vlcer is made moist by the thinner excrement in like sort as by the groser it is made filthie and for that cause it néedeth two kind of medicines that is to saie exicatiues to expell or drie that which is moist and mundificatiues to purge the filth Now then séeing that nature ceaseth no time truelie there can be no time found in which both these excrements may not be gathered together in an hollow vlcer Wherefore there shall be no time in which thou shalt not vse both kindes of medicines that is to saie which shall exicate and mundifie And now we haue found out of what kinde the medicine ought to be but that is not sufficient for it is néedfull to inuent some perticular which is to be applied to the vlcer Now by what method and howe shall they be found out forsooth by the same which is set out in our bookes of the faculties of simple medicamentes for we haue shewed in them certaine medicines desiccatiue certaine humectiue certaine refrigeratiue and certaine to make hot yea and certaine by coniunction to make hot and drie or to refrigerate and moist or to heate and moist or to refrigerate and drie and that there is in euerie of them a difference more or lesse but in multitude infinite Notwithstanding they be contained within limites to their vse which doe easilie comprehend them in the first order or degrée or second or third or fourth now of what degrée shall that medicine be which is méete to engēder flesh which must both moderately dry and also mundifie truely of the first degrée for that medicine which surmounteth this degrée doth not onely cōsume the aboūdaunce of the humor flowing to the part but doth also deuoure the bloud flowing letting the part to be restored cōsuming the flesh or the matter wherof the flesh groweth surely it is declared that such be Olibanum and the meale of barly beanes Eruum and Iris and Aristolochia and Cadmia and Panax Pomphilix and we haue shewed that all these differ among themselues more or lesse and that some of them abound onely in simple qualities and other some in compound For Aristolochia and Panax doe drye more than the rest and also by nature are more hot barley and bean flower doth much lesse drye than these and haue no heate at all Olibanum doth moderately heate but doth lesse dry thā these in so much as in certaine bodies it dryeth not at all The meale of Eruum and Iris and Aristolochia and Panax are in a meane But now let vs repeate againe that wée haue profitably touched Olibanum in bodies of moist nature is able to engender flesh but in dry natures he cannot for it is néedefull to consider that there is a two folde difference of the first indicatiōs that which is according to nature shewing the cōseruation of it selfe further doth also require things lyke to it selfe and that which is against nature declaring the taking away of it selfe and also requiring things contrary for euery thing perisheth or is ouercome of his contrary and in his contrary And truely the Vlcer how much it is to moist doth so much the more require medicines which doth drye But the nature of the bodie how much it is more moist so much the lesse it requireth a medicine which doth excicate wherefore if there be any vlcers in which there is like humiditie because they are in a bodie of dryer tēperament truely it is requisite the more to be excicate that which is in a moister temperature doeth so much lesse néede drye medicines as there is difference betwéene nature and nature For it behoueth the flesh that is engendred to be like that which was there before Therefore whereas the flesh is dryer than in times past it is conuenient that the new be made dryer so that it ought to be the more largely to be dryed how much the more it shall be drye so much the more shall the medicine which shal be applyed haue a dissicatiue vertue but in a moist nature there is so much lesse néede of a medicine dissicatiue how much the flesh is lesse drye Therefore like as Olibanum hath such temperament cōcerning the nature of mans bodie that is agréeable to a temperate meane nature but it doth somewhat more largely drye These that be moyster in like sort as it is to moist for them that be most drye so that of right Olibanum maketh mattier both in certaine Vlcers and also natures doth not engender flesh and in certaine it doth engender flesh Therefore if thou dost marke thou shalt finde the successe aunswerable vnto reason for in a moister nature it may engēder flesh in a dryer it cānot Doest thou not therfore perceiue of how many Theoremes or intencions of curing he hath néede that will cure an vlcer by a right Methode for after that it is found out that the fault is in moisture altogither it sheweth foorthwith that ther must be prepared a dissicatiue medicine but for that there are of drying medicines some that dryeth more and some lesse that which is expedient must be taken partly of the diuersitie of the vlcers partly of the nature of the sicke Therefore he that will rightly cure an vlcer must not onely cōsider the nature of the body but also to haue learned all the speculation of medicines diligently and also to know the signes of bodies which are of dry or moist temperament Now therefore consider what great rashnesse is of pronouncing these Methodicians which think that they haue done sufficiently to the curing of an hollow Vlcer if they vnderstād that it must be filled with flesh Truely the way of curing cōsisteth not in this but in finding that out which shall fill it with flesh but that shal fill with flesh quod he is alreadie founde by experience then confesse that which shall cure to be founde out by experience neither doe they vainely boast neither extoll the Methode although experience is cōdemned yea of the Empericks themselues which is without certaine limitation for they write in their commentaries of medicines in this manner An Emplaister for those that haue soft bodies and for children and women they know how that Olibanum in such natures can engender flesh and fill hollow Vlcers so that there be no other accidence notwithstanding where such bodies are moist and because of their moystnesse require moderate drying Medicines or that there is some other cause of the successe they cannot tell Againe they shall finde an other medicine written for olde folkes and another against those Vlcers which will hardly be brought to a cicatrice and hath the sides swollen called in Gréeke Oxthothe and they write in all their cōmentaries curatiue many other seperatiues for which as néere as we can inuent a conuenient medicine to the propertie of curing nature for seperations in euerie Arte go about to deuide that which is proper from that which is common and how much any doth diuide
happen to the vlcerate partes as wel by the occasion of anie perticular member as of all the bodie wherevnto the bloud or anie ill humours doe resort first remedie must be had either to the particle that is cause of the fluxe or else to the whole bodie Thus then we shall cure first the varices that are often resorting vnto the vlcered place before you cure the vlcer and then afterward you may the easilier cure the vlcer Likewise in them that haue a disease in the splene or in anie other notable part first it behoueth to cure the sayd parte and then after to procéede to the curation of the vlcer howbeit none of the curations héereof is proper to the vlcer but some other affects or dispositions that either engendereth the vlcer or that nourisheth and conserueth it The third Chapter BVt now I thinke it time to define that there is no indicatiō of outward or as they terme it of primitiue causes of curation but the indication or curation to haue his beginning of the affects it selfe But those thinges that ought to be done perticularlie are found out either of that which the indication sheweth either of the nature of the affected part or of the temperature of the aire or other like things but to speake brieflie no indication may be taken of things that be not yet come But forasmuch as we ought to know the affect that is not manifest vnto vs by reason or wit we are often constrained to enquire of the extreme and primitiue cause For this occasion the vulgar people supposeth that the saide primitiue cause is Indication of curation which is altogether otherwise As it appeareth likewise in those where the affect may be exactlie knowen For if Ecchymosis or an Vlcer or Erisipelas or putrefaction or Phlegmon bée in anie parte it is a superfluous thing to enquire the efficient cause of these diseases except they be remaining For in so doing we shall cure that thing which is alreadie finished and shall prohibite the efficient cause to procéed anie further But if the said efficient cause which produced the effect hath no longer biding there then we shall remooue awaie the affect For to put awaie the cause that is not there it were impossible For curation appertaineth to the thing present as prouidence to the thing to come For that thing which doth not now hurt neither is to be feared that it will hurt héereafter is out from both the offices of the arte that is to saie from curation and prouidence Wherefore in such thinges there ought to bée no searching of anie indication neither yet to cure nor to prouide as is sayd before notwithstanding the knowledge of the primitiue cause is profitable to vs in things vnknowen Neuerthelesse the Emperikes take sometime the primitiue cause as parte of the course of the disease that the Gréekes call Sindrome wherein they haue obserued and experimented the curation as in that that hath bene hurt with a mad dog or venimous beasts Thus doth also some Dogmatists which doth affirme to cure such diseases by experience onelie without rationall Indication for they take the cause primitiue as part of all the Syndrome and vniuersall course but the primitiue cause serueth nothing to the indication of curing although it be profitable to knowe of the nature of the disease to them that haue not knowen the nature of venimous beasts by vse and experience and thereof taketh indication curatiue trulie the outward cause of curation béeing knowen doth nothing profite to the indication but to the knowledge of the present affect For put we the case that we knowe that the venime of a Scorpion is of a colde nature and for that cause as of a colde thing I take Indication for the remedye howbeit the case is suth that I haue no signe whereby I doe vnderstand that the bodie is hurt of a Scorpion it is manifest that if I doe knowe that the bodie is hurt of a Scorpion that then I would inforce me to warme all the whole bodie and also the part affected without abiding for anie experience in taking mine indication of the nature of the thing We haue declared in the booke of Medicaments wherein it behoueth them to be exercised that will take anie profit of these present Commentaries no such facultie can be foūd without experience Truelie it should be a gifte of felicitie if anie hauing the sight of Litargerium Castoreum or Cantarides forthwith to vnderstand their vertues For like as in all things is committed error as well by those that excéede as by those that lacke so héere as the Prouerbe is among the Gréekes this Thiapauson that is to saie they differ among themselues Also they affirme that the vertue of medicines is not yet knowen and that after so great experience the other that suppose and saie that the saide vertues be knowen onelie by experience The first speaketh vndiscréetlie if that be a thing imprudent to affirme a thing impossible the other be altogether stupidious sturdie and foolish But for this present time we will saie no more because I haue spoken more plainlie in the third booke of Temperamēts also in the bookes of Medicaments Neuerthelesse for the knowledge of diseases some primitiue causes are profitable but after that the present disease is altogether knowen then the cause primitiue is totallie vnprofitable Now we haue declared that it doeth not become vs to meddle and confound both the doctrines together but the Emperikes ought to be spoken by themselues and the rationals by themselues We must now call to mind because we haue purposed in this present Commentarie to intreate of the doctrine Rationall although to some things that we do saie we doe not adde absolutelie that all be not true but onlie after the sentence of the methodicall sort but that euery man ought to adde and reason that thing by himselfe And at this time we haue said that there is no cause primitiue which is profitable to the Indication curatiue although it serueth well to the knowledge of the disease And we confesse that the cause primitiue is part of the Syndrome and of all the Emperikes course that they cure all diseases by reason by experience But in all that we shall saie héereafafter it is not necessarie to adde such words Then let vs returne to our first purpose in taking the principall indication certaine and vndoubtfull whereof we haue also vsed héere before as we haue said that the disease that requireth to be cured iudgeth the end whervnto the Surgion ought to intend and of the same all other indications are taken Wherefore we haue begun to speake that the said indication hath no manner of affinitie with the cause primitiue for put we the case that anie vlcer be come of a fluxe in anie part then it is manifest that the sayde vlcer procéedeth of corrupt humours for nature is accustomed so for to doe in diseases when she purgeth the bodie
Chirurgerie is not onelie to know the names of sicknesses and diseases but the name of euerie perticular medicament as wel simple as compound And also to know all other strange tearmes appertaining to this arte Wherefore Galen in this booke of Tumours against Nature hath taken greate paines not onelie in setting forth of their names but of theyr true diuisions natures and dispositions with their figures formes and humours by which they doe grow and are maintained without which knowledge no Chirurgion can either rightlie cure either else vnderstand the nature of those things which he doth take in hand Therefore I haue thought it good to set before your eies this most worthie booke which Galen hath writtē of tumors against nature wherein he hath most excellently set forth not onely the most apt names but also the humors that the same tumors doe spring of For like as he hath declared in his methode of curing the diuersitie of wounds and vlcers with their natures formes and properties and also with their accedents symptomata and causes Yea I say not onely with these but also with the knowledge of the temperaments natures and qualities of euery medicament proper for their remedies with their trew deuisions and names to that ende that euery one of them may be exactly and perfectly knowen from other And for the better vnderstanding hereof I haue added in the ende of this booke of Tumors against nature an other booke of Galen of the names of medicines which be proper for diseases which I haue thought very meete and conuenient for you to vnderstand to that ende that you may be accounted men of knowledge in your arte not onely to be accounted so but to be so in deede Thus taking my leaue of you I desire you most hartely to be studious herein and so being you shall incourage me further to procede in other things of this arte which may be much for your profit And thus I commit you to the almightie Lord who illuminate you with knowledge of this most worthy Arte. Your louing brother to the vttermost of my power Thomas Gale maister in Chirurgerie An. Domini 1563. Mense Septembris 25. Claudus Galeni de Tumoribus preter naturam OF those things which chaunceth to mans bodie one thing is that which the Gréekes do call Oncos which we name a tumor or swelling for so doe they tearme that thing which is a swelling or a distention in length breadth and déepnesse Also sometime that bignesse which is aboue natures constitution they do cal Oncos These do not onlie chance vnto them that be sicke but to those that be whole also For corpulent persons and women with childe are more bigger in breadth and thicknesse than according to nature and yet they are not affected against Nature as we haue sayde in other places The other tumor is that which is according to natures constitution or as we may tearme it a naturall tumour in the braunes of our armes and caufe of our legge which is in a meane betwixt those that be according to nature and those against nature For corpulent bodies also leane bodies are not against nature but the one is aboue natures constitution and the other vnder and so both these dispositions are called not naturall But that tumour which cōmeth of the dropsie and leanes in a consumption both these are against nature But now in this presēt booke we doe purpose to intreate of those Tumours which bée against nature which doth not onelie occupie the whole bodie but also may chaunce to anie part thereof so that it bée alwaies determined that the agreuation of this vnnaturall constitution be against nature and the end of the same to be the hurt of the naturall action But we néede not to speake much of these Tumours for that they be commonly knowen vnto all men not onelie to the Phisitions but to all other persons The other tumours which groweth of immeasurable fatnesse and flesh and also women béeing with childe doe make those which are aboue natures constitution And we considering all other Tumours which are according to nature and necessarie for the making of our bodie as in the braunes of the armes and cause of the legges c. All other tumours which doth excéede that which is aboue nature and those which be naturall we account against nature And taking our beginning at the first of them called an inflammation or Phlegmon Of Phlegmon or Inflammation Chap. 2. THe Grecians vse to call that an inflmmation which commeth with great tumor or swelling in the fleshie parte strained and stretched forth resisting with pulsation dolour hot and red The cause of these accidents is not onelie vnknowen to the multitude of the common sort but also vnto manie Phisitions or as we terme them those that vseth the art of Medicine for diuerse of them not séeking out diligentlie doe simplie pronounce that which séemeth good vnto themselues mistaking the thing But consideration must be had héerein if you will procéede in this mattier Therfore there is neuer anie great tumour that chaunceth in anie parte of the bodie against nature except the same parte be affected with one of these two thinges For either it is made flowing increased and stretched forth through ouer much hotnesse either else it taketh some new substance outwardlie And when this fluxe doth happen is stretched out with swelling it is tourned into spirites and béeing refrigerated it doeth easilie tourne againe into his accustomed swelling But we sée no spirits in the inflamed parte neither yet the part inflamed being refrigerated doe not alwaies come againe into their former constitution And it is manifest by incision also that there is no spirites therein contained for if the inflamed part be cutte much bloud will runne out and all the place séemeth euidentlie full of bloud like vnto a wet Spunge But yet you shal sée no spirits come forth either presentlie or yet long after and the coulour of bloud is altogether inseparable There is no part of the bodie that is red but bloud and flesh neither is the multitude of flesh the affect of inflammation for although the multitude of flesh be in the bodie without multitude of bloud yet the tumour trulie shall be bigger than natural and the coulour shall be healthfull and not swarue from his accustomed nature for in anie thing which naturallie increaseth the coulour is not augmented for then should Snow be made more white Pitch more blacke and Golde more yeolowe And the increasing of substance differeth manifestlie from alteration for thinges increase according to their quantitie and altereth according to their qualities but coulour sheweth the qualitie of the substance and not the quantitie Therefore the multitude of flesh differeth from an inflammation and for that cause the bodies which abound with bloud bée most troubled with inflammations Now séeing that sometime in wounds there be greate inflammations and yet there floweth forth thin and watrie humours the place
