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
if they shall exiccate without mordication That is also an healthfull medicine which is made of Honie Plaister wise béeing made of the best Honie and this be resolued in oyle of Roses which in all respectes is the best and voide of Salt yea and the Waxe also which is put into such medicines must be washed in like sort If thou puttest in anie Turpentine it behooueth that thou wash it and so much the sooner if thou put anie other Turpentine in for the sharpe and biting Sanies is washed and purged awaie by all medicines which thou doest wash But if hée that is wounded bée strong in bodie and voide of superfluous excrements in him it is requisite to vse more strong medicines As I once did whē as a young man studious in Philosophie was wounded in the breast hauing a good strong bodie and burnt with the Sun in the Summer season The Trochifce of Polida dissolued in Sope and afterward made warme beeing put ouer hot water I applyed it as a Liniment For that first of all we must haue regarde that nothing bée colde which toucheth the wound For because the affected part is most sensible and also the chiefe of the principall partes are continuall and of temperament cold by which all occasions that is grieued is with cold sendeth also his greiefe to the braine But if it be of these that come into the muscles it causeth also conuulsiō For we haue shewed in our Anathomie that the muscles are the instruments of voluntarie motion and the like conuulsion shall be looked for in the tendons by the same causes but when as I had applied the foresaid medicine to the wound of this young man and had couered much of the partes aboue the wound with the same I did continuallie foment with hot oyle the partes about the arme pits neck and head and opening a veine the first daie I tooke some bloud from him and the fourth daie this young man also was well insomuch as the vlcer looked wrinkled small and shrunke together notwithstanding I thought good to continue with the same medicines vntill the seauenth daie after which daie he was perfectlie well Trulie you may foment this wound with oyle and chieflie as we haue saide when it is cured for oyle is of contrarie nature to the Trochisce and maketh the Vlcer filthie neither is there small difference to applie oyle to a bare nerue where the skin couereth it Therefore the mattier is to be wiped awaie from the wound with a probe hauing soft lint rolled about it You may if you will wet your Lint in Sapa least that thou touch the Vlcer with drith with Sapa that is Sirium called also with vs and in Asia Hepsama therefore dipping thy lint in this and after pressing it out thou shalt mundifie the Vlcer and let this Sapa bée warme the first daies chiefly but if all things doe prosperously succéed thou maist wet it also without daunger with swéete Wine for all swéete wine is void of all biting qualitie such is the wine called Thereum and Scybelites And next these is Carginum what Wines so euer are swéete and yeolowish such is Falcrun being vnprofitable for all these are sharpe and vnmeasurable hot And the vlcer comming now to ciccatrize white and thin Wine and that which will not abide the mixture with water neither swéete smelling is better than swéete wine and thou shalt eschue the vse of water to a wounded nerue and also a relaxing Cataplasme next vnto the vse of these Trochisces is the vse of Diachalciteos which we openlie vse this must be molten in Sūmer with oyle of Roses but in winter with the Oyle of Sauine we haue described this medicine in the first booke of compounding medicines the Pastilles or Trochisces or call them how you lyst of Polyda are knowne to all men which if you haue not you may take the Trochisce of Andro or Pasio or else our owne which is stronger than the rest And we haue declared that to strong bodies strong medicines are conuenient as to tender bodies gentle medicines this right Methode haue I inuented and experience doth confirme it but Thessalaus with his Sophistes sitting in his high throne shall be had in reputation among brute people as Cercidas saith While he confirmeth by his reasons that there is one curation of gréene wounds neither this to require any Indication to the nature of the parts yet one of so great same in his learning hath excogitated a marueilous cure of wounded Nerues for presently he cutteth them a sunder geuing the wounded man no warning thereof although in this he goeth from his secte for it had bene better to cut a sunder the wounded muscles and arteries veines or any other thing but not the Nerue otherwise that thing which they flie they are found to doe that they may take a contrary indication for the difference of the parts but let vs leaue them and intreate of a Nerue wounded ouerthwart in which there is greater feare of conuulsion inflammation comming of Feuers which are not cut but those which pertaine to the cure of the Vlcer are like also to these Yet it behoueth more largely to take away bloud and vse more thinne diet and to kéepe him altogether quiet in a soft bed and to foment largely with hot Oyle the arme pits necke tendons ligaments and head if the wounded Nerue be in these that are in the legges like as we vsed Oyle to the arme pittes when the wound was in the hand so in these the flankes are largely to be fomented with Oyle and so to ascend by the whole spine to the necke and head And the contused Nerues whereas the skinne also is contused and wounded require the same medicines which is vsed in drying the wounds of the Nerues But yet such medicines as may further draw constringe or binde the parts diuided by contusion but those which are contused without the like affect of the skinne ought to be fomented often with hot Oyle which haue power to euaporate and to haue like regard to the whole bodie as I saw this to happen and dyd spedely cure it fomenting it with oyle but haue often séene the Nerues to be contused with the skinne and the wrestlers for the custome of the accident being taught by vse haue a Cataplasme made of Oximell and Beane floure which truely is an healthfull medicine but if dolour also commeth with contusion it doth behoue to put in molten pytch and boyle them well together and so to apply the medicine hot and if thou wilt make it more drying put in the floure of Eruum and if thou wilt haue it yet more drying put in Iris ilirica the regard to be had to the whole bodie it is common to these as if the Nerue be all cut there resteth after no perill of conuulsion but yet the part shal be weake it hath the same cure that the other Vlcers haue although the Thessalians know
