the facility thereof and for the saving of blood and spirits I have thought fit to commend to your consideration this new method as to the discretion of the Artist shall be esteemed fit Also I have observed that in surfeited delicate bodies of great personages such as are over-pomper'd with pleasure ease and fulnesse if by any way or accidents such happen to have a Gangrene seldome one of them escapeth death especially if they be ancient and have the dropsie or Scorbute and on the contrary amongst those which are weak poor indigent and miserable people which have bin by long continued ulcers fistulaes or other grievous maladies spent to extream weaknesse although seeming half dead before the work begin scarce two of ten dye amongst them upon amputation if the work be judiciously and in a fit way and time performed for I by practice have often observed that where an infirmity hath pulled down a Patient low and almost past hope of recovery especially if the disease proceeded by any outward violence that such bodies have bin by my experience found to be generally most hopeful of recovery either by amputation in the one or the other kind as the occasion will most fittest bear and on the contrary persons that are to be dismembred in full strength if it be to be acted in the sound part bear a far greater venture of their lives then the miserable dejected wretches do as aforesaid except it can be effected in the putrid part And one observation more to be by all men had in regard namely that our God in Naturehath created in mans body such a strong antipathie betwixt the living and the dead parts thereof that when by any violence in Nature either by distemperature from within testified by Feavours Pestilential or others or by the outward violence of Engines of Warre or other incident mischances as by Fractures Contusions c. whereby one part or limb of mans body becommeth sphacelated and dead before the other it is manifest that the living parts do as it were either in fear or disdain of the dead parts or for some other secret cause in Nature though not without great pain and grief notably withdraw themselves each from the other as in disdain leaving neither warmth not at all any comfort motion nor sense either by blood or spirits or ought else moving in the dead Veines Nerves nor Arteries neither any sense in the Periostcon that sensible Panicle that covereth the bones but as by a comparison of a Snail may in part be explained they wholly withdraw themselves for the Snail having by the vertue of natural warmth stretched her self out of her shell either for her necessity nourishment or delight in a moment apprehending cold or danger retyres into her shell and with all her force by her own slime shuts her self close up again and so rests her self in a supposed safety with her no doubt content even so all the living instruments faculties or vessels of Nature as in a nauseous disdain contempt or fear of the dead parts forsake the sphacelated parts and leave them utterly desperate and impotent and by vertue of the Radical Balsam of Nature contracts and shrowds her relict living parts as Artists may judge by the mortified toes of children but much the better where Art is at hand to aid Nature so that thereby the dead parts become as a noysome and heavy burthen to the living parts so as if you wound the sphacelated part it is not onely senselesse but also it is without blood or spirits at all neither doth blood or humours run any more nor so much as move in the sphacelated or putrid Veines at all and whilest lively Nature is as aforesaid shutting her dead enemy out of her living doores by stopping up all the breaches that she may hold the relict of her own if animal Art have not the charity to take her dead enemy from her yet vital agility assisted by natural motion and will in his due time doth efficiate what fairly can be expected for the assisting of Nature and supplying all defects proceeding ex intemperie all which excellent offices in Nature no question proceed de praesciencia Dei Here followeth a brief relation of amputation or of dismembring in general but more particularly being for the taking off of members in the rotten or mortified places which haâ—h in many cases been approved by the Authour thereof by his own long experience FOr brevity sake in this place I will not spend time to write of the general diseases causes or reasons that might urge the amputation of any member having elsewhere written somewhat thereof onely my intent for the present is to aquaint the younger sort with my long experienced practice for the manner of dismembring in a mortified part where just cause is offered having undertakeen it meerly for the publique good by informing the younger sort of Surgeons as well for their incouragements in the safe and warrantable putting in practice my pactical Method therein as also to shew and fore warn them from being over-much mis-led in the insisting upon old errours and traditions of their Masters Patrons and Predecessours too punctually As for example A Chirurgical â—ase put betwixt two Surgeons Suppose the younger Surgeon in consultation with his Friend or Brother Surgeon by way of asking advice should put the case and say I have a Patient that hath the toes of his feet putrefied fistulated and many wayes perforated with foul bones therein so that it is unsound even almost to the joynts of the ankle or the like and I have endeavoured by Art and with advice the best I can to heal him and cannot prevail in the Cure Wherefore since the toes of the foot cannot be cured the rest of the foot as unprofitable were as I suppose best to be taken away and no lesse of the legge also for it will be but a hinderance to the Patient considering that he cannot stand thereon and is full of grievous pain I will therefore conclude according to custome to take all off a little below the Gartering place leaving a fit room for the stilt to rest the body upon The which his said friend admitteth of as good practice and so he proceedeth to the work as being a rational and fair course and warrantable If the rest of his suggestion or indications be answerable The Chirurgical case answered and admitted unto the aforesaid allegation the work is doubtlesse good and so I my self would heretofore have done untill my practice taught me better things but now by my own practice which I much rather would ground on then upon ipse dixit I take a shorter course For if the bones of the toes of the feet onely were foul fistulated c. as is suggested yea and therefore incurable for so stands the suggestion as being so by reason of some great contusion wound or ulcer or otherwise as aforesaid with divers fragments of foul bones in them or the
of Amputating or cutting off of putrid members in the mortified part I after considered with my self that I could not properly proceed therein except by the defining of a Gangrene in the first place because a Gangrene is ever the fore runner of a Sphacelus and the material cause of Amputation either in the general body of Man or in any the particular parts thereof and from the which no Animal creature no not Man himself can decline from Ab initio statutum est omnibus semel mori For from the beginning all men are constituted once to dye and yet there is an interim for each man of not being in health neither really dead but quafi moriens vel semi mortuus dying or half dying In the which iâ—terim or intermission of time a man may by an accident be said to be in such a distemper as he may be gangrenated or in a Gangrena as the Artist tearms it either in part or in all and yet by the permission of God and by the help of Art that supposed dying man or member of man may receive cure and be heaâ—d again although in mans judgment not well versed in the mystery of healing he be supposed to be at the gates of death Even so a Gangrene presaging a Sphacelus may in some cases be cured as daily experience sheweth that divers Gangrenes receive cure so that to conclude a man that hath a Gangrene in one or more parts of his body untill it be taken away that man is evâ—r as it were under the Shadow of Death Nam Mors sequitur ut umbra Death attendeth us as our shadow Thus much briefly by way of Preface touching the Gangrene A Treatise of Gangrena A Definition of a Gangrene and the several causes thereof A Gangrene in his progresse may justly be termed an effect destroying nature and therefore against nature it is a disease woful painful horrible and fearful to man-kind and justly so for that it often endeth in Sphacelus which is the destruction of the part affected if not of the whole body Causes The causes thereof are infinite for number but to speak in brief in one generall term for all how the dâ—sease commeth first to invade mâ—ns body it ever proceedeth ex intemperie which is of distemper ever by force invading nature this intemperies or distemper may be said generally two wayes to be taken either Externally or Internally Externally It may be tearmed external or from without as well when it proceedeth by externall violence of the ayr by thunder and lightning or otherwise by the mighty and immediate hand of God as it doth to many or by feavours violent contagious or pestilential as Anthrace the small Pox or the like whose secret causes with the reasons thereof are hidden in God and therefore â—y mans wisdome are not to be found out although some affirm the Conjunction or Opposition of the Planets have power or give cause hereunto according to the Poet Astra regunt homines sedregit Astra Dâ—us The Stars govern mans body and God governeth the starres or it proceedeth of outward violence namely sometime by mans hand his intention or invention as by great wounds whereof great hemorrage and so as by a just consequent a Gangerne followeth as also by a violent contusion given either by violence of weapons as by wounds made by Gun-shot Swords Speares knives c. And oftentimes by obstructions in the blood sometimes caused by stripes c. whereby fractures of bones distortions of joynts contusious inflammations Convulsions great and sudden fears and other distempers proceed among which great accidents Gangrena is to be feared will be one and not the least although it may be called one of the last and it may also happen by the fall of a house a tree any weighty thing yea by a tyle a stone by the bite of any venemous Beast of a Dog and innumerable other accidents according to Gods secret appointment or permission Nam Accidit in puncto quod non reparatur in anno That may happen in a moment that cannot be repaired in a year And further a distemper may fall out to be a disease of the similar parts deprived of their naturall and proper temperament this deprivation 1. What a distemper is Simple distemper Compound distemper is caused two wayes either by a simple distemper by reason of the excesse of one quality viz. of heat cold dry or moisture or by a compound distemper by reason of the extuberance or over bearing of the two qualities together hot and moist hot and dry cold and moist and cold and dry again a distemper is either a fault of the meer quality Phlogosis alone viz. an inflammation or it hath an adjuâ—ct fâ—ult of the humours as a Phlegmon again many times a Gangrene proceedeth Phlegmon from a surfeir or a distemper of fulnesse or inanition which may proceed Intemperies by starving or recessus of dew nutriment to satisfie nature A second definition of a Gangrene Second definition of the Gangrene A Gangrene is a beginning of putrefaction being a dreadful Symptome of a disease in any member of the body and sheweth it self for the most part by inflammation with great dolour the grieved How to know it part often appearing of a sad dusky reddish colour or livid though not alwaies and being for the most part tumifieed or swollen the pain being to the judgment of the Patient so intolerable as if there were a fire-coal burning therein or the like in effect and for that reason the German Writers call this by the violent heat of the disease the Heisbrant or the hot burning coal for in truth a Gangrene is of a burning sudden fierce destroying nature and therefore against nature being a disease dreadful to mankind as is said and justly so for that it menaceth to the part affected if not to the whole body eminent destruction yea death it self except speedy remedy by Gods mercy be at hand The causes of this disease as aforesaid are many for number whereof The causes of Gangrene I will set down but part viz. It may proceed either from great hemorrage mentioned that is exceeding effusion of blood and spirits or by a distemper of the four humours proceeding either by Repletion or Inanition Or by extream erosion or corrosion of caustick Medicines or corrosive humours By imbecillity of nature as by weaknesse of infants and old age by a venemous and poysoned blood as in contagious times and namely when the small Pox or Plague reigneth Small Pox or Plague may prâ—ducâ— Gangrena's causing sudden putrefaction of humours also it may proceed by great burnings and scaldings by over-much hunger and thirst by the pricking of a nerve or of nerves by a Feavour precedent by a Frost and also by extream cold by the bitings of venemous Beasts or Wormes or mad Dogs by want of good concoction or humours by obstructions of or from any
so afterwards the dead part falls off and the living part is conserved And this manner in my judgment saith Fabritius is best but this Authour conceiveth Fabritius to be but a relater not a true practiser of the aforesaid course in amputation for that that work is so terrible and cruel neverthelesse In this recited Chapter you have the opinions of some of the ancient The way of amputation made better by experienâ—â— and learned Writers touching Sphacelated members and the manner of the amputation of those times since which the Art hath been by Gods favour very much illustrated so that where the complaint formerly was that by reason of great hemorrage namely the large effusion of blood and spirits in the work of their amputations many of their Patients perished under the Surgeons hands in the very act of amputation I may to Gods glory and so justly do I affirm for a truth that for the space of near 24 years I have been a Surgeon in the Hospital of Saint Bartholomews where I have taken off and holpen to take off many more then one hundred of legs and arms besides very many hands and fingers amongst all which not one of them all hath dyed in the time of their dismembering nor afterwards through the exceeding effusion of blood in the operation that ever I could gather or conceive and furthermore I affirm that not above four of each twenty dismembred but lived to have been healed and have been delivered whole out of the Hospital notwithstanding whatsoever their diseases have been and for that horrid cruel course mentioned by the aforesaid recited Ancients of burning the ends of the stumps in the the tender living and most sensible parts since I have known the Art of Surgery which hath been by the space of 50 years that I have used it I never saw it used by any in England nor elsewhere and yet I will not deny but the best Artist that is in the first work of amputation or in the second dressing of the Patient after amputation may be so put to it that if he provide not himself of a cauterizing button he may heartily wish he had had a small button ready for fear of the losse of his Patient upon an unexpected flux and howsoever it is a good Art and safe to my knowledge both for the Patient and Surgeon and but fitting for him so to be provided for fear of need onely I advise it to be privately absconded for the reputation sake Thus much of the manner of amputation from the Ancients This precedent