AN INSTITVTION OF A CHIRVRGIAN, CONTEYNING The sure Groundes and Principles of Chirurgiry, by Thomas Gale. &c.
PHoebus who chasith awaye the darke and vnconfortable night: castinge his goldyne beames on my face, woulde not sofer me to take anye longer slepe: but said awake for shame, & beholde the handy worke of our sister Flora, how she hath reuested the earth wyth mooste beautyfull colours, meruaylouslye set in trees, plantes, herbes, and floures: in so muche that the old and wetheryd cote of wynter, is quite done away, and put out of remembrance, at whiche wordes of Phebus, my hart quickened in me, and all desire of slepe was eftsones forgotten, Wherfore I am now cumme into this beautiful mydowe to recreate my selfe, and gather some of those pleasant herbes, and floures, whiche here doe growe. But let me see? me thinke I perceyue .ij. men walkinge to gether and reasonynge also very earnestlye. I wyll aproche neerer vnto them, perchaunce they be of my acquaintaunce: Suerly I shoulde knowe them. I am deceyued [Page] yf the one be not my frende maister Gale, and the other maister Feilde. It is so in deade. Wherfore I will go and salute them. God that hath brought vs together in to this place, make this daye prosperous and fortunate vnto you both.
Brother Yates the same we wishe vnto you, & you are welcome into our cōpany.
This faire and plesant mornynge, will not soffer maister Yates to kepe his bed: but leuynge the citye, he rometh the feildes, to espie oute some strange herbes, vnto hym yet vnknowen.
I muste of force confesse, that you doe hitte the nayle on the heade: but sence my happe is so fortunate, as to mete wyth you both, and that nowe in this pleasant mornyng: I wolde leaue of my former determinyd purpose, and require you to enter into some talke of Chirurgerye. For sens you both ware brought vppe vnder Maister Ferris (beinge nowe Sergeant Cherurgian, vnto the Quenes Maiestie) one at whome bothe for his knowledge, & experience, you dyd not a lytleprofite: and also that you haue had longe practise your selues: you shoulde meruaylouslye pleasure me, and profit other, for so may it come to passe, that it myghte be in the place of an Institution vnto those that shall here after desire the knowledge [Page 2] of Chirurgerye.
Your request is honest, and reasoble: and therfore not to be denyed.
We waxe abought the like thinge when as you saluted vs, wherfore renewyng our first talke, we will accomplishe your desire.
I haue redde manye authour in Chirurgerie, and yet finde small profit by them.
What be the names of youre authours.
Theodoricus, Brunus, Lanfrancus, Rolandus, Rogerus, Bartilpalia, Vvilhelmus, Guido, Brunsvvicke, and Vigo.
What parte of Hippocrates, Galene, Auicenne, Paulus, Rhasis, Albucasis, and Haliabbas, haue you rede? theis be of greter authoritie, and of whom you shal learne sounde doctrine.
Wyth theis I haue not ben much acquaynted.
Well, then the nexte waye is that you do put oute suche questions as you wolde haue answered, and stande in doute: and also answere to that which shalbe demaunded.
right gladly, for ther is no waye by whyche I shall so muche, and in so shorte a tyme profit.
Truth it is, wherfore let vs begin [Page] wyth out further detractynge of tyme.
Then seyng our talke shal wholly be the institution of a Chirurgian, it ware mete, and conuenient first to vnderstande what Chirurgery is. Wherfore answere me I pray you, what call you Chirurgirie?
Guido de Cauliaco (in his boke which he calleth his Collectorie) defineth it in this sorte. Chirurgirie is a parte of terapentike helinge men by infition, vstion, & articulation.
Those wordes, are taken out of a booke ascribyd to Galen, beinge intituled Introductio, seu Medicus. But he should not haue called it corruptly terapenticke, but therapeuticke. For Therapeuticòn is that part of phisicke, which curyth. this part consisteth eyther in curyng by conuenient diet: eyther by medicyne: or els by outwarde vse of the hāde. there Galen (or he that was author of the booke aboue said) affirmeth howe ye which healith by the hande, is a portion of the curatiue parte. this helpeth men by incisions, vstions, and reducinge the bones into their naturall seate.
Yet this is no perfect definitiō of Chirurgerie, because the definition doth not contayne in it so muche, as to Chirurgerie is required.
Then you shall here an other definition [Page 3] out of Guido. He saith that Chirurgery is sayde of this greke worde Ciros, whiche signifieth an hand: and Gyos that is worke, or operation: as who sholdd saye, Chirurgerie is the science of workynge by the hand: how like you this definition?
Worse then the other, both for yt it is no definition, but only the signication of the name: and also for that Ciros and Gyos, be no greke wordes, which shoulde showe, that eyther Guido was no grecian, or els that his workes are corruptyd.
Truth it is, for Chirurgia, is deriuid Apò tês cheiròs caì toû érgou, but both the description of Chirurgerie, & also the Etymologie & signification of the name, doth right wel showe what Chirurgerye is: although it be no answere to our demaunde.
Then I pray you let me learne at your handes, what ys the trew and essentiall definition of Chirurgorye.
Right gladly. Galene in his boke of medicinall definitions, sayth that Chirurgerye is the quicke and redy motion of stedfast handes with experience: or an artificiall action in phisicke, done by the handes: wherby is obteyned the desiered scope. So that you may by theis wordes hether to aledgyd out of the introduction, and the booke of medicinall definitions, [Page] forme a definition on his wyse. Chirurgery is the arte, whiche curyth those infirmities, & grefes of mans body, whiche are to be done by right vse, and application of the hande.
In this definition is to be notyd, that Chirurgery doth not cure al greifes which require helpe of the hande: but onlye suche as are curable. Also it is to be vnderstande, though in the definition is put no other wayes of curynge those grefes, but by the right vse of the hande, yet Chirurgerie hath nede both of that parte whiche curith by dyet, and of that whiche helpeth by medycine. As is moost euident & clere in great inflammations, & also in those bodyes in whiche Cacochimia (that is to say yll Iuse) is found, where the humours are defilyd and corruptyd.
Then it shold seme that Chirurgery is so ioyned to the other two partes, that it can not be well seperatyd from them: although they be now two distincte artes.
Truth it is, and in the begynnynge, phisicke and Chirurgery ware both one: & one man exercised both, for so did the princes of phisicke Hippocrates and Galene.
Then I perceyue that Chirurgerie is not so base, as it is taken for: and that it is of great antiquitie, beinge the most auncient [Page 4] parte of phisicke, and was exercisyd of Emperours, Kynges, Philosophers, and Phisicians.
The basenes of it, and eke smal estimation, comyth of the vnleterrid and rude Emperikes: who takyth on them the office of a Chirurgian, whan as they knowe nothynge lesse, then what Chirurgery meaneth. but as touching the antiquitie of Chirurgery, you shal not beleaue vs, but regarde the wordes of Cornelius Celsus (whiche are written in his .vij. booke) who sayth. Haec pars cum sit vetustissima, magis tamen ab illo parente omnis Medicinae Hippocrate, quàm à prioribus, exculta est. This part of Phisicke (saith Celsus beinge the most auncient, yet it was more increasyd by Hippocrates (the father of all Phisicke) then of al those that ware before his time. Here you maye perceyue, that it is the most auncient and eldyst part.
The same Celsus also setteth oute certayne noble persons who daylye more, and more, did augment the art, for it did florishe in Aegypte by reason that Philoxenus dyd exercise it. Also Gorgias, Sostratus, Hieron, the tvvo Apollonij, & Hammonius of Alexander. At Rome also Tryphon and Euelpistius, and Neges ware ryght excellent in Chirurgerie: [Page] and by there lerned workes, dyd cause the arte not a litle to florishe. Podalirius, and Machaon (the sonnes of Aesculapius) being vvith Agamemnon, in the Troian warres, cured the woundyd Soudiours: as Homere the Greke Poet affirmeth.
All theis as you say ware right excellent in Chirurgery: and famous also, chefely for curing of woundes, and vlcers. In like sorte, was Chiron Centaurus, and Achilles, wyth diuers other.
Seynge that I haue learned that Chirurgery is the .iij. parte therapentike, what Chirurgiry also is, of the antiquitie, & authors of the same: I wold gladly vnderstande of howe many partes it doeth consist & stande on.
It hath .ij. partes: the one called Theorike, conteynynge the speculation and knowledge, the other Practike, whiche is the manuall operation and exercise. The theorike parte, is obteyned by demonstration, and exacte knowledge of the principles of the arte, and this, both doth inuente, and teache what is to be done, whiche way, and also by what meanes. This parte a man maye perfectlye knowe, although he neuer doeth exercise any portion of the practike. the practicke parte is founde oute and inuentyd by reason and experience, and it [Page 5] doeth rightly, and redelye exercise the same thinges, that the Theorike hath inuentyd. This parte no man can exactly obtaine, excepte that both he doeth se other whiche are skylfull in the arte to worke: and also diligentlye exerseth it him selfe euer bearing firmely in minde, both what he haue sene of other men brought to good ende, and what he haue also done hym selfe.
Then seinge that you haue vttered vnto me howe manye partes of Chirurgirye ther are: I pray you first beginne wyth the Teorike parte of it, and let me vnderstande exactlye what it is, and that beinge finishyd, procede to the practicke.
To set out the theorike it wyll by profitable: but as touchyng the practicke it ware both superfluous & vayne, seyng yt the perfite curing of apostemes, & tumours, are set out in the boke of tumoures against nature, also the true & exacte cure of vlcers, is at large opened in an other worke, whose title is a perfecte and exacte methode of curynge vlcers. Furthermore the practise of healing wounds both in similer & instrumentall partes, also of fractures, and luxations: you shall fynde in his Enchiridion of Chirurgerie. And as touching wounds made wyth the common gonpouder and pellet, you shall receyue the trew and methodicall cure, [Page] in a tretise berynge name of curynge woundes made wyth gonshotte, in whiche treatise is set out, and also manifestlye confuteted, the grose and fonde errours not onlye of Iohn Vigo, Alfonce Ferrius, and Hier. Brunvvicke (which make the shote venemous, and consequentlye the wounde therewyth made, and so the cure to be lyke as is in venemous woundes:) but also by demōstration he ouertroweth al those, that be of that opinion. So that for the practicke parte, I do not se what is more to be desired: excepte it ware some treatise, in whiche might be comprehended the arte of phlebotomic or lettynge of blode, and also of scarification, and boxinge whiche I hope (God grauntynge hym lyfe) he wyll hereafter set out.
Theis be a numbre of worthye bookes, whiche do contayne the practise of so worthye an arte. God graunt you longe lyfe maister Gale, to accomplishe that you haue yet behinde.
Although some perchaunce more busie then lerned: and yet more lerned, then discrete and modeste, and yet parhappes more destrete & modest, then a fauour of those that trauayleth for the profit, and vtilitie of other: haue not a litle lifted vp the groyne, & bent the brow, & with manifest wordes of contumelie rewarded me: yet the loue of my countrye, and desire [Page 6] to profyt those of my profession: shall euer be a sufficient spurre, to prouoke me to continue as I haue begonne, for trew it is that the Poet Pertius writeth.
‘Foelix à tergo quem nulla Ciconia pinxit.’Whiche maye ryghte well be englyshed, althoughe not verbatim yet in meanynge on this or lyke sorte.
But returne we to that, from whence we are somewhat digressed, our talke, and communication at thys presente shall not further extende then to institute the Chirurgian in the theoricke parte of hys arte. Wherefore sence you haue learned what Chirurgerie is, wyth dyuers other apte, and nedefull thynges: it dothe behoue you to knowe the subiecte of Chirurgerye. For all Artistes and workemen haue their subiectes, and matter on whyche they doe exercise there arte. So the Mason hathe stones, and bryckes, whyche accordynge to hys arte, he heweth, squareth, cutteth, & proportioneth. In lyke sorte dothe [Page] the Carpenter wyth Woode, and Tymber and the Smyth wyth yron. All whyche be accompted subiectes to these artes. And yf the Mason Carpenter and Smythe, be so curious and dilygent, in knowyng, chosyng, and consyderynge of stones, tymber, and yron, whyche be thynges of no great valour or estimation: howe muche more then behoueth it the Chirurgian to knowe what the subiecte is on whyche he must exercise hys arte?
You haue ryghtlye sayd, and by these your wordes I gather, that the subiecte to the arte of Chirurgirie, is that whyche is to Physike: I meane mans bodye beyng apt aswell to sycknes and infyrmities, as also to health.
You haue ryghtlye aunswered, but thys is not sufficient to aunswere that mans bodye is that stone, tymber, yrone and matter whereon the Chirurgian muste exercise hys arte: excepte you also doe knowe the partes of mans bodye, there situation, nature, and office. as of bones, cartilagies ligamentes, Nerues, vaynes, arteries, muscles, fleshe, and skynne. For I thynke no man is so rude but doth consider, that wythoute the perfect knowledge of these, how easely he shall fall into intollorable errours, especiallye in phlebotomye, in fractures, and luxations, [Page 7] and where as occasion is offered to make incision.
The more I here you two speake of Chirurgirye, the further me thynke I fynde my selfe from the knowledge thereof. And so much the rather, that by your wordes I gather howe that the subiecte and matter of Chirurgerye (beynge the bodye of man) cannot be fully knowen, wythout the exercise of the Anotomye. Wherefore I cannot a lytle meruayle at some, who beynge Chirurgians in name, doe not onlye neglecte thys knowledge of Anotomye: but also Inuieth those that doe therein trauayle.
Wel let such go wyth there wilfull blindnes, & obstinate ignorance, and let vs nowe consider what the ende of Chirurgery is.
I suppose that maister Yates knoweth that the ende or intention of Chirurgery, is to heale all suche curable infirmities, as are to be cured by the office and dewe administration of the hande.
I render to you both harty thankes, for that by your talke I haue learned what Chirurgiry is, the antiquitie of it, & noble authours that did professe it, of howe manye parts it doth consiste on, also what is the subiect or matter on whych the Chirurgian doth exercyse his art, and what is the ende or final intention [Page] of Chirurgerye: nowe I wyll further desyre you to showe me the waye to procede in lernynge and obteyning thys noble and famous arte.