first but if the linament falleth away of his owne accord then gently pressing the roote of the vessell with thy fingers that nothing flowe to the wound take this away the hand hanging downe and put on an other In this wise shalt thou cure the vessel vntill it be defended with flesh and from the beginning to the ende keping the part vpright keping herein a measure in this figure of situation for you must beware least that dolour chaunceth and stirre againe fluxe for there is nothing that doth more prouoke fluxe and increase inflammation than dolour This medicine as I haue saide I vse many waies sometime to the Aloes the double waight of Franconcense sometime equall portion of both sometime the Franconcense to be a little more than the Aloes or else a greater portion but not double and sometime putting in the stead of Franconcense Manna for Manna is a medicine that is more restringent than Franconcense and Franconcense is more Emplastique than manna and it is manifest that in hard bodies there must be the more portion of Aloes as in soft more of Franconcense so shall the one of them be more astringent and the other by his claÌ„minesse and grossenesse cleauing more to the small pores which they call Emplasticoteron therefore where thou wilt studie to make the medicine more Emplastique it behoueth that thou vse those Franconcense that be tough and as I may terme it more Rosin lyke such truely is softer and whiter and when it is chawed as Aloes and Manna is not made smaller but defendeth the parts cleauing together lyke Chiamastiche but these are proper to that treatise which sheweth the compositioÌ„ of medicines which we could not but somewhat touch in this booke for either we must neuer haue made mention of any particular exaÌ„ple but haue bene satisfied with vniuersall methodes or if particular should be put to vs the preparation of them was to be touched But as we before haue saide it is conuenient that wée be here pleased with one or two examples put out of those remedies which are inuented by Methode and this thing I will still remember But lette vs turne likewise to that againe that in speaking we haue little finished and I haue made the longer mencion of these medicines rehearsed because I am persuaded that it excelleth al other and I maruell if it shall chaunce any man to finde a better therefore I vsed it alwayes in the PaÌ„nickles or Membranes of the brayne and also in wounds of the necke yea of the Iugulane veines themselues which the Gréeke writers name Sphagitadas insomuch as it also stayeth flux of bloud in them and that without bynding neither in ioyning these that thou make to much hast as certaine foolish Chirurgions doe vse but compresse with the one hand the lower part of the vessell or griping hold it with the other hand apply the medicine to the wound and gently presse it to the wound vntill it cleaneth being congeled after binde it from aboue backward and not as in the ioynts from below vpward for it behoueth to make your rolling toward the roote of the vessells and to represse that which floweth There are many other medicines which haue an emplastique facultie yea without griefe but there is none that doth so incarnate It is chiefely to be regarded in this case that the medicine falling of that flesh be engendred about the vessel But those medicines which make an asker when the asker falleth of they leaue the part more bare than for their naturall state for the generatioÌ„ of the asker is as I may terme it of the partes subiect round about halfe burnt for what manner a thing these quenched coales are that they prouide against winter such are the askers being reliques of the adust flesh so that how much of the part is burnt to an asker so much truely it loseth of his naturall flesh therefore all that waÌ„teth of the part where as the asker falleth away and so is sâ—…ne bare and without flesh And there hath followed to many a flux of bloud that could hardly be stenched after that the asker hath fallen of wherefore who so will in these also minister all things by a method he will long before consider all these wayes wherewith bloud is stenched and choose that which is with least daunger not omitting the other wayes as often as necessitie requireth for I haue found great necessitie of vsing medicines making an asker and also of hot yrons whereas the fluxe of bloud sprang of erosion of anie humour which did putrifie as also in that affect where all that doth putrifie is taken of it it is most safe to burne as it were the rootes of it or else to vse medicines which make an askar and by this occasion we come to that necessitie both in the priuie members and also in the fundament because those partes both for their naturall heate and that they be the conduites of Excrementes they putrifie of a small cause That scope which thou tendest vnto for those medicines making an askar must not onelie be hot but such as hath with it also ioyned astringent facultie such is perceiued to be Chalcitis and Misi and Vitriall whether thou vsest them crude or rawe or adust Those that are made of vnflaked Lime are more vehement than these but yet Lime hath no astringent vertue therefore the askars fall sooner of which are made with these but those that are made with astringent Medicines doe longer cleaue to the bodies which thing trulie is verie profitable for that flesh groweth vnderneath it and is made as a certaine couering to the vessell that floweth Wherefore it behoueth vs not to bée rash as manie bée in taking of the askers whereas is perill of fluxe of bloud except it bée in those affectes whereas through the putrefaction wée are compelled to applie to the bodie hotte yrons All Phisitions I know not by what reason call that affect in Gréeke Nemon of the Verbe Nemomai which signifieth to féede or deuour because this affect procéedeth by eating the sicke partes vnto those that are found deuouring some part of them so that they call it not of the substance of the thing shewed but of an augmentation The plentie of matter of all Medicines which haue this facultie are set out in their proper Commentaries I call them proper whose Titles are De simplicibus Medicamentis and also De compositione eorum The fift Chapter THerefore séeing we haue set out the sum of this method whereby thou maist cure such fluxes of bloud as are in the vpper parte we are bent to set out the Treatise of those fluxes which come out of the deapth of the bodie The bloud that floweth out of the vessell either is stenched for that it floweth no more to the parte because the diuision is stopped or else through both which I suppose to bée most sure But the bloud is let to flowe to the parte either through binding or when
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
drawe the vrine out of a hollow veine from the bloud and it is not carried of his owne accorde into the reines as though that were the best Neither doe the hollow veines drawe together and wind about thrust forth the vrine into the oblique reines nor into these which lie right vnderneath in the sides to be strained out with all the bloud and because it is thinner than bloud to be transmitted euen as all the Wine runneth into the vessell of the Wine presse and as the coniealed milke is strained the Whey alone runneth and not the chéese in like manner the reines doe expell the vrine into the bladder through Vreteras which are growing on the sides of the bladder and the humour which is receiued Asclapiades saith is resolued into vapours into the bladder and into the bodie hauing as it were two tunicles in it the vapors are let passe by waies vncertaine darke straight such as can by no sense be perceiued And they being once againe growen together do receiue their first forme and so out of vapours humours are engendered for so he hath depriued the reines and Vreteras of their function Neither doe the part of bloud receiue pure bloud aboue the reines but those things which are beneath doe receiue the bloud from the reines vnto whom they bring fastned through pressing wil as Serum be carried being purged and distilled as certaine of the scollers of Erasistratus saie for if Serum were heauie neither should it be carried of the stomacke into the liuer to be distributed neither into the reines by Caua neyther doth a watrie humour runne into the reines and a sanguine humour by Caua backward like vnto oyle and water mingled which when they are poured on the ground each run contrarie waie as other Erasistratians affirme Nor yet as Licius saith the vrine is