Dâ—finition I have takes out of some of the ancient Authours from their own words verbatim that the Reader may consider how far it differeth from the scope hereafter to be handled An Introduction to amputation but chiefly for the mortified place LOving Reader the general opinion of the most ancient as also of the modern Writers yea and of the best Artists with us at this present living as farre as I can gather or conceive is that the fafest and best way for the cure of sphacelated or putrid dead members is to amputate them in the sound part and not in the putrid and their general reasons are to prevent that none of the putrid venemous or gangrenated blood or spirits should remain untaken away Ense recidendum est ne pars sincera trahatur for fear it should infect the sound and so consequently confound the whole masse of the blood and spirits and to conclude kill the whole body but the horrid pain the patient thereby susteineth with also the great uncertainty of his life after his extream sufferings caused me ever to mislike my own works therein yea although the successe for the most part was answerable to my desire And I further confesse tradition tooke place with me in the Hospital of S. Bartholomews in part where I was as is said a Surgeon for many years yea and that in my whole practice there as also with the rest of the Surgeons my partners untill after reading some Frustrà fit per plura quod fieri potest per pauciora ancient Authors I conceived that I might in some cases save a mans life by amputating in the sphacelated part notwith standing the general vate and tenent aforesaid to the contrary whereupon by accident about the year 1617. having a fit Patient which had a mortified leg and was as feeble and weak as possible a living creature might be insomuch I was of opinion upon the first view of him that Natures third was at hand spun out in him so that it was even sinne and pitty for me to hinder natures course or to shorten her course in hasting it with violent Art and namely by dismembring him in the whole part who had not blood and spirits in such a case according to the word to keep life and soul together but by consequent he must dye in the very act and therefore I confesse I intended the Patient should dye by Nature rather then to be killed by Art ever esteeming it a great sin to take away a limb from any creature but with some good hope thereby to preserve his life But again considering Christian duty and that I was tyed to do my best to preserve life to the utmost in my power I conceived there might be peradventure yet some small hope of life if I could without pain to the weak Patient or losse of blood ridde away his rotten member so I in short concluded to take it off in the dead place which as all men may conceive I without pain quickly effected and by Gods mercy the next day I found that my poor Patient after the loathsome stinck of his putrid limb was removed from him he began to chear up and so after from day to day was refreshed more and more and nature as it were rejoyced even as a tree refresheth after the dead boughs are pruned off so my poor Patient grew more and more lusty and chearful and to conclude in the space of 10. weekes he was perfectly healed and being then sound and lusty gave thanks to the Governour of the Hospital in full payment of his cure and so departed from the Hospital upon a leg of wood he then being fair and fat and very formal the which blessing of health to the poor man and light of knowledge by that experience to me did put me in mind of my duty in just thankfulnesse to God and also it animated me further to proceed in the like practice upon many others which since that time I have with good successe to Gods glory in the same manner well healed I then also began with my self to consider and as it were to question the reason why this latter Age of ours consisting of more pregnant wits then former Ages and that by good reason their judgments should in Art farre exceed the former as having had the experience light knowledge and examples from all the precedent Ages I say I
death waiteth at the dore The third pleadeth in this manner following and saith the former The third supposition answered supposition granted yet for my patient although his wounds received be desperate as formerly is suggested it would be held great rashnesse and unadvised cruelty in me if I should but offer to take off this member especially in the wounded part yeâ— or elsewhere at the least before it be brought to digestion wherefore I hold it my safest way to follow a rational method by joyning the parts fitting to be joyned as aforesaid and to proceed in the cure the which if by Art I could effect I should rejoyce though my patient were left with an unprofitable limb but if the hope of healing came short then I should hold it fit if it must be taken off to do it in a sound part and not in a putrid according to the now general practice in that kind which is warrantable But yet let the The resolution young Artist take this note from me that when he apparently seeth that a limb cannot be saved without amputation that whilest his patient is yet in strength as afore is expressed that he do his duty first to shew the patient his opinion grounded upon Art and good reason and if his patient give way to it then in the Name of God the sooner he taketh it off he better but if the patient do not approve of the motion good reasons tbeing given him the errour rests in him but if he consent to the work let him take it off in the wounded part although it be not wholly gangrenated circular regarding that memorable old verse Principiis obsta serò medicina paratur Quum mata per longas invaluere moras And further let the understanding Artist consider as followeth that if the bullet have taken away one full third part of a legge or arm in the circumference thereof with the breach of both the bones the great contusion and laceration considered with also the losse of blood and spirits thereby happening it may be feared justly that the limb although the party live will hardly or never be saved but howsoever it will be no way serviceable being done by a contused wound lacerated so that if ever it be healed the wound must come to suppuration and thereby to digestion so that by that reason some part more will be spent and lost by quitture and by consequent if by the part taken away the part contused so fall out that the half limb with the office and vigour thereof be lost or come away by the just course of Art in the healing scarce one often scape with life by reason of the pain and great expence of blood and spirits incident as is said and by reason of the long continuance of the griefe so that it falleth out that for the most part Nature is tyred out and the Patient dyeth in Marasmus or hecticke and such an end is more to be feared at Sea where want of fitting nourishment is then at Land So much I held fit to expresse of my experience and opinion for young Artists to ruminate on And now forward again to my yet unfinished scope of dismembring in the mortified part in the prosecution whereof let me as by the way yet again put the Reader in mind once more of the old document or phrase viz. That there is no general rule but may admit an exception even so in this case there are divers times places and causes Amputation in a mortâ—fied part in some casâ—s forbidden wherein amputation in a mortified part is utterly forbidden as namely the Patient being in a violent Feavour or in a Delirium for one case and yet even then neither is it wholly desperate and so to be utterly inhibited but onely during that paroxisme for if by Gods mercy through the help of the expert Surgeon or Physician the prefent fit I mean the Delirium be but removed and the Feavour taken away if there be any way to save the life of the Patient such amputation I mean in the mortified part is in my opinion the most safe easie and rational way being of all other the most likely way to preserve the life of the Patient for by that the Artist without pain or effusion of the blood may ipso facto remove impurum à puro the putrid from the sound and utterly alter the so much imagineâ— or suggested corrosion or venomous quality thereof so as justly it may be said then it is in this effected Causa ablata est ergo tollitur effectus the cause is taken away and therefore the effect ceaseth A second inhibition Another inhibition is when an amputation is to be done and there is no mortified place to do it in which in the most happeneth and then in such a case the Reader will grant the expert Surgeon is freely admitted to chuse his place so that he chuse it secundum Artem according to Art and so proceed and such occasions are very frequent as namely for one when the occasions of dismembring proceed from corrosive putrid or fistulous Ulcers in Joynts or by foul bones or by fractured bones or by dislocated bones or members distorted or otherwise by diseases incurable and unsufferable when and whereas no mortified place can fitting be found the Surgeon then must be left to take the convenientest whole place A third inhibition Another inhibition generally is when an occasion hapneth in a putrid body where Gangrenous and livid spots or otherwise discoloured spots happen here and there to and fro upon the body presaging a hidden and venomous humour or violence or otherwise deficiency in Nature from within him Gangrenes do proceed de abdita causa Naturae by occult causes in Nature or when a dissolution in the harmony of Nature manifestly appeareth to be at hand or when Pestilential or Carbunculous spots happen upon a Patient which many times mortifie even to the bone and yet such Pestilential Gangrenous spots after separate of themselves and the Patient liveth and is healed for that often in such cases the patients receive an ordinary Cure which my eyes have seen more then one so escape and cured in the Plague time and many other occasions may hinder such amputations which are not now in the apprehension of my memory to unfold Onely I desire that younger Artists would observe to hold the general rule in wounds made with Gun-shot formerly touched namely that they foresee where they cannot save a Limb to be serviceable that they with the approbation of the Patient and likewise by Advice for younger Artists in the cure of Gun-shot by amputation good advice they take it away in time whilest Nature is in her strength and if they have a fit mortified place then to do it there if possibly they can and the rather because there the work is in part done to their hand not regarding though the stump fall out somewhat too long for
medicine to the mouth or throat though some use in place thereof a splatter yet this instrument is far steddier better and The Commendation of it cleaner and being through hollow as is said the tongue is not apt to slip or slide from under it any way Of the Speculum Ani. THe Speculum Ani declareth his use by his name belonging onely The use to anâ— or the fundament to open the same as occasion shall be offered upon every grief or disease happening thereunto and cannot Reasons for the necessity of it well be forborn in the Surgeons chest For if there happen in the orifice of the fundament any excoriation or exulceration then can nothing better be brought to the grieved place then by this Speculum neither can the grief be seen without it the manner of the opening of the fundament therewith needs not to be discribed For I hold none so witlesse which cannot make use thereof when they once see but the instrument and yet let not the young artist be too busie in using An advertisement for the right use of the instrument Note 1. of this instrument without good reason For if by injection without it he can cure the Patient it is much better so to do and much easier to the Patient then to use the instrument One principall reason is the Patient hath not alwayes power to help himself by giving way to the safe use of this instrument for the Sphingtures or gathering muscles of the fundament will not of themselves without resistance be opened but often will against the Patient his own will make such unexspected resistance that if the artist which dilateth give not back he may bruise the said muscles and thereby make new work for it ought well to be had in mind how dangerous it is to the life or health of the Patient to use needlesse force in that part Of the cauterizing Irons THe ancient Chirurgions of former ages used these instruments far more then in these our times The necessary use of them in many cures is now forborn by reason the terror thereof to the Patient is The use great yet the use of them is very needful as namely to cauterize any vein or Artery in strong fluxes of blood which cannot otherwise be stayed And in the Epilepsie or falling sickness they are often used with When where the use is required good successe also they are good to make a funtanel or Issue in the hinder part of the head or in the neck so likewise in the cure of the Lethargy or Apoplexy if upon learned and good advice there be held just cause so to do But they have been used commonly by the ancient Surgeons of former ages for the opening of Apostumes and surely they are better in my judgement for the good of the Patient in many Apostumes then the Launcet yet I confesse I make no use of them my The benefit of the instrument fear and scandal hindereth self in that kinde because of the fear they put the Patient into and for speech of people who are ready to scandalize an Artiâ—â— upon each light occasion These instruments have likewise been commonly used by the ancients in dismembring namely to cauterize sometimes the whole end of the stump and sometimes onely veins and arteries and doubtlesse with good warrant they may yet be so used but in that case they are wholly now forborn for reasons aforesaid and for that a more pleasant course is known both for the Patient and the Artist yet I conclude it is very fit the Surgeons Chest be furnished with divers sorts of them if the allowance of the Surgeon will admit it Of Storks bils Ravens bils Crowes bils Goose bils and the Terebellum The use THese last recited instruments have their several uses to draw out bullets arrow-heads broken bones or whatsoever else of unnatural things are gotten into any part of mans body In the use of each of Care in their use is to be had for divers reasons them great care and respect is to be had not to use extreme violence on the sudden to draw out the offending thing for it is not always necessary to draw it forth by the way of the first wound but perhaps it may with far lesse danger be thrust quite through the member and taken out on the other side Sometime also the offending thing as a bullet may be so fixed in a bone or otherwise betwixt bones that it is far better not to move it then to offend the part where it is fixed or seated sometimes also Nature will better cast it out then thou canst by Art devise to do and over-forwardnesse doth often as much hurt as good It happeneth also sometimes that the orifice of the wound is to be dilated or inlarged to draw out a loose bone or other thing In such a case if it The drawing out of a loose bone be meerely loose it is best to take it out the first dressing but if it be loose at one end onely and fast at the other except thou without flux of blood or danger of the member canst remove it forbear and give nature leave to do her office and have patience For otherwise young Artists which are forward to tear cut and search too boldly do often that harm which is unrecoverable To conclude since experience and God and man are to be sought unto for knowledge reason make an Art if thou have reason be careful to ask counsel both of God and man that thou maist answer thy deeds both here and in the world to come For the subject of thy Art is the most precious of Gods creatures Thus much for the use of the aforesaid instruments at this time Of Incision sheeres THere is in every Art or Science a due respect to observe the having Incision sheeres are rather for form then necessary use of some things for form and order sake and if any instruments in the Surgeons Chest may be termed for form sake to be placed there the Incision sheeres are of that kinde for they are generally desired The seldome use of the Instrument but scarce once in a mans like worth the usage For admit there were an occasion to dilate or inlarge a wound it is far better done with the Incision knife which justly will obey the Artist his will without An Incision knife will excuse the want of the sheeres more or lesse doing then need requireth and this instrument is no way so justly to be limited Wherefore though I have here nominated it I forbear any perswasive words to urge the use of it but leave the Artist to his will therein Of the use of Probes of several siezes THe use of a Probe can no way be forborn in the Surgeons Chest Probes very needful for no Chirurgical work is well and artificially effected without some occasion of the use thereof more or lesse as namely oftentimes
