the Basilica and concurs to the generation of the median Moreover when there is need to open the Basilica and it shall be no where conspicuous the Cephalick or median being easie to be discerned at the same time you may in stead thereof open the median or if it be not to be found the Cephalick pressing but the trunk thereof with your thumb as we said before lest the head should be evacuated in stead of the liver You may do the same in the Basilica if when there shall be necessity to open the Cephalick it shall not appear Most of those which at this day open a vein in stead of the median open that branch of the Basilica which ascends together with the Cephalick to make the median But you must understand that the median descends between the two bones of the cubit even to the end thereof and then divided into many branches it is at length spent on the back of the hand behind the thumb the fore and middle fingers or the after-wrist Sometimes it runs back into the following branch and then at the wrist it departs from it to be bestowed upon the forementioned parts The other branch of the Cephalick which we may call the fore and outward Cephalick descending directly down to the midst of the wand thence wanders overthwart into the hind part of the arm where encreased with a branch from the Basilica it is distributed over all the back of the hand which with the median it nourisheth But the branches of these veins do so run through the fore-named parts that by the way they yield them necessary provision CHAP. XXII The Description of the Axillary Vein THe Axillary arising at the insertion of the pectoral muscle or a little higher The axillary it divided into the deep axillary and outward axillary after it hath produced the two Thâ—racicae it is divided under the tendon of that muscle into two fair branches that is to say into the inner deep Axillary and the skin or outward Axillary The deep or inner having still for his companion in his descent the axillary artery and the nerves of the third conjugation after it hath produced the small external musculous of the arm it goes into the bending of the elbow where running somewhat deep with the artery and nerve into the muscles of the cubit it is divided into three other branches of which one descending with the wand slides under the ring into the inner side of the hand and hath bestowed two small branches on the thumb two others on the fore and one upon the middle-finger so that all of them ascend by the sides of these fingers the other descending with the artery as the former alongst the cubit sends branches to the rest of the fingers like as the former The third goes on the foreside between the two bones even to the wrist and the square muscle But you must note that the veins of which we now treat do not only make these divisions mentioned by us but infinite others besides as well in the parts which they go to as also in the inner muscles of the hand which they nourish And thus much of the internal and deep axillary vein For the external or skin-Axillary which first appears under the skin especially in lean bodies a little above the inward production of the arm it is divided in that place into two branches the one whereof descending to the bending of the arm meets and is united with the Cephalick branch sooner or latter that so it may produce the median as we formerly mentioned The other branch having sent forth many shoots of a different length and thickness as well into the skin as into the other neighbouring parts descending alongst the lower side of the bone of the cubit properly so called is at length spent upon the fore and outward Cephalick branch which we said descended alongst the wand and thus united they run over all the hand where in the right hand between the middle and fore finger they make the Salvatella but in the left The Salvatella and Splenitica in the same place they produce the Splenitica But alwaies remember if in dissection you find any thing otherwise than we have delivered it that the distribution of the vessels is so various especially in the hands that there can no certain rule be delivered thereof CHAP. XXIII The Distribution of the Axillary Artery THe Axillary Artery from the first original which is presently after the two Thoracicae descending between the muscle called Biceps or the two-headed muscle and the Brachicus with the deep Axillary vein distributes a large branch amongst the outward muscles of the arm which extend the cubit and is spent in the external muscles of the same which arise without from the productions of the arm And this is called the Ramus Musculus or Musculous Branch as also the vein that accompanies this artery Then this artery when it comes to the bending of the cubit thrusting it self into the muscles bending the fingers communicates certain branches to the parts pertaining to the de-articulation of the cubit with the shoulder and other parts there situate as it did in the upper parts by which it descended hither An Anatomical Axiom Verily it may be a general rule that Every vessel sends or bestows certain portions thereof by the way to all the parts by which it passes But if you should ask why I have not prosecuted these productions I would answer I never intended to handle other than large and fair branches of vessels by rash incision of which there may happen danger of death or a disease For it would be both an infinite and needless business to handle all the devarications of the Veins Arteries and Nerves Therefore this Artery sunk into these Muscles when it comes almost to the midst of the cubit presently or a little after it is divided into two large branches the one of which alongst the wand and the other alongst the cubit is carryed into the hand on the inside under the Ring For both these branches are distributed and spent upon the hand after the same manner as the branches of the internal Axillary-vein that is having sent by the way some little shoots into the parts by which they pass at the length the branch which descends by the Wand of the remainder thereof bestows two sprigs upon the Thumb on each side one and two in like manner on the fore-finger and one on the middle the other which runs alongst the Ell performs the like office to the little and the middle or Ring-finger as you may see by dissection CHAP. XXIV Of the Nerves of the Neck Back and Arm. The 7 pair of nerves of the Neck NOw we should handle the sinews of the Arm but because these proceed from the Nerves of the Neck and Back I think it fit therefore to speak something of them in the first place The first pair Therefore from the Neck
the parts of the Wrist which it hath common with the After-wrist have been already also plentifully explained this only remains to be noted that the skin as well of the Hands as of the Feet is of a middle nature between pure flesh and pure skin no otherwise than that which covers the fore-head but that this which covers the Palms of the Hands and Soles of the Feet is unmoveable but it is most thick especially on the Feet lest it should be easily offended by continual going Besides the common parts the Wrist is composed of eight small Bones mutually knit together in a certain order and by Diarthrosis with the two Bones of the Cubit but mutually and amongst themselves by Synarthrosis by interposition of Gristles and Ligaments as well common that is coming from the Muscles as proper descending alwayes from the upper to the lower But these same Bones are some less than othersome besides they are hard and without marrow gibbous on the outside for the security and comliness of the Hand but hollow on the inside for to give way to the Tendons going into the Fingers These Bones are disposed in two ranks The first rank contains only three but the second five The three of the first rank are thus arrayed or placed that one of them may receive the Appendix Styloides of the Cubit the other the Ell and the Wand together and the third may be received by the Wand But three of the five Bones of the second order sustain the four Bones of the After-wrist and are knit to the same by Synarthrosis after which manner of connexion they are joyned to the Bones of the first rank the fourth sustains the first Bone of the Thumb to which also it is coarticulate by Synarthrosis the fift and last is seated on the inside against the Ell chiefly above that Bone of the first order which receives the Appendix Styloides of the Cubit this is least and weakest of them by reason of its gristly substance which makes the Ring with certain Ligaments running from one of the inner sides of the Wrist to the other This Ring is placed there as well for the preservation of the Sinews What the Annulus or Ring is Veins and Arteries passing under it lest when we lean upon our Hand and Wrist these parts should be hurt by compression as also for the commodity of the action of the Muscles bending the Finger which in the performance of their action and the contracting themselves might deform the Hand by their passing forth of the cavity of the Wrist For what attraction soever is made by strings if it be free and not hindred is according to a straight line Now follow the Bones of the second part of the Hand or of the After-wrist The bones of the Afterwrist These are four in number gibbous without but arched within or hollow in the middle for hence is the Palm of the Hand or certainly the greater part thereof their ends next the Fingers are somewhat remote from each other that in these clifts the Muscles Inter-osses might find a place and seat But these ends have each an Appendix as you may perceive in the Sceleton of a Child But you must note that by the first Bone of the Wrist or After-wrist we mean that which is in the fore-side of the Hand that is to say that in the Wrist which lies under the Thumb and that in the After-wrist which is seated under the Fore-finger as those which keep in order the Fingers which exceed the rest in necessity and dignity The Figure of the Bones of the Hand The 1. shews the inside of the right-Hand and the 2. shews the back-side of the same The Charact. 1 2 3 4 5 6 7 8 shew the eight Bones of the Wrist A 1 2 the first bone of the After-wrist lying under the Thumb I. II. III. IIII. The four other bones of the After-wrist annexed to the Fingers B C the two bones of the thumb D E F 1 2. the three bones of the fore-finger which are the same in the other Fingers M 1 2 a little bone sometimes fastned outwardly at the joynt of the eighth bone of the Wrist N 1 a process of the eighth bone of the wrist swelling out into the ball of the Hand O 1 a process of the fift Bone of the Wrist from which a ligament proceeds P 2 an appendix of the Bones of the Wrist by which they are articulated to the After-wrist Q 2 another Appendix which with its head entereth into the cavity of the Finger R 1 2 the space between the Bones of the After-wrist S 1 2. Two little Sâ—â—d-bones set on the inside and outside of the first joynt T 1 Two Seed-bones in the first of the four-fingers VV 1. One Seed-bone in the second and third joynt of the Fingâ—rs The bones of the Fingers After these follow the fifteen Bones of the Fingers that is three in each which are hollow and fistulous full of a thin and liquid marrow and not of gross and thick as in the Arm and Thigh They are outwardly gibbous but inwardly hollow and flat for the fitter seat of the Tendons ascending alongst the Fingers on the inside even to the upper joynt The which that Nature might the better strengthen and preserve it hath produced from the lips of the inner cavities of these Bones a membranous and strong ligament which running over-thwart from one side to the other doth so straitly close the Tendons to their Bones that they cannot go forth of their places or incline to either side They are connexed on the out-side that they might be more fit to hold any thing But for the first Bones of the four Fingers and Thumb four are joyned together with so many Bones of the After-wrist by Syâ—tarthresis for the Bones of the After-wrist are moved by no manifest motâ—on the fift is knit to the second rank of the Bones of the Wrist therefore that Bone cannot be attributed to the After-wrist as some have written seeing it hath manifest motion and is knit by Diarâ—â—rosis but the Bones of the After-wrist are only fastned by Synarthrosis For the second and third rank of Bones of the Fingers they are knit the second to the first and the third to the second by Diarthrosis and Arâ—hrâ—dia because besides the manifest motion they have they receive each other by a superficiary cavity as those of the first rank the Bones of the After-wrist and those of the second rank them of the first and those of the third them of the second And all the Bones of the Fingers are larger and thicker at their basis but smaller towards the ends and they are bound by ligaments especially proper which as we said formerly descend from the first to the second so that the last bones seeing they have not to whom to communicate their nerves make and produce nails thereof Whence the Nails are generated Wherefore the nails are generated
that the head of a Muscle is one while above another while below otherwhiles in the midst as in the Midriff as you may know by the insertion of the Nerve because it enters the muscle by its head From their Belly From their belly also there be some differences of muscles taken for some have their belly immediately at their beginning as the muscles of the buttocks others at their insertion as the Midriff others just at their head as those which put forth the Calf of the leg in others it is somewhat further off as in those which draw back the arm and which bend the leg in others the belly extends even from the head unto the tail as in the intercostal muscles and those of the wrist in others it is produced even to their insertion as in those of the palms of the hands and soles of the feet some have a double belly distinguished by a nervous substance as those which open the mouth and those which arise from the root of the lower process of the shoulder-blade From their Tendons Moreover the differences of muscles are drawn also from the Tendons for some have none at least which are manifest as the muscles of the lips and the sphincter-muscles the intercostal and those of the wrist others have them in part and want them in part as the Midriff for the Midriff wants a Tendon at the ends of the shorter ribs but hath two at the first Vertelra of the Loins in which it is terminated Others have a Tendon indeed But some of these move with the bone some not as the muscle of the eyes and besides some of these have broad and membranous tendons as the muscles of the eyes and Epigastrium except the right muscles In others they are thick and round as in the benders of the fingers in others they are less round but more broad than thick such is the Tendon arising from the twin muscles and Soleus of the leg others have short Tendons as the muscles which turn down the hand othersome long as those of the palms of the hands and soles of the feet besides others produce Tendons from the end of their belly which Tendons are manifest others from the midst as the Temporal Muscles Besides also others diffuse many Tendons from their belly as in the hands the benders of the fingers and extenders of the feet Othersome put forth but one which sometimes is divided into many as those which bend the third articulation of the foot otherwhile many muscles by their meeting together make one Tendon as the three muscles of the Calf of the leg and those which bend the cubit and leg All Tendons have their original when the nerves and ligaments dispersed through the fleshy substance of a muscle are by little and little drawn and meet together until at last carried to the joint they are there fastned for the fit bending and extension thereof From the contrariety of their Actions for some parts have contrary muscles benders and extenders From their action From their function other parts have none for the Cods and Fundament have only lifters up From their function for some are made for direct motions as those which extend the fingers and toes others for oblique as the Supinators of the hand and the Pronators others perform both as the pectoral muscle which moves the Arm obliquely upward and downward as the upper and lowers fibers are contracted and also outright if all the fibers be contracted together which also happens to the Deltoides and Trapezius I have thought it good to handle particularly these differences of muscles because that by understanding them the prognostick will be more certain and also the application of remedies to each part and if any occasion be either to make incision or future we may be more certain whether the part affected be more or less nervous CHAP. IX Of the parts of a Muscle HAving declared the nature and differences of a Muscle we must note that some of the parts thereof are compound and universal others simple or particular The compound and simple parts of a Muscle The compound are the head belly and tail The simple are ligaments a nerve flesh a vein artery and coat For the compound parts by the head we understand the beginning and original of a muscle which is one while ligamentous and nervous otherwhiles also fleshy By the belly that portion which is absolutely fleshy But by the tail we understand a Tendon consisting partly of a nerve partly of a ligament promiscuously coming forth from the belly of the Muscle For as much as belongs to the simple which are six in number three are called proper and three common The proper are a Ligament from a bone a nerve proceeding from the Brain or spinal marrow and flesh compact by the concretion of blood The common are a vein from the Liver or trunk arising from thence an artery proceeding from the Heart What use each simple particle hath in a muscle a Coat produced by the nervous and ligamentous fibers spreading over the superficies of the muscle But for the simple use of all such parts the nerve is as it were the principal part of a Muscle which gives it sense and motion the ligament gives strength the flesh contains the nervous and ligamentous fibers of the Muscle and strengthens it filling up all the void spaces and also it preserves the native humidity of these parts and cherisheth the heat implanted in them and to conclude defends it from all external injuries for like a fan it opposeth it self against the heat of the Sun and is a garment against the cold and is as a cushion in all falls and bruises and as a buckler of defence against wounding-weapons The vein nourishes the muscle the artery gives it life the coat preserves the harmony of all the parts thereof lest they should be any ways disjoined or corrupted by purulent abscesses breaking into the empty or void spaces of the Muscles as we see it hapneth in a Gangrene where the corruption hath invaded this membrane by the breathing out of the more acid matter or filth CHAP. X. A more particular inquisition into each part of a Muscle HAving gone thus far it remains that we more particularly inquire into each part of a Muscle that if it be possible nothing may be wanting to this discourse The nature of a Ligament Wherefore a Ligament properly so called is a simple part of mans body next of a bone and grislle the most terrestrial dry hard cold white taking its original immediatly or by the interposition of some Medium from the Bones or Grisles from whence also the Muscles have their beginning whereby it comes to pass that a ligament is void of sense unless it receive a nerve from some other place for so the ligaments which compose and strengthen the tongue and yard are partakers of sense and it inserts it self into the bone and grisle that
the Hand taken in general NOw it befits us to describe in order the Muscles of the Arm but first we must know what it is that we call the Arm. But seeing that cannot fitly be understood unless we know what the Hand is seeing that the Arm is a part of the Hand therefore first we must define what a Hand is and then divide it into its parts Therefore the Hand is taken two manner of wayes that is generally and specially The Hand generally taken signifies all that which is contained from the joyning of the Arm to the Shoulder-blade What is meant by the hand in general even to the ends of the fingers But in particular it signifies only that which is comprehended from the furthest bones of the cubit or the beginning of the wrist to the very fingers ends Therefore the Hand in general is an instrument of instruments made for to take up and hold any thing It is composed of three great parts that is of the Arm Cubit and Hand vulgarly and properly so called but the hand taken thus in particular is again divided in three other parts the Carpus or Brachiale the wrist the Metacarpium or Postbrachiale the After-wrist and the fingers all these parts seeing each of them are not only organical parts but also parts of organical parts are composed of all or certainly of the most of the similar parts that is of both the skins the fleshy pannicle the fat Veins Arteries Nerves Muscles or Flesh Coats both common and proper Bones Gristles and Ligaments all which we will describe in their order The differences of the hand from the site thereof But first I think good to admonish you of the differences of the hand taken from the site thereof and these differences are six in number the fore the hind the internal the external the upper and lower side or part thereof By the fore we mean that part which looks directly from the Thumb to the Shoulder by the hind we understand the part opposite to it which from the little finger looks towards the basis of the Shoulder-blade By the inside we signifie that part which lies next to the sides of the body when the hand retains its natural site by the out-side the part opposite to it The upper and lower side you may know by the very naming thereof Why the hand is divided into so many fingers Why the nails are added to the soft flesh of the fingers The Hand properly so called is divided into five fingers that so it may hold and take up bodies of all figure as round triangular square and the like and gather up the least bodies with the Fingers ends as Needles Pins and such like Nature hath bestowed two Hands upon us that so they may help each other each moving to each side But for the taking up and holding of small bodies it was fit that the Fingers of their own nature soft should be armed with nails that consisting of soft flesh and a hard nail they might serve for all actions for the nail is a stay to the soft flesh which otherwise would turn away in meeting with an hard body the use of the Nails is to scratch shave and pull off the skin to rend pinch and pluck asunder small bodies They have not bony hardness that so they might not break but bend Why the nails grow continually Yet other creatures have hard Nails to serve them instead of weapons Their figure is round because such a figure is less obnoxious to external injuries and by reason they are subject to wearing they grow continually Nature hath placed flesh on the inner and side-part of the Fingers so to press more straitly the things they once take hold of so that by holding them close together we can hold water that it may not run out The length of the Fingers is unequal that when they are opened and stretched forth they make as it were a circular figure for so it comes to pass that the hand can hold all bodies but especially round It remains that we prosecute the distribution of the Veins Arteries and Sinews which run over all the parts of the Hand taken in general and particular whereby we may more commodiously hereafter handle all the proper parts thereof CHAP. XXI The distribution of the Subclavian Vein and first of the Cephalica or Humeraria TWo large Veins descend from the Subclavian the one from the lower-side the other from the higher Yet sometimes and most usually both these proceed from the same common orifice as in men of a low stature in the Arm. The one of these is called the Axillaris The Cephalick vein the other the Humeraria or Cephalick therefore this Cephalick passing forth of the Subclavian runs superficially along the fore-side between the Muscle Deltoides and the Tendon of the pectoral Muscle and descends in the midst between the common Coat of the Muscles and the fleshy pannicle even to the bending of the cubit where in lean bodies it is plainly to be seen whereas in fat bodies it is hardly to be perceived being as it were buryed in abundance of fat This vein having in its descent sent forth some small branches both to the skin as also to certain Muscles over which it runs is divided into two a little above the outward protuberation of the Arm. One of the branches into which it is divided descending obliquely to the fore-part of the cubit a little below the bending of the cubit it meets and is united with the like branch in the same place as shall be shown hereafter The median vein How by opening the median vein you may draw more or less blood from the head or liver That which arises from this concourse is called the Median-vein because it arises from two branches and is seated between them They usually open this Median-vein in the diseases of the head and Liver which require Phlebotomy but if it shall not be sufficiently manifest when you judg it must be opened for a general evacuation of the whole body you may cut one of these branches by whose concourse it is made which you shall think the fitter and because each branch draws from the next parts according to the straightness of the fibers rather than from the opposite side if you would evacuate the Head and Liver equally by opening either of these branches it is convenient that opening that branch for example which comes from the Cephalick you presently lay your Thumb upon it until you suppose you have drawn a just quantity of blood from the Liver by the Basilica or Liver-vein which done you may take off your Thumb and suffer the bloud to follow freely by the open branch of the Cephalick until you have drawn as much bloud as you shall judge requisite otherwise you will draw it but from one part to wit the head So you shall evacuate it only from the Liver if you open the branch which comes from
