further appear From Choler is produced Herpes and its differences From the Pituitous or Phlegmy humor proceeds Oedema From the Melancholly humor Scirrhus From black Choler Cancer From the watry humor Hydrocephalus Hernia aquosa But of the wheyie humor and the thin excrementitious matter called Ichores from which various less swellings by the Latines called Tubercula do arise there is a very vast difference and oftentimes these ferous and wheyie humors as likewise the salt and cholerick humors are mingled with other and from hence originally proceed divers Wheals or Pushes in the â—kin as to instance Psydrasia Vari Sudamina Spinyctides and Terminthi Essere Arabum Elcydria Scabies Lepra Graecorum Vitiligo Impetigo and Lichen Crusta Lactea Achores Favi Tinea with many other of the like Nature Moreover from the humors there is derived also a certain peculiar kind of tumors yet nevertheless differing from those we have hitherto made mention of in a twofold respect The former difference lies in this that it proceeds not from one single humor but from more to wit Phlegm I mean such as hath other humors Melancholly or Choler mixt therewith yet notwithstanding so that the cause conjunct may not any longer be said to be an humor but some other matter generated from out of those humors The later difference consists in this that the aforesaid matter is included in some one peculiar Membrane Tumors of this sort are Strumae and Scrofulae Bronchocele Ganglia Nodi Melicerides Atheromata Steatomata Testudo Talpa and Natta Out of the humors likewise where you are to understand such humors that degenerate into another matter take their rise and original those tumors which the intelligent Artist cals Polypus Pamela sub lingua bernia carnosa Verrucae Fungi and others the like There are moreover tumors that have their very being from malignant humors and these are Variolae Morbili Lepra as the Arabians or Elephantiasis as the Greeks name it Tumors Venereal of different kinds Bubones and pestilential Carbuncles From flatulency or windiness are derived Emphysemata as the Grecian Authors or Inflationes as the Latines call them and all other flatulent tumors whatsoever From the solid parts lying out of their proper places arise Hernia in the Cods and Navel when the Intestines fal down thither Epiplocele And hitherto also is to be reduced Aneurisma a tumor that hath its original from an Arterie dilated as in like manner Varix being a tumor from a dilated Vein From the Bones proceeds that which we term Exostosis and from the Vertebrae or turning Joynts of the Back when they stick out is caused Gibbositas like as in other parts also tumors arise when disjoynted or broken Bones slipping out of their own place happen to fal down thither But now those tumors receive various appellations by reason of the part affected of which enough hath been written already in its due place And moreover as concerning divers of these Tumors this is to be taken notice of that very many and that in most Countries have indeed been not a little infested by them and that they have been likewise as ordinarily cured of them but yet notwithstanding what the German Italian French Spanish and other names of several Nations are and unto what names of the Grecians Latines and Arabians they may fitly answer is not alwaies manifest which very thing hath exceedingly perplexed and puzled the studious Physitian in his perusual of Authors And of this also Johannes Philippus Ingrassias who took a worlâ— of pains in comparing together and explaining the Greek Latine and Arabian names extreamly complains as wil appear by what he writes in his Book of tumors Tract 1. Chap. 1. page 220 after this manner I cannot but exceedingly admire and withall greatly lament the so great unhappiness of our Age in the which we are evermore infested with divers and almost innumerable kinds of Diseases and day after day are sadly afflicted especially more with this kind of Tumor he here speaks of Dothien or Furuâ—â—â—lus by reason of an unwholsome and corrupt kinâ— of Dyet insomuch that questionless the Affect â—s most perfectly known but as for name it hâ—th none other than what is as obscure and as ambiguous unto most men as that of Epinyctis and Psydâ—acion so that hence we find it a business of the highest difficulty to discover the proper head of the Disease and the Method of curing it either in the Latines or the Greeks and Arabians themselves writing in the Latine Tongue Of the signs Diagnostick Prognostick and of the indications and Cure of Tumors in generall some there be that are wont to assert many things But in truth there is but very little that can be said as concerning Tumors in this manner that is generally considered but what for the most part is agreeable to certain species of them of all which we wil now speak in order and particularly in the Chapters following Chap. 2. Of Tumors arising from Humors in general THat kind of Tumors which is caused by the Humors is found to be most frequent and usual and therefore we wil treat of it in the first place The primary and nighest cause hereof is a humor elevating and raising up a part beyond Natures intention unto a greatness more than is ordinary Which said humor having for the most part a certain excess of qualities adjoyned wiâ—h it and thereupon becomes either hot or cold or moist or dry derives that quality unto the part affected the which quality since it differeth from the temper of the grieved Member must therefore necessarily excite in the same an unequal temper and hence it is that an intemperies or distemper is concomitant with a Tumor The Causes Now of the humors that cause these Tumors there is great diversity For both the Natural and preternatural humors whose differences we have already spoken to in their proper place excite Tumors hereunto belongs the matter that is wheyey and waterish filth and corrupt matter and all things else into which the humors degenerate and which are to be found in Tumors and yet are not in the number of the parts of the Body of which there is great variety Galen in his second Book to Glauco The variety of such things as are often found in Apostems and seventh Chapter writes that in Apostems there have been found to be substances conteined like unto Stones Sand Shels Wood Mud or Slime the filth of Baths the dregs and lees of Oyl together with many other such like resemblances And in his fourteenth Book of the Method of Physick and twelfth Chapter he further informs us that in Tumors have been discovered substances resembling Nails Hairs Bones Shels and Stones And that Worms also may be found in Tumors frequent experience testifieth Fallopius with others have seen such Tumors and I my self have more than once beheld the like Nicolaus Remigius in his third Book of the worship of Devils and first Chapter writes that
different Affect and such as is familiar and common unto Children and that it is bred out of sweet flegm which is manifestly declared by the viscousness and clamminess of the rotten filthiness as also by the whiteness thereof and somtimes from a flegm mingled with Blood as the color declareth which is not very red and it soon cometh to a maturity and somtimes likewise from Melancholy or Choler as Gulielmus Placentius writeth of this same Affect in the first Book of his Chirurgery and Chap. 5. Johannes Philippus Ingrassias in his Book of Tumors Tract 1. Chap. 1. without any the least scruple conceiveth that this Tumor is to be referred to Hydrocephalus But in regard that Hydrocephalus is bred of Water and hath no blood at al mingled therewith neither may be suppurated this therefore cannot be granted unto the said Ingrassias nor by any means allowed of And lastly there is another Tumor which they cal Nata Natta Natta and Napta being great and soft without any pain and color growing forth especially in the back and somtimes notwithstanding breaking forth in the shoulders and other parts hanging by a smal slender Root but yet so greatly encreasing that it weigheth some pounds and is in bigness equal unto a Melon or Gourd which because it hath not alwaies one and the same form and figure it hath likewise therefore by Authors divers and several names conferred upon it The matter that is therein contained doth indeed now and then seem to be fleshy but in truth it is no flesh but like unto fat and therefore it may not unfitly be referred unto Steatoma The Causes They refer the cause of these Tumors unto a salt flegm or else a flegm mingled with Choler But in regard that these Tumors may be referred to Melicerides Atheromata and Steatomata it may therefore most fitly be determined and asserted That these Tumors have the very self same cause that those said Tumors have only here lieth the difference That in these there is greater store of matter and thereupon it is likewise that these Tumors arrive at a greater bulk and bigness than the former Signs Diagnostick These Tumors are easily known from the descriptions before declared for they are soft Tumors or at least such as are not very hard broad and large and shut up in their peculiar Membrane Prognosticks 1. If these kind of Tumors be in the Head they then are dangerous by reason of the vicinity and neerness of the Skull in regard that they corrode the Skul and corrupt it especially about the Sutures 2. If there be present a great corruption of the Skul it is then far better to let this Tumor alone and not meddle with it than to cure it 3. Those of them that are without any corruption of the Skul are cured with more safety 4. Like as it was in the Tumors mentioned in the former Chapter so it is likewise in these unless the whol Tunicle be drawn forth together with the humor there is no perfect health and soundness to be expected or hoped for since that if there be any thing left behind there wil from it a new Tumor arise and break forth The Cure Universals and generals being first premised and the body sufficiently evacuated the matter constituting the Tumor is to be taken away which is done by digestive and resolving Medicaments or by those that suppurate or by Chirurgery And therefore if the Tumor be without any Ulcer and corruption of the bone then let discussing Medicaments be administred Now the Discussives are such as are wont to be used in Scrofulae and Tumors But it is somwhat rare that these Tumors are cured by Discussives If therefore they cannot be so taken away and removed to wit by Discussives alone then Maturatives and Suppurating Medicaments are likewise to be administred such like as have been already propounded in the foregoing Chapter Or Take Onions roasted under the Embers the Yelks of Eggs hard boyled of each three in number Swines Grease or unsalted Butter half a pound the Root of Marsh-mallows boyled to a softness and bruised very smal one pound and make a Cataplasm And yet notwithstanding we are not to expect and wait for a perfect Concoction and generation of Pus in regard that Pus easily and soon gets a sharp and malignant quality and so corrodeth the Skul And therefore so soon as any signs of Suppuration shal appear the Tumor is maturely to be opened The Incision is to be either simple and downright or else it is to be made in the form and figure of a Cross according to the bigness of the Tumor The Pus being wholly evacuated the Ulcer is to be throughly cleansed by convenient Medicaments as for example with such as this Take Barley Meal two ounces Myrrh half an ounce Sarcocol one ounce Honey as much as will suffice mingle c. The Ulcer when it is throughly cleansed is to be filled up with Flesh and consolidated If the bone be corrupted it is then to be shaven and to be cured in like manner as it is wont to be in the rottenness of the bones But as for the Cure by Chirurgery it is to be ordained and instituted in like manner as was declared in the Chapter foregoing Chap. 37. Of Verrucae or Warts THere are moreover other Tumors likewise that are said to have their original not from humors but from a solid substance But since that these same humors take their original either from a vitious and luxuriant juyce nourishing the parts or else from excrementitious humors mingled together with them we wil therefore subjoyn this kind of Tumors unto those that were but even now explained and treated of And first of al there are indeed certain smal Tumors that arise in the Skin like unto little hillocks Verrucae which are called Verrucae or Porri For with the Latines Verruca is properly the higher and more eminent part of a Mountain or Hil and according to Gellius in his third Book and Chap. 7. the rough part thereof whereupon it is that those places are termed Verrucosa that are unequal and have divers eminent parts But now these Verrucae from their several forms have gotten divers and several appellations For one is called Sessilis by the Greeks Myrmecion Verruca sessilis and by the Latins Formica which is fixed and fastened with deeper roots broad beneath and slender above and this thrusteth forth it self in the Skin less than the other kinds of them and it is likewise stable and permanent and not altogether so movable as the rest Now they conceive that it is so named either from their blackish color such as there is in Ants or Pismires or else because that when it is hard pressed it exhibiteth a sense of pain like unto the bitings of those aforesaid Pismires and it is for the most part bred in the Hands or likewise in the Feet neither is it altogether without pain and in this
beyond Natures intention and hath its production from somwhat that is preternatural and comes to be adjoyned to some one or other part Nor is it of any validity what Rudius here objects That in Tumors which have their original from the humors and those likewise which have for their causes the strutting forth and falling down of parts and such like that there the difference is to be taken from the efficient next and containing cause and that from this cause we may gain excellent artificial and profitable Indications but not so from the consideration of magnitude augmented For albeit they differ in the containing special cause that this is now and then an humor somtimes above and somtimes also an Intestine or Gut fallen down yet in the general cause they agree which is some one thing or other preternatural added unto the part and swelling it up into a Tumor And in every Tumor as it is likewise in al other diseases depending upon the cause containing no profitable Indicacion can be gained or may be expected from this cause no not in those Tumors which have their dependance upon the influx of humors For the general Indication though it be altogether useless is this that the humor which lifteth up the part into a tumor is to be removed but how and by what means this may be effected is wholly left unto the skil of the knowing Artist In the mean time I wil not deny but that those tumors which have their original from the humors may fitly enough be ranked among the diseases that are compounded of augmented magnitude distemper arising from the afflux of matter and a vitiated figure yet however this is not to be granted in al Tumors And hence it is without doubt that Galen hath placed the Tumors one while amidst the Affects of the similary parts as in the twelfth Chapter of the difference of Diseases and assoon again among those Diseases we call organical and this he doth in the thirteenth of his Method and first Chapter Neither is it to be denied That now and then Authors whilst they make mention of preternatural Tumors do not intend al Tumors in general such as are also those that are produced by the falling down of the bowels or by some boney substance sticking out but those in special which are caused by the afflux of humors and these are evermore diseases that may properly be said to be compounded of magnitude augmented intemperies an unmeet figure and most usually also the solution of Unity The Cause The containing Cause of a Tumor as we take it in the general is somthing beyond Natures intent added unto a parâ— which elevates distends and swels it up to a more than ordinary greatness The Difference Now the matter which we say is added being threefold to wit a Humor a Wind and a solid Substance the primary Difference then of Tumors ought to be taken from that which we commonly term the Containing Cause Tumors then are somtimes thus differenced that some are great others not so some external some internal some new others that are of longer standing But these differences are meerly accidental denoting a certain mutation or change and an alteration of the condition but the species oâ— kinds they vary not in the least But the differences specifical and which constitute the several kinds are taken from the matter and the containing Cause which is threefold as hath been said First of al therefore Tumors derive their very being from the humors but these as yet have not obtained any peculiar appellations to be called by but at leastwise are al of them comprehended under the general name of a Swelling yea as some say they are only called Tumors Secondly Winds it shut up in any part distend the same and lift it up into a Swelling or Tumor and this sort of Tumors the Grecians cal Emphysemata the Latines Inflationes by reason of their windy original In the third place now and then somwhat resembling flesh or skin or that is hard and solid as a bone and other such like matter is super-added unto some one part and there causeth a Tumor or Swelling But in regard that these very substances have their original from the humors we will thereupon adjoyn this sort of Tumors unto the first kind And lastly even the very solid parts of the body themselves cause Tumors whenas they change their place together with their scituation and slip down upon some other part which they both distend and elevate neither have these any peculiar names to be known by There are yet some other differences behind From the quality of the concomitant matter some are said to be hot others cold some moist others dry some soft and loose others hard From their magnitude the greater of them are by a general name simply called Tumors the less Tubercula From their scituation that some are internal others external and these again either more deep and profound or else superficial From their figure some of them are said to be broad others again sharp-pointed But now to comprehend al those differences of Tumors under names and to give you the number of them is not very easie to do Galen in the close of his Book of Tumors writes That there was not any one kind of these preternatural Tumors which there he had omitted but that he had spoken of them all and had not left any one unmentioned And out of that Book Johannes Philippus Ingrassias in his Book of tumors first Tract first Chapter and second Commentary pag. 77 hath collected Sixty one Tumors which he reckons up in this order 1. Corpulentia 2. Phlegmone Tumors their number and names according to Galen 3. Abscessus calidus 4. Sinus 5. Fistula 6. Abscessus ex solidis humidisve corporibus that is to say an impostumated matter issuing from solid and moist bodies 7. Atheroma 8. Steatoma 9. Meliceris 10. Anthrax 11. Cancer 12. Gangraena 13. Sphacelus 14 Erysipelas 15. Herpes similiter 16. Herpes Esthiamenos 17. Herpes miliaris 18. Scirrhus 19 Ecchymosis 20. Aneurisma 21. Oedema 22. Phagedaena 23. Vlcus Chironium seu Telepium 24. Scabies 25. Lepra 26. Elephantiasis 27. Exostosis 28. Satyriasmus seu Priapismus 29. Achor 30. Cerion 31. Myrmecia 32. Acrochordon 33. Psydracion 34. Epinyctis 35. Dothien 36. Phyma 37. Bubon 38. Phygethlon 39. Struma 40 Sarcocele 41. Hydrocele 42. Epiplocele 43. Enterocle 44. Entero epiplocele 45. Cirsocele 46. Varices 47 Bubonocele 48. Exomphalos 49. Ascites 50 Tympanites 51. Anasarca 52. Epulis 53. Parulis 54. Thymus 55. Vva 56. Paristmia 57. Antiades 58 Polypus 59. Encanthis 60. Vnguis 61. Staphyloma But Ingrassias himself not content with this number Tumors their number and names according to Ingrassias Tumors of the Head are twenty seven adds unto these one hundred sixty five more to wit of such properly belonging unto the head twenty seven the which in page 301. he enumerates after this manner 1.
again forced unto some other parts until at length it come unto the weakest which is not able to expel these transmitted humors so that being here left they cause a Tumor For it cannot be that a Tumor should be caused by the matter transmitted and sent from divers places unless we grant as needs we must that there is a part which sends them a part receiving them and the passages by which the humors flow The parts do then transmit when the vigorous faculty by the quality or store of matter is incited to expulsion For unless the faculty were provoked it would never attemp this expulsion and unless it were strong and vigorous it could never effect it And this is likewise much furthered by the external causes exciting the fluxion to wit Heat which attenuates and dissolves the humors and cold that by constriction presseth the parts together and thereby causeth the greater afflux of the said humors Notwithstanding unto these two may be added also a third cause of the defluxion and that is a certain 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 or violent issuing forth of the humor it self as usually it doth appear in persons that have the Dropsie where we find a water through its own weightiness descending into the Feet and Cods which motion notwithstanding is wont to cease in the night time but this would not be if the humor were expelled by Nature and not rather as in truth it is forced down by its own gravity Now as for the humors flowing together from elswhere the parts receiving they are received by such parts as are feeble and through their weakness altogether disposed for the reception of a fluxion For evermore the more vigorous Members send away that which is superfluous unto the weaker The weaker Members we account such as either have contracted a certain debility in their very first formation or being afterward hurt do contract unto themselves a kind of preternatural constitution or else they are such as Nature her self makes and intends for weak and so framed and constituted that they may the more easily receive the excrements of other parts such are the skin and the parts loose and porous For Nature that she might the better preserve the principal and more noble parts from Diseases hath purposely ordained in mans body some certain parts weak and feeble that so the principal parts oppressed and burdened with Humors might into them empty whatever is superfluous and burdensom and these as we have said are the skin and glandulous or kernelly parts And hence it is that the Heart transmits the peccant humors unto the Arm-pits the Brain sends them behind the Ears and the Liver thrusts them forth to the Groyns The parts ready to receive are al those that have any connexion with the part that transmits the humors and which have the passages through which the humors are conveyed alwaies patent and open but as for waies whereby to expel and drive them forth they are either none at al or otherwise such as are exceeding narrow and over streight or else lastly these passages are so scituated that they lie directly under the parts transmitting so that the conveyance of Humors unto them from the abovesaid parts is render'd the more facile and easie As for the waies and passages through which the humors run the passages by which the tumors flow they are either such as lie hid or else such as are open and very manifest For whereas the whol body is confluxile that is to say apt and ready to flow together hence it is that the humors have their fluxion out of one part into another by these occult or hidden passages So the Whey as we may term it being gotten in great abundance into the Abdomen or Cavity of the Belly commonly called the Paunch by these privy Passages descends into the Cods and the Thighs and lifts up the said parts even unto a Tumor or swelling the same which likewise very often happens in other parts Somtimes the humors assembled together betwixt the Skul and skin of the Head descend thence along under the skin into the inferior parts but very seldom and rare it is that from hence any tumors are produced But most an end those humors which excite and raise tumors flow through passages that are patent enough the Veins and Arteries But that we may briefly come to speak of the differences of Tumors arising from Humors the differences of tumors whence they are taken although very many of these differences are accidental yet notwithstanding those by which the tumors proceeding from humors are truly and properly distinguished among themselves are taken from the variety of the containing Cause or the Humor as an efficient cause producing the Tumor Now the Humors are divers Blood Choler Flegm Melancholly black Choler Choler adust and Whey From which likewise various sorts of Tumors are excited and caused And then again one while the humor exciting the tumor is as we use to say simple and sincere from whence also the tumor proceeding therefrom is said to be a pure tumor or assoon again divers humors concur to the making up of one Tumor and from hence the Tumors which we term spurious that is such as are improperly so called take their Original The Signs Diagnostick It is easily known whether the Tumor proceed from the falling down of any part and if this be not the Cause we may then safely conclude that the rise of it is from the afflux of humors unto the part affected But now whether or no the Tumor takes its beginning from congestion or rather from fluxion may by this be discerned to wit that those Tumors which are caused by congestion or the storeing up of humors are a longer while and by degrees arriving at their perfection neither take they up so much room in the part nor lastly was there any the least preceding cause or sign of a defluxion But now if the tumor be generated from a fluxion it wil be discerned by the presence of the contrary signs And certainly if so be there were not in the grieved part any foregoing pain or heat it manifestly shews that the said fluxion is caused by a transmission and not by means of an attraction like as on the other hand a preceding pain or heat of the affected part argues the Tumor to proceed from the attraction of humors For the Signs whereby to discern and understand the times take this advertisement viz. That the beginning of it is then when the part first of al is perceived to be distended and stretch'd forth The increment or growth when as the part appears now to be elevated into an indifferent big swelling and when the Symptoms that accompany al sorts of Tumors are evidently augmented The state or heighth of it is when the swelling and with it together al the symptoms are at their highest pitch The declination is then when both the bulk of the swelling and all the
unless it make use of the blood for a vehicle or as we say a Conduit-pipe of conveyance and that the acrimonious humor it self excites a pain in that part into which it is thrust and shut up hereupon it is that there follows a conflux of blood unto that part and from it proceeds an Inflammation And much after this manner the Pleurisie the Peripneumonia or the Inflammation and Impostume of the Lungs the Quinsie the Phrensie the Inflammation of the Ears and Gums the hot Tumors or Swellings in the groins called Bubones Carbuncles and such like are generated and excited The Differences The principal Differences of an Inflammation are taken from the variety of the containing cause and from the great difference of the blood that stirs up and begets the Inflammation For a Phlegmone is said to be for distinctions sake either that which is a true and legitimate one or otherwise that that is not a true Phlegmone but rather a bastard and spurious one The true and legitimate Phlegmone is that which proceeds from good blood and such as is in a due natural temper or at leastwise such as whereof there is more than ordinary store and this is absolutely and simply termed a Phlegmone But the spurious and counterfeit Phlegmone is that which hath its rise and original from corrupt and vitiated blood and such as swerves from its natural temperament and this may be occasioned two manner of waies for if the blood doth neither lose its nature nor change its substance but only hath mingled together with it some other Humors then there are three bastard spurious sorts of an Inflammation that thence arise To wit if Choler be mingled with the blood producing an Inflammation it is then called Phlegmone erysipelatodes if Phlegm Phlegmone oâ—dematodes if Melancholy Phlegmone scirrhodes But if the blood change its substance it then excites not any kind of blood-Tumor for the blood as Galen writes upon this very subject in his 2d Book of the Differences of Feavers Chap. 9. if it be overmuch heated and as it may be so expressed boyled to an extream intense heighth then it s more subtile and fat part is converted into yellow Choler but the more thick part into black Choler or as we usually call it the Melancholy humor The Signs Diagnostick The Signs of Inflammation as may be gathered out of its definition are heat pain a swelling and stretching out of the part a renitency or Resistance a redness of color and a pulsation or beating 1. And in the first place in this kind of Tumor there is present so intense a heat that from it the Tumor hath its very name and denomination and many indeed are the causes wherefore this heat is necessarily raised and stirred up For first of all the blood that through its overgreat abundance excites the Phlegmone is hot which heat it also communicates to the part affected Moreover whenas by the plenty of blood and oftentimes likewise by a certain kind of thickness al the pores are so filled up and obstructed that the hot exhalations cannot sufficiently be sent forth and evaporated neither the heat eventilated or cooled as is ought to be the heat by retention of these exhalations and fuliginous vapors is much encreased Unto which also a third cause may be added to wit putrefaction for the blood contained in the inflamed part assumes at length a putredinous quality by which as is to be seen likewise in other things the heat is excited and communicated unto the part inflamed And this heat is somtimes greater somtimes less according to the greatness and growth of those causes The second sign is Pain for whereas there are two remarkable causes of pain an Intemperies or distemper and the solution of continuity they both of them take place in Inflammations For in truth this extraordinary heat by its distemper first of all excites pain and then the abundance of blood by filling ful and distending the part dissolveth continuity and thus doing is the cause of this pain Again the pain that is thus caused is various much different viz. distending or stretching out pulling or twinging pressing and burdening according to the variety of the parts affected but more especially there is present a beating pain which likewise for this very reason is peculiarly reckoned up amongst the proper signs of a Phlegmone and of which more hereafter In the third place a Distension For when the plentiful store of blood doth not only fill the Veins and Arteries but even the whol substance of the part all things are now distended and stretched out but chiefly the skin the which as it lieth round about al the other parts and hath a Membranous substance must necessarily partake of the distension and the extensive pain 4. Fourthly Renitency or resistance or as the Grecians cal it Antitupia in like manner follows upon this repletion and distension For albeit the inflamed part be not hard in its own nature yet it is so stuffed out and distended with store of blood that now it wil no longer answer the touch neither yield thereunto but resist and withstand it and withal it appears hard unto the touch 5. Fiftly the parts inflamed wax red the blood imparting this color unto them For there is nothing in mans body that assumes this redness of color besides the blood and flesh 6. And lastly In the sixth place there is perceived in the inflamed parts a Pulse and beating pain to wit when with grief and extream irksomness there is perceived a bearing of the Artery in the inflamed part which while the part was â—ound was not to be perceived From whence we are instructed as Galen writes in his sixt Book of the parts affected Chap. 7. that this beating pain doth not happen unto al the parts but only to such of them as have in them certain notable and remarkable Arteries The heating pain how it is caused and that have a part endued with an exquisite sense and when the Inflammation is raised up unto a magnitude worthy of observation Now this Pulsatory or beating pain chanceth from hence that when they are lifted up and distended the parts inflamed by reason of their store of blood do not allow nor afford a due free and sufficient room unto the Artery now distending it self but that themselves are rather stretched out by the Artery lifting it self up which said distension excites the pain And this pulsatory pain is then most of al perceived whenas the Inflammation tendeth toward a suppuration For then the blood boyls as it were and grows exceeding hot from whence it also comes to pass that it assumes and makes use of a larger space of room and so much the more distends the part by the which part the Artery is henceforth much pressed kept down in its motion which we cal Diastole and then afterward hereupon the Artery likewise compresseth and bears down the adjacent and neer neighboring parts that lie round
is not the original efficient cause of this said Tumor but rather of that which we usually call Herpes And in his Chap. 9. concerning Tumors he asserts that Herpes is bred or caused when a cholerick fluxion being indeed purely and exactly such happens to be excited and to exulcerate the Skin but that when this said cholerick flux is mingled with a waterish matter and with blood so is less sharp and when it rather swels up the part into a Tumor then exulcerates it that then an Erysipelas is excited But contrariwise in his Book of black Choler Chap. 5. in his fourteenth Book of the Method of Physick Chap. 1 2 3. and B. 17. Chap. 2. in his Book of the Differences of Feavers Chap. 5. and in his Book of the way of curing by Blood-letting Chap. 8. and in divers other places asserts that Choler is the cause of this Tumor which latter opinion of Galen most of our Physitians follow But truly if we lay aside the Authorities and Opinions of the Ancients and look wel into the thing it self and if we confer the name of an Erysipelas upon that Tumor that is so well and commonly known unto our Country-men and lastly if we take good notice of those things that dayly befall the sick Persons in a Disease so well known we shall then without any scruple judg the Opinion of Galen which he propounds unto Glauco in his second Book and Chap. 1. and in his Book of Tumors Chap. 9 to be by far the more true and probable For the very colour it self of the part affected being altogether rosie instructs us that Blood rather than Choler is the cause of this Tumor And although this kind of Tumor doth now and then from red or ruddy become yellowish yet notwithstanding this is not altogether true of every Erysipelas but only of some one certain species and difference thereof Moreover the humor that excites and causeth this Tumor is not altogether so sharp and tart as is Choler and for this cause doth neither exulcerate nor produce extream heat or over vehement pain Notwithstanding the Blood that excites this Tumor is the thinnest and most intensely hot and it is vulgarly said to be bilious or cholerick the same that Galen also tels us in his second Book to Glauco Chap. 1. where he writes that Choler alone when it lieth hid and secret and consists in some one member doth excite and cause the Tumor Herpes But then if so be that the fluxion shall be mingled and consist of blood and yellow choler being both of them hotter than is meet or else from the blood in this manner waxing hot and being according to its substance most thin we then call it an Erysipelas For albeit that Galen in very many other places asserts an Erysipelas to proceed from Choler yet not withstanding what he means and intends by Choler he hath sufficiently declared in the place before alleadged And if we consult experience and those accidents that betide the sick Parties we shall then find that he could not intend any thing but that Choler which they term natural and alimentary or nourishing that is to say the hottest and thinnest part of the blood but such as is now grown extreamly hot therefore the neerest that may be to Choler But now whatsoever kind of Choler we assign to be the cause of this Tumor whether yellow or pale or like the rust of Brass or Leek-coloured they wil not any of them agree with those things that happen in this Tumor Furthermore this humor hath conjoyned with it a depraved quality and a peculiar sort of corruption and before such time as it breaks forth it exciteth and causeth exceeding great streights not much unlike to those that the Plague upon the first invasion is wont to produce and therefore the same kind of Alexipharmaca or counterpoysons that we make use of in the Pestilence are here likewise to be administred for the expulsion thereof Notwithstanding the words of Galen and of other Authors that affirm the original of this Tumor to spring from yellow Choler may be drawn to a better sence I mean that they may be more rightly interpreted if we say that by Choler is to be understood the natural part of the blood which is more thin and hot and which is very commonly called Choler but it were more fitly and properly named a bilious or cholerick blood the which so soon as it begins to wax intensly hot and to boyl it then excites this kind of Tumor And very frequently there is also herewithal mingled a certain portion of a most subtile thin and intensly hot whey the which if thou hast a mind and art pleased to cal it a bilious cholerick whey I wil not gainsay or oppose thee and then there is bred an exulcerated Erysipelas yet only superficially like as oftentimes it is wont to happen in the Face when there arise and appear little bladders ful of a waterish humor and then the Skarf-skin alone is affected and parts assunder But if together with it the Skin it self shal be exulcerated which ever and anon chanceth in the Thighs then we may conclude that adust humors are therewith mingled and this kind of Erysipelas is said to be not pure or if you will impure But of this Tumor enough hath been spoken in the second Book of Feavers Chap. 16. which here we judg it not fit to repeat in regard that there the Reader may by perusal be fully acquainted with what hath been written I wil only repeat this that the first rise of this affect is from a Feaver or move plainly that the affect is primarily and originally a Feaver For neither doth an Erysipelas or Rosa invade the part but with a Feaver which oftentimes a day or two before it breaks forth is wont exceedingly to afflict and excruciate the sick Person But this Feaver is critically determined as we wont to express it and the Patient freed therefrom by means of this Tumor and thereupon it is that oftentimes a pain or some kind of swelling is perceived in the Glandules under the Arm-pits or else in the Groyns until that at length Nature shall have driven forth the matter unto some extream part of the Body for then the Feaver is wont to cease albeit the Tumor is wont to stick and continue in the part affected for a certain space after Touching the Cure this likewise is to be observed like as it hath been more at large declared in the place before alleadged that it ought to be altogether perfected and compleated and we must use the utmost of our endeavor that the humor the conteining cause thereof may be called forth and not retained therein since that by the deteining thereof greater evils are wont to be introduced and made way for which may sufficiently appear even by the example of that Country-man or Peasant mentioned by Gulielmus Fabricius in his first Century Observ 82. who having
and the very natural flesh it self wanting and that Ulcer is no simple and single Disease but a Compound one such as is conjoyned with magnitude augmented There may likewise together with an Ulcer be conjoyned divers other Diseases a Distemper an Inflammation an Erysipelas an Excrescent Flesh and other Diseases which yet notwithstanding belong not unto the Essence of an Ulcer but may be taken away the Ulcer stil remaining the essence whereof doth consist only in the solution of Continuity together with some kind of diminution of the part affected The Subject of an Ulcer is a part soft or fleshy The Subject the word Flesh being here taken in a large acceptation viz. not only for the Musculous flesh but for that likewise that comprehendeth the flesh of which the Intestines the Bladder and other of the Bowels consist and herein lieth the difference between it and the rottenness that is in the Bones The Causes The neerest Cause is any matter whatsoever it be that hath in it any corroding quality which comprehendeth under it not only the sharp humors that are bred in the body but likewise all those external Causes that have in them a corroding power such as are corroding Medicadicaments and poysons for it is false that which some assert that the very same Ulcers arise only from internal Causes since that experience teacheth us that the very same Ulcers may be excited also from external Causes And so Galen himself being witness in his fourth Book of the Method of Physick and Chap. 9. it is most apparently known even by experience it self that by the Fire scalding hot water Oyl and other the like fervent juyces in burnings and scaldings they are not Wounds that are excited but Ulcers like as also Medicaments and Poysons that cause putrefaction and burning excite Ulcers And so poysonous and contagious vapors breed Ulcers like as Scabbiness by contagion and infection breedeth Scabbiness to wit whilest the Contagion that is imparted and communicated unto the Skin corrodeth it And in the very same manner the vapors that are drawn in by breathing from the Lungs of Phthisical Persons do exulcerate the Lungs and by contagion do breed a Phthisis or Consumption And in the like manner upon the very same ground Venome and Venereal Poyson being rub'd and chaf'd into any body or by any means communicated thereunto infecteth and exulcerateth the same Neither is it of any weight or moment that Eustachius Rudius endeavoreth to reduce such like Ulcers as these rather unto Wounds then unto Ulcers For by this means he confoundeth altogether the Difference that is betwixt Ulcers and Wounds in regard that Ulcers Wounds do not differ only in this that Ulcers are evermore with a loss of some of the substance whereas Wounds may be without any such loss but likewise in that Wounds arise from some Cause that either cutteth into the part or pricketh it or breaketh or bruiseth it but these to wit the Ulcers proceed from a Corroding Cause whether it be external oâ— whether it be internal And this is also manifest in Medicaments that putrefie for who can deny that to be an Ulcer that is excited from the Juyce of Spurge from the which said Medicaments that Contagion that is in Scabies the French Pox and the Phthisis or Consumption differeth but very little For although as Rudius there Objecteth we do not deny that such like Poysons have likewise in them a power of infecting the humors which being corrupted may afterward also promote these Ulcers yet notwithstanding we say that all power whatsoever of corroding is not to be denied unto this very Contagion it self although afterward when the corruption of the humors happeneth in the body the increase of the Ulcer be thereby much promoted and furthered The Differences The Differences of Ulcers some of them are Essential others of them only Accidental The Essential are those that are taken from the very form of the Ulcer from the Subject and from the efficient Cause thereof Those that are taken from the form of the Ulcer are drawn from its figure its magnitude and the like For some Ulcers are great others but smal some of them long others short some of them broad others but narrow some straight others again oblique wreathed in and fistulous some of them equal in which the flesh in all the parts of the place affected is equally wasted others unequal in which there is a greater part of the flesh consumed in this place and a less portion in another place of the same Ulcer From the part affected some Ulcers are said to be External others Internal some sleight and superficial others of them profound and deep and they may be in this or in that part The Differences arising from the Causes shall he shewn in the next following Chapter wherein our purpose is to treat of the Causes of Ulcers But now the Accidental Differences of Ulcers are those that are taken from such things as are without the Nature Constitution of the Ulcer and they are such as are taken from the scituation of the Ulcer or else from their time viz. that some of them are Recent and new others of them old and inveterate And hither likewise there may not unfitly be referred those Differences that are taken from Causes accidental and such as are not common unto all Ulcers to wit that some Ulcers are joyned together with a fluxion but that others of them want the said afflux that some of them are pure others of them sordid and soul corroding eating up and Creeping along For these Differences depend upon the Causes And hitherto likewise belong those Differences that are taken from the Accidents and Symptoms of the Ulcers to wit that some of them are altogether void of pain others of them accompanied with a pain an itching pricking and burning some of them easie to be cured others difficult and rebellious by the Greeks called Dysepulota some of them benign and favorable others such as have contracted a most pestilent and malignant quality And hither likewise are to be referred those Ulcers that they commonly call Chironia and Telephia And yet nevertheless besides these Differences that may be properly called such there may yet some others be given that are improperly so called and such as may rather be termed the Complications of Ulcers with other Diseases then Differences and such like Differences are these to wit that some Ulcers are conjoyned with Pain a Distemper a Phlegmone a Callous or Brawny Flesh a Gangrene a Cancer Worms and the Rottenness or Corruption of the Bones And the truth is the Differences and Distinctions of Ulcers are drawn from the Springs aforesaid But it being a truth likewise that some of the sorts of Ulcers are taken and drawn from divers and several Fountains that so we may not treat of Ulcers without any Method I conceive that our Discourse touching these Ulcers will be most Methodical if we handle them in the
ceased and his strength by degrees returned there being no purulent spittle at all that offered to come forth his Cough likewise and difficult breathing were not very urgent and troublesom neither for the first Week did any heat and thirst very much affect the sick person in the interim the wounds being handled after the Vsual manner there daily flowed forth an indifferent Quantity of well concocted pus or purulent matter These means being continued unto the second month and the External wounds being purified and consolidated the sick person was suddenly taken with a most dangerous suffocation so that he was in great peril of being strangled by an Asthma as it were and he was likewise very much afflicted with a cough Atrophy and Hectick Feaver until at length the imposthume of the Lungs brake and with the Cough five or six pints of purulent matter were cast up at his mouth after which the exulceration of the Lungs being cured by fit and proper Remedies the consumption Fever Hectick and all the rest of the symptoms remitted and the Patient was restored unto his perfect health To wit those Wounds of the Lungs are not mortal in which only the substance of the Lungs is hurt and not the great vessels and such as are not so great that they abolish respiration or suddenly destroy the vital faculty either by their dislipating the sprits through some notable Hemorrhage or else suffocating the heart by pouring out the blood upon the Lungs and upon the heart On the contrary if the wound of the Lungs be great and that not only the substance of the Lungs but likewise the great vessels that are therein to wit those notable and observable branches of the Arterial vein and the veiny Artery be wounded those wounds are mortal being such as in which the blood and vital spirit is poured forth and dissipated or else through the overgreat abundance of the blood the Lungs and heart are oppressed and the Patient suffocated Hippocrates in the place alleadged in Coacis addeth yet another cause of death which yet nevertheless doth not bring so sudden a destruction unto any person as those in the former case even now mentioned where the wound being great it is not the vessels containing the blood that are indeed hurt but the great and rough Artery so that by reason of the largness of the wound there is more breath that goeth forth by the wound then by the mouth for then by reason of the sympathy the heart is affected the vital spirits dissipated the Lungs and heart by the ambient Air altered and offended And indeed those wounds of the Lungs bring death likewise in which either the substance of the Lungs beginneth to be exulcerated and that a Consumption is excited or in which the blood is poured forth into the Cavity of the Thorax where it beginneth to putrefy and where it causeth either a feaver or an Empyema But in regard that this doth not alwaies happen and not at al in some wounds of the Lungs and that likewise when it doth happen there is no necessity that the Patient die for this cause therefore those wounds of the Lungs are not to be accounted necessarily Mortal For Felix Platerus in his 3. B. of Obsrv Page 690. relateth that a certain person that he knew falling into a Consumption from a Wound of the Lungs was yet nevertheless Cured and perfectly recovered A certain Coffermaker sayth he one of our Citizens having from a servant of his received a wound very deep in the lowest part of the Thorax by a prick from the point of a knife by the wound he voided forth a most stinking and loathsom pus or matter by the ill savor whereof the whol neighborhood was infected and offended and likewise some certain smal parcells of his Lungs in which the cartilaginous branches of the rough Artery did manifestly appear which persevering a long time albeit that he was in a manner wholly wasted away yet nevertheless at the length the flowing forth of the purulent matter remitting the wound was closed and he restored unto perfect soundness living after this many years as a foot-post in carrying of letters and thus he prolonged his life for forty years safe and found as we say although as it is very probable he wanted great part of his Lungs in one side The wounds of the rough Artery Fifthly That the wounds of the great rough Artery commonly called Aspera Arteria are not mortal but that they may be cured even the Laryngotomy or Cutting of the Laryinx of which we have spoken before in the Second Book of our Pract Part. 1. Chap. 24. doth evidently demonstrate To wit those of them are cured that are not great and in which the membranes only by which the rings of the rough Artery are fastened and linked together are wounded examples of which Schenkius in the Second Book Of his Observat hath collected And I my self also have twice seen such like wounds cured But if those very cartilaginous rings be wounded by reason of their hardness the part cannot again be made to grow together as formerly as Hippocrates teacheth us in the sixth of his Aphorisms Aph. 19. And in the seventh of his Aphorisms Aph. 28. and Galen in Book 5. of his method of Physick Chapt. 7. And yet notwithstanding such like Wounds do not cause a sudden death but a flow and lingering one while that the Lungs are either altered and weakned by that Air that violently breaketh in upon the Lungs thorow the wound or else that a certain smal gobbet of flesh grow unto the wound which by intercepting the breath at the length choaketh the Person But those wounds alone of the rough Artery throttle the Party in which the jugular veins and Arteries being hurt the blood violently and al at once rusheth into the Lungs intercepteth the breathing and so suffocateth the wounded person which yet nevertheless happeneth not by reason of the wound of the said rough Artery but by reason of the wound of the Jugular vein or the soporal i. e. more plainly the sleep-conveying Artery that is very neer unto it Wounds of the Diaphragm Sixthly Hippocrates reckoneth up the Wounds of the Diaphragm among those wounds that are mortal But Galen in his Book 5. of the Method of Physick Chapt. 9. distinguisheth between those wounds of the diaphragm that are inflicted upon the nervous part therof those that are made in its fleshy part and those he wil have to be mortal but these latter Curable And yet nevertheless in the Sixth of the Aphorism Aph. 18. he writeth that the wounds of the nervous part of the Diaphragm are not alwaies mortal but that the great wounds therein are only so For then it is indeed that those grievous symptoms plainly appear viz. a deliry or stupid dotage difficult breathing Feavers Convulsions and as Aristotle hath likewise observed in his third Book of the parts of living Creatures and tenth Chapt. the
out into three scituations viz. The inward outward and hinder part towards the ham but the opposition of the patel bone hinders its falling out to the fore part of which shal be spoke hereafter in the Luxations of the particular parts The Difference is taken from the Efficient Cause From the Efficient Cause because the Luxation is somtimes from external Causes as fals blows jumpings running and from a violent distorsion extension and impulsion of the part but somtimes from internal causes as while a humor sliding into the cavity of the joynt drives it out of its place There are also certain improper Differences Improper Differences or rather complications of other preternatural Affects with Luxations as that an Inflammation fracture wound or somwhat else is joyned with the Luxation Signs Diagnostick A Joynt being fallen forth into another place is easily known by the sight and touch for there appears a Tumor in the part into which the joynt is fallen but a hollowness in the place from whence the joynt is fallen and that appears so much the easier if the body be not very thick and fat or the place be void of flesh Again if the Luxation be perfect that Member is made shorter whenas the joynt no longer included in its Cavity but falling out of it is drawn upwards yet somtimes the Member becomes longer as is afterwards said in particular When then the Member luxated is alwaies unlike to the sound one in scituation figure and longitude we must alwaies compare the Member affected with the like sound part of the same name Arm with Arm Thigh with Thigh in the same man where yet we must observe that the Member with which we compare it be found and have no fault Thirdly because Articulations are made for motion if a joynt fal out of its natural seat it must needs be that the motion of the joynt is hurt therefore where there is a suspition of a Luxation yet the motion is not hurt we must conclude that there is yet no luxation made Lastly because a joynt falling forth of its seat doth compress the sensible parts into which it is fallen as the Tendons Nerves Muscles from thence there is raised a pain And these are the signs of a perfect Luxation but if there be only a Subluxation the Signs propounded wil either be more gentle or some of them wil be wanting If there be a Luxation of a joynt joyned by a Synarthrosis in which the Bones do gape it is known by the thickness of the Member greater than usual and by a greater bunching out than the heads of the bones do consist of As concerning the Causes The signs of the Causes the external and violent are apparent by the relation of the Patient and the Luxation proceeding from thence happen suddenly but if the Luxation he by reason of the loosness of the Ligaments it happens by degrees and the luxated Member is moved and totters up and down with inordinate motions and whiles the joynt is forced into its seat the Member indeed acquires its natural longitude which being let alone again presently it becomes longer Also if the head of the Bone luxated be thrust with the fingers to the contrary part it easily recoil back every where about the joynt there is a Cavity begotten that if the finger be thrust into the joynt it easily goes in no body resisting as if al were empty When some Epiphysis is pulled off from its being it is known by the impotency of motion and by the crackling when they are handled and moved Prognosticks 1. In the Bodies of Children and yong folks and those that are softer the bones luxated are easily restored yet being restored are not so faithfully retained the contrary happens in riper and harder bodies 2. The Joynts which are dedicated to fewer differences of motions are more difficultly replaced but better contained 3. By how much the further the joynt is fallen from its bosom by so much the more difficultly 't is restored by how much the neerer by so much the sooner 4. The Luxations in which the brows of the bones are broken are worst of al for though the joynts be restored to their places yet they continue not long but fal out again upon the sleightest cause 5. The joynts which are fallen forth by reason of the Laxness of the Ligaments though they be replaced yet do easily fal forth again 6. Those Luxations which have a great pain inflammation or wound happen on them are hard to be cured and want not their danger and cannot be restored without danger of Convulsions nay of death Wherefore if the bone being reduced the Nerves be distended it must presently be forced out again as Celsus doth counsel 7. Old Luxations and which are grown hard with a Callus and which have a clammy humor filling up the Cavities of the Bones are never or very hardly cured therefore every Luxation must presently be replaced 8. They who in their Childhood have had their joynts fal forth and are not replaced they grow less than others 9. What Member also soever hath been troubled with a long continued Luxation by how much 't is the less able to be moved by a natural motion by so much the more 't is extenuated and wasted both because by intermission of motion the Native heat of the part is dulled and because the Vessels are comprest by the luxated joynt and the necessary influence of blood and spirits is hindered 10. A Luxation of the head brings death by reason of the compression of the Spinal Marrow presently at its first rise and the prohibition of the influx of animal Spirits We shal afterwards speak in particular of the Prognosticks of the rest of the joynts The Cure The Bone luxated and which is fallen out of its natural seat shews a reposition to its natural place and this Indication is satisfied and Luxations are cured by straining and forcing them to the part opposite to that from whence the change is made which replacing of the joynts fallen forth of their seats is called ton arthron embole and arthrembole But the replacing of luxated Bones is compleated three waies either by the hands of the Chirurgeon and his Servants which is the most simple and is called Palestrical because 't was used in the wrestling places if at any time the Fencers Limbs were luxated and 't is convenient in soft bodies and where the evil is fresh or by some vulgar instruments the joynts are forced into their seats as by the help of reins swathes ropes ladders seats two leav'd doors which is called the Methodical way and is convenient for children women and the stronger males and for old luxacions or 't is performed by instruments and certain singular engines and 't is called organical and 't is applied to stronger bodies and old Luxations and altogether to those which cannot be restored the two former waies But concerning such Engines see Hippocrates de artic et