have ready a band and bolster to make it up again that Of the Launces points Of the veine opened his launcets be not too spear pointed I mean small pointed for the broadest pointed Launcets make the best work likewise that orifice be large not deep yet not overlarge for it is overlarge when the blood tumbleth out without a stream for that spendeth too much the spirits and it is also too narrow when the stream is small and the veine is puffed up with wind Note also that if your Patient incline to faintnesse Of faintnisse in blood-letting with a remedy or swounding you cause him betimes to thrust his longest finger of the other hand into his throat and a little provoke himself to casting it helpeth presently let him reiterate the same work if occasion be But if he chance on a suddain as oft it happeneth to be gone in a swound beware you lay him not on his back with his head too low as it is usual Of sweunding in blood letting the remedy approved with some to do for so you may chance to lose him I have seen the like once done by an ignorant blood-letter wherefore remember it but rather bend him with one arme forewards and with your other hand stop very close his mouth and nostrels and in very short time you shall perceive wind to come and it will gather to his mouth and he will strive for breath then let go your hand and all is well and as often as he fainteth do so This is a safe course which with good successe I have used from my youth to this day The quantity of blood to be taken away at sea Further note that at sea especially where fresh food or good nourishment is not at hand it is good to be sparing in the quantity of blood to be taken away and rather often take blood away then too much at once except blood abound too much which is not easily judged by every young Artist For sometimes the party is idle-headed by distemper of the blood which by cooling broths and julips ought rather to be tempered providing also that he have the benefit of nature I mean a loose body Remedies for idlenesse in the head through distemperature of blood Phlebotomie not ealwayes to be used or be provoked thereto by art and by this means rather seek to cure then by rash Pplebotomy for you must consider that in the blood consisteth the life of man wherefore be not rash in that work and as is said hold ever this rule that if the Patient neither on the day thou wouldest open a vain nor on the day before we have had a stoole that thou attempt not to let him blood before first he hath had one stoole procured Observe well Of the vains to be opened him at the least if not more which is soonest and safest done by a suppository the next safest and better way is by a glister The veines commonly opened are six in number namely one in the forehead one under the tongue three in the arm and one in the foot The three in the arm are most in use whose names are Cephalica the uppermost or head vain so called of the Greek word Cephale which signifieth a head and is commonly opened in all griefs of the head where it can be taken in want whereof it is almost as good to take the middle veine The next is the median or the middle veine it is the second principall vein which is generally taken as indifferent for the whole body Aspecial observation concerning the liver vein The third is the Basilica or the liver vein being the lowest in the arm and more respecteth the liver then the two former But hold this general rule that if thou intend the opening of a vein to help the liver and that the liver vein will not be well taken then take the median vein for thou must know that all veins have their original in the liver Some arms have but one fair vein appearing then it followeth of necessity thou must take that for many learned Physicians are of opinion that generally the fullest vein in the arm is best and fittest to be taken except some special cause alter their minds for their words are often quae majus turget majus urget which may be englished the vein which sheweth most is most faulty Causes of bâ—ood letting in the forehead Under the tongue In the saphane vein The vein in the fore-head is also often taken for pains in the head as rheumes distillations of humours and the like The veins under the tongue in the squinancie or angine imflammations and swellings of the Amygdals of the throat or of the root of the tongue the liver vein called saphane chiefly is taken for womans sicknesses not often seen at sea though some necessary occasions chance of the taking thereof in men at sea for diverting and sometimes for curing of some special diseases which for brevity having spent my limited time I omit Incision knife THis Instrument is mentioned in the beginning of the uses of Instruments under the title Incision knife The Burras Pipe From whence it hath its original The use of the Burras Pipe THis Instrument thus named doubtlesse was by a Surgeon borrowed at first from some Gold or Silver-smith and never paid him again for the Gold smiths use it daily and cannot perform their works without a Burras Pipe but the Surgeons make other use thereof namely for the most part to retain corroding powders in as Vitrioll burnt Allom praecipitate and such other caustick medicines which well used perform very much in healing So also their abuse bringeth The danger of the abuse of it shame to the Artist and often unrecoverable damage to the Patient For it is common with many Artists in the healing of new wounds to mix praecipitate either with a digestive Unguent or with Basilicâ—n and Dorsell or plegents laid on tents according to the form of the wound and An errour in healing of a new wound observed to put it in as they say either to enlarge the wound or to help digestion to take away proud flesh to mundifie and the like and if not praecipitate then must they be busie with Vitrioll or Allom burned or with Directions for the cure of a new wound some caustick medicine in that kind But I would advise the Surgeons Mate not to use any corroding medicine at all in new or fresh wounds but let the flesh grow as proud as it will the ground being clear from whence it groweth namely if it be from a wound wherein is no putrified bones and if so be that the wound be full of flesh and then will not cicatrize a little burned Allom or Vitrioll will doe well and then to your former dressing again remembring that each third or fourth dressing be merely drie lint you shall find good therein and if you onely take lint and wet it
though great Consider therefore diligently whether the brain it self be hurt or no if the brain be offended it is to be known partly by the inflammation dolour apostumation retraction convulsion or deprivation of the functions of the senses and death also is suspected presently or within a few dayes to follow and if the palsie possesse the opposite part it being sound and whole it is doubtful and the sympathie of parts will cause oft-times an abscesse in the Liver and Messenterium and an intemperature of the vitall faculty with a continual fever and death It shall therefore be necessary for the wise artist to know the manner of the hurt that he may wisely prognosticate the danger for if only the Pericran be hurt by incision without any contusion and far from the commissures or seames it is not dangerous at all to be cured and the cure to be wrought is as in other wounds but if it be much wounded by punction or contusion and symptoms arise with a tumour in the head then dilatation is needfull that the contused blood which is between the Cranium and the Pericranium may be extracted and let it be quickly done so shal the symptoms cease and the cure will be easie but and if the offence of the Pericranium be in the suture or seam it is more dangerous because the brain doth sympathize with it If the Fibres passing through the sutures of the Pericranium from Dura mater be wounded or contused it exceeds the other in danger therefore to resist putrefaction let the wound be mundified and if no fracture of the bone be the wound appearing only in the flesh without any offence of the Pericranium the cure shall be as in other wounds But if a fracture in Cranium chance Special observation if the bones of the head be brâ—ken there is required great care namely let the form magnitude thereof be well considered observing also diligently what bone it is and in what part it is hurt and whether the fragments are great or little or sharp pricking the Membranes or not which of what sort soever they be they are diligently to be drawn out with as much ease as may be to the Patient and if they cannot being broader within then without let the trapan be carefully used the use whereof is touched in the book of instruments under the name trapan Sometimes there is onely a depression and then a levatory instrument wil excuse the use of a trapan and take away the spils and fragments which are upon the membrane the blood also which shal issue out upon the same may by a spunge be taken away keep it likwise from cold and of a temperate heat and the place hurt being well cleansed poure mel rosarum warm into the wound or 2 parts of hony and one part of oyl or syrup of drie roses or common hony with turpentine with the yolk of an eg which are remedies mundifying and grateful to the membranes and ought to be applied warm but above all others the linament of Arceus is the chiefest balsom for wounds in the head The general remedies for wounds of the head must neither overmuch refrigerate nor overmuch calefie but be of a moderate or temperate calour The general manner to proceed to the cure of the wounds in the head is as followeth First let the hair be shaven away the next if any loose bons be take them out the next to be done is if a depression of Cranium be strive with the elevatorie to raise it the next is to stay the flux of bloud if any be leaving of the grief undressed for two daies that the veins may knit then inquire of the Patient if he have the benefit of nature if not procure him one not many stools and only see he have natural stools once a day or in two daies not by potion nor pils but rather by glister or suppositorie At the second opening of the wound if occasion serve use the Trapan or take out any spils or bones that seem to offend if Instructions very needful in the bead wounded the second time openâ—d they be very loose not else force nothing out of the wound except the Patient his great necessity force thee thereunto for nature is kind and ready to do wondrous help in the cure of the head For the second application have ready of the noble linament of Arceus never sufficiently commended and being somewhat hotter then the partie would willingly bear it annoint the wound therewith in each place with a little soft lint on a Probes end leaving the said lint therein and with plegents of lint drie fil up the orifice after anointing about the edges of the grief apply a plaister either of Emplast Betonicae Stipticum Paracelsi Minium Mellilote or Diacalsitheos In want of Arceus linament you may take oleum rosarum and mel rosarum which are not much inferior to the former being warm applied some use therewith also a digestive of Turpentine and the yolk of an eg well mixed ana alike quantitie wherewith they spread plegents and then dip them in the warm mel and oyl mentioned and so apply them which is very good and the most ancient practice in curing wounds of the head In want of oyl of Roses oyl of Olive will do wel and common hony for mel rosarum though not so well and if cause be some Artists mix spirit of wine or good aqua vitae with the former medicine and it comforteth wel the brain and very much furthereth good and speedy healing good bowlstring and ligatu re doe much avail to the cure of the head also it is good to keep the partie lying and in a dark place till the greatest danger of accidents be past remembring withall that the overstrict keeping him in may also be very offensive to the sick Let good diet strictly be observed if occasion be and the use of Glisters likewise upon good reasons is also to be approved and it is good to open the Cephalike vain if the brain have been long uncovered or yield a spumous white and thick excrement which seems to be a portion of the substance of the brain likewise to purge the body mundifie the wound and corroborate the brain with Cordials and fomenttations fitting the chiefest is good wine and hony to foment with but I seldome use any Fomentations my self having cured divers Fractures in the Cranium without any Fomentations at all for the use of them at Sea I know is troublesome and dangerous except great Diligent observation of the accidents of a wound required cause Be careful also to observe the danger of thewound according to the accidents thereof for if it be little and superficial it is cured as an other wound but if it pierce the second table it must not be passed lightly over for if you be occasioned to use the Trapan it is to be applied the third fourth or fifth day after the hurt at the farthest
