dislocated 2. Internal By the afflux of Humors which falling into the Joints relax and resolve the Ligaments and so causeth the Bones to slip out of their places The Signs especially in a lean Body are manifest enough The Bone causeth in the place to which it is forced a tumor or rising and in that whence it is forced a cavity If there be a perfect Dislocation the Member will be drawn up and shorter unless the luxation happen by the laxity of the Ligaments than it becomes longer the part is painful chiefly upon motion In a Subluxation these Accidents are lesser and seldom all together Prognosticks In Children and other tender Bodies the Bones may be reduced more easily but are kept in with more difficulty the contrary happens in strong and full grown persons The Dislocation of the Head is mortal that of the Vertebra's dangerous and that which is inveterate is hard to be cured That which proceeds from an inward Cause is of a slower Cure and does easily return Cure The Bone forced out must be reduced to its place either by the Hands Ligatures or Instruments but by which of these three it shall be performed the Nature of the affected part will declare 'T is certain that these four Manual Operations Extention Setting Binding and Well-placing must here be used as well as in Fractures of Bones Extention must be made so great that there may be a cavity between the Bone that remains well and that which hath been forced away to the end that in the setting the one may not rub against the other whence afterwards are wont to rise very grievious and sometimes incurable Accidents In the Setting care must be had not to wrest the Bones nor the Muscles but to keep their natural figure Before you proceed to binding up the Member endeavour to preserve the part from inflammation and flux of Humors and strengthen it with the following Medicines A strengthening Plaster Take Frankincense Mastick Bole-armonick Dragons-Blood of each half an ounce fine-Flower an ounce Roots of great Comfrey two drams Weather-Sewet three ounces white-Wax as much as sufficeth to make a Plaister Another Take Litharge Wax Rosin of each three ounces being melted over the fire add to them of great Comfrey Bean-Meal Bole-armonick steeped in Vinegar and dried of each three ounces Tragacanth two ounces Make it into a Plaister If the pain or other symptoms do not necessarily require it you ought not to loosen the Bandage before the fifth sixth or seventh day and then do it with as little motion as is possible Lastly lay the Part even and in such a posture in which when found it can longest remain without trouble If you find the Dislocation accompanied by an Inflammation beware of extending the part or doing ought to it before that be removed which you are to do first with emollient and afterwards with discutient Medicines An Emollient Unguent Take the compound Ointment of Marsh-mallows two drams Hogs-grease half an ounce Oyl of white-Lillies Roses and Mirtles as much as is sufficient to make it into a Linament A Discutient Plaister Take Colophony Frankincense Mastick Pitch of each an Ounce Cummin-seeds Fennel-seeds of each six drams Wax and Oyl of Dill as much as sufficeth Mix them and make it into a Plaister CHAP. VI. Of particular Dislocations 1. THe Jaw-bone except it be in young Children can hardly be dislocated otherwise than forwards Sometimes it is only dislocated in one side and is easily restored sometimes in both in which case it is difficult to set and very dangerous and often mortal It is very seldom luxated from a debility of the Muscles sometimes from the laxity of the Ligaments for
either with hands or Bandage and mean while reduce it into its place If the Hip be forced out forward the Groin is swoln and the Buttocks fallen the Leg is neither longer nor shorter nor cannot be bent but with trouble and the Urine is suppressed Though it be not set aright yet the Patient in time will be able to go well enough upon it though sometimes it falls out that he must somewhat trail his Leg after him To restore it let the Patient lie on his sound side and strongly stretch out his Leg press it into its former place and in case the hand be too weak thrust it in with your Knee If it be dislocated backward the Patient can neither stretch out nor bend his Leg nor is he able to bring his Heel to the ground and if he should force himself to do so he would fall backward the Leg is shorter there is a hollowless in the Groins and if the Buttocks be pressed upwards you shall find an unusual swelling Though it be not put in yet the pain will in time vanish and then the Leg may be bent again but it remains shorter and straight nor is the Foot turned inward nor outward Lay the Patient on his Belly and strongly extend his Leg mean time apprehend the Thigh bone above the Knee stretch it outward from off the sound Leg press the Head into its Cavity in which yet it will not stay if thenceforth the Patient do not keep himself very quiet 10. The Dislocations of the Tibia and Fibula are cured after the same manner as those of the Cubitus and Radius 11. If the Knee pan be out of its place let the Patient stand upright and press it in again lay on the side whence it hath been forced away a hollow Splint answerable to the shape of the said Pan and below in the cavity of the Leg put one or more compressing Splints binding the whole Leg so stiff that the Knee may not bend CHAP. VII Of Ruptures HAving thus roughly handled the boney and hard parts of the Body it now follows that I treat the soft and fleshie more gently and describe their Synthesis or re-unition again Therefore I begin with the broken Peritonaeum which sometimes gives way to the Intestines at other times to the Cawl and not seldom to both to get out of their natural place into the Groins or Scrotum there causing a Rupture called Entorocele or Hernia Intestinalis if the Guts come out an Epiplocele or Hernia Omentalis if the Omentum or Cawl be out The Peritonaeum is made up of two strong but soft Membranes which do so contain whatsoever is included in the Belly or lowest Cavity that when sound nothing can fall out In Women the Os Pubis is its utmost Limit In Men its outermost Membrane reaches farther and constitutes the first proper Coat of the Testicles In the Groins it comprehends the Seminal Vessels as in a Sheath called Processus or Productio Peritonaei This being stretch'd or enlarged or coming to burst is the proximate cause to the lately mentioned Ruptures The Groins therefore are the usual places of Ruptures But do not imagine that the Peritonoeum cannot be distended or burst in other places and there to cause a Rupture It happens sometimes above the Navel yet seldom Beneath and on the side of the Navel far above the Groins I have not only seen it often with many others but seen it ordered and dressed just like an Abscess the Chirurgeon giving no other reason for his mistake than that it was not the place of Ruptures which those that love the Art and their own Honour may take notice of Most times the Ileon falls down yet sometimes the other Guts come out with it and fall into the Scrotum which cannot come to pass by a simple distention of the abovesaid process but that necessarily in all such great Ruptures it must be broken The Causes which make the Peritonaeum to burst or to dilate are Falling Leaping Blows bearing of heavy Burdens strong Vomiting or Coughing difficult going to Stool Winds retained and all vehement Motions of the Body Signs The Tumor is sometimes bigger sometimes lesser sometimes altogether vanisht but with the least Motion returning Though the Caul or Intestines should be fallen down never so much they may easily without any pain be thrust in again unless Wind or Excrement hinder it in which case the Rupture is very painful If the Intestines be full of Wind the whole belly is tense you may hear a noise and the Patient breaks Wind upwards and downwards If the Excrements be grown hard the Patient goes with difficulty to Stool and the swelling weight and hardness little by little encreaseth If the Peritonaeum be only relaxed and widened then the Tumor from little becomes bigger by degrees but if it be broken it suddenly descends Prognosticks In little Children Ruptures are easily cured in aged people slowly or not at all especially if the Peritonaeum be burst If the Intestines be filled with Wind or Excrements there follows pain and if that be not suddenly removed an Inflamation Gangrene and at last Death it self Cure Lay the Patient on his Back with his Legs on high and a little asunder by which it often comes to pass that the Caul or the Intestines return of themselves into their former place but that not happening press them in gently with your fingers And if you cannot effect this by reason of Wind or hardened Excrements then use the following Medicines Where the Excrements are indurated Take Roots of Marsh-mallows two ounces of white Lillies one ounce Leaves of Mallows Violets Pellitory of the Wall of each half a handful Flowers of Camomile and Melilot of each two pugils Bran half a handful Boil them in Water and to the Liquor Add of Barly and Bean-meal of each three ounces Lin-seed and Fenugreek of each two drams Oyl of Roses and white Lillies Ducks-Fat and Hens Fat of each an ounce Make it into Cataplasm In case this Cataplasm be not sufficient or seems not to be so then bathe the Patient two or three hours in Oyl sweet Milk or Water wherein Emollients have been boyled not forgetting in the mean time Clysters and Purges Against Wind. Take Oyl of Camomile Rue of each one ounce Oyl of Nard and Dill of each three drams Spirit of Wine two drams a little Wax Make it into an Oyntment Another Take Oyl of Wormwood one ounce Oyl of Nard and Nutmeg exprest of each half an ounce Oyl of Mace and Carraways distilled of each one dram Malmsey an ounce and half Boil it a little then add to it as much Wax as is sufficient to make it into an Ointment Inwardly use the seeds of Anise Fenel Carraways and others Medicines dispelling Wind which also are to be mixt in the peculiar Clysters requisite to this purpose Also the Cumin Plaister used by some may here do good service Or Take the Styptick Plaister of Crollius Gum-Caranna
