of Medicine not onely to the sauegarde of their Prince and people but also to their immortall fame and perpetuall and euerlasting honour The noble Latinestes haue also deserued no lesse fame both in séeking out the knowledge of simples and also in setting foorth of most worthie woorkes in the Arte of Medicine as these worthie men Cornelius Celsus Plinius and before them Cato Verro Alexander and many more which were men of worthie fame all these as I haue saide béefore haue taken their originall and beginning from Hippocrates and Galen It is also most apparant that there are manie worthy men that haue written in these latter dayes no small number in our time and of manie Countries some dyd wryte in Fraunce some in Spaine some in Germanie and some in our owne Countrie and many of them were famous men and menne of great and excellent knowledge and practise As Lamfranke Archbishoppe of Millon Guido of the schole of Mompillor and Commissarie to the Pope Rogerus and Roulandus of the schole of Mompilor and Chirurgians vnto the King of Fraunce Rose Anglus Gilbertus Anglus Hugo Wiklefe Anglus of the schoole of Cambridge Theodoricus and Brunus of the schoole of Bonane Arnoldus de villa noua and Plasentinus of the schoole of Mompilior Petrus de Argilat and Gordonus all these dyd write of the Arte of Medicine about two or thrée hundred yeres since and all these builded their foundation and tooke their originall of Hippocrates and Galen and nowe in our tyme there hath bene famous writers as Iohannes Vigo Antonius Muse Antonious Gallus Nicolaus Masse Iohannes Baptista Montanus Iacobus Siluius Alfonsius Ferrey Hollerius Leonardus Fuchius Iohannes Tagaltius Gabrielus Falopius Rioldus Columnus Antonius Calmisius Vassalius Ioh. Fernelius Amatus Lucitanus Frāciscus Valleriolus Ieronimus Cardanus Matthiolus and a great many more of learned men who we will passe ouer the troubling of tyme. All these which I haue spoken of of what Countrie so euer they were they tooke their originall and foundacion of our Father Hippocrates and Galen although they haue founde out many thinges appertaining to the Arte of Medicine which we finde no mention made of neither in Hippocrates nor in Galen yet they had their foundation from them and all these men of what countrie so euer they were they haue dronke of the water that flowed out of their two welles and doe greatly reioyce therein and who that list to reade their workes may perceiue the truth thereof Now my friendes to tell you the truth in my iudgement what was the cause of these mennes writinges I take it to be chiefely to sette forth the glory of God in his wonderfull creatures and workes as touching their natures qualities and properties which doth appertaine vnto this artist which doth vse the Arte of Medicine to consider vppon for all maner of thinges vnder Heauen doe serue either for mannes nourishment or else for the making of his bodie or else for necessarie remedies in the time of sicknesse or else for preseruatiues to kepe him from sicknesse and to preserue health So carefull was the highe and mightie Lorde God for his creature man that he made all these thinges to serue his vse as necessarie helpes in the time of his necessitie and placed him in the place of ioye with great solemnitie But alas his frayle nature was the cause of his sodaine ouerthrowe from ioye to sorow from pleasure to paine from rest and quietnesse to perpetuall labour and vnquietnesse from a most temperate Ayre and pleasant place into a miserable worlde tormented with innumerable contrarie ayres and chaunge of windes Yea I saye euen from the place of health into the worlde of sicknesse and miserie where our bodies be altered and weakened euerie daye by mixing together of contrary Elements and we being subiect to the same are dayly tormented with innumerable diseases And although Adam at the first creation was indued with most excellent wisedome and knowledge by the power might of the Lorde God so that he dyd know all things that were vpon the face of the earth in the waters and déepe partes thereof not onely their qualities and properties but their substanciall formes and figures and gaue them names as he himselfe thought good for he had perfect knowledge of all thinges by the deuine spirit of God which dyd worke in him according to his first creation but when he had sinned against the Lord God then was taken from him his diuine knowledge and lefte here in this world bare and naked to take paines and studie for all those things that he would receiue commoditie of Now man as I sayde before being wrapped about with innumerable sicknesses diseases and sodaine chaunces which bée subiect to the arte of Medicine which Arte I call the arte of curing and healing was constrained to séeke for remedies in the tyme of his necessitie And sought out Herbes Rootes and manye other thinges to helpe his diseases and griefe withall and by vse and longe time of practising they dyd finde out the natures and properties of many thinges wherewithall some tymes they dyd good but by chaunce for they obserued neither the natures of bodyes nor their temperatures nor the disease neither yet the causes thereof but onely regarded those thinges which they dyd sée and féele Thus farre wyde was man from that excellent knowledge which was geuen him in the beeginning for in the beginning he was not onely indued with most beautie but also with most excellent giftes of knowledge and wisedome All other creatures besides man which hath not sinned against the LORD GOD but followed the nature of their first creation all these wée sée by experience haue a certaine deuine nature in them which man lacketh for man dyd lose it through sinne which these creatures haue not done and for the proofe héereof we will begin with the dog which being sicke séeketh for a certaine grasse eateth thereof and with the same cureth his griefe and disease Onelie a diuine nature teacheth him this without anie studie The Squirrell also prouideth her selfe nuts against Winter The little Ant or Pismere doth gather séeds into the ground and biteth them in the end after such a cunning sort that they may not grow The Storke also being grieued or anoyed with anie vncleane thing that she hath eaten flyeth to the sea and giueth her selfe a clister with salt water ministring it with her bill at her neather end by meanes whereof she purgeth and cleanseth her selfe of her griefe and sicknesse Thus may you perceiue the diuine and wonderfull workes of almightie God working in his creatures by a diuine nature but man lacking this diuine knowledge and lefte onelie to reason and Experience is constrained by greate studie to bring to passe those thinges which by imperfection of Nature dooth lacke in him By meanes wherof all these most worthie men afore said haue put in writing manie worthie Bookes of this arte which arte they haue obtained by greate
Chirurgerie is not onelie to know the names of sicknesses and diseases but the name of euerie perticular medicament as wel simple as compound And also to know all other strange tearmes appertaining to this arte Wherefore Galen in this booke of Tumours against Nature hath taken greate paines not onelie in setting forth of their names but of theyr true diuisions natures and dispositions with their figures formes and humours by which they doe grow and are maintained without which knowledge no Chirurgion can either rightlie cure either else vnderstand the nature of those things which he doth take in hand Therefore I haue thought it good to set before your eies this most worthie booke which Galen hath writtē of tumors against nature wherein he hath most excellently set forth not onely the most apt names but also the humors that the same tumors doe spring of For like as he hath declared in his methode of curing the diuersitie of wounds and vlcers with their natures formes and properties and also with their accedents symptomata and causes Yea I say not onely with these but also with the knowledge of the temperaments natures and qualities of euery medicament proper for their remedies with their trew deuisions and names to that ende that euery one of them may be exactly and perfectly knowen from other And for the better vnderstanding hereof I haue added in the ende of this booke of Tumors against nature an other booke of Galen of the names of medicines which be proper for diseases which I haue thought very meete and conuenient for you to vnderstand to that ende that you may be accounted men of knowledge in your arte not onely to be accounted so but to be so in deede Thus taking my leaue of you I desire you most hartely to be studious herein and so being you shall incourage me further to procede in other things of this arte which may be much for your profit And thus I commit you to the almightie Lord who illuminate you with knowledge of this most worthy Arte. Your louing brother to the vttermost of my power Thomas Gale maister in Chirurgerie An. Domini 1563. Mense Septembris 25. Claudus Galeni de Tumoribus preter naturam OF those things which chaunceth to mans bodie one thing is that which the Gréekes do call Oncos which we name a tumor or swelling for so doe they tearme that thing which is a swelling or a distention in length breadth and déepnesse Also sometime that bignesse which is aboue natures constitution they do cal Oncos These do not onlie chance vnto them that be sicke but to those that be whole also For corpulent persons and women with childe are more bigger in breadth and thicknesse than according to nature and yet they are not affected against Nature as we haue sayde in other places The other tumor is that which is according to natures constitution or as we may tearme it a naturall tumour in the braunes of our armes and caufe of our legge which is in a meane betwixt those that be according to nature and those against nature For corpulent bodies also leane bodies are not against nature but the one is aboue natures constitution and the other vnder and so both these dispositions are called not naturall But that tumour which cōmeth of the dropsie and leanes in a consumption both these are against nature But now in this presēt booke we doe purpose to intreate of those Tumours which bée against nature which doth not onelie occupie the whole bodie but also may chaunce to anie part thereof so that it bée alwaies determined that the agreuation of this vnnaturall constitution be against nature and the end of the same to be the hurt of the naturall action But we néede not to speake much of these Tumours for that they be commonly knowen vnto all men not onelie to the Phisitions but to all other persons The other tumours which groweth of immeasurable fatnesse and flesh and also women béeing with childe doe make those which are aboue natures constitution And we considering all other Tumours which are according to nature and necessarie for the making of our bodie as in the braunes of the armes and cause of the legges c. All other tumours which doth excéede that which is aboue nature and those which be naturall we account against nature And taking our beginning at the first of them called an inflammation or Phlegmon Of Phlegmon or Inflammation Chap. 2. THe Grecians vse to call that an inflmmation which commeth with great tumor or swelling in the fleshie parte strained and stretched forth resisting with pulsation dolour hot and red The cause of these accidents is not onelie vnknowen to the multitude of the common sort but also vnto manie Phisitions or as we terme them those that vseth the art of Medicine for diuerse of them not séeking out diligentlie doe simplie pronounce that which séemeth good vnto themselues mistaking the thing But consideration must be had héerein if you will procéede in this mattier Therfore there is neuer anie great tumour that chaunceth in anie parte of the bodie against nature except the same parte be affected with one of these two thinges For either it is made flowing increased and stretched forth through ouer much hotnesse either else it taketh some new substance outwardlie And when this fluxe doth happen is stretched out with swelling it is tourned into spirites and béeing refrigerated it doeth easilie tourne againe into his accustomed swelling But we sée no spirits in the inflamed parte neither yet the part inflamed being refrigerated doe not alwaies come againe into their former constitution And it is manifest by incision also that there is no spirites therein contained for if the inflamed part be cutte much bloud will runne out and all the place séemeth euidentlie full of bloud like vnto a wet Spunge But yet you shal sée no spirits come forth either presentlie or yet long after and the coulour of bloud is altogether inseparable There is no part of the bodie that is red but bloud and flesh neither is the multitude of flesh the affect of inflammation for although the multitude of flesh be in the bodie without multitude of bloud yet the tumour trulie shall be bigger than natural and the coulour shall be healthfull and not swarue from his accustomed nature for in anie thing which naturallie increaseth the coulour is not augmented for then should Snow be made more white Pitch more blacke and Golde more yeolowe And the increasing of substance differeth manifestlie from alteration for thinges increase according to their quantitie and altereth according to their qualities but coulour sheweth the qualitie of the substance and not the quantitie Therefore the multitude of flesh differeth from an inflammation and for that cause the bodies which abound with bloud bée most troubled with inflammations Now séeing that sometime in wounds there be greate inflammations and yet there floweth forth thin and watrie humours the place