Before we set oute the waye howe to attayne the knowlege of Chirurgerie, it is conuenient to showe what maner a man a Chirurgian shoulde be whome we shoulde instructe in this arte. For manifest it is, that all men are not to be admitted vnto thys mysterye.
Truthe it is for accordynge to the prouerbe. The diuell made a souter a shypman. signifying here by that nature repugning all thynge is in vayne Howe vnapte and vnfyte thynke you, is a swyne to be taughte to hunte: suerly as vnapt, as a hounde is apte & fytte: but in the admission of one to learne oure arte, is to be noted the gyftes of nature, & also education from hys infancye. For yf men exercising artes of lesse estimation and pryce, doe with dilygent care chose suche as are fytte for their facultye & arte: howe much more oughte he Chirurgian so to doe?
It is suerly so and the gyftes of nature required in hym that should be a Chirurgian Cornelius Celsus doth name to be these. He must be a yonge man, hauyng a sure [Page 8] & stedfast hand, voyde of trimblyng, and that he hath the vse of the lefte hande, as well as of the ryghte, a sharpe and quicke slighte, one voyde of all feare, wythoute folyshe pitie: so that he be no moued anye thynge by the clamor and noyse of the patient. but minding to cure hym, whom he taketh in hande, he shall neyther haste more then is meete, or yet make lesse incision then is requisite. Hippocrates in a hooke intituled Lex Hippocrates, speaketh of hym that shall learne Phisycke in thys sorte, Quisquis enim medicam scientiam verè sibi comparare volit, hijs Ducibus, voti sui compos fiet. Natura, Eruditione, Loco studiis apto, Institutione à pueritia, Industria & tempore. Primò nanquè omnium, natura est opus. Hac etenim repugnante vrita fiunt omnia. at si ad optima viam natura demōstret, artis eruditio facilè eueniet: quam quidem prudentia sibi comparet oportet, ita vt ab ipsa pueritia institutio accedat, atque hoc in loco disciplinis quidem conuenienti. Praeterea operam sedulò nauare oportet: eámquè ad longum certè tempus, quo ipsa iam insita disciplina, foeliciter satis, & cum profectu fructus suos ferat. Whosoeuer (sayth Hippocrates) wyll learne the arte of Phisycke, [Page] folowyng these guides he shal haue hys define. Nature, learnyng, an apte place for stodye, good bryngyng vppe from the chyldhoode, diligence, and tyme. For fyrst of all nature is to be looked for. For nature repugnynge, all thynges are frustrat. But yf that nature be inclyned vnto the best thynges, the knoweledge of the arte wyll easely folowe, whyche it behoueth to get throughe prudence, so that from the chyldehoode he be well trayned vppe, and that in a place apt for stodye. further more he muste bestowe greate dilygence, and that for a longe tyme, so that learnynge (beynge nowe grafted in hym) maye happelye, and that wyth increase brynge forthe her fruites. And Hippocrates resembleth the stody of Phisycke vnto agriculture or tyllage. For (saythe he) what consyderation is of those thynges whyche the earth bryngeth out, the lyke in all poyntes is of the knowledge of Phisycke. For our nature is as it ware the feilde, the disciplynes of teachers, are like the seades: also the institution and bringynge vp from the childhode, is resembled to the castynge of seade into the grounde in dewe and conuenient tyme, the place in whyche he must learne, is as it were the ayre gyuinge norishment to suche thyngs, as sprynge oute of the grounde. The industrie & diligence bestowed in the art, is lyke the [Page 9] tyllage of the plowman, and laste of all, tyme dothe strengthen these, and suffereth them perfectlye to be norished. And of thys tyme speaketh also the poet.
If thys shoulde be obserued amonge phisicians, I doe not doubt but their shoulde be more famous men among vs, and fewer rude and bussardlye Emperickes: but thys toucheth nothing the Chirurgian.
As muche as the Phisician, for doe you not remember, that Hippocrates comprehended Chirurgirye vnder Physicke beynge one portion of the curatiue parte?
Also as touchynge education Hyppocrates in hys booke called De Medico. would haue a Chirurgian folow the warres. For he speakyng of the other partes of Physycke saythe. Nexte is the Chirurgerye of woundes receyued in the warres, and extraction of dartes and thynges in them fyxed. For seldome cyuill and instestine diuisions chaunce in all tymes, yet in externe and outwarde warres, these chaunce moste commonlye. [Page] Wherefore he that wyl vse thys Chirurgery, it behoueth hym to frequent the warres, and folowe outwarde armyes, and hostes of men. For so shall he be exercised for that necessitye and vse.
In dede so dyd Podalirius, Machaon, and Achilles, wyth other more of whom mention is made.
Yea but many Chirurgians wyll not occupye themselues in learnyng those partes of whyche they haue daylye exercise. Muche lesse then couit to folowe the warres, they haue not suche a burnynge zeale vnto their arte.
The more pitye, not for their cause, but for the common weales.
If all these pointes are required in him that shoulde be a Chirurgian (as I must confesse they are) howe happeneth it, that their are an infinite number of Chirurgians in name, whyche haue scarse one of these fornamed, gyftes. And yf they haue any, it is boldnes, for that wanteth not in them, they are as boulde, as blynde bayerd.
Yea but where Celsus praiseth bouldnes in a Chirurgian, he meaneth the vertue called fortitude, whiche where as necessytie doth require, is not moued wyth [Page 10] the teares, countenaunce, and clamour ether of the pacient or of the standers by: but myndynge the health of the sycke, according to arte maketh incision, and doth suche lyke thynges.
And to aunswer you, why their are suche a sorte of rude Emperickes yea Hosiers, Taylours, fletchers, Minstrales, Souters, Iogelers, wiches, baudes, and to conclude (an infinite number whyche hertofore ware prohibited the exercise of thys arte) suche as other wyse cannot get anye lyuynge: is for that Chirurgerie is nowe, as it was in the tyme of Hyppocrates. Who sayth that other artes are not exercised wythout lawes, and penalties: but Chirurgerye is free for all persons, the more is the pitye, when as so muche hurte and damage doe daylye spryng, through the abuse of so noble an arte. so that I am more then halfe perswaded, that Chirurgerye wyll hardlye, or neuer gather strength agayne, and florishe: excepte the prynce hauinge compassion of poore deplorated Chirurgerye, doth by vertue of lawes driue awaye from her, theis here forenamed enemyes.
But yet I doe meruayle at those, whyche are as it were Chirurgians by profession, knowynge themselues voyde of a number of the poyntes required in a Chirurgian, [Page] that for loue to their contrye, and conscience sake: they wil not yet at the leaste chose suche seruantes, as had some of the fornamed vertues. Whyche yf they dyd, their were yet some hope that Chirurgirie shoulde hereafter floryshe.
Their aunswere is, that when the skey fall we shall haue larkes. They thynke that they shoulde not haue seruantes to serue in that vocation. For few say they, that haue well brough vp there sonne, will put hym to the arte, vecause it is accounted so beggerly, and vile. Wher as in deade if for a season they woulde take the more paynes them selues, & admitte none, but such as shuld be somwhat meet, there wolde be a nombre glade to studye the art, because it woulde come to estimation, and be a worshipfull lyuynge to the professer. But shall I shewe you what I thynke is the chefe cause: science hath no greater enymie, then Ignorance, and also the prouerbe is trew, like wil alway to the like, and hereof comith it, that suche carpenter suche chippes, suche maister suche man.
Yet me thynketh that one maye be a good Chirurgian, thoughe he haue not all the pointes reconyd of Hippocrates and Celsus. As one myght thynke hymselfe ryght happye, though he neuer dyd attayne to Aristoteles [Page 11] summum bonum, or Plato his Idaea.
It is one thyng to say a good Chirurgian, and an other to saye an excellent Chirurgian. But let that passe, I woulde we had good Chirurgians. And because the descriptions of Hippocrates and Celsus touching what maner a man a Chirurgian should be) semeth somwhat to straite to you: I wyll showe you what conditions Guido requyreth in hym. Not for that I do preferre the authoritie of Guido, before suche fathers and parents of Chirurgirye, as both Hippocrates and Celsus ware, but because perhappes Crassa crassis conueniunt magis. Guido requyreth .iiij. thinges in hym that is or shoulde be a Chirurrurgian. Firste that he shoulde be lettered, secondly that he shold be expert, thyrdlye that he be ingenious, and last that he be vertuous and well maneryd. Theis wordes you shall finde in his Collectorie.
And as touchyng theis .iiij. pointes note first wher Guido sayth he muste be lettered, he doth meane he shoulde be lerned, and that chefelye in suche doctrine as is in his art requisite. That is at the lest, that he can wright, red, and vnderstande the mynde of latyne authour. If he had knowledge in geometrie for makynge his incision, for curynge [Page] fractures, and luxations, and also in curinge malignant vlcers: knowynge what figure woulde mooste spedelye vnite, and Ioyne the lyppes of the vlcere: it ware very commendable. Naturall Philosophie is a goodlye ornature to the Chirurgian, for it showeth hym what resulteth whan as there is diuers and sondry simples mixed to gether: but I will go to the second pointe, he must be experte, that is he muste be garnished wyth muche and longe experience, whiche is excogitated be firme and certayne reasons, and by them also confirmed, otherwise he is to be accompted rude, and an Empericke, if he hath not reason annexed and ioyned to his experience. Thirdlye sayth Guido. He must be ingenious, vnto whiche there are fyue thynges principally required. Fyrst is the redye and good conceyuynge: then a firme and sure memorye, nexte a sounde and ryght iudgement, after a easey callynge thinges to mynde whyche he haue harde or sene, and laste a lyuelye and sharpe redynes in findynge and inuentynge remedyes. The maners whyche Guido woulde haue in a Chirurgian are reconed of Hippocrates and Celsus, whiche briefelye I wyll numbre: they muste be bolde and wyth out feare in suche cures as are with out peryll, and wheras necessitye requireth. Also in cures that be doutful, not to be [Page 12] to raishe and hastie. to be gentle and courtyous towarde the sicke pacient, to be frendlye and louyng, towarde those of hys profession. Also wyse and circunspecte in Prognostications, last of all, he muste be chaste and temperate of body, mercifull towarde the pore, and not to gredy of mony. and this is sufficient touchynge the description of hym, that muste be admitted in Chirurgerye. Nowe let vs talke of the instrumentes wherewith a Chirurgian ought to be garnished.
That is well sayde and of those instrumentes I wold gladly haue vnderstandynge.
And so you shal, & for the suerer and sounder doctrine, you must note that instruments are said two maner of wayes. for eyther thy are medicinal, or els instruments of metal: as Iron, leade, tynne, copper, siluer, & golde, ye medicinal instrumēts are medicines, as potiōs, emplastres, cataplasmes, cerotes, vnguentes, oyles, Balmes, trochise, waters, & suche other. but principally as touching vnguents the Chirurgian (after Guido his minde) ought alwaies to haue in redines, v. sundry vnguentes aunswering to fiue intentions curatiue of Chirurgirie, that is to say: for to suppurate and maturate, he must haue Basilicon, to mundifie and [Page] clense, Apostolicon. To incarnate and cause fleshe to growe, he shall prepare Vnguentum Aureum. To conglutinate wyth, he shall vse Vnguentum Album. And where as any accidence chaunce, as dolour and payne, he shall occupye Vnguentum Dialthaeum. But I shall not nede to make any longer processe of medicinall instrumentes, when as I haue as I suppose abundantlye shewed in my Antidotarye not onely all the principall intentions curatiue required in Chirurgirye: but also haue set oute medicinall instrumentes both symple and compounde, required in thys arte: as also their compositions vse and vertues. Their are also set oute proper medicynes, dicated and apted to the seuerall partes of mans bodye as heade, breast, stomacke, longes, lyuer, splene, kydnes, bladder, and suche lyke, as is proued of Galen in hys worke intituled Secundū locos Althoughe manye be of the contrarye opinion. And amonge the reste I wyll showe you a notable historye, I thynke to manye knowen, as well Phisitians and Chirurgians, as other worshipfull and honest. It fortuned that in London. 1562. that there was a fraye made, and the one was thurste throughe the breast vnder the pappe, and out vnder the lefte shoulder blade so that of force the longes were persed [Page 13] through. There ware diuers Phisicions called vnto the woundyd pacient, and they all affirmed constantly death to folowe. I also beinge called vnto the same pacient, did also affirme that death woulde folowe, excepte he receyued a certain potion of whiche I had experience in the like case in the warres, in England, France, Scotland, and other places: and he in dede receyued it, and so the longes ware preserued from putrifaction and the congelyd blod was expellyd oute, the wounde clensyd, and finally by the arte of Chirurgirie he was restored to his perfecte helth.
That man do I right well know, his name is Henry Smith a water man, he was hurte at quene hiue, and he is yet liuyng and in good helth.
Well then, let vs speake of metallyne instrumentes. of whiche some of them are generall: so called, for that thy do generally serue in all woundes, and vlcers: and there are particuler instrumentes, seruynge to seuerall vses or partes of the bodye. Yet haue I hard that diuers affirme howe that in woundes generallye there nedyth no other instrumentes then an incision knife, to dilate and inlarge the wounde. and so wyth the fingers to take out the thynges fixid, whether it be pellyt, splente, arrowe head, or what els so euer it be: [Page] but the errouors of theis are so grose as requireth no aunswere, seinge that throughe suche kindes of incisions, it happeneth the greate vaynes, and arteries to be cut, and so greate flur of blode to folowe, (beside the doulour, and payne whiche foloweth and many tymes losse, and mutilation of the membre) as is in no case tollorable.
Truth it is, but touchynge general instrumentes, those which are in most vse and ought to be had in redynes of the Chirurgian are theis: incision sheares, an incision knyfe, a flewme, a lance, whose pictures you maye here set oute, and all this serue to cut and enlarge a wounde: a cauterizin Iron to cauterize with, and stangh fluxe of blode: a payre of pincers or nippers, to take of plastres, splegeants and thinges fixid in the wounde, a probe to serche the wounde with. a crockyd hoke: a nedle and a quill to sowe and stiche with.