Belly-ach that the membranes of the Pudenda were so far stretcht out that the unskilful have taken it for the Matrix it self and do so still For though many Authors have dared to write that the Womb may be cut out without danger of life seems altogether impossible to a skilful Anatomist To cure this Disease lay the Patient on her back with her Knees on high and Legs asunder then take a Wax-Candle of a competent thickness mix therewith some Castoreum or Assa Foetida and with it gently press the Womb inward and having sastened the Candle with a Bandage apply outwardly to the Belly the Emplastrum Barbarum or the following Take the Roots of Cyprus Bistort of each a dram Galls Acacia of each half a dram Cypress-Nuts Date-stones Myrtle-Berries of each one dram Pitch and Colophony as much as sufficeth to make it into a Plaister Then presently enjoyn the Patient to lie still with the Legs cross and to beware of speaking aloud of scolding and of whatever may occasion coughing or sneezing Here great care is to be had that your Wax-Candle be not too thick to the end that by its continual friction it may not cause Fluorem Album whereby the strength of the Body would certainly come to decay Yet because ev'n by the greatest care and circumspection this inconvenience will hardly be altogether or always prevented therefore those do very well and discreetly that long-ways perforat the Candle and thereby give a convenient passage for the humors flowing that way CHAP. IX Of the falling down of the Fundament IF the Gut be sunk down anoint it with Oyl of Rose and Myrtle mixing a little Powder of Galls amongst it and with your Fingers and a small Linnen-Rag put it in If an Inflamation hinder the reducing it then bathe the Anus with these Medicines Take Flowers of Elder Camomile and St. John's-wort of each a handful Red Roses rwo Pugils the tops of Wormwood and Melilot of each half a handful Boil therein Milk and Red Wine and bathe the part Here especially care is to be had that no external cold may come to the fallen-out Anus for then you may sooner than you are aware of be surprized with a Gangreen Wherefore do your utmost to put it in again with speed and in the mean time endeavor with the above prescrib'd Bathing and warm Linnen Rags to preserve its natural heat There is yet another though in appearance ridiculous yet in reality a good way of reducing the Gut With a strong hand strike five or six times the Patient's Buttocks and thereby the Muscles called Ani levatores will presently draw the Anus into its right place again But before the Patient be thus chastized take care that the Gut may first be anointed with Oyl of Roses or of Myrtle CHAP X. Of the second Operation called Diaeresis or the seperation of what was united together HItherto we have joined together again what had been disjoined now it follows that we separate what is united and treat of the second Manual Operation called Diaeresis which teacheth us the manner of Cutting and Burning and that both in the hard and soft parts of the Body In the soft the Cutting is called Incision In the hard it is performed four manner of ways By Terebration or Perforation by Rasion or Scraping by Limation or Filing by Serration or Sawing Burning is done either by an Iron which is the Actual Cautery or by Medicaments called the Potential Cautery as shall be declared particularly hereafter CHAP. XI Of opening a Vein BLeeding one of the greatest Remedies in the Art of Physick is sometimes highly necessary but sometimes so dangerous that it ought not to be used without very urgent Causes Here therefore I think it will be better somewhat to digress for fuller information than to leave the unskilful in their error The Blood is the darling of Nature by whose assistance she performeth all her Operations and which can hardly be drawn from her without dammage yet does Art require that those who meddle with it being neither venturous nor timorous but discreet and couragious and making out of necessity a virtue do sometimes proceed to the opening a Vein yet for no other than these four following causes 1. In a Plethora or super-abundance of blood that by this means Nature may be eased of her too heavy burden and the innate heat preserved from suffocation 2. For Revulsion-sake when the blood and the therein mingled humors by flowing too plentifully to this or that part hinder the Cure Here you are always to chuse a Vein of the opposite side and that sometimes the farthest distant sometimes the nearest 3. For the Derivation or conveyance of the Blood which is already got into the part but is not yet altogether setled there nor extravasated into another place in which case a Vein is to be opened the nearest to the Part. 4. For Refrigeration when the heat of the Blood is so excessive that it cannot be allayed by cooling Medicines or not time enough These limits are too narrow for some who will needs take into those a fifth cause which they make the Corruption of the Blood held by them to be as great an inducement for bleeding as any of the four by us recited to the end say they that Nature being rid of part of what is corrupt may be the better able to correct what remains But I much wish 1. That they could make this discharge without the loss of that strength which is so highly necessary 2. That they would be present when their Patient is to bleed and precisely tell to what degree of corruption his blood is come that so the Chirurgeon may know how much of it he is to take and how often forasmuch as they will not allow that Bleeding is good in all sorts of the Blood 's corruption but in that only which is not gone considerably far 3. That they would declare why they will have cur'd the greater corruption by Purging and the lesser by Bleeding since that they give to the one as well as to the other and that duly the name of Cacho-Chimia Let them shew that things differing only secundum Majus Minus do differ in specie and so require specifically different Remedies Others proceed yet further and shed innocent Blood in all sorts of Fevers without any consideration of spots of the Plague or of Poison it self thus freeing themselves from a great deal of labor and trouble otherwise caus'd to the Physitian from the variety of Fevers But because the nature of all Poyson and Malignant Humors is continually to assault the Heart and suddenly to prostrate the strength of the strongest Persons and since Bleeding doth likewise both not only diminishing strength but also drawing the malignity toward the Heart and driving in again for the oppression of Nature what she had thrown out for her relief I do intreat and warn all the Practisers of our Art That as they love the
less danger than the next foregoing and people oftner recover upon it yea Learned Writers assure us that by this Operation and the use of Injection they have cured many of Ulcers of the Lungs Concerning the Place of Opening Authors are not agreed in it the reason whereof is obvious For the Diaphragma runs higher in some persons than in others whence it comes to pass that the collected Humors in some Patients lie higher than in others Secondly the Chest is raised in some flat in others which here much alters the case Besides the Lungs do often grow so fast to the Pleura that the sanious matter cannot easily be carried into the Cavity of the Breast In which case it would be ill done to chose the place of Opening lowest in respect of the Diaphragma And in regard that in this as in other swellings the most eminent place is esteemed the most convenient for opening it cannot be otherwise but that one Chirurgeon hath made choice of this place and another useth that place as the best Upon which account Hyppocrates Guido Amatus Lusitanus c. do make the apertion between the third and fourth Rib counting from beneath upwards Fienus Riverius and many others between the fourth and fifth Paulus Aegineta Vidus Vidius Fabritius ab Aquapendente Sennertus c. between the fifth and sixth which place in my opinion is the safest for if higher the Pericardium if lower the Diaphragma may be wounded of which there have been many sad Examples But in this difference of dissenting Writers what hath been said will direct you to pass into the safest Haven All things therefore well considered chuse the place where to make your Apertion not the forepart for before the Sternum or Breast-bone will hinder your operation here nor in the back-part for the Ribs are so close to one another that without hurting some Vessels you cannot make any Apertion there but on the side four or five inches from the Sternum Neither ought the Incision to be so near to the upper Ribs as to the lower because the intercostal Vessels viz. the Vein Artery and Nerve lie in the lower part of each Rib where Nature hath assigned them a place branching themselves into the middle of the intercostal Muscles which dissemination nevertheless hinders not but that the Incision may be made in the middle between the two Ribs After you have marked the place with Ink charge the Patient to breath forth as long as possibly he can without taking it in and in the mean time make an oblique but small Orifice and put into it a Silver or Leaden Pipe and take forth four or five ounces of Matter to run out in a day In case the Matter does not come forth well place your Patient on the wounded side and make him to cough if by reason of its toughness it will not yet come forth then inject into the cavity some abstersive exsiccating and healing Medicines As Take Goats whey eighteen ounces Honey of Roses four ounces the Juice of Celandine and Smallage of each six drams Mingle it Or Take the Roots of Comfrey the greater an ounce of Sanicle half an ounce the Leaves of Betony Agrimony Periwincle Burnet of each half a handful the Cordial Flowers two pugils the Seed of St. John'swort Holy-Thistle Roman-Nettle of each half a dram Boil them in Water and Honey to a pint and half strain it and keep it for your use Of this Injection the Patient may also drink a little twice or thrice a day It is yet further to be observed that the collected Matter is often contained in a Membrane of its own and by its rising manifests it self from without and then the Latines call it Vomica Pulmonis In which case you must not stay till the Membrane breaks of its self for by delay the Matter flowing up and down is more difficulty to be got out of the Breast but open it presently taking no other place but the most raised part of the swelling Now since an Empyema for the most part follows upon a Pleurisie and 't is dayly found that ignorant Chirurgeons take all kind of pain in the Sides Belly and Breast although caused from Winds only for a Pleurisie thereupon immediately opening a Vein I thought therefore necessary to write in this place of the Pleurisie as much as is necessary for a Chirurgeon to know for the preventing such mistakes The Pleurisie then is an inflammation of the Pleura and commonly of the Lungs themselves caused from afflux of Blood accompanied with Pain Cough spitting of Blood shortness of Breath continual Feaver strong and quick Pulse The Cause is the Blood sometimes alone when a true Pleurisie sometimes mixt with other Humors then it occasions a Bastard one The Signs as may be seen in the Description are so evident that those who know not how to distinguish it from a Cholick are not worthy of any excuse The Prognosticks The sooner the matter is concocted and the whiter and easier 't is ejected the quicker and safer is the Issue If the Cough and difficulty of breathing lessen not by a copious Expectoration 't is an ill sign If the Patient come not to spit the third or fourth day then will he scarce see the seventh If upon Bleeding and other fit means the pain cease not the Patient must either die or the Pleurisie will turn to a Consumption or an Empyema The Cure In this case Bleeding is one of the most necessary and safest means of Cure and if used in time the Patient in the very Operation and before the Vein be closed will find relief and sometimes be altogether freed of the pain Nor do I know any Disease in which there may to the Patient's benefit be so much Blood taken away at once as in this There are different Opinions concerning what side the Patient is to bleed on But those have had little Experience of this sickness who have not found that Patients at least in these Countreys are relieved much more and sooner when they are bled in the Arm of the same side where the Pain is than when it is done in the opposite side The Pain not ceasing in four and twenty hours we are necessitated to bleed twice or thrice most commonly in the same Arm but here you must well observe the Patient's strength After letting Blood sometimes Purging Swearing and Expectorating Remedies are very necessary One only Medicine I cannot conceal from you because of its Excellency The Industrious Physitian Dr. Hadden in his Cure of the Pleurisie hath much commended it and I have after once Bleeding always in the beginning used it with great success viz. Take the Juice of Dandelion an ounce and half the Water of Plantane two ounces of Holy-Thistle and Scabious Syrup of Poppies Erratick of each an ounce Crabs-Eyes a scruple and half Mix it Let the Patient every half hour take down a spoonful or two of it until the Flux be stopped After which you