cord in the wheel of a Pulley and this is called the Olecranen What the Olecranum is Here truly we use this word cubit in the first signification Wherefore we say the Cubit is composed of two Bones the one of which we call the Radius or Wand or the lesser Focile of the Arm The two Bones of the Cubit the other we properly call the Cubit or Ell. These two Bones stick together at their ends being firmly bound together by strong ligaments but the middle-parts of them are a pretty way distant from each other and chiefly towards their lower ends for the better situation and passage of the Muscles and Vessels from the inner side to the Exterior as shall be shewed in fit place The Wand hath two Epiphyses or Appendices the one at the upper end the other at the lower The two Appendices of the Wand The upper is round and hollowed on the surface like a Bason it receives the fore process of the Bone of the Arm bound to the same by strong ligaments descending as well from that process of the Arm as the Olecranon into the circumjacent parts of this Appendix of the Wand The figure and site of the Wand This connexion is made for this use that we may turn our Hand upwards and downwards by the Cubit turned and twined about this process But the lower Appendix of this Wand is hollowed on the inside that so it might more commodiously receive the Bones of the Wrist but gibbous without that it might be safer now this Wand is softer and thicker at the lower end but lesser and harder above where on the inside it hath a swelling out whereby to receive the Muscle Biceps besides on the out-side of the middle thereof it is somewhat gibbous and round so to become more safe from the injuries of external bodies but it is hollowed or bended on the inside for the better taking and holding any thing in the Hand But that side which lies next to the Ell is flatted for the fitter original and seat of the Muscles lastly it is seated upon the bone of the Cubit or Ell just against the Thumb But the Ell or Bone of the Cubit properly and particularly so called The Appendices of the Bone of the Cubit hath in like manner two Appendices the one above the other beneath The upper which also is the greater is fitted to the Orb of the Arm in which it goes to and again for the extention and bending of the Arm no otherwise than a Rope runs in a Pulley but that it turns not absolutely and perfectly round which is caused by the two processes of unequal bigness the which are therefore stayed in the holes or cavities of the Bone of the Arm the greater process which we called Olecranon is letted by the exterior hole that so the extension of the Arm can be no further but the lesser process by the inner hole makes the bending thereof the less perfect The composure of these Bones is by Ginglymos and it is strengthned not only by common ligaments coming from the Muscles which move the Bones themselves but also by proper Ligaments descending from the processes of the Arm and the Lips of the holes and cavities standing about the Appendix of the Cubit The other lower and lesser Appendix is in some sort hollow on the inside for the fitter receiving the Bones of the Wrist but the outside is round and ends in a point The figure of the Cubit-bone or Ell. when it is called by the Greeks Styloides But now this Ell contrary in this to the Wand is thicker towards the Arm but slenderer towards the Wrist And besides in the thicker part thereof it is hollowed or bended towards the inside and in the same place is gibbous or bunching forth on the outside but it is round and straight unless on that side which lies next the Wand for the rest it is hollow and full of marrow like the Wand The site of the Radius or Wand is oblique but that of the Cubit or Ell is right that the Arm might be the better and more easily moved because the motion by which the Arm is extended and bended is according to a right-line but that by which the inside of the hand is turned upwards and downwards is performed obliquely and circularly Wherefore it was expedient that the Wand should be oblique and the Cubit streight for the Cubit-bone is appointed for to extend and bend the Arm but the Wand to perform the wheeling and turning about thereof and this is the cause that it was fitting there should be a different connexion of these Bones with the Arm. These things were fitting to be spoken concerning the nature of these Bones that in the cure of fractures we may work the more safely and happily taking indication from that which is agreeable to Nature wherefore now it remains that we come to the description of the Muscles which are seated in the Arm the Cubit-bone The Muscles moving the Cubit or Ell. These are four in number two extending it and two bending it The first of the benders is called Biceps by reason of its two heads the one whereof descends from the Coracoides The Biceps or two-headed Muscle the other from the lip of the cavity of the Shoulder-blade by the fissure or clift of the Head of the Bone of the Arm. These two Heads under the Neck of this Arm becoming fleshy are firmly united at the Belly and midst of the Arm and thus united are at the length implanted by a strong Tendon to the inner protuberation of the Wand The Brachiaeus The other is called the Brachiaeus by reason of the strait coherence thereof with the Bone of the Arm this fastened under the Biceps descends obliquely on the Back and upper part of the Bone of the Arm into the top of the Wand and the inner side of the Ell. The Longus But the first of the Extenders is called the Longus or long-Muscle this descends from the lower Rib of the Shoulder and cleaving to the Bone of the Arm goes thither fastned and as it were alwayes straitly joyned with his fellow-Muscle specially neer the Cubit whereof you shall presently hear The Brevis The other termed the Brevis or short Muscle being the companion of the Long descends on the hind-part of the Neck of the Bone of the Arm as it were growing to and lying under the former Long-Muscle so that making one common broad Tendon outwardly fleshy inwardly nervous they are inserted into the Olecranum so by mutual assistance to extend the Cubit CHAP. XXVII The Description of the Bones of the Wrist After-wrist and Fingers WE said before that the Hand taken more particularly and properly What the Hand properly so called is is divided into the Wrist After-wrist and Fingers and that the Hand in this signification is bounded by the ends of the Bones of the Cubit and Fingers All
a more exact sense to distinguish of hot cold moist dry smooth equal rough soft hard great little and such other qualities Then follow the two Pronatores of which one called the round The Pronatores comes obliquely from the inner side of the hind-process of the arm almost to the middle of the wand to which it adheres by a membranous and fleshy tendon even to the place appointed for insertion The other square three or four fingers broad yet somewhat slender seated within under all the muscles which descend on the inside to the wrist or fingers upon the ends of the bones of the cubit ascends transverse from below the Ell unto the top of the Wand where it ends in a membranous tendon The Carpi-flexores Both the Carpi-flexores or wrist-benders arise from the hind but inner process and descend obliquely the one more or less than the other the one alongst the Ell but the other alongst the wand and that which descends alongst the Ell is inserted into the eighth bone of the wrist which we said made part of the Ring the other which follows the wand is inserted with his greater part into the bone of the wrist and with the rest into the first bone of the after-wrist which sustains the fore-finger Now remain the Digitum-flexores or Finger-benders which because they lye upon one another The Digitum-flexores The Sublimis Digitum-flexor the upper is called the Sublimis but the lower the Profundus The Sublimis or upper arising from the inner part of the hind process of the arm and from the upper parts of the Ell and Wand descends between the two bones of the cubit even to the wrist and ring divided into four tendons it is inserted into the second de-articulation of the four fingers which it bends by the force of this his proper insertion as also the first as well by the power of the common ligament as by certain fibers coming from it which it sends thither by the way in its passage But these four tendons neer unto this their insertion are divided into two so to give passage and add strength to the tendoâ—s of the deep muscles descending into the third and last joynt of the fingers But this same Profundus or deep muscle arising from the upper and inner parts of the Ell and Wand descends between these two bones under the Sublimis also undivided even to the wrist The profandus Digitum-flexor where it is divided into five tendons which it brings forth under the common ligament and the divisions of the tendons of the Sublimis even to the last joynt of the fingers which they bend by this their proper insertion as also of the bones of the first and second joynts of the fingers by the means of the common ligament and fibrous productions which they bestow upon them by the way Besides these fore-mentioned there is seen also a certain membranous ligament which engirts the tendons in the compass of the fingers CHAP. XXIX Of the Muscles of the inside of the Hand THe Muscles of the inside of the hand are seven in number the first is called Thenar The number of the muscles of the inside of the hand because it makes the greater part of the Palm the second from the site is called the Hypothenar the third the external Abductor of the thumb The four other are called by reason of their figure the Lumbrici or wormy-muscles or the Aâ—ductores or Drawers of the four fingers to the thumb The Thenar Now the first called Thenar thicker than the rest arises from all the bones of the After-wrist taking its beginning from that bone which bears up the Ring-finger whence ascending alongst the Vital line even to the end thereof at the first bone of the After-wrist sustaining the fore-finger it is at length inserted into the last joynt of the thumb by the longest fibers but by the middle and shortest fibers almost into all the inner parts of the first bones of two joynts and by reason of this the thumb is drawn to the other fingers and from them again by his lower original Some divide this muscle into three by reason of his divers actions making the first to arise from the root of the bone of the After-wrist which bears up the Ring-finger but the other from that middle bone of the After-wrist which sustains the middle-middle-finger but of the third from the upper end of that bone which under-props the fore-finger and that the insertion of them all is as we formerly mentioned But the former opinion likes me better both for shunning confusion and abbreviating the doctrin of the number of Muscles The Hypothenar The Hypothenar arises from the fourth bone of the After-wrist and that bone of the wrist which sustains it and then with its longest fibers it is inserted into the second joynt of the Ring-finger and by the shortest into the first through which occasion as also in respect of its two-fold action some have divided it into two that the one of them might lead it from the rest and the other might draw it to the thumb The external Abductor of the thumb The Lumbrici The third the external Abductor of the thumb descends from the first bone of the after-wrist into the first and second joynt of the thumb wherefore some have divided it into two The Lumbrici or four external Abductores of the fore-fingers arise from a membrane investing and binding together the tendons of the Digitum-flexores or finger-benders and at length on the sides towards the thumb even by a small tendon running even to the second joynt of the four-fingers The Interesses Now the Interesses of the after-wrist remain to be spoken of these are six two in each of the spaces between the fingers one internal the other external of which the internal descending with oblique fibers from the side of the first bone of the after-wrist goes also into the sides of the fingers that so it may the more closely bind together the bones of the after-wrist whose action is manifested when we thrust our fingers into a strait glove or when we bend our hand Some think that it helps also the drawing of the fingers towards the thumb The external ascends also by oblique fibers from the sides of the second bone of the after-wrist to the first joynts of the fingers intersecting the internal which we now described after the manner of the letter X for to extend the palm of the hand and help the drawing away of the fingers of the thumb The number of the muscles of the whole taken in general Here concluding the description of the Muscles of the whole Hand taken in general you shall note that they are 39 in number that is eight appointed to move the Arm four set to move the cubit in general seven seated on the out-side of the cubit and as many on the inside in the same Cubit moving the Wand and with
thereof it is extended into the first and greater bone of the Pedium so to extend the great toe drawing it inwards to the other foot The Toe-stretcher is two-fold And this muscle with the precedent bends the foot if they both perform their part at once but if severally each draws the foot towards his side The third which is the Digitum-tensor or Toe-stretcher is twofold the one takes its original from the top of the leg and running alongst the Shin-bone and passing under the Ring carries it self into the foot in which it ends by five tendons going to all the joynts of the toes and by a sixth at that bone of the Pedium which sustains the little toe whereby as we formerly said it helps the bending of the foot The other descends into the midst of the Shin-bone and somewhat fastned thereto by one tendon passing under the ring it goes to the great toe But you must note that all these tendons have nervous ligamentous and fleshy fibers so separated from each other that they can equally alone perform their function as if they were more distinct muscles And we must think the same of the rest which have distinct tendons presently from their fleshy part The six hind-muscles The six hind-muscles follow of which the two first are called the Gemelli or twins by reason of the similitude of their thickness original insertion and action The third is called the Plantaris because it is spent upon the sole of the foot as the Palmaris upon the palm of the hand The fourth is termed the Soleus or sole-muscle by reason of the resemblance it hath to the fish of that name The fift the Tibiaeus pâ—sticus or hind-leg muscle which descends alongst the back-part of the leg-bone The sixth and last the Digitum-flexor or Toe-bender equivalent to the deep muscle of the hand Some make but one muscle of this and the Tibiaeus posticus which produces three tendons others had rather make three as thus that one should be the Tibiaeus the other the bender of four toes the third the bender of the great toe The two Gemelli or Twin-muscles Now for the two Gemelli or twins the one is internal the other external the internal passes forth from the root of the inner Condyle of the thigh but the external from the external Condyle and from this their original presently becoming fleshy especially on the outside they meet together a little after in their fleshy parts and with the Soleus they make the thick and great tendon at the midst of the leg In what place the kibes breed which from thence is inserted into the back-part of the heel in this very tendon breed painful kibes The action thereof is to help our going by putting forth the foot whilst it draws the heel towards its original The Plantaris The Plantaris the least and slenderest of them all passes forth fleshy from the outward head of the leg-bone and from thence the space of some four fingers bredth it ends in a strong and slender tendon which it sends between the twin and sole muscles to the sole of the foot there to produce a membrane which covers the sole of the foot and a Muscle equivalent to the upper bender of the Hand The Soleus or sole-muscle the thickest of them all and seated under the Twin-muscles The Soleus descends from the Commissure of the Leg and Shin-bones and about the midst of the Leg after it hath mixed his tendon with that of the twin-muscles it runs into the foresaid place that it may extend the foot for the foresaid use The Tibiaeus posticus descends from the hinder appendix of the Leg and Shin-bones The Tibiaeus posticus and adhering to them almost as far as they go by a strong tendon being as it were bony at the end thereof it is inserted into the Boat-like bone and the two first nameless bones so to help the oblique extention of the foot The last being the Digitum-flexor or Toe-bender is twofold for one arises from the Leg-bone The Digitum-flexor twofold in that place where the Poplitaeus ends and inserted into that same bone it goes even to the back-side of the inner Ankle and from thence into the joynts of four of the toes The other draws his original from almost the middle of the Shin-bone and somewhat inserted into it it goes by the heel and pastern-bone to the great Toe mixed with the precedent their action is to bend the first joynt of the Toes rather by the force of the common ligament than by the small portion of the tendon which ends there But it is their action to bend the last dearticulation of the Toes by their proper insertion CHAP. XL. Of the Muscles moving the Toes of the Feet NOw follow the Muscles moving the Toes these are eight in number Their number one on the upper and seven on the lower side The first proceeds from the Pastern Heel and Die-bones below the external Ankle or the ligament of these Bones with the Leg-bone and obliquely stretched to the top of the foot is parted into five small tendons to the sides of the five Toes so to draw them outwards towards it original The Abductor of the Toes of Pediosus The Flexor superior whereupon it is called the Abductor of the Toes and also Pediosus because it is stretched over the Pedium or back of the foot The first of the seven of the lower side called the flexor superior or upper-bender arises from the heel and stretched alongst the foot under the strong membrane which from the heel is straitly fastned to the extremity of the bones of the Pedium to strengthen the parts contained under it is inserted by four tendons at the second joint of the four toes which it bends Here you must note that neer the insertion thereof this muscle divides its self like that muscle of the hand which is called sublimis that so it may give way to the deep which as we said descends alongst the fingers to which a certain common membranous ligament adjoyns it self which involves and fastens it to the bone all alongst the lower part of the fingers even to the last dearticulation The second equivalent to that muscle of the Hand which is called Thenar The muscle equivalent to the Thenar seated on the inner side of the foot arises from the inner and hollow part of the Heel and Pastern-bones and ends in the side and inner part of the great Toe which it draws from the rest inwards This may be divided into two or three muscles as the Thenar of the hand to draw the great Toe to the rest as much as need requires just as we said of the Hand The third answerable to that of the hand which is named the Hypâ—thenar passes from the outer part of the Heel and ascending by the sides of the foot it is in like manner inserted into the side of the little
