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
shall not take an Indication of it after foure â—…neths but that which we haue taken at the verie beginning And for a truth that I may not permit such an vlcer to abide so long time but at the first I will take awaie the cause thereof But I cannot coniecture what may shewe the time more than the number of daies except Thessalus will saie that to haue knowledge of such an vlcer we must tarrie the time but in such a case he sheweth himselfe altogether foolish That is to saie if he confesse openlie that hée knoweth not the first affect which hath inueterated the vlcer Furthermore he must plainlie also confesse the Indication curatiue to be taken of the disease and the knowledge of the disease to be taken of other things But bée it so that time serueth somewhat to the disease neuerthelesse the Indication curatiue is not taken of time But to what purpose serueth it if any Vlcer bée inueterate to do away that which letteth the coition to renue the place which is pained For thou foolish fellow if for the maligne fluxe which the Gréekes call Cachoethae the lippes be affected in such sort what shalt thou profit if thou doe cut them before thou hast prouided to stop the fluxe Trulie thou shalt but make the Vlcer wider than it is as some doe that cure vlcers after the same manner as thou doest For the cause remaining which before made the vlcer harde and flintie thou shalt doe no other thing in cutting awaie the lips but enlarge the vlcer For those which thou cuttest shall be made hard come again as they were before Although that prudent Thessalus hath not added this thing that the partes of the vlcer which are hard stonie and discouloured ought to be cut awaie but commandeth by an absolute sentence that those thinges which hinder the closing of the vlcer ought to be cut awaie and to be renued But if trulie hée had counsailed to take awaie the causes that hinder the adglutination of the vlcer and that this reason were auncient and olde I would not accuse him for it is commanded almost of all the auncient Phisitions which doe write of the curation of vlcers by a certaine reason and Method that those causes which doe excite the vlcers ought to be cut awaie euen trulie as of all other diseases For trulie I do thinke it expedient that the efficient cause remaining which exciteth the vlcers ought first to be taken awaie In other diseases it is not expedient but chieflie there the curation must be taken in hand where the efficient cause remaineth And if the sayd Thessalus hath not spoken of the causes that let the conglutination and hath onelie spoken of the lips as he hath said afterward it appereth that he is ignorant of more than he knoweth of those things which appertaineth to the curation of vlcers But it is possible that this alone is the cause which hindereth the cure of the vlcer And it may as it is aforesaid be the cause that intemperauncie which is without a tumour against nature be in the vlcerate partes and also that it be ioyned with a tomour the which doth not require that the lips should be altogether cut awaie It maye also bée the cause that Varix which is aboue it or that the milt which augmenteth it or some disease in the liuer and beside this the weaknesse of the affected part be nothing else but a manifest intemperancie And besides this a vicious humour in the bodie which the Gréekes call Cacochimia and the chiefest of all the causes which may be to the vlcers an incommoditie Truelie great abundance of humours which the Gréekes call Phlethora resorting vnto the vlcer doeth hinder the curation But if Thessalus be of that opinion that the lippes onelie must be taken awaie I saie that of many things he knoweth but one alone which is so euident that the shepheards are not ignorant thereof for if a shepheard sawe the lips of an vlcer hard flintie wan blacke or a leadie coulour hée would not doubt to cut it awaie Then for to cut awaie is an easie thing but for to cure by medicines is a greater matter and that requireth a true methode Neuerthelesse Thessalus neuer knew howe the lips might be cured by medicines for all men confesse that he hath swarued from this part of the art and as he himselfe hath shewed it séemeth that he had neither experience nor rationall knowledge of medicines which is a manifest thing by the booke that he hath made of medicines before rehearsed But of this one worke consequent wée shall entreate of those things which hée hath not writâ—…n well And now we doe intend with deliberation to speake of the curation of inueterate vlcers of the which he hath before intreated Certainlie it had bene better to haue called them Cachoethae and not inueterate theÌ„ to declare their nature disposition and cause of their generation and the curation of either of them And first to know the common curation of all vlcers for as much as they be vlcers of the which I haue written in the third booke next after the perticular and proper cure of either of them afterward the kinde of the efficient cause as I haue spoken of in this present booke And although Thessalus hath done nothing of all these things yet he doth thinke that the vlcerate place must be renued when it is made like vnto a new wound to cure it as a bloudie vlcer what is he that is exercised in the workes of the Arte that vnderstandeth not euidentlie that such a doctrine hath bene written by him that neuer cured vlcer Is it possible that a man may cure an inueterate vlcer as you may cure a bloudie wound and after he hath made it lyke vnto a fresh wound shall it be in drawing of the vlcer together by rollers or ioyning them by stitches or neither by the one or by the other but by conuenient medicines What is he that knoweth not that an vlcer called Cachoethae is caued or hollow séeing that it is made by corrosion Is it possible O foole and impudent Thessalus that a caued vlcer may grow together and be adglutinated before the cauitie be filled with flesh is not that to cure an vlcer as a gréene wound then hast thou thy selfe written in vaine that hath taken indication to cure caued vlcers not with closing but with the filling of the cauitie But if euery vlcer called Cachoethae were not hollowe of it selfe yet when it is made bloudie in cutting the lips awaie as thou commaundest then of necessitie it is made hollow and requireth great space betwixt the lips euen in such manner that I cannot sée how thou maist make them conglutinate together as a bloudie wound for if thou assaie by force and violence the lippes that are so farre a sonder of necessitie there commeth Phlegmon which letteth the sayde lyppes to close together The which thing I suppose that