the nourishment of the reines Therefore the reines doe drawe the vrine for that it is familiar and pleasant vnto them and not by following that which is made emptie For so when no more vrine did abound then was it made emptie by Ischuria that is to saie through suppression of the vrine in the reines bladder or other passage belonging vnto vrine as wée haue said before more largelie In the Tractice of the stomacke and the throate by their straight passages there is no Deglutitio by contraction as Erasistratus saith In the Tractrice of the liuer there is a distribution of Chylum out of the stomacke and entrailes into the liuer by the veines Meseraica In the Tratrice of all the partes there is distrubution of bloud out of the liuer and Caua into all partes by the braunches of the veine And not as Erasistratus affirmeth by the expression of the stomacke for this although it were so yet by reason of the length of time it should haue small power for the distribution of bloud through the veines not by the veines contraict about the bloud which they containe not with that succession vnto that parte of our substance which is made vacant and dispearsed from our heat the which thing those that recouer from sicknesse doe declare who if they haue not more nourishment flowing and abounding in them then there is place vacant they shall neuer recouer their accustomed helth moreouer the abundance of bloud in the bodie could neuer be gathered together vpon the liuer In the tracture of purging medicines it may appeare they drawe proper qualities or certaine humours familiar vnto them out of our bodies as Scamonium draweth yeolowe choler out of one that hath the Ianders Elleborus niger draweth blacke choler ex Melancolico Cnicus Coccum Gnidium draweth fleame ex Leucophlegmatico flos aeris Squamma aeris aes Vstum Chamedris Chamelion draweth a thin and watrie excrement ex Ascitico and these tumors are not engendered in vs of the medicines themselues making our bodies supple as Asclepiades doth falselie surmise denying the facultie attractiue vnto euerie conuenient qualitie whereby Magnes draweth yron Succinum a little moate and corne the water layde vnderneath it in earthen vessells and certaine medicines doe pull out splints and arrowe heads fastned verie déepe in the flesh and also poison of Serpents which was put in the same Likewise certaine medicines drawe the poison of Vipers some the poison of Pastinaca marina other of others insomuch that the poison drawen out hath ben found lying vpon the medicine By the which similitude the same substance may drawe thinges other medicines drawe not by hooke and crooke Attomos ioyning together as they mette one another with Epicurus the which he and Asclepiades did appoint to be the first elements of all things Retentrix The reteiner of proper qualities drawen vnto euerie parte vntill digestion be perfect when there is nourishment but if there be excrements which doe trouble the part wherein it lieth as in the entrailes the bladders c. swelling with quantitie or sharpe and biting qualitie or in both together The childe is reteined in the wombe vntill that through greatnesse weight biting or that the infant be auoide with sweate or vrine the Membranae béeing broken or through some other vrgent cause it is constrained to be deliuered This facultie like as the rest is in all parts which are to be nourished but it appeareth most plainlie in those parts which are greatlie hollow as in the stomacke womb bladder and is most delighted in these oblique passages but in other partes it is more obscure it is also placed in the temperature of those partes euen as all the rest are Coctrix The digester of the substaunce reteined in the part the which substance is so much the rather made like vnto the parte by alteration as it is more néerer of greater similitude to the same in qualities as of bloud flesh is soone made but that substance which hath lesse similitude with the part it is necessarie that it be chaunged flower first by all the meane qualities as of bloud hot moist and red ther cannot at the first dash be made a bone colde hard and white but there must néeds be many alterations and chaunges in the middle And for that cause there are two kindes of instruments pertaining to nutrition The one is that which draweth carrieth conteineth and digesteth the nourishment and as it were a straunge burthen expelleth and beareth it such are first Cocturae Os Gula Ventriculus Intestina second Mesaraice Venae Hepar Caua vena thirdlie all the parts Similares and of these Organice and Vene capillares the which as the chiefest prepare by alteration the nourishment méete for euerie part The other is that which by drawing the excrement of nourishment doth diuide carrie reteine and purge it as are Lien Rene Ambae Vesicae with the passages of the stomack chiefly by Crassa intestina Spincteres ambo Musculi octo epigastrij And those muscles which doe make the restraint of the breath and also those which is verie profitable and necessarie for the siege and vrine and vnto the bearing of a childe Thorough this nourishing alteration when as the partes are made that which remaineth is like vnto them and therefore it is called Assimulatio but through the ingendering alteration those partes which before were not are afterwards created Expultrix the expeller of those things which could not bée ouercome digested or perfectlie altered and that could not be made like vnto that which ought to be nourished when they are gréeued as it were with a strange burden the part which demaunded them either by concoction or attraction and when they stretching out in quantitie or troubling with sharpe qualitie or both doe greatly hurt it This facultie is excedingly delited with croked wayes which are these parts the stomacke entrailes wombe both the bladders veines and arteries Expulsion which is contrary vnto attraction is often times through one passage as vomite and swallowing downe through the throte the séede and the encrease through the neck of the priuie parts The distribution of nutriment the attraction of purging medicines voluntarie expultion of the iuice abounding in vs through Mesaraicas venas These nourishing faculties are vnderstanded by the name of naturall things for that from the conception of the séede euen vnto death they are in a liuing creature and also in a plant for they help generation action one likewise furthereth an other that by nutrition there may be a certaine particuler generation and corruption wherefore these thrée bookes entreat almost onely of these faculties vnto whome corruptio diminutio atrophia are contrary These faculties with certain instruments which haue action cōmon vnto all the bodie are of two sorts that is generall and perticuler The generall are either all present as in the stomack and liuer or else thrée of them onely as in the two bladders for one of them digest or two of them alone as in the reines for neither they digest nor reteine or at the least very little by reasō that they want great capacitie or else the facultie expultrix as the entrailes which haue for that cause onely croked passages in their tunikes And forasmuch as these ought to be nourished as wel as the other similer parts They haue foure particuler faculties nourishers of them placed in the temperature of their substance Hetherto wée haue declared which are the naturall actions how they be made and of what parts FINIS MIEVL X. VAVLT MOVRIR-EN VERT V. QVE VIVRE EN HONCTE AT LONDON Printed by Thomas East DWELLING BETWEENE PAVLS Wharfe and Baynards Castle 1586.
