provoked and stirred up both for the repairing of the clour and the pouring in of blood And to tel you the truth in what place soever there is such an effusion of Blood it may in general be called Ecchymosis yet notwithstanding Paulus Aegineta in his fourth Book Chap. 30 according to the diversity of the parts affected reckoneth up three kinds or species all which may be called by their several distinct and peculiar names The first is those which we call Hypopia and by Hippocrates named Hypophthalmia that is Subocularia to wit palenesses or wannesses under the Eyes Now it is termed Hypopion from Ops that is the Eye because it appeareth under the Eyes and it is an Affect differing from that we call Hypopyon the difference lying in this that the former is written by ω and ι the latter by ο and Ï… from Pus which the Greeks call Pyon because it is a collection of Pus or purulent matter under the Cornea Tunicle The second Species is Hyposphagma which some in special term Suggillatio to wit an effusion of blood into the Adnata or Cornea both of them Tunicles of the Eye touching which we have already spoken in the first Book of our Practice Part 1. Sect. 2. Chap. 32. The third Species is that which is caused by the Contusion or bruising of the Nails this Species Hippocrates calleth Hyponychos and the Latine Authors term it Subungulus in regard that it is an Affect under the Nails Contusion Somtimes with Ecchymosis there is likewise conjoyned a Contusion yea and somtimes also there is so great an abundance of Blood poured forth that it being collected under the Skin and the Muscles it there causeth a certain hollowness and lifteth up the part into a Tumor or Swelling There is also somtimes according to the Nature of the part conjoyned therewith a pain from whence it happeneth that more blood floweth thereto and by this means an Inflammation yea and sometimes likewise at the length a Gangrene is excited There is to bâ—â—â— a notable History of this in Johannes Philippus Ingrassias in his Jatropologia When in the yeer 1537. in an Hippomachie or Tilting as we call it the Marquess of Terra Nova ran with the Baron of Volaterran it so chanced that the armed Knee of the Marquess by reason of the Fury and extraordinary fierceness of their Horses gave so great a blow upon the bare and unarmed Leg of the Baron that the Contusion or bruise that followed thereupon was so great and grievous that the Baron died thereof four daies after By reason of this his so sudden and unexpected death the Physitians were question'd and called to an account for that they had not rightly and as was fitting managed the Cure In whose behalf and defence Johannes Philippus Ingrassias wrote those two Books of Apology under the name and Title of Jatropologia There is likewise extant in Gulielmus Fabricius Cent. 2. Observat 83. another History which you may there see shewing how dangerous Contusions may be The Signs Suffusions and these Suggillations are easily known For the very colour it self and the Swelling if at least there be any fal under the sense and are apparently to be seen The Causes are known by those things that went before and such as are likewise present For if any external Cause went before as a Blow a Fall and the like the Physitian may understand it from the relation of the Patient But if none of these shall happen we are then to consider the Blood in the Body and well to weigh by what means it becometh thus peccant and offensive Prognosticks 1. Although in truth these Ecchymomata are for the most part void of all danger and the blood that is yet thin may easily be dispersed yet if this be not done and that the blood be deteined any thing long in the part affected out of its own Vessels it then may prove to be of dangerous Consequence in regard that by this means there may be excited both a Corruption of that very part that is affected and likewise a damage and detriment unto the whol Body For the Blood being clotted together unless it be forthwith insensibly discussed or turned into Pus which is necessarily done where the Flesh is withall greatly bruised so that hence the part yet continueth soft it putrefieth and corrupteth and breedeth a Gangrene and very frequently bringeth Death and Destruction upon the sick Person 2. But there is great danger threatned and nigh at hand when the part affected continueth not any longer green or wan but inflamed and becometh very red hard and distended Of which we related that former notable History out of Ingrassias The Cure As for what therefore concerneth the Cure we wil first of all treat of the Cure of that Ecchymoma that followeth upon a Contusion For even this also very often happeneth and whoever he be that knoweth the Cure of this he shal have a sufficient store of Medicaments with which he may cure the rest since that the discussing Medicaments that are here to be drunk have their place likewise in the other First of al therefore if the contusion be great we must use the best of our â—kil and care to prevent and hinder the afflux of blood unto the place lest that thereby an Inflammation should be excited This is to be done by Venesection for which cause Galen commands That in a fal from on high and in beatings and bruisings a vein be opened and that although the blood doth not greatly abound yet that by opening a Vein it be drawn forth lest that an Inflammation should be excited from whence not only evil symptoms but oftentimes also even death it self hath its original And the truth is this Venesection is forthwith to be ordained and put in practise withal at the same time Defensives and Repellers are likewise to be placed neer about the part that may impede and prevent the influx of blood into the part affected such as are made up of Bole-armenick Terra sigillata or Sealed Earth of Lemnos Dragons blood Roses Myrtles the Nuts of the Cypress Tree Galls Pomegranate flowers Roots of the lesser Consound and the like As for instance Take Bole armenick Terra sigillat of each an ounce and half Chalk half an ounce let them boyl in Vinegar after they be boyled Take Pouder of red Roses the pure sine flour of the Root Consolida or Consound of each half an ounce and with the Oyl of Myrtles make a Cataplasm Or only which is likewise in common use the white of an Egg shaken together with Rose water and with burds or the courser part of flax applied unto the place affected Or Take the white of four Eggs the Oyl of Myrtle and Roses of each one ounce Bole armenick Dragons blood of each half an ounce Cypress Nut two drams a little Vinegar Mingle them c. And this is also here to be taken notice of that there be not many
that out of it store of Blood be poured forth unto the Heart overwhelming it and suffocating the heat thereof Thirdly Al the internal wounds of the greater Vessels that cannot by any art be closed upon regard they cause the Blood being plentifully poured forth either out of the Veins or the Arteries that the spirits be suddenly dissipated therefore of necessity they speedily suffocate the wounded person Fourthly All those Wounds are said to be Mortal that suddenly take away the Respiration and hinder the ventilation of the Heart so that the Native heat of the Heart is suffocated and so cause that the Man die even almost in the very same manner as Apoplectical persons are wont to die And such like wounds are especially the Wounds of the Brain but yet not all of them since that there are many Wounds of the Brain that are not Mortal as afterwards we shall shew you and as we have already told you in the first B. of our Practice first part and 23. Chapter But those great Wounds and such as are the Cause that the Animal spirits be suddenly dissipated or that the blood being poured forth of the Vessels the Orifice of the Nerves be quite stopped and so by this means the influx of the Animal Spirits be hindered or that from the same an inflammation of the Brain or a feaver be excited And this is not only done by the Wounds of the very Brain it self but likewise by the strokes and vehement Confusions of the Head by which the Vessels of the Brain and those neer about it are broken and the Blood poured forth of them unto the beginning of the Nerves and there subsisting hinder the influx of the Animal Spirits And this may also happen if the Sinus or hollow places of the Brain chance to be hurt so that out of them blood be poured forth unto the Basis of the Brain and so it is likewise in the Wounds of the Eyes if they penetrate so deep that they open either the Vessels of the Brain or those that are in the Basis thereof or those that are neer about the said Basis of the Brain and so that the Blood poured forth unto the Basis of the Brain hinder the influx of the Animal spirits by compressing the beginning of the Neryes For although that the Blood if it be poured forth above upon the Brain may possibly be emptied forth by perforating and opening of the Cranium or Skul yet nevertheless if it be poured forth unto the Basis of the Brain it is impossible that it should ever be evacuated There seemeth yet nevertheless to be another way whereby the Blood poured forth into the Brain or about the Brain bringeth Death within a vâ—ry few daies if it cannot be evacuated For when as it is without the Vessels it beginneth to putrefie usually about the fifth day from whence feavers deliries and Convulsions are excited so that the man dieth in the same manner almost as one in a Phrensie That which is done by the Wounds of the brain the very same happeneth likewise from the spinal Marrow if it be indeed wholly cut assunder in the superior part thereof for then the motion of all the inferior parts and so of the Thorax likewise is abolished and the wounded persons are suffocated And unto one of these four waies I conceive that al kinds of Mortal Wounds may be referred And therefore if a Wound penetrate into any interior part of the Body so that thereupon the wounded person die within a short space of time we are then to Judg that that Wound was Mortal and if diligent inquiry be made I am of Opinion that it may be referred unto some one kind or other of these Mortal Wounds whether that Wound hurt the vital faculty it self immediatly or else hurt it by the intervening of some other Disease or Symptom For as Nicolaus Boetius writeth out of Felinus in his 323. Decision Numb 10. it is all one whether a Wounded man die of his Wound or of some infirmity caused by the same Which yet nevertheless is so to be understood if the Wound necessarily attract that Disease or that Symptom which is the Cause of Death But as for all the other Wounds whatsoever that cannot be referred unto some one of these manners I conceive that they cannot simply nor necessarily be accounted Mortal The which that it may be made the more plainly to appear we have it now in our purpose in special to weigh and discover unto you the Wounds of all parts that are to be accounted Mortal Now Hippocrates Judgeth the wounds of seven parts to be Mortal What Wounds accounted Mortal by Hippocrates whilest in his sixth Sect. Aphor. 18. he thus writeth Whosoever hath his Bladder out through or his Brain or his Heart or his Midriff or any of his smal Guts or his Stomack or his Liver that Wound is Mortal Which Aphorism notwithstanding in his Coaca or his Tract of Playsters Aphor. 509. he both Limiteth and Amplifieth when he thus saith From a Wound even Death it self may almost happen if any one be wounded in his Brain or in his spinal Marow or in his Liver or in his Midriff or in his Heart or in his Bladder or in any one of the greater Veins Death likewise soon followeth if any extraordinary great Blows be inflicted upon an Artery and upon the Lungs so that the Lungs being wounded the Breath that passeth out at the Mouth is less then that which issueth forth at the Wound But they suddenly perish whosoever they are that have received a Wound in the interior Nerves whether smal or g eat if the Blow or Wound be both Transverse and great but if the Wound be but smal and straight there are some that escape the danger But there is neither Death nor any great dangâ—r impending from those Wounds that are inflicted on those parts of the Body in the which there are none of these or which are as far distant at may be from these Indeed he limits the Aphorism whilest that he doth not simply write that such like wounds are altogether Mortal but almost and for the most part He amplifyeth it whilest that he addeth the spinal Marrow the greater and thicker Veins the rough Artery and the Lungs and the interior Nerves And therfore we wil in order consider the wounds of these parts For it is without doubt that the Wounds of the rest of the Parts are not at all of theâ—selves Morâ—al and this Hippocrates himself teacheth us in the above mentioned Aphorism 509. in Coacis Celsus in his 5. B. and 26. Chap. thus rendereth the foresaid Opinion of Hippocrates He cannot possibly be preserved that hath the Basis of his Brain his Heart his Stomack the parts of his Liver the Marrow in his Back-bone wounded or that person that hath either the middle of his Lungs or the Jejunum i. e. the hungry Gout or any of the smaller Guts or the Stomack or the Reins be