And what be the instrumentes whiche are called proper?
Proper instrumentes are theis whose figures also folowe. as a trappan, seruynge to the heade whan as the scul or cranium is fracturyd, speculum oris, and speculum matricis, also gossipium, seruyng for luxations and fractured bones. a siryngie masculine [Page 14] and also femyne setons for the necke, aleuatorie and longe neeles of woode. to drawe through the wounde. also gosebilles, crowesbilles, & diuers other described & set out of Albueasis, Celsus, Tagaltius, and others.
Theis instrumentes be of meruaylous vse, and wyth out whiche the Chirurgian can nether perfectlye, nother wythout greate greife and peril do that is required. and amonge the rest in my iudgement the trappen is most necessarie, and of an excellent inuention in hurtes of the heade. For with out it wher cranium is fractured, brosyd, or els anye of the inwarde panicles depressed, you shall litle preuayle. I my selfe haue vsed it wyth great profit diuers tymes, and especiallye ons in Cambridge sheire, whiche I woulde declare vnto you, but that I shoulde be somwhat tedious.
Nothynge lesse, but rather pleasant. for by vtterynge of thynges done, great profit may insewe, and we haue decreed to spende this daye in the talke of Chirurgirye wherfore we desire you declare that historie and we wyll geue diligent eare.
Right gladlye. Anno. 1559. a seruant of one maister Wrothes, ridynge to the feildes and ledynge a yonge horse in a halter [Page] tyed fast abought the arme of the seruant: the horse beynge wylde, and not broken, starkinge asyde vnhorsed thy man, and drewe hym by the arme a bought a great feilde so long, that what wyth strikynge, what wyth drawynge, halyng and pullynge, being weried he stode still, vntyll company came and losed the halter, and toke vp the man halfe deade, and conuayed hym vnto his maisters house. Chirurgians ware sent for, who fyndynge. the seruant spechlesse, and wyth out remembraunce of any on whome he sawe: they not perceyuynge the cause hereof them selues, nether yet could be showed of the pacient the place affected, departed and left hym as vncurable. Maister Wrothe sent for me, and I seinge hym spechlesse, and without remembraunce, coniectured the hinder parte of the heade to be hurte, and smittyn of the horse, whiche I was more certayne of, whan felynge that parte I founde it softe. Wherefore I takynge of the heer, dyd made firste incision and after that set a trappan on his heade, and bored Cranium through, and toke oute the peace of bone, which done: ther yssued out muche blod, blacke in colour, and drawynge to putrifaction out of the contused and broken vaynes. the nexte daye folowynge, the seruant spaeke and came agayne to his perfecte remembraunce, and I vsyng thynges in this cure as arte required, [Page 15] God restored the man in my handes to his perfecte helth. I coulde also showe you other examples wher the like chaunses haue happened, and the Chirurgians eyther not knowynge, or wilfullye neglectynge this profitable instrument, haue brought the pacients to there laste ende. so happened it to a seruaunt of maister Pagetes in fylpotte lane. 1538. ond diuers other, whome for breuitie I do let passe.
This was a worthy cure, and this is a noble instrument, but the Chirurgians whiche neglecte thuse of this or the like instrumentes, are of the opinion of that the rude Emperike Smith was, who in a folishe boke of him published, did inuay against Chirurgians whiche trapened the heade in any griefe of the same, and semeth to him selfe as it ware an other Thessalus to ouer throughe the famous authers, and Inuentours of this instrument. whan (in the iudgement of the lerned) he was no more to them comparable, then the light of a sparke of fire, is equall to the mooste radiant and shyning beames of beautifull Phoebus.
This nowe spoken of instrumentes (whiche a Chirurgian muste haue in redines) shall suffice. nowe let vs showe the methode and way howe the person beinge fitte to be admitted to Chirurgirye, maye lerne the arte, lesse that confusedlye he lerne that firste, [Page] whiche sholde be last, and so set the carte before the horse, to his no small hyndraunce.
And for this ther is to be folowed and obserued two preceptes: firste, that we procede from thynges comon, vnto those whiche are particuler, or from thynges vniuersall, vnto more perticuler. as first to knowe an inflāmation, then howe many kyndes of inflāmations there are. the seconde precepte is, that we begynne at thynges knowen and so procede vnto those whyche are lesse knowen, as firste in the curation of woundes, we muste begynne wyth a simple wounde: whiche done, we shall procede to the curation of compounde woundes. so in lyke maner in vlcers, firste to knowe and cure a simple vlcer, and then to take in hande compounde vlcers, begynnynge wyth those that are lesse compound, and haue smalest accidents: and so to procede vnto those that are more cōpound, & haue most & greatest accidents ioyned wyth them. the like is also to be obserued in other arts, & sciēties, as in iudgyng of colors, first to know whight & blacke, then other colors which are not so manifest according as they com & spring of ye mixture of theis .ij. now knowynge & considering theis two preceptes, it is necessary for the right vse of his instruments medicinall, & metalline: to cōsider two thinges, that is to say, thinges called accordinge to natur and thynges against nature.
I pray you [Page 16] what are those which are called accordynge to nature? & how many be they in nombre?
Guido numbreth those thinges whiche are called accordynge to nature to be .vj. that is to say, helth, the cause of helthe, theffect of helth, strength, custome, & cōplexion. and helth is defined to be an effecte according to nature, apte to performe the actiōs of the same.
And what doe this .vj. thynges accordynge to nature, teache and showe me?
Because the Chirurgian is natures freinde, & minister: theis showe you that you muste conserue & kepe them by ther like, & also to expel ther contraries, which wold distroy and ouerthrowe them.
And wherof do theis .vj. thinges spring, & by what thynges shall I conserue thē? for although you say vnto me, yt they are conserued & kept by ther like, yet is it not sufficient to my vnderstandinge, except you two showe me what they are.
I wyll tell you, theis .vj. thinges which are secundum naturam, spring of, vij. natural thinges entring the cōposition of mans body. that is to say .iiij. Elements, fire ayer, water, yearth. cōplexions, as hote, cold, moyst, & drie .iiij. humors, blod, coller, fleume & melācholie, mēbres of mās body. vertues, animal, vital, & natural, with ther operatiōs, & spirits. of theis .7. natural springeth helth & ye other rehersed which are accordīg to nature [Page] The conseruation of helth dothe consist in the right vse of .vj. thynges named in latyn res non naturales. lyke as in the abuse of them, the decay of helth and bredynge of sycknes and infirmities feloweth.
It is right so, and theis sixe are called, ayer: meate and drynke: motion and quiet: slepe and wachynge: repletion and inanition: and the perturbations or affections of the mynde.
I trust I am sufficientlye taught how to vse my instrumentes accordyng to the indication taken of the thinges which are accordynge to nature: nowe I pray you let me vnderstande what those thynges are whiche are againste nature, howe manye they are in numbre, and what indication is to be taken of them: for the further vse of my instrumentes.
Those whiche are agaynste nature, are so called: because they are contrary to the same, and doe further destroy and ouercume nature, and are vtter enemyes to helth, and theis are .iij. in nombre: sycknes, the cause of skynes, and the accident. the cause of sycknes, is that effecte contrarye to nature, whyche goeth before the sycknes, and prouoketh the same, and ther are accoumpted of Galen, and the Gretians whome I folowe) two causes of [Page 17] sycknes. the one beinge outwarde, called procatarctike, or cause primatiue: the other is with in vs, and is named the cause antecedent, or precedent, or cause interne. sicknes also is defyned of Galen to be an affecte againste nature: of whyche the action of nature is firste hurte, & vitiated. and the same Galen doth also make iij. kindes of sicknes generallye, accordynge to the partes of mans bodye in whyche they are. as in the similer partes, sycknes is called intemperature, whiche is eyther hotte, colde, moyst, or drye: or els hotte and moyst, hotte and drye: cold and moyst: cold and drye: and yf it be in the instrumental partes, the sycknes is namyd, yll constitution or conformation: but yf sycknes happen bothe to similer and instrumentall partes, then it hath to name, solution or diuision of cōtinuitie. Also the accident is one effect against nature in lyke sorte as the cause of sicknes and sycknes it selfe is: but it differet from them in this, that like as the cause goe the before sycknes and prouoketh it: so doth the accident folowe sycknes, lyke as the shadowe doth the man. nowe this worde accident, is taken generally, of whiche we wyll nothyng speake, and it is vnderstande more straytlye, or properlye, so is accidente three wayes diuided. for eyther the action is hurte and quite abolished, as blyndelnes in the eye: or els diminished, as [Page] dimnisse of syght, or els the actions is corrupted as the syght depraued, and for the indication whiche is taken of theis three thynges agaynste nature: note theis twoo greate, (and of all men alowed) conclusions. Contraria sunt contrariorum remedia. also, similia conseruantur similibus. lyke as thynges whyche are accordynge to nature, are conserued and kepte by ther lyke: so also thynges contarye, are remedies for ther contraryes. and therfore theis iij. thynges agaynste nature, showeth you that they are to be expelled and put away by there contraryes. as for example, solution of continuitye beinge sycknes bothe of similer and instrumentall partes showeth that he muste be put awaye by his contrarye, that is vnition and Ioyninge agayne, also heat is put awaye by couldnes: couldnes by heate: drynes by moystnes, and moystnes by drines: and so in like sorte in other sycknesses the indication is taken of the contrarietie. doe you nowe vnderstand this?
Right well, so that nowe I doe perceyue that the right vse of my instrumentes medicinall, and metallyne, is takyng of thynges accordynge to nature, whyche showeth the conseruation by lyke and agreable medicynes: and of thynges agaynste nature, whyche teacheth me to applye thynges contrarye [Page 18] wher by I may take awaye all that which is againste nature. but yf you wilbe so good as to set oute (though it be in breafe wordes compendiouslye) those thynges agaynste nature, whyche falleth vnder the handes of the Chirurgian, as you haue made playne to me those thynges whyche are accordynge to nature: I shoulde thynke my selfe so muche bounde, as hardly I shalbe able to recōpence. for althoughe I knowe that thynges contrary to nature, are to be remoued by there contraryes, yet if I haue not the exacte knowledge what those thinges are, I shall very hardly be able to aplie and vse there contraries.
It is suerlye so, for howe muche wyde you are in knowledge of the sycknes: so farre wyde shall you also be in fyndyng out apte and conuenient remedies, and those perticuler grefes, or affectes againste nature whyche are subiecte to Chirurgirie (as Galen witnesseth in the .14. booke 13. chapter of his therapeutike methode) are for the mooste part reduced to .v. Titles or chapters. that is to wete tumours againste nature, woundes, vlcers, fractures, and luxations, there be other thinges besides theis which require the vse of the hand: but theis rehearsyd perfectly knowen, thother wilbe easye to attayne vnto.
Then I praye you begynne fyrst wyth tumours, and those beyng fynished procede to the rest.
Fyrst it behoueth you to know that thys woorde tumour (called in Greeke onchos) is not that whych Auicenne, and the Arrabians name Apostema, and the Latinistes call Abscessus. For tumour is a generall name to all apostems, and tumours, where as thys worde aposteme strecheth no further but onely where as phlegmone is torned into matter, & three other tumours called Atheroma, steatoma, & meliceris. so that this word aposteme, is not so large and generall a name, as tumour is: and therfore abused of Guido, and other, where they call all tumours agaynste nature, by the name of apostemes.
Why syr, be not all tumours agaynst nature?
No for sothe, for then it had bene for hym superfluous to haue added these wordes, against nature. And Galen in his boke De tumoribus praeter naturam, maketh three kyndes of tumoures. One that is secundum naturam, accordyng to nature: as the branes, muscules, and other emynencies of mans bodye. The seconde is called aboue nature: when [Page 19] as these forenamed partes are increased more then their naturall forme, and fygure: but yet in suche sorte that the partes can doe theyr officies. The laste kynde of tumour is called tumour agaynst nature. Because thy hurte the action of the parte where it infesteth.
I doe nowe cal to rememberance Master doctour Cunyngham who made also the same diuision of tumours .1563. when he red the booke of Galen of tumours agaynst ture to the Chirurgians of London in the hall, but I pray you let me learne what a tumour against nature is?
Out of the same booke of Galen, you may gather thys defynition. A tumour agaynst nature, is an augmentation, or swellynge, excedyng the natural fygure of the same and hurteth the action of the same. But Auicenne saith that an aposteme (for so calleth he a tumor) is a sicknes cōpound of thre kind of infirmities, that is to say of intemperatures, of yl cōstitutiō, & solutiōs of cōtinuity: these words you shall finde in the first booke of his Canon.
How many kind of tumours are there.
Guido & other writers of his time make iii. kindes of tumors: Apostema, Pustula, & Exitura. Apostema he calleth a great tumor [Page] in whych the matter (whereof it springeth) doth offende rather in quantitie, then qualitie. pustula he doth make a lesser tumour, in whych the matter dothe hurte by qualitye, rather then quantitie. And thys tumour tharabians call Bothor. the threid, whiche Guido nameth Exitura: is that whiche the Grecians doe properly cal Apostema, & the latinistes: Abscessus.
But the Grecians doe make differences of tumors, accordynge to the substaunce wherof they doe spryng. so shal ther be but two kyndes of tumors generally. that is to say. humoralis, spryngyng of humors, and flatuosus commynge of wyndye spirites: this Guido termeth Apostema ventosum.
And howe many differences is ther of tumors whych do spryng of humors?
Twoo, simple, and compounde.
Howe many simple be ther?
There be also .ij. hote & colde
Why are theis tumours called simple and compounde?
They are called simple, whan as they sprynge of one sincere humour, with out the mixture of other. and they are called compounde, whan the tumor cometh of two [Page 20] or more humors.
Wherfore are the tumors called hotte, or colde?
They are called hotte, because they sprynge of hoote humours: and named coulde by the lyke reason, because thy are ingendryd of could humours.
How many hotte tumours be ther, and how many colde?