but the choice of the day is not material as some suppose where there is apparant necessitie except on the day of the full of the Moon and then there is danger more then at other times but necessitie hath no rules The cure of wounds in the face would if it were possible be done without a cicatrice but that cannot be performed without a drie stitch with also a most artificial convenient binding the lips of the wound together with also a sure natural balm wherefore I will not stand to teach the drie stitch here for it is not proper at sea it fits the land bettet In the work of suture or stitching take heed that the skin and flesh be not overthick which you take up with your needle and let not your stitches be too close A true ligature of the face is somewhat difficult to be performed because of the cavities thereof which are to be filled with linnen clothes or tow or lint the better to keep the ligature to the wound Where ligature is needfull The Nose and Eare wounded require good and carefull ligature and Emplasters that will cleave fast to the grief The wounds of the eyes are dangerous by reason of their affinity as well with the Pericranium as the other Membranes of the brain so that they are for the most part full of bitter pain causing losse of sight wherefore by Glisters bloud letting cupping Glasses Purgations and sober diet the accidents are to be stayed The medicines outwardly which I have used ever with good successe are the artificial Balm with fine lint warm applied on the eye lids and a Paracelsus plaster over that and therewith I have done great cures in wounds of the eyes but I never dropt any medicine into the eye it self The wounds of the neck are healed as other are unlesse the hinder part thereof be hurt which hath like symptomes to the brain If the shoulder be wounded it is cured as other wounds except the wound be in the joint-bone ligaments and nerves which needeth a suture and if it be overthwart a convenient Fascia or Ligature for the sustentation of the arm is to be carefully provided for without good ligature those wounds do not well For ought else their cures are common to other wounds The cures of the arm are sometimes dangerous chiefly if the bone and ligaments or the muscles with veins and nervs be incised thwart let the remedies therefore be such as are proper and agreeable to the nerves as namely the artificiall Balm very warm applied and a Paracelsus plaster with ligature fitting But if the hands be wounded and the tendous ligaments and sinewie parts thereof offended divers abscesses in many places with Inflammations appear sometimes and exceeding sore Sometimes pains arise which may occasion the use of purgations blood-letting anodine medicaments and a spare wholsome diet In these cures the artificiall bearing up of the arm is a chief part of the cure thereof and keeping the hand in one even position The wounds of the Thorax external suffer to be covered with flesh and to be healed as other wounds but wounds that penetrate the inward patts are dangerous namely if any great quantitie of bloud lie in the capacitie of the Thorax which cannot be evacuated by the wound but if it can be evacuated there is hope otherwise it is desperate Also if the blood may be extracted and no internall part seem hurt heal up the wound and be careful the aire get not into it but if the external orifice be litle and the internal great and wide the Membrane being burst and a rib uncovered as it oft times falleth out it is to be judged incurable and a Fistula will remain their continually And if the former part of the Thorax be strook thorow even to the latter but not thorow both if the wound be little and slender there is some hope of cure otherwise not but it is commonly past cure yet neglect not thy duty nor despair for God is merciful Let thy cure be attempted with good diet as is said cly sters bleeding syrupe of Violets and Hysop and the like unguentum potabile drunk fasting Ê’ ii or 3 for a dose and such local Medicines as are mentioned but if pain or the like accident shall be in any part of the Thorax use anodine medicaments as well as sanative lest pain hinder rest and overthrow all The outward wounds of the belly do nothing differ from the generall method of other wounds touching local Medicines onely in stitching they differ much but the inward differ as the parts offended may be divers as namely when the Omentum commeth out with all hast put it into its place lest it corrupt and the aire alter it if it shall be put in cold it will putrifie and bring grievous Symptomes it were better to make a Ligature about so much as is out and cut it off being careful of the guts If the intestines passe out by a wound the wound being very little they will hardly be reduced unlesse they be pricked for they will swell with wind but if the substance of a gut be wounded sow it together and consolidate it and if the liver splene stomack kidneis or bladder be wounded let nature work its part for there is small hope by art to prevail The wounds of the Scrotum are cured as other wounds of the sinewie parts The cure of the Hyppe wounded agreeth with that of the shoulder afore mentioned The Knee wounds also are cured as other sinewie parts wounded are The ancle foot and sole thereof wounded are hard of cure because there are many bones ligaments tendons and finewie parts among them they are also placed in the lowest part of the body and therefore are subject to defluction of humours Of Gun-shot wounds VVOunds made by Gunshot are alwaies compound never simple and are the more difficult of cure by reason of a certain Wounds by Gunshot are compound humor without the veins found neer them inclining to coruption the quality thereof being changed by the sudden violence of the blow The composition of which wounds for the most part consists of loss of substance contusion fraction of many sinewie fibres veins arteries membranes and bones yea often shivered into divers pieces being in The divers form ofwounds by Gunshot form different as some round narrow and wide and in figure cuniculous triangular quadrangular fistulous c. at the first bringing with them no Hemorrhea or flux of blood although the veins be broken open the blood returning back through the fearful violence of the strok The first curative intention of these wounds is dilatation where by the enemy to nature may by an open orifice be expeld The symptoms of such wounds are Hemorrea furtive or a stealing flux of blood trickling out by little and little Gangrene unawares assaulting the part also apostumation dolour and the like Wherefore as an entrance to the cure let an universall
of maturation or no also by depressing the cutis a little with your finger When an Apostume will suppurâ—â—e Hâ—ppocrat cap. 2. lib. 47. Mark also out of the words of the Ancients to know when an Apostume will proceed to suppuration Hippocrates lib. 47. cap. 2. hath these words that whilest Pus is in making paines and feavers do afflict but Pus being made paines and feavers do decline And to Tagalt Instit confirm the former words Tagaltius in his Institutions cap. 3. hath these following verses Duritia longa pulsus dolor calor aucti Signant pus fieri sed facto dicta remissa Sub digito undans albescens pars acuta The fourth time of an Apostume The declination of Apostumes I cannot stand to amplifie but I refer you as before to Mr. Galles Institution of a Chirurgion as also to Johannes Vigo and other good writers for a more ample doctrine in that point onely note that when the tumour or apostume is ripe mine opinion is rather it be opened by a potential caustick medicine then by actual incision when it may be as conveniently effected and that for many good reasons and one sufficient reason in mine opinion is if you use incision you must needs put in tents dossels or the like with medicines to keep open the orifice and also to enlarge it which doing you stop the passage of natures true evacuation twixt each dressing offending the parts adjacent and hinder the unition of the disjoyned parts against conscience detracting good healing yea and thereby hazard divers evil accidents to follow as fistulaes c. from Caustick incision commended all which by caustick incision you are freed and fear not at all the application of a convenient potential caustick medicine in due time and place especially the impostume being ripe and the skin thin for you can pierce no further then thorow the cutis though you would for being onely thorow the skin the matter will choak your caustick or corrasive medicine neither doubt at all that your work shall succeed otherwise then well for nature will provide remedy speedily easily and safely to heal your patient provided you be also careful to use your endeavour with good warm medicines duly applyed and with also the use of good ligature which is one principall good help good diet and other reasonable means likewise had for I have ever observed in my practise that a hot tumour in any outward part of the body growing either by repletion obstruction fever or by the evil disposition of the bloud for the most part yea even in pestilential and venemous Fevers in good bodies not being pocky nor too too old are easily healed by any understanding Artist that can joyn reason and experience together many several wayes namely for one if you perceive a beginning or 〈◊〉 of humours together in any part of the body consider what might be the cause thereof as near as you can if you find it to be fulnesse of the body or costivenesse you have divers present remedies that way to flye unto Laxative Medicines fitting viz. at the first make the Patient a suppository then give him a glyster if need be and a Laxative medicine also according as you shall see cause regarding the quality and quantity of the humour abounding but remember where the body is costive you were best to begin as is said with a suppository first and that having caused one stoole proceed with a purge if you see further cause or a glyster for often onely one suppository doth what you require also good fomentations that may by the pores of the skin help to breathe some part of the matter will do well and so the rest by discussing and mollifying medicines the easier be cured If the grief begin in the head or throat you may use phlebotomy either under the tongue on the forehead or on the arm in the head vein or median vein but if you perceive that by emptying the body artificially and cooling the blood with convenient medicines as also answerable slender diet and opening a vein that the collected peccant humours will not be discussed nor put back then may you proceed to attraction and suppuration as you see cause for it were most grosse to seek to detain that which Nature hath resolved to cast forth wherefore if you see cause to bring forward any Apostume you may then consider by the quality thereof what course to take namely by attractive alterative or suppurative Medicines as touching attractive medicines good attractives at Sea to be had are Gum Elemni of it self spread on lether and 〈◊〉 applied and Galbanum also is very good provided it be dissolved in wine and not in vineger Mellilot plaister will well bring forward an Apostume hot or cold and helpeth suppuration Commonpitch is a good attractive Burgundy pitch is also good Of these the discreet Chirurgions Mate may use the fittest in his discretion and if he desire violent attraction of any slothful cold tumour let him set a large cupping glasse thereon Maturatives or alterative Medicines in the 〈◊〉 Chest and Ship to be had are very many yea more then I can call to mind at this time wherefore to be brief Emplastrum Diachylon cum Gummis I put for the principal for it is for that purpose only Paraâ—elsus Plaisters applyed thick spread the place first anointed with oyl of Lillies will do well But where time and place is convenient in my opinion a mean Cataplasme warm and thick applyed suppurateth best and easiest viz. make a decoction of Althaea roots or Line seeds and the cause being cold add Fenigreek a little to this decoction adde Bean or Barley meal oyl of Camomil Dill and Lillies of each a small quantity Dialthaea a little or Axungia porcina and apply it warm and shift it twice in 24 houres Or â„ž flowers of Camomil Mellilote and of Elders an a M. ss Wormwood M. ss Althaea roots bruised â„¥ ss make a decoction thereof in fair water a sufficient quantity adding of Bean meal or Barley meal M. j. and being boyled into a due form of a Cataplasme adde oyl of Camomil or Dill â„¥ iiij Axungia porcina â„¥ ij In want of some one of these flowers another for need will serve and if none of them were to be had yet there is many other meaner helps to bring forward an Apostume which time will not now permit me to rehearse When you have an intent to bring any tumour to suppuration you must neither purge nor bleed your Patient neither appoint him a thin dyet When you would an Apostume should go back if it be above the navil in the breast back or head then let your purging Medicines be such as purge downward onely but if it be below the navil or in the arms or legs vomitive Medicines do best except some especial hinderances as Asthma or the like And to those uses none are so effectual as those
which are of Mercury truly prepared for that they do not only duly evacuate but also divert and draw back the humours from the place offended which in truth is a great help to nature Also blood letting where occasion is may be used for diverting and mitigating a stubborn disease but after the use of Mercurial purges it is held of many not to be good to open a vein of which opinion I am without extraordinary reason urge the contrary And further if you intend to repel an Apostume you may make use of this following Cataplasme of Bean meal or wheat meal boyled with water and vinegar a convenient quantity that it be not over sharp adding a little Terebinthine and very warm apply it with also good close ligature and shift renuing the medicine every sixth or eight hours but observing as it is rehearsed that to repel an Apostume slender diet with convenient evacuation of the belly and Phlebotomy are as principals to be used Also a safe Cataplasme to repel an Apostume in the beginning is â„ž farina fabarum or Bean flower and castle sope ana â„¥ j. wine vineger as much as will suffice boyl these one quarter of an hour together and you may mix a little water with the vinegar for fear it break the skin and apply it warm Note further that to an Apostume broken by a causticke I commonly use no other thing then unguentum basilicon warm from the first to the end of the cure or my artificial balm which I much rather commend upon my long experience except some dressings now and then I apply to it onely dry lint and if nature be not beneficial to incarn and help healing to my desire I use a gentle absterfive medicine namely a little precipitate mixed with the said basilicon or else unguentum Aegytiacum very hot but that only for one dressing one time and then to my former course again for certain daies together namely till the Esker be faln and at the least three dressings after which if it give me not good content in hope of amendment then I proceed further one degree namely I use for one dressing of oleum sulphuris per campanam or oleum Vitrioli with which I onely touch the Ulcer within I also give a purge thereupon if the Patient be strong and then to my old form again till nauure be at rest I mean as is said till the Eskar be clean gone and yet five or six daies further but if then I see it be still stubborn I proceed to the next step or degree and crave help from my honest old friend Mercury who if he fail me judiciously applied then I confess I am almost to seek but he seldom failed me performance if my Patient were not the cause the disease being by Art curable The mercurial medicine I most use in such cases you shal find to be rehearsed in the cures of Fistulaes and Ulcers If an Apostume be opened by a caustick medicine the Apostume of it self being concavous I mean having a great hollowness going deep this way or that way strive you not at all either with tents plegents or dorssels to fil the said concavities and to divide the parts asunder which desire unition but only dress the outward or superficial part with warm basilicon artificial Balm or the like convenient medicine putting it a little within the entrance of the orifice of the Apostume upon a little lint on the end of thy Probe until the first second and third dressing after the opening be past and if thou have any of thy Cataplasme remaining with which thou didst ripen the Apostume apply the same very warm if not apply some good Emplaster over it anointing it with balm artificial and tpplying daily thereto a good balm or basilicon warm and fear not if thou make thy applications warm and use good rowling and boulstring which is a principal part of the belly where thou seest cause but thou shalt heal comforably onely forget not if occasion be that sometime thou make injection into the concavity of the Apostume with some fitting mundificative or abstersive medicament namely with a fitting Lotion it will do well but use it warm