bosom of the head of the Thigh to the end that the Thigh might by so much the easier and more readily be bowed extended moved to the sides and turned about and not easily slip forth The Causes The Causes of a perfect Luxation of the Thigh are the same as of the Luxation of the Shoulder to wit external and violent a fal a blow or some other violent and indecent extension and distorsion of the Thigh but the causes of an imperfect Luxation are the humors flowing to this joynt and by degrees thrusting it out of its seat The Differences But this joynt fals forth to four parts the former hinder but seldom whenas the brow of the Cavity in this part is higher to the outer and inward part most often whenas at that place the brow is lower and somtimes the Thigh admits of a Subluxation from an internal cause whence when Paulus Aegineta lib. 6. de remed c. 118. writes that the Articulation of the Hip doth only suffer a Luxation and not a Subluxation that is to be understood of that only which is from an external and violent cause for we see oftentimes that by a flux of humors some have the Ligaments in the Thigh relaxt and mollefied that they cannot retain the head of the Thigh-bone firmly in its Cavity whence follows a certain Subluxation Signs Diagnostick the Diagnostick signs of a thigh luxated to the fore part If the Thigh be luxated to the fore part a Tumor appears about the Groins whenas the head of the Thigh leans to the Pubes the Buttocks on the contrary by reason of the Muscles contracted with the Thigh to the Pubes seem wrinkled the Urine is supprest by reason of the compression of the bladder by the head of the Thigh the external Thigh can neither be bent nor brought to the Groin whenas the head of the Thigh is in the very bending place the man is also in pain if he be forced to bend his Knee by reason of the former Muscle which ariseth from the bone which belongeth to the Loyns for that is comprest and being retcht is lift up by the head of the Thigh and whenas it can be no further extended it resists otherwise it equals in length the whol sound Thigh to the Heel for the Thigh going forth of its Cavity comes to the fore part and a little lower by which it comes to pass that the Thigh hurt equals the length of the sound one which especially fals out so at the Heel the Toes of the Foot cannot easily be extended nor turned to the ground whence in walking the Patient is compelled to tread only on the Heel But in them who at strong age have this joynt fallen forth into this part and not restored they when the pain ceaseth and the joynt is accustomed to be contained in that place into which it is fallen can forthwith go upright without a staff and wholly upright for by reason of the inflexibility of the Groyn they use the whol Thigh more straight in going than when it was sound somtimes also they draw their foot upon the ground whenas they cannot easily bend the upper iunctures which are at the Groyn and Knee although they walk upon the whol foot but in those at whose render age this joynt fallen forth is not restored their Thigh-bone is more diminished than that of the Leg or Foot but the Thigh is little diminished only the flesh every where is abated especially at the hinder part to the hinder part If the Thigh-bone be luxated to the hinder part there are contrary signs to those mentioned to wit The Head of the Thigh being fallen to the Buttocks is discovered by a Tumor about those parts both by the sight and touch the Groyns on the contrary appear more loose the affected Thigh by reason of the compression and distension of the Muscles compassing the head of the Thigh cannot be extended and 't is rendered shorter than the sound one the heel doth not touch the ground whence the Patients can neither stand nor go but fal headlong backwards because the body slides to that part and the head of the Thigh being out of its proper place is not directly opposed to under-prop the body yet the man may bend his Thigh if he be not hindered by pain for whenas the head of the Thighs is by force with its whol neck expelled into the great Muscle of the Buttocks which extends this Articulation this Muscle admitting the head of the Thigh fallen forth is most of al tormented whenas 't is distended and prest under it and of necessity must be seized on by an Inflammation but in process of time when this Muscle is freed from an Inflammation and contracts a certain glutinous humor that part of it which toucheth the joynt grows to a Callus and the Knee is bent without any pain moreover the head of the Thigh being luxated to the hinder part the Thigh and Foot appear moderately straight and do not incline much one way nor other But when in ripe age the Thigh-bone fallen forth is not restored when the pain is ceased and the joynt accustomed to be turned in the flesh the man indeed may walk yet he is forced to bow very much towards the Groyn when he walks and that for two reasons Because the Thigh is rendered much shorter and the heel is far off from touching the ground for if he try never so much to stand on that foot leaning upon no other thing he wil every where fal backwards but if in tender age this joynt luxated after this manner be not reduced the Thigh-bone is made short and the whol Thigh is spoiled and is less increased and made slenderer being for no use To the outer If the Thigh be luxated to the outer part it is known by these signs Between the Anus and Cod there is seen a Cavity and leanness on the contrary in the buttocks a certain Tumor the Thigh by how much the head of it is fallen forth to a higher place is rendered shorter the Knee with the Leg looks inwards the Heel toucheth not the ground whence when the Patient would walk he goes only a tiptoes And if in those of ripe age this Joynt be not restored but the flesh into which the Joynt is fallen grows callous and the pain therefore ceaseth they may go without a Staff and therefore when they use their Thigh in these the flesh is less offended but they to whom in tender age this misfortune happens require a diligent care for if they be neglected the whole Thigh becomes unprofitable and is little increased the flesh also of the whole Thigh is more abated then in the sound one Lastly a Luxation of the Thigh to the inner part is known this way to the inner the Thigh is longer if it be compared with the other and that for two reasons for the head of the Thigh sticks to the bone which proceeds from the Hip upwards
bent and moved Prognosticks Whenas this Articulation is more loose the Patel Bone may easily be restored to its seat The Cure That the Patel bone may be reduced into its seat let the Patient stand firmly upright upon a place but let the Chirurgeon with his hands force the Patel Bone from that part into which it is fallen to that from whence it is fallen when the Bone is restored to its place fit Medicines must be laid upon it and the hollow of the Knee must be filled up with Bolsters that the Thigh cannot be bent then a hollow piece of the figure of the Patel Bone must be placed about it especially on the side to which it fel that the Patient may not bend his Knee When there is no more danger lest the Parel Bone fal out again let the Patient by degrees accustom to bend his Knee again Chap. 11. Of the Knee Luxated THe Knee may not only be Subluxated but it may suffer a perfect Luxation and truly oftentimes fals to the inward and outward part seldom to the hinder part but seldomest of al to the fore part and not unless from a most violent cause in regard that the opposition of the Patel Bone doth hinder it The Causes This Luxation also happens from blows fals jumping vehement running and an uncomely extension or contraction and distorsion of the Legg Signs Diagnostick To what part the Knee is Luxated is easily known for in the side to which the joynt is broke forth a bunching out but a Cavity in the side from which it is departed is discoverable both by the sight and touch its figure is depraved the Thigh is extended and cannot be bent whence the motion is necessarily depraved or wholly lost Prognosticks 1. The Knee if it be compared with the Elbow the joynt in the Knee by reason of its manner of juncture oftener fals out and is easier reduced For the structure of the Bones with which both joynts are contained is more straight in the Elbow more loose in the Knee besides many processes and many bosoms joyned to one another do every where bind up the joynting of the Elbow but in the Knee the bunchings forth of the Thigh are cast into the smal Bosoms of the Leg. 2. For the same cause a Luxation of the knee is less dangerous nor doth an Inflammation easily happen for whenas an Inflammation ariseth from the force with which the bones are expelled and reduced again and the pain arising from hence because in the Knee the joynt may fal forth and be reduced without any great force there is no fear of an Inflammation The Cure The Knee luxated to the inward and outward part is not hard to be restored by moderate extension made either with the hands in a new Luxation and childs body or with reins in a Luxation not so late and stronger bodies and with forcing the bones with the hand into the contrary part from which they sel But a Luxation made backwards is commodiously restored if the Patient be placed with his Face on a Bench and some servant put a Linen Globe into the hollow of the Ham at what part the Bone sticks forth and strongly force the bone fallen forth towards the fore parts but let the Chirurgeon take hold of the lame Leg with both hands and of a sudden so bend and bow it that his Heel touch his Buttocks A Knee Subluxated by none or very little extension made and forcing it to the contrary part is reduced into its place When the Bone is reduced which is known by the free exten sion of the Leg and comparing it with the other Knee convenient Medicines must be laid upon it and binding up must be ordered and the Patient must forbear going til there be no more fear of a new Luxation Chap. 12 Of the Distraction of the Bracer THe Bracer adheres to the greater Bone of the Leg and as it was said in the former Chapter above to the Knee below the Ankle but 't is drawn from the great Bone three waies to wit To the fore part and both sides The Causes But this Divulsion comes from those Causes from which we said the Knee was luxated especially when walking in a slippery place the foot is not firm but dubiously is wrinched inwardly or outwardly the same may be by a fal from on high or by a blow Signs Diagnostick A Tumor appears in the part to which the Bracer is distracted and is discovered by the sight and touch and motion is hurt The Prognostick The reducing of the Bracer is easie The Cure For by the hands of the Chirurgeon it may easily be compelled and brought back into its seat by forcing it into that part contrary to its fal afterwards convenient binding up must be ordered putting bolsters to that part to which the Bracer is fallen and rest for some weeks must be commanded the Patient til the Ligaments are confirmed again Chap. 13 Of a Luxation of the Foot and its Bones and of the Toes BY the word Foot we understand al that part of Mans Body reaching out from the lower part of the Leg to the very ends of the Toes which contains divers Bones after divers manners joynted together and united by Membranous Ligaments to wit The Ankle the Heel the Ship-like Bone the Tarsus Metatarsus and Bones of the Toes of the Luxations of al which we should now speak but because the Bones of the Tarsus Metatarsus and Toes are here united almost after the same manner as the Bones of the Wrist after-Wrist and Fingers are to one another they are subject also to the same Luxations have the same causes are known by the same signs and are reduced the same way but the ship-like bone may suffer the same things as the Bones of the Tarsus it is not worth our labor to add much of these but those things which are said of the bones of the Hand may also be applied to these Luxation of the Ankle and Heel Some things only we shal add of the Luxation of the Ankle and Heel whenas no Bones in the Hand do answer unto these The Differences The Ankle joyned with the greater and lesser focil by a Ginglymus may be luxated perfectly and imperfectly to every part to wit The outward inward fore and back part But the Heel lying under the Ankle is often moved indeed more forward and backward but seldom to the sides The Causes The Luxation of these parts is from a violent fal a blow or some other inconvenient distorsion of the Foor But in particular the Heel is luxated and pulled from the Ankle if one leaping from on high do fal and stick heavily upon the Heel or in dancing doth insist much upon the Heel The Signs Diagnostick The Ankle if it be fallen to the outward part the lower part of the Foot is turned inwardly if to the inward part there are contrary signs if it be luxated to the fore part the broad Tendon
the Nerves and Tendons in general and of the pricking of the Nerves Page 2674 Chap. 16 Of the downright Wounds of the Nerves as also of the Ligaments by Cutting Page 2683 Chap. 17 Of the Wounds of the Joynts Page 2685 Chap. 18 Of a Wound with a Contusion Page 2687 Chap. 19 Of Wounds caused by the biting of Living Creatures Page 2689 Chap 20 Of Wounds by Gun-shot Page 2691 Chap. 21 Of Poysoned Wounds Page 2704 Chap 22 Of Particular Wounds Page 2710 Chap. 23 Of the Diseases and Symptoms that happen unto Wounds ibid. Chap. 24 Whether it be Lawful for a Christian by Amulets the Greeks cal them Periapta we Preservatives or else by hanging Seals about their bodies or by the like means to defend and preserve themselves from all danger by Weapons Page 2716 PART V Of Fractures Chap. 1. Of Fractures and the Cure of them in General Page 2727 Chap. 2 Of a Fracture with a Wound Page 2739 Chap. 3 Of a Fracture with a Wound in which there is no bone made bare and yet nevertheless a Cause to fear the falling forth of some fragments of the broken bone Page 2742 Chap. 4 Of the preternatural Affects that happen unto Fractures Page 2744 Chap. 5 Of Distorted and ill set Bones Page 2745 Chap. 6 Of Correcting the Callus that is greater or less then what it ought justly to be Page 2746 Chap. 7 Of the Slenderness and Weakness of the Member Page 2747 Chap. 8 Of the Fracture of the Arm. Page 2748 Chap. 9 Of the Fracture of the Shoulder Page 2749 Chap. 10. Of the Fracture of the Leg Page 2750 Chap. 11 Of the Fracture of the Thigh Page 2751 Chap. 12 Of the Fracture of the Nose Page 2753 Chap. 13 Of the Fracture of the Jaw bone Page 2754 Chap. 14 Of the Fracture of the Channel bone or the Bone of the Throat Page 2755 Chap. 15 Of the Fracture of the Shoulder-blade Page 2756 Chap. 16 Of the Fracture of the Sternum or Breast-bone Page 2757 Chap. 17 Of the Fracture of the Ribbs Page 2758 Chap. 18 Of the Fracture of the Spina Dorsi or Back bone Page 2760 Chap. 19 Of the Fracture of the bones of the Hand Page 2761 Chap. 20 Of the Fracture of the Hip-hone ibid. Chap. 21 Of the Fracture of the Whirlbone in the Knee ibid. Chap. 22. Of the Fracture of the Bones of the Foot Page 2762 PART VI. Of Luxations Chap. 1 Of Luxations in general Page 2669 Chap. 2 Of a Luxation with Pain Inflammation Wound Fractures Page 2672 Chap. 3 Of a Luxation of the Mandible Page 2674 Chap. 4 Of a Luxation of the Channel Bone Page 2675 Chap. 5 Of a Luxation of the Back bone and Ribs Page 2676 Chap. 6 Of a Luxation of the Shoulder Page 2677 Chap. 7 Of a Luxation of the Elbow and Radius Page 2681 Chap. 8 Of a Luxation of the Hand and its Fingers Page 2682 Chap. 9 Of a Luxation of the Thigh ibid. Chap. 10 Of a Luxation of the Patel Bone Page 2685 Chap. 11. Of the Knee Luxated ibid. Chap. 12 Of the Distraction of the Bracer Page 2686 Chap. 13 Of a Luxation of the Foot and its Bones and of the Toes bid Books Printed by Peter Cole Printer and Book-seller of LONDON at the Exchange Several Physick Books of Nich. Culpeper and A. Cole c. 1 Idea of Practical Physick in twelve Books 2 Sennertus thirteen Books of Natural Phylosophy 3 Sennertus two Treatises 1 Of the Pox. 2 Of the Gout 4 Twenty four Books of the Practice of Physick being the Works of that Learned and Renowned Doctor Lazarus Riverius 5 Riolanus Anatomy 6 Veslingus Anatomy of the Body of Man 7 A Translation of the New Dispensatory made by the Colledg of Physitians of London Whereunto is added The Key to Galens Method of Physick 8 The English Physitian Enlarged 9 A Directory for Midwives or a Guide for Women 10 Galens Art of Physick 11 New Method both of studying and Practising Physick 12 A Treatise of the Rickets 13 Medicaments for the Poor Or Physick for the Common People 14 Health for the Rich and Poor by Dyet without Physick The London Dispensatory in Folio of a large Character in Latine The London Dispensatory in twelves a smal Pocket Book in Latin Mr. Burroughs WORKS viz. on Matth. 11. 1 Christs call to all those that are Weary and Heavy Laden to come to him for Rest 2 Christ the Great Teacher of Souls that come to him 3 Christ the Humble Teacher of those that come to him 4 The only Easie way to Heaven 5 The excellency of holy Courage 6 Gospel Reconciliation 7 The Rare Jewel of Christian Contentment 8 Gospel-Worship 9 Gospel-Conversation 10 A Treatise of Earthly-Mindedness 11 Exposition of the Prophesie of Hosea 12. The Evil of Evils or the exceeding sinfulness of Sin 13 Precious Faith 14 Of Hope 15 Of Walking by Faith Twenty one several Books of Mr. William Bridge Collected into two Volumns Viz. 1 Scripture Light the most sure Light 2 Christ in Travel 3 A Lifting up for the Cast-down 4 Sin against the Holy Ghost 5 Sins of Infirmity 6 The false Apostle tried and discovered 7 The good and means of Establishment 8 The great things Faith can do 9 The great things Faith can suffer 10 The Great Gospel Mystery of the Saints Comfort and Holiness opened and applied from Christs Priestly Office 11 Satans power to Tempt and Christs Love to and Care of his People under Temptation 12 Thankfulness required in every Condition 13 Grace for Grace 14 The Spiritual Actings of Faith through Natural Impossibilities 15 Evangelical Repentance 16 The Spiritual Life and in-being of Christ in all Beleevers 17 The Woman of Canaan 18 The Saints Hiding place c. 19 Christ Coming c. 20 A Vindication of Gospel Ordinances 21 Grace and Love beyond Gifts New Books of Mr. Sydrach Simpson VIZ. 1 Of Unbelief or the want of readiness to lay hold on the comfort given by Christ 2 Not going to Christ for Life and Salvation is an exceeding great Sin yet Pardonable 3 Of Faith Or That beleeving is receiving Christ And receiving Christ is Beleeving 4 Of Covetousness Mr. Hookers New Books in three Volums One in Octavo and two in Quarto These Eleven New Books of Mr. Thomas Hooker made in New-England Are attested in an Epistle by Mr. Thomas Goodwin and Mr. Philip Nye To be written with the Authors own hand None being written by himself before One Volum being a Comment upon Christ's last Prayer in the sevententh of John Ten Books of the Application of Redemption by the Effectual Work of the Word and Spirit of Christ for the bringing home of lost sinners to God Dr. Hills WORKS The Kings Tryal at the High Court of Justice Wise Virgin Published by Mr. Thomas Weld of New-England Mr. Rogers on Naaman the Syrian his Disease and Cure Discovering the Leprosie of Sin and Self-love with the Cure viz. Self-denial and Faith A Godly and
Fruitful Exposition on the first Epistle of Peter By Mr. John Rogers Minister of the word of God at Dedham in Essex Mr. Rogers his Trearise of Marriage The Wonders of the Load-stone By Samuel Ward of Ipswich An Exposition on the Gospel of the Evangelist St. Matthew By Mr. Ward The Discipline of the Church in New-England By the Churches and Synod there Mr. Brightman on the Revelation Christians Engagement for the Gospel by John Goodwin Great Church Ordinance of Baptism Mr Loves Case containing his Petitions Narrative and Speech A Congregational Church is a Catholick Visible Church By Samuel Stone in New-England A Treatise of Politick Powers Dr. Sibbs on the Philippians Vox Pacifica or a Perswasive to Peace Dr. Prestons Saints submission and Satans Overthrow Pious Mans Practice in Parliament time Barriffs Military Discipline The Immortallity of Mans Soul The Anatomist Anatomized The Bishop of Canterbury's Speech Woodwards Sacred Ballance Dr. Owen against Mr. Baxter Abrahams Offer Gods Offering Being a Sermon by Mr. Herle before the Lord Major of London Mr. Spurstows Sermon being a Pattern of Repentance Englands Deliverance By Peter Sterry The Way of God with his People in these Nations By Peter Sterry Mr. Sympson's sermon at Westminster Mr. Feaks sermon before the Lord Major The Best and Worst Magistrate By Obadiah Sedgwick A sermon A Sacred Panegyrick By Stephen Marshal A sermon The Craft and Cruelty of the Churches Adversaries By Matthew Newcomen of Dedham A sermon Clows Chyrurgery Marks of Salvation Mr. Stephen Marshals New WORKS VIZ. 1 Of Christs Intercession or of sins of Infirmity 2 The high Priviledg of beleevers They are the Sons of God 3 Faith the Means to feed on Christ 4 Self-Denial 5 The Saints Duty to keep their Hearts c. 6 The Mystery of spiritual Life THE FIFTH BOOK OF Practical Physick OF THE EXTERNAL DISEASES THE FIRST PART Of Tumors Chap. 1. Of the Nature Causes and Differences of Tumors The names of a Tumor THAT External Affect which by the Latines is termed a Tumor Tuber Tuberculum i. e. a greater or a lesse Swelling the same do the Grecians call Onchus it is likewise by Hippocrates and the ancient Greek Physitians named Oedema Oedema For although in the account of latter Physitians yea and in Galen's time also such tumors as were soft and though roughly handled were yet altogether void of pain these only were said to be Oedemata which the Ancients with an addition called Oedemata Malthaca and Anodyna that is soft and painless Swellings Yet this word Oedema with Hippocrates and the more ancient Physitians signifieth in general all and every particular preternatural Tumor as is observed by Galen in the 1. Prognost text 29. in his Comment upon B. 4. of the Aphorisms Aph. 34. on the fift of the Aphorisms Aphor. 65 66. and elsewhere very frequently Somtimes also by a general name they cal it Phyma Phyma and then generally it signifies every Tumor that of its own accord and without any external cause breaks forth especially into some one or other outward part of the body even as a Plant shoots out of the Earth the truth of this will soon appear if we consult Galen in the sixth of his Epidemicks Comment 1. text 23. In the Books of the more modern Latines theirs especially whom they usually stile barbarous or illiterate al sorts of whatsoever Tumors are comprized under the name of an Apostem nay more Tumors whether rightly called Apostems among these latter Physitians there want not some who haply ignorant enough of the Greek Tongue make bold to write that all those are very much mistaken who assign any difference between the name of a Tumor and an Apostem which Magisterial Censure of theirs notwithstanding clashes both with the Authority of all the more ancient Physitians and the propriety of the Greek Tongue Apostem what it is for the Greek Physitians wil have only that Tumor or Swelling which is come to a suppuration to be called an Apostem as after in the third Chapter shal be shewn and by the Latines this Tumor is termed Abscessus and Vomica but by the more Modern and ignorant Authors it is rendered Exitura from a word taken out of the Interpreter of Avicen But now all Swellings or Tumors come not to a suppuration as for instance that which we commonly call Erysipelas or St. Anthonies fire Herpes and oftentimes Phlegmone which is an unnatural Swelling hot and red and of such like Tumors divers others Neither is this confusion and promiscuous use of names to be charged upon the Arabians but upon the illiterate Interpreters of them who have unskilfully tendered the Arabian words by such as are very unfit and improper For the Arabians altogether as exactly as the Grecians have made a distinction in name betwixt Tumors and Apostems calling Tumors by a general name Bothor but an Apostem they termed Dubellet and Dubellatum And therefore for the due and proper signification of each word the Authors that have written in the same and not in a differing Language are to be consulted that is to say as Galen in his smal Tract to Thrasybulus whether or no the art of preserving the health relate to Physick in the thirty second Chapter tels us if it be a word of the Assyrian Tongue we must for the right understanding of it have recourse to those who were the Authors thereof or if it be a word in the Persian Indian Arabian or Aethiopian Language or any other Tongue we must accordingly apply our selves to such as are skilful therein A Tumor Now then what a Tumor may properly be said to be we wil here make an exact inquiry with thiâ— proviso of which the Reader is desired to take notice that our chief and main drift is here to treat of such Tumors as are besides Natures intention and may therefore be justly ranked among the several kinds of Maladies or Diseases Now therefore every swelling or augmentation of a part beyond its natural habit may not be reputed a preternatural Tumor For although some men that are fat and gross grow to a breadth and thickness beyond their Natural habit yet notwithstanding whenas hereby there is not the least hurt or detriment of any one action caused in them in which case only somthing is said to be preternaturally affected these may not be said to have in them any thing that is beside the intent of Nature Every Tumor is not a Disease or preternatural but only somthing that is not Natural and above that which is according to Nature as Galen saith For there is this middle constitution betwixt those bodies that are in al points according to Nature and those that have in them somwhat that is preternatural or besides Natures intention as the same Galen gives us to understand in his Book of this sort of Tumors in the first Chapter thereof So then albeit haply the growth of some one part
may be extended beyond its natural habit yet so that this notwithstanding its operations may not be impeded and that there be not the least sense of pain accompanying it in this case we say that such like Tumor or Swelling is nor besides Nature neither as yet is it to be termed a Disease but rather a symptom And hence it is also that Galen in his Book of Tumors entitles it not of Tumors simply so called but of Tumors preternatural And much less reason is there that the Breasts of Nurses when they are distended with the abundance of milk and hereupon are wont to appear far greater than in thoâ—â— that give not suck and likewise in child bearing Women that the lower belly though exceedingly dilated in such especially who are neer their time of Delivery should be said to be affected with a Disease in regard that these things happen according to the course and Laws of Nature But what a Tumor is A Tumor what it is and unto what kind of Disease it belongs is not altogether so manifest For many and differing definitions hereof we find given by several Authors which here particularly to recite is not requisite nor worth the while and Galen himself seems now and then to thwart himself and not alwaies to be of one and the same judgment in giving us the definitions of this Tumor we are now treating of For in his thirteenth Book and first Chapter of the Method of Physick he tels us that a Tumor is a Disease wherein the parts have receded from their natural habit and quantity And in his first Book of the causes of Symptoms and the second Chapter he refers Tumors unto organical Diseases for there he writes that Phlegmones or Inflammations Scirrhos or hard Swellings in the Skin Abscessus i. e. Impostumes or Ulcers and other affects of this nature are to be accounted Diseases of the parts instrumental But in his Book of the difference of Diseases Chap. 13. and of the Causes of Diseases Chap. 6. he reckons up Tumors among the distempers arising from the first qualities and the diseases of the similary parts The Physitians likewise that have written since his time differ in their Opinions Fallopius adheres to Galen's Opinion in his 13. Book Chap. 1. of the Method of Physick before mentioned and refers Tumors unto those Diseases we cal instrumental to wit when there is a preternatural magnitude or augmentation Hieronymus Capivaccius in the Chapter where he writes concerning a Phrensie tels us that every tumor must needs be a disease in the intemperies or distemper proceeding from the first qualities and that there is no necessity why it should be accounted an Affect arising from an ill constitution which Opinion of Capivaccius is assented unto by Hieronymus Fabricius ab aquapendente But others there are among whom Eustachius Rudius is one who assert that a Tumor is an evil compounded of magnitude augmented and a distemper alwaies accompanying it as its concomitant and that the augmentation of magnitude with this intemperies or distemper proceeding as before said from the first qualities is the formal cause of every tumor and Rudius determines that those tumors only which are caused in the parts by reason of a preternatural afflux of matter are Tumors properly so called but that the Tumors happening in disjoyntings or dislocations in the falling down of the Intestines into the Cods and in the Tumor Aneurisma are not properly so to be accounted But if we exactly weigh this Controversie and withal accurately sift out the signification of the word Tumor and Onchus and likewise if we wil heedfully inquire into the essence of a Swelling as it may be considered in it self we must then with Galen rightly define a Tumor under the notion of a swelling The definition of a Tumor that it is an affect or disease in the which the parts of our body recede from their natural state by an augmentation of their magnitude For the word Onchus with the Grecians sounds as much as the distance of the parts to wit by reason of their being extended in magnitude breadth and profundity as is observed by Galen in the first Chapter of his Book of Humors so that it may justly be reputed a grand absurdity in the definition of a Tumor to assert that it is this or that and in the mean time to omit the augmentation of magnitude this being all one as to affirm that a Tumor may be without a Tumor that is to say a Swelling For although it be a truth which erewhile we hinted and that which Galen likewise observes in his Book of the differences of Diseases the twelfth Chapter that a Tumor if it be not such and so great that thereby any hurt and detriment shal accrue to the Member affected in any one of its operations is not properly a disease but a symptom and that that preternatural Affect ought to be defined rather by the intemperies or distemper that accompanies it and very much annoyes the actions then by the swelling which in no wise impedes or offends them Yet notwithstanding it wil not therefore follow that a Tumor also which is a disease and which doth indeed so greatly hurt and hinder the operations is to be defined rather by the dyscrasie and intemperies than by the augmentation of magnitude And the truth is that very frequently Tumors when they have their original either from a fleshy or from a boney and hard substance or lastly from a flatulent Spirit which is not internally either hot or cold are altogether free from an intemperies or as we commonly term it distemper In the mean time notwithstanding we deny not but that other diseases that are no way essential to a Tumor may yet be joyned with and accompany this augmented magnitude which doth altogether constitute and make up the essence thereof For if the matter causing the Tumors exceed in heat cold driness or moisture it forthwith derives this distemper unto the part affected insomuch that hence it comes to pass that the disease also then concurs and is concomitant with the intemperies or distemper Moreover if the same matter shal either by corroding or distending any part disunite what before was close and compact then there immediately happens that which we call the solution of Unity Somtimes also it comes to pass that the figure and shape of some part is altogether marr'd or at least very much vitiated and somtimes likewise the Cavities Pipes and Passages are either compressed or at leastwise very much obstructed through the abundant afflux of matter the which accidents very frequently if not for the most part concurring with a Tumor hence it is also that in the difference and cure of Tumors we handle not only the augmented quantity but likewise even al those other concomitant Diseases Mean while it stands good for an undeniable truth That a Tumor as such that is a Swelling is an affect or disease in the magnitude augmented
Eczesma 2. Elcydrion sive Papilla 3. Sycon that is a Fig or pushes in the head resembling it 4. Exanthema that is an Ulcerous blowing out like a flower 5. Ganglion 6. Hydrocephalus 7. Syriasis 8. Phrenitis 9. Lethargus 10. Typhomania seu agrypnon coma 11. Catochus Pauli 12. Catalepsis seu Catoche 13. Carus 14. Apoplexia 15. Rhia alsabian 16. Sibare 17 Fatera 18. Sekakilos 19. Testudo 20. Talpa 21. Topinaria 22. Lactumen 23. Cornu 24. Alopecia 25. Ophiasis 26. Pityriasis 27. Phthiriasis Those properly belonging to the Eyes and the parts thereof Tumors of the Eyes and their parts 63. sixty three which in page 351. he reckons up in this order following 28. Proptosis Galeni sive ecpiesmos Pauli 29. Taraxis 30. Ophthalmia 31. Epiphora introductorii 32. Chemosis 33. Xerophthalmia 34. Sclerophthalmia 35. Scirrhophthalmia 36. Phlyctaena 37. Bothrion 38. Coeloma 39. Argemon 40. Epicauma 41. Encauma 42. Myocephalos 43. Melon 44. Clavus Pauli et Aetii 45. Clavus introductorii Celsi 46. Hypopyon 47. Onyx that is Vnguis a Nail 48. Hyposphagma 49. Achlys Aetii 50. Nephielion Aetii 51. Vla or Nephelion 52. Leucoma 53. Sebel 54. Bothor Avicennae 55. Hymene panastasis 56. Nyctalopia 57. Anthracâ—sis 58. Carcinoma 59. Synchysis 60. Mydriasis 61. Proptosis Pauli 62. Ptylosis 63. Madarosis or Milphosis 64. Pladarotes 65. Emphyspma 66 Symphysis or Ancylosis 67. Eutropion 68. Laâ— ophthalmos 69. Trachoma 70. Sycosis 71. Tylosis 72. Dasyma 73. Pachytes 74. Barytes 75. Hydatis 76 Psocophthaâ—mia 77 Truhe 78. Thalazion 79. Porosis 80. Litâ—iasis 81. Alanâ—isac 82. Sude Avicennae 83. â—arcosis 84. Lupia 85. Mydesis 86. Pustula Abenzoaâ—is 87. Scleriasis 88. Anchilops 89. Aegylops 90. Epinyctis Plinii And 〈◊〉 these he mentions many more in other parts Tumors in all other parts of the Body 97. to the number of ninety seven and in this following order he sets them down 91. Auritus 92. Parotis 93. Pherea 94. Ozaena 95. Sarcoma 96. Theluâ— Albuc 97. Alharbian Avicennae 98. Chaisum Arabum 99. Haemorrhoides Arabum 100 Batrachos 101. Glossomegethos 102. Ancyloglosson 103. Aphtha 104. Cynanche 105. Paracynanche 106. Synanche 107 Parasynanche 108. Gongrona 109 Folium 110 Bronchocele 111 Alhadal 112 Dionysisci 113. Hypopion 114 Jonthi or Vari 115 Montagra 116 Ephelis 117 Ignis sylvaticus 118 Noli me tangere 119 Buttizaga 120 Gutta rosacea 121 Sparganesis 122. Chondriosis 123 Trichiasis 124 Gynaecomaston 125 Pleuritis 126 Peripneumonia 127 Phtoe 128 Althahalop 129 Napta 130 Cyphosis or Cyrtosis hybosis 131 Lordosis 132 Scoliasis 133 Coeliacus 134 Aurys Rasis 135 Colica 136 Hâ—os 137 Condylomata 138 Haemorrhoides 139 Marisca 140 Hepaticus 141 Cachexia 142 Altherel Bellunensis 143 Thelegi 144 Altherbel Bellunensis 145 Splenicus Aureliani 146 Nephritis 147 Lithiasis 148 Satyriasmus Pauli 149 Cercosis 150 Mola 151 Nymphomegethos 152 Kion Hippocratis 153 Seliroma Pauli 154 Arthritis 155 Podagra 156 Cheiragra 157 Ischias 158 Lupia Guidonis 159 Tophi 160 Cornua Avicen 161 Ancylosis or Ancyla 162 Paâ—onychia 163 Pterigion Celsi 164 Condya 165 Perniones 166 Gemursa Plinii 167 Dentes muris Bellunensis 168 Alliathan 169 Lupus 170 Dactilia Haliab 171 Malum moriuum 172 Terminthos 173 Emphysema 174. Phlyctaena 175 Turmusios Avicen 176 Impeâ—go 177 Essere 178 Palmos 179 Clavus 180 Calli. 181 Aegritudo bovina Abenz Albuc 181 Dracontium 183 Syrenes or Pedicelli Guâ—don Argelatae 184 Variolae 185 Morbilli 186 Rubeola 187 Crystalli 188 Exanthemata 189 Ecthymata Fernel 190 Hidroa or Sudamina 191 Epinyctis Romanorum 192 Bothon lenes 193 Ganglia 194 Seps Hippocr 195 Spina ventosa 196 Bubasticon Vlcus 197 Hypersarcon 198 Cacoethes 199 Sepedon 200 Nome 201 Therioma 202 Herpes Esthiamenos Celsi 203 Herpes ecthiomenos Avicen 204 Thymion Celsi 205 Ignis sacer Celsi 206 Cerion Pauli 207 Paratrimmata 208 Aposirmata 209 Zerma 210 Rancula 211. Spina 212 Morsus Diaboli 213 Patursa that is Morbus Gallicus 214 Scopuli 215 Tincosati 216 Pinitae 217 Spili 218 Tusius Aviceâ—â— 219 Eparma Hippoc. 220 Rosboth 221 Cunus Rasis 222 Albothir Albucasis 223 Nakir Albuc 224 Alchalan Abenz 225. Arcella Abenz 226 Rosulae sataritiae So that the number of all the Tumors recited by Johannes Philippus Ingrassias amounts unto two hundred twenty six But that Entities should be multiplied in this manner without any cause is altogether unfitting For as al the affects which are here reckoned up under the name of Tumors are not properly to be accounted Tumors besides that one and the same Tumor is somtimes repeated under different names So again Ingrassias having not at this time compleated the remaining Sections of his Works concerning Tumors it is not sufficiently apparent what Tumors he would have us to understand under some of these names Now for the truth of this that I may give you an instance or two of what hath been said he reckons up among Tumors Sinus and Fistula Vlcus Chironium and divers other Ulcers But before or since Ingrassias who hath there ever been that hath taken the liberty or made so bold to enumerate among the Tumors that are properly so called such as are these following viz. Lethargus Typhomania Catochus Catalepsis Carus Apoplexia Lordosis Coeliaca affectio Colica Affectus hepaticus Splenicus and other such like Affects which relate either to Symptoms or the kinds of other Diseases rather than unto Tumors And in very truth many of the Tumors wherewith this Catalogue is stuft are not peculiar kinds of Tumors but only differences of their species according to the parts affected Tumors their Differences Now therefore we conceive that there are two main Differences especially to be heeded in Tumors one whereof ariseth from the variety of Causes and the other is by reason of the parts affected We have said before that the conteining cause of a tumor is threefold a Humor a Wind and a solid Substance Again the humors are various much different to wit Blood Phlegm Melancholy a black humor a waterish and wheyish humor and divers other thin excrements as also mixt humors and matter into which other humors degenerate and likewise malignant humors From the Blood there is caused an extraordinary Corpulency which the Greeks call Polysarcia and an Inflammation Their Cause containing There are likewise that refer a Gangrene a Sphacelus unto an Inflammation in regard that an Inflammation somtimes degenerates into them But because that a Gangrene and Sphacelus do very often proceed from other causes without an Inflammation and have not alwaies a Tumor to accompany them and are of neerer alliance unto Ulcers very usually degenerating into them we wil therefore treat further of them anon when we come to speak of Ulcers But with more right it is that unto an Inflammation we refer an Erysipelas or Rosa as it is commonly termed Bubo Furunculus Phyma Phygethlon Parotis Carbunculus Paronychia Perniâ—nes Ecchymosis as afterward from the special Explication of these Affects wil
with his own Eyes he beheld while they took out of an Impostume ful of filth and opened in the Calf of a Mands Leg a certain round substance or Globe such as is to be seen in Weavers Shops And Wierus in his Book of the Devils impostures Chap. 13. relates that in the incision of an Impostume on the left side of a certain Gâ—â— above the Spleen there was taken forth an Iron Knife and after it there issued out abundance of filth and corruption The like whereunto Langius also hath observed in his first Book and thirty eighth Epistle Now if any such strange thing chance to happen the Vulgar People are wont to ascribe it presently unto the Sorceries Spels and Charms of their Devilish Neighbors But there is no necessity why for all things that are evacuated out of Impostumes besides purulent matter we should by and by have recourse to such Causes as these or rank them among the supernatural Causes of humors seeing that many of these contingents may be generated out of the humors erewhile rehearsed For whenas Experience makes it manifest that in most parts of mans Body smal Stones Sand and Gravel Hairs or such like and also divers kinds of Worms may be produced out of the excrementitious humors and that likewise not only in the Body of man strange and wonderful kinds of Worms and other little Animals may be bred out of the Corruption of others it should not seem any great wonder that the matter in Tumors especially if it be naught and hath been long there shut up and deteined doth admit of those various and strange mutations happening by means of its rottenness and putrefaction But yet notwithstanding if such things be found in Impostumes that are come to a suppuration and likewise in Tumors which cannot be generated in mans Body by nature or at leastwise by Natures strength alone without the concurrence of Art such as are all things formed of Metals Bodkins Knives Iron Nayls and the like then indeed they cannot be referred unto natural causes but may upon more than probable Grounds be imputed unto the Impostures subtilty and power of the Devil But as for the manner how such things may be either generated in the Body or covertly conveyed into it is not my purpose here to determine I therefore proceed to dispatch what I have further to deliver touching the rest of the causes of Tumors that take their rise and original from the humors So then Tumors how caused by congestion or the heaping together of humors as for what concerns the causes remote be they what they will for their kind they may easily be known if we do but enquire into the manner how Tumors come to have their first being and withal take notice from whence and after what sort or by what means that humor which hath rightly gained to be stiled the containing Cause comes into the part affected Now therefore that humor which is the nighest and containing Cause of a Tumor is either insensibly and by degrees heaped up in the part or else altogether as in a heap which the Grecians express by the word Athroos flow into it The matter is gradually and by little and little gathered together in the part affected primarily and most especially by reason of somwhat amiss in the member to wit when either the concoctive power is grown weak and therefore cannot as it should digest the nutriment but generates more excrements than it ought to do or else when the expulsive faculty doth not cast out all the excrements as it ought to do and this may come to pass either through its own weakness or otherwise because the way by which those excrements should be ejected is not sufficiently open And again a humor is likewise then heaped together in the parts whenas the food it self is naught and unwholsom for hence it happens that either so great abundance of excrements are caused that the expulsive faculty cannot cast them al forth or else that they are so thick that Nature cannot easily expel them But upon what causes these causes do depend hath been already declared in its proper place nor is it requisite that we should at large repeat what hath been spoken Only in a few words take this That the weakness of the faculties wholly depends upon the intemperies or distemper of the parts and the decay of their native heat The passages are obstructed by overmuch and thick matter which happens to be condensed by the vehemency of cold Meats of an ill juyce produce store of excrements Now what these meats are Galen gives us to understand in his Book touching meats of a good and evil juyce A Humor then flows to some part this being in truth the more usual cause of Tumors when either it is drawn by that same part tumors how caused by an afflux How by attraction or transmitted unto it from some other place Attraction primarily proceeds from heat caused either by overmuch motion or from the heat of the Sun and Sun-beams from the fire or lastly from any sharp Medicine taken in For the parts so soon as they are heated by these causes draw unto themselves humors from the rest of the body although there be not therein any excessive store of humors and yet I deny not but that the more the body abounds with humors the greater is the store of them that is attracted Moreover Pain likewise frequently enough excites Tumors by attracting the humors unto the part aggrieved Yet we say not that pain of it self draws the humors but that this is done by some other means and commonly it is said to draw for these three causes First because Nature while she attempts to relieve the suffering part sends in an extraordinary supply of blood and spirits to the part in pain and this she doth with an endeavor more than usual so that by this means she over fills and hurts the parts she intended to succour Secondly the grieved part by this time grows hot from that abundance of blood and spirits transmitted thither by Nature and hereupon fals to drawing more than before by reason of this adventitious heat And lastly pain weakens the Members Now the Members once weakned if they attract not yet they readily receive and in the least resist not the matter flowing in upon them from several parts Secondly A Tumor is caused by a defluxion when as the humors are transmitted unto some part although they be not drawn by that part For whereas there is in every part a faculty not only of attracting al things familiar and agreeable unto it but also of expelling and casting out whatever is superfluous and burdensom hence it is that being stir'd up and provoked by the excess or offensive quality of the excrements and humors it expels and thrusts forth unto some other part whatever is useless or at least burdensom unto it Where if it be not digested or evacuated by transpiration it is thence
Tetrapharmacum that is made up of four Remedies viz. Wax Râ—zin Pitch and Fat. In Bodies that are soft and loose the fat of Swine but in bodies more compact Bulls fat is most approved for use For this is carefully to be needed in Maâ—uratives i. e. Ripening Medicaments that they ought to have in them the neerest resemblance that possibly may be unto the nature of that body whereunto they are applied And therefore in Children Women and generally in al bodies that are softer than ordinary the moister kind of Remedies take place and on the other hand in bodies more hard and close Remedies of the moister sort are required And this in like manner is to be understood touching the Nature of a tumor or swelling As to instance in Inflammations such Remedies as moderately heat and moisten provided alwaies as I said that they be temperate are used with the best success And yet notwithstanding because that in some other Tumors naturally more cold there is a maturation though more slow and the matter of them being thicker than ordinary if it be not converted into a laudable Pus or Quitrier yet it is turned into a matter neer of kin thereunto and the heat of the part although it be greatly furthered and carried on by temperate Maturatives yet can it not ripen the cold matter upon these abovesaid considerations Medicaments that are experienced to be somthing hotter are to be added unto the former The same is likewise to be observed in parts naturally cold as also in old age And hence it is that of such Remedies which ripen the crude matter in Tumors we constitute two kinds The Diffeferences of Maturatives Of the former sort are all those that are moderately hot and clammy which are of use in hot Tumors and these are properly such as are said to further and hasten Maturation of which sort are those before recited Hydrelaeum sweet Oyl Wheaten Meal and Flour Milk the Pith of white Bread the Fat of Swine fresh Butter Wax mingled with a double quantity of Oyl Mallows and Marsh-mallows decocted with Oyl the Mucilage of Linseed of Fenugreek of Mallows and of Marsh-mallows If any desire a Composition let him make such an one as this that followeth Take of the pouder of the Root of Marsh-mallows the Leaves of Mallows of each one ounce of Wheat flour an ounce and half of the seed of Fenugreek and Linseed of each half an ounce of Saffron half a dram boyl them in the Decoction of dried Figs or in Milk add hereunto of the Fat of Swine and the Vnguent Dialthea of each one ounce and make herewith a Cataplasm Of the second sort are such as are somwhat hotter which are to be used in cold Tumors and in colder Natures because there the parts likewise are colder and such are Turpentine the Gum of the Fir-tree the Larix-Tree and the Pine-tree dried Figs Raisons Fenugreek seed Lineseed Onions roasted under embers Leaven Oyl of Chamomil and Oyl of white Lillies the Fat of an old Hen old Butter Bdellium Galbanum and Ammoniacum Out of which such a like Cataplasm as this may be made Take of the pouder of the Roots of Marsh-mallows Wheat flour Linseed Fenugreek seed dry figs pounded to a Mash of each two ounces of Leaven half an ounce of the pouder of Chamomile flowers two drams let them boyl in a sufficient quantity of Water then add thereunto of the Fat of an old Hen and Oyl of Camomile of each an ounce and half and so make up a Cataplasm Or Take the Leaves of Marsh-mallows the roots of white Lillies Holy-hock Roots of each an ounce and an half Onions one ounce boyl them to a softness then mash them and pass them through a hair sieve Ad hereto of Wheaten flour Linseed Leaven of each one ounce Turpentine half an ounce of Saffron half a dram Oyl of Camomile and Hens fat of each a sufficient quantity and so make a Cataplasm The most usual are the Emplaster of Melilot and Diachylon magnum with Gums When as the corrupt stinking matter is arrived at its ful ripeness The Evacuation of stinking and corrupt matter or the matter of the Tumor is changed into an humor resembling this Pus so often mentioned it is then to be evacuated and cast out of the Body the which since it may be effected in a twofold manner either sensibly or by an insensible digestion the best course were more especially in the face lest that a Cicatrix or scar should ensue and remain upon the opening of the Tumor impostumated to discuss and scatter abroad the matter by an insensible transpiration for which very purpose certain Medicaments are described by Galen in his sixth Book of the composition of Medicines of the second rank the 14 15 and 16. chapters and there you may see them But it is not often that this happens and when it doth there is cause to fear lest that if there be great store of corrupt matter some part thereof should be left remaining and hardened or that if the filth aforesaid be acrimonious and corroding that then it may be rendered more sharp by delay and the application of Remedies that are hot and so by this means the part affected as also the parts neeâ— adjoyning should be greatly hurt and injured and therefore for the most part the safest way is to open the Apostem if it chance not in a convenient time to be opened of its own accord The opening of Apostems Now then an Impostume is to be opened in the highest and most eminent place where the skin usually is at the thinnest but then notwithstanding the incision must be in that place of the part affected which is most sloping that so the passage forth of the corruption may be rendered the more facile and easie Now the opening thereof is effected either by some Caustick Medicament or else by the help of an Iâ—on incision knife But most an end the safest way is to open the impostume with an Iron Instrument rather than by a Caustick Medicament For Medicines most commonly protract and delay the Cure excite and cause both heat and pain in the part whereupon it happeneth that the temper and constitution of the part which was before much weakened by the Disease becomes now wholly subverted and from hence dangerous symptoms do frequently shew themselves Now and then notwithstanding as for instance in the watery Tumor of the Testicles when with the Iron we cannot easily penetrate unto the bottom of the place wherein the vitious matter is contained we ought to use a potential Cautery For the way being once opened by a potential Cautery may afterward be dilated as much as we see cause for that so the Instrument may the better pierce the part and reach even unto the deepest place and bottom thereof The said operation with an Iron is effected whenas the opening is made by an Iron Instrument made red hot How many waies a
tumor may he opened or else with an Iron Incision knife that hath not been heated in the fire We very seldom make use of the hot Iron and then never but in cold tumors and that also only whilst the impostume is in those parts that have in them either many or else large Veins and Arteries that so the flux of Blood which we cal the Hemorrhage may the better be pre-cautioned and prevented But as for the Incision Iron that hath not been heated we use it most frequently and that with very good success But if it shall so happen that upon the opening of the Impostume somtimes pain and somtimes an efflux of blood shal ensue and likewise that by reason of the abundant evacuation of the matter or else that by pain and fear a sinking away or swooning should follow in this case we must endeavor that the Section may be performed with the greatest speed and the least pain that possibly may be If an Hemorrhage be feared we must have in a readiness those Medicaments that stop the flux of Blood as Frankincense Aloes the white of an Egg Bole Armenick Pomegranate flowers Dragons blood and the like To prevent fainting and swooning especially in Children Women and other fearful persons we ought to have at hand such Medicaments as are in use against this faintness of mind As also that there may be a right and orderly proceeding in the Section or opening The opening of a Tumor in what manner to be performed the condition of the part the scituation of the Veins Arteries and Nerves as likewise the Nature of the Muscles all these ought to be exactly known and learned by the Chirurgeon from what is written by Anatomists lest otherwise Veins and Arteries should be cut and an Hemorrhage thereby caused or that pain should arise from this hurting and cutting of the Nerves or that hereby the Member should be altogether deprived of sense or lastly that by the hurting of the Muscles the part should be wholly deprived of its motion Moreover also a special regard must be had unto the fibres in the Muscles so that the Section ought to be performed according to the conduct of these fibres that is to say not oblickly or overthwartly for this kind of Section wil greatly annoy the action of the part We must again heedfully weigh and consider in what measure and how great the Section ought to be For if it be over little the Pus or corrupt matter especially if it be thick and cloddy wil have no passage forth without compression of the part which wil both assuredly excite pain and beget a kind of brawny hardness in the part which may be the cause of a Fistula And on the other side if the section be made overgreat and wide there wil then be left remaining a great and unsightly scar and which is worse the ambient Air getting in wil alter the part and therefore the Section ought to be made in such a manner and measure as shal be most requisite for the evacuation of the Corruption and filth And although the section be somwhat with the least it may notwithstanding very easily be dilated by thrusting a tent into the hole thereof To make the Incision we admit of either the Razor or the Knife of Myrtle wood edged on both sides with which the Italians and French open Veins or else that Knife which we cal Phlebotomus which the Germans use or lastly that which we cal Syringotomos an Instrument crooked and of use only in the incision of an internal or a concavous body The incision being made if there be but little filth The evacuation of the Pus or corrupt matter the part is with the finger to be pressed down to the end that it may the more readily flow forth but if there be great store of this filth and matter it is then to be drawn forth leisurely and by little at a time lest haply if it should be evacuated al together suddenly and on an heap as it were much of the spirits should therewithal exhale and thereupon a fainting and swooning should ensue After Incision and the emptying forth of the corruption it will be convenient the first day to strow thereon the dust of Frankincense on the second day to lay thereon some kind of Digestive or other that so if any thing yet remain undigested the compleat digestion thereof may hereby be accomplished And if there be present any filth or any kind of uncleanness which may hinver the growth of flesh shal chance to occur they are forthwith to be wiped and cleansed away As for example Take Turpentine one ounce Honey of Roses half an ounce and of Barley Meal as much as is requisite and so make a mixture and use it for the purpose aforesaid If the Ulcer require yet a more forcible cleansing by reason of its extraordinary nastiness then we ought to use the stronger Abstersives as Vnguentum Apostolorum c. And at length Sarcoticks that is such Medicaments as cause flesh to breed and grow are wisely to be applied and the orisice of the Ulcer to be shut up with a scar Here we are to take notice That somtimes Impostumes may for a long space he hid not only underneath the external Muscles Of Impostumes lying hid two histories but likewise under the more profound yea and the more internal Muscles also Concerning the Impostumes of the Muscles of the lower belly or Paunch we have already spoken in the third Book Part 10. Chap. 7. As touching the Impostumes in the great Muscle Psoa Gulielmus Fabricius in his first Century and sixty third Observation relates two Histories And first he tels us that a certain Matron took her bed complaining of acute and extream pains about her Loyns which was accompanied with a Feaver swooning fits and difficulty of making water And when it was sufficiently understood by the kind of the pain and other signs and tokens to be an inward Impostume for outwardly there appeared not any thing neither could there any thing be discerned by the touch and that this Apostem could be no where but under the Psoa Muscle and when that the sick party was foretold the extream danger and hazard of her life unless the Impostume were opened and the humor caused to flow forth both her self and her friends gave their consent that on one side of the Spina dorsi or back-bone the skin and the exterior Muscles even unto the Psoa Muscle should be opened by an Incision with a Razor which was done accordingly and out there flows a purulent and stinking humor and so after that some certain cleansing and abstersive Medicaments had been for some few months applied she became perfectly recovered The other History which he relates is this In the Year One thousand five hundred eighty five a certain yong man aged twenty seven years or thereabouts as he was descending from the highest pitch of the Mountain Cinecius unto the
