or else that as the curation is taken in hand doeth bring more discommoditie and also a more grieuous sicknesse than that which is taken in hand to be cured As when we goe about to cure Vitiliginem Antiquam Lichenas Hemorroidas Sinuosa vlcera and the old Fistulas Cancers and to conclude when as we haue a stubburne patient which doth giue no regard to the Surgions that gouerneth him these are the causes why that all cannot be brought to their health by arte In like manner Chirurgerie is diuided into two partes generallie the one is which doth declare what things belong to the art doth set forth the precepts wherwith the workman being furnished may worke rightly This part the Gréeks do call Theoreticon we do cal it Theorica that is to saie the learned or speculatiue part the other doth folow that doth perform in effect that precepts of the former it is called in Gréek Practica or rather Poetica that is to say a bringer of things to passe for it wholy doth consist in doing and bringing to effect and séeing that the whole Arte doth depend of these we maye with good cause thinke Chirurgerie worthie to be called an arte as whose ende is affection and woork For she doth exercise all her properties either in soft mēbers or in harde parts The soft parts are those which haue their beginning of bloud and are called fleshie and the hard parts do spring of séede And chirurgerie doth exercise her facultie in those partes by incision by cutting or by taking away by reposition and adustion And truely of this arte there are certaine other more speciall partes as those about the which the arte it selfe is speciallye occupied that is to saye Tumors against nature wounds vlcers fractures and Luxacions Therefore as there be fiue parts which the art doth intreate of so there be fiue partes of Chirurgerie in the whole as which doe teache vs to cure tumours which woundes and which vlcers and which can put fractures and luxacions in their proper place But the ende wherevnto Chirurgerie directed all his actions and prouisions is the ablation and taking away of those sicknesses which maye be cured by ministracion of conuenient medicines with the hande to restore the sicke vnto his health which ende truely the workeman cannot alwayes obtaine vnto For those causes which we declared before séeing that it is not in his power to cure euery sicknesse And this long arte vaunteth hir selfe vnto the famous companie of excellent and noble authors worthie of great renowne In whose register that diuine man Hippocrates the patron and defender of the noble arte of Medicine doth of very right challenge to him selfe the chiefest place by whose meane this parte of medicine is better declared then it was before his time the which thing the deuine monuments which he left to his posteritie doe witnesse I doe meane his bookes wherein he doth speake of the woundes of the head of fractures of the lyms of vlcers of fistules of the emorodes and of the furniture of Chirurgerie and of cutting out of the Anathomies Furthermore Chirurgerie béeinge as it were deuided at length from the other hath chosen vnto hir selfe a proper place and beganne to haue hir proper professors for in the time of olde writers in the florishing age of Hippocrates Chirurgia was not deuided from the other parts of medicine for they were then both Phisitions and Chirurgions And Philoxenus declareth it to haue florished in Egipt which hath set foorth and garnished this Arte in many volumes And after him Gorgias Sostratus Hieron and the two Apollonij Amomus Alexandrinus and many other excellent men and it is certaine that there was no meane professors of the same arte at Rome as the auncient Fathers Tryphon Euelpistus and Meges the most excellent of all as Celsus writeth But how much Galen excelled in restoring and enriching this parte of medicine his learned Commentaries vpon the bookes of Hippocrates wherein he doth declare of the Arte of Medicine and vpon his booke De articulis de fracturis And moreouer his sixe bookes of the first methode of curing called Therapeuticon and the last two of the same the two also De arte curatiua ad Glauconem his booke De tumoribus preter naturam his booke De compositione medicamentorum secundum genera doe testifie abūdantly Moreouer Paulus oegeneta ought greatly to be commended who in a method compendious but yet most exact hath comprehended all Chirurgerie both in his fourth booke and also in his sixt Furthermore Auicenna Rasius Albucasis and Haliabbas being of the schoole of the Arabians haue intreated most diligently of the Arte of Chirurgerie as Auicenna in his fourth Canon and the third fourth and fifte féen Also Rasus in his seuenth booke to Almanser the King Albucasis in a whole volume Haliabbas in his ninth booke of practise of the regall disposition neither hath she lacked hir honour of Latines Celsus and Plinius Captaines who with great beautie and like dignitie haue intreated briefly of this parte Why should I passe ouer Guydo de Gauliaco who onely among the French we haue knowne to haue intreated very well of Chirurgerie if ye regard the reason of the arte We may trulie gather by his rude spéech that he wanted onelie such happie time wherein he coulde not come to the knowledge of the Gréeke tongue nor to the pure eloquence of the Latine tongue whilest at that time ignorance and barbarousnesse exercised tyrannie ouer good learning which was the cause that in rehearsing the place of Galen the truth of the author was much desired But if God graunt me life I will diuide those places of the Arte of Medicine from the common place I trust that I shall helpe Guido and I will of a barbarous and impure writer make him a fine and eloquent Latinist restore him to his beutie which our friēd Siluius hath performed in correctīg Mesueus the same doe I faithfullie promise to the studious to multiplie in repairing of Guido if God prosper our indeuours although perhaps without méete or equal thanks yet shall I doe it with due labour and good will But now I will returne to my purpose for manie famous men and authors most worthie of fauourable commendations haue set forth this arte among the which Guido Vigonius and among the men of this age Tagaltius being my fellowe in office and my companion in my studies haue done greate things and worthie of praise in amplifying and garnishing this part whereby it may be gathered how much is vnto this art to be attributed which so many renowmed haue each one in his workes and monuments set forth increased and enriched that men might know it to be most profible and in effects most euident among all the partes of medicine Now must we show what are the duties and office of a Chirurgion and howe he should enterprise the same for there be thrée chiefe points