but one therefore we haue aboūdantly intreated of Nerues but how we shall cure the inflammation that commeth to them we shall set out when as we shall intreate of Phlegmone The fourth Chapter SEing that the ligaments called in Greke Syndesmous be of like kinde to the tendones they can suffer the force of most vehemēt medicines because they do not come to the braine and be voide also of feeling for all the Nerues come either from the braine or else from the marow in the spine of the backe the tendones also as we haue shewed their substaunce is compounded of the Nerue Ligament they so farre forth spring from the braine as they participate of the substance of the Nerue But yet are lesse vexed with cōuulsion than the Nerues But the ligaments forsooth séeing they spring of the bone those that are round are like vnto Nerues but differ from them much in hardnesse yet in that they are white without bloud and not hollow and deuided into Fibers they are like the Nerues and tendones so that they which are ignorant in the Anatomie when as they sée the round ligaments and tendones they take them for Nerues and chiefely they which vnderstande not that they are harder than the Nerues but where they are brode there they know them to differ from Nerues But they cannot discerne thē among them selues but thou which knowest the natures of all their parts and also their forme and in what place they are in the whole bodie and in what part of the bodie it happeneth a wound to be made thou doest presently vnderstand whether it be a Nerue that is wounded or a ligament or tendon If the ligament woūded be such one as goeth from bone to bone it is chiefely without daunger and that thou drying it with all kinde of desiccatiues shal not any thing hurt the patient but if it goeth into the muscle how much it is lesse dangerous than in the Nerue and Tendon so much the more it ought to be feared if it be not rightly cured and none of these can be brought to passe by a methode of these Phisitions which deny the indication that is taken of the part to be profitable to the curation of Vlcers neyther yet of such as doe confesse this if they be ignoraunt in the nature of euery parte which as we haue shewed consisteth of the temperament of Elements But although these know no other thing yet at the least they vnderstād that they are shewed of the constitution of the instrumentall parts Thessalus truely and his Disciples are also very ignorant herein as if Abdomen were now presently wounded so déepe that some intestine came forth they know nothing at all how it ought to be put in and if Omentum fall out whether it is to be cut away or not or whether it is to be trussed vp or no or whether the wounde must be stitched or not or if it be stitched in what wise it ought to be done neither should we haue vnderstanded these things if wée had not learned by reason of the Anatomie the nature of all the parts therein conteined which truely to declare is a thing necessary not onely for the better vnderstanding that shall follow but also for probation the skin is most outward of all this and is ended in a thinne pannicle called Membrana within the skinne as it was in the mid place there is a double neruous thinnesse of the Muscles which the Grecians call Aponeurosin stretched out in manner of coates or membranes many Anatomistes are ignorant that they be two when as they so cleaue and ioyne together in such wise as it requireth labor to separate them and also for that they are most thinne nexte these immediately followeth two right and fleshie muscles which stretch from the breast to Ossa pubis and all these rehearsed cleane and grow together and that which is made of these the Grecicians which haue set out the way when the stitching of Abdomen ought to be made called Gastroraphias named Epigastrion that is to say Abdomen that which is next these is called Peritoneon and they thought it to be one simple bodie but falsely séeing that it is made of two bodies both which are without bloud and Neruous but one of these Neruous thinne pānicles belōgeth to those muscles which goe ouerthwart the other being very thin lyke a cobweb is the true Perotineum and Abdomen is such a like thing in the middest of it selfe the parts of it which are distant and on both sides as it were foure fingers bredth at the side euen from the skinne haue the oblike muscles the former which came from the brest the next which ascend from the intestines after these muscles that which is ouerthwart Vnder which is Peritoneum therefore there is lesse daunger in this place than in the middest séeing it hath no such thinne coate or pannicle and that they cal Aponeurosis and that stitching may hardly be made in the middest because that chiefely in this part the intestines goeth out and may hardly be put in and the muscles that dyd constraine and draw them be the right and fleshie muscles which I sayde came from the brest to Os pubis therefore of force the intestine commeth out through two causes as oft as anie of these bée wounded from the partes which are on the side because that is gathered together by the muscles which are there from the middle partes because the muscle which should containe them is not strong inough that the place is verie apt for comming forth if the wound be greater then of force more Intestines must fall out and are more hardlie put in againe Furthermore for another cause small woundes are harde to bée handled for except that which commeth out bée presentlie put in his place againe it is inflamed and riseth in tumor so that it cannot be put in by so straight an hole therefore in such woundes the meane hole is lesse daungerous and it is truelie necessarie to knowe these thinges then it followeth next that wée consider how one shall most conuenientlie handle these kinde of woundes for Thessalus precept which thinketh these woundes to bée glutinated with medicines called Enema doeth serue so little to the purpose that I thinke it more manifest that it shoulde bee vnknowen to anie hauing his wit therefore first of all séeing wée must doe that that the Intetestines which are falne out bée put in againe into theyr place secondlie that the wound bée stitched thirdlie that thou applie a conuenient medicine and last to regard that most worthie to be affected Goe to now let vs speake of the first séeing therefore there is as is sayde a thrée folde difference of these wounds in bignesse let vs attempt to take of euerie of them a proper Indication admit that in the beginning the wound be so small that the Intestine which fell out béeing inflated cannot againe bée put in whether or no
of the partes where they are first put on and doth put and fixe them in those in which they end I thinke it reasonable to beginne the ligature vpon the fracture it selfe and so to proceede vnto the rest of the member for hée that doeth otherwise putteth the bloud to the affected parte but if he beginne vppon the hurt parte and endeth in that which is whole such ligature shall not onelie be voide of hurt in these which we haue saide but be also profitable for that it suffereth no inflammation to arise about the Fracture of which principallie regard must be had and it is to be feared least great inflamations folow both of the stretching into the contrarie part which we vse in forming rightlie the member and also that the causes which make the Fracture do first hurt the flesh inuesting the bones by constipation and contusion neither meruaile I if some such thing like an inflamation happeneth to the portion of the bones when as such as are not rightly cured are manifestlie séene to be more moist than nature requireth where wée sée a wound with a broken bone neither commeth Caries of the bone in Gréeke named Sphacelus anie other waie which is corruption of the whole substaunce of the bone Therefore thou shalt not bée negligent but expell thou all the superfluous moisture from the partes which are about the fracture Therefore thou maist begin vpon the affected part and bring the roller about twice or thrice and procéed then toward that which is sound for verilie he that thus doth roll shall defend the fluxe of bloud to come from the whole partes to those which are affected and doeth also put out from hence that which is héere alreadie collected Séein then that there are two partes which maye both receiue anie thing of the affected part and also send vnto it Forsooth they which lie vppon it are most readie vnto both as well for the multitude as also greatnesse But the extreme parts for the contrarie cause can receiue or send but little neither can minister much either to the affected partes either receiue of them againe Wherefore when as Hyppocrates made the first two ligatures with the first he did not expell that was in the affected part to those that are aboue and also doth expell that which floweth from them with the roller For with the first rollings about which he doth make vpon the fracture and by deducing it to the lower parte he thrust some mattier thether and letteth that none shall flowe from thence The rest of all the inuoluings with which he will haue the roller to goe from the lower partes vpward that they may in the same place with the first both repell to the higher partes and also preserue fluxe from these wherefore the two first rollers doe defend and strengthen the Fracture neither suffer they inflamation to arise Notwithstanding these alone are not sufficient to both these vses so that Hippocrates did deuise for their defence a remedie that splents bée applied with the last rollers which might also strengthen these and he commaūdeth to vse some one medicine which is against inflammation least there should follow inflammation such a medicine is Ceratune humidum Therefore all these are inuented as we haue sayd by reason and also the figure of reposition this also hath a two fold indication the first dependeth of the common knowledge onely the other which is taken of the naturall constitution of the members to be cured the first indicatiō sheweth that such figure is to be chiefely chosen which is most frée from dolor and griefe so that there follow no inflammation to the part and that the patient be best able to remaine longest in this without mouing The second indication which is taken of nature willeth that the arteries veines nerues and muscles be most rightly placed And these indications doe agrée For the rightest figure of euery part is frée from dolor and that which of the rest is most frée from dolor is most natural to the part for to the arme the figure which is cornerwise in Gréeke Eggonios for the leg that which is somewhat lesse stretched out Furthermore not onely the naturall habit is profitable to euery member not onely in auoyding of dolor but also the custome séemeth much to profit and this is the waye of finding out the figure in which the member is to be kept which also differeth not in séeking out the figure vsed in extending the parts a sunder called in Gréeke Diatasis and also when the partes of the broken bone are brought into their naturall place for it is cōuenient that both thou dost extend the member in the most right forme and that which is furdest from dolor and also that thou formest it into his naturall habit and much more that thou roll it in the same figure and also placing it to rest for the mouing thereof doth not onely prouoke dolor but also doth wrest the bones by mouing the member being in one figure and to change it to another for except I haue forgottē those precepts which we haue written in our bookes Da musculorum motibus it is necessarie that whereas the figure is altered there some of the muscles to be strained and to be made round as they were contracted and other to be lose and relaxed Therefore of force where they are extended there they are compressed of the roller and by the compression doe suffer paine and dolor And where there is no extention there the ligature is lose and slacke and so the fracture wanteth his staye and for because of all these we must studie that we doe both extend and forme the member and also roll and repose the member to rest vnder one and the self same figure and ther is no precept left vnset out which belongeth to the first worke in Fractures Thou shalt as Hippocrates commaundeth lose the roller the third daye least there should arise dolor and itching in the member vnaccustomed to be so couered and also that the perspiration of that which is now fixed in the member be not letted by whose occasion there doth not onely fall thereto an vnhappy itch but also the skinne to be vlcerate and coroded with the sharpnesse of Sanies wherefore we must poure in so much of temperate water as shal be sufficient to take away this Sanies And if thou wilt againe doe as it is aforesaid thou oughtest to doe it the vii daye All things now are apparent so that nothing hindreth being frée from inflammation and somwhat gentler than for naturall constitution Then it shal be lawfull to apply splents and roll it more wider asūder for it was not without danger to vse splents before the inflamation was past But now when as it is ceased that néede is to strengthen the fracture surely you shall vse thē with much commoditie And you may also let the rollers remaine longer time the partes hauing no néede to expell Sanies
or else that as the curation is taken in hand doeth bring more discommoditie and also a more grieuous sicknesse than that which is taken in hand to be cured As when we goe about to cure Vitiliginem Antiquam Lichenas Hemorroidas Sinuosa vlcera and the old Fistulas Cancers and to conclude when as we haue a stubburne patient which doth giue no regard to the Surgions that gouerneth him these are the causes why that all cannot be brought to their health by arte In like manner Chirurgerie is diuided into two partes generallie the one is which doth declare what things belong to the art doth set forth the precepts wherwith the workman being furnished may worke rightly This part the Gréeks do call Theoreticon we do cal it Theorica that is to saie the learned or speculatiue part the other doth folow that doth perform in effect that precepts of the former it is called in Gréek Practica or rather Poetica that is to say a bringer of things to passe for it wholy doth consist in doing and bringing to effect and séeing that the whole Arte doth depend of these we maye with good cause thinke Chirurgerie worthie to be called an arte as whose ende is affection and woork For she doth exercise all her properties either in soft mēbers or in harde parts The soft parts are those which haue their beginning of bloud and are called fleshie and the hard parts do spring of séede And chirurgerie doth exercise her facultie in those partes by incision by cutting or by taking away by reposition and adustion And truely of this arte there are certaine other more speciall partes as those about the which the arte it selfe is speciallye occupied that is to saye Tumors against nature wounds vlcers fractures and Luxacions Therefore as there be fiue parts which the art doth intreate of so there be fiue partes of Chirurgerie in the whole as which doe teache vs to cure tumours which woundes and which vlcers and which can put fractures and luxacions in their proper place But the ende wherevnto Chirurgerie directed all his actions and prouisions is the ablation and taking away of those sicknesses which maye be cured by ministracion of conuenient medicines with the hande to restore the sicke vnto his health which ende truely the workeman cannot