man who weighed more than four hundred pound yet notwithstanding this man appeared in publick and to tel you the whol truth in this Person Nature began to assay some certain kind of evacuation of the serous or wheyie humor by the Navel And the very same hath been found to happen unto others also in whom the Body hath attained unto so immense a bigness that they could neither move nor yet so much as breathe freely But now in such like Persons as these there is not an equal augmentation of all the parts of the Body as it is in them who grow and are naturally enlarged but only of their Flesh and of their Fat there is an excessive and over-great encrease The Causes The conjunct Cause therefore of this Tumor of the whole Body is the Flesh and the Fat. And here truly one while the Flesh and otherwhile the Fat is augmented and sometimes they are both alike encreased But the Antecedent Cause is the over-great abundance of Fat and good Blood And for this cause it is that this Tumor is referred unto Tumors proceeding from the Blood And yet notwithstanding the Reason of these is far differing from that of other Tumors arising from the Blood For the conteining Cause of bloody Tumors is the Blood but the conteining Cause of this Tumor is the Fat and Flesh and the antecedent Cause is the Blood The rest of the bloody Tumors that are properly so called spring from the Blood issuing out of the Veins or Vessels into some other places which never hapeneth in this extream and extraordinary corpulency in the which Blood is never known to fall or issue forth into other places but it is evermore put unto the Body But now what the Causes may be that much Flesh and Fat should be generated will easily and soon be discovered if we wel consider the Causes of breeding Flesh and Fat Now then Flesh is abundantly bred in those whom we call Eusarcoi that is Persons of a pure untainted and sound Flesh yet alwaies provided that the material cause of Flesh to wit nourishing Food be not wanting and likewise that the native virtue generating Flesh be as it ought to be vigorous and active That which administers matter towards the breeding of flesh is great abundance of good blood the which to produce and generate meats of a good and plentiful juyce and also a due and right temper of the Liver to wit hot and moist are evermore requisite But now again that much Flesh may be bred from much Blood it is required that there be a sound and healthful habit of Body and a good temperament of the musculous parts in the Body which said temperament is likewise hot and moist Hereunto also as we are to understand very much conduceth an easie or idle kind of life in the which there is not much Blood wasâ—ed as also the suppression of their accustomed bleedings and evacuations of Blood especially in Women As touching the original and increment of Fat many and various are the Opinions and controversies among the Physitians at this very day the which for me in this place to examin were altogether impertinent And therefore in a word we say that Fat is generated from the Oyly and fattish part of the Blood falling from out of the Veins and Arteries into the membranous parts and there digested by the innate virtue and temperate heat of the Membranes That great store of Fat should be bred in the first place the Liver is a principal cause thereof For if by reason of its excellent and perfect temperament it doth not generate either much earthy and cold nor much cholerick and hot juyce but produce a sweet fat and oyly Blood and fil the Veins and Arteries therewith and if this Blood be not consumed or wasted in the habit of the Body but that it stil continue to be more cool and moist then this Blood is there converted into Fat Ease likewise and the intermission of Exercise the retention of accustomed evacuations aliment temperately hot and moist and generally all things which either outwardly or inwardly any waies conduce to the making up of a plentifull and temperate mass of Blood or that have in them an efficacy in qualifying and allaying the over-intense heat of the Blood of the Entrails and of the habit of the Body Hence it is that Galen hath left it upon record that all Bodies tending towards a cold and moist temperament become Fat. And with this of Galen agreeth what Prosper Alpinus in his Book of the Egyptian Physitians Chap. 9. hath written his words are these The Bodies of the Egyptians saith he are hot and dry in regard that they live under the hottest and withall dry position of the Heavens but because they moderate and lessen this heat and driness by their dayly drinking of water by their continual use of meats that have in them a cooling virtue and likewise by their frequent use of Baths which they make for themselves with sweet Water their bodies hereupon become extraordinarily fat to fat that he never beheld in any part of the world in so great a number and generally such extream fat and gross Persons as he saw at Grand Cayre in Egypt For he reports that very many of them are so exceeding gross and corpulent and generally so fat in their Breasts that they have Paps of a far larger size and thicker than the greatest that ever he had observed in any Woman Other things there are which demonstrate unto us the truth of this assertion to wit that a hot temperament of the Liver makes very much for the breeding and augmenting of fat For I my self knew a Person of Honor who after he had been sick and was recovered of a malignant Feaver grew to be so extreamly fat and gross that he could very hardly move or stir himself in any place where he fat and as for the bulk of his body he came never a whit behind him whom we have formerly mentioned Signs Diagnostick As concerning Corpulency therefore it is sufficiently obvious to every mans Eye But then whether or no it only produce some kind of deformity and be no more then a Symptom or else whether it be not to be accounted a Disease or preternatural affect the hurt and offended actions wil evidence unto us of which we wil now speak Prognosticks 1. What the inconveniencies and discommodities are that this over-great fleshiness or as we term it extream Corpulency carries along with it I shal give you an account thereof in the words of Avicen that expert Arabian Physitian For thus he in his fourth Book Part 7. Tract 4. Chap. 5. Superfluous fat saith he is that which hinders the body from and in its motion walking and operation and streightning the Veins with an undue and dangerous constriction whereupon it oppilates and stops up the passages of the Spirit so that hereby it is many times extinguished and for the same reason likewise it is
that such Persons have no refreshment from the breathings in the ambient Air which finding the passages obstructed proceeds not so far as the Praecordia or Entrails to moderate and qualifie their excessive heat and they are in continual fear lest that their Blood should again be driven forth unto the streightned place Whereupon haply they wil give way that a Vein be suddenly opened which may prove very pernicious unto them And truly in this kind of disposition there happeneth unto them an extream dangerous constriction or streightning of their breathing a beating of the Heart Hereupon they are evermore exposed to a sudden death and especially those of them that are fatned in their younger daies for these have alwaies their Veins very smal and much streightned And they are likewise exposed unto the Apoplexy and Palsie and throbbing of the Heart and the Flux Diarrhaea by reason of their humidity they are also subject to fainting and swooning fits and the worst sorts of Feavers neither can they away with fatsting or thirst by reason of the constriction of the passages of breath the vehemency of the cold of their complexion their smal store of Blood and the abundance of their Phlegm And to this moreover may be added that they are whether they be Men or Women issueless and barren the Male being not able to Generate nor the Female to produce the Embryo in the Womb. As also their Seed is little or none at all to wit because it is concocted through the imbecility of the heat although there may be store of Seed in regard of their humidity or moisture yet notwithstanding such as is waterish and in Galens judgment thin and unmeet for Generation or if it be generative it is of Females only And the like may be said of Women that those of them which are fat do not conceive or if they do now and then conceive they forthwith miscarry and lastly their appetite to wit that which is natural is exceeding weak Thus far Avicen 2. The truth is that the Cure of this affect may be hoped for but it is wont to proceed but very slowly neither is it to be compleated in a short time and it is mainly requisite hereunto that the Patient be as we say morigerous and in all points ready and willing to submit The Cure The Cure of this Tumor consists in the removal of the Cause which is an over-great store of Flesh and Fat Now this abundant flesh and fat is taken away by wasting and annihilating what is already generated and then by taking a course that it may not again be multiplied and this may be done if we take care that too great an abundance of Blood be not bred or that which is already in the Body that it be by degrees wasted and lessened Both these intentions are accomplished by those things that heat and exsiccate or dry much For whereas the Liver if it hath a gentle remiss and temperate heat generates great plenty of sweet and Oyly blood and so continually foments matter for the breeding of much fat and store of flesh if now this temperate constitution of the Liver shal be altered and the Liver rendered more hot dry than formerly then instead of good and laudable I mean fat and oyly blood it generates that which is hot and cholerick or that which is serous wheyish waterish And thus it is that Medicaments hot and dry do both retard the propagation of an abundant and oleaginous blood and also they waste and by degrees consume the fat that is there already bred throughout the body But then for the wasting or lessening of the flesh already bred those Medicaments are the most prevalent in which siccity or driness is predominant and the heat in a mediocrity By what hath been said you cannot but understand how that in curing this affect we ought heedfully to observe whether it be the flesh or whether or no it be the fat that offends in the excess and so accordingly fit and proper Medicaments are to be made choyce of and as for such as are undoubtedly exceeding ful of flesh and such generally are al those that have the constitutions and habits of Wrastlers we are not to prescribe unto them such Medicaments as either cause or encrease heat but only such as meerly dry and attenuate and such are Venesection i. e. Blood-letting Purgation abstinence from food and frictions or rubbings In fat persons we may notwithstanding properly enough make use of Remedies that are of a heating Nature but yet so as that in the administring of them we be very circumspect lest that by the overmuch heating we procure some other Disease And therefore when as the blood administers matter for the raising of an abundant store of flesh and fat it is to be forthwith evacuated and diminished And for such as are ful of flesh we may safely enough exact a more liberal and copious evacuation of the blood yet alwaies provided that the evacuation be not proscecuâ—ed unto the extream as Hippocrates cautions us in the first Book of his Aphorisms Aphor. 3. But in those that abound with fat this letting out of the blood ought to be more sparing since that fat persons are more propense unto cold distempers Cupping-glasses also either with or without scarification are very useful and proper for both the one and the other Frequent rough and hard frictions of the whol body are likewise chiefly convenient Pliny in B. 11. Chap. 37. writes That the Son of L. Apronius who had been Consul was contented to have his fatness drawn away from him Fat drawn out of the body of one extreamly fat thereby to alleviate and lighten his body til then immovable of some part of his burden But no man wil easily admit of so desperate and barbarous a Remedy and therefore I forbear to speak any thing more concerning it Exsiccating or drying Baths whether taken by drinking or made use of for the bathing of the body are in this case of singular benefit Frequent purgations with Aloes unto which may be added Mirrh and Nitre are here likewise very convenient and consequently the Pills de Tribus must needs be a proper Remedy Such are also al bitter and hot Medicaments administred as namely Wormwood Myrrh Frankincense Rue Oxymel simplex and Oxymel compositum Oxymel of Squils the Syrup de duabus and de quinque radicibus and generally al things that provoke and expel Urine Wherefore the roots of Asparagus and Fennel and of Parsley and such like ought very frequently to be used This Pouder likewise is much approved of and commended viz. Take Salt of Nitre one dram Allum two scruples Myrrh Frankincense the Rind of the Wood Guajacum the Root of Sarsaparilla of each of these two drams and so make a Pouder Of the which let half a dram be administred in the morning for two months together Also the Salt of Vipers is very effectual for the purpose
any further enquiry thereinto we wil therefore make the more accurate search after thereby to find out the Cause of an Inflammation in this manner following There would be no Tumor at any time generated in any part of the Body were it not that either its substance as it were boyling over with heat is poured out or that from without some new substance makes its approach For there are but two only causes to be assigned of the augmentation of the bulk and quantity in any thing whatsoever For either the radical moisture through an internal or external heat is resolved into an aery substance which as it is wel known requires a far greater space room for dilatation then formerly it had or else as we said before some new substance is extrinsecally from some other place superadded thereunto Now therefore of necessity it is that one of these two causes must be present when as in that hot and burning Tumor which we commonly call a Phlegmone the part is lifted up into a greater bulk than is ordinary or agreeable to the intention of Nature But now that the fervency and boyling up of the natural moisture or the effusion thereof is not the Cause appears by this because that every thing that is poured forth and converted as it were into spirits when it is cooled it assumes again its pristine quantity and as we may so express it puts off and laies aside the Tumor as by common experience it is most apparent But as for the parts inflamed let them be never so vehemently cooled yet wil they never return into the former state and condition nor ever cast off the Tumor or Swelling Furthermore if by reason of the effusion of the part and its conversion into spirits a Tumor should be caused in the part inflamed then necessarily upon the incision of the part the spirit should appear which yet as we see is nothing so but that rather there follows an effusion of Blood and the whole place by its colour and the looks thereof seems altogether full of Blood It remains therefore that the accession of some new substance is the cause of a Phlegmone But now that this new substance is the Blood appears from hence to wit that the Phlegmone is exceeding red both within and without Now this red colour is only proper unto and inseparable from the Blood Blood the nighest cause of an Inflammation for there is nothing that waxeth red in the Body beside the Blood and the Flesh which later notwithstanding viz. the Flesh cannot by any means be the cause of a Phlegmone For if the increment of the flesh were the cause of an Inflammation there would be indeed a Tumor or Swelling in the part yet so as notwithstanding the internal heat should remain sound and in an healthful plight without the least distemper and that also it should not in the least vary its pristine nature when as in no one thing that is augmented according to its substance the heat may properly be said to be heightned and encreased so far forth that the increment of the substance and quantity should any way differ from the change or alteration of the qualities But now the case is otherwise in a Phlegmone wherein the colour is changed and the heat grown to be more intense the said colour evidently demonstrating not only the quantity but likewise the quality of the substance Moreover that the Blood is cause of a Phlegmone may be manifestly evidenced by this that the place in the greatest Inflammations especially which now and then happen in Ulcers appears and seems all bloody round about which certainly would never be if blood were not the cause of the Inflammation Furthermore that Blood is Cause of the Inflammation that generating of the Inflammation which happeneth in Wounds doth evidently demonstrate For in new and fresh Wounds the Blood its true at the first flows forth but then afterward being compressed and kept in either by the hand or else with Ligatures or Medicaments that stop the issuing forth of blood or else lastly being suppressed and staid of its own accord it is then reteined either in the Orifice or Cavities of the dissected Vessels and there it is compacted and so wrought that it grows together like as clotted blood useth to do and there by a continued heaping up of the blood abundantly flowing thereunto it lifts up the part into a Tumor or Swelling and causeth an Inflammation An Inflammation what it is Since therefore the Conjunct Cause of an Inflammation is proved to be the Blood preternaturally flowing thereunto it is no hard matter thence to collect that an Inflammation is a preternatural Tumor of the fleshy parts as Galen in the place alleadged takes and understands the name of Flesh arising from the preternatural afflux of the blood and that therupon it must necessarily be hot red extended and accompanied with a kind of renitency or resisting property pain and pulsation or beating The manner how an Inflammation is bred But now that there may not be left to remain any the least obscurity about the nature of an Inflammation we will here add the manner also how a Phlegmone is generated and this we wil do out of Galen who in his Book touching the unequal Intemperies Chap. 3. hath in these words described it it is saith he a hot fluxion or flowing the which when it hath seized upon and seated it self in some muscelly part at first the greater Veins and Arteries are fil'd up and distended and next after them the lesser and so it is carried on untill that at length it arrives even at the least of them In these when the matter of the fluxion is forcibly impacted and cannot therein be any longer conteined it is then transmitted unto the outward parts partly through their own Orifices and partly by a percolation as it were and straining or sweating out of it through the Tunicles and then the void spaces which are betwixt the most principal parts are filled full with the fluxion And so all those parts or places are on all sides very much heated and overspread Those parts or Bodies are the Nerves Ligaments Membranes the Flesh it self and before al these the Veins and Arteries For whereas the Veins and Arteries run along unto each particular part by the which is received both nourishment and vital Spirit so long as the blood flows in a due measure and just proportion and is conteined within those its receptacles the part is not wont to suffer any Inflammation at all but then only when at the length the blood is overcopiously and all on a huddle emptied and poured forth into the substance of the part by the Veins and Arteries By which very thing also a Phlegmone is distinguished from other fluxions in which the matter is diffused without the Veins into the whole substance of the part and there doth distend and dilate it For in a Phlegmone although all the
about it The Prognosticks In an Inflammation there are two things that it mainly and principally behoves us to presage to wit The termination of an Inflammation Which is threefold its event or termination and then the exact and punctual time of the said termination Now the Event is said to be good when Nature overcometh the matter that breeds the Inflammation which hapneth when either the Tumor is resolved and the matter insensibly exhaled which is the best kind of solution of an Inflammation or else when the matter is suppurated and turned into that which we term Pus being a thick and purulent matter Or otherwise secondly The event may be said to be evil or if ye wil worst of all when Nature doth not overcome and master he peccant matter which hapneth when the Inflammation if it be external suddenly vanisheth and retires back to the internal parts or when the natural heat being overcome and extinguished the Member thereupon becomes putrified and seized upon by a Gangrene insomuch that if it be not forthwith cut off ruine and death it self threaten the whol body Or else in the third place there follows a Neutral Event as some cal it which is absolutely evil when the Tumor is hardened and when upon the resolution and discussion of the thinner parts the more thick and gross parts remaining behind the Inflammation degenerates into a Scirrhus But now which of these events is to be hoped for or expected may probably be guessed at by comparing together the vigour and strength of Nature with the matter that causeth the Disease For if the matter be not overmuch not thick not over deeply scituated not shut up under a hard and thick skin if the body be not greatly impure and Nature be strong then a resolution and an evacuation by an insensible transpiration may be hoped for But if the matter more abound be more than ordinary thick be contained in a deeper place than usually and be pent up under a thicker skin then a suppuration is to be expected That the matter is retreated unto the inward parts may be conjectured by this token to wit When we perceive the Tumor to be diminished albeit there were no repulsive remedies administred and applied to drive back the matter That the extinction and overthrow of the heat is neer approaching may be presaged by this whenas the heat redness of color pain and the pulse or beating is lessened the Tumor notwithstanding still remaining touching which more hereafter when we shal come to treat of a Gangrene But then lastly an Inflammation for the most part then degenerates into a Scirrhus when the matter is over viscous and clammy and hard therewithal and when the Natural heat being strong and vigorous forthwith even in the very beginning of the distemper remedies that discuss and dissipate over forcibly are thereunto applied which said remedies disperse and scatter the thinner parts thereof and leave the thicker still remaining That the time of the Event may be known The times of an Inflammation it is requisite that the times of the Inflammation be first of all known and they are likewise heedfully to be observed by us upon our knowledg of them in relation unto the Cure For unless the times of an Inflammation be well known and considered we may soon run our selves into an Error whilst we administer and apply Remedies that are any waies improper or incongruous unto any one particular of those several times Now then Inflammations like as all other Tumors and Diseases have four times or periods its beginning encrease state or perfection and its decay or declination It commenceth or begins when the parts are replenished with blood and when the swelling pain and stretching out are encreased this we cal the augmentation The state or perfection is then when the Tumor Distension Pain and all the other symptomes are most vehement and in the heighth of their extremity And lastly the declination is then said to be when the matter generating the Tumor is diminished and the pain heat together with the other symptoms are become more remiss and gentle or otherwise the matter is converted into Pus or purulent matter But the truth is these times are some while shorter somtimes longer and the Inflammations are somtimes sooner and somtimes more slowly terminated For as Galen tels us in the sixth Book of the Aphorisms Aphor. 49. that which is of a thinner substance is in a shorter space digested and that which is thick or tough requires a longer time for its digestion but that which is thick and viscous requires a far longer time And that Inflammation which hath seated it self in the fleshy parts is terminated according to the period of acute Diseases to wit fourteen daies for the substance of the flesh is more soft and permeable by reason of its thinness But the substance of the Ligaments Tendons and Nerves being more thick and hard and thereupon with greater difficulty receiving the fluxion for the same cause also doth with more difficulty discharge it self therof and hereupon the Inflammation in those parts is the longer time ere it attain unto its state and perfection and is not so soon curable but yet notwithstanding the Cure is in this case seldom or never prorogued beyond the term of fourty daies if both the Physitian rightly in al points discharge his part and likewise the patient be in al things willing to submit The Indications and Cure Whereas the containing cause of an Inflammation is the blood which hath preternaturally i. e. beyond or besides Natures intention flown in unto the part the Cure is effected if that blood be removed out of the diseased part and then great caution be had that it thenceforth flow no more unto the part affected that so by this means as wel the containing as the antecedent cause may be wholly taken away For whenas the affect cannot possibly be removed without a first removal of that which causeth it and the case so standing that the causes ought to be taken away in the very same order that they follow one the other in therefore we say that the Fluxion must first of all be extirpated The Cure of a fluxion or flowing of the blood Now this intention may be accomplished if care be taken to prevent the bloods abounding in the body and that that which is there in great plenty flow not unto the part affected The benefit of blood-letting in an Inflammation and this with most safety and speed is to be effected by opening a Vein For by this Venesection or blood-letting the great store of abounding blood is diminished and the same is likewise drawn back from the aggrieved place hence it is that there is an exceeding great benefit arising from and following upon this opening of a vein in an Inflammation so that it is seldom or never to be omitted if the strength of the patient wil permit it to be done And indeed hardly can
any other Remedies with safety in this case be applied unless opening a Vein have the precedence and the abundance of blood be thereby diminished For if we administer remedies to drive back the body stil continuing full of blood it is greatly to be feared lest that the matter should not be received by the other parts and thereupon that it should altogether attempt a flowing unto some one or other certain particular part And as for digestives hot as they are if they should be made use of in a body that is full there might be just cause to doubt lest that there should be more matter attracted then discussed and dissipated A Purgation Moreover also albeit a Cacochymy or ill digestion and bad nutriment be not the cause of an Inflammation yet notwithstanding since it is a very rare thing to find a Body that is altogether free from this said Cacochymie it wil be very requisite to ordain a Purgation which compleated other Medicaments also are afterward to be administred with an expectation of more success and greater benefit And as we hinted to you before although Inflammations take their Original principally from the blood yet notwithstanding vitious humors very frequently give an occasion of their being as also doth the aforesaid Cacochymie and indeed herein the hot humors challenge the first place For if by these Nature be at any time stir'd up and provoked and it be so that she cannot of her self expel them then she endeavors to thrust them forth by some and some unto the other parts but when she fals short in the effecting of this also unless she should withall transmit the blood thither and that by an acrimonious humor sent unto the part a pain is excited hereupon a conflux of the blood unto that same part into which Nature assaies to empty forth the vitious humor is caused and so consequently an Inflammation is generated And from hence it is also that from a Cacochymie there is very frequently produced a Pleurisie an Inflammation or Impostume of the Lungs the Squinancy or as we use to term it the Quinsie and that kind of madness which we commonly call the Phrensie Moreover also the blood is abated and no excessive store thereof bred in the body if that meat be not taken in which either by its overgreat proportion or else by reason of its substance afford too much nourishment and exceedingly conduceth to the generating a more plentiful store of blood than is requisite Wherefore let the sick Person abstain from Wine and let him use a sparing and slender Diet which both hindreth the breeding of much blood and if it be already over-much doth by little and little lessen it But that the blood may not flow to the part affected it may be prevented if we deprive it of that which necessity requires that it should have to help forward and facilitate its motion and if we likewise correct the thinness thereof together with its overmuch aptness to motion if we obstruct and streighten the passages through which it ought to be moved and if we recall and draw it back from the part affected The blood therefore that it may be withheld from flowing unto the part affected is to be altered driven back intercepted and derived unto some other place Alteration of the blood The Alteration of the blood is altogether necessary that so if it be overhot thin and fluxile or movable it may be cooled thickned and rendred more unapt and less prone to motion and this Alteration for the most part we ought the rather to procure in regard of the Feaver which almost ever accompanieth the Phlegmone or heat of the Liver For it is a rare thing that they which are infested with an Inflammation of any part should yet not be sensible of a Feaver Wherefore we must use Medicaments made of Succory Endive Violets Lettice Sorrel Barley the greater cold Seeds the juyce of Citron of Pomegranates and such like And if the blood be more than ordinarily hot and thin we ought also then to add those things that have in them an astringent quality and such are Roses Purslane Plantane and the like But here notwithstanding we ought carefully to look to it lest that the Veins being narrow and overstreightned or there being obstructions in the Bowels by the use of these or such like astringents more obstructions should be bred or increased And then again we ought not only to administer contrary Medicaments for the altering of the blood but likewise to remove from the Patient and cause him to omit and forbear the use of such things as either introduce or augment those qualities whose absence we now require as being better than their company For instance a hot Air is to be shun'd surfeits with over-eating and drinking must be avoided and Wine forborn or if any be drank it must be that which is weak and wel diluted all kind of violent motion is to be omitted and rest rather to be indulged Wrath and venereal Embracements ought likewise here carefully to be avoided and abstained from Revulsion or drawing back ought moreover to be ordained Revulsion or drawing back and the humor is to be turn'd away unto a contrary place that is we must so order it that a contrary motion may be procured unto the humor and that it may move unto that part unto which it naturally tends so that it may not flow unto the part affected For that the turning away and drawing of an humor flowing into some part unto that which is contrary may be termed Revulsion we rightly take it for granted and by Hippocrates at the first appointed and ordained The contrariety in Revulsion For as Galen informs us in his fifth Book of the method of Physick Chap. 3. this was the invention of Hippocrates that a Revulsion should be made unto the contrary or opposite places Now although it be much controverted by Physitians what is here to be understood by this word Contrary yet notwithstanding we judg the Opinion of Gaâ—en to be very plain and perspicuous if we wel exâ—mine together what he hath here and there oftenâ—imes written upon this subject and if we take a right view of the conditions that are requisite in a Revulsion But that Galen by the word Contrary understood nothing else but the parts contrary that is far distant and remote from the part affected is every where manifested in his own writings for thus he argueth in his fourth of the meth of Physick Chap. 6. If it be a perpetual standing rule as we have learn'd from him viz. from Hippocrates that a fluxion if but beginning is to be drawn to the contraries but if already fixed in the aggrieved particle it is then to be evacuated either from the particle it self which is afflicted or else from that which is next neighboring unto it we may now hence readily conclude as to the point of this blood-letting that at first i. e. in
2. Among these Tubercles or little Swellings they of them are the more hopeful and least to be feared which bunch forth externally in the outward Skin and are sharp-pointed and equally maturate and wax ripe and are not hard neither divided and cleft in two parts or such as have their tendency downwards For so saith Hippocrates in the sixth of his Epidemicks and first Section The Cure We must use our utmost Skil and endeavor that so the matter that is the cause of the Furunculus may be most speedily turned into Pus for which end and purpose those Medicaments that have been already described and propounded in an Inflammation are here likewise very requisite and necessary Now those things that convert the matter into Pus or purulent matter are Wheat masticated and imposed upon the place Raisons of the Sun Figs bruised and laid upon the part and Diachylum simple or without Gums Or Take of Linseed meal pouder of Marsh-mallow roots of each half an ounce of dried fat Figs in number four Raisons of the Sun stoned an ounce boyl them all and then add of fresh or unsalted Butter two ounces make therewith a Cataplasm Or if the pain be more vehement and violent Take Roots of white Lillies one ounce the leaves of Mallows and violets of each a large handful boyl them to a softness and pass them through an hair sieve then add of Barley meal Wheaten meal and flour of Linseed of each half an ounce the Yelks of two new laid Eggs the fat of a Cock and fresh Butter of each one ounce and make a Cataplasm Or Take Turpentine the marrow of an Hart the fat of a Calf the fat of a Goose Wax fresh Butter the best Honey Oyl of Roses of each half an ounce and mingle them for a Cataplasm This Tumor when it is maturated unless it break of its own accord is to be opened And so soon as it is opened it ought to be cleansed Take the juyce of Smallage half an ounce Barley meal two drams Frankincense a dram and half Turpentine one ounce the Yelk of one Egg Honey of Roses as much as wil suffice mingle and make them into the form of a Liniment After it is cleansed it is to be filled up with flesh and shut up with a Cicatrice or scat like as we are wont to do in other Impostumes Chap. 10. Of the Tumor Phyma UNto an Inflammation there appertains likewise the Tumor Phyma which aâ— Galen acquaints us in his second Book to Glauco Chap. 1. and his third Book of the Method of Physick Chap. 3. is a Tumor or Swelling of the Glandules which forthwith is augmented and hasteneth unto a suppuration The place affected are the Glandules The Cause The Cause or Humor exciting the Phyma is blood yet not that which is pure but that which is Phlegmatick and thereupon the Inflammation is not altogether so great and intense and this kind of Tumor appertains unto the Inflammation Oedematodes as we usually term it and appeareth most an end in Children seldom in Youths and most rarely in those that are of ful age Signs Diagnostick It is known by a round Tumor of Swelling and which is much elevated little or nothing red and almost void of pain and in a glandulous or kernelly part Prognosticks 1. This kind of Tumor is altogether free from danger it is likewise instantly augmented and for the most part it is suppurated and healed without the help and assistance of Medicaments 2. The Cure is more easily accomplished in Children more difficultly in Youths and such as are of ful growth and perfect age The Cure We must endeavor that it may be suppurated with al possible speed And to this end Natures attempt and operation is to be furthered al that may be by maturative Medicaments imposed on the part of which we have already spoken enough where we treated of an Inflammation and a Furunculus which yet notwithstanding in this case by reason of the coldness both of the part and cause ought to be somwhat more strong and forcible Wheat chewed and laid on is here very useful as likewise Raisons of the Sun stoned and also the Diachylum Plaister both the simple and that likewise with Gums As Take pouder of the Roots of Marsh-mallows Wheaten meal the meal of Lupines of each one ounce of dried fat Figs six in number Leaven half an ounce then boyl them and add thereto one Onion roasted in the Embers Oyl of white Lillies as much as wil suffice and so make a Cataplasm Or Take Turpentine the Honey found at the entrance of the Bee-hive of each one ounce Ammoniack dissolved in Vinegar half an ounce Oyl of white Lillies as much as will suffice and make an Vnguent For to tel you the truth there are some that conceive that a Phyma is not presently to be cut and opened so soon as it is suppurated but they rather are of opinion that an assay should be made that it may appear whether or no the matter may possibly be dissipated and scattered by discussives and therefore Galen in his eighth Book of the faculty of simple Medicaments commends Southernwood Parietary commonly known by the name of Pellitory of the Wall and by others likewise called Feverfew Nettles Marsh-mallow roots and Ammoniacum softened with Honey but this happeneth but very seldom And therefore the safest course is unless it break of its own accord that it be artificially opened lest that the long detaining of the matter should cause and produce much danger Chap. 11. Of the Tumor Phygethlon IN the self same Glandulous parts of the Body there is likewise another kind of Tumor excited which the Greeks name Phygethlon but the Latines cal it Panus or rather as Celsus in his fifth Book and Chap. 28. Panis from the similitude and resemblance of its figure But here the cause is more hot and like as Phyma hath its original from pituitous or flegmatick blood so a Phygethlon or Panis hath its rise from cholerick blood as Galen instructs us in his second Book to Glauco Chap. 1. But most an end this kind of Tumor chanceth after Feavers or else after the pains of some one or other part and chiefly those torturing pains which invade and afflict the belly The Signs Diagnostick The Signs of a Phygethlon are a Tumor or Swelling hardness heat distension and greater pain than might probably be expected in regard and reference unto the magnitude of the dimension of the Tumor There is likewise somtimes a Feaver to accompany it But very frequently notwithstanding there is not any one of al the aforesaid perceived outwardly to wit when and where the matter lieth deeper rooted and is there kept concealed but only at least some certain prickings are inwardly perceived This sort of Tumor is long ere it come to a maturation neither is it fitly and properly converted into Pus Prognosticks 1. That Phygethlon which becomes not more hard than ordinary al on a sudden
that are less noble and worthy Which likewise happeneth when the Blood is infected and corrupted by reason of some external Corruption from whence it is that a Carbuncle is never excited by the Congestion or heaping up of blood but is evermore generated by a defluxion that is al at once made and thereupon it is deservedly accounted among Inflammations and is said to be very neer neighboring unto a Phlegmone or Inflammation Neither is it only generated of black Choler like as a Cancer but it is bred by adust and burnt blood degenerating into black Choler or else having black Choler mingled therwith Now the aforesaid adust blood is generated from an ill and unwholsom course of Diet and from meats of a depraved and viâ—ious quality affording and supplying the whol matter of all the blood And this is likewise much more promoted and furthered by the external Constitution of the Air overheating burning and corrupting the humors and especially its occult and malignant Constitution depraving the humors and indeed there is hardly any Carbuncle to be found that is altogether void of and free from malignity The Differences Yet notwithstanding in regard that this Malignity is somtimes greater and somtimes less and that some Carbuncles invade very many in a Pestilent constiâ—ution of the Air and others again here and there seiz upon the sick without any such pestilent constiâ—ution of the Air Carbuncles therefore are to be distinguished into Pestilent and noâ— Pestilent Moreover some of them arise with a Pustule or with such Pushes as are caused and raised by the fire which if they be broken there lieth underneath within a Crusty Ulcer and this happeneth if not alwaies yet for the most part and such as these are in special by Avicen called Pruna or Ignis Perficus Others of them arise and appear without Pustules Signs Diagnostick The Carbuncle beginneth as hath been said for the most part from a smal Pustule but somtimes there is not only one of the greater Pustules breaking forâ—h but likewise many smal one like Millet seeds rising and appearing very thick in the particle which when they are broken the Ulcer becometh crusty such as is excited by a red-hot Iron But before these Pustules break forth there is a certain itching felt in the part and therby there is one or more Pustules arising and appearing yet notwithstanding the Carbuncle somtimes beginneth without any manner of Pustule and a crusty Ulcer is excited the crustiness being one while somwhat blackish another while having in it the resemblance of the color of Ashes and then again in a very short space after it groweth forth and becometh like unto Bubo's after a round acute figure with an extraordinary great heat burning and pain al which are especially exasperated about the Evening and then they so vex the sick party that he can hardly withhold his hands but that he must be rubbing of the part from which rubbing there afterward arise very many of the aforesaid Pustules The flesh that lieth round about them waxeth hot and hath in it at the heighth an extream great and burning heat it likewise obtaineth a color somwhat blacker than is that in an Erysipelas and a Phlegmone like as if there were somthing of black choler mingled together with the red There happen moreover other Symptoms besides the former to wit a Feaver which as Galen also testifieth in his fourteenth Book of the Method of Physick Chap. 10 infesteth those that are surprized with a Carbuncle more than those that are affected with a Phlegmone or Erysipelas a nauseousness likewise a vomiting a dejection of the Appetite a trembling with a panting and beating of the heart frequent faintings and swoundings dotage all which said symptoms do so much the more afflict and grieve the party by how much the matter is the more malignant For there is a certain difference even of those Carbuncles themselves not only in regard that with the aforesaid adust blood which is the conjunct cause of the Carbuncle there is somtimes this another while that humor mingled but more especially in that one Carbuncle is Pestilent and another not Pestilent For albeit every Carbuncle be malignant by reason of the hot Matter being adust and putrefying which hath in it a power and quality to corrupt the flesh and cannot wel return into any more benign or better nature neither may it wel be suppurated yet notwithstanding every of them is not Pestilent neither hath every of them any adventitious Malignity but sometimes only besides the Native malignity of the Carbuncle there chanceth likewise another kind of malignity from the common state or the contagion of the Air. But now a Pestilent Carbuncle is discerned from that that is not Pestilent first of al by the present Pestilent constitution of the Air. For it is hardly possible that a Carbuncle should arise at such time as the said Pestilent Constitution is predominant which in it self should not be Pestilent Moreover al the symptoms and signs that appear in the Carbuncle are both more frequent and more grievous in a Pestilent Carbuncle than in a Carbuncle that is not pestilent For even the Feaver also which is adjoyned unto the Carbuncle resembleth and carrieth along with it a Pestilent nature and although it seem outwardly to be more moderate and gentle than that which appeareth in the Carbuncle that is not Pestilent yea somtimes so that it can hardly be perceived yet notwithstanding at that very time it the more burneth the inward parts and is by far the more dangerous the fresh color of the face is changed the tongue becometh black and is dry the excrements of the Belly are liquid and cholerick the appetite is dejected there is likewise present a nauseousness and a vomiting of the most offensive and the worst humors a difficulty of breathing a stinking breath and there is also much sweat and this is either somwhat hot or else as we term it a cold sweat The sleep is somtimes very sound and somtimes watchings infest the sick party dotings also accompany the same as likewise faintings and swooning fits And hereupon it is that there is more danger threatned by one Carbuncle than there is by another For although every Carbuncle be not pernicious yet notwithstanding as Galen testifieth in the 3. of his Epidem Comment 3. tit 2. the most pernicious of al is the Pestilent or that which besides its own proper and particular malignity hath also adjoyned with it that which the constitution of the Air bringeth along with it and which is attended with all those pernicious symptoms which if they remit very much of their former intensness and vigor there is then left remaining some hope of safety and recovery but if from day to day they are heightened and become more vehement there is then no safety or hopes of escape to be expected The Prognosticks 1. By how much the blacker the Carbuncle is by so much the worse is
there is not somthing of malignity and therefore the malignant matter is with more safety thrust forth unto the superficies of the body by those Medicaments we term Alexipharmaca then drawn to the more inward parts by Medicaments that purge That fervent heat also of the adust blood is to be altered and the malignity to be opposed by convenient Medicaments as the juyce of Citron of Pomegranates Sorrel Borrage Bugloss Water Germander Succory and the like with which in a pestilent Carbuncle other Alexipharmaca may also be firly mingled As Take Conserve of Sorrel Borrage Bugloss of each one ounce and half the species of Diamargarit frigid Confection of Hyacynth Elect. de Gem. of each half a dram of candied Citron rind six drams the candied roots of Scorzonera or Vipers Grass half an ounce with the juyce of Citron make an Electuary Unto which in a Pestilent Carbuncle we may add Bole-armenick Terra Sigillata or sealed Earth Harts horn Bezoar stone and the like Very many there be that in a Carbuncle do much commend Scabious and they conceive that it never ought to be passed by and they write that either the Juyce or the Water or the Decoction thereof is of singular use and benefit in a Carbuncle It wil not likewise be amiss to fence and guard the Heart with Topicks by Epithems that are otherwise known applied to the Region of the Heart and the Pulses that so by all manner of means the Heart may be preserved safe and sound from all the malignity Afterward as for what concerns the conjunct cause or the Tumor it self the way and means of curing a Carbuncle is not altogether the same as in other Inflammations unless haply there appear to be in it very little of an offensive quality Neither must we make use of Repellers but the malignant and poysonous matter is rather to be attracted from the more inward unto the external parts unless perhaps they may be administred for the mitigating of the vehemency of the pain touching which more hereafter And therefore so soon as Venesection hath been administred the part affected is forthwith to be scarified and that likewise with lancings that go deep enough that so the corrupt malignant and poysonous blood which unless it be instantly emptied forth of the part affected corrupteth the parts neer adjoyning may be quite drawn forth Immediately upon this the part affected is to be cleansed and throughly washed with warm salt water or with some other convenient liquor lest that the blood should clod and so grow together in the part Now if the corrupt blood seem not as yet to be sufficiently evacuated the scarifications ought then to be repeated We are likewse allowed when the place is scarified to apply thereto Cupping-glasses or Leeches Yet notwithstanding iâ— with great violence the humor flow unto the part then Atrractives may not safely enough be administred since there is cause to fear lest that the matter flowing thereto in great abundance the pain should be made the more vehement which may possibly excite and cause watchings augment the Feaver and deject the Natural vigor but rather if the matter flow thereunto over hastily and with too great force we are then to make use of those Medicaments which by moderate repressing and driving back may likewise digest And such is the following Cataplasm Take Arnogloss we commonly term it Lambs-tongue or Way-bread Lentiles Bread that is neither wholly purged from its bran neither yet such as is altogether branny of all these a like proportion let them boyl in Water or Wine and so make a Cataplasm which is to be applied twice or thrice every day But now this said Medicament that we have mentioned or such like is not to be imposed and laid upon the very Carbuncle it self but only neer about it some three fingers distance from it For by this means the malignant matter it self is not driven back but only the extream heat and pain is mitigated the flux of matter is somwhat retarded and hereby is prevented the retreating back again of the matter unto the more inward parts But yet neither must this be passed over in silence that it is not evermore requisite to fence the Carbuncle with such a guard but notwithstanding this for the most part iâ— necessary to wit That that part which hath a neer relation with a noble Member should be wel guarded forasmuch as it is no way hurtful but indeed profitable that some of the matter should be derived and evaporated unto the other ignoble parts Moreover the place being scarified there are not to be applied those Medicaments that otherwise are wont to be laid on in regard that they promote and further the Pus or purtilent matter and by this means may encrease the putrefaction and rottenness since that a Carbuncle in putrefying evermore creepeth and spreadeth so that very often a Mortification chanceth unto such parts but rather those Medicaments that are drying and such as resist putrefaction For which end and purpose we may administer the Pastils or Pomanders of Andro Musa Polyidas and Pasio which are to be dissolved first of al in Wine and then also afterward in Vinegar touching which see Galen in his Composition of Medicaments in general the fifth Book Chap. 11 and 12. They commonly likewise make use of the Aegyptiack Unguent There may also be made a Cataplasm of the Meal of the Pulse Orobus with Oxymel Morsus Diaboli or Devils-bit is likewise very much commended if while it is yet green and wel bruised it be laid on or else boyled in Wine and drunk There be many likewise that here make use of those things that are experimentally found to be helpful by the propriety of their substance among which Scabious is especially commended as also Morsus Diaboli or Devils-bit they take to wit the Scabious whilest it is green and bruise it wel and then they add thereto the Yelk of an Egg Hogs grease that is old and a little Salt and herewith they make a Cataplasm which is often to be renewed Some likewise take the Herb Comfry for the same use and with it they prepare and make such a Medicament as this that followeth Take of the Juyce of the greater Symphytum or great Comfrey Scabious Cranes-bill or Doves-foot of each one ounce of Barley Meal two ounces and an half and mingle them for a Cataplasm Others there are who if there be present an extream heat and pain commend this Viz. Take Plantane Leaves and Sorrel Leaves of each two handfuls boyl them to a softness then let them be bruised when they are throughly bruised add to them the Yelks of four Eggs Treacle two drams Barley meal a sufficient proportion and so make a Cataplasm Many likewise there are that commend those Wallnuts that are old and Oyly being bruised of the which some make such a Cataplasm as this that followeth Take the Kernels of Walnuts such as are old and rancid or mouldy in
in the first place Scarification is to be administred or likewise if need so require Cupping-glasses are to be applied that so the corrupt blood may be evacuated After this the part is to be fomented with warm Vinegar or the Decoction made of the Reddish Root of Serpentaria or Vipers Grass Cuckowpint Solomons Seal and Wine as much as wil suffice For such like Remedies dissolve the clotted blood and draw it forth from the very bottom unto the outmost part of the Skin And after let there be applied the Diachylon-Flower-de-luce Emplaster Or Take Southernwood Cumin Seed Camomilo Flowers of each one dram the Juyce of Wake-robbin or Cuckowpint as much as will suffice make hereof a Cataplasm Or Take Oylan ounce and half Wax an ounce the Juyce of Marjoram an ounce and half let them dissolve together at the Fire and then add of the Spirit of Wine one ounce And to conclude that which Paraeus adviseth is to be taken notice of to wit that in the contusion of the Muscles and especially those about the Ribs the Flesh a little swelleth up and becometh as it were snotty and purulent insomuch that if it be pressed down and squeezed together is sendeth forth a flatulent Air with a certain kind of low noyse and gentle hissing and withall the print and impression of the Fingers remaineth and is to be seen for some while after And therupon in that void space that the Flesh separating it self from the Bones hath lest there is a purulent and rotten filth gathered together by which there is caused a syderation and putrefaction If therfore this shal happen the Malady is speedily to be taken in hand the best means used and the part most strictly and closely to be drawn together and furthermore Oxycroceum or Ireat Diachylon or the like Digestives are to be administred And thus much shall suffice to have been spoken touching Tumors arising from the Blood there now follow those Tumors that arise and proceed from Choler Chap. 17. Of the Tumor Herpes HAving hitherto treated of and explained the Tumors arising from the blood it now remaineth in the next place that we likewise explain and declare those Tumors that proceed from Choler Among the which the Erysipelas is commonly wont to be first propounded and reckoned up But since that as we conceive the Erysipelas as it is now adaies with us or as it hath been by the Ancients vulgarly termed Rosa may more fitly be recounted among the Tumors arising from the blood we have therefore treated thereof above among the Tumors proceeding from blood in the seventh Chapter wher we handle the Erysipelas But now Herpes is truly and properly a Tumor proceeding and taking its original from Choler And it is termed Herpes from its creeping to wit because it seemeth to creep like unto a Snake and for this reason because that no sooner doth one part seem to be healed and wel but the Disease instantly creepeth unto the next adjoyning parts And although to speak truly there are very many Maladies that Creep along yet in special that Tumor is by Physitians termed Herpes that is excited in the superficies of any part from yellow choler sincere or simple that is severed from all other humors and from thence creepeth along unto the parts next adjoyning For as the Erysipelas ariseth from blood very than and choletick so the Herpes proceedeth from excrementitious Choler Celsus seemeth to propound and mention Herpes under the name and notion of Ignis Sacer or the Sacred Fire whereas other Latine Physitians understand an Erysipelas under this appellation of Ignis Sacer. The Causes The conteining Cause of Herpes being sincere pure and sharp Choler severed and separated from the rest of the humors which by its implanted thinness penetrateth and pierceth even unto the outward or Scarf-skin and is by and through it diffused it hence appeareth and by consequence followeth that the Tumor or swelling in it is yet less than in an Erysipelas For as in an Erysipelas the Swelling is less than in a Phlegmone by reason of the smal store and thinness of the matter that is found in the one more in the other less so again in the Herpes the swelling is less than in the Erysipelas for the very same cause But as for the Antecedent and Procatartick Causes they are almost the very same as in an Erysipelas yet notwithstanding somwhat more disposed to the generating of an excrementitious yellow choler then to the breeding of a cholerick Blood The Differences The Differences of Herpes are taken from the diversity of the conteining Cause and the humor For although every Herpes hath its original from Choler and a thin humor yet notwithstanding since there are certain degrees of its tenuity thinness and purity if that humor or choler be simple and of a thin substance then the Affect that reteineth the general name is termed a simple or single Herpes But then if there be any portion of Flegm mingled therewith there is produced an Herpes that causeth and raiseth little Bladders in the Skin like unto the Millet whereupon it is called Herpes Miliaris And lastly if the Choler be more sharp and biting so that it eat through the skin unto which it adhereth it is then termed Herpes Esthiomenos that is the eating Herpes and this same by Galen in his 14. Book of the Method of Physick Chap. 17. is called absolutely and only Herpes and is almost of the same nature with an exulcerated Erysipelas from which notwithstanding it differeth in the thinness of the humor For so saith Galen in the place before alleadged It is saith he an exceeding thin humor that exciteth the Herpes even so thin that it doth not only pass through all the interior parts which likewise are of a fleshy substance but also the very Skin it self even unto the utmost part of the Scarf-skin the which alone in regard that it is kept in and reteined by it it both gnaweth and likewise eateth through whenas if it could also in like manner pass through it by sweating it would not then excite and produce any Vlcer But now the exulcerated Erysipelas and the Herpes Esthiomenos differ likewise in this regard that the exulcerated Erysipelas doth not only seiz upon the Skin but also upon some part of the Flesh that is underneath it but the Herpes exulcerateth only the Skin Signs Diagnostick In regard that the Herpes is apparent and manifest unto the Senses it is therefore easily known For it is a broad Tumor that hath little or no heighth in it so that the part is scarcely lifted up at al but may seem rather to be exasperated then to swel up unto any heighth There is moreover present to accompany it a certain kind of hardness and a pain and as it were a certain sense and feeling of an heat and burning But the Herpes Miliaris hath divers smal Pustules like unto Millet in the very top and outside of the Skin of the