CERTAINE VVorkes of Galens called METHODVS MEDENDI with a briefe Declaration of the worthie Art of Medicine the Office of a Chirurgion and an Epitome of the third booke of Galen of Naturall Faculties all translated into English by Thomas Gale Maister in Chirurgerie AT LONDON Printed by Thomas East dwelling betweene Paules Wharfe and Baynards Castle 1586. TO THE RIGHT Honourable Sir Henrie Neuell Knight Lord a Burgauene and his singuler good Lord c. FOrsmuch my singuler good Lord as I haue perceiued you to be naturallie inclined to the art of Medicine and chiefelie to haue vnderstanding in that part which is commonlie called Chirurgerie I haue not beene a little carefull since my acquaintance with your Lordship to further you in the same studie euen to the vttermost of my power and forasmuch as you haue so profited not onelie in the Theorike part but also in the practike I haue thought all my paines labors well bestowed And although I should holde my peace and saie nothing heerein yet a great number of poore men and others which haue bene cured of your Lordship of many sundrie griefes and diseases will set abroade and bewraie your notorious and charitable deedes And forasmuch as your Honour hath better vnderstanding in this worthie arte than a greate manie of those which take vpon them the name of Chirurgions I might verie well saie the most parte And forasmuch as your Lordship beareth such a singuler loue vnto the same arte I am therefore moued to dedicate these my simple trauailes vnto your Honour to bee the patrone and defender thereof for I doe perceiue that now in our time no good enterprise can be gone about but false detraction and enuie is like to ouerthrowe the same which hath mooued mee for as much as you are a noble man the rather to dedicate my trauailes vnto your Honour to bee my aide and succour in the defending of this my small trauaile which I protest I haue not taken in hand neither for vaine glorie neither yet for anie worldlie profit or gaine for since the first time that I beganne to sette out anie parte of this arte in our English tongue I haue both susteined great displeasure and also lost manie profites of those which were in times past my speciall friendes and the greatest matter that they haue to saie against mee is onelie that I goe about to make euerie bodie cunning in the arte of medicine with setting foorth of these my workes in the English tongue but if it shall please your good Lordshippe to vnderstand my bounden dutie first to almightie God of whom I haue receiued the talent and also my dutie to my naturall Countrie whom I ought to profite with my talent according to the saying of our sauiour Iesus Christ which saith He that hideth his talent in the ground and vseth it not to the profit of his neighbour it shall be taken from him againe Wherefore my good Lord I thinke it my dutie to set foorth these thinges for the commoditie of the common wealth of my Countrie What greater profite may come vnto any in the time of neede than to cure his grieuous woundes without which hee should presentlie die to cure his grieuous sores which dooth not onelie eate the flesh but fretteth and rotteth in sunder the great bones with most vehement griefe and paine and also great inflammations and tumours against Nature which taketh awaie the naturall actions of the bodie and molesteth it with most vehement and continuall paine and also curing of broken bones and bones beeing out of ioynt to restore them into their naturall places againe with many other griefes appertaining to the same arte which were heere to long to bee recited And for as much as manie haue taken vppon them the curation of these diseases aboue sayde and haue committed many great errors for lacke of knowledge to no small daunger of Gods people no lesse hurt of the cōmō wealth I haue thought it therefore my bounden dutie to set foorth my onelie one talent in furthering of knowledge euen as the poore widow did which had but onelie one farthing and put the same into the Lords treasure like as that same was accepted with almightie God so I trust he wil accept this my good will according to the knowledge which he hath giuen me so that at the last daie I trust he shall not saie vnto mee thou hast hidde thy talent in the ground and not profited therewith as thou shouldest haue done And also I trust that good men of my Countrie shal haue no cause to haue an euill opinion in mee either through negligence or idlenesse for that they may well perceiue that these trauailes do both require studie and time of setting foorth Now my singuler good Lord if they shall saie it is not good because it is in the English tongue then I must alleadge vnto them the famous men which were the chiefe setters forth of the same art as Hippocrates and Galen amongst the Grecians whatsoeuer they might vnderstand by foreine languages either else gather by reason or by experience or obseruation of time all these whatsoeuer they were they did write them in Greeke which was their owne