symptoms are sensibly diminished The Signs Prognostick 1. As for the Prognosticks of Tumors in general take this for an observation That in reference to the place aggrieved inward Tumors are alwaies accounted to be more dangerous than those which are external and as considered of themselves they have in them more or less danger of death according to the excellency and use of the part affected 2. By how much the greater the Tumor as likewise by how much the greater the intemperies or the distemper accompanying it is and by how much also the humor exciting the Tumor is more malignant and vitious with so much the greater danger and difficulty is the Cure thereof to be expected And on the other side look by how much the humor generating the Tumor is more mild and benign so much the less of danger is there in it and likewise so much the less of difficulty in the curing thereof But of all the sorts of Tumors those arising from a windiness are with the greatest facility remedied as being in a manner discussed and dissipated of its own accord 3. Al Tumors deriving their Pedigree from the humors Tumors arising from the humors how many waies terminated unless they make a retreat and then vanish either of their own accord or forced thereunto by Medicaments taken in for Natures assistance are usually terminated these four waies as Galen in his B. of an unequal temper informe us to wit either by dispersion which you may likewise cal discussion wrought by insensible transpiration or else secondly By suppuration when as the humor which causeth the swelling is converted into a purulent matter or else thirdly By corruption when as the constitution and the radical heat of the part affected is destroyed and wholly corrupted by the pravity and malignancy of the matter or else lastly By induration when the matter that gives being to the Tumor hath acquired an accidental and adventitious hardness Of Resolution an infallible sign is a lightness in the Member contrary to its former weight and heaviness and a cessation of the troublesome heating with which it was formerly disquieted The signs of a tumors resolution The Signs of a neer approaching suppuration are these The signs of the suppuration of a tumor viz. a pain and palpitation in the part together with a Feaver either now invading it or at least the increase of a Feaver already and formerly present according to that of Hippocrates in his second Book and forty seventh Aphorism While the peccant and crude matter is under concoction and until it arrive at a ripeness and maturation as we usually term it Feavers are alwaies present But so soon as the concoction of the crude or raw matter is compleated so that the filth and impostumated matter appear then the part becomes in a manner lighter than it was the heat abated diminished the pain asswaged and a part of the Tumor is eminently elevated and begins to grow sharp or sword-pointed and this sharp point forthwith becomes of a white colour and the part if touched with the Finger seems softer and the purulent matter sensibly appears to fluctuate and yeild unto the touch of the Hand Yet notwithstanding it oftentimes chanceth that the filth and corruption lies altogether hid and obscured so that it may not easily be discerned either by reason of the depth of the place or the thickness of the part as Hippocrates in his sixth Book Aphorism 41. doth rightly advertise us Signs of maturation which is nothing else but a ripening of crude or raw matter now nigh at hand Signs of corruption and induration are a blackness or a Leaden colour of the part affected A sign of Induration is a diminution of the Tumor but an augmentation of its hardness A sign of the Tumors retreating and decreasing is a sudden and unexpected lessening of the swelling which said diminution if it proceed from an internall cause is evermore evill unless the matter retiring be evacuated by a fit and convenient way Upon the going back of the matter immediately there follows a Feaver if there were none before or if there were any before it is now much augmented and other evil symptoms arise from the retention of the matter in the Body Now the best way of freeing the part of any Tumor that grieves and afflicts it is that which is performed by resolution and next unto this that which is wrought by suppuration but it is very il that Tumors or swellings should be hardened and it is far worse nay worst of all that the part it self should be corrupted The Cure The nature of a Tumor or swelling in it self simply considered i. e. as it is magnitude augmented affords no useful indication at all but it is taken from the Cause conteining for upon the removal of this forthwith the swelling vanisheth If there be a distemper accompanying it then for the better effecting the Cure it is expedient in Tumors that are hot that we use means to cool them if they be cold that we heat them if moist that by the help of Art we exsiccate and dry them and lastly if they be dry it is requisite that we should moisten them But then in this alteration of the parts their Nature Temper Action Use Figure Scituation and Sense al which prescribe the measure of alteration are carefully to be considered of which I have already treated at large elswhere in my Institutions the fifth Book second part second Section and first Chapter In the removal of the Cause we must heedfully look whether the Tumor be already compleated the Causes of a tumor how to be taken away and not like to receive any further increase or addition or otherwise whether it may not be further augmented For if the Tumor be already arrived at its perfection then there is no more required but that we look back unto the conteining Cause and then that we take the best course to remove it But if the Tumor be not already at the heigth but only in a tendency thereunto we must then also look back a little further unto the Antecedent Cause as likewise the Câ—uses more remote and those al of them we ought speedily to remove And this is especially to be done whenas the Tumor is generated from an afflux of humors For in this kind of Tumor the fluxion it self is to be opposed and if possible all its Câ—uses to be taken away Now the Fluxion may be totally removed if the flowing humor be either evacuated by drawing of Blood or by Purgation or if the course of the flowing humor be turned another way which is effected either by drawing it back unto the contrary parts or by intercepting the motion of the humors in their passages or by repulsing of them from the part affected or lastly by deriving of them unto the parts adjacent Now the Causes of a Fluxion are taken away A Fluxion how it may be taken away if we
of theirs since that those who are affected with the Elephantiasis are not made hereby ever a whit the greater unless haply we have respect not so much unto the greatness of the body in such as are thus affected as unto the greatness of the danger of death thereby threatned to wit that look as the Elephant is the greatest of al the four-footed Creatures even so among diseases this appeareth to be the greaâ—est and an Affect almost remediless and incurable touching which thing Macer in his Book of the virtues of Herbs and Chap. 15. speaketh unto the same purpose Or else this Malady is so called because that creeping along upon the Thighs it causeth them to become as are those of an Elephant rough and unequal or else because that among other Diseases this is exceeding vehement strong and violent like as is the Elephant or otherwise it is so called and this indeed seemeth to be the most true and genuine reason thereof because the members the skin of those that are affected with this Disease are rendered tumid and swoln scaly rough and rugged ful of swellings and unequal like unto the skin of Elephants Galen in his Book of Tumors Chap. 14. writeth that this Malady when it first beginneth is likewise called Satyriasmus in regard that the face of those that are afflicted with this Disease is rendered like unto the face of the said Satyres For the lips of such as are troubled with Elephantiasis are thereby made thick and the Nose swelleth and thereupon it seemeth as if it were pressed down the Ears become flaggy and much wasted the Jaw bones are colored as it were and overspread with a certain kind of redness and in the Forehead there appear here and there Tumors or Swellings like as if they were certain Horns although there be others indeed that think the Satyriasmus to be so called even for this very cause that in the beginning of this Malady the sick parties are extreamly libidinous and lustful like as are the said Satyres And yet notwithstanding Aetius in Tetrab 4. Serm. 1. Chap. 120. out of Archigenes rendereth another kind of reason of this resemblance and that indeed different from the former to wit because the Cheeks and face in such as are thus affected are lifted up together with a certain redness and the Chin it self is dilated upon the Convulsion as it were of the Muscles of the Jaws even as we see it likewise to befal those that laugh in a certain kind of likeness and resemblance unto the Pictures of Satyres which Coelius Rhodiginus in his 19. Book of the reading of Antiquâ—ties and Chap. 25. conceiveth to be â—o called from the Greek word Seserenai because that these Satyres sing and sport themselves with their mouths wide open and gaping and their lipâ— drawn forth like unto those that laugh A d there are some that give us a thâ—â—â— reâ—son and ground of this appellation to wit b cause thâ—â— those who are affected wiâ—h thiâ— Elephantiasis are like unto Satyres in their propension unto Venery and lustfulness It is likewise termed Leontiasis either in regard that this Malady is inviâ—â—ible like as the Lyon or else because as Aetius hath it in Tetrab 4. Serm. 1. Chap. 30. the forehead of the sick person is with a certain swelling rendered and made more loose after the resemblance of the flexile skin of the Lions Eye-brows or else because the breath and the very spiriâ—s of such as are affected with this Malady do even stink like unto the breathing of Lions and their very excrements also or else because those that are affected with this Disease have a most filthy and terrible face insomuch that like as do Lions they strike a terror into those that come suddenly and unawares to behold it This Malady is by our Physitians called the Malady of St. Lazarus because that such as are Elephantiack do so abound and are ful of Ulcers like as was that Lazarus the beggar of whom there is mention made in the Evangelical History Luke Chap. 16. Now this is a very sad and grieâ—ous Malady and as it were an Universal oâ— Cancer of the whol body whereupon it comprehendeth under it many more sorts and kinds oâ— Diseases For fi st of al there is present magnitude augmented and a â—â—â—lling up and down in the body especially in the external parts whose beauty feaâ—ure and 〈◊〉 likewise is hereupon corrupted there is likewise present a hot and dry distemper by which the parts are so exulcerated and corrupted that as length they fal off Celsus in his third Book and Chap. 25. thus describeth the whol Idea of this Malady The whol Body saith he is affected so that the very Bones likewise may in a manner be said to be vitiated and corrupted The highest and utmost parts of the body have in them both spots and swellings that stand thick and close one by the other The redness of these parts is by little and little converted into a black color The top of the skin is unequally both thick and thin hard and soft and is exasperated by certain scales the body waxeth lean the mouth the calves of the legs and the feet swel and are puffed up When the disease comes once to be old the fingers and toes are quite hidden under the swelling there ariseth also a light and gentle Feaver that easily consumeth and wasteth the sick person that is already overwhelmed with the aforesaid evils and mischiefs The Causes The containing cause is black Choler and this not without malignity diffused and spread abroad throughout the whol body Now we find touching the generating of this humor viz. black choler a long and tedious dispute among Authors and we find them holding divers and different Opinions In this the truth is they al agree that this humor is generated from the adustion and burning of other humors but then in this they differ viz. from the adustion of what humors this proceedeth Avicen in the third Section of his fourth Book Tract 3. Chap. 1. seemeth to have comprehended them all whiles he mentioneth five Species or kinds of this humor The first is that which proceedeth from the Blood the second that from the melancholly humor the third that which is from the adustion of bitter Choler the fourth that which ariseth from Flegm burnt the fift and last that that proceedeth from the thick and hot part as being very apt to be burnt of the Chyle as to Instance from all salt Flesh Fish and the like But although it cannot be denied that there is here in this case an adustion of humors present and that salt humors are the cause of this Malady yet notwithstanding since that there are very many other Tumors and Ulcers that have their original from adust humors here therefore the very specifical cause is altogether to be sought for which notwithstanding cannot easily be explained but it consisteth in an occult i. e. an hidden and secret Malignity But