many wayes friuolous and foolish For our bodies doe not consist of little bodies called Atomes and of little passages or pores but if this were true it should not be possible to shewe in what maner musterd might change or alter the state of the same pores if any of them should shew the truth yet we would not agrée vnto their sect because they promisse that they wil be content with their apparent communities therefore lette them not vse these names neither let them hinder vs no more in our matters For it is lawfull without the name Metasincrisis to say in other wordes the curation of inueterate vlcers as the Emperickes doe Also we haue declared in the second booke how they talke of this woord Atonias that is to say imbecilitie yet know not what it meaneth For if they vse this name as the Emperickes do then it should signifie nothing else but that the actions are not kept for if they say that certaine faculties doe gouerne liuing creatures which we all the auncient writers doe affirme but yet notwithstāding they repugne against the precepts of Asclepiades also they propound vncertaine things to the which the authors doe not agrée they touch the truth a little yet they commaund to eschew it But tell me true Thessalus what meaneth this worde Metasincrisis if thou saie that it betokeneth to change the pores thou art deceiued and supposest vncertaine thinges But if thou saist that it is a great matter to cure the particle grieued of the bodie as the man thou saist no more thā the Emperikes except the name For they doe knowe that men are made whole by medicines but they know not the cause or reason by what meanes the remedies restoreth health For none of the Emperikes can tell if the facultie of the medicaments chaungeth the pores or if it maketh a Simitrie or if it altereth the qualitie of the Patients particle that is grieued Howbeit the Emperikes are discréete men if they saie that they know onelie one thing that is to saie if they haue noted and obserued the times how vtilitie hath followed when the medicament of mustard hath ben ministred to such vlcers and in what time Neuerthelesse they speake not of method neither yet repugne against it neither be displeased with the notise thereof nor dispraise the ancient writers neither Hyppocrates but rather praise him and affirme that he hath said all thinges well But Thessalus doth not onlie despise Hyppocrates but all the other auncient Phisitions neither doth he vnderstand that he hath written all the precepts of rebellious vlcers without reason emperiklie For if he had written them well then it should haue bene counted a worke most profitable But it appeareth not that he hath done so séeing that he peruerteth the right order of remedies and vseth his remedies to the grieued part before he hath prepared the bodie For this is an argument of great ignorance séeing that almost it is a principle in Chirurgerie that all the bodie must be purged of the euill excrementes before anie strong medicine be applyed vnto the affected parte For who is he that will iudge either by reason or experience for there is no other third thing to iudge by in what art so euer it be nor in anie part of life he shal finde that it is agréeable to reason for a man to minister strong hot medicines to anie particle of the bodie before he hath purged the bodie of all anoiance prepared the same to health for the said medicine draweth the excrements and superfluities from all the bodie like as boxing or Ventosis doth it doth so fasten to the affected part that it may be scarcelie remoued Therefore it must be asked of these Thessalions frō whence this opinion cōmeth to Thessalus to write fables as cōcerning the curatiō of rebellious vlcers séeing that none of the Emperiks nor yet Rationals haue written so before this time For neither Thessalus himselfe neither anie other of his sect dare affirme that the order of such remedies either doth agrée with experience or reason For neither can they giue Indication of time neither yet of the affect of the disease Yet for all that Thessalus is not all together ignorant because he iudgeth that the cause the hindereth the ciccatrise must be considered and taken awaie because also that he iudgeth that this must be done not onelie in vlcers but also in all other diseases as the ancient writers do admonish But they answere nothing to the purpose for they saie alwaies that we do not vnderstand them as if they knew perfectly the thought of Hyppocrates and of all the ancients And they affirme the Thessalus hath a good opinion when he saith that there is a communitie of inueterate vlcers that Hyppocrates vnderstood it so in his booke of Vlcers which writeth in this maner It is profitable that the bloud doe flowe continually from the inueterate vlcer when so euer it séemeth néedfull It were not farre from my purpose if I should speak of the iudgement and opinion of Hyppocrates though I haue not promised that I would so do in this place But that which I will saie shall be of the interpretation of the wit knowledge of the auncient Phisitions the which truelie as yet haue giuen no sect but studying with simple pure minde to inuent some thing profitable to mans health It is well perceiued therfore that they haue found some thing by reason and some thing by vse and experience Then dyd they write their inuentions many times without giuing reason thereto and sometime they did and if they did giue anie reason it was to profit the readers For if they intended to be profitable to their successors and when as they knew reason of inuēting things then diligentlie they set it forth and where they thought it obscure they thought it superfluous to rehearse and therefore let it passe Now it is well knowen vnto all men though I hold my peace that the ancients haue loued no verbositie For that cause afore recited not only Hippocrates but also all the other ancient Phisitions sometime not making mention of the middlemost speaketh of the third thing For if the first be a signe of the second the third of necessitie must followe after the second And thus oftentimes omitting the first and second they spake of the third I haue oftentimes declared how the ancients and chieflie Hyppocrates haue written after this manner But he that will know and perfectlie vnderstand the maner of curing ought to be exercised in their stile and manner of interpreting For this I will intreate of that which I haue purposed The fift Chapter FOr those Vlcers which after medicines to them ministred be not cured those the Phisitions cal in Gréeke Cachoethae but we cal them maligne and rebellious to cure But we haue spoken in the booke aforesaid what the curation of vlcers is Therefore in these kindes of vlcers that be
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
of Medicine not onely to the sauegarde of their Prince and people but also to their immortall fame and perpetuall and euerlasting honour The noble Latinestes haue also deserued no lesse fame both in séeking out the knowledge of simples and also in setting foorth of most worthie woorkes in the Arte of Medicine as these worthie men Cornelius Celsus Plinius and before them Cato Verro Alexander and many more which were men of worthie fame all these as I haue saide béefore haue taken their originall and beginning from Hippocrates and Galen It is also most apparant that there are manie worthy men that haue written in these latter dayes no small number in our time and of manie Countries some dyd wryte in Fraunce some in Spaine some in Germanie and some in our owne Countrie and many of them were famous men and menne of great and excellent knowledge and practise As Lamfranke Archbishoppe of Millon Guido of the schole of Mompillor and Commissarie to the Pope Rogerus and Roulandus of the schole of Mompilor and Chirurgians vnto the King of Fraunce Rose Anglus Gilbertus Anglus Hugo Wiklefe Anglus of the schoole of Cambridge Theodoricus and Brunus of the schoole of Bonane Arnoldus de villa noua and Plasentinus of the schoole of Mompilior Petrus de Argilat and Gordonus all these dyd write of the Arte of Medicine about two or thrée hundred yeres since and all these builded their foundation and tooke their originall of Hippocrates and Galen and nowe in our tyme there hath bene famous writers as Iohannes Vigo Antonius Muse Antonious Gallus Nicolaus Masse Iohannes Baptista Montanus Iacobus Siluius Alfonsius Ferrey Hollerius Leonardus Fuchius Iohannes Tagaltius Gabrielus Falopius Rioldus Columnus Antonius Calmisius Vassalius Ioh. Fernelius Amatus Lucitanus Frāciscus Valleriolus Ieronimus Cardanus