of the length of ones hand plain from the crown even to the beak the beak being divided to the middle region of the eye being roundish at the end thereof B. The neck a yard long consisting of seventeen Vertebrae each whereof on each side is furnished with a transverse process locking downwards of some fingers length excepting the two which are next the head as which want these and are joyned together by Ginglymos C. The back is of a foots length consisting of seven Vertebrae D. The holy-bone of two foot long in whose top there is a transverse process under which there lies a great hole E. Three more but less F. G. H. After which there follows the cavity or socket whereinto the head of the thigh bone is received and hid This externally and on the side produceth a perforated bone noted with the letter I perforated I say at the beginning for it is presently united at the letter K. then it is forked and divided into two other bones whereof one is bigger then the other The less is noted with the letter L. then they are both united at the letter M. each of them is half a foot and four inches long But from that part whereas they first begun to be divided to what whereas they are united there is a hole some four fingers broad but the length of ones hand or more and it is noted with the letter N. The residue of the bone is like to a pruning knife three inches broad but six in length the end whereunder is the letter O. it is joyned by coalition P. The rump consisting of nine Vertebrae like to a mans The thigh bones are two whereof that which is noted with the letter Q. is of the length of a foot and of thickness equal to a horses thigh The other next under which peradventure you may call the leg-bone noted with R. is a foot and half long it hath joyned thereto the Fibula or lesser focil of the length but which grows smaller as it comes lower S. Is the leg to which foot adheres being one foot and a half long divided at the end into two claws the one bigger the other less whereof each one consists of three bones T. Eight ribs which are inserted into the Sternon the three middlemost of these have a bony production like to a hook V. Is the Sternon consisting of one bone of some foot 's length representing a buckler to this there is joyned another bone which stretched over the three first ribs is in stead of clavicles or collar-bones X. The fi st bone of the wing which is one foot and half long Y. Two bones under this equivalant to the ell and wand under which there are six other bones composing the point of the wing noted with Z. This whole Sceleton is seven foot long and so many foot or more high from the feet to the beak there are many other observable things in his composure but I have thought fit to omitt them for brevitie sake The effigies of a Manucodiata or bird Paradise Tom. 2. l. 21. cap. 22. We have read in Thevets Cosmography that he saw a bird in America which in that country speech is called Touca in this very monstrous and deformed for that the beak in length and thickness exceeds the bigness of the rest of the body it feeds on pepper as the black-birds and felfars with us do upon Ivie-berries which are not less hot then pepper A certain Gentleman of Provence brought a bird of this kinde from that country ro present it to King Charls the ninth but dying in the way he could not present it alive Wherefore the King wished the Mareschal de Rets to give her to me that I might take forth her bowels and embalm her that she might be kept amongst the Kings rarities I did what I could yet not long after she rotted she resembled a crow in body and feathers but had a yellowish beak clear smooth and toothed like a saw and of such length and thickness as we formerly mentioned I keep it yet as a certain monstrous thing Tom. 1 cap 11. lib. 4. Thevet writes that in the Island Zocotera there is frequently found a certain wilde beast called Hulphalis of the bigness of an Ethiopian Monky It is a very monstrous creature but in nothing more then that it is thought to live upon the air only the skin as if it were died in grain is of a scarlet colour yet it is in some places spotted and variegated it hath a round-head like to a boul with feet round broad and wanting hurtful nails The Moors kill it and use to eat the flesh of it being first bruised that so it may be the more tender Thevet tom 1. lib. 11. cap. 13. In the Realm of Camota of Ahob of Benga and other mountains of Cangipa Plimatiq and Catagan which are in the inner India beyond the river of Ganges some five degrees beyond the Tropick of Cancer is found a beast which the Western Germans call Giraff This beast in head ears and cloven feet is not much unlike our Doe it hath a very slender neck but is some six foot long and there are few beasts that exceed him in the length of their legs his tail is round but reacheth no further them his hams his skin is exceeding beautiful yet sowewhat rough having hair thereon somewhat longer then a Cow it is spotted and variegated in some places with spots of a middle colour between white and chesnut so as Leopards are for which cause by some Greek Historians it is called Cameleopardalis it is so wilde before it be taken that with the good-will it will not so much as be seen Therefore it inhabits lives only in desert and secret places unknown to the rest of the beasts of that region she presently flies away at the sight of a man yet he is taken at length for that he is not very speedy in running away once taken he is as easily and speedily tamed as any wilde beast whatsoever He hath above his crown two strait horns covered with hairs and of a foot length When as he holds up his head and neck he is as high as a-Lance He feeds upon herbs and the leaves and boughs of trees yea he is also delighted with bread The effigies of a Giraffa Such as sail in the red sea along the coast of Arabia meet with an Island called by the Arabians Cademota in that part thereof where the river Plata runs is found a wilde beast called by the barbarous inhabitants Parassoupi being of the bigness of a Mule headed not unlike one yet rough and haired like to a Beat but not of so dark a colour but inclining to yellow with cloven feet like a Hart she hath two long horns on her head but not branched somewhat resembling those to much magnified horns of Unicorns For the natives of the place bitten by the venomous tooth of either beast or fish are
which we will describe at large in our Treatise of Anatomie CPAP. V. Of Temperaments What a Temperament is A Temperament is defined a proportionable mixture of hot cold moist and dry or It is a concord of the first disagreeing faculties That harmony springs from the mixture of the four first bodies of the world This whether Temperament or Concord is given to Plants and brute Beasts for the beginning of their life and so consequently for their life and form But as Plants are inferiour in order and dignity to beasts so their * Anima What the life performs in Plants life is more base and infirm for they have only a growing faculty by which they may draw an Alimentary juyce from the earth as from their Mothers breasts to preserve them and their life by which they may grow to a certain bigness and lastly by which they may bring forth their like for the perpetual continuance of their kind But the * Anima What in beasts Mans soul comes from above life of beasts have to the three former the gift of sense annexed by benefit whereof as by a certain inward knowledge they shun those things that are hurtful and follow those which profit them and by the power of their will they move themselves whither they please But the soul of man far more perfect and noble than the rest ariseth not from that earthly mixture and temper of the Elements but acknowledgeth and hath a far more divine off-spring as we shall teach hereafter The manifold division of a Temperament They divide a Temperament at the first division into two kinds as one a temperate another an untemperate The untemperate is of two sorts The one wholly vicious which hath altogether exceeded the bounds of mediocrity The other which hath somwhat strayed from the mediocrity of temper A Temperament ad Pondus but notwithstanding is yet contained within the limits of health as that which brings no such evident harm to the actions but that it somewhat hinders them so that they cannot so well and perfectly perform their duties But the vicious Temperament doth three manner of wayes corrupt the functions either by weakning depraving or abolishing them For so Stupor or astonishment diminisheth and sloweth the quickness of motion Convulsion depraves it Ad pondus vel ad justitiam the Palsie abolisheth it and taketh it away The temperate Temperament is also divided into two kinds which is either to equality of weight or justice It is called a Temperature to weight which ariseth from the equal force of exactly concurring qualities and as placed in a perfect ballance draws down neither to this nor that part They think the example of this Temperament to appear in the inner skin of the fingers ends of a man tempered to Justice For seeing the most exquisite touch resides there they ought to be free from all excess of contrariety for otherwise being corrupted by too much heat or cold moisture or driness they could give no certain judgment of the tangible qualities For which thing Nature hath excellently provided in the fabrick and coagmentation of the parts of which the skin consists For it is composed of hot and moist flesh and therefore soft and of a tendon and nerve cold and dry and therefore hard which are not only equally fitted and conjoyned but wholly confused and mixed together by which it comes that removed from all extreames of opposition it is placed in the midst as a rule to judg of all the excesses that happen to the touch So it was fit the eye which was to be the instrument of sight should be tinctured with no certain colour that it might be the less deceived in the judgment of colours So it was convenient the Hearing should not be troubled with any distinct sound whereby it might more certainly judg of equal and unequal sounds not distinguished by a ratable proportion neither was it fit the tongue should have any certain taste lest the access of that taste should deceive it in knowing and judging of so many different tastes A Temperament ad justitiam The temperature tempered to justice is that which although it is a little absent from the exact and severe parility of mixed qualities yet hath that equality which doth fully and abundantly suffice for to perform all the functions fitly and perfectly which nature doth require wherefore we can judg no otherwise of it than by the integrity of the Actions For hence it took its name for as distributive Justice equally gives to every one rewards or punishment according to their deserts so Nature having regard to all the parts of the body gives them all that temper which may suffice to perform those duties for which they are ordained Let us for an example consider a Bone no man doubts but that like as the other similar parts of the body The Temperament of a bone proceeds from the mixture of the four Elements but nevertheless nature weighing the use of it and ordaining it to support the rest of the body would have more of the terrene and dry Element infused into it that it might be the stronger and firmer to sustein weight But a Ligament seeing it was made for other uses hath less of that earthly driness than the bone but more than the flesh altogether fitted to its nature So it hath seemed good to nature to endue all the parts of the body not only with an equal portion but also proportion of Elements and qualities we call that a Temperament to justice and we say that it is in Plants brute Beasts and all natural bodies which enjoy that temper and mediocrity which may be agreeable to their nature Hereupon by comparison arise eight kinds of intemperate tempers As Four simple Hot temperate in Driness and Moisture The kindes of untemperate tempers Cold temperate in Driness and Moisture Moist temperate in Heat and Cold. Dry temperate in Heat and Cold. Four compounds Hot and Moist Hot and Dry Cold and Moist Cold and Dry. But these Temperaments are either of the whole Body or of some part thereof And that either Principal as the Brain the Heart the Liver the Stones Or Of the rest of the parts composed of other which have no principality in the body Again such Temperaments are either healthful which suffice perfectly to perform their actions or unhealthful which manifestly hurt them the signes whereof may be read described by Galen And you must observe that when we say the body or any part of it is hot Lib 2. de Temper in Arte medica we understand more hot than is fit for one of that kind which is tempered to justice as when we say a man hath a hot liver we mean his liver is hotter than a man justly tempered should have for all other tempers whether of the whole body or any of the parts thereof are to be referred to this and in the cure of diseases
some muscles arising from many parts are inserted into some one part as divers of those which move the arm and the shoulder which arising from many spondyls are inserted into the bone of the shoulder and the shoulder-blade Others arise from one part and insert themselves into more as those which arise from the bottom of the shoulder-blades are extended and inserted into some eight or nine of the upper ribs to help respiration and the benders and extenders of the fingers and toes Others arising from many bones are inserted into as many as some of those which serve for respiration to wit those which we call the hinder Saw-muscles and the Semispinatus which sends a tendon into all the ribs Others have their original from many bones end in grisles of the seven ribs as those two which lie under the Sternon Moreover also these differences of muscles may be drawn from the original and insertion that some proceed from bones and are inserted into the next bone to help and strengthen the motion thereof as the three muscles of the Hip Others arise from an upper bone are not inserted into the next but into some other as the long muscles Some are named from the part they move as the temporal muscles because they move the temples others from their office as the grinding muscles because they move the skin as a Mill Differences of Muscles takeâ— from their figure to grind asunder the meal From their form or figure because some are like Mice other like Lizards which have their legs cut off for that they imitate in their belly body or tendon the belly or tail of such creatures and from whence the name of Musculus and Lacertus are derived Such are those which bend the wrist and which are fastened to the bone of the Leg and which extend the foot others are triangular as that which lifts up the arm called Epemis or Deltoides and that which draws the arm to the brest called the pectoral muscle Others quadrangular as the Rhomboides or Lozenge-muscle of the shoulder-blade and the two hindsom-muscles serving for respiration and two of the wrists which turn down the hand others consist of more than four angles as the oblique descending and that muscle which joins it self to it from the shoulder-blade others are round and broad as the Midriff others circular as the Sphincter-muscle of the fundament and bladder others are of a pyramidical figure as the seventh muscle of the eye which compasses the optick nerve in beasts but not in men Others have a sem-circular form as that which shuts up the eye seated at the lesser corner thereof others resemble a Monk's cowl or hood as the Trapezius of the shoulder-blade Besides others at their first original are narrow but broad at their insertion as the Saw-muscle of the shoulder and the transverse of the Epigastrium others are quite contrary as the three muscles of the Hip others keep an equal breadth or bigness in all places as the intercostal muscles and those of the wrist others are long and slender as the long muscle of the thigh others are long and broad as the oblique descending muscles of the Epigastrium others are directly contrary Differences from their perforations as the Intercostal which are very narrow From their perforations for some are perforated From their magnitude as the midriff which hath three holes as also the oblique and transverse of the Epigastrium that so they may give passage forth to the preparing spermatick vessels and to the ejaculatory vessels the Coat Erythroides associating and strengthening them others are not perforated From their magnitude for some are most large as the two Muscles of the Hip others very small as the eight small muscles of the neck and the proper muscles of the Throtle and the wormy muscles From their colour Others are of an indifferent magnitude From their colour for some are white and red as the Temporal muscles which have Tendons coming from the midst of their belly others are livid as the three greater muscles of the calf of the leg which colour they have by the admixtion of the white or tendinous nervy coat with the red flesh for this coat by its thickness darkning the colour of the flesh so that it cannot shew its redness and fresh colour makes it seem of that livid colour From their site From their situation for some are superficiary as those which appear under the skin and fat others deep in and hid as the smooth and four twin muscles some are stretched out and as it were spred over in a streight and plain passage as the muscles of the thigh which move the leg except the Ham-muscle others oblique as those of the Epigastrium othersome transverse as the transverse of the Epigastrium where you must observe that although all the fibers of the muscles are direct yet we call them oblique and transverse by comparing them to the right muscles as which by the concourse of the fibers make a streight or acute angle From their Fibers From the sorts of fibers for some have one kind of fiber yet the greatest part enjoy two sorts running so up and down that they either are crossed like the letter X as happens in the pectoral and grinding muscles or else do not concurr as in the Trapezii Others have three sorts of fibers as the broad muscle of the face From their Connexion From their coherence or connexion or their texture of nervous fibers for some have fibers somewhat more distant and remote immediately at their original than in other places as you may see in the muscles of the buttocks Others in their midst and belly which by reason thereof in such muscles is more big or tumid their head and tail being slender as happens in most of the muscles of the arm and leg in which the dense mass of flesh interwoven with fibers disjoins the fibers in so great a distance in othersome the fibers are more distant in the tail as in the greater Saw-muscle arising from the bottom of the shoulder-blade in others they are equally distant through the whole muscle as in the muscles of the wrist and between the ribs From their Head From their head for in some it is fleshy interwoven with few fibers as in the muscles of the buttocks in others it is wholly nervous as in the most broad muscle common to the arm and shoulder-blade and in the three muscles of the thigh proceeding from the tuberosity of the hucklebone in some it is nervous and fleshy as in the internal and external muscle of the arm Besides some have one head others two as the bender of the elbow and the external of the leg others three as the Three-headed muscle of the Thigh But we must note that the word Nerve or Sinew is here taken in a large signification for a ligament nerve and tendon as Galen saith Lib. de Offilus and moreover we must observe
adiposae a b The Emulgent veins with the Arteries under them cc dd The Ureter from either kidney to the bladder e f The spermatical veins to the testicles the right from the hollow vein the left from the Emulgent g g Veins coming from the spermatical to the peritonaeum h i the spermatical Arteries k The lower mesenterical Artery l. The ascending of the great Artery above the hollow vein and the division of it and the hollow vein into two trunks m The Arterie of the loins called lumbaris n The holy Artery called Sacra o A part of the right gut p The bladder of Urine * The connexion of the bladder with the peritonaeum q A part of the vessels which lead the seed from the Testicles is here reflected r s The scrotum or cod that is the skin that invests the Yard and Testicles t The fleshy Pannicle or membrane which is under the cod u The coat which is proper to the Testicles with his vessels x A part of the yard excoriated or flayed and hanging down The sixth going from the fore and upper part of this descend nt artery 6. Haemorrhoidalis sue mesenterica inferior descends with the Haemorrhoidal veins to the fundament presently from his beginning sending forth certain branches alongst the colick gut which by Anastomasis are united with other branches of the Coeliacal Arterie for whosoever shall look more attentively he shall often observe that veins are so united amongst themselves and also arteries and sometimes also the veins with the arteries For Anastomasis is a communion and a communicating of the vessels amongst themselves by the application of their mouths that so by mutual supplies they may ease each others defect But they call this the lower meseraick artery The seventh proceeding from the trunk with so many branches as there be Vertebra's in the loins goes to the loins and the parts belonging to them that is the spinal marrow of that part 7. Lumbaris and other parts encompassing these Vertebra's whereupon it is stiled the Lumbaris or Loin-Artery The eighth maketh the Iliack arterie until such time as it departs from the Peritonaeum where the Crural Arteries take their original This Iliack Artery sends many divarications towards the Holy bone where it takes its beginning and to the places lying neer the Holy bone which Iliacâ— because they run the same course as the Iliack veins for brevitie's sake we will let pass further mention of them till we come to treat of the Iliack veins CHAP. XXII Of the distribution of the Nerves to the natural parts IT remains that before the bowels be taken away we shew the nerves sent to the entrails and natural parts that as wise and provident men we may seem to have omitted nothing The originaâ— of the nerves which are carried to the natural parts First we must know that these nerves are of the sixth Conjugation which descend as well to the stomach all alongst the Gullet and the sides thereof as those at the roots of the ribs on both sides within But when they are passed through the Midriff those which are distributed amongst the natural parts follow the turnings of the veins and arteries but specially of the arteries Wherefore if you have a mind to follow this distribution of the nerves you must chiefly look for it in those places in which the artery is distributed amongst the Guts above the loins Their Magnitude and Use These nerves are but small because the parts serving for nutrition needed none but little nerves for the performance of the third duty of nerves which is in the discerning and knowing of what is troublesom to them For unless they had this sense there is nothing would hinder but these bowels necessary for life being possessed with some hurtful thing the creature should presently fall down dead but we have this benefit by this sense that as soon as any thing troubles and vellicates the bowels we being admonished thereof may look for help in time And besides if they were destitute of this sense they might be gnawn ulcerated and putrified by the raging acrimony of the excrements falling into and staying in them but now by means hereof as soon as they find themselves pricked or pluckt presently by the expulsive faculty they endeavour to expel that which is troublesom and so free themselves of present and future dangers CHAP. XXIII The manner of taking out the Guts WHen the Guts are to be taken out you must begin with the right Gut And you must divide it being first straitly tied in two different places at a just distance about four fingers from the end with a sharp knife between two ligatures Then you must shew its proper coats and fibers and that common one which it hath from the Peritonaeum This being done you must in like manner bind the trunk of the gate-vein as neer the original as you can that so all his branches being in like manner tied there may be no fear of effusion of blood you must do the like with the Coeliack Artery at the left Kidney and in the lower Mesenterick which descends to the right Gut with Haemorrhoidal veins This being done pull away the guts even to the Duodenum which being in like manner tied in two places which ought to be below the insertion of the Porus Cholagogus or passage of the Gall that you may shew the oblique insertion thereof into that gut for the obliquity of its insertion is worth observation as that which is the cause that the Gall cannot flow back into its bladder by the compression of this Gut from below upwards Then all these windings of the Guts may be taken away from the body CHAP. XXIV The Original and Distribution of the descendent Hollow Vein The original of the Hollow vein It is divided into two Trunks BEcause the rest of the natural parts do almost all depend upon the descendent Hollow Vein therefore before we go any further we will shew its original and distribution We said before that all Veins proceeded from the Liver but yet in divers places For the gate-vein goes out of the hollow part and the hollow vein out of the Gibbous part of the liver which going forth like the body of a tree is divided into two great branches the lesser of which goes to the vital and animal parts and the extremities of these parts as we shall shew in their place The greater descending from the back-part of the Liver above the Vertebra's of the loins to the parts beneath The division of the greater branch of the hollow vein goes in the manner following The first division thereof is to the membranes of the reins which come from the Peritonaeum Wherefore there it produces the Venae adiposae or fatty veins so called because they bring forth a great quantity of fat in those places Of these fatty veins there is a diverse original for the right doth oftentimes arise from