language tongue to that end they might the better bee vnderstanded and sooner bee learned Also in like manner the worthie Arabians as that noble king Auicen Auerois Albucasis Mesue a great sort more of worthie men which did collect and translate manie noble workes of Medicine out of the Greeke tongue the Ebrue tongue and many other languages into their owne naturall tongue which was then the Arabian tongue In lyke manner the Latinists were no lesse diligent to collect and gather both out of the Greeke and Arabian tongue wrote it in their owne tongue as you may reade in the workes of those famous men Plinius and Cornelius Celsus with manie other more whose workes are manifest at this present daie If these worthie men haue beene moued with good conscience for knowledge sake and for the better maintenance of their common wealth in setting foorth of this art for the reliefe comfort succour helpe and health of those that be sicke and diseased or other waies wounded or hurt in warre or by mischaunce c. Why should not I then without blame or reproch for the furtherance of knowledge and other necessarie things aboue rehearsed set foorth in our English tongue some part of this good and necessarie arte for the instruction and further knowledge of those young students which are desirous to learne the same and to vse the same to the profite of the common wealth in the time of necessitie I doe not meane that honest Artists as Tailers Shoomakers Weauers or anie other handie occupations that they should leaue their artes wherein they are perfect and fal to this art of Medicine for I doe wish with all my heart that politike lawes might be made to constraine euerie man to follow that art in
Medicus that dooth cure vlcers and woundes therefore it séemeth to mée that Mtdicus and Chyrurgus bée indifferent names for those that professeth the arte of curing and for anie thing that I can perceiue either by the wordes of Hyppocrates or Galen or by anie other notorious and famous writers that haue written in this arte The Chirurgions ought not to bée forbidden neither the ministring of purgations nor yet of dyet for as much as they be their chiefe and principall instruments without which they cannot bring to passe their desired scope of health And if we shall speake of the antiquitie of names I suppose the name of Chirurgia to be much more auncient than the name of Phisicke for I suppose Phisicke to be deriued of Phisilogia which worde doth signifie naturall knowledge of mannes bodie and of all the partes and members of the same c. And Chirurgia is deriued of Chiro which is a hand or as we might saie a ministration of Medicamentes done with the hand vnto mannes bodie onelie by experience So that all those that were before the time of Hyppocrates were accounted but as experimenters and to followe an arte without a right methode which that noble man Hyppocrates perceiuing dyd lyke a most famous Philosopher according to reason ioyne together all these vnperfect sects which were in his dayes verie manie and taught them one perfect and true waie methodicallie to worke and also certaine rules howe they shoulde learne the same arte and diuided it into fiue speciall partes as we shall declare héereafter which partes béeing perfectlie vnderstanded is the right waie to procéede to the curation of mannes bodie and without knowledge of these fiue partes no man can methodicallie and rightlie cure anie Vlcers Woundes Apostumes or anie other diseases as wée haue sayde before for whosoeuer taketh vpon them hauing not knowledge of these he may be called a practiser and experimenter or an emperike as the most parte of our Chirurgions may be called that bée not learned in these partes and doth worke onelie by experience without reason but those that vnderstand these partes and followeth a methode in their curing whether they doe cure Wounds Tumours against nature Apostumes Vlcers or what other thinges so euer it bée that doeth appertaine to the arte of curing that same Artist may be called Medicus a Medendo that is to saie of curing for so doeth Galen name him in his third and fourth booke De Methodo Medendi according to the translation of that learned man Linaker And forasmuch as ye shall the better credit the worthinesse of this arte of Chirurgerie as well for the antiquitie thereof as for the Instruments appertaining to the Artist I haue héere set forth before your eies an Epistle made by Franciscus Valleriolus in the commendations of the arte of Chirurgerie which Valleriolus is one of the most notable learned men in the arte of medicine that is nowe liuing whose wordes héereafter followeth The office of a Chirurgion and the Instruments appertaining vnto the same Art set forth by Franciscus Valleriolus Medicus Anno Domini 1562. IT is commonlie knowen I haue shewed it before that the other part of the Arte of Medicine is that which cureth with the hand which also the Gréekes doe call Kyrurgicon for the manner of working wée kéeping that name doe call it Chirurgia This part as it is counted among the olde writers the ancientest so trulie both for the magnitude and for the profite of the effects it is counted the chiesect Moreouer Podalirius and Machaon being the first authors of that art as it is supposed and the lawfull issue of Aesculapius the father of the art of Medicine doe declare the ancientnesse thereof whom as Homer writeth followed Agamemnon their Captaine in the Troyan warres and to haue bene no small helpe to his souldiers in curing of them not by the helpe of inward medicines onlie but in curing diligentlie of their wounds with yron instruments and with other fit medicines therevnto appertaining whereby it doeth appeare this parte of Medicine to be onelie proued of them and the same to bée auncientest Furthermore the profit and vtilitie thereof doeth of it selfe manifestlie appeare by the curations of greate