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 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 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 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 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, 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 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: 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 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, 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 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.

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 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, 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 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 & 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, 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 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. 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 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, 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 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 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 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 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 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: 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 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 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, 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, 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 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 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 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 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 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.

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 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 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 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. 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 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 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 & 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 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 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 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 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.

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 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 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 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 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 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 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: 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.

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 〈1 page duplicate〉 〈1 page duplicate〉 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 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, 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.

Whiche is as muche in effecte to be vttered in our vſuall language as VVith vvhat thou firſt filſte thy veſſell. Of the ſame longe time it vvyll ſmell.

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 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 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 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?

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.

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 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 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 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.

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 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. 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 〈1 page duplicate〉 〈1 page duplicate〉 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 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?

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 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 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, 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.

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.

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 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 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.

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 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 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 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 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 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. 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 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.

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. 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 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 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.

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 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 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.

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.

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 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 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 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?

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 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 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 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 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 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 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.