by the fibers of the ligaments and the excrement of the Tendons which are terminated at the bottom of the nails Now remain the Ossa Sesamâ—idea The Ossa Sesamâ—idea or Seed-bones or Seed-bones these are 19 in number in the inner Joynts of each of the Hands and as many in each foot viz. two in the first joynt of the four fingers and in the second of the thumb and one in each of the rest For the inner side of the joynts you may for the most part observe one in each of them yet in the second joynt of the Thumb there be two above the two Tendons which are somewhat gristly Their use They are made for this use that they may firm and strengâ—â—en the joynts so that the Bones of the Fingers may not be turned awry or thrust forth of their places by strong and violent motions as it sometimes happens in the Whirlbone of the Knee They are called Sesamâ—idea from the resemblance they have to the seed of Sesamum which is somewhat long and flat CHAP. XXVIII Of the Muscles which seated in the Cubit move the Wand and with it the Hand The muscles of the Cubit NOw we must describe the Muscles of the formerly described parts that is those which are seated in the cubit which are carryed to the inside of the Hand and those which are called the Interâ—sses Now the Muscles of the cubit are 14 seven external seven internal two of the seven external do primarily twine or turn up the Wand and secondarily or by accident The Supinatores The Carpitensares The Digitum-tensores The Obliqâ—ator â—ateâ—nuâ— The first of the Supinatores The second The upper of the Carpitâ—nsores The lower turn the palm of the hand upwards whereupon they have called them supinatores or turners up of the Hand two extend the Wrist whereupon they are named Carpi-tensores or the Wrist-extenders two the fingers whence they are styled Digitum-tensores or finger-stretchers to conclude the seventh and last is termed Aâ—ducter or Obliquater externus The first of the two Supinatores is called the Long or Longest because it descends from the out-side of the Arm above the processes thereof and is inserted by a round and strong tendon into the lower Appendix The other descends obliquely from the outward and upper process of the Arm and is inserted at the third part of the Wand by a membranous and fleshy tendon before and on the inside thereof The upper of the two extenders of the Wrist descending above the Wand from the external upper process of the Arm is inserted by two tendons into the first and second Bone of the After-wrist which sustain the fore and middle-fingers The other and lower descending from the same place as the former above the cubit is inserted into the fourth bone of the After-wrist which bears up the little finger These Muscles whilst they move alone that is each with his Antagonist to wit the Wrist-benders they move obliquely The greater of the Dâ—gitum-tenâ—â—â—res upwards or downwards the whole Hand properly so called The first and greater of the extenders of the Fingers or Finger-stretchers arising from the Olecranum or Bone of the Cubit descends superficiarily between the two Bones of the Cubit even to the Wrist in which place it is divided into four Tendons which passing under the Ring seated there end each distinguished by a common Ligament above the Bone or the After-wrist in the last joynts of the four fingers adhering nevertheless firmly to the Bones which are above these joynts The lesser The other which is the lesser arising almost in the middle of the Wand goes obliquely to the Thumb into which it is inserted by two Tendons the one thicker which is inserted into the root thereof and draws it from the other fingers the other slenderer continued even to the upper joynt thereof and by its action extending the Thumb The seventh which is the Abductor or Obliquator is seated at the hind-part of the hand that is The Obliquator or Abductor caâ—ternuâ— towards the little finger we have often found this divided in two yea verily we have found it trifide or divided into three this year in three or four dead bodies one portion thereof went to the lower side of the Ring-finger with two tendons the other in like manner to the middle and fore-fingers and the third to the thumb And for all that it is thus divided yet some have taken and accounted it for one Muscle because it hath one original and action which is to draw the fingers backwards some have added to this the extender of the thumb by reason of their common original and thus of four muscles they have made one divided into seven tendons distributed as is formerly shewed But when the Obliquator of the Ring-finger is wanting as it often happens the extender of the finger supplies that defect by certain productions of tendinous strings But some also have written that this muscle which we said hath seven tendons is only a production of the deep fore-muscle which should be sent through the space between the bones of the cubit yet I had rather make it a muscle of it self by reason of its strait adhesion with the bones of the arm and wand And let thus much suffice for the external muscles of the cubit which you may comprehend in the number of seven as we have done or in six if you take away one of the four or in nine if you had rather resolve it into four with Galen or in eight if you divide this muscle only into three For in very deed the Abductor or Obliquator of the Ring-finger is not often found in men Now must we come to the inner muscles of the cubit The muscles of the inner part of the cubit the first of which compasses the skin of the palm of the hand whence it is called the Palmaris The second and third joyned by the communion of their action turn down or prone the wand and consequently the hand so that the palm looks towards the feet whereupon they are called Pronatores The fourth and fifth joyned also in affinity of action bend the wrist wherefore they are named Carpi-flexores Wrist-benders The sixt and seventh are appointed to bend the first second and third joynts of the fingers wherefore they are termed Digitum-flexores Finger-benders For their original the Palmaris the least and uppermost of them all The Palmaris descends fleshy from the hind-process of the inner arm and a little after ending in a long and slender tendon it is spent in the skin of the palm of the hand even to the roots of the finger For it was necessary that the skin should straitly cohere with the subjacent parts not only for the fitter taking or comprehension of any thing lest that skin in holding should be wrinckled and drawn away from the palm and fingers and so be an impediment but besides that the hand might have
them Now they say the Testudo is a tumor contrary to nature soft diffused What the Testudo or Talparia is vaulted or arched like a Tortois sometimes it arises in the head in form of a Mole and then it is called a Mole The Nata is a great and fleshy tumor not in shape unlike a Melon or rather the flesh of a mans Buttocks whence it may seem to have had the name unless we had rather say It had it What the Nata is because it more usually breeds upon the buttocks than upon any other part of the body The Glandula takes its denomination from an Acorn called Glans in Latine What a Glandula the which it somewhat resembles in the compass and form of the tumor or else because it most commonly breeds in the Glandules or Emunctories of mans body The Nodus or knot is a round tumor hard and immoveable named from a rope tied on a knot What Nodus Guido Cauliacensis affirms Knots commonly to grow in nervous bodies but at this time they more usually arise on the bones of such as have the French Disease CHAP. XX. Of the cure of Lupiae that is Wens or Ganglions A Wen or Ganglion is a tumor sometimes hard sometimes soft yet alwayes round What a Ganglion is using to breed in dry hard and nervous parts And seeing that some of the tumors mentioned before in the former Chapter stick immoveable to the part to which they grow because they are contained in no cist or bag othersome are moved up and down by the touch of your fingers because they are contained in a bag or bladder it commonly comes to pass that Wens have their bladder wherein to contain them and therefore we thimk fit the rather more freely and particularly to treat of their cure because they are more difficultly cured especially where they are inveterate and of long standing The causes The Primitive causes of these are dull blows fallings from high places strains and other such like occasions But the antecedent and conjunct causes are the same with those of an Atheroma Meliceris and Steatoma Signs The description formerly set down will furnish you with the signs by which you may know when they are present certainly from very small beginnings they grow by little and little to a great bigness in the space of six or seven years some of them yield much to the touch and almost all of them are without pain Their cure at the beginning You may hinder such as are beginning and first growing from encrease by somewhat a strong and frequent rubbing with your fingers For so their bag or bladder together with the skin wax thin and the contained humor grows hot is attenuated and resolved But if so you nothing prevail you must lie upon them with your whole hand or a flatted piece of wood as heavy as you can Plates of lead rubbed with Quick-silver until such time as the cist or bag be broken by your impression Then apply and strongly bind unto it a plate of Lead rubbed over with Quick-silver for I have many times found by experience that it hath a wonderful force to resolve and waste the subject humor But if the Wen be in such a place in which you can make no strong impression A resolving plaister as in the face chest belly and throat let there be applyed an emplaister which hath a resolving force such as this following hath Things to wast or consume the bag â„ž gummi ammon bdellii galban an â„¥ iij liquefiant in aceto trajiciantur per setaceum addendo olei liliorum lauri an â„¥ i aqu vitae parum pulveris ireos salis ammon sulphur vivi vitrioli Romani an Ê’ ss Let them be incorporated together and make an Emplaister according to Art But if the tumor cannot be thus resolved it must be opened with a knife or cautery And after the Eschar is removed and the bag wasted by Aegyptiacum Mercury and the like the ulcer must be cleansed replenished with flesh and cicatrized Sometimes Wens grow to so great a mass that they cannot be cured by the described remedies wherefore they must be taken away by the root by your Hand and Instrument if so be that there be no danger by reason of their greatness and so that they adhere not too closely to the adjacent parts and if they be not too nigh to the greater veins and arteries for it will be better in such a cause to let them alone The manner to take away Wens This shall be your way to cut them off or take them away A small Incision must be made even to the bladder or bag by which thrust in a Probe of a finger's thickness hollowed in the midst round at the end and as long as need shall require then draw it many times about between the skin and the bag even to the root of the Wen that so the skin may be divided long wayes then it will be requisite to make another Incision overthwart so that they may intersect each other like a cross then presently draw the skin from the bladder from the corners of the Wen towards the root and that with your finger covered with a fine linnen cloth or else with a Razor if need require But you must observe that in a Wen there are alwayes certain vessels which are small in the beginning but much encreased in process of time according to the encrease of the Wen whereof they are as it were the roots wherefore if any Haemorrhagie or flux of bloud happen let it be stopped by binding the vessels at their heads roots or make a strait ligature at the roots of the Wen with a piece of whipcord or with a many times doubled thred and let the ends hang forth until it fall away of its own accord Neither will it be sufficient to have cut away all this tumor but also it will be fit to cut away a portion of the skin wherewith the tumor was covered and only to leave so much as shall suffice to cover the part then with a needle and thred draw together the lips of the incision but in the interim let tents be put into the bottom of the ulcer until it be perfectly cleansed the rest of the cure be workman-like performed even to the cicatrizing thereof A History The Chirurgeon Collo and I using this method in the presence of Master Dr. Violanius the Kings Physitian took away a Wen from Martial Colard the Maior of Burbon it hanged at his neck as big as a man's head and it weighed eight pounds which made it so troublesome and burdensom to him that he was forced to carry it bound up in a towel as in a scrip What Wens to be cured by ligature Which dangerous to cure Verily if these kind of tumors have a slender root and broad top they must be straitly tyed and so cut off But it is
vel unguenti and there may be use of a resolving and repercussive Ointment as â„ž plumbi usti loti pomphol thuris an Ê’ ij ss absinth pontic â„¥ ss olei rosarum â„¥ iij ceraeÊ’ vi succi solani quantum sufficit ad unguenti crassitudinem They very much commend Theodoricks Emplaister to asswage the pain of ulcerated Cancers â„ž olei ros cerae all an â„¥ ii ss succi granat solani an â„¥ ij cerusae lotae â„¥ i plumbi usti loti Theodoricks Emplaisters tuthiae prapar an â„¥ ss thuris mastich an Ê’ ij fiat empl molle This following Ointment I have often used with good success â„ž Theriac veter â„¥ i succi cancrorum â„¥ ss succi lactucae olei rosar an â„¥ i ss vitel ovorum sub cinerib coct ij camphor Ê’ ss pistentur omnia in mertario plumb fiat ungentum â„ž Spum argent axungiae porci recentis cerae alb an lb ss olei boni â„¥ viij vitel ovorum assat iiij fiat unguent servetur usui And when you will use it mix it with a little Ointment of Roses Leaches The application of Whelps Chickens c. I have also mitigated great pain by applying Leaches to an unulcerated Cancer in that part where the torment was most vehement by disburdening the part of some portion of the malign humor which same thing I have done by application of young Whelps or Pigeons or Chickens cut long-ways and presently applyed to the ulcer and now and then changed assoon as their heat seems dissolved and others applyed for the natural heat in an Anodyne or mitigating medicine Epist 21. The Estate of Erysimum John Baptista Theodosius in his Epistles writes that a cataplasm of the herb Erisimum or Cadlock being beaten is very good to be applyed to a Cancer not ulcerated but if the Cancer be ulcerated he boils this same herb in Hydromel and so by injections and lotions cleanses the ulcer The signs of the Cancer in the womb and mitigates the pain If the Cancer affect the womb the Patient feels the pricking of the pain in the groin above the pecten and in the Kidneys and is often troubled with a difficulty of making water but when it is ulcerated it pours forth filth or matter exceeding stinking and carion-like and that in great plenty the filthy vapour of which carryed up to the heart and brain causes often swounding Now to mitigate the pains of such like places the following medicines are of good use â„ž Mucag. semin lini faenugr extract in aqua rosar plantaginis quod satis est Of this being warm make a fomentation â„ž Rad. Altheae lb ss coquatur in hydromelite pistetur trajiciatur addendo ol rosar parum fiat Caplasma Also you shall make divers pessaries according to the different kinds of pain also make injections of the juyce of Plantain Knot-grass Lettuce Purslain mixed together and agitated or laboured in a leaden Mortar with a little Oyl of Roses for this kind of medicine is commended by Galen in every kind of ulcerated Cancers Also this following Water is very profitable Lib. 9. Simpl. and often proved by me â„ž Stercoris bubuli lb iiij herbae Roberti plantag sempervivi hyoscyami portulac l. ctuc. endiv. an m. i. cancros fluviatiles num xij Let them be all beaten together and distilled in a leaden Alembick keep the liquor for use and with it make often injection into the part or if the site of the part will permit let the cancerous ulcers be washed therewith and pledgets of lint steeped therein be applyed and renewed ever and anon for so the acrimony and force of the inflammation is retunded and the pain asswaged Galen beats into powder River-Crabs burnt Lib. 4. de comp med secundum gen the powder mixed with Ointment of Roses is most profitably applyed upon lint to cancerous Ulcers It will be very convenient to put into the neck of the womb the following Instrument made of Gold or Silver whereby the cancerous filth may have free and safe passage forth and the filthy and putredinous vapours may more easily breathe forth Therefore let it be hollow quite through some five or six fingers long and about the bigness of ones thumb at the upper end perforated with many holes whereby the filth may have passage forth Let the outer or lower end be some two fingers thick in the circumference make it with a neat spring that may hold that end open more or less according to the Physitians mind let there be two strings or laces put unto it by which being tyed before and behind to the rowler with which the woman shall girt her loins the Device may be kept from falling as your may see in the following figure A Vent made like a Pessary for the Womb affected with a cancerous Ulcer A Shews the upper end perforated with five or six holes B The lower end C That part of the end which is opened by the spring which is marked with the Letter D. EE The strings or laces Neither is that remedy for not ulcerated Cancers to be contemned which consists of a Plate of lead besmeared with Quick-silver for Galen himself testifies Lib. 6. simp Plates of Lead that Lead is a good medicine for malign and inveterate ulcers But Guido Cauliacensis is a witness of ancient credit and learning that such plates of lead rubbed over with Quick-silver A History to such malign ulcers as contemn the force of other medicins are as it were Antidotes to waste and overcome their malignity and evil nature This kind of remedy when it was prescribed by that most excellent Physitian Hollerius who commanded me to apply it to the Lady of Montigni Maid of Honour to the Queen-mother troubled with a Cancer in her left brest which equalled the bigness of a Walnut did not truly throughly heal it yet notwithstanding kept it from further growth Wherefore at length growing weary of it when she had committed herself to a certain Physitian boldly promising her quick help she tryed with loss of her life how dangerous and disadvantagious the cure of Cancer was which is undertaken according to the manner of healing other ulcers for this Physitian when he had cast away this our medicin and had begun the cure with mollifying heating and attractive things the pain inflammation and all the other symptoms encreasing the tumor grew to that bigness that being the humor drawn thither could not be contained in the part it self it stretched the brest forth so much that it broke it in the middle just as a Pomgranate cleaves when it comes to its full maturity whereupon an immoderate flux of bloud followed for staying whereof he was forc't to strew caustick powders thereon but by this means the inflamation and pain becoming more raging and swoundings coming upon her she poor Soul in stead of her promised Health yielded up her Ghost in the Physitians bosom CHAP. XXXI Of the
differences of a fractured Skull The differences of Fractures common to these of all other parts are drawn either from Their Nature according to which fractures are call'd Simple as when they are found solitary and by themselves Compound and that either Mutually with themselves as a contusion or Collision with Incision a Fissure with an Effracture Or with other symptomes as Swelling Pain Heat Bleeding Convulsion and the like Their Quantity whence they are called great indifferent and small according to the triple dimension of length breadth and profundity Their Figure from whence they are called Right Oblique Transverse Round Triangular Their Site whence they are termed on the fore or back or the right or left or the upper or lower part or superficiary and profound The Part whence it is called a Fracture of the Forehead Nowl Bregma and Stony bones and hence it is judged what may be deadly or hopeful of recovery easie or difficult to cure CHAP. II. Of the causes and signs of a broken Skull The external causes THe causes of a broken Skull are external as a fall a blow or stroak with any kind of weapon sharp obtuse heavy hard the bitings of Beasts and many other things of the like kind But the signs by which we come to know that the Skull is broken are of two kinds for some of them are found out by the reasoning and discourse of the mind other by the sense as those which lay open the wound to the eye and hand Rational causes The Rational signs shew by these things which have happened upon the thing it self whether it be and of what sort it is For you may know the Skull is broken if the Patient shall fall down with the stroak or if he shall fall headlong from a high place upon some hard thing If for sometime after the stroak he shall lie without speaking sight and hearing if he shall have felt and feel much pain so that he is often forced to put his hand to the wound But also the weapon is to be considered that is whether if it be heavy obtuse pricking or sharp Also we must consider with what and how great strength the stroak was given and with how great anger and from what distance the weapon fell Also we must consider whether the Patient received the blow with his head unarmed and naked whether he fell into a swoon presently after the blow whether when he came to himself he was in his right senses whether his eyes were blinded whether he were troubled with a giddiness or diziness and whether he bled at the nose mouth ears or eyes and lastly whether he vomitted Aphor. 50. sect 6. For Hippocrates writes that those who have their Brain cut must necessarily have a Feaver and Vomitting of choler to ensue thereupon which Galen confirming in his Commentary saith that the same happens also when the Wound comes to the Membranes of the Brain Also a dull sound as from a broken vessel coming from the skull the hairy scalp and Pericranium being taken off and it being lightly smitten upon with an Iron probe is said to be a sign of a fracture thereof Lib. 8. cap. 4. as it is recorded by Paulus Aegineta Truly all these signs make a great conjecture or rather assuredness that the skull is wounded and the Brain hurt as which cannot happen unless the bone be broken as Celsus hath written Yet many have had their skulls broken who had no such sign immediately after the blow but this is very seldom But I do not think fit amongst so many signs here to omit that which is set down by Guido If any saith he will know in what place the skull is broke let the Patient hold fast between his fore-teeth one end of a Lute-string or thread and the Chirurgeon hold the other in his hand then let him lightly touch or play upon the string with his fingers for in the very instant of the sound or stroke the Patient will be certainly admonished or perfectly perceive the part of the skull that is broken and as orecome and forc'd by this sense of pain will by lifting up of his hand make demonstration thereof As yet I have not been able to find the truth hereof by experience although I have made tryal of it in many Wherefore I cannot say any thing certainly of this sign as neither of that which is mentioned by Hippocrates in Coais Praes In such as you doubt whether the Bones of the Skull be broken or not you must judg by giving them the stalk of the Asphodil Hippocrates and Guidoes conjectural signs of a broken skull to chaw on both sides of their jaws but so that you bid them withall observe whether they perceive any Bone to crackle or make a noise in their heads for those which are broken seem to make a noise But passing over these things now let us come to those signs which may be obvious to our senses CHAP. III. Of the Signs of a broken Skull which are manifest to our sense THose signs are here said to be manifest to sense which when the Bone is bared Sensible signs of a broken skull before the dividing of the skin manifest the wound to our Eyes fingers and probe But if the hairs stand upon one end in the wound you may know the Bone is broke because the hair which yields to the violence of the blow cannot be so cut the Bone which resists the stroak being not violated as it is observed by Hippocrates wherefore we may by the sight of this one thing Lib. de vulner cap. before any inspection of the wound it self suspect by a probable conjecture that the Skull is broken and perswade the beholders or standers by so much Moreover we may before we have cut the skin across or laid bare the Bone give a guess by our feeling whether the Skull be broken or no if we by pressing down our fingers neer the wound shall perceive the bone either to stand up or be pressed down otherwise than it should naturally be The skin being câ—t cross-wise and the Bone laid bare if the fracture be not obvious to the Eye What Probe must be used in searching for a fracture you must try with our probe which must neither be too thin nor too sharp lest by falling into some natural â—ranies it may cause us to suspect without any cause that the Bone is broken neither let it be too thick lest the little clifts may deceive you If when your probe comes to the Bone it meets with nothing but that which is smooth and slippery it is a sign that it is whole But on the contrary if you find it any thing rough specially where there is no suture it shews the Bone is broken But let the Chirurgeon consider that the fractures are not seldom upon the sutures and that the sutures have not alwayes one and their natural site as also it often comes to pass