Apostumes of wounds of vlcers of luxations and of Fractures all the which this part of Medicine doeth intreate of exactlie And of this part we will intreate in this Chapter and of the same we will shew forth these things what that art is and what be the parts of it what is the end thereof who be the authors what the office and dutie of a Chirurgion is what be his instruments which he hath accustomed to vse in healing what a one he ought for to be and to conclude who ought to be accounted the best Chirurgion and thus we will finish our Chapter Chirurgerie is defined of Galen to be a certaine order of curing which is accomplished by accustomed incisions and adustions and other thinges which are done by the hande Moreouer the author of the Introductorie whosoeuer hée hath bene hath defined the same after this manner as they doe properlie call it a taking awaie of things hurtfull by incisions and concinations by a certaine methode reason In like manner it is the curation of wounds and vlcers which is administred to mans bodie But if anie man will set forth the order of it more curiouslie and expreslie he wil call it the third part of the methode Therapeutichon which doth cure diseases by the artificialnesse of the hand by adustions and incisions and by curing luxations and by putting broken bones into their places and such like Guido of Caliacensia hath so defined that it maye be a science which may both teach the order and qualitie of operation chiefelie by adglutination and incisions and other operations of that kinde which bée done by the vse of the hand restoring men to their health as much as is possible Also it behoueth vs to vse this name of Science more largelie in this place and applie it vnto that parte of Chirurgerie which doth profit by meditation of preceptes and giuing of Methode and not by curing with the hand For it is manifest that Chirurgerie is an Arte and not a Science properlie whose end is the bringing to effect and not the contemplation of the veritie onelie and for that cause Aristotle would haue the same worthelie to be an arte and also hath thought it good to place it amongest those artes which do pertaine to the vse of the hand But other things being put in the definition doe kéepe their place of difference in like manner this parte is not put vnaduisedlie to the definition that men be restored to their health as much as is possible for although that health is counted to a Chirurgion for a perpetual scope yet that same cannot alwaies be obteined by arte because there be many diseases vncurable which doe chaunce eyther because they are such by their owne nature as Elephantiasis
greatly delighting them selues in the onely dignitie of the Arte not knowing what it meaneth which doe oftentimes let bloud their poore patients without any IndicatioÌ„ or councel of one learned in the same arte or of some graue and learned Phisition but also they will geue inward medicines a gods name a matter truely most worthie of publike punishment For as much as I haue séene many by such their rash and bold enterprises brought into daunger yea and some haue I séene miserably languished and depriued of lyfe Therefore let not that young Chirurgion which would be estéemed worthie of his arte presume to take in hande these thinges without the councell of an auncient maister learned in the same arte or else a graue Phisition such a one which is learned in the arte of medicine the matter it selfe geuing also such libertie or time But otherwise if there be no learned maister present or that any present necessitie doe constraine the same then truely the younger Chirurgions may boâ—…t bloud and also if néede bée minister a medicine so that he haue good erudicion iudgement and experience Moreouer the Vnguentes where with the Chirurgion ought to be furnished and the same to haue alwayes in his saluetorie as these Vnguentum Basilicum Vnguentum Apostolorum Vnguentum Aureum Vnguentum Album and Vnguentum de Althea as Basilicon to superate and materate and Apostolicon to mundifie and clense Vnguentum Aureum to incarnate and to fill Vnguentum Album to cicatrise Vnguentum de Althea to cease dolour and paine and to make soft Moreouer as for emplaisters pouders fomentations and such like the expert Chirurgion doth prescribe of them very many sortes according to the reason of curing And these are the medicinall instruments pertaining to the art of Surgerie By the manual instrumeÌ„ts ye shal chiefely vnderstaÌ„d instrumeÌ„ts of yron very méete most necessarie to the ChirurgioÌ„s vse wherof some are to make incisioÌ„ to cut of a thing other some are to draw out certaine are to search also some be properly to stitch or sowe and other some to make adustion to cut or make incision Forfices Nouacula rasorius scalpellum Chirurgicum for Phlebotomie seu lancetam forsipes to draw out called commoÌ„ly Tenaculae volcellae seu volcellae which in French they call pinsettas the crooked hooke vncus seu vncinus and that Yron instrument which the Grecians call Diocleum graphiscum is apt as Celcus writeth to draw out arrowes For to serch we doe fitly vse a probe for to sow a néedell and a quill are properly vsed and to adustion diuerse kindes of cauteries commonly called actuall are occupied and for the variable meanes of their vse they haue diuerse figures and diuers names for some be sharpe at the point and other be not and other cauteris they call myrtea oliuaria dactilica cultellaria so called of the similitude of thinges which these instrumentes doe represent for the cauteris called Mirtia doe imitate the figure of the leaues of Mirtills Oliuaria of an Oliefe dactilica of the Date as Cultellaria doth represent the forme of a knife these are the common instruments necessarie for Chirurgions There are certaine other instruments proper and appointed to certaine partes of the bodie as modioli which the common Chirurgions