Barley Lentiles Beans of each one handful Arnogloss or Lambs Tongue two handsuls Pomegranate flowers Roses the grains of Myrtle Sumach of each half an ounce Let all except the Barley be grossly poudered and then boyl them in Wine until the Barley be soft and make hereof a Cataplasm Or Take the Rinds of the Pine tree burnt and washed a dram and half Ceruss three drams Frankincense one dram Goats fat six drams Oyl of Myrtle two ounces Wax at much as wil suffice make herewith an Vnguent But if we have a mind to dry more than ordinarily we may ad the prepared file-dust of Iron the flower of Brass and Lime washed This is likewise commended Take the spume or froth of Silver half an ounce the juyce of Leeks and Beets of each sive ounces Mingle them c. Hieronymus Fabricius writeth that with very good success he made use of this following Remedy Take the juyce of Tobacco three ounces green or Citron-coloured Wax two ounces Rosin of the Pine tree an ounce and half Turpentine one ounce Oyl of Myrtles as much as wil suffice for the making and forming of a soft Seoer-cloth But if the Ulcer be already putresied we must then betake our selves to the Remedies that are stronger and more forcible such as are the little sweet Bals of Andro Musa and Polyidas a for example Take Litharge and Ceruss of each two ounces the Rinds of Pomegranates half an ounce Myrrh one dram Frankincense a dram and half the flower of Brass and Allum of each a dram and with the Oyl of Myrtle and Waie a sufficient quantity of each make an Vnguent But if these wil not serve the turn and that the Ulcer and putrefaction creep further and become broader we must then have recourse unto the stronger sort of Remedies They refer likewise unto choletick Tumors those that we cal Phlyctaenae Impetigines Lichenes Sudamina and Epinyctides But because that these little risings or swellings proceed not from pure Choler but from Choler mingled with serous and salt Humors we wil therefore treat of them below with the rest of the Tumors of this kind Chap. 18. Of the Tumor Oedema LIke as those Tumors that we have already hitherto handled have their original from hot Humours so there are likewise some certain peculiar Tumors that arise from cold Humors and in the first place Oedema that hath its original from Flegm For although Hippocrates and other ancient Physitians under the name of Oedema understand al other Tumors whatsoever in general yet notwithstanding those of latter times by Oedema do understand some one certain kind of Tumor only and this they specially term Oedema being a Tumor that is lax or loose soft without pain yielding unto the touch and compression of the singers having its original from thin flegm or else from the more cold and moist part of the Mass of blood The Causes The containing Cause of this Tumor is that flegm that is contained in the blood to wit if it be so increased that it irritate and stir up the Expulsive Faculty For then Nature being stirred up and provoked thrusteth forth the matter out of the greater Vessels unto the less and expelleth it from the more noble parts unto the weaker until at length it be received and retained by the most weak and infirm part The cold and heavy Humor it self likewise very often by its own weight tendeth downwards and also unto the extream parts And thereupon it it that although the Oedema may be excited in al parts whatsoever of the body yet notwithstanding it chiefly and more especially ariseth in the Hands and the feet as it evidently appeareth in Persons that are Hydropical Cachectical and Phthisical in regard that those parts are more remote from the fountain of heat But now this Oedema is not suddenly generated but by degrees and by little and little For why the Humor is thick and therefore altogether unfit for any speedy and sudden motion Galen in his second Book to Glauco and third Chapter determineth that the Oedema is caused by a Pituitous or flegmy substance or else by the Spirits when they are ful of vapors and such a like Tumor or swelling happeneth in dead Carkasses From which place as likewise from the 14. of his Method of Physick Chap. 4 Johannes Philippus Ingrassias in his Book of Tumors the first Tome page 113. endeavoreth to prove a twofold kind of Oedema the one from thin flegm the other from a vaporous spirit and that to wit the former he asserteth to be a Disease and the latter a Symptom only that followeth upon Phthisis and the water betwixt the Skin one species of the Dropsie and the Cachexy But yet although it be not to be denied that Carkasses in the very first beginning of there putrefying and as it were a certain kind of fermentation swel up in some sort yet that in the Cachexy or Phthisis the Oedematose swellings of the Feet should in this same manner be caused I cannot easily beleeve in regard that such a like putridness doth not then happen but it is far more credible that such like Tumors are caused from a serous wheyish Humor abounding in the body and descending unto the Feet and there abiding and sticking fast as in a part more cold than the other parts of the Body And be it indeed granted and admitted that in the similar parts there may be some kind of slatulent Spirit collected and that it may lift up the part into a Tumor yet notwithstanding this Tumor is not properly Oedema but is rather to be termed Empneumatosis or Emphysema And albeit such a like Tumor is by Galen in his 14. Book of the Method of Physick Chap. 4. called a Symptom yet we say that Galen then useth the name of a Symptom in the general for every Affect preternatural that followeth another But if we wel weigh and consider what this Tumor properly is we affirm that it is altogether and in al respects a Disease in regard that it is magnitude augmented and for the most part an impediment and hindrance unto men in their walking And although such an Oedema doth not indeed requite a peculiar Cure yet notwithstanding it is not for al that to be razed out of the number of Diseases and placed among the Symptoms For those Diseases that simply depend upon other Diseases require not any proper and peculiar kind of Cure but those being removed these likewise are taken away But now that very Humor that is the cause of Oedema is generated by an error and default in the sangnification touching which we have spoken in the third Book of our Practice third Part second Section and first Chapter The Signs Diagnostick Oedema is known in this manner The Tumor is soft and loose and if it be pressed down with the singer it easily yieldeth and giveth way by sinking and so there is a little pit and print of the singer left behind For the moist
Phthiriasis OUt of the Humors mingled together there are likewise generated both Tumors and Ulcers in Infants that seize especially upon their Heads touching which we have already treated in the fourth Book of our Practice Part 2. Chap. 3 4 5. where we handled the Diseases of Infants and therefore I conceive it altogether needless here to repeat any thing of what was there at large delivered I shal only therefore here further acquaint you with these few things following The first whereof is this That theâ—e Affects here propounded as likewise those which we have next of al explained are indeed by the most referred unto Tumors and yet notwithstanding because there is here an Ulcer evermore conjoyned with these Affects and the truth being that the Ulcer seemeth rather to have in it the Nature of a Disease than the Tumor hath which is indeed but very smal and inconsiderable we judg that they may alike fitly and properly be referred unto Ulcers But yet how ever our purpose is to continue the same Method â—â—d â—s I may so say to spin the same thrid that we find begun by most Authors and according to their guidance and direction And moreover as for what concerneth the Affects here propounded what we are to understand by Crusta Lactea and what we mean by Achores Favi and Tinea we have already told you in the place before alleadged as for Helcydria Psydracia and other the like Affects of the Head comprehended under the general name Exanthemata they are al together handled by Galen in his first Book of the Composition of Medicaments according to the places affected and the last Chap. but by the rest of the Greeks in divers and distinct Chapters Halyabbas seems to comprehend them al under the name of Tinea whenas in the eighth Book of his Theory and Chap. 18. he thus writeth But these Vlcers Tineae saith he are very smal and they happen unto the Head and there is in them a bladder that hath many species and kinds The first whereof is that we cal Favosa which hath its original from a salt flegm the sign whereof is this That there is an Vlcer whereby the Skin of the Head is perforated and ful of little holes in the which there is a certain moisture like unto an Honey-comb The second is that we cal Ficosa being round and hard in the upper parts of which there is a certain redness and in the concavity thereof somthing like unto the smal grains and seeds that are in Figs. There is likewise a third species that it called Ameda and they are Vlcers with the which there are in the Head many little holes that are somwhat less than those that are in the Favosa and out of these there issueth forth a certain humidity like unto the water of flesh There is also a fourth sort of Pustule but they are smal and red ones the figure and form whereof is like unto the Teâ—â—s of Dugs from which there floweth out a moisture like unto the wateriness of the blood There is likewise a fifth species thereof that is dry and of a white color like unto the Lupina from which there flow forth as it were bulls and white sâ—ales Where he constituteth four moist species of Tinea and the fifth species dry and under the moist he comprehendeth not only Achores and Favi but likewise even Papulae and â—icus But now by Papulae we are to understand al smal Pustules out of which there issueth forth an humidity like unto waterish blood so called from their figure by which they resemble the Teaâ—s of the Breasts They are called likewise Elcydria For although this name in the general signifieth any little Ulcer yet notwithstanding Galen in his first Book of the Composition of Medicaments according to the places and last Chapter attributeth this name in special unto the Ulcerous Pustules in the Head And indeed Alexander in his first Book and Chap. 7. yet more especially ascribeth this name unto the said Papulae and so doth Paulus Aegineta in his third Book and Chap. 3. And Aetius Tetrab 2. Serm. 2. Chap. 70. And Celsus likewise under the name of a little Ulcer seemeth in special to understand Achores and Favi when in his fifth Book Chap. 28. Title touching the several kinds oâ— Pustules and the Cure of them he thus writeth But out of Pustules saith he there now and then arise likewise smal Vlcers that are either more dry or more moist and they are accompanied somtimes only with a kind of Itching but otherwhile they are also attended with an Inflammation or with pain and there issueth forth either Sanies or Pus or both of them And this especially happeneth unto such as are yet in their Childhood and then but very seldom in the midst of their body but very frequently in the higher parts thereof But now Sycosis or Ficus Sycosis is a Tumor so called from the resemblance it hath with a Fig because that in the Cavity thereof there is something found like unto Fig seeds round somewhat hard reddish and Ulcerous from which there is somthing smal and glutinous or clammy tat now and then floweth out of it breaking forth of the Chin and especially the Beard and somtimes also it breaketh forth in the Hair From whence it is that Celsus in his sixth Book and Chap. 3. constituteth two species thereof where he thus writeth There is likewise saith he an Vlcer that from the likeness it hath with a Fig is by the Greeks named Sycosis And here the flesh groweth forth and this is indeed the general name thereof But now under it there are two species the one whereof is an hard and round Vlcer but the other moist and unequal Out of the hard there floweth forth somthing that is smal and glutinous but out of the moist there issueth forth more and that of a very ill savor Now both these are in those parts that are covered with Hair But then indeed that which is callous and round breaketh forth more especially in the Beard whereas on the other side that which is moist appeareth chiefly in the Hair It is bred likewise in the Arse and then the Latines cal it Marisca But here we meet with very great variety of names especially among the Arabians And â—eâ— her so only but likewise there is great variety of difference that occurreth in explaining the cause thereof For Galen in his Book of preternatural Tumors and Chap. 16. asserteth that a salt flegm but in his first Book of the Composition of Medicaments according to the places Chap. 10. he saith that a humor mingled of a thin wheyish and corroding and likewise of a thick glutinous and clammy juyce is the cause as wel of the Achores as of Favi Paulus Aegineta in his third Book and Chap. 3. writeth that a nitrous and salt flegm is the cause of both these Affects Alexander in his first Book and Chap. 8. mentioneth
Glandules are situated under the Vessels like as also in other Glandules already mentioned And somtimes likewise but this is very rare they are bred from the Flesh of the self same places which by a certain affinity is converted into the nature of Strumae and is augmented by the access of Matter For first of all the Glandules of the said parts in like manner as all other parts the Flegm being dried or the Melancholly humor or both of them together mingled become hard like as a Scirrhus doth But somtimes the very substance of the Glandulous flesh being dried waxeth hard which yet notwithstanding being afterward moistened by the melancholly or Flegmy humor increaseth and becometh preternaturally augmented Yet notwitstanding in regard that both those waies of generation are coincident and in a manner one and the same Galen thereupon seemeth for the most part to sleight this difference and in his Book of preternatural Tumors Chap. 11. he there saith that such as are affected with hardened Glandules may properly be said to be affected with Strumae But yet notwithstanding touching the Causes we have before in the place alleadged acquainted you that Platerus determineth that Flegm alone and the Melancholly humor are scarcely sufficient to generate Strumae seeing that if they were from those alone they would not then be of long continuance but they would rather be obnoxious unto putridness or turned into Pus like as are other Tumors but that these Strumae derive their original from a Juyce nourishing these parts For whereas Glandules are nourished with a thicker Juyce than other fleshly parts if this Juyce exceed in Quantity it then generateth divers kind of Tumors But although this be altogether to be granted yet notwithstanding this is not altogether impossible but that some melancholly and flegmy humor be mingled together with the aliment of the Glandules Now this matter of the Strumae is included in a peculiar Membrane which the formative faculty that is seated and planted in all the parts that have life in them produceth For whenas there is some Membrane distended or even broken by the superfluous humor that floweth thereto Nature extendeth and dilateth the same and attempteth the structure and forming as it were of a new Membrane The Differences These Strumae are by some distinguished into Malignant and Benign and they will have those to be benign that are without an Inflammation without pain and those they will have to be malignant that have with them both Inflammation and pain and that are the more exasperated by Medicaments But we must know that those Strumae that are termed malignant are not properly Strumae but a Tumor as it were mingled of Strumae and a Cancer so that this Tumor doth not alone proceed from a flegmy and Melancholly humor but it hath likewise mingled together with it a black Choler They are likewise distinguished in this manner that some Strumae are free others of them infiltrated Those of them are said to be free and simple that are not complicated with any Vessel or tied together with it but such of them as are knit together either with some notable Vein or some Nerve and are as it were wrapt and folded within them these we call Strumae infiltrated or haply as by a name more fit and congruous Strumae implicated Those things that should have been further declared touching these Strumae have already been propounded in the place alleadged viz. in the second Book of our Practise Part 1. Chap. 35. and there they may be seen Chap 34. Of Ganglium and Nodi GAnglion so called by the Greeks and by the Latines Ganglium is by some reckoned up among the Affects of the Head But by Paulus Aegineta in his fourth Book Chap. 16. and Book 6. Chap. 39. and by Aetius in Tetrab 4. Serm. 3. Chap. 9. it is attributed unto many parts and it is an Affect of the Nervous parts and by the Author of the Physical Definitions it is thus defined viz. that it is a preternatural rowling together or knot of a Nerve which groweth together into one Body The very same Tumor Guido in his second Tract Doct. 2. Chap. 4. seemeth to call it Lupia and Tagautius in his Chirurgicall Institutions Book 1. Chap. 13. writeth that it appeareth in Aetius out of the Cure Philagrius that Lupia of the modern Physitians the Glandula of Avicen and Ganglion of the Greeks is one and the same Affect But by what names these Tumors are called by the Germans is not very evident For if we wel weigh the Descriptions and Signs yea and the Cure likewise of Ganglion and Lupia of the Greeks and the latter Physitians as also of the Glandules of Avicen Ganglium is that Affect which by the Germans is called Vberbein uberbein so called not that it is indeed a Bone but because it is a Tumor upon a Bone to wit in that same place where the Bones are only covered with the Skin or because it resembleth the hardness of a Bone Notwithstanding Platerus doth not cal those Tumors that arise from the Nerves and which Authors every where describe under the name of Ganglium by the name of Vberbeine but a peculiar kind of Tumor when the Periostium being shaven or eaten through there springeth up and groweth unto the former as it were a new Bone But now that Tumor which he propoundeth under the name of Ganglium viz. which is bred about the joynts especially the Knees somtimes comprehending the whol Joynt and this one while in a more narrow and other while in a broader limit and somtimes also so stopping and hindering the motion thereof that the Member is altogether either motionless or else so that it cannot be wholly and entirely moved seemeth to be that Tumor which the Germans cal Glied-shevva Glied-shevva to wit because as it were a certain Mushrom it ariseth under the Skin neer about the Joynts and especially the Knee which is not alwaies round but often overspreadeth the whol Knee when yet notwithstanding Ganglion is alwaies a round Tumor as Ambrose Parrey writeth in his sixth Book and Chap. 20. But as I told you likewise before there is a great confusion in the names And therefore as Joh. Tagautius in the first Book of his Physical Institutions and Chap. 2. adviseth us the thing it self is to be heeded with al care and circumspection and as for the names we need not much to regard them since that oftentimes one and the same word hath in several Authors various and different appellations Ganglion ariseth indeed in al or the most parts of the body and yet more especially in those parts that are moved neer about the Joynts to wit In the Hands and Feet and in those very places where the Bones are only covered with Skin and where there is a concourse of the Tendons Ligaments and Nerves And yet notwithstanding Aetius addeth the Head and Forehead as likewise the Elbows and Arms but it
is but seldom that it happeneth in these parts The Causes That it hath its original from a blow or from hard labor Paulus and Aetius teach us which is indeed to be understood of the evident cause But how these evident causes come to produce those Tumors is not so evident and manifest Vulgarly the greater part determine that they arise from a dull sluggish thick flegm or else from Melancholy But others assert and that more rightly that by means of some fal by reason of extension or of some extraordinary hard labor and over working by al or any of which either a Nerve or a Tendon is too far extended or likewise according to the Membrane even as is were broken the nutriment of the Nervous part doth as it were sweat forth and adhere neer about the Fibres and the substance of the same Nervous part and so becometh changed into this substance by reason of the formative faculty of the said parts and then covered with a peculiar Membrane After which manner if the Periostium be opened even in the Bones their nutriment is turned into a boney knot as Platerus giveth us to understand For look as it is in Trees if their Rind or Bark be wounded or in any other manner opened Nature sweating forth the aliment suffereth it not rashly to diffuse it self al abroad but changeth it into a knot so in like manner albeit the Membranes that wrap about the Bones or Nervous parts may be broken yet Nature permits not the aliment rashly to flow abroad through the open passages but from thence under the Skin formeth a Tumor included and shut up in a peculiar Membrane But now that Ganglion that Platerus describeth happeneth not from the default of one only Nerve or Tendon but chiefly in those places where there is a concourse of Tendons Ligaments and Nerves and especially about the knee either when those parts by reason of their overgreat motion are very much exercised or else while Wounds are in curing For if the juyce of these parts to wit of the Tendons Nerves Membranes and Ligaments shal chance upon the occasion of the aforesaid Causes to flow forth abroad out of the said parts and shal withal begin to be luxuriant and to abound and shal likewise adhere unto the Fibres of the same parts it is then changed into such a like fungous or Mushrom-like matter which oftentimes overspreadeth the whol joynt and is thereupon by the Germans called Der Gliedshevva And yet notwithstanding it may likewise so chance that a vitious humor abounding in the body may flow in into such a like weak part and may be mingled together with the said thick juyce that nourisheth these parts and may through that open passage flow together with it unto the aforesaid parts and may there augment the Tumor Signs Diagnostick This Tumor is bred in those parts that are not covered with much flesh but only by the Skin and therefore it lieth not hid very deep and it is now hard now soft now greater now less and somtimes it is in bigness equal unto and many times greater than an Egg it is void of al pain and yet notwithstanding if it be forcibly pressed together it then manifesteth a certain kind of dul and stupid sense it may be thrust and moved unto the sides but neither forward nor backward That Ganglium which Platerus describeth is a Tumor for the most part arising in the Knee soft without pain and of a different color from smal beginnings somtimes encreasing to so great a bulk and magnitude that it comprehendeth the whol joynt from whence it chanceth that the sick person can neither stand upright no go straight neither is he able in going to tread upon the ground or at least as it were only on tiptoe Prognosticks 1. This Disease is of long continuance and oftentimes lasteth for many yeers and accompaninieth the sick parties even unto their dying day 2. Those of them that are in the very junctures of the joynts impede and hinder the motion of the whol Member 3. The Ganglium likewise that is neer about the Joynt unless it may be taken away by Medicaments is altogether incurable For it admitteth not of Section or cutting in regard that it may easily happen that by Section a Nerve Tendon or Ligament may be hurt The Cure Universal or general Remedies having been first premised it is requisite that the Tumor be mollified and discussed or if this cannot wel be done that it be suppurated or cut out Therefore if Ganglium or Nodus the Knot be recent and new and the little Bladder within which it is included be yet tender we must then in the first place do our endeavor that the said bladder may be broken And therefore the Tumor is to be rubbed with the hand so long until it wax hot and become softer and afterward let it be close pressed together with some thin plate or some other solid thing so long that the bladder may be broken and that the matter therein included may be thereby dispersed And therefore let a thin plate of Lead be imposed upon the place affected and bound close upon it with a Swathe which is not to be removed until after ten daies Others there are that first of al anoint the Tumor with Ammoniacum dissolved in the form of an Emplaster and then after they apply a thin plate of Lead Oribasius made use of this that followeth Take Ceruss Pitchy Rosin old Oyl Ammoniacum Galbanum of each one ounce Wax four ounces mingle them c. Or Take Aloes and Myrrh of each six drams Litharge of Gold one ounce Ladanum half an ounce Ammoniacum the Fat of a Calf and of a Fox of each six drams Oyl of white Lillies two ounces Wax as much as wil suffice make an Emplaster Or Take of unslaked Lime the Fat of a Goose of each one ounce Ammoniacum half an ounce Turpentine one ounce mingle them c. Or Take of the Emplaster Oxycroceum one ounce the Mucilage of Marsh-mallow seed and Fenugreek seed of each half an ounce Galbanum Sagapenum and Ammoniacum dissolved in Vinegar of each three drams Rosin six drams white Wax half an ounce Mingle them and make an Emplaster Or Take Gum Ammoniacum Bdellium Galbanum dissolved in Vinegar of each one ounce and half Oyl of white Lillies of Camomile of Bays the Spirit of Wine of each half an ounce the pouder of the Flowerdeluce Root and live Sulphur of each half a dram mingle them and make an Emplaster If the Ganglia give not way unto these Medicaments we must then betake our selves unto those Remedies that cause suppuration As for Example Take the Roots of white Lillies and Marsh-mallow Roots of each an ounce and half the Root of Fern one ounce fat dried Figs in number ten the Root of Squils or the Sea Onion one ounce the Flowers of Melilote and Elder flowers of each one smal handful boyl them in the Broth of a
the Stones becometh much moystened being hereby much effeminated and so by this means the humidity thereof is in great measure retained And that we may conclude this Discourse the Elephantiasis alone as Palmarius writeth more than any other of those Diseases that are of long continuance seemeth to rejoyce it self as it were in the variety and interchange of Remedies And there are in this affect if in any other certain cessations and intermissions almost from all Remedies oftentimes to be allowed unto the sick Person and then the same Remedies are anew to be repaired and new ones to be added since that scarcely ever did any recover of this Disease that placed the hope of his safety in one only Remedy though it were never so generous and prevalent Julius Palmarius puts much confidence in Hydrarge which as he writeth doth every whit as much in this case as the flesh of Vipers or the Viperine Treacle or the Iron Instrument or the Fire But in regard that it wil take up too much of our time and cost much pains here to acquaint you with all that we might touching this subject And in regard also that the same Palmarius in his Book of the Elephantiasis hath taken notice of many other such like Observations as touching this Disease and that Aetius likewise Tetrab 4 Serm. 1. Chap. 121. c. hath collected very many things concerning it and that much also may be found in Forestus his Rosa Anglica and in other Authors that have written upon this Subject and lastly in regard that Schenkius likewise in the sixth Book of his Observations hath collected many strange and rare things touching this Elephantiasis in all these respects I think it not amiss to refer the Reader unto those aforesaid Authors for his more still satisfaction And Petrus Palmarius likewise in his Lapis Philosoph Dogmatic Chap. 24. reciteth an History of a certain Leprous Woman whom he Cured with Aurum Potabile exuberated and exalted upon a Sphere as Chymists speak and with the Antimony of Alexander Suchtenius Chap. 41. Of a flatulent or windy Tumor ANd thus have we now at length dispatched and finished the Explication of al those Tumors that have their original from the Humors it now remaineth that in the next place we treat of those Tumors that arise from winds For there are peculiar Tumors that have their original from flatulency or a flatulent and windy spirit which the Greeks call Pneumatoseis and Empneumatoseis and Emphysemata but the Latines call them Inflationes Now this flatulent Tumor as Galen tels us in his Book touching the course of Diet in acute Diseases Comment 4. Text. 21. is generated after a twofold manner to wit By a flatulent Spirit collected in certain Cavities these Cavities being either exposed to the sense or else such as are Contemplable by Reason Now by Cavities contemplable by reason as he explains himself in his second Book to Glauco Chap. 5. he understandeth those very Pores of the similary parts and those little spaces that are interposed betwixt the said similary parts The Causes The Proxime i. e. the neerest and conjunct Cause of his Tumor is a Wind or flatulent Spirit Now this is generated as Galen writeth in his third Book of the Causes of Symptoms and Chap. 4. from a heat weak and languishing For as absolute Cold cannot possibly excite any Vapor so on the other side vehement heat discusseth the Vapor That which supplieth matter unto these flatulencies is a humor thick flegmatick or melancholick The same do both flatulent Meats and Drinks afford as also a cold moist and cloudy Air an idle and sedentary life and the suppression of accustomed Evacuations The thickness of the part likewise that wil not permit the Vapors to breath forth maketh much for the accumulation and heaping up of Winds The Differences Now there are of these flatulent Tumors many Differences and this especially in regard of the parts affected whiles that somtimes these Winds are collected under Skin and about the Membranes of the Muscles somtimes in the Membranes of the Bowels somtimes in the very Cavities of the Bowels viz. the Stomack Womb Abdomen and Scrotum or Cods Signs Diagnostick The flatulent Tumor is known by this That the part is somtimes lifted up into a greater and somtimes into a less heighth and oftentimes likewise there is from the distension a pain excited but yet notwithstanding there is no kind of heaviness felt and perceived in the parts and unless the wind be shut up in some cavity it doth very seldom continue long in one place but wandereth up and down If the Tumor may be pressed with the finger it leaveth no pit but the Tumor either resisteth the touch of the finger or else the wind passeth unto some other part and if it he smote with the hand it then sendeth forth a noise like hat of a Dâ—um and by how much the cavity in the which the wind is contained is the greater so much the greater is the noise or found The Emphysema differeth from Oedema because that the cause of Oedema doth alwaies stick in the pores and the spaces of the parts that are contemplable be Reason now what those parts are you may understand by what we have said in the beginning of this Chapter But the cause of Emphysema is often collected in some one certain Cavity And albeit that same flatulent spirit be likewise somtimes disperâ—ed through the streghtest passages of the parts yet notwithstanding as we have told you these Oedema's being pressed no leaves hole or pit behind them but as for the Emphysemata â—hey are not hollowed into a pit and for Oedemata likewise if they be touches by the â—â—nd make no noise at al as do the Emphysemata Prognosticks 1. Flatulent Tumors if they be smal and be not cherished by some pertinacious cause they are then without danger 2. It the flatulent Tumor be great it then argueth a great debility of the hear and an abundance of matter and therefore it is more dangegerous because more contumacious and stubborn 3. If the flatulent matter be detained in the Muscles it is then hardly cured in regard that the spirit is dispersed from the ambient Membranes into almost al the parts of the Muscle as Aetius writeth Tetrah 4. Serm. 3. Chap. 2. The Cure The wind that distendeth the part is to be taken away and means used that it may not breed again and flow unto the part and the pain if any there be is to be mitigated and moderated And therefore such a kind of Diet is to be ordained that maketh not for the generation of winds and the matter out of which the wind is bred is to be evacuated and the heat of the part that generateth the windiness is to be corroborated and corrected touching which we have already spoken in the places that shal be presently alleadged Such things as are hot and dry discuss windiness and of this sort are the seeds
an extream troublesome palpitation and beating of his Heart For the removal of this great Distemper there were many Remedies prescribed and administred not only by my self but likewise by the most expert Physitians of our Vniversity there All which when they could not in the least prevail over this contumacious and head-strong Disease by reason of the Patients continuing and persevering in his accustomed ill course of Diet he grew the worse thereby and after some few months were passed in the which by the advice of the Physitians he took no Physick at all for they were willing to commit unto Nature a part of the Cure of this Chronical Affect he began to complain of that part that lieth under his left Shoulder-blade The place of his grief being lookt upon and throughly considered there appeared unto me a notable Tumor soft unto the touch and attended with a beating and when pressed down with the Fingers it was then seemingly wholly hid and non-apparent but these were no sooner taken off but forthwith it returneth as before In short the Disease having gotten deep rooting being now become incurable our Patient within a very short time after departed this life But now that we might get the truth and certainty both of the nature and constitution of this Disease as also of the Cause thereof we dissected that part that was affected with the Tumor out of which there issued forth great store of Blood unsavory and stinking as it was all which Blood being wholly evacuated and throughly cleansed there appeared the prime and principle Artery under the Heart having its original from the great Vein in its ascending up into the Head exceedingly dilated and extreamly torn This Vein descending downward creepeth along through the Region of the Intercostal Muscles the Blood that flowed forth of it being heaped up in the spaces of the Muscles and in tract of time putrefying and corrupting had so vitiated and marred the Vertebra and Rib of that place that it seemed unto us altogether rotten and putrefied And therefore say we some other way and means of the generating of this Tumor is to be sought and found out The Author of the Book of the Medicin Definitions defineth Aneurysma by the relaxation of an Artery And so likewise Fernelius in the seventh Book of his Patholog and Chap. 3. asserteth that Aneurysma is a dilatation of an Artery ful of spiritful blood but all this while they do not express the manner how this is done Neither is it ever a whit credible that Aneurisma is caused by the dilating of both the Tunicles of the Artery but only by the widening of one of them For the Atteries have indeed a double Membrane one external which is slender thin and soft having of straight Fibres very many but of oblique ones very few and of transverse ones none at all the other internal which is close thick and hard having transverse Fibres but wanting straight and oblique ones And therefore if the Internal Tunicle be either broken by extension as easily it may be in regard of its hardness or else if it be opened by Section it doth not easily Cement and close together again because it is hard but now the external Tunicle in regard of its softness doth easily and soon grow together again and because it is so soft and wanteth both oblique and transverse Fibres it is thereupon extended by the Blood and the vital Spirit seeking their passage forth in an imperious and violent manner and so this kind of Tumor cometh to be excited in the which the force and the impetuous violence of the blood and the vital spirit may be discovered by the very touch Neither is that which Platerus objecteth of any weight or moment to wiâ— when he tels us that upon the alone bare Section that he saw made in the skin that covered over the Tumor the blood forthwith at first hid it self but then instantly sprang forth amain and this oftentimes saith he is in so great abundance that it cannot by any one use he what means he wil be any more stanched but that it issueth forth in greater abundance insomuch that the whol stock of Blood being almost spent it hath oftentimes brought a sudden Death upon the sick Person But indeed if we should determine that the Aneurisma proceedeth from the dilatation of these Tunicles of the Artery this Objection would then carry some weight along with it But in regard that according to the truth of the matter we have already asserted and determined that an Aneurysma ariseth from the dilatation of the exterior Tunicle alone of the Artery the internal being opened either by Section or by Rupture we cannot therefore by any means grant that the Arterial blood lieth hid under the whole Skin but because the external Tunicle is extraordinarily extended it cohereth and sticketh so close unto the Skin that it is extended together with it and is in a manner so become one therewith that it is almost impossible to cut the Skin without cutting the external Tunicle of the Artery And so then the result of al that hath been said wil be this to wit The nighest cause of Aneurisma That the proxime and nighest cause of Aneurysma is the opening of the interior Tunicle of the Artery and the dilatation of the external Now it is very frequently opened by Section when unexpert Chirurgeons instead of a Vein open an Artery or when at least together with the Vein they cut through the Artery that lieth under it Now if this at any time happen the external Tunicle in regard of its softness and neer alliance with the Tunicles of the Veins very easily and soon closeth together again but the interior by reason of its hardness remaineth open from whence through the patent and open place the Blood and vital Spirit endeavoreth to break forth and by this means distendeth the external Tunicle and causeth this kind of Tumor The same may likewise happen if the internal Tunicle of the Artery be broken either by the violent and impetuous motion of the Arterial blood or by any violent external cause and the overgreat distension of the Artery the external Tunicle that is more apt for extension being al this while safe and sound But now Whether or no that pulsation of the Arteries of which Platerus maketh mention in his Tract touching the palpitation of the Heart and touching which out of Fernelius and Ludovicus Mercatus we have already treated in the fourth Book of our Practice Part 2. Sect. 3. Chap. 9. may or ought properly to be referred unto Aneurysma I very much doubt For whenas the Membrane of either Artery is then whol and entire it seemeth rather to be an Affect in the Veins of kin to the swoln and distorted Veins that we cal Varices than this Tumor Aneurysma of which we are now treating Signs Diagnostick The Aneurysma is easily known and discerned from Ecchymosis because that in Aneurysma the color
threds or else the Tumor being opened about the midst of it after the emptying forth of what is therein contained we cut off the skin that being left remaining that was tied about and then a long spleen-like Plaister wel moistened in Wine and Oyl being laid thereon we conclude and perfect the Cure by Liniments But who is he that seeth not that this kind of Cure is not only cruel and so cruel that few or none wil submit unto it but that it hath likewise much danger in it and yet for al that doth not heal the sick person For although the Artery be bound about yet notwithstanding after the threds are loosened there is cause to fear lest that either an Haemorrhage follow or else that a new Aneurysma be caused And therefore the more secure and safe course is only to bind hard and press together the Tumor with Bands and Medicaments that so it may not gain any further augmentation Chap. 44. Of the swoln Veins caled Varices VArix with the Greeks Kirsos this being the name given unto it by the Greek Physians only for we find Aristotle in the third Book of his History of living Creatures Chap. 11. and 19. and Plutarch in the Life of Caius calling it Ixia as Galen in his tenth Book of the Method of Physick and last Chap. defineth it and as out of him Paulus Aegineta hath transcribed it in his sixth Book Chap. 82. and Aetius Tetrab 4. Serm. 2. Chap. 48 is the dilatation of a Vein this said dilatation of a Vein being called Varix as that before mentioned dilatation of an Artery was termed by the Greek Physitians Aneurysma of which in the foregoing Chapter But now these Varices happen in divers parts of the body but most frequently in the Thighs and yet notwithstanding somtimes likewise in the Temples as Paulus telleth us in the place before alleadged and somtimes in the lowest part of the Belly under the Navel and oftentimes also about the Testicles and the Cods which said Tumor is in special called Kirsocele The Causes They are generated from great store of Melancholly blood which as Galen writeth in his Book of black Choler Chap. 4. Nature oftentimes transmitteth unto those Veins that are in the Thighs by the which being distended and dilated they are rendred Varicose or swoln up and the skin that toucheth upon these kind of Veins in process of time becometh of a blackish color But now as for such in whom there is only great store of blood flowing in that is not Melancholy it resting indeed and wholly relying upon those Veins which there in that place are naturally more weak than elswhere doth dilate them but scarcely even dye them of such a like color as it happeneth when Melancholy blood shal produce these Varices For such are in very great danger if any one assay to cut forth the Veins affected of being surprised with Melancholly For this is frequently seen to happen not only in Varices but even in the Haemorrhoids also that consist of the same kind of humor even as the coming of them upon those that are mad is wont to be a freeing and discharging of them from their madness as Hippocrat in the sixth of his Aphorisms Aphor. 21. And yet notwithstanding scarcely ever doth good blood though it abound never so much by its great plenty alone produce and cause Varices as it doth if it be both plentiful and withall if it be thick which by its weight tendeth downward unto the Thight Whereupon it is also that the Varices have not their being until the ripeness of age as Hippocrates in Coac praenot toward the end teacheth us in regard that a thick and melancholly blood is not generated sooner in the Body And likewise Pliny in his eleventh Book and Chap. 45. writeth that the Varices happen in the Thighs of Men only and very rarely in Women Such likewise as are bald in these the Varices become not great but for such as while their baldness is upon them are afflicted with these Varices these come again to receive their Hair Hippocrat in the sixth of his Aphorisms Aphor. 34. Which yet notwithstanding Galen asserteth to be a falshood in his Comment unless haply any one wil understand this of that affect that Physitians call Madarosis that is the shedding or falling off of the Hair For this Affect since that it hath its original from vitious humors as likewise the Alopecia hath and also that we call Ophiasis if those very depraved humors being translated into the Thighs do cause the Varices the sick Persons may then possibly recover and receive their Hair again For if at the first the loss of the Hair proceeded from vitious humors their corrupting and corroding the very roots of the Hair then questionless these said humors taking now their course into some other place the Hairs will again return unto their naturall State The more remote Causes all those that make for then generating and breeding of thick and melancholly blood and especially the Spleen when it is distempered maketh much unto and helpeth forward the generation of these Varices And that likewise which much furthereth the flowing of the aforesaid humors unto this part may be comprised under on of these Heads to wit either a blow or streining overmuch long and tedious foot journeys extream hard labor and the like Signs Diagostick These Varices are easily known whenas swelling Veins is the very superficies of the Members and especially of the Thighs appear unto the very sight it self and the part affected appeareth either Leaden coloured or black and the Tumor being pressed down seemingly retreateth back but forthwith returneth again Prognosticks 1. These Varices of themselves carry little or no danger in them neither bring they any unto the Party thus affected but they rather preserve and free such as have them from other Diseases especially Melancholly Diseases touching which Hippoc. in the sixth of his Aphorisms Aphor. 21. thus writeth If Varices or the Haemorrhoids happen unto such as are mad they are thereby freed of their madness and the whole Body is by them throughly purged from all flatulent Blood 2. But if they be unseasonably taken away as Galen in his Book of Venesection against Erisistratus and Chap. 6. and in his Book of black Choler and Chap. 4. teacheth us Madness the Pleurisie the pain of the Reins the Haemorrhoid Flux the Cough and spitting of Blood the Apoplexy Cachexy Dropsie and other Diseases arise 3. Sometimes these Varices do pass into the Elephantia of the Arabians touching which we shal speak further in the next following Chapter The Cure Unless therefore the Varices be of the biggest size and that the Veins and the Skin by reason of their extension be so extenuated that there be great cause to fear a Rupture a profusion of blood and Death it self and again unless they be inflamed and extreamly painful or that there be present some great and
in the Stomack and that accordingly blood be bred in the Liver yet it is oftentimes discussed and wasted by some certain Causes such as are overmuch exercise Watchings Cares Griefs and Diseases which melt away dissolve and discuss the aliment so that there is too great an evacuation hereof by the Belly by Sweats and by the flux of Blood and such likewise are immoderate Rest Meats and Medicamens that dry excessively Fevers especially such of them as are acute and Malignant But the Nutriment is not rightly assimilated by the parts in regard of some vitious quality it hath in it by reason of which it cannot be assimilated by the parts and so likewise the Nutrition may be frustrated by some external error or else by reason of the Object to wit because the Blood is such that it cannot by the nourishing faculty be perfectly overcome and assimilated But now in regard of the faculty there is not a sufficient Nutrition â— In regard of the nourishing faculty by reason of some defect and want of native heat and radical moysture For Nature maketh great use of this Native heat as of the next instrument in nourishing And this especially happeneth by reason of the preternatural affects of the Heart and principally its heat and driness whether it be that the Heart be primarily affected as it is in the Hectick Fever or else that it suffer through some default of the neighboring parts as it happeneth in the Ulcer of the Lungs For whereas the nourishing faculty as we said erewhile maketh great use of the innate and Native heat as its principal Instrument in reteining Concocting agglutinating and assimilating and it being so that the innate heat is cherished by the heat that floweth in if the temper of the Heart be not right and as it ought to be then the heat that floweth in and consequently the innate heat likewise wil be much amiss and not rightly tempered and so it can be no fit Instrument of the nourishing Faculty And that that Hectick Feavers do but slowly and sensibly bring to pass this the burning and melting Feavers accomplish in a very short time by the heat whereof not only the aliment and substance of the body is consumed and melted away but likewise the temperament both of the Heart and also of the whol body is converted into that which is more hot and dry The same happeneth by reason of over hard labors cares long continued diseases and in general al causes that are able to consume the Radical moisture and weaken the Native heat Now this Atrophy happeneth especially in the softer parts The subject the fat and the flesh and indeed the fat is first of al wasted and then afterward the flesh is likewise extenuated But now as for the harder parts such as are the Membranes Cartilages and especially the Bones although these may also in the like manner be dried yet notwithstanding they cannot possibly be so extenuated and diminished that thence the whol body should decrease And hence it is likewise that the said extenuation and Atrophy of the body doth appear especially in those parts in which there is much fatness and where there are more or greater Muscles as in the Eyes and Temples The particular Atrophy The Atrophy that happeneth in the parts is various It happeneth oftentimes privately in the Limbs the Arms and the Thighs And hither belongeth the Atrophy of the Eye The causes thereof which are the same As for the Cause of the particular Atrophy like as the Causes of the Atrophy of the whol body consist in some one principal Bowel whose action is necessary for the nutrition of the whol Body or is indeed universal and such as may exsiccate and dry the whol body so in like manner the particular Atrophy of any one part hath a private cause or at least such a one as belongeth unto that particular part Yet notwithstanding the Causes are the same as of the universal Atrophy to wit the weakness of the Nutritive Faculty The weakness of the Nutritive Faculty and the defect of Aliment The Faculty is hurt when the part is over cooled and left destitute of its proper heat For if this happen the part can neither attract nor retain not alter nor assimilate the Aliment Now the part is refrigerated and the heat decayed and rendered dul and unfit for action not only from the external Air as also from cold water but likewise it may proceed from overmuch rest in the Palsie or else from the streightness of the passages through which the Spirits flow in The defect of nutriment The Nutriment faileth especially by reason of the narrowness of the passages through which it floweth unto the part that needeth it And this happeneth for the most part from external causes when the Veins that carry the blood unto the part for its Nutriment are pressed together by the bones when they are loosened and out of joynt or else from some certain Tumor that is nigh unto it or by the brawniness and hardness of the flesh or else lastly when the Veins that convey the Nutriment are cut in sunder See likewise Galen's Book of Marcor a Species hereof arising from an Hectick Feaver Signs Diagnostick The extenuation of the whol body as likewise of some one particular part thereof is visibly apparent to the sight so that there wil be no need of many signs For if the whol body be greatly wasted by an Atrophy then the Face fals away and becometh lean the Temples fal down the seat of the Eyes is rendered hollow and deep the Nostrils become sharp and such kind of Face because that Hippocrates describeth it in his Prognosticks they commonly cal an Hippocratical Face Al the Ribs are conspicuous the shoulder blades and the Chanel bones stick out the Neck is extenuated and the Larynx or the top of the cough Attery buncheth forth the Belly falleth down the Buttocks become withered and weak the Thighs Arms Hands and Feet are emaciated and grow lean But in regard that the Atrophy hath its dependance upon many and several causes they are therefore al of them to be inquired into that so the Cure of them may the more rightly be proceeded in And therefore enquiry must be made whether external Causes to wit tasting cares grief over hard labor and the like went before If we find no such thing we are then to make enquity into the internal Causes to wit whether there be present a Hectick or any putrid Feaver or whether there had not been one a little while before and likewise a discovery must be made touching the Stomach Spleen and Liver in what state and condition they are for by the Diseases of the Bowels it may easily be known what the Cause of the Atrophy is Prognosticks 1. By how much the more the Atrophy is but recent and newly begun by so much the more easily it is cured but by how much the longer it hath
continued by so much the more difficult it is to be cured 2. When only the Alimentary humor is consumed there is then hopes of an easie and speedy Cure but that Atrophy is more difficuâ—â—ly cured in which the substance of the flesh is already wasted and most difficult of al when the Membranous and fibrous parts are already exsiccated and extreamly dried Yea such an Atrophy can no more be cured than that Atrophy that befalleth all persons whatsoever that live unto an old age 3. If the Native heat be not as yet so far forth weakened but that it my possibly be repaired there is then some hopes of recovery since that the Cause being removed and the heat restored there may be nutrition again procured unto the body 4. And therefore we altogether conclude that from the Causes especially we are to conjecture what we are to hope for as touching the Cure For if those causes may be taken away and removed there is then some hopes of the recovery of health but if they may not there is likewise then no hopes of safety The Cure As for what concerneth the Cure of an Atrophy when the Body is over dried and that the Atrophy dependeth upon the defect and failing of Nutrition it sheweth that then humectation or moistening of the body is first of al to be procured Now the body is moistened if we do our endeavor that the Aliment may be drawn forth out of the Veins unto al the parts of the body In those that are sound and that being attracted it may be retained and assimilated by the parts of the body But first of al all the Causes whether they be evident and external or internal they are to be removed And therefore if fasting and hunger went before let fitting food be again administred if over much labor sollicitous cares and troubles of the mind and the like these al of them are to be removed For these Causes being taken away and convenient food being exhibited the body is easily restored But in those that are sick if by reason of the dejected appetite and some disease either the Aliment be consumed or the Faculty weakened that disease being removed and the sick person taking food again the restauration of the body followeth But now for the curing of the diseases of the Stomach Liver Spleen Lungs and in what manner these and the like Diseases are to be removed we have abundantly taught you in our Practical Physick From whence this likewise appeareth very plainly that it is but in vain for us to use our utmost endeavor for the nourishing of the body whiles the body is replenished with vitious humors For the more we nourish impure bodies the more we hurt them as Hippocrates tels us in the second Book of his Aphorisms Aphor. 10. For even the good juyces and meats are likewise corrupted by the said vitious humors and so the Cacochymy is augmented And therfore these bad and offensive humors are first of al to be prepared and evacuated And this is altogether true in the Cure of al and every Atrophy that our main care and regard must be in reference unto the cause upon which it dependeth and that our first and chief pains must be bestowed in the removal thereof and afterwards we are to bethink our selves how the extenuated body may again be fetcht up and restored by Aliment There ought also to be great care taken that this very restauration of the body be rightly accomplished And therefore first of al there ought to be given Aliments that are soon and easily concocted and next of al such as do a little nourish although they be more difficultly and slowly concocted Unto such as are free from Feavers and Obstructions and that are not troubled with any pain in the Head neither have their Hypochondria dâ—stended Milk may very fitly be allowed Womens Breast Milk especially then Sheeps Milk thirdly Cows Milk adding thereto a little Sugar as also the juyces and Broths of Flesh as of Partriges Hens and Pullets Capons Wether Mutton Veal together with Bread and especially these Broths that they cal consummate and restoring Broths Those Emulsions likewise are singularly good that are made of Almonds Barly with Wheaten flour But this is especially useful and here in this â—â—â—e much approved of that is made of the bruised pulpy flesh of a Capon Almonds Sugar Milk and the flour of Rice They likewise here very much commend the Indian Nut and they write That by the alone use hereof extenuated bodies have been fatned In a cold Marcor Wine is allowable and may benefit but in a hot and torrid Marcor it is altogether to be avoided But now in the manner of Refection and Nutrition A note touching the manner of refection Hippocrates his seventh Aphorism of the second Sâ—ction is to be observed Those Bodies saith he that have been a long time extenuating are slowly and by degrees to be repaired again but those that have had but a short time for their wasting must in as short a space he restored to their wonted fleshiness For as Galen explains it those bodies that are in a short time extenuated they suffer this not from the colliquation and melting of the solid parts but from the evacuation of the humors and the spirits but those bodies that have been long extenuating in those the very flesh melteth away and the other parts likewise by which the concoction and distribution and sanguification is perfected in the whol body are rendered and made lean wherefore there cannot be so much aliment concocted as the body stands in need of And because of this we are to take the longer time in the refection and repairing of such like decayed bodies and their Nutriment must be but thin and spare this spateness of Nutriment being by Hippocrates termed slowness in nourishing But as for such as have only their humors and spirits evacuated in these we may safely and without any the least danger cause a speedy and ful refection and restauration in regard that the strength of the solid parts serveth here for a firm foundation After sleep gentle Frictions may be instituted The frictions and baths that are to be administred the hands being first anointed over with the Oyl of sweet Almonds A Bath of Waters is likewise very useful for it evidently moisteneth those that are over dried as we may easily perceive in such as have travelled long in the hot and scorching Sun or else have been over exercising themselves any other way and thereby are made over hot as also in such as have their moisture overmuch dried up by watchings cares or by any other waies and means And Galen is very frequent in the mentioning of Baths which here and there he largely treateth of insomuch that unto us who have no such great regard unto baths he may seem somthing too curious But at this very day many in Asia do imitate the Care and Custom of the Romans