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
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
be as it were of a natural disposition in the right easie obtaining of things with that he hath to do of a stedfast memory of a quick remembrance handsome in his doings of a good iudgement diligent and apt in searching or inuenting remedies but chieflie of all as concerning manners let him be deuout or religious towards God mercifull of minde and vnfearefull in sure things and such as must néedes bée done and in things doubtful and perillous he must be warie and not too rash in like maner he must be familiar gentle and pleasant towards his Patients milde tractable amongst the brethren of his Arte and as the Gréekes do call him Philectairos that is to saie a louer of his companions Also he must be prudent very circumspect and slow in prognosticating not a gréedie catcher chast also and temperate not couetous of monie for he which doth exercise the art of Chyrurgerie rather for lucre sake desire of gaine than for anie good wil toward his neighbour he is no right Chyrurgion but as it were borne out of time and thus I make an end Thus farre I haue declared vnto you the saying of Valleriolus that learned man But forasmuch as some men doe more regard the authorities of authors than they doe the true iudgement of reason and experience which two are the foundation of all Artes and wil alleadge and saie this is but his owne inuention wherfore I wil not beléeue him though it appeare neuer so much to be reasonable shal I credit one or two mens sayings that the art of Chyrurgerie is so auncient or that the instruments appertaining to the same art is diet and medicaments no I will not beléeue it for those instrumentes doe pertaine onelie to Phisicke and not to Chirurgerie for the instrumentes of Chyrurgerie be onelie outward medicines as Plaisters Vnguents oiles pouders c. with a great many of yron instruments fit for his art wherefore I am not bounde to beléeue Franciscus Valleriolus The answere My friend hast thou so soone forgotten Hyppocrates who confuting all dispearsed sects did conclude That diet wherein consisteth the gouernment and nourishment of the sicke man That purgations being necessarie for the euacuation of euill humours And also outward medicines as plaisters vnguentes oyles balmes c. That all these thrée were vnited together by the authorie of Hyppocrates and that in no case they might be separated one from another if we wil rightlie cure the body of man and follow a right method which method Hyppocrates hath constituted and set forth and willeth all men to follow the same Then I saie either we must breake Hyppocrates precepts and by that meanes grow into ignorance againe either else we must follow the true and right method set out by him wherein he did vse all these instruments generallie and indifferentlie as time and cause dyd require And also Galen as it may more at large appeare in his fourth booke De Methodo Medendi in his bookes of purging medicaments where he doth confute diuerse Physitions which woulde not admit purging medicines in outward diseases as Asclapiades c. Saying That purging medicaments are necessarie to be vsed where there be great and daungerous wounds and where there be great accidents that chanceth vnto the same to purge draw awaie the superfluous quantitie of those humours which might hurt the grieued part or hinder the curation thereof as he doth declare in the same booke De Methodo Medendi And he saith in his bookes of purging medicamentes That purgations are needfull for the curation of Cancers Herpis Erisipulas Spasalus Gangrena and many other outward griefes which chanceth vnto mans bodie And he doth affirme that without these things he could not haue brought to health his diseased patients Thus it doth manifestly appere both by Hyppocrates Galen that these be not onelie generall instruments but also common instrumentes and therefore of necessitie must be vsed either else the Chirurgion must leaue these euill affects vncured which he ought take first to indication off Obiection Yea sir you saie verie well for in the time of Hyppocrates and Galen the Chyrurgions were Phisitions and were great learned men and vnderstoode all partes of the arte and the nature of Medicines both simple and compound wherefore it was lawfull for them to vse all these instruments generallie indifferentlie but it is not so for our Chyrurgions and that I will proue by the authoritie of Tagaultius in his institution of Chyrurgerie The aunswere You haue sayd verie well sir and by him I am verie well content to be iudged for he is both a man of excellent learning and also worthie to haue perpetuall fame for his painfull trauaile in that excellent booke of Chyrurgerie that we may the sooner come to our purpose I will recite a few of his sayings whereas he declareth what the art of Chyrurgerte is and what manner of man hée must be and what properties he must haue that ought to vse the same arte how he should be trained vp in the same art and what is the subiect of the same and what be the things that he must cure the same subiects with with what instruments the same must be cured Now I will recite you certaine sentences as héereafter followeth which are taken forth of the same booke of Tagaultius that you before haue alleadged and I trust being well and indifferentlie construed shall make more with my sayings than with yours The vvordes of Iohannes Tagaltius declared in his booke vpon the art of Chirurgerie TO the exact knowledge of the arte or science which is called Chyrurgerie it behooueth the Artist to know foure things First what Chyrurgerie is what is the matter subiect to Chirurgerie what is the end of Chirurgerie and also what order is to be obserued kept in the learning of Chirurgerie And we doe knowe what Chirurgerie is by thrée manner of waies First by the Etimologie of the word or name by his definition and by his diuision Chirurgerie after his Etimologie is called the operation with the hand for it is named Apo tes chiros cai tou ergou that is to saie of the hande and his worke because this Arte is exercised by the administration with the hand and héereof commeth it to passe that the minister with the hand is called Chirurgus that is to saie a Chirurgion Chirurgerie according to the assentiall definition is an Arte which by the administration of the hand doth expell driue awaie sicknesse out of mans bodie whereof chieflie principallie it taketh cure and charge or else Chirurgerie is an art which by the cunning working with the hand doth put awaie or remoue the sicknesses or diseases of mans bodie The matter subiect to the art of Chirurgery the whole intention which the Artist doth occupie himselfe about is onlie mans bodie subiect to diseases infirmities which diseases and infirmities requireth the help of medicaments ministred