of Medicine not onely to the sauegarde of their Prince and people but also to their immortall fame and perpetuall and euerlasting honour The noble Latinestes haue also deserued no lesse fame both in séeking out the knowledge of simples and also in setting foorth of most worthie woorkes in the Arte of Medicine as these worthie men Cornelius Celsus Plinius and before them Cato Verro Alexander and many more which were men of worthie fame all these as I haue saide béefore haue taken their originall and beginning from Hippocrates and Galen It is also most apparant that there are manie worthy men that haue written in these latter dayes no small number in our time and of manie Countries some dyd wryte in Fraunce some in Spaine some in Germanie and some in our owne Countrie and many of them were famous men and menne of great and excellent knowledge and practise As Lamfranke Archbishoppe of Millon Guido of the schole of Mompillor and Commissarie to the Pope Rogerus and Roulandus of the schole of Mompilor and Chirurgians vnto the King of Fraunce Rose Anglus Gilbertus Anglus Hugo Wiklefe Anglus of the schoole of Cambridge Theodoricus and Brunus of the schoole of Bonane Arnoldus de villa noua and Plasentinus of the schoole of Mompilior Petrus de Argilat and Gordonus all these dyd write of the Arte of Medicine about two or thrée hundred yeres since and all these builded their foundation and tooke their originall of Hippocrates and Galen and nowe in our tyme there hath bene famous writers as Iohannes Vigo Antonius Muse Antonious Gallus Nicolaus Masse Iohannes Baptista Montanus Iacobus Siluius Alfonsius Ferrey Hollerius Leonardus Fuchius Iohannes Tagaltius Gabrielus Falopius Rioldus Columnus Antonius Calmisius Vassalius Ioh. Fernelius Amatus Lucitanus Frāciscus Valleriolus Ieronimus Cardanus Matthiolus and a great many more of learned men who we will passe ouer the troubling of tyme. All these which I haue spoken of of what Countrie so euer they were they tooke their originall and foundacion of our Father Hippocrates and Galen although they haue founde out many thinges appertaining to the Arte of Medicine which we finde no mention made of neither in Hippocrates nor in Galen yet they had their foundation from them and all these men of what countrie so euer they were they haue dronke of the water that flowed out of their two welles and doe greatly reioyce therein and who that list to reade their workes may perceiue the truth thereof Now my friendes to tell you the truth in my iudgement what was the cause of these mennes writinges I take it to be chiefely to sette forth the glory of God in his wonderfull creatures and workes as touching their natures qualities and properties which doth appertaine vnto this artist which doth vse the Arte of Medicine to consider vppon for all maner of thinges vnder Heauen doe serue either for mannes nourishment or else for the making of his bodie or else for necessarie remedies in the time of sicknesse or else for preseruatiues to kepe him from sicknesse and to preserue health So carefull was the highe and mightie Lorde God for his creature man that he made all these thinges to serue his vse as necessarie helpes in the time of his necessitie and placed him in the place of ioye with great solemnitie But alas his frayle nature was the cause of his sodaine ouerthrowe from ioye to sorow from pleasure to paine from rest and quietnesse to perpetuall labour and vnquietnesse from a most temperate Ayre and pleasant place into a miserable worlde tormented with innumerable contrarie ayres and chaunge of windes Yea I saye euen from the place of health into the worlde of sicknesse and miserie where our bodies be altered and weakened euerie daye by mixing together of contrary Elements and we being subiect to the same are dayly tormented with innumerable diseases And although Adam at the first creation was indued with most excellent wisedome and knowledge by the power might of the Lorde God so that he dyd know all things that were vpon the face of the earth in the waters and déepe partes thereof not onely their qualities and properties but their substanciall formes and figures and gaue them names as he himselfe thought good for he had perfect knowledge of all thinges by the deuine spirit of God which dyd worke in him according to his first creation but when he had sinned against the Lord God then was taken from him his diuine knowledge and lefte here in this world bare and naked to take paines and studie for all those things that he would receiue commoditie of Now man as I sayde before being wrapped about with innumerable sicknesses diseases and sodaine chaunces which bée subiect to the arte of Medicine which Arte I call the arte of curing and healing was constrained to séeke for remedies in the tyme of his necessitie And sought out Herbes Rootes and manye other thinges to helpe his diseases and griefe withall and by vse and longe time of practising they dyd finde out the natures and properties of many thinges wherewithall some tymes they dyd good but by chaunce for they obserued neither the natures of bodyes nor their temperatures nor the disease neither yet the causes thereof but onely regarded those thinges which they dyd sée and féele Thus farre wyde was man from that excellent knowledge which was geuen him in the beeginning for in the beginning he was not onely indued with most beautie but also with most excellent giftes of knowledge and wisedome All other creatures besides man which hath not sinned against the LORD GOD but followed the nature of their first creation all these wée sée by experience haue a certaine deuine nature in them which man lacketh for man dyd lose it through sinne which these creatures haue not done and for the proofe héereof we will begin with the dog which being sicke séeketh for a certaine grasse eateth thereof and with the same cureth his griefe and disease Onelie a diuine nature teacheth him this without anie studie The Squirrell also prouideth her selfe nuts against Winter The little Ant or Pismere doth gather séeds into the ground and biteth them in the end after such a cunning sort that they may not grow The Storke also being grieued or anoyed with anie vncleane thing that she hath eaten flyeth to the sea and giueth her selfe a clister with salt water ministring it with her bill at her neather end by meanes whereof she purgeth and cleanseth her selfe of her griefe and sicknesse Thus may you perceiue the diuine and wonderfull workes of almightie God working in his creatures by a diuine nature but man lacking this diuine knowledge and lefte onelie to reason and Experience is constrained by greate studie to bring to passe those thinges which by imperfection of Nature dooth lacke in him By meanes wherof all these most worthie men afore said haue put in writing manie worthie Bookes of this arte which arte they haue obtained by greate
therefore this indication is taken of thinges naturall as whether health may be restored or not whether the strength of the patient sufficeth for life or not and whether the cause of health may be conserued and so of the rest The indication taken of things against nature is whether we may cure the sicknesse with his accidence or not whether we may resist the cause of these two or not this is to be knowen thrée waies First when the sicknesse of his owne proper nature is incurable as Elephantiasis absolute and as they tearme it confirmed or when the sicke patient refuseth his necessarie remedies when the diseases are curable As for example the cutting awaie of a member in which there is a Cancer c. Or when the curation bringeth a worse and more perillous disease as olde Cancer being cured or continuall Emorodes for if you cure these there is daunger of life or of madnesse or of consumption Nowe the third indication doth teach conuenient remedies for their curation their vse and instruments wherewith it is brought to passe The first of these instruments is an apt diet or regiment in the vi things not natural The second is Pharmacon which he vnderstandeth for purging medicaments Also letting of bloud with plaisters vnguents pouders c. But in the two first the Chirurgion must consult with the learned graue Physition There be many yron instruments beside these medicinall instruments which be both proper and common for this arte as héereafter followeth Thus farre we haue spoken the wordes of Tagaltius as they be set forth in his booke of Chirurgerie as well for his definition of Chirurgerie as for the antiquitie thereof and also what manner of conditions hée ought to haue what learning he ought to be brought vp in and what he ought to learne first and what last and what is the matter or subiect proper to his art and what instruments the artist must haue both common and proper to 〈◊〉 and bring to passe withall his desired scope and 〈◊〉 of his worke which is the curation of mannes bodie in these thinges that hée hath charge of This is the effect of the words of Franciscus Valleriolus as well as of Iohannes Tagaultius as it may appeare in their words héere aboue written Now my friend where you did alleadge Tagaultius to proue that a Chirurgion ought not to minister diet and Purgations neither yet anie inward medicines for that you saie it doth propertie appertaine to Phisicke it séemeth to me by the wordes of Tagaultius that it maketh little for your purpose Obiection No sir by your saying both Valleriolus and Tagaultius saith the contrarie doe not they saie that a Chirurgion ought not to giue inward medicines without the counsaile of a Phisition and declareth what inconuenience hath come by the vndiscréete ministring of the same I take this to be a sufficient proofe The answere No not so sir we may not confound the instruments which are necessarie to an Arte because that some Artists doe abuse their instruments neither Tagaultius nor Valleriolus meane so but their meaning was that those that did practise the Arte of Chyrurgerie which dyd not vnderstand or knowe the principles of their arte neyther the causes of diseases nor yet the diseases themselues nor how to take indication for the curation neither yet knoweth the nature of the medicines which he doth minister These be they that Tagaultius and other learned men do reproue which I must néeds confesse ought not onelie to be forbiddeÌ„ in inward medicines but also outward medicines for if I should speake of all mischiefes that hath bene done by the applications of outward medicines how some hath bene maimed and vndone for euer and other some brought to death the number of them would séeme verie strange vnto you and therefore we will let it passe at this time with praier vnto almightie God for his mercifull helpe héerein that he may moue the hart of the Prince with the Magistrates of this Realme to take such order for the safegard of the people and for the honour of this Realme for that that learned men may be the better incouraged to studie this arte But as concerning the instruments there is neither these two men neither yet anie other before their time since the time of Galen that hath forbidden the vse of them to the Chirurgion for both these men doth put theÌ„ in their bookes as most common and special instruments affirming them as most speciall instruments pertaining to the art of Chirurgerie that without these those euill and vicious humours that hindereth the curation of vlcers tumours against nature c. cannot be purged awaie neither can the temperaments other naturall things of the bodie be kept in perfect state without an apt and méete diet But for to counsaile with the Phisition being a graue and learned man in the principles of this arte In matters of waight I take it to be verie necessarie for what is he that is wise that will refuse the counsaile of a wise and a learned man and speciallie of him that professeth the principles of the same arte for Phisiologia whereof the Phisition taketh his name is the first and chiefest parte which he that worketh in the art of medicine doth proue for that it doth consist in the knowledge of the seauen natural things and in the residue therevnto appertaining But yet this doth not followe that a learned an expert Chyrurgion should not vse diet and Purgations and other inward medicines at all times when néede doth require for if you would so vnderstand it one part of their sayings should repugne against another and so confound the whole but their mening was that the vnlearned Chirurgions and these that be younge men which be not well practised that they shoulde take counsayle as well of the learned Physition as of the learned Chyrurgion for this Arte is so ioyneed togeather that neyther maye the partes bée diuided neyther yet the Instrumentes without the ouerthrowe and destruction of she whole Arte for it was neuer perfect before the time of Hyppocrates till that hée ioyned all these partes and Instrumentes together and taught a perfect method and waie of curing by a right vsing and ministring of the same I for my part haue read no few authors not onelie of the Grecians but also of the Arabians of the Latinists yet could I neuer â—…nde in any of their workeâ— that they doe write of Chirurgerie where they doe leaue out dyet and parging medicines apointing the Chirurgion onely to cure with outward medicines for I am certaine that in all their scope of curing both of tumors against nature of vlcers c. That their first indication is to take away those euell affected which may let the curatioÌ„ that is to say to remoue away these euell humors which might repaire vnto the greued part and also to alter such distemperatures by conuenient dyet and other thinges as
Therefore as often as we purpose to finde out the cure of a simple vlcer we in this talke presuppose that the fleshie part is diuided without losse of anie portion of the same for it wanteth a broad skin which we haue called in Gréeke Epithermia which must be made by inducing a ciccatrize Therefore it is necessarie both to regenerate this also to vnite it together so there be two things vnto which thou must looke as in an hollow vlcer because there is a double affect in both But peraduenture some of them will saie how is a plaine vlcer knowen from an hollow if there be both a double affect in either also a double scope of curing appointed that is to saie the multitude of the lost parts where in an hollow vlcer not onelie the ouer skin is perished but also the skin it selfe yea and sometime no small portion of the flesh In an vlcer filled there wanteth not flesh but yet outwardlie there lacketh his couering but we will shew héereafter what the cure is of those kindes of vlcers now let vs vnderstand what is the due cure of an vlcer in that it is onelie an vlcer hath no other affect ioyned with it therefore for that héere is onelie diuision put forth it behoueth to ioyne the sides that are diuided and not onelie to ioyne them but to make them also to indure surelie they which are ioyned shall remaine together two waies when as some of themselues doth so remaine other by the helpe of other things of themselues they onelie remaine which doth grow together and close by the helpe of other those which are gathered together and so holden with anie glutenous thing but those that grow together must of force be naturallie soft Trulie such is both the flesh it selfe and also whatsoeuer commeth of flesh but whatsoeuer are hard drie their parts cannot grow together but doth require some glue or band whereby the sides ioyned may so remaine But the cure of such bodies shal be set out héereafter Héere let vs procéede with our talke begun of those which may be vnited scarching out also the cause of ioyning closing for like as in hollow vlcers there must be flesh ingendred so in a simple vlcer that the sides may close And nature trulie is the cause that if thou dost exactly put together the sides which are separated they wil close together without anie outward labour and now there springeth another scope for thee to consider the bringing of the sides together beginning with which thou shalt finde out with what thou shalt bring this to passe for thou shalt close them together which are separated either with a roller with two ends put about or with stitching or hookes which the Gréekes call Agkleras or with some of these or else all it is necessarie that the roller which is put about bée not too softe or will bée broken lyke Alga the Gréeke writers doe call it Vrouothes that it maye safelie holde neither yet so hard that in compressing it may offend then let not thy rolling or binding be so loose that it cannot doe good neither yet so straight that by compressing it may cause dolour These thinges if thou shalt obserue without doubt the vlcer will close if that it bée frée from all iuyce or fluxe or intemperatnesse or inflamation or anie other fault But if for the greatnesse it cannot be that the partes diuided may from the bottome bée exactlie ioyned neither being able with stitching neither with splents neither with rolling to come vnto them or that there is Sanies nowe gathered there or some dolour annexed such an vlcer cannot close together by the onelie ioyning of the sides when as that that is pained causeth somewhat to flowe more yea and although that which floweth bée according to nature yet the strength of the parte which are méekned both for the dolour and paine and also thorough the wound cannot beare that which is iust but are burthened as though it were the contrarie and héereof springeth superfluous Sanies yea and it is meruaile if there followeth not inflamation also if there be Sanies collected in the middest of the sides of the vlcer without paine or that there bée anie meane place betwixt which is voide of Sanies but yet is filled with the aire the Vlcer cannot bée adglutinated by closing together the partes diuided when as the Sanies do deuour the vnion and the voide places which are betwixt the partes to be ioyned doe let the frontes of the inward sides to touch Therefore at the least that those partes of the vlcer maye close they require Natures helpe to bée filled with flesh and surelie these are so little if the sides of the vlcer bée rightlie ioyned that it may be done in one daie or in two at the most Therefore for this time it behooueth to vse some desiccatiue medicine which may drie the part that it may consume the Sanies if anie there bée or if anie shall flowe into the voide places to kéepe it back Now therfore thou shalt cause me to call to remembrance the medicine which doth incarnate moderatlie drie that we may knowe whether the glutinatiue medicine ought to be drier or 〈◊〉 truly the incarnatiue medicine if it shuld cōsume al the bloud which floweth it should by that meanes take away the matter it selfe whereof flesh springeth But truelie a glutinatine medicine either néedeth not at all the generation of flesh or else verie little Wherefore it behooueth it to be more desiccatiue than that which must incarnate so that by this reason there is but a small difference betwixt these medicines but yet by another reason ther is great difference in as much as that which doth incarnat ought eft-soones also to haue a vertue abstersiue whereby it may not onlie dry the abundance of moisture but also may take away all the filth Aglutinatiue trulie neither may mundifie neither purge but to bring all the whole substaunce together And medicines which be called Abstersiue and astringent hath such facultie for these surelie haue facultie to constrain and stop and not to mundifie and purge whereof it followeth that when we studie to incarnate we must chiefly flie an astringent medicine because it fixeth the filth more straitlie than may easilie be loosed Therefore wine is the best medicine for euery vlcer in that it is an vlcer and if it be not added that it is an vlcer I suppose thou wilt vnderstand For it is onelie added for remembrance sake least anie should thinke not as defining anie thing necessarie so that if thou shewest thy selfe mindfull of all those things which in the former booke are set out of naming euerie thing and also of the subiects there is no cause that hence forth I shal define such things vnto thée it shal be abundantlie for me if I onelie in euerie of them separate the simple effects from those that are compound of which things I haue somwhat