alwayes obtaine vnto For those causes which we declared before séeing that it is not in his power to cure euery sicknesse And this long arte vaunteth hir selfe vnto the famous companie of excellent and noble authors worthie of great renowne In whose register that diuine man Hippocrates the patron and defender of the noble arte of Medicine doth of very right challenge to him selfe the chiefest place by whose meane this parte of medicine is better declared then it was before his time the which thing the deuine monuments which he left to his posteritie doe witnesse I doe meane his bookes wherein he doth speake of the woundes of the head of fractures of the lyms of vlcers of fistules of the emorodes and of the furniture of Chirurgerie and of cutting out of the Anathomies Furthermore Chirurgerie béeinge as it were deuided at length from the other hath chosen vnto hir selfe a proper place and beganne to haue hir proper professors for in the time of olde writers in the florishing age of Hippocrates Chirurgia was not deuided from the other parts of medicine for they were then both Phisitions and Chirurgions And Philoxenus declareth it to haue florished in Egipt which hath set foorth and garnished this Arte in many volumes And after him Gorgias Sostratus Hieron and the two Apollonij Amomus Alexandrinus and many other excellent men and it is certaine that there was no meane professors of the same arte at Rome as the auncient Fathers Tryphon Euelpistus and Meges the most excellent of all as Celsus writeth But how much Galen excelled in restoring and enriching this parte of medicine his learned Commentaries vpon the bookes of Hippocrates wherein he doth declare of the Arte of Medicine and vpon his booke De articulis de fracturis And moreouer his sixe bookes of the first methode of curing called Therapeuticon and the last two of the same the two also De arte curatiua ad Glauconem his booke De tumoribus preter naturam his booke De compositione medicamentorum secundum genera doe testifie abūdantly Moreouer Paulus oegeneta ought greatly to be commended who in a method compendious but yet most exact hath comprehended all Chirurgerie both in his fourth booke and also in his sixt Furthermore Auicenna Rasius Albucasis and Haliabbas being of the schoole of the Arabians haue intreated most diligently of the Arte of Chirurgerie as Auicenna in his fourth Canon and the third fourth and fifte féen Also Rasus in his seuenth booke to Almanser the King Albucasis in a whole volume Haliabbas in his ninth booke of practise of the regall disposition neither hath she lacked hir honour of Latines Celsus and Plinius Captaines who with great beautie and like dignitie haue intreated briefly of this parte Why should I passe ouer Guydo de Gauliaco who onely among the French we haue knowne to haue intreated very well of Chirurgerie if ye regard the reason of the arte We may trulie gather by his rude spéech that he wanted onelie such happie time wherein he coulde not come to the knowledge of the Gréeke tongue nor to the pure eloquence of the Latine tongue whilest at that time ignorance and barbarousnesse exercised tyrannie ouer good learning which was the cause that in rehearsing the place of Galen the truth of the author was much desired But if God graunt me life I will diuide those places of the Arte of Medicine from the common place I trust that I shall helpe Guido and I will of a barbarous and impure writer make him a fine and eloquent Latinist restore him to his beutie which our friēd Siluius hath performed in correctīg Mesueus the same doe I faithfullie promise to the studious to multiplie in repairing of Guido if God prosper our indeuours although perhaps without méete or equal thanks yet shall I doe it with due labour and good will But now I will returne to my purpose for manie famous men and authors most worthie of fauourable commendations haue set forth this arte among the which Guido Vigonius and among the men of this age Tagaltius being my fellowe in office and my companion in my studies haue done greate things and worthie of praise in amplifying and garnishing this part whereby it may be gathered how much is vnto this art to be attributed which so many renowmed haue each one in his workes and monuments set forth increased and enriched that men might know it to be most profible and in effects most euident among all the partes of medicine Now must we show what are the duties and office of a Chirurgion and howe he should enterprise the same for there be thrée chiefe points
fewe woordes I haue proued here bothe by reason and by experience that the knowledge of this part named Phisiologia doeth chiefely and specially apertein to the arte of Chirurgerie and without the knowledge hereof we shal neuer rightly or methodically cure any maner of woūd griefe or disease neither is he worthie to take the name of a Phisition neither yet of a Chirurgion but to be called by the name of an Emprike or experimenter curing onely by chaunce without any reason but euen as the blinde Carpenter which Galen hath spoken of before sometime cutting to much and some time to little and many times marring all his woorke for want of skill ere that he beware Now to conclude for this first part he that will be further instructed herein let him reade Hip. de natura hominis humoribus elamentis de natura formatione fetus many other bookes of Hyppocrates and chiefelie that where he diuided the similer parts As Osteotome that is to saie the diuision of the bones Condrotome the Cartalages Syndestmotome the ligaments Arteriotome the Arteries Phlebotomae veines Neurotome the nerues Miotome diuiding of the Muscles Tenontotome the tendons c. There be diuers other bookes of Galen which be verie profitable to be read for this matter as his bookes of Anathomie also his bookes De temperamentis de optima corporis constitutione de facultatibus naturalibus de placitis Hippocrates Platonis de motu musculorum de causis respirationis and manie more worthie bookes of his which we will let passe There bée manie other bookes also written by diuerse men as Guido and other which doe intreate of these naturall things and speciallie of the Anatomie of mans bodie and for that you may the easilier better vnderstand these naturall things which euerie Chirurgion ought to know and haue in perfect memorie to that end he may remoue those things which doth hurt them or let them of their perfect operation which you may easilie knowe if you vnderstand their natures and properties figures c. Which Table followes héereafter as you may heholde Naturall things Eelements be foure Fire Aire Water Earth Temperaments Simple be foure Hot. Colde Moist and Drie Equall one Cōpound be foure Hot and Drie Hot and moist Colde and moist Colde and drie Foure humours Sanguine Flegmatike Cholerike and Melancholie Members Similer Bones veines arteries cartilage flesh fatnesse pannicle ligament nerues and skinne cōpound Head heart liuer lungs armes and legges Three faculties Animall Vitall and Naturall Operations or actions Animall Feeling and moouing Vitall Beating of the pulse And breathing Naturall Generatio Auctio and Nutritio Spirites be three in nūber Animall Vitall Naturall In The braine The Heart The Liuer Pathologia is that part of the arte which hath the knowledge of sicknesse against nature with their Symptoma and accident and they be thrée in number that is to saie sicknesse it selfe the cause of sicknesse and the accidents which followeth after sicknesse sicknesse it selfe may come two waies either of outward causes or of inward causes we do commonlie call the outward causes primatiue the Gréekes call them Cathertica the inward causes we do cōmonlie name Antecedent or Internam The affectes commonlie followe these causes and if the affectes come of outward causes then commonlie they be wounds contusions fractures dislocations biting of mad dogs of serpents c. If they come of inward causes then they make tumors against nature as Phlegmō Eresipula Oedema Sirrhus with many kinde of malignant and stubburne vlcers to be cured which tumours and vlcers cannot be made whole except their causes with their euill affects may be remoued and taken awaie I suppose that there is no man but hée will iudge this part of the art chieflie to pertaine to Chyrurgerie for that it taketh cure of wounds vlcers and tumors against nature as I haue said before Then if this part doe appertaine to the art of Chyrurgerie as it is most certaine it doeth it behoueth the Chyrurgion perfectlie and rightlie to vnderstand what kinde of sicknesses there be with their differences names what partes of the bodie these sicknesses may be in and what manner of sicknesse it maketh in the same partes As for example euill complection maketh a distemperature in the similer parts euil constitution or euil cōposition maketh a deformitie or imbecilitie in the instrumentall partes And solution of vnitie or continuitie chaunceth both in the similer partes and instrumentall And all these doe appertaine to the Chirurgion to haue most exact knowledge of for he that taketh vpon him to cure an vlcer or a wound or anie other manner of griefe and doth not know the nature of the parts neither yet what part it is in neither yet the cause neither how to remooue the same cause it is vnpossible as I haue sayde before that he shoulde cure the same griefes or diseases rightlie And therefore these blinde emperikes that haue neither reason nor method to leade them to doe those things which they dailie doe I saie their dooings are so pernitious that many people taketh great hurt thereby shall I saie hurte nay rather brought to vtter destruction and many times to death The Symptoma or accidents which followeth sicknesse is also diuided into thrée partes The first is the qualitie being altered as with vehement heate in Phlegmon The action or function hurt but not vtterlie depriued The action vtterlie depriued and taken awaie For these causes aboue rehearsed it is speciallie required that a Chirurgion shoulde be learned and also to haue greate experience that hée maye rightlie iudge and discerne one disease from another with their natures and causes to the end that when you come to the curation thereof you may take right indications what to do first what next and so foorth to the end for other waies you may applie medicines nothing fit for the purpose but those that might doe great harme and you might also applie those first that would be applied last and those last which should be applyed first and in the end marre all your workes as the blinde Carpenter doth Thus farre I haue proued for Phisiologia to be one part of Chyrurgerie or of the Art of curing as we may tearme it and I thinke there is no man that will count him to be a right Chyrurgion that lacketh this part of the Arte or that is not verie expert in the same And for the further knowledge héereof there be certaine bookes appointed of Galen and other auncient writers that you may reade concerning the same part as hereafter followeth Libro Hippocrates de Morbis libro Epedimsorum Hippocrates Galen de locis affectis Galen de Morbis Symptomatis de 4. temporibus morborum Galen de differentijs morborum causis Smptomatis Galen de inequali intemperie Galen de arte Medica Galen de tumoribus praeter naturam Hippocrates de Vulneribus vlceribus Fistulis fracturis immorodibus c. And also
be these Dogmatists which are not able by reason to vnderstand the naturall principles of bodies but of these Thessalions voide of method what doest thou yet speake Therefore those which cure by right method doe finde apt remedies for euerie kinde of vlcers as also conuenient diet they do most apparantlie declare by the things it self how much it profiteth and how great light it doth bring to the arte of curing the Treatise of nature it selfe declareth for I haue not once declared vnto you how that sometime they which goe from one medicine to another doe let slip and neglect that which is profitable and that with some one of their remedies which they haue vsed the same vlcers haue béene cured therefore they haue worthilie despised the facultie of such remedies which because of the vntimelie vse they haue séene not onelie the profite but much for to hurt and that in the first vse it hath done no euident thing Furthermore thou hast séene no lesse the grieuous pains of the eies to be healed either with bath either with drinking of wine either with foments either with letting of bloud eyther with purging vnto which these common sort of Phisitions haue applied no other thing than these medicines which are made of Opium and Mandrake and Henbane bringing great daunger vnto the eies inasmuch as they taking no other thing awaie for the present but the paines it selfe these doe kill the sence as thou hast knowen many by the vse of these medicines when they haue bene too much applied neuer after to haue come to their naturall state and that first their eyes were dim and they haue hardly séene after to be vexed with suffusion which is called Hipochysis or with too greate dilatation of the ball of the Eie named Mydriasis or with Tabes or Corrugation called Rhetiosm Thou hast knowen also being with me from sixtéene yéeres of age neuer to haue seene vnder anie maister this worke but to haue excogitated it by reason and how long time I did consider that Aphorisme of vnalayde wine or bath or foment or letting bloud or purging taketh away the paines of the eyes And what trust I had by the rest of Hippocrates laborers that there was nothing in this Aphorisme either false or might not be brought to passe that was it which stirred mée to search vntill going Hippocrates way I found by what meanes I should discerne when and how euery of the forenamed should be vsed By which reason I made manifest to many which haue séene the like things of how great force the medicinall methode is and how great occasion of euill they are which haue not obserued the olde arte of Phisicke haue builded new sectes and now truely although from the beginning I haue refused it yet by entreating you haue compelled mée to take al this whole worke in hand which I pray the gods may be profitable by others truely I haue small hope aswell for the contempt of good letters which now do raigne as also for the admiration of riches estimation and ciuill power vnto which whosoeuer doe turne himselfe is not able to finde the truth in any thing But these things shall be determined as pleaseth the gods and we now for our power shal restore the Methode of curing which was found of the auncient Phisitians being now neglected repeting againe the disputation which we haue begunne of the