and charge it not often with it not at all except great cause yet upon due occasion if an Apostume turn to a moist watry concavous Ulcer thou maist then add to thy Lotion Aegyptiacum but be not too busie with such medicines It may be also thou maist think how shall a good healing follow where the sore is not searched and with tents and like medicines A Caution healed first at the bottome my loving Brother in that thou shalt behold the excellency of Nature in our bodies which being once eased of the burden of that vicious and offending humour which was the cause of the disease it will at first seem admirable to thee being a divine work for nature intends healing without thy help first by little and litle she avoideth the dregs of the disease and ever as fast within by Gods providence incarning new flesh as the quitture is outwardly avoided not by means of thy incarnitives I must tell thee whereon I advise thee not to trust albeit they be never so good experience will shew thee that Abstersive medicines namely such as have vertue to scower and exiccate or drie leaving a certain stâ—pticknesse behind them do best incarn judiciously applyed yea and those medicines which are most caustick of all are truly most incarnative for I speak this upon my known experience that upon the true and judicious use of them the Ulcer will soon incarn only with the use of dry lint far more then with any unctious Medicine whatsoever yea though it be Unguentum aureum for it is an infallible rule in An infallible rule that divine mystery of healing who so can dry well can heal well if thou with thy over many causticks following each other or by keeping the parts too much asunder hinder it not for too much exiccation or drying will make work not heal which beware of Some Artists have in use long hard tents this way that way or dorsels or plegents for perpetual keeping open an Apostume for say they I will see a good ground and a sound healing at the bottome ere I take out my tents and then I will begin to shorten them I say such are unworthy Surgions yet I deny not an Apostume or Ulcer may be in such a part of the body as namely in the corner of the eye or in ano which in no wise will safely suffer healing till some caustick medicine have well searched yea and as it were seared the bottom which once effected go on in the name of God with your precedent courses of healing again namely with all soft gentle and speedy healing means as before said For Natura naturans naturat omnia and mark it for by this reason an old wife oftentimes exceedeth a great Artist in healing for she wrestleth not
Nature that is onely every day or the second day a naturall stool or an artificial help by suppositories or glysters if there be great necessitie not otherwise and if a Fever happen give him a barley water with a little oyle of Vitrioll therein and if that help uot open a vein on the contrarie side and if you fear putrifaction of humours give him a little Diatesseron Triacle or Mithridate or the like if he complain much of the pain search the cause namely see that the ends of the bones lie right and that the splints gall him not also that there be no wrinckles in the clouts applied The ingredients of a restrictive the manner of composing it and that it be not too hard or too soft bound all these things duely considered The Medicines I use are as followeth either I use a restrictive stuffe which is as followeth â„ž Bole â„¥ iij. Aluminis Thus ana â„¥ ss Radix Consolidae in powder â„¥ ij Lapis Zabulosus â„¥ i ss These all made into fine powder and mixed with the yolkes and whites of two egges together if they may be had adding wine vineger and mixed as much as will serve to make this medicine into the form of a Cataplasme and in want of egges use water and vineger onely so much as is needfull also if Comfry roots be not to be had or Thus they may be forborne you may in their places for need though not so very well use Bean-meal I have done very well many times onely with Allum Bole Egs water and vineger though Bean flower is also very good or Wheat flower and as for the medicine called Lapis Zabulosus here recited it is a medicine found out in the Arch-Duke of Brandenburg his Countrey named in the Germane Tongue Bc in broucke which in our language is a broken bone being in substance like chalk and in form like a bone some pieces like ribs other like fingers others like legs or armes bones of nature so growing This medicine I know to excell many other in healing Fractures both outwardly applied in Cataplasmes and inwardly taken daily the quantitie of Ê’j in fine powder in wine beere or water the patient fasting for two houres after the taking thereof In great Fractures the Germane Chirurgions prescribe this aforesaid medicine dayly to be taken for twentie foure dayes if they see cause so long to use it The other form of application to Fractures used and commendable as I have said and from which I am digressed is a good strong Lixivium made with fresh water and ashes till it be slipperie namely let the water be made seething hot ere the ashes be put in adding if th ey be ready or may be had in the Ship these hearbs following St. Johns wort Wormwood Centaury Rosemary Sage Camomile and Mellilote flowers or at the least some of them also you may adde Lupines thereto but howsoever though there be no herbs adde salt good store when it is cleared but not before and then though you have neither hearbs nor lupines it will be of good force for it is the vegetable salt in the ashes which is the best healer the next best is the minerall or Sea-salt wet the clowts rehearsed therein and wring them out hard and apply them smooth close and hot about the member binding it so up this second form is esteemed of most Artists the safer for avoyding Gangrenes which fractures are much incident unto by reason of great store of contused bloud gathered that can hardly be discussed on the instant which thereby causeth obstructions whereupon followeth inflammation and pain and consequently a Gangrene and surely the first is not inferiour to this for by the means of the Allum and the Vineger it swageth pain tempereth well the parts and yet repelleth and discusseth the bloud gathered and being once baked to it fortifieth mightily the member by sticking close and hard to it I have used it long without repcntance and the other sometime but for that it helpeth of it self to keep the member to his straightnesse I the rather use it Observation for the cure of the great bone of the legge fractured These things ready I mean the one or the other form suppose then the greater fossill or bone of the leg were fractured make true extention as is said that both ends of the bones meet together namely let one strong man take the one end of the fractured limbe and another the other end thy self standing free and let them draw out the member directly when thou art ready and not before neither by jumps but leisurely and together likewise if they bear their hands too high or too low in drawing they cause great pain to the Patient How to know when the â—â—ds of the bones meet arâ—ght and likewise cause the bone to lie unapt to thine hand to reduce it It is known when the ends of the bones meet for that not onely the member is returned to his former beautie again but also by it much of the pain is eased for it is a sure rule if the pain abate not all is not well The bone I say first well reduced bring your stuffe formerly rehearsed and put it under the leg the parties that extended not forsaking their hold and lap it about smooth and close as you can without wrinckles lumps or seams and that the ends may also fold smooth one over the other wrapping it double and smooth over the shin bone the cause why I use to fold it double on the shin bone leaving it there to be opened is that if it chance there be a wound it may be dressed the better without undoing all but if no wound be yet it fortifieth the bone the better by the doublenesse thereof being smooth then lay your next cloth broader and longer then the first over the first being wet in water and vineger if there be cause and wrung out Let the second cloth I fay as also the first be longer then the splints that the ends of the splints may rest thereon and not on the bare leg placing the splints in their order about the leg till you have compassed the leg laying them as is said not too close together that they ride not one over another neither touch each other nor come upon the ioynts remembring to put all your tapes under together in number it were fit to have five or sixe namely two on each end and two for the midst Also if there be a wound you must so order the matter that you may daily apply to the wound necessary medicines whereas otherwise if there be no great cause namely through much pain or the like you may well forbear six daies or ten daies provided that you see the leg be straight and well laid in an even position or form and that it may lye the safer it were good to be provided with the afor esaid bundles of reeds or bents as thick as the leg or thicker to come
the disease hath his beginning the more dangerous it may be adjudged By the complaint of the sick you shall know partly in what part of the body the disease is though not alwayes if the small guts be in the fault there is alwayes great pain about the navil but if it be in the gut Duodenum colon or rectum then the chief pain is in the lower parts of the belly according to their places The causes of the Flux with the signs of death This disease proceedeth sometimes by Apostumation of the small guts and then it is exceeding painful before it come to a Flux neither can any anodine glyster prevail at all to give ease till the full suppuration of the guts be perfected and that the Apostume be brâ—ken If this disease proceed from a former great obstruction either of the liver of the lungs or the speen there is small hope of life to be had Also when convulsions of the sinews singultas and vomitting or any one of these signs especially the two first appear then commonly death is at hand One learned Writer rehearsing Hippocrates for his Author saith that usually before death in this disease a black or blewish spot will appear behind the left ear of the sick which I also have seen observing it of late you shall find Plantane water to be a very good liquor to give any dry medicine in for the flux especially where there is any complaint of Plantane water and seeds and roots are very good for the flux heat or excoriation Plantane seeds are also good and so is a decoction of the roots of Plantane very good for that use or for glysters where it may be had The purging medicines which are called Diauretick or that provoke urine are also praised by Writers but I leave them to be done with great judgement onely if you use any medicine to cause urine the powder of yellow Amber is a sure one and without any manifest hot or offensive quality so is the powder of the Sea-horse peezel and the morse tooth of any of which if you give Ê’j for one dose you may safely do it but ℈ is sufficient at once Oyl of Terbinthine and of Amber are good diauâ—â—tick medicines and much more fotceable then the former but not so fit in this disease but rather good to drive gravel from the kidneys and serve well touching the The giving of vomits require great care and a good judgement cure of many cold and slothful diseases as the Dropsie Scurvy Lethargy and the like A vomitive medicine is not amiss in Fluxes whilst the party hath strength but the young Artist may easily make an error small in shew which notwithstanding may quickly cost a man his life wherefore if he attempt in such eases to cause vomit as one principle let him have care to the true dose of his medicines but first let us have good confideration whether it be convenient to use any such medicine or no for where easier medicines will cure never attempt greater but mistake me not I speak these things of love onely to children in Art and not to grave Artists from whom I would gladly learn my self Further I advise the younger Artists not to strive to stay a Flux as is said in a full body till nature be first unburthened partly by the disease and partly by medicines fit But as concerning Phlebotomy rehearsed as necessary in the cure of this disease do it not without great discretion and judgement for the Patient weakned formerly with so terrible a sicknesse and his spirits spent bleeding by a vein not advisedly done may suddenly overthrow and kill him yet again I must confesse that rule holdeth not generally CERTAIN SIGNES PROGNOstications and instructions which I hope will not be unprofitable for YOUTH concerning Fluxes The signs preceding the flux THe Signs of the disease are alwaies manifest of themselves the signs afore-running or demonstrating of the instant disease are these following Pain and torture of the intestines or ventricle Galen testifieth cap. 2. locorum affectorum in the very beginning of a Flux saith he sharp choler is sent forth wringings and as it were off-scouring or off-shavings of the intestines appear then after there followeth a little blood and then beginneth the disease Dysentery and by the relation of the Patient it will often appear if the pain be above or below the Navil A painful slow expulsion of the excrements of the belly with small fragments bloody and fatty do argue the higher intestines to be affected but if the grief be lower a pain below the The excrements in fragments and fat therewith Navil shall torment the Patient then you shall see much fatnesse with fragments and those fragments of the lower intestines will be more grosse and lesse mingled with the excrements A Dysentery slaying popularly and killing many may be adjudged contagious and is thought to follow a pestilential constitution and if in the times of a general infection by the disease Dysentery or Lientery a white Flux called Diarrhaea with Tenasmus appear in the Patient that party a little after shall be afflicted with the Dysentery The Ulcers of of the small intestines are more dangerous then the ulcers of the greater Difficulty of the intestines if it proceed from a black choler is held mortal Aph. 24. Sect. 4. Mortal signs in the Dysentery Long difficulties of the intestines hunger and wearinesse are evil signes and it is so much the worse if it be with a fever â—ph 3. Sect. 6. Every Flux especially if it be Dysenterial happening after a long sicknesse is mortal but chiefly if it be sudden because it argueth a sudden corruption of humours and great debility A Flux drawing to a languishing dropfie is mortal If in a Dysenteria a blew blew spot appear behind the ear the Patient shall dye The Fluxes that are from the beginning waterish and afterwards like an unguent are evil In all Fluxes of the belly and in all other diseases of weaknesse of the appetite inconstancy of the minde heavinesse in sleep imbecility of the legs a hoarse and barking voice a weak pulse beating often pains over the whole body chiefly about the belly blacknesse of the face or of a deadly or leady colour and coldnesse in all the extreme parts theseafore-said signs foretel evil but the signs contrary to these aforesaid are healthful The Hicket after an immoderate flux of the belly is mortal A good sign Belching following a Flux of the belly is good because it is a sign that nature hath received or again begun concoction A bad sign A flux of the belly which is not appeased by fit remedies is pernitious A pestilent flux of the belly beginning with lienteria Dearrheae or Tenasmus is worse in children then in ancient men as experience teacheth If that by the difficulty of the Intestines the excrements come forth like peeces of flesh it is a deadly sign Aph. 26.