of Vines Rosemary and Orris roots For the same purpose you may sprinkle the floor with sweet water A sweet water if the Patient be able to undergo such cost As â„ž majoranae menthae radic cyperi calami aromat salviae lavendulae faenicul thymi stoechad fâ—â—r chamaem melilot satureiae baccarum lauri juniperi an M. iij. pulv caryophyl nucis Moschat an â„¥ j. aqua rosar vitae an lib. ij vini albi boni odorifici lb. x. Perfumes to burn bulliant omnia in balneo Mariae ad usum dictum You may also make perfumes to burn in his chamber as thus â„ž carbonis salicis â„¥ viij ladani puri â„¥ ij thuris masculi ligni baccarum Juniperi an â„¥ j. xylâ—aloes benjoini styracis calamit an â„¥ ss Nuâ—is moschatae santal citriu an Ê’ iij. caryophyll styracis liquidae an Ê’ ij zedoariae calami ar mat an Ê’ j. gummi tragracanth aqua rosar soluti quod sit satis Make hereof perfumes in what fashion you please For the rottenness and corruption of bones we wil treat thereof hereafter in due place CHAP. XII Certain memorable Histories HEre I think good for the benefit of young practitioners to illustrate by examples the formerly prescribed Method of curing Wounds made by Gunshot The famous and most valiant Count of Mansfelt Governour of the Dutchy of Luxembourg Knight of the Order of Burgundy coming to the aid of the French King was at the Battel of Moncontour The malign symptoms which usually happen upon wounds made by Gunshot where in the conflict he received so great a wound at the joint of the left arm with a Pistol-bullet that the bones were shivered and broken in so many pieces as if they had been laid upon an Anvil and struck with an hammer hence proceeded many malign symptoms as cruel and tormenting pain inflammation a feaver an oedematous and flatulent tumor of the whole arm even to the fingers end and a certain inclination to a Gangraene which to resist Nicolas Lambert and Richard Habert the King's Chirurgeons had made many and deep scarifications But when I came to visit and dress him by the Kings appointment and had observed the great stench and putrefaction I wished that they would use lotions of Aegyptiacum made somewhat stronger then ordinary and dissolved in Vinegar and Aqua vitae and do other things more largely spoken of in the Chapter of a Gangraene For the Patient had also a Diarrhoea or Flux whereby he evacuated the purulent and stinking filth which flowed from his Wound Which how it might come to pass we will show at large when we come to treat of the suppression of the Urine Matter may flow from the wounded limbs into the belly For this seemed very absurd to many because that if this purulent humor flowed out of the arm into the belly it must needs flow back into the veins be mixed with the bloud and by its pernicious and contagious passage through the heart and liver cause exceeding ill symptoms and lastly death Indeed he often swounded by the ascent of the filthy vapours raised from the ulcer to the noble parts which to resist I wished him to take a spoonful of Aqua vitae with some Treacle dissolved therein I endeavoured to repress the oedematous and flatulent Tumor possessing all the arm with stoups dipped in Oxycrate A brief recital of the manner of the cure to which was put a little Salt and Aqua vitae these stoups I stayed and held to the part with double cloaths sowed as strait as I could Such a compression held the broken bones in their places pressed their Sanies from the ulcers and forced back the humors flowing to the part into the center of the body If at any time I omitted this compression the tumor was so encreased that I was in a great deal of fear lest the native heat of the part should be suffocated Neither could I otherwise bind up the arm by reason of the excessive pain which molested the Patient upon the least stirring of the arm There were also many Abcesses about his elbow and over all his arm besides For the letting forth of whose matter I was forced to make new Incisions which he endured very stoutly At length I cured him with using a vulnerary potion and by cleansing the ulcers and correcting the putrefaction with Aegyptiacum dissolved in wine and honey of Roses and so poured into the ulcers and repressing the growth of proud flesh with the powder of burnt Alum drying it after the detersion with liniments Now this I can truly affirm and profess that during the time of the cure I took out above threescore splinters of bones and those necessarily amongst which there was one of the length of ones finger yet by Gods assistance at length he became sound in all things but that he could not put forth or draw in his arm Not long after by the Kings command I went to see Charles Philip of Croy Lord of Auret the Duke of Asches brother not far from Mounts a City of Henalt He kept his bed seaven months by reason of a wound made by a Bullet the space of three fingers above his knee Horrid symptom occasioned by a wound made by Gun-shot When I came to him he was afflicted with these symptoms intolerable pain a continual feaver cold sweats watchings excoriation of the hippes by reason of his long lying upon them his appetite dejected with much thirst He oft sunk down as if he had the Falling-sickness had a desire to vomit and a continual trembling or shaking so that he could not put one hand to his mouth without the assistance of the other he swounded frequently by reason of the vapours ascending to the noble parts For the thigh-bone was broken long-ways and side-wayes with many splinters of bones whereof some were plucked out others remained sticking fast in He besides also had an ulcer in his groin which reached to the midst of his thigh many other sinuous ulcers about his knee All the muscles of his thigh and leg were swoln with a flegmatick cold and flatulent humor so that almost all the native heat of those parts seemed extinct All which things being considered I had scarse any hope to recover him so that I repented my coming thither Yet at length putting some confidence in his strength and prime of youth I began to have better hopes Therefore with his good liking first of all I made two Incisions so to let forth the matter which lying about the bone did humect the substance of the muscles Incisions wherefore made This had happy success and drew out a great quantity of matter then I with a Syringe injected much Aegyptiacum dissolved in Wine and a little Aqua vitae into these Incisions so to restrain and amend the putrefaction repress the spongie loose and soft flesh resolve the oedematous and flatulent tumor asswage the pain and stir
let the work-master take a needle some four fingers long square and having sharp edges drawing after it a three or four doubled strong thred With this let him bind the vessel after the following manner Let him thrust his needle on the outside into the flesh some half fingers breadth from the loosed vessell untill he come to the end thereof then let him put it about it and bring it back again but so that there be no more then the space of a fingers breadth between the going in and coming forth of the needle In this space let him put a linnen rag three or four times doubled and thereupon bind somewhat strait the two ends of the thred together For so he shall hinder the knot from hurting the flesh which lies under it in the bindings The Haemorrhagie of small vessels is not to be regarded and also add strength thereto For so the bound up orifice of the vessell will in short space be agglutinated to the adjoyning fresh and that so firmly that there hath never been seen any one drop of blood to have flowed from a vessell so bound up But if the blood which flows forth proceed from any small vessell you must not use this future and ligature nor make any such great matter thereof for it will quickly be stanched by the only application of Astringents presently to be mentioned CHAP. XXIII How to performe the residue of the cure of the amputated member An emplastick medicine NOw must we shew what medicins are fitting to be applyed after the amputation of a member which are Emplasticks as those which exceedingly conduce to green wounds As â„ž boli arm â„¥ iiij farin vol. â„¥ iij. picis resinae an â„¥ ij pulverisentur omnia subtiliss simul mixtis fiat pulvis herewith let the wound be strewed and lay thereupon dry Lint but let the following repercussive or defensitive be applyed to the member A repercussive â„ž Album ovorum vj. boli areâ— sang drac gypsi terrae sigill aloes mastiches gallar comâ—ust an â„¥ ij in pollinem redigantur omnia bene agitentur addendo olei rosarum myrtil an â„¥ ij fiat defensitivum ad formam mellis This ointment must be applyed upon stoops dipped in Oxycrate and that so that it may not only cover the cut member but also be spread further and cover the neighbouring parts as when the Leg is cut off it must be laid upon the joint and spread higher than the knee some four fingers upon the thigh How to place the member how often to dress it for it hath not only a repercussive faculty but it also strengthens the part hinders defluxion by tempering the blood asswaging pain and hindring inflammation It will also be good to moisten your double cloths and bandages in Oxycrate then must you place the member in an indifferent posture upon a pillow stuffed with oaten huskes or chaffe Stags hair or wheat bran It must not be stirred after the first dressing unless great necessity urge for four dayes in winter but somewhat sooner in summer For the ligatures wherewith the vessels are bound they must not be loosed or otherwise taken away before the mouthes of the vessells are covered with their glue or flesh lest by too much haste you cause a new flux of blood This agglutination will be performed by applying refrigerating astringent and emplastick medicins such as this following powder An emplastick powder â„ž boli arm farin hord picis res gypsi an â„¥ iiij Aloes nucum cup. cort granat an â„¥ j. incorporentur omnia simul fiat pulvis subtilis herewith let the whole ulcer be strewed over for three or four dayes space which being ended let only the seats of the vessels be powdred therewith and that for eight or ten dayes so that we need no further doubt of the agglutination of the vessels In the mean space let the digestive be applyed to the rest of the Ulcer untill it be come to suppuration for then you shall give over your digestive and betake you to detersive and mundificative medicins Detersives As â„ž terebinth ven lotae in aqua vitae â„¥ vj. mellis ros colati â„¥ iiij succi plantag Apii centâ—â—r minoris an â„¥ ij bulliant omnia simul usque ad consumptionem succorum auferantur ab igne addendo farinae fab hord an â„¥ j. theriac Gal. â„¥ ss aloes myrrhae aristolech an â„¥ iij. croci ℈ j. fiat mundificativum Why after dismembring the Patients complain of pain as if the part were yet remaining on But seeing the case stands so that the Patients imagin they have their members yet entire and yet do complain thereof which I imagin to come to pass for that the cutt nerves retire themselves towards their originall and thereby cause a pain like to convulsions for as Galen writes in his book De motu musculâ—rum that contraction is the true and proper action of a nerve and muscle and again extension is not so much an action as a motion now we must indeavour to give remedy to this symptome Which may be done by anointing the spine of the back and all the affected part with the following Liniment which is very powerful against Convulsions the Palsie numness and all cold effects of the nervous bodies â„ž salviae chamaepytheos majorana An ointment for the spine of the back against all affects of the nerves How to procure the falling away of the ends of the bones rorismar menth rutae lavendulae an m. j. flor chamaemel melilot summit aneth hyperici an p. ij baccarum lauri juniperi an â„¥ ij radicis pyrethriÊ’ij mastic assae odorat an â„¥ i ss terebinth venet lb. j. olei lumâ—r aeneth catell an â„¥ vj. olei tereâ—inth â„¥ iij. axung hum â„¥ ij crociÊ’j vini albi odoriferi lb j. câ—rae quantum sufficit contundenda contundantur pulverisanda pulverisentur deinde macerentur omnia in vino per noctem postea coquantur cum oleis axungia praedictis in vase duplici fiat linimentum secundum artem in fine adde aquae vitae â„¥ iiij Besides in dressing these wounds the Chirurgeon must use diligence to procure the falling away of the ends or scales of the bones which the saw and the appulse of the air never before coming hereto have tainted which may be done by applying to their ends actual Cauteries that is hot irons in using of which you must have a special care that you touch not the sensible parts with fire neither must the bones themselves be forcibly pluckt off but gently moved by little and little so that you shall think you and the Patient have exceedingly well performed your parts if they fall away at the thirtieth day after the Amputation All these things being performed you shall hinder the growth of proud flesh with the cathaereticks such as are burnt Vitriol the powder of Mercury and other things amongst which is Alum burnt and powdered
away of the Eschar and then the Ulcer must be dressed like other Ulcers Celsus lib. 5. But oft-times the Callous which possesses the sinuous cavity of a Fistula overcome by the power of acrid and escarcotick medicins comes whole forth and falls out like a pipe and so leaves a pure Ulcer underneath it Which I observed in a certain Gentleman when I had washed with strong Aegyptiacum divers times a fistulous Ulcer in his thigh shot through with a bullet then presently by putting in my Balsam formerly described he grew well in a short time Fistulaes which are neer great vessels Nerves or principal intrails must not be medled with unless with great caution Remedies for a Fistula proceeding from a corrupt bone When a Fistula proceeds by the fault of a corrupt bone it is to be considered whether that fault in your bone be superficiary or deeper in or whether it is wholly rotten and perished For if the default be superficiary it may easily be taken away with a desquammatory Trepan but if it penetrate even to the marrow it must be taken forth with cutting mullets first having made way with a Terebellum But if the bone be quite rotten and perished it must be wholly taken away which may be fitly done in the joints of the fingers the radius of the Cubit and Leg but no such thing may be attempted in the socket of the Huckle-bone the head of the Thigh-bone or any of the Rack-bones when they are mortified neither in those Fistulaes which are of their own nature uncurable but you shall think you have discharged your duty and done sufficiently for the Patient if you leave it with a prognostick The cure of what Fistulaes may be attempted and which may not Of this nature are Fistulaes which penetrate even to the bowels which come into the parts orespread with large vessels or Nerves which happen to effeminate and tender persons who had rather dye by much then to suffer the pain and torment of the operation Like caution must be used when by the cutting of a Fistula there is fear of greater danger as of convulsion if the disease be in a nervous part A palliative cure of a Fistula In these and the like cases the Chirurgeon shall not set upon the perfect cure of the disease but shall think it better to prevent by all means possible that the disease by fresh supplies become no worse which may be done if he prevent the falling down of any new defluxion into the part if by an artificial diet he have a care that excrementitious humors be not too plentifully generated in the body or so order it that being generated they may be evacuated at certain times or else diverted from the more noble to the base parts But in the mean space it shall be requisite to wast the faulty flesh which growes up more then is fitting in the Ulcer and to cleanse the sordes or filth with medicins which may do it without biting or acrimony and putrefaction CHAP. XXIII Of the Fistulaes in the Fundament FIstulaes in the Fundament are bred of the same causes as other kindes of Fistulaes are The causes to wit of a wound or abscess not well cured or of a haemorrhoid which is suppurated Such as are occult Signs may be known by dropping down of the sanious and purulent humor by the Fundament and the pain of the adjacent parts But such as are manifest by the help of your probe you may finde whither they goe and how far they reach For this purpose the Chirurgeon shall put his finger into the Fundament of the Patient and then put a Leaden probe into the orifice of the Fistula which if it come to the finger without interposition of any medium it is a sign it penetrates into the capacity of the Gut Besides also then there flowes not only by the Fundament but also by the orifice which the malign humor hath opened by its acrimony much matter somewhiles sanious and oft-times also breeding Worms Fistulaes may be judged cuniculous and running into many turnings and windings if the probe do not enter far in and yet notwithstanding more matter flowes therehence then reason requires should proceed from so small an Ulcer Symptomes You may in the orifices of all Fistulaes perceive a certain callous wart which the common Chirurgeons tearm a Hens arse Many symptomes accompany Fistulaes which are in the Fundament as a Tenesmus strangury and falling down of the Fundament The art of binding and cutting a Fistula of the Fundament If the Fistula must be cured by manual operation let the Patient lye so upon his back that lifting up his legs his thighs may press his belly then let the Chirurgeon having his nail pared put his finger besmeared with some ointment into the Patients Fundament then let him thrust in at the orifice of the Fistula a thick Leaden Needle drawing after it a thread consisting of thread and horse-hairs woven together and then with his finger taking hold thereof and somewhat crooking it draw it forth at the Fundament together with the end of the Thread Then let him knit the two ends of the thread with a draw or loose-knot that so he may straiten them at his pleasure But before you binde them you shall draw the thread somewhat roughly towards you as though you meant to saw the flesh therein contained that you may by this means cut the Fistula without any fear of an Haemorrhage or flux of blood It sometimes happens that such Fistulaes penetrate not into the Gut so that the finger by interposition of some callous body cannot meet with the needle or probe Then it is convenient to put in a hollow Iron or Silver Probe so through the cavity thereof to thrust a sharp pointed needle and that by pricking and cutting may destroy the Callus which thing you cannot perform with the formerly described Leaden Probe which hath a blunt point unless with great pain The description of a hollow silver Probe to be used with a needle as also a Leaden Probe A. Shews the Needle B. The hollow Probe C. The Needle with the Probe D. The leaden Needle drawing a thread after it The Callus being wasted the Fistula shall be bound as we formerly mentioned That which is superficiary needs no binding only it must be cut with a crooked scalprum and the Callus being consumed the rest of the cure must be performed after the manner of other Ulcers But you must note that if any parcel of the Callous body remain untoucht by the medicin or Instrument the Fistula reviving again will cause a relapse CHAP. XXIV Of Haemorrhoides What they are HAemorrhoides as the word is usually taken are tumors at the extremities of the veins encompassing the Fundament caused by the defluxion of an humor commonly melancholick Their differences and representing a certain kind of Varices Some of these run at an hole being opened
they be either shaken or removed out of their sockets must be restored to their former places and tyed with a gold or silver wyer or else an ordinary thred to the next firm teeth untill such time as they shall be fastened and the bones pefectly knit by a Callus To which purpose the ordered fragments of the fractured bone shall be stayed by putting a splint on the outside made of such leather as shoe-soals are made The description of a fit ligature for the under Jaw the midst thereof being divided at the Chin and of such length and breadth as may serve the Jaw then you shall make ligation with a ligature two fingers broad and of such length as shall be sufficient divided at both the ends and cut long-wayes in the midst thereof that so it may engirt the chin on both sides Then there will be four heads of such a ligature so divided at the ends the two lower whereof being brought to the crown of the head shall be there fastned and sowed to the Patients night-cap The two upper drawn athwart shall likewise be sowed as artificially as may be to the cap in the nape of the neck It is a most certain sign that the Jaw is restored and well set if the teeth fastened therein stand in their due rank and order The Patient shall not lye down upon his broken Jaw lest the fragments of the bones should again fall out and cause a greater defluxion Unless inflammation In what time it may be healed or some other grievous symptom shall happen it is strengthened with a Callus within twenty dayes for that it is spongious hollow and full of marrow especially in the midst thereof yet sometimes it heals more slowly according as the temper of the Patient is which takes also place in other fractured bones The agglutinating and repelling medicin described in the former chapter shall be used as also others as occasion shall offer it self The Patient must be fed with liquid meats which stand not in need of chewing untill such time as the Callus shall grow hard lest the scarce or ill-jointed fragments should fly in sunder with the labour of chewing Therefore shall he be nourished with water-grewel ponadoes cullasses barley-creams gellies broths rear-egs restaurative liquors and other things of the like nature CHAP. VIII Of the fracture of the Clavicle or Collar-bone AS the nature and kinde of the fractured Clavicle shall be Hipp. sent 63. sect 1 de art so must the cure and restoring thereof be performed But howsoever this bone shall be broken alwayes the end fastened to the shoulder and shoulder-blade is lower than that which is joyned to the chest for that the arm drawes it downwards The collar-bone if broken athwart is more easily restored and healed than if it be cloven long-wayes For every bone broken athwart doth more easily return into its former state or seat whiles you lift it up on this or that side with your fingers But that which is broken schidacidon or into splinters or long-wayes is more difficultly joined and united to the ends and fragments for those pieces which were set will be plucked asunder even by the least motion of the arms and that which was knit with the shoulder will fall down to the lower part of the breast The reason of which is the collar-bone is not moved of its self but consents in motion with the arm In restoring this or any other fracture How to restore the fractured Clavicle The first way you must have a care that the bones ride not one over another neither be drawn nor depart too far in sunder therefore it will be here convenient that one servant draw the arm backwards and another pull the shoulder towards him the contrary way for so there will be made as I may so term it a counter-extension While which is in doing the Surgeon with his fingers shall restore the fracture pressing down that which stood up too high and lifting up that which is pressed down too low Some that they may more easily restore this kind of fracture The second way put a clew of yarn under the Patients arm-pit so to fill up the cavity thereof then they forcibly press the elbow to the ribs and then force the bone into its former seat But if it happen The third way that the ends of the broken bones shall be so deprest that they cannot be drawn upwards by the forementioned means then must the Patient be laid with his back just between the shoulders upon a pillow hard stuffed or a tray turned with the bottom upwards and covered with a rug or some such thing Then the servant shall so long press down the Patients shoulders with his hands untill the ends of the bones lying hid and pressed down fly out and shew themselves Which being done the Surgeon may easily restore or set the fractured bone But if the bone be broken so into splinters that it cannot be restored and any of the splinters prick and wound the flesh and so cause difficulty of breathing you then must cut the skin even against them and with your instrument lift up all the depressed splinters and cut off their sharp points so to prevent all deadly accidents which thereupon may be feared If there be any fragments they after they are set shall be covered with a knitting medicin made of wheat flour frankincense bole armeniack sanguis draconis resina pini made into powder and mixed with the whites of eggs putting upon it splints covered with soft worn linnen rags covered over likewise with the same medicin and then three boulsters dipped in the same two whereof shall be laid upon the sides but the third and thickest upon the prominent fracture so to repress it and hold it in How to bind up the fractured clavicle For thus the fragments shall not be able to stir or lift themselves up further than they should either to the right side or left Now these boulsters must be of a convenient thickness and breadth sufficient to fill up the cavities which are above and below that bone Then shall you make fit ligation with a rowler having a double head cast cross-wise of a hands breadth and some two ells and a half long more or less according to the Patients body Now he shall be so rowled up as it may draw his arm somewhat backwards and in the interim his arm-pits shall be filled with boulsters especially that next the broken bone for so the Patient may more easily suffer the binding Also you shall wish the Patient that he of himself bend his arm backwards and set his hand upon his hip as the Country Clowns use to do when they play at leap-frog But how great diligence soever you use in curing this sort of fracture yet can it scarce be so performed It is a difficult matter perfectly to restore a fractured clavicle but that there will some deformity remain in
