CHAP. I. Of Manual Operations in general.

ALthough the word Chirurgery signifies all Manual Operations in general; yet, by reason of its pre-eminence above all the rest, it is now only given to that Art, which endeavours to remove the Di­seases of the Body, by the assistance of the Hands.

'Tis true, that External Accidents require not only the help of the Hands, but also Internal Means; therefore it is no wonder for a Part of Physick to require the whole: Chirurgery being a Part, which depends upon the Body of Phy­sick: But these internal Medicines we impart to you, not as Chirurgeons, but as Physicians.

The General Operations of this Art, to which all the particular ones may be reduced, are of four sorts:

1. Synthesis, which teacheth how to unite parts disjointed.

[Page 2]2. Diaeresis, To separate parts unnaturally joyned.

3. Exaeresis, To remove what is superfluous.

4. Anaplerosis, To supply those that are want­ing.

CHAP. II. Of Synthesis or Ʋnition.

UNition is of two sorts; one regards the Hard and Boney; the other the Soft and Fleshy parts of the Body.

The Unition of Bones is again twofold; the one, setting Bones broken; the other, reducing Bones wrenched or disjointed. We will begin with Fractures.

CHAP. III. Of the Nature, Difference, Signs, Progno­sticks and Cure of Fractures in general.

A Fracture is a Solution of Continuity in the hard parts of the Body, caused by an hard Instru­ment externally forced upon the part.

The Differences are taken, 1. From the Man­ner; there being some transverse, which are pro­perly called Fractures; others that are made ac­cording to the length of the Bone, called Fissures: and others are Comminutions, when the Bone is [Page 3] broken into many small parts. 2. From the Part, it being some times in the Head, sometimes in the Shoulders, Ribs, Arms, Legs, &c. 3. From the Accidents; there being sometimes a Wound accompanying it; at other times, a Dislocation, Inflamation, Gangrene, &c.

Cause] is, Whatever is able to break, bruise, or cut: Sometimes also a Bone corrupted by the Pox, Gout, or otherwise, hath been broken without any external force.

Signs.] A Bone being transversly or oblique­ly broke, by handling it, you perceive an ine­quality; the Patient is scarce able to move the Part affected, and sometimes that Part is short­er than the other; the Thigh, Leg or Foot be­ing broken, the Patient cannot stand at all; but he may somewhat, though with pain, in a Dis­location: And this is the surest difference be­tween a Fracture and a Dislocation. A Fissure is discerned by the thickness, pain and uneven­ness of the Part, and requireth the judgment of a skilful Chirurgion. A Comminution is easie to be perceived, the Bone being very unequal, and here and there yielding to the Fingers.

Prognosticks] A Transverse Fracture is more ea­sie to cure than an Oblique; or when accompa­nied with apparent Inequalities; that, where but one Bone is broken, than where two are, or where the Bones are much shattered; that, which [...]s made in the midst of the Bone, than what hap­pens to be near the Head; and a single one, than a compound. If the Patient remain undressed be­yond the seventh day, the Member is in danger of mortifying, especially if that the Part be too [...]ard bound.

[Page 4]The Cure.] A broken Bone requires these four Operations; Extention, Conjoining, Ligature, Well-placing; and withal, the application of out­ward and inward Remedies.

Extention can hardly be performed without pain; which yet will be much less, if the Mem­ber be so extended, that the Muscles do not la­bour; that is to say, The Part must be so laid, that when in health, they could hold out longest without tiring. Sometimes the extension must be greater, sometimes lesser; which will be performed aright, if regard be had to the time of the Fracture, to the Age of the Patient, and to the greatness of the Bone. A recent Fracture, a tender Patient, a small Bone, require a gentler Extention: on the contrary, an old Fracture, a strong Patient, and a big Bone, a greater. The manner of extending I describe not, because it is better learnt by the frequent view of Practice, than by Reading.

After Extention, you are to join the Bones to­gether; in the doing of which, the Muscles must not be wrested, but retain their natural position and figure.

Then the Part must be bound with a double Rowler; the first is to be rowled thrice about the Fracture, and then upwards. The (second (which must be twice as long) is to be once wound about the Fracture, proceeding down­wards, and then upwards again, a little higher than the first Rowler; to which you will give more firmness, if you bind some convenient Splints (of Wood, or rather of Past-board) round about the Member.

The Ligature ought not to be too strait, lest it [Page 5] cause pain, and rob the Part of its nourishment; nor too loose, lest the Bones slip out of their place. And unless great pain, or other symp­toms require, it must not be opened before the third day; and at the second dressing, it must be bound somewhat closer; and after­wards changed but once every four, five or six dayes.

Lastly, The Part ought to be well placed, that is, softly, evenly, and a little raised. If you lay it too low, the Bone will bend outwards; if too high, it will bend inwards: Wherefore you must observe a mean.