Diuers, and sondrye, as you shall perceyue by the processe of our talke. but the most famous are foure: spryngynge of the iiij. humours simplye, wyth out the myxture of other of theis two &c.
Whiche be thay.
One comyth of blode, and is called Phlegmone, in Englishe, inflamation: an other springeth of coller, and is called Erysipelas, or. S. Anthonies fyer: and theis be hoote tumours. an other cometh of fleume, and is named Oedema: the forth is ingendred of melancholie, and hath to name Scirrhus. This two tumours, are colde, all other simple tumours are aptly reduced to theis .iiij.
And what be the compound tumours?
They be diuers and varieth ther names accordynge to the mixture of humours. [Page] and the humor are mixyd, equally, or inequally, if they be myxed equally: then the tumour is called Phlegmone and Eryspelas. but yf they be inequallye mixyd, then the tumor, taketh name of the humor whiche surmounteth, as blod surmounting choller, in a tumor: it is called Phlegmon Erisipelatodes, if fleume be myxed with blode in stede of coller in forme as is aforesayd: then the tumor is named phlegmone Oedomatodes, and if blode myxyd with melancholy surmounte it is called Phlegmone scirrhodes. so in lyke case there are .iij. tumors whiche take names of the humors myxyd with collor, coller hauynge the dominion as whan blod is wyth collor they call the tumor Eryspelas Phlegmonosum. If fleume, Eryspelas Oedematosum, and if melancholike then the tumor hath to name Eryspelas scirrhosim in lyke maner, fleme hauing dominion in the moisture wyth any of the other three humors, the tumor is firste called Oedema, and then yf coller be mixyyd wyth it they adde this worde Erysipelatosum. If blode the tumor is called Oedema Phlegmonosum, and yf melancholie, then is it namyd Oedema scirrhosum. and to conclude, the lyke is to be sayde of melancholie whan as any of the other .iij. are mixed wyth as scirrhus [Page 21] Phlegmonosus, scirrhus Erysipelatosus, and Scirrhus Oedematosus: blod, coller or fleume beinge vnequallye mixyd wyth melancholye.
What profit insueth to the Chirurgian by knowynge the mixtur of theis humors, in tumors against nature?
Greate profite, for by knowyng the true mixture, he is taught therafter accordingly to vary his medicines. for like as a simple tumour hath a simple cure & is curyd by his contrarie: so a compounde tumor hath a compounde cure & is curyd by his contrarie. as for the more plainer vnderstandyng, if ye tumor be mixyd of fleume and melancholie equallye: then shal you equally mixe suche medicynes together, as are conuenientlye vsed in Oedema and Scirrhus, But if fleume, and melancholie be inequally mixyd: and the greater portion is fleume, then in the composition you must in lyke maner put the greter portion of suche medicynes as you vse in Oedema, and the lesser of suche as are applyed in Scirrhus. and this rule, and precepte is to be diligently obserued in all compounde sycknes. and for because the mixture of theis tumors, is so necessarie for a Chirurgian, as you maye righte well perceyue by that whiche is nowe spoken: beholde this table which showeth you all the mixture and names [Page] of tumors against nature. Whych for the great profit wolde be commytted to Memorye, of him that wil haue the Methode of curyng cōpounde tumors against nature.
You promysed to showe the tumors which are refered to the .iiij. principall simple tumors, Phlegmone Erisipelas, oedema: and scirrhus.
And that we promised, we will performe, first vttering ther names: & that being done, we wil show you ther definitions. And we wil begin wt sanguine tumors, which are referred to Phlegmone: & then procede to the reste. There are referred to phlegmone: Phygethlon, Bubo, Phyma, Dothienes, Anthrax, gargareon, Paristhmia, aneurisma, Gangraena, & Sphacelus.
What is Phlegmone?
Galen affirmith phlegmone (or as we cal it in English, an inflāmation) to come of the flux of blode by the greater vaines, & arteries, vnto those which are lesser: & frō them vnto those vaines which are lest of all (which because they are no greater then heres, are) called capillares. These vaines beinge fylled wt this contynual flux of blod, part yssuith out be ye mouthes of the vaines: & part by ye cotes of ye same, wherby the voide spaces are filled, inflamed, distended [Page 22] & streched out. And this tumor galen calleth the inequall intemperature of the muscle. And note, that there are two kindes of inflammations. One which is called vera inflammatio, & this springeth of good and naturall blode. The other is named Non vera, coming of yll and vnnaturall bloode, and this is common to all inflammations.
What cal you Phygethlon?
That which Celsus nameth Panus and this tumour is an inflammation of the glandilous partes in the neecke armpites and grine, which yf they be indurated after this inflamation, ther cometh tumors which is named Choerades in latine strumas and Guido nameth them scrofulas and then this tumor is numbred amonge flegmatike tumours. And is wyth vs vsually called the kings euyll: because the kings and Queenes of England (by a diuyne and peculer gyfte of God) doe cure suche as are molested wyth this infirmitie, whan as no arte of Chirurgerye can take place. And thys differeth muche from that syckenes whyche the Latynestes name Regium morbum.
Wherefore is it called in Greeke Choeras?
Eyther of stones apearing [Page] by the Seas, or els of swyne whiche are often vexed wyth this tumor.
As touchyng Bubo, Guido calleth it a flegmaticke aposteme, wherfore I wyll let that passe vntyll we come to the reasonynge of the same.
You seame to accuse vs of errour, or ignoraunce whan as we shoulde numbre flegmatike apostemes as you cal them amonges sanguine tumours. But I wyll this affirme boldlye that Guido eyther meaneth some other tumor whiche he so calleth: or els he repugneth manifestly wyth Galens authoritie. for Galen maketh Bubo a simple inflammation of the glandelous partes in that flankes.
I doe not accuse you but rather showe you Guido his mynde: which seing that it doth not agree wyth Galenes I muste gyue place and alwaye preferre Galen before Guido. Wherfore I pray you procede with the other inflammations and showe me what the tumor is whiche the Grekes call Phyma.
This tumor is a pushe which wyll presently as yt ware come to suppuration, and it is called Phyma by similitude it hath with puffes or mushrumes spryngyng oute of the yearth. and ther be two kyndes of theis tumors, one comynge of heate, an other of coulde [Page 23] but we in this place do nombre onely the hoote tumor amonge inflammotions.
Dothienes foloweth nexte in order.
Dothienes in Greke, is called of Auicenne, Aldemurenul, of Celsus furunculus, with vs a felone or cattes heare, & is a sharpe swllynge wyth inflammation chancing in the fingers with dolour & torneth to matter spedelye, and theis often haue a feuer ioyned with them.
What is Anthrax?
That same which we cal Carbunculus. and is an vlcerous tumor springyng of grosse melancholycke bloude putrifyed. This tumor foloweth greate inflammations, and ther are two kindes of carbuncles. the one more Ientle and benigne: the other pestilential, and mortall, and the carbuncle is both wyth pustles and also without.
Guido maketh difference betwixte anthrax and carbunculus.
Ther is no difference at all, but that anthrax is a greke worde & Carbunculus a Latyne. For Guiddes difference wher he maketh anthrax a malignant tumor, is no other thing then the pestilential carbuncle. but his diriuation of the name is more ridiculous where [Page] he saith that Anthrax is said of Antra, whyche he saith signifieth the harte, but in what tungne Antra is vsed for the hart that he left vnwrittē, sure I am, that it is neyther latyne, Greke, nor arabicke worde.
Wel then I am herein satisfied touchynge the Carbuncle, what defyne you Gargareon to be?
Gargareon called in latyne Columella is an inflammation of vuvla, like as Paristhmia or tonsille are inflamations of the kernelles situated in the beginning of ye iawes. Guido & other of his sect call them Amygdalas.
Anecurisma is nexte.
This tumoure is no other thynge, then a dilatation or rather relaxation of the arteries, whereby the bloode and spirites are dispersed makyng a softe tumour whych beynge pressed, with the fyngers semeth to vanish awaye: but the fyngers taken agayne away, The tumour cometh to his wonted bygnes againe.
If you doe in like sort set out what Gangraena & sphacelus are then you haue finyshed all suche tumoures as are referred to flegmone.
Galen in hys second booke whych he wrotte to his frende Glauco defyneth [Page 61] gangraenam to be a mortifycation of the member vnconfyrmed, sprynging of greate inflammations. And Sphacelus called of diuers wryters Aschachilos. and of the latinestes syderatio is the exacte and confyrmed mortification of the member.
Then by your wordes I gather that bothe Gangrena and Sphacelus folowe after greate inflammations: and that they two differ in this, that Gangrena is as it were in growing and increasing euer more and more towarde mortification of the member: and sphacelus is whan as Gangraena ceasith to corrupte further the member, and that is nowe perfectlye mortifyed and deade voyde of all naturall heate, blode, spirites, and feeling.
You haue rightly sayde.
Then seyng we haue thus ended suche sanguyne tumoures as are referred to Phlegmone, I praye you in lyke maner procede in the coloricke tumours whyche are of like affinite with Erysipelas?
Wee wyll so doe. Vnto Erysipelas are referryd Herpes, Phlyctaenae, Epinyctides and Hydroa. But fyrste wee wyl define what Erysipelas is, and then procede to the reste.
I thanke you that you will accomplishe my request and desire.
Erysipelas beynge of much affinitie with Phlegmone, called also of the Latinestes ignis sacer, of vs wylde fyre or Saincte Anthonies fyre, is a fluxe of coller staying aboute the skynne nothyng molesting the fleshe. And it differeth from Phlegmone fyrste that there is no pulsatiue dolour in it, then that in the inflammation of bloode the colour is alwaye redde: in Erysipelas the colour is yelowyshe pale: laste that Phlegmone ys an affecte of the muscules: and Erysipelas is onely of the skynne and thys is to be vnderstande of Verum Erysipelas.
Is there any more then one kynde of Erysipelas?
Haue you forgottē that which was before rehearsed of compounde tumours? And that there was Erysipelas Phlegmonosum, Oedematosum, and scirrhosum? These be comprehended in dede vnder the name of compounde colloricke tumours or Erysipelas illegittimum.
So then you make two kinds of Erysipelas verum: and also illegittimum.
It is ryghte so. And that [Page 25] whyche is illegittimat or not ryghte Erysipelas is also diuided into two kyndes. The one commyng of the groser and thicker sencere coller and is named Erysipelas wyth vlceration and the other is coller hauynge other humoures mixed with it as I saide before.
Seynge then that I vnderstande what Erysipelas is, and howe manye kyndes also there are of them: I praye you let me vndestand what herpes, is for that foloweth nexte in order.
Herpes is that tumour and affection of the skynne whyche Hippocrates so dothe name of corrodyng and deuourynge the skynne: for herpo is that whiche is called in latyne Serpo whereof commeth hérpys quasi serpens. And there is two kyndes of herpes, one called herpes Estiomenos, so called because it eateth and deuoureth: the other is named Cenchros in latyne miliaris for that the tumour is like Millit seade.
Guido dothe speake of Estiomenus in this wyse. Estiomenus est mors et dissipatio membri: et propter hoc dicitur Estiomenus, quasi hominis hostis, cum putrifactione & mollificatione membri.
where Guido sayth that Estiomenus [Page] is the death and dissipation of the membred and for that is called Estiomenus as who shoulde saye the enemye of man, comynge with putrefaction and mollification: I do litle in my Iudgement alowe hym, first that he leaueth the princes of Phisicke Hippocrates Galene and Paulus, and foloweth those of smale lernynge and authoritie: and then that he will seame to interprete that tungue in whiche he had small knowledge. for wher ded he euer red amonge the Grecians that the tumour Estiomenus was confoundyd with Sphacelus, which in dede is the mortification of the membre. and agayn wher lerned he the deriuatiō of Estiomenus to be hominis hostis. But this maye yet seame tolorable in Guido, whan that Auicenne gyuynge occasion of errour to other, comprehendynge both kyndes of herpes, vnder the name of formica, doeth also mooste absurdlye comprehende myrmecias (that is to saye formicas and is a kynde of wartes) vnder the name of herpes and so confoundeth bothe to gether. but this shall suffice touchynge herpes.
Then let me lerne what Phlyctenae are.
Actius in his .xiiij. booke [Page 26] and .63. chapter sayth that they are pustules comynge of sharpe coller: lyke to the blestres whiche cometh of scaldynge water, and, bryng no vehement dolour or payne, whiche beinge broken ther floweth oute a yeloushe humour, continuynge vnto the third or sometyme forth daye.
And what doth theis kinde of pustules differ from those whiche are called Epinictides?
Very much. for epinyctides be the mooste yll and malignant kynde of pustules. be swarte, and leady in coloure wyth greate and vehement inflammation abought them. and theis beinge opened ther is founde a flymye exulceration in them. this tumor is neuer greater then a beane: and is called Epinyctis because comonlye they sprynge in the nyght season, and then mooste molesteth the pacient. The Arrabians call this tumour essare, or saire. and Plynie nameth it Pustula lyuens.
There yet remayneth those tumours whiche the Grecians doe call Hidroa and the Latinistes Sudamina.
Auicene nameth them planta noctis and Rasis Alhasaphum. Theis are certayne colericke [Page] pustule comyng of muche and abundant swette whiche through the sharpnes therof doe exasperate and vlcerate the skynne: and thus haue you lerned the most famous and notable colloricke tumors wherfore we wyll nowe conuerte oure talke to suche as are phlegmatike.
You do meane suche as are referryd to Oedema do you not?
Yes verely and they be called by their names. Atheroma, Steatoma, Meliceris, Hidrocele, Ascites, Leucophlegmatia, chaeras, Bronchocele, and Hydrocephalon: and as touchynge Oedema it is thus defyned. Oedema is a tumour softe, lose, and with out dolour or grefe, springynge of fleume. and it is deuyded into Oedema that is a deseace, and into that whiche is symptoma or accident. of this Galen maketh mention in the .xiiij. boke .iiij. chap. of his therapeutike methode. the trew Oedema is that whiche folyshly the Barbarous Cirurgians call vndimia.