and if it be where there is a double Bone as in the Leg and below the Elbow the Flesh and Ligaments between them is to be divided which being performed let the Bone be separated with a very sharp Saw If the Flux of Blood be not great to apply only those Medicines that stop Blood will be sufficient but if great an actual Cautery is to be used which is only to be applied upon the great Vessels then let the Ligature be taken off and the Part be fitly bound up If either the Patient or Chirurgeon be averse to the use of a Cautery then as soon as the Member is taken off let the Skin together with the Flesh in four distinct places opposite one to the other be taken up with a Needle and waxed Thread and the Ligature being loosened above or drawn down that if possible they may meet So by this way is the Hemorage staid the Bone preserved from all danger and the Wound sooner cured But this way is painful and troublesom therefore ought it the seldomer to be used Aquapendens his way When the principal design of Art in this Operation is to put a stop to Putrefaction to cause as little pain as may be and to stay the Flux of Blood all which the above-quoted Author thinks may be done if the Member be amputated in the dead Part but near to the sound then the Bone being divided with burning-hot Irons let the remainder of the dead Part be cauterized till the Patient perceive the heat of the Fire So he writes that by this course a Flux of Blood is not to be feared less pain is caused and within the space of two or three days will appear a separation of the Mortified Part from the Sound but in my opinion we ought to consider well of the Cause For in a Spacelus sprung from an Internal Cause in a Body otherwise sound this way is the best but in a Spacelus caused from a defect of innate Heat the former is more profitable CHAP. XXV Of the Fleshy Rupture SArcocele which is a Fleshy Rupture is a Tumor besides Nature produced from impure Blood flowing in too great quantity itno the Testicles and there degenerated into Flesh In this Definition received by the best Physitians and Chirurgeons I note two things 1. The cause of this Tumor not to be impure Blood seeing the best may produce it not simply abounding in quantity because it also happens in wasted Bodies though 't is not so soon generated nor arrives to such a greatness in these as in those Bodies but the true cause is the Erosion Rupture or Dilatation of the Membranes which close the Mouths of the Capillary Vessels that the nutritious Blood may not flow too suddenly into the Part from whence more Blood flows into the Part than what is required for its nourishment and Nature changeth that Blood which otherwise would purifie into a fleshy Substance 2. This flesh sometimes grows to the second of the common Tunicles of the Scrotum and not to the Testicles in which case it may be taken aways without either hurting or cutting of them out Signs are the hardness and slow encrease of the Tumor which is rather more troublesome than painful except accompanied with sharp Humors no appearance of any Tumor in the Groin Prognosticks A Sarcocele is hardly cured by the help of Medicines and seldom by manual Operation without taking off the Testicle if it extends it self into the Groins for the most part incurable Cure In the beginning when the Membranes of the Vessels being eroded broke or dilated do give leave for too much leave to issue forth Bleeding and the use of Repelling and Restringent Medicines profit much but when it hath begun to augment then we may use these following means Let there be made a little Orifice into the Scrotum rather in its Superior then Inferior Part through which by the help of Plegets let Suppurating Medicines be applied so that if possible to waste the Flesh every dressing diligently wiping away the Matter but not at all that the remaining Flesh may be the better consumed If these things succeed not draw forth the Testicle and by Incision take off as much Flesh as may be done without injury to it then restore it again into its place and the remainder of the Flesh endeavor to consume by Suppuration But if there be no hope of curing this Rupture by the recited means draw forth the Hernious Testicle as far as you may then pass once or twice a Silken Thred above the Tumor by the Process of the Peritonaeum then pass both ends of the Silk through the Orifice it self so that which was on the right side may be on the left and that of the left on the right and having ordered that the process of the Peritonaeum may be tied with a knot then cut off the Testicle letting both the ends of the Silk hang out of the Scrotum and so cure it as another Wound I cannot here but friendly advise 1. The Chirurgeon ought to consider well of the Cause before he comes to the Operation it self for sometimes the Parastates are so swell'd especially the Testicles being Scirrhous that they may easily deceive a very curious Examiner 2. The Ligature ought to be made as near to the Tumor as possible for by how much the higher part of the Process of the Peritonaeum be perforated it is observed to be so much the thicker which thing will retard the Suppuration and the falling of the Thread in the mean time Convulsions coming on denounce death 3. The Spermatick Vessels detain'd in the Scrotum oftentimes by Natures variety exceed the Testicles themselves in greatness which causes no other inconvenience but only Fear which I have observed to be true in more than one CHAP. XXVI The Extraction of the Stone out of the Bladder THe Stone is a hard Body concreted from Slimy Salt or Earthy Matter by a peculiar Lapidifying quality causing Pain Obstruction and other Symptoms in the place where it is detained The Cause is a Pituitous Salt or Earthy Matter which neither by heat nor cold by a peculiar lapidifying quality is changed into a Stone Signs The Urine is white slimy crude and troubled suddenly adhering to the Urinal sometimes it is bloody sometimes sandy or gravelly sometimes full of little Threads and not seldom supprest a great thirst a frequent making of Urine but with pain and by drops The Patients place themselves with their Thighs across always holding their Privy-Parts in their hands pressing the bottom of their Belly the Privy-Part is always erected very painful to go or walk in the Region of the Belly a weight perceived the Patient seldom making Water without going to Stool the Intestine commonly falls out especially in young People Although all these Signs seem plain yet they may sometimes deceive a Phisician it was formerly the Custom with a Catheter passed through the Ureter into the Bladder then
and Species of Diacarthamum Cream of Tartar Take Syrup of Roses solutive with Senna Diacarthamum of each an ounce Jalap eight grains Cream of Tartar two scruples Parsley-water as much as is sufficient to make it into a Potion A Purging Wine which cures the Dropsie it self Take Roots of Orrise Gentian Succhory Fennel Masterwort of each an Ounce the middle Bark of Elder an Ounce and half Leaves of Ground-pine a handful Rosemary two Pugils Flowers of Centaury the less one Pugil Seeds of Smallage Coriander Carraway Roman-Nettle Fennel of each a Dram Senna two ounces Agarick three Drams Jalap half an ounce Turbith a Dram and half Let them be cut and infused in six Pints of Rhenish-wine Dose four ounces Medicines consuming Water outwardly used Roots of Orrise Bryony Birthwort Flowers of Elder Camomil leaves of Celandine Centaury Calamint Rue Dill wild Majoram Sulphur vivum Salt Allum Bay-berries Ammoniacum Bdellium Take Cows-dung half an ounce Pidgeons dung two drams Sulphur vivum half an ounce Nitre two drams Honey Vinegar of each an ounce and half Bean meal two ounces Bay-berries Cummin-seeds of each half an ounce Oyl of Dill Nard of each an ounce White-wine as much as is sufficient to make it into a Poultice Or Take Frankincense Mastick Myrrhe of each half an ounce Camphire half a Dram Goats-dung an ounce and half Brimstone Salt Cummin-seeds of each three drams Turpentine and Wax as much as sufficeth According to Art make it into a Plaister Hydrocephalus is always of difficult Cure Water contained in the Ventricles of the Brain or between the Brain and Meninges is very dangerous but less dangerous when collected between the Dura and Pia Mater or between the Dura Mater and the Skull For the Dura Mater may be divided into a Lancet if you can come at it but least danger of all when detained without the Skull Purging Sudorificks and Diureticks seldom do any good here but Cauteries Blisters Issues Setons are more profitable but sometimes we are forc'd to come to Incision or Ustion which Remedies although dangerous have cured several Some Chyrurgeons use with an actual Cautery to burn the Skin of the Head in five six or more places but not together and at once but at several times lest the Patients strength should be too much spent continually choosing that place which the watry Humor makes to appear most convenient Some with a Lancet open the Skin near to the Sagital Suture Which of these Remedies are best cannot absolutely be declared I must esteem an Actual Cautery when the Water is between the Skin and the Skull but if under the Skull between the Meninges I do not see how this operation can be performed without a Lancet But which of them soever you chuse have a care of discharging all the Water at once for in the very Operation it self the Patient dies or at least is very much debilitated for till the end of the Cure all the Water is not to be taken away lest the debilitated Parts be deprived of that heat which the Water possest do corrupt but rather what remains must be consumed by Internal and External Discussives and this is to be observed in all Watry Tumors that are Cured by a Paracenthesis In the same manner the Watry Tumor in the Navel and Cod ought to be handled after other Medicines have been applied in vain Dropsie of the Breast belongs not to Chirurgery except where a Paracenthesis is convenient concerning which Read the 15 th Chapter of the first Part. CHAP. VII Of the Flatuous or Windy Tumor THe Flatuous Tumor is a Disease produced of Wind not yielding without resistance to the Fingers Difference Some are without pain others with it in the one the wind is in motion in the other quiet Causes of Wind are Phlegm especially when mingled with Choler which as Ferment doth froth so it proceedeth wind it always happens upon a debility of the Parts by reason of which