call Trepans malleus scalpri and the same are conuenient to scrape cut or pul out bones as well of the head as other parts euen as Falx is proper to the fundament speculum oris to the mouth and speculum matricis to the matrise there are innumerable other sorts of instrumentes conuenient to drawe out dartes gunshots other infixed things whereof to speake I doe now cease and will prepare my selfe to set out a Chirurgion what maner a man the best ChirurgioÌ„ should be which thing I often times haue declared to be the chefe effect of the matter for wée know what Galen hath saide of the Phisition aswell in his booke De institutione artis medicinalis as also in the third booke de naturalibus facultatibus and in his third fourth de methodo medendi Galen calleth him that cureth woundes and vlcers medicus that is to say a Phisition he saith that the Phisition ought to be prudent and well exercised and also he ought to be of quicke nature and of pregnant wit that he may promptly obtaine all thinges and verie well instructed in learning and moreouer appointed to the best maisters to learne of and one induring labor paine a great louer of the truth studious and most déeplie vnderstanding his art approoued by much vse and long experience and all this saie I must be applied to the Chyrurgion which will bée most excellent estéemed for an vndoubted Artist but beside these there be certaine things which doe pertaine priuatlie to a ChyrurgioÌ„ as to the manual Artist do not so much pertaine to the ancient maister of the art of Medicine for a Chyrurgion ought to be a young man or els but little past youth that is betwéene the same and auncient mans estate for the age flourisheth most in sense strength to exercise rightlie whatsoeuer belongeth to his art wherfore they which are aged men cannot so aptlie bring things to passe which arte requireth for the imbecilitie of their senses for they follow them rather by counsaile Furthermore he must haue a sure and strong hand and steadfast to all workes that hée shall doe whether it be to make incision adustion also for the cutting awaie of a member Also it behooueth him to haue a quicke and cléere eie and he must not be fearefull of mind but rather without pittie if he do intend to cure him that he taketh in hand Furthermore neither let him make the more hast neither let him cut Canteries or cut off lesse than néede requireth for the clamor or crying out or for the tendernesse of the sicke Patient but let him doe all things as though he heard not the clamors of the sicke neither let his minde be therwith anie thing troubled And wée haue declared that a Chyrurgion ought to excell in learning for therein chiefelie doth his erudition manifestly appeare if he vnderstand exactlie both the Theorike and the Practike parts that is to saie to know things naturall and not naturall and also those that are against nature Also if hée know what be the causes of wounds vlcers fractures and luxations with their accidents and also what be their conuenient remedies and how to remoue the same In lyke manner he shall excell in practise if hée haue had much and good exercise in the operations of his Arte by working spéedelie trimlie and readilie consulting with the auncient maisters of the same arte in those things that pertaine to Pharmaceuticen Diateticen And although he vse those things which be searched out by reason confirmed by frequent vse wherein truelie the faith and honestie of a Chyrurgion séemeth chieflie to consist The Chyrurgion ought to
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
from the Sea or somewhat more the place it selfe toward the Sea for Tabia is in the lowest straight which is betwixte Surrentum and Naplis but more one the side toward Surrentum Furthermore all that side of the hill is of good bignesse stretching in length to the Sea Tirrhenum this hill doeth a little bend towarde the West neither goeth it wholie towarde the South therefore this Hill doth kéepe the straight frée from the winde which bloweth from the East Eurus subsolanus and Boreas there is ioyned to this in the lowest of the straight another bigge Hill which the auncient Romanes in their Hystories and those also that bée now diligent call Vesuuium now Vesuuium is a a famous and new name and knowen to all men for the fire sent out of the earth in it which thing doth not as I thinke helpe to the drynesse of the aire and that beside the fire there is not in all the straight either standing water marrish or floud of anie account this Vesuuius Hill is toward all those windes which blowe from the North toward the Eastuall setting of the Sunne and much ashes commeth from it euen to the Sea béeing the ashes of that burnt in the hill and of that which yet is burned all these make the aire drie surelie there may bée the like drie hill in other partes of the earth found that is not farre from the Sea neither yet so bigge that it is subiect to the violence of windes nor yet so lowe that it shall receiue easilie the vapours of the fieldes Beware also that it bée not toward the North so shoulde it bée auerted from the Sunne and if it may bée in a temperate place of the world as that is which is at Tabias it should so much profite let the hearbes in the Hill be these Agrostus and Lotus and Poligonon and Melissofillon the shrubbes also Lentiscus Arbutus and Rubus and Hedera and Cetisis and such lyke and so hast thou the hill prepared The Cattell that doe féede on the Hill at Tabias are Kine and the milke of these beastes is as thicke as the milke of Asses is thin and I truelie least there shoulde bée anie kinde of milke that might profite wanting of Kine thicke milke of Asses thinne and of Goates that which is a meane I did put in to féede both Kine Asses and Goates the olde Phisitions would haue a woman giuing milke to those that are consumed with Pthoe to stande and giue them sucke