I remembre Guido nameth it both vndimia and also ydemea, and cimia: but let that passe. I pray you set out those three famous apostemes flegmatike whiche you call Atheroma, Steatoma, and meliceris.
This aposteme called in [Page 27] Latine abscessus and of Haliabbas, Selaa, of Auicenne Nodi, haue diuers names after that thynge whiche is in euery of them conteyned. For Atheroma whiche is a tumor of like colour on all partes and with out payne and dolour, conteyneth in the neruous cootes a shlyme humour and lyke a pultesse in substaunce. and somtyme there is founde in it heres, skales like bones, & hard thynges as they ware stones. and Steatoma that is to saye adipinus nodus, or a fattye knote or a tumor, is an augmentation of fatnes againste nature gathered in some parte of the bodye. Meliceris or Nodus mellaeus, is a rounde tumour harde and voyde of grefe in whiche the neruous coates do conteyne an humour lyke in substance to honye. and all theis iij. effectes are first small and lytle. and so by lytle and litle augmente and waxe. and are conteyned wyth in there seuerall fylmes or coates.
What defyne you hydrocele to be?
Hydrocele is that whiche in Latine is called hernia aquosa or humoralis, and is a tumour springynge of a watrye humoure gathered in the purse of the testicles.
And what is ascites?
It is one kynde of the dropsie. and this tumour is whan that a serose humour [Page] is conteyned betwixt the inwarde coate of abdomen and the intestines. This coate is called peritonaeum.
Leucophlegmatia foloweth next.
It is also named Anasarca and hypostarca and is an inequall tumour going through the hole body. this may in my conceypte be aptlye termed an vniuersall oedema of all the bodye, as touchynge cherades we haue spoken amonge sanguine tumours.
There yet remayneth two tumours Bronchocele, and hydrocephalon.
Bronchocele is a tumour in the throte called also Bocium, & it is a greate and rounde swellynge of the necke betwixt the skynne and aspera arteria, in whiche is conteyned some tyme, fleshe, some time like hony, fatnes, or a pultesse. and sometyme sayth Celsus ther are founde hears mixyd with bones also Hydrocephalon is a watry tumour ingendred for the more part in the heades of children. or els it come of grosse blode collected in anye parte of the heade, ther be .iiij. kyndes of this tumour. one whan the humor is betwixt pia mater and the braine. the seconde whan the humor is collected betwixte the coates and the bones: [Page 28] the .iij. is betwixt pericranium & the bone, the last is betwixt the skynne & the bone. & thus we haue set out the most notable kindes of flegmatike tumours.
Seinge that you haue fynyshed three kyndes of tumours sanguine coloricke and flegmatike, nowe I pray you let vs speke of melancholicke in like sorte.
Vnto Scirrhus are referred. Cancer, Elephantiafis, Satirasmus Psora lepra, Enchimoma, melasma, varices, sarcocele, Polipus Verruce, acrochordines, myrmeciae, & suche lyke. and firste we will take oure beginnynge with Scirrhus, you shal note that ther are reconyd of Galen .ij. kyndes of Scirrhus. one that is exquisite. the other not exquisite. The exquisite Scirrhus is definyd to be an harde tumour against nature, with out dolour or felyng and is incurable. The second kynde of Scirrhus is also a tumour againste nature harde, but not al together insensible and therfore curable. although it be not wyth out difficultie.
Nowe seyng I haue lerned what Scirrhus is and also howe manye they are, I praye you procede to Cancer.
Cancer called of the grecians Carcinoma, and Carcinos, is an inequal tumor against nature, horrible to beholde-of swartishe colour and with great payne. It is called cancer of fygure and similitude it hathe wyth the sea crabbe. for like as in that, the feete are on bothe sydes of it: so in this tumour the vaines beyng fylled wyth a grose melancholike humour, they are swolne and discended like as it were the fet of a crabbe or this tumour maye otherwyse be called cancer because it dothe so inseberablye cleaue to the place where as it once is fyrmely fyred. and there be twoo kyndes of Cancer. one that is wyth vlceration and is called Cancer Vlceratus, an other that is withoute vlceration and is named Cancer Occultus.
What is Elephantiasis.
It is an vniuersall Cancer of the body, and is that which the latter writers of the Arabians name Lepra, &. S. Lazarus sycknes: it taketh name of the beaste called an Elephant be cause of the greatnes of the affecte length and rughnes of the skynne. It is also named Leontiasis because of the lose & rugose tumour of the skynne. This sycknes is terrible, contagious and in the number of those infirmities placed whych are contagious.
And when thys tumour is but [Page 29] [...] [Page] [...] [Page 29] yet in the begynninge. it is not called Elephantiasis but Satyriasmis. takynge that appellation of the satyres whome the Poetes describyd to be deformyd and monstrous.
Seynge that Elephantiasis is not lepra Grecorum, I pray you: shewe me ther difference.
Galen in his booke of difinitions doth difine it in this sorte. lepra is mutation of the skynne into an habite against nature, wyth asperitie and ychyng, dolour and skales and occupieth diuers partes of the body. and there is no smal affinitie betwixte lepra and scabies: both being affections of the skynne, both springynge of melanckolicke Iuse. and they differ in figure. for lepra occupyeth and deuoureth depely the skynne in rounde figure, and casteth skales like fishe: and scabies called also psora infestyth rather the vpper parte of the skynne and is diuersly figured.
Enchymoma foloweth next. and melasma.
Galen in his booke de tumoribus praeter naturam .10. cap. saith that they are tumours happenyng to olde men throughe the contusion of the vaynes: wherby the bloode flowe out of the coates of the vaynes. of theis some be blacke, some betwixte blacke and redde [Page] in colour. & they come of small & light occasions
The next tumours are varices in greke called Cirsous which I take to be ye swelling of the vaines through to great fluxe of grose & melancholike blod. And I haue most comonly sene them in the shankes and testicles.
And those be the proper places for this tumour: lyke as the two tumors nexte folowynge sarcosele and Polypus haue ther peculier partes which they doe infest, as sarcosele is a fleshye tumour growynge in the testicles, and is called in Latine hernia carnosa: the other is a fleshye branche springynge in the nosthrilles, and letteth the operation of the same. and it taketh name of a fleshe called Polypus. for lyke as that fishe hath many legges, so also hath this tumour manye rootes wherby it cleueth and groweth to the nosthrelles.
It is right so, and verruca whiche is nexte in order, is a certayne tumour apperinge in the vppermost parte of the skynne it is named with vs a warte, of this sorte be acrochordones, and myrmeciae. Acrochordon is a rounde warte hangyng as it ware by a threde and therof taketh name. and is called in Latyne verruca pensilis. and myrmecia is also a kynde of wartes whyche groweth deper and is hard and fixed to the skynne, narowe aboue, [Page 30] and brode beneth, prouokyng dolour and paine and is blacke in colour. and thus haue we finished and declared vnto you all the notable tumours whiche are referred to the .iiij. simple Phlegmone, Erysipelas, Oedema, and Scirrhus.
Yet amonge all theis I here you make no mention of morbus, whiche I thynke is to be numbred amonge tumours against nature?
I do not well vnderstande your meanynge, for manye a tumour is called morbus. for morbus is a Latine worde, and all sycknes and infirmyties be called morbi
Yea but I meane that scabbe whiche the common Chirurgians calleth the morbus, and the morbus cause, and the better lerned nameth it morbus gallici
It it is a great thynge to be trayned vp in ignoraunce or Barbarous doctrine at the first, for euer after do what you can they will haue some tast therof, as right excellently the Poete Horatius said.
‘Quo semel imbuta recens seruabit odorem. Testa diu &c.’Whiche is as muche in effecte to be vttered in our vsuall language as
And this may right well be verifyed wyth those of our tyme: one rude Emperike called it the morbus and a numbre foloweth hym in his folly. and an other because he wolde seme connynger then the rest, wyth as muche ignorance nameth it morbus, Gallici brekynge the olde Pricians head, and yet wil not, or can not gyue hym a plaster. But if you will vse that vsuall name you might haue named it morbus Gallicus, or Lues venerea, and so haue obserued cō gruitie in spekyng. but as touchyng the names of that contagious infirmitie, which is vsually named morbus gallicus: in my opinion they all doe nothyng expresse the nature of the sycknes. and lyke as the authors, whiche wright of it varieth in the names: so do they both in knowyng the disseace, and cure of the same.
What then shall I properlye call it?
That same that Maister Doctour Cunyngham hath inuented a similitudine cum chamaeleonte bestiola. That is he calleth it Chamaeleontiasis. the reasons hereof, the definition, cause, signes, prognostications, & newe kynde of curation, he hath expressed in a [Page 31] booke therof wrytten, whiche I trust he wyll hereafter publishe.
And dothe he not numbre chameleontiasis amonge tumours against nature?
Nothynge lesse, for he accompteth all those tumours, swellyng, knottes, vlcers, and suche like infesting the body of man: but as accidents. and no parte of the infirmitie, neyther laboureth he so muche in theis as in expellynge the sicknes whiche bryngeth forth theis accidentes. for theis are to be remoued with out difficultie or great trauayle.
I iudge his newe inuented way of curation to be extreme and dangerous to the pacient. for both the fumes, vnguents, and strayte order of diet with the wood, are wel knowen to be dangerous, and yet many tymes doeth not that whiche they promise. but yet yf his way be perfite it is the more to be likyd and he worthy prayse.
His waye is voyde of danger, easie to the pacient, exacte also and perfite.
Seinge then that Chamaeleontiasis vulgarlye termyd morbus gallicus is not to be numbred amonge tumours againste nature I: pray you procede to the other parte of your diuision, for I remembre that you sayde [Page] ther ware .iij. kyndes of tumours, the firste you called humoralis because it doth springe of humours. the second ventosus, for that it is ingengendryd of spirites. The third you termyd. tumour varius, because they hae miryd causis. somtyme of humours and spirites myxyd, and somtyme of other causes. Therfor I pray you nowe let me lerne how many tumors are referryd to ventosus tumour.
The most fomous are two. Tympanites and priapismus.
What is tympanites?
That whiche Hippocrates nameth a drye dropsie. and is a tumour spryngynge of wyndye spirites, collected betwixt peritonaeum and the intestines. and if you smite the body of the pacient vexid wyth this tumour it will gyue forth a sounde lyke to the tympanie and hereof it first toke name.
And what tumour is that whiche is callyd Priapismus?
Priapismus is a tumour of the yarde, wherby it is destēdyd out in length and breth through vaporous spirites fillyng the nerue called neruus cauernosus constituens colis substantiam.
There yet remayneth to [Page 22] to speke of those tumours which you terme tumores varios.
Ther doe so as you saye. and theis be the notablest of those tumours. vitiligo, exanthemata, parotides, mentagra, Epiplocele, Enterocele, Enteroêpiplocele, Bubonocele, exomphalos, Arthritis, podagra. Chiragra.
What call you vitiligo.
If you will generallye take it, it signifyeth a foulnes and staynynge of the skynne, coming of the yl disposition of the parte, whiche can not make good assimulation of the norishement. and ther be two kyndes of this tumor, the one named in greke Leucae of the Arabians Albaras, and in Latine vitiligo alba whiche is a mutation of the skynne in to more whightnes. the other is named alphos, and of Auicenne morphea, and we vsuallye cal it the morphew. and ther are two kyndes of morphew, the one whight called of Celsus Leuca Alphos, the other blacke. and he termeth it mela. and alphos, is deriuyd of this Greke verbe Alphenein, whiche signifyeth to alter or change. and so doth the morpheu alter & change the coulour of the skynne.
And what tumors are those whiche the grekes do cal exanthemata?
They be pustules and tumours breaking out of the skinne, bringing with them feuers and manye other accidentes. And there are two sortes of them: one hygher springing of thimne and cholorike bloode, the other broader and commeth of melancholike and grose blode. the fyrst kynde we call the small pockes, in Latine Morbilli, the other the measelles, & Variolae in Latyne.
Parotides folowethe nexte in order.
Parotides be inflammations whych happen to the karnelles that are behynd the eares. And they springe sometime of sincere bloode, sometyme of fleume, sometyme of choller, and sometyme of melancholie. And herein note the prouidence of nature. For she hathe made the rare and lose partes called karnelles to be as emunctories for the noble partes. As the karnelles behynde the eares, serue to the brayne. Vnder the armpittes seruynge to the spirituall members. And the karnelles in the gryne doth receyue the superfluities that commeth from the liuer, whan as it doth exonerate and purge it selfe, and this is moste manifest in pestilentiall constitutions in whyche theys noble members thurst and expell the venome to there purgien places.
As for Mentagra you nede not to speake of, for I knowe ryght well, it is no other thynge then Morbus gallicus, or Chamaeleontiasis, as the booke bearynge the name of Mentagra doth testifye.
And yet bothe you and the authour of that booke doe herein mysse the quishynge, as suer as you make your selfe of thys. For thys tumour whych Plinius calleth Mentagra, & impetigo in Greeke Leichin sprange first amōg the Italians in the time of Tiberius and is a deformitie of the skynne beginnyng for the more parte at the chynne and wyll spedelye turne into leprye and caste of skales lyke fyshe. And Galen wytnesse in the v. boke & v. Chap. Secundum loca. That impetigo wyl turne into Lepram. Therefore what difference is betwixt Mentagra and Chamaeleontiasis it is easely conceyued, the one hauing Causam occultam as I may terme it, and the other manifestam.
And what Iudge you epiplocele to be.
I wyll not onelye speake of that, but also of thother kindes of hernia, which foloweth nexte. And fyrste you must note that epiplocele is a Greeke worde compounde of [Page] epiploon whiche the latinestes call Omentum and we name it the caule, and cele which signifieth ramex or hernia. So that epiplocele is a tumor comyng whan as omentum falleth in to the purse of the testicles. And by the lyke reason Enterocele taketh name, when as the intestines falleth into the foresayde place. And Enteroepiplocele foloweth whan as bothe Omentum and the intestines fall in scrotum, or purse of the testicles. Furthermore Bubonocele is a tumor called in latyne inguinis ramex and happeth whan as Peritonaeum is ruptured or wounded by the flankes. Exomphalos is a tumour perteining to the ouertwart muscules of abdomen, which being relaxed ther foloweth a sterting or emynency of the nauel.