is like unto the rest of the skin and the Tumor is soft and loose and for the most part giveth way and yieldeth unto the compression of the fingers the blood running back into the Artery from whence it instantly again floweth forth There is likewise a Pulse to be felt in an Aneurysma Although that Paraeus hath observed that somtimes in the Aneurysma if it be great there is neither any pulse to be perceived not any return of the blood upon the compression unto the more internal parts and this I also observed my self in a certain Woman but then notwithstanding there is to be perceived a motion and as it were the loud noise of boyling water and that not only when it is pressed down with the fingers but likewise at other times and this hissing or singing noise is not only to be perceived upon the touch of the fingers but also upon the putting of the Ear close thereto which proceedeth from the motion of the vital spirit in its passage through streight and narrow places All which signs proceed not from the effusion of the blood under the skin but from the dilatation of the Artery Prognosticks 1. Al Aneurysma's are very hard to cure 2. Yet notwithstanding those of them that are less and newly arisen wil admit of a Cure But such of them as are old and greater in regard that that blood cannot be driven back by Astringents neither may the Artery be consolidated and so they are no waies to be cured but by Section wil hardly admit of any cure at al. For the Tumor being opened and the Artery as it is necessary being cut the Arterial blood floweth forth together with the vital spirit abundantly al as it were at once and with great violence so that the sick person is oftentimes precipitated into extream hazard and danger of death And there are many remarkable instances that might be given of such sick persons as in the opening of the Aneurysma have died under the hands of unskilful Chirurgeons 3. Neither hath the Tumor that is joyned with an Aneurysma any great danger in it but that the life may together with it be lengthened out for a long time I knew a certain neer Neighbor of mine in whom an unskilful Chirurgeon when he should have opened a Vein cut an Artery and it is now already above thirty yeers that she hath had an Aneurysma as big as a Walnut in the inward bending of the Arm and al this while hitherunto she hath enjoyed and stil even at present doth perfect health as if she ailed nothing at al. And therefore we conclude that better it is somtimes for the Patient to bear and undergo this sleight inconvenience than to submit himself unto a dangerous Cure The Cure And therefore forthwith even in the very first rise of it so soon as ever we perceive that there is an Aneurysma excited for it is not suddenly done but that dilatation of the exterior Tunicle of the Artery is caused sensibly and by degrees let Astringents and Repellers be imposed upon the place affected that so the force of the blood may be abated and qualified and the open hole of the Artery may be shut up For which end and purpose there may likewise very fitly be administred a thin Leaden plate which doth repel thicken and bind close together the loosened Artery There may also be administred astringent Cataplasms and the Emplaster against a Rupture And because that the Aneurysma somtimes also ariseth from the cutting of an Artery we must do out endeavor that if an Artery be cut whether it be purposely done or whether it happeneth by any ill accident that it may immediately shut and close up again and that may right manner which in regard that it is not here so easily effected because of the violent and impetuous motion of the Artereal blood as it is in the Veins therefore we prescribe the following Medicament as very fit and proper for the Consolidating of the Wound of the Artery Take of Frankincense two parts of Aloes one part and an half Mingle them and having shaken them wel together with the white of an Egg tye up all with the Flâ—x of a Hare as much as wil suffice and let them be laid upon the Wound of the Artery And of this kind there are divers other Medicaments to be prepared of the Roots of the greater Comfry Mustick Frankincense Pomegranate Rinds Acacia or binding Bean-tree Hypocistis or the hardened juyce of Cystus Myrtle Gals Aloes sealed Earth of Lemnos Bole-armenick Lapis Hemarites or the Blood-stone and the Emplaster Diachalcitis If in this manner and by these means the growth and encrease of the Aneurysma cannot be hindered there are indeed some that advise and perswade us unto Section and the Tumor being opened the Artery that is to be cut must be intercepted by binding it about with two bands and then it must be dissected between the two bonds and these bonds as they teach us are not to be loosened until that Nature hath covered over the wound with fleshâ— and that now al the fear of the bloods issuing forth and al the danger of an Hemorrhage be past and gone Now as for the manner of cutting the Aneurysma Aegineta acquaints us with it in his sixth Book of Physick Chap. 37. in these words If the Tumor saith he be caused by opening then we use to inflict upon the skin a straight Section made longwaies and then after this the lips of the skin being parted and far sundred by little hooks we make bare the Artery severing it from its Membranes by Instruments very fit for this purpose and then after the transmission of a Needle under it we tie it with two threds and then so soon as we have pricked with a Pen-knife the middle part of the Artery and have evacuated what was therein contained we then betake our self unto the suppurative cure until at length the ties of the threds fal off But now if the dilatation be caused from the rupture of an Artery then it behoveth us as far forth as possibly we can to lay hold upon the whol with our fingers together with the skin then to cast through it beneath that we have laid hold on with the fingers a Needle that may if you please have in it two threds or rather one thred doubled and after the casting through of the Needle and thred we are then to cut in two the every bandle as I may so cal it of the double thred and so to bind about the Tumor on this side and on that with the two threds But if there be any cause to fear lest these threds should slip and fail then in this case there is likewise another Needle to be cast through that may throughout lie and press upon the former and this Needle may likewise draw after it two threds or a double thred and the handle thereof being cut in sunder we then bind about the Tumor with four
threds or else the Tumor being opened about the midst of it after the emptying forth of what is therein contained we cut off the skin that being left remaining that was tied about and then a long spleen-like Plaister wel moistened in Wine and Oyl being laid thereon we conclude and perfect the Cure by Liniments But who is he that seeth not that this kind of Cure is not only cruel and so cruel that few or none wil submit unto it but that it hath likewise much danger in it and yet for al that doth not heal the sick person For although the Artery be bound about yet notwithstanding after the threds are loosened there is cause to fear lest that either an Haemorrhage follow or else that a new Aneurysma be caused And therefore the more secure and safe course is only to bind hard and press together the Tumor with Bands and Medicaments that so it may not gain any further augmentation Chap. 44. Of the swoln Veins caled Varices VArix with the Greeks Kirsos this being the name given unto it by the Greek Physians only for we find Aristotle in the third Book of his History of living Creatures Chap. 11. and 19. and Plutarch in the Life of Caius calling it Ixia as Galen in his tenth Book of the Method of Physick and last Chap. defineth it and as out of him Paulus Aegineta hath transcribed it in his sixth Book Chap. 82. and Aetius Tetrab 4. Serm. 2. Chap. 48 is the dilatation of a Vein this said dilatation of a Vein being called Varix as that before mentioned dilatation of an Artery was termed by the Greek Physitians Aneurysma of which in the foregoing Chapter But now these Varices happen in divers parts of the body but most frequently in the Thighs and yet notwithstanding somtimes likewise in the Temples as Paulus telleth us in the place before alleadged and somtimes in the lowest part of the Belly under the Navel and oftentimes also about the Testicles and the Cods which said Tumor is in special called Kirsocele The Causes They are generated from great store of Melancholly blood which as Galen writeth in his Book of black Choler Chap. 4. Nature oftentimes transmitteth unto those Veins that are in the Thighs by the which being distended and dilated they are rendred Varicose or swoln up and the skin that toucheth upon these kind of Veins in process of time becometh of a blackish color But now as for such in whom there is only great store of blood flowing in that is not Melancholy it resting indeed and wholly relying upon those Veins which there in that place are naturally more weak than elswhere doth dilate them but scarcely even dye them of such a like color as it happeneth when Melancholy blood shal produce these Varices For such are in very great danger if any one assay to cut forth the Veins affected of being surprised with Melancholly For this is frequently seen to happen not only in Varices but even in the Haemorrhoids also that consist of the same kind of humor even as the coming of them upon those that are mad is wont to be a freeing and discharging of them from their madness as Hippocrat in the sixth of his Aphorisms Aphor. 21. And yet notwithstanding scarcely ever doth good blood though it abound never so much by its great plenty alone produce and cause Varices as it doth if it be both plentiful and withall if it be thick which by its weight tendeth downward unto the Thight Whereupon it is also that the Varices have not their being until the ripeness of age as Hippocrates in Coac praenot toward the end teacheth us in regard that a thick and melancholly blood is not generated sooner in the Body And likewise Pliny in his eleventh Book and Chap. 45. writeth that the Varices happen in the Thighs of Men only and very rarely in Women Such likewise as are bald in these the Varices become not great but for such as while their baldness is upon them are afflicted with these Varices these come again to receive their Hair Hippocrat in the sixth of his Aphorisms Aphor. 34. Which yet notwithstanding Galen asserteth to be a falshood in his Comment unless haply any one wil understand this of that affect that Physitians call Madarosis that is the shedding or falling off of the Hair For this Affect since that it hath its original from vitious humors as likewise the Alopecia hath and also that we call Ophiasis if those very depraved humors being translated into the Thighs do cause the Varices the sick Persons may then possibly recover and receive their Hair again For if at the first the loss of the Hair proceeded from vitious humors their corrupting and corroding the very roots of the Hair then questionless these said humors taking now their course into some other place the Hairs will again return unto their naturall State The more remote Causes all those that make for then generating and breeding of thick and melancholly blood and especially the Spleen when it is distempered maketh much unto and helpeth forward the generation of these Varices And that likewise which much furthereth the flowing of the aforesaid humors unto this part may be comprised under on of these Heads to wit either a blow or streining overmuch long and tedious foot journeys extream hard labor and the like Signs Diagostick These Varices are easily known whenas swelling Veins is the very superficies of the Members and especially of the Thighs appear unto the very sight it self and the part affected appeareth either Leaden coloured or black and the Tumor being pressed down seemingly retreateth back but forthwith returneth again Prognosticks 1. These Varices of themselves carry little or no danger in them neither bring they any unto the Party thus affected but they rather preserve and free such as have them from other Diseases especially Melancholly Diseases touching which Hippoc. in the sixth of his Aphorisms Aphor. 21. thus writeth If Varices or the Haemorrhoids happen unto such as are mad they are thereby freed of their madness and the whole Body is by them throughly purged from all flatulent Blood 2. But if they be unseasonably taken away as Galen in his Book of Venesection against Erisistratus and Chap. 6. and in his Book of black Choler and Chap. 4. teacheth us Madness the Pleurisie the pain of the Reins the Haemorrhoid Flux the Cough and spitting of Blood the Apoplexy Cachexy Dropsie and other Diseases arise 3. Sometimes these Varices do pass into the Elephantia of the Arabians touching which we shal speak further in the next following Chapter The Cure Unless therefore the Varices be of the biggest size and that the Veins and the Skin by reason of their extension be so extenuated that there be great cause to fear a Rupture a profusion of blood and Death it self and again unless they be inflamed and extreamly painful or that there be present some great and
destruction of the innate and natural heat as on the contrary the life of the part dependeth upon the preservation and safety of the said Native heat we conclude that whatsoever destroyeth the Native heat of the part that same may likewise be accounted a cause of the Gangrene and Sphacelus Now the Native heat is destroyed when by its contrary it is either corrupted or suffocated or dissipated or altogether extinguished for want of Aliment It is destroyed by its contrary either acting by a manifest quality and cold or else by a secret and hidden quality as by poyson It is suffocated when the transpiration it hindered It is dissipated by a greater heat It is extinguished if necessary food and sustenance be denied so that there are as you see five causes of the Generation of a Gangrene and Sphacelus to wit overmuch cold a poysonous quality the hinderance of transpiration a vehement external heat and a defect of Aliment and the heat flowing in For first of al we see that oftentimes in the Winter those that take Journeys in the Snow and Ice have the extream parts of their feet and of their hands their Ears and their nostrils almost dead with cold by reason of the vehemency thereof and thus it happeneth somtimes also that by reason of Medicaments over cooling in a Phlegmone or an Erysipelas carelessly and incauteously administred the part is taken and surprised with a Gangrene or a Sphacelus although I had rather refer this case unto transpiration hindered There is also a very great power of destroying the innate heat in those things that are poysonous and such things as destroy our Bodies by a secret and hidden quality For somtimes the humors in our bodies do so degenerate and acquire so great a malignity that they bring a Necrosis or deadness unto those parts whither they are by Nature thrust as we see it done in a Carbuncle And so in like manner the biting and stingings of poysonful Creatures do corrupt and putrefie the parts And the same also is done by the Septick Medicaments which if they be not wisely and carefully administred have in them a power of corrupting the flesh especially in places that are hot and moist as in the Emunctories the privy parts and the other places that are like unto these Thirdly Transpiration hindered exciteth likewise a Gangrene For whereas our heat standeth in need of perpetual ventilation and cooling if this be denied it is suffocated by the abundance of Vapors And for this very cause in great Inflammations and