vnto whose minde I agrée both for that it is naturall and also for that they would haue it taken before it were refrigerated of the ambient aire Furthermore let this bée to thée a great precept that those that shall haue néede to drinke milke that the beast standing present they drinke it presentlie as it is milked putting Honie into it whereas it curdeth in the stomacke or if thou wilt haue it spéedelier to passe into the bellie adde some salt And the young man that had an vlcer through the Pestilence in Aspera Arteria was cured of it and manie other after him Another young man of xviij yeares in age when as he was vexed with Catarrhus many daies first with the cough he voided bloud fresh but not much after that a péece of the pannicle which outwardlie couereth all Aspera Arteria ascending vnto Larinx it séemed to me coniecturing both by his thicknesse and féeling of the patient to be the inward tunicle of Larinx but this hurt not his voice and this also though in longer time it was perfectlie cured but those which come to this affect through the Pestilence séemed to bée verie easilie cured for that his whole bodie was héere purged and dried for that many of them did vomite and all were made laxatiue so that those which escaped wer purged they had blacke Pustules aboundantlie through the whole bodie In many they were vlcerous but in all they were drie and it was manifest to many that beheld them that they were the dregges of the bloud which putrified in the Feauer which as it were lyke certaine ashes Nature did thrust out to the skinne lyke as it thrust out manie other superfluities but there is no néede of Medicines for these Exanthemata when they fall off by themselues in this sorte those that had the vpper parte of the skinne vlcerate the crust of the vlcer fell off and the parte vnder it was almost whole and after a daie or two was ciccatrized others whose skinne was not vlcerate the Exanthemata it selfe was rough and scabbie and fell awaie like a certaine scale and after were cured therefore it is no meruaile though those that haue Exanthemata in the lungs be cured because of the drinesse of the Vlcers the which before wée haue shewed that the purposed scope of curation in all Vlcers that in these Vlcers springing through the pestilence was héere present for they were all drie and rough and many of them like to a scab and many like Lepria therfore séeing that Experience testifieth with reason and that the curation of vlcers haue this one end that is to saie to be exiccated you may saue many of those that casteth forth bloud from the lungs as we our selues haue done The thirteenth Chapter NOw we haue before declared how those shall be cured that haue broken anie great vessell of the lungs either through falling frō high or that they immoderatly did strain them in crying or did beare a burthen aboue their strength or any hard or waightie thing outwardly haue fallen on their brest but how they may be cōueniently cured which putteth forth bloud through Catarrhus we shall now declare putting for more manifest doctrine a like example of that the curation which was done to a noble woman at Rome when as she heard such like talke as we right now had of those that reiecteth bloud out of the lungs that she had spit out in the night somewhat either through Catatrhus or through coughing presently she sent for mée promising her selfe to be obedient to all thinges I would commaund her for she had heard before that time some that if one applyed not presently strong medicines and that before the Vlcer was inflamed all was in vaine and that this was the cause of their destruction which reiected bloud therefore we thought not good to let hir bloud because through the drienesse of hir bodie she had abstained foure dayes from meate But commaunded that she should vse sharpe clisters then with some hot medicine to rubbe much the thighes and handes and after to shaue the head on which I layd the medicine that is made of Stockdoues dung and after thrée houres I bathed hir not touching the head with any fat things thus I couered the head with a conuenient cap and for that time I nourished hir with supping after which I gaue hir some of the Auster fruites of Autumne and when she went to bed I gaue hir of Triakle foure monthes olde and being
in this is one of the two necessarie either to get out the inflation or to inlarge the wound the first is better I suppose if it may bée done thou shalt doe this no other waie than by remouing the cause which brought the inflatiō but what cause is that trulie the refrigeration of the aire ambient Wherefore the cure must procéede of heating thinges therefore it shall bée conuenient to heate the Intestine with a hotte Spunge put in hot water and afterward expresseed out and in the meane time to prepare auster Wine made hotte for that doeth more heate than water and strengtheneth the Intestine but if the inflation of the Intestine ceaseth not by this meanes thou must cut so much of Peritoneum as is inough to put in the Intestine conuenient Instrumentes for this Incision are Springotoma that is to say such as serue the Incision of Fistulas Kniues which are double edged or haue sharpe pointes are to be refused the conuenient placing of the Patient is when the wound is made in the lower parte if hée lie vpwarde and when it is in the vpper partes if hée lie backwarde in both these one thing is to bée regarded that the Intestine which is out bée not pressed of those that are within and that shall this waie bée done as if the wounde bee in the right side to bende the bodie to the contrarie parte if in the lefte then to the right side in such sorte that the wounded parte alwaie bée higher than the rest and this is profitable also both in great and meane wounds for that is a common aduice in all But the reposition of the Intestines into their place when as they are fallen out