before spoken and nowe neuerthelesse shall speake not so much trulie for the things it self as that many Phisitions deceiued by the word thinke hollowe and vnequall new and old filthie and cleane with inflamation and without inflamation to be differences of vlcers Therefore it is necessarie to make distinction which bée the proper differences of Vlcers and which be complections of other affects but of this a little héereafter Truelie the wonted doctrine of the olde Physitions which I would were now in vse is altogether natural for they shew the cure of euerie simple effect but of them all that doeth chieflie Hyppocrates for the curatiue methode shall best procéede if we shall speake seuerallie of euerie simple by themselues after shew another method of all compounds as if there were two diseases in the order of diet retaining and flowing as Thessalus supposeth when as we had spoken of the cure of either of them seuerallie we must doe in like sort of these both ioyned together So in like sort I suppose because there is one kinde of all vlcers in that they are vlcers and also one other kinde of inflamations in that they are inflamations it behooueth to set out the cure of an vlcer by it selfe and the cure of an inflamation by it selfe after to ioyne both cures together which thing if we shall doe truelie we shall finde by the methode declared that euerie vlcer ought to be dried and bound but yet not mundified the hollownesse in the flesh also to bée dryed and mundified but yet not to bée astringed Also after the same manner which wée spake of in hollowe Vlcers wee shall for the portion iudge Nature whether it bée softe and loose or harde and drie and impact for the first how much moyster it is so much lesse néed it hath of desiccatiues the last howe much drier it is so much the more it requireth vehement desiccatiues and medicines astringent the emperike I suppose will héere make mention of children and women and delicate bodies and will account young folkes Plowmen and Marriners of contrarie sorte but séeing that he vnderstandeth not that the medicine doth profite children and women though the moystures of their complection and another agréeth in lyke sorte with Plowmen and Marriners because of their drie temperament neither can he gesse exactlie the cure of euerie bodie neither yet finde out the cause of errour whereby it dooth come to passe that he knoweth not how to goe to an apter medicine when that which he first knewe by experience doth little profit And thus we haue brieflie spoken of glutinatiue medicines and héere followeth another method pertaining to the preparation and composition of them for by and by wée applie to an hollow vlcer what we list whether it be a medicine drie or moist for we may strow it in euerie part of the vlcer or else annoint it but in woundes we cannot so doe where there is a greate déepnesse for as soone as thou hast ioyned the sides of the wound thou canst not touch the parts which are in the bottome diuided Therfore it is to be considered whether the medicine be moderatly drie and astringent but also whether it may come to the bottome Cerussa and Litharge be moderate drying and astringent but if thou doest strowe it vppon the wound like as ashes thou shalt not profite for the vertue of the medicine that is so drie cannot come to the profunditie therefore there is requyred some moistures or else of some moisture medicine that it may be plaister like but these belongeth properlie to that speculation which sheweth the composition of medicines and not to that which sheweth the reason of curing But if we shall néede it vnto this matter we shall touch it in our worke héereafter The fift Chapter NOw will I turne again to the vlcer which requireth to be cicatrised of which a little before we made mention the end of these also whereto we drawe is of the like kinde that an hollow vlcer is for it behoueth to regenereate somwhat that is lost and not onely to vnite that is diuided but the which is here to be regenerated is after an other sort than in an hollowe vlcer séeing that the matter there is bloud but héere it is flesh for that which is hollowe is filled by engendering flesh whose beginning is bloud and that vlcer is cicatrised that is alreadie filled by engendering skinne which is made of the flesh subiect and surely the flesh which may ingender in an hollowe vlcer may be like to that which is lost but the skin which shal be restored cannot in all pointes be like the which was before but a thing like the skin which also may supply the office of the skinne but yet is not the skinne in déede And the cause trulie wherefore the skinne perished cannot be againe ingendered like as flesh and fatnesse be is to be sought out of naturall problemes But we must héere learne both how to imitate nature and also the vse of the skin and of this thing we will now shew the methode and for that our purpose to couer the flesh with some naturall couerture for that is to cicatrise an vlcer either we must regenerate skin or make the vpper part of the flesh like vnto skinne but skinne indéede cannot be engendered therefore let vs attempt that which may be done But what waie shall we do this forsooth by alteration for we labour that some part of the flesh may no longer be flesh but maye bée lyke skinne but by what waie sayest thou shall it be altered forsooth by the helpe of some medicine whose qualitie will alter and héere against my will in this place commeth the talke of elements without which neither can there be founde a medicine which can cicatrise much lesse anie that hath vertue to incarnate and glutinate therefore because the skin is both drier and thicker than flesh if we shall drie and binde the flesh we shall also make it like the skinne And thus thou hast the summe of the medicine which doeth cicatrise but this trulie is not sufficient for glutinatiues be also dry and binding there if thou doest marke the substaunce of things thou mayst find how these differ from them but for because in the adglutination of vlcers wée must drie that which floweth so that the sicke part may be frée from superfluitie in making a cicatrise we do not onelie consume that which floweth but also the moisture contained in the flesh truelie it is conuenient that the medicine which doth cicatrise bée a great deale drier than that which â—…th adglutinate when hée that will adglutinate hath his scope that he doe consume the abundance of the moisture which is according to Nature he that will cicatrise doth not take awaie onelie this but also some parte of that which is according to Nature Therefore vnripe gâ—…s and the Pomegranad rinde the fruit of the EgyptiaÌ„ spine are moderate desiccatiues Calcitesâ—
shall not take an Indication of it after foure â—…neths but that which we haue taken at the verie beginning And for a truth that I may not permit such an vlcer to abide so long time but at the first I will take awaie the cause thereof But I cannot coniecture what may shewe the time more than the number of daies except Thessalus will saie that to haue knowledge of such an vlcer we must tarrie the time but in such a case he sheweth himselfe altogether foolish That is to saie if he confesse openlie that hée knoweth not the first affect which hath inueterated the vlcer Furthermore he must plainlie also confesse the Indication curatiue to be taken of the disease and the knowledge of the disease to be taken of other things But bée it so that time serueth somewhat to the disease neuerthelesse the Indication curatiue is not taken of time But to what purpose serueth it if any Vlcer bée inueterate to do away that which letteth the coition to renue the place which is pained For thou foolish fellow if for the maligne fluxe which the Gréekes call Cachoethae the lippes be affected in such sort what shalt thou profit if thou doe cut them before thou hast prouided to stop the fluxe Trulie thou shalt but make the Vlcer wider than it is as some doe that cure vlcers after the same manner as thou doest For the cause remaining which before made the vlcer harde and flintie thou shalt doe no other thing in cutting awaie the lips but enlarge the vlcer For those which thou cuttest shall be made hard come again as they were before Although that prudent Thessalus hath not added this thing that the partes of the vlcer which are hard stonie and discouloured ought to be cut awaie but commandeth by an absolute sentence that those thinges which hinder the closing of the vlcer ought to be cut awaie and to be renued But if trulie hée had counsailed to take awaie the causes that hinder the adglutination of the vlcer and that this reason were auncient and olde I would not accuse him for it is commanded almost of all the auncient Phisitions which doe write of the curation of vlcers by a certaine reason and Method that those causes which doe excite the vlcers ought to be cut awaie euen trulie as of all other diseases For trulie I do thinke it expedient that the efficient cause remaining which exciteth the vlcers ought first to be taken awaie In other diseases it is not expedient but chieflie there the curation must be taken in hand where the efficient cause remaineth And if the sayd Thessalus hath not spoken of the causes that let the conglutination and hath onelie spoken of the lips as he hath said afterward it appereth that he is ignorant of more than he knoweth of those things which appertaineth to the curation of vlcers But it is possible that this alone is the cause which hindereth the cure of the vlcer And it may as it is aforesaid be the cause that intemperauncie which is without a tumour against nature be in the vlcerate partes and also that it be ioyned with a tomour the which doth not require that the lips should be altogether cut awaie It maye also bée the cause that Varix which is aboue it or that the milt which augmenteth it or some disease in the liuer and beside this the weaknesse of the affected part be nothing else but a manifest intemperancie And besides this a vicious humour in the bodie which the Gréekes call Cacochimia and the chiefest of all the causes which may be to the vlcers an incommoditie Truelie great abundance of humours which the Gréekes call Phlethora resorting vnto the vlcer doeth hinder the curation But if Thessalus be of that opinion that the lippes onelie must be taken awaie I saie that of many things he knoweth but one alone which is so euident that the shepheards are not ignorant thereof for if a shepheard sawe the lips of an vlcer hard flintie wan blacke or a leadie coulour hée would not doubt to cut it awaie Then for to cut awaie is an easie thing but for to cure by medicines is a greater matter and that requireth a true methode Neuerthelesse Thessalus neuer knew howe the lips might be cured by medicines for all men confesse that he hath swarued from this part of the art and as he himselfe hath shewed it séemeth that he had neither experience nor rationall knowledge of medicines which is a manifest thing by the booke that he hath made of medicines before rehearsed But of this one worke consequent wée shall entreate of those things which hée hath not writâ—…n well And now we doe intend with deliberation to speake of the curation of inueterate vlcers of the which he hath before intreated Certainlie it had bene better to haue called them Cachoethae and not inueterate theÌ„ to declare their nature disposition and cause of their generation and the curation of either of them And first to know the common curation of all vlcers for as much as they be vlcers of the which I haue written in the third booke next after the perticular and proper cure of either of them afterward the kinde of the efficient cause as I haue spoken of in this present booke And although Thessalus hath done nothing of all these things yet he doth thinke that the vlcerate place must be renued when it is made like vnto a new wound to cure it as a bloudie vlcer what is he that is exercised in the workes of the Arte that vnderstandeth not euidentlie that such a doctrine hath bene written by him that neuer cured vlcer Is it possible that a man may cure an inueterate vlcer as you may cure a bloudie wound and after he hath made it lyke vnto a fresh wound shall it be in drawing of the vlcer together by rollers or ioyning them by stitches or neither by the one or by the other but by conuenient medicines What is he that knoweth not that an vlcer called Cachoethae is caued or hollow séeing that it is made by corrosion Is it possible O foole and impudent Thessalus that a caued vlcer may grow together and be adglutinated before the cauitie be filled with flesh is not that to cure an vlcer as a gréene wound then hast thou thy selfe written in vaine that hath taken indication to cure caued vlcers not with closing but with the filling of the cauitie But if euery vlcer called Cachoethae were not hollowe of it selfe yet when it is made bloudie in cutting the lips awaie as thou commaundest then of necessitie it is made hollow and requireth great space betwixt the lips euen in such manner that I cannot sée how thou maist make them conglutinate together as a bloudie wound for if thou assaie by force and violence the lippes that are so farre a sonder of necessitie there commeth Phlegmon which letteth the sayde lyppes to close together The which thing I suppose that
many wayes friuolous and foolish For our bodies doe not consist of little bodies called Atomes and of little passages or pores but if this were true it should not be possible to shewe in what maner musterd might change or alter the state of the same pores if any of them should shew the truth yet we would not agrée vnto their sect because they promisse that they wil be content with their apparent communities therefore lette them not vse these names neither let them hinder vs no more in our matters For it is lawfull without the name Metasincrisis to say in other wordes the curation of inueterate vlcers as the Emperickes doe Also we haue declared in the second booke how they talke of this woord Atonias that is to say imbecilitie yet know not what it meaneth For if they vse this name as the Emperickes do then it should signifie nothing else but that the actions are not kept for if they say that certaine faculties doe gouerne liuing creatures which we all the auncient writers doe affirme but yet notwithstāding they repugne against the precepts of Asclepiades also they propound vncertaine things to the which the authors doe not agrée they touch the truth a little yet they commaund to eschew it But tell me true Thessalus what meaneth this worde Metasincrisis if thou saie that it betokeneth to change the pores thou art deceiued and supposest vncertaine thinges But if thou saist that it is a great matter to cure the particle grieued of the bodie as the man thou saist no more thā the Emperikes except the name For they doe knowe that men are made whole by medicines but they know not the cause or reason by what meanes the remedies restoreth health For none of the Emperikes can tell if the facultie of the medicaments chaungeth the pores or if it maketh a Simitrie or if it altereth the qualitie of the Patients particle that is grieued Howbeit the Emperikes are discréete men if they saie that they know onelie one thing that is to saie if they haue noted and obserued the times how vtilitie hath followed when the medicament of mustard hath ben ministred to such vlcers and in what time Neuerthelesse they speake not of method neither yet repugne against it neither be displeased with the notise thereof nor dispraise the ancient writers neither Hyppocrates but rather praise him and affirme that he hath said all thinges well But Thessalus doth not onlie despise Hyppocrates but all the other auncient Phisitions neither doth he vnderstand that he hath written all the precepts of rebellious vlcers without reason emperiklie For if he had written them well then it should haue bene counted a worke most profitable But it appeareth not that he hath done so séeing that he peruerteth the right order of remedies and vseth his remedies to the grieued part before he hath prepared the bodie For this is an argument of great ignorance séeing that almost it is a principle in Chirurgerie that all the bodie must be purged of the euill excrementes before anie strong medicine be applyed vnto the affected parte For who is he that will iudge either by reason or experience for there is no other third thing to iudge by in what art so euer it be nor in anie part of life he shal finde that it is agréeable to reason for a man to minister strong hot medicines to anie particle of the bodie before he hath purged the bodie of all anoiance prepared the same to health for the said medicine draweth the excrements and superfluities from all the bodie like as boxing or Ventosis doth it doth so fasten to the affected part that it may be scarcelie remoued Therefore it must be asked of these Thessalions frō whence this opinion cōmeth to Thessalus to write fables as cōcerning the curatiō of rebellious vlcers séeing that none of the Emperiks nor yet Rationals haue written so before this time For neither Thessalus himselfe neither anie other of his sect dare affirme that the order of such remedies either doth agrée with experience or reason For neither can they giue Indication of time neither yet of the affect of the disease Yet for all that Thessalus is not all together ignorant because he iudgeth that the cause the hindereth the ciccatrise must be considered and taken awaie because also that he iudgeth that this must be done not onelie in vlcers but also in all other diseases as the ancient writers do admonish But they answere nothing to the purpose for they saie alwaies that we do not vnderstand them as if they knew perfectly the thought of Hyppocrates and of all the ancients And they affirme the Thessalus hath a good opinion when he saith that there is a communitie of inueterate vlcers that Hyppocrates vnderstood it so in his booke of Vlcers which writeth in this maner It is profitable that the bloud doe flowe continually from the inueterate vlcer when so euer it séemeth néedfull It were not farre from my purpose if I should speak of the iudgement and opinion of Hyppocrates though I haue not promised that I would so do in this place But that which I will saie shall be of the interpretation of the wit knowledge of the auncient Phisitions the which truelie as yet haue giuen no sect but studying with simple pure minde to inuent some thing profitable to mans health It is well perceiued therfore that they haue found some thing by reason and some thing by vse and experience Then dyd they write their inuentions many times without giuing reason thereto and sometime they did and if they did giue anie reason it was to profit the readers For if they intended to be profitable to their successors and when as they knew reason of inuēting things then diligentlie they set it forth and where they thought it obscure they thought it superfluous to rehearse and therefore let it passe Now it is well knowen vnto all men though I hold my peace that the ancients haue loued no verbositie For that cause afore recited not only Hippocrates but also all the other ancient Phisitions sometime not making mention of the middlemost speaketh of the third thing For if the first be a signe of the second the third of necessitie must followe after the second And thus oftentimes omitting the first and second they spake of the third I haue oftentimes declared how the ancients and chieflie Hyppocrates haue written after this manner But he that will know and perfectlie vnderstand the maner of curing ought to be exercised in their stile and manner of interpreting For this I will intreate of that which I haue purposed The fift Chapter FOr those Vlcers which after medicines to them ministred be not cured those the Phisitions cal in Gréeke Cachoethae but we cal them maligne and rebellious to cure But we haue spoken in the booke aforesaid what the curation of vlcers is Therefore in these kindes of vlcers that be