My brother Yates doth the redierly conceyue the differences of these kynde of Hernia, for that he hathe a peculer waye of curyng some of them, especiallye of Enterocele or Hernia intestinalis, as Guido tearmeth it wherefore we wyl no lenger stande in vttering the differences of them, but procede to arthritis Podagra & Chiragra. For I thynke the daye wyll scarslye suffyce to declare, that whyche yet remayneth, and therefore as touchynge Arthritis you shall note and consyder that it [Page] is a tumour commyng of the fluxe of humors into the Ioyntes: and is named in Latyne morbus articularis. And so is thys tumour common to all the Ioyntes of the bodye except it be the handes and the feete.
Yea for yf thys fluxe happeneth to the handes, it is named Chiragra. And yf to the feete, then it is called properly of the place, Podagra.
Theys dyseases of the Ioyntes be greuous and paynefull, haue they no other cause but the flux of humours?
The fluxe of humours is but the interne or antecedente cause, whyche commeth of the primatyue, but it is no part of our myndes to sette out eyther the causes sygnes, or curation, of tumours, seynge that wee haue done that in oure booke of the methodicall cure of tumours agaynst nature.
Seynge that you haue nowe spoken of all the notable and famous tumours agaynste nature, I praye you turne your talke to woundes, whyche Auicenne and those that folow him calleth Plaga.
Before we enter further Herein to sette oute the differences of woundes, it is conuenente to knowe what a [Page] wounde is. and the moste parte of writers doe agree that a wounde is the solution of continuitie newly made in the partes of the bodye with out putrifaction or matter.
Yea for whan as putrefation or matter doth folowe, then it leuyth the name of a wounde and is called an vlcer.
And maye a wounde degenerat into an vlcer?
Yea for sothe, and so dothe mooste partes of woundes especiallye if they be greate and in suche partes as may not be cured wyth balmes.
And howe many differences be ther of woundes?
Many, but the chefe & principal and that also are necessarie, are numbred to be three, and we wyll showe you wherof the differences sprynge.
Doe you so.
Guido and other famous writers of his tyme, taketh the difference of woundee of three thynges. The firste is taken of the nature of the parte, in which the wounde is made. The seconde difference springeth of the substaunce or essence of the solution of continuitie. The thirde difference springeth of the difference of the diuisiō, or solutiō of cōtinuitie.
And howe are the woundes called. those difference cometh of the nature of the parte in whiche that wounde is.
It is called a wounde in the similer parte, and a wounde in the instrumentall parte.
Then to know theis woundes exactly it doth behoue to knowe theis partes of the body whyche you called similer, and instrumental.
It doeth right so. and it is called a similer parte because it is simple and may be deuided in to like partes. and that also whiche is required to the constitution of the organicke or instrumentall partes. Suche partes of the bodye are fleshe, fatnes, arterye vayne nerue, tendon, ligament, bone, and such like. & those be named instrumentall partes, whiche are made of theis simple or similer partes. And the instrumentall partes are the heade, eye, nose, tungue, harte, lyuer, longues, armes, feets, and a greate numbre of suche lyke, and euery of theis partes haue ther seuerall vse and office, as more largelye appeareth in the booke of Galen intituled de vsu p [...]rtium.
And howe manye sondrye woundes are ther in the similer partes.
Ther be three, whiche are [Page] taken of the substaunce of the similer partes. for it maye be in the similer parte whyche is softe as woundes made in the fleeshe, and fattenes, or elles in the harde symiler parte, as woundes in the bones, or fynally it maye happen to the meane similer parte, whyche is neyther harde nor yet softe, suche be those woundes in the vaynes arteries neruys tendons & ligamentes.
And what difference is there of the woundes in the organike or instrumentall partes?
There is a threefoulde difference of those woundes accordyng to the parte affected. For eyther the wounde is made in the principall partes, as in the harte, lyuer, or bryane: or els in those partes whych serue theis principal partes, as woundes in Aspera arteria, the throte, and bladder. Or it is in the organike partes which are not seruisable, to anye of the principall, as woundes happenynge in the nose, eye, eare, hand, foote, and such like.
Then there be syxe differences of woundes taken of the nature of the parte, three in the simyler, and three lykewyse in the instrumentall partes. Nowe lette me vnderstande the difference of woundes taken of the essence of the solution of continuitie.
There is a twofoulde difference. [Page 28] for eyther it is a symple wounde, or elles it is a compounde wounde.
What is a simple wounde?
A symple wounde is solution of continuitie, newlye made beynge voyde of accydentes or other affectes wyth it complycated and ioyned.
And what is a compounde wounde?
The contrarye to a simple wounde. For it is solution of continuitie hauynge one or more affectes and accidentes complicated and Ioyned with it.
You haue nowe showed two kyndes of woundes the one taken of the nature of the wounded parte, the other of the essence of the solution of continuitye, there yet remayneth to set oute, such as springe of the proper difference of solution of continuitie.
There doth so as you saye. And the proper differences are taken of twoo thynges. That is to weete of the quantity and of the fygure?
And howe be the woundes named, whyche haue there dyfference of quantitye.
They are called by these names. a great or litle wounde: a long or shorte [Page] [...] [Page 37] [...] [Page] wounde: a brode or narrowe wounde, a deape or shalowe wounde: and an equall or els an inequall wounde.
And how be those woundes named whiche are taken of the figure of the wounde?
They be thus termed. a right wounde an obliquike or croked wounde, and a retorte wounde. There are besides theis three principall differences of woundes: other woundes, althoughe they be not proper. as a wounde disrupted or broken, a wounde whiche is cutte, a wounde partlye broken, and partlye cutte: also, a wounde in the begynnyng, middes or ende of a muscle, and suche like, but theis differences alredye numbred shall suffice, as touchynge the Institution of a Chirurgian in this parte.
I suppose no lesse. but what vtilitie springeth by knowing theis differences of woundes?
Right great, for you shall not rightlye and methodicallye cure them, excepte you knowe ther differences. For of them is taken the prognostications, the intentions curatiue, the inuention of medicines, and maner of curation. for you wyll not a like prognosticate lyfe & death to the pacientes, of a simple [Page 37] and wounde made in the fleshe. and of a greate wounde made in the ventricules of the brayne.
That is verelye so, for the one is with out perill and danger, and the other euer mortall and deadlye. Althoughe Galen affirmeth that his maister Pelops yet beynge a lyue) he sawe a younge man wounded in one of the former ventricles of the braine, and that he was restored to helthe.
In dede those woundes for the more parte are deadlye. and wher as Galen in his .viij. booke de vsu partium, reherseth that historie, he maketh it miraculous, and that the yonge man came to helth, rather by the goodnes of God then helpe of art. But let vs retorne from whense we are digressed. A grene and shalow wounde voyde of accidentes, haue not the same curatiue intentions, that a deape and holowe wounde hath, with whiche is also annixed inflamation, flux, dolour, and payne.
That is more clearer then sonne at myd day, as the sayng goeth.
And touchinge the inuention of medicynes howe saye you, wyll you inuent like for woundes in the nerues and ligamentes, that you wyll for those in the fleshe? or in woundes of the brayne, that you wyll in woundes of the handes?
No verelye, nor I thynke none so rude that will so offende.
I pray God ther be not. but to the right vse of medicines taken of ye difference of woūdes, wolde you in a wounde in whiche is inflammation, and deperdition and losse of fleshe, aplye incarnatiues to cease inflammation or contrarye wyse?
That ware a pointe of extreme demency and madnes.
Well then this last vtilitie springing of the difference of woundes showeth you howe to aply your medicynes, and whan also, whiche must be first, and whiche nexte.
No man can that denye. Wherefore seinge, that we haue passed ouer the differences of woundes, it foloweth nexte in order that we doe procede to vlcers.
And that you may the better vnderstande those thynges whiche hereafter shall folowe, it is requisite to lerne firste what an vlcer is.
Then I praye you define what an vlcer is.
An vlcer is defyned to be the solution of vnitie in the fleshye partes, hauyng more dispositions lettynge and hindringe the adglutination of the same, of whiche cometh [Page 38] matter, and other lyke fylthines.
You may also brieflye define it, folowyng Auicen, in this maner. an vlcer is the solution of continuitie made in the fleshe, conteynyng matter and pus.
And whereof are vlcers ingendred?
They spring of woundes yl handled, of pustules, and apostumes comyng to vlceration.
And doeth vlcers spryng of woundes?
They doe: for whan as a wounde doeth ons conteyne matter, it is no more called a wounde, but an vlcer.
How many kynde of vlcers be theyr?
Ther be two kyndes, a simple vlcer, and a compound.
And what is a simple vlcer?
A simple vlcer is a solution of continuitie, wyth matter, voyde of accidents and complication with other affectes. and here you must note accordynge to our supposition, that whan I saye a simple vlcer, I meane not one simple infirmitie or sycknes: for I am not ignorant that euery vlcer doth consist of intemperatnes, solution of continuitie, and somtyme [Page] also of yll composition. And therfore whan I speke of a simple vlcer, I meane that whiche is opposite or contrary to that vlcere, whiche is complicated with many affectes.
Then by youre wordes I gather, that a compounde vlcer is solution of continuitie in the fleshe hauynge matter, and diuers affectes with it ioyned. Nowe I praye you let me vnderstande howe many differencis there be of vlcers.
The most notable vlcers are .vj. in numbre.
Whiche be they?
Their names in Latine be theis vlcus saniosum, virulentum, sordidum, cauermosum, putridum & corrodens. And we must by circunlocution make them playne vnto you, for the deffecte of apte wordes in our language.
And can theis haue no other names?
Yes forsoth.
Howe many wayes?
Fiue principall wayes.
Whiche are they?
Firste an vlcer may be named of humours, nexte of sanies or matter, [Page 39] then of accidentes, after of the sycknes, last, of similitude with some lyuinge thyng.
Whiche waye name you vlcers of humours?
Those whiche springe of blode are called sanguine, of choller, choloricke, of fleume flegmaticke, and of melancholie, melancholicke.
And howe are they called whiche come of sanies or matter.
You muste note that vlcers be named of sanies, foure sundry wayes.
Howe so?
Because sanies is called by foure names,
Whiche be they?
Sanies, pus, sordicies, and virulentia, and hereof cometh that of sanies, the vlcer is named a sanious vlcer, of pus, a purulent vlcer, of sordicies, a felthie vlcer, and of virulentia, the vlcer is named a virulent vlcer.
Before you procede further here in, I praye you define me what sanies or matter is.
Sanies is a norishement corrupte, whiche nature coulde not digeste. and note that ther is twoo kyndes of sanies, good and laudable, and also yll and nought.
What call you good matter or sanies?
It is called good whan as it is whight in coulour, lyght and equall, voyde of stincke and horrible smell, and is also digested.
And what define you yll matter or sanies?
It is that whiche is contrary to the good. A corrupte norishement in which the substance is inequall, indigested, yll smellinge, and diuersly discolored.
What is that you call pus, of whiche the vlcer is named purulent.
It is yll matter or sanies comynge of norishement and superfluites of the weke membre, whiche tendeth to corruption, throughe the naturall heate altered into an vnnaturall state.
I praye you let me learne what virus is.
It is subtile and thinne sharpe sanies, ingendred of thinne watry humours, whiche throughe the aboundaunce, the heate can not digest and ouercome.
Ther yet remayneth to speke of that kynde of sanies whiche you called sordicies.
It is grosse matter ingendred of the grosnes of humours.
Well, nowe retorne againe to the names and appellations of vlcers. Howe I praye you are vlcers called after accidentes, whiche the grekes cal Symptomata?
It is called of corrosion a corrodynge vlcer, in greke Phagedenicum, of putrifaction vlcus putridum, of dolour and payne, it is called vlcus dolorosum.
And how is the vlcer called of sycknes.
It is called in this maner of cancer a cancerous vlcer, so in like maner of fistula the vlcers is called fistulosum or vlcer fystulate.
Seing you are come to that talke of a fistula in knowledge of which, & also exacte curation you are not a litle commended: I pray you define what a fistula is.
It is an holow and depe vlcer hauynge a straight orifice. and the halownes of the same is harde, out of which many tymes floweth matter, & the fistula hath manye denominations accordyng to the place in which it is, for whan it happeneth only in ye fleshe, it is [Page] called fistula carnosa, in the vaines venosa, in the arteries: arteriosa: in the neruys or senowes neruosa, in the cartilagies cartilaginosa in the muscules musculosa, in the bones ossea, and also of teares and droppis whiche it putteth fourth, it is namyd fistula lachrimalis. so in Ano it is called fistula Ani.
Well nowe turne we againe to the last parte of the deuision and showe me howe vlcers are called of similitude.
I will, the ante or phishmere in Latine formica crepeth and maketh holes. and of like sorte, the vlcer whiche crepith and maketh manye holes in mans bodye, is hereof termed formicosū vlcus. and also of the holow caues of the grounde called cauernae, the holow vlcer is named cauernosum: and so in like sorte of other thinges, for of the similitude the vlcer taketh name.
I here you not make anye mention of those famous and notable vlcers called Teliphea and Chironia vlcera. neyther can they be comprehended vnder any of the .vj. principal kyndes of vlcers.
Yes forsoth, but Galen whō I folow, accompteth those differences of Teliphea and Chironia vlcera, superfluous, and he [Page] [Page] [Page 41] comprehendeth them vnder the name of phagaedenicum, or corrodens vlcus. Therfore we may aptly place them among corrodyng vlcers, whiche is the syxte kynd of the notable vlceres before rehersed.
And be all theis kyndes of vlcers of like facilitie in curyng?
No verely, for ther be some which are easelie cured, & other also whiche will hardlye or not with out great difficultie receiue curation.
Whiche be those that wyll easelye be cured?
Such vlcers as happen in persons of good complexions, whose bodies are norished with good blode, & haue no abundance of superfluous moistnes. for Auicene saith that in bodyes of the beste complexion, the vlcers are more spedely healed.