Matthiolus and a great many more of learned men who we will passe ouer the troubling of tyme. All these which I haue spoken of of what Countrie so euer they were they tooke their originall and foundacion of our Father Hippocrates and Galen although they haue founde out many thinges appertaining to the Arte of Medicine which we finde no mention made of neither in Hippocrates nor in Galen yet they had their foundation from them and all these men of what countrie so euer they were they haue dronke of the water that flowed out of their two welles and doe greatly reioyce therein and who that list to reade their workes may perceiue the truth thereof Now my friendes to tell you the truth in my iudgement what was the cause of these mennes writinges I take it to be chiefely to sette forth the glory of God in his wonderfull creatures and workes as touching their natures qualities and properties which doth appertaine vnto this artist which doth vse the Arte of Medicine to consider vppon for all maner of thinges vnder Heauen doe serue either for mannes nourishment or else for the making of his bodie or else for necessarie remedies in the time of sicknesse or else for preseruatiues to kepe him from sicknesse and to preserue health So carefull was the highe and mightie Lorde God for his creature man that he made all these thinges to serue his vse as necessarie helpes in the time of his necessitie and placed him in the place of ioye with great solemnitie But alas his frayle nature was the cause of his sodaine ouerthrowe from ioye to sorow from pleasure to paine from rest and quietnesse to perpetuall labour and vnquietnesse from a most temperate Ayre and pleasant place into a miserable worlde tormented with innumerable contrarie ayres and chaunge of windes Yea I saye euen from the place of health into the worlde of sicknesse and miserie where our bodies be altered and weakened euerie daye by mixing together of contrary Elements and we being subiect to the same are dayly tormented with innumerable diseases And although Adam at the first creation was indued with most excellent wisedome and knowledge by the power might of the Lorde God so that he dyd know all things that were vpon the face of the earth in the waters and déepe partes thereof not onely their qualities and properties but their substanciall formes and figures and gaue them names as he himselfe thought good for he had perfect knowledge of all thinges by the deuine spirit of God which dyd worke in him according to his first creation but when he had sinned against the Lord God then was taken from him his diuine knowledge and lefte here in this world bare and naked to take paines and studie for all those things that he would receiue commoditie of Now man as I sayde before being wrapped about with innumerable sicknesses diseases and sodaine chaunces which bée subiect to the arte of Medicine which Arte I call the arte of curing and healing was constrained to séeke for remedies in the tyme of his necessitie And sought out Herbes Rootes and manye other thinges to helpe his diseases and griefe withall and by vse and longe time of practising they dyd finde out the natures and properties of many thinges wherewithall some tymes they dyd good but by chaunce for they obserued neither the natures of bodyes nor their temperatures nor the disease neither yet the causes thereof but onely regarded those thinges which they dyd sée and féele Thus farre wyde was man from that excellent knowledge which was geuen him in the beeginning for in the beginning he was not onely indued with most beautie but also with most excellent giftes of knowledge and wisedome All other creatures besides man which hath not sinned against the LORD GOD but followed the nature of their first creation all these wée sée by experience haue a certaine deuine nature in them which man lacketh for man dyd lose it through sinne which these creatures haue not done and for the proofe héereof we will begin with the dog which being sicke séeketh for a certaine grasse eateth thereof and with the same cureth his griefe and disease Onelie a diuine nature teacheth him this without anie studie The Squirrell also prouideth her selfe nuts against Winter The little Ant or Pismere doth gather séeds into the ground and biteth them in the end after such a cunning sort that they may not grow The Storke also being grieued or anoyed with anie vncleane thing that she hath eaten flyeth to the sea and giueth her selfe a clister with salt water ministring it with her bill at her neather end by meanes whereof she purgeth and cleanseth her selfe of her griefe and sicknesse Thus may you perceiue the diuine and wonderfull workes of almightie God working in his creatures by a diuine nature but man lacking this diuine knowledge and lefte onelie to reason and Experience is constrained by greate studie to bring to passe those thinges which by imperfection of Nature dooth lacke in him By meanes wherof all these most worthie men afore said haue put in writing manie worthie Bookes of this arte which arte they haue obtained by greate
or else that as the curation is taken in hand doeth bring more discommoditie and also a more grieuous sicknesse than that which is taken in hand to be cured As when we goe about to cure Vitiliginem Antiquam Lichenas Hemorroidas Sinuosa vlcera and the old Fistulas Cancers and to conclude when as we haue a stubburne patient which doth giue no regard to the Surgions that gouerneth him these are the causes why that all cannot be brought to their health by arte In like manner Chirurgerie is diuided into two partes generallie the one is which doth declare what things belong to the art doth set forth the precepts wherwith the workman being furnished may worke rightly This part the Gréeks do call Theoreticon we do cal it Theorica that is to saie the learned or speculatiue part the other doth folow that doth perform in effect that precepts of the former it is called in Gréek Practica or rather Poetica that is to say a bringer of things to passe for it wholy doth consist in doing and bringing to effect and séeing that the whole Arte doth depend of these we maye with good cause thinke Chirurgerie worthie to be called an arte as whose ende is affection and woork For she doth exercise all her properties either in soft mēbers or in harde parts The soft parts are those which haue their beginning of bloud and are called fleshie and the hard parts do spring of séede And chirurgerie doth exercise her facultie in those partes by incision by cutting or by taking away by reposition and adustion And truely of this arte there are certaine other more speciall partes as those about the which the arte it selfe is speciallye occupied that is to saye Tumors against nature wounds vlcers fractures and Luxacions Therefore as there be fiue parts which the art doth intreate of so there be fiue partes of Chirurgerie in the whole as which doe teache vs to cure tumours which woundes and which vlcers and which can put fractures and luxacions in their proper place But the ende wherevnto Chirurgerie directed all his actions and prouisions is the ablation and taking away of those sicknesses which maye be cured by ministracion of conuenient medicines with the hande to restore the sicke vnto his health which ende truely the workeman cannot alwayes obtaine vnto For those causes which we declared before séeing that it is not in his power to cure euery sicknesse And this long arte vaunteth hir selfe vnto the famous companie of excellent and noble authors worthie of great renowne In whose register that diuine man Hippocrates the patron and defender of the noble