especially in the moist parts there very frequently happeneth a Gangrene the Native heat being extinguished as otherwise likewise we see that a little flame is extinguished and put out by casting thereon good store of water and that the flame is stifled if it be put under a Cupping-glass that hath no hole or vent in it or any other Vessel whatsoever that is kept covered which is preserved in a Cupping-glass that is perforated or any other Vessel that is open And this chiefly happeneth if in Feavers especially if they be malignant the humor be with violence either thrust forth or that of their own accord they rush unto any one part And so I remember that here a certain Citizen that was taken with a malignant Feaver from the humors that were thrust down unto the Scrotum had the said Scrotum al of it so inflamed and mortified with a Sphacelus that there was a necessity of cutting off the whol Scrotum or Cods so that the stones hung down altogether naked and bare which yet notwithstanding the Gangrene being cured became afterwards covered again with flesh that grew out of the Groyns That Inflammation likewise which the Gangrene followeth is sometimes caused by Wounds and these not alwaies great but oftentimes also very smal and sleight Wounds that seem inconsiderable and of no moment So Henricus ab Heer relateth in the first Book of his rare Physical Observations Obser 12. That he was present and saw a man fifty nine yeers of Age who having pared the Nails of his Toes and cut them to the quick was presently surprized with a Gangrene and within a very short space died thereof And he telleth us likewise of two other eminent persons who being desirous to have the hard and callous brawniness of their feet pared away were both of them taken with a Gangrene that within a short time caused their deaths And this may likewise be done by Emplastick Medicaments in great Inflammations and especially if they be unseasonably applied in moist places which frequently produce there a suffocation of the Native heat Fourthly A preternatural heat likewise and such as is extraneous and from without produceth the Gangrene by wasting the Radical moisture and the Native heat and so many times a Gangrene followeth after great burnings And lastly A Gangrene ariseth from the defect of Aliment to wit the blood and the spirit flowing in that is altogether necessary and requisite for the cherishing of the Natural heat implanted within For whereas the innate heat standeth in need of continual Nutriment as the flame doth of Oyl if this be denied it languisheth and is extinguished like as is the flame when the Oyl in the Lamp faileth And in this manner a Gangrene happeneth unto the external parts of the body somtimes in an Atrophy Consumption and the like Chronical and long continued Diseases that extenuate the body And for this very cause it is that when the greater Joynts are put out of Joynt if they be not again wel and rightly set then the disjoynted bone presseth together the vessels that lie neer and hindereth the influx of the blood and of the Spirits into those parts that lie underneath from whence there followeth a leanness and consumption of the said parts and in process of time very frequently a Gangrene also And so it is found by experience that from a hard Tumor about the Vena Cava where parting several waies it descendeth into the Thighs pressing the same together and hindering the descent of the blood into the Thigh a Gangrene very often ariseth And in this manner a Gangrene likewise happeneth if any part be too hard and long bound about with Ligatures and bands or else if Medicaments that are over astringent shal be imposed upon any part Signs Diagnostick It is no hard matter to know the Gangrene For the color of the part beginneth to be changed and turned unto black the flesh to grow loose and flaggy the pulse and sense to be diminished and the heat to be abolished Which said Symptoms the more the Gangrene tendeth unto a perfect corruption and a Sphacelus by so much the more are they increased and made more evident For in a perfect and absolute corruption and Sphacelus the life and sense of the part are wholly abolished there is no pulse at al to be perceived the part whether you cut or burn it is insensible of pain the flesh appeareth to be
and the Skin it self For albeit while the place of the Itch be scratched there is perceived a certain seeming pleasure yet nevertheless this pleasure doth not belong to the Nature of the Itch but it followeth only upon the scratching whilst that the parts that were gnawn by a sharp matter do suddenly return unto their natural state and their wonted smoothness For like as there is a pain excited from that sudden motion unto a preternatural state so in like manner there is a certain pleasure felt from this sudden motion and return unto their Natural state Now the truth is the Itch it self ceaseth after scratching because that the matter which was the cause of the Itching is evacuated and because also that the solution of Continuity that exciteth the pain is again brought unto an Union and quietness if the scratching be any thing strong The Causes The neerest cause of the Itch is a salt Excrement that is biting and sharp to wit either meer pure Choler or else black Choler commonly called Melancholy or else a salt flegm Which excrement albeit that it be present also in the scabby Affect yet in the Itch it is more thin and insinuateth it self through the least particles But it sticks between the true skin and the scarf-skin and thereupon by its acrimony it goadeth as I may so say and pricketh the sensible particles in the skin and provoketh them unto scratching And indeed like as the Nature of the excremens it self maketh much for the sticking of the said Excrement in the Skin this Excrement although it be thin yet having in it a certain kind of clamminess and glewishness by the which it sticketh very close and pertinaciously unto the parts so doth likewise the thickness of the skin it self by reason of which it cannot exhale But now that excrement is collected by reason of the heat and driness of the Liver the use of sharp meats and many Spices And hence it is that old men those especially of them that in their youth had a hot Liver and such of them as then used a hot kind of Diet in their meat and drink are in their old age so sensible of the Itch and at length come to be troubled with scabbiness See further hereof in Galen his second Book of the Causes of Symptoms and the sixth Chapter The Differences Now according to the variety of the humor and the nature of the places affected there is a certain difference likewise of the Itch. For look how the matter is more or less sharp so the Itch that is excited is more or less contumacious and troublesom And somtimes there is felt an itching in the skin of the whol body and somtimes in some parts only Prognosticks 1. The Itch is for the most part the forerunner of Scabbiness shortly to follow For if the Itch be of any long continuance there is then at the length collected a greater abundance of the matter and this receiving a putridness is rendered more sharp and it corrodeth the Scarf-kin and exciteth Pustules 2. By how much the worse the humor is that exciteth the Itch by so much the worse is the malady also To wit the Itch that is excited from burnt blood or Choler is sooner ended and gone but that which proceedeth from salt slegm lasteth longer and longest of al that which hath its original from burnt Melancholy 3. The Itch in which there is great pleasure taken in the scratching thereof is evil because that it ariseth from a sharp Choler 4. The Itch in old people is seldom cured especially in those that are decrepit For since that old age is fit for the treasuring up of these salt humors that disposition of the body is hardly changed and brought unto a better state And yet notwithstanding if diligence and care be shewn it is somtimes healed And Mercurialis in his Tract of the Diseases of the skin Chap. 3. relateth that Leonellus Pius a man fourscore yeers old was freed from an extraordinary great Itch by the benefit of Medicaments 5. Hippocrates in Coacis writeth that the Itch in those that have Consumptions if it succeed the suppression and binding of the Belly is not only dangerous but deadly For by reason of the trouble and disquiet of the Itch those in Consumptions can neither sleep nor take any restr whereupon there is little or no Conconction and therefore they have their death hastened upon them The Cure The Itch seeing that it is a pain if it be extraordinary great and vehement and cause watchfulness thereby decaying the strength sheweth that mitigation by Anodynes is to be procured but the Cause that it dependeth upon calleth for evacuation And indeed the next Cause since that it is a sals humor sticking in the Skin this is likewise to be evacuated from the Skin And in regard that this said next cause is nourished by a like humor contained in the Veins therefore this is likewise to be evacuated And because that this humor is generated from a distemper and vitious disposition of the Bowels it is therefore to be anointed and so the generating of such like humors is to be prevented Those Moisteners take away the Itch that mitigate the sharp matter that is the Cause of the Itch. Now those things that evacuate these excrementitious humors from the Skin are those Medicaments that Cleanse Mollifie and make thin Purgers take away the Antecedent Cause Alterers amend the vitious disposition of the Bowels but more especially a good course of Dier And therfore in the first place the Salt Nitrous and sharp humor is to be prepared and evacuated The humor is prepared by such Medicaments as have in them a power of Cooling and Moistening and such as withall attenuate the Thick Clammy humor such as are Succoâ—y Endive Borrage Bugloss Fumitory Hope Maidenhair Asparagus Roots Polypody Mother of Time and Syrups made out of these and more especially that oâ— Hops Fumitory Succory the Byzantine Syrup and the Syrup of Maidenhair Now the Humors are evacuated by the Leaves of Sene Polypody black Hellebor Jalap the compound Syrup of Polypody the Electuary Dracatholicon Confection of Hamech Extract of black Hellebor the Melanagoge Excract The forms oâ— these are elsewhere propounded and so they are also in the Chapter of the Scabs And sometimes also Venesection if the Age and strength wil bear it is to be instituted and because that it often falleth out that either the Haemorrhoids or the Courses suppressed and kept it may afford matter and occasion unto this Evil it wil therefore not be amiss to provoke and draw forth these Haemorrhoids or Courses But for the tempering and allaying the heat of these Adust humors as also of the Bowels themselves there is nothing that doth it sooner then the Whey of Goats Milk which may be given from one pint to three But it wil be better for use if there be added some Juyce or Syrup of Fumitory But that which more especially correcteth the
is that these Medicaments that even now we named and those that we shal hereafter further mention do not al of them generate hairs only by their manifest qualities and by taking away the Causes of the falling off of the hair but that they likewise produce hair by some occult quality that is in them such like Medicaments are therefore especially to take place in the production of a Beard not where there hath been a shedding or falling off of the hairs of the Beard but where they never as yet grew It is also wel known that it much conduceth unto the speedy growing of the Beard if the first soft hairy down upon the Chin be often shaved off by which means the Aliment is the more abundantly allured and drawn unto the Roots of the hair For the furthering and hastening of the Beard these following Medicaments are likewise commended Take Oyl of Dill Oyl of Spike of each five ounces the tender Sprigs of Southernwood two handfuls Squils three drams the best Wine three ounces let them boyl until the Wine be consumed and then use it Or Take Oyl of Garden Pinks and sweet smelling Spike of each three ounces Oyl of Roses four ounces of Cloves one dram of Ladanum two drams sweet smelling Wine two ounces Let them boyl al of them unto the consumption of the Wine Add of Musk one scruple and mingle them Chap. 3. Of the shedding of the Hair ALthough as we have already said al shedding of the Hair may be termed a Defluvium or falling off yet nevertheless use and custom have so far prevailed that the shedding of the Hair here and there in the Head in al or most parts thereof is in special termed a Defluvium or falling of the Hair so that they fal not only in one place but either they al fal off throughout the whol head or at least they most of them fal away in most parts of the Head The Causes There is not one Cause alone of this Defluvium of the Hair but the Causes are many to wit Either the want of Aliment or the pravity of the humors corroding the roots of the hair or the thinness of the skin not admitting the aliment of the hair The two former Causes have their place in those that are Phthifical in whom if the hair fal off this cometh to pass as Galen tels us in his Comment Aphotism 10. Sect. 5. because there is here both the greatest defect of Aliment and somtimes also the corruption of the humors The same happeneth for the most part in malignant Feavers such especially of them in which the Brain being withal affected the sick persons are seized on by a Delirye or Dotage For even in these Feavers also the sick parties are greatly extenuated and there is wanting unto the body a necessary aliment and the depraved humors likewise lie gnawing at the roots of the hair and eat them asunder The hair also falleth off in those that have the French Disease by reason of the pravity of the humors which somtimes happeneth likewise unto those that have drunk poyson and it is reported for a truth That whosoever toucheth the Salamander his hairs wil shed and fal away Bun somtimes also the hair fals off by reason of the thinness of the skin and this happeneth unto Women and especially