hollow vlcer and of the first inuention of those things which doth fill an vlcer with flesh let that suffise which hitherto we haue saide and let vs graunt if they will vnto the Empericks all that they say And for the vse of things foūd out I haue often shewed to thée in themselues and now nothing lesse I will go about to demonstrate by reason how these Empericks cannot by certaine reason go vnto another medicine whē they haue nothing profited with the first and that rightly chaunceth for when as they know not the cause of the vnhappie successe of the first medicine neither can declare the lyke in the second and when they are ignorant of the cause wherefore the first medicine doth not his affect neither are able to vnderstād why it taketh no place this thing truely being not knowen they cannot reasonably go to another when as they cannot in the same medicine perceiue the like cause The third Chapter NOw therfore let vs set out Hyppocrates waie and the true method of curing an hollow vlcer surelie it behoueth to begin thus that is of the substance of the thing therefore séeing that an hollow vlcer that is our scope that the flesh which is lost may be restored it is néedfull to knowe that the thing which engendereth flesh is good bloud nature as I may tearme it being the workman and author notwithstanding it is not sufficient to name simplie Nature vnlesse we consider also whose nature and where For it is manifest that Nature it selfe is the ingenderer of flesh of those bodies that be subiect whereas flesh is to be made and surelie it is declared that the nature of euerie bodie doeth consist of the temperament of hot cold moist and drie therefore it is manifest that the iust temperament of these in those parts whereas we shall restore the lost flesh is as it were the workman And first of all in euerie hollow vlcer these two things are to be considered whether the bodie being subiect be in iust temperature that is to saie whether it be according to nature For we haue declared that health of similer bodies is the iust temperature of the foure qualities and whether the bloud that floweth to the part be good or else but indifferent for if either of these doe offend there are trulie many affects against nature notwithstanding there is now put to vs but onlie the hollownesse in the fleshie parts Therefore let vs imagine the part to be sound and the bloud which floweth to the parte to be frée from fault either in qualitie or quantitie surelie these thinges béeing as is sayde there is no impediment but that flesh shall prosperouslie growe and that without the helpe of anie outwarde medicine for both causes which ingender flesh béeing present and nothing outwardlie hindering then it cannot bée but that flesh must bée ingendered But in the first engendering of flesh there must of force spring a double excrement as we haue shewed in our commentaries of Nature that there followeth euerie mutation of the qualitie of the nourishment an excrement grose and thicke and another thin And these excrementes chauncing euer through the whole bodie that which is thinner is inuisible by persperation notwithstanding it is forthwith visible as often as the naturall heate diminisheth or that hée vseth more large diet than is méete or that there happeneth to the creature more vehement motion The other excrement is the filth that is sent to the skin Furthermore in vlcers the thinner excrement is called Sanies in Gréeke Icor the groser is named Sordes and the
vlcer is made moist by the thinner excrement in like sort as by the groser it is made filthie and for that cause it néedeth two kind of medicines that is to saie exicatiues to expell or drie that which is moist and mundificatiues to purge the filth Now then séeing that nature ceaseth no time truelie there can be no time found in which both these excrements may not be gathered together in an hollow vlcer Wherefore there shall be no time in which thou shalt not vse both kindes of medicines that is to saie which shall exicate and mundifie And now we haue found out of what kinde the medicine ought to be but that is not sufficient for it is néedfull to inuent some perticular which is to be applied to the vlcer Now by what method and howe shall they be found out forsooth by the same which is set out in our bookes of the faculties of simple medicamentes for we haue shewed in them certaine medicines desiccatiue certaine humectiue certaine refrigeratiue and certaine to make hot yea and certaine by coniunction to make hot and drie or to refrigerate and moist or to heate and moist or to refrigerate and drie and that there is in euerie of them a difference more or lesse but in multitude infinite Notwithstanding they be contained within limites to their vse which doe easilie comprehend them in the first order or degrée or second or third or fourth now of what degrée shall that medicine be which is méete to engēder flesh which must both moderately dry and also mundifie truely of the first degrée for that medicine which surmounteth this degrée doth not onely cōsume the aboūdaunce of the humor flowing to the part but doth also deuoure the bloud flowing letting the part to be restored cōsuming the flesh or the matter wherof the flesh groweth surely it is declared that such be Olibanum and the meale of barly beanes Eruum and Iris and Aristolochia and Cadmia and Panax Pomphilix and we haue shewed that all these differ among themselues more or lesse and that some of them abound onely in simple qualities and other some in compound For Aristolochia and Panax doe drye more than the rest and also by nature are more hot barley and bean flower doth much lesse drye than these and haue no heate at all Olibanum doth moderately heate but doth lesse dry thā these in so much as in certaine bodies it dryeth not at all The meale of Eruum and Iris and Aristolochia and Panax are in a meane But now let vs repeate againe that wée haue profitably touched Olibanum in bodies of moist nature is able to engender flesh but in dry natures he cannot for it is néedefull to consider that there is a two folde difference of the first indicatiōs that which is according to nature shewing the cōseruation of it selfe further doth also require things lyke to it selfe and that which is against nature declaring the taking away of it selfe and also requiring things contrary for euery thing perisheth or is ouercome of his contrary and in his contrary And truely the Vlcer how much it is to moist doth so much the more require medicines which doth drye But the nature of the bodie how much it is more moist so much the lesse it requireth a medicine which doth excicate wherefore if there be any vlcers in which there is like humiditie because they are in a bodie of dryer tēperament truely it is requisite the more to be excicate that which is in a moister temperature doeth so much lesse néede drye medicines as there is difference betwéene nature and nature For it behoueth the flesh that is engendred to be like that which was there before Therefore whereas the flesh is dryer than in times past it is conuenient that the new be made dryer so that it ought to be the more largely to be dryed how much the more it shall be drye so much the more shall the medicine which shal be applyed haue a dissicatiue vertue but in a moist nature there is so much lesse néede of a medicine dissicatiue how much the flesh is lesse drye Therefore like as Olibanum hath such temperament cōcerning the nature of mans bodie that is agréeable to a temperate meane nature but it doth somewhat more largely drye These that be moyster in like sort as it is to moist for them that be most drye so that of right Olibanum maketh mattier both in certaine Vlcers and also natures doth not engender flesh and in certaine it doth engender flesh Therefore if thou dost marke thou shalt finde the successe aunswerable vnto reason for in a moister nature it may engēder flesh in a dryer it cānot Doest thou not therfore perceiue of how many Theoremes or intencions of curing he hath néede that will cure an vlcer by a right Methode for after that it is found out that the fault is in moisture altogither it sheweth foorthwith that ther must be prepared a dissicatiue medicine but for that there are of drying medicines some that dryeth more and some lesse that which is expedient must be taken partly of the diuersitie of the vlcers partly of the nature of the sicke Therefore he that will rightly cure an vlcer must not onely cōsider the nature of the body but also to haue learned all the speculation of medicines diligently and also to know the signes of bodies which are of dry or moist temperament Now therefore consider what great rashnesse is of pronouncing these Methodicians which think that they haue done sufficiently to the curing of an hollow Vlcer if they vnderstād that it must be filled with flesh Truely the way of curing cōsisteth not in this but in finding that out which shall fill it with flesh but that shal fill with flesh quod he is alreadie founde by experience then confesse that which shall cure to be founde out by experience neither doe they vainely boast neither extoll the Methode although experience is cōdemned yea of the Empericks themselues which is without certaine limitation for they write in their commentaries of medicines in this manner An Emplaister for those that haue soft bodies and for children and women they know how that Olibanum in such natures can engender flesh and fill hollow Vlcers so that there be no other accidence notwithstanding where such bodies are moist and because of their moystnesse require moderate drying Medicines or that there is some other cause of the successe they cannot tell Againe they shall finde an other medicine written for olde folkes and another against those Vlcers which will hardly be brought to a cicatrice and hath the sides swollen called in Gréeke Oxthothe and they write in all their cōmentaries curatiue many other seperatiues for which as néere as we can inuent a conuenient medicine to the propertie of curing nature for seperations in euerie Arte go about to deuide that which is proper from that which is common and how much any doth diuide
vntemperature of the flesh being subiect The second by the vice ill qualitie of the bloud comming to it The third of a great measure and quantitie of the said bloud Ought not the diuision to be made thus or otherwise That is to saie the cause wherefore some vlcers are stubburne and difficill to be healed is for the mistemperance of the flesh exulcerate or else for the gathering of humors vnto the vlcerate part Yet againe the mistemperate flesh ought to be diuided into two differences The first is when the flesh being subiect is out of his nature onelie in qualitie The second is whē with the euill qualitie it hath tumor against nature The flowing of humours is diuided into two differences that is to saie into the qualitie and quantitie of humours Sometime diuerse of the said dispositions are mixed together and sometime all But the methode for to cure them ought not to bée giuen all together but each one by himselfe The second Chapter AND if the distemperance of the flesh bée drie moderate it with bathing and wetting in temperate water But at all times that this remedie shall be vsed the end of the bathing and wetting shall be till the particle come ruddie and rise in a lumpe Then cease the bathing and moisting for if you bath it anie more you shall close the humour againe that was loosed and so you shall profit nothing Likewise the moistning facultie of medicines ought to be greater than is accustomed in a whole part If the flesh be more moist than naturall habitude you must haue regard to the contrarie for the facultie of medicines in the case ought to be desiccatiue and to vse no water But if thou must wash the vlcer take wine or Posca that is to saie Oxicratum or the decoction of some sharpe hearbe Likewise you shall coole the pride of the flesh that is too hot and heat that which is too cold you shall know such intemperatures partlie by the coulour and partlie by féeling of the diseased patient For sometimes they confesse they feele great heate in the particle sometime manifold coldnesse and so delight themselues in hot or colde medicines And sometime appeareth rednesse and somtime whitenesse But to distinguish these thinges it is not the duetie of this our proponed worke in the which worke we shew not the method to know the affectes but to cure them in such wise that by consequence of words we bée come vnto the said methode to knowe the affects Againe let vs returne to our purpose If anie parts are vlcerate with tumour against nature first the tumour must be cured What ought to be the curation of all tumours we shall saie héereafter Presentlie we shall intreate of that which is ioyned vnto vnkind vlcers But when the lips of the vlcers are discoloured and somewhat hard they must be cut vnto the whole flesh But if such affect is like to procéed further deliberation must be had least that which doth séeme to be repugnant vnto nature shall be cut out or in longer space to be cured without doubt in such a case it is good to know the patients mind For some had rather to be long in curing than to suffer incision and other are readie to endure all thinges so that they may the sooner be made whole Likewise héere shal be spoken of the ill iuyce which floweth to the exulcerate part and in as much as it is a malignant and a wicked humor it shall be spoken of héereafter in his owne place When as therefore the humour which floweth to the vlcerate parts is not farre of nor doth abound in qualitie or quantitie it shall be then conuenient to direct it and to restraine the fluxe which commeth vnto it and also to coole the heate of the parts that be néere the vlcer Furthermore you must behold the ligature or rolling at the vlcer and leading it to the whole part as Hyppocrates commandeth in the fractured bones Also that the medicines that are ministred to the sayd vlcers must be more stronger than they that are applied to a simple vlcer And if the fluxe of humours wil not staie with conuenient medicines then you must séeke further the cause of the said fluxe and take it awaie If the fluxe come by weaknesse of the member that receiueth it the sayd weaknesse must be cured And such curations also shal be proper for the vlcerate part But if the cause of the fluxe be through the abundaunce of the bloud or of the ill disposition of all the bodie or of anie of the superiour parts you must first take awaie the said causes The weaknesse of the part forth of which abundance of iuyce doth flow cōmeth whole of the intemperancie not altogether Wherof it followeth that the vlcerate flesh is only intemperate and not weake and féeble sometime it chanceth both the one the other For the great intemperancie is the cause of the imbecilitie of the affected part the which intemperancie is cured as is aforesaid in refrigerating the heate humecting the dry warming the cold desiccating the moist And if the place be too colde moist together the medicines must be in warming drying together so of the other intemperances in putting away euery qualitie the surmounteth by his contrarie The reason is Euerie thing the behaueth it selfe wel is according to nature not only in liuing things but in plāts also in al other things ther is an equality which the Gréeks cal Simmetron without excesse of al vicious humors For the thing where nothing can be taken fro or put to neither anie part or anie qualitie it is all perfect in one equalitie contrariwise the thing that must haue taken fro it or else somewhat added to it is not in a naturall perfect estate Wherefore it is not possible to cure rightlie but in taking awaie that which is excesse putting to it the which lacketh In another place we must speake of the ouermuch or lacke of things but when anie qualitie is ouer much it is necessarie that the other qualitie contrarie to him ouercome him againe and the corruption of humors or intemperancie bée remoued in restoring the said qualitie that wanted for in cooling that which was too hot thou shalt restore that which lacketh diminish that which was too much abundant Thus it is necessarie that the curation of the things that are put farre from their naturall habitation by some intemperancie be made perfect againe by thinges of contrarie vertue And thus the flesh or anie part thereof wherein is fluxe of humours because of weaknesse ought to be made in this manner as is sayd before and when the intemperancie is cured then procéede to the cure of the vlcer first curing the intemperancie as if it had come without the vlcer By the which thing it is manifest that all such curation is not proper to the vlcer but to the intemperancie Likewise if anie fluxe of humours