order following to wit 1. If we first of all treat of a simple Ulcer or an Ulcer considered in the General 2. Of an Ulcer with a Distemper 3. Of an Ulcer with an afflux of humors 4. Of a sordid and foul Ulcer 5. Of an Ulcer with Tumors 6. Of Flesh growing forth luxuriant and proud 7. Of an Ulcer that is wan or Leaden coloured and withall Callous 8. Of an Ulcer that is hollow and fistulous which we commonly call the Fistula 9. Of an Ulcer with Worms 10. Of an Ulcer with a rottenness of the Bones 11. Of the Ulcer by the Greeks called Dysepulot Malignant the Ulcers Telephia and Chironia and Phagedaena 12. Of pain with an Ulcer 13. Of the Ulcers of the Legs and other parts 14. Unto which we wil add something touching Burnings 15. We wil conclude all with a short Discourse touching a Gangrene and Sphacelus Chap. 2. Of a simple or single Vlcer IN the first place therefore we wil handle a simple Ulcer and shew you what are the Causes of an Ulcer considered in the general and what differences it hath according to its form its causes and the place affected by what signs the Ulcer and its essential differences may be known and what is to be pre-advised as touching the cure and what the Ulcer in general indicateth and pointeth out and lastly what kind of Method and course it requireth for the curing of it The Causes We have already told you in the precedent Chapter that the neerest cause of an Ulcer is a matter that hath in it a corroding quality whether it be bred in the Body or whether it happen unto the body from without Of the first sort are al Humors whatsoever that are sharp and endued with a corroding Faculty bred in the body But now this humor is either bred without the part affected or else it is generated in the very part it self that is affected Without the affected part there is generated a cholerick humor a salt flegm a Whey that is salt nitrous and sharp and black Choler or Melancholy For these if they be bred in the body and flow unto any one part they may corrode and exulcerate the said part But from what Causes such like humors may be generated in the body we have already shewn you in the second Book of our Institutions touching the causes of Diseases and elsewhere Now they flow unto the part affected either by transmission or by attraction both which from what causes they proceed we have declared above in the first Part and Chap. 5. of an Inflammation And more especially in the Spring time various Ulcers are wont to arise from some internal vice of the Humors as likewise from unseasonable and immoderate exercises For if as Galen writeth in his third Book upon the Aphorisms Aphor. 20. in the Spring the Body be impure there happeneth indeed then some such like thing in the Spring time even as we see there is wont to be in the exercises of the Body For although these exercises be never so safe and healthful in themselvs yet nevertheles if you bring forth a man that is full either of flegm or yellow choler or black choler or even also of blood it self to exercise you shal undoubtedly by this exercising of him procure unto him either the Falling-sickness or the Apoplexy or if not these yet most assuredly the rupture of some Vessel in the Lungs or a most acute and violent Feaver But unto such as have had exercise enjoyn'd them for the purging out of humors that lie low and deep this their exercise drawing forth unto the skin a Gacochymy that is to say abundance of bad and offensive humors and scattering it throughout the parts doth for the most part excite and cause Vlcers and the Scabies or Scabbiness For this is that which Hippocrates hinteth unto us when he saith That if we exercise an impure and impurged body Vlcers wil from thence arise And so indeed in the very like manner in the Spring time the heat of the ambient Air dissolving the humors calleth them forth unto the skin by an effect altogether like unto that of exercises For the effects of the Spring do not only resemble the effects of Exercises but they are also most like unto the works and operations even of Nature her self For indeed the parts that the Spring time acteth like as doth Nature her self are as wel to cause that occult and secret perspiration throughout the whol body by the which all the superfluities of the body are emptied forth as throughly to purge the body also by diseases after a various and different manner Thus â—aâ— Galen But then these Humors get their acrimony in the part it self by reason of some distemper in the said part And after this manner like as even the Pus or puâ—â—lent matter it self by its concoction and long abode in the part becometh more sharp and stil so much the sharper and corroding by how much the humor out of which it is generated is more tart and sharp so likewise doth the blood which is corrupted by the part affected and so putrefieth But now the Causes that happen unto the body from without are Septick or putrefying and Caustick Medicaments Neither do I here exclude the very actual fire it self from bearing a part in the number of the external causes in regard that the Eschar that is left remaining appertaineth rather unto ulcers than unto wounds And hither likewise is to be referred that contagion by means whereof the vapors exhaling from the Lungs of Phthisical persons by others attracted drawn in with the breath do likewise exulcerate their Lungs and so cause in them a Phthisis or Consumption and also the nastiness and infections of such as are scabbed Leprous and affected with the foul Disease being communicated unto the skin do exulcerate it and there generate a like disease But that attraction which is caused in gauling interfairing or in wearing of the skin by the wringing and streightness of the shoo is not rightly and fitly referred unto and reckoned up amongst the nighest and most immediate Causes For by the said attrition the humor only is attracted that afterwards corrodeth the Skin and exciteth therein little bladders or blisters But now what the special causes of special Ulcers are we shal afterwards shew you in its proper place where the peculiar causes of each particular Ulcer shal be explained of the Ulcer cannot be filled up neither can there flesh enough grow forth from whence it is that an hollow Cicatrice is caused 19. If the Ulcer after such time as it is filled up with flesh and that a Cicatrice ought to have been brought thereupon wax crude and raw again there is then great cause to fear that the Ulcer wil turn into a Fistula 20. Ulcers that are in the Feet and in the Hands are wont somtimes to hasten on Inflammations of the Glandules in the Arm-pits or in the
Groins and Tumors in bodies that are plethorical and cacochymical For the matter flowing down unto the ulcer in the Hand or in the Foot those very parts themselves likewise being become more loose and weak do first of al receive and drink it in 21. The ulcers of the Thighs are for the most part hard to be cured and especially if they be cherished by any distemper and default in the Spleen for then the thick and melancholy humors that flow unto the ulcer do hinder the Cute thereof 22. Ulcers that have continued long and are now become inveterate are not to be cured without much danger unless the body be first of all carefully purged and a good course of Diet be observed of which very thing Gulielmus Fabricius in his third Century and Observ 39. giveth us an instance in a certain man who having had an inveterate ulcer cured in his left Thigh by an unskilful and immethodical Empirick after some few months was surprized with a Pleurisie in his left side upon which he died and that during his sickness he spit forth just such stuff and excrements as before were wont to flow forth of the ulcer See likewise Ambrose Parry in his seventeenth Book and Chap. 51. touching Pus likewise from an ulcer in the Arm evacuated by the Urine The rest of the Prognosticks shal be handled in the special differences of the ulcers Indications Since that the Essence of an ulcer consisteth in the solution of unity and the diminution of the magnitude of the affected part the solution of unity sheweth that union must be endeavored and that which is lost and diminished indicateth its own restauration to wit the ulcer as an ulcer is to be filled up with flesh and united and then shut up with a Cicatrice But then when the ulcer is conjoyned with its cause that either excited the ulcer from the very beginning or else if in the Cure it obtain the Nature of that cause without which the ulcer had not been the said cause is then first of al to be removed But then it is requisite likewise that the temper of the part affected as also the blood that floweth thereto be such as it ought to be but if there chance to be any thing amiss in these it is to be corrected touching which we shal hereafter speak further in the special differences of Ulcers If therefore that Humor that excited the ulcer be stil present it is to be evacuated for in every affect in which the cause is stil present the Cure is evermore to be begun from the removal of the Cause And moreover because that in the beginning there wil alwaies fal forth some of the blood without their proper vessels and because that oftentimes together with it other vitious humors in the body flow thither lest therefore that which stâ—cketh in the pores of the parts should putrefie and breed an Inflammation this blood is to be concocted and changed into good and laudable Pus From whence likewise it is that Galen in his Book of the times of the whol Disease and Chap. 3. writeth that ulcers have their peculiar times and that in the beginning there iâ— thrust forth a thin inconcocted and waterish Sanies which in the augmentation by the help and benefit of concoction becometh thicker and at length in the state is changed into Pus that is good and white And therefore in the beginning of an ulcer it wil be requisite to use Concocters which they commonly cal Digestives And furthermore the filth and impurities which are wont to be generated in an ulcer in regard that they hinder the curing thereof are to be wiped clean away So soon as the ulcer is cleansed the Cavity thereof is to be filled up with flesh and at the length the ulcer is to be shut up with a Cicatrice There is yet nevertheless likewise regard to be had unto the parts affected For in the ulcers of the external parts the green iust of Brass burnt Brass Vitriol Antimony and the like have their place which nevertheless are by no means to be admitted of in the internal parts If likewise the part be so constituted and framed that it may give a passage unto other things like as the Gullet doth the Medicaments are then so to be ordered that they adhere unto the part Those parts that are endued with an exquisite sense wil not admit of sharp Medicaments which those parts that are of a more dul sense wil wel enough sustain touching which we shal speak here and there in the particular ulcerâ— But now how an ulcer may be filled up with flesh Galen teacheth us in his third Book of the Method of Physick and Chap. 3. To wit unto the generating of flesh there are necessarily required the efficient Cause and the matter The efficient is Nature which as it doth in the whol body so likewise in each particular part doth attract and draw so much Aliment as is necessary and there she retaineth it concocteth applieth and assimilateth it The matter is a pure and sincere blood that is generated from meat and drink But because in every concoction there is generated a twofold excrement one more thin that insensibly exhaleth or else is discussed by Sweat the other more thick the same likewise happeneth in the generation of Flesh in the Ulcer and if they be left remaining in the part they wil moisten it and hinder the generation of Flesh And therefore these Excrements in the Ulcers are to be clean wiped away and dried up And this is that which is so frequently commonly alleadged out of Galen in his third Book of the Method of Physick and Chap. 4. and in his fourth Book of the Method of Physick and Chap. 5. and in other places here and there where he saith that every Ulcer requireth exsiccation And Hippocrates in the beginning of his Book of Ulcers thus writeth That which is dry saith he commeth neer unto that which is sound but that which is moist cometh very nigh unto that that is vitiated And so the Cure of an Ulcer it is indeed the work of Nature that restoreth the flesh that is lost from the Blood flowing unto the part and bringeth a Cicatrice over the Ulcer being silled up with flesh The Physitian he only removeth those impediments that are an obstacle to Nature in her operation whilest he cleanseth away the Excrements and drieth the Ulcer and when he doth this he is then said to generate Flesh and to introduce a Cicatrice The Cure At the beginning therefore if the body be plethorical or Cacochymical then the abundance of Blood is to be diminished or the Body evacuated lest that the humors flow yet longer unto the part affected And withall let there likewise be a good and wholsome Course of Diet appointed unto the Patient that so there may no more of these bad humors be generated in the Body And for all those things likewise that we call not natural there
encrease and so the Cicatrice should thereby be raised the higher For in regard that the Skin is a Nervous substance it cannot therefore be so generated anew as the flesh but in place and stead thereof there is somthing generated that is like unto the skin and this we cal a Cicatrice This is likewise to be taken notice of That Epulotick Medicaments ought to be endued both actually and potentially with a drying faculty and that therefore for the producing and causing the Cicatrice Emplasters are most fitly and commodiously administred and applied Gabriel Fallopius in his Book of Ulcers Chap. 13. propoundeth this Unguent which he termeth de Tutia Magistrale and he there writeth that of al that he had ever seen this is absolutely the best Viz. Take Oyl of Roses and Oyl Omphacine of each six ounces Oyl of Myrtle and the Vnguent Populeon of each three ounces Plantane Leaves and Garden Nightshade of each two handfuls Let the Herbs be cut very smal and let them be mingled altogether for the space of eight daies shaking and stirring them wel together every of those daies Then strain them and to the straining add of Wax four ounces mingle it with the rest upon the fire until that they be al melted after this mingle them better with a Wooden Spatter and while it is yet blood warm add of the Litharge of Gold or Silver six ounces Ceruss two ounces Tutty prepared two drams burnt Lead six drams Brass burnt unto a redness three drams Camphire one dram and half stir them wel about in a Mortar by the space of two hours An Epulotick Pouder Take the Roots of Tormentil Bistort Round Aristolochy Acorn Cups Egg-shels burnt Frankincense Dragons blood of each half an ounce Lapin Calaminaris one dram Litharge two drams and make a Pouder This following Emplaster is likewise very useful the which I have oftentimes made trial of and that with very good success Viz. Take of the Vnguent Diapompholyx the Emplaster Diapalma and the Emplastrum Gryseum of each one ounce Gum Elemi two drams Sugar of Saturn one scruple Wax as much as wil suffice and make an Emplaster Chap. 3. Of an Ulcer with a Distemper BUt it many times so happeneth that the ulcer is not solitary and alone and pure but that other preternatural Affects are conjoyned therewith whereupon also the Cure is varied And therefore we intend in the next place to treat of these ulcers in special An ulcer with a Distemper And first of al there is indeed oftentimes a distemper conjoyned with an ulcer which when it happeneth the Cure of the ulcer is then much hindered For in regard that the Nature of the part is the Efficient cause of the Cure of the ulcer and that the blood is the matter if the part be intemperate neither of these can be in that right temper that they ought to be neither can the ulcer be filled up with flesh nor closed with a Cicatrice unless the flesh lying underneath it be in its natural temper as Galen tels us in his third Book of the Method of Physick Chap. 8. But what the differences of the Distempers are we have already acquainted you in the second Book of out Institutions Part 1. Chap. 3. which here also have their place and there may concur together with the ulcer a difstemper that is hot or cold moist or dry a distemper hot and moist hot and dry or cold and moist cold and dry and indeed the distemper may be either with or without mater But of the distemper with matter we shal speak in the following Chapters Here therefore in this Chapter we shal treat only of a Distemper without matter The Causes Now such a Distemper as this either it was present before the rise and appearance of the ulcer or else it was excited even in the very time of the ulceration But for the Causes of these Distempers what they are we have likewise told you in the place before alleadged Which that we may apply unto ulcers a hot distemper in ulcers is excited by a hot Air by too many Swath-bands and bindings and by Medicaments that are over hot And on the contrary a cold distemper is caused by the cold Air from the not sufficiently fencing and guarding the ulcer with Swathbands and warm Rowlers against the coldness and injuries of the external Air as likewise it is excited by cold Medicaments The moist distemper is produced by the moist Ambient Air and hence it is that in some places the Air is greatly hurtful unto ulcers and by the â—fflux of humors touching which more in che Chapter following A dry distemper is caused by a dry Air by Medicaments that are over drying and by the want or scarcity of Aliment Of Compound Distempers the Causes are likewise compound Signs Diagnostick The signs of a hot Distemper are that heating Causes went before and also that not only the Lips but even the very flesh it self of the ulcer appeareth more red than usual and the sick person himself perceiveth a great heat in the ulcer which for the most part a pain followeth Cold Medicaments being thereunto applied do exceedingly refresh and delight and withal do greatly benefit the Patient and on the contrary hot Medicaments are greatly hurtful the excrements of the ulcer are sharp and biting A cold distemper cooling Causes went before it in it the Lips of the ulcer decline unto a whiteness or unto a wan leaden color and they are soft and hot things are helpful and agreeable unto the ulcer but cold Medicaments are on the contrary very hurtful If the Distemper be moist then moistening Causes had their precedence the flesh is soft and appeareth lank and flaggy and somtimes it groweth forth overmuch the excrements of the ulcer are many such things as are drying do benefit and those Medicaments that moisten do greatly hurt And lastly A dry distemper is known by this That drying Causes went before the Lips of the ulcer appear dry and squallid and hard the excrements of the ulcer are but few or none at al. Moisteners are profitable but drying Medicaments cause much hurt unto the sick person Prognosticks 1. Whereas as Galen tels us in his fourth Book of the Method of Physick Chap. 1. for the healing and curing of ulcers the flesh that lieth underneath them ought to be altogether temperate therefore it is that these ulcers become hardly curable by reason of the distemper in the part lying next under it 2. Ulcers with a distemper either hot or cold or moist are cured without any great difficulty For with one and the same pains and at the same time and with the very same Medicaments we may both remove the distemper and cure the ulcer 3. But those ulcers that are attended with a dry distemper are the hardest of al to be cured because that the cure of the ulcer being for a while neglected and laid aside it behoveth the Physitian to be altogether intent and
for a fomentation and then let them be filtatred and hard pressed according to the usual manner An Astringent and Epulotick Injection followed upon this Fomentation Take the Leaves of Plantane of new Ivy the Flowers of red Roses of each one pugil the grains of Myrtle shaken wel together one pugil and half the Leaves and Flowers of Centaury the less of each one pugil Roch Allum one ounce Pomegranate Rinds one ounce and half let them boyl all together in red Wine and then strain them Of the straining we ordered them with a sraight Syringe Squirt or Injection pipe to cast into the Vlcer the Vlcer being first of all throughly cleansed and purified which cleansing was indeed wholly effected and wrought by the fore-ordained Injections but more sepecially likewise and most speedily with this following Vnguent for it hath an admirable and excellent virtue in the cleansing of Vlcers from all their thin Ichorous excrements and impurities the Ingredients that it consisteth of are these that follow Take Juyce of Smallage half a pint this is admirable in cleansing of Vlcers the best Honey four ounces Barley meal two ounces of the bitter Vetch Orobus half an ounce Choyce Myrrh two drams Turpentine one ounce and half let them be boyled al together and make an Vnguent in which let Linen Rags be wel wet and then put into the Cavities of be Vlcer in purgeth Vlcers most excellently and without any biting at al. For the filling up of the Vlcer with flesh we made use of this following Emplaster Take Litharge of Gold six ounces Oyl of Roses Omphacine one pint and half Vinegar of Roses half a pint boyl them together with a gentle fire continually stirring them about with a Spatter until they shal have gotten a blackish color and the consistence or thickness of soft Bituminous Clay and a Cerot Make a long Roller-like Emplaster of which make an Emplaster fit for the Vlcer and lay it upon the Vlcer But in the end and conclusion of the Cure we made use of the Emplaster Diachalcitis with the Emplaster of Diapompholyx in the curing of which so great and hollow an Vlcer after the throughly cleansing of the same we found by good experience that there was nothing could be better and more available then the applying of pillows or bolsters a little thicker than ordinary round about the said Vlcer and so binding these bolsters on very hard strongly to press down into the flesh lying underneath that other flesh that lay gaping far disjoyned from it for as Experience then taught us this if there be any thing that will do it doth most especially procure agglutination and sodering together Chap. 10. Of Fistula's FIstula's differ from a Sinuous and furrowed Ulcer only in this to wit That they are moreover callous and hard and therefore here after sinuous Ulcers we think it fit to treat o Fistula's If the Sinus or nook be not speedily cured the Pus wil moreover cause furrows such as we usually term Coney-burrows and the part wil contract a callousness or thick insensible brawniness and it wil become so hard that it can by no manner of means be agglutinated and united again unto the parts lying underneath which Malady is after this called a Fistula For a Fistula is a Sinus nook or furrow narrow and long or a Sinuous ulcer that is for the most part narrow and callous and thereupon such as wil hardly admit of any Cure The Causes But now these Fistula's for the most part have their original from Impostumes For these either by reason of the impurity of the body or the too great abundance of naughty humors if they be permitted long to continue or else if by the unskilfulness of the Physitian they shal be over long delayed and not wel cured the Pus then causing the aforesaid Coney-furrows they wil at length become very deep and withal callous and of an insensible brawny hardness The Differences There is moreover of Fistula's very great variety and diversity For of these some are profound and deep others of them straight and others lie transversly and overthwart the flesh again some of them are simple single and alone but others of them taking their rise and beginning from one and the same orifice are double or even likewise threefold or oftentimes they have very many Sinu's or hollow nooks and lastly some of them tend unto and terminate in a Bone others tend unto a Nervous part and a third sort of them â—ven unto the Veins or Arteries Signs Diagnostick But now these Fistula's in the general are known especially by the Probe or Instrument that is conveyed into the Sinus to discover the depth thereof which how it tendeth and passeth along and how deeply it penetrateth it easily seen and discerned And withal when the searching Instrument is drawn forth we may then easily learn whether the Fistula be moist or whether it be dry But if it be oblique so that the Instrument cannot pass along in a direct and straight manner we then are wont to put in a little long plummet of Lead or rather which is much the better a Wax Candle that may be turned about any way And moreover that flesh that lieth round the Fistula appeareth to be white dry hard and without pain or else if there be any pain it is very little and moderate unless haply it be neer unto a Nerve and the Pus that issueth forth is crude and raw and somtimes likewise very stinking loathsom But now whether or no there be one or more of these Sinus's this is altogether to be discovered by the Probe or searching Instrument which the Pus likewise that is now and then sent forth wil sufficiently evidence For if there flow forth more Pus then what probably can be contained and generated in one only Sinus or hollow Nook or if when the sick Person removeth and changeth his seat that Pus that before was stopped shal begin again to flow forth this may be a sure and certain sign and token that there are here present more then one of the Sinus's and that the Fistula penetrateth very deep But if there are more orifices of the Fistula then we cannot so easily discover by the Instrument whether there be one only Fistula or more but then by a Syringe Pipe or Squirt liquor is to be injected by one orifice the which liquor if it flow forth again by all the orifices then it is al but one Fistula but if it issueth not forth at all the orifices then there are more Fistula's then one And this is likewise discovered by the colour of that that issueth forth for if that humidity that floweth forth by all the orifices be of one and the same colour it is then a sign that the Fistula is but one but if it be of a different colour it is then an argument that there are more Fistula's then one But how far the Fistula's reach and in what part they end
oft as it is hot we may put it into cold water to cool it And whatsoever of the humor sweat forth out of that bone it is to be cleansed and wiped away with a Spunge or a Linen cloth lest that otherwise it corrupt the neerly scituated parts After the burning we are then in the first place to apply Rose-water with the white of an Egg for the preventing of the Inflammation and the moderating of the pain afterward we are to administer the Oyl of Roses with the Yelk of an Egg and then after this Butter with Honey of Roses But unto the bone that is burnt the Pouder of the Root of Sow-fennel of Aristolochy Euphorbium or some other of the forementioned Remedies is to be imposed and laid upon the corrupted bone until the said bone be separated and parted After the taking forth of the corrupted bone some drying Pouder and such as are called Cephalick Pouders is to be strewed upon the place After this the Ulcer is to be filled up with flesh and at length to be closed and shut up with a Cicatrice Chap. 14. Of Ulcers hard to be cured commonly called Cacoethe Telephium and Chironium THere are Ulcers likewise that are here and there in the Writings of Physitians termed Dysepulote Ulcers Cacoethe Telephia Chironia and Phagedaena which what they are we shal in this and the following Chapter explain unto you And in general al those Ulcers may be called Dysepulote or hardly healed that are not to be cured without much difficulty and such as are not closed up with a Cicatrice without much ado Touching the right curing of which Galen wrote both the fourth Book of his Method of Healing and his fourth Book of the Composition of Medicaments according to their kinds And this indeed happeneth for four causes as Galen tels us in his fourth Book of the Method of Healing Chap. 1. For of those Ulcers that are hardly cured and rebellious some of them are made such by reason of the distemper in the ulcerated part and others of them become such by means of the humor flowing in unto them But now this very distemper may again be said to be twofold since that the subjected flesh is somtimes such as hath exceeded the bounds of Nature in the quality only but somtimes likewise with a certain necessary Tumor or swelling And in like manner the afflux of humors admitteth of a twofold division to wit into First the bad and depraved quality and secondly the excessive quantity of the humor or juyce that floweth in But in the mean while either some or else al the aforesaid Affects are alike and indifferently mingled together Yet nevertheless the same Galen in the sixth of the Aphorisms Aphor. 45. addeth a fifth cause where he writeth That Ulcers retrain a long time not only because of the afflux of humors or by reason of any disposition in the Member contracted from the humors flowing in but also thirdly by reason of some passion of the bone that is corrupted in that place For although Ulcers that have a corrupted bone lying underneath them may somtimes be cured and covered over with a Cicatrice yet notwithstanding that foundness is not firm and of any continuance but the Ulcer is afterward again renewed and this happeneth so long as the rotten bone remaineth unhealed And yet nevertheless Galen in his first Book of the Composition of Medicaments according to their kinds Chap. 18. distinguisheth between these Dysepulote Ulcers that is to say such as are hardly brought to a Cicatrice Malignant ulcers and the Ulcers Cacoethe or Malignant and he calleth such of them Dysepulote that arise from the conflux of either many or sharp humors without this that the part affected hath already such a disposition that although that that floweth in should be good yet notwithstanding it corrupteth it now those Ulcers that have already gotten this aforesaid disposition he calleth Cacoethe or malignant So that al those Ulcers that are hardly cured from what cause soever it be may in general be called Dysepulote Ulcers and now in special likewise those that are so made without any depraved disposition of the part affected But in regard that al the differences and causes of Ulcers hardly cured have hitherto been explained there is no need that we add any thing more concerning them And yet nevertheless there is one cause of those Ulcers that are hardly curable that I have somtimes observed which I think it not fit here altogether to pass over in silence It happeneth very often that in long continued Ulcers the skin is extenuated and the fleshy panicle and fat is wasted which if it happen we may conclude that the Ulcer is not healed since that the skin can by no means be agglutinated unto the flesh lying underneath it for when the Capillary Veins tending to the skin are eaten asunder they cannot then convey unto the skin that blood that is necessary for consolidation This is known because that the skin is not only by the touch perceived to be extenuated Ulcers Chironia but the color is likewise changed and becometh wan and dark and the skin as it were withereth away There is in this case little or nothing to be performed by Medicaments but the skin is either to be corroded by some Caustick Medicament or else as I have sometimes caused it to be done the Ulcer is to be opened longwaies with the Iron and this may very easily be done As touching the Ulcers Chironia and Telephia the Chironian Ulcer hath its name from the Centaure Chiron though some there are notwithstanding that render another reason of the said appellation Zenodotus as Erasmus of Rotterdam relateth in Chil. 2. Cent. 8. Prov. 21. thought that Chiron received from Hercules a Wound in his Foot and that the said Wound being altogether incurable he perished thereof so that incurable Ulcers are hence called Chironian Ulcers But Pliny in his twenty fifth Book Chap. 6. and Ovid in the fifth Book of his Fasti are of opinion that Chiron was not wounded by Hercules who was his friend but that Chiron being entertained by Hercules Chiron his Arrow fel accidentally upon the Foot of Hercules and caused therein a most dangerous and envenomed Wound and that Chiron himself healed this Wound with Centaury which Plant was therefore by those that came after called Chironium and that this Chiron was the first Inventor of the ancient Chiturgery being a part of Physickâ— and that from Hands and the operation of those hands it received â—s name So that any contumacious and malignant Ulcer that by reason of its contumacy hath need of some Chiron to cure iâ— and which was at the first cured by the said Chiron may be called a Chironian Ulcer Celsus in his sixth Book and Chap. 28. defineth a Chironium Ulcer in this manner It is saith he great and hath lips that are hard callous and swelling The Sanies that issueth out of it is not much but
destruction of the innate and natural heat as on the contrary the life of the part dependeth upon the preservation and safety of the said Native heat we conclude that whatsoever destroyeth the Native heat of the part that same may likewise be accounted a cause of the Gangrene and Sphacelus Now the Native heat is destroyed when by its contrary it is either corrupted or suffocated or dissipated or altogether extinguished for want of Aliment It is destroyed by its contrary either acting by a manifest quality and cold or else by a secret and hidden quality as by poyson It is suffocated when the transpiration it hindered It is dissipated by a greater heat It is extinguished if necessary food and sustenance be denied so that there are as you see five causes of the Generation of a Gangrene and Sphacelus to wit overmuch cold a poysonous quality the hinderance of transpiration a vehement external heat and a defect of Aliment and the heat flowing in For first of al we see that oftentimes in the Winter those that take Journeys in the Snow and Ice have the extream parts of their feet and of their hands their Ears and their nostrils almost dead with cold by reason of the vehemency thereof and thus it happeneth somtimes also that by reason of Medicaments over cooling in a Phlegmone or an Erysipelas carelessly and incauteously administred the part is taken and surprised with a Gangrene or a Sphacelus although I had rather refer this case unto transpiration hindered There is also a very great power of destroying the innate heat in those things that are poysonous and such things as destroy our Bodies by a secret and hidden quality For somtimes the humors in our bodies do so degenerate and acquire so great a malignity that they bring a Necrosis or deadness unto those parts whither they are by Nature thrust as we see it done in a Carbuncle And so in like manner the biting and stingings of poysonful Creatures do corrupt and putrefie the parts And the same also is done by the Septick Medicaments which if they be not wisely and carefully administred have in them a power of corrupting the flesh especially in places that are hot and moist as in the Emunctories the privy parts and the other places that are like unto these Thirdly Transpiration hindered exciteth likewise a Gangrene For whereas our heat standeth in need of perpetual ventilation and cooling if this be denied it is suffocated by the abundance of Vapors And for this very cause in great Inflammations and especially in the moist parts there very frequently happeneth a Gangrene the Native heat being extinguished as otherwise likewise we see that a little flame is extinguished and put out by casting thereon good store of water and that the flame is stifled if it be put under a Cupping-glass that hath no hole or vent in it or any other Vessel whatsoever that is kept covered which is preserved in a Cupping-glass that is perforated or any other Vessel that is open And this chiefly happeneth if in Feavers especially if they be malignant the humor be with violence either thrust forth or that of their own accord they rush unto any one part And so I remember that here a certain Citizen that was taken with a malignant Feaver from the humors that were thrust down unto the Scrotum had the said Scrotum al of it so inflamed and mortified with a Sphacelus that there was a necessity of cutting off the whol Scrotum or Cods so that the stones hung down altogether naked and bare which yet notwithstanding the Gangrene being cured became afterwards covered again with flesh that grew out of the Groyns That Inflammation likewise which the Gangrene followeth is sometimes caused by Wounds and these not alwaies great but oftentimes also very smal and sleight Wounds that seem inconsiderable and of no moment So Henricus ab Heer relateth in the first Book of his rare Physical Observations Obser 12. That he was present and saw a man fifty nine yeers of Age who having pared the Nails of his Toes and cut them to the quick was presently surprized with a Gangrene and within a very short space died thereof And he telleth us likewise of two other eminent persons who being desirous to have the hard and callous brawniness of their feet pared away were both of them taken with a Gangrene that within a short time caused their deaths And this may likewise be done by Emplastick Medicaments in great Inflammations and especially if they be unseasonably applied in moist places which frequently produce there a suffocation of the Native heat Fourthly A preternatural heat likewise and such as is extraneous and from without produceth the Gangrene by wasting the Radical moisture and the Native heat and so many times a Gangrene followeth after great burnings And lastly A Gangrene ariseth from the defect of Aliment to wit the blood and the spirit flowing in that is altogether necessary and requisite for the cherishing of the Natural heat implanted within For whereas the innate heat standeth in need of continual Nutriment as the flame doth of Oyl if this be denied it languisheth and is extinguished like as is the flame when the Oyl in the Lamp faileth And in this manner a Gangrene happeneth unto the external parts of the body somtimes in an Atrophy Consumption and the like Chronical and long continued Diseases that extenuate the body And for this very cause it is that when the greater Joynts are put out of Joynt if they be not again wel and rightly set then the disjoynted bone presseth together the vessels that lie neer and hindereth the influx of the blood and of the Spirits into those parts that lie underneath from whence there followeth a leanness and consumption of the said parts and in process of time very frequently a Gangrene also And so it is found by experience that from a hard Tumor about the Vena Cava where parting several waies it descendeth into the Thighs pressing the same together and hindering the descent of the blood into the Thigh a Gangrene very often ariseth And in this manner a Gangrene likewise happeneth if any part be too hard and long bound about with Ligatures and bands or else if Medicaments that are over astringent shal be imposed upon any part Signs Diagnostick It is no hard matter to know the Gangrene For the color of the part beginneth to be changed and turned unto black the flesh to grow loose and flaggy the pulse and sense to be diminished and the heat to be abolished Which said Symptoms the more the Gangrene tendeth unto a perfect corruption and a Sphacelus by so much the more are they increased and made more evident For in a perfect and absolute corruption and Sphacelus the life and sense of the part are wholly abolished there is no pulse at al to be perceived the part whether you cut or burn it is insensible of pain the flesh appeareth to be
cold is made soft and flaggy so that it yieldeth unto the touch when it is pressed by the fingers which yet nevertheless after it is throughly dried becometh black wan and altogether deadned and it yieldeth a noysom and stinking savor like that of a dead Carkass and the skin if it be taken up with the fingers seemeth to be separated from the flesh lying underneath it And here Ambrose Parry adviseth every Physitian that when he hath discovered by these signs that there is a Gangrene and a Sphacelus he no longer defer the doing of what is to be done neither suffer himself to be deceived by the motion some whereof is oftentimes stil left remaining even in a mortified and dead Member For in a Sphacelus the corrupted parts are moved not by the motion of the whol and entire Muscle but because the Head and no more of the Muscle is yet whol the which while it is moved it doth together with it draw the Tendon that is inseparable from it and the tayl likewise thereof although it be now wholly dead and without any true and proper motion And these signs that appear in a perfect corruption and Sphacelus are stil the same in every one of them whatsoever the cause be that it draweth its original from whether it be from cold or from a poysonous quality or from transpiration hindered or from an extraneous heat or lastly from the defect of Aliment unless it be in this only that such like Symptoms in a Sphacelus that hath its original from an occult cause and such as is poysonous as for example the Delirium or dotage the Syncope and the like are greater and more grievous But in a Gangrene and mortification that is but yet now beginning there is observed a diversity of the signs and symptoms according as the Gangrene hath its original from divers and different causes For in a Gangrene that ariseth from cold there suddenly appeareth an acute and pricking pain and a redness in the part which soon after is changed into a black color and the heat that was in the part is extirguished and there is perceived a coldness and stupidity with a certain kind of horror as it useth to be in Quartan Agues And moreover in a Gangrene that proccedeth from a poysonous and malignant humor in the body which Nature thrusteth forth unto the external parts there is present a continual Feaver and a strong conflict of Nature with the Disease from whence the Syncope Dotage and the like have their original and such a Gangrene as this ariseth for the most part in the external Members and the extream parts thereof as for instance the great Toe of the Foot with a certain Pustule or Bladder under which there is present a black spot which oftentimes is suddenly derived into the whol Leg and Thigh But that Gangrene that followeth upon great and extraordinary Inflammations that proceed most usually from the hinderance of Transpiration is known by this That the fresh and flourishing color that is wont to appear in Inflammations is turned into that which is pale and wan that beating pain which before did infest now ceaseth the sense is become dul and there arise very great Pustules that are ful of a thin ichorous excrement like unto that that cometh from the washing of raw flesh Which appear almost the same when the Gangrene hath its original from an extraneous heat If lastly the Gangrene seize upon the part by reason of the want of Aliment or through a dry distemper then there is present neither pain nor inflammation nor swelling but rather a leanness and the body is immediately cooled and this Gangrene happeneth for the most part in those places of the body that are the utmost and extream as for instance the Ankles and Toes But when at length the Pustules arise and the part becometh pale and wan then the pains likewise appear and the Feaver is excited But if the Gangrene happen by reason of hard tying and Ligatures then the part swelleth and it distended and there arise greater Pustules ful of a thin excrement resembling the washing of raw flesh but the evident Causes we may easily learn and understand from the sick person himself Prognosticks 1. That the Gangrene is a Malady very dangerous is sufficiently manifest unto every one For unless it be speedily cured it degenerateth in a very short time into a Sphacelus and the part becometh altogether dead For this cause therefore there is not any the least delay to be made but help is to be afforded with al possible speed which may be done with less difficulty in a body that is as yet young strong and vigorous where the vital spirits are as yet entire and especially where the Muscles and Nerves are as yet unhurt 2. But that Gangrene which is with an afflux of poysonous humors and an occult quality is more difficult to be cured than that which is without any such afflux for there are but very few that recover of such Gangrenes 3. There are Gangrenes that are yet more dangerous and these are they that begin in the moist parts for the innate heat is sooner suffocated in such parts by the great store of humors abounding therein 4. And for this cause it is that the Gangrene that ariseth in Hydropical persons is likewise very seldom cured but most usually it degenerateth into a Sphacelus and that which ariseth from the Antecedent Cause is likewise ever more dangerous than that which hath its original from the primitive Cause in regard that in the former the Bowels are more affected 5. But a Sphacelus is yet far the more dangerous Malady For the part that is taken with the Sphacelus can no way be restored and made sound again but it is forthwith to be cut off and separated from the part that hath life which if it be not speedily done then the sound parts that lie neer wil likewise be infected and the putridness wil at length creep into the rest of the body from whence there wil be extream danger of present death before which there usually precede Dotings Watchings the Syncope Convulsions Ructures and Belchings Sobbings and a cold Sweat breaking forth over all the Body and some of them die while they ate yet speaking and others of them die being as it were oppressed with sleep The Cure The Cure of the Gangrene that it may be rightly proceeded in first of al regard is to be had unto the Dyet and the Antecedent Cause if it be present in the body before ever we come to Topicks Most Physitians prescribe and command a Diet that is cool and drying which albeit that it be most true of that Gangrene that is accompanied with an afflux of Humors and followeth great Inflammations yet nevertheless the Diet is somtimes also to be varied according to the variety of the Causes as anon in the species or several kinds of Cure we shal further shew you And so also
a wollen Cloth be wee therein and so imposed upon the place affected it hath likewise been happily and successfully administred in the Gangrene of the Cods of which we have spoken above Take Vitriol one ounce the tops of the Oake one handful Frankincense half an ounce Camphyre two drams Vrine two pints and half boyl them to the Consumption of a third part and then strain them But the Aegypriack Unguent is not alone to be applied but upon the Unguent that Cataplasm is also to be imposed which resolveth drieth and hindreth putrefaction such an one as Johannes de Vigo in his second Book first Tract and seventh Chapter describeth and commendeth and which many other Physitians and Chirurgeons now a daies likewise make use of And all these are to be applied blood-warm and they are so long to be continued untill the putridness be removed But if the Malady wil not yield unto these Remedies then we are to have recourse unto those that are stronger to wit Causticks such as those Trochisques of Andro Polyidas Musa and Pafio which dissolved in Vinegar and Wine may be imposed upon the part Many indeed do here commend and prefer Arsenick before all other Remedies but Gulielmus Fabricius doth and not without good Cause reject and altogether disallow of it in the Cure of a Gangrene as that that not only hath in it a Septick and putrefying faculty and a quality of melting the flesh as it were but that likewise produceth very great and grievous Symptoms vehement pain Dotings Syncope's and the like the malignant vapours being communicated unto the principal part It is therefore more safe to make use of an actuall Cautery as that which hindereth and preventeth putridness drieth and corroborateth the part This is also much commended Take Mercury dissolve it in Aqua fortis when it is dissolved precipitate it the Oyl of Tartar after it is precipitated wash it Or Mercury alone dissolved and mingled with the Water of the Trinity Flowers and wollen Cloaths wet in this Liquor may be imposed on the part The Crust in what manner soever it be produced is to be taken away by those Medicaments that have been above declared in the first Part and Chap. 13. touching a Carbuncle Neither are we to wait so long til Nature shal altogether have separated the Corrupt from the Sound but the highest part of the Crust is with the edge of a Knife or a Penknife to be cut even unto the sound part that so there may be a way made for the Medicaments unto the deeper parts and the rest that are corrupted For if we expect until the Crust shal be freed of its own accord it may possibly happen that under the Crust a new putridness may be contracted The rest of the Cure is in the same order to be proceeded in as is fit to be done in Ulcers Fourthly If the Gangrene happen from overmuch heat A Gangrene from too much heat then a Cold Diet being prescribed and the hot humors being duly qualified and evacuated if the Malady take its original from an internal Cause the Member affected is to be scarified and then washed with such a Decoction as this Take the Water of Endive Sorrel Lettice Nightshade and Vinegar of each one pint Syrup of Sorrel two pound of Lupines half an ounce Water Germander half a handful Salt three ounces boyl them till a third part be consumed After this the Aegyptiack Unguent and the Cataplasm but even now mentioned is to be imposed and the rest which were before prescribed are speedily to follow Where notwithstanding this is to be observed that unless in case of urgent necessity we must not have recourse unto the actual Câ—utery lest that hereby to wit by the power and force of the fire the extraneous heat which is the Cause of the Gangrene be augmented Fifthly and lastly If the Gangrene arise from the defect of Aliment and Blood and Spirits A Gangrene by reason of an Atrophy in the part and chiefly in truth if it be by reason of a Driness and an Atrophy necessaâ—ry Nutriment being denied unto the part then meats that are hot and moist easie of Digestion and such as generate much and good blood are to be given unto the sick Person and outwardly the body is likewise to be moistened with Oyntmentâ— of sweet Oyl or with Oyl of sweet Almonds and all things are carefully to be avoided that exsiccate and dry the body And unto the part it self that is already affected with the Gangrene the Aliment is by all manner of means to be attracted And therefore here there is no place left for Defensives in regard that they shut and stop up all passage of the blood and Spirits unto the part affected And therefore we are not only to anoynt the part affected and the other members with the Juyce of Earth-worms which is made of the said Earth-worms first washed in Water and then in Wine so put into a great Vessel with good store of the Oyl of sweet Almonds Violets and melted by a gentle and moderate heat over hot Embers and afterwards strained which is a sprecial and soveraign Remedy in the Atrophy and extenuation of the parts but the part affected is therwith likewise gently to be rubbed and chafed unto which also Cupping-glasses not scarified are to be applied But it wil be most fit and requisite if there be already present a putridness to administer those things that do alike both attract and resist putridness such as are Salt Water boyled with Water-Germander Liquid Pitch with the meal of Lupines of the bitter Vetch Orobus Myrrh and the like But if the Gangrene hath already made any progress the part is then to be scarified and the Aegyptiack Unguent and that likewise that is compounded of Pitch and those other things a little before mentioned are to be laid thereon A Gangrene from the interception of the blood spirits Moreover If the Gangrene happen from the interception of the Blood and the Spirits likewise whatsoever the Cause then be that thus intercepteth the blood and the spirits it is immediately to be taken away as if the said interception be from the binding of the part it is forthwith to be loosened and withal those Medicaments that resist putridness as likewise those that discuss that that is corrupted such as are those that are made of the Meal of Beans of the bitter Vetch Orobus of Lupines Aloes Water-Germander and the like are to be imposed And if the Gangrene hath already gotten unto any heighth the place is to be scarified and those other things that are required in al Gangrenes are to be done If an astringent and repelling Medicament be the Cause the said Medicament being removed the heat is to be recalled by Frictions Lotions and Anointings And so we must also proceed in the Gangrene that hath its original from other Causes that intercept the Spirits For the Cure of the Gangrene
it self doth scarcely at al differ the difference lying only in the removal of the Causes But if the Malady become to that that the Member is now already altogether mortified and dead and that it be sphacelated from whatsoever cause it be that the Malady hath its original there is then one only way of curing it For seeing that what is altogether dead in the body cannot possibly recover life again and that it hath now altogether the nature of a thing that is preternatural there is this one only Indication to wit that it is to be taken and amputated from the body Which if by reason of the unfitness of the place it cannot conveniently be done then the case is wholly desperate For some parts are much more fitly scituated for amputation than others as for instance the fingers the feet the hands the genitals may be cut off with less danger But if the Malady be in the Thorax or Chest or in the Belly the parts cannot then be cut out and especially if there be many particles of the Member at Once infected For it somtimes so falleth out that the whol Member is not to be taken away but only some part thereof But oftentimes indeed the whol Member is wholly to be amputated and cut off to wit when the putridness hath seized Upon and corrupted al the parts thereof round about which in some may be speedily done and without any great danger as in the Scrotum or Cods but in other parts the amputation is ful of difficulty and peril as in the Feet Army and Hands But after what manner the said amputation and the taking away of that which is corrupted is to be performed we wil now acquaint you Now this may be done divers waies some there be that having first applied a Defensive upon the sound part they then with many straight and oblique Sections scarifie the dead flesh that lieth neer unto the sound and this they do very deep even unto the very bone And afterward upon the Wounds they strew the pouder of Arsenick and Sublimate that so the mortified part may be separated from the sound But in this way of extirpating the corrupt flesh Arsenick as we lately gave you notice is suspected and therefore in the stead thereof we are to administer other burning Medicaments of the ashes of Vine-sprigs and unslaked Lime The Crust that is al over the part affected is to be taken away with a Pen-knife neither must we expect til it be separated of its own accord Yet nevertheless that the dead part may be dried and be easily separated from the sound Fallopius applieth this Sparadrape Take Aloes Myrrh Acacia Gallia Moschata Alipta Moschata al the Saunders Lign Aloes Cumin Allum of each one dram make a Pouder Of which Take one ounce Ship-pitch Rosin of the Pine-tree Colophony of each two ounces Frankincense Mastick Styrax liquid of each one ounce and half Gum Arabick and Tragacanth of each half an ounce Let them be all melted put a Linen cloth into the Liquor until it be throughly soaked in the Medicament And afterwards let al other things be done as it useth to be in other Ulcers There are others that with an actual Cautery burn that that is corrupted even until there be a pain perceived in the part and al other things are afterward to be done according to art But now Fallopius doth advise us if much dead flesh be to be taken away not to make use of an actual Cautery alone in regard that from the said burning there wil be caused a most abominable loathsom stench Others there are that by Section and the Razor amputate that that is corrupted and afterwards to avoid the Hemorrhage and to dry up and consume the reliques they apply likewise an actual Cautery if need require But what hath hitherto been spoken touching this way and method of Curing is to be understood only of that Sphacelus wherein the whol Member is not corrupted and when there is no cause of taking away the Bone likewise For if the whol Member be corrupted The cutting off the corrupted Member when to be done and therefore to be amputated this cannot be effected either with an actual Cautery or a Potential neither yet with a Razor but there is a necessity of cutting off the whol entire Member the Foot the Hand c. But in what manner this amputation ought to be performed Authors differ much in their opinions concerning it Celsus in his seventh Book and Chap. 33. perswadeth us to make the Section between the sound flesh and the dead and rather to take away some of the sound than to leave any of the dead flesh remaining left the Malady that is left corrupt that that is sound Which way of curing most of our late Physitians disapprove of by reason of those dangers that follow the Section in the sound part to wit an immoderate profusion of the blood and an extraordinary great pain and the faintings and swoundings that depend upon these And therefore that these may be avoided they advise us to make the Section in the corrupted part alone Fallopius indeed with a Razor cutteth into the dead flesh even unto the bone a fingers breadth distant from the sound part and then after this he forthwith taketh away the bone with the saw and then again with Irons red hot he burneth the greater Vessels and the flesh even unto the causing of pain Hieronymus Fabricius also leaveth a portion of the sound flesh as much as one fingers breadth and appointeth the Section likewise to be made with a Razor in the dead flesh and he afterwards burneth the part with fire-hot Irons after the same manner to hinder and restrain the Hemorrhage and to waste and consume the reliques of the putrefaction But here in this place we are to advertise you that somtimes the putridness wil yet creep further and infect the neer neighboring parts but then again that somtimes the putridness ceaseth neither doth it creep any further unto the parts neer adjoyning which whensoever it happeneth then round about the corrupted part there appeareth a Circle that is exactly red and of an exquisite sense In the latter case indeed that way of curing seemeth not altogether improper and unfit in a part that is corrupted and dead For by this means those many dangers which accompany that Section that is made in that part that is alive are prevented to wit the profusion of blood pain and faintings since that through the corrupted part the blood cannot pass and because that the said part hath no sense at al. But if there be any of the dead flesh left remaining this when the putridness shal cease any longer to creep although there shal not be any Cauteries administred wil afterwards divide it self of its own accord and then it wil be separated by Nature upon the administring of fit and proper Medicaments But if as yet the putridness be creeping forward and that Nature hath not