arte of Medicine doth of very right challenge to him selfe the chiefest place by whose meane this parte of medicine is better declared then it was before his time the which thing the deuine monuments which he left to his posteritie doe witnesse I doe meane his bookes wherein he doth speake of the woundes of the head of fractures of the lyms of vlcers of fistules of the emorodes and of the furniture of Chirurgerie and of cutting out of the Anathomies Furthermore Chirurgerie béeinge as it were deuided at length from the other hath chosen vnto hir selfe a proper place and beganne to haue hir proper professors for in the time of olde writers in the florishing age of Hippocrates Chirurgia was not deuided from the other parts of medicine for they were then both Phisitions and Chirurgions And Philoxenus declareth it to haue florished in Egipt which hath set foorth and garnished this Arte in many volumes And after him Gorgias Sostratus Hieron and the two Apollonij Amomus Alexandrinus and many other excellent men and it is certaine that there was no meane professors of the same arte at Rome as the auncient Fathers Tryphon Euelpistus and Meges the most excellent of all as Celsus writeth But how much Galen excelled in restoring and enriching this parte of medicine his learned Commentaries vpon the bookes of Hippocrates wherein he doth declare of the Arte of Medicine and vpon his booke De articulis de fracturis And moreouer his sixe bookes of the first methode of curing called Therapeuticon and the last two of the same the two also De arte curatiua ad Glauconem his booke De tumoribus preter naturam his booke De compositione medicamentorum secundum genera doe testifie abūdantly Moreouer Paulus oegeneta ought greatly to be commended who in a method compendious but yet most exact hath comprehended all Chirurgerie both in his fourth booke and also in his sixt Furthermore Auicenna Rasius Albucasis and Haliabbas being of the schoole of the Arabians haue intreated most diligently of the Arte of Chirurgerie as Auicenna in his fourth Canon and the third fourth and fifte féen Also Rasus in his seuenth booke to Almanser the King Albucasis in a whole volume Haliabbas in his ninth booke of practise of the regall disposition neither hath she lacked hir honour of Latines Celsus and Plinius Captaines who with great beautie and like dignitie haue intreated briefly of this parte Why should I passe ouer Guydo de Gauliaco who onely among the French we haue knowne to haue intreated very well of Chirurgerie if ye regard the reason of the arte We may trulie gather by his rude spéech that he wanted onelie such happie time wherein he coulde not come to the knowledge of the Gréeke tongue nor to the pure eloquence of the Latine tongue whilest at that time ignorance and barbarousnesse exercised tyrannie ouer good learning which was the cause that in rehearsing the place of Galen the truth of the author was much desired But if God graunt me life I will diuide those places of the Arte of Medicine from the common place I trust that I shall helpe Guido and I will of a barbarous and impure writer make him a fine and eloquent Latinist restore him to his beutie which our friēd Siluius hath performed in correctīg Mesueus the same doe I faithfullie promise to the studious to multiplie in repairing of Guido if God prosper our indeuours although perhaps without méete or equal thanks yet shall I doe it with due labour and good will But now I will returne to my purpose for manie famous men and authors most worthie of fauourable commendations haue set forth this arte among the which Guido Vigonius and among the men of this age Tagaltius being my fellowe in office and my companion in my studies haue done greate things and worthie of praise in amplifying and garnishing this part whereby it may be gathered how much is vnto this art to be attributed which so many renowmed haue each one in his workes and monuments set forth increased and enriched that men might know it to be most profible and in effects most euident among all the partes of medicine Now must we show what are the duties and office of a Chirurgion and howe he should enterprise the same for there be thrée chiefe points
greatly delighting them selues in the onely dignitie of the Arte not knowing what it meaneth which doe oftentimes let bloud their poore patients without any IndicatioÌ„ or councel of one learned in the same arte or of some graue and learned Phisition but also they will geue inward medicines a gods name a matter truely most worthie of publike punishment For as much as I haue séene many by such their rash and bold enterprises brought into daunger yea and some haue I séene miserably languished and depriued of lyfe Therefore let not that young Chirurgion which would be estéemed worthie of his arte presume to take in hande these thinges without the councell of an auncient maister learned in the same arte or else a graue Phisition such a one which is learned in the arte of medicine the matter it selfe geuing also such libertie or time But otherwise if there be no learned maister present or that any present necessitie doe constraine the same then truely the younger Chirurgions may boâ—…t bloud and also if néede bée minister a medicine so that he haue good erudicion iudgement and experience Moreouer the Vnguentes where with the Chirurgion ought to be furnished and the same to haue alwayes in his saluetorie as these Vnguentum Basilicum Vnguentum Apostolorum Vnguentum Aureum Vnguentum Album and Vnguentum de Althea as Basilicon to superate and materate and Apostolicon to mundifie and clense Vnguentum Aureum to incarnate and to fill Vnguentum Album to cicatrise Vnguentum de Althea to cease dolour and paine and to make soft Moreouer as for emplaisters pouders fomentations and such like the expert Chirurgion doth prescribe of them very many sortes according to the reason of curing And these are the medicinall instruments pertaining to the art of Surgerie By the manual instrumeÌ„ts ye shal chiefely vnderstaÌ„d instrumeÌ„ts of yron very méete most necessarie to the ChirurgioÌ„s vse wherof some are to make incisioÌ„ to cut of a thing other some are to draw out certaine are to search also some be properly to stitch or sowe and other some to make adustion to cut or make incision Forfices Nouacula rasorius scalpellum Chirurgicum for Phlebotomie seu lancetam forsipes to draw out called commoÌ„ly Tenaculae volcellae seu volcellae which in French they call pinsettas the crooked hooke vncus seu vncinus and that Yron instrument which the Grecians call Diocleum graphiscum is apt as Celcus writeth to draw out arrowes For to serch we doe fitly vse a probe for to sow a néedell and a quill are properly vsed and to adustion diuerse kindes of cauteries commonly called actuall are occupied and for the variable meanes of their vse they haue diuerse figures and diuers names for some be sharpe at the point and other be not and other cauteris they call myrtea oliuaria dactilica cultellaria so called of the similitude of thinges which these instrumentes doe represent for the cauteris called Mirtia doe imitate the figure of the leaues of Mirtills Oliuaria of an Oliefe dactilica of the Date as Cultellaria doth represent the forme of a knife these are the common instruments necessarie for Chirurgions There are certaine other instruments proper and appointed to certaine partes of the bodie as modioli which the common Chirurgions call Trepans malleus scalpri and the same are conuenient to scrape cut or pul out bones as well of the head as other parts euen as Falx is proper to the fundament speculum oris to the mouth and