corruption bréedeth in it and occupieth the space that is betwéene the lippes of the wounde so that the ruption cannot close Wherefore these aboue rehearsed declare vnto vs all causes howe small so euer they bée For although some hath had rigour or though the bodie hath béene ouerthrowen by some Feauer so that there bath not bene good concoction or that it hath béene defatigated and wearied then immediatlie there shall bée paine in the part where the ruption and wound is because that the said ruption hath bene latelie ioyned together but not so substantiallie because of time Wherfore it followeth that a little thing may easilie part them fil the place againe with superfluous humours But what engendereth in such wounds or ruptions nothing but new Ecchimosis and much like vnto the first That is to saie when the flesh was first broken except that this Ecchimosis that is new of more and corrupter mattier than that which was at the beginning which came of bloud and therefore now this is more easilie digested and resolued than that which was at the beginning And thus the which we haue spoken hetherto shall suffice for the disputation of Vlcers thus we conclude this fourth Booke of our Therapeutike methode called Methodus Medendi FINIS THE FIFT BOOKE of Galen called in Greeke 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and in Latine Methodus Medendi The effect of the same 1 The curation of vlcers which chaunce in the fleshie partes and then the curation of Vlcers in the Instrumentall partes 2 Of the ruption of a veine or Arterie 3 How a fluxe of bloud may staie by deriuation 4 The Medicaments that wil make a crust which doth much to the stopping of a flux of bloud 5 Of spitting and distillation of bloud 6 The curation of Vlcers in the pudend places 7 The curation of a veine or diuided Arterie 8 The reiecting of bloud both from other parts also from the lungs The first Chapter SEeing that in the two last bookes we haue taught how anie shall rightlie cure Vlcers we will by the waie shew that all other Phisitions which vse the arte not searching out the Elementes of those simple particulars in vs cannot cure anie thing onelie by reason but yet least of all other those which professe Thessalus doctrine The rest which are by méere experience onelie taught suppose that at the least those Vlcers which are in diuerse partes are to bée cured by diuerse reasons But those that followe Thessalus as their Captaine for his excellent wisedome thinke that euerie Vlcer in what parte of the bodie so euer it bée requireth like curation for if it bée hollowe they saie it must bée filled with flesh if it bée equall then to bée ciccatrized if there bée supercrescent flesh then that flesh must bée diminished if it bée bloudie and new then it must bée adglutinated As though he that knew this must of force cure rightlie or that this reason were vnknowen to the common people when as there is none that is héerein ignoraunt But they vnderstand not howe the hollownesse is to bée filled with flesh neither howe that which is filled ought to bée ciccatrized or to take awaie that is ouermuch encreased or to ioyne together that which is pure and bloudie without hollownesse such workes trulie are properlie appertaining to the art of Medicine found out by the helpe either of Reason or Experience or both Therefore repeating againe let vs briefelie ouer-runne those things wherby the beginning of these which are to be spoken may be ioyned with the aid of those which we haue alreadie set out Wée haue declared that euerie Vlcer requireth desiccatiue medicines but that which hath hollownesse beside that it needeth desiccatiues it also doeth require abstersiues that which requireth to haue the lippes ioyned together such is a gréene wound called in Gréeke Enema doth aske both more drying medicines and also that be gentle astringent without anie abstersion Furthermore those vlcers which néede to bée ciccatrized require not onelie yet more drying medicines but also strong astringent remedies and whereas there is supercrescent flesh against nature there are required sharpe and abating medicines such of necessitie bée hot and drie If anie accident bée ioyned with the Vlcer the Indication of curation must bée taken of the nature thereof and of this all the faculties of medicines also to bée had If there should superfluous mattier growe in the Vlcer it behooueth to haue medicines which should take it awaie and such haue a greate deale more abstersiue vertue than some incarnatiue medicines haue Also if there bée séene more copious moisture there is néede of a medicine more desiccatiue but yet not to exceede his kinde and if the medicine shoulde be glutinatiue it ought to bée drying and astringent if it shall incarnate it must be desiccatiue and some thing abstersiue and so in all other as is alreadie declared Also if the flesh subiect should be intemperate first truelie we must cure this intemperatnesse that which is drier by medicines humectiue the moist by desiccatiues Also that which is hot by refrigeratiues the colde by medicines that are hot And if by coniunction of two qualities the flesh bée intemperate it must be cured by ministring a contrarie medicine which hath double qualities for this one thing is common to all affects against nature that they cannot come againe to their owne nature without such medicines as haue contrarie qualitie Furthermore at this time the causes of these intemperatiues are to be considered whether these be common to all the whole bodie or else proper of some partes which should infest the vlcerate member by societie the Gréekes call it Simpathia First of all trulie the cause that nourisheth this intemperatnesse is to be cured and after that the intemperatnesse it selfe which is now made for this indication is common to all such as spring of anie cause We haue also declared that there are diuerse indications taken of the differences of vlcers and also those which are taken of the temparament of the sicke bodie haue a contrarie reason for those Indications séeing they are taken of those things which are against nature declare that all contrarie things must be applied these Indications because they are taken of natures selfe shew that like things must be vsed for if how much the part is drier so much the more it requireth to be dried that which is lesse drie is lesse to bée dried In like sort trulie it is declared in making hot or colde Neither haue we let passe that of the excellencie of the member or contrarie state Also to the sharpnesse or dulnesse of féeling there is to bée had a contrarie scope of curing The second Chapter THerefore we will now consider that which remaineth of the curation of this kinde of infirmities we call this kinde for more euident doctrines sake solution of vnitie neither is it anie matter if thou call it solution of continuitie This kinde doth not onelie
by the hand For all things that the art of Chirurgerie doth finde out either by reason or experience it teacheth the same to be done by the administration of the hand to the vtilitie profit of mannes bodie Furthermore Chyrurgerie is diuided into two parts that is to saie into Theorike and Practike The Theorike part doth teach and is a science obteined by demonstration by knowing the principles of the art This part a man may haue although hée neuer exercise or practise anie parte of the same as the learned Phisitions and other learned men which dailie readeth the principles of Chirurgerie But the Practike parte of Chirurgerie is an arte which doth rightlie and readilie by the administration of the hand vse such things as are inuented amoÌ„gst mechanical arts which part no man can be perfect in except he be brought vp and exercised in the same And doth both continuallie sée other expert men worke in the same arte diligentlie obserue such things as he dooth sée wrought Now these two partes are commonlie exercised about these griefes with their accidents that is to saie tumors against nature gréene wounds vlcers fractures dislocations with such like which requireth the helpe of the hand Therefore ther are required foure things in a good Chyrurgion first that he be learned verie skilfull in the principles of his art secondly that he be wel brought vp vnder some cunning man wel experienced thirdly that he be ingenious wise fourthlie that he be of good honest manners and of a vertuous life The erudition and learning of a Chyrurgion doth consist in knowledge of naturall things thinges not naturall and things against nature The experience of a Chyrurgion doth consist in those thinges that are found out by reason and confirmed by dailie vse and experimenting of them for otherwise he will bée accounted a râ—…e emperike which ioyned not reason with experience To be ingenious and wise it is verie necessarie for he ought to haue a readie wit to conceiue things and a firme memorie in calling of them to remembrance a discréete and right iudgement an excellent perfection in working a diligent and readie wit in inuenting and finding out of remedies to helpe his grieued Patient withall The manners and conditions required in a Chirurgion is boldnesse and a minde voide of feare in necessarie things and in the time of necessitie and not to be too rash in matters of doubt and perill gentle and milde towards his Patients and to those of his profession to be curteous and gentle yea and as the Gréekes call him Philitairos that is a louer of his fellowes he ought also to be prudent and circumspect in prognosticating vertuous and temperate of life mercifull toward the poore and not gréedie of monie hauing these properties hée may procéede orderlie in learning the art of Chyrurgerie and the order to be obserued in the same is to begin with easie things or as we may tearme them common things to perticular or from vniuersal things to those that be lesse vniuersall also from things most manifest and knowen to things more obscure darke and vnknowen Hetherto we haue spoken of that part which doth appertaine to the knowledge of Chyrurgerie and now we will intreate of the execution and operations of the same The operations which a Chirurgion executeth about the bodie of man that he may bring to passe his intended scope and desired end are thrée that is to diuide and separate things contayned to ioyne and vnite together that which is diuided to take awaie that thing which is superfluous We diuide and separate that thing which is contained by incision and excision and by letting of bloud and scarification we doe also ioyne and vnite together that which is diuided by consolidating of wounds and restoring of members dislocated into their proper places and curing of fractures Wée take awaie that which is superfluous by remoouing of tumours against nature as Ganglia Nodus Cancers Strumas Mirmecias and by drawing of water out of the bellies of such as haue the Dropsie or by cutting off such members as be superfluous and to doe those things quicklie and readilie with a good zeale toward his patient and not to make anie vaine promises for monie or to take in hande those grifes which cannot be cured and that he may more perfectlie readilie and safelie doe those things it is requisite that he doe consider thrée speciall indications according to the saying of Galen that is to saie First the conseruation of those things which be naturall and the expulsion of those which be against nature The second indication sheweth whether we may bring to passe and fulfill that which the indication doth require that is whether we can conserue that which is natural and take awaie that which is against nature The third indication is that which findeth out remedie dooth declare vnto vs with what things we may accomplish that which the first indication requireth and the second giueth leaue to be done touching the indication which consisteth in the conseruation of naturall things they be sixe that is to saie health or a naturall aptnesse in doing the actions The cause of health the effects of health which is the action according to nature strength which doth alwayes coÌ„tend against sicknes custoÌ„e which is like another nature Complections and temperaments which are to be conserued and kept be their like Nowe for those things which be against nature which we ought to expell and driue awaie are thrée in number that is sicknesse which is an effect against nature of it selfe and first hurteth the action the cause of sicknesse and the accidents or Symptomata which followeth the sicknesse as the shadow doth the bodie All these things are cured and put away by their contrarie but forasmuch as the expulsion or curation of things doth principallie consist either in simple or in compound things Note that which is simple is cured by his contrarie that which is compound by their contraries Solution of vnâ—itie Heate Coldnesse Drinesse Moistnesse Superfluous quantitie Quantitie diminished Abounding in number Number diminished Obstruction Straightnesse Inlarging Figure altered Luxation by Vnition Coldnesse Heate Moistnesse Drinesse Diminution Augmentation Taking awaie Putting to Opening Inlarging Astriction Reduction to his forme Restoring to his place In like manner in compound sicknesses we must both consider the contrarietie of euerie simple sicknesse and also in applying apt and conuenient medicaments for the same But the indication for applying remedies is taken of that sicknesse which must first be cured and that whose cure is the curation of another and that without whose cure the other cannot be cured yea and that which most grieueth the Patient and is most dangerous is first to be cured The second indication is that which sheweth whether we may bring to passe that which the first indication doth require that is to conserue things naturall and to expell those that be against nature
might be hurtful vnto the same and then to procéede with locall remedies by outward application vnto the greued part This is Galens doctrine also that no strong medicine shal be outwardly applyed for the resoluing of inflammations before the bodie be purged And furthermore in virulent and malignant vlcers which Galen nameth Cacoethe and where the bodie is full of euill and vicious humors which humors Galen calleth Caccochimia these faith Galen must be purged away before we procéede to the cure of the vlcer for otherwaies the vlcer may not be cured and if it bée it wil come againe either in the same place or else in some other or else the same humors not being euacuated may be the cause of some other greater disease in the body worse then that which was cured wherfore Galen doth reproue Thesalus in his fourth booke called Therapenticon saying Thesalus goeth about to cut away the lippes of the vlcer to apply his Malagma of Mustard seede by meanes whereof he hath inflamed all the parte and made the vlcer worse then it was before not taking any indication of the affect neither yet of the cause thereof by meanes whereof he committed great errour as Galen doth say and was accompted for a rude emperike and for an vnskilfull Phisition Obiectiō Why sir it séemeth to mée by your wordes and by the saying of these men that be learned in the arte that Phisicke and Chirurgerie are both one arte and I will assure you if these woordes be true which you recite of Hippocrates and Galen that they were both Phisitions and Chirurgions and vsed all the whole arte together then I must néedes concéeue that the vsing of all these partes together made them so excellent men and of such notable fame and that your deuiding the arte in two partes and exercising the same seuerally hath made you that be both Phisitiōs and Chirurgions vnexpert to the greate detriment and ill report of the whole arte Wherefore I most hartely desire you for that that I may know both the art and the artist the better to declare the diuision of these fiue parts which you haue spoken of before perteining vnto these artists Sir I will right gladly doe the best that I can to satisfie your desire although I haue not that learning in the Gréeke and Latine tongue which I would wish for your sake that I had and also which this arte doeth require in him that shall presisely set footh the same yet with the little learning that I haue and according to reasō and experiēce which two be the foundatiōs of euerie arte as Galen doth say in his third booke de Methodo medendi I will doe my indeuour to declare vnto you these parts in as few woords as I can desiring you to accept my good will and if I haue left out any thing by the reasō of the briefenesse of my writing which other learned men doe finde fault with all thē I most heartely desire them both for curtesie and humanitie sake to amend the faults that they shall finde and in so doing they shal not onely be profitable to the cōmon welth in the furtheraunce of this arte but also bynde mee during my life to honor them serue them and loue them and incourage mée to take further paines to the vttermost of my power Now that wée may accomplish our former talke as concerning these fiue parts pertaining to the arte of medicine which haue bene set out by these names of the auncient Phisitions long before Galens time as I haue declared vnto you before The parts Phisiologia Pathologia Hygiena Semiotica Theraputica Partaining to the arte of medicine The first part called Phisiologia is that which doth cōsider the vnnaturall thinges whereof the bodie of man is made as Elementes temperaments humours members spirites vertues and operations The Elements be foure as Fier Ayer Water and Earth The humours be foure also as Bloud Choller Flegme Melācholy And the temperaments be foure likewise as hot colde moyst and drye These foure are the matter whereby all the members of the bodie are made with the temperamentes and spirites therein conteined and he that shall cure the bodie of man rightly must chiefely vnderstand how to cōserue euery one of these by their like and to expel and remoue from them their contraries For the knowledge of these it doth behoue the artist to haue long experience and chiefely in that part which wee call the Anathomie of mans bodie which is the deuiding and seperating of dead bodies that wée may therby vnderstand all the partes of the same bodie with theyr position figure number place nature temperature office and affects and also to know their names and true diuisions and which be similer and which be compound and instrumentall for of the simuler and simple members the compound are made Simuler parts be these bones cartilages ligamentes membranas or panicles fleshe nerues arteries veines fatnesse and the skinne These be called simuler parts whereof the instrumentall or compound partes are made and some requireth more of these and some lesse according to the necessitie of the member for some member doth require all these and some doth not The compound or instrumentall members be the head the heart the liuer the legges the eyes and all other like Which member both simuler and compounde the Chirurgion ought to know with their natures temperatures and actions and their other necessarie properties or else he cannot rightly cure them when they are greued and hurt But in the curing of them that he hurt he shall distemper them that be quiet for how can he conserue the right temperament of any thing whose temperature he knoweth not that is vnpossible except it be by chaunce as the blinde man shooteth at a Crowe and hitteth one by misfortune or as Galen doth compare him which knoweth not the partes of mans bodie with their nature vnto a blinde Carpinter which cannot sée his woorke cutting more or lesse then is necessarie by meanes whereof his woorke doth neuer come to a good perfection Therefore who so euer is not expert as I haue saide before in the temperamentes and natures of these parts he can neither cure woūds nor vlcers neither yet any other thing rightly neither can he tell by what way the vlcer or wound shal be cured neither whether it may be cured or not neither yet whether any cause doe remaine that may let the curation neither how to remoue the same nor whether nature and strength may suffer the same causes to be remoued nor how to maintaine the strength and temperaments of the same bodie for he being ignorant in these seuen naturall thinges whereof the bodie of man consisteth which bodie being subiect to the arte of medicine he must of necessitie I say be also ignoraunt not onely of the preseruation of health with his temperaments but also to be ignoraunt in the curation of hurtes and diseases which chaunceth vnto our bodies Wherefore in