firmly and more far and wide press forth and repress the superfluous blood from the sound part They presently in like sort cast the second ligature upon the very fracture giving it two wraps then going downwards yet so as that they are opener or wider and farther distant each from other and not so close together as the circumvolutions of the first ligature that so they may press the humors the less to the extremities of the part as those which cannot receive and bear without inflammation and danger of a gangrene such abundance of humours for that they are not sufficiently spacious as also more remote from the fountain of native heat which is greater in the center than in the circumference At the lower end of the hurt part the circumvolutions either end Why the third ligature must be rowled contrary to the two first or else are twined thence back again They cast on the third ligature in that lower end of the hurt part and rowl it smoothly and gently upwards the windings being made contrary to the windings of the first and second ligatures that they may so draw back into their natural state the muscles which peradventure have been drawn aside by the force of the former wrappings These ligations finished they apply three splints of past-board or some such matter the first below the fracture and that truely more broad and of sufficient length and then two others one on each side distant each from other some fingers breadth to the end to keep the bone that it do not stir to this side or that being wrapped about with Tow or Cotton Then they think of placing or laying the part The Surgeon must be mindfull of three things in placing the member to which purpose they propound to themselves three scopes The first is that the part may lye soft the second smooth or even the third somewhat high The hurt part ought truely to lye soft for that hard lying presses it and causes pain and inflammation which whiles the Patient cannot patiently endure he is forced to change his place whilest he every way seeks ease for his pain and thus he now and then moves the fractured part which ought to be kept quiet without any motion It must lie smooth or even because an unequal or uneven site distorts or draws awry the part whilest one portion of the hurt part is born up and sustained by that which lyes under it but the other hanging down hath nothing thereunder whereupon it may rest Sect. 2. de fract Therefore Hippocrates bids us diligently to take heed that the heel do not hang down nor the foot remain without a pillow for hence pain and defluxion of humors is to be feared But the part ought to lye somewhat high that the defluxion may be hindred which is easily stirred up by a prone and declining site for if the foot shall be placed in a lower figure the blood which flowes thither from the leg will cause inflammation But on the contrary if it be higher nothing can flow down thereinto Therefore absolutely not only the foot but also the thigh and leg are to be placed higher than the rest of the body yet keeping such a mean Sent. 33. 56. sect 2. de fract that the part may not be too much distended as Hippocrates admonisheth us In the mean time this hurt leg or side ought to be of equal length with the sound and for that purpose it must be stayed on both sides with Junks as we shall shew you hereafter when we come to speak of a broken leg The bandage being performed as we have said the following night and the next day the Patient feels the member more straitly bound than when it was first wrapped yea verily the knee is lifted up into a soft tumor by the expression of the humor from the wounded part but on the contrary the ensuing day the ligation is slackened and relaxed some portion of the humor contained in the part being digested Also the next day all things are perceived more loose When the first ligation must be loosed there being made a larger resolution of the humor Then therefore the bandages must be loosed and that not only lest that the fragments of the bones should fall forth of their place but also that we may gratifie the Patient by that alteration or change of place and besides that we may avoid itching which usually happens to parts too long bound up by reason of the suppression of acrid and fuliginous excrements which use to be gathered in great quantity in a part at rest and bound up both from the excrementitious humors wherewith the part is moistened and the alimentary humors in a part which is idle and at quiet by reason the difflation and transpiration are hindred by want of exercise and the pores of the skin shut up by the abundance of the ligatures so that by the suppression thereof many have not only an itching but also the skin being broke by the acrimony of these as well vapours as humors which are kept shut and pent up have ulcers break forth Therefore when such accidents shall be feared the part shall so long be fomented with warm water and oil as you shall think fit for such fomenting asswageth pain relaxeth that which was too much straitned by the binding and amends the refrigeration of the part caused by the repercussion and expression of the blood and spirits the native and internal heat being by this means revived If together with the tumor there be a contusion and sugillation it must be the longer fomented that the excrementitious humor residing in the part may be digested But if this quantity of time shall not suffice then must you use stronger digestives yet have a care you use them not too long for so you should hinder the generation of a Callus Therefore that saying of Hippocrates must here be remembred which saith That a weak fomentation and the short time of using one doth attract but not discuss but a longer and stronger wastes the flesh Besides also you must have regard to the temper and habit of the Patient for fomentations used to plethorick bodies draw superfluous humours to the part Sent. 15. sect 3. de offic The Ancients bid that the ligatures be loosed every third day untill their seventh day but after the seventh on every seventh day but hereof nothing can be certainly and perpetually decreed For according to the accidents the patients must be dressed sooner or later more often or seldom renewing the ligatures and the rest of the dressing Therefore if no symptom urge I would have none of these things which are done to the Patient at the first dressing to be moved unless as slowly and seldom as you may For you hinder the knitting of the bone if you never so little move the ends of the fragments thereof for as you see wood is joined together by glue and pewter with sowder so
who have not halted during the rest of their lives Why those halt who have had this bone fractured The cause hereof is the knitting by the concretion of a Callus hinders the free bending of the knee going especially on even ground is more easie to the Patient but an ascent is far more difficult and absolutely painfull The Patient must necessarily for this kinde of fracture lye or keep his bed at the least for forty dayes CHAP. XXIII Of a broken Leg. Sent. 65. sect 2. de fract THis kind of fracture is cured after the same manner as that of the arm or cubit Hippocrates admonisheth us that the Tibia or leg-bone is more dangerous to be broken and more difficult and slow to be healed than the Fibula or shin-bone because that is the thicker and as it were the upholder of the whole bulk of the body but this other is but as it were a certain additament or assistant provided for the staying or bearing up of the muscles of the leg by which the foot is moved The leg-bone being only broken the signs thereof are perceived only in the inner part of the leg for that the shin-bone being whole suffers it not to throw or cast forth it self On the contrary when the shin-bone only is broken the signs thereof appear only in the external part of the leg because the leg-bone being opposed thereto Signs that both the bones are broken doth not suffer it to cast in its self and with its fragments to turn inwards But when both the bones are broken the signs of the fracture may equally appear both here and there But when only one of these bones are broken the fracture is far more easie to dress and heal because that which remains whole is a much more firm stay to that which is hurt than any splints can be But that I may the better instruct and make ready the Surgeon for the restoring of this fracture A History I will illustrate the matter by an example from my self John Nestor Doctor of Physick Richard Hubert and I went together to visit a Patient at the place of the Frier Minorites Wherefore intending to pass over the Sein within sight of the place I endeavoured to make my horse take boat and therefore switched him over the buttocks The Jade madded herewith so struck at me with his heels that he brake both the bones of my left leg some four fingers breadth above my ankle Then I fearing some worse mischief and lest the Jade should double his blow flew back and as I fled back the broken bones flew in sunder and breaking through the flesh stocking and boot shewed themselves whereby I felt as much pain as it is credible a man was able to endure Wherefore I was presently carried into the boat that so I might be carryed to the other side of the water to be dressed but the stirring of the boat as they rowed almost killed me with bitterness of pain for that the sharp fragments of the bones were rubbed against the flesh which lay next them Being ferried over as I was conveyed into the next houses my pain was much increased whilest lifted by the hands of divers persons one while up another down sometimes to the left side other whiles to the right with my whole body and all the parts thereof When at the length I was laid upon a bed I was somewhat freed from the bitterness of my pain A soon made medicine and had time to wipe off the sweat which ran down over all my body Then was I dressed with such a medicine as the time and place would afford we composed it of the white of an egge wheat-flour soot of a chimny and melted butter For the rest I entreated Richard Hubert that he would handle me as if he knew me not neither that moved for love of me he should remit any thing of the severity of art but chiefly that he would stretch my foot straight out What to doe when the leg 〈◊〉 broken and if the wound were not sufficiently wide that he would inlarge it with his incision-knife that so he might the more easily set the broken bones in their due place that he would with his fingers whose judgement is far more certain than the best made instruments search whether the splinters which were in the wound were quite severed from the bone and therefore to be taken forth that he would with his hand press forth the blood and the clods of blood which were in a great quantity concrete at the mouth of the wound that he would bind up and place my leg in that site and manner as he thought best which is that he would have three rowlers in a readiness the first whereof he should cast directly upon the wound so that he should begin his ligation at the wound also he should put splints about it some three but others two fingers breadth of the length of half a foot somewhat depressed and hollowed whereby they might be the more easily put about the leg more straitly at their ends and a fingers distance each from other which at the last he should bind with fillets like those wherewith women use to binde up their hair yet so that the binding might be more strait upon the wound and that he would fill the cavity of the ham and of the ancles with boulsters made of flax wrapped in linnen clothes that he would fortifie the sides of my leg with Junks made of bents or little sticks and lined with linnen cloth stretched from my heel to my groin and bound over in four places so that the straight figure of the leg might scarcely be perverted by any force that he would gently and smoothly lift up my leg to an indifferent The figure of a Leg fractured with a wound and bound up height and lastly that he should arm it from the violence of external injuries by putting it in a box or case But you must note that the fit placing or laying of the leg is a matter of such moment that â—f any error be here committed it will cause no less than lameness For if it be lifted up higher than is fit the Callus will be hollow on the foreside if lower then it will be gibbous or bunching forth Neither also do they commit a small error who do not fill up the cavities at the ancles after the afore-mentioned manner for hereupon the heel will be much afflicted whilest it is forced to sustain a tedious and painfull compression which at length brings a hot distemper because the spirits cannot freely flow thereto which I finding by experience not knowing the cause wished them ever now and then to lift up my heel whereby it might enjoy the benefit of perspiration and the spirits have free entrance thereinto and the contained vapours passing forth To conclude my hurt leg was laid upon a cushion after the manner you see here described CHAP. XXIV Of some
put to undergo solid offices and motions According to the variety of causes Remedies therefore medicines shall be applyed For if the ligature of the part be too strait it shall be loosed yea verily the fractured place the ligature being taken away shall be quite freed from ligation and a new kind of ligature must be made which must be rowled down from the root of the vessels that is from the arm-pits if the arm or from the groin if the leg be broken to the fracture yet so as that you may leave it untouched or taken in for thus the bloud is pressed from the fountain and spring and forced into the affected part by a way quite contrary to that whereby we have formerly taught in fear of inflamation to hinder it from entrance into the affected part Also gentle frictions and fomentations with warm water may be profitably made When we must desist from fomenting and frictions from which you must then desist when the part shall begin to grow hot and swell If any too long continue these frictions and fomentations he shall resolve that which he hath drawn thither For this we have oftentimes observed that frictions and fomentations have contrary effects according to the shortness and continuance of time Pications will also conduce to this purpose and other things which customarily are used to members troubled with an atrophia or want of nourishment CHAP. XXX Of fomentations which be used to broken bones Warm water The effects thereof DIvers fomentations are used to broken bones for several causes When we use warm water for a fomentation we mean that which is just between hot and cold that is which feels lukewarm to the hand of the Physitian and Patient A fomentation of such water used for some short space doth moderately heat attenuate and prepare for resolution the humour which is in the surface of the body it draws bloud and an alimentary humour to the part labouring of an atrophia it asswages pain relaxes that which is too much extended and moderately heats the member refrigerated through occasion of too strait binding or by any other means On the contrary too hot fomenting cools by accident digesting and discussing the hot humour which was contained in the member We mean a short time is spent in fomenting when the part begins to grow red and swell Notes of short just and too long fomenting Fomentations hurt plethorick bodies a just space when the part is manifestly red and swoln but we conjecture that much or too much time is spent thereon if the redness which formerly appeared go away and the tumour which lifted up the part subside Also in fomenting you must have regard to the body whereto it is used For if it be plethorick an indifferent fomentation will distend the part with plenty of superfluous humours but if it be lean and spare it will make the part more fleshy and succulent Now it remains that we say somewhat of the fracture of the bones of the feet CHAP. XXXI Of the fracture of the bones of the feet Why the fractured bones of the foot must be kept in a strait posture THe bones of the instep back and toes of the feet may be fractured as the bones of the hands may Wherefore these shall be cured like them but that the bones of the toes must not be kept in a crooked posture as the bones of the fingers must lest their action should perish or be depraved For as we use our legs to walk so we use our feet to stand Besides also the Patient shall keep his bed until they be knit The end of the fifteenth Book The SIXTEENTH BOOK Of DISLOCATIONS or LUXATIONS CHAP. I. Of the kinds and manners of Dislocations A Dislocation is the departure or falling out of the head of a bone from its proper cavity into an accustomed place besides nature hindring voluntary motion What a Luxation properly so called is What a Luxation not properly so called is There is another kind of Luxation which is caused by a violent distention and as it were a certain divarication and dilatation or extension into length and bredth of the ligaments and all the nervous bodies which contain strengthen and bind together the joints Thus those who have been tormented and racked have that thick ligament which is in the inner cavity of the huckle bone too violently extended Those who have suffered the Strappado have the ligaments encompassing the articulation of the arm bone with the shoulder blade forcibly and violently distended Such also is their affect whose foot is strained by slipping There is a third kinde of Luxation The third kind of dislocation when as those bones which are joyned contiguous and one as it were bound to the sides of another gape or fly asunder as in the arm when the ell parts from the wand in the leg when the one focile flies from the other yet this may be referred to the second sort of dislocations because it happens not without dilatation or else the breaking of the ligaments There is also a fourth added to these The fourth as when the Epiphyses and heads of bones are plucked from the bone whereon they were placed or fastned which unproperly called kind of Luxation hath place chiefly in the bones of young people and it is known by the impotency of the part and by the noise and grating together of the crakling bones when they are handled Now the bones of young folks are also incident to another casualty for as the bones of old people are broken by violence by reason of their driness and hardness thus the bones of children are bended or crooked in by reason of their natural softness and humidity CHAP. II. Of the differences of Dislocations SOme Dislocations are simple others compound What Luxations are simple What compound We term them simple which have no other preternatural affect joyned with them and such compound as are complicated with one or more preternatural affects as when a dislocation is associated with a wound fracture great pain inflamation and an abscess For through occasion of these we are often compelled so long to let alone the luxation until these be remitted of themselves or by our art Some dislocations are compleat and perfect as when the bone wholly falls out of its concavity What a compleat Luxation is other some are unperfect as when it is only lightly moved and not wholly fallen out wherefore we only call them subluxations or strains Differences of Luxations are also drawn from the place for sometimes the bone is wrested forwards otherwhiles backwards upwards downwards somewhiles it may be wrested according to all these differences of site and otherwhiles only according to some of them Differences are also taken from the condition of the dislocated Joint in greatness and littleness from the superficiary or deep excavation of the sinus or hollowness and lastly from the time as if it be