many wayes friuolous and foolish For our bodies doe not consist of little bodies called Atomes and of little passages or pores but if this were true it should not be possible to shewe in what maner musterd might change or alter the state of the same pores if any of them should shew the truth yet we would not agrée vnto their sect because they promisse that they wil be content with their apparent communities therefore lette them not vse these names neither let them hinder vs no more in our matters For it is lawfull without the name Metasincrisis to say in other wordes the curation of inueterate vlcers as the Emperickes doe Also we haue declared in the second booke how they talke of this woord Atonias that is to say imbecilitie yet know not what it meaneth For if they vse this name as the Emperickes do then it should signifie nothing else but that the actions are not kept for if they say that certaine faculties doe gouerne liuing creatures which we all the auncient writers doe affirme but yet notwithstāding they repugne against the precepts of Asclepiades also they propound vncertaine things to the which the authors doe not agrée they touch the truth a little yet they commaund to eschew it But tell me true Thessalus what meaneth this worde Metasincrisis if thou saie that it betokeneth to change the pores thou art deceiued and supposest vncertaine thinges But if thou saist that it is a great matter to cure the particle grieued of the bodie as the man thou saist no more thā the Emperikes except the name For they doe knowe that men are made whole by medicines but they know not the cause or reason by what meanes the remedies restoreth health For none of the Emperikes can tell if the facultie of the medicaments chaungeth the pores or if it maketh a Simitrie or if it altereth the qualitie of the Patients particle that is grieued Howbeit the Emperikes are discréete men if they saie that they know onelie one thing that is to saie if they haue noted and obserued the times how vtilitie hath followed when the medicament of mustard hath ben ministred to such vlcers and in what time Neuerthelesse they speake not of method neither yet repugne against it neither be displeased with the notise thereof nor dispraise the ancient writers neither Hyppocrates but rather praise him and affirme that he hath said all thinges well But Thessalus doth not onlie despise Hyppocrates but all the other auncient Phisitions neither doth he vnderstand that he hath written all the precepts of rebellious vlcers without reason emperiklie For if he had written them well then it should haue bene counted a worke most profitable But it appeareth not that he hath done so séeing that he peruerteth the right order of remedies and vseth his remedies to the grieued part before he hath prepared the bodie For this is an argument of great ignorance séeing that almost it is a principle in Chirurgerie that all the bodie must be purged of the euill excrementes before anie strong medicine be applyed vnto the affected parte For who is he that will iudge either by reason or experience for there is no other third thing to iudge by in what art so euer it be nor in anie part of life he shal finde that it is agréeable to reason for a man to minister strong hot medicines to anie particle of the bodie before he hath purged the bodie of all anoiance prepared the same to health for the said medicine draweth the excrements and superfluities from all the bodie like as boxing or Ventosis doth it doth so fasten to the affected part that it may be scarcelie remoued Therefore it must be asked of these Thessalions frō whence this opinion cōmeth to Thessalus to write fables as cōcerning the curatiō of rebellious vlcers séeing that none of the Emperiks nor yet Rationals haue written so before this time For neither Thessalus himselfe neither anie other of his sect dare affirme that the order of such remedies either doth agrée with experience or reason For neither can they giue Indication of time neither yet of the affect of the disease Yet for all that Thessalus is not all together ignorant because he iudgeth that the cause the hindereth the ciccatrise must be considered and taken awaie because also that he iudgeth that this must be done not onelie in vlcers but also in all other diseases as the ancient writers do admonish But they answere nothing to the purpose for they saie alwaies that we do not vnderstand them as if they knew perfectly the thought of Hyppocrates and of all the ancients And they affirme the Thessalus hath a good opinion when he saith that there is a communitie of inueterate vlcers that Hyppocrates vnderstood it so in his booke of Vlcers which writeth in this maner It is profitable that the bloud doe flowe continually from the inueterate vlcer when so euer it séemeth néedfull It were not farre from my purpose if I should speak of the iudgement and opinion of Hyppocrates though I haue not promised that I would so do in this place But that which I will saie shall be of the interpretation of the wit knowledge of the auncient Phisitions the which truelie as yet haue giuen no sect but studying with simple pure minde to inuent some thing profitable to mans health It is well perceiued therfore that they haue found some thing by reason and some thing by vse and experience Then dyd they write their inuentions many times without giuing reason thereto and sometime they did and if they did giue anie reason it was to profit the readers For if they intended to be profitable to their successors and when as they knew reason of inuēting things then diligentlie they set it forth and where they thought it obscure they thought it superfluous to rehearse and therefore let it passe Now it is well knowen vnto all men though I hold my peace that the ancients haue loued no verbositie For that cause afore recited not only Hippocrates but also all the other ancient Phisitions sometime not making mention of the middlemost speaketh of the third thing For if the first be a signe of the second the third of necessitie must followe after the second And thus oftentimes omitting the first and second they spake of the third I haue oftentimes declared how the ancients and chieflie Hyppocrates haue written after this manner But he that will know and perfectlie vnderstand the maner of curing ought to be exercised in their stile and manner of interpreting For this I will intreate of that which I haue purposed The fift Chapter FOr those Vlcers which after medicines to them ministred be not cured those the Phisitions cal in Gréeke Cachoethae but we cal them maligne and rebellious to cure But we haue spoken in the booke aforesaid what the curation of vlcers is Therefore in these kindes of vlcers that be
manifestly that they haue no regarde of other things that appeare in the affected part for to come to such euacuation But I doe not say thus that purgation is euacuation the which is no indication of the course of the bloud but for bicause wée must sometime haue consideration to the letting forth of bloud although there be no course of bloud present which may flow to the greued part for when the disease is very strong there is none which vnderstandeth the arte of medicine but will let bloud And truely the Emperickes themselues let bloud when any is fallen from an high place or when there is any part sore brused hurt with any wound though the pacient were whole and sound before and without superfluitie of bloud By the which it appeareth that it is not the flowing of the bloud to the affected parte which giueth indication but the magnitude and vehemēcie of the disease the force of the strēgthes excepting yet from our talke children As for example If a man be whole and sound and without any maner of hurt and hauing abundance of bloud it is not necessarie because of his abundance to take his bloud from him For there is no indication to be taken of the bloud for because the man is whole for to such men fasting doth profit small eating and sometime Purgation or bathing and Frications may suffise Letting of bloud is not necessary to such as the Emperickes say Likewise Purgation is not good in the onely abundāce of humours for euen as letting of bloud is done either for abundance of bloud or for the magnitude of the disease so is purgation giuen either for the abundaunce of ill humours or for the force of the disease As touching letting of bloud we haue spoken of in another booke and shall doe againe hereafter But in this present booke I will speake of purgatiōs for they that be diseased require them not onely because it doth euacuate the noysome and superfluous humours with the which the bodie is grieued but also putteth foorth and clenseth the excrements within the bodie And for this cause Hyppocates as well in his other works as in that he hath written of Vlcers considereth the vehemencie and strength of the disease whereof he taketh Indication of purging and sayth thus Purgations of the bellie is profitable to many Vlcers and also to woundes of the head of the bellie and of the ioynts and where there is daunger of the rottennesse of the bones or where stitching behoueth in woundes or where erosions bée or where Herpis other affects be which hindereth the curation of Vlcers and also where rolling must be vsed By these words it is apparant truelie that Purgations are profitable both to wounds and Vlcers at all times when they be great and grieuous For not onelie the sayd affects but other bée made great and grieuous thrée manner of waies that is either through the excellencie of the afflicted part either else through the greatnesse of the affect or else because the said affects are Cacoethae that is to saie hard to be cured Hyppocrates hath made mention of all these thinges perticularlie when he dyd intreate of woundes of the head and bellie and of the excellencie and dignitie of hurt parts I thinke it is manifest to all men that he must bée vnderstoode not onelie the lower bellie but also the superiour for in diuiding the Trunke of mannes bodie which is betwixt the necke and the legges is two greate capacities The first is contained vnder the Thorax and aboue Diaphragma and the second vnder Diaphragma vnto Os Pubi or to Peritoneum which couereth the inwarde parte of the bellie And for certaine those woundes which hath pearced within the Thorax or within Peritoneum is verie dangerous chiefelie if anie of the inward parts bée wounded Likewise there are verie fewe but they doe know that the woundes of the ioyntes are Cachoethae and are harde to bée cured Which thinges the Emperikes vnderstand onelie by experience and they that haue studied and haue attained to the knowledge of mannes bodie vnderstand these thinges by the nature of the hurt parte For in tendonie and sinnowie parts where bones are void of flesh there is great daunger of paine waking and priuation of rest and also of conuulsion Such woundes as these be and such as be stitched that is to saie those that are so great that they néed stitching or at the lest of binding or rolling requireth purgation We haue declared in the last booke that all the greater wounds ought to be ioyned together either by stitching or by binding Likewise the vlcers where there is daunger of corruptiō of the bones are oftentimes ioyned with great inflamations Also they that procéede of ill humours bée Cachoethae and with erosion Also Herpetes come of cholerike humours and all other olde vlcers come of such like cause Wherefore in all the vlcers before especified Hyppocrates commandeth to purge by the bellie and afterward he addeth these wordes In all vlcers whereto Erisipel as is come the bodie must be purged in that part most profitable for the vlcer so that the purgation be made either by the vpper partes or else by the lower which difference hée hath set forth in the booke of Humours where he commandeth to tourne awaie the humour to the contrarie parte As for example There is a great flux that commeth to one part of the bodie where there is an vlcer it behoueth to make another in the contrarie parts and thereof he speaketh in the said booke Wherefore if there be as yet a great fluxe which dooth runue to the sore part we shall make reuulsion to the contrarie part that is to saie if the vlcer be in the vpper parts by purging downward and if it be in the neather partes by purging the vpper ventricle But if the fluxe bée newe stopped in such sorte that is fixed in the member it is expedient to driue it out by the next partes séeing that the passages be the next places séeing that the accesse and attraction of purging medicines is more easie and prompt to remoue those things that be néere rather than those thinges that be farre of the which reason belongeth to another part of the art which entreateth of purging medicines therfore hereafter it shall be declared and made perfect Now I will shew the force or if you will call it the magnitude of the disease to be appointed for a certaine indication of taking away bloud or giuing purgation And also that Hippocrates was the first inuenter of the sayd indication I will speake in the bookes following of diseases and in this booke I will speake of vlcers I haue alreadie spoken of Purgations For séeing that euery disease is greuous thrée maner of wayes it is either for the excellencie and noblenesse of the part or for the magnitude of the affect or for the frowardnesse of the same affect called in Gréeke Cacoethia Hippocrates hath made