in the Summer time And hence it is that those who travel out of Germany into Italy or other hot Regions find now and then this shedding of their hair for by the heat of the Ambient Air the Skin is made thin and it chanceth also that the matter out of which the hair ought to be generated doth withal transpire Signs Diagnostick The Defluvium or falling of the hair that is in special so called is easily known by the continual shedding of the hair But it is distinguished from baldness the Alopecia and Ophiasis because that in Baldness the hair fals off in the fore part of the head only but in Alopecia and Ophiasis the hair fals from al parts of the head and the head alone but then in this Defluvium the Affect we now speak of the hairs fal off in al parts of the body equally one while more and another while fewer of them But from what cause it is that they fal off may be known from the causes that went before For if there went before any sickness that was in it self apt to consume the aliment of the Body it is then credible that the shedding of the hair proceedeth from the scarcity of the Aliment But if vitious malignant and depraved humors excite and cause any disease it is then an argument that the falling of the hair proceedeth likewise from the pravity of the humors If lastly there went before causes rarefying the skin it is then probable that the said Defluvium of the hair proceedeth from the thinness of the Skin Prognosticks 1. Among al other the species of the shedding of the hair this Defluvium in special so called is most easily cured unless the cause be such as is not to be removed For the skin hath not as yet contracted any preternatural disposition that is difficultly cured And therefore it is that the Defluvium or falling of the hair that happeneth after acure and malignant Feavers is easily cured when the Feaver being healed there is an Aliment again supplied unto the body and the hair that is already fallen off is for the most part restored without the use of any Medicaments 2. But in the Consumption such a defect of the Aliment and such a vice of the humors cannot by any means be amended And therefore in this case there is not only no cure to be had for this shedding of the hair but the sick persons die also And therefore in such as are in Consumptions the falling of the hair is a sure and certain sign of Death approaching as in the fiftth of the Aphorisms Aphor. 11. 3. If the hair fal off by reason of the skins thinness it may then by the use of thickness be restored without any great difficulty The Cure The shedding of the hair is cured by taking away the cause upon which if dependeth If therefore the hairs fal away from the scarcity and want of Aliment it sheweth us that we must use our endeavor that there may be sufficient aliment bred in the body and that that which is bred may be drawn unto the skin of the head If this Defluvium be from the depraved humors and these be supplied from al parts of the body they are then to be evacuated but if they lie only at the roots of the hair they are then to be discussed If these humors be of a poysonous Nature as in the French Disease we ought then to meet with and oppose that poyson If the Affect proceed from the thinness of the skin the skin is then to be thickened If therefore this Defluvium or falling of the hair arise from the want of Aliment we ought then especially to
ceased and his strength by degrees returned there being no purulent spittle at all that offered to come forth his Cough likewise and difficult breathing were not very urgent and troublesom neither for the first Week did any heat and thirst very much affect the sick person in the interim the wounds being handled after the Vsual manner there daily flowed forth an indifferent Quantity of well concocted pus or purulent matter These means being continued unto the second month and the External wounds being purified and consolidated the sick person was suddenly taken with a most dangerous suffocation so that he was in great peril of being strangled by an Asthma as it were and he was likewise very much afflicted with a cough Atrophy and Hectick Feaver until at length the imposthume of the Lungs brake and with the Cough five or six pints of purulent matter were cast up at his mouth after which the exulceration of the Lungs being cured by fit and proper Remedies the consumption Fever Hectick and all the rest of the symptoms remitted and the Patient was restored unto his perfect health To wit those Wounds of the Lungs are not mortal in which only the substance of the Lungs is hurt and not the great vessels and such as are not so great that they abolish respiration or suddenly destroy the vital faculty either by their dislipating the sprits through some notable Hemorrhage or else suffocating the heart by pouring out the blood upon the Lungs and upon the heart On the contrary if the wound of the Lungs be great and that not only the substance of the Lungs but likewise the great vessels that are therein to wit those notable and observable branches of the Arterial vein and the veiny Artery be wounded those wounds are mortal being such as in which the blood and vital spirit is poured forth and dissipated or else through the overgreat abundance of the blood the Lungs and heart are oppressed and the Patient suffocated Hippocrates in the place alleadged in Coacis addeth yet another cause of death which yet nevertheless doth not bring so sudden a destruction unto any person as those in the former case even now mentioned where the wound being great it is not the vessels containing the blood that are indeed hurt but the great and rough Artery so that by reason of the largness of the wound there is more breath that goeth forth by the wound then by the mouth for then by reason of the sympathy the heart is affected the vital spirits dissipated the Lungs and heart by the ambient Air altered and offended And indeed those wounds of the Lungs bring death likewise in which either the substance of the Lungs beginneth to be exulcerated and that a Consumption is excited or in which the blood is poured forth into the Cavity of the Thorax where it beginneth to putrefy and where it causeth either a feaver or an Empyema But in regard that this doth not alwaies happen and not at al in some wounds of the Lungs and that likewise when it doth happen there is no necessity that the Patient die for this cause therefore those wounds of the Lungs are not to be accounted necessarily Mortal For Felix Platerus in his 3. B. of Obsrv Page 690. relateth that a certain person that he knew falling into a Consumption from a Wound of the Lungs was yet nevertheless Cured and perfectly recovered A certain Coffermaker sayth he one of our Citizens having from a servant of his received a wound very deep in the lowest part of the Thorax by a prick from the point of a knife by the wound he voided forth a most stinking and loathsom pus or matter by the ill savor whereof the whol neighborhood was infected and offended and likewise some certain smal parcells of his Lungs in which the cartilaginous branches of the rough Artery did manifestly appear which persevering a long time albeit that he was in a manner wholly wasted away yet nevertheless at the length the flowing forth of the purulent matter remitting the wound was closed and he restored unto perfect soundness living after this many years as a foot-post in carrying of letters and thus he prolonged his life for forty years safe and found as we say although as it is very probable he wanted great part of his Lungs in one side The wounds of the rough Artery Fifthly That the wounds of the great rough Artery commonly called Aspera Arteria are not mortal but that they may be cured even the Laryngotomy or Cutting of the Laryinx of which we have spoken before in the Second Book of our Pract Part. 1. Chap. 24. doth evidently demonstrate To wit those of them are cured that are not great and in which the membranes only by which the rings of the rough Artery are fastened and linked together are wounded examples of which Schenkius in the Second Book Of his Observat hath collected And I my self also have twice seen such like wounds cured But if those very cartilaginous rings be wounded by reason of their hardness the part cannot again be made to grow together as formerly as Hippocrates teacheth us in the sixth of his Aphorisms Aph. 19. And in the seventh of his Aphorisms Aph. 28. and Galen in Book 5. of his method of Physick Chapt. 7. And yet notwithstanding such like Wounds do not cause a sudden death but a flow and lingering one while that the Lungs are either altered and weakned by that Air that violently breaketh in upon the Lungs thorow the wound or else that a certain smal gobbet of flesh grow unto the wound which by intercepting the breath at the length choaketh the Person But those wounds alone of the rough Artery throttle the Party in which the jugular veins and Arteries being hurt the blood violently and al at once rusheth into the Lungs intercepteth the breathing and so suffocateth the wounded person which yet nevertheless happeneth not by reason of the wound of the said rough Artery but by reason of the wound of the Jugular vein or the soporal i. e. more plainly the sleep-conveying Artery that is very neer unto it Wounds of the Diaphragm Sixthly Hippocrates reckoneth up the Wounds of the Diaphragm among those wounds that are mortal But Galen in his Book 5. of the Method of Physick Chapt. 9. distinguisheth between those wounds of the diaphragm that are inflicted upon the nervous part therof those that are made in its fleshy part and those he wil have to be mortal but these latter Curable And yet nevertheless in the Sixth of the Aphorism Aph. 18. he writeth that the wounds of the nervous part of the Diaphragm are not alwaies mortal but that the great wounds therein are only so For then it is indeed that those grievous symptoms plainly appear viz. a deliry or stupid dotage difficult breathing Feavers Convulsions and as Aristotle hath likewise observed in his third Book of the parts of living Creatures and tenth Chapt. the
perfectly Cured albeit that the wounded person die not thereof but a Callousness being brought over it the Pipe still remaineth by which the Urine is voided forth But yet nevertheless it is not long that a man can continue to live with such a like wound and therefore we say here again as we said also before that there is a difference to be made between a wound Mortal and a wound incurable But yet notwithstanding touching al the Wounds of the bowels hitherto mentioned this is to be observed that albeit there have been observed some examples of such like wounds that have been Cured yet that this hath happened very rarely and that among these those are to be numbered touching which Averrhoes saith that in the Cure of Diseases there are somtimes Miracles wrought For when fit and proper Medicaments cannot be applied unto internal wounds but that the whole work must be committed unto Nature if in this Case Nature be not very strong and Vigorous the wounded person is very hardly Cured but for the most part an inflammation Convulsions Faintings and Swoundings and other the like Symptoms supervening the party dieth And therefore Hippocrates saith rightly in the sixth of his Aphorism Aphor. 18. that such wounds are Mortal and in his Coaca that most commonly and for the most part men die of such Wounds And therefore if upon the receiving of such a wound the sick person die within a short time after the Cause of his Death ought to be imputed unto the Wound since that much help is not to be hoped for from the Physitian as we shal also anon shew you And Lastly Hippocrates reckoneth up the Wounds of the greater Veins among those that are Mortal Wounds of the great Veins and indeed rightly But now by the word Phlebae he understandeth both the Veins and Arteries and by Pacheis he meaneth great and lying hid within which elsewhere he termeth Aimorrhous that is to say pouring forth Blood such as are the great hollow Vein and the great Artery and the great branches of these For such veins and arteries seeing that they cannot be shut close by any ligature whatsoever the blood and the spirits plentifully flowing forth of them the strength and powers of the Body are soon dejected or else the blood that is fallen forth without its own proper Vessels if it hath no passage forth but that it be still deteined in the Body it Clotteth together and putrefieth and getteth unto it self a very evil corrupt and Malignant Nature causeth a Gangreen and exciteth most grievous Symptoms and at length bringeth even death it self upon the party And indeed this danger is most grievous and formidable in the Arteries when the Blood and vital spirits being poured forth the powers of the Body are dejected and the mans life endangered neither can the Arteries be easily brought to close by Reason of their continual motion and hard substance And these are the Wounds that as Hippocrates rightly saith are Mortal Of which notwithstanding as I told you before some are simply or altogether Mortal which Prosper Farinaceus Tit. de Homicidis Quest 125. Part 3. defineth that they are such that require not the Care and advice of Physitians but are such of which the Wounded person dyeth that is by Reason of which although they be Cured by all the Art and industry of the most skilful Physician yet nevertheless the Wounded person instantly dieth thereof And others of them are not altogether Mortal and certain in their causing of death which the same Prosper Farinacius defineth to be such of which the Wounded party dieth not suddenly and of which somtimes he dieth not at all But what Wounds of the latter sort are Mortal that is of which although some are now and then cured and recover their perfect health and strength yet nevertheless this or that particular person may truly be said to have died of them will indeed plainly appear from what we said before touching the Mortal Wounds of each single and particular part And yet nevertheless this is likewise to be added that we are especially to Judg