Now, whether these four Operations have been duly performed, may be known by the ensuing Signs.

The Extention is well done, if the part be strait, and as long as its fellow; if it appear to outward view every where even, and a little hollow about the Fracture.

The joining together is duly made, if the Bone be any thing firm, and all about the Fracture be found equal.

The Ligature is as it ought to be, if the Pa­tient, as soon as he is dressed, find the pain aba­ted; if the pain do somewhat encrease the first and second night, and there be perceived the third day, without the place of binding, a little swelling yielding to your hands.

The Bone is well placed, if in the second dres­sing you find all even.

Before you rowl the Ligature about the Member, bathe the part with Spirit of Wine or Red Wine; or, with Oyl, Wine and Vinegar mix'd together; Or, take the White of an Egg, [Page 6] with some Bolus, Frankincense, Dragons-Blood, &c. Or anoint it with Oyl of Roses, Mirtles, Violets, &c. or lay Plaisters on it. In Winter, the Oxycroceum will do well: At all times that which follows;

Take Mastick, Frankincense, of each two drams, Aloes, Gum Tragacanth, Dragons-Blood, Bole-Armonick, of each a one dram; Lapis Haematitis, Burnt Talch, of each one dram; Whites of Eggs, and Oyl of Roses, as much as is sufficient. Make it into a Plaister.

If a Wound accompany the Fracture, then ought you to extend the Part first (yet some­what gentler than in a simple Fracture) then you are to join the Bones together; next, to observe the Wound, to bring the Lips thereof together with Plaisters, rather than with a Nee­dle, and to guard it with a Defensive: And last­ly, rowl the Part, and lay it conveniently.

If there be a Cominution, or great shattering of the Bones joined with the Wound, then endea­vour with Forceps to remove the small loose Bones, leaving those to Nature that are yet any way fixed; for she will, though somewhat later, of her self throw them out; and sometimes she will unite them again to the whole. Yet, to forward her, you may assist Nature with the following Medicaments.

Take Ashes of Earth-worms, three drams; Virgins-Honey, an ounce and half, mix them, and make an Oyntment.

Or,

Take Aloes, Myrrhe, of each half a dram; Roots of Comfrey the great, Round-Birthwort, of each three drams, Euphorbium, two drams; [Page 7] Turpentine and Wax, as much as is sufficient, with a little Oyl of Lillies, to make it into an Oyntment.

If the Bone be bare, cover it with its own skin and Nuscles, and defend it from the Air as much as is possible.

If it be bare and also started out, endeavour to reduce it again into its place; but if it be got out too far, take away the pieces thus started out, with Saw or Nippers.

Now these Manual Operations being well per­formed, the Patient must observe a good Diet; open a Vein upon occasion, and afterwards purge the Blood. In the Fractures of the lower parts, purging is not convenient; but if the Patients Belly be bound, he must take a Suppository.

In the Fractures of the upper parts, Purging or administring Clysters, is oftner necessary, and may be done by the ensuing compounded or simple Medicines, which may also serve you in all other Accidents that we may describe in this whole Treatise.

CHAP IV. Of particular Fractures of Bones.

THe Fractures of the Skull are divided into six several kinds; A Fissure, Contusion, Fra­cture, Incision, Puncture and Contra fissure.

A Fissure is made by a hard and blunt Instru­ment, and passeth sometimes through both Ta­bles, sometimes through one only.

A Contusion is made, when by a hard and blunt Instrument the Skull is so hurt, that it appears whole from without, but yet is sever'd from the [Page]

[Page] [Page 11] whole within: Which yet in little Children may be done without a Fracture.

A Fracture is made, when a part of the Skull is separated from the whole.

An Incision is made by a cutting Instrument; where sometimes one part of the Bone is rais'd up and separated, as it were, but is yet fast to the rest of the Bone; sometimes a part is quite taken away; sometimes there remains a mark in the Bone according to the Figure of the Instrument.

A Puncture is made by a pungent or thrusting Instrument, and seldom passeth through both Tables.

A Contra-fissure is made, when the part struck remaining whole, the opposite part is cleft.

The Signs are, Swimming of the Head, dim­ness of the Eyes, Vomiting, Bleeding at the Mouth, Nose and Ears. The Patient grows dumb, and suddenly falls to the ground: whereupon follows Raving, a Feaver, Convulsions, Palsie. Any hard thing, as a piece of Wood, a Spoon, &c. being put into his Mouth, he is not at all, or hardly able to bite upon it. Here it must also be carefully enquired, in what manner, and with what Instrument he hath been hurt? Whe­ther he be young or old, tender or strong, heal­thy or unhealthy? Presently after the Fall or Stroke, before the Part swells, you may some­times feel the hurt with your Fingers; and if there be a Wound with it, you may either see it, or find it out with a Probe.

Prognosticks.] The Fractures of the Skull, how fair soever they may look, is never without dan­ger, but more