not hurtfull as Aerugo aes Vstum aeris Squāma Cadmia Pomphilix Litarge Cerussa Yet they ought not to be ministred to the vlcers of the inward parts of whose nature we haue written in the booke of temperaments and in the booke of simple medicines But if we go about to glutinate the vlcer and bring it to a ciccatrise we must choose glutinatiue medicines such as will not cause erosion But if we will clense the vlcer we must vse things abstersiue and such as wil absterge it moderately as raw Honey which of al things for this purpose is the chiefest But as touching adstingent potions called Austerae and other such like alimentes they be knowen vnto all men This woord Auster is called Stiphos in Gréeke that is to say little astringent and that which is lower or bitter is called in Gréeke Striphnon But the medicines which may be taken without danger are spoken of in the booke of Medicaments Neuerthelesse I wil shew some forme of wholsome Medicaments for the inward vlcers which are these namelie Hipocystis Balaustium Cytini Punicorum Galla Malicorium Terra Samia Lemnium Sigillum Rosarum Succus Acacia other or like kinde which be profitable for inward vlcers and you must minister the said medicaments with some decoction of adstringent things as of Quinces Lentiske or the tops of Rubus or of Vines or gréene mirtills or with adstringent Wine It is now manifest and I thinke none is so ignorant but will iudge that hée must eschue drinking of wine if there be Phlegmon or else there is no daunger In like maner it is euident that the said Medicaments must be prepared receiued with decoction of moist things Also you must mixe gumme Tragacanthen in those medicines which are for the vlcers in Gula you must vse Gargarises in the Vlcers that are in the partes called Fauces and Paristhmia but if the vlcer bée in Aspera Arteria called Trachia then the Patient must be layed vpright and kéepe the medicine long time in his mouth in loosing all the muscles that be in that place for in so dooing some part of medicament will flow by little and little to the grieued parte For when the sayde Aspera Arteria is in his naturall state or in good health then we may easilie know when anie potion passeth through it For like as we must take heede when as it is in good health least anie fluxe fall that waie which maye hurt it so in like manner we must beware when it is grieued least anie thing doe fall that waie which may prouoke the cough then it séemeth that the Indications of it are taken of the scituation and forme of the part Also Honie must be mingled in all Medicaments which are ordained for the Vlcer in the Thorax and Lungs Therefore if we vse astringent medicines they will remaine in the bellie Then the instrument which is profitable for the digestion and distribution of the said medicamēts ouer all the bodie shal be honie Also it being mingled with the said medicines shall be occasion of their quicke passage ouer the bodie neither shall it anie thing anoie or hurt the vlcer In like manner if there be an vlcer in the bladder in the raines honie and such as prouoketh vrine must bée mingled with the said medicines But I thinke that it is apparant to all men though they take not me the author of the same how that the vlcerate partes may be discerned or knowen by their substance action vtilitie scituation and figure The which things trulie haue ben amplie declared in the booke which entreateth of the signes of the affected parts but now there is no time to talke of them therefore I will returne to the method of curation Also I saie and affirme that not onelie these aboue rehearsed but also many other be the indications of the figure and scituation of the partes For you cannot well and exactlie binde the affected part before ye take indication either of the figure or scituation or of them both Neither can you set the pipe of a clister well before ye take such Indication What should I make mention of Argalia speciallie when as you cannot minister it before you perfectlie knowe the scituation and figure of the bladder Then trulie by these things it dooth manifestlie appeare that the affected part giueth indication to the curation But in ruptures truelie which the Gréekes call Regmata many Indications may be taken to one purpose and principallie the indication that is taken of the scituation ought to be considered For the ruptions that be hid in the deapth of the bodie require other curations than the woundes which appeare outwardlie and for because they be such as be with Ecchimosis or contusion about the broken flesh therefore they declare diuerse Indications curatiue For alwaies the Indications curatiue do answere to the number of the affects wherof we wil shew more copiouslie heereafter when we shall speake of Phlegmon how that the affects that are in the déepe places of the bodie requireth stronger medicines than those in the vpper parts Then at the least I iudge it to be manifest that it is necessarie that the strength of the medicamentes that are ministred outwardlie ought to be resolued when the affected part which should be cured by those is hid in the deapth and profunditie of the bodie Therefore it behoueth to augment the vertue of the same medicaments so that by the passage thereof it may be staked Certainlie Ecchimosis doth indicate euacuation for the remedie of the cure Wherefore medicamentes that will moderatlie heate and drie be most conuenient for it For they that do vehementlie drie trulie do resolue and digest more at the beginning than they which drie but simplie But I will speake héereafter somewhat of this disease which is difficill and serious to cure But of that which did pertaine to the matter wee haue largelie spoken of Truelie those medicamentes that moisteth and heateth more than they which the Gréekes call Calasticke Also those which doe somewhat to drinesse which the Gréekes call Suntatica be the chiefe and principall remedies for all Ecchimosis But we must take héede the medicines do cleaue to the ruptions that are in the deepnesse of the bodie and also that they be of strong vertue that they be sharpe and such as will digest and to speake brieflie such medicines ought to be of great force inasmuch as Ecchimosis is in the déepnesse of the bodie and far from the skin In such affects the vse of a cucurbite is profitable which is an instrument inuented of Phisitions to cause vlcerate attraction And when Ecchimosis is digested by the vse of a cucurbit then you may minister those things which may drie the broken flesh and conioyne it with ligature adde that which may coagulate and ioyne the wounde together for Ecchimosis being resolued and digested the broken flesh shall coagulate together But if it be resolued then
corruption bréedeth in it and occupieth the space that is betwéene the lippes of the wounde so that the ruption cannot close Wherefore these aboue rehearsed declare vnto vs all causes howe small so euer they bée For although some hath had rigour or though the bodie hath béene ouerthrowen by some Feauer so that there bath not bene good concoction or that it hath béene defatigated and wearied then immediatlie there shall bée paine in the part where the ruption and wound is because that the said ruption hath bene latelie ioyned together but not so substantiallie because of time Wherfore it followeth that a little thing may easilie part them fil the place againe with superfluous humours But what engendereth in such wounds or ruptions nothing but new Ecchimosis and much like vnto the first That is to saie when the flesh was first broken except that this Ecchimosis that is new of more and corrupter mattier than that which was at the beginning which came of bloud and therefore now this is more easilie digested and resolued than that which was at the beginning And thus the which we haue spoken hetherto shall suffice for the disputation of Vlcers thus we conclude this fourth Booke of our Therapeutike methode called Methodus Medendi FINIS THE FIFT BOOKE of Galen called in Greeke 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and in Latine Methodus Medendi The effect of the same 1 The curation of vlcers which chaunce in the fleshie partes and then the curation of Vlcers in the Instrumentall partes 2 Of the ruption of a veine or Arterie 3 How a fluxe of bloud may staie by deriuation 4 The Medicaments that wil make a crust which doth much to the stopping of a flux of bloud 5 Of spitting and distillation of bloud 6 The curation of Vlcers in the pudend places 7 The curation of a veine or diuided Arterie 8 The reiecting of bloud both from other parts also from the lungs The first Chapter SEeing that in the two last bookes we haue taught how anie shall rightlie cure Vlcers we will by the waie shew that all other Phisitions which vse the arte not searching out the Elementes of those simple particulars in vs cannot cure anie thing onelie by reason but yet least of all other those which professe Thessalus doctrine The rest which are by méere experience onelie taught suppose that at the least those Vlcers which are in diuerse partes are to bée cured by diuerse reasons But those that followe Thessalus as their Captaine for his excellent wisedome thinke that euerie Vlcer in what parte of the bodie so euer it bée requireth like curation for if it bée hollowe they saie it must bée filled with flesh if it bée equall then to bée ciccatrized if there bée supercrescent flesh then that flesh must bée diminished if it bée bloudie and new then it must bée adglutinated As though he that knew this must of force cure rightlie or that this reason were vnknowen to the common people when as there is none that is héerein ignoraunt But they vnderstand not howe the hollownesse is to bée filled with flesh neither howe that which is filled ought to bée ciccatrized or to take awaie that is ouermuch encreased or to ioyne together that which is pure and bloudie without hollownesse such workes trulie are properlie appertaining to the art of Medicine found out by the helpe either of Reason or Experience or both Therefore repeating againe let vs briefelie ouer-runne those things wherby the beginning of these which are to be spoken may be ioyned with the aid of those which we haue alreadie set out Wée haue declared that euerie Vlcer requireth desiccatiue medicines but that which hath hollownesse beside that it needeth desiccatiues it also doeth require abstersiues that which requireth to haue the lippes ioyned together such is a gréene wound called in Gréeke Enema doth aske both more drying medicines and also that be gentle astringent without anie abstersion Furthermore those vlcers which néede to bée ciccatrized require not onelie yet more drying medicines but also strong astringent remedies and whereas there is supercrescent flesh against nature there are required sharpe and abating medicines such of necessitie bée hot and drie If anie accident bée ioyned with the Vlcer the Indication of curation must bée taken of the nature thereof and of this all the faculties of medicines also to bée had If there should superfluous mattier growe in the Vlcer it behooueth to haue medicines which should take it awaie and such haue a greate deale more abstersiue vertue than some incarnatiue medicines haue Also if there bée séene more copious moisture there is néede of a medicine more desiccatiue but yet not to exceede his kinde and if the medicine shoulde be glutinatiue it ought to bée drying and astringent if it shall incarnate it must be desiccatiue and some thing abstersiue and so in all other as is alreadie declared Also if the flesh subiect should be intemperate first truelie we must cure this intemperatnesse that which is drier by medicines humectiue the moist by desiccatiues Also that which is hot by refrigeratiues the colde by medicines that are hot And if by coniunction of two qualities the flesh bée intemperate it must be cured by ministring a contrarie medicine which hath double qualities for this one thing is common to all affects against nature that they cannot come againe to their owne nature without such medicines as haue contrarie qualitie Furthermore at this time the causes of these intemperatiues are to be considered whether these be common to all the whole bodie or else proper of some partes which should infest the vlcerate member by societie the Gréekes call it Simpathia First of all trulie the cause that nourisheth this intemperatnesse is to be cured and after that the intemperatnesse it selfe which is now made for this indication is common to all such as spring of anie cause We haue also declared that there are diuerse indications taken of the differences of vlcers and also those which are taken of the temparament of the sicke bodie haue a contrarie reason for those Indications séeing they are taken of those things which are against nature declare that all contrarie things must be applied these Indications because they are taken of natures selfe shew that like things must be vsed for if how much the part is drier so much the more it requireth to be dried that which is lesse drie is lesse to bée dried In like sort trulie it is declared in making hot or colde Neither haue we let passe that of the excellencie of the member or contrarie state Also to the sharpnesse or dulnesse of féeling there is to bée had a contrarie scope of curing The second Chapter THerefore we will now consider that which remaineth of the curation of this kinde of infirmities we call this kinde for more euident doctrines sake solution of vnitie neither is it anie matter if thou call it solution of continuitie This kinde doth not onelie