Whiche vlcers are harde to be cured?
All those vlcers whiche fofoweth after any sycknes.
Wherfore shold those vlcers be so rebellious, and hard to receyue curation?
Bycause nature doeth exonerat & vnburthen her selfe of the dregges and reliquies of yll, and vicious humours.
Are ther no other vlcers: but theis that be harde to cure?
Yes, and suche be all vlcers whiche happen to persons hauyng accidentaly there bodyes most or drye.
Gyue me an example of those bodies whiche accidentally are moyst.
You nede no other example to set before youre eyes, then persons hauynge dropsies, and women with childe. where vlcers happen in such bodyes they, wil not cicatrize because of aboundance of superfluous moysture.
I thynke it so. But if that the greate moystnes, do let the vlcer to be cured: thē in bodies that be drie, it foloweth the vlcers to be easelye healed. Howe happeneth it, therfore that you affirme vlcers in drie bodyes to be harde of curation?
And yet in theyse my wordes I do not committe anye errour. For I speake not simplye of all drie bodies: but of those that ware drie accidentally. suche be the bodyes of them that haue hecticke feuers, and marasmus. In theis the vlcers, for defecte of good bloode can not consolidate: but with greate difficultye.
And you haue also the lyke example in olde men whose vlcers wyll hardly [Page 42] receyue cure for the defecte of good blood, they beinge not able, for the imbecillitie of naturall heate) to concocte and digest, ther meate.
Then by your wordes I do fynde: that in three sortes of people the vlcers will not wyth out difficultie be cured, that is to say in those, where vlcers foloweth greate sicknes, and in bodyes whiche are accidently moist, and those also which are likewise drie. Now before we fynishe oure talke of vlcers, I woulde learne of you what putrifaction, corrosion, and digestion is. the knowledge of theis is ryght profitable in vlcers.
It is so, and note that, putrifaction accordynge to oure Authors Chirurgians, is defined to be a transmutation of the hole substance of the bodye or parte of the same, springynge of outwarde and vnnaturall heate? whiche beinge contrarye and deadlye ennemy, to naturall heate, doeth corrupte, and destroye the same.
And corrosion is a consumption of the fleshe whiche cometh through sharpe humours, whiche resolueth consumeth & dryeth the substance of the norished part: which being resolued the substance of the flesh is diminished and vlcerated.
Theis two, putrifaction and corrosion seameth to be as you say, although. for [Page] want of naturall Philosophie I can not herein iudge, but it behoueth the lerner alwayes to beleue and credit the teacher: but what is digestion?
Digestion is taked in twoo wayes, one waye it is taken for an orderly distribution of the worke of naturall heate made for the augmentation and norishement of the partes. The other waye it is a dispositin of naturall heate ordayned to the preperation of huhumours wherby the humours are made redie to be thrust oute by the vertue expulsiue. and this last awaye is that whiche the Chirurgian ought to consyder.
Now you haue thus finished tumors against nature, woundes, and vlcers, it is tyme to intreate of fractures. Wherefore I praie you let vnderstande what a fracture it.
A fracture called in Greeke Catagma is a solution of continuitie made in the bone. But the later grecians as Aetius and Paulus nameth a fracture, the diuision of the bone or els rupturynge or breakyng of the same or any solution of the bone violentlye comyng of any outwarde cause.
Yet Guido de Caulico and other of hys tyme defyneth a fracture to be solution of continuitie of the bone not comming [Page 43] of euery cause, but onely whan as it commeth of contusion, and thys difference he putteth, for that sayth he a bone broken and a bone cut may be knowen a sonder. For because a cut bone is not to be properlye named a fracture, but rather a wounde in the bone.
There is no greate repugnancie amonge them neyther let vs be curious aboute wordes, so the thynge whereof we intreate maye be euident and plaine. Wherfore I praye you showe me nowe how many kindes there be of fractures.
There be twoo kyndes of fractures. a simple fracture, and a compound.
What is a simple fracture?
A symple fracture is solution or diuision of continuitie made in the bone wythout any other affecte ioyned with it.
What is a compounde fracture?
It is also a solution of vnity made in the bone hauyng one or more affectes to it connected and ioyned.
How manye differences be there of fractures?
You must note that lyke as there be symple and compounde fractures, so in lyke maner there be differences of fractures [Page] both symple and compounde. Wherefore lette me knowe of whych fracture you woulde know the difference.
I woulde ryght gladly vnderstand all the differences, although for want of knowledge I can not orderlye demaunde of you. Wherefore, I praye you fyrst to begynne with the differencies of symple fractures, and then to the compounde.
That we wyll gladly. and fyrste it behoueth you to consider that there be manye and diuers kyndes of fymple fractures. For some fractures are ouerthwart and diuides the bone in sonder and they are three, Cauledon Raphanidon, Sicyedon, that is to say the bones are broken like vnto the similitude of stalkes of herbes, radish, or cucumers. There are besides theis fissures or ryftes made in the bone longwyse called in Greeke Schidacidon. Also there is an other kynde of symple fractures whan as the bone is broken into manye small and lyttle peeces, and this is named Alphitidon. Theis be the principall differences of simple fractures.
And what are the differences of compound fractures?
The chefe and notable being accompanyed with sycknes and accidents are theis. a fracture with a wounde, a fracture [Page] [Page] [Page 44] hauinge wyth hym ioyned gangraena, a fracture with inflamation, a fracture with dolour and payne, a fracture with cōtusion, a fracture with callus to muche increased and growne, a fracture with to muche dryenes, and also hardnes of callus. and a fracture with superfluous moysture of callus, and suche like.
Are ther no other kyndes of fractures besides theis two simple and compounde?
There be no other proper kyndes. for of necessitie, it must be eyther simple or compounde, and Galen maketh but twoo kyndes of simple fractures, a fracture made secundum longitudinem, and a fracture made per transuersum. But Cornelius Celsus addeth the thirde difference to it: his wordes are theis lib. 8. cap. 7. omne os, modo rectum, vt lignum in longitudinem finditur, modò frangitur transuersum, interdum obliquum, &c. Whiche is as muche to saye, as euery bone is fractured eyther in length as woode cleauen, eyther it is broken ouertwharte, and some tyme it is fractured oblique or crokid.
Albucasis nameth other kindes as fracture in cranio, a fracture in the Iawes, a fracture in the nose, a fracture of the spine of the backe, a fracture of ye fossiles, & so of other bones. [Page] so of other bones.
He doth right so as you say, but in my opinion theis be no differences of fractures: but rather noteth the parte affected
That is moste manyfest and hereof we haue spoken in oure Enchiridion of Chirurgery, more at large, where we set oute the differences of fractures, and the exacte maner of curinge them. But because you may the suerer beare theis differences of fractures seurer in memorye, behoulde this table which setteth out all the diuisions of them, and if you take paynes to comitte them to memorye, then you haue in effect the whole theoricke of solution of continuitie, made in the harder partes of mans bodye.
I thanke you syr, and I will not omit the greate profit, whiche wyll folowe for the present payne. For the gaine wyll remayne, whan at the payne shalbe quite forgotton. Nowe for the tyme of the daye whiche yet remayneth: finishe luxations, and what els you thynke conuenient, for the institution of a Chirurgian.
We wyll accomplishe your requeste, and first note that a luxation or dislocation (which the grecians also call exarthrema) is a displacynge of the ioynte, and mouyng of it [Page] [Page] [Page 45] out of this natural seate into an other place vnacustomed wherby the voluntarie motion of the same is hindred.
And this luxation is eyther perfit as whan the bones are quite diuided, and put a sondre, or els it is an imperfecte luxation, whan the Ioint is but only wrasted, and not altogether diflocated, this the Grecians call pararthrema.
Howe many kyndes of luxations are ther?
There be twoo kyndes of luxations, a simple luxation with whiche there is no other affecte ioyned: and a compounde luxation hauynge one or more effectes to it connected and complicated.
What effectes be those whiche are ioyned with compounde luxations, or rather to speake properlye, what effectes doe make the luxation compounde?
The most comon are theis, a luxation with a fracture, a luxation wyth Pleghmone, a luxation with a wounde, a luxation with dolour, a luxation with hardnes, a luxation with fluxe, and so in lyke sorte you maye numbre other effectes, as they are with the luxation connected.
You haue nowe fynished youre talke touchynge the definitions and differences of tumours against nature, woundes, vlcers, fractures and last of luxations. & among the rest you make three of them, to be solutions of continuitie, that is to say, woundes, vlcers and fractures: I praye you aunswere me, be ther no more kyndes of solution of continuitie then theis?
Ther is no solution of continuitie: but is comprehended vnder one of theis three. as you maye perceyue by the differences of solution of vnitie, set out in the .iiij. booke of Galens therapeutike methode.
I praye you reherse those differencies.
Ther is a solution of continuitie, left in the fleshye parte after a wounde called Thrauma. Ther is a solution called Helcos, wher as ther is an vlcer in the fleshe, there is solution of vnitie in the bone named catagma. also spasma is a solution of continuitie in the nerue by conuulsion or distension, Apospasma is lyke wyse in the lygaments. Rhegma is a rupture of the fleshe. There is also a solution of continuitie called contusion, in Greeke, Thlasma, and is properlye in the vesselles. [Page 46] Theis are the principall kyndes of solution. But nowe seinge we haue plainly made discourse of all suche sycknes, as fall vnder that portion of the that curatiue parte, which is called Chirurgirye, whereby you are taught to applye contrarie remedies, for the expellynge of the fornamed grefes: it is requisite to vnderstande the operations, whiche a Chirurgian muste vse in obteynynge his desiered scope: I meane in restorynge helth to his pacient.
I praye you then let me lerne what those operations are.
They in numbre three. First to diuide or separate the continuitie. secondly, to vnite and ioyne together, that is diuided and seperated. and laste of all to take awaye that is superfluous.
And we diuide the continuitie, by makynge incision, letynge of blood, and scarification: where as neade requireth. as also we vnite and ioyne together, that is deuided whan as we consolidate and conglutinate woūdes, whan as we heale factured bones causyng callus to growe out the fracture, & whan we repose and put bones luxated and dislocated into the natyue and wounted seate. Last of all we doe take awaye, that whiche is [Page] superfluous whan as we take awaye tumours againste nature. as ganglia, Cancers, nodos, strumas, and wartes called achrocordonas, also takynge the water oute of the bodies of those whiche haue a dropsie: or takyng away the sixte finger or to a of the hande or fote.
All this I wyll kepe well in memorye.
The Chirurgian must also in theis his operations obserue sixe thynges principally. First, that he doeth it safelye, and that wythout hurte and damage to the pacient. secondly, that he do not detracte tyme or let slepe good occasions offered in workyng, but with suche spede as arte wyll soffer, let hym finishe his cure. Therdly, that he worke iently, courtyously, and wyth so lytle payne the pacient, as conueniently you may, and not roughly, butcherly, rudlye, and wythoute a comblenes. Forthly, that he, be as free from crafte and deceyte in all his workynges, as the East is from the Weast. Fiftly, that he taketh no cure in the hande for lucre or gaynes sake only, but rather for an honest and competent rewarde, with a godly affection, to doe his diligence. Laste of all, that he maketh no warrantyse of suche sicknes, as are incurable, as to cure a Cancer not vlcerate, or elephantiasis confirmyd: but circumspectlye [Page 47] to consider what the effecte is, and promyse no more then arte can performe: and you shall doe theis thynges muche the better, (yea wyth oute theis, you can not any thynge profit your pacient) yf you vnderstande the maner, and exacte wayes of stichynge woundes, of makyng tentes, splanes, stuphes, bolsters, and conuenient rollynges, wherfore if the day will therto suffise, we wyll declare and make playne theis thynges vnto you, and so finishe our talke of the institution of a Chirurgian.
I praye you let no tyme be herein lost, for lothe I ware to departe with out the knowledge of them, and for that you first made mention of stichynge, I pray you first begynne wyth it.
Then you must well marke and diligentlye consyder, that ther are three kyndes and maners of stichynge takynge names of ther effectes. The firste is called conglutinatiue or incarnatiue, the seconde is named compressiue, the thyrde is reseruatiues of theis, we wyll orderlye intreate, and first touchynge incarnatiue stichynge, note that the vse of it is in all grene and freshe woundes made in the fleshe, whose lyppes or sydes can not be conserued and kepte together, onlye wyth rollinge and ligature.
And maye not this kynde of stichynge be vsed also in olde woundes?
Yf you wyll vse it in olde woundes whose lipppes are harde and thicke it behoueth you firste to make scarification of skynne abought, and so let blood flowe oute, and then you may vse it. and note that ther are v. sundry kyndes of stichynge incarnatiue.
Whiche are they?
I wyl set them out vnto you. The first kynde is done wyth an euen stronge and softe threid of sylke, makyng the first stiche in the myddds of the wounde, then the seconde stiche in the mydde space betwyxte the firste stiche and the one ende of the wounde, and the threide stiche shalbe lyke the seconde in the other syde of the wounde. And so euer betwyxte two stiches in the myddes, take an other vntyll the sydes of the wounde be aptlye and decentlye ioyned together. And you must also take hede, that your stiches be not to thicke or thynne set. For yf they be to thycke, you shall as Celsus saythe, prouoke dolour and payne, and cause inflammation, and if they be to thynne and rare, then it can not conteyne the sydes of the wound to gether. The seconde kynde of incarnatiue stichynge [Page 48] is vsed in greate woundes of the theis and shoulders: and is in this maner. Ioyne the sydes of the woundes together, and marke howe many stiches it requireth, and for euery stiche you muste prouide a nedly and a threid, and put a nedle in the myddes of the wounde, and wynde the threid rounde abought the nedle many and sondry tymes, and the nedle remayne styll in the wounde, vntyll the consolidation of the same. You must in lyke sorte doe wyth the other stiches, whyche are to be made, accordynge to the quantitie of the wounde. The theird kynde of incarnatiue stichynge, is done wyth quylles or rolles made of stupes in the bygnes, and forme of quilles, beinge writhed, and made euen and smothe. And this waye of stichynge is thus, You shall drawe the sydes of the wounde to gether, puttynge your nedle and threid throughe bothe sydes of the wounde, and agayne put the nedle backe agayne throughe the same hole, and so leaue a loupe of the threid behinde, into whyche you shall put the one ende of the quytle, then drawe strayte bothe endes of the wounde to gether, a [...]d fasten them to the other ende of the quylle, and cut of the threyde, and let the quylles so remayne vntyll the wounde be [Page] perfectlye healed. The forthe kynde is done by hookes, greate or lytle, accordynge to the bygnes of the wounde, & the hokes must be crocked and bowed at both endes. You shall faste an hoke on the one syde of the wounde, and drawe the other ende towarde thother syde, in whyche you shall fasten the other hooke. This kynde requyreth no violence, but only serueth wheras the wounde wyll easelye come to gether. The fyfte and laste kynde of stichynge is wyth clothes threcornored being of suche bygnes, as maye suffise for the hurte membre. whiche kynde of stichynge is very conuenient in those woundes where as we wyll not haue the cicatrize to be seame, as in the face. and theis clothes muste be wette in some viscouse, and glutinous lyniment and laye them to on eyther syde of the wounde, and whan they be dryed, you shall make youre stiches in the clothe conuenientlye, and aptlye, and so ioyne the sydes of the wounde together, and theis be the fyne kyndes of incarnatiue stichynge.