by the Event whether any such Wound be actually Mortal or not For although some strong and lusty Boor or a Man otherwise exactly found and healthful shall recover of some such wound yet Nevertheless it will not necessarily follow that therefore an old person a Child a Woman or any other that is but of a weak constitution must recover of the like wound but albeit the former of these was cured of the like wound yet this latter may necessarily die of the same But now whether or no such dangerous Wounds be Mortal in this or that particular person Nicolaus Boerius in his 323. Decision Num. 11. teacheth us how we may discover it by fix Conjectures The first whereof is the shortness of the time to wit if the sick person die very suddenly after the Wound of which space of time albeit there be very many opinions touching it yet notwithstanding he saith that the principal is this if the wounded person shall die within three daies after the wound received But yet however there are some that extend this space of time unto the fifth or even also unto the eighth day But others notwithstanding extend this term even unto the eighth month or a whole year and this seemeth unto me most probable And unto this space of time the Mosaical Law Exod. Chap. 21. seemeth to have respect The Second Conjecture is the persevering of the vomiting and feaver and other Symptoms that from the very first signifyed and threatened death And this is a right Conjecture and according to the Opinion of all Physicians yea even of Galen and Hippocrates himself For those great and mortal Wounds have their Decretory and Critical daies like as Acute Diseases have as Hippocrates tels us 2 Prorrhet in the which good or evil Symptoms are wont to happen And therefore if grievous Symptoms such as are Convulsions Vomitings sobbings Dotages Syncopes and the like which otherwhiles also are wont to presage Death in such as are wounded presently and even from the very first invade the wounded person or else appear upon him on the Critical day and after continually persevere they then signifie that they were necessarily brought upon the Party by the Wound and therefore that the Wound is altogether mortal The third Conjecture is the breadth and depth of the Wound For a Wound that is very great and dangerous in it self may yet although it be great yet not be dangerous if by it no Noble part be hurt The fourth Conjecture is the quality of the instrument with which the Wound is given and by which the person inflicting the Wound is convinced that he had a will and purpose to kil the party Wounded But this conjecture concerneth rather the Court of Justice then the Colledg of Physitians who inquire not so much after the will and intention of the person wounding as simply and
solely after the quality of the Wound it self The fifth and sixth is the Continual pain from whence the Convulsion is brought upon the wounded person But these conjectures belong unto the Second And thus whether or no any one die of a dangerous Wound and of that kind of them which almost alwaies are Mortal the Physitian out of those six aforesaid Conjectures maketh use of two of them especially whereby he Concludeth that that wound touching which the inquiry is made was in it self Mortal and deadly First from the shortness of the time that the wounded party lived after his Wound And then next of all from the State and Condition of the wounded person who alwaies after his Wound falleth from bad to worse until his Death and those grievous and deadly Symptoms which either presently or on the Critical day followed upon the wound and continually afflicted the sick wounded person And unto the two former we may not unfitly add likewise a third to wit if nothing hath been either committed or omitted that might render the Wound Mortal For from these we may Collect both that the Condition of the Wound was such that it might bring death unto the Party and that the wounded person had such a disposition that was not able to master the Wound And these in all the aforesaid particular parts are those Wounds that are deservedly to be accounted Mortal As for the wounds of the rest of the parts Hippocrates rightly pronounceth them not mortal indeed experience teacheth us that somtimes the greatest and most dangerous wounds have been cured of which there are divers Histories recited by Valleriola in his fourth Book Observat 10. And there are every where the like extant in the observat of Guilhel Fabricius and the writings of other Physitians But yet notwithstanding it oftentimes so happeneth that those very wounds of which some have recovered have proved mortal unto some others and that very many also die of most sleight and inconsiderable wounds And Hippocrates in 2. Prorrhet writeth that a man may chance to die of any kind of wounds Of which we meet with examples almost in every Author Touching the Child of Philias Hippocrates in the seventh Book of his epidem writeth that he died of only the making bare of the forehead bone a feaver supervening for one day and a certain wan leaden color contracted in the sad bone And the same Hippocrates likewise relateth that the Child of one Theodorus upon the making bare of a bone almost of no moment died the 23. day after And that a certain person Master of a great ship having hurt and bruised his fore-finger on the right hand and his mouth with an Anchor an inflammation and convulsion supervening on the thirteenth day following died thereof And that Telephanes also the son of Harpalus by his free woman received a blow in the great toe of one of his feet upon which an inflammation a vehement pain followed which remitting the sick person fell into a convulsion and died the third day And so Pliny writeth in the seventh Book of his Natur Hist Chapt. 53. That Aemilius Lepidus Crushing but his thumb against the bedpost breathed his last And that Caius Aufidius going into the Senate house only hurting his foot died of the same ere he could be carried home to his own house Petrus Forestus in the sixth Book of his Chirurgical observat Observat 50. reporteth that a certain Consul Alcmarianus by name washing his feet as he was wont to do and endeavoring to cut and pare away the thick Callous skin in the sole of his foot wounded himself and that a spasm following upon it he died immediatly And oftentimes likewise a Gangreen followeth upon the wounds and make them deadly And so Petrus Forestus in the sixth Book of his Chirurgic observations Obser 49. telleth us of a certain person that hurt his Leg by hitting of it against somthing that was hard and that upon this bruise and wound of his Leg a Gangrene soon after following took his life from him And Guilhel Fabricius in the fifth Cent. of his observat Obser 2. mentioneth two examples One of a certain Labourour who prickt his foot with a thorn and the other of a woman that with a thorn likewise wounded the very tip of her right forefinger both which upon the supervening of a Gangrene died And Johannes Matthaeus in his Physick Quaest quaest 27. writeth that at Freudenberg a town of the Dominion of Nassaw receiving but a sleight wound in one of his shoulders died thereof And that another in the County of Oldenburg being but very sleightly wounded with a knife in the middle of his Thigh died immediatly And that at Lemgovia a certain Citizens son being but sleightly hurt in his Arm by the sword of a Student Contrary unto the expectation of all that saw him died within one hour after And Horatius Augenius in the first Tomâ— of his Epist Book 9. Epist 2. relateth very many histories of them that have perished upon sleight and inconsiderable wounds And examples to confirm this truth we very frequently meet with in the reading of Authors and more especially those before mentioned Now this happeneth for divers Causes which Hippocrates likewise in 2. Prorrhet toucheth upon in these words Whosoever saith he would know concerning wounds in what manner they shal end each of them Particularly in the first place he ought indâ—ed to make a narrow search strict inquiry into the several kinds of men which of them are better able to bear out a wound and which of them are worse able to undergo the same He ought moreover to know the several ages in which every particular is difficult to be cured and to be wel acquainted likewise with the several parts and places in all kind of bodyes how far forth they differ each from other He ought also to know even these other things that happen in each of them of what nature and quality they are and whether they be good or evil For if any one shall know and wel understand all these things he may indeed then likewise know the several events of each particular wound But he that shall be ignorant of these things can never know what shall be the ends and events of Wounds I shall reckon them up in this order following VVounds Curable from what causes they are made Mortal For First of all if the Sword dart or whatsoever it be that inflicteth the Wound be poysoned a Wound then that seemeth but sleight in it self may yet bring death Secondly The Idaea of Men as Hippocrates speaketh ought heedfully to be attended for such as are of a Robust strong body and sound these likewise bear and undergoe the most grievous Wounds and they are oftentimes cured of them without any great a doe and although that many times very grievous Symptoms may supervene insomuch that you would judg them even ready to die yet notwithstanding beyond all hope
of the wounded part be by all manner of means preserved 6. That all the symptoms and whatsoever may possibly hinder the uniting and Coalition of the part may be taken away and removed And thus although that a wound only considered as a wound is one simple Affect and seemeth to indicate and require one only uniting yet nevertheless the very truth is that there are herein couched very many indications as before we told you Chap. 5. Of things extraneous and from without that are to be taken forth of the VVound IN the first place therefore we must use our endeavour that there may be nothing extraneous in the wound that may hinder the union and glutination thereof And therefore first of all the blood is not instantly to be suppressed and we must permit whatsoever we find sticking in the lesser veines cut assunder freely to flow forth For so by this means there will both a less quantity of Pus be generated and all the danger of putrefaction and inflammation be prevented Which is likewise very well known by him who out of simple wounds is wont either to extract the blood by sucking it forth with his mouth or to squeez it out by the compression of the wounded part with his finger Moreover when there are any hayres neer about the wound they are to be shaven away lest that they fall within the lips of the wound Thirdly if sand or earth or any such like thing stick within the lips of the wound it is to be cleansed away with wine Fourthly if there shal be any Clods of blood in the wound seeing that they may hinder the uniting excite pain and putrefying may cause a fever they are therefore to be wiped away with a piece of a soft Linen Cloth or a lock of wool or if need require they may likewise and must be taken forth with an iron instrument In which action notwithstanding we must use no manner of violence at the first setting upon the cure neither is all the Clotted blood at once to be taken forth and especially if a Hemorrhage be feared since that the clods of blood may stop the orifices of the veins and the vessells may grow together under them but this is to be deferred until the second or third dressing when we have afterward nature her self which beginneth to expel whatsoever is extraneous helping and assisting Fifthly the little broken bones likewise if any such be in the Wound are to be taken forth In the first dressing nevertheless only those things are to be taken forth that are altogether free and loose so that they may be taken out of the Wound without offering any violence thereunto but as for such smal pieces as yet stick fast unto other bones in these Natures endeavour is to be expected and so it wil soon be seen whether she intend to unite these fragments that are broken with the rest of the bone or else whether she purpose to make a separation Sixthly if Glass be broken in the wound it is to be taken forth and this is also to be done if any other kind of Weapon or Arms wherewith the wound is inflicted stick in the Wound But before we assay the extraction of the said weapons we are to look and consider whether or no the wounded person be likely to live after the drawing forth of those things aforesaid For if there be no hopes of life remaining there is no such taking forth of any thing to be attempted no not of the weapon it self lest that the Chirurgeon should be thought to have hastened on the parties death and lest the wounded person dye under the very hands of the Chirurgeon which happeneth sometimes in the wounds of the Heart of the Brain the basis thereof especially the Vena Cava or great hollow vein or the great Artery For it hath been observed that such wounded persons though the weapon hath been left in the wound have yet lived for the space of a whole day but that upon the drawing forth of the weapon by reason of the Hemorrhage following thereupon they have instantly died But where there is any hope that the sick person may be recovered of his wound we ought then to labour that first of al the weapon be drawn forth For the weapons as likewise leaden bullets although they may somtimes stick very long in the body yet notwithstanding it is a very rare thing that a wound should be perfectly cured the weapon stil secretly abiding in the body But now to draw forth the weapons aright is a thing of much difficulty The drawing forth of the Weapons and this difficulty ariseth especially from the place into which these weapons being thrust into the body have penetrated And therefore for him that wil attempt rightly to draw out the weapons forth of the body there are two things mainly necessary First wel to consider and mind the substance and nature the figure situation and connexion of each several part of the body and then Secondly to know the diversity of the weapons from their matter magnitude and figure and it is likewise altogether necessary in the drawing out of the Weapons to be cautious that the veins Arteries Nerves and tendons be not torn or violated For as Ambrose Parry saith truly it would be a thing very shameful and much unbecoming an Artist that the hand of the Chirurgeon should do more hurt then the iron weapon But that the weapons may the more fitly and expeditely be drawn forth let the wounded person be set in such a posture and figure as he was in when he received his wound Which if it cannot altogether be done yet lying along let him so be placed that he may come as neer as is possible unto that figure Now the Weapons are taken forth in a twofold manner How many ways the Weapons may be drawn forth either by extraction or impulsion that is to say either the same way that the weapon went in or else that way that it tendeth It is extracted the same way that it was thrust in either without making any section or else by a section made in the part For if the weapon hath not pierced very deep if it hath not passed thorow the great vessells and Nervous places and if that either right opposite unto it or the way that it tendeth it hath bones veins arteries or nerves and lastly if there be no great fear of any danger to follow upon a wide opening of the part then in this case it may be drawn back the same way by which it pierced into the body and that without any section at all But if there be any danger and cause to fear lest that the body may be torn if the weapon be drawn back the same way by the which it entered in the wound is then to be dilated either by section or else even without it to wit with that instrument which Celsus in his fifth Book and Chap. 7. calleth Ypsiloeides or