Furthermore Callus in Gréeke or Poron shal so luckely follow when it behoueth to the generation of it as it is afore declared some of the proper norishment of the bone to be gathered together and grow Therefore this is now to be cōsumed away from the lips of the fracture or else to be euapored for else truely it shall make solution of continuitie neither shalt thou let it slip so long time that thou knowest not how the fracture goeth forward for we haue often séene that when the bones were vehemently dryed Callus hardly dyd grow Wherefore it is méete to poure vpon these a little warme water the third or fourth daye leauing when as the flesh riseth in a red tumor and wée must leaue herein before it beginneth to asswage Contrarywise when as we will digest any thing we shall not leaue of before all the tumor be vanished which sprong of the perfusion and whereas the aboundant moisture is and let that Callus doth not better grow there we shall go about with cōuenient ligature to exicate as is before saide and with perfusion of water which must be altogether little or much for it shal be but little when it ceaseth and before any thing floweth to it the humors which be about be digested and doth dissolue those which are déepe fixed For it is expedient so to lose dissolue these which are to be expelled by rolling for a great deale of water doth more digest than attract Surely it is euident that in that ligature which doth expell the endes of the rolles are lesse to be coarcted but wheras we must nourish there the endes must be straiter and the other inuoluings more lose Now séeing we haue founde out not onely what time we must helpe the generation of Callus but also by what maner now there resteth to set out the vniuersall order of diet For in the beginning they ought to vse most thinne dyet as we will proue when we take in hand the proper curation of inflammations Furthermore we will declare that sometime it shal be expedient to let bloud and also to purge but what time Callus is ingendred the bodie is to be nourished with good iuyse which may much nourish of which there accustometh to follow not onely good iuise but that which is also tough of which principally Callus is made for séeing that it cannot grow of a serous and thin moisture that it can spedely grow of that which is grose and brickle and voide of fatnesse but yet in time waxeth drye it is made friable and apt to breake The bignesse of Callus shal be such as it were a safe band to the bones yet not compresse the muscles for that Callus which is to little is not sufficiēt for the bones that which is to great bringeth dolor to the muscles so that diligent hede must be had to encrease it if it groweth to little and to let it if that it doth increse to much And thou shalt doe these both by the quantitie of the perfusion and also qualitie and quantitie of meates and also the faculties of medicines which are to it outwardly applyed but we haue before spoken of perfusion and order of dyet of medicines and such as haue an emplastike substāce do moderately heat they doe both bring forth Callus and also increaseth them But such medicines as haue a digestiue facultie doe deminish those Callus which are now great but if thou studiest that neither Callus shal be encreased or deminished but art content to let it grow further vse thou some of those medicines which are applyed to gréene wounds which because they doe moderately drye they cause Callus moderately to coagulate and grow and this is sufficient touching ouerthwart fractures Now of those that are in length the cure is in all points as the other but yet the ligature must be straiter made in the fractured place and that which is a sunder must be inwardly thrust to those which are diuersely fractured and chiefely with a wound as it doth cōmonly happen to these Hippocrates willeth that splents bowed like a sawe and dipped in redde and auster wine chiefely in sommer be put about it For if any doth vse either Oyle or Serot they doe putrifie because the affect being goeater than the rest doe more drye than they require to be dryed And let all the medicines as he commaundeth be drying but yet considering the meane of excication he willeth such medicines to be of the kinde of Enema But if any shall at the beginning vse an Enemon medicine let it be such a one as is apt to be poured in and all other thinges are to be done after his precepte not onely in these rehearsed but also if the bare bone requireth to be cut with a saw or that thou shalt take away some fragment or that it behoueth to minister to nature expelling it what so euer Hippocrates doubted of those instruments which the legges are to be layde in called Solenas whether they are to be vsed or not all men doe know that I iudge the reasons laudable and Glosconum which is inuented of the later Phisitions we doe account it as worthie of praise as anie other doe vse it when in the time of engendering flesh Yet it séemeth that Hyppocrates knew not that although otherwise he was not negligēt in excogitating instruments which should be profitable but the instruments in which the legs are placed was rightly deuised of them that by one axiltrée which was placed in the end of the instrument at the lower parte caused by a double extension a contrarie indeauour to the whole member the one of thē which extendeth the member right out is called in Gréeke Eutigporos the other which extendeth it first vpward afterward backward is called Translatiue in Greeke Metaleptice both are done by bands or cordes that band is most aptest to this vse that hath two ends for this being put about the member the armes being put about the axiltrée of it maketh the first extension called Eutigporos and when as the band is put about the parts of the broken member it maketh the translatiue extension called Metaleptice the armes of him being moued first vpward after backward for these are also to be put about the axiltrée Furthermore the armes with the bands being put about as it were bowed the extention which is made frō the higher parts to the lower ought to be done by the pulley or vice which are placed in the sides of Glottocomon thou maist call this instrument Solena with his adiection Solena Machanicum or Glottocomon Mechanicum but we shal more largelie speake of instruments whē we set out the cure of luxations where also we will no lesse speake of the varietie of ligatures which are to be put about Now séeing I haue made mention of Solena Mechanicū which doth much profit the leg but when it is reposed otherwise put or whē as the
manual tractation of fractures in Cranio called Chirurgia Now I will héereafter shew how much of that is to bée cut awaie that is affected that which is vehementlie fractured is to be all taken awaie and if certaine fragments come out further from it as sometime it is séene to happen it is not expedient to follow these to the end being assured that hurt or damage shall follow to them that haue it if all other thinges be rightlie done wée doing so not once or twice but often haue had our desire And the Indication of doing things is héere also taken of the nature of the affected partes for the ligature which in other fractures reason hath found out to kéepe backe inflammations thou canst not vse to the head Therfore thou canst not staie that which floweth neither expulse out of the affected partes that is in them contained without which remedies none of the other bones can bée conserued sound For imagine that in the arme the bone is broken vnto the marowe and that none afterward doe vind it as it becommeth a Fracture it must follow necessarilie that not onelie the matter which is gathered outwardlie vnder the skinne and muscles but also which is in the marow doth both first and principallie corrupt the marrowes it selfe also with it the whole bone Séeing that when all things are rightlie done this doth sometime chance How then may not such things happen to the head séeing that it cannot haue the ligature which is due to Fractures and also the matter sinketh downe in such sort as all lieth vpon the coate or pannicle in other Fractures when it is well rolled it is so farre that it suffereth no superfluous moisture to be gathered in the affected bone that it maketh the member leaner than for his naturall constitution The waie that is excogitated by ligature cannot both so exact the fractured bone the parts about it that they shall neither be inflamed or yéeld anie mattier neither is there anie medicine which in other partes can without ligature as we haue said kéepe the fractured bone drie frée from superfluities Wherefore we had néede first to make bare some part of the Fracture wherby we may mundifie wipe awaie the Sanies from the coate and when the time of inflammation is past and all is exactlie drie then to incarnate and ciccatrize the place Our talke is not héere naked voide of matter as the Sophists which knoweth not the workes of the art do demand why the fractures of the head hath no Callus they haue O good sirs a Callus and you be so mad that you do assigne causes of that which are not as though they were we in times past did sée the bone of the fore part of the head broken which next followeth this is called Os temporis in which it happeneth that the commissares are ioyned as it were like scales in it there was most long and manifest Fractures which I nothing touching but cutting out the bone of the fore parte of the head did cure the man that he now hath liued many yéeres but if I had in like sort let alone the bone of the fore part of the head the coate vnder it would sure haue putrified then the fracture to haue engendered Callus for if no Sanies should flow inwardlie from the affected parts it shuld haue bene néedlesse to haue cut out the bone therefore they as their manner is doe trifle for I truelie in another hauing the like fracture did thinke to let the higher bone alone and to take out that which was in the sides whereby the Sanies might flow out But when I did marke both the thicknesse and the hardnesse of the bone I did iudge it better to take out the bone than for regard of the fluxe to finite vehemently the braine and I also thought that it might happen that if there were a great hole in the side that the braine might perchance come to this part Further there that not in one place is in the sides a springing of nerues and that of no small quantitie when as in the high bones of the head there neuer springeth the least nerue of all and I being by these things warned did abstaine frō taking out the bone that was in the side of the head and it euer had Callus and if it were rightlie cured and now trulie there resteth that wée séeke out what is our principall scope of all both medicines and eke of all our diligence when as the bone is perforated whether that which is most delicate and answerable to the pleasure of the Patient which now the most part vse or else that which is héereto repugnant that is that which is done by most vehement exiccatiue medicines which Meges Sidonius doth praise and a certaine Citizen of ours doth alwaies vse insomuch that he forthwith applied to the bare coate or pannicle an emplaister called Isen and vpon this outwardlie Oximell trulie this old man was sufficientlie exercised in this part of the art but I did neuer sée anie other vse them neither yet durst I doe so Notwithstanding I can thus much witnes with Eudemus for that was the olde mans name they rather escaped which were of him cured than of those who vsed delicate medicines and I had also gone about to trie the like waie of curing if I had continuallie remained in Asia but séeing I haue bidde at Rome I doe followe the manner of the Citie committing the greatest part of such workes to those whom they call Chirurgions But iudging the nature of the things it selfe I conceiue that such certaine determination to be confirmed by our experience The auditorie cunduit which stretcheth not onelie vnto Dura mater but also toucheth the nerue which goeth from it to the braine this although it be so néere doth abide as it is said most vehement medicines Therefore it is no meruaile if after the perforation of Cranium Dura mater before it is much molested with inflammation doth desire most strong medicines hauing naturallie as it were a drie substance FINIS Thomas Gale vnto the friendlie Reader IT is requisite that euerie one that vseth this art of Medicine in the curation of diseases or sicknesses not onelie to know the diuisions natures of the same but also to knowe the names by meanas whereof euerie one of the same may be knowen from another and chieflie in this part for the better vnderstanding of Tumours against nature wherin Galen hath taken great paines not onelie in their true diuisions but also gathering together their most apt and auncient names giuen vnto them by the olde writers And if anie names did lacke for such sicknesses as raigned in his daies he did deuise most apt and conuenient names for the same Aristotle saith whosoeuer is ignorant in the tearmes of his art that he is ignorant in the whole arte Therefore it is necessarie for those that professe so noble an art as