the Chrystalline salt purified from grosse Salt-peeter knowne to be pure by that it doth contain no common salt therein being also wholly combustible of temperament it is either hot or cold as is The Nature plainly seen by his office and vertue do I say vertue yea and vice both I may say for in truth for wounding and killing salt goeth beyond Mercury this is the dangerous part of gun-powder which giveth it the force of piercing to the heart which God deliver all Christians from feeling it and accursed be that hellish Germane Monk Germane Monk Europs Doct rs Sal Nitriof two sorts which taught it first in Europe This Sal nitri is either animal or vegetable or both and may also not unfitly be tearmed mineral growing in mines and it is every where for every creature living may be said to have a part thereof man and beast I am sure hath a great part The spacious kingdome of Sal Nitri of it It is a most medicinable subiect as any is in the world and no man can live without it for our bloud and urine hath it in it yea and our very excrements are mixed therewith it is also in caves in mountains and plains and where not The inward vertue of Sal Nitri The dose for Hemoragie But to leave such discourse whereto I have not appointed this little time I say Sal nitri in the Chirurgions chest is a worthy medicine and the purer it is the better it is for all uses Touching the inward uses thereof it is good against Hemoragia or bleeding of a vein whether it be by the nose or any inward vein of the body taken Ê’ j. dissolved in plantane or fair water Helpeth the Calenture In the Calenture it is approved good to coole the boyling of the blood taken as aforefaid the dose for a need if the heat be great may be given every foure houres or the party may have a barley water rather made wherein two drachmes or more may be dissolved to drink at will it will not offend him onely if he take too great a The dose dose at once it may cause him to vomit but it will not hurt him It is the best thing I do know for the furring of the mouth and the throat in fevers the place gently washed therewith dissolved in water it presently bringeth away all the whitenesse and furring without offence Cleanseth the mouth furred used in water The mouth cleansed a Lotion needful It is not ungrateful of taste but so soon as you have taken such furring away I advise you that you have ready some gentle sanative lotion to inject to take away the acrimony thereof for it is abstergent and yet without violence or danger you may use therefore the ordinary lotion one part faire water two parts and so inject to cleanse the mouth after the use thereof I have expressed other uses of Sal Nitri proper in the cure of the Scurvy to which I referr the Reader Certain plain Verses for the use of Young Chirurgions by the Author gathered in praise of SALT SAlt with the world did begin whose end exceedeth time In it lie hidden secrets rare which no tongue can define Our Saviour his disciples deere to Salt did oft allude Who by their blessed voyces fill'd the earth with spiritual food Salt many jewels far exceeds salt guideth health and life Salt Author is of all increase ' gainst salt there is no strife Salt and his force his place his time his power in life and death His choice his change his actions strange admire we may on earth What living creature can want salt what plant or tree may grow What metal perfect doth endure if salt it do forgo His several kinds are infinite his vertues without number His quantity so large in all as to man seemes a wonder The aire the earth the Ocean deep with salt are seasoned so As wanting it fowl beast nor fish nor man could breath I know And for one instance do but note in blood what taste you finde Note urine eke how salt it is if it digresse not kinde Yea sweat and spittle though they be but excrements indeed Have store of salt which thing we finde by nature so decreed The earth produceth salt in all her creatures more and lesse Yet different each in some degree exeperience doth confesse Both hot and cold yea moist and dry is salt in temperament Yea volatile and fix also observing each intent Some sowre some sweet some sharp is sound some bitter eke in taste Yea liquid solid corrasive and purging salt thou hast All colours strange in salt are seen true healing therein stands And poyson strong abounds in salt salt loseth metals bands The spirit of salt makes liquid Sol and Luna at thy will That potable they may be wrought a work of worth and skill By salt are cured many griefs thongh hidden and profound Yet the exceeding use thereof is certainly unfound Salt doth preserve the food of men that travel far by sea And seasoneth well our meats at home which else would soon decay Of gain that doth thereby arise all people have a part It maketh barren land bear fruit which cheers the Plough-mans heart The Marchant is enricht thereby and all that fish in lakes Great store of food is gain'd by salt all things it savory makes In Physick and Chirurgery it hath the greatest part It doth contain an essence true which glads the fainting heart It causeth appetite at need it quencheth thirst at will It ceaseth pain of raging gowts it fevers hot doth still Thereby are bleeding wounds made well and that without delay Yea sordid Ulcers it makes sound and tumours takes away For meat and medicines there 's not ought with salt compar'd may be Wherefore I 'le cease to praise a thing above capacity God grant we all may seasoned be with salt devoid of strife That while we live we may do good and gain eternal life Sal metallorum est lapis Philosophorum OF SVLPHVR Sulphur is taken in general three manner of waies SUlphur is generaly taken for every fatty oylie or any way combustible part of any creature whether it be Animal Vegetable or Mineral namely in animal it comprehends Adeps Axungia Pinguedo and what else is combustible In Vegetables it includes Rosine Terebinthine Gum Oyl Wax Vinum Ardens or Aqua vitae Touching Minerals or Metals it includes all sorts of Bitumens with also the oyles of Metals as of Gold Silver Iron or any other together with all sorts of Brimstone Also it comprehends all sorts of Minral salts I mean their oyles as the oyl of Vitriol of A special observation Example A general rule Allom or of common salt c. And further it is to be considered that every Animal vegetable or Mineral substance whatsoever is said to contain his own pec liar and different Sulphur as for example in wine or beer or any other liquid
pestilential Boyle Of the second outward sign of the Plague THe second outward signe in the Disease is the most fierce burning Carbuncle called Anthrax or the burning coale which happeneth his ubique namely in every part of mans body without order rule or controule within the body as well as without The second sign Anthrax and at the first appearance thereof if visible it doth appear commonly inflamed and hard and 〈◊〉 the middest thereof with a burning pain afflicting the sick like to burning fire yea and will sometimes blister even with the ardent Fervour thereof and in others The effcte of it it will itch very much which if it be scratched there will come forth a sharp reddish yellowish or sometimes a dusky coloured Ichor The description of it And to some again the paine is so fierce and great that the Patient will grow to to be mad with extremity thereof The description of it The shape or figure of this Disease is most commonly somewhat round and the colour uncertaine according to the predomination of the humour infected or infecting or sometimes it is pale though the party be in a feavour sometimes reddish sometmies black or purple or greenish and the two last colours are most feareful and this disease is seldome healed without so much losse of the musculous flesh and skin as it taketh first hold of in what part soever it happen except by sweating medicines in the beginning of the disease the fury thereof be changed but it is a very good signe of life when it separateth it selfe so that the Fever cease for the Carbuncle commeth seldome or never to suppuration as doth the Bubo But it will admit separation and come to a kind of unperfect digestion many times and after wil come to fall out as a gangrenated part doth where Nature is strong and it usually will separate and come away in one intire piece from the sound but if it grow black and separate not nor any circular digestion be and the Feaver abate not then it may befeared Death is at hand for little hope of recovery is in the Patient The danger of it And againe if it appeare greenish the party commonly dyeth also you shall see some Carbuncles smooth as glasse and of a blacke shining colour not unlike pitch with intollerable paine and the member whereon they are fixed will be ponderous and unwildy to move to and fro and seeming to the patient as if it were heavily overburthened or as though it suffered by hard ligature and I have seen Patients that have had Carbuncles within the body whereof one hath been within the stomach and some have it in their liver and ther principal parts but such live not many dayes I have taken out the whole eye from one by a Carbuncle seated therein who recovered and from another the halfe nose from another the halfe of the beard with also the lippe whereon it grew which of it selfe fell off by separation and from the third one of his testicles I mean one of his stones with the purse and all and that man was with the halfe of his Scrotum living at the writing hereof as in my other Treatise elsewhere is mentioned Thus much of the second principal signe or apparant Demonstration of the Plague namely the Carbuncle Of the Blaine The third signe a Pestilential Blain THe third manifest and demonstrative signe of this Disease is the Pestilential Blain whereof some infected have many and divers have not one and this Disease is a painful angry push somewhat like the small pock but yet in colour more red or The descripion of it cloudy seldome transparent as a small pock usually is but farre more paineful some have them somewhat lesse some bigger with a small head of an angry blew or reddish colour sometimes of a lead colour and somewhat hard or fleshy and as it were growing upon a large root or stool this Disease is found in every part of the body but this Blain seldome killeth or hindreth the cure of the diseased but it rather serves for a demonstrative sign of the Disease then otherwise and helpeth to breathe out the venome as I gather For if by vertue from above or of good Medicines or by strength of nature the feavour The cause of it be overcome the Blain dryeth away and requireth no other cure For as I conceive it only proceeds ex ebullitione Sanguinis Venenosi of the ebullition or boyling of venemous blood which being thrust out either by the immediate work of God or Art or Nature health easily followeth and the blains vanish unlesse by natures weaknesse or through the undue use or want of Phlebotomy or of purging medicines or for want of following the cure by Diaphoretick medicaments in season the venome be repelled from the supeâ—ficies to the centre as too oft in the cure of that disease it happeneth and in such a case eminent death is to be feared And so I conclude of the third notable sign the Blayn Of the Marks or spots commonly though neither properly nor alwaies truly called Gods Tokens The fourth sign Gods tokens The fourth apparent outward sign of the plague is the markes or spots appearing upon the skin usually called Gods tokens but not as being ever certain tokens of the pestilence and so of death to the patient as vulgarly they are taken to be by ignorant people Of the ignorantly mistaking them in their unexpert conjectures and opinions for that it is daily manifest many have spots of several formes and colours when venomous feavours reign and yet have not the Plague and again many have suspitious and fearful spots which the vulgar term Gods tokens and recover and live many yeares after my self have cured not a few in that kind that are now to Gods glory living these spots are upon some bodies like Flea-bitings in others larger in some again as big as a penny Of the several colours In some bodies there are very many and sometimes they are like freckles and they are most commonly found upon the breast and sometimes upon the back arms and legs of the patients they are in some of a colour blewish or of a sad red and some are like lead-colour and others purple some are of a pale-blew and these spots are ever without pain but the very appearance of any spots to any in the Plague cause sudden fear to the Patient which though the markes be insensible yet through sudden fear they produce faintings Their effects caused by fear swoundings trembling of the heart and death following thereupon although neither the Patient feel pain as is said neither alwayes the Artist can judge by reason he seeth just cause of sudden death to his Patient the reason being secret with God as inwardly afflicting maukind de Praescientia Dei namely of the fore-knowledge of God So much of the marks spots or tokens in some appearing in the Disease of