Rice one pound let it be steeped in the Water of Bean flowers untill it break afterwards add of choyce Mastick six drams Borax two drams and then destil them Or Take the Pith or Crumb of White Bread one pound Root of Solomons Seal half a pound Goats Milk as much as wil suffice and let them be destilled Or Take Flowers of the Elder and of Bean flowers of each a like proportion pour hereunto Goats Milk and strain it let them stand in a cold place for eight daies and then destill them When you use the Water Take of Beans hulled beat them into a very fine Pouder and cast the same into the said Water and after this let the Face be washed with this Water and permitted to dry leisurely of it self In the end dissolve Camphyre in the Spirit of Wine and mingle it with Eldern Water and let the Face be washed with this Water Or Take Whites of Eggs in number twenty four Cinamom two drams Asses Milk or Goats milk two Quarts and destill them Emulsions likewise made of the four greater Cold Seeds bitter Almonds and Pines are here very useful There are also Decoctions made with which the Face is to be washed of Beans Cicers Lupines Rice Or Take Roots of white Lilies Solomons Seal Borrage of each one ounce Mallows Sope-wort Parietary or Pellitory of the Wall and Violets of each two pugils Beans hulled one handfull Flowers of Mallows half a handful make a Decoction with which let the Face be washed Liniments moreover and Unguents are made use of among which are the Pomacea or Pomata as they are commonly called The Oyl of Talck is now adaies much in the mouths of many and very much used in the Nurseries of great Women But this last seemeth rather to belong unto the Face-fucusses then unto the true Cosmeticks unless it be administred only to cleanse and after the use thereof when they go abroad in publick washed off from the Face Medicaments that whiten the Hand But now the more Choice and delicate Women that are unaccustomed to labor do not only administer certain Medicaments unto their Faces but unto their Hands likewise that so they may become soft and white and these Medicaments are made of the Crumb of White Bread the Meal of Barley of Cicers of Lupines and Honey all which being wel wrought together with Water or else mingled with soft Sope and Honey they wash their Hands therewith Or Take Meal of Cicers of Beans of sweet Almonds of each two ounces the Roots of Flowerdeluce of Florence two drams Honey and Rosewater of each as much as wil suffice and Mingle them And here likewise the Pomatum Unguent is of much use Or else such a Sope may be made Take of Venice Sope one pound let it be dissolved in Rose-water add thereunto the Pouder of Flowerdeluce of Florence one ounce the Meal of Cicers one ounce and half and mingle them There are likewise many other Medicaments which we mentioned a little above for the making of the Face fair and clear and they are here also very useful Many other things there are of this Nature that we may see in Rondeletius in his Tract of Fucusses Of Mending and Beautifying foul and deformed Cicatrices What things they be that amend the deformed Cicatrice The rectifying and amending of deformed Cicatrices is not unfitly referred unto the Cosmetick or Beautifying Medicaments For when as upon the Solution of continuity either by reason of a Wound or an Ulcer there is from the Juyce nourishing the Skin for the uniting of the part something generated that is like unto the Skin and stiled by the name of a Cicatrice this said Cicatrice is indeed like unto the whole skin and yet it is oftentimes differenced from it in colour and many times likewise in figure because that somtimes it becometh more high and raised and otherwhiles it is depressed kept low and leaveth as it were a pit and so consequently a certain inequality or unevenness and thereby breedeth a deformity which in the progress of time is wont to be somewhat changed whilest that the Cicatrice is rendered day by day more like stil unto the Skin Which if yet nevertheless we have a desire that it may be speedily effected it may then be done by some certain Medicaments such as are first the Oyl of Myrrh which is made if the Yelk be taken out of an Egg hard boyled and then the Egg filled up with Myrrh and put into a moist place until it be all dissolved into a Liquor and this likewise may be wrought by the destilled Oyl of Myrrh The moisture also that sweateth forth of Eggs whiles they are in rosting is very useful for this purpose The Oyl likewise of the Yelks of Eggs the Fat of the Thymallus Fish which they commonly call Ascia the Oyl that is pressed forth of the Kernels of Peaches Oyl of bitter Almonds and Oyl of Been Or else an Unguent may be made of Borax Camphyre and Mans fat or of Litharge and the Oyl of Roses and the Oyl of bitter Almonds mingled with Honey or else an Unguent may be made of the Juyce or Root of wild Cucumber and Honey and with this the Cicatrice may be anointed for one day but the day following with Milk and this by turns from day to day must for a while be continued Or Take the Mucilage of Fenugreek seed and of Fleawort of each two drams Oyl of Tartar by straining half an ounce Oyl of Roses one ounce Ceruss and Borax of each one dram and mingle them Or Take the Root of Dragon-wort of Solomons Seal of each two drams Bitter Almonds Peach Kernels of each one dram Egg-shels burnt half a dram Frankincense and choyce Myrrh of each one dram Sugar Candy three drams the Mucilage of Fenugreek seed one ounce Oyl of the Yelks of Eggs and Mans fat of each as much as wil suffice Mingle and make a Liniment But if the Cicatrice be deep it is not so to be amended by Medicaments that it may be made equal and even with the rest of the Skin but the Cicatrice is by Section or else by some corroding Medicament to be taken away and the Cavity as much as is requisite is to be filled up with flesh and afterwards a new Cicatrice is to be brought al over the part Cicatrices after the smal Pox and Measles But most of al after the smal pox and Meazles there are oftentimes very frequently left behind in the Face unsightly and deformed Cicatrices that cause an exceeding great eye-sore and il-favoredness and thereupon that they may be amended the help and assistance of the Physitians is oftentimes implored But for the taking away of these Cicatrices those Medicaments that we a little before mentioned are very useful and so are those likewise that have been prescribed before in this present Chapter for the making of the Face more fair and clear And for this out of al these there
Womb from the pollution of the blood and the corrupted seed and that it did consist and was nourished in the Womb of the Mother or that this Maiden being then but an Embryo in the Womb of the Mother while it yet lay therein suffered somthing from the nauseousness and vomiting of the Mother and from affrightment befalling her or from some grievous Affect that she lay under He conceiveth moreover that the Mother might be affrighted and terrified upon the sight of some Sepulchre or that she happened to come in place where they were anointing some dead body or that she took conceit and a loathing from the putrid and stinking Excrements that flow from such as lie in child-bed or else that she was some way or other greatly affected by these and the like accidents You may read more hereof in the alleadged Epistle of Libavius And another Example of the stink of the whol body the same Libavius hath in the following Epistle where he writeth that he wel knew a certain yong woman that after she was married and living in Wedlock while she had her Courses had such a stink coming from her as never Jakes had worse and that during this time her Husband lived very discontentedly as one much afflicted therewith THE FIFTH BOOK THE THIRD PART SECT II. Of things amiss in the Hair and Nails Chap. 1. Of the Nature of the Hairs AFter the faults of the Skin we wil and that not unfitly subjoyn those things that are amiss in the Hair For the Hair is fixed in the Skin neither is it any where else to be found but in the Skin Neither indeed are the Vices of the Hair to be passed over in silence in regard that even these are although ignoble yet parts of the body For as no man can wel deny That the Nails the Hoofs and Horns of al living Creatures and likewise that the Feathers in Birds are parts of their body and that none can wel say that a Peacocks Tail and al the various Feathers in Birds that are of so many several colors I say as none can wel affirm that these Feathers affording so great variety are a thing meerly excrementitious and not parts of their body so likewise it is in no wise to be denied that the Hairs are also a part of the body And this we are sufficiently taught by the conformation of them by their various figure and their different colors The same is likewise proved by the use of them and so also by their diseases touching which we shal speak hereafter and especially that we cal Plica Polonica And lastly That very effective and conformative power that the Hair hath as wel as other parts as we shal by and by shew you cleerly demonstrateth the truth of this And the growing of the Hairs again after their being cut doth not in the least prove that they therefore are no parts For both the Nails and the Hoofs the Claws of Lobsters and in certain bruit Beasts the Horns after they are shed and fallen off yet they grow forth again and so do likewise the Teeth in Men and Women We are indeed vulgarly but erroneously taught That Hairs are generated when from the heat of our bodies fuliginous and thick vapors are out of the third Concoction elevated in the parts of our body and are driven unto the pores of the Skin in the streight passages whereof whiles they stick they are there conglutinated until at the length the pore being filled up other vapors coming underneath drive it forward and these vapors are likewise followed close by other vapors and after them by more and so in the end they are thrust forth out of the pore and the hair is formed which afterward the like vapors succeeding and thrusting forth the hair and agglutinating themselves unto the root thereof it thence cometh to be prolonged But now if the Hair should be generated in this manner The breeding of the Hair a reason could not then be given why hair should not alike be bred in al parts of the body and in those parts where they are bred why there should be in some places more store thereof in some less and why some of them are alwaies growing when others grow not at al. In the Neck and Face there grow no hairs naturally but in the Head and Cheeks there are great abundance of them as also in the privy Parts in the Armpits Eyelids and above the Eyelids on the Eye-brows The hair in the head and beard is ever growing and is continually lengthened out but those hairs that are in the Eyelids ever keep at one and the same length and moreover they evermore remain straight And furthermore no cause could at al be given wherefore men only should have Beards and that women should not likewise have them whenas notwithstanding women have on their heads most usually the longer hair Moreover the hair is by Aristotle in his third Book of the History of living Creature Chap. 12. distinguished into that which is bred toegther with us such as is the hair of the head eyelids eyebrows and that that is afterwards bred to wit such as at length ariseth in process of time as age comes on of which there could no cause at al be rendered if according to the vulgar opinion the hairs had their original out of those vapors that break forth And therefore there is some other cause of the hairs original to be sought for in the discovery of which Galen hath also been very curious and taken great pains insomuch that he here taketh occasion which otherwise he doth but very seldom to make mention of the wisdom power and goodness of Almighty God the Author and Framer of al things and he hath here endeavored to examine his Omnipotency and Wisdom in this particular and to confute Moses as we may see in his eleventh Book of the use of the Parts Chap. 14. But if we seriously weigh the matter we cannot by any means grant that the hairs are bred only from the excrements or the vapors exhaling out of the body and sticking in some certain places but we are rather to determine that they are generated from the formative we may term it the pilifique or hair-breeding faculty for the causes a little before mentioned And that the hairs are generated not only from some kind of fuliginous vapors but from a matter that is far more solid and neerly allied unto the matter of the Nails and Horns we are taught even by this that the hairs are not easily corrupted but are even after death preserved a long while whol and entire Touching which Gabriel de Zerbis relateth a History in his Book of the Anatomy of Mans Body in the Title of the Anatomy of the Hair fol. 15. in these very words At Rome we both saw and touched saith he the dead body of a Woman buried in the way called Appia just opposite unto the why where Cicero was buried and
is that these Medicaments that even now we named and those that we shal hereafter further mention do not al of them generate hairs only by their manifest qualities and by taking away the Causes of the falling off of the hair but that they likewise produce hair by some occult quality that is in them such like Medicaments are therefore especially to take place in the production of a Beard not where there hath been a shedding or falling off of the hairs of the Beard but where they never as yet grew It is also wel known that it much conduceth unto the speedy growing of the Beard if the first soft hairy down upon the Chin be often shaved off by which means the Aliment is the more abundantly allured and drawn unto the Roots of the hair For the furthering and hastening of the Beard these following Medicaments are likewise commended Take Oyl of Dill Oyl of Spike of each five ounces the tender Sprigs of Southernwood two handfuls Squils three drams the best Wine three ounces let them boyl until the Wine be consumed and then use it Or Take Oyl of Garden Pinks and sweet smelling Spike of each three ounces Oyl of Roses four ounces of Cloves one dram of Ladanum two drams sweet smelling Wine two ounces Let them boyl al of them unto the consumption of the Wine Add of Musk one scruple and mingle them Chap. 3. Of the shedding of the Hair ALthough as we have already said al shedding of the Hair may be termed a Defluvium or falling off yet nevertheless use and custom have so far prevailed that the shedding of the Hair here and there in the Head in al or most parts thereof is in special termed a Defluvium or falling of the Hair so that they fal not only in one place but either they al fal off throughout the whol head or at least they most of them fal away in most parts of the Head The Causes There is not one Cause alone of this Defluvium of the Hair but the Causes are many to wit Either the want of Aliment or the pravity of the humors corroding the roots of the hair or the thinness of the skin not admitting the aliment of the hair The two former Causes have their place in those that are Phthifical in whom if the hair fal off this cometh to pass as Galen tels us in his Comment Aphotism 10. Sect. 5. because there is here both the greatest defect of Aliment and somtimes also the corruption of the humors The same happeneth for the most part in malignant Feavers such especially of them in which the Brain being withal affected the sick persons are seized on by a Delirye or Dotage For even in these Feavers also the sick parties are greatly extenuated and there is wanting unto the body a necessary aliment and the depraved humors likewise lie gnawing at the roots of the hair and eat them asunder The hair also falleth off in those that have the French Disease by reason of the pravity of the humors which somtimes happeneth likewise unto those that have drunk poyson and it is reported for a truth That whosoever toucheth the Salamander his hairs wil shed and fal away Bun somtimes also the hair fals off by reason of the thinness of the skin and this happeneth unto Women and especially in the Summer time And hence it is that those who travel out of Germany into Italy or other hot Regions find now and then this shedding of their hair for by the heat of the Ambient Air the Skin is made thin and it chanceth also that the matter out of which the hair ought to be generated doth withal transpire Signs Diagnostick The Defluvium or falling of the hair that is in special so called is easily known by the continual shedding of the hair But it is distinguished from baldness the Alopecia and Ophiasis because that in Baldness the hair fals off in the fore part of the head only but in Alopecia and Ophiasis the hair fals from al parts of the head and the head alone but then in this Defluvium the Affect we now speak of the hairs fal off in al parts of the body equally one while more and another while fewer of them But from what cause it is that they fal off may be known from the causes that went before For if there went before any sickness that was in it self apt to consume the aliment of the Body it is then credible that the shedding of the hair proceedeth from the scarcity of the Aliment But if vitious malignant and depraved humors excite and cause any disease it is then an argument that the falling of the hair proceedeth likewise from the pravity of the humors If lastly there went before causes rarefying the skin it is then probable that the said Defluvium of the hair proceedeth from the thinness of the Skin Prognosticks 1. Among al other the species of the shedding of the hair this Defluvium in special so called is most easily cured unless the cause be such as is not to be removed For the skin hath not as yet contracted any preternatural disposition that is difficultly cured And therefore it is that the Defluvium or falling of the hair that happeneth after acure and malignant Feavers is easily cured when the Feaver being healed there is an Aliment again supplied unto the body and the hair that is already fallen off is for the most part restored without the use of any Medicaments 2. But in the Consumption such a defect of the Aliment and such a vice of the humors cannot by any means be amended And therefore in this case there is not only no cure to be had for this shedding of the hair but the sick persons die also And therefore in such as are in Consumptions the falling of the hair is a sure and certain sign of Death approaching as in the fiftth of the Aphorisms Aphor. 11. 3. If the hair fal off by reason of the skins thinness it may then by the use of thickness be restored without any great difficulty The Cure The shedding of the hair is cured by taking away the cause upon which if dependeth If therefore the hairs fal away from the scarcity and want of Aliment it sheweth us that we must use our endeavor that there may be sufficient aliment bred in the body and that that which is bred may be drawn unto the skin of the head If this Defluvium be from the depraved humors and these be supplied from al parts of the body they are then to be evacuated but if they lie only at the roots of the hair they are then to be discussed If these humors be of a poysonous Nature as in the French Disease we ought then to meet with and oppose that poyson If the Affect proceed from the thinness of the skin the skin is then to be thickened If therefore this Defluvium or falling of the hair arise from the want of Aliment we ought then especially to
take care that by appointing a due meet course of Diet there may be generated sufficient store of good blood But for the drawing of this unto the place affected frictions are more especially to be made use of Yea indeed almost before the use of any Topicks the frictions or rubbing of the head are to be administred as Galen teacheth us in his first Book of the Composition of Medicaments according to the places Chap. 2. For Friction doth both attract the Aliment unto the head and also strengthen and thicken the skin If this falling of the hair proceed from the pravity of the humors then universal purgations if need require being first premised the head is often to be rubbed and discussives are to be administred but yet let the Discussers be moderate especially if there be a concurrence of an abundant aliment left that by the excessive and overmuch use of them the aliment be likewise dissipated and the skin rendered over thin and therefore Ladanum is very fitly mingled together with the Unguents If the Defluvium depend wholly upon the thinness of the skin then we ought to apply those things that condense and thicken the skin Galen commendeth especially Ladanum the Oyl of Mastick and the Oyl of Myrtle mingled together Or else let Ladanum be dissolved in Wine and so made use of And Ladanum is also very fitly administred in almost every falling off of the hair But in regard that it is of too thick consistence in it self to be anointed with it is therefore to be dissolved in somthing that is liquid Wine or Oyl and indeed such an Oyl is to be made choyce of that may satisfie and answer the cause But seeing that Unguents and Oyls are troublesom unto many who wil not endure that their heads should be anointed with Oyntments or Oyls therefore for these we must provide Lotions for the head that please them better which are to be made or Southernwood Maidenhair Golden Maidenhair Mastick Roses Rosemary Ladanum And we must here again repeat what we gave you notice of about the end of the foregoing Chapter to wit That there are some who appoint and not without good reason such kind of Medicaments to be made for the recovery of the hair that do not only by a manifest quality take away the cause of the shedding of the hair but such as also by an occult and peculiar faculty do conduce unto the breeding of hair and such as these are only known by experience And these are al the Capillary Herbs Southernwood Reed root sharp-dock root the root of the greater Bur Asarabacca Ladanum Honey and Water destilled from it Bees beaten together with the Honey-combs or the pouder and ashes of them aâ— also of Wasps Flyes Moles Mice the Land Urchin Bears fat and Serpents fat Of which there are made many Compositions As for instance Take the Rind of the Reed root burnt Bees ashes of each two drams Southernwood burnt one dram Ladanum two drains Honey half an ounce Oyl of sweet Almonds and Bears fat of each as much as wil suffice and make a Liniment For the shedding of the hair after sicknesses this following is found to be good Take Maidenhair Southernwood Golden Maidenhair of each half a handful the Leaves of Myrtle of Roses and of Wormwood of each two pugils boyl them in a sufficient quantity of common Oyl and red Wine until the Wine be wasted then strain and squeeze them hard Take of the aforesaid Oyl four ounces Ladanum one ounce Mastick half an ounce and mingle them according to art Or Take Root of the Bur-dock six ounces Maidenhair three handfuls Southernwood one handful Pour thereunto as much white Wine as wil suffice and let them be destilled in a bladder Vnto what is thus destilled if you please you may add the Water of Honey Or else let the Roots of the Bur-dock be boyled in Ley and the head washed therewith Chap. 4. Of Alopecia and Ophiasis Alopecia THat which is called Alopecia and Ophiasis is a peculiar kind of the falling of the Hair Alopecia is so termed from Foxes because that this kind of shedding of the Hair is familiar unto them But Ophiasis is so called from its figure Ophiasis because that the bald and smooth parts destitute of their Hair and writhed seem like unto Serpents It is common unto both these Affects that in them the Hairs fall off areatim as they term it and hence it is likewise that this Malady is in the general called Area And Celsus in one and the same Chapter treateth of Area Area Alopecia and Ophiasis Now the name of Area is imposed upon this Affect from Country Garden-plats For as there the Beds or quarters are distinct and in certain places only and as these Beds when they are void of Plants are Naked and bare so it is likewise in these Areae for here in certain places the Skin appeareth smooth bare and slippery These Affects differ only in their figure For Alopecia hath no certain figure but as Celsus saith is dilated under any kind of figure But the Ophiasis creepeth up and down writhingly like unto a Serpent and one while being extended from the hinder part of the Head it creepeth along on both sides the Head even unto the Ears the breadth almost of two fingers and as soon again being carried beyond the Ears it creepeth forward Serpent-like even unto the very Forehead it self And moreover there is in the Ophiasis far more hurt and danger in the Cause thereof so that not only the roots of the Hair but even the Skin it self also is eaten and gnawn thorow to wit as far as the roots of the Hair reach The definition of Alopecia and Ophiasis And so Alopecia and Ophiasis may be thus defined that they are a falling off of the Hair after the aforesaid manner areatim having its Original from a corrupt and depraved humor gnawing assunder the roots of the Hair The Author of the Book of Medicaments soon provided referreth the Alopecia and Ophiasis unto those Affections that vitiate and marr the Colour of the Hair But we are to know that this is not proper unto the said Areal falling off of the Hair but that this change of Color in the Hair doth either precede the Alopecia and Ophiasis to wit when from a vitious Nutriment the Hair first becometh white but afterwards they fall off or else the colors of the Hair are changed after the Alopecia and Ophiasis For when after the Areae Hairs are again bred they are then either white or yellow like as it is in Horses after that the hair is fallen off by reason of some Ulcer caused by attrition or gauling there is wont in the place thereof to appear and grow again white hairs which happeneth from a vitious Nutriment and the weakness of the Skin And of this Celsus gives us notice in his sixth Book Chapter 1. to wit that the Ophiasis is extended unto the Hair
of the Head alone but that Alopecia may be extended even unto the very Beard also The Causes The Cause of both these Maladies is a depraved and sharp humor of eating assunder the roots the Hair of whatsoever kind it he But for the most part notwithstanding this Malady iâ— caused by a salt flegm adust or putrified Whereupon Galen in his Book of the differences of Symptoms and Chap. 4. writeth that these Vices follow a depraved Nutrition of the Skin of the Head But that one while the Alopecia another while the Ophiasis is excited and that the Hairs do sometimes constitute a strait and direct Area and sometimes that that is winding and writhed the Cause of this is the great abundance and the quality of the matter For if there be an extraordinary great store thereof and it be likewise thin then it equally and alike eateth through the Hair in the more and greater places but if the Matter be less and mingled with a thick humor then there followeth an unequal and writhed Defluvium or shedding of the Hair because that the humors being unequal and mingled do not flow right forward but creeping along obliquely they gnaw assunder the hair The more remote Causes are the heat of the Liver and Head and especially the fault of the first and second Concoction by reason whereof salt and sharp humors are generated which although it may happen in every age yet nevertheless it happeneth more especially in Childhood and Youth and it followeth the Affects Tinea Achores and Favi by reason of the Causes that we mentioned in the Diseases of Children And somtimes likewise External and Malignant Causes make very much for the generating of this Disease among which Galen in his first Book of the Composit of Medicam according to the places Chap. 2. reckoneth up Mushroms because that they make very much for the generating of vitious and corrupt humors And hither likewise belongeth the poyson of the French Disease in regard that this also eateth through the roots of the hair which other poysons may likewise do Signs Diagnostick We have already before told you in what respects this falling of the Hair differeth from baldness and that shedding of the Hair that we call Defluvium But Alopecia differeth and is known from Ophiasis by the very figure of the Area and because that in the Alopecia the hair only falleth off without any hurt as all of the Skin But in the Ophiasis there is not only a falling off of the hair but likewise an excoriation of the Skin And the very color of the skin is also changed and in some it appeareth more whitish in some more pale and in others more black and if it be pricked there floweth forth a serous whitish blood Touching the difference between Alopecia and Ophiasis Celsus in his sixth Book and Chap. 4. hath these words That Area saith he that is termed Alopecia is dilated under all kind of Figures and it happeneth in the hair of the Head and in the Beard But that which from the likeness of a Serpent is called Ophiasis beginneth from the binder part of the Head and is not extended above two fingers in length it Creepeth on both sides the Head even unto the Ears and in some unto their Foreheads also the former of these in all Ages but this latter only in Infants But Alopecia and Ophiasis differ from Tinea in this because that in Ophiasis the Excoriation of the Skin is superficial and when it is cured the hair groweth again But in Tinea the excoriation and Ulceration is more deep and the skin is oftentimes so corrupted that the hair never groweth again As for what concerneth the signs of the Causes the Skin it self sheweth what kind of humor it is that offendeth which that it may be the more exactly known the hair that remaineth behind is to be shaven away and the Skin to be gently rubbed there are other signs also that wil instruct and teach us what kind of humor it is that aboundeth in the body The hairs likewise that grow anew by the various colour that they have according to the Nature of the peccant humor wil shew us what humor is the Cause of this Malady Prognosticks 1. Alopecia and Ophiasis although they bring not much danger along with them yet nevertheless they cause a great deformity and among the Romans those Slaves that were disfigured by the said Area and especially by the Alopecia were sold at a far lower rate then other Slaves And in our daies also these Areae in regard that they cause a suspition of the French Pox are therfore accounted very disgraceful unto him that is affected therewith 2. But whether the Ophiasis or the Alopecia may be soonest and most easily cured it is a great question among Authors and they herein much differ Celsus and Avenzoar are of Opinion that Ophiasis is more easily cured then Alopecia And on the Contrary Alexander in his first Book Chap. 2. and Serapio in his first Book Chap. 1. teach us that the Alopecia is more easily cured then Ophiasis But Celsus seemeth to speak only of the Alopecia of Infants which in the course of yeers and change of age is of it self oftentimes cured But if Alopecia and Ophiasis be such as are grown to maturity or likewise in one and the same age be compared the one with the other then the Ophiasis seemeth to be altogether the more difficult to be cured in regard that it hath its original from a matter more thick and far worse then the former and such as doth not only eat assunder the roots of the hairs but likewise even the very Skin it self which is never done in the Alopecia 3. Yet notwithstanding by how much the longer either of these Maladies hath been and continued by so much the more difficult is the Cure thereof and by how much the less while they have continued by so much the more easily are they cured 4. If by Rubbing the place become red there is then hope of Cure the sooner it is thus the more easie the Cure but if it wax not red at all then there remaineth no hope at all of any Cure 5. That kind of Areae is also the worst that hath made the Skin thick and somwhat fat and slick or slippery in all the parts affected 6. Alopecia and Ophiasis that proceed from the Leprosie are altogether incurable and that that hath its original from the French Disease is not to be Cured untill the Disease it self be Cured 7. There then shines forth some hope of a Cure to follow when the excremities of the Areae that are neerest unto the remaining hairs do again begin to send forth other hair For then those parts that are nigh unto the sound have the less receded from their Naturall State and so consequently will the sooner again return unto their Natural State and begin to produce hair The Cure If a Vitious humor abound in the whole body
two Locks growing forth on their Heads entwisted and infolded within themselves inwardly and entangled together with the hairs nigh unto them the Lock hereby becoming exceeding very thick and then indeed it was nothing at all troublesom But now this same Disease hath begun to Creep further and fleeth up and down throughout the whole Kingdom of Polonia to the great disquiet and torment of all sorts of People It infringeth the Bones looseneth the Limbs infesteth the Vertebrae of the Limbs maketh the members round like a Globe and writheth them back it causeth them that are affected therewith to bunchout it poureth forth Lice and so filleth the Head with fresh supplies of these said Lice following one after the other that it can by no means be sâ—eed of them If these Entangled Locks be shaven off that humor and the poyson thereof sheds forth into the body and then as we wrote before extreamly tortureth the persons thus affected it disquieteth and troubleth the Head Feet Hands all the Limbs all the Joynts and in a word all the parts of the body And it is found by experience that such as have shaven off these bundles of hairs so closely entwisted within themselves that these have soon after been taken in their Eyes or else have been most grievously tortured with Defluxions unto the other parts of the body If we attempt to Cure the Party by the usual purging Medicaments the affected Person is the worse for them and the tormenting pain rageth so much the more because that the said purgation is not able to master and expel the Noxious offensive humors but only stirs them abroad and thereby scattereth and disperseth them throughout the whole body for after purging those that are afflicted with this Pest are so exceedingly tormented with a burning pain of all their Members that nothing can possibly be added unto the sharpness bitterness of the Torture Women for the most part are taken herewith and likewise those men that are inclined unto the French Disease as also the Children begotten by them that are infected with the said Disease and those likewise who by Repercussive Medicaments have driven back and repressed the Porrigo of the head which the vulgar cal Tinea and moreover such Women as in the time of their Monthly Courses are not sufficiently purged Of which Women some of them there have been that in their young and most vigorous age having had no more than a shew of their Courses but withal an extraoâ—dinary flux of blood from the Nose these in their declining age this flux at the Nose ceasing have fallen into this very disease of the intangled Locks Some there have been though very few who having been for some yeers tortured and afflicted with this kind of Disease and not at al shaven their heads and having undergone al the vexation nastiness and filthy deformity of this disease not without extraordinary great trouble and a most intollerable nauseousness have at length recovered upon the falling off of these virulent intangled Locks but yet nevertheless the greatnest part of them perished Many kinds of Medicaments have been sought for and made trial of but as yet there hath been found none that would effect the Cure The force likewise and nature of the Disease and the cause thereof have been sought for but as yet there indeed appeareth nothing of certainty touching what we have sought for The Country Boors give out that they have found great relief by carrying tied about them an Vrchin pulled in pieces and for the total abolition of the said affect they make themselves a meat of the said Vrchin it self but yet we find that even in this there is not any thing much available They furthermore provide themselves of a Decoction made of the Leaves of Bears-breech with the which when they wash their heads the locks we mentioned before break forth and withal great store of Lice This Affect communicates with that fuliginous and sooty exhalation out of which the hairs are bred and it seemeth to have some affinity with the affect Tinea and by its excruciating and racking the bones with the French pox by the great abundance of Lice with the Phthiriasis by the pain of the Joynts with the Gout Arthritis and by the miserable contraction of the Members that it causeth it seems to have some neer alliance with the Spasm That I may add no more most worthy and renowned Professors your Excellencies wel skill'd and most expert in this kind of Art wil easily collect how necessary this deliberation is and with how great a benefit you shal oblige unto you the whol most vast Kingdom of Polonia when by your deep Wisdoms and Skill you shal have discovered and found out a present Remedy for this kind of Pestilent Malady with the which it is generally vexed and disquieted in a most violent manner and when you have found out an expedient Remedy if you then please to communicate it unto us by your Letters Many there have been who as the first Authors and Inventors of various Medicines live yet even unto this very day in perpetual praise the glory and renown of this Medicine found out by your excellent and magnifique Wisdoms shal be properly your own shal make you famous and shal for ever flourish in succeeding ages I expect from you your most friendly and courteous Answer but if I have not sufficiently neither yet in fit and proper words and such as were requisite expressed the quality and condition of this Disease I desire of your Excellencies that you would herein excuse me a man wholly conversant in another kind of Art I have presented you with a certain Adumbration of this Disease and in a manner shadowed forth unto you this Malady the more interior Nature and hidden parts thereof your excellent Wisdoms by the sharp and quick sight of your knowledg will easily search into and contemplate I bid your Excellencies heartily farewel From Zamoscium this last day of the month of October in the Yeer one thousand five hundred ninety nine And yet notwithstanding there are others that tel us how that this Disease is very common and familiar even in other Regions also For in the Observations of Schenckius we may likewise see that this Disease was known also unto the Brisgoi and Alsatians For thus Schenckius writeth in the first Book of his Medicinal Observations Observat 13. There is saith he with us at this day to be observed a certain most horrid uncombed and most intricate kind of hairie Tufts both in the head and beard no whit strange and unusual unto ours but altogether unknown unto the Ancient Physitians of former times in what Age soever they lived with which such as are affected you may see them have hanging down from the rest of the hair of their head and beard even unto the shoulders breast and somtimes also even unto the very Navel very long tufts and bushes of hair wonderfully intricate oftentimes a
unto my remembrance a certain Drink no doubt at the first brought thither out of Polonia that was much in use in my Country in the City Vratislavia and it is made of Bears-breech the vulgar cal it by the common Polonian name Barsiez or as the Germans pronounce it Barkech which those that are Feaverish and especially the great Drinkers after their excessive Cups the day before use in their broths and in their ordinary Drink to asswage their chirst Now it is made in this manner The Leaves of Bears-breech dried are boyled in a sufficient quantity of Water that the Decoction may get only a yellow and not a purple color Unto the Decoction there is added a little Leaven or Breâ—d twice baked made of the Pounder of Bears-â—â—ch with the sour Leaven of fine white Bread â—â—d then for some certain daies set in a warm place where it gets a boyling heat and fermentation until such time as it hath contracted a caste somwhat tart and sour But now whether or no this kind of Drink hath a power of doing any thing toward the expulsion of the matter in this Disease we are to consult with Experience And it is their part who live in those places to make publick those Medicaments that use hath taught them to be fit and profitable that so al their Experiences being conferr'd together there may at the length be composed a Method of Curing this Disease But in regard that the Plica hath some symptoms common with the Scurvy such as are the pains of the Limbs Cramps and the like and that the aforesaid illustrious Count Nicolaus Sapieha was affected with both those Diseases I think it not amiss therefore here to place the History of his Disease which wil add some light unto what we but even now spake touching the Plica and to what we have likewise before in the third Book of our Practice written concerning the Scurvy The History of the Disease of that Generous and Illustrious Lord Count Nicolaus Sapieha Earl of Coden Chief Standard-bearer of the great Dukedom of Lituania c. This Illustrious Count without doubt contracted this his Disease of the Plica in his own Country from the same common cause from whence the vulgar have it but as for the Scurvy he got it from the many Errors by him committed in his Dyet during his various troublesom Journeys throughout almost al Europe and from the Quartan Feaver that followed upon the same For when in the heat of Summer as himself related the story unto me he had travelled over the Pyrenean Mountains out of France into Spain and in this his Journey had drunk good store of Wine out of bladders that was corrupt and ful of Vermin the Autumn following in Spain he fel into a Quartan Ague The long continuance whereof having made him impatient and being quite tired out with the tediousness of a Methodical Cure he committed himself unto a certain Soldier for Cure who took some certain Cups of the strongest Spanish Wine and into the same he puâ—s the pouder of al sorts of sweet Spices and this Wine he gave him to drink not only to satiety but even to Ebriety until he had made him almost drunk by which be kindleth within him a continual Feaver which indeed lasted not long and quite took away the Quartan but yet nevertheless imprinted such a Dyscrasie in his Bowels and humors that shortly after the Scurvy followed thereupon With which being grievously afflicted at home in his own Country and yet notwithstanding so that he could not wel tel what the disease was he made a Journey unto Padua and there he committed himself for Cure unto the most Eminen Physitians of that University But yet he recovered not that health and strength that he had expected and hoped for and thereupon he is sent back again home into his own Countrey with this following Consilium which we may term a Direction Advice or Counsel The Advice of that most Famous and Eminent Doctor Johannes Prevotius Chief Professor of Physick in the University of Padua TOuching the manifold Diseases that this Noble person lieth under it is neither my purpose at large to treat of them since that I am not ignorant that they have already been discoursed of by some of the most Eminent Physitians in their long and learned Disputes neither indeed wil either the state and condition of mine own health not yet sufficiently confirmed permit the same nor likewise the health and safety so much desired by this illustrious person for whom I conceive that help and assistance is far more requisite than word â—nd tedious Discourses I shal therefore with al brevity state and determine the whol case and ingeâ—â—â—ly declare unto you my Opinion touching the same not that I may interpose my Judgment in opposition unto the Opinion of these grave and learned men but that I may in some measure gratifie the request of this eminent person and if I may any waies possibly be serviceable unto him in procuring his health that I may not in the least be wanting in the discharge of the Duty and Office of a Christian It seemeth therefore unto me that this illustrious Lord is disaffected with a twofold kind of Diseases the one of them most manifest depending upon Causes that are commonly known and confessed the other occult and secret the Causes whereof are as yet obscure neither seem they hitherto to be sufficiently expressed by any There is manifestly appearing a Catarrh of matter that is thick tenacious white oftentimes insipid and tastless and very rarely sharp and biting flowing and falling down unto the parts of the mouth and somtimes also unto the stomack There is moreover an exetraordinary pain of the lower belly returning afresh after long intervals and Cassations with an astriction and costiveness of the belly and a certain grievous and painful sense of extension and stretching about the Region of the Navel of the Hypochondria especially the left and somtimes also of the Loyns which indeed is wont in great part to cease upon the plentiful Evacuation of the Wind and a snotty kind of Excrement that comes from him To these we may add the Nephritick distemper and want of rest and sleep this latter being indeed very familiar and frequent with him for he usually passeth many whol nights together without sleep and the former to wit the distemper of the Kidneys hath now of a long time sorely troubled him with a redness and heat of his Urine and excretion of sand and gravel with his water The causes of al which Maladies it is most manifest that they are derived from the evil constitution of the internal Bowels and the excrements of several sorts from thence arising For the Brain being overmoist not without much weakness of the innate hear contracted by reason of a great wound he received in it at Paris engendereth much flegm there being added unto al this in a special manner the consent of
perfectly Cured albeit that the wounded person die not thereof but a Callousness being brought over it the Pipe still remaineth by which the Urine is voided forth But yet nevertheless it is not long that a man can continue to live with such a like wound and therefore we say here again as we said also before that there is a difference to be made between a wound Mortal and a wound incurable But yet notwithstanding touching al the Wounds of the bowels hitherto mentioned this is to be observed that albeit there have been observed some examples of such like wounds that have been Cured yet that this hath happened very rarely and that among these those are to be numbered touching which Averrhoes saith that in the Cure of Diseases there are somtimes Miracles wrought For when fit and proper Medicaments cannot be applied unto internal wounds but that the whole work must be committed unto Nature if in this Case Nature be not very strong and Vigorous the wounded person is very hardly Cured but for the most part an inflammation Convulsions Faintings and Swoundings and other the like Symptoms supervening the party dieth And therefore Hippocrates saith rightly in the sixth of his Aphorism Aphor. 18. that such wounds are Mortal and in his Coaca that most commonly and for the most part men die of such Wounds And therefore if upon the receiving of such a wound the sick person die within a short time after the Cause of his Death ought to be imputed unto the Wound since that much help is not to be hoped for from the Physitian as we shal also anon shew you And Lastly Hippocrates reckoneth up the Wounds of the greater Veins among those that are Mortal Wounds of the great Veins and indeed rightly But now by the word Phlebae he understandeth both the Veins and Arteries and by Pacheis he meaneth great and lying hid within which elsewhere he termeth Aimorrhous that is to say pouring forth Blood such as are the great hollow Vein and the great Artery and the great branches of these For such veins and arteries seeing that they cannot be shut close by any ligature whatsoever the blood and the spirits plentifully flowing forth of them the strength and powers of the Body are soon dejected or else the blood that is fallen forth without its own proper Vessels if it hath no passage forth but that it be still deteined in the Body it Clotteth together and putrefieth and getteth unto it self a very evil corrupt and Malignant Nature causeth a Gangreen and exciteth most grievous Symptoms and at length bringeth even death it self upon the party And indeed this danger is most grievous and formidable in the Arteries when the Blood and vital spirits being poured forth the powers of the Body are dejected and the mans life endangered neither can the Arteries be easily brought to close by Reason of their continual motion and hard substance And these are the Wounds that as Hippocrates rightly saith are Mortal Of which notwithstanding as I told you before some are simply or altogether Mortal which Prosper Farinaceus Tit. de Homicidis Quest 125. Part 3. defineth that they are such that require not the Care and advice of Physitians but are such of which the Wounded person dyeth that is by Reason of which although they be Cured by all the Art and industry of the most skilful Physician yet nevertheless the Wounded person instantly dieth thereof And others of them are not altogether Mortal and certain in their causing of death which the same Prosper Farinacius defineth to be such of which the Wounded party dieth not suddenly and of which somtimes he dieth not at all But what Wounds of the latter sort are Mortal that is of which although some are now and then cured and recover their perfect health and strength yet nevertheless this or that particular person may truly be said to have died of them will indeed plainly appear from what we said before touching the Mortal Wounds of each single and particular part And yet nevertheless this is likewise to be added that we are especially to Judg by the Event whether any such Wound be actually Mortal or not For although some strong and lusty Boor or a Man otherwise exactly found and healthful shall recover of some such wound yet Nevertheless it will not necessarily follow that therefore an old person a Child a Woman or any other that is but of a weak constitution must recover of the like wound but albeit the former of these was cured of the like wound yet this latter may necessarily die of the same But now whether or no such dangerous Wounds be Mortal in this or that particular person Nicolaus Boerius in his 323. Decision Num. 11. teacheth us how we may discover it by fix Conjectures The first whereof is the shortness of the time to wit if the sick person die very suddenly after the Wound of which space of time albeit there be very many opinions touching it yet notwithstanding he saith that the principal is this if the wounded person shall die within three daies after the wound received But yet however there are some that extend this space of time unto the fifth or even also unto the eighth day But others notwithstanding extend this term even unto the eighth month or a whole year and this seemeth unto me most probable And unto this space of time the Mosaical Law Exod. Chap. 21. seemeth to have respect The Second Conjecture is the persevering of the vomiting and feaver and other Symptoms that from the very first signifyed and threatened death And this is a right Conjecture and according to the Opinion of all Physicians yea even of Galen and Hippocrates himself For those great and mortal Wounds have their Decretory and Critical daies like as Acute Diseases have as Hippocrates tels us 2 Prorrhet in the which good or evil Symptoms are wont to happen And therefore if grievous Symptoms such as are Convulsions Vomitings sobbings Dotages Syncopes and the like which otherwhiles also are wont to presage Death in such as are wounded presently and even from the very first invade the wounded person or else appear upon him on the Critical day and after continually persevere they then signifie that they were necessarily brought upon the Party by the Wound and therefore that the Wound is altogether mortal The third Conjecture is the breadth and depth of the Wound For a Wound that is very great and dangerous in it self may yet although it be great yet not be dangerous if by it no Noble part be hurt The fourth Conjecture is the quality of the instrument with which the Wound is given and by which the person inflicting the Wound is convinced that he had a will and purpose to kil the party Wounded But this conjecture concerneth rather the Court of Justice then the Colledg of Physitians who inquire not so much after the will and intention of the person wounding as simply and
consistence And when the Needle is passed through one lip of the Wound it is then likewise to be put through the other Lip of the Wound and lest that the Lip through which the Needle ought in the Second place to be passed through should in following fal under the other and so be drawn aside too much from the other therefore without there is an instrument laid unto it which they term Cannula or Canalicus To wit a little Pipe partly Gold The Instrument Cannula and partly Brass or else all of Silver having holes through one end thereof that so through the holes the Needle may pass and that the Lip of the Wound may rest it self upon the Pipe lest that whiles the Needle is passing through it should be moved and so not follow upon the drawing forward of the Needle and Thread And yet nevertheless the Lip of the Wound may likewise be held together by the tops of the Fingers to wit the fore Finger and the middle Finger and with the other it may be sewed together if so be that the Thread pass through readily which will be if in the Tayl the Needle be hollow about the hole as we have said and that the Thread in respect of its thickness bear a proportion with the Needle Now the sewing is performed after this manner The First way of sewing In the middle of the Wound the Needle drawing after it a double Thread if the Wound be great the Lips of the Wound are to be thrust through and a knot being tied the Thread is to be cut off a little above the knot And then in the middle spaces on either side other holes are to be made with a Needle and single Thread and a knot being then likewise made the Thread is to be cut off and this is to be continued until the Lips of the Wound be rightly sewed together And this Suture is termed Intercissa because that after every prick a knot is tied The Suture intercissa and the Thread cut off But we are well to look that the stitches stand neither too wide nor yet too close for if they be too thin they will not rightly hold the Lips of the Wound together and if they be over thick they then cause pains and Inflammations And therefore between one prick and another let the space that is left be such that the Skin may as it were follow the Needle drawing it Some will have it that betwixt every stitch there ought to be a ful Fingers breadth But it is very seldom that there is need of so many stitches neither do all Wounds require one and the same number of stitches but according as the Wounds do gape more or less so there will be need of more or fewer stitches And yet notwithstanding it will not somtimes be amiss that not only the Skin but likewise that some of the flesh if it lie underneath be taken in to the end that the sewing may be so much the more firm and that the Skin be not broken thereby And yet nevertheless we are to look well unto it and to be exceeding Cautious that the Tendons be not prickt with the Needle And this is altogether the most usual and most Convenient manner and way of stitching and sewing of wounds in which this is likewise to be understood for all other cases this only we are yet to acquaint you with out of Celsus his 5. B. and 26. Chap. that the stitches ought so to be made that the very Lips are not indeed quite to touch one the other that so if there chance to be any humor gotten together within there may be made a passage whereby it may flow forth And hence it is that the Chirurgeons are likewise wont to thrust in Tents anoynted with some fit and convenient Unguents that so the Humors that are wont to be gathered together in the wounded part may flow forth and then also that the Medicaments may the better penetrate unto the bottom of the Wound Indeed Felix Wirtzius rejecteth the Use of Tents in Wounds of the Joynts The Vse of Tents and of the Hands in his second B. of Chirurgery and 13. Chap. But Guilhelm Fabricius upon very good ground refuteth this Opinion in his 4. Cent. Observat 76. and by four Examples he proveth the same to be both absurd and dangerous The First Example is of a certain Citizen of Colen who neglecting these Tents a Wound that he had received in his Hand closed up in the supersicies thereof whereupon about the fourth day a great pain arose which was followed by a Feaver an Inflammation and a Phlegmone so that the Hand was in many places exulcerated and it was not to be restored again without much labor and long time The Second Example is of a Citizen of Lausanna who pricked the hollow of his Hand with a Pen-knife And because the Chirurgeon by reason of the narrowness of the Wound could not by Tents keep it open there followed thereupon most grievous Symptoms and the sick person could hardly be restored to his former soundness until he had long endured much Pain and Torture The Third is of a certain Country Woman one Hildena by Name who with a Thorn prickt the very tip of her fore Finger But when as for the cause aforesaid the superficies of the Wound had closed up and the Pus or filthy corrupt mattier was gotten together about the Nervous parts there arose a great pain and upon this there soon followed an Inflammation and a Gangrene and from thence a Sphacelus And yet notwithstanding this Woman having had her Finger cut off even unto the Hand-Wrist at length recovered The Fourth Example is of a certain Boor nigh unto Lausanna who had a Thorn run into his Ankle-bone But he neglecting the same and the Orifice of the part where the Thorn went in shutting up too soon there arose first a pain and then there followed soon after an Inflammation and a Gangrene and at length a Sphacelus invaded and seized upon his whol Leg and refusing to give consent that the Leg should be cut off he died within few daies after It appeareth therefore from these Examples that Narrow Wounds albeit they are in the Nervous parts are so long to be kept open until the Wound shall be sufficiently purged For so it is that in every Wound whatsoever there wil get together more or less of this Pus or purulent mattier as we shal afterward more fully shew you and this if there be not opened for it a passage forth must needs be there reteined and this by little and little groweth hot and becometh very sharp whereupon in the wounded part especially if it be Nervous there followeth a pain which by attracting the Blood and the Humors exciteth and causeth most grievous Symptoms And yet nevertheless Fabricius here adviseth us that the Tents are with such Art and industry so to be sitted and fabricated that at the least they may
hold together the gaping superficies of the Wound until the rest of the wounded parts to wit the Flesh and the Nerves be sufficiently purged and yet so that they may not by any means hurt the Nervous parts And that therefore the depth of the Wound is diligently to be observed and great care to be taken that the edge of the Tent and more especially if either a Nerve or any thing Nervous be discovered and laid open press not together the bottom of the Wound But now in those Wounds that are so narrow that they will not receive in any Tent that is thick and that that is slender and weak as that which is over flexible is turned this way and that way and therefore cannot reach unto the very bottom of the Wound in this Case he tels us that his custom was to impose a piece of a Gold or Silver thread as long as the Wound was deep wrapt up in fine Linen and anointed with some Anodyne and Digestive Unguent When the Lips of the Wound shall in this manner be conjoyned they are wont commonly and indeed not amiss to impose the white of an Egg well shaken together and put into hurds with this following powder Take Frankincense two parts and Dragons Blood one Part And make a Powder Or Take Bole-Armenick and Terra Sigillat of each six drams Frankincense Mastick Sarcocol of each two drams and half Myrrh and Aloes one dram and half Tragacanth Dragons Blood of each one dram Barley Meal and Bran Meal of each half a dram Make hereof a Powder and mingle the same with the white of an Egg shaken together and put upon hurds and so imposed upon the wound upon which also other hurds that is only wet with the white of an Egg is to be imposed Neither is this Medicament administred but for very good Reason since that it suppresseth the Flux of Blood asswageth pain and preventeth Inflammation But now if there be no fear at all of any such excessive Flux of the Blood or of any afflux of the Humors we shal not then need to make any such provision against it seeing that the Hurds and those Medicaments stick so Tenaciously unto the part that being throughly dried on they contract the said part causing great trouble unto the same and when they come to be removed they excite much pain And now although that what we have already said might suffice Other waies of Sewing of Wounds as touching the stitching or sewing of Wounds yet nevertheless we think it not amiss here further likewise to add some other waies of the Sewing of Wounds as we meet with them in several Authors For there is moreover another manner also of sewing of Wounds which is indeed performed altogether in like sort as Leather-dressers are wont to sew their Skins together and this is then only fit when the Intestines are wounded and the Veins and Arteries cut assunder There is yet another way of Sewing them which is done with two Needles and this way Celsus used and describeth it in his 7. B. and 16. Chap. where you may see it fully set down There is among the Ancients mention made likewise of Buttons The Buttons of VVounds For as Celsus writeth in his 5. B. and 26. Chap. if the Wound be in the Flesh so that it gape and that the sides thereof cannot easily be drawn together into one then fewing is improper and in this case buttons are to be imposed the Greeks call them Agcterae that may only a little contract the sides to the end that afterwards the Cicatrice may be the less broad And because that the way and manner of Uniting the sides of the Wound by buttons was generally so wel known unto them from thence it was that neither the matter of these buttons neither the form of them was ever sufficiently described by the Ancients Guido whom many follow writeth that these buttons were made of Iron Circles as it were or Semicircles a little crooking on either part the hooks whereof being on both sides fixed and fastened within the Lips of the Wound did answer exactly the one to the other But seeing that in this manner to fasten in such hooks as these and being so fastened there to keep them in the Skin and especially the Flesh that is so sensible was nothing else but a keeping there of so many pricking sharp-pointed Needles as it were with an intolerable pain it it not therefore Credible that the Ancients by Buttons do understand any such Iron Instrument to be fastened within the Skin and there exciting pains that were not to be endured The Opinion of Gabriel Fallopius is far more probable who in his Tract of Wounds in General Chap. 12. tels us that the Button was that kind of sewing that above we called Intercisa and which at this day is in very frequent Use in the which both the Lips of the Wound are by a Needle drawing after it a double Thread thrust through and upon the Wound with three turnings in both the Heads of the Thread are drawn together and tied up into a knot And although that in Authors there be mention made of Gold and Iron Buttons yet notwithstanding we are here to know that the Word Button is a general word and signifyeth every Instrument whatsoever that Joyneth and keepeth together any things unto which they are applied And so Caesar in the 4. B. of his Warrs in France speaketh of Beams or Rafters conjoyned with Buttons There was yet as we read another way among the Ancients of sewing and stitching of Wounds but this they thought not so convenient and therefore it soon ceased as to the use thereof in the which they on both sides thrust through the Lips of the Wound so many Needles drawing Threads as they thought necessary for the Conjunction of the Wound and then after this above the Wound they woon'd a Thread about both ends of the Needle in the very same manner as Women when they intend to keep their Needles in the Garments they are making rowl together their Threads about both the ends thereof As touching the binding up of wounds this is likewise to be observed that we make an exact enquiry whether the Wound be a simple or single one or else whether it be reduplicated and manifold For it somtimes so happeneth that although there be but one Wound in the Skin yet notwithstanding in the Muscles under the Skin there are two or three For if this should so chance and that the Chirurgeon should Cure only one of the Wounds and altogether neglect the other that lieth hid then will Pus get together in that other wound and there cause great pain Inflammation Feaver and other grievous Symptoms Of the truth of which Gulielm Fabricius in his 4. Cent. Observat 84. and 85. giveth us two remarkable Histories Where he likewise teacheth us that the hollow nook that lieth hid may be opened and there he also describeth and plainly delineateth