speculum matricis to the matrise there are innumerable other sorts of instrumentes conuenient to drawe out dartes gunshots other infixed things whereof to speake I doe now cease and will prepare my selfe to set out a Chirurgion what maner a man the best ChirurgioÌ„ should be which thing I often times haue declared to be the chefe effect of the matter for wée know what Galen hath saide of the Phisition aswell in his booke De institutione artis medicinalis as also in the third booke de naturalibus facultatibus and in his third fourth de methodo medendi Galen calleth him that cureth woundes and vlcers medicus that is to say a Phisition he saith that the Phisition ought to be prudent and well exercised and also he ought to be of quicke nature and of pregnant wit that he may promptly obtaine all thinges and verie well instructed in learning and moreouer appointed to the best maisters to learne of and one induring labor paine a great louer of the truth studious and most déeplie vnderstanding his art approoued by much vse and long experience and all this saie I must be applied to the Chyrurgion which will bée most excellent estéemed for an vndoubted Artist but beside these there be certaine things which doe pertaine priuatlie to a ChyrurgioÌ„ as to the manual Artist do not so much pertaine to the ancient maister of the art of Medicine for a Chyrurgion ought to be a young man or els but little past youth that is betwéene the same and auncient mans estate for the age flourisheth most in sense strength to exercise rightlie whatsoeuer belongeth to his art wherfore they which are aged men cannot so aptlie bring things to passe which arte requireth for the imbecilitie of their senses for they follow them rather by counsaile Furthermore he must haue a sure and strong hand and steadfast to all workes that hée shall doe whether it be to make incision adustion also for the cutting awaie of a member Also it behooueth him to haue a quicke and cléere eie and he must not be fearefull of mind but rather without pittie if he do intend to cure him that he taketh in hand Furthermore neither let him make the more hast neither let him cut Canteries or cut off lesse than néede requireth for the clamor or crying out or for the tendernesse of the sicke Patient but let him doe all things as though he heard not the clamors of the sicke neither let his minde be therwith anie thing troubled And wée haue declared that a Chyrurgion ought to excell in learning for therein chiefelie doth his erudition manifestly appeare if he vnderstand exactlie both the Theorike and the Practike parts that is to saie to know things naturall and not naturall and also those that are against nature Also if hée know what be the causes of wounds vlcers fractures and luxations with their accidents and also what be their conuenient remedies and how to remoue the same In lyke manner he shall excell in practise if hée haue had much and good exercise in the operations of his Arte by working spéedelie trimlie and readilie consulting with the auncient maisters of the same arte in those things that pertaine to Pharmaceuticen Diateticen And although he vse those things which be searched out by reason confirmed by frequent vse wherein truelie the faith and honestie of a Chyrurgion séemeth chieflie to consist The Chyrurgion ought to
therefore this indication is taken of thinges naturall as whether health may be restored or not whether the strength of the patient sufficeth for life or not and whether the cause of health may be conserued and so of the rest The indication taken of things against nature is whether we may cure the sicknesse with his accidence or not whether we may resist the cause of these two or not this is to be knowen thrée waies First when the sicknesse of his owne proper nature is incurable as Elephantiasis absolute and as they tearme it confirmed or when the sicke patient refuseth his necessarie remedies when the diseases are curable As for example the cutting awaie of a member in which there is a Cancer c. Or when the curation bringeth a worse and more perillous disease as olde Cancer being cured or continuall Emorodes for if you cure these there is daunger of life or of madnesse or of consumption Nowe the third indication doth teach conuenient remedies for their curation their vse and instruments wherewith it is brought to passe The first of these instruments is an apt diet or regiment in the vi things not natural The second is Pharmacon which he vnderstandeth for purging medicaments Also letting of bloud with plaisters vnguents pouders c. But in the two first the Chirurgion must consult with the learned graue Physition There be many yron instruments beside these medicinall instruments which be both proper and common for this arte as héereafter followeth Thus farre we haue spoken the wordes of Tagaltius as they be set forth in his booke of Chirurgerie as well for his definition of Chirurgerie as for the antiquitie thereof and also what manner of conditions hée ought to haue what learning he ought to be brought vp in and what he ought to learne first and what last and what is the matter or subiect proper to his art and what instruments the artist must haue both common and proper to 〈◊〉 and bring to passe withall his desired scope and 〈◊〉 of his worke which is the curation of mannes bodie in these thinges that hée hath charge of This is the effect of the words of Franciscus Valleriolus as well as of Iohannes Tagaultius as it may appeare in their words héere aboue written Now my friend where you did alleadge Tagaultius to proue that a Chirurgion ought not to minister diet and Purgations neither yet anie inward medicines for that you saie it doth propertie appertaine to Phisicke it séemeth to me by the wordes of Tagaultius that it maketh little for your purpose Obiection No sir by your saying both Valleriolus and Tagaultius saith the contrarie doe not they saie that a Chirurgion ought not to giue inward medicines without the counsaile of a Phisition and declareth what inconuenience hath come by the vndiscréete ministring of the same I take this to be a sufficient proofe The answere No not so sir we may not confound the instruments which are necessarie to an Arte because that some Artists doe abuse their instruments neither Tagaultius nor Valleriolus meane so but their meaning was that those that did practise the Arte of Chyrurgerie which dyd not vnderstand or knowe the principles of their arte neyther the causes of diseases nor yet the diseases themselues nor how to take indication for the curation neither yet knoweth the nature of the medicines which he doth minister These be they that Tagaultius and other learned men do reproue which I must néeds confesse ought not onelie to be forbiddeÌ„ in inward medicines but also outward medicines for if I should speake of all mischiefes that hath bene done by the applications of outward medicines how some hath bene maimed and vndone for euer and other some brought to death the number of them would séeme verie strange vnto you and therefore we will let it passe at this time with praier vnto almightie God for his mercifull helpe héerein that he may moue the hart of the Prince with the Magistrates of this Realme to take such order for the safegard of the people and for the honour of this Realme for that that learned men may be the better incouraged to studie this arte But as concerning the instruments there is neither these two men neither yet anie other before their time since the time of Galen that hath forbidden the vse of them to the Chirurgion for both these men doth put theÌ„ in their bookes as most common and