fewe woordes I haue proued here bothe by reason and by experience that the knowledge of this part named Phisiologia doeth chiefely and specially apertein to the arte of Chirurgerie and without the knowledge hereof we shal neuer rightly or methodically cure any maner of woūd griefe or disease neither is he worthie to take the name of a Phisition neither yet of a Chirurgion but to be called by the name of an Emprike or experimenter curing onely by chaunce without any reason but euen as the blinde Carpenter which Galen hath spoken of before sometime cutting to much and some time to little and many times marring all his woorke for want of skill ere that he beware Now to conclude for this first part he that will be further instructed herein let him reade Hip. de natura hominis humoribus elamentis de natura formatione fetus many other bookes of Hyppocrates and chiefelie that where he diuided the similer parts As Osteotome that is to saie the diuision of the bones Condrotome the Cartalages Syndestmotome the ligaments Arteriotome the Arteries Phlebotomae veines Neurotome the nerues Miotome diuiding of the Muscles Tenontotome the tendons c. There be diuers other bookes of Galen which be verie profitable to be read for this matter as his bookes of Anathomie also his bookes De temperamentis de optima corporis constitutione de facultatibus naturalibus de placitis Hippocrates Platonis de motu musculorum de causis respirationis and manie more worthie bookes of his which we will let passe There bée manie other bookes also written by diuerse men as Guido and other which doe intreate of these naturall things and speciallie of the Anatomie of mans bodie and for that you may the easilier better vnderstand these naturall things which euerie Chirurgion ought to know and haue in perfect memorie to that end he may remoue those things which doth hurt them or let them of their perfect operation which you may easilie knowe if you vnderstand their natures and properties figures c. Which Table followes héereafter as you may heholde Naturall things Eelements be foure Fire Aire Water Earth Temperaments Simple be foure Hot. Colde Moist and Drie Equall one Cōpound be foure Hot and Drie Hot and moist Colde and moist Colde and drie Foure humours Sanguine Flegmatike Cholerike and Melancholie Members Similer Bones veines arteries cartilage flesh fatnesse pannicle ligament nerues and skinne cōpound Head heart liuer lungs armes and legges Three faculties Animall Vitall and Naturall Operations or actions Animall Feeling and moouing Vitall Beating of the pulse And breathing Naturall Generatio Auctio and Nutritio Spirites be three in nūber Animall Vitall Naturall In The braine The Heart The Liuer Pathologia is that part of the arte which hath the knowledge of sicknesse against nature with their Symptoma and accident and they be thrée in number that is to saie sicknesse it selfe the cause of sicknesse and the accidents which followeth after sicknesse sicknesse it selfe may come two waies either of outward causes or of inward causes we do commonlie call the outward causes primatiue the Gréekes call them Cathertica the inward causes we do cōmonlie name Antecedent or Internam The affectes commonlie followe these causes and if the affectes come of outward causes then commonlie they be wounds contusions fractures dislocations biting of mad dogs of serpents c. If they come of inward causes then they make tumors against nature as Phlegmō Eresipula Oedema Sirrhus with many kinde of malignant and stubburne vlcers to be cured which tumours and vlcers cannot be made whole except their causes with their euill affects may be remoued and taken awaie I suppose that there is no man but hée will iudge this part of the art chieflie to pertaine to Chyrurgerie for that it taketh cure of wounds vlcers and tumors against nature as I haue said before Then if this part doe appertaine to the art of Chyrurgerie as it is most certaine it doeth it behoueth the Chyrurgion perfectlie and rightlie to vnderstand what kinde of sicknesses there be with their differences names what partes of the bodie these sicknesses may be in and what manner of sicknesse it maketh in the same partes As for example euill complection maketh a distemperature in the similer parts euil constitution or euil cōposition maketh a deformitie or imbecilitie in the instrumentall partes And solution of vnitie or continuitie chaunceth both in the similer partes and instrumentall And all these doe appertaine to the Chirurgion to haue most exact knowledge of for he that taketh vpon him to cure an vlcer or a wound or anie other manner of griefe and doth not know the nature of the parts neither yet what part it is in neither yet the cause neither how to remooue the same cause it is vnpossible as I haue sayde before that he shoulde cure the same griefes or diseases rightlie And therefore these blinde emperikes that haue neither reason nor method to leade them to doe those things which they dailie doe I saie their dooings are so pernitious that many people taketh great hurt thereby shall I saie hurte nay rather brought to vtter destruction and many times to death The Symptoma or accidents which followeth sicknesse is also diuided into thrée partes The first is the qualitie being altered as with vehement heate in Phlegmon The action or function hurt but not vtterlie depriued The action vtterlie depriued and taken awaie For these causes aboue rehearsed it is speciallie required that a Chirurgion shoulde be learned and also to haue greate experience that hée maye rightlie iudge and discerne one disease from another with their natures and causes to the end that when you come to the curation thereof you may take right indications what to do first what next and so foorth to the end for other waies you may applie medicines nothing fit for the purpose but those that might doe great harme and you might also applie those first that would be applied last and those last which should be applyed first and in the end marre all your workes as the blinde Carpenter doth Thus farre I haue proued for Phisiologia to be one part of Chyrurgerie or of the Art of curing as we may tearme it and I thinke there is no man that will count him to be a right Chyrurgion that lacketh this part of the Arte or that is not verie expert in the same And for the further knowledge héereof there be certaine bookes appointed of Galen and other auncient writers that you may reade concerning the same part as hereafter followeth Libro Hippocrates de Morbis libro Epedimsorum Hippocrates Galen de locis affectis Galen de Morbis Symptomatis de 4. temporibus morborum Galen de differentijs morborum causis Smptomatis Galen de inequali intemperie Galen de arte Medica Galen de tumoribus praeter naturam Hippocrates de Vulneribus vlceribus Fistulis fracturis immorodibus c. And also
these sixe things not naturall Therefore it may be saide Necessitas non legem habet therefore there ought no lawe to bée made against that thing that must be of necessitie As for example of necessitie we must eate drinke that we may liue Therefore it were tyrannicall to forbidde vs to eate and drinke for they be proper things for vs whereby we doe liue But yet the abusing of meate and drinke may be spoken against and good and iust lawes made for the reformation thereof In like manner for abusing the arte of Phisicke or Chirurgerie there hath béene good and wholesome lawes made héertofore and I trust in our Lord God shall be hereafter againe But to commaund from them the knowledge of their arte or anie parte thereof or other necessarie instruments or medicaments wherewith they should cure their grieued and wounded Patients which other wayes must of necessitie perish or else not bée cured at all Such commaundements or lawes were tyrannicall and not to be well thought of for that they should let the workes of mercie in this most excellent arte of curing to be ministred vnto the people orderlie for their safegard curing of their diseases There were much to be spoken of these sixe vnnaturall things which maketh nothing for my purpose héere in this place for that I intend nothing but to proue that these bée necessarie instruments for the Arte of Chyrurgerie by certaine examples as you haue heard for these things are spoken of at large not onelie in many worthie bookes which are set forth by Hyppocrates and Galen but also in all other worthie mens bookes that haue written of this art at large as it may appeare at this present daie Some men might héere aske a question why these are called not naturall things for it is to be thought that sléepe meate and drinke moouing c. should be naturall But forasmuch as both health and sicknesse doth come by these things therfore they be called not naturall They bée not called against nature for sicknesse the cause of sicknesse and the accidents that follow sicknesse those be called Praeter naturam against nature Neither may they bée called naturall for the that sicknesses cōmeth by thē But they are indifferētly called not natural These things are so necessary for our bodies as I haue said before that we do not onlie liue by them but the matter substanticall of our bodies after generation is increased and mainteined by them and also all the humours and temperaments with the spirits and other things contained in the same bodie should vtterlie cease if it were not but for those sixe thinges Thus I conclude with these examples aforesaid to proue this part to be necessarie for the art of Chirurgerie doubting nothing but those that be learned men and men of reason will so iudge for so haue the auncient fathers before our daies appointed it to be Now that you may the better come to the perfect knowledge of these things I thinke it good to declare vnto you some of the bookes which both Hyppocrates and Galen haue written Hyppocrates de elementis Hyppo de Aqua Aere regionibus Hyppo de flatibus Hyppo de vrinarum differentijs Hyppo de ratione victus salubris Hyppo de ratione victus prauatorū Galen de sanitate tuenda Galen de imperica dieta sub figuratione Galen de aqua Gal. de ptissana Galen de Euchimia Caccochimia Galen de attenuante crassante victu with many more bookes written by most excellent men sence their times which were superfluous here to be rehersed for as much as these are most necessary to be vnderstoode and sufficient for the profe hereof And thus I commit this part vnto your friendly iudgement procéeding vnto the fourth part called Semiotica Semiotica is an other part perteining to the arte of Chirurgerie which part doth iudge by signes and tokēs what the diseases are and what be their natures and what humors or other things be the cause therof and whether they may be cured easely and in short time or whether they be hard to be cured must be cured in longer time or if they cannot be cured at all Or else whether it is not necessarie that it be not cured at all least worse diseases should come by the curation of them and specially this part is necessarie about the curatiō of wounds to know which are deadly and which are not deadly and also which are maymed and which are not maymed and to foresée daungerous and perillous accidents which might chaunce vnto the woūded man as paralisis conuulsions gangrena spasalus and manie other more daungerous diseases which the Chirurgiō ought not onely to foresée by meanes whereof he might resist the same But also when any of the greuous accidēts doe happen he might make a good and a true prognosticatiō what might happen after these greuous and perilous sicknesses and also in wounds that chaunceth in daungerous places to prognosticate and declare the great perill thereof vnto the sicke and gréeued pacient or else vnto his friendes as it shall be thought most conuenient for except he make a true and a iust prognostication he shall get vnto him selfe dishonestie and cause the worthie arte to be euil spoken of This parte of the Arte can not be attained vnto without great knowledge and long experience and also a most excellent wit For Hyppocrates sayth in his Aphorismus that this part is the most hardest he saith that the lyfe of man is short the arte of medicine long the occasions to minister medicines many prouing of experiments perillous but iudgement and prognostication of sicknesse to be most difficult and hard Wherefore Hippocrates and Galen did will all men that would auoyde slander and euill name to beware wise in prognosticating and not to be rashe and quicke How many men haue gotten dishonestie for lacke of knowledge of this parte of the Arte and by mistaking of the Symptomata and accidents it were wonderfull to number them And also how many sick men haue béene ouerthrowen and vndone for lake of knowledge of the same parte it is not to be spoken Wherefore this part is most necessarie and requireth most diligent and exacte studie as it doth appeare both by Galen and Hippo in Galen where he hath written vi bookes de differentiis causis morborum Symptomatum which doth chiefely perteine to this parte of the Arte. And also that most excellēt and worthie man Hippocrates hath written two diuine workes wherein is conteined diuers bookes the one called his Aphorismus and the other his prognostications which are the most worthiest bookes that euer were written for him that shall practise in this Arte for therein may he learne the diuine iudgement of Hippo. And also how to prognosticate rightly which two thinges doe most chiefely and principally appertaine to the Art of Chirurgery Thus I haue declared vnto you the foure principall parts or as we may tearme
be these Dogmatists which are not able by reason to vnderstand the naturall principles of bodies but of these Thessalions voide of method what doest thou yet speake Therefore those which cure by right method doe finde apt remedies for euerie kinde of vlcers as also conuenient diet they do most apparantlie declare by the things it self how much it profiteth and how great light it doth bring to the arte of curing the Treatise of nature it selfe declareth for I haue not once declared vnto you how that sometime they which goe from one medicine to another doe let slip and neglect that which is profitable and that with some one of their remedies which they haue vsed the same vlcers haue béene cured therefore they haue worthilie despised the facultie of such remedies which because of the vntimelie vse they haue séene not onelie the profite but much for to hurt and that in the first vse it hath done no euident thing Furthermore thou hast séene no lesse the grieuous pains of the eies to be healed either with bath either with drinking of wine either with foments either with letting of bloud eyther with purging vnto which these common sort of Phisitions haue applied no other thing than these medicines which are made of Opium and Mandrake and Henbane bringing great daunger vnto the eies inasmuch as they taking no other thing awaie for the present but the paines it selfe these doe kill the sence as thou hast knowen many by the vse of these medicines when they haue bene too much applied neuer after to haue come to their naturall state and that first their eyes were dim and they haue hardly séene after to be vexed with suffusion which is called Hipochysis or with too greate dilatation of the ball of the Eie named Mydriasis or with Tabes or Corrugation called Rhetiosm Thou hast knowen also being with me from sixtéene yéeres of age neuer to haue seene vnder anie maister this worke but to haue excogitated it by reason and how long time I did consider that Aphorisme of vnalayde wine or bath or foment or letting bloud or purging taketh away the paines of the eyes And what trust I had by the rest of Hippocrates laborers that there was nothing in this Aphorisme either false or might not be brought to passe that was it which stirred mée to search vntill going Hippocrates way I found by what meanes I should discerne when and how euery of the forenamed should be vsed By which reason I made manifest to many which haue séene the like things of how great force the medicinall methode is and how great occasion of euill they are which haue not obserued the olde arte of Phisicke haue builded new sectes and now truely although from the beginning I haue refused it yet by entreating you haue compelled mée to take al this whole worke in hand which I pray the gods may be profitable by others truely I haue small hope aswell for the contempt of good letters which now do raigne as also for the admiration of riches estimation and ciuill power vnto which whosoeuer doe turne himselfe is not able to finde the truth in any thing But these things shall be determined as pleaseth the gods and we now for our power shal restore the Methode of curing which was found of the auncient Phisitians being now neglected repeting againe the disputation which we haue begunne of the hollow vlcer and of the first inuention of those things which doth fill an vlcer with flesh let that suffise which hitherto we haue saide and let vs graunt if they will vnto the Empericks all that they say And for the vse of things foūd out I haue often shewed to thée in themselues and now nothing lesse I will go about to demonstrate by reason how these Empericks cannot by certaine reason go vnto another medicine whē they haue nothing profited with the first and that rightly chaunceth for when as they know not the cause of the vnhappie successe of the first medicine neither can declare the lyke in the second and when they are ignorant of the cause wherefore the first medicine doth not his affect neither are able to vnderstād why it taketh no place this thing truely being not knowen they cannot reasonably go to another when as they cannot in the same medicine perceiue the like cause The third Chapter NOw therfore let vs set out Hyppocrates waie and the true method of curing an hollow vlcer surelie it behoueth to begin thus that is of the substance of the thing therefore séeing that an hollow vlcer that is our scope that the flesh which is lost may be restored it is néedfull to knowe that the thing which engendereth flesh is good bloud nature as I may tearme it being the workman and author notwithstanding it is not sufficient to name simplie Nature vnlesse we consider also whose nature and where For it is manifest that Nature it selfe is the ingenderer of flesh of those bodies that be subiect whereas flesh is to be made and surelie it is declared that the nature of euerie bodie doeth consist of the temperament of hot cold moist and drie therefore it is manifest that the iust temperament of these in those parts whereas we shall restore the lost flesh is as it were the workman And first of all in euerie hollow vlcer these two things are to be considered whether the bodie being subiect be in iust temperature that is to saie whether it be according to nature For we haue declared that health of similer bodies is the iust temperature of the foure qualities and whether the bloud that floweth to the part be good or else but indifferent for if either of these doe offend there are trulie many affects against nature notwithstanding there is now put to vs but onlie the hollownesse in the fleshie parts Therefore let vs imagine the part to be sound and the bloud which floweth to the parte to be frée from fault either in qualitie or quantitie surelie these thinges béeing as is sayde there is no impediment but that flesh shall prosperouslie growe and that without the helpe of anie outwarde medicine for both causes which ingender flesh béeing present and nothing outwardlie hindering then it cannot bée but that flesh must bée ingendered But in the first engendering of flesh there must of force spring a double excrement as we haue shewed in our commentaries of Nature that there followeth euerie mutation of the qualitie of the nourishment an excrement grose and thicke and another thin And these excrementes chauncing euer through the whole bodie that which is thinner is inuisible by persperation notwithstanding it is forthwith visible as often as the naturall heate diminisheth or that hée vseth more large diet than is méete or that there happeneth to the creature more vehement motion The other excrement is the filth that is sent to the skin Furthermore in vlcers the thinner excrement is called Sanies in Gréeke Icor the groser is named Sordes and the
or parte more thinges so much he commeth néerer vnto the propertie but the proper thing it selfe cannot exactly be either written or spoken and for this cause those Emperickes which were most diligent in their Arte as also well néere all the dogmatistes doe acknowledge that there cannot be left in writing any exacte curing but that which wanteth concerning the coniecture of the nature of the pacient Some of them affirme that it is to be added or considered of the proper vse of euery Phisition other some by reasoning artificially but yet none of them was so rash to professe that he had one medicine which might engender flesh in euery hollow vlcer for truely thou shalt not finde in authours such a Medicine that will cure euery hollow Vlcer but that the medicine is to be chaunged according to the humour and temperament of the pacients member Therefore wée leauing here the impudencie of the Methodicians goe to lette vs heare what the Emperickes saye who doe iudge that sometyme is to be added or considered in the finding out proper remedies for the pacient by the proper vse and exercitation of euery one for as wée haue after sayd there is not in phisicke any thing or any remedie which is not in fine difficil but in euery thing his qualitie cannot be hiddē for either it may be spoken written or perceiued For in an vlcer moisture and filthinesse may be shewed but the quantitie in neither may be shewed although we studying to goe néerer vnto the thing it selfe naming it wée say small and plentifull filthinesse or thin and grosse or very much or little and indifferēt and competent or else calling it otherwise in like sort whereby we may come néerer to shew the quantitie Now therefore I will haue thée diligent to attend that thou maist know how much it is better to doe euery thing by a method rather than by experience only be it so knowen that this or that medicine hath vertue to fill an hollow vlcer in those whome wée name of moyster complexion as an obseruer or empericke in those which haue soft flesh and to women and children that he hath not now any thing profited with such medicine Therefore wée will séeke out the cause why it dyd not profit and will reduce this vnto one of these two for either the medicine hath dried to little or else to much the signes of which be Sordes and Sanies for if there be more Sordes in the vlcer and that all the vlcer is moister the medicine hath dried to little but if it be cleane and without moysture it hath dryed to much Therefore forthwith wée may know the measure also of the excesse effect by the manner of the signes and we shall afterward make our medicine which shall be applyed so much the more or lesse drying but the Empericks truely if any medicine applyed doth not make flesh to grow hée verely beholdeth but yet being ignorant whether that springeth because his medicine dryeth to little or much he cannot go vnto another medicine In like sort truely both Erasistratus and Herophilus being as I haue shewed halfe dogmatistes shall ill cure an vlcer for they attempt to cure onely those affects by reason which are proper to the organicke members but an vlcer as we said is common both to similer and also instrumentall parts therefore so farre forth as it is in the similer partes so farre foorth they will cure it Emperiquelie Also if they proue to cure those vlcers whose substance is vtterlie perished or else is vnperfect diminished in these also it followeth necessarilie that they maye manifoldlie erre from curing reasonablie for if that is lost by anie similer substaunce it is necessarie that he who will looke to the restoring of this againe be skilfull of vniuersal nature But of these we shall héereafter speake in the meane season I suppose it to be most euidentlie set out that euerie one cannot rightlie cure an vlcer and that the first indication of all which is manifest to euery priuate person is the least part of curing For it is necessarie that by demonstration he hath learned how that heate and colde moisture and drynesse be qualities actiue and passiue And further to know all those things which we haue written in our bookes De Temperaments or else where in other volumes belonging héereto And hetherto our talke hath bene of the hollowe Vlcer we onelie curing the hollownesse it selfe for it is not yet set out what is the proper curation of an vlcer but that shall also be performed after the same methode because it is taken both of the temperament of the affected parte and also of the facultie of medicines and surelie both these doe depend of the Treatise of Elements for if that be graunted that in a methode the foure qualities are causes of generation and corruption it shall not be lawfull either to haue begunne either to procéede or to finish a methode for trulie it belongeth to the Treatise of Elements that thou mayest shewe the qualities to doe and suffer naturallie Therefore that we héeretofore haue shewed is now confirmed in this present talke that no Phisition can consider of anie similer partes without naturall knowledge or speculation but there is onelie set out of similer parts Héere now our talke doth somewhat insinuate that neither in the instrumentall parts anie can finde out the perfect cure which haue not attained the speculation or true knowledge But this shall bée more euidentlie set out in the worke The fourth Chapter BVt now it is time to go to the verie cure of an vlcer which is alone or simple the vlcer trulie shall be alone if there be neither affect or accident present but if the part vlcerate be not molested with fluxe nor visited with ill iuyce neither out of his naturall temperature neither is there anie hollownesse or yet losse of skin for this thing a good sort of Phisitions do let slip not vnderstanding howe there remaine two affects in the part after the hollow vlcer is filled with flesh made plaine the one being the losse of the substance of the skin the other of the solution of continuitie Therefore as often as this one thing commeth that is solution of continuitie whether that be of the ouer skin the Gréekes cal it Epithermia or whether it be of the skin called Thermia or it be the affect of the flesh vnder it which is called an vlcer it doth onelie require to be adglutinated for if the sides of the skin be perfectlie ioyned together there shal be nothing in the middest of a contrarie kind like as in the vlcer which is now filled and is made plaine for in this the sides of the vlcer touch not but the skinne of all the exulcerate part is porished which ought forsooth to be restored But in that wound whereas there is diuision made with anie edged toole there is onelie adglutination required not also the generation of skin