although endeavoring to concoct the Humors yet are notable Signs are Inflation with a resistance yielding to the Fingers a rumbling noise especially if shaken Prognosticks It seldom comes is fleshy parts in other parts it brings many inconveniencies in weak and Cacochymick bodies it 's of difficult and tedious Cure Cure The same Diet in here to be observed as in an Oedema Pease Beans Turnips Chestnuts and all Crude Fruit do extreamly hurt On the contrary Wine and other things moderately warming profit as also Spices and those things which disperse Wind as Nutmegs Mace Anise Carraways Lovage The Stomach and the whole Body require purging and corroborating Medicines always mixing with them those that disperse Wind and sometimes also where Corroboratives are used Anodines Laudanum Opiatum cautiously used that is half a grain or a grain for a Dose is here excellent For besides that it ceaseth pain it also by its Diaphoretick quality removes the Cause of the Disease To cause Sweat is as necessary as Bleeding is unnecessary Outward Medicines discussing Wind. Roots of Galangale Lovage Herbs Dill Mint Marjoram Peniroyal Rosemary Rue Chervil Flowers of Elder Mellilot Camomil Seeds Anise Carraways Cummin Fennel Nutmegs Cardamum Castor Oyl of Rue Nard Spike Dill Carraway distill'd Mace Nucista exprest and distill'd Mellilot-plaister Take Oyl of Wormwood Rue of each two Drams Oyl of Nucistae exprest one Dram of Mace distilled half a Dram Castor dissolved in Aqua vitae two Scruples Make it into a Linament Or Take the Leaves of Rue Calamint of each half an handful Bean-meal two Ounces Seeds of Cummin and Anise of each half an Ounce Bay-berries Salt of each three Drams Nitre Brimstone of each a Dram Goats dung six Ounces White-wine as much as is sufficient Mix them and boyl them into the Consistence of a Cataplasm Or Take the Roots of Pelitory of Spain half a Dram Venice-Sope three Drams Castor dissolved in Aqua vitae one dram Seeds of Cummin Carraways of each two drams Ashes of Earth-worms half a dram Oil of Spike half an ounce Mastick three drams Wax and Turpentine as much as sufficeth Make it into a Plaister according to Art CHAP. VIII De Herpete HErpes is a Tumor besides Nature sprung from yellow Choler disfiguring the Skin with corroding and spreading Pustules Difference Where Choler solely predominates it produceth Herpes exedens but where Phlegm is mixt with Choler a Herpes Miliaris Cause is sometimes Choler alone sometimes mixt with Phlegm and I see not why the serum of the Blood may not often be here taken as a Cause For the Lymphaeducts being out of order do produce Mutations in mans body heretofore unknown Signs Are little Pustules like to Millet-seed a heat itching and after rubbing a moistness and little Ulcers Prognosticks Herpes is of difficult Cure but of little danger unless so rendred by the immoderate use of Repellents Cure The same Diet is here required as in an Erysipelas Moreover Purging is here very necessary Bleeding not to be allowed of the use
again but if great not so easily yielding to the touch not so strong a Pulsation but there is a noise observed as of boiling Water yet in the Head and Jaw I have found after death an Aneurism which while the man was alive there could be no Pulse perceived In the hard parts is greater Circumspection to be used than in the soft and fleshy Prognosticks It is difficultly cured if great not at all except with the taking off the Member for the most part it is a long Disease although I have seen it kill without any other accidental Cause within two years If Incision be made Death suddenly follows Cure In the beginning there may be some Hopes Astringents and Repellents and convenient Ligatures by which we do not seldom administer something of Remedy to the Patient as also the applying a piece of Lead straightly bound on have sometimes cured little Aneurisms But where the Tumor is encreased there are some would have the Skin divided and the Artery tied both above and below and cut out the middle with the Tumor and loosen not the Ligatures till the Wound is perfectly cured and there is no fear of an Hemorrage but this Operation is dangerous painful and troublesome and oft-times of little Benefit But to preserve Life I would take off the Member CHAP. XVII Of Opthalmia OPthalmia is an Inflammation of the Membranes of the Eye from Blood with Redness Pain and shedding of Tears Difference A light Inflammation and which depends from external Causes is called a Bastard Opthalmia Taraxis or Epiphora but a great Inflammation accompanied with pain and tears a true Opthalmia And if it be so great that the Eye-lids are so inflamed and as it were turned inward 't is called Chemosis Causes are two 1. Internal as Blood oft-times mixt with Serum or Choler seldom with Phlegm or Melancholy 2. External as Smoak Dust c. Signs vary according to the variety of Causes If it proceed from too great a quantity of Blood the Face looks red and the Vessels of the Eyes are extended If either from more of Serum or Choler the Redness of the Face is less but the Tears are more sharp and the pain greater if from more of Phlegm the reddish pain Heat and Acrimony of Tears are more remiss and the Eye-lids at night are as it were glewed together If from any thing of Melancholy there are but few Tears and the Eye-lids are not closed together the Inflammation is not great but stubborn Prognosticks An Opthalmia is flower cured in Children than in old people Continual pain menaceth Blindness by how much greater the Inflammation is so much the more dangerous it is Cure The Diet must be the same as in a Phlegmon all sharp things are carefully to be avoided as Garlick Radishes Mustard c. little or no Suppers profit Purging the use of Glisters Bleeding ought to be oft-times re-iterated as also Cupping-Glasses Leeches Blisters sometimes also Seatons Issues and Artereotomy it self which is not to be done by any but an expert Chirurgeon Sneezing is hurtful Provoking of Sweat is sometimes necessary sometimes not which the Physician must distinguish Dieureticks are of great use provided they are not too hot External Remedies vary according to the variety of Causes if from Smoke or Fire let them be extinguished If from Dust or any thing got into the Eyes 't is to be taken forth which is often performed by blowing or by the spurting in of Rose-water If from the inversion of the Eye-lids the Hairs are to be cut off or wholly to be pull'd out If the Eye-lids are glew'd together they are to be separated with Butter Beer or Cream the Rheum is gently to be wiped and let the Patient have a Care lest by the rubbing of his Eyes he increaseth his Disease Fat things are here hurtful Repellent Medicines except in the very beginning are not to be used or in a very slight Opthalmia Medicines good for the Eyes Roots of Valerian Solomons-Seal Orrise Vervain Herbs Betony Celandine the great Eyebright Fennel Fumitory Plantain Flowers of Roses Violets Anni-seeds Quince-seeds Linseeds Pippins boil'd or rotten Camphire Mussilage of Lin-seeds Tragacanth Fresh Veal Whites of Eggs all sorts of Milk especially Womans Tutty white and green Vitriol Saccharum Saturni Glass of Antimony White Troches of Rhasis fresh Cheese not salted Ung. Saturni A Water for the Eyes Take Waters of Eyebright and Celandine the greater of each an ounce and half White-wine six drams Glass of Antimony eight grains prepared Tutty fifteen grains White-Vitriol two grains Sugar-Candy two drams Camphire four grains Make it into a Collirium Another excellent one Take Wheat three handfuls Bruised Ginger three drams Common Salt a handful and half White-wine Water of Roses of Fennel Plantain of each ten ounces Infuse them in a Copper Vessel the space of forty days strain them and reserve the Liquor for your use Another very much esteemed Take a whole Egg boil it hard then the shell and Yolk being taking away put into the Cavity Sugar of Saturn six grains Camphire two grains White-Vitriol three Grains Honey of Roses half an ounce then press it very hard and let the prest out Liquor be dropt into the Eyes twice or thrice a day Another second to none Take Waters of Fennel and Eyebright of each a pint Common Salt six drams prepared Tutty white Vitriol of each half an ounce Let them boil a little and reserve for use Let not the great quantity of Vitriol afright any it causeth only a slight pain which suddenly vanisheth but 't is of so great virtue that it cannot sufficiently be extoll'd but its use will prove it true A Powder for the Eyes Take Dulcified Vitriol half a dram prepar'd Tutty fifteen grains Sugar-candy a scruple Make it into a fine Powder Unctious Medicines seldom are applied to the Eyes or else this Ointment is much commended Take Verdigrease twelve grains Camphire Lapis Calaminaris of each half an ounce prepared Tutty half a dram fresh-Butter washed in Rose-water two ounces Make it into an Ointment An Anodine Cataplasm Take Camomile and Melilot Flowers of each a pugil rotten Apples two ounces Fenugreek-seed an ounce Crums of Brown Bread three ounces two yolks of Eggs Saffron half a dram Boil them in Cows-milk to the consistence of a Poultice An Anodine Collirium Take the Juice of Housleek two drams Whites of Eggs half an ounce Womens-Milk two ounces Rose-water an ounce white Troches of Rhasis one scruple Opium three grains Mix them Another which I have often found excellent in the greatest pain Take Gum Tragacanth two drams Mussilage of the seeds of Fleawort three drams Rose-water and Plantain-water of each as much as sufficeth Make it into a Collyrium of an indifferent Consistence and let it be instilled by drops into the Eyes and Linnen-Cloaths wet in it outwardly applied CHAP. XVIII Of a Quinsie A Quinsie is a Tumor of the Jaws from Blood hindring Deglutition and