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
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
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
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
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
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—
beginnings thou shalt not néede either stitching or hookes but if thou wilt otherwise binde it vse thou either stitching or hookes Few stitches shall in this suffice And thou shalt cure greate vlcers with vehement desiccatiue medicines if thou remembrest that which before is spoken The medicines which doe moderatly drye will abundantly heale small vlcers Déepe vlcers be euer also great therefore they must be rolled with two beginnings and the lippes of it be spedely adglutinated and those which are both verye déepe and also long as they are great two wayes so doe they shew a double indication therefore they require vehement siccatiues Neither ioyne thou the lippes to soone together and rolle it with two beginnings and take déepe stitches In like sort if there come many differences together of which euery one hath his indication it is expedient to vse them all so that they be not contrary But if they be contrary among themselues wée haue heretofore shewed how it behoueth them to be denied of these but wée will more largely set it out hereafter And now it séemeth good in this place to ende this third booke In the fourth which shall follow we will dispute of those affectes which for the more part accustome to follow vlcers and with these there shall be set out the curations of inward causes FINIS THE FOVRTH Booke of Galen called in Greeke 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and in Latine Methodus Medendi The effect of the same 1 The right method of curing malignant stubburne Vlcers 2 What Vlcers be hard to be cured 3 The method of curing an vlcer difficill to be cured by the reason of the intemperancie of the flesh 4 The curation of an vlcer when as the part is exulcerate with a tumour against nature 5 The method of curing another affect when as ill humours doe flow to the particle 6 How a man may know in certaine diseases the originall cause 7 The opinion of Thessalus in the curation of malignant vlcers 8 That of time no indication ought to be taken contrarie to the opinion of Thessalus 9 The curation of malignant vlcers according to the sentence of Hippocrates 10 That an ill affect comming to the vlcer ought first to be cured before the vlcer be taken in hand 11 The curation of those affects that flow to the vlcer according to the sentence of Hippocrates 12 What indication ought to be taken of the scituation and figure of the parts The first Chapter WE haue said that there is one kind of disease that is called solution of continuitie which cōmeth into all the parts of the bodie of mankind howbeit it hath not one name in them all For solution of continuitie in the fleshie part is called an vlcer in the bone a fracture the Gréekes call it Catagma in the nerue a conuulsion the Gréekes call it Spasma There be of the same kindes of Solutions which the Gréekes call Apospasma Regma Thlasma Thlasma in the ligament Apospasma Regma in the veines and muscles because of anie violent stroke or grieuous fall or anie other great motion The solution of continuitie called Ecchimosis in the Gréeke commeth most often with concussion and ruption Sometime solution of continuitie commeth by opening the orifices of the veines in Gréeke named Anastomasis Also it commeth of that which is called of many Diapedisis Other solutions of continuitie happen of Erosion in Gréeke called Anabrosis But it is a disposition alreadie medled and composed with an other kinde of disease that consisteth in the quantitie of the partes as before hath bene shewed when as we did intreate of hollow vlcers which doe procéede of two causes that is to saie of Exition and Erosion It is manifestlie knowen by what meanes exition commeth And if erosion abound inwardlie it commeth of Cachochimia if outwardlie it is done either by strong medicine or fire it behoueth then as is said before to take diligent héede and discerne the simple diseases from the compound for to a simple disease a simple remedie is conuenient and to a compound disease a compound medicine Also we haue said before what method must be kept to cure cōpoūd diseases yet notwithstāding it is not inough to know the generalitie of the said method but to be exercised in all parts thereof Séeing then that in the same is néede by manner of speaking of sundrie perticular methods because that euerie kinde of disease hath his owne methode then that which resteth of the curation of vlcers must bée performed in this booke taking the beginning héere Euerie vlcer is simple and alone without other dispositions and affects with it or it is with some other disposition or diuerse whereof some haue not onelie stirred vp the same vlcer but hath augmented it The other are without which the said vlcer cannot be cured Of thē we haue spoken héere before we shal speake in this present booke of the dispositions which augmenteth the vlcer in the which lyeth double counsaile of curation that is to saie either to take the said dispositions all wholie out of the bodie or to surmount the incommoditie that aboundeth in it The which thing may be easilie done if the dispositiō be little but if it be great the vlcer may not be cured vntill the same disposition be taken awaie Wherefore we must diligently consider what the said affects and dispositions be and how many in number in taking our beginning as is sayd before Euerie vlcer is by it selfe alone or with hollownesse the the flesh being subiect be natural and that there be nothing betwixt the ioyning of the lips that may let the conglutination therof which oftentimes happeneth either by haire a Spiders web mattier oyle or such lyke things that may let the ioyning together And these things are as Symptomata and accidents of the sayd wound which if they be present maye hinder the curation but if they be not they let not but the disposition of the flesh is cause of that which followeth For with the same flesh and by the same lips that were asunder are closed and the hollownesse filled It behoueth then that the sayd flesh be naturall because that these two things may be wel and commodiously made perfect Then it is naturall if it kéepe his owne temperament which thing is common to all other partes for it behoueth that the flesh subiect be wholie temperate as well to close the vlcers as to fill them with flesh But is that enough I praie you Must not the bloud that commeth to it be good also and moderate in quantitie I thinke this trulie to be true For that bloud which is corrupt doeth so differ from adglutination and filling the flesh as also somtime to exulcerate and erode the bodie And if it be ouermuch in quantitie it engendereth excrements in the vlcers as we haue before spoken and hindereth the curation And also there be thrée kindes of vlcers which are difficill and hard to be cured The first aboundeth by the