for that they onely are the woorkes of medicines Wherefore thou must haue the more regard of the iust teÌ„perature of the vlcerate partes as often as thou wilt either incarnate or glutinate or ciccatrise the motions of nature are to be obserued which euery of these rehearsed doe follow but otherwise they shall not be obserued except the part be founde according to nature as if there were inflammation With an vlcer no man will atteÌ„pt either to incarnate or conglutinate or ciccatrise before the inflammation be expelled so in lyke sorte I suppose that if there be onely intemperatenesse without inflamation we shall not hope for any of the foresaid before this be cured Therfore hereof spriÌ„geth again a certain indicatioÌ„ of the finding out of medicines which were before coÌ„prehended for all they were siccatiâ—… but they did differ among themselues by reason of excesse and defect it is not before defined how forsoth they should make hot or refrigerate But the Methode as it were enforceth to search out also this thing But it behoueth to marke not onely whether it doe exciccate but also whether it doe greatly heate or refrigerate Wherefore thou shalt eschew the vse of Altercum and Mandrage and Meconium although they excicate as much as is méete for an vlcer because they vnmeasurably refrigerate Resin and Pitch and Asphaltus although they doe moderately exciccate yet they be moderately hot therefore no man will vse these alone neither otherwise than mixed with other which doe gently refrigerate making of all one temperate medicine But if these thinges are thus as truely they are it is conuenient also to marke the temperature of the ayre for this being as a certaine medicine comming outwardly to our bodies if it be to hot or colde it hindreth the cure Therefore diligence is to be had that the medicine doth helpe the excesse of it Therefore Hippocrates vseth medicines of colder facultie in the hot times of the yeare and in colde times hotter medicines And here truely thou art not ignorant howe a certaine dul methodician did coÌ„fesse that he did marke how the ayre about the pacient was affected in heate and colde and yet not to suffer the times of the yere to be regarded as though the names it selfe of the times of the yere did either profit or hurt and not their temperament or that the olde wryters for this cause had not respect to it But I thinke it abundantly shewed that who so will by a certaine methode cure an Vlcer he must of force both come to the first Elements and also consider the times of the yeare and the temperaments of bodies not onely in the whole but also in euery part Againe we must repeat that that hath béen spoken of indication which is taken of moist and dry for like as the moist nature requireth moister medicines and dryer natures drier medicines so here the hotter nature requireth hotter ayre the colder requireth colder For that in those which are against nature and those which are according to nature there is a contrarie indication For those that are according to nature shew the lyke those that are against nature contraries If wée will conserue them these must bée of force remooued The ninth Chapter ANd thus I suppose that I haue cléerely taught that he who shall well cure an vlcer must consider the complection of bodies times of the yeare natures of partes also that the first indication curatiue is taken of the onelie effect but for all that the remedies cannot be thereby found out except we first do ascend to the elements of bodies and way the patients temperament not onely of the bodie but also of the sicke part and considering with these the temperature of the aire which truelie doe both pertaine vnto the present state and also vnto regions that there are together in one curation contrarie indications how to vse them it shall be set out héere after more largely notwithstanding now also it shall not be from the purpose to speake also in this place thereof in few wordes for I do think no meruaile although the patients complection be moister and yet the part affected to be drier or contrariwise that the part be moister the teÌ„perature of the whole bodie drier in like sort than the part is of contrarie temperament in hotnesse coldnesse with the whole bodie therefore like as if the whole bodie were in meane temperature which we haue called best we shuld not neede to alter anie thing in medicines touching the nature of the Pacient so whereas the bodie is soone drier or moister or hotter or colder than is requisite it behoueth so much to increase the force of medicines as the bodie is declined vnto natural intemperatnesse We haue not forgotten to thinke what naturall temperatures is what is against nature for wée haue spoken of that inother our works but chieflie in the booke which is intituled of inequall temperatures admit therefore that the whole complection of the sick bodie is more moist and for that cause require medicines lesse deâ—iccatiue that the affected part is in the number of those which are more drie such we haue said be the parts lesse fleshie as about the fingers ioynts also the parts about the eares nose eies téeth And to be briefe wheras there are many cartilages cotes ligaments bones nerues for héere is no fat or flesh or but verie little the indication within these is héere taken of the nature of the part is contrarie to that which is taken of the nature of the whole bodie wherfore if so be that howe much the complection of the Patient is more moist than is requisite so much the parte affected is more drie we shal neither adde neither yet subtract from the medicine but we must vse such a medicine as we wold apply to the vlcer made in the parte of meane temperature and where the bodie is moderatlie temperate but if the part be so much the more drie than is requisite as the temperameÌ„t of the bodie is moister we must so much increase the drinesse of the medicine or the temperament of the part excéede the temperament of the whole as if the exulcerate part excéed in drinesse foure parts the iust temperatnesse that the patients nature is thrée degrées moister it is manifest that the part which is nowe vlcerate requireth a medicine one degrée drier than where as the part is temperate it is euident that all these are taken by coniecture and that he shal best coniecture which is exercised in reasoning of these trulie in all such there are together at one time contrarie indications neither shall I néed to speake also of those indications which are taken of hot colde because they may be vnderstood by the which is spoken Trulie in other the indications are separated by times in which there are finished it behoueth also chieflie in the beginning of the curation that one to cease
vntemperature of the flesh being subiect The second by the vice ill qualitie of the bloud comming to it The third of a great measure and quantitie of the said bloud Ought not the diuision to be made thus or otherwise That is to saie the cause wherefore some vlcers are stubburne and difficill to be healed is for the mistemperance of the flesh exulcerate or else for the gathering of humors vnto the vlcerate part Yet againe the mistemperate flesh ought to be diuided into two differences The first is when the flesh being subiect is out of his nature onelie in qualitie The second is whē with the euill qualitie it hath tumor against nature The flowing of humours is diuided into two differences that is to saie into the qualitie and quantitie of humours Sometime diuerse of the said dispositions are mixed together and sometime all But the methode for to cure them ought not to bée giuen all together but each one by himselfe The second Chapter AND if the distemperance of the flesh bée drie moderate it with bathing and wetting in temperate water But at all times that this remedie shall be vsed the end of the bathing and wetting shall be till the particle come ruddie and rise in a lumpe Then cease the bathing and moisting for if you bath it anie more you shall close the humour againe that was loosed and so you shall profit nothing Likewise the moistning facultie of medicines ought to be greater than is accustomed in a whole part If the flesh be more moist than naturall habitude you must haue regard to the contrarie for the facultie of medicines in the case ought to be desiccatiue and to vse no water But if thou must wash the vlcer take wine or Posca that is to saie Oxicratum or the decoction of some sharpe hearbe Likewise you shall coole the pride of the flesh that is too hot and heat that which is too cold you shall know such intemperatures partlie by the coulour and partlie by féeling of the diseased patient For sometimes they confesse they feele great heate in the particle sometime manifold coldnesse and so delight themselues in hot or colde medicines And sometime appeareth rednesse and somtime whitenesse But to distinguish these thinges it is not the duetie of this our proponed worke in the which worke we shew not the method to know the affectes but to cure them in such wise that by consequence of words we bée come vnto the said methode to knowe the affects Againe let vs returne to our purpose If anie parts are vlcerate with tumour against nature first the tumour must be cured What ought to be the curation of all tumours we shall saie héereafter Presentlie we shall intreate of that which is ioyned vnto vnkind vlcers But when the lips of the vlcers are discoloured and somewhat hard they must be cut vnto the whole flesh But if such affect is like to procéed further deliberation must be had least that which doth séeme to be repugnant vnto nature shall be cut out or in longer space to be cured without doubt in such a case it is good to know the patients mind For some had rather to be long in curing than to suffer incision and other are readie to endure all thinges so that they may the sooner be made whole Likewise héere shal be spoken of the ill iuyce which floweth to the exulcerate part and in as much as it is a malignant and a wicked humor it shall be spoken of héereafter in his owne place When as therefore the humour which floweth to the vlcerate parts is not farre of nor doth abound in qualitie or quantitie it shall be then conuenient to direct it and to restraine the fluxe which commeth vnto it and also to coole the heate of the parts that be néere the vlcer Furthermore you must behold the ligature or rolling at the vlcer and leading it to the whole part as Hyppocrates commandeth in the fractured bones Also that the medicines that are ministred to the sayd vlcers must be more stronger than they that are applied to a simple vlcer And if the fluxe of humours wil not staie with conuenient medicines then you must séeke further the cause of the said fluxe and take it awaie If the fluxe come by weaknesse of the member that receiueth it the sayd weaknesse must be cured And such curations also shal be proper for the vlcerate part But if the cause of the fluxe be through the abundaunce of the bloud or of the ill disposition of all the bodie or of anie of the superiour parts you must first take awaie the said causes The weaknesse of the part forth of which abundance of iuyce doth flow cōmeth whole of the intemperancie not altogether Wherof it followeth that the vlcerate flesh is only intemperate and not weake and féeble sometime it chanceth both the one the other For the great intemperancie is the cause of the imbecilitie of the affected part the which intemperancie is cured as is aforesaid in refrigerating the heate humecting the dry warming the cold desiccating the moist And if the place be too colde moist together the medicines must be in warming drying together so of the other intemperances in putting away euery qualitie the surmounteth by his contrarie The reason is Euerie thing the behaueth it selfe wel is according to nature not only in liuing things but in plāts also in al other things ther is an equality which the Gréeks cal Simmetron without excesse of al vicious humors For the thing where nothing can be taken fro or put to neither anie part or anie qualitie it is all perfect in one equalitie contrariwise the thing that must haue taken fro it or else somewhat added to it is not in a naturall perfect estate Wherefore it is not possible to cure rightlie but in taking awaie that which is excesse putting to it the which lacketh In another place we must speake of the ouermuch or lacke of things but when anie qualitie is ouer much it is necessarie that the other qualitie contrarie to him ouercome him againe and the corruption of humors or intemperancie bée remoued in restoring the said qualitie that wanted for in cooling that which was too hot thou shalt restore that which lacketh diminish that which was too much abundant Thus it is necessarie that the curation of the things that are put farre from their naturall habitation by some intemperancie be made perfect againe by thinges of contrarie vertue And thus the flesh or anie part thereof wherein is fluxe of humours because of weaknesse ought to be made in this manner as is sayd before and when the intemperancie is cured then procéede to the cure of the vlcer first curing the intemperancie as if it had come without the vlcer By the which thing it is manifest that all such curation is not proper to the vlcer but to the intemperancie Likewise if anie fluxe of humours
and sendeth all the corruption to the skinne in such sort that the skin is vlcerate and all the bodie purged What is then the curation of such vlcers certainlie as of other vlcers wherein no corrupt affect or disposition is which the Gréekes call Cacoethae But if it be so it is euident that no indication is to be taken of the cause which hath excised the vlcer but if the vicious humour remaine some indication might then be taken of the saide cause for otherwise it should be an absurde thing that that which is no more remaining shuld require curation or if he shuld shew curation where there is no néede Wherfore it is a strange thing and wholie against reason to saie that the indication curatiue ought to be taken of the cause primitiue And for because that the said Indication is not taken of the same cause it is euident that it must be taken of the cause present But what is such an Indication forsooth if a man will properlie define it it is a thing which appertaineth to prouidence which the Gréekes call Prophalacticae but if anie will abuse the word it is called Therapeutica But for as much as of the vlcers themselues certaine be simple and certaine be hollow if a man will diligentlie marke and consider the curation of them is brought to passe in eschuing and foreséeing those things which bée hurtfull vnto nature And when we woulde bring anie thing to good successe wee had néede of Natures helpe as in closing of an Vlcer and regeneration of flesh in the which things the chiefest care and regard appertaineth vnto that part of the arte which is called Prouidence but it is called vulgarly healing And therefore this part of the art that is named Prouidence is diuided into two kindes The one is that which doth remoue awaie the disease present the other which withstandeth the disease that it maye not come to his fulnesse Therefore the younger Phisitions héere doe not vnderstand that their disputation and contention consisteth onely in names wherfore if they were studious in things they should finde out that there were two differences of the functions and actions of medicine that is to saie the disease alreadie come or to withstand those that are not yet present Then there is no man but he wil confesse that to cure or to heale is no other thing but to take awaie the disease that is present whether it be done awaie by the worke of nature or by medicines but prouidence is a thing that letteth the disease that hée may not come truelie they which doe cure the ill humours which come to the vlcer doe minister the art of medicine by reason and methode in purging and taking awaie those things which doe hinder the course of Nature And these two manners of curing are properlie called in Gréeke Prophilactica for they let as it was sayde before that the filthie mattier engendereth not in the vlcer neither yet ouermuch moisture which may hinder the curation The fourth Chapter IT is but in vaine truelie thus carefullie to striue about the name but it is more conuenient in my iudgement to giue some good method to cure the vlcers such as I haue spoken of as wel in the booke going before as in this But I doe much meruaile at the dulnesse of Thessalus writing thus of the curation of vlcers the which are called Cacoethae The communities of vlcers that continue long time and that are vncurable or els returne againe after the matter induced be verie necessarie in likewise as in vlcers that may not grow together be closed it must be considered what is the cause that letteth and procureth the saide growing together the which cause ought to be taken awaie But in them that renue the ciccatrise againe it behoueth to kéep the same ciccatrise that is to saie in strength for so we haue translated To metafuicrinen and in comforting the suffering member or all the bodie in common and in ordering it that it endure not lightly by the remedies appropriate therto And when Thessalus had propounded such wordes in the beginning of his booke of Surgerie he writeth afterward more plainelie of this matter The vlcers that endure long and may not be healed or that renue and come after the ciccatrise giue such indications that is to saie if they come not to ciccatrise it behoueth you to let the vnion and comming together to renue the vlcerate place againe And after that you haue made it like vnto a fresh wound it must be healed as a bléeding wound But if the said cure profit nothing you ought to mittigate the inflamation make as much diligence as you can But the vlcers that come to a ciccatrise and open againe in their accessions exulcerations you ought to cure them like vnto thē where there is a fresh inflamation afterward you ought to applie vpon the said vlcer a plaister of mittigatiue things vntill the ire and fearcenesse be abated after this is done you ought to dresse the ciccatrise and then make the parts about it waxe red in wrapping it about with a Malagma made of mustard séed or with some other medicament that may change the said parts make them lesse subiect to diseases And if they cease not with these things you ought to haue cure of all the body in strengthening it with diuerse exercitations gestings and vociferations in commanding thē that kéepe him to such things as these be That is to saie in manner of liuing by diminishing or augmenting by degrées in beginning vomiting made by Raphanus You shall also vse white Eliber and all other thinges which we vse in diseases that be difficult to take awaie which are subiect to reason and manner of liuing This is the saying of Thessalus Now it is time to consider the stupiditie of the man I saie the stupiditie if he thinke he hath sayde well and the boldnesse of him culpable to saie nothing and by this meanes supposeth to deceiue the Readers But tell mée Thessalus what is the Indication curatiue that is taken of an olde Vlcer Trulie I neuer found out curation of the olde Vlcers nor of the newe not by time in what disease so euer it bée but of the affect that I purposed to cure But if we altogether regard time as if the Indication curatiue were taken of it the second daie we should giue an other indication than the third likewise to giue the fourth daie another then the fift and so of the sixt all other daies following For by this meanes we shall no more consider the affect of the disease that we goe about to cure and the Indication no more to bée taken of them whereby we coulde neuer thinke of a straunger reason howe then are the communities of vlcers necessarie that continue a greate while seeing that the time it selfe can indicate nothing at all For when an Vlcer is with erosion that commeth of all humours we