Method had been practised For he himself oftentimes very rightly inculcates and writeth very cleerly that it is Nature that cureth the Wound and not the Physitian or Medicaments For if the Pus ought to be moved this is performed by Nature or if that flesh be to be generated and the broken bones to be strengthened by a Callus these are the work and business of Nature If the Wound be to be Agglutinated it is she that must do it and if the Excrements ought to be expelled this is likewise her Office And through the strength of Nature there happen Miracles oftentimes in Wounds Yea as he proveth in his 37. Chap. a strong Nature wil likewise bear out and overcome the Errors of the Chirurgeon committed in the Cure And so no doubt may those Chirurgeons that stil use the old way and Method of curing produce the like examples on their part That Student that was run through the Thorax his Lungs being withal wounded of whom we made mention in the 2. B. of our Practise 2 Part. Chap. 11. and a little above in the 3. Chap. of the Wounds of the Lungs was cured within the space of one Month the care of which Wound in regard that it was inward was chiefly to be committed to Nature and the cure thereof to be ascribed unto her and not either unto the old or the new way of Curing And Glandorpius relateth that a Wound of the Oesophagus was in twenty four daies drawn all over with a Cicatrice as you may find the relation in his Speculum Chirurgic Observat 30. And indeed I will in the next place most readily grant him that those frequent terebrations which seem somtimes to be instituted rather for the exercising of the Chirurgeons Body then for any need the Patient hath of them are not alwaies safe and that they somtimes bring more damage then benefit unto the sick person But yet that the Wounds of the Head are not to be uncovered before the fifth or the seventh day this I shall not so easily grant him seeing that such Wounds pass through divers parts and heap up divers sorts of Excrements and for the most part there is Blood collected between the Skul and the Membranes of the Brain which is therefore with al possible speed to be evacuated For which cause the Terebration also and the perforation of the Skul is somtimes necessary lest that this Blood if it be kept in putrifie and so cause grievous Symptoms Yea and as oftentimes it doth bring Death it self upon the wounded person which may likewise very easily happen if those Wounds should seldom be opened and cleansed Secondly The Reasons alleadged by Caesar Magatus and out of him by Ludovicus Septalius are of no great moment at least they carry not that weight in them that may perswade the rejecting of the old and usual way of curing Wounds First they mainly urge this and indeed herein chiefly consisteth the very strength and pith of this Opinion that the heat of the wounded part is to be preserved and they accuse Galen for that he hath omitted an indication of the greatest moment and that he hath troubled himself more then he needed in other things of far less moment and about the generating of Excrements in the Wound whereas if the innate heat be preserved there will be but very few Excrements bred and those that are will be such as can no waies hinder the glutination of the Wound Where we willingly grant and do confess that Nature as she is the Curer of other Diseases so she is the healer of Wounds likewise and that it is she alone and not the Medicaments that by the benefit of the Natural heat doth perform this glutination of Wounds and therefore that the innate heat and the natural temperament of the part is carefully to be preserved and cherished And this albeit that Galen hath passed it by in that place where he professedly treateth of the Cure of Wounds but whether he hath therein done well or ill I here dispute not yet notwithstanding in other places he often inculcates that there cannot possibly be any curing of the Wound unless the part obtain its own Natural temper and those very Medicaments which are called Sarcotick are provided for that very purpose the Conservation of the heat of the part as we said before in the precedent Chap. But here two Questions arise the first this whether the natural heat be preserved bettter in this new way or in that other old and wonted Method of curing and whether or no there be any necessity that more excrements should be generated in the old way then in this new manner of curing The Second Question is this whether the alone preservation of the Native heat be sufficient for the curing of the Wounds We deny both As for the First it shall be shewn in the following Arguments that the more rare and seldom opening and uncovering of Wounds is oftentimes more hurtful and prejudicial unto the Native heat then useful and serviceable thereto but on the contrary the more frequent uncovering of the Wound and as oft as there is need thereof is no way offensive unto the Native heat and that therfore it is not by reason of the uncovering of the Wound but by reason of the debility of the heat or the constitution of the part or the Body that those Excrements are generated For when there is blood poured forth in the Wound from hence it is that the heat and spirit is dissipated and the part rendered the weaker from whence it is likewise that in the Concoction that is made in the part there are very many Excrements generated And that somtimes fewer and somtimes more Excrements are generated in the Wound this is not therefore because that the Wound is more seldom or more frequently opened and uncovered but because the whol Body and the wounded part are more or less disposed unto the generation of the said Excrements But as for the Second to wit that the innate heat alone is not alwaies sufficient for the curing of the wound this is apparent since that there oftentimes so many impediments and obstacles cast in Natures way that unless they be by the Physitian removed and that indeed very frequently even every day Nature can by no means attain unto her end and drift The Pus first of all and the Excrements that are collected in the wound are to be evacuated and somtimes a passage forth likewise made for them as oft as need requireth by Tents and those Medicaments that cherish the heat dry up the Excrements and hinder the generating of them and help forward the Glutination of the wound are often to be laid on since that when they are once laid on they are soon defiled with the Pus and Sanies that is to say the thick and thinner Excrements of the wounds and thereby weakned and the virtue of them is likewise otherwise dissipated by the heat of the part And albeit
biting sting or stroke of any venemous wilde Beast is far more grievous and dangerous then that Wound which is free from Poyson And a smal Wound likewise when it is thus Poysoned may and often doth bring Death whereas otherwise great Wounds may be healed 2. And indeed by how much the more for number and greater for danger and contumacious the Symptoms are and unyielding unto the remedies administred though never so fit and proper by so much the more dangerous they are and for the most part deadly But if the Symptoms be but few and those not very grievous and such as are mitigated by the Remedies administred there is then so much the greater hope of Recovery and safety 3. By how much the Poysoned Wound is nigher unto the Heart by so much the more dangerous is it and so likewise for that wound that is neer unto the Brain The Cure It sufficiently appeareth what Indications a wound considered as a wound pointeth out unto us and supplyeth thus withal and it is likewise sufficiently manifest by what hath hitherunto been said how it is to be cured But now if we look upon it as poysoned then we are to endeavour in the first place that this poyson may not penetrate unto the more interior parts especially the Heart and then in the next place that its power and strength may be broken and weakned by Alexipharmick Medicaments which we commonly term Counter-Poysons And therefore first of all we ought carefully to heed whether any part of the poysoned Weapon yet stick fast within the Wound For indeed all our attempts of curing the Wound wil be frustrated unless the weapon be drawn forth and therefore we must labor that with all possible speed it may be taken forth by the operation of the hand but if it cannot thus be taken forth then together with the emplasters which have a power in them of calling forth the poyson we are to mingle with them those things that are able to draw forth the Weapons and all other extraneous bodyes out of the Wounds touching which we have spoken above in the eighth Chapter And then moreover that so the poyson may not penetrate unto the more inward parts especially the heart first of all as Celsus in his fifth Book Chapt. 27. teacheth us that member is to be bound up upon the wound but yet notwithstanding this binding must not be overhard and streight lest that the member should hereby be benummed and lose all its sense and feeling or that which somtimes through the unskilfulness of the Chirurgeons cometh to pass it should be taken with a Gangrene Then the poyson it self is to be drawn forth and called out unto the more external parts The Ancients to extract and call forth the poyson were wont to appoint the sucking of the wound and they who performed this office they termed Psylly and they thought that these had a kind of propriety of attracting and drawing forth the poyson by sucking and also of resisting the sayd poyson whereas the truth is that it was only to shew their boldness and adventurousness in thus doing touching which Celsus in his fifth Book Chapt 27. thus writeth but if this indeed sayth he be not done that is if there be want of a Cupping-glass or the like then a Man is to be provided who may suck the poyson out of the wound Neither indeed have these men whom they call Psylly any more special and peculiar knowledg then others but only a boldness and confidence confirmed by much use and practise For the Poyson of a serpent as likewise some certain poysons that Huntsmen use hurt not by their tast but only they impoyson a Wound And presently he adds and therefore sayth he whosoever he be that following the example of those Psylly shall suck the Wound and yet would both himself be safe and so also preserve him for whom he doth this office let him carefully attend this advice that so he perish not that he admit not of any part of the Vlcer into his Gums or his Palate or any other part of hit mouth Now the truth is that the poyson is most safely drawn forth by Cuppingglasses especially in the bittings and strokes of venemous Creatures which said Cuppingglasses wil draw forth the poyson the more powerfully if unto them there be added and administered Scarifications and especially if they be made deeper then otherwise upon sleight occasions After the removal of the Cuppingglasses then the Gutts of Hens or other birds or if you please the bodies of them being cut in the midst the parts whiles they are yet hot may be layd upon the Wound And if the place be not nervous in the bitings of these poysonous Creatures the flesh round about it is to be pared away yea and quite cut off And Galen relateth of a certain vine-dresser that being bitten by a viper he presently with the pruning hook cut off the singer that was bitten and so by thus doing escaped and avoyded all the danger It will likewise â—prove to very good purpose if the wound be washed with Vinegar or Wine in which Treacle hath been dissolved or with the Decoction of Camomil-flowers or the root of the sowr or sharp dock Yea and in the bitings of poysonous Creatures if the place that is wounded be not Nervous a most effectual remedy is the Actual cautery that by the force and power of the sire doth both consume the poyson as also prevent and hinder the penetrating unto the more internal parts But if the sick person wil not admit of an Actual Cautery then the potentiall Cautery or caustick Medicaments are to be administred And care is likewise to be taken that the Eschar may fall off as soon as may be and if it fall not off soon enough of it self the wound is to be freed therefrom with the penknife neither is the ulcer immediatly to be glutinated and therfore an Onyon with Salt or Wild Garlick or Rue are to be imposed upon the wound And these very things not withstanding although that Caustick Medicaments have not been premised are to be imposed upon the Wounded or bitten place for the drawing forth of the poyson As for instance the Onyon Wilde Garlick Rue Doves dunge Wallnuts with Garlick Salt and Hony as the Author of the Book of Remedies against poyson telleth us in his fourth Chapter which whether they be taken inwardly or only outwardly imposed are able to free from poysons whether inwardly drunk or else caused and brought upon the body by the bitings and strokes of venemous Creatures St. Johns wort Swallow-wort Elecampane Raddish Dittany long and round Aristolochy Very useful also are Carduus Benedictus Scabious Rue Gentian Vipers grass and indeed all kinde of simples whatsoever that attract and draw poyson either by a manifest quality as heat or else by an occult quality and peculiar likeness Touching the former this is to be noted that in those parts that are Nervous we are