a Wound penetrating into the Cavity it self all the Tunicles being divided the Wound of the Abdomen ought to be united by a Stitch a little Orifice being left through which a Tent is to be put which must not enter the Wound of the Stomach but only outwardly touch it let it be armed with this or the like Take Oyl of Mastick of Fir-tree of each an ounce Manna of Frankincense two drams Powder of the Roots of Tormentil of the greater Comfrey of each a dram Saffron a Scruple Earth-worms half a dram White-Wine two ounces boil them to the Consumption of the Wine and make a Liniment Take Turpentine half an ounce Yolk of an Egg Oyl of St. John's-wort an ounce Mix it and make a Liniment Wounds of the Small-Guts sometimes though seldom may be cured this I can prove by a notable Example Those of the Great-Guts are more easie Where the Small-Guts are hurt the Chyle and sometimes the Meat Drink comes forth through the Wound there is great pain with a Fever and Nauseousness Where the Great-Guts the Excrements come out at the Wound or at least the scent the Body is bound the Wound is forthwith to be stitcht together and the Gut to be restored into its natural place well cleansed with warm Water and this following Powder sprinkl'd upon it Take Aloes Mastick Frankincense Mummy Dragons-blood of each a dram Make it into a Powder Wounds of the Liver and Spleen require bleeding and if the Belly be bound Clisters are daily to be injected to the Wound it self are to be applied Astringent and Drying Medicines Wounds of the Kidneys are difficultly and slowly cured If made into the Cavity it self the Blood that comes forth is Serous otherwise more pure This Liniment is of great esteem to be used outwardly Take Rosin of the Pine six ounces Oyl of Bays and Turpentine of each an ounce Gum Elemny four ounces and an half Mingle them Inwardly are to be given the Troches of Alkakingi Gordonius de Carabe or Sealed-Earth Bole Turpentine and Wound-Drinks Wounds of the Bladder are generally cured after the same manner but it is very seldom that they leave not behind them a Fistula The following Pills are of great use in Wounds and Ulcers in the Kidneys and Bladder Take Mans Bones calcin'd three drams Chalk Burnt Talk of each a dram Troches of Winter Cherries three drams Venice-Turpentine a little boil'd as much as is sufficient Make them into Pills about the bigness of little Pease rowling them in the Liquoras-powder let the Patient take morning and evening six of these The End of the Second Part of the Second Book BARBETTY'S CHIRURGERY The Third Book of the Second Part Of CHIRURGERY Of Vlcers CHAP. I. Of the Nature Differences Causes and Signs of Vlcers AN Ulcer is a Solution of continuity with Diminution of Magnitude in the soft Parts from a Corroding Matter Differences are taken .1 From the Form of the Ulcer so 't is great little long short broad narrow right transverse equal unequal deep superficial 2. From the Part affected which sometimes is the Skin and Flesh only sometimes the Tendons Nerves and Vessels that carry the Blood 3. From the Causes which shall be presently spoken of 4. From the Symptoms so 't is painful itching obstinate verminous carious Cause is a sharp and corrosive Humor and that is twofold 1. Internal as Choler Melancholy Serum Salt Phlegm and other Malignant Humors 2. External as Burning and Corrosive Medicines the Sweat of Man infected with the Itch Leprosie or Pox. Signs of Ulcers in general are manifest enough the particulars you shall have in their places Prognostick By how much deeper the Ulcer is so much the longer 't is in Curing Ulcers in Parts that are subject to much Humidity are difficultly cured If an Ulcer cannot be cured in a long time or when Cicatriz'd breaks out again the Cause is the Bone being foul under it Ulcers near to the Nerves Veins or Tendons are dangerous In Cacochimick Bodies their Cure is tedious If the Matter which comes from them be good it gives hope of an easie Cure Good Matter is of a middle consistence between thin and thick white light equal and not at all stinking That which is ill is thin and fluid pale livid and of ill smell Old and inveterate Ulcers are not cured without danger except the Body be well purged and a good order of Diet observed otherwise some Diseases will ensue CHAP. II. Of the Cure of Vlcers PUrging and Bleeding are here often necessary but a good ordered Diet always Hot Meats and Drinks hurt as also all Sweet and Salt things Outwardly the Humor ought to be concocted and turned into Matter the lost flesh ought to be repaired and then to be skinn'd Remedies necessary to perform these are Digestives Sarcoticks and Epuloticks which are set down in the seventh Chapter of the second Book of the second Part. We will add some Compounds A Defensive Take Guaiacum-Wood long Birthwort-Roots of each an ounce Centaury the less Wormwood Agrimony of each a handful Boil them in white Wine and to two ounces and an half of the strained Liquor add of the Meal of Orobus half an ounce Myrrhe powdered two drams of honey of Roses two ounces Spirit of Wine an ounce Venice-Turpentine as much as is sufficient to make it into a Liniment A Sarcotick Take the Brown Ointment of Foelix Wurtz three drams Basilicon half an ounce Gum Elemni two drams Turpentine six drams Colophony Mirrhe Aloes Mastick of each half an ounce Litharge of Gold three drams Oyl of Roses as much as sufficeth to make it into an Ointment An Epulotick Take Sacchar Saturn Litharge of each two drams Lapis Calaminaris one dram Roots of Tormentil Bistort round Birthwort Dragons-Blood burnt Egg-shels of each half an ounce Make them into a Powder Let it be sprinkled upon the Ulcer or mingled Gall half an ounce Honey as much as sufficeth to make it into a Linament CHAP. III. Of an Vlcer with foul Bones IT falls out sometimes that the Bone which lies underneath the Ulcer to be foul Bones are corrupted and contract a rottenness either from the long Flux of Humors or from the Acrimony and Malignity of them or from an Occult quality or from a Contusion in some manner injuring the bone it self or from sharp Medicines Signs of Corruptions are many Where the Bone lies open to the sight at first it appears of the colour of fat then yellow afterwards black and unequal but where it cannot be seen Chirurgeons may judge that there it is a Corruption 1. If a Fistula preceded or the Ulcer hath been of long continuance 2. If the Ulcer being skinn'd break out again 3. If the flesh above it becomes loose spungy pale or livid 4. If with the Probe you find no resistance but an Inequality 5. If the Matter be much thin and stinking Prognostick If the Caries be near the Nervous parts or in the Joynts or about
the Tendons Arteries or Veins 't is not easily cured but for the most part the Tendon and Nerve are corrupted with it No Ulcer can be cured whilst the Bone remains foul Cure The corrupted Bone ought to be corrected either with Medicines or with Chirurgery or by both Therefore the flesh must be divided as soon as may be that the Carious Bone may be laid open left some considerable Nerve Tendon or Artery be hurt according to the length of the Part and the Ductus of the Fibres not transverse then let those Medicines be applied that may separate the Corrupted Bone from the Sound and that may preserve the Sound from Corruption Medicines against Corruption of the Bone Roots of round Birthwort Briony Orrise Dragons Hores-strong Guaiacum Bark of the Pine Aloes Euphorbium Mirrhe Alom Chalcanthum Lime Chrysocalla burnt Pumice the Scales of Brass Aqua-fortis Spirit of Brimstone of Vitriol Salt Tartar Oyl of Vitriol Brimstone Antimony Take Mummy Sarcocols of each half a dram Euphorbium a dram Mix them and make a Powder Take Roots of Round Birthwort Orrise Hore-strong of each half an ounce Mirhe Aloes of each a dram and half Bark of the Pine Scales of Brass of each a dram Earth-worms two drams Honey as much as sufficeth to make it into an Ointment Take Juice of Celandine the greater two ounces Spirit of Wine an ounce Mirrhe Aloes of each two drams White-Vitriol a scruple Mingle them for an Injection If the corruption of the Bone be so great that it cannot be removed by Medicaments then we must come to Chirurgery and either scrape the foul Bone if the corruption be small or Perforate it if great or rather use an actual Cautery for without these you will scarce be able perfectly to cure it CHAP. VI. De Vlcere Depascente c AN Ulcer further and deeper spreading is call'd Depascens and if it be with putrefaction is called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 if without it Phagaedaena if only in the Skin Herpes if ill-natured Cacothe Cause is the salt Serum of the Blood salt Phlegm burnt Choler or some other Malignant Humor These Ulcers can scarce be cured unless the Cause be first removed and the whole Blood purified therefore here must be observed a good Diet often Purging and sometimes Bleeding External Medicines for Depascent Ulcers Plantain Night-shade Flowers of Red-Roses Balaustians Cypress-Nuts Pomegranate rinds Frankincense Mastick Tutty Ceruse Litharge Red-Lead Burnt-Lead Brimstone Pepper Ginger Mercury Ung. Aegyptiacum Fuscum Diapompholigos Emplast de plumbo de minio Gryseum de ranis cum Mercurio Take flowers of Red Roses Balaustians of each a handful Leaves of Plantain half a handful Cypress-nuts Mirtle-berries Pomegranate rinds of each half an ounce Boil them in Red Wine Wash the Ulcer with it then use over it this following Take prepared Tutty half an ounce Burnt-Lead washed Ceruse of each an ounce Bole-Armenick half an ounce Ung. Aegyptiacum as much as is sufficient to make it into an Ointment Or Take Long-Pepper half a dram Ginger a scruple Flower of Brimstone Litharge of Gold each two drams Gunpowder a dram Ung. Fusci of Felix Wurtz three drams Ung. Album Camphoratum as much as sufficeth Make it into an Ointment Take Mastick Frankincense Mirrhe of each three drams Litharge of Gold Burnt-Lead of each half an ounce Quicksilver extinct in Turpentine two drams Brimstone half an ounce Pitch and Wax as much as is sufficient to make it into a Plaister Concerning the Cure of these Ulcers 't is to be noted 1. External Medicaments ought to be changed three or four days for Nature rejects the best longer applied 2. They ought not to be drest above once or twice a day except the Matter be very sharp that the Medicine may not be disturbed in its Operation 3. Repellent and Mercurial Medicines are not to be used except with continual Purging you drain the Body of its Impurities 4. These Ulcers are seldom cured without the use of purging or drying Decoctions made of China Guaiacum Sarsa c. CHAP. V. Fistula's A Fistula is a long narrow hollowness or a sinewous Ulcer narrow and callous not easily receiving Cure for the most part taking its beginning from an Abscess Difference are straight oblique simple manifold that is having many hollownesses some going to the Bone some to the Veins Tendons or Nerves Signs The edges of this Ulcer are white hard without pain or but little sometimes moist but commonly dry Outwardly the Cavity may be perceived in one place or other by pressing the Part in which also sometimes there is a noise perceived and the Matter now in lesser quantity otherwhiles in greater is prest out through the Orifice of the Fistula By a Probe we can search the Cavity of a straight Fistula but in an oblique we use a Wax-Candle instead of a Probe That is more convenient when the Fistula penetrates to the Bone this when it is in the fleshy and sensible parts If the Fistula remains only in the fleshy parts that which is touched by the Probe is soft and the Matter that comes out is white equal and in great quantity If it extend to the Nerve there is great pain in searching it to the bottom of the hollowness and the Matter is fat and oyly but is less in quantity and the action of that Member which the Nerve goes to is rendred very uneasie If it passeth to the Bone that which is touched by the Probe is hard not yielding and painful where the Periostium is not consumed The Bone is foul is rough and seems unequal to the touch the Matter is black stinking and very thin If the Cavity joins to a Vein the Matter is like dregs but reder and thicker where the Vein is eroded If it penetrates the Arteries that which comes forth is thin and shining and comes forth with a leaping Prognostick All Fistulas are of hard Cure some incurable others that ought not to be cured to wit those by which the superfluous Humors have for long time been vented A recent Fistula and not deep in a young body and otherwise sound is easily cured but an old deep Fistula having many Sinew's in an ancient emaciated cachochimick Body is very difficult Those are also difficultly cured yea for the most part incurable which touch the Tendons Nerves Veins Arteries Bones and those that are in the joints Vertebra's Cavity of the Breast and lower Belly the Womb Bladder or Guts Fistulas are wont to come in those places where Nature is accustomed to discharge her self of vitiated Humors to wit in the Abdomen Groins Buttocks Fundament Cod and Perinaeum Where the edges are not very hard but somewhat soft and mattery they do promise speedier Cure Cure of Fistulas are twosold one Real and the other Palliative by this the Fistula is dried within and skinned without the hollowness nevertheless remaining commonly continuing some little while closed but easily breaks forth again except by a good Diet often Purging