manifestly that they haue no regarde of other things that appeare in the affected part for to come to such euacuation But I doe not say thus that purgation is euacuation the which is no indication of the course of the bloud but for bicause wée must sometime haue consideration to the letting forth of bloud although there be no course of bloud present which may flow to the greued part for when the disease is very strong there is none which vnderstandeth the arte of medicine but will let bloud And truely the Emperickes themselues let bloud when any is fallen from an high place or when there is any part sore brused hurt with any wound though the pacient were whole and sound before and without superfluitie of bloud By the which it appeareth that it is not the flowing of the bloud to the affected parte which giueth indication but the magnitude and vehemēcie of the disease the force of the strēgthes excepting yet from our talke children As for example If a man be whole and sound and without any maner of hurt and hauing abundance of bloud it is not necessarie because of his abundance to take his bloud from him For there is no indication to be taken of the bloud for because the man is whole for to such men fasting doth profit small eating and sometime Purgation or bathing and Frications may suffise Letting of bloud is not necessary to such as the Emperickes say Likewise Purgation is not good in the onely abundāce of humours for euen as letting of bloud is done either for abundance of bloud or for the magnitude of the disease so is purgation giuen either for the abundaunce of ill humours or for the force of the disease As touching letting of bloud we haue spoken of in another booke and shall doe againe hereafter But in this present booke I will speake of purgatiōs for they that be diseased require them not onely because it doth euacuate the noysome and superfluous humours with the which the bodie is grieued but also putteth foorth and clenseth the excrements within the bodie And for this cause Hyppocates as well in his other works as in that he hath written of Vlcers considereth the vehemencie and strength of the disease whereof he taketh Indication of purging and sayth thus Purgations of the bellie is profitable to many Vlcers and also to woundes of the head of the bellie and of the ioynts and where there is daunger of the rottennesse of the bones or where stitching behoueth in woundes or where erosions bée or where Herpis other affects be which hindereth the curation of Vlcers and also where rolling must be vsed By these words it is apparant truelie that Purgations are profitable both to wounds and Vlcers at all times when they be great and grieuous For not onelie the sayd affects but other bée made great and grieuous thrée manner of waies that is either through the excellencie of the afflicted part either else through the greatnesse of the affect or else because the said affects are Cacoethae that is to saie hard to be cured Hyppocrates hath made mention of all these thinges perticularlie when he dyd intreate of woundes of the head and bellie and of the excellencie and dignitie of hurt parts I thinke it is manifest to all men that he must bée vnderstoode not onelie the lower bellie but also the superiour for in diuiding the Trunke of mannes bodie which is betwixt the necke and the legges is two greate capacities The first is contained vnder the Thorax and aboue Diaphragma and the second vnder Diaphragma vnto Os Pubi or to Peritoneum which couereth the inwarde parte of the bellie And for certaine those woundes which hath pearced within the Thorax or within Peritoneum is verie dangerous chiefelie if anie of the inward parts bée wounded Likewise there are verie fewe but they doe know that the woundes of the ioyntes are Cachoethae and are harde to bée cured Which thinges the Emperikes vnderstand onelie by experience and they that haue studied and haue attained to the knowledge of mannes bodie vnderstand these thinges by the nature of the hurt parte For in tendonie and sinnowie parts where bones are void of flesh there is great daunger of paine waking and priuation of rest and also of conuulsion Such woundes as these be and such as be stitched that is to saie those that are so great that they néed stitching or at the lest of binding or rolling requireth purgation We haue declared in the last booke that all the greater wounds ought to be ioyned together either by stitching or by binding Likewise the vlcers where there is daunger of corruptiō of the bones are oftentimes ioyned with great inflamations Also they that procéede of ill humours bée Cachoethae and with erosion Also Herpetes come of cholerike humours and all other olde vlcers come of such like cause Wherefore in all the vlcers before especified Hyppocrates commandeth to purge by the bellie and afterward he addeth these wordes In all vlcers whereto Erisipel as is come the bodie must be purged in that part most profitable for the vlcer so that the purgation be made either by the vpper partes or else by the lower which difference hée hath set forth in the booke of Humours where he commandeth to tourne awaie the humour to the contrarie parte As for example There is a great flux that commeth to one part of the bodie where there is an vlcer it behoueth to make another in the contrarie parts and thereof he speaketh in the said booke Wherefore if there be as yet a great fluxe which dooth runue to the sore part we shall make reuulsion to the contrarie part that is to saie if the vlcer be in the vpper parts by purging downward and if it be in the neather partes by purging the vpper ventricle But if the fluxe bée newe stopped in such sorte that is fixed in the member it is expedient to driue it out by the next partes séeing that the passages be the next places séeing that the accesse and attraction of purging medicines is more easie and prompt to remoue those things that be néere rather than those thinges that be farre of the which reason belongeth to another part of the art which entreateth of purging medicines therfore hereafter it shall be declared and made perfect Now I will shew the force or if you will call it the magnitude of the disease to be appointed for a certaine indication of taking away bloud or giuing purgation And also that Hippocrates was the first inuenter of the sayd indication I will speake in the bookes following of diseases and in this booke I will speake of vlcers I haue alreadie spoken of Purgations For séeing that euery disease is greuous thrée maner of wayes it is either for the excellencie and noblenesse of the part or for the magnitude of the affect or for the frowardnesse of the same affect called in Gréeke Cacoethia Hippocrates hath made
not hurtfull as Aerugo aes Vstum aeris Squāma Cadmia Pomphilix Litarge Cerussa Yet they ought not to be ministred to the vlcers of the inward parts of whose nature we haue written in the booke of temperaments and in the booke of simple medicines But if we go about to glutinate the vlcer and bring it to a ciccatrise we must choose glutinatiue medicines such as will not cause erosion But if we will clense the vlcer we must vse things abstersiue and such as wil absterge it moderately as raw Honey which of al things for this purpose is the chiefest But as touching adstingent potions called Austerae and other such like alimentes they be knowen vnto all men This woord Auster is called Stiphos in Gréeke that is to say little astringent and that which is lower or bitter is called in Gréeke Striphnon But the medicines which may be taken without danger are spoken of in the booke of Medicaments Neuerthelesse I wil shew some forme of wholsome Medicaments for the inward vlcers which are these namelie Hipocystis Balaustium Cytini Punicorum Galla Malicorium Terra Samia Lemnium Sigillum Rosarum Succus Acacia other or like kinde which be profitable for inward vlcers and you must minister the said medicaments with some decoction of adstringent things as of Quinces Lentiske or the tops of Rubus or of Vines or gréene mirtills or with adstringent Wine It is now manifest and I thinke none is so ignorant but will iudge that hée must eschue drinking of wine if there be Phlegmon or else there is no daunger In like maner it is euident that the said Medicaments must be prepared receiued with decoction of moist things Also you must mixe gumme Tragacanthen in those medicines which are for the vlcers in Gula you must vse Gargarises in the Vlcers that are in the partes called Fauces and Paristhmia but if the vlcer bée in Aspera Arteria called Trachia then the Patient must be layed vpright and kéepe the medicine long time in his mouth in loosing all the muscles that be in that place for in so dooing some part of medicament will flow by little and little to the grieued parte For when the sayde Aspera Arteria is in his naturall state or in good health then we may easilie know when anie potion passeth through it For like as we must take heede when as it is in good health least anie fluxe fall that waie which maye hurt it so in like manner we must beware when it is grieued least anie thing doe fall that waie which may prouoke the cough then it séemeth that the Indications of it are taken of the scituation and forme of the part Also Honie must be mingled in all Medicaments which are ordained for the Vlcer in the Thorax and Lungs Therefore if we vse astringent medicines they will remaine in the bellie Then the instrument which is profitable for the digestion and distribution of the said medicamēts ouer all the bodie shal be honie Also it being mingled with the said medicines shall be occasion of their quicke passage ouer the bodie neither shall it anie thing anoie or hurt the vlcer In like manner if there be an vlcer in the bladder in the raines honie and such as prouoketh vrine must bée mingled with the said medicines But I thinke that it is apparant to all men though they take not me the author of the same how that the vlcerate partes may be discerned or knowen by their substance action vtilitie scituation and figure The which things trulie haue ben amplie declared in the booke which entreateth of the signes of the affected parts but now there is no time to talke of them therefore I will returne to the method of curation Also I saie and affirme that not onelie these aboue rehearsed but also many other be the indications of the figure and scituation of the partes For you cannot well and exactlie binde the affected part before ye take indication either of the figure or scituation or of them both Neither can you set the pipe of a clister well before ye take such Indication What should I make mention of Argalia speciallie when as you cannot minister it before you perfectlie knowe the scituation and figure of the bladder Then trulie by these things it dooth manifestlie appeare that the affected part giueth indication to the curation But in ruptures truelie which the Gréekes call Regmata many Indications may be taken to one purpose and principallie the indication that is taken of the scituation ought to be considered For the ruptions that be hid in the deapth of the bodie require other curations than the woundes which appeare outwardlie and for because they be such as be with Ecchimosis or contusion about the broken flesh therefore they declare diuerse Indications curatiue For alwaies the Indications curatiue do answere to the number of the affects wherof we wil shew more copiouslie heereafter when we shall speake of Phlegmon how that the affects that are in the déepe places of the bodie requireth stronger medicines than those in the vpper parts Then at the least I iudge it to be manifest that it is necessarie that the strength of the medicamentes that are ministred outwardlie ought to be resolued when the affected part which should be cured by those is hid in the deapth and profunditie of the bodie Therefore it behoueth to augment the vertue of the same medicaments so that by the passage thereof it may be staked Certainlie Ecchimosis doth indicate euacuation for the remedie of the cure Wherefore medicamentes that will moderatlie heate and drie be most conuenient for it For they that do vehementlie drie trulie do resolue and digest more at the beginning than they which drie but simplie But I will speake héereafter somewhat of this disease which is difficill and serious to cure But of that which did pertaine to the matter wee haue largelie spoken of Truelie those medicamentes that moisteth and heateth more than they which the Gréekes call Calasticke Also those which doe somewhat to drinesse which the Gréekes call Suntatica be the chiefe and principall remedies for all Ecchimosis But we must take héede the medicines do cleaue to the ruptions that are in the deepnesse of the bodie and also that they be of strong vertue that they be sharpe and such as will digest and to speake brieflie such medicines ought to be of great force inasmuch as Ecchimosis is in the déepnesse of the bodie and far from the skin In such affects the vse of a cucurbite is profitable which is an instrument inuented of Phisitions to cause vlcerate attraction And when Ecchimosis is digested by the vse of a cucurbit then you may minister those things which may drie the broken flesh and conioyne it with ligature adde that which may coagulate and ioyne the wounde together for Ecchimosis being resolued and digested the broken flesh shall coagulate together But if it be resolued then
happen in the similer and simple partes but also in the compound and instrumentall but yet there be other indications of remedies taken of the similer partes then of the Instrumentall of which they that follow Hyppocrates methode know both because they know the natures of both partes But those that follow Erasistratus and Herophilus haue but one Indication that is to saie that which is taken of the Instrumentall partes Wherefore they haue no certaine method in these which follow whatsoeuer indications are taken of the bodie or sicknesse hot colde moist or drie but yet they are not ignorant of the Indications taken of the forme position excellencie quicke féeling of the part or those which are contrarie That which we saie shal be more manifest if we set out the the partes themselues Therefore because alreadie abundantlie we haue entreated of those Vlcers chieflie which happen in the fleshie partes it is time to speake of them which chaunce in the veine and arterie and nerue and not of these absolutelie by themselues but as they are in the instrumentall partes of man Wherefore if anie hath a greate arterie or veine wounded there followeth presentlie great flux of bloud and the wound in the veine will hardlie be glutinated in the arterie it can more hardlie be done as many Phisitions suppose but peraduenture cannot be done at all Therfore we must againe speake of either of them and first of the fluxe of bloud and next of adglutination But for that such fluxes are caused by Anastomasin and Diepedesin as we presentlie declare it shall not be from our purpose for that they both haue a common cure to make mention of them in this place although they séeme to be another kinde of disease trulie the bloud floweth out of the veine or arterie the mouth of them being opened or their coate diuided or as I may tearme it strained or sent out in manner of sweate surelie the coate of thē is diuided either by wounding or contusion or ruption or erosion Anastomasis happeneth both through the imbecilitie of the vessels and also through the plentie of bloud which breaketh to the mouth of it with violence furthermore by anie thing cōmming outwardlie hauing a sharpe qualitie Diapedesis commeth when as the coate is made more thin and the bloud attenuated and furthermore it maye come to the mouth of anie of the small veines béeing opened Therefore we must speake of either affect by himselfe and first of all of that diuision which we haue sayd to come of erosion or wounding or contusion or ruption so that those things which doe wound are edged tooles and apt to cutte those that make contusion are heauie and harde those that cause ruption doe it by straining the same doth also the vehemencie of anie action the abundance of ill iuyce or humours not in respect of the strength but for that it is not contained in his vessells Also anie heauie or hard thing falling from aboue entering in for anie such thing when the vessels or veines are emptie or else containing but a small substaunce entering in it if it hath an obiect which is hard it causeth contusion if the vessell be full it bruseth it before it maketh cōtusion When that which happeneth is like as if thou diddest fill a bottle or bladder and diddest let a stone fall on it or else violently diddest strike it against a stone truely the like to this is that which happeneth to falles from aboue for looke what respects the bottle hath to the stone the same hath the man vnto the ground and whosoeuer breaketh any vessells of the lungs with great and most vehement clamour must refer the ill receiued vnto the violēce of the action In like manner he which hath broke any vessells that is to say any veine or arterie by bearing a great burden or by going about to lift it on his shoulder or else to lift it vp with his hands so much the rather to whome it happeneth of most swift running or most strong leaping or otherwise any part being violently extended For it is like as if one should stretch out a rope or leather though many vesselles are broken because they containe not the bloud in thē chiefly when it is flatulent as may appeare both in hogs-heads which full of must doe oftentimes breake also in other of most strong bodies The third Chapter AND if the vessell be ruptured either of wounding clamour fall or contusion the cause of these truely doe cease but if it come of aboundance it may againe happen that the vessell may be ruptured the efficient cause is yet remayning also in this affect the abundance truly is to be euacuated then the bloud to be suppressed and after the vlcer to be cured but where as the efficient cause is ceassed there the bloud is first to be stenched and after the vlcer is to be cured How therefore will we stench the bloud truely by stopping the ruptured vessel the bloud that was caryed by it being auerted and conueied to another place for if the bloud should be caried to the place vnto which it dyd in the beginning flow and that the mouth of the vessell be in like sorte open the man truelie being vexed with the fluxe shall sooner die than the fluxe of bloud shal cease surelie the wounds wil be closed if the sides which are diuided be brought together or that the mouth of it be stopped and the sides of the wounde closed by the helpe of our hands if we may come to it with ligature or such remedies as are colde and astringent Neither is it lawfull to stitch the wound of a veine or arterie as they affirme who saie that no Indication is to be taken of the substance and nature of the wounded part the mouth of the vessell shall be stopped the bloud being then coniealed the Gréekes call it Thombros and also by things outwardlie applied on both sides about may be put vpon it and also in many wounds the skin it selfe or what else we mixt with it such are linaments in Gréeke called Motos those medicines because they haue a clammie and grose substance doe stoppe the pores the Gréekes name them Emphlastica as also medicines which make a crust which the Gréekes name Escharan The olde Phisitions despised these in such like wounds as it were a great ieopardie These also are done not onelie by the fire it selfe but also with medicines hauing a firie facultie and the mouth of the vessell is stopped by these medicines the bloud trulie shall be auerted and turned to other members both béeing drawen vnto the next partes and also by reuulsion to the contrarie the Gréekes call that Parochetensis but this Stuti Pasis and these also bée inuented of Hyppocrates being verilie the common remedies of all immoderate euacuation Deriuation is made vnto the next parts when as that which is voided is euacuated by the nosethrilles Also reuulsion to the contrarie partes is when