special instruments affirming them as most speciall instruments pertaining to the art of Chirurgerie that without these those euill and vicious humours that hindereth the curation of vlcers tumours against nature c. cannot be purged awaie neither can the temperaments other naturall things of the bodie be kept in perfect state without an apt and méete diet But for to counsaile with the Phisition being a graue and learned man in the principles of this arte In matters of waight I take it to be verie necessarie for what is he that is wise that will refuse the counsaile of a wise and a learned man and speciallie of him that professeth the principles of the same arte for Phisiologia whereof the Phisition taketh his name is the first and chiefest parte which he that worketh in the art of medicine doth proue for that it doth consist in the knowledge of the seauen natural things and in the residue therevnto appertaining But yet this doth not followe that a learned an expert Chyrurgion should not vse diet and Purgations and other inward medicines at all times when néede doth require for if you would so vnderstand it one part of their sayings should repugne against another and so confound the whole but their mening was that the vnlearned Chirurgions and these that be younge men which be not well practised that they shoulde take counsayle as well of the learned Physition as of the learned Chyrurgion for this Arte is so ioyneed togeather that neyther maye the partes bée diuided neyther yet the Instrumentes without the ouerthrowe and destruction of she whole Arte for it was neuer perfect before the time of Hyppocrates till that hée ioyned all these partes and Instrumentes together and taught a perfect method and waie of curing by a right vsing and ministring of the same I for my part haue read no few authors not onelie of the Grecians but also of the Arabians of the Latinists yet could I neuer â—…nde in any of their workeâ— that they doe write of Chirurgerie where they doe leaue out dyet and parging medicines apointing the Chirurgion onely to cure with outward medicines for I am certaine that in all their scope of curing both of tumors against nature of vlcers c. That their first indication is to take away those euell affected which may let the curatioÌ„ that is to say to remoue away these euell humors which might repaire vnto the greued part and also to alter such distemperatures by conuenient dyet and other thinges as
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
beginnings thou shalt not néede either stitching or hookes but if thou wilt otherwise binde it vse thou either stitching or hookes Few stitches shall in this suffice And thou shalt cure greate vlcers with vehement desiccatiue medicines if thou remembrest that which before is spoken The medicines which doe moderatly drye will abundantly heale small vlcers Déepe vlcers be euer also great therefore they must be rolled with two beginnings and the lippes of it be spedely adglutinated and those which are both verye déepe and also long as they are great two wayes so doe they shew a double indication therefore they require vehement siccatiues Neither ioyne thou the lippes to soone together and rolle it with two beginnings and take déepe stitches In like sort if there come many differences together of which euery one hath his indication it is expedient to vse them all so that they be not contrary But if they be contrary among themselues wée haue heretofore shewed how it behoueth them to be denied of these but wée will more largely set it out hereafter And now it séemeth good in this place to ende this third booke In the fourth which shall follow we will dispute of those affectes which for the more part accustome to follow vlcers and with these there shall be set out the curations of inward causes FINIS THE FOVRTH Booke of Galen called in Greeke 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and in Latine Methodus Medendi The effect of the same 1 The right method of curing malignant stubburne Vlcers 2 What Vlcers be hard to be cured 3 The method of curing an vlcer difficill to be cured by the reason of the intemperancie of the flesh 4 The curation of an vlcer when as the part is exulcerate with a tumour against nature 5 The method of curing another affect when as ill humours doe flow to the particle 6 How a man may know in certaine diseases the originall cause 7 The opinion of Thessalus in the curation of malignant vlcers 8 That of time no indication ought to be taken contrarie to the opinion of Thessalus 9 The curation of malignant vlcers according to the sentence of Hippocrates 10 That an ill affect comming to the vlcer ought first to be cured before the vlcer be taken in hand 11 The curation of those affects that flow to the vlcer according to the sentence of Hippocrates 12 What indication ought to be taken of the scituation and figure of the parts The first Chapter WE haue said that there is one kind of disease that is called solution of continuitie which cōmeth into all the parts of the bodie of mankind howbeit it hath not one name in them all For solution of continuitie in the fleshie part is called an vlcer in the bone a fracture the Gréekes call it Catagma in the nerue a conuulsion the Gréekes call it Spasma There be of the same kindes of Solutions which the Gréekes call Apospasma Regma Thlasma Thlasma in the ligament Apospasma Regma in the veines and muscles because of anie violent stroke or grieuous fall or anie other great motion The solution of continuitie called Ecchimosis in the Gréeke commeth most often with concussion and ruption Sometime solution of continuitie commeth by opening the orifices of the veines in Gréeke named Anastomasis Also it commeth of that which is called of many Diapedisis Other solutions of continuitie happen of Erosion in Gréeke called Anabrosis But it is a disposition alreadie medled and composed with an other kinde of disease that consisteth in the quantitie of the partes as before hath bene shewed when as we did intreate of hollow vlcers which doe procéede of two causes that is to saie of Exition and Erosion It is manifestlie knowen by what meanes exition commeth And if erosion abound inwardlie it commeth of Cachochimia if outwardlie it is done either by strong medicine or fire it behoueth then as is said before to take diligent héede and discerne the simple diseases from the compound for to a simple disease a simple remedie is conuenient and to a compound disease a compound medicine Also we haue said before what method must be kept to cure cōpoūd diseases yet notwithstāding it is not inough to know the generalitie of the said method but to be exercised in all parts thereof Séeing then that in the same is néede by manner of speaking of sundrie perticular methods because that euerie kinde of disease hath his owne methode then that which resteth of the curation of vlcers must bée performed in this booke taking the beginning héere Euerie vlcer is simple and alone without other dispositions and affects with it or it is with some other disposition or diuerse whereof some haue not onelie stirred vp the same vlcer but hath augmented it The other are without which the said vlcer cannot be cured Of thē we haue spoken héere before we shal speake in this present booke of the dispositions which augmenteth the vlcer in the which lyeth double counsaile of curation that is to saie either to take the said dispositions all wholie out of the bodie or to surmount the incommoditie that aboundeth in it The which thing may be easilie done if the dispositiō be little but if it be great the vlcer may not be cured vntill the same