it remains for some time in the same condition 3. When it relaxeth so that it is restored into its former seat and quiet by its Antagonist The Glandulous flesh is white thick and spungy formed of seed from whence it cannot properly be call'd flesh to this purpose ordained 1. To prop up the Vessels 2. To receive the superfluous Humidities whence they are called the Emuâ—ctories of the noble Parts Some Anatomists make strange diversities of them but it will appear to any one that diligently enquires into all the Glandules that they differ not so much in substance as in their Use and Humor The Viscerous flesh or the Parenchemick is red hard convenient to prop the Vessels and to serve for many particular and various operations this is the flesh of the Lungs Heart Liver Spleen which shall be treated of in their places Chirurgical Considerations The Muscles are subject to many Diseases very many of which are of so little consequence that they shall not be numbred here some we have declared in another place the following require consideration oftentimes wonderfully exercising the patience and diligence of the Chirurgeon 1. An Atrophy of the whole Body oftentimes comes from an Internal Cause But if of the Finger Hand Arm Foot for the most part from an External Cause Thus a Fracture Luxation Contusion Tumor too hard Ligature and the like so vehemently compressing the Veins and Arteries that it hinders the free passage of the Blood to the Parts upon which happens an Emacitation for where the Vessels are wholly divided or stopt so that the least quantity of Blood cannot be carried to the Parts there follows not a Wasting of the Part but a Mortification in this Case the External Causes must be removed And care is to be taken that the Blood may again be carried to the Part Here chafing the Part and the use of Nettles as many will is good the Chymists commend much Alumen Plumosum all hot Oyls likewise are here good and this Oyntment is of excellent vertue Take fresh tops of Savin Juniper Lovage of each two handfuls Camomile Flowers Juniper-berries of each two handfuls Oyl of Bayes White-Lillies of each twelve ounces Hogs-grease three ounces Dogs-grease an ounce and half Aqua vitae two ounces Boil them to the consumption of the moisture then add to the express'd Liquor Oyl of Spike three drams Juniper a dram Mustard-seed in Powder half a an ounce Roots of Pellitory of Spain Long-Pepper powdred of each two draws Yellow wax as much as is sufficient to make it into an Ointment Or Take Pulvis Amianti three drams Roots of Pellitory of Spain a dram and half Castor Euphorbium Oyl of Earth of each two drams Gum Ammoniacum an ounce and half Laudanum and Wax as much as sufficeth to make it into a Plaister 2. The true reason of the generation of Wens in my opinion is this the mouths of the Arteries appointed to carry nourishment to the Muscles sometimes are more opened than they ought to be whether it be by Fall or Blow or from an internal Cause especially in Plethorick People and in Parts disorderly moved the native heat converts the extravasated Blood into Flesh But seeing the Member requires not so great a quantity of nourishment it increaseth into a preternatural Swelling and if this Blood be impure Choler produceth Pain Phlegm Viscousness Melancholy a Cartilaginous hardness and 't is to be attributed to these Humors that this preternatural flesh is more yellow white or livid 'T is seldom included in a proper Tunicle except where Phlegm is its greatest Cause and then those Tumors are generally in the Neck The Veins grow big according to the increase of the Tumor so that under the Skin they appear as thick as ones Thumb 'T is not in it self malignant yet by ill applications may be easily made so Air is very hurtful if the Tumor be exposed to it For the most part the best Remedies are here used to little purpose on the contrary the Tumor more and more increasing You cannot promise any Cure except you take it away by a Thred Knife or both In the beginning the Medicines that are to be applied ought to be very astringent and repelling the Part is gently to be rouled having applied to it either a Plate of Lead or a Diachalcitheos Plaister or of Frogs with Mercury or the following Take Pomegranate-rinds Bistort-roots of each one dram Scales of Iron Quick-silver Burnt-Lead of each two drams Bole-armenick Lapis Haematitis of each a dram and half Turpentine Wax as much as is sufficient to make it into a Plaister according to Art In the mean time Purging Bleeding Scarification and the Application of Leeches are not to be neglected Sweating also Watchings and Abstinence profit very much But if the Tumor yields not to these Remedies but daily increaseth Suppuratives are to be applied but if these within few days effect nothing and the Tumor continuing in the same state an actual Cautery may be used which let not the contrary Opinions either of Chirurgeons or standers-by hinder for by its use the increase of the Tumor will be stayed for a long time yea sometimes the Disease will be wholly eradicated But if the Flesh begins to repullulate again beyond expectation the Surgeon ought not to defer to endeavour either by a Thred or Knife its extirpation the Thred being small and strong must be twice wound about the neck of the Tumor and tied with a double knot which must be straightned the same day and so every day until the Tumor be deprived of its colour sense and life which is within seven or eight days then 't is to be taken off with a crooked Knife which is very easie to perform seeing neither any great pain or flux of Blood is to be feared If the Thred be wet in Mercurial or Arsenick-water it hastens the mortification of this Tumor But in this Operation a Phlegmatick Body is required for in other Bodies pain and inflamation do so much afflict the Patient that 't is seldom that the Thred in a short time should take them off yet the Chirurgeon may to lessen the Symptoms and to cool anoint with a Feather the part which the Thred toucheth with white camphorated Ointment of Roses or the like continually putting the Patients in mind how that others bear it more quietly But if you design to use a Knife only the whole Tumor must be endeavoured to be taken away except you will consume the remaining by Medicines which is very rarely effected besides the Chirurgeon must have a Care that he divides not the greater Vessels lest there follows a Flux of Blood not to be stopped 3. The Viscerous Flesh belongs rather to the Physicians care than the Chirurgeons 4. Of the Glandulous Flesh we have treated particularly in several places In general 't is to be noted 1. That the Glandules are of a cold temperament therefore require hot Medicines but very ill suffers cold 2.
operation is injured 3. A just magnitude one Foot greater than the other causeth a troublesome walking 4. A Natural Figure Softness Thickness yea colour it self 5. A convenient Connection and sight 6. The presence of the Vital Spirits which are brought to the Part by the Arteries 7. The presence of the Animal Spirits which are carried by the Nerves 8. Outwardly the Skin that covers the whole Body Inwardly the Dura Mater the covering of the Brain Palate Tongue Jaws Breast and lower Belly requires also a particular Consideration 9. It is likewise necessary that the Nutriment be well concocted naturally carried and receiv'd that there may no defect be observed in the Parts The End of the First Book of the Third Part. The SECOND BOOK OF THE HEAD CHAP. I. Of the Outward Parts of the Head THE Head as Supream Lord both of its own and of a thousand other Bodies not only governs it self but others well when formed with a healthy Constitution and instructed with the knowledge of its own Office but they live a miserable life whose Head is not justly and with Art composed and who neither enquire into or know its Substance or Figure It s Figure is Oval the upper part is call'd Vertex the fore-part Frons the hinder-part Occipút the sides Temples the rest is call'd the Face and consists of the following parts First appears the Skin in several places endowed with Hair but in all with a Scarf-skin Under this lies the Membrana Carnosa and Pericranium which takes its rise from the Dura Mater and passing through the Sutures of the Skull first invests the Skull then all the other Bones Anatomists that are very curious make the Pericranium to be double the outward retains the old name of Pericranium the inward is called Periostium The Bones which lie under these Membranes first we divide into the Skull and Jaws then into many other Bones The Skull is composed of eight Bones joyned together by proper and common Sutures The proper Sutures are true or spurious The true are three 1. The Coronal 2. The Sagittal 3. The Lambdoidal The Spurious are the two squamous Sutures of the temporal Bones The common are three likewise 1. The Frontal 2. The Sphoenoidal 3. The Ethmoideal The Bones themselves which have many perforations and cavities for the passage of the Air of the Veins Arteries and Nerves are eight 1. The Bones of the Fore-head always in Children sometimes in old people is divided just to the root of the Nose by the sagittal Suture 2 3. The Bones of the fore part of the Head or Bregma 4 4. Temporal Bones or Petrosa 6. The Lambdoidal or Bone of the hinder-part of the Head 7. The Sphoenoidal or Wedge like Bone 8. The Ethmoideal Bone or Cribrosum The Muscles of the Forehead are the two Attollentes Muscles of the hinder part of the Head are the two Deprimentes The Jaws consist of several Bones conjoined so by Harmony that in old people they appear but as one the one is called the upper the other the lower Jaw The upper Jaw is composed of eleven Bones of each side five the odd eleventh is placed in the middle 1 2. Os Zygomaticum or yoke-bone makes the lower part of the Orbite of the Eye constituting with its Apophisis the Os Jugale or Zygoma 3 4. Os Lachrymale makes the internal corner of the Eye having a large Orifice descending to the Nose 5 6. Os Maxillare or Jaw-bone particularly so called which is the greatest of all the Bones which constitutes the Jaws 7 8. Os Nasi or Bone of the Nose which in its end hath five united Cartilages 9 10. Os Palati or Bone of the Palate 11. Vomer A peculiar Bone above the Palate which supporting the interstice of the Nose and joined to it by Harmony The upper Jaw moves not but when the whole Head moves therefore needs not proper Muscles The lower Jaw which generally remains divided in the fore-part till the eighth year and afterwards is so closly joined together as it appears to be but one Bone hath two Processes and in them a Cavity big enough to allow a convenient situation to the Veins Arteries and Nerves from whence