within ten days by reason of the five branches of nerves which arising from the second and fifth conjugation of the brain are distributed into the moving muscles thereof which too violently extended brings the forementioned symptomes Practitioners affirm that the Jaw twelve days after it is set is free from the danger of relapse If it have been dislocated some few days before you go about to restore it you must use softning and relaxing medicines to it but when it is put in the joint apply a medicine made of the whites of eggs and oyl of roses to asswage the pain and apply clothes dipped in oxycrate At the second dressing you shall apply such things as have power to agglutinate and strengthen the ligaments and other relaxed parts and also to keep it being restored in its place This shall be the form of such a medicine An astringent medicine â„ž Pulv. boli armeni sang draconis farinae volat mastich picis resinae an â„¥ ss albuminis ovorum q. s fiat medicamentum afterwards you may use emplast Diacalcitheos dissolved in oyl of roses and vinegar and other things as occasion shall be CHAP. IX How to set the Jaw dislocated forwards on both sides The first manner of setting a jaw bone FIrst of all the Patient must be placed upon the ground or some low seat with his face upwards and his head must be firmly held by your servant that so it may be the more immoveable then the Surgeon shall put both his thumbs wrapped in clothes lest he hurt them by rubbing them upon the Patients teeth as also to keep them from slipping into the Patients mouth and press with them the larger teeth of the luxated jaw but put his other fingers without under his chin Another and so lift up the whole jaw with them But if the operation cannot be thus done for that the mouth on the inside is so shut and closed that the thumbs cannot be put thereinto then must you thrust in woodden wedges made of soft wood as hazle or firr being cut square and of some fingers thickness These shall be wedged in on each side above the grinders then cast a ligature under his chin whose ends your servant shall hold in his hands and setting his knees upon the Patients shoulders shall pull them upwards then at the same time the Surgeon shall press downwards the woodden wedges The jaw bones thus restored shall be kept so by convenient ligation and dressed with medicines as it is fitting and in the mean space you must forbid the Patient to speak Diet. or needlesly to open his mouth Wherefore he must abstain from hard meats and such as require much chewing until his pain be quite passed and use only spoon-meats as Barley-creams panadoes jellies cullasses broths and the like CHAP. X. Of restoring the Jaw dislocated forwards but on one side What the Surgeon THe Patient must be placed on a low seat so that he may be under the Surgeon then your servant standing at his back shall hold his head firm and steddy that it may not follow the Surgeon drawing extending and doing other things necessary for restoring it Then the Surgeon putting his thumb between the grinders shall press down the jaw and gently drawing it aside What the Patient ought to do force it into its cavity in the mean while also the Patient as much as in him lies shall help forwards the Surgeons endeavour in opening his mouth as little as he can lest the muscles should be extended and he shall only gape so wide as to admit the Surgeons thumb for so the temporal muscles shall be restored to their place and favour the restitution If he open his mouth as wide as he can they will be extended after a convulsive manner if on the contrary he shut his teeth too close there will be no passage for the Surgeons thumb unto his grinding teeth Some there be which affirm Signs that the jaw is dislocated backwards The cure that the jaw bone may sometimes be dislocated towards the hind part and that then the mouth is so close shut that the Patient cannot open it nor gape and that the lower rank of teeth stands further in and nearer the throat than the upper Now for restoring it the Patients head must be straitly holden behinde whilest the Surgeon the mean while putting both his thumbs into the Patients mouth holding his other fingers without under the Patients chin he shall by shaking it draw it to him or forwards and so restore it to its place For my own part I confess I never saw this kind of Luxation and I easily perswade my self that it can scarce ever happen for the reason I gave in the former Chapter But nevertheless if it by any means chance to happen yet can it not be a perfect luxation but an imperfect one the jaw being onely but a little thrust back to the throat to those mammillary additaments And then it may easily be restored by listing or drawing forth the jaw and suddenly forcing it from below upwards CHAP. XI Of the luxation of the Collar bone AS the Collar bones may be broken wrested and crooked so also they may be dislocated Differences of the luxated collar bones Now they are dislocated either against the sternum or against the shoulder blade or acromion theteof yet both these kinds of dislocations are very rare by reason of the strait and firm connexion which the collar bone hath with the foresaid parts but chiefly where it is joyned to the sternum it can scarcely be deprest for that it is as it were underpropt with the first rib But it may be dislocated inwardly outwardly and side-wise The cure and according to this variety there must be divers ways to restore it yet generally the Collar bone is put into its place by moving or extending the arm But if need require the Patient shall be laid upon the ground with his face upwards a Tray with the bottom upwards a hard stuffed cushion or the like thing being put under his shoulders for thus it will so come to pass that the shoulder and chest will stand so forth that presently by lifting up by pressing down or drawing forth the arm forwards or backwards as the bone shall be flown out to this or that part you may restore it for thus the prominency may be forced into its cavity But it will be requisite to bind it up and lay boulsters thereon and to give it rest as if it were fractured Galen writes Com. ad sent 62 sect 1. de art that when he was five and thirty years old whilst he exercised himself in the place of exercise his collar bone was so far separated from the Acromion that there was the space of three fingers between them And that this luxation was restored in forty days space by so strait and strong a ligation that he perceived the motion of the beating arteries under the
sit The figure of a Chair for a Semicupium A. Sheweth the whole frame of the Chair B. The hole wherein the patient must sit C. The Cistern that holds the water D. A Cock to empty the water when it groweth cold E. A Funnel whereby to pour in warm water There may also bee another decoction made for the bath as thus ℞ rad raph alib an lb. ii rad rusc petrosel asparag an lb. i. cumin foenicul ameos an ℥ iiii sem lini faenug anʒvi fol. marub parietar florum chamaem melil anethi an m. ii bulliant omnia secundum artem in aquae sufficienti vini albi odoriferi exigu â quantitate ad consumptionem tertiae partis pro Semicupio Also the same decoction may be used for glisters adding thereto two yolks of eggs and four ounces of oil of lillies with ʒi of oil of juniper which hath a certain force to asswage the pain of the stone and collick But a far less quantity of the decoction in a glyster must be used in these diseases than usually is appointed in other diseases otherwise there will be danger lest the guts being distended should more press upon the kidnies and ureters troubled in some sort with inflammation and so increase the pain and other symptoms This following cataplasm shall be profitably applyed to the grieved place to wit the loins or flanks and bottom of the belly for it is very powerful to asswage pain and help forwards the falling down of the stone An anodine Cataplasm ℞ rad alth raphani an ℥ iiii pariet foenic. senicionis nasture berul an m. i. herniariae m. ss omnibus in aquâ sufficienti decoctis deinde contritis adde clei aneth chamaem pingued cuniculi an ℥ ii farin cicer quantum sufficit-fiat cataplasma ad usum praedictum Signs of the stone fallen out of the ureter into the bladder After by these means the stone forced out of the ureter is fallen into the bladder the pain presently if there be but one stone for sometimes more with much gravel do again fall into the ureter is mitigated and then the patient is troubled with an itching and pricking at the end of his yard and fundament Therefore then unless he be very weak it is fit that he ride and walk a foot and take ʒiv of species Lithontribon in four doses with white wine or the broth of red Cicers three hours before dinner and supper Besides let him plentifully drink good wine and after he hath drunk let him hold in his urine as long as he can that so it being gathered in great plenty it may presently thrust the stone out of the bladder with the more force for which purpose you may also inject the following liquor into the bladder ℞ syrupi capill ven ℥ i. aquae alkekengi ℥ iii. oleo scorpionum ℥ ss Let it be injected into the bladder with a syringe CHAP. XXXIX What must be done the stone being fallen into the neck of the bladder or passage of the yard AFter the stone is fallen out of the capacity of the bladder and stops in the neck thereof or passage of the yard the Surgeon shall have a special care that he do not force or thrust back the stone from whence it came but rather that hee presse it gently with his fingers to the end of the yard the passage being first made slipperie by injecting some oil of sweet almonds But if it stop in the end of the Glans it must be plucked out with some crooked instrument to which if it will not yeeld a Gimlet with a pipe or case thereto shall bee put into the passage of the yard and so it shall bee gotten out or els broken to pieces by the turning or twining about of the Gimblet which I remember I have divers times attempted and don for such Gimblets are made with sharp scrues like ordinary gimblets The delineation of a Gimblet made to break the stones in the passage of the yard together with its pipe or case The effigies of another lesser Gimblet Verily what Gimblets soever are made for this business their bodie or poin◠must bee no thicker then a small probe least whil'st thay are forced or thrust into the Vrethra or urinarie passage they might hurt the bodies next unto them by ther violent entrance CHAP. XL. What cours must bee taken if the stone sticking in the Urethra or urinarie passage cannot bee gotten out by the fore-mentioned arts BUt if the stone bee more thieck hard rough and remote from the end of the yard than that it may bee gotten out by the means formerly mentioned in the precedent Chapter and if that the urine bee wholly supprest therewith then must you cut the yard upon the side with a straight wound When the yard may bee safely cut for you must not make incision on the upper part for fear of a flux of blood for a large vein and arterie lieth there-under nor in the lower part for so it would scarce ever heal again for that it is a bloodless part and besides the continual and acrid falling of the urine would hinder the agglutination wherefore the incision must bee made on the side on that part whereas the stone most resist's and swels out For that part is the more fleshie yet first the end of the skin of the prepuce must bee much drawn up so to cover the Glans which beeing don the Vrethra shall bee tied with a thred a little above the stone that so the stone may bee staied there and may not fall back again Therefore then incision beeing made the stone must bee taken forth and the skin which was drawn more violently to cover the Glans is to bee let go back again for so it will com to pass that a whole part of the skin may cover the cut-yard and so it may bee more the speedily united and the urine may naturally flow out I have by this means oft-times taken forth the stone with the instruments here delineated Instruments fit to take the stone forth of the opened Urethra or urinarie passage of the yard Then for the agglutination if need require it will bee requisit to sow up the lips of the wound An agglutinative medicine and applie this agglutinative medicine following ℞ tereb venet ℥ iiii gum elemi ℥ i. sang dracon mastic an ʒ ss fiat medicamentum ut dictum est then the whole yard must bee covered over with a repercussive medicine made of the whites of eggs with the pouder of bole armenick aloës farina volatilis and oil of roses Lastly if need so require a wax-candle How to hasten the agglutination or leaden string anointed with Venice turpentine shall bee thrust into the Vrethra to hasten the agglutination and retain the natural smoothness and straightness of the urinarie passage least peradventure a a caruncle grow therein CHAP. XLI What manner of section is to bee made when a
point by the ring Into the open and hollow mouth of this instrument which is noted with the letter C. the patient must put his yard and into this concavity or hollowness goeth a stay somewhat deep it is marked with the letter B. and made or placed there both to hold or bear the end of the yard and also by his close joint that it must have unto the vessel to stay the urine from going back again when it is once in But the letters A. and D. do signifie all the instrument that the former part and this the hinder part thereof Now this is the shape thereof The figure of an Instrument which you may call A Basm or Receptacle for the Vrine Those that have their yards cut off close to their bellies are greatly troubled in making of urine so that they are constrained to sit down like women for their ease I have devised this pipe or conduit having an hole through it as big as one finger which may be made of wood or rather of latin A. and C. do shew the bigness and length of the pipe B. sheweth the brink on the broader end D. sheweth the outside of the brink This Instrument must be applied to the lower part of os pectinis on the upper end it is compassed with a brink for the passage of the urine for thereby it will receive the urine better and carry it from the patient as he standeth upright The description of a Pipe â—r Conduit serving in stead of the yard in making of water which therefore we may call an artificial yard CHAP. X. By what means the perished function or action of a thumb or finger may be corrected and amended WHen a sinew or tendon is cut clean asunder the action in that part whereof it was the author is altogether abolished so that the member cannot bend or stretch out it self unless it be holpen by art which thing I performed in a Gentleman belonging to Annas of Montmorency General of the French Horse-men An history who in the battle of Dreux received so great a wound with a back-sword upon the out side of the wrist of the right hand that the tendons that did erect or draw up the thumb were cut clean in sunder and also when the wound was throughly whole and consolidated the thumb was bowed inwards and fell into the palm of the hand so that he could not extend or liâ—t it up unless it were by the help of the other hand and then it would presently fall down again by reason whereof he could hold neither sword spear nor javelin in his hand so that he was altogether unprofitable for war without which he supposed there was no life Wherefore he consulted with me about the cutting away of his thumb which did hinder his gripings which I refused to do and told him that I conceived a means how it might be remedied without cutting away Therefore I caused a case to be made for it of latin whereinto I put the thumb this case was so artificially fastened by two strings that were put into two rings made in it above the joynt of the hand that the thumb stood upright and straight out by reason whereof he was able afterwards to handle any kind of weapon The form of a thumb or finger-stall of Iron or Latin to lift up or erect the thumb or any other finger that cannot be erected of it self If that in any man the sinews or tendons which hold the hand upright be cut asunder with a wound so that he is not able to lift up his hand it may easily be erected or lifted up with this Instrument that followeth being made of an equal straight thin but yet strong plate of latin lined on the inner side with silk or any such like soft thing and so plac't in the wrist of the hand that it may come unto the palm or the first joynts of the fingers and it must be tied above with convenient stayes and so the discommodity of the depression or hanging of the hand may be avoided therefore this Instrument may be called the Erector of the Hand The Erector of the Hand CHAP. XI Of helping those that are Vari or Valgi that is crook-legged or crook-footed inwards or outwards What Varus is THose that are said to be Vari whose feet or legs are bowed or crooked inwards This default is either from the first conformation in the womb through the default in the mother who hath her legs in like manner crooked or because that in the time when she is great with childe she commonly sits with her legs across or else after the child is born and that either because his legs be not well swathed when he is laid into the cradle or else because they be not well pleased in carrying the infant or if he be not well looked unto by the Nurse when he learneth to go for the bones are very tender and almost as flexible as wax What Valgus is But contrariwise those are called Valgi whose legs are crooked or bowed outwards This may come through the default of the first conformation as well as the other for by both the feet also and the knees may be made crooked which thing whosoever will amend must restore the bones into their proper and natural place so that in those that are varous he must thrust the bones outwards as though he would make them valgous neither is it sufficient to thrust them so but they ought also to be retained there in their places after they are so thrust for otherwise they being not well established would slip back again They must be stayed in their places by applying of collars and bolsters on that side whereunto the bones do lean and incline themselves for the same purpose boots may be made of leather of the thickness of a testone having a slit in the former part all along the bone of the leg and also under the sole of the foot that being drawn together on both sides they may be the better fitted and sit closer to the leg A plaister to hold fast restored bones And let this medicine following be applyed all about the leg â„ž thuris mastich alces boli armeni in â„¥ i. aluminis roch refine pini sicca subtilissimè pulveris an Ê’iii farinae vilat â„¥ ss album â—vor q. s make thereof a medicine You may also add a little Turpentine lest it should dry sooner or more vehemently then is necessary But you must beware and take great heed lest that such as were of late varous or valgous should attempt or strain themselves to go before that their joynts be confirmed for so the bones that were lately set in their places may slip aside again And moreover until they are able to go without danger let them wear high shoos tied close to their feet that the bones may be stayed the better and more firmly in their places but let that side of the soal of the shooe
or in swallowing the milke What is to be observed in the milk We may judg of or know the nature and condition of milk by the quantity quality colour savor and taste when the quantity of the milk is so little that it wil not suffice to nourish the infant it cannot be good and laudable for it aâ—gueth some distemperature either of the whole body or at least of the dugs especially a hot and dry distemperature But when it superaboundeth and is more then the infant can spend it exhausteth the juice of the nurses body and when it cannot all be drawn out by the infant it clutteâ—eth and congealeth or corrupteth in the dugs Yet I would rather wish it to abound then to be defective for the superabounding quantity may be pressed out before the childe be set to the breast The laudable consistence of milk That milk that is of a mean consistence between thick and thin is esteemed to be the best For it betokeneth the strength and vigor of the faculty that ingendreth it in the breasts Therefore if one drop of the milk be laid on the nail of ones thumb being first made very clean and fair if the thumb be not moved and it run off the nail it signifieth that it is watery milk but if it sâ—â—ck to the nail although the end of the thumb be bowed downwards it sheweth that it is too gross and thick but if it remain on the nail so long as you hold it upright and fall from it when you hold it a little aside or downwards by little and little it sheweth it is very good milk And that which is exquisitely white is best of all For the milk is no other thing then blood made white Therefore if it be of any other colour it argueth a default in the blood so that if it be brown Why the milk ougâ—t to be very white it betokeneth melancholick blood if it be yellow it signifieth cholerick blood if it be wan and pale it betokeneth phlegmatick blood if it be somewhat red it argueth the weakness of the faculty that engendreth the milk It ought to be sweet fragrant and pleasant in smell for if it strike into the nostrils with a certain sharpness as for the most part the milke of women that have red hair and little freckles on their faces doth it prognosticates a hot and cholerick nature Why a woman that hath red hair or frecles on her face cannot be a good Nurse if with a certain sowerness it portendeth a cold and melancholick nature In taste it ought to be sweet and as it were sugered for the bitter saltish sharp and stiptick is nought And here I cannot but admire the providence of nature which hath caused the blood wherewith the childe should be nourished to be turned into milk which unless it were so who is he that would not turn his face from and abhor so grievous and terrible a spectacle of the childes mouth so imbrued and besmeared with blood what mother or Nurse would not be amazed at every moment with the fear of the blood so often shed out or sucked by the infant for his nourishment Moreover we should want two helps of sustentation that is to say Butter and Cheese Neither ought the childe to be permitted to suck within five or six daies after it is born both for the reason before alledged and also because he hath need of so much time to rest quiet and ease himself after the pains he hath sustained in his birth in the mean season the mother must have her breasts drawn by some maid that drinketh no wine or else she may suck or draw them her self with an artificiall instrument which I will describe hereafter That Nurse that hath born a man childe is to be preferred before another What that Nurse that hath born a man-childe is to be p eferred before another because her milk is the better concocted the heat of the male-childe doubling the mothers heat And moreover the women that are great with childe of a male-childe are better colored and in better strength and better able to do any thing all the time of their greatness which proveth the same and moreover the blood is more laudable and the milk better Furthermore it behoveth the Nurse to be brought on bed or to travail at her just and prefixed or natural time Why she cannot be a good Nurse whoâ—e childe was born befoâ—e the time for when the childe is born before his time of some inward cause it argueth that there is some default lurking and hidden in the body and humors thereof CHAP. XXII What diet the Nurse ought to use and in what situation she ought to place the infant in the Cradle BOth in eating drinking sleeping watching exercising and resting the Nurses diet must be divers according as the nature of the childe both in habit and temperature shall be as for example if the childe be altogether of a more hot blood the Nurse both in feeding and ordering herself ought to follow a cooling diet In general let her eat meats of good juice moderate in quantity and quality let her live in a pure and clear air let her abstain from all spices and all salted and spiced meats and all sharp things wine especially that which is not allayed or mixed with water and carnal copulation with a man let her avoid all perturbations of the minde but anger especially let her use moderate exercise Anger â—reatly hu teth the Nurse The exercise of the arms is best for the Nurse How the childe should be placed in the Cradâ—e unless it be the exercise of her armes and upper parts rather then the leggs and lower parts whereby the greater attraction of the blood that must be turned into milk may be made towards the dugs Let her place her childe so in the Cradle that his head may be higher then all the body that so the excremental humors may be the better sent from the brain unto the passages that are beneath it Let her swathe it so as the neck and all the back-bone may be strait and equal As long as the childe sucketh and is not fed with stronger meat it is better to lay him alway on his back then any other way for the back is as it were the keel in a ship the ground-work and foundation of all the whole body whereon the infant may safely and easily rest But if he lie oâ— the side it were danger left that the bones of the ribs being soft and tender not strong enough and united with stack bands should bow under the weight of the rest and so wax crooked whereby the infant might become crook-backed But when he beginneth to breed teeth and to be fed with more strong meat and also the bones and connexions of them begin to wax more firm and hard he must be laved one while on this side another while on that and now and then also on his