be sprinkled with warm Water Itching that the humor the cause of Itching may be discust and the pain abated otherwise if there be no Itching we must forbear warm sprinklings lest the Ligaments be relaxt or rather when the binding is loosened the place must be fomented with some strengthening Decoction As Take of the Leaves of Myrtle Oak Wormwood of each one handfull red Rose flowers half a handful Pomegranate rind one ounce Pomegranate flowers Missleto of the Oak of each half a handful Boyl them in harsh Wine A Luxation with a wound If a Wound be joyned with the Luxation that is very dangerous and oftentimes kils the man whenas from distention of the Nerves and Muscles a Pain Inflammation Convulsion acute Fevers are caused and the danger is by so much the greater by how much the Member is greater and the Nerves and Muscles about it are the greater whence a Luxation of the Shoulder and Thigh with a Wound for the most part brings death and the danger is the greater by how much the Wound is neerer the Joynt and therefore Hippocrates is against the reducing of luxated bones and their bindings up and commands to use at the beginning only things that asswage pain and take away Inflammation and thinks that none of these can safely be reduced besides the Fingers Hands and Feet in these also he commands al things to be done very diligently for neither a Finger in which there is least of danger ought to be replaced when there is an Inflammation but either before the Inflammation comes or after t is allaied But much more is this to be done in other Joynts of al which Hippocrates Artic. 4. Text. 16. and 17. saith For in whomsoever the bones of the Leg luxated with a wound made do wholly hang forth from the joynts of the foot whether they tend inwardly or outwardly they are not to be reduced but let them suffer he that wil to replace them for ye may know that if they remain reduced they shal die and their life shal be of very few daies for there are few of them which pass the seventh day for that which kills them is a Convulsion moreover it happens also that both the Leg and the Foot do gangraene We must know for certain that these things wil so come to pass And there also Text 28 29 31. which places there you may see and also Galens Comment And therefore presently at the beginning and before an Inflammation come in a Fracture with a wound we must try whether the joynt may be restored into its seat with moderate extension for it can by no means endure strong which if it succeed to your mind we must labor chiefly in this to keep off an Inflammation but if the joynt being replaced an Inflammation or Convulsion doth happen the joynt must be thtust out of its place againâ— if it can be done without violence or if we fear this danger 't is safer especially in the greater joynts to defer the reducing til the Inflammation is ceased and the fear of it is past When the Inflammation is now ceased which is wont to be about the seventh or ninth day both must be signified foretold to the standers by and the danger which is at hand by the reducing and the weakness of the part by which the man is rendered lame and maimed if the joynt be not restored and if they urge the restitution of the joynt it must be attempted without any violence afterwards the Cure of the Wound must be ordered as in a fracture with a wound but the member it self must be so placed that the Patient as much as may be may be free from pain See Hippocrates of these things in the place before alleadged Somtimes also it happens that a Fracture is joyned with a Luxation therefore the Chirurgeon must be wary and if the Fracture offer it self neer the Joynt let him consider whether the Joynt be whole or luxated lest while he cure the Fracture he neglect the Luxation Thus I remember a Neighbors Child a Boy about nine yeers of age whenas a Vessel into which they were wont to pour their hot Drink after it was boyled fel upon his Thigh and his Thigh-bone was broke and the Joynt of the same luxated which when the Chirugeon observed not and only Cured the Fracture and restored not the Hip-joynt the Boy became lame But if there be a luxation with a Fracture the Member must be extended the common way and the luxated Joynt must be reduced into its proper place and the broken bones must be conformed and composed and first of all indeed the luxated Joynt must be replaced if it may be done then the Fracture must be Cured and fit Medicines must be laid on them both of which we have spoken already and convenient binding up must be ordered but if the Joynt cannot be restored to its place without danger before the Fracture be cured then the Fracture must be cured first afterward when the callus is generated we must endeavor that the luxated Joynt also be restored Last of al The Cure of an old Luxation if a Luxation by reason of an Inflammation coming upon it or a Wound or Fracture joynd with it cannot presently be restored but there is a callous hardness contracted about the Joynt the place must be fomented either with plain warm water or with a mollefying Decoction made of Marsh-mallows Mallows Camomile flowers Fenugreek seeds and the like but after the Fomentation the Joynt must be anoynted with Oyntment of Dialthaea or some other mollefier or this like Cataplasm must be laid upon it Take of Marsh-mallow roots wild Cowcumber of each three ounces Mallows Marsh-mallow leaves of each a handful Boyl them til they are soft and searce them through a hair Searce add of the Flour of Fenugreek Flax seed of each half an ounce Oyl of sweet Almonds Hogs grease as much as is sufficient make a Cataplasm If the hardness be greater add to the things boyled wild Cowcumber root and lay on it Diachylum magnum When the Member shal be sufficiently mollefied if need be Digesters may be applied as Betony Sage Hysop Groundpine the Plaister of Betony and the like Or Suffumigations wish a fire-stone or Mil-stone or Bituminous and Sulphurous Baths if they may be had Lastly when whatsoever was hard is mollefied and discussed the joynt in convenient manner must be restored to its place and the rest must be performed as was said above Chap. 1. Chap. 3. Of a Luxation of the Mandible ANd let it suffice to have said this briefly of Luxations in general now we must say somwhat in particular of the Luxations of the chief joynts And first of al as concerning the Luxation of the Mandible whenas Nature hath made only the lower jaw movable in al creatures the River Crocodile excepted which as Aristotle witnesseth 1. Hist Animal c. 11. and 3. Hist Animal c. 7. moves its upper
Jaw it is easily apparent that that only can suffer a Luxation The which notwithstanding is not easily luxated by reason of the most straight coarticulation of it with the bones of the head and the exceeding strength of the Muscles that draw it upwards but into what part the Mandible may be luxated its structure and insertion do plainly teach us For as concerning its structure it hath two processes in its hinder part on each side the former of which drawn forward being broad and thin ends as it were in a point but the latter is carried backwards and makes a long and transverse head that is inserted into the Os Jugale but this is fitted to the second bosom ingraven in the Temple bone The Differences From which it doth manifestly appear that the lower Mandible cannot be luxated to the hinder part because the Teat-like processes of the Temple bone do hinder it not to the right especially in those of ripe age because the left head of the Jaw hinders not to the left because the head of the Jaw in the right side hinders that In those of ripe age I said for 't is wel known by Anatomy that the lower Mandible in Infants is cleft and in the midst of the Chin is joyned with a great deal of Cartilage which Cartilage if it be relaxt by a flux of humors or the Chin be struck that the bone be separated from the Cartilage perhaps the Jaw may be luxated to the right or left side the which yet seldom happens and therefore is not considered But in the riper aged because that Cartilage hath so degenerated into a bony nature that it can by no means be separated no not by boyling nay not the least footstep almost remains of a line or any seam but it appears one continued bone Physitians do rightly affirm that the luxation can be made only to the fore part But this Luxation happens if the former and sharp process like to a Beak which by the Greeks is called Corone do slide forth below the Os jugale that it becomes so much lower then it that it can no more return upwards again into its place for otherwise though this process be let lower then the Os jugale yet there is not presently a Luxation made but the mouth being shut it returns into its place again but this Luxation is made either in one side only when only its right or left part slips forth or in both sides together when the whol bone of the lower jaw on both sides is fallen out of its seat The Causes But the most common Cause of this Luxation nay almost the only Cause is the too much opening and gaping of the mouth whether it be by yawning or by taking some heavy burden in the Teeth and lifting it on high so that the forenamed process becomes lower than the Os Jugale as was said and withal be turned aside for its return into its seat is not prohibited unless it be turned aside Yet this very thing happens seldom and hardly and the Jaw is seldom luxated by reason of the strength of the Muscles by which 't is tied to the upward parts For from both processes of the lower jaw arise Nervous and most strong Tendons with which the Muscles are inwrapped which are called Crotaphitae and Masseteres Signs Diagnostick That the jaw is fallen out of its seat may be known in general because the lower jaw hangs forth to the fore part and the process of the bone like to a beak stands out by the jaw For if the process resembling a beak fal out of the Os Jugale it must needs be that there also it hang forth which in a man not very fat is easily known both by sight and touch The mouth remains open whence the speech is hindred and the spittle flows forth involuntarily If the jaw be luxated on one part that with the chin is inclined to the contrary part which is not luxated the mouth is distorted whence the Teeth cannot be joyned neither do they answer to their equals but the dog-teeth are under the Cutters In the luxated part there is perceived only a certain bunching out and the temporal Muscle appears stiff But if the jaw be luxated on both sides al of it with the chin hangs forth and that straight out towards the fore part or to the Breast the lower Teeth go further out than the upper yet they answer one to another the Cutters to Cutters the Dog-teeth to Dog-teeth neer the Cheeks on both sides there appears a certain eminency which the acute beak-like process doth make the temporal Muscles whose Tendons this process doth receive yea is wholly compassed by them appear stretcht stiff and hard Prognosticks 1. The Luxation of the Mandible is a dangerous evil and a jaw luxated as Hippocrates teacheth 2. de Art and Galen in his Comment must speedily be replaced since that the temporal muscles and the Nerves inserted in them and consequently the brain it self are easily drawn into consent For the temporal Muscles have the greatest consent with the brain and do receive nerves from the brain of the third conjugation from whence do arise not only pains inflammations continual feavers dul sleeps but also death it self is often hastened about the tenth day 2. Those whose Mandible is not reduced are wont to void by stool filthy and thin Choler and if they vomit the vomit is pure 3. Yet there is greater danger instant and the replacing is harder if the jaws be luxated on both sides then if only on one side whenas al the Muscles with which the jaw is contained are then distended The Cure The Mandible luxated shews that it must be reduced into its seat again which how it ought to be done Hippocrates teacheth 2. de Artic. t. 15. and 16. in these words One ought to hold the head of him that is luxated another the lower jaw the man gaping as much as he can conveniently and taking it about the chin with his fingers both within and without first a little while to stir it up and down and then with his hand to move it aside and to command the Patient that holding the luxated jaw he further it and be very obedient to him moving it Then endeavor must be used that at once of a sudden we strike it off of its three figurations for the lower jaw must at once be promoted from its distorsion to its natural position and it must be driven backwards and the Patient obeying these ought to shut his mouth not to gape any longer and this indeed is the reducing of it which cannot be done by other figurations but afterwards a little Physick wil suffice a bolster laid on with a Cerote we apply a loose binding up yet we perform this office more safely if the man be bended backward and his head supported with a leather Cushion wel stuffed put under it that it may yield as little as may be If the jaw