incommodi quam commodi adferunt Huc accidit quod Cathartica hujusmodi Medicamenta quae fortia acuta sunt per se venenosa censentur non est autem venenum veneno apponendum omne enim tale addituns suo tali ut est communis Regula facit illud magis tale Major probatur ex Joh. Mesue de consolatione Medicinarum â—bi inquit Omnis Medicina laxativa est de genere venenosarum rerum cujus excessum Natura non patitur nullo propterea Cathartico Pestis tempore corpora vacuanda sunt Quandoquidem Medicus pro suo officio doctrina quam profitetur minister custos imitator Naturae dicitur Natura autâ—m in Peste à Centro ad superficiem conatur veâ—â—num pellere ergo Medicus riâ—e imitatur Naturae ductum juxtâ— Aphorism Hippocrat Libr. 21. Aphorism 1. Quo Naturae vergit ad loca conferentia eo ducere oportet c. Et quia Cathartica innata sua vi crudelitate Naturam regetivam totius corporis prosternunt qua ob Pest is quoque acuitatem impetum languida infirma est virtus vero hoc tâ—mpore conservanda qua prestrata periclitatur aeger ergo nullum Pharmacum dandum est The precedent Caveat touching purging Medicines Englished is in effect as followeth ONe Petrus Sibyllenius a learned Physician of his time in his Treatise De Peste doth write touching the use of Catharticke or purging Medicines in the case of the Plague as followeth and reciteth his reasons and authority for the same in these words Solutives forbidden in the cure of the Plague Concerning the opinion which some Physicians hold that solutive and purging Medicaments are convenient in the beginning of this most sharp sicknesse the Plague and that the venemous humour is to be driven out of the bodies infected with the Plague by their force and heat The censures of Galen and Avicen by strong arguments are repugnant to their opinions And Hippocrates confirmeth their anthorities in his L b. 4. de Dieta or of Diet which is to be used in sharp sicknesses where he saith when in any sharp sicknesse the opening of a Vein or solutive Medicaments are necessary the Vein is first to be opened And Avensoar in the Lib. 3. de Theisir saith before But in our Climate that Rule is not in gâ—â—â—ral gâ—od but is list to fit occasion and due time any purgation be he would advise that a general evacuation might be made meaning that letting blood is fit to be done And because saith he the use of laxative and purging Medicaments are ill hurtfull and dangerous to the body by reason of many evident cases therefore he likewise condemneth the errour of the unlearned and barbarous Physicians and Mountebanks of his times which would drive away the cause of the disease by violent purging Medicines as namely with Mercurius praecipitate which red powder they call falsly a precious Cathartick or purging Medicine which having a great force of heat in them they do draw forcibly and swiftly both the blood and humours which are in the Veines and do drive them out to the prejudice of Nature by which commission Nature which governeth the body is disabled stupified and beaten down in her endeavour touching her Crisis her working and contending with the poysonous vapours so as for the most part it hapneth that thereupon proceedeth a symptomatical expulsion which is not far from death it self And therefore such Medicines are not fit to be used in the beginning of the sicknesse namely the Plague Moreover all purging Medicaments draw the humours to the inward parts that is from the superficies or outward parts to the centre of the body which is the heart and the effects follow deadly for in venemous diseases the venomeought to be driven from the centre to the outwards therefore Cathartick or purging Medicines being ministred in the beginning of this sicknesse do more hurt then good And in this further is to be added that such purging Medicines as are so strong and sharp are esteemed to be venemous of themselves and there is no venome or poyson to be put to poyson for every such thing as is added to his like as the general Rule saith maketh that more such The Major is proved by Joh. Mesues de consolatione Medicinarum where he saith that all laxative Medicines are of the sort of venemous things whose excesse nature cannot endure therefore in time of the Plague the diseased bodies are not to be made empty by purgations The Office of a Physician seeing that a Physician is called by reason of his office and Learning which he professeth a Minister a keeper and an imitator of Nature The help of Nature in the Plague Nature in the Plague endeavours as much as in her is to expel the venome to the superficies of the body Therefore a Physician ought to follow the tract of Nature according to the Aphorisme of Hippocrates 21. Lib. 1. Aphoris Where Nature aymes his course thither it behoves the Physician to intend his Artificial help A reason of the danger of laxative Medicines And because Cathartick means by their innate force and cruelty do overthrow Nature the ruler of the whole body which also is made weak by reason of the sharpnesse and force of the Plague Nature is to be preserved and no laxative Medicine to be given Of variety of particulars for Brothes to be made for the sick according to mens several abilities or necessities and as the time and place hath to be added more or in part forborn upon each just occasion Of herbs convenient for Brothes ANd first for herbs fittest to be used in Brothes in this disease they are Buglosse Borage Endive Succory Strawberry leaves Marigolds Parsely Betony Violet leaves Sorrel Wood-Sorrel Plantane any of these are very good and so is Rosemary and Tyme so that you take not too much of any of them remembring also for the seasoning and relishing of Brothes as also for Sawce you may safely make use of Sugar Cynamon Currants Citrons Oranges Limons juice of Limons ripe and unripe Grapes preserved Barberries Cherries and Prunes Wine Vineger Verjuice Mace Cloves Nutmegs Saffron and Wine if occasion be to refresh the spirits for as I have said I esteem it far above any the simple waters of hearbs for a Vehicle in the disease of the Plague Necessary meats to be boyled in Broth. Also you may make your Brothes either of a Cock orrather of a Cock Chicken or of Mutton or Veal or for the meaner sort of what else their means will reach unto for many things that be held unsavoury nauseous yea and dangerous to the dainty are found to be very conveniene wholesome comfortable and precious to the poorer sort as Garlick Leekes Onions Chyves Wormwood Centory Angelica Bay-berries Gentian and divers others whose tastes are harsh A Cordial Drink to cool and contemperate the blood being a China broth if the Patient please to be
pence weight according to their several ages and capacities and also if you can and that you have convenience it is good that you remove the sick Patient sometimes from one Bed to another where convenience means and ability is and that you use sprinkling the Rooms with Wine Vineger sometimes as is said where it may be had Of such Dyet as is fitting for the sick of the Plague to take FIrst note that a very sparing Dyet in general is the most fir if the Patients have full bodies but in this disease commonly all appetite is forgotten with the Patient yet when you find that the danger of death by the disease is over and that the Patient amendeth then good refreshing and nourishing food is best using it sparingly Fitting meats to be eaten by the sick And first for the delicate and they which may have it let them in the Name of God eat Pheasant Partridge Quail Chickens Rabbits Capons Veal Lamb or Mutton any of these are very good taken with moderation And so are all field-Birds which are used to be eaten excepting those which live upon the Water as the Swan Unfitting meats Goose Duck Plover Wigion c. Also generally the most kind of fresh-Water Fish may well be eaten of except the Eel the Tench Meats forbidden and the Salmon Playce Flounders Whitings Soles Smelts and such like are good moderately taken also Pearch Roch Stone Gudgeons Breames Trouts Fresh Beefe and Pork are excepted against and I think it fit to avoid it where there is no want of other things But on the contrary where there is scarcity let thy ability be thy guide and in the Name of God in want of others let none be so unwise to refuse Beef nor the Broth or pottage thereof for experience sufficiently approveth them good neither egges poached nor soft sodden no nor Bread and Butter when their stomachs will bear it for these all nourish well very moderately taken And remember that if your Patient begin to amend of his disease and that his appetite grow deny him not competent food in a sparing manner and let him have as neer as may be that which is of light digestion and not too much at once but give it him often For understand that after once the masse of blood hath been corrupted and that Nature by Gods mercy with the help of good meanes hath again gotten the upper hand the body will require good nourishment and often to be supplyed The use of Verjuyce is very wholesome in the disease with Meats and also in Possets where inward heat is and thirst withal but not where cold is and the use of Goose-berries of unripe grapes Preserved Cherries Prunes sowre Pomegranates and the like are very good as is else-where mentioned and no lesse good is the use of Oranges Lemons Pome-Citrons and Pomegranates The cure of Angina Mendosa or a false Squinancy being a species of a contagious touch happening when the Plague reigneth Being a pain in the Neck or lower parts of Gula or of the Muscles of the Neck and Throat in which sicknesse there is generally small or no External nor Internal appearance although there sometime is in both and therefore is called Angina Mendosa Phlebotomy needful MAny begin the disease of the Plague with the aforesaid complaint for which one good remedy is Phlebotomy at the first not under the tongue onely in that case for that if you do it sufficeth not in so fierce a disease but that you must also be forced to open a vein in the arm Wherefore let the Surgeon if he be urged thereunto take the fullest vein of the arm of that side which the pain or complaint inclineth most unto but concerning general evacuation by Phlebotomy in Pestilential Feavours never do it when any indication of a Crisis by the disease appeareth for fear of offence and if so be that one side suffer not more then another then take it on the right arm and take a reasonable good quantity of blood namely from The quantity of blood to be taken a man 6 or 8 ounces or ten ounces not more for fear of dejecting the spirits and a lesser proportion to a weaker Patient and make a reasonable large orifice which in such a case is best and if after apparent need be which seldome is open the veines under the tongue but howsoever I would begin with the arm And for a Gargarisme use Barley water with Diamoroâ— and a little Ordering of â—argarismes of Syrup of Vineger or a little Sal-niter is very good and for outward application take a small handful of Camomil flowers of clean ashes of wood without coales or drosse a handful and a few Rose leaves and two spoonfuls of oyl of Roses with as much of wine Vineger boyl it with small beer into a Cataplasme and very warm apply it and shift it morning and evening if the rose leaves be not to be had or the Camomil flowers use Elder leaves in place it will do well and ordinary oyl or butter for a need will serve where oyl of Roses is wanting or the old Medicine of Mel and Album Graecum with a little Vineger mixed is right good and the next morning after Phlebotomy give the patient a Diaphoretick of Aurum Vitae eight graines and appoint him to sweat four houres and no doubt but the disease will be therewith soon at an end Of the use of Phlebotomy in the aforesaid disease I have had experience oftentimes this yeere and even upon my own Son who being in a violent burning Feavour with an Angina Mendosa and being very unwilling to be let blood under the tongue first for fear of losse of time I caused to give him a suppofitory then after within â—three houres I gave him a Cordial Diaphoretick Gr. 8. of Aurum vitae which he did sweat upon for three or almost four houres very plentifully and was somewhat revived and reasonable chearful neverthelesse he still finding a great fulnesse of blood entreated me to open a vein for him in the Arm the which I did and took from him as I conceived ten ounces of blood he being of a full able body and about twenty yeeres of age and without any more medicines or time of complaint by Gods mercy he came to his perfect health again the second day from the beginning of his desease And I may truly to Gods glory affirm that in this yeere 1638 I have cured very many of Feavours with also complaints of swellings in their throats meerly by that Diaphoretick of Gold of my own practice called Aurum vitae and that with onely one dose given and no more and the parties became thereby perfectly whole the very next day without the taking any other Medicine and by the same medicine and onely by the once giving I also have healed very many of the Plague in one day whereof some had risings of tumours which by their once sweating spent without further