the Teeth receive their Nutriment and Sense The Branches of the Nerves about the Chin pass out again through a little Orifice are distributed into the Muscles of the Lips It is moved by six pair of Muscles which are 1. Pterygoâ—… Internus Attollentes 2. Digastricus Attollentes 3. Latus Deprimens 4. Pterygoideus Externus bringing them forward 5. Masseter 6. Musculus Temporalis This Muscle hath this peculiar to it self that it is covered by the Pericranium by which the subjacent temporal Bones are altogether destitute of it which is not observ'd in any other part of the Body But no man hitherto as I know of hath yet given the Reason of it for whatsoever hath been delivered by others concerning this hath been so slight that they give little satisfaction to the lovers of Truth But of late Job Mekeren an Experienced Chirurgion of this City hath in an Epistle communicated something particular relating to this matter the substance whereof I here give you until he put forth his Observations some of which I have seen TO Dr. PAUL BARBETTE Physician at Amsterdam SIR I Will truly declare to you my Opinion concerning the Question I informed you I had moved in the company of some Physicians which was Why the Bones which lie under the temporal Muscles are not covered and invested by the Pericranium as are the other Bones On the 6th of Janaury 1654 being commanded by the Honourable Senate of this City to open the Head of PETER JACOBS Brick layer then was my Opinion which I had been hitherto big withal sufficiently confirmed for as soon as I had observed a great depression in the upper part of the Skull I also found a great quantity of coagulated Blood which had part of it past through the Ears and part of it remained yet in the Cavity of the Ear then being very desirous to know the way by which this Blood had descended into the Cavity of the Ear which when I had diligently enquired into I also discovered the reason and cause wherefore the Pericranium covers in this place the temporal Muscles and not the Bone under them First The Opinion and the Answer which the Honourable and Experienced Dr. TULPH Burgomaster of Amsterdam had given to the propounded Question to wit from whence this Blood should come which very often in Wounds of the Head flows out of the Ears I found to be true and reasonable for I perceived as the Noble Consul had affirmed to me that the Blood from the upper part of the Head did descend between the Skull and Pericranium and so did enter the space that is between the Os Parietale and Petrosum and from thence to be as it was strained through a Sieve into the Cavity of the Ear afterwards in searching further I found
of some Humor which renders the Cure very difficult For this I commend the often praised Restorative Powder 3. A great Tendon is inserted in the Calcaneus or Bone of the Heel which being wounded or much contused brings Convulsions and death it self About this place comes Kibes whose cause is intense cold or heat with driness Here first are observed Fissures in the Skin then follows an Ulceration All fat things and Plaisters profit here especially the following Take Powder of Galls of round Birthwort of each half a dram red Lead a dram Mercury sublimate six grains Litharge Mirrhe of each a dram and half Camphire a scruple Franckincense two drams green Wax as much as sufficeth to make it into a Plaister In the room of green Wax you may take the Fat of Deer or of Rams 4. The Fingers or Toes being frozen must be rubb'd with Snow or with a bruised frozen Turnep then this following Plaister is much commended Take Hogs-grease fresh Oyl of Olives of each an ounce white Wax two ounces boil them a little and make a Plaister 5. Issues are often made in the Joynts we have formerly declared the place In the Arms between the Muscle Deltois and Biceps in the Thigh two fingers breadth above the Knee in the inside in the Leg the uppermost two fingers breadth below the Knee the lowermost two fingers or three above the Ankle That you may make these Issues without pain instead of a Conclusion take this Caustick which works without pain which is also very much to be commended in sordid and cancerous Ulcers and in Excrescencies Take Crude Brimstone white Arsnick Crude Antimony of each two ounces the Brimstone being melted by a gentle fire and stirred about with a Spatula add the Arsnick and Antimony powdred and mix them whilst they are incorporated with the Brimstone and look red Afterwards Take of this Mixture an ounce Caput mortuum of Vitriol half an ounce Mix them and make a Powder let it be washt six times in Spirit of wine and dried for your use A TREATISE OF THE PLAGUE THE Plague is a Disease whose nature is not to be comprehended by us the Cause thereof seems to proceed from a Spirituous and Infectious Vapour which is powerful enough to make a sudden dissolution of the consistence of the Blood by which means the Heart is deprived both of strength and life I do assert that the Nature of it is not to be comprehended by us as well because it is a Punishment inflicted on us by the immediate hand of Almighty God who vouchsafes not that his Incomprehensible Wisdom and Essence which is sometimes faintly described to us should be narrowly pryed into by his creatures as also that it is in it self so mutable that if we should seriously recollect our selves and recount the several Pestilences wherewith all former Ages have been visited we shall not thereby be able to instance in two of that whole number which have agreed with each other in all circumstances From whence we may easily infer that in the Cure of this Disease an Experienced Physician may much more safely follow the Dictates of his own Reason than adhire strictly to the Method Prescriptions of others For although it doth sometimes by the more remarkable symptoms sufficiently evidence it self yet we cannot likely discover its Nature and Essence although we should the most industriously attempt it But that we may cautiously enquire into it we must know that it is sometimes not accompanied by any Fever And it is necessary that what Physician soever is ignorant of this should either by perusing good Authors or his own Experience acquaint himself throughly with it I have been sent for to several Patients my self who although they appeared otherwise in good health not refusing their meat nor disturb'd in their sleep have nevertheless had Buboes arising in their Groin on their Neck under their Arm-pits or behind their Ears which have apparently discovered a greater Malignity than could be discerned in those Buboes which in other persons have been attended by a violent Fever And many hereupon who have been incredulous and lightly regarded the cautions which I have given them upon this account have with great danger to themselves experimented that as soon as those Buboes have sunk down the Pestilential Symptoms which have appear'd have been very dreadful and much more dangerous than in those that have carefully used the means prescribed to them who have been also much more easily and speedily cured than the other Sometimes the Plague is accompanied with a Fever and again there are some Pestilent Fevers without the Plague To distinguish this Fever from the Plague I used to observe that they that are seized with it complain of pain in their Head and Stomach which sometimes is dispersed over the whole Body sometimes it confines it self to the Arm-pits the Neck the Parts behind the Ears or to the Groin To outward appearance there is not the least swelling If the Patient by such means as is requisite be provoked to sweat at the beginning of the Disease the pain utterly ceaseth and in a few dayes he will be perfectly restored to his health the Disease not having at all discovered it self by any outward Symptoms Why such a Fever should be accounted a Species of the Plague I see no reason But there is no one but will confess it to have seized on that Body on which Buboes Carbuncles and Spots do outwardly appear The cause of the Plague is either Internal or External but unto which soever we impute it it is necessary to conclude that there is in it a power of dissolving the natural Consistence of the Blood and depriving the whole Body of its strength As to the Inward Cause which is Meat and Drink it is evident to all that it cannot produce in any Body whatsoever so great sudden a change but it is most certain that by a long continued course of bad Diet the Blood may by degrees be after such a manner dissolved weakned and corrupted that some part of it assuming to it self a malignant quality a man may be surprized by a sudden Disease sometimes be deprived of life it self which hath been observed in sick persons at several times when there hath been no contagion in the place nor any suspected who have been troubled with perfect Buboes and other Symptoms of the Plague much more intolerable than others have been at any time when the Air hath been infected As to the outward Causes every one confesseth that there are such but their Nature is known but to few The Chymists who are able by the force of Fire distinctly to separate the Parts of simple Drugs endeavour to find the Original of the Contagion in a Volatile Salt which suddenly dissolves the fixed Salt of the Blood which hath indeed some appearance of truth though it will not be relished by all men If you enquire into the Cause hereof from others their
and Sign pag. 116 Bubonocele pag. 33 Bullets their Extraction 73. Medicines for that purpose pag. 159 Burnings and their Cure pag. 190 C. CAncer its Difference Cause and Cure 122 of the Bone pag. 212 Carbuncle its Difference Cause pag. 121 Carpus pag. 210 Cartilage what 215. Swordlike 210. of the Breast-bent pag. 216 Cataract of the Eye the cause and removing it pag. 60 Catharticks pag. 112 Cautery Actual and Potential 37. Conveniency and Inconveniency pag. 44 69 Child dead the signs 75. It s Extraction pag. 74 The Glandules of the Chyle 253. It s motion by the Intestines pag. 254 Cholerick people how known pag. 203 Chilification its History pag. 153 154 Chirurgery what it signifies and the operations thereof pag. 1 Cicatrice or skars taken away pag. 244 Circocele pag. 33 Closing the Womb pag. 46 Comminution what pag. 2 Contra-Fissure what pag. 10 11 Contraction of the Member its cause pag. 236 Convulsion the Remedies pag. 256 Corrosives pag. 112 Cubit its Bones pag. 210 D. DIairesis what 2. Its parts Diaphoreticks pag. 36 Diaphragm and its parts pag. 308 Diarthrosis what pag. 208 Dislocation pag. 17 Dortos pag. 320 Dropsie Cause and Sign pag. 103 Dura Mater E. EAr Membrane thin and strong pain soreness 46 Its Bones pag. 209 Emphyma its Signs Cure pag. 54 Enarthrosis what pag. 208 Enterocele pag. 26 33 Epedymis pag. 320 Epigastrium pag. 311 Epiglottis indurated pag. 215 Epiploica pag. 226 Epulis pag. 292 Erysipelas its Cause Cure pag. 95 Excresis what pag. 2 Extention pag. 4 Extirpation of a dead part pag. 78 Extraneous Bodies how drawn out of a Wound pag. 157 Eye its parts Lids their Substance and Vse Iris pag. 274 F. FAce what pag. 268 Falx of the Dura Mater pag. 293 Fat whether part of the Body pag. 247 Fibre its Difference and Vse pag. 220 Fibula fractur'd pag. 16 Fissure what pag. 3 Fistula its Cause Signs and Cure 186. of the Breast 302. Lachrymalis pag. 285 Flesh what 237. Fleshy Rupture its