in a great wound doeth verilie require a perfect minister for he ought to compasse outwardlie all the whole wounde with his handes and to presse inwardlie and to gather together and to leaue the place bare to him that stitcheth it and also to compasse moderatlie that which is stitched vntill all the wound bée stiched Now wée will next teach the aptest waie of stitching such woundes in Abdomen because it behooueth that Abdomen doe close and ioyne with Pentoneum you must beginne from the skinne and thrust the néedle from without inward and when as it hath gone through both the skinne and the muscle called Rectum leauing that Peritoneum which is vnder it thou shalt from within thrust thy néedle outward by the rest of Peritoneum and so by the rest of Abdomen putting the néedle from within outwardlie and when it hath gone all through this againe this Abdomen is to be thrust through from without inwardlie and when thou hast left that Peritoneum which is vnder and come to the contrarie parte thou shalt also thrust this through from within outwardlie and with all the Abdomen that is next after this beginne heere againe and stitching it with the Peritoneum of the contrarie side and againe putting it through the skinne next the néedle is to be put in that part inwardlie and stitching that Abdomen with the contrarie Peritoneum and againe going through the skin and thus againe and againe till it be done and vntill the whole wound be stitched the space betwixt the stitches ought to be most smal which pertaine to the kéeping fast of those parts which be vnder but this smalnesse is not sure inoughe to the strength of the skinne and kéepe it from breaking which is the spaces betwixt the stitches wherefore eschuing the excesse of both let vs choose a meane betwixt both and this also is as it were a common thing in all wounds that is the substance of the thréed it selfe wherewith wée stitch for that which is too harde must of force teare the skinne that which is to softe is presentlie broken in lyke sort if thou doest thrust thy néedle through the edges of the wound the rest of the skinne béeing most little is constrained to teare when it is violentlie brought together but if thou goest farre from these thou leauest much of the skin vnglutinated and although these things be common to all woundes yet they are especiallie to bée eschued in the stiting of Abdomen and the stitching of Abdomen ought to bée done this waie rehearsed for if anie doe suppose that he may make Peritoneum to close with Abdomen but it will scarcelie growe with him because it is neruous or else as manie vse which ioyne them together that be naturallie of affinitie as Peritoneum to Peritoneum and Abdomen to Abdomen and that shal be in this sort it behoueth to begin of the Abdomen next vs from without inwardlie to thrust a néedle through it onelie letting passe both sides of Peritoneum of the contrarie part from without inwardlie drawe the néedle through both lips after put that backe again and thrust it from within outwardlie through the contrarie Abdomen this waie differeth from the common and vsuall stitching which at once thrust the néedle through foure sides because it altogether hideth Peritoneum vnder Abdomen Now let vs speake of medicines truelie those ought to bée of the same mattier that they are which are named Enema which we haue in the bookes going before shewed to vnite the wound of other partes ligature outwardlie is chiefelie héere necessarie the last parte of the curation in these differeth much from the other for the space betwixt the flankes and arme pittes ought to bée wholie couered with softe Wooll dipt in Oyle moderatlie hotte and yet more sure if thou put in by a Clister into the Intestines some such like thing and if anie of the Intestines be wounded that which is outwardlie to bée done must bée performed in manner aforesayde but that which is iniected must bée auster and red Wine bloud warme and so much the rather if it bée pearced through to the inward partes And the thicke Intestines are easilie to bée cured as on the contrariwise those that bee thinne bée harde to be healed yet Ieiunium is altogether incurable both for the bignesse multitude of the vessells and also for that his coate is verie thin and neruous Further because this Intestine receiueth all the pure coulour and is next the liuer of all the rest And thou mayst boldlie cure the woundes of the stomacke which are in the lower fleshie partes for it may happen to take good successe not onelie for that these partes are thicke but also for that the medicines which doe cure doe easilie rest in this place But the woundes which are in the mouth of it and in Gula inioye but onelie the medicines which touch them in the going downe the sensiblenesse hindereth also the cure of those which are in the mouth of the stomack But it is easier to learne the way which he vsed in curing of the woūds in the stomacke than other deadly wounds for I toke not in hand to write these workes for that intent I woulde not anie man should not reade