like I would not proceed as aforâ—said if the Patient were mine and he or she otherwise of a good habit of body the joynts of the ankle it self not being fistulated nor plainly corrupted but rather I would take off the foot I mean the toes onely before the A note of practise put joynts of the ankle and spare the joynt of the ankle and that with a fitting Instrument made for the purpose with good hope to effect the cure and to save the joynt to the great joy and good service of the Patient for I would save him a part of the foot to stand upon yea and if to stand on I dare say to go on in a reasonable manner the which I have more then once put in practice and effected with good successe but on the other side if that the joynt of the ankle be diseased so that this my way will not take good effect then I will yield the foot is not to be saved by reason of the aforesaid defects thereof A yeelding to the first proposition and then in such a case I will give way and say that the whole legge is best to be taken away as aforesaid and it is an artificiall course and good practice Yet under favour let me put the Reader in mind of another rationall good Method which were a farre better course then to take away a guiltlesse sound legge if any other means were found and the practice of our times had experienced and approved thereof it is a modern practise frequently practiced in the East-Indies as it hath An East-India practise been credibly reported to me by sundry credible Surgeons who having spent some time in travell there have related it to me namely that they have seen divers persons who having formerly had their feet chopped off at the ankles by censure of their Countrey Lawes for trespasses committed and the said men have been cured by their own Countrey Surgeons and after have pue their stumpes into large Canes or rcedes which they tearm Bamboes being stuffed with Cotton Wooll or the like and they all their lives after have been imployed to runne of Etrands and get their livings as before notwithstanding the want of feet though as I conceive not with former like speed which hath put a longing desire in me I confesse having had opportunity above some others to have tryed the experience in the Hospital but a fit subject hath not presented it self to me for a tryal for I have I confesse ever been tender in that point and loath to put any one Patient against his own free-will upon new inventions by beginning new practice upon him making an unwilling person the first example every Patient in such a case having just freedome to chuse his way although on the other side a Patient fit for such a tryal of Art ought to be one who by a violent contusion as of a wound made by Gun-shot or some other violence as a violent bruise by an intolerable weight had spoyled the foot and ankle and not any one whose disease proceeded from any evill habit in the blood as in a body having Struma or scrupulous tumours for there is small hope in such for their stumps will not heal sound to bear their bodies It is unjust in nature that any member being sound should suffer for an unsound one For I confesse I esteem it very unjust in Nature rhat any one part of a sound member should suffer and be taken off for the fault or defect of another being sound and blamelesse especially when any better or other comfort can possibly be found As for example for the offence or disease of the toes let onely the toes suffer and no more of the members of the body be lost if it may so be and for the offence of the foot and joynt thereof if it be intolerable by exceeding pain and therefore not to be sustained it is just that so much be amputated as deserveth expulsion and not as is said to take away a sound and blamelesse legge when it is innocent and free from fault errour or disease for the noblenesse of each member of mans Of the excellenâ—ies of the uses of part of a member body and namely of the legge is highly even in humanity to be tendred and regarded being a great honour and comfort to the man when if withont a foot by the help of Art namely of a hollow Case or the like with an artificial foot adjoyned a man may decently and comely walk and ride go over a stile yea and runne and sit streight and behave himself man like in a Bed and at board and do good service for the defence of his Countrey or of himself in regard whereof I should esteem that Artist a very unworthy nnwise and wilsull person who by any good meanes could keep a profitable part of any member untaken off and would presume to take it away for any reason or pretence whatsoever and besides it is no small dishonour to the Art of Surgeryr Wherefore I will conclude this point in perswasive manner admonishing young Surgeons as I have recited elsewhere well to be advised by counsel of the most ancient and best experienced Artists before they undertake any amputation whatsoever and not to think themselves to be disparaged by craving counsell but rather graced thereby following the precepts of that sweet Lily in the Preface of his Grammar Qui dubitat qui sapè rogat mea dicta tenebit Is qui nil dubitat nil capit inde boni Which may bear this English construction Who doubts and askes he expert proves and Lilies Rule makes good Whilest he that 's wise in his own conceit puts on the Idiots bood A Caueat against rash incision and chiefly abscission And as for my Brethren of the younger sort let me lovingly advise you neither for vain ostentation sake nor popular applause by rashnesse to be guilty of the effusion of blood by unadvised amputation though you may pretend you have Art for a sufficient warrant or for a Buckler lest God touch your hearts for it in secret who seeth not as men see for the artificial shedding of blood hath no warrant nor encouragement written in Gods book wherefore in matters of weightbe not too rash but be advised by counsel this my second declaration of amputation was as else-where is recited chiefly published to encourage the taking off of a member in the putrid or dead part where a circular putrid part is notwithstanding the practice I well know is Old now new practice in amputating mentioned by many ancient and modern Writers inhibited as also it hath by reason of old tradition been generally shunhed and not so much as been attempted in our times and yet neverthelesse some of the ancient Writers as Falâ—pius Fabritius de aqua pendente Johannes de Vigo and some others as they themselves affirm have used it with good successe although by reading their workes
I observe by their method that they were rather narrators one from anothe then truly actors but be it as it will this one comfort the Surgeon shall be Comfort to the patient in ubscissing in the mortified part sure to find thereby he shall no way endanger his patient in that course either by losse of blood or spirits nor shall the Patient endure any pain at all in the act of amputation after that way and the practice is good and warrantable in divers yea in most cases as hereafter I shall explain and as my self of many yeares experience may boldly affirm and it is likewise beneficial for the Common-wealth and for a true instance of the truth thereof I have many of my Patients so dismembred at the writing hereof living and in perfect health I mean which were dismembred in the putrid part and that upon some Patients on both the legges at one instant performed amongst which tryals I made of one legge was in Anno Domini 1617. Secondly I had one Thomas Brown about Anno 1619. a Sayler who had received a great wound by Gun-shot at Sea upon the right legge the greater Fossels A bislory for an example thereof being broken in sunder so that the shot had carried away two inches of the said bone in length together with the lacerating the muscles nerves Artcries Veines c. whereby it was so contused lacerated and torn asunder with also so much losse of substance that nature could not bear to heat that member to be any way serviceable for ought besides there had followed upon the wound so great and intolerable hemorrage or expence of blood and spirits that the member mort fied by reason of the former great evacuations and contusions neither could nature in that Patient possibly have born a dismembring Losse of blood causeth Gangrena in a whole part without eminent danger of present death and so was the estate and case of this Patient before he came by me to be cured in Saint Bartholomews Hospital wherefore considering well his most desperate estate I resolved to make a second experience of him and did take off the wounded legge in the lacerated dead part wherein I conceive as afore-said all men of judgment will easily be of opinion that the Patient by that work was without danger of death or pain and without losse of any drop of blood and I healed this patient by Gods mercy in five moneths and he had been by the half sooner whole had not he lost so exceeding much blood and spirits by his wounds as afore-said and this Patient was living at the writing hereof being many yeares after the amputation the method of which cure with the manner of amputating thereof shall God assisting me hereafter be set down Another example The next I took off in the mortified place was one Thomas Hog a shippe-Carpenter a Scotchman who also was living at the writing hereof this man at his labour aboard the shippe standing stoutly at his work at the straining of a Cable as it was running out of the bits of the ship as the Sea-men terme it the Cable tooke hold of his legge close by the ankle and forceably bruised in peices not onely the veines arteries and nerves with the softer parts but brake also the bones in sunder with extream violence insomuch as by reason of the want of a Surgeon present to dresse him by great effusion of blood and spirits the legge mortified the next day and he after that fell unto my part in the Hospital to be cured the which being emboldened by the good successe of the two former I took off his legge also in the mortified part as I did the other and made a perfect cure thereof in three moneths and he followed the trade of a ship-Carpenter at the writing hereof Another example Also two yeares after I cured an Apprentice of one Master Goddard an Upholster at the sign of the Crown in the Poultry in London named John Harding in his Masters house who after a fierce pestilential Feavour had his right legge mortified in bed as he lay and I took it off in the mortified part at or near the gartering place which by the ancient use of Art of our times must have been taken off in a sound place notwithstanding the great feeblenesse of the Patient at that time and his eminent danger of death he being extream feeble and at the point of death in which case to have taken it off in the sound part he doubtlesse would have dyed under my hand but by Gods mercy he lived divers yeares after and went most neatly on an Artificial legge not easily discovered Another history Remarkable A history or a relation of a remarkable example of an amputation by me performed upon a woman in Saint Bartholomews Hospital of both her legges and part of seven of her fingers in one morning together all taken off in the mortified part without pain The amputation of both the legs and part of seven fingers of a woman in one morning or losse of blood or spirits at all and the woman was living at the writing hereof and the Patient was a certain poor maid or woman servant in London named Ellin French of whom there were made Bookes and Ballads that were sung about the streets of her namely that whereas the said maid or servant was given to pilfering and being accused thereof by her Mâ—ster and Mistresse used to curse and swear and with words of execration to wish that if she had committed the crime she stood accused of that then her legges and hands might rot off the which thing accordingly no doubt by the providence of God came to passe as a judgement upon her namely that both her legges almost to the gartering place with parts of seven of her fingers did rot off the which wretched woman neverthelesse being referred to me in Saint Bartholomews Hospital to be cured by Gods mercy and permission I healed her perfectly by cutting off both the Sphacelated legges in the mortified parts with also part of her seven fingers as is said all in one morning without pain terrour or of any losse of blood unto her in the taking them off and made her perfectly whole in a very short time namely within three moneths so merciful is our God unto us vile creatures when we are most unworthy of such his mercies she is at the instant writing hereof also living Now with your friendly patience onely one example more I will trouble you with namely of the cure of a mortification proceeding of a Carbuncle in a Feavour Pestilential by me performed and I A hisâ—â—ry will therein conclude my shewing of instances although I could declare many more of living persons and I will haste to shew forth the manner of my acting of such amputations The work was of a certain Stationer then dwelling in Pauls Church-yard whose name I conceal for that at the writing hereof