Cure pag. 80 Focil its Dislocation pag. 23 Fracture what 2. It s Cause and Cure 3. Of the Skull 10. Of the shoulder of the Hip of the Jaw-bone of the Nose 13. of the Ribs of the Breast-bone of the Back-bone 14. of the Elbow of the Fibula of the Knee-pan 16. great and little pag. 334 Froenum or Bridle pag. 321 Frons pag. 268 G. GAngrene its Difference Causes pag. 126 Ganglion pag. 336 Gibbosity its Cause and Cure c. pag. 304 Ginglymus what pag. 208 Glandes pag. 333 Glandules of the Eye 274. Of the Chyle of the Loins 253. of the Neck pag. 263 Glotis straight wrong pag. 216 Gums pag. 278 H. HAir its shedding 249. Whether parts of the Body 247. Hare-Lip its Cure pag. 87 Hand pag. 266 Head what its Figure Parts c. 268. Wounds their Cure 172. Sores pag. 194 Heart its History 306. its Wounds pag. 174 Haemmorrage of the Nose how cured pag. 231 Herps its difference cause cure pag. 109 Hip-Bones Fractur'd pag. 14 Humors of the Eyes pag. 274 Hydrocele pag. 33 Hydrocephalus its Cure pag. 281 Hypocondria pag. 311 Hypogastrium Ibid. I. JAws their Bones pag. 270 Jejunum pag. 315 Iliack Passion pag. 324 Inflammation its cause and cure pag. 90 Infundibulum pag. 294 Internal Means pag. 1 Intestines 315. Intestines or Small Guts their Wounds pag. 157 Joynts what pag. 266 Iris of the Eye pag. 274 Issues when where and how made pag. 70 K. KIdneyes and their History 313 218 their Wounds pag. 176 Kings-Evil its Cause Sign Cure pag. 113 L. LAbour Natural and Preternatural its Cause pag. 74 Larinx cannot be inflamed pag. 216 Leeches their choice and use pag. 63 Leg pag. 210 Ligaments what and how many their Wounds and Wrenches pag. 217 Ligature pag. 5 Linea Alba pag. 312 Lips and their parts pag. 278 Liver its History its Vse 255 317 its Situation 312. its Ligaments 324. its Inflammations Vlcers Gangrene 325. its Wounds pag. 175 Loosness pag. 280 Lungs and its parts 306. their Wounds Signs Cure pag. 173 Lymphatick Vessels pag. 261 M. MAnual Operations pag. 1 Marrow of the Brain Spinal 293. of the Bones pag. 207 Matrix fallen down pag. 34 Mediastinum 305. its Cavity pag. 309 Medicines discussing Wind 108. against too great encrease of flesh corroding 257. Drawing or attractive 118. for a Cancer 124. provoking Sweat Cordials 128. Against a Gangrene 129. for the Eyes 138. against a Quinsie 143. stopping a flux of Blood 154. against Convulsions 156. against proud flesh 157. to draw forth Thornes Bones Bullets c. 159. Digestives 161 179. Sarcoticks 162 179. Vulneraries 162 Epulottick 164 179. against Wounds of the Nerves 166. Defensives 179. against Worms 181. against Corruption of the Bones 183. against spreading Vlcers 184. against Fistula's 188 against Burnings 191. Purging Choler 7. Purging Phlegm 8. purging Melancholy 9. Repelling 92. Resolving or Discussing 92. Suppuratives 93. Anodins 94. Emollients 102. Purging water 104. Cosmetick water of Minsickt 243. taking away Skars pag. 244 Meliceris its Cause Sign and Cure pag. 111 Membranes what and how many pag. 219 Mesentery and its History its Tumors Corruption Vlcer pag. 316 Metacarpus pag. 336 Metatarsus pag. 338 Mouth its Inflammation Vlcer Gangrene pag. 291 Muscle what c. pag. 237 N. NAils whether parts of the Body pag. 247 Nates of the Brain pag. 294 Nerves their Difference 233. their Coutusion its Cause and Cure pag. 234 Nodes pag. 214 Nose and its parts 277. Haemorhage how cured pag. 231 Nostrils broken pag. 13 Nymphae pag. 323 O. OCciput pag. 268 Oedema or Phlegmatick humor its Cause Sign Cure pag. 98 Omphalocele Navel-Rupture pag. 33 Opthalmia its Difference Cause Signs c. pag. 284 P. PAlate pag. 278 Palsie pag. 280 Paracentesis when in what place and how performed pag. 48 Paronychia its Cause Sign Cure pag. 133 Part of the Body what it is and its division 205 parts of the Body divided pag. 266 Patella or Knee-pan its Fracture pag. 16 Pericardium its parts and Liquor pag. 306 Pericranium what from whence pag. 268 Peritonaeum pag. 314 Pia and Dura Mater 292. their Wounds and Cure 295. its History pag. 292 Phlegmatick people how known pag. 203 Pixis pag. 312 Pexus Choroides pag. 294 Pleura its divers pains pag. 308 Physick and Physicians pag. 1 Pleurisie its cause and cure pag. 58 Polipus its cause and cure pag. 289 Poâ—rigo its cause pag. 280 Porus Biliarius pag. 318 Processus vermiformis of the Brain pag. 295 Prostataes pag. 320 Pudenda Virginam if clos'd how to be opened pag. 46 Pylorus pag. 315 Q. QVinsey its Cause Difference Sign pag. 141 Quintessence of Arsenick pag. 124 R. RAdius pag. 210 Ranula its Cause pag. 291 Rete Mirabile pag. 294 Ribs and their difference 210 302. Fractur'd 14 Dislocated pag. 23 Rostra pag. 210 Ruptures their Causes 26. Cure pag. 29 S. SAnguine persons how known pag. 202 Scarf-skin and Skin pag. 243 Scirrhus its Cause Sign
been several times quenched Hawes also boiled and made into a thick Electuary and strained is beneficial if taken in the morning fasting and an hour or so before supper the quantity of a Walnut Besides take new Milk with its Cream on it quench therein divers times red-hot Pebble-stones so that the Milk may grow hot of it then mix with it two or three well-beaten Yolks of Eggs two ounces of Sugar melting in it an ounce and an half of the Suet of a Deer or Stagg and about half an ounce of Album-graecum using it for a Clyster which cleanseth and healeth the Guts and allays the sharpness of the Blood and other corrosive humors that annoy the Bowels But take heed of not stopping too suddenly the Bloody Flux or any other Laske for if you do the annoyance will remain in the Body and cause Impostumes Difficulty of breathing and other dangerous Distempers Wherefore consult with thy strength and if that be considerable make not too much hast yet keep a bridle upon it so as to be able to stop it when there is need Mean time if it be without a Fever or heat you may do much with new Milk drinking it also mornings and evenings warm some red-hot Stones having been quenched therein and some Sugar mixed with it to prevent curdling in your Stomach This Medicine was known to the famous Grecian Physicians Aetius Alexander Trallianus and Galenus himself l. 10. de Simpl. Med. facult If you add a little Album-graecum to it 't will be the better I have my self done much good with thus prepared Milk but then there must be no Fever which if there be you 'l easily perceive it by a great thirst quick pulse hot hands and little sleep c. For bloody Fluxes are not wont to be accompanied with shaking Fevers but only with hot fits which spend more of the Patients strength in an hour than shaking Agues in several days which is to be well heeded Eggs boiled hard in Vinegar and given to the Patient that is troubled either with the Bloody or any other Flux it will be stopped The Roots of Tormentil or of Snake-weed pulverised and this powder drunk in a convenient vehicle the weight of a drachm is one of the most approved remedies against these Fluxes Tormentil-roots being very powerful not only to stop them but also to take away their catching malignity The Moss that grows on wild Rose-shrubs reduced to powder and taken in Wine wherein have been boiled the husks of Acrons is an approved remedy in this case Scrape red Lead or Rudle such as Carpenters mark their lines with put it into Wine or Broath wherein hath been boil'd the broader kind of Plantain and Tormentil-roots or take it in an Egg. Hares-blood dried and taken inwardly is also a tried Medicine in this Distemper Item open a new-laid Egg take out the white and fill it up with Nutmeg or the pulverised root of Tormentil or of Snake-weed and give it the Patient to eat or put into it some pulverised Blood-stone and it will do good I have used with good success the Seed of the broader Plantain grosly beaten and rosted in an Egg against the Flux and I know it also to have been beneficially used against the Bloody Flux Take of Mummy a little Mastick Bol-Armeniack Sanguis Draconâ— mix them together and make a powder of them and take of it in a convenient Liquor the weight of a dram once or twice a day Take Rye-biscuit and boil it in Water with Coriander and the roots of Tormentil or of Cranes-bill quench some Steel in it once or twice and give of it to the Patient to drink Make a Decoction of Shepherds-purse and Meadow-sweet in Water and Wine and now and then drink of it Burn live Crafishes in an earthen Pipkin well-closed until they be so burnt as to be reduced to powder of which give to the Patient mornings and evenings a Thimble-full or two in a convenient Liquor A dried Liver of a sucking Lamb or of any other such Animal is very good in this case provided such a Liver before 't is dried be boiled in Vinegar Let the Patient take a drachm of it twice a day Also the Blood of a Lamb or of a Hind both dried will have here a good effect Take a Pigeon Wood-cock or Patridge and having drawn any of them fill them with Mastick and a little Nutmeg and so rost them on a Spit and whilst they are rosting baste them with red Wine and so let them rost till they grow so hard as will make them pulverable then reduce them or any of them to powder and take a spoonful of it at a time in warm Broath The highest Experiment in this case is Crocus Martis taken in the Juyce of the broader kind of Plantain or in a Pulse of red Beans or Rice-broath the dose is half a dram But when the pain is very great you may then add to it some opiat Medicine as of the Trochisques de Garabe or one only grain of Laudanum Opiatum And give the Patient now and then a little new-made Treacle or mix with it a few grains of the Confection of Archigenes for of such Medicaments a Field-Apotheque is not wont to be destitute For the Patients ordinary drink boil water and in it Coriander dried Sloes dried slices of Quinces burnt Harts-horn Mastick Nutmeg or any one of these putting to it some of the roots of Snake-weed Tormentil or such like adstringent roots Of this water the Patient may drink according as his necessity shall require The red Juyce of Quinces boiled up without Sugar is also much to be commended in this case for strengthening the bowels two or three spoonfuls of it being taken at a time and that twice a day In many places a drink is made of Sloes Pilosella or Mouse-ear and Juniper-berries infusing them all in common water and letting them ferment together This yields a pleasant acid drink allaying the violence of the Flux and quenching thirst withal The Rich may make Granat or Quince-wine But I have here undertaken to deliver such things as are parable and cheap for the poor common Souldier I am sorry that in the Field there is no conveniency of administring Clysters For though I prescribe none without great necessity yet Clysters being of great benefit in Diseases of the bowels they being to them like Plaisters I cannot but recommend in this Distemper Clysters of Milk wherein Pebble-stones have been several times quenched mixing a little of the melted Suet of a Stag or Hind without any Oyl or other fat I remember I had once a Patient of quality that had about an hundred stools within twenty four hours who by the use of such Clysters once or twice applied was fully restored The cause whereof is that the Milk washes the bowels and clears them of the sharp humors that annoy them moreover it is healing and repairing by reason of the Pebbles quenched therein The Sugar