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
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
mencion of all these things where he speaketh of Purgations But some perchaunce will say How then doth not Hippocrates councell vs to take away the bloud for these causes aboue especified By my iudgement he commaundeth them thus but in few wordes and that not without demonstration as he and all the auncients were accustomed to doe Thou shalt vnderstand that it is so if that thou wilt reade againe his words that are these In euery fresh wound except it be in the belly it is expedient to let bloud flow out of it more or lesse For by that meanes the wound shall be lesse grieuous the inflamation lesse and all the places about it But if thou shalt remember hereafter those wordes that he writ when he did entreate if vlcers and also those thinges that he hath propounded in all his other bookes that is to say how that a Phisition ought to be an imitator and follower not onely of nature but also of those things which shal be profitable when they come to their naturall state Then thou shalt plainly vnderstād the minde of Hippocrates and also how that bloud ought to be drawen when wounds be great but if out of such wounds bloud doth not flow especially when as it is a thing most conuenient then thou must adde and supply those thinges that be néedefull and necessarie The matter that followeth he conioyneth it with that which is abouesayde Also it is profitable that from inueterate vlcers bloud doe flow and also from the parts which are about them But forasmuch as he hath said before that bloud should flow from euery gréene wound except that he made mencion now of inueterate vlcers it would séeme to some that he dyd entreate onely of greene and fresh wounds Therefore he did well adde this that is to say how that it is a thing most méete to draw bloud from inueterate vlcers Wherefore now seeing that the doctrine which we haue taken of him is true and firme that is to say how a flux beginning at the contrary parts ought to be drawen how that which is alreadie fixed in the partie ought to be purged either from the payned part or from the part next vnto it therefore it is now easie for vs to conclude of the detraction of bloud how that in the beginning it ought to be done in the part farre of and then in the vlcerate parts Furthermore if you doe adde vnto these which I haue before spoken how that Hippocrates coūselleth to euacuate the superfluous humour and that detraction of bloud ought to be vsed when it surmounteth and that a medicament ought to be giuen which hath vertue to purge humours Chollerike Melancholicke and Phlegmatike Yet haue in remembraunce all these woords how that none of them is the curation of vlcers no not so much as of an vlcer but rather of Cacochimia that is coniunct with the vlcer or of Plethor or of Phlegmon or of Herpis or other like dispositions Neither yet be not forgetfull of this thing that is to say that none of the accidents of the vlcer giueth such proper indication as magnitude In the booke precedent we haue intreated of vlcers wherein we haue declared all the differences of vlcers how many and what they be what is the indication of either of thē Howbeit I haue not sppken in the saide booke how the indication of purging is taken of the vehemencie of the disease bicause it should not be to much prolixitie demonstration Neither in the saide booke I haue connixed the curation of all the bodie with the vlcers but yet I haue declared in this present booke in as much as it was agréeable and vtill for my purpose The seauenth Chapter BVt the firme and perfect demonstration of this kinde of Indication which is taken of the vehemencie of the disease shal be shewed héereafter In like maner the indication which is takē of the age that which is takē of purging humours Likewise the Indication which is taken of the afflicted parts shal be declared in the bookes which follow But as yet we haue onlie made mention of the curatiue Indication that may be taken of the nature of the said parts that is to saie of temperance substance But trulie we haue nothing touched the Indication which is taken of the scituation figure of the partes Therefore we will speake of the indications that be profitable for the curation of Vlcers The part trulie that hath sharpe and quicke senses ought as much as is possible to be cured without dolour or paine But the Anodinon of such remedies is spoken of in the Booke which entreateth of the simple medicaments But he that hath but small senses and those that be not quicke may if the disease require suffer strong medicines But we must haue regard and consideration to the strength of the principall member whereof we will more copiouslie héereafter declare when as we shall haue occasion to speake of Phlegmon But if it be not a principall member surelie without daunger you may minister vnto it such medicines as mittigate and asswage the Gréeks call them Calasticke whereof we will plainlie and more at large declare héereafter At this present we will declare the indication which is taken of the scituation and figure of the partes and then we wil finish and conclude this fourth booke For this cause haue we excogitated and inuented certaine medicines that must be giuen to him that hath his ventricle vlcerate the which medicines must be dronken at once but to him that hath his throate vlcerate they must be ministered at sundry times by little and little because of the passing which bringeth great vtilitie to the vlcer neither they must be ministred so in such case as to him that hath his ventricle vlcerate Likewise we haue declared by the situation and figure of the said part that such medicines ought to be made grosser and thick more clammy than the other because that the throte is a passage of things that is eaten and dronken And for that cause remedies which may conioyne cleane on euerie side of it is most conuenient and not such as are thinne and easie to slide away For the thicke are alwaies about the parts and the clammy doe cleaue vnto it Likewise vlcers that are in the thick intestines haue more néede of medicines which are cast out by the fundament in asmuch as they be next vnto it But the vlcers that are in the thin intestines because they be fardest from the fundament require both medicines that is to say those that are receued by the mouth and those that are cast in by the fundament Now truly the cōmon indication of all the interior parts is that we ought to choose things that be most familiar to the nature of man be they meates or medicaments and to eschew those things which be contrarie vnto it Although to Vlcers which bée in the outwarde partes the vse of such medicaments be