Ther be twoo thynges touchynge theis stichynges that I muste require of you. The one is what maner a nedle we muste vse in oure stichynge: the other wyth what thynges we shall make oure linyment whyche must be extended on the lynynge cloth vsed in the fyfte kynde of incarnatiue stiching.
The nedle muste be longe and smale, beinge thresquare, the eye holowed in, that the threid maye the easelyer folowe. to the whiche neadle ther muste be a quille made holowe, called in latyne canulla, this serueth to holde the sydes of the wounde to gether stedfastlye whill you make your stichynges. as touchyng the matter wherof you shall make your liniment, it consisteth one myrrhe, franckensence, sanguinis draconis, mastick, sarcacolle, pich, mylldust, al theis, or parte of them, must be myxed wyth the whight of an egge, and so extended on the clothes.
This I vnderstande ryght well: wherfore procede to the seconde kynde of stichyng whyche you call compressiue.
That stichynge whiche we call compressiue vsed to staye and stanche greate fluxe of blode, is in thys sorte. foulde in the sydes of the woundes, as the skynners vse in sowynge ther skynnes: and stich the, mouer castyng them. and we vse this also in woundes of the intestines, and panicles wounded. But this kynde of stichynge, in my opinion is not so good and safe, for that if one stiche breake all the other are losoned.
Then I praye you procede to the thyrde kynde of stichynge, called reseruatiue.
This laste kynde serueth onely to kepe the sydes of the wounde to gether vntyl it be made hole. and is in lyke forme, as other comon stichynges, sauinge that the sides are not so straite drawne to gether, as in other woundes. and is right good in woundes ruptured and torne, and whereas thynges are afterwarde to be taken out, and whan as the wounde must be purged, and this shall suffice touchynge the knowledge of stichynge. ther be other inuentions and wayes of stichyng, which are to be lerned rather be seinge the connynge Chirurgian worke, then by many lynes set out in bookes.
Then I praye you procede to lynimentes and tentes.
Tentes, and lynimentes to be profitable, no man sene in Chirurgerie douteth. but at thys present, it shalbe sufficient to showe whan, howe, and to what endes, they be vsed: and also of what matter they are made, and of ther diuers formes.
I pray you vnto howe many endes doth it serue?
Vnto .viij. sondry vses.
Whiche are they?
Firste we vse tentes to enlarge [Page 50] and ampliate a wounde, or to mundifye the same, and wheras matter and sanies is to be taken oute of deape woundes. Secondlye we are constrayned to vse tentes in profounde and deape woundes, whiche of necessitye requyre a newe regendrynge of fleshe. Thirdlye in woundes whyche through the ayre are altered, and therfore are made fylthy and sanious, and require mundification. Fortlye we muste vse them in contused woundes. Fyftlye the vse of them is ryghte profitable in woundes, that hath inflammation or are any tumour agaynst nature ioyned wyth them. Sextly, in woundes whiche come of bytynge. For suche woundes are not spedelye to be conglutinated: but rather kepte open. for that (yf we beleue Cornelius Celsus) all bytynge dothe participate of venome: and therfore that must be drawen oute, and not kepte in throughe to hastye cicatrizynge of the wounde. Seuenthly, we occupye tentes and lynementes in those woundes, in curynge of whyche we muste handle the bones. Last of all, we vse tentes in olde woundes whyche are digenerated into the nature of vlcers.
Seynge you haue showed to what endes tentes serue: I praye you sette [Page] out the matter and substance wherof they doe consiste.
For the better vnderstandynge hereof it behoueth to consider, for what cause and intention they are made. for some tyme they be vsed to clense and purge the wounde, and then they are made of softe and olde lynnynge clothe, some tyme they are vsed to kepe the wounde open and wyde, and then they are made of stupes cleane & well kempte, or els of coton woll. And for that cause also ther are tenies made of siluer or copper, beinge made holowe, and put into the wounde. as for examples sake, in woundes of the nose, wherby he maye both aptly drawe in the ayer, and also the wounde be purged of suche fylthynes as groweth. Further more whan as we wyll ampliate, and enlarge a wounde, than we make tentes of spongies, or the roote of the gentian. for theis suckynge the moysture in the wounde do therewith swell and waxe bigger, wherby the wounde is inlarged. And as touchynge the forme and figure of tentes, they are made long, shorte, bygge, and litle, accordyng as necessitie require but. yet this is generall, that all tentes be made bygge at the one ende, and lesser euer towarde the other: lesse that they might slyppe into deape woundes. and theis tentes are somtyme dipped in vnguentes, and somtyme put [Page 51] into the wounde or vlcer drye, accordynge as occasion is offred, and this shall suffice, touchynge tentes, ther vse, forme, and matter on whiche they are made.
Boulsters foloweth nexte.
Boulsters called puluilli or plumacioli, are muche profitable and necessarie in woundes: for they compresse the membre diuided, and norishe, and conserue naturall heate, and keape the membre from the wayte and payne of the rollers. and in the olde tyme they vsed to sowe betwyxte two cleane and whight lynnynge clothes, fethers, and so made bolsters, whyche they vsed as is aforesayde. But for because they ware compelled eftsones, & often to alter ther boulsters, beynge weried throughe continuall makynge newe, they inuented to make boulsters of stepes, made with flaxe, somtyme they make theis bolsters of woll or cotton fynly carded, and nowe it is in comon vse to make boulsters of fyne and softe lynnyng clothes thrise or more timner dubled, as necessitye requireth. also manye do make and ordayne boulsters of spongies. of theis boulsters some be applyed wette, and some be vsed drye, and there be for the more parte .vj. kyndes of boulsters.
Whyche are they?
Retentiue, conglutinatiue, expulsiue, restrictiue, confortatiue & conseruatiue. Theis take theis names of ther vse and office. for those bolsters whiche be retentiue serue in wounds, for to stanche blod, being but lytle and smale, and layd on a stupe or splegiant mixyd with the whight of an egge, and some restrictiue medicine. The conglutinatiue bolster serueth to kepe the sydes of greate woundes to gether, after that they be stiched, and the forme of theis boulsters accordynge to Auicenne is threcornord, and so adapted to the member that one of the corners of eyther bolster lay on the wounde. The expulsiue bolster is ordayned to put out matter or sanies in vlcers and woundes, whiche be depe and holowe, and theis be made eyther of lynnynge clothe, or els of spongies. The restrictiue boulster is made of lynnyng clothes dubled twoo or three foulde dypte in wyne or vineger, or other decoction, and so wronge out and layde on eyther syde the wounded parte: and this doeth restrayne the fluxe of humours flowynge to the parte, and kepeth backe inflammation and other accidents, whiche myght infest and grefe the weake membre. and the vse of theis boulsters is ryght profitable in fractured bones or luxations. The confortatiue boulsters serue to conforte and [Page 52] strengthen the weake membre and are diuersly made, some of fyne lynnynge clothes in whyche is sowed fethers, and this is made lyke a twilte, and serueth for the armes or legges to keape them warme, and norishe natural heate. There be also some made of towe, whiche are accustomably vsed in woundes of the heade. Other are made of spongies, dipped in some hotte liquore, or oyle, and after wronge oute and applyed to the ioyntes and coulde partes: the conseruatiue bolster serueth in luxations, to kepe the membre reduced to his natural forme, in the same state. as the shoulder bone being reduced to his wounted seate, we laye a bolster vnder the arme, or as they comonly say in the arme pitte, and theis be the moste notable and vsuall kyndes of boulsters vsed in the arte of chirurgirye.
Yf you in lyke maner make playne vnto me the maner of ligature and rollynges, I shal thynke my selfe satisfyed for this present.
We will fulfil you request, and firste folowynge Auicenne in his fourth fen. of his forth booke, we make .iij. sondry sorts of ligature or rolling, that is to say incarnatiue, expulsiue, and retentiue. the incarnatiue or rather conglutinatiue, is vsed in grene woundes, or fractures. And the roller muste be [Page] rolled vppe one both endes of the same, and the begynnyng of the ligature muste be on the contrarye, or opposite parte of the wounded place, wyndynge the one parte of the roller, towarde the hyegher parte of the membre, the other towarde the lower parte. The breath of the roller muste be suche, as may couer all the wounde, besides some partes of the sounde fleshe. the roller muste be drawen strayter vppon the wounde, then in the other partes. but yet not so straite, as may cause dolour or payne, inflamation and fluxe of humors, and let the endes of the roller be stiched and sowed, and not tyed on a knot. The seconde sorte of rollynge, called expulsiue, is properly vsed in olde and holowe vlcers: and this doeth expell the matter, and filthines gathered in the botome of the vlcer vnto the mouthe and orifice of the same. This is wyth a roller begynnyng at the lower parte of the affected membre, and so makynge the ligature straighte, and so procede to the vpper parte of the membre, makynge your rolling lesser, vntyll you come to the orifice of the vlcer.
Be not offended I praye you, though I seame to breake of your talke, and or you procede further, let me vnderstande what you call the hyer parte of a membre.
I call wyth Galen the hyer [Page 53] parte of a menber that which is most neare the lyuer or hearte.
Then I pray you retourne to youre former talke.
There yet remayneth to speake of the thirde kinde of ligature, whiche is called retentiue, and this onelye dothe serue to kepe on medicines on the wounde, vlcer, or part affected, and in apostemes and other yll dispositions, and this is done with one onely roller beginninge firste on the parte affected, and so prosede according to vse. fasting the roller wyth stichyng, and this kynde of ligature must be done softly, iently not to hard or straight but without doloure or payne, and must be losed whan necessitie doth require. & if that it fortunyth the roler to cleaue faste to the medicine or mēber, take it not away with violence, but wette it so longe with wyne made warme vntill it wil of the one accorde lose and be taken away without griefe or payne, and note, that youre roller be made of fine and softe lynninge clothes, not to muche worne, and vnable to holde, let it be also of that length and breath, that the parte affected doeth require. as for example rollers, for the thigh must be .v. fyngers in latitude. for the arme three fingers brode, for the finger the roller being a finger brode shall suffice, as touching the longitude or lengthe of the roller, it is to be [Page] made as necessitie require, & occasion is offred,
Wel then, seinge that we haue ended this talke of stichyng, tentes, boulsters, stupes, and rollynges, we wyll here conclude for this present. for behoulde the sonne draweth farre west, and the tyme wyll scarse suffice for oure iornye homewarde, and what you heare doe want, you shall fynde in other of my workes. but in our goinge towarde the Citie, let me heare what you haue borne awaye of this dayes talke.
I wil repete in briefe wordes so much as I can remember.
1 Firste whan as I met you in the morning, being in talke of Chirurgirye you shewed me what it was and gaue me therof diuers definitions.
2 Secondlye you proued it to be the thirde parte therapeutike and shewed the antiquitie and worthynes of the same wyth certayne noble princes and capitaines who exercised Chirurgirye.
3 Then you saide that Chirurgirye did consist of two partes, the one being [Page] called the theoryke, the other the pracise.
4 After that you declaryed what was subiectum Chirugiae the thynge on whiche the Churugian doth exercise hys arte and also what was the ende of Chirurgirie.
5 Further you sete out what maner a person he should be that muste learne the arte of Chirurgiry, and what condicions are in hym required, and what the cause was that there is so manye rude Emperikes and vnskylful professours of Chirurgirye.
6 Consequently you did make mencyon of the chefe and mooste necessarye instrumentes where with a Chirurgian oughte to be furnyshed, bothe metalline and medicinall with there proper office and vse.
7 Then you sete out the methode & way to be obserued in learning the art [Page] of Chirurgirye and of the righte vse of instrumentes both metallyne and medicinall.
8 Nexte folowyth such syckenes as fal vnder the hands of the Chirurgian that is to say, tumors againste nature, woundes, vlcers, fractures, and luxations wyth the definitions diuisyons differences, and diuers names of euery of them.
9 After these thynges finyshed, you set oute certayne kyndes of solution of continutye taken out of Galen.
10 Also you sete out the operations of the Chirurgian, which are required in curing the fornamed grefes & what thynges are herein to be obseruyd or fled.
11 Finallye you set oute the arte and maner of styching, tentes, plumacyes, stupes, boulsters, and rollynges: wyth there differencis, substaunce, fygure vse [Page] and comodytye. theys seme to be the argumentes of this daies talke except I be deceyuid.
They be so indede, and now beholde, we be come to the Citie. Wherfore we wyll now leaue of talke here, and you both shall this night take parte of suche cheare as God hath sent me, and let vs recreate oure spi-rites, and be merye I pray you.
I thanke you hartly syr, and I reioyse that my brother Yates haue so firme and perfite a memorye, God sende more suche to folowe Chirurgirye.
I thynke you bothe for the great benefice I haue receyued at your handes. and God graunte me to spende many dayes in this sorte.
AMEN.