disposition be taken awaie Wherefore we must diligently consider what the said affects and dispositions be and how many in number in taking our beginning as is sayd before Euerie vlcer is by it selfe alone or with hollownesse the the flesh being subiect be natural and that there be nothing betwixt the ioyning of the lips that may let the conglutination therof which oftentimes happeneth either by haire a Spiders web mattier oyle or such lyke things that may let the ioyning together And these things are as Symptomata and accidents of the sayd wound which if they be present maye hinder the curation but if they be not they let not but the disposition of the flesh is cause of that which followeth For with the same flesh and by the same lips that were asunder are closed and the hollownesse filled It behoueth then that the sayd flesh be naturall because that these two things may be wel and commodiously made perfect Then it is naturall if it kéepe his owne temperament which thing is common to all other partes for it behoueth that the flesh subiect be wholie temperate as well to close the vlcers as to fill them with flesh But is that enough I praie you Must not the bloud that commeth to it be good also and moderate in quantitie I thinke this trulie to be true For that bloud which is corrupt doeth so differ from adglutination and filling the flesh as also somtime to exulcerate and erode the bodie And if it be ouermuch in quantitie it engendereth excrements in the vlcers as we haue before spoken and hindereth the curation And also there be thrée kindes of vlcers which are difficill and hard to be cured The first aboundeth by the
happen to the vlcerate partes as wel by the occasion of anie perticular member as of all the bodie wherevnto the bloud or anie ill humours doe resort first remedie must be had either to the particle that is cause of the fluxe or else to the whole bodie Thus then we shall cure first the varices that are often resorting vnto the vlcered place before you cure the vlcer and then afterward you may the easilier cure the vlcer Likewise in them that haue a disease in the splene or in anie other notable part first it behoueth to cure the sayd parte and then after to procéede to the curation of the vlcer howbeit none of the curations héereof is proper to the vlcer but some other affects or dispositions that either engendereth the vlcer or that nourisheth and conserueth it The third Chapter BVt now I thinke it time to define that there is no indicatiō of outward or as they terme it of primitiue causes of curation but the indication or curation to haue his beginning of the affects it selfe But those thinges that ought to be done perticularlie are found out either of that which the indication sheweth either of the nature of the affected part or of the temperature of the aire or other like things but to speake brieflie no indication may be taken of things that be not yet come But forasmuch as we ought to know the affect that is not manifest vnto vs by reason or wit we are often constrained to enquire of the extreme and primitiue cause For this occasion the vulgar people supposeth that the saide primitiue cause is Indication of curation which is altogether otherwise As it appeareth likewise in those where the affect may be exactlie knowen For if Ecchymosis or an Vlcer or Erisipelas or putrefaction or Phlegmon bée in anie parte it is a superfluous thing to enquire the efficient cause of these diseases except they be remaining For in so doing we shall cure that thing which is alreadie finished and shall prohibite the efficient cause to procéed anie further But if the said efficient cause which produced the effect hath no longer biding there then we shall remooue awaie the affect For to put awaie the cause that is not there it were impossible For curation appertaineth to the thing present as prouidence to the thing to come For that thing which doth not now hurt neither is to be feared that it will hurt héereafter is out from both the offices of the arte that is to saie from curation and prouidence Wherefore in such thinges there ought to bée no searching of anie indication neither yet to cure nor to prouide as is sayd before notwithstanding the knowledge of the primitiue cause is profitable to vs in things vnknowen Neuerthelesse the Emperikes take sometime the primitiue cause as parte of the course of the disease that the Gréekes call Sindrome wherein they haue obserued and experimented the curation as in that that hath bene hurt with a mad dog or venimous beasts Thus doth also some Dogmatists which doth affirme to cure such diseases by experience onelie without rationall Indication for they take the cause primitiue as part of all the Syndrome and vniuersall course but the primitiue cause serueth nothing to the indication of curing although it be profitable to knowe of the nature of the disease to them that haue not knowen the nature of venimous beasts by vse and experience and thereof taketh indication curatiue trulie the outward cause of curation béeing knowen doth nothing profite to the indication but to the knowledge of the present affect For put we the case that we knowe that the venime of a Scorpion is of a colde nature and for that cause as of a colde thing I take Indication for the remedye howbeit the case is suth that I haue no signe whereby I doe vnderstand that the bodie is hurt of a Scorpion it is manifest that if I doe knowe that the bodie is hurt of a Scorpion that then I would inforce me to warme all the whole bodie and also the part affected without abiding for anie experience in taking mine indication of the nature of the thing We haue declared in the booke of Medicaments wherein it behoueth them to be exercised that will take anie profit of these present Commentaries no such facultie can be foūd without experience Truelie it should be a gifte of felicitie if anie hauing the sight of Litargerium Castoreum or Cantarides forthwith to vnderstand their vertues For like as in all things is committed error as well by those that excéede as by those that lacke so héere as the Prouerbe is among the Gréekes this Thiapauson that is to saie they differ among themselues Also they affirme that the vertue of medicines is not yet knowen and that after so great experience the other that suppose and saie that the saide vertues be knowen onelie by experience The first speaketh vndiscréetlie if that be a thing imprudent to affirme a thing impossible the other be altogether stupidious sturdie and foolish But for this present time we will saie no more because I haue spoken more plainlie in the third booke of Temperamēts also in the bookes of Medicaments Neuerthelesse for the knowledge of diseases some primitiue causes are profitable but after that the present disease is altogether knowen then the cause primitiue is totallie vnprofitable Now we haue declared that it doeth not become vs to meddle and confound both the doctrines together but the Emperikes ought to be spoken by themselues and the rationals by themselues We must now call to mind because we haue purposed in this present Commentarie to intreate of the doctrine Rationall although to some things that we do saie we doe not adde absolutelie that all be not true but onlie after the sentence of the methodicall sort but that euery man ought to adde and reason that thing by himselfe And at this time we haue said that there is no cause primitiue which is profitable to the Indication curatiue although it serueth well to the knowledge of the disease And we confesse that the cause primitiue is part of the Syndrome and of all the Emperikes course that they cure all diseases by reason by experience But in all that we shall saie héereafafter it is not necessarie to adde such words Then let vs returne to our first purpose in taking the principall indication certaine and vndoubtfull whereof we haue also vsed héere before as we haue said that the disease that requireth to be cured iudgeth the end whervnto the Surgion ought to intend and of the same all other indications are taken Wherefore we haue begun to speake that the said indication hath no manner of affinitie with the cause primitiue for put we the case that anie vlcer be come of a fluxe in anie part then it is manifest that the sayde vlcer procéedeth of corrupt humours for nature is accustomed so for to doe in diseases when she purgeth the bodie