as it is diuerted to the contrarie partes or is deriued to the parte adiacent or by refrigeration either of the whole bodie or else of the affected partes so that colde potions haue often staied the fluxe of bloud as also colde things in fomentations outwardlie applied In like sorte Oxicratum and sowre Wine and anie other that haue either astringent vertue or onelie refrigeratiue facultie And the diuision is shut if that which is diuided be drawen together or closed or els stopped Trulie it is drawen together both by restriction and refrigeration and ligature and binding but it is stopped either inwardlie or outwardlie inwardlie by the bloud coniealed which the Gréekes call Thombros outwardlie both with this and also with Linamentes Spunges Askars and with such medicines as through the clammie and grose substaunce doe stoppe the pores the Gréekes call them Emplastica and also with putting the foresaide medicines to the hurt parte How euerie of these shall be done it is alreadie set out But the fluxes of bloud which breake out of the déepe partes of the bodie cannot be stopped either by binding or ligature no not with hot yrons and to bée briefe neither with such things as we goe about to touch the diuided bodie with or else the part but rather with reuulsion and deriuation to the partes which 〈◊〉 next Also meate and drinke which haue an Emplastique facultie and by astringent medicines Of these thou half plentie in their proper volumes what Indication is taken of the partes that happen to the common Indications curatiue rehearsed as it were an ouerplus in euerie affect for wée vse sometime Instrumentes according to the propertie of the part some to the Matrixe other to the Bladder and other to all the thicke Intestines for wée make mirtions of some profitable Medicines into the Intestines by a Clister and into the Matrixe by those which the Gréekes call Metrenchitas as into the Bladder by pipes directlie pearced through And truelie the fluxes of bloud by those partes are rare and yet sometime they chance And although they are not dangerous by the profuston it selfe yet when as they long continue they are not voide of perill For we did sée bloud flowe out of the Matrixe foure daies neither coulde it bée stopped by anie remedie vntill wée stayed it vsing the iuyce of Plantaine for this medicine is most profitable to such fluxes of bloud as come through erosion vnto which I doe vse to mixe in this case some more vehement medicine and sometime an other which is proper for the affected parte which thing is euer to be done and to be receiued in all fluxes for the chiefest document For in these fluxes of the Matrixe Bladder and Intestines the quantitie of the profusion is to be estéemed that we may take it as the first or second indication of curation and yet by the waie not neglecting the cause of the whole affect for if anie great vessell bée broken or vehementlie opened and doth gape wée néede astringent Medicines as Balaustium and Hiposistes and Rhoes and Omphacium and Acacia and vnripe galles and Malicorium but if it be a little vessell that is rupturned or but a little opened so that the bloud bée not much which floweth out of it Aloes and Manna and the rinde of the Pine trée and Sigella Lemnia and the fruite of the Aegyptian Spine and Saffron and Lapis Haematites and such lyke bée profitable medicines giuen in redde and sowre Wine but if thou canst not get anie such Wine nor Plantaine nor Nightshade for they are also good wée maye boyle in water the sprigs of Rubus and of Caninus Rubus and Mirtus and Lentiscus and Iuie and to conclude all such as haue an astringent vertue whether it be roote or fruit or rinde or bud and by like reason the decoction of astringent apples and chiefelie Quinces Mixtiles and Medlers is a conuenient remedie The sixt Chapter AND if there happen a certaine fluxe of erosion the Gréekes call it Anabrosin it is not for the more part abundant but small and flowing by little and little therefore you must vse the Trochisce of Pasionis or Andronis or Polyeida or else of our inuention which haue in kinde the same force but more stronger These cease the erosion if regard be first had as is saide to the whole bodie But if the fluxe bée too abundant wée must vse those medicines which are most vehementlie astringent vntill the vehement force be broken then mixe the Trochisce with them and after you maye vse the Trochisce alone with anie of the forenamed iuyces or decoctions And truelie the medicines which are outwardlie applyed to the parte whether they be astringent or colde without astriction these I doe not alwaies allow as many Phisitions doe for they séeme to me to doe contrarie altogether to that which ought to be done to kéepe the bloud within and fill the vessells which are in the déep parts We did sée some of those which did cast forth bloud out of his lungs to be manifestlie hurt by refrigerating the breast so that some of them did vomit bloud because their bellie was refrigerated in like sorte some of them that blead in the nosethrils were worse by refrigeration of the head Therefore I counsaile not euer or without difference or in euerie time that the places which are about the parte whereas the bloud floweth to be refrigerated no not vntill thou hast first tourned it to the other partes As for example in fluxe at the nose when thou hast vsed as I sayde letting of bloud or frictions of the ioynts or binding or fixing cururbites vnder the ribbes But thou shalt not forthwith vse to the forehead and head refrigerating medicines but first reuulsion to the contrarie partes fixing in the toppe of the hinder part of the neck a cucurbite or boxing as it may be tearmed for there is a double euersion of the fluxe of bloud at the nose both that which is to the lower partes of the whole bodie and that which is made to the hinder parts of the head because the nose is placed both in the higher and also in the former parte for that part which is low is contrarie to that which is higher and that which is behinde to that which is before But of fluxe of bloud wée haue hetherto abundantlie spoken It is euident that the affect named Dyapedesis is to be cured with astringent and refrigeratiue medicines and if it chaunce at anie time through too thinne bloud you must vse grose dyet What this same diet is wée shall héereafter set out and we haue alreadie after a sorte set it out in our Booke which is entituled De Attenuante victu Nowe we must retourne to the curation of the forenamed affects Therefore the Vlcer which is in the veine if it bée in the ouer part hath the like curation to an vlcer in the flesh of which I haue disputed in the two bookes going before this For if