not spoken of FINIS AN EPITOME VPpon Galens three bookes of naturall Faculties verie necessarie for the Students both of Philosophie and Phisicke set forth by Maister Iames Siluius Phisition FAcultas is a certaine cause Effectrix place◠in the temperature of a parte in the beginning of simples The faculties gouerning our bodie in the which our life cōsisteth are in number thrée Naturall Vitall and Animall In time Nature vse 1. Naturall is in the liuer dispearsed by the veines into the whole bodie being the third and lowest 2. Vitall is in the heart distributed by the arteries into the whole bodie being the second and meane 3. Animall is in the braine and carried by the nerues into all parts indued with the fence of féeling and voluntarie mouing being first and chiefest Indignitie place and fortitude We must first intreate of the naturall as the nourisher or piller of the rest as we proued in the order of reading or teaching Galens bookes The natural faculties which bee first principall are Generatrix Engenderer Auctrix Increaser Nutrix Nourisher which are called powers Vegitable Arist de animal lib. 2 cap. 4. The first two falties 1. Actio 1. The verie motion actiue is a substantiall forme in Materia or production to substance or procéeding to forme And that is either of all or of part as generation of humours in a liuing creature of bloud through moderate heate of both kindes of choler by immoderate heate of fleame and melancholike humours by a slowe heate and that commeth of some meate more of some lesse in all temperatures And these humours are either naturall or vnnaturall 2. Opus 1. A thing made and finished by action as all parts the bodie fashioned in the womb and by generation complete vnto the which perfection of partes the séede being rightlie once conceiued Generatrix is the chiefe and principall worker Two other faculties 1. Alteratrix The which generallie be hot colde moist and drie in their first and element all faculties and doth change the séede bloud menstruall substance into a man in which is the qualities of féeling tasting smelling and séeing for it is necessarie that out of Alteratrix bones veines nerues and all other partes be made but perticularlie she doth worke vpon that substance by facultie making bones nerues veines c. For of the foure elements mingled doth grow the perticular faculties alteratrix wherof is made the substance of euerie similer parte and so many faculties of alteratiō ther. be in liuing creatures or of planets as there are found similer parts in them 2. Formatrix This facultie verie artificiallie and with great cunning and for some cause dooth fashion the matter which is chaunged so that it may haue an apt figure for placing composition hollownesse wholenesse soundnesse Apophyses Epiphyses and other things necessarie pertaining to the constitution of the bones natures veines arteries c. The which constitution is méete for the action and vse of the parte that after shal be created that nothing be lacking nothing superfluous which otherwise might be in better sorte Auxiliares or helping facultiez as they were hande-maidēs Nutrix Nourisher Austrix Increaser This doe not onely serue for the increase of the young being once ingendred but also from the time that the séede is conceiued for it is méete that the séede be augmented by nutrition that it may suffise to constitute so manie and such parts as be necessary The male séede is first nourished with the female and afterward with a small halituouse portion of the bloud of menstruum Facul auctrices nourishers 1. Actio Is an increasing that is to saie an ampliation of the found partes which were engendered of a liuing creature in length breadth and déepnesse kéeping the proper forme and first continuitie as it is sayde in the 1. li. cap. 5. De generatione This is the worke of nature onelie when as these things which are extended to vs or pulled from vs or are amplified in one measure onelie or not in all together then this facultie beareth rule from the birth vnto the flourishing age and as I saide helpeth the facultie Generatrix in the wombe and is onelie in a liuing bodie 2. Opus The small partes of a liuing creature borne into the world which are brought into a reasonable bignesse and the bodie being little made great Auxiliares or helping faculties Alteratrix Chaunger Coctrix Digester Nutrix Nourisher Of the which we will intreate héereafter more at large Facul nutrices 1. Actio That is nutrition or the perfect assimulation of nourishment with the thing nourished that is when that thing which floweth as the forme of nourishment is put vnto fastned made like vnto all the sound parts of the nourished bodie without anie ampliatiō for the iuyce or humor when it falleth a Vasis euen as certain dew so is it dispersed through all the part which ought to be nourished and by and by it is put or ioyned vnto it and after hauing gotten sufficient drynesse and clammie humour through naturall heate it is glued and fastned it increaseth cleaueth together and is vnited in one The which commeth not so to passe in Anasarca Hidrope when as the nutriment being more watrie and not so clammie by reason of the abundance of thin watrie humours falleth frō the sound parts of the liuing creature at the last it is made like vnto the parte which should bée nourished when it is nutriment in déede other are nutriments in power more proper and remoue The which is not in Leuce 1. Vitiligo 2. Opus All the parts enduring with nourishment so long as is possible Attractrix which draweth vnto the part conuenient qualitie and iuyce This facultie like as the rest being found in some instrument as in the stomacke reines wombe milt bladder purging medicines and Alexiteries is easilie transposed into the other parts Auxili facult helping facul 3. Retentrix The reteiner of the same vntill digestion be done Coctrix Digester in altering and that maketh it like Expultrix Expeller of that which molesteth the part in quantitie qualitie or both But we will intreate of these foure faculties as most principall héereafter more at large 1. Attractrix The drawer of conuenient qualitie and iuyce into euerie parte to nourish the same the which is common vnto all partes that drawe vnto them such nutriment as is most proper for them sometime thorough straight pores as in the stomacke and sometime onelie by the temperature of the parte as almost in all the other partes or else to the voluptuous delectation of the parte whereby the mouth of the matrixe doth drawe the séede of man to the verie end and whereby the gall doth separate and drawe yeolow choler from the liuer but in the Gall yeolow choler is not ingendered as Asclapiades saith like as neither he affirmeth melancholik humour in the splene but of him it is drawen from the liuer to nourish it selfe The reines doe diuide and onelie
drawe the vrine out of a hollow veine from the bloud and it is not carried of his owne accorde into the reines as though that were the best Neither doe the hollow veines drawe together and wind about thrust forth the vrine into the oblique reines nor into these which lie right vnderneath in the sides to be strained out with all the bloud and because it is thinner than bloud to be transmitted euen as all the Wine runneth into the vessell of the Wine presse and as the coniealed milke is strained the Whey alone runneth and not the chéese in like manner the reines doe expell the vrine into the bladder through Vreteras which are growing on the sides of the bladder and the humour which is receiued Asclapiades saith is resolued into vapours into the bladder and into the bodie hauing as it were two tunicles in it the vapors are let passe by waies vncertaine darke straight such as can by no sense be perceiued And they being once againe growen together do receiue their first forme and so out of vapours humours are engendered for so he hath depriued the reines and Vreteras of their function Neither doe the part of bloud receiue pure bloud aboue the reines but those things which are beneath doe receiue the bloud from the reines vnto whom they bring fastned through pressing wil as Serum be carried being purged and distilled as certaine of the scollers of Erasistratus saie for if Serum were heauie neither should it be carried of the stomacke into the liuer to be distributed neither into the reines by Caua neyther doth a watrie humour runne into the reines and a sanguine humour by Caua backward like vnto oyle and water mingled which when they are poured on the ground each run contrarie waie as other Erasistratians affirme Nor yet as Licius saith the vrine is the nourishment of the reines Therefore the reines doe drawe the vrine for that it is familiar and pleasant vnto them and not by following that which is made emptie For so when no more vrine did abound then was it made emptie by Ischuria that is to saie through suppression of the vrine in the reines bladder or other passage belonging vnto vrine as wée haue said before more largelie In the Tractice of the stomacke and the throate by their straight passages there is no Deglutitio by contraction as Erasistratus saith In the Tractrice of the liuer there is a distribution of Chylum out of the stomacke and entrailes into the liuer by the veines Meseraica In the Tratrice of all the partes there is distrubution of bloud out of the liuer and Caua into all partes by the braunches of the veine And not as Erasistratus affirmeth by the expression of the stomacke for this although it were so yet by reason of the length of time it should haue small power for the distribution of bloud through the veines not by the veines contraict about the bloud which they containe not with that succession vnto that parte of our substance which is made vacant and dispearsed from our heat the which thing those that recouer from sicknesse doe declare who if they haue not more nourishment flowing and abounding in them then there is place vacant they shall neuer recouer their accustomed helth moreouer the abundance of bloud in the bodie could neuer be gathered together vpon the liuer In the tracture of purging medicines it may appeare they drawe proper qualities or certaine humours familiar vnto them out of our bodies as Scamonium draweth yeolowe choler out of one that hath the Ianders Elleborus niger draweth blacke choler ex Melancolico Cnicus Coccum Gnidium draweth fleame ex Leucophlegmatico flos aeris Squamma aeris aes Vstum Chamedris Chamelion draweth a thin and watrie excrement ex Ascitico and these tumors are not engendered in vs of the medicines themselues making our bodies supple as Asclepiades doth falselie surmise denying the facultie attractiue vnto euerie conuenient qualitie whereby Magnes draweth yron Succinum a little moate and corne the water layde vnderneath it in earthen vessells and certaine medicines doe pull out splints and arrowe heads fastned verie déepe in the flesh and also poison of Serpents which was put in the same Likewise certaine medicines drawe the poison of Vipers some the poison of Pastinaca marina other of others insomuch that the poison drawen out hath ben found lying vpon the medicine By the which similitude the same substance may drawe thinges other medicines drawe not by hooke and crooke Attomos ioyning together as they mette one another with Epicurus the which he and Asclepiades did appoint to be the first elements of all things Retentrix The reteiner of proper qualities drawen vnto euerie parte vntill digestion be perfect when there is nourishment but if there be excrements which doe trouble the part wherein it lieth as in the entrailes the bladders c. swelling with quantitie or sharpe and biting qualitie or in both together The childe is reteined in the wombe vntill that through greatnesse weight biting or that the infant be auoide with sweate or vrine the Membranae béeing broken or through some other vrgent cause it is constrained to be deliuered This facultie like as the rest is in all parts which are to be nourished but it appeareth most plainlie in those parts which are greatlie hollow as in the stomacke womb bladder and is most delighted in these oblique passages but in other partes it is more obscure it is also placed in the temperature of those partes euen as all the rest are Coctrix The digester of the substaunce reteined in the part the which substance is so much the rather made like vnto the parte by alteration as it is more néerer of greater similitude to the same in qualities as of bloud flesh is soone made but that substance which hath lesse similitude with the part it is necessarie that it be chaunged flower first by all the meane qualities as of bloud hot moist and red ther cannot at the first dash be made a bone colde hard and white but there must néeds be many alterations and chaunges in the middle And for that cause there are two kindes of instruments pertaining to nutrition The one is that which draweth carrieth conteineth and digesteth the nourishment and as it were a straunge burthen expelleth and beareth it such are first Cocturae Os Gula Ventriculus Intestina second Mesaraice Venae Hepar Caua vena thirdlie all the parts Similares and of these Organice and Vene capillares the which as the chiefest prepare by alteration the nourishment méete for euerie part The other is that which by drawing the excrement of nourishment doth diuide carrie reteine and purge it as are Lien Rene Ambae Vesicae with the passages of the stomack chiefly by Crassa intestina Spincteres ambo Musculi octo epigastrij And those muscles which doe make the restraint of the breath and also those which is verie profitable and necessarie for the siege and vrine and vnto the bearing of a childe Thorough this nourishing alteration when as the partes are made that which remaineth is like vnto them and therefore it is called Assimulatio but through the ingendering alteration those partes which before were not are afterwards created Expultrix the expeller of those things which could not bée ouercome digested or perfectlie altered and that could not be made like vnto that which ought to be nourished when they are gréeued as it were with a strange burden the part which demaunded them either by concoction or attraction and when they stretching out in quantitie or troubling with sharpe qualitie or both doe greatly hurt it This facultie is excedingly delited with croked wayes which are these parts the stomacke entrailes wombe both the bladders veines and arteries Expulsion which is contrary vnto attraction is often times through one passage as vomite and swallowing downe through the throte the séede and the encrease through the neck of the priuie parts The distribution of nutriment the attraction of purging medicines voluntarie expultion of the iuice abounding in vs through Mesaraicas venas These nourishing faculties are vnderstanded by the name of naturall things for that from the conception of the séede euen vnto death they are in a liuing creature and also in a plant for they help generation action one likewise furthereth an other that by nutrition there may be a certaine particuler generation and corruption wherefore these thrée bookes entreat almost onely of these faculties vnto whome corruptio diminutio atrophia are contrary These faculties with certain instruments which haue action cōmon vnto all the bodie are of two sorts that is generall and perticuler The generall are either all present as in the stomack and liuer or else thrée of them onely as in the two bladders for one of them digest or two of them alone as in the reines for neither they digest nor reteine or at the least very little by reasō that they want great capacitie or else the facultie expultrix as the entrailes which haue for that cause onely croked passages in their tunikes And forasmuch as these ought to be nourished as wel as the other similer parts They haue foure particuler faculties nourishers of them placed in the temperature of their substance Hetherto wée haue declared which are the naturall actions how they be made and of what parts FINIS MIEVL X. VAVLT MOVRIR-EN VERT V. QVE VIVRE EN HONCTE AT LONDON Printed by Thomas East DWELLING BETWEENE PAVLS Wharfe and Baynards Castle 1586.