of Wounds the chiefest of them is the exposing of the Wound unto the Ambient Air by which the innate heat is altered and weakned But now this is prevented if the Wound be but seldom uncovered by opening thereof Fourthly whereas Hippocrates in his 2. Sect. of Fractures Title 7. commendeth that Cure under which there is little or no impostumation and loss of the bones this appeareth to be so in this new way of curing and therefore he determineth that this is the most perfect and this Magatus proveth by an example of his own for that in this manner he had Cured Wounds of the Head wherein there was likewise an extraordinary hurt of the bone in so much that any one would have Judged that a great part thereof would have dropt out without any impostumation and abscession of the bone or any thing else Fifthly He therefore thinketh that this new way of curing is to be preferred because that under it fewer Excrements are generated then under the common and wonted manner which as he writeth is manifest by experience Sixthly Caesar Magatus in his first B. and 32. Chap. bringeth this likewise for a Reason because that those things that are extraneous and strangers to the Body and which at the first could not be drawn forth by the Chirurgeons being such as require the work of Nature may more easily be driven forth if the Wounds be but seldom uncovered and that for this very Reason to wit because that in this new way and Method the Natural heat is more rightly preserved cherished and augmented as was said before in the first Reason And Seventhly in the place alleadged he produceth this for one of his Reasons that in this his new way the virtue of the Medicament that was administred in the first dressing is best of all continued and made to endure even unto the perfect agglutination of the Wound and especially if it be of such an essence that it cannot hastily be dissipated And as for those Excrements that usually are here to be found he thinketh also that it cannot be by them corrupted since that the Excrements that are generated are not worth a speaking of II. They in Like manner reject the Ancient Way and Method of Curing Wound as drawn thereunto both by experience and Reason Experience indeed because that as is said before under the Ancient way of Cure fewer Patients and with far more difficulty do recover of their Wounds then under their new way And as for the Reasons they alleadg they are these The First is this because that under the ordinary and wonted way of curing The Reasons moving Magatus and Septalius to reject the Ancient way of Curing Wounds the wounded part is exposed unto the Ambient Air and by it the Natural heat therof may be dissolved offended and weakned and that thereupon the part is rendered the more apt and Obnoxious unto a reception of the Afflux of Humors and the Concoction therein is less happily perfected and so there are generated greater store of Excrements that in time prove a great impediment unto Nature in her work Secondly They say that from this frequent unbinding and loosening of the wound the handling thereof and the moving of the part the cleansing thereof and the laying on of new Medicaments and by means likewise of the new binding up a pain is oftentimes excited which they say may very well be the cause of a Fluxion For it can no waies be saith Caesar Magatus in his 1. B. and 32. Chap. but that while we handle the part there will be some pain excited and indeed the greater by how much the greater the Wound is and the part wherein it is endued with an exquisite sense For we are forced in the opening of the Wound and the new binding it up again to move the part from its former Scituation We take away the Medicaments we cleanse and wipe away the Pus we impose new Medicaments and then we binde up the Wound again al which operations cannot possibly be performed without pain Thirdly They object that if the Wound be too often opened and uncovered there will then Exhale much of the heat and Spirits Fourthly and last of all That Nature also as often as the Wound is loosned and uncovered so often is she disturbed and d stracted from her proper work and office III. Caesar Magatus in his 1. B. and first Chap. and Ludovicus Septalius in the 1. B. of his Physical Ammadversions after this manner endeavour to infringe those causes and Reasons Magatus his Confutation of the Reasons of the Ancients for their often uncovering of VVounds for which it seemed necessary unto the Ancients and at this day doth seem altogether needful and requisite that Wounds should often be uncovered and new Medicaments imposed and laid on And first of all this is brought for a common and received opinion that in hollow wounds there is evermore generated a double kind of Excrements thick and thin as it appeareth from Galen his 3. B. of the Meth. of Curing and 9. Chap. and that therefore we are alwaies so to reckon that it ought to be throughly dried up and wiped away and that therefore the Wound is daily to be opened that so the Pus may be cleansed away and new Medicaments applied For those that were at first laid on cannot long keep entire their strength and virtues in regard that they are dissolved by the heat of the part and also corrupted by the mingling of the Excrements But if the Excrements be not throughly dried up and purged forth being reteined in the Wound they hinder the generating of Flesh and the conglutination of the Wound and become likewise more sharp and Corrosive Yea further they often acquire a putridness from whence may proceed Pains Inflammations Impostumations Worms and Gangrenes The Answers Now unto this they thus Answer first of all that there is no great danger threatened from the Pus since that there is no neccessity that there should be any great store thereof bred in Wounds but then only when by Reason of the frequent uncovering of them the Native heat is debilitated Neither is there any need say they that these Excrements should be consumed by the imposing of various Medicaments seeing that the Wounds of the internal parts the Liver the Lungs the Tongue and other parts in which we cannot possibly come to apply Tents or Liniments spread over with unguents they are yet nevertheless healed by Nature And albeit as Caesar Magatus writes in his 1. B. and 44. Chap. it may be admitted that two Excrements to wit a thick and a thin may be generated in the Wound yet nevertheless he thinks not this a sufficient Reason why the wound should be often uncovered For the thin Excrement may partly be digested by insensible exhalation and partly driven quite forth of the Wound by the heat of the part and for the thick there is so little thereof at the very first that it
that Galen where he treateth of those Medicaments that are necessary for the curing of Wounds maketh no particular mention in special of those Medicaments that cherish and preserve the Natural heat which that he ought to have done I deny not yet notwithstanding he elsewhere very frequently tels us that the heat and temper of the wounded part is to be preserved and that unless the temper of the part be in a right frame and Condition it is not possible that the Cure of the Wound should ever succeed happily and those very Medicaments themselves that he often propoundeth for the drying up of the Excrements of the wounds do Cherish the heat and as I said in the foregoing Chap. it seems to me that those Digestive and Sarcotick and Glutinating Medicaments are made and provided rather for the conservation of the native heat then for the doing of any thing else The second Reason that Magatus brings for his new way of Curing wounds is this that there cannot be excited any Afflux of humors since that in this way the heat of the part is preserved and that by the often handling of the wound there is not any pain caused that may excite a Fluxion But as we shall further shew you in the following Reason the truth is that in this more rare and seldom opening of the wound the heat of the part is not better preserved then in the former old way But then as touching the pain that may be excited by the more frequent uncovering of the Wound the Cleansing and purifying thereof the imposing of new Medicaments and the new binding of it up it is the part and office of the skilful Chirurgeon so to handle the wounded part that the least pain and as little as possibly may be excited Neither in the evacuation of the Pus is the part to be pressed down hard together but the said Pus is most lightly and gently to be wiped away unless haply the Wound be sinuous and full of turnings For in such wounds the pressing together of the Sinuous winding part is both useful and necessary yea moreover for the better pressing forth of the Pus from the very bottom of the Sinus there are likewise little pillows or Cushions to be imposed And then the benefit and commodity that ariseth from that short and momentany pain will not only countervail but likewise far exceed the discommodity and inconvenience Thirdly Neither is this that he alleadgeeth for his third Reason of any weight or moment to wit that in this new way the wounded part is more rarely exposed unto the Ambient Air then in the ordinary and usual way For the good and Benefit that proceedeth from the Cleansing of the Wound and the imposing of Necessary Medicaments is far greater then the hurt and damage that is brought thereunto by the admission and letting in of the Ambient Air. And this discommodity may likewise in great part be prevented if the Wound be not uncovered in a cold Air but in that that is somwhat warm or temperate and that this be no oftner done then urgent necessity shall require and that before ever we begin to open the wound all things Necessary and Requisite for this new binding up be at hand and in such a readiness that the whol business may be performed with al possible speed Fourthly Neither is this any sufficient Reason for the preferring of this new way of curing before the old to wit that in a wound of the head the bone that was impostumated and no hopes but that it would be lost hath yet in this new way been preserved For it is not as yet proved that the same might not as wel have been in the Ancient way and Method of curing and it is daily observed that in the use of the old way those bones that seemed to be impostumated and like to fall out have yet again been Agglutinated unto the rest Fifthly Magatus affirmeth indeed that under that new way there will be fewer Excrements collected then under the Ancient way but he doth not prove this and he evermore presupposeth that the innate heat is more rightly and better preserved in the more rare and seldom opening of the wounds then in the frequent uncovering of the same And we grant indeed that by the vitious and faulty concoction of the part many the more Excrements may be bred therein but this notwithstanding we deny that these Excrements proceed only from the debility of the heat caused and contracted from the Air in regard that there may be very many causes thereof to wit the abundance of vitious humors in the Body and the conflux of them unto the wounded part some of the greater vessels hurt and pouring forth much blood a contusion and bruising of the part and many other such like Sixthly Unto the sixth Argument we Answer and grant indeed that there is also a more happy expulsion made by Nature of smal bones and other Extraneous bodies if the innate heat of the part be strong and vigorous but then notwithstanding this is yet again to be proved and it is not to be presupposed that the Native heat is more rightly to be preserved and corroborated in this more rare uncovering of the wound as we said before in answer unto the first Argument Seventhly and lastly Magatus alleadgeth likewise this for an Argument but without any proof at all that the virtue of the Medicament at first imposed for the perfect agglutination of the Wound will the better endure and be kept intire touching which hereafter in the causes for which Wounds are often to be uncovered in the first Reason we shal speak further And now likewise in the next place those Arguments for which they reject the Ancient Method of curing Wounds are by us well to be weighed and considered And as for what concerns experience the question is stil in Controversie and not as yet determined to whether of these two waies the better is to be ascribed seeing that it cannot be denied that hitherto infinite numbers have in the old way been cured And here we are to take special notice that many things in the curing of Wounds are oftentimes attributed unto Art and the skil of the Artist that are rather to be ascribed unto Nature that is the alone curer of Wounds as of all Diseases whatsoever And Caesar Magatus himself confesseth in his 1. B. and 31. Chap. that a strong and vigorous Nature correcteth likewise many errors that have been by the Artist committed sleighting and overmastering those things that might have proved prejudicial unto her through the ignorance and inconsiderateness of the Chirurgeon and this he saith that himself hath frequently found by experience whiles of set purpose he took little pains nor much troubled himself thereabout as being minded and resolved to observe what Nature in those stronger bodies was able of her self to perform and that therfore he somtimes administred those Medicaments that were not altogether so fit
and convenient and that yet notwithstanding the sick party by the help and assistance of Nature recovered and became sound again But now as for those Reasons that he objecteth against the Ancient way the first of them is this that the wounded part is too often exposed unto the Ambient Air from whence its heat is weakned and so thereupon great store of Excrements bred and treasured up But as for this that is so often imputed unto the Ambient Air frequently admitted into the Wound and that for this cause alone the greater abundance of Excrements are collected this is only said but no waies proved For these Copious and abundant Excrements do not proceed from the Air but they have other causes For that smal and inconsiderable appulse of the Air which yet notwithstanding as I have said is by all means possible and as much as may be to be avoided and the operation therefore to be performed in a warm place it cannot cause so great an alteration And moreover also the Excrements are likewise collected because that the Blood and Humors faln forth of the Vessels are necessarily converted into Pus and Sanies that is to say thick and thin Excrements although the temperament of the part be sound and unhurt But that the very temperament of the part may be hurt even by the Wound it self as also by the cutting and opening of the Vessels and likewise by the efflux of the Blood and Spirits is a truth that cannot be denied and Caesar Magatus himself in his first B. and 9. Chap. taketh upon him to prove the same at large And this very weakning of the part by Reason of the wound inflicted and the change and alteration of the temperament is the cause that not presently and on the very first day the Pus is generated in the Wound but for the most part on the fourth day to wit when Nature hath recovered and gotten her strength again and the heat of the part is renewed And furthermore the Bodies on which Wounds are inflicted are not evermore exactly found and pure but oftentimes Cacochymical albeit they may seem exactly sound which although they receive but some very light and sleight wound yet this in these Cacochymical bodies degenerateth into an Ulcer by reason of the vitious humors that abundantly flow unto the wounded part As for what is in the Second place objected that from the frequent loosening of the wound the often handling and moving of the part a pain and thence a fluxion may be caused in the part affected with the Wound unto this objection we have already before given an Answer To wit that the experienced and skilful Chirurgeon may very easily prevent the said pain and although that some pain should chance to be excited from the uncovering of the Wound yet nevertheless the inconvenience and pain that would arise from the reteining and not cleansing away of those Excrements might prove far greater and of a more dangerous Consequence Thirdly Magatus although without cause feareth lest that in the uncovering of the Wound there should happen a dissipation of the spirits and Native heat For if there be any such dissipation of the Spirits and heat this happeneth together with the very effusion of the blood But then so soon as this flux of the Blood stoppeth the orifices of the Vessels do again shut close so that there needs no fear at all of any such dissipation of the Spirits and Nature being otherwise sollicitous and careful about the preservation of the spirit and the Radical heat expelleth the offensive and hurtful Excrements and stil reteineth those that are useful as we may plainly see it to be done in Critical Evacuations Fourthly and lastly they object this also that as often as wounds are unbound and opened so often is Nature disturbed and distracted from her proper Office and Work But there is no ground at all for this fear For Nature cannot in so short a space of time as while the Wound is opened and bound up again possibly be disturbed unless there happen a very great and extraordinary alteration But it will be rather disturbed if the Wound be not cleansed from those Excrements III. Caesar Magatus and Ludovicus Septalius do not solidly confute those causes by which the Ancients and all the Chirurgeons even unto our very times were moved and drawn unto this often opening and unbinding of Wounds For First of all that they determine and conclude that Wounds are therefore often to be uncovered that so those Excrements that are necessarily generated may be evacuated this say these is not indeed Requisite and altogether needful in regard that the thin Excrement may partly be digested by exhalation and partly be driven out of the wound by the heat but as for the thick if any such be generated it is confounded and mingled together with the Pus and so by Nature expelled together with the said Pus But experience it self teacheth us that this is most false that the thin Excrement is alwaies digested by exhalation seeing that oftentimes we find that it rendereth the Wound exceeding moist and that there floweth forth great store thereof And for the thick Excrement although it be mingled with the Pus yet notwithstanding it is not of its own accord wholly evacuated or if it be evacuated it is but very slowly and therefore being retained it acquireth an Acrimony and so causeth a pain and a new afflux and therefore it is speedily and seasonably before this shal happen to be evacuated and cleansed away and for this Reason the Wound is to be uncovered as oft as need shall require For neither indeed doth Nature her self expel these Excrements Nature the truth is doth separate the useful Excrement from that that is altogether unuseful But when the Excrements are thus separated the useful from the unuseful and stick in the Cavity of the wound Nature hath then no more that she can do for it is not in her power to expel them but the Excrement either of its own accord and by reason of its weight floweth forth or else it is thrust out by the flesh growing underneath it and this if it be not done it is left stil to remain in the wound Neither also can the wounded part be alwaies kept in such a Scituation and so placed that the Pus by its weight tending downward should of its own accord flow forth For all wounds whatsoever that are inflicted in the fore parts of the Body are altogether unfit for such a Scituation as is requisite for a Spontaneous efflux of the Pus or Noisom purulent Mattier seeing that it is no waies convenient that the Patient should lie upon his face And so likewise the Wounds of the hinder part although that they be so Scituated that the Pus may easily flow forth from them yet nevertheless a lying upon the wounded part is no waies fit and convenient but painful and troublesom in regard that the whole bulk of
of Gabelchoverus Oswaldus Gabelchoverus in his Practica Germanica thus Describeth it Take the fat of a Boar and of a Bear of each one pound and these being melted he poureth them into red Wine Vnto this fat he addeth powder of the Blood-stone one ounce Red Saunders six ounces Earth-worms prepared two drams Vsnea or Moss of a dead mans Skul as much as may be gotten and then he mingleth them and maketh an Vnguent touching the use whereof he writeth almost the very same that Crollius doth Another Description Others have this Description of it Take the Lard of a Brawner melted on the fire and poured forth upon cold Water as much as you think good the powder of prepared Earth-worms the powder of the Blood-stone and of Red Saunders and Vsnea or Moss of a mans Skul of each as much as will suffice and mingle them at the Fire Johannes Wiltichius leaveth out the Vsnea or Moss and he thinks the matter not great whether it be put in or left out of the Composition Neither doth he add the Mummy or the fat or the Blood And this others likewise do And I my self knew one who undertaking such a Cure Compounded as oft as he pleased this Unguent only of the fat of a Porker and a few other things without any of the said Vsnea or any thing else taken from the Body of Man That Polypragmatick Johannes Colerus in the 18. B. of his Oeconomy Colerus his Description and 154. Chap. gives us this Description Take the fat of a Brawn and of a Bear of each half a pound Moss of a Mans Skul one pugil Earth-worms one quart Blood-stone two ounces Red Saunders and Root of the greater Consound of each three ounces mingle them and with Wine make an Vnguent Neither do they all agree as touching the time wherein they would have this Unguent to be made Crollius requireth the preparing of it the Sun being in the Sign Libra Others do include this time within narrower bounds yet and they will have it to be only the tenth and eleventh day of September But others there are that allow us any time for the providing of it But now as for the manner of using this Medicament it having been so fully and largly described and set down before out of Crollius I hold it needless here to repeat it The Sum is this in a word The manner of using it the wound it self is not to be anoynted with this Unguent but the weapon or the instrument what ever it be wherewith the wound is inflicted or if this cannot be had then any other weapon or wood but more especially that of the Sallow Tree or any thing else put into the Wound and there died and stained with the blood of the wounded person And they likewise conceive that it matters but very little or not at all whether the wounded party be present or many miles distant neither have they any regard at all unto the wounded person but only unto the weapon that this be anoynted But yet nevertheless some there are who give in charge likewise that the Wound be every day washed and made clean with Urine or Wine But now lest any one should doubt of the effect of this Medicament they first of all appeal unto Experience and Rudolphus Goclenius the younger writeth that he is able to nominate Emperours Kings Princes Earls and Lords whose Authority and Credit was no way to be called in question that were ready to give their testimonials touching the efficacy of this Unguent Reasons alleadged for the Weapon-salve Moreover the Patrons of this Unguent think as they tel us that there may be natural causes rendered of this Action And Crollius term al ignorant and simple that doubt of the efficacy of this Medicament or that refer this Cure unto Sorcery But now that they may prove that this Cure may be performed in a Natural way they first of al take a great deal of pains to prove that there are some actions to be instanced in that are not wrought by the intervening of any Corporeal contact but by an occult Sympathy and Magnetism as they call it And so the Load-stone draweth Iron albeit that it touch it not corporeally and it is moved toward the Pole The Stars do also Act upon these inferior Bodies without any the aforesaid Contact The Torpedo or Cramp-Fish affecteth the hand of him that holdeth the Spear There are some likewise that can by no means endure to be in the Room with a Cat shut up in a Basket and although they see her not yet they can by no means brook her presence so that unless either the Cat be carryed forth or themselves removed into some other Room they presently fal into swounding sits Dogs likewise know their Masters foot-steps as also the treadings and traces of wild beasts by which they follow and pursue them The shade of the Yew-Tree is very hurtful unto mankind And very many more of such like instances and examples that may be observed in Nature they heap up to prove that there may be Natural occult Actions without any Corporeal Contact which because that they are most manifest in the Load-stone therefore from it they cal them all in general Magnetick Actions Another thing that they presuppose and take for granted is this that there is a certain spirit of the world diffused al the world over which spirit say they is the Director and Vehicle of al occult powers and Actions and which conjoyneth and keeps together all the parts of the world and causeth a sweet and admirable agreement and harmony between them But Thirdly As for what concerns the virtues of the Weapon-salve they tel us that there is in it a two-fold virtue one in the Unguent it self to wit of Consolidating and agglutinating of the Wound and the other that that is in the Weapon anoynted which carrieth that power unto the wound They derive this former virtue from many things of which this Medicament is compounded and from the influence of the Constellations as also the Astral and Elemental Conjunction And therefore as we told you before some there are that never make this Unguent but at such a certain time of the yeer and position of the Stars But the other virtue they derive from the Natural Balsam which together with the Blood sticketh upon the Weapon or instrument pressed upon the Wound but first besmeared with the Blood of the wounded person For this Balsam say they by reason of that Sympathy it hath with the Wounded part communicateth unto the Wound the said virtue of the Medicament by the Mediation of the spirit of the World And for the confirming of this they produce likewise other examples The Zenith as they term it of young Maidens being cast into the fire they say very grievously hurteth the virgin from whom it came and that the Secundines or after births if they be ill handled wil cause great damage and danger
unto that Woman out of whom they flowed Although they do not likewise here sufficiently and cleerly explain themselves For Crollius writeth that this Cure is performed by the Magnetick attractive virtue of the said Medicament caused by the Constellations which virtue say they by the Medium of the Air may be brought unto the Wound and conjoyned therewith and then immediatly he addeth that there are three things that by this Medicament Cause so admirable an effect 1. The Sympathy of Nature 2. The influence of the Celestial Bodies performing its operations by the Elements 3. The Balsam that being endued with a healing virtue is Naturally put upon any one whatsoever without any distinction of either Person or Sex Reasons against the defenders of the Weapon-salve But in very truth that we may briefly open unto you and shew you our Opinion touching this Unguent that which in the first place rendereth it very suspicious is this that they give us not one only way for the composition of this Unguent but very many and in some of them those things are omitted and wholly left out from which others derive al the virture of this Medicament as is apparent from the many descriptions above mentioned And so Wittichius leaveth out of the Composition the Vsnea or moss the Fat and Blood of man which yet nevertheless others make the very Basis and Foundation of all the virtue of this Medicament and it is with them the principal part thereof And yet nevertheless they will all of them promise you the very same effect and every of them extolleth his own as sit and proper for al Wounds whatsoever the Weapon be wherewith they are inflicted and whether they be by pricking or by Cutting or by any thing cast at the party or by a fal albeit that Goclenius indeed and Crollius do except those Wounds that are in the Nerves Arteries or any of the more principal Members as the Heart Brain c. What others object against the Composition of this Medicament to wit that the Authors of this Unguent require the Vsnea or Moss that is cut off from the Skul of a Man hanged as also joyning therewith Mummy Mans Blood a little warm and Mans fat and that in the Mans Blood and fat they think the marrow and pith of the whole business that is to say the whole virtue of this Unguent to consist whâ—ch these Judg to be superstitious this Objection I no waies own neither will I defend it it being so well known that Mans fat and Skul Mummy and Vsnea are made use of by other Physitians without any superstition in the Curing of Diseases And yet notwithstanding of this I must here admonish you that seeing that Magitians and Wizards as will appear out of Apuleius upon the 2. and 3. B. of Ovids Metamorphosis and Nicolaus Remigius in his 1. B. of Daemonolatry and â—6 Chap. and 2. B. Ch. 1. and others also that have written of witches and Sorcerers seeing I say that these are wont in their sorcery to use mans Blood and Flesh and other parts of Mans Body every one ought to be careful who will make use of such Medicaments that he do not superstitiously use the said Medicament for the procuring of a Natural effect and so thereby gratifie the Devil who is the enemy of Mans both Soul and Body and so unawares do him Service which may be done if he use such Medicaments for those effects that are not in the Natural power of those things and therfore if those effects shal follow they are to be imputed and ascribed unto the Devil by such like superstitious practises laying snares for mankinde rather then unto the thing it self As touching the effect of this Medicament that it doth not evermore answer the desire and expectation we are shewn by Guilbel Gabricius in his third Cent. and 25. Observation And be it so that as many great and eminent persons have testified divers who have made use hereof have recovered yet nevertheless these can attest no more but this that the person was wounded that unto him there was administred this kind of Cure by the Weapon-Salve and that this person recovered but that he recovered by the virtue of this Medicament this they cannot testifie For there may be oftentimes many things conjoyned with some effect that are not the Cause thereof And therefore as it doth not follow that such a person walking it Lightened therefore his walking was the cause of the Lightening so no more will it follow this wounded person was healed and he applied the Weapon-Salve therefore the Weapon-Salve was the cause of the cure unless it be demonstrated that from the said Unguent this effect necessarily followed And in nothing indeed is the fallacy of the cause more frequent then in Physick where oftentimes the healing of some Disease is attributed unto this or that Medicament whereas the truth is it proceeded not from the said Medicament but either from Nature her self or else from such other Medicaments as were administred before together with or after the said Medicament whereunto the Cure is ascribed And a very great difference there is between Physick and other Arts. For in other Arts the effect being upon somthing that is solid dependeth wholly upon the Artificer and if there be any thing well or ill done by him all this is to be imputed and ascribed unto the Artist unless it so fal out as happily it may and often doth that by reason of the unfitness of the subject matter for as we use to say a Mercury or Statue is not made of every piece of Wood or else by reason of some fault in the Instrument somwhat may happen to be done amiss since that as we told you before in the first B. of our Institutions and 1. Chap. the subjects of other Arts do nothing at all but only obey the will of the workman whereas in Physick the subject matter thereof hath a certain innate power by which being assisted by the Physitian for the most part of its own accord it tendeth unto health from whence it is that by Hippocrates 6. Epid. Comm. 5. Text 1. they are said to be the Curers of the Diseases of Nature So that the whol business in short comes to this that the State of the Controversie here is not whether in a person wounded and recovered again the Cure were done by the Weapon-Salve but this whether or no the Weapon-Salve were the Cause of the healing of the Wound touching which we are now to make a little further enquiry Now it being so that Nature as we shewed you above is the Cause of the Wounds Conglutination but without the virtue of any Medicament under what Notion or Consideration soever and that oftentimes likewise even by Lard or some other thing of no great moment laid on many Wounds without the help of any other Medicaments or any assistance from the Physitian have been Cured therefore in the Cure likewise that is by
of blood and the matter of the inflammation may be withdrawn and kept back And indeed by how much the danger in the wound is the greater by so much the more spare ought his diet to be but so soon as the danger of the wound is diminished then his diet may be by degrees augmented so that he may feed somwhat more fully but yet stil with a due moderation And therefore albeit that Hippocrates in his B. of Affects saith that Wounded persons ought to be pinched and afflicted with hunger this is not simply so to be taken but that we are alwayes to heed the danger of the wound and especially of the inflammation conjoyned therewith and according as this danger shal be greater or less so the diet prescribed may be more ful or ought to be more sparing as we may see out of the same Hippocrates in his Book of Fractures comment â— Text. 44. and Comment 3. Text. 12. as also out of Galen in his Commentary upon those Texts of Hippocrates But yet notwithstanding there is some consideration and respect to be had unto the Age time of the year Region Custome and Temperature according to that 17. Aphorism of the first Section As touching the Patients drink in our Regions Beer may fitly and conveniently enough be drunk His Drink I mean that drink that is made either of Barly or of Wheat and this is to be made somtimes weaker and somtimes stronger according to the state and condition of the wounded party and the wound it self Wine is not allowable in those wounds that are dangerous and where there is present or the danger of an Inflammation threatened and neer at hand in regard that it may by reason of its heat and thinness be a vehicle or means to convey the humors unto the part affected And therefore Hippocrates in his Book of Ulcers text 1. writeth in this manner A small and moderate quantity of Meat and the drinking of water is mostly fit and requisite in all Wounds whatsoever but yet rather in those that are new and fresh then in those that are old and of a long standing and then especially when in the wound there is present an Inflammation or if there shal be any feared or when there is any danger lest that any thing may be vitiated or when the wounds of a joynt are attempted by an inflammation or when there is any fear of a convulsion at hand and lastly when the Belly hath received a Wound And therefore for those that have been long accustomed to drink water and where there is no great plenty of beer either simple and pure water may be administred unto the patient or else a Medicate water destilled out of the juice of Pomgranates Coriander seed Citron rinds of Barley water or the water destilled out of the whol Citron When the danger of the inflammation as past then that wine that is thin and weak may be allowed the patient how and then In wounds that are more grievous and ful of danger Medicate drinks may be provided and made of vulnerary herbs As for what Concerns the motion and rest of the body Motion and rest which of them fittest for those that are wounded Rst is most convenient for wounded persons but more especially for the wounded part For motion moveth and scattereth the humors and rendereth them apt to flow and the moving of the wounded Member exciteth a pain in it and yet nevertheless for the Patient to walk casily and gently his leggs being sound unhurt it wil be no way amiss but very good for him so to do touching which Celsus in his fifth Book and Chapt. 26. thus gives us his opinion The best Medicament likewise saith he is Rest and quietness and to More and walk unless for those that are sound and in health is not so fit and convenient but yet nevertheless it is least dangerous in those that are wounded in their head or Arms but more unto such as are wounded in their inferior parts But motion or walking is then least of all convenient when the wound is either in the Thigh or the Leg or the Foot The Commotions likewise and all perturbations of the mind are carefully to be avoyded Affects of the mind how they are to be ordered and more especially wrath and Anger And therefore those persons that may be an occasion of incensing and provoking to anger the sick person are not to be permitted to come where he is nor so much as any mention to be made of them in his hearing But the Patient ought rather to be moved and stirred up unto a moderate and fitting mirth and cherefulness and all possible tranquillity and calmness of Mind And of all other things that are prejudicial unto the Patient at this time the use of Venus and the company of women is the most hurtful Immoderate and overlong watchings are also very offensive in regard that they inflame and cause a commotion in the humors The sick persons belly must be kept open and soluble and if it chance at any time to be stopt and shut up it is then again to be opened and loosened with mild and gentle Clysters Chap. 13. Of keeping the flux of humors from the Wounded part And thus much touching the general cure of Wounds which yet notwithstanding is somtimes to be varyed according to the variety of the subjects the Nature of the wounded part and the condition of the diseases and the symptoms that flow thereupon and of this we shall now speak And first of all indeed it oftentimes happeneth that the body that is wounded may not be exactly and perfectly sound but that it may be either Plethorical or cacochymical so that there may be great cause to fear lest that either great abundance of blood or the vitious humors that have been long treasuring up in the body may by occasion of the wound rush unto the affected part and there excite various evils And therefore we are to use our utmost endeavour to hinder and prevent the afflux of the humors unto the wounded part Now this flux is especially prevented if care be taken to hinder all those causes that may excite the said flux and moreover al those things that may overmuch and prâ—ternaturally heat the wounded part excise a pain therein or render the same soft loose and so consequently the more apt to receive the flux or overheat the humors disperse them and so render them the more fit for motion are wholly to be removed and taken quite away And such a care and orderly course there ought also to be taken in point of dyet that it may not in any wise generate either too great abundance of blood or had and corrupt humors And furthermore we are likewise to succour and help the weak and infirm part by those things that corroborate and strengthen it the pain if there shall be any is to be mitigated if there be present any heat it is to be
the Liver Ibid. P. 7. Sect. 1. Chapt. 11. Of the Wounds of the Reins Ibid. P. 8. Sect. 1. Chapt. 5. Of the Wounds of the Bladder Ibid. P. 9. Sect. 1. Chapt. 5. Of the Wounds of the Testicles Ibid. Chap. 11. Of the Wounds of the Yard Ibid. P. 10. Chap. 15. Of the Wounds of the Abdomen Book 4. P. 1. Sect. 2. Chapt. 1. We treated of the Wounds of the Womb. Chap. 23. Of the Diseases and Symptoms that happen unto Wounds And now since that it often happeneth that other Diseases as likewise divers symptoms do happen unto Wounds and follow upon them al which yield forth peculiar Indications and so draw the cure to themselves deject and weaken the strength of the Patient and render the Wounds very difficult to be cured and dangerous we ought therefore to treat of those also and to shew you how and by what means they are to be removed and taken way until which be done no Cure of the wound is to be expected Of Feavers And indeed in the first place it happeneth very often that Fevers follow upon Wounds And therefore although I have already treated of Feavers in a peculiar Tract by its self yet nevertheless in regard that it much concerneth us to know and rightly to understand the differences of Feavers that follow upon Wounds that so we may the better remove them we wil therefore herein this place speak somthing of them inspeciall and particularly And therefore first of al we are diligently to inquire what the nature of this Feaver is that followeth upon the Wound and what the Cause of it For these kind of Feavers are very various some of them being every day Feavers having their Original from the great disturbance of the spirits and the boyling heat of the blood by reason of anger Fear and upon all occasions of the humors being disturbed by the motion of the body or the commotion of the Mind And moreover also Secondly these feavers happen while the Pus and especially if there be great store of it is in breeding according to that of the 47. Aphor. of the second Sect. Thirdly from an Inflammation Fourthly and somtimes these putrid Feavers are likewise generated from the putridness that is in the wounded part And fifthly from the store of the vitious humors The first kind of Feavers invadeth the Patient at the first in the very beginning The first kind of seaver from the disturbance of the humors and as I told you before it proceedeth from the passion of the mind and the motion of the body and the disturbance of the blood and spirits following thereupon And hitherto also belongeth most vehement pain which by dsturbing the humors and causing restlesness may both set on fire those humors and the spirits and likewise excite a Feaver Their Signs Now these Feavers are known by this that they invade the wounded person instantly upon the inflicting of the Wound and together with it But yet notwithstanding because that the putrid Feavers may likewise somtimes invade the person immediatly and even from the very first beginning therefore by what Signs these Ephemerae or every day Feavers may be discerned from the putrid we have told you before and the difference will sufficiently appear from what we have written hereof in our first Book of Feavers and sixth Chapter Prognosticks And the truth is these Feavers of themselves bring with them no danger at all unto the sick person and yet Nevertheless neither can they at all promise any safety unto him seeing that then the time of the fluxion and Inflammation that are wont to follow upon the Wound is not as yet overpassed and gone The Cure But now this Feaver requireth not any peculiar Cure but if the Patient will but only submit himself unto the strict Rules of Dyet soon vanisheth of its own accord But yet nevertheless all the Causes thereof if they be yet present or that there be any fear of their returning are to be removed for otherwise they may easily draw upon the person some kinde of danger And in regard that otherwise about the fourth day Inflammations and fluxions are wont to happen these Feavers if they continue so long as until the said fourth day may possibly attract and augment those Evils And then again while the Pus is in breeding A Feaver from the generating of Pus and especially if there be a great abundance thereof generated Feavers are caused as Hippocrates telleth us in the 2 Aphorism Sect. 27. For then whatsoever over aboundeth in the wounded part and cannot be changed into the substance of the part beginneth to putrefie and there is caused as it were a certain kinde of boyling forth of putrefied mattier And yet notwithstanding Nature doth what lieth in her power and what she is not able to turn into the substance of the part she doth what she can so to work and frame it that it may not be altogether corrupted but most of it turned into Pus And therefore from this Ebullition or boyling there is indeed a heat of the blood in the Veins and Arteries communicated unto the Heart which when it is thither come it kindleth a Feaver that is like unto an Ephemera of many daies rather then to putrid Feavers properly so called Signs And therefore the Signs of Putridness are absent and appear not and so likewise for the Signs of an Inflammation and these Feavers invade the wounded person at that time wherein the Pus is wont to be generated and especially about the fourth day The heat is much but withall sweet the pulse great swift and frequent The Urine differeth and recedeth but little from its Natural state and there is no ill and dangerous Symptom Joyned together with it to accompany it Prognostick This Feaver of it self hath no danger at all in it but soon after ceaseth Cure And this that it may so much the sooner be done there is a passage forth to be made for the Pus and this so much the more speedily if the Pus be conteined in a more noble part or in a part that hath consent with some one of the more principal and noble parts and withal we are to endeavour that al the afflux of the Humors may be hindered and prevented And Thirdly Feavers from an Inflammation Feavers are somtimes kindled from the Inflammation that followeth and happeneth unto the wounded part somtimes Quotidians or every day Feavers and somtimes putrid Feavers even according as the Spirits Wax hot and this heat is communicated unto the Heart and also according as the putrid Vapours transfused into the Veins and Arteries do penetate unto the Heart and heat it Signs Now these like Feavers are known from the Signs of an Inflammation touching which we have spoken in the first Part and 5. Chapter But whether the Feaver be a Quotidian or a right putrid Feaver this may be known by the Signs of them both of which we have likewise
to be cured in that manner we told you of in its own proper place Touching the Inflammation Now very often there happeneth unto Wounds an Inflammation and somtimes likewise an Erysipelas And indeed an Inflammation doth most commonly if not evermore follow upon the inflicting of a Wound and more especially in the Nervous parts in regard that the afflux of Blood unto the part affected stirreth up and causeth a pain therein and moreover because that the Blood when it cannot sufficiently flow forth from thence it putrifieth and very easily exciteth an Inflammation which is prevented by a due and sufficient efflux of the Blood touching which Hippocrates thus writeth in his B. of Vlcers If there flow forth of the Wound Blood more or less according to the strength of the wounded person then both the Wound it self and those parts that are neer about it are the less troubled and affected with any Inflammation that shall follow upon the Wound And therefore if there be any cause to fear an Inflammation and if the blood hath not sufficiently flown forth then forthwith a Vein is to be opened in the opposite place and the Blood is to be evacuated according to the strength of the sick person and as he is well able to bear it Yea and moreover if there be already present an Inflammation and that the Patients strength will bear it and necessity so require Venesection and Purgation are both of them to be administred according as there shall be need If the Inflammation be excited from pain then we are to endeavour that the said pain be taken away and withal that the afflux of Humors be repressed Avicen for this use highly commendeth the Cataplasm that is made of the Pomegranate boyled in astringent Wine then bruised in a Mortar and so made up into the form of a Cataplasm There may likewise a Cataplasm be made of the meal of Barley of Sea-lentiles Mouse Ear and Oyl of Roses But if the Inflammation be not removed by these the rest of the Cure is then to be performed as we shewed you before in the first Part Chap. 5. Touching an Inflammation Of the Erysipelas If an Erysipelas follow upon the Wound this will soon appear from those Signs that we gave you in the first Part and 7. Chapter touching an Erysipelas And in what manner it is to be cured is manifestly declared by those things that are there spoken of And the truth is Hippocrates in his B. of Ulcers teacheth us that whensoever an Erysipelas shall follow upon an Ulcer that then the Body is to be purged And indeed if it be so that Choler abound lest that there should be an afflux thereof unto the Wound it will be very expedient wholly to evacuate the same And yet notwithstanding because that the Erysipelas which we cal Rosa hath its original rather from the thinnest of the Blood and that part of it that is peculiarly corrupted Sudorificks are therefore most especially useful as there we told you Hippocrates was wont to impose upon the part affected the Leaves of Woad or the Juyce thereof with Clay We may likewise apply unto the place affected Cataplasms of Barley meal and Eldern Water and other the like such as we have there mentioned to wit in the place before alleadged Of the Super-excrescent Flesh And sometimes likewise it so happeneth that the Flesh becometh Luxuriant and proud as we term it and groweth forth beyond all reason and measure which hidereth the production of the Cicatrice and its covering over of the Wound or at least it causeth the same to be unfightly and deformed But this happeneth through the unskilfulness or want of care in the Physitian who administred Medicaments that were not sufficiently drying And therefore what Flesh we finde to be superfluous we must take it away that so the Wound may be shut up with a Cicatrice But now this is the work of the Physitian who is to consume the superfluous Flesh with Medicaments that are sufficiently strong in their drying cleansing and if need so require somwhat Corroding likewise But now what those Medicaments are with which this may be done we have told you before in the 2. Part and 7. Chapt. whither we refer you Of all which Medicaments there mentioned the most useful and principal is the Green Water there spoken of which both consumeth the superfluous flesh and likewise bringeth the Cicatrice over the Wound when it is cured Of the Haemorrhage There happen also many Symptoms unto Wounds which partly deject the strength of the Patient and partly render the Curing of the Wound more difficult then otherwise it would have been And first of all there oftentimes happeneth indeed an extraordinary great Haemorrhage and profusion of the Blood which doth not only deject the strength and Spirits depriving the Patient oftentimes of his Life but it likewise very much hindereth the Cure For so long as the Flux of Blood lasteth there can nothing at all be done in the Cure Now that said Haemorrhage happeneth upon the wounding of the greater Veins as also the Arteries not only the greater of them but the mean and middle sort of these Arteries But touching this Symptom we have already spoken above in the 14. Chapter where you may see further Of pain with the VVound And oftentimes likewise there is an extraordinary vehement pain following and accompanying the Wound For although there be indeed hardly any Wound without pain yet nevertheless very usually this pain is tollerable and such as the Patient can wel bear But somtimes it is vehement and altogether intollerable which happeneth more especially when the Nerves and the Nervous parts are hurt and Wounded and an extream vehement pain arising immediatly upon the inflicting of the Wound is a sure and certain Sign and token that either a Nerve or a Nervous part is wounded The Cause Now this pain is excited in Wounds somtimes by reason of Errors committed by the Patient in the Course of his Dyet whiles he eateth all manner of bad and corrupt food as Cabbage and Cole-worts salt Fish Swines flesh or the like whiles he exposeth the wounded part unto the cold Air and moveth it overmuch by exercise And somtimes also this pain happeneth by the Carelesness of the Chirurgeon who administreth Medicaments that are overhot and too sharp hindeth the part too hard and streight placeth â— not aright thrusteth into the Wound Tents over long or thick leaveth the Pus over long in the Wound and suffereth some piece of bone to prick and molest the part that lieth next unto it And somtimes also without any of these Causes a pain may be excited by an internal afflux of the Humors and this pain oftentimes invadeth the wounded person suddenly and with a certain unwonted coldness and Chilness and this is oftentimes a very shrewd sign of some great Inflammation instantly to follow or even of a Gangrene very nigh at hand and this especially if together with the pricking
virtue in themselves and therefoâ—â—e before ever he make use of them he ought to inquire by what power and virtue it is that they perform what they do Which if he neglect to do he then implicitely enters into a compact with the Devil who hath made that promise that he will perform this for such as shal make use of those Characters and form of Words according to his prescription and so consequently such a one cannot at al be free from impiety And that this is a truth those two Histories following will sufficiently make good Martinus del Rio in the 2. B. of his Magic Disquisition Quaest 27. Sect. 1. relateth of Henricus Cornelius Agrippa who having at Lovain a youth boarding in his House that was over curious and prying it so came to pass that during this youths abode with him Agrippa having at length occasion to ride a Journey far from his home he delivered the keyes of his Study unto his Wife whom he afterward put away by divorce with this prohibition and charge that she should not suffer any to enter thereinto in his absence But this youth having by his importunity and earnest intreaty gotten leave to go into the study and lighting upon a little Conjuring book while he was reading therein lo a knocking at the Study door but the persisting stil in his reading there is another knocking heard at the Study door which the youth still reading on and not answering the Divel entereth in and asketh wherefore he was called at which the youth being astonished and so far affrighted that he could not make any ready answer the Divel immediately choaked and strangled him For as he that readeth any thing in an unknown Language he himself haply may not understand what he reads which yet one that standeth by may understand so it was here although this youth knew not that he called for the Devil yet notwithstanding the Devil wel knowing his own watch-word and the engagement or Compact he had entered into soon came upon calling The other History we have related by Henricus Brucaeus in the Miscellanies of Smetius B. 5. Epist 17. which he tells us that he received from Doct. Naevius and that the truth of this History was there confirmed by many of the Citizens At Leipswich little Girl not understanding what she did by reason of her Childishness and want of Age whilst she was imitating all the Actions carriage and behavior of her Nurse which she had seen her oftentimes use in the raising of storms and tempests causeth thunder and Lightening by which a village not far distant from this City was set on fire The little young Girl being brought before the Senate it was there with much deliberation debated whether they might legally proceed against her But it was decided by the opinions of all the Counselors there present that they could no way proceed against her neither punish her by reason of her nonage and ignorance of what she did Which History doth sufficiently teach us that any one may even unwittingly incautelously and almost without his consent cast himself into such a like compact with the Devil For when as the aforesayd Girl although by reason of her tender Age she understood not what she did made use of those Ceremonies that were delivered and prescribed by the Devil unto the Witch her Nurse the Devil was presently ready at hand according to the Compact betwixt them and ray sed the aforesaid Tempest Which if any one of a riper age which might easily understand that in these kind of Ceremonies themselves there can be no such power and virtue had done such a one without doubt had not been acquitted by the Counsellours nor gone unpunished by the Senate And therefore we conclude that there is none unless he be out of his wits that wil make use of the means aforesaid seeing that he may easily understand that such like Ceremonies Words and Characters do not perform those things they are sayd to do either by any Natural power and virtue of their own or else by any power given them from God or the good Angells but that they have this their power from that wicked spirit And he whosoever he be that shal make use of them cannot be acquitted and freed from gross impiety Magick and Idolatry But whereas there are some that endeavor to derive these virtues from the Constellations Whether there be any virtue in the seals and therefore teach how to make divers of these Seals under some certain position of Stars we are therefore in the next place to examine that opinion also And the very truth is that among all the Seals of Arnoldus de villa Nova and of Paracelsus in his B. Archidox Magic there is none at all to be found that wil render a man inviolable and so as not to be hurt by any kind of Weapons and therefore this invention of the Devil seemeth to be newer and since their times But now in regard that there is one and the same reason for all those aforesaid effects that are promised from these kind of Seals we conceive it therefore very fit to speak something in the General touching the aforementioned Seals For if we shall in the general demonstrate unto you that these Seales have in themselves no such natural virtue or efficacy we shall thereby withall shew unto you that these seals likewise that are made use of against Wounds have not their virtue and power from the Constellations That under the name of Astrology such like Magical Trumpery should be exposed to sale Magick is no new thing for it was of old thus wont to be done in the Eastern Countryes Touching which Pliny in the 30. B. of his Natural History and Chapt. 1. sayth thus Maggick that most fraudulent of all the Arts hath very much prevayled all the world over and that now of a long time for these many Ages But indeed there is no cause why any should admire at this the so great authority of Magick in regard that she alone of all the Arts adding unto her self and comprehending within her self three other of the most famous and sovereign of them and such as have the greatest command upon the mind of Man hath reduced them into one only to wit her self alone For first of all there is none that doubteth and that wil not readily grant that she hath her birth and original from Physick and that she so crept in under a fair and specious pretence of safety and health as a higher and more sacred Art then Physick it self And so hath she likewise by her blandishments and large admirable promises added unto her self the strength and power of religion with which now a days mankind is so strangely blinded And that she might the more easily suggest these her promises she intermingleth the Mathematicall Arts there being none that is not very greedily desirous to know things future as concerning himself verily believing that these things are