the bladder matrixe and Intestines and lungs which you must vse in euerie of them taking the kind of the medicine of the substance of the sicke parte but first considering the affect and taking the waie of vsing them of the forme and scituation and héereof sprang clisters for the mouth in Gréeke called Otenchitas and Clisters for the Matrixe named Metrenchitas Catheteras and the Clisters for other partes Vlcers in the stomacke breast and lungs are cured by those medicines which are eaten and dronken the Vlcers in the Intestines are two waies cured for those that are next to the stomacke are cured by those medicines which are eaten and dronken and those which are lower in the intestines are cured by iniections made when neither that which is ministred by low by Clisters can come to those Vlcers that are néere vnto the stomacke neither that which is receiued at the mouth can in full strength come to the lower partes and so the Vlcers in the breast and lunges are more hardlie cured than those in the stomacke for that they are further off and there the strength of the medicine somewhat abated and for this cause the medicines receiued at the mouth ought to bée stronger than those which are presentlie applied to the Vlcer and for that cause the Phisitions haue excogitated most strong and cutting medicines whereas they will purge the mattier in the breast and lunges yea verilie such as would ciccatrize the Vlcer if it were in the stomacke Also that this is throwen out by coughing that is taken of the forme of the partes because these haue no such passage as the matrix bladder eare nose and mouth and hereof commeth it that the stomacke may be purged two waies vpward by vomite and downward by the stoole for this kinde of Indication is taken of the Instrumentall partes inasumuch as they be instrumentall like as those that are to bée exiccated are taken of the nature of the similer partes of the affectes themselues againe such as in Vlcers because our disputation was of them but that they are to bée dried as is before set out and also if they will purge mattier in the stomacke they cannot without daunger prouoke vomite for if there bée fleame fixed in it to cleanse it by Oximell and rootes but they shall more safelie vse deiection when it is perlllous least hée that vomiteth shoulde teare that is vlcerate and should attract some ill iuyce from the partes adiacent and for this cause the Vlcers of the lungs are most harde to bée cured because thou canst not purge them but by coughing and if thou prouokest the cough thou tearest the partes so that the ill by mutuall successe cōmeth to a circle or as we may terme it made worse for those partes which are torne doe againe make inflammation and secondlie the inflammation must bée maturated and the mattier againe requireth to bée purged so that of all these the cure is made difficill both for that those medicines which are conuenient cannot touch the Vlcers as they may in the stomacke and that in the midde waie they loose well néere their vertue And further because by respiration they are mooued and are rent by coughing wherfore when as anie vessell in the lunges is ruptured if it be not adglutinated before there commeth inflammation knowe thou that afterward it is incurable The xij Chapter BVt the vlcers which are in the inward cote of Aspera Arteria chieflie which are néere Larinx or else in it these may bée cured and we haue healed diuerse which were so affected trulie we finde the curation of these vlcers by this occasion in the beginning of this great Pestilence which I praie God may once cease a young man who had béene sicke nowe nine dayes all his bodie brake out full of vlcers which happened well néere to all that escaped that daie he coughed somewhat the daie following when he had bathed him he forthwith coughed more vehementlie and therewith voided a little crust named Ephelcis and the man had manifest féeling of an vlcer in Aspera Arteria that is in the necke néere vnto Iugulum and he also opening his mouth we looked in his throate if that there were anie vlcer in it but we could sée none and truelie the patient should manifestlie haue felte it by the going downe of the meate and drinke if anie had béene there and wee also to bée more certaine made him take certaine things with Vineger and Mustard but none of these did bite him and yet hée felt dolour and paine in his necke in which place hée was so vexed that hée was constrained to coughe wée perswaded him all that wée might that hée should resist it and not cough which thing hée did and that with the more ease For that which dyd irritate was little and wée by all possible meanes gaue diligence to ciccatrize the Vlcer applying outwardlie medicines exiccatiues and hée lying vpright wée gaue him moist of those medicines which are good in such lyke vlcers bidding him to holde it in his mouth and by little and little to let it flowe into Aspera Arteria he so dooing saide he felt manifestlie the force of an astringent medicine aboue the Vlcer whether that the force of it by transumption was sent thether or whether the medicine it selfe in forme of a dew floweth through the Arterie as it were strained to the Vlcer the patient himself was voide of the knowledge in Phisicke being of the number of those which cure by vse and exercitation emperiklie Therefore hée sayd that hée felt both the medicine flow into the arterie and that it also sometime prouoked coughing but he did much striue and staied the cough and hée of his owne accord being taken with the sicknesse at Rome remained thrée dayes after the nine daies were past after taking shippe first hée sailed through a Riuer to the Sea the fourth daie after hée came by shipping to Tabia and vsed the milke which hath a meruailous vertue and not without cause commended Of which somewhat to speak the time it selfe giueth occasion and not onelie of that milke we will speake which is at Tabia but also of all other milke neither must we onelie helpe those which are in Italie but all other Nations as much as we can Wherefore touching the milke in Tabia there doe come many things touching his praise both the place it selfe béeing of sufficient light and the aire compassing about béeing drie and the healthfull fodder for the Cattell and this also may anie doe by arte in other places if anie shew the hearbes and shrubbes in an hill somewhat high which may make the milke both astringent and healthfull of which we wil héereafter shew examples But yet thou canst not also make the aire ambient in like sort therfore thou maist choose the likest there as thou art The aire shall bée most like where there are such things like it the height of the hil moderate thirtie furlong
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
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