is corrupted by taking the air and by the falling down of the urine and filth and by the motions of the thighs in going it is ulcerated and so putrifies An historie I remember that once I cured a young woman who had her womb hanging out at her privie parts as big as an egg and I did so well performe and perfect the cure thereof that afterwards she conceived and bare children many times and her womb never fell down CHAP. XLI The cure of the falling down of the womb BY this word falling down of the womb Remedies for the ascention of the womb we understand every motion of the womb out of its place or seat therefore if the womb ascend upwards we must use the same medicines as in strangulation of the womb If it be turned towards either side it must be restored and drawn back to its right place by applying and using cupping-glasses But if it descend and fall down into its own neck but yet not in great quantity the woman must be placed so that her buttocks may be very high and her legs across then cupping-glasses must be applied to her navel and Hypâ—gastrium and when the womb is brought into its place injections that binde and drie strongly must be injected into the neck of the womb For the falling down of the womb properly so called stinking fumigations must be used unto the privie parts and sweet things used to the mouth and nose But if the womb hang down in great quantitie between the thighs it must be cured by placing the woman after another sort and by using other kinde of medicines First of all she must be so layed on her back her buttocks and thighs so lifted up and her legs so drawn back as when the childe or secundine are to be taken or drawn from her then the neck of the womb and whatsoever hangeth out thereat must be annointed with oyl of lillies fresh butter capons grease and such like then it must be thrust gently with the fingers up into its place the sick or pained woman in the mean time helping or furthering the endeavour by drawing in of her breath as if she did sup drawing up as it were that which is fallen down After that the womb is restored unto its place whatsoever is filled with the ointment must be wiped with a soft and clean cloth lest that by the slipperiness thereof the womb should fall down again the genitals must be fomented with an astringent decoction made with pomegeanate pills cypress nuts gals roach allom horse-tail sumach berberies boiled in the water wherein Smiths quench their irons of those materials make a powder wherewith let those places be sprinkled let a Pessary of a competent bigness be put in at the neck of the womb but let it be eight or nine fingers in length according to the proportion of the grieved patients body Let them be made either with latin or of cork covered with wax of an oval form having a thread at one end whereby they may be drawn back again as need requires The formes of oval Pessaries A. sheweth the body of the Pessarie B. sheweth the thread wherewith it must be tied to the thigh When all this is done let the sick woman keep her self quiet in her bed with her buttocks lying very high and her legs across for the space of eight or ten dayes in the mean while the application of cupping-glasses will staye the womb in the right place and seat after it is restored thereunto but if she hath taken any hurt by cold air let the privie parts be fomented with a discussing and heating fomentation or this wise A discussing and hearing fomentation â„ž fol. alth salv lavend. rosmar artemis flor chamoem melilot an m ss sem anis foenugr an â„¥ i. let them be all well boiled in water and wine and make thereof a decoction for your use Give her also glysters that when the guts are emptied of the excrements the womb may the better be received in the void and empty capacity of the belly for this reason the bladder is also to be emptied for otherwise it were dangerous lest that the womb lying between them both being full should be kept down and cannot be put up into its own proper place by reason thereof How vomiting is profitable to the falling down of the womb Also vomiting is supposed to be a singular remedy to draw up the womb that is fallen down furthermore also it purgeth out the phlegm which did moisten and relax the ligaments of the womb for as the womb in time of copulation at the beginning of the conception is moved downwards to meet the seed so the stomach even of its own accord is lifted upwards when it is provoked by the injurie of any thing that is contrary unto it to cast it out with greater violence but when it is so raised up it draws up together therewith the peritonaeum The cutting away of the womb when it is putrified Lib. 6. the womb and also the body or parts annexed unto it If it cannot be restostored unto its place by these prescribed remedies and that it be ulcerated and so putrified that it cannot be restored unto his place again we are commanded by the precepts of art to cut it away and then to cure the womb according to art but first it should be tied and as much as is necessary must be cut off and the rest â—eared with a cautery There are some women that have had almost all their womb cut off without any danger of their life as Paulus testifieth Epist 39. lib. 2. Epist mâ—d John Langius Physician to the Count Palatine writeth that Carpus the Chirurgian took out the womb of a woman of Bononia he being present and yet the woman lived and was very wel after it Trac de miâ—and moâ—b caus Antonius Benevenius Physician of Florence writeth that he called by Vgolius the Physician to the cure of a woman whose womb was corrupted and fell away from her by pieces and yet she lived ten years after it An history There was a certain woman being found of body of good repute and above the age of thirtie years in whom shortly after she had been married the second time which was in Anno 1571. having no childe by her first husband the lawful signs of a right conception did appear yet in process of time there arose about the lower part of her privities the sense or feeling of a weight or heaviness being so troublesome unto her by reason that it was painful and also for that it stopped her urine that she was constrained to disclose her mischance to Christopher Mombey a Surgeon her neighbour dwelling in the Suburbs of S. Germâ—ns who having seen the tumor or smelling in her groin asswaged the pain with mollifying and anodyne fomentations and cataplasms but presently after he had done this he found on the inner side of her lip of
figure of a Colt with a Mans face At Verona Anno Dom. 1254. a Mare foaled a colt with the perfect face of a Man but all the rest of the body like an Horse a little after that the wars between the Florentines Pisans began by which all Italie was in a combustion The figure of a winged Monster About the time that Pope Julius the second raised up all Italie and the greatest part of Christendome against Lewis the twelfth the King of France in the year of our Lord 1512. in which year upon Easter day near Ravenna was sought that mortal battel in which the Popes forces were overthrown a monster was born in Ravenna having a Horn upon the crown of his head and besides two wings and one foot alone most like to the feet of birds of prey and in the knee thereof an eie the privities of male and female the rest of the body like a man as you see by this figure The third cause is an abundance of seed and overflowing matter The fourth the same in too little quantity and deficient The fift the force and efficacy of imagination The sixt the straightness of the womb The seventh the disorderly â—ire of the partie with childe and the position of the parts of the body The eight a fall strain or sâ—â—â—k especiall upon the belly of a woman with childe The ninth hereditary diseases or affects by any other accident The tenth the confusion and mingling together of the seed The eleventh the craft and wickedness of the deviâ— There are some others which are accounted for monsters because their original or essence full of admiration or do assume a certain prodigious form by the craft of some begging companions therefore we will speak briefly of them in their place in this our treatise of monsters CHAP. II. Of Monsters caused by too great abundance of seed SEeing we have already handled the two former and truly final causes of monsters we must now come to those which are material corporeal and efficient causes taking ouâ— beginning from that we call the too great abundance of the matter of seed It is the opinion of those Philosophers which have written of monsters that if at any time a creature bearing one at once as man shall cast forth more seed in copulation then is necessary to the generation of one body it cannot be that only one should be begot of all that therefore from thence either two or more must arise whereby it commeth to pass that these are rather judged wonders because they happen seldome and contrary to common custome Superfluous parts happen by the same cause that twins and many at one birth contrary to natures course do chance that is by a larger effusion of seed then is required for the framing of that part that so it exceeds either in number or else in greatness So Austin tells that in his time in the east an infant was born having all the parts from the belly upwards double but from thence downwards single and simple for it had two heads four eies two breasts four hands in all the rest like to another childe and it lived a littly while â—aliâ—s Rhodiginus saith he saw two monsters in Italie the oâ—e male the other female handsomely and neâ—rly made through all their bodies except their heads which were double the male died within a few daies after it was born but the female whose shape is here delineated lived twenty-five years which is contrary to the common custom of monsters for they for the most part are very short-liv'd because they both live and are born as it were against natures consent to which may be added they do not love themselves by reason they are made a scorn to others and that by that means lead a hated life But it is most remarkable which Lycosthenes telleth of a * Woman-monster for excepting her two heads she was framed in the rest of her body to an exact perfection her two heads had the like desire to eat and drink to sleep to speak and to do every thing she begged from dore to door every one giving to her freely Yet at length she was banisht Bavaria lest that by the frequent looking upon her the imagination of women with childe strongly moved should make the like impression in the infants they bare in their wombs The effigies of a * Maid with two heads The effigies of two a Girls whose backs grew together In the year of our Lord 1475. at Verona in Italie two a Girls were born with their backs sticking together from the lower part of the shoulders unto the very buttocks The novelty and strangeness of the thing moved their parents being but poor to carry them through all the chie towns in Italy to get mony of all such as came to see them The figure of a man with another growing out of him In the year 1530. There was a man to be seen at Paris out of whose belly another perfect in all his members except head hanged forth as if he had been grafted there The man was fortie years old and he carried the other implanted or growing out of him in his arms with such admiration to the beholders that many ran very earnestly to see him The effigies of a harned or hooded monster At Quiers a small village some ten miles from Turine in Savoy in the year 1578. upon the seventeenth day of January about eight a clock at night an honest matron brought forth a childe having five horns like to Rams horns set opposite to one another upon his head he had also a long piece of flesh like in some sort to a French hood which women use to wear hanging down from his forehead by the nape of his neck almost the length of his back two other pieces of flesh like the collar of a shirt were wrapped about his neck the fingers ends of both his hands somewhat resembled a Hawks talons and his knees seemed to be in his hams the right leg and the right foot were of a very red colour the rest of the body was of a tawnie color it is said he gave so terrible a scritch when he was brought forth that the Midwives and the rest of the women that were at her labor were so frighted that they presently left the house and ran away When the Duke of Savoy heard of this monster he commanded it should be brought to him which performed one would hardly think what various censures the Courtiers gave of it The monster you see here delineated was found in the middle and innermost part of an* Egg with the face of a man but hairs yielding a horrid representation of Snakes the chin had three other snakes stretched forth like a beard It was first seen at Autun at the house of one Bancheron a Lawyer a maid breaking many eggs to butter the white of this egg given a Cat presently killed her Lastly this monster comming to the hands of the Baron Senecy was
into pieces the salt or that earthy matter which remains after the boiling away of the Capitellum with a knife or hot iron spatula form them into cauteries of such figure and magnitude as they think fitting and so they laye them up or keep them for use in a viol or glass closely stopped that the air get not in Or Take a bundle or sufficient quantity of Bean-stalks or husks of Colewort-stalks two little bundles of cuttings of Vines four handfuls burn them all to ashes which put into a vessel of river-water so let them infuse for a dayes space being stirred ever now and then to this add two pounds of unquencht Lime of Axungia vitri half a pound of calcined Tartar two pounds of Sal niter four ounces infuse all these being made into powder in the foresaid Lye for two or three daies space often stirring it then strain the Capitellum or liquor through a thick cloth until it become clear Put it into a bason and set it over the fire and when as the moisture is almost wholly spent let two or three ounces of vitriol be added when the moisture is sufficiently evaporated make cauteries of that which remains after the formerly mentioned manner Take of the ashes of sound knotty Old oke as much as you please make thereof a Lye pour this Lye again upon other fresh ashes of the same wood let this be done three or four times then quench some Lime in this Ley and of these two make a Capitellum whereof you may make most approved cauteries The sign of good Capitellum For such ashes are hot in the fourth degree and in like sort the stones whereof the Lime by burning becomes fiery and hot to the fourth degree Verily I have made Caureries of Oke-ashes only which have wrought quickly and powerfully The Capitellum or Lye is thought sufficiently strong if that an egg will swim therein without sinking Or Take of the ashes of bean-stalks three pounds of unquencht lime Argol of the ashes of Okewood being all well burnt of each two pounds Let them for two daies space be infused into a vessel full of Lye made of the ashes of Oke-wood and be often stirred up and down Let this Lye then be put into another vessel having many holes in the bottom thereof covered with strums or straw-pâ—pes that the Capitellum flowing thorough these strait passages may become more clear Let it be put twice or thrice upon the ashes that so it may the better extract the heat and caustick quality of the ashes Then putting it into a Barbers basin set it over the fire and when it shall begin to grow thick the fire must be increased and cauteries made of this concreting matter The following cauteries are the best that ever I made trial of The faculty of the silken cautery as those that applied to the arm in the bigness of a Pease in the space of half an hour without pain especially if the part of it self be painless and free from inflammation eat into the skin and flesh even to the bone and make an ulcer of the bigness of ones fingers end and they leave an eschar so moist and humid that within four or five daies space it will fall away of it self without any scarification The cause of the name I have thought good to call these cauteries Silken or Velvet ones not only for that they are like Silk gentle and without pain but chiefly because I obtained the description of them of a certain Chymist who kept it as a great secret for some Velvet and much entreaty Their description is this Take of the ashes of Bean-stalks of the ashes of Oke-wood well burnt of each three pounds Their description let them be infused in a pretty quantity of river-water and be often stirred up and down then add thereto of unquench't lime four pounds which being quench't stirr it now and then together for two daies space that the Capitellum may become the stronger then strain it through a thick and strong linnen-cloth and thus strained put it three or four times upon the ashes that so it may draw more of the caustick faculties from them then boil it in a Barbers basin or else an earthen one well leaded upon a good Char-cole-fire until it become thick But a great part of the secret or Art consists in the manner and limit of this boiling for this Capitellum becomming thick and concreting into salt must not be kept so long upon the fire until all the moisture shall be vanished and spent by the heat thereof for thus also the force of the foresaid medicines which also consists in a spirituous substance will be much dissipated and weakned therefore before it be come to extreme driness it shall be taken from off the fire to wit when as yet there shall some thick moisture remain which may not hinder the cauteries from being made up into a form The made up cauteries shall be put up into a glass most closely luted or stopped that the air may not dissolve them so they shall be laid up kept in a dry place Now becaus the powder of Mercury is neer to cauteries in the effect faculty thereof which therefore is termed pulvis Angelicus for the excellency therefore I have thought good to give you the description thereof which is thus â„ž auripigmenti citrini floris aeris an â„¥ ii salis nitri lbi ss alumin. rochae lbii. vitrioli lbiii The description of Mercury or Angelical powder Let them all be powdred and put into a Retort having a large receiver well luted put thereto Then set the Retort over a Furnace and let the distillation be made first with a gentle fire then encreased by little and little so that the receiver may wax a little reddish â„ž Argenti vivi lb ss aquae fortis lbi ponantur in phiala fiat pulvis ut sequitur Take a large earthen pot whereinto put the viol or bolt-head wherein the Argentum vivum and Aqua fortis are contained setting it in ashes up to the neck thereof then set the pot over a furnace or upon hot coles so that it may boil and evaporate away the Aqua fortis neither in the interim will the glass be in any danger of breaking when all the water is vanished away which you may know is done when as it leaves smoaking suffer it to become cold then take it forth of the ashes and you shall finde calcined Mercury in the bottom of the colour of red Lead separated from the white yellow or black excrement for the white that concretes in the top is called Sublimate which if it should remain with the calcified Mercury you shall make it into powder and put it in a brass vessel upon some coals stirring or turning it with a spatula for the space of an hour or two for thus it will lose a great part of the acrimony and biting whence it will
Christ and love toward his neighbors with hope of life everlasting left that he being carried away by favor or corrupted with money or rewards should affirm or testifie those wounds to be small that are great and those great that are small for the report of the wound is received of the Surgeon according to the Civil Law Wounds termes great for three respects It is recorded in the works of antient Physicians that wounds may be called great for three respect The first is by reason of the greatness of the dissolved Unity or resolution of Continuity and such are these wounds which made by a violent stroke with a back-sword have cut off the arm or leg or overthwart the breast The second is by reason of the dignity or worthiness of the paâ—t now this dignity dependeth on the excellency of the action therefore thus any little wound made with a bodkin knife in any part whose substance is noble as in the brai Heart Liver or any other part whose action and function is necessary to preserve life as in the Weasant Lungs or Bladder is iudged great The third is by reason of the greatness and ill habit or the abundance of ill humors or debility of all the wounded body so those wounds that are made in the nervous parts and old decayed people are said to be great But in seaching of wounds let the surgeon take heed that he be not deceived by his probe For many times it cannot go into the bottom of the wound but stoppeth and sticketh in the way either because he hath not placed the patient in the same posture wherein he was when he received his hurt or else for that the stroke being made down right slipt aside to the right or left hand or else from below upwards or from above downwards and then he may expect that the wound is but little and will be cured in a short time How long a Surgeon must suspend his judgment in some cases when it is like to be long in curing or else mortal Therefore from the first day it behooveth him to suspend his judgment of the wound until the ninth for in time the accidents will shew themselves manifestly whether they he small or great according to the condition of the wound or wounded bodies and the state of the air according to his prinitive qualities or venemous corruption General signs whereby we judg of diseases But generally the signs whereby we may judg of diseases whether they be great or small of long or short continuance mortal or not mortal are four For they are drawn either from the nature and essence of the disease or from the cause or effects thereof or else from the similitude proportion and comparison of those diseases with the season or present constitution of the times Therefore if we are called to the cure of a green wound whose nature and danger is no other but a simple solution of Continuity in the musculous flesh we may presently pronounce that wound to be of no danger and that it will soon be cured But if it have an Ulcer annexed unto it that is if it be fanious then we may say it will be more difficult and long in curing and so we may pronounce of all diseases taking a sign of their essence and nature But of the signs that are taken of the causes let this be an example A wound that is made with a sharp-pointed and heavy weapon as with an halberd being stricken with great violence must be accounted great yea and also mortal if the accidents be correspondent But if the patient fall to the ground through the violence of the stroke if a cholerick vomiting following thereon if his sight fail him together with a giddiness if blood come forth at his eyes and nostrils if distraction follow with loss of memory and sense of feeling we may say that all the hope of life remaineth in one small sign which is to be deduced from the affects of the wound But by comparing it unto the season that then is and diseases that then assault mans body Wounds deadly by the fault of the air we may say that all those that are wounded with Gun-shot are in danger of death as it happened in the skirmishes at the siege of Rean and at the battle of Saint Denis For at that time whether it were by reason of the sault of the heavens or air through the evil humors of mans body and the disturbance of them all wounds that were made by Gun-shot were for the most part mortal So likewise at certain seasons of the year we see the small-pocks and meazles break forth in children as it were by a certain pestilent contagion to the destruction of children only inferring a most cruel vomit and lask and in such a season the judgment of those diseases is not difficult Signs of a fractured scull But you by the following signs may know what parts are wounded If the patient fall down with the stroke if he lye â—ensless as it were asleep if he avoid his excrements unwittingly if he be taken with giddiness if blood come out at his ears mouth and nose and if he vomit choler you may understand that the scull is fractured or pierced through by the defect in his understanding and discourse You also may know when the scull is fractured by the judgment of your external senses as if by feeling it with your finger you finde it elevated or depressed beyond the natural limits if by striking it with the end of a probe when the Perictanium or nervous film that investeth the scull is cut cross-wise and so divided there from it it yield a base and unperfect sound like unto a pot-sheard that is broken or rather like to an earthen-pitcher that hath a cleft or rent therein But we may say that death is at hand if his reason and understanding fail him Signs of death by a wound on the head if he be speechless if his sight forsake him if he would tumble head-long out of his bed being not at all able to remove the other parts of his body if he have a continual fever if his tongue be black with driness if the edges of the wound be black or drye and cast forth no sanions matter if they resemble the colour of salted-flesh if he have an apoplexy phrensie convulsion or palsie with an involuntary excretion or absolute suppression of the urine and excrements Signs that the throat is cut You may know that a man hath his throat that is his weason and winde-pipe cut First by the sight of his wound and next by the abolishment of the function or office thereof both wayes for the patient can neither speak nor swallow any meat or drink and the parts that are cut asunder divide themselves by retraction upwards or downwards one from another whereof cometh sudden or present death You may know that a wound hath pierced into the brest or