maligne we may vse these names indifferentlie that is to saie we call them Cachoethae inueterate or Diuturnus In like manner the affect of the disease called Cachoethae that is to saie stubburne and rebellious to be cured that maketh some thing for our purpose to know neuerthelesse the saide diuturnitie of the saide vlcers because they come againe or be of long continuance waxe olde haue no conuenient indication of curing but that must hée considered because the vlcerate part is ill affected that ill affect béeing once knowen the cure is manifest But thou wilt aske how can this be done trulie if thou wilt heale the vlcerate part affected thou must first take awaie the abundance and corrupt vicious humors from all the bodie for in cleansing awaie the same the diuturnitie is taken awaie but the finding out which is profitable to vs commeth not first of the diuturnitie but of the ill disposition malignitie of the humour by meanes whereof these thrée things following must chiefly be considered that is the signe the affect and curation The signe is the diuturnitie or continuance of the vlcer the affect is the vicious humours repairing to the vlcer and the curation is the taking awaie of the saide humours By this meanes you shall finde that the auncient Phisitions manie times after the first made mention of the third leauing the middlemost as Hyppocrates did whē he said it is vtill to cause the bloud to flowe out often of inueterate vlcers But it is inutill that the indication curatiue should be taken of the diuturnitie of the vlcer but of the ill disposition of the bloud For a little after he saith thus the vice and euill bloud hindereth greatlie the cure of the said vlcers Also putrefaction of the bloud all things that commeth by transmutation of the bloud letteth also the curation of the sayd vlcers And afterward he speaketh of vlcers that come not to a cicatrise The vlcers trulie saith he may not be closed together if the lips and partes that are rounde about be swart or blacke with rotten bloud or Varises that causeth the fluxe if you cure not the sayd partes that bée about it they will not come together And afterward hée writeth of the cure of Varises and then maketh mention of the purging of all the bodie as well in woundes as in Vlcers where feare of daunger or putrefaction in Gréeke called Sphaselos doth remaine and besides in Vlcers called Herpes and Esthioninus that is to saie which doe erode and eate the skinne And thus Hyppocrates is wont to call those vlcers after this sorte wherein anie ill humour doth cause erosin And thus when he speaketh of them that ensueth he saith in such wordes In euerie Vlcer whereas chanceth Erisipelas all the bodie must be purged And finallie if you reade diligentlie the booke of vlcers you shall finde that he taketh Indication alwaies of the affect of the disease if he haue anie consideration of time it is onelie to knowe the affect And that it is so you may know it in the beginning of the said booke which concludeth thus You may not minister anie moist thing to Vlcers what vlcers so euer they be but wine Then sheweth hée the cause and saith Drie vlcers are néerest to health and moist the contrarie then after he saith it is an vlcer for that it is moist but if it be dry it is whole Therfore in all his cure in as much as he hath constituted the end of al the cure of vlcers to be drinesse it ought to be considered Then he findeth out the perticular thinges admonishing vs manie times of the same end writing in this manner Euerie wound that is diuided with a cutting Instrument receiueth medicines in the beginning that ought to be applied to rawe and bloudie wounds the which Medicamentes in Greeke is called Enaimon which is drying and letteth the wound to come to suppuration for it is more drier by the reason of the bloud which floweth out of it And agayne Hyppocrates sayth All vlcers that are well purged they come sooner to drynesse and ciccatrize but if anie superfluous flesh do grow it is by the reason of some contusion And againe he saith if that anie of the wound cannot consode together the moistnesse is the cause thereof In all these sayings Hyppocrates admonisheth vs of the first Indication curatiue of all Vlcers for of a truth the curation of an Vlcer for as much as it is an vlcer is moderate drynesse whereof the demonstration hath bene giuen in the booke going before For the curation of an vlcer that is coniunct with another affect whereof the cure ought to procéede is not like to a simple vlcer for the first curation of such a one as is coniunct with anie other affect shall begin first of the same affect and then at the vlcer For if there be either Phlegmon or swart coulour or Ecchymosis or Erysipilas or Oedema in the vlcerate part first you must begin the curation at one of the sayde affectes Neuerthelesse all men knowe well that sometimes these Vlcers are not well cured but are made greater for that the partes round about the Vlcer is affected either with Phlegmon either by brusing either with some other tumour which should haue ben first taken awaie before you had procéeded to the cure of the vlcer And for a certaintie it is not possible to heale the vlcer if the place where these be be not first cured And therefore Hyppocrates putteth vs in memorie of those things which he hath spoken of in the beginning of his booke and also of those things before especified and of those that be present he writeth thus Euerie wound that is diuided with a cutting Instrument or sharpe pointed receiueth Medicament called Enaemon and also a medicament desiccatiue that may let the filthie mattier But if the flesh be contused or cut with a blunt weapon remedie must be giuen in such wise that it come soone to suppuratiō For in so doing it shal be the lesse molested and grieued with Phlegmon And also it is necessarie that the putrified flesh which hath bene contused incised come first to suppuration and afterward new flesh to be engendered By these wordes Hyppocrates sheweth manifestlie that all the affects of the vlcerate partes ought to be desiccated except those where Pus will sodainelye bréede And so he going forward saith that Pus commeth through some putrefaction Furthermore that all putrefaction commeth through moistures and heate and therefore the Cataplasmes made of Barlie meale séeing that they are hot and moist we will minister it to all diseases where it is expedient to engender Pus for the Barlie meale with water and oyle and likewise bread with oyle or a fomentation of much hot water or the Malagma called Tetrapharmice and to conclude all things that moist and heat ingender Pus And if in the parts where Phlegmon is there ariseth pulsation in such wise that there is no
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
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
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