are performed and whether by a Natural Cause or by the assistance of the Evil Spirit But now unto any one that shal accurately and exactly and without any prejudice weigh and consider the whole business it wil very easily appear that these vertues and effects cannot proceed from any Natural Cause For two things there are in those Seals the matter it self and the Characters engraven upon it unto neither of which this virtue can be ascribed for the matter is from Nature and hath in it no such virtues and this they themselves see a necessity of confessing And here therefore for the proving of the efficacy of these Seals they betake themselves to Amulets and pretend the virtue of them But be it so indeed that all things whatsoever are written touching these Amulets are true as most certain it is that very many of them are yet what is all this unto these Seals in which if we consider the Metals Characters and the like it is without all doubt that those things have in them no such virtues And Paeony the Hoof of the Beast Alx and the like do shew and put forth those virtues that they have albeit there be no Characters at all engraven upon them and the like also Galen in the place before alleadged tels us that he himself had by experience found to be true of the Jasper-stone And then as these Seals have not their virtue from the matter so neither from the Characters that are from the Artificer and cannot have any such virtues either from the Artificer or from themselves For why these Characters are from an Idea in the minde of the Artificer which doth not work any effect upon things external And of themselves they are nothing else but Figures But now there is no power nor efficacy at all in Figures for the working any effect in regard that they are nothing else but only qualities of a quantity For all virtue and power of acting is principally from substance which by its qualities is efficacious and operative Action is between Contraries of the same kinde and such are not Natural and Artificial among which are these Characters Neither do things Artificial work upon things Natutal nor alter or affect them as they are such but they Act and work upon them as they have a Natural matter And so on the contrary things Natural do not Act upon Artificial things by altering or affecting them as such but as they consist of a Natural matter And therefore Images or Names engraven upon matter can of themselves perform nothing and the matter if it be at all affected by the Heavens is equally and as much affected if it hath not any Image or Figure at all engraven upon it and as for Characters Figures and Words engraven upon the mater they have in them no peculiar virtue of receiving the Influences of the Caelestial Bodies neither can they give any such virtue unto the Matter The truth is that Rodolphus Goclenius the younger doth indeed endeavour to give an Answer unto this objection whilest in his Magnetick Synarthrosis page 101. he thus writeth It is not the Statue saith he as a Statue neither yet the Seal nor the Image and figure as such that can affect any other Statue or quality For the very truth is that these Artificial Seals do acquire no virtue at al from Art but the virtue is instilled and infused into them from Heaven and the Stars I say again that this same Celestial Ray and Astral spirit that is sent down hither and here hath its influence in this sublunary world doth not only Accomodate it self unto the Metalls Stones and those plants aforesaid but doth likewise secretly and imperciptibly insinuate it self into their very substance with the which even from the very first Creation it hath obtained a Mutual and sympathetick familiarity connexion and continuation But now this spirit hath its influence without any adjuration Consecration and invocation of Devills but altogether in a Natural way But all that he answereth is nothing worth For this is that very thing according as it is in the Question which he ought to prove to wit that upon Metals and papers ignorantly engraven and Lettered there can any such like virtue as is attributed unto these Seals be derived from heaven and the Stars For although we do not deny that the Stars have their secret influences upon these inferiour bodies and therefore he hath taken much pains to very little purpose in proving of it to wit that the Stars do act upon these inferior bodies not only by their motion and light but also by their occult influence yet nevertheless two things there are especially of which there is great question to be made The first is this whether the Stars have in them any such virtue of producing fortuitous Events and meer casualties and such effects as are not Natural but wholly depend upon the will and good pleasure of Men. And the other is this to wit why they do not communicate those their influential virtues unto Metalls as they are of themselves but only unto such of them as are engraven with Characters For what have those Characters to do with the Stars And what hath Mars in the Heavens to do with the image of an Armed man Or what hath Saturn to do with an old man holding the plough And so of all other the Planets And the very same is likewise to be sayd the case standing al one touching the signs of the Zodiack and the rest of the Asterisms unto which Names have been given by Men according to their wills and pleasure for the teaching and instructing of others in the grounds of Astronomy who could if they had so pleased have given some other names unto those Asterisms which we now from them call Pisces or Sagitarius Like as the Hollanders even in our Age have most freely and according as they thought good imposed names upon all those Meridional signs that they observed in their Navigations to the Southerly parts And so the signs and figures likewise denoting those Asterisms have been imposed according to the wills and fancies of Men and therefore we conclude that there is no Necessity at all why the virtue of any Star should insinuate it self into any such Character as is imposed meerly by the wil and fancie of Men although it be engraven and inscribed at such a certain time the Star being then in such or such a position And therefore the whole controversy at length returns to this that from a Naturall Cause there can no such virtue be ascribed unto Seals and such like Characters and if there be any for of this very thing there is great doubt to be made and many things without question are much talked of and boasted which indeed were never yet experimentally found to be true as Paracelsus Arnoldus de villa Nova Thurneiserus and other of our more Modern Authors produce many things to this purpose I say if any such
by no Art or means that can be used the ends and extreme parts of them may be brought and made to stick fast together as before and that they lie not directly one against the other this kind of Fracture is in special called Cauludon from the resemblance and likeness that it hath with a broken stalk And Paulus Aegineta writeth that this Cauludon Catagma is likewise called Raphanedon and Sicnedon from the similitude of a broken Raddish and Cucumber But if the bone be not only broken into two parts but that it be likewise shivered into many that Fracture is termed Suntrimma or Comminution and by Galen it is also called Caruedon because that it is made after the manner of broken Nut-shels But if the bones be cleft according to their length like as Wood is cleft it is then called Parameces that is to say properly a right or straight Fissure or Cleft and by Galen it is termed Schidacedon In the Head this species of the solution of Unity hath names peculiar and proper unto it touching which see Hippocrates in his B. of the Wounds of the Head and in his first B. of Practise Part 1. Chap 23. And of these Fractures there are likewise several other differences for some of them are great and some again but smal Fractures some of them simple or single Fractures and all but one alone but then another Fracture there is that is manifold as consisting of many some equal others unequal and the bones are also broken somtimes in one manner and somtimes in another manner and that very different And the truth is the Ancients gave them their names from the Figure and the likeness of other parts and as we told you before they called them Cauledon Raphanedon Sicnedon Catagma and somtimes likewise Alphitedon when the bone is broken and shattered into many smal and thin parrs not unlike unto Meal they cal another sort of Fracture also Calamedon that is to say the breaking of a Reed eis Onucha after the form of a Nayl All which Appellations notwithstanding are for the most part sleighted and neglected by Hippocrates who instead of them hath made use of Names more ordinary and usual as one rather desirous to interpret and choosing rather by speaking of them in more words so to describe them And somtimes al the parts of the broken bone do again Joyn and grow together but somtimes some one or other parts of the broken bone impostumateth and droppeth out There are likewise divers other differences that are taken from the part affected For one is said to be a Fracture of the Shoulder another of the Arm another of the Thigh and so of the other parts And then indeed in the Arm either but one of the two bones or else both of them to wit the Vlna and the Radius bones are broken And in like manner it is also in the Thigh the case being one and the same The bones of the Nose are likewise broken and so are also the Channel bones the Ribbs and the whirl-bone And there are moreover besides these other differences that are meerly accidental when as a bone broken either abideth stil in its own place or else is carried forth thereof and lifted above some other bone and that somtimes the Fracture is but newly made and somtimes it is old and of a long continuance And there are also other differences that are improperly so called as that a Fracture is conjoyned somtimes with a Wound somtimes with a Luxation or disjoynting and somtimes with other affects For somtimes there is a Fracture made the Skin and Flesh lying above it stil remaining sound and whole and somtimes these happen likewise to be hurt and wounded And somtimes also together with the Fracture there happeneth a loosening of the Joynt neer unto it And somtimes unto a Fracture there happen an extraordinary pain a swelling and an Inflammation but somtimes again there are none of al these joyned with or following upon the Fracture The Causes Now all things may be said to break the bones that so endeavour to bow and bend them that they being not flexible must necessarily be broken Galen in his second B. of Fractures and Text 9. reduceth them all unto four Causes whiles he writeth after this manner It is either somthing saith he that can bruise and batter if it be laid on with great force and violence and this without doubt ought to be some Body that is hard of substance and heavy in its weight or else it is somwhat that doth not only divide the Skin or that divideth likewise somthing that lieth under the Skin even unto the very bones but which divideth also the very bones themselves which Malady Hippocrates himself indeed calleth Edra that is to say a Decession in his B. of the Wounds of the Head And moreover also some by leaping from an high place have broken either the Ankle or the Thigh bone which in these persons were drier and not so thick perhaps as in others For I my self also have seen in the common wrastling when in the turning of a man round a Fracture hath happened unto him who having hereby had his Ankle together with the Calf of his Leg broken by the greatness of the Wound the bones have been made naked and bare For this Fracture happened upon his Ankles being gotten under the Leg of his Adversary that wrastled with him in a transverse or overthwart manner so that both the Heads thereof as well that toward the Foot as that above toward the Knee were pressed downward with great violence like as we also see it in Wood which we our selves endeavour by bowing and bending it round to break For if a piece of Wood be put upon ones Thigh and then from both ends or Heads pressed down vehemently with the Hands we shal then soon perceive it to be broken in the middle part But yet notwithstanding even the very Constitution of the bones doth somtimes cause the Fracture of the bones the Constitution of them being somtimes so brittle that it cannot brook the least violence and somtimes again more hard so that it cannot be broken but with a far greater violence and force And rottenness likewise rendereth the bones very frail and weak and especially that which followeth the French Pox and in those that often make use of Mercurial Inunctions Of this strange and wonderful frailty and weakness in the bones there is extant a Memorable History in Marcellus Donatus in his Hist Medic. Mirabil B 4. Chap. 5. And the story is briefly this Vincentius Morellus Coach-man unto that Famous Poet and Noble Patrician D. Dionysius de Pietis sporting and playing the wag with others of his fellow Servants snatcht up half an Orange from off the Table and threw it as hard as he could at the Head of his fellow Servant running before him but as it fel out he did himself more mischief then the other For in that Arm wherewith he threw
turned into Pus abundance of the said Pus must necessarily be bred which if it be reteined as needs it must if the Wound be wholly bound up soon becometh sharp and so exciteth an iâ—ching and pain and divers other mischiefs although that Nature be strong and vigorous yet nevertheless the generating of abundance of the said Pus cannot be avoided since that all whatsoever is bruised must of necessity be converted into Pus And although that Magatus doth cut and make little slits in all the Linen that he putteth upon the Wound that so there may be a free and ready passage for the Pus yet notwithstanding all the inconveniences that proceed from the retention of the Pus cannot by this means be prevented For if those Swathes and Linen Clothes shal not be shifted before the fifteenth and somtimes even the thirtieth day they must certainly be very much desiled and polluted by the Pus and Sanies whereupon in the wounded part an itching pain and exulceration may follow But then on the other side if the Swathes be still kept whole and not at all cut and thereupon to be loosned every third day it is then to be feared lest that the Pus reteined may in the mean time excite some mischief or other and also lest that in so many loosenings and new bindings up again the bones may be removed out of their places and having been wel set and joyned together they should again be depraved and disordered which may easily be avoided if the binding be but seldom loosened and the Wound kept open And yet notwithstanding as often as the Wound is dressed it may be covered over with a new Swathe which may contain both Medicaments and those Coverings they cal Splenia and may defend the Wound from the external Air and it may be loosened as often as there is any need thereof but then indeed it must be without any agitation shaking or violent moving of the broken Member And there must also no Splinters be applied lest that they too much compress the Wound and beget a pain and Inflammation And if any will needs apply them yet notwithstanding they are not to be put upon the very Wound but neer unto the same Yet the truth is the number of the Swathes may very well supply the use of these Ferulae or Splinters And these things are thus simply to be performed if there be neither any bone naked and bare and that we fear not the impostumating and falling cut of any broken piece and fragment of the bone Chap. 3. Of a Fracture with a Wound in which there is no bone made bare and yet nevertheless a Cause to fear the falling forth of some fragments of the broken bone IT happeneth oftentimes notwithstanding in Fractures with Wounds that there is no bone at all left naked and bare and yet nevertheless we may have great cause to fear that some broken bone may impostumate and drop forth and this is done when the bones are made dry and withered so that they cannot be agglutinated unto the sound bone or in a Fracture when they are so separated from the rest of the bone that they can no more be joyned therewith For then Nature endeavoureth to thrust forth whatsoever is troublesom and burdensom unto her and what cannot be united unto the rest of the bones neither is she at rest until whatsoever offendeth be wholly expelled out of the Body and this oftentimes she doth at length perform although it be a long time first Now this happeneth when the bones are either corrupted by the Sanies or else when they are altered by the external Air or else likewise when they are so separated in a Fracture from the rest of the bones that they cannot possibly be any more conjoyned with them Signs Diagnostick Now what the Signs are of a bone like to be impostumated and to drop forth we are told by Hippocrates in his 3. B. of Fractures Text 18. The First Sign is this that there floweth forth a greater abundance of the Sanies or thin Excrement then could rationally be expected from the greatness and Constitution of the Wound Secondly That the Lips of the wound do not meet together or if they do at any time meet together yet they soon seem as it were to be broken and to be stirred up and provoked to excretion and they become as it were loose and spungy and there is perceived in the wounded part a certain silent motion For Nature doth not entirely heal a Wound when there is somthing remaining within that cannot possibly be agglutinated with the rest Thirdly If the bone be left bare of Flesh it is then altogether a Sign of its separation and dropping forth in regard that then it may be altered and corrupted by the external Air and that the Veins and Arteries which convey the Aliment can no longer run forth unto it And Fourthly It is then likewise a Sign that the bones will fal out if they be broken and shattered into many smal pieces and fragments for then they cannot all of them be easily Conglutinated Prognosticks 1. It is a Sign of an Abscession instantly to follow if there be good Flesh bred in the sides of the sound bone 2. But the time in which the bones are wont to recede and fal forth is various and not at all times alike For in those of a tender Age and in the Summer and if the bone be not very great it is twenty thirty or perhaps fourty daies ere the bone will be separated and fall forth But if the bone be any thing great in one of a ful and ripe Age and in the Winter time it is usually threescore daies yea and somtimes longer ere it impostumate and drop forth The Cure If the bone that is like to fal forth be moved out of its place and that it stick in the very Wound it is immediatly as we told you before to be drawn forth with the Volsella or Pincers if it may indeed be so drawn forth without any pain and violence but otherwise the whole business is to be committed unto Nature which by degrees wil at the length separate that which cannot be agglutinated And yet nevertheless she is to be assisted and holpen by the Physitian and therefore the binding ought to be instituted in a loole manner and often unbound that so the Pus and filth may not be deteined but that it may freely and easily flow forth And likewise there are no Splinters to be imposed upon that place by which the bone is like to fal forth lest that by compression they cause pain And so also there are Medicaments to be laid upon the Wound that have in them a power of drawing forth of the Wound the bones and whatsoever is extraneous and no way belonging unto the part affected and such Medicaments we have above mentioned in the place alleadged But if there be some great and extraordinary portion of the bone like to
somwhat weak in its motion and the above mentioned causes went before What to be done for the breeding of a greater Callus But now that there may be generated a greater Callus we are to allow unto the sick person a full dyet and meats that breed a thick and viscid Juice the swathes are likewise to be loosened and the part to be plyed with warm water untill it appear to be very red For in this manner there is drawn unto the part affected a greater store of blood that so there may be supplyed a more plentiful matter for the generating of the Callus There are likewise Medicaments to be imposed Dropacisms as they call them that are moderately heating and attracting a more plentiful Aliment unto the place affected There is likewise to be administred one dram of the Stone Osteocolla with the Water of the greater Comfry ground smal upon a Marble in Prisan flesh broth or Wine which hath a singular virtue to generate the Callus as by examples Guilhelmus Fabricius proveth in his First Century and Ninetyeth Observation The Callus bigger then it justly should be But then somtimes on the contrary the Callus is generated bigger then what justly it should be which proceedeth from the over-abundant afflux of the Aliment especially when it is too thick as also by the giving of the Osteocolla Stone hand over head which although it hath indeed a notable virtue in generating the Callus yet Nevertheless it is more sutable and convenient for aged persons and such as are of riper years then for such as are very young For if it be administred unto these there is then generated a Callus greater then what justly it should be as by an Example Guilhelm Fabricius teacheth us in the place before alleadged Signs thereof Now this Callus is known by the very touch by which it is easily discovered as also by the pain which ariseth from the Compression of the Muscles and the Nervous parts whereupon the part also is rendered unfit for motion and especially if the fracture be made neer unto the Joynt The Callus how it is to be made less Now the Callus if it be over-great is diminished and made less by discussive and digestive Medicaments as by frictions of Sâ—â— Nitre and Oyl and by a perfusion and fomentation made of Salt water or a decoction of the Leaves of Beets Mallows Pellitory of the wal Sage flowers of Camomile and of Melilote or else a Cataplasm made of these is to be layd on Or else let the part be anoynted with this Unguent Viz. Take Goose fat Bears fat Mans fat of each two ounces Juice of Earth-worms one ounce Ammoniacum a dram and mingle them But yet if the Callus be harder then ordinary then let Emollients be added unto Digestives and before the application of Cataplasms let the place affected be fomented with some Decoction As Take Roots of Marshmallows one ounce Roots of white Lilyes and Bryony of each half an ounce Flowers of Marshmallows and Mallows of each one handful Camomil and Melilote of each half a handful Linseed and Fenugreek of each half an ounce boyl them for a fomentation and of the mass make a Cataplasm But let these fomentations be used not only until the part wax red and begin to swel but that also the part may again fal and become lank and wrinkled Let this Dyet be very sparing neither let him eat much food that yieldeth a thick and clammy Juice Guilhelmus Fabricius in his 1 Century and Observat 21. maketh use of these Medicaments for one whose Callus was grown too great by the use of the Stone Osteocolla First of all he twice a day fomented the Callus with the following Emollient Decoction Take the Roots and Leaves of Marsh-Mallows Bryony white Lillies Bears Breech Flowers of Camomile and Melilote of each one handful Common Worm-wood and Red Roses of each one ounce boyl them in Vinegar one part and Water four parts unto the Consumption of the third part After this he anointed the Callus with the following Unguent Take Mans fat Bears fat and Goose fat of each two ounces the Juyce of Earth-worms and Vinegar of Squils of each one ounce Mingle and make an Vnguent After the Inunction he applied the following Emplaster spread upon Leather Take the Emplaster of Frogs with Mercury and of the Mucilage of each one ounce and mingle them In this manner he proceeded for six daies until he saw that the Callus was not only much mollified but also most manifestly diminished And afterwards instead of the Plaister he fitted unto it a Leaden Plate and with a Swathe he bound it fast and firmly upon the Callus And by the use of the Remedies and the blessing of God upon them the Callus was softened Resolved Extenuated and Depressed and the sick person restored again unto his former health Chap. 7. Of the Slenderness and Weakness of the Member ANd furthermore it happeneth oftentimes that after a Fracture the Member remaineth slender and weak which is caused either through the scarcity of the Aliment whiles that by the long and various bindings of the Swathes the Veins carrying the Aliment unto the part are streightened and welnigh closed up or else when the sick person hath not food enough allowed him to Eat and Drink and that likewise which maketh very much hereunto is a long continued rest of the Member and its Cessation from Motion And therefore we must by all means endeavour that a more plentiful Aliment may be attracted unto the part And therefore as much as is fit the Member is to be moved and reduced unto its wonted and accustomed motions and to be fomented with Decoctions that only attract the Aliment unto the part affected and do not any waies scatter it And Dropacisms are here likewise of singular use Or Take Oyl of Costus and of Camomile For broken bones that grow not together as formerly of each half an ounce Oyl of Castor and the Martiat Vnguent and Mans fat of each one ounce and mingle them And somtimes also it happeneth especially in aged persons that the broken bones will not be brought to grow together again of which thing Guilhelm Fabricius in his 1 Cent. Observat 92. hath a History The very like whereunto there happened here of late in a very learned man who is yet living This man was in the very same case with the other mentioned and described by Guilhel Fabricius For he can indeed write with his right Hand but if at any time he desire to list up his whole right Arm which he had broken either forward or backward he then needeth the assistance and support of his left Hand Now this cometh to pass if the bones after they be set be not kept in their places steady and unmoved and this likewise was the cause of what happened unto that learned person we but even now mentioned For he being very Fleshy and
lameness follow thereupon 2. The Thigh will at length in fifty days be brought to grow together again and to be Consolidated and not sooner in regard that as I sayd before it is the greatest of all the bones and therefore requireth the longer time that the Callus may be generated by which it is brought to grow together The Cure The Thigh bone being broken if the bones be removed out of their places there will then be need of a very strong and forcible extension since that the Muscles that encompass about the Thigh are the greatest of all the rest so that these strong Muscles when they are contracted toward the place of their original may easily overcome and master those bonds by which the Extension is made which if it should so be the Leg is thereby rendered shorter which is altogether a great deformity and very much inconvenient For although the Arm be somwhat shorter yet it may be concealed neither wil there be any great hurt thereby but the Thigh if it be made shorter it unavoidably causeth a lameness and unseemly halting There being made a sufficient extension the Muscles being of all other the strongest do easily draw up the lower part of the broken bone unto the upper parts But now nevertheless that this may the more rightly and decently be done a sufficient extension being made by the parts of the Palms sticking forth as in al other Fractures let the bone be set directly straight and so pressed close together And afterward let a Necessary and fit Medicament be imposed thereon and the Fracture conveniently be bound up and here it wil not be amiss to cut in pieces some linen Clothes and to wrap them round about upon the Hip and neer the Ilia Guts as likewise the Groins and that which is betwixt the Arse and the Genitalls as for other Causes so likewise more especially for this to wit that the external Splinters offend not the naked part The Pipe that is fitted unto the Thigh ought either to take in the whole Thigh The Pipe of what kind it must be or else not at al by any means to be administred For if the Pipe that is fitted thereto be any whit shorter then that it reach even unto the Ham and beyond it it will bring more hurt then help thereunto for it cannot be prevented but that upon the motion of the body or the Legg the Thigh also must be moved The Pipe will also be very troublesome unto the Ham and it will suffer the Knee to be bowed And therefore if any bend the Knee there is a Necessity that the Thigh bands be likewise therewithal moved and the Muscles figured in this and that manner and the broken bones moved out of their places And therefore it seemeth to be the most expedient course that the Thigh be al of it conveyed into the sayd Canalis or Pipe which is to reach from the Hip even almost as low as the Foot But now this Pipe is at a fitting distance to be bound on with many bands both unto the Thigh and Legg and on both sides woollen Clothes are to be applyed that so the Member may not decline unto either part and this is altogether to be done that so the whole foot to wit the Thigh with the Legg and foot may lye a long softly and without pain but yet so firmly that the sick person may not either through impatience or whilest he sleepeth move the same For it is to be observed as well in the Fracture of the Thigh as of the Legg that the bottom of the heel be kept in as much as may be and rightly placed for if the foot hang down and the rest of the Legg be supported and propped up there is a Necessity then that the bones should be seen to stick out in the fore-part of the foot but if the Hee l be placed higher then what is Just fitting the rest of the Body being gently lifted up the bone in the fore part of the Legg will necessarily shew it â—elf more flat then what is Just and meet and this so much the more if the Mans heel be naturally greater then ordinary And this is likewise in the Fracture of the Thigh and Legg to be taken notice of that if by reason of the swathes or the binding on too hard of the splinters or else from any other cause there arise in the Ham or the parts beneath it a swelling greater then what might Justly be expected then that which is too streight and close presseth the part too much is to be loosned but the swoln part is to be fomented or anoynted with those things that have in them a virtue of asswaging pain as also of digesting and gently driving back the humor such as the moist and oyly wool throughly wet in wine and oyl or the like Medicaments But yet Nevertheless as already hath been sayd in regard that although this cure should in this manner be accomplished lameness and halting doth for the most part follow thereupon therefore Guilhelm Fabricius in the place alleadged propoundeth a new and artificial way and Method of Curing the Fractures of the Thigh declaring it by an example and withal he writeth that he had reduced the way of curing the Fracture of the Thigh which hath alwaies hitherto been accounted most difficult unto that facility that even any Novice or young Practitioner may without any hesitation or doubting cure such a like Fracture if he wil but use a little diligence and be but provided of fit Instruments But now as for that way and Method of Curing together with the Instruments described and delineated to the life we refer you for a sight of them unto the place alleadged Chap. 12. Of the Fracture of the Nose ANd these bones to wit of the Legg Thigh Arm and shoulder are those that are more frequently broken then any other But yet nevertheless it so happeneth somtimes that other bones may also be broken touching all which we shall now proceed in our progress orderly to treat of them all even from the Head unto the foot And first of all as touching the Fracture of the Nose The Fracture of the Nose this may happen many ways as Hippocrates teacheth us in his Second Book of the Joynts and 37. Text. For either a part of it may be broken off and yet notwithstanding the Nose it self is stil kept that it neither hang downward neither be turned and made to stand awry or that either of these should happen and this either in that part that is Gristly and sticketh forth or else in the rest of it which is kept and held together with bones And somtimes also even in the very midst of the Nose where it is sharp the flesh neer unto the bone is bruised and battered or the bone is likewise somwhat hurt but yet not much and now and then also a wound happeneth unto the Fracture Prognosticks 1. The Nose of all
regard we have extant the most learned Books of Hippocrat upon this very subject touching Fractures and the Joynts and the most accurate Comment of Galen upon them I held it altogether needless and not worth while to treat more largely of them as I see that others have done before me but think it fitter for me to refer the Reader unto them if he desire to see more hereof THE FIFTH BOOK THE SIXTH PART Of Luxations Chap. 1. Of Luxations in general THere are very many Bones in the Body of Man which are composed and joyned together after divers sorts But they are chiefly composed by a Symphysis and Articulation A Symphysis is a union of the Bones without motion but the Conjunction by Articulation is composed for motion the differences of it are chiefly two a Diarthrosis and Synarthrosis Diarthrosis is with a manifest motion Synarthrosis with an obscure one of which consult with the Books of Anatomists When therefore the Bones which are joyned by Articulation do fal out of their place What Luxation is the Disease is called by the Greeks Exarthrema by the Latines a Luxation which is the falling down of the Joynt out of its place which is called the Acetabulum or hollow into another place by which voluntary motion is hindered where by a Joynt is understood What a Joynt is as Galen and Hippocrates also do teach Artic. 1. Text. 1. not that aggregate of the two ends of the Bones joyned together but only the head of the joynt The Causes Internal Causes But the Causes of a Luxation are either Internal or External The Internal are humors which falling down upon the joynts either do relax the Ligaments that they suffer the Bones to fal out of their seats or by filling them up do shorten and contract them that they draw the heads of the bones out of their seats To which haereditary defects must be referred whenas Experience doth teach us That oftentimes those that have bunches in their backs do generate the like and lame folks beget lame But the external violent Causes are External blows fals violent extension and the like which can expel or draw forth the Bones from their seat and that sometimes is done even in the Birth and the Arms or Thighs may be luxated while the Infants are drawn forth with violence by ignorant Midwives nay in the Mothers Womb Infants may have a luxation of their bones by a blow fall compression as Hippocrates seems to intimate 3. de Art 88. and 94. and 4. de Artic. Text. 2. and 3. but al causes of what kind soever do cause luxations either by violent distension or impulsion most commonly a luxation is caused by violent impulsion when from causes happening from without as fals jumping blows and the like the bones are violently expelled out of their seats Al other causes are to be referred to distension to wit when the Cavities receiving the heads of the bones which the Greeks cal Cotylae are rendered either narrower or larger and relaxt this Cavity is made narrower when a humor or some matter doth possess the bosom of the joynt and drives the bone out of its seat which happens somtimes in pains of the joynts but the Articulation is made larger or looser when the brows including the bosom are broken for so the bones may more freely wander and sal forth and the Articulation is made looser also when some humor doth too much mollefie and relax the Ligaments and renders the whol Articulation more loose The same happens when the Ligaments are too much distended or broken But the Bones are more and easier luxated in Children and young folks whose Ligaments are softer and weaker than in those of riper age whose Ligaments are firmer and stronger It happens also in them whose bodies are wasted and have weaker Ligaments but those who are fleshy and wel habited have not their joynts easily fal forth when as the joynt is on every side straightly girt in with strong Muscles also those joynts are easier luxated which are composed for many sorts of motions but those which have fewer different motions do not so easily fal forth of their seats those joynts also which are contained with one Ligament are more easily luxated than those with two the greater bones also are more difficultly luxated and not unless by a violent cause the lesser bones more easily last of al some bones do more easily some more hardly fal out of their places according to the nature of the Articulation as afterward shal appear in particular This must be observed in general That the joynts which are in a plainer bosom are more easily luxated but those which are hid in a deeper bosom more difficultly The Differences The proper Differences are taken either from the Subject or the Form The Differences from the subject or the Efficient Cause From the Subject because the bones which are luxated are joyned either by a Synarthrosis and with an obscure motion as when the broad bone of the shoulders departs from the shoulder bone or the Channel Bone from the top of the broad bone of the shoulders or the radius from the Elbow which kind of Luxation the Arabian Interpreters cal a disjunction when the bones gape as it were or by a Diarthrosis with manifest motion which Luxation is most properly so called There is also a peculiar kind of Luxation but improperly so called when the Epiphyses of the bones are pulled from the bone on which they were placed which happens chiefly to young folks From the Form because the Joynt somtimes wholly fals out of its seat From the Form which Luxation is called by the general name Exarthrema or Luxation but somtimes it fals forth only in part and to the brink of the bosom or hollow which the Greeks cal Pararthrema the Latines a Subluxation to which kind of Luxation also belongs that elongation when the Ligaments being luxated and made longer the joynt indeed according to the longitude doth somtimes depart from its seat yet fals not wholly out of it But from the variety of the Scituation to which the joynt fals forth there are fetcht three differences chiefly From the variety of the scituation The first is if the bone which is naturally placed in the upper part fal out to the lower or on the contrary The second is if that become on the right side which ought to be placed on the left or on the contrary it fal from the left to the right which others cal outwardly or inwardly The third is if that which was placed in the fore part fal to the hinder and on the contrary that which was placed behind fal out to the fore part and the joynts of some parts may be luxated into al these differences some only into certain differences not al so the elbow hand thigh fal forth into four differences viz. To the inward outward forward backward but cannot upward the knee fals
Afterwards by degrees strew in two ounces of white Vitriol poudrered then add two ounces of Litharge and at length when they are almost boyled to a just thickness add one ounce and half of Tacamahacca stir them again and boyl them to the consistence of a Plaister Gulielmus Fabricius Centur. 5. Observ 67. propounds such a one Take of the Plaister Slotanum half an ounce new Wax two ounces Osteocolla one ounce Pouder of the roots of the greater Comfrey Terra Sigillata of each three ounces Pouder of Pomegranate flowers Cypress Nuts red Roses of each one ounce Oyl of Roses or Mastick as much aâ— wil suffice mix them But before such Plaisters and Places be laid on it wil be good for some time before to foment the part with the following Decoction and to anoynt it to mollefie it if any thing be hard that it may be rendered more fit to be replaced As Take of Sage Marsh-mallows Flowers of Camomile Melilote St. Johns-wort of each one handful let them be boyled for a Fomentation Take of Oyl of Worms of Orrace of white Lilies of each one ounce Oyntment of Agrippa half an ounce Dialtheaea one ounce mix them Secondly A Luxation of the Vertebrae inwards if the Vertebrae be luxited inwards the restitution of them is altogether more difficult yet in tender bodies if the Evil be new some Plaister firmly sticking to the Skin may be applied to the place affected and the luxated Vertebrae may be drawn forth thither In those of riper age Guil. Fabricius Cent. 5. Observ 69. thinks an extream Remedy is rather to be attempted then to reliâ—quish the Patient who otherwise must lead the miserable life of the Disease or die To wit as Fabricius teacheth Incision must be made with a Knife even to the descending appendix of the Vertebra then through the same Wound putting in the Knife again two Incisions more must be made one to the right the other to the left side of the Appendix then the Appendix being laid hold on by Instruments fit for this purpose it must be drawn upwards and the Vertebra replaced in its natural seat but in the interim whiles these things are done it must needs be that the Back bone be extended for the Vertebra wil the easier start into its natural position The Wound must be smal or great according to the greatness of the dislocation for if only one Vertebra be prest in a smal Wound wil suffice but if two or more it must needs be great that both the luxated Vertebrae may be laid hold on If a Flux of blood do hinder so that the operation cannot be done presently after Incision is made it must be stopt with Hurds closely wreathed up and wet with the White of an Egg and strewed with a pouder to stop blood where this must be observed that the whole Wound especially on each side of the Appendix be most carefully filled up with those Hurd but that this may be done commodiously many little pillows must be made of Hurds wreathed up into this fashion and so one after another must be thrust into the Wound til it be filled afterwards let some Plaister that wil stick fast be applied and let it be bound with a Rowler after some hours when the blood is stopt the Hurds must be taken out gently that the blood break not forth again afterwards the Instrument must be applied as was said but the Instrument must be strong and toothed as we use in drawing forth a Stone if two Vertebrae be luxated both must be laid hold on and that with two Instruments There must therefore be two Chirurgeons who must equally and with one consent draw upwards moreover let the Chirurgeon have a care that the Incisions be not made too deep at the sides of the Appendix by reason of the Nerves which proceed from the spinal marrow to the sides of the Vertebrae moreover it is necessary that this operation be done at the beginning of the Disease while the strength is firm and before the part affected is possest with an Inflammation and Tumor neither makes it any matter whether the Patient be without Speech or Understanding which somtimes happens But if the Chirurgeon be not called at the beginning the second third or fourth day at least before the operation the place must be fomented with the Decoction of Beâ—ony Primrose Sage Camomile Melilote Roses and Juniper berries to which he may add some things mollefying as Mallows Marshmallows and then try to reduce them after the operation the Back must be anoynted with Oyl of Roses and Worms and the Wound also must be handled after the manner of other contused Wounds I have writ in the place alleadged that this operation seems to me not safe enough and to which few wil submit â— although Guil. Fabricius with Celsus l. 3. c. 33. affirms that it makes no matter whether the Remedy be safe or not which is the only one and he thinks this operation is not so dangerous since that in the middle of the Back there are no great Vessels of Veins and Arteries besides the Nerves in the Appendixes are smal Of the Luxation of the Ribs hath been spoken l. 2. p. 2. c. 25. Chap. 6. Of a Luxation of the Shoulder THe Shoulder bone with its round head covered every where with a Cartilage is joyned to the bosom of the neck of the Shoulder-blade by a most perfect manner of Articulation and most commodious for the undergoing and performing of all motions and when as this bosom is not deep enough engraved to receive the head of the Shoulder lest this Joynt should be subject to often Luxations provident Nature hath provided by strong Ligaments and a peculiar process and moreover besides the Cartilage with which she hath pargetted over this bosom she hath joyned another about it which indeed grows not to the bosom yet being tied with Ligaments begins thicker and by degrees is extenuated towards the Center yet if a violent cause come this Joynt fals out oftener and easier then the rest The Differences But this Joynt falls out downwards for the most part or under the Arm-pit hole for whereas as as Galen renders the Causes of this business 1. de artic tex 2. there are six places about every dearticulation Above and Below Before and Behind Without and Within the inner part of this Joynt by which it tends plainly upwards hath a fleshy part of a Muscle cast over it which by some is called Deltoides from its likeness to the Greek letter Δ but by that part it declines towards the Neck it hath the back of the Shoulder-blade where by the conjunction with the Neck-bone the top of the Shoulder is made which is called the Acromion where it looks inward that process meets with the Shoulder-blade which for its fashion some cal the Anchor-like some the Cornicular process which wholly forbids that the Joynt fal forth into that part But that it may fal into the hinder part
whenas there it leans on the Shoulder-blade Who is there amongst us that can so much as conceive it There are four parts then remaining which want a Guard into which it is likely the Joynt may fall Hippocrates in the alleadged place admits of no other Species of Luxation of the Shoulder but under the Arm-pitâ— nay he plainly denies that it can fal forth to the fore part yet Galen hath seen it five times once in Asia and four times at Rome and no wonder whenas in the Cities where Hippocrat lived there were scarce so many Men as in one Street at Rome and therefore there were more Examples of Diseases especially the wrastling place coming into use by which their Limbs were diversly distorted and perverted Parry l. 15. c. 21. 29. and 30. adds two differences more viz. upwards and outwards but those are very rare and you may see the places alleadged concerning them But 't is doubted whether the shoulder can suffer only a perfect Luxation or also a Subluxation Hippoc. 1. de artic tex 22. denies it and not without cause and reason for whenas the head of this joynt is round and inserted into Cavities which have their brims round it cannot stay in them and this is altogether true if the Luxation happen from an external violent cause but if the thick humors flow into the bosom of the shoulder-blade and there by their long stay do stick concreted and hardened they may by degrees thrust the head of the shoulder out of its seat and cause an imperfect Luxation yet this happens seldom in the shoulder more often in the Hip. The Causes From which it appears now that the Cause of a perfect Luxation of the shoulder is a violent cause a fal a blow vehement extension or distorsion of the Arm but the cause of a Subluxation is a thick humor fallen into the bosom of the shoulder-blade Signs Diagnostick That the shoulder is fallen under the Arm-pit is easily known and it is most certainly shewn by its proper and inseparable sign viz. somwhat round and hard under the Arm-pit is sensibly obvious to the touch to which notwithstanding other signs also are added not proper but common for there appears an unusual Cavity at the top of the shoulder but that is a common sign both of the shoulder fallen forth and of the broad bone of the shoulder blade In which things that Physitians are often deceived Galen teacheth at large both by his own and others example 1. de artic tex 61. the same falling forth of the shoulder is shewed by its unlikeness compared with the sound one by a sharp bunching out as it were of the upper process of the shoulder-blade by a departing of the Elbow from the Ribs more than usual and the difficult and painful bringing of it to them and the exceeding length and inequality of the same compared with the sound one unless the shoulder fallen downwards be nevertheless drawn up by the Muscles and the impotency of the Arm to any motion which sign also is not inseparable whenas the Muscles about the shoulders what way soever hurt whether by a Luxation or by any other Cause are unfit for motion If the shoulder be fallen forth to the fore part there is seen an unusual Cavity in the hinder part and too great a bunching out in the fore part the head of the shoulder is distorted towards the Breast the Elbow tends to the hinder parts and is with difficultly stretcht out to the fore parts and the signs are wanting of a shoulder luxated into the Arm-pit Prognosticks 1. The head of the shoulder fallen to the fore part is easier reduced than if it be fallen into the Arm-pit 2. An old Luxation of the shoulder is very hardly reduced and being replaced it fals forth again 3. They who have their shoulder reduced which is true also of other joynts the parts adjoyning being affected with no Inflammation may presently use their shoulder without any pain and these think they have no need of any further care or providence but 't is the Physitians part to correct their opinion whenas these have their shoulder more easily fal forth again then those whose neighboring parts are possessed with an Inflammation for these cannot use their joynts 4. They whose head of the shoulder could not be reduced if they grow stil that shoulder is not equally augmented as the sound one and though it be augmented somwhat yet it is rendered shorter than the other which happens by reason of the compression of the Muscles and Veins and because the whol joynt is immovable but in those who at ripe age have the head of the shoulder break forth and'tis not restored the part which is above the joynt is extenuated and becomes more slender habited The Cure That the joynt of the shoulder fallen forth to the Arm-pit may be restored into its seat from which it fel three things must be done as Galen teacheth 1. de artic text 5. First the head of the shoulder is to be forced to the fore part then to the upper part at last to the hinder part to wit that a contrary way to the Luxation may be undertaken for the head of the shoulder departing from its proper bosom is first forced to the fore part secondly by its weight 't is carried downwards thirdly 't is drawn backward to the Arm-pit hole by the Muscles But if the shoulder be fallen forth to the fore part it must be forced a contrary way to the hinder part yet that it may be freed from the Muscles with which it is detained there must first be some extension of the shoulder made yet but little But the waies of reducing it as we may see in Hippocrates 1. de artic and other Authors are various of which we wil reckon up the chief and most usual and those which require least preparation and are most safe The first way of reducing a luxated shoulder The first way is by bringing about the head of the shoulder about the neck of the shoulder-blade to wit when the Chirurgeon puts his hand most straightly under the Arm-pit and wheels about the shoulder with the other hand that the middle joynts of the fingers force it into its Cavity which way indeed wants not its danger for by the circumvolution not only the nervous and membranous bodies but also the brows of the bosom may be razed nay the Cartilage compassing the bosom cannot easily be pulled or hurt without great dammage yet it hath its place in children and other softer bodies so that the Chirurgeon do exercise it warily The second way is by the heel after this manner The second way The Patient must be laid with his back on the ground and between the hollow of the Arm-pit the head of the shoulder and the ribs a bal of a middle size made of Leather or some other matter not very soft must be fitted to it but the Chirurgeon sitting right against the
in its upper part hath a point which is sent into the bosom of the Spatha A. hollowed in the lower part next of al in place of that Spatha or Ambi there is a piece of wood which reacheth from the Shoulder even to the Bench on which the Patient sits Thirdly because that Spatha which is put under the Shoulder hath not a round head but a cross piece of wood prefixt which is sent under the Arm-pit Fourthly because the Arm is not bound to the Ambi or Spatha but only lies upon it but the swathe which is cast upon the luxated Arm on both sides of the Arm is made fast beneath to that drawing Engine For brevity sake we omit many more waies of reducing which present themselves every where in Authors and of these we have now reckoned up and others we may somtimes use this somtimes that as they are ready and at hand for it is not safe to defer the reducing long til more laborious Instruments are acquired If the Shoulder be luxated to the fore part The shoulder luxated to the fore part 't is restored almost the same waies as when ' t is fallen into the Arm-pit to wit by extending the Shoulder and drawing its head up and down and forcing it into its Cavity It differs only in this That in this kind of Luxation the shoulder being drawn downwards must be driven to the hinder part but the Chirurgeon must have a diligent care lest the head of the shoulder in the action do fal down into the Arm-pit which may be done if the Arm-pit be filled up with a bal or some round thing of a just bigness and this operation may be facilitated by a servant standing at the back of the Patient and with a rope or strong and broad swathe drawing upwards the shoulder-blade lest that follow upon the extension of the shoulder made by the Chirurgeon The shoulder being reduced Medicines that do hinder Inflammation and strengthen the relaxt and soft Ligaments must be applied of which we made mention in the precedent part concerning Fractures and above Chap. 1. of Luxations in general the most convenient way of swathing is if a bal made up of Linen or course flax and dipt in convenient Medicines be put under the Arm-pit that the head of the shoulder return not thither let the first swathe be here afterwards let it be rowled once or twice about the joynt hence let it be brought to the shoulder-blade and again descend to the joynt at last that it may draw the Arm the more upwards and keep it so let it tend to the neck on the other side and there be bound neither let it be loosened before the third or fourth day unless an Inflammation command otherwise But the swathe being taken off or laid on some Cerote must be applied viz. Diapalma if it be Summer or if it be Winter Barbarum or Oxycroceum Last of al we must not pass by here the Luxation of the top of the broad bone of the shoulder-blade The loosening of the tops of the broad bone of the shoulder blades of which Hippocrates 2. de artic tex 62. hath these words But in those in whom the top of the shoulder is pulled off the bone which is pulled off is seen to stick out But the bone is that which joynâ— together the throat and shoulder-blade whenas in this part the Nature of man is different from other Creatures Physitians therefore are wont to be most of al deceived in this wound for when the bone pulled off sticks forth the upper part of the shoulder appears low and hollow that they use the means as if the shoulder were fallen out truly I have known many Physitians in other things good enough who whiles they endeavor to reduce such shoulders thinking they were fallen out have caused much hurt by troubling them and have not given over til they have changed their opinion or thinking they had reduced the joynt they knew not what they should do more the Cure of these is this as to others of the like sort a Cerote Bolsters Linen Clothes and Swathing made after this manner the bone sticking out must be forced downwards and on that part many Bolsters must be laid and they must be prest down very wel and the Arm must be fastened to the Ribs towards the upper part and kept so for by no means whatsoever can it be done that the bone pul'd off can come close and grow together yet we must wel know and foretel also that these things are safe if you would have it otherwise because neither smal nor great hurt happens to the Shoulder by this Wound only the place becomes more deformed For whenas neither this bone can be restored to its ancient seat after the same manner as it was by Nature but it must needs be that it be comes little or much strutting out at the upper part neither doth any thing else return wholly into the same state which communicating and cohering with another hath been pul'd off from its ancient coherence In a few daies the pain at the top of the Shoulder is asswaged if it be bound down rightly Thus much Hippocrates see Galen also in his Comment Chap 7. Of a Luxation of the Elbow and Radius THe Elbow and Radius are joyned with the lower head of the Shoulder Tthe Elbow by a Gynglymus that is by that kind of Articulation in which the bones joyned together do mutually receive and are received by one another for the Shoulder hath in its lower part two bosoms the former or lesser of which receives the outer process of the Elbow but the hindermost or greater is devoted to the hinder process of the same but for receiving of the Radius the Shoulder hath also a peculiar head called the outer head The Differences From which we may easily collect that the Elbow may not only be wholly and perfectly luxated but also may suffer a subluxation next of all that it may be luxated into al the four Differences of place forwards backwards outwards inwards but the Radius as sometimes it follows the Elbow luxated into any part but sometimes states in its place so sometimes it alone fals from the Elbow without any luxation of it The Causes As the Luxation of other parts proceeds from violent Causes so this also and indeed the Luxation of the Elbow to the fore part for the most part is from a violent and sudden extension of the Arm to the hinder part from a violent bending of the Arm and outwardly or inwardly from a perversion of the Arm the Causes of a subluxiation are humors flowing to the Joynt which by degrees do fil up the Cavities engraved both in the lower part of the Shoulder-bone and also in the Elbow and Radius and do thrust forth the Elbow or Radius out of their seat The Signs Diagnostick It is easily discovered by the Sight and Touch into what part the Elbow is luxated