of the affected partes there remayneth another scope that is that they may bée adglutinated by the helpe of another thing which thing is a certaine humour comming betwixt the endes of the broken bones as it were a Glewe and to ioyneth them fast together which if that be found not to bée done thou maist call the affect vncurable and that such an harde bone as is in young men striplings and men and much more in olde persons cannot growe together I thinke it euident to all men for truelie that bone onelie will be vnited which is verie soft such are the bones in Infants but some doeth greatlie hope that the partes of a broken bone separated may againe bée adglutinated and knit by some other substaunce or glew comming betwixt It is shewed that euerie part of the bodie doeth attract to himselfe his owne and lyke nourishment which if it bee true then surelie the conuenient nourishment of the bones is groser and more earthlie than anie other nourishment in the whole creature so that it is not repugnant to reason neyther a thing impossible that of this same proper Element which aboundeth and groweth in the edges of the Fracture maye by his comming betwixt the bones close them together for to Vse sheweth and Experience consenteth to that hope which reason doeth geue therefore it is hence foorth to be considered by what meanes this thing that groweth in the fractures how much and what maner a one may comfort For it is euidēt that we require not what maner a one but such one as obserueth in both a mediocritie wherefore this simentrie both in qualitie and quantitie being found out Furthermore it is requisite to séeke out by reason whether we may attaine to them both or not but the time when this shal be done is no lesse necessarie to be sought out whether presently as the fracture is made shall wée make vnition as in woūds or that this be not a time cōuenient but a more apter must be found suerely thou being instructed by the nature of the thing maist find out this as wel as all other Therfore what is the nature of the thing Forsoth the broken bone comprehended vnder some of the rehearsed differences of fractures goe to now let vs sée whether any thing may be taken of euery difference which serueth to the curation beginning with that fracture which is made ouerthwart named Cauledon the parts of the broken bone doe here so lie one besides another that they lay not directly euen wherefore it is manifest that first they be brought directly euen to that ende they may the better grow together then to doe some of the things that follow truely that shall follow if one vsing the example of the whole part doth draw the bones that are a sunder to the contrary part of which is taken most sure indication of the transposition of them For truely it may happen that the trāsposition of the member shall be made forward backward into this and the part For it is méete that whatsoeuer are backward be brought forward and yet neuerthelesse the other part of the broken bone is to be moderately thrust to the contrary Contrariwise that which is forward is to be deduced backward the other part by little and little to be brought forward In like sort the consideration of those which are wressed to the right side is if they be brought to the left side and againe those which are in the left side if they be changed to the right side alwayes drawing the other part moderatly to the contrary but there is no smal daūger least in bringing the partes by contrary motion same of the shiuers which sticke out be broken neither are both the endes euen as those which are sawed asunder and if they be broken the endes of the broken bone cannot exactly be ioyned and that for two causes for if the péeces fall betwixt the two parts they let the parts to touch which are formed right or if any fragment falleth outwardly neither so shal there be perfect coniunction of the bones which thou hast framed in such wyse as they shal be like their first vnion for that onely happeneth when the shiuers of the bones be put againe in their owne places And if they being broken doe perish there must of force be a voide space betwixt the bones vnited together in which Sanies being collected and in space putrifying doth corrupt also the whole member And for these causes the bones which are a sunder ought to be drawen right out and this cannot well be done except first they be stretched backward the Gréekes call it Antithasis therefore it behoueth to make this Antithasis of bones either with thy hands if the member be little or with bands put about the member or else with such instruments as Hippocrates hath taught and when as they haue enough drawen back and that they be out of doubt least they in bringing together should touch them selues then put them right and losen the bandes and let the muscles of the parts to be in one and in the meane while helpe thou with thy hands and if any thing doth leape vp amend and forme it and next this whereto thou must bend is that the member doth remaine vnmoued least any of the parts which thou hast placed be moued for so of force they must againe separate And if thou commit it to the patient that he looke to the quiet rest of the member peraduenture waking he wil regard it But sléeping truely he wil moue it but that the bones formed may kéepe their situation not onely the man sleping but sitting and rising when the bed is made it behoueth to binde the fracture with a safe Ligature which may exactly kéepe the parts of the broken bone together But for that loose ligature suffereth the bones to mooue that which is too straight by compressing doth bring dolour let vs giue diligent héede that eschuing both discommodities we maye inioye both commodities which wée shall doe if wée eschue extremitie so that we shall not make the ligature so straight that it compresseth neyther yet so easie that it bée loose and if euerie member were of equall thicknesse then the broadest roller were most commodious because it shoulde embrace all the broken bone of euerie parte equallie and continentlie But seeing it is not so although to the breast thou vsest a most broade roller thou canst not so doe in the ioyntes and necke but in such a narrowe roller is better for that it will not wrinkle and that it toucheth the skinne of the whole member about which it is put but if it holdeth the Fracture with a fewe fouldes it is not without daunger Therefore how much surenesse wanteth through the narrownesse so much must bée added by often rolling about and by deducing it towarde the sounde partes but séeing all rollings which doe constipate and coarct the flesh without dolour hath that propertie to presse the humours out
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