of the partes where they are first put on and doth put and fixe them in those in which they end I thinke it reasonable to beginne the ligature vpon the fracture it selfe and so to proceede vnto the rest of the member for hée that doeth otherwise putteth the bloud to the affected parte but if he beginne vppon the hurt parte and endeth in that which is whole such ligature shall not onelie be voide of hurt in these which we haue saide but be also profitable for that it suffereth no inflammation to arise about the Fracture of which principallie regard must be had and it is to be feared least great inflamations folow both of the stretching into the contrarie part which we vse in forming rightlie the member and also that the causes which make the Fracture do first hurt the flesh inuesting the bones by constipation and contusion neither meruaile I if some such thing like an inflamation happeneth to the portion of the bones when as such as are not rightly cured are manifestlie séene to be more moist than nature requireth where wée sée a wound with a broken bone neither commeth Caries of the bone in Gréeke named Sphacelus anie other waie which is corruption of the whole substaunce of the bone Therefore thou shalt not bée negligent but expell thou all the superfluous moisture from the partes which are about the fracture Therefore thou maist begin vpon the affected part and bring the roller about twice or thrice and procéed then toward that which is sound for verilie he that thus doth roll shall defend the fluxe of bloud to come from the whole partes to those which are affected and doeth also put out from hence that which is héere alreadie collected Séein then that there are two partes which maye both receiue anie thing of the affected part and also send vnto it Forsooth they which lie vppon it are most readie vnto both as well for the multitude as also greatnesse But the extreme parts for the contrarie cause can receiue or send but little neither can minister much either to the affected partes either receiue of them againe Wherefore when as Hyppocrates made the first two ligatures with the first he did not expell that was in the affected part to those that are aboue and also doth expell that which floweth from them with the roller For with the first rollings about which he doth make vpon the fracture and by deducing it to the lower parte he thrust some mattier thether and letteth that none shall flowe from thence The rest of all the inuoluings with which he will haue the roller to goe from the lower partes vpward that they may in the same place with the first both repell to the higher partes and also preserue fluxe from these wherefore the two first rollers doe defend and strengthen the Fracture neither suffer they inflamation to arise Notwithstanding these alone are not sufficient to both these vses so that Hippocrates did deuise for their defence a remedie that splents bée applied with the last rollers which might also strengthen these and he commaūdeth to vse some one medicine which is against inflammation least there should follow inflammation such a medicine is Ceratune humidum Therefore all these are inuented as we haue sayd by reason and also the figure of reposition this also hath a two fold indication the first dependeth of the common knowledge onely the other which is taken of the naturall constitution of the members to be cured the first indicatiō sheweth that such figure is to be chiefely chosen which is most frée from dolor and griefe so that there follow no inflammation to the part and that the patient be best able to remaine longest in this without mouing The second indication which is taken of nature willeth that the arteries veines nerues and muscles be most rightly placed And these indications doe agrée For the rightest figure of euery part is frée from dolor and that which of the rest is most frée from dolor is most natural to the part for to the arme the figure which is cornerwise in Gréeke Eggonios for the leg that which is somewhat lesse stretched out Furthermore not onely the naturall habit is profitable to euery member not onely in auoyding of dolor but also the custome séemeth much to profit and this is the waye of finding out the figure in which the member is to be kept which also differeth not in séeking out the figure vsed in extending the parts a sunder called in Gréeke Diatasis and also when the partes of the broken bone are brought into their naturall place for it is cōuenient that both thou dost extend the member in the most right forme and that which is furdest from dolor and also that thou formest it into his naturall habit and much more that thou roll it in the same figure and also placing it to rest for the mouing thereof doth not onely prouoke dolor but also doth wrest the bones by mouing the member being in one figure and to change it to another for except I haue forgottē those precepts which we haue written in our bookes Da musculorum motibus it is necessarie that whereas the figure is altered there some of the muscles to be strained and to be made round as they were contracted and other to be lose and relaxed Therefore of force where they are extended there they are compressed of the roller and by the compression doe suffer paine and dolor And where there is no extention there the ligature is lose and slacke and so the fracture wanteth his staye and for because of all these we must studie that we doe both extend and forme the member and also roll and repose the member to rest vnder one and the self same figure and ther is no precept left vnset out which belongeth to the first worke in Fractures Thou shalt as Hippocrates commaundeth lose the roller the third daye least there should arise dolor and itching in the member vnaccustomed to be so couered and also that the perspiration of that which is now fixed in the member be not letted by whose occasion there doth not onely fall thereto an vnhappy itch but also the skinne to be vlcerate and coroded with the sharpnesse of Sanies wherefore we must poure in so much of temperate water as shal be sufficient to take away this Sanies And if thou wilt againe doe as it is aforesaid thou oughtest to doe it the vii daye All things now are apparent so that nothing hindreth being frée from inflammation and somwhat gentler than for naturall constitution Then it shal be lawfull to apply splents and roll it more wider asūder for it was not without danger to vse splents before the inflamation was past But now when as it is ceased that néede is to strengthen the fracture surely you shall vse thē with much commoditie And you may also let the rollers remaine longer time the partes hauing no néede to expell Sanies
patient changeth his bed or goeth to the stoole it shal be good because nothing shal want to the Treatise héereof to cōmend much Glottocomon of which they make the one side also the table in which they place the foote to be moueable for that it may serue to the bignesse of euerie member And this shall be sufficient to vnderstand of the other fractures with these which Hyppocrates hath commanded The sixt Chapter HIppocrates trulie hath writtē a whole booke of those wounds which happen in the head in which he hath set out all thinges which héerein are to be done we hauing finished this worke will goe about to explicate his workes at this present Trulie for that in these Commentaries we haue added more than the he hath spoken and defined that he left vndefined It behoueth that we speake first of the hollow cutting instruments called Gneliscus next of Phacotus after of the narow cutting kniues and last that we intreate of the vse of medicines therefore there are some fractures of Cranium which commeth to the second table called Diploen some to the inward part of the bones some are simple fractures some are contusions and some the marks of those wherwith the stripe was made remaine the simple fractures which come to the second table those néede the narow kniues before spoken of It is requisite both to haue many of them also differing in bignesse least the should want which is most apt for the purpose and the bone affected being made bare as the manner is you shall first vse the broadest knife next another which is narower so the rest orderlie vntill you come to the narowest and this is to be vsed in the second tables Afterward both these so to the end it must be cured with drying medicines which for that cause are called Cephalica those are made of Iris illiriaca and meale of Eruum and Manna Aristolochia and the rinde of the roote of Panax and to conclude all such medicines as mundifie without corrosion for the generation of flesh is the worke of nature it selfe there the patient in that behalfe hath no néed of the art of medicine that the flesh which doth engender may close cleue about to euerie part of the bone the shall chieflie followe if there be no filthinesse vpon it neither yet anie oyle or fatnesse therefore this one thing which the Phisitions helpe to the production of flesh in the hurt patients the all the place be drie euerie part of the affected bone pure all these are cōmon of all fractures when as the flesh beginneth to grow of the fractures which come to the coates of the braine if it be onlie a simple fracture the narow kniues before remembred must be vsed but if the fracture be with contusion the which is contused must be cut out first pearcing it through with Teribles or Trappons and after with kniues or at the beginning with Cylciscos as néede doth require But the which is done with Teribles is dangerous because while they more boldlie vse it they doe often hurt Dura mater which is the next bone Also that which is done by Cicliscos is not without fault when that it doth immoderatlie shake that which requireth rest Therfore it liketh me best if the fractures be great the bones fractured vehemently to vse Cicliscos for with small incision thou maiest make space with lenticuler Exciscories if the bones be sure and firme they must be pearced through with a Terible And certaine because they should not erre haue deuised such Teribles as cannot sinke downe and for that cause are named Abaptista there goeth round about a circle a little standing out somewhat aboue the sharp end of the Terible Trulie it is conuenient to haue many such Teribles seruing to the thicknesse of euerie Cranium for to a thicker Cranium a longer Terible is conuenient I do cal it so whose space frō the point of the Terible the circle extant compassing it is longer to a thinner Cranium a shorter Terible this also is that which hath a lesse space betwixt the point the ring the goeth out And trulie whether I shal call these more dangerous or surer than the other but they vse those that are called Choenicidas but vse thou with good successe Cicliscos if thou bée not skilfull of those things which maye deceiue thée neither yet more fearefull than needeth first those that are broader then those which are narrower vntill thou come to Dura mater But that bone which must bée cut out is not to bée made bare round about with the Ciclisce but on that part chieflie where the fracture is most grieuous for besides other the pannicle it selfe doeth most spéedelie separate from the bones that are vehementlie affected so that there is no feare of touching that which is alreadie separated for if thou hast once made one part bare settest thy knife which hath in the end a blunt and light forme of a lentle which is like a pease and the edge erected in length when as you haue set the broade part of the lentle vpon the pannicle strike it with a mallet so then thou shalt diuide Cranium for doing thus all things come to passe as we would haue thē for one cannot wound the pannicle yea though he did it slipping touching it onelie with the broade part of the lentle which if it doth anie where cleaue to Cranium the roundnesse of the lentle doth without daunger take that awaie for the instrument it selfe called Lentle cutting Cranium followeth at his back it going before so that thou shalt not finde out another waie of pearcing which shall bee lesse daunger or yet more spéedie For thou wilt chieflie praise this in most vehement Fractures which manie of the later Phisitions doe call Eupei somata and Camaroseis Eupei somata are when in the middest they indeauour or to take a péece of the bone forth the coate or Membrana remaining bare Camaromata which haue the same part exalted wherewith he did take awaie the fractured bones from the part affected are such as most spéedelie cut an hole out when as the ende of the Instrument called Lentle doeth easilie enter in and those which are farre gone from the naturall habite we shall prepare with an Instrument called Ostagran Some of the bones which are vehementlie crushed béeing lifted vp and turned to that parte chiefelie that we maye put in the instrument called lentle which done all things after that néedeth followe with securitie and spéedinesse that thou mayest almost rehearse that famous saying in which all things are well Dimidium facti qui bene caepit habet that is he which hath begun a thing wel hath halfe brought it to passe for héere thou hast not the halfe of the whole but rather the whole or else but little lesse when as thou hast put in the Instrument called a Lentle And this is the best
not spoken of FINIS AN EPITOME VPpon Galens three bookes of naturall Faculties verie necessarie for the Students both of Philosophie and Phisicke set forth by Maister Iames Siluius Phisition FAcultas is a certaine cause Effectrix place◠in the temperature of a parte in the beginning of simples The faculties gouerning our bodie in the which our life cōsisteth are in number thrée Naturall Vitall and Animall In time Nature vse 1. Naturall is in the liuer dispearsed by the veines into the whole bodie being the third and lowest 2. Vitall is in the heart distributed by the arteries into the whole bodie being the second and meane 3. Animall is in the braine and carried by the nerues into all parts indued with the fence of féeling and voluntarie mouing being first and chiefest Indignitie place and fortitude We must first intreate of the naturall as the nourisher or piller of the rest as we proued in the order of reading or teaching Galens bookes The natural faculties which bee first principall are Generatrix Engenderer Auctrix Increaser Nutrix Nourisher which are called powers Vegitable Arist de animal lib. 2 cap. 4. The first two falties 1. Actio 1. The verie motion actiue is a substantiall forme in Materia or production to substance or procéeding to forme And that is either of all or of part as generation of humours in a liuing creature of bloud through moderate heate of both kindes of choler by immoderate heate of fleame and melancholike humours by a slowe heate and that commeth of some meate more of some lesse in all temperatures And these humours are either naturall or vnnaturall 2. Opus 1. A thing made and finished by action as all parts the bodie fashioned in the womb and by generation complete vnto the which perfection of partes the séede being rightlie once conceiued Generatrix is the chiefe and principall worker Two other faculties 1. Alteratrix The which generallie be hot colde moist and drie in their first and element all faculties and doth change the séede bloud menstruall substance into a man in which is the qualities of féeling tasting smelling and séeing for it is necessarie that out of Alteratrix bones veines nerues and all other partes be made but perticularlie she doth worke vpon that substance by facultie making bones nerues veines c. For of the foure elements mingled doth grow the perticular faculties alteratrix wherof is made the substance of euerie similer parte and so many faculties of alteratiō ther. be in liuing creatures or of planets as there are found similer parts in them 2. Formatrix This facultie verie artificiallie and with great cunning and for some cause dooth fashion the matter which is chaunged so that it may haue an apt figure for placing composition hollownesse wholenesse soundnesse Apophyses Epiphyses and other things necessarie pertaining to the constitution of the bones natures veines arteries c. The which constitution is méete for the action and vse of the parte that after shal be created that nothing be lacking nothing superfluous which otherwise might be in better sorte Auxiliares or helping facultiez as they were hande-maidēs Nutrix Nourisher Austrix Increaser This doe not onely serue for the increase of the young being once ingendred but also from the time that the séede is conceiued for it is méete that the séede be augmented by nutrition that it may suffise to constitute so manie and such parts as be necessary The male séede is first nourished with the female and afterward with a small halituouse portion of the bloud of menstruum Facul auctrices nourishers 1. Actio Is an increasing that is to saie an ampliation of the found partes which were engendered of a liuing creature in length breadth and déepnesse kéeping the proper forme and first continuitie as it is sayde in the 1. li. cap. 5. De generatione This is the worke of nature onelie when as these things which are extended to vs or pulled from vs or are amplified in one measure onelie or not in all together then this facultie beareth rule from the birth vnto the flourishing age and as I saide helpeth the facultie Generatrix in the wombe and is onelie in a liuing bodie 2. Opus The small partes of a liuing creature borne into the world which are brought into a reasonable bignesse and the bodie being little made great Auxiliares or helping faculties Alteratrix Chaunger Coctrix Digester Nutrix Nourisher Of the which we will intreate héereafter more at large Facul nutrices 1. Actio That is nutrition or the perfect assimulation of nourishment with the thing nourished that is when that thing which floweth as the forme of nourishment is put vnto fastned made like vnto all the sound parts of the nourished bodie without anie ampliatiō for the iuyce or humor when it falleth a Vasis euen as certain dew so is it dispersed through all the part which ought to be nourished and by and by it is put or ioyned vnto it and after hauing gotten sufficient drynesse and clammie humour through naturall heate it is glued and fastned it increaseth cleaueth together and is vnited in one The which commeth not so to passe in Anasarca Hidrope when as the nutriment being more watrie and not so clammie by reason of the abundance of thin watrie humours falleth frō the sound parts of the liuing creature at the last it is made like vnto the parte which should bée nourished when it is nutriment in déede other are nutriments in power more proper and remoue The which is not in Leuce 1. Vitiligo 2. Opus All the parts enduring with nourishment so long as is possible Attractrix which draweth vnto the part conuenient qualitie and iuyce This facultie like as the rest being found in some instrument as in the stomacke reines wombe milt bladder purging medicines and Alexiteries is easilie transposed into the other parts Auxili facult helping facul 3. Retentrix The reteiner of the same vntill digestion be done Coctrix Digester in altering and that maketh it like Expultrix Expeller of that which molesteth the part in quantitie qualitie or both But we will intreate of these foure faculties as most principall héereafter more at large 1. Attractrix The drawer of conuenient qualitie and iuyce into euerie parte to nourish the same the which is common vnto all partes that drawe vnto them such nutriment as is most proper for them sometime thorough straight pores as in the stomacke and sometime onelie by the temperature of the parte as almost in all the other partes or else to the voluptuous delectation of the parte whereby the mouth of the matrixe doth drawe the séede of man to the verie end and whereby the gall doth separate and drawe yeolow choler from the liuer but in the Gall yeolow choler is not ingendered as Asclapiades saith like as neither he affirmeth melancholik humour in the splene but of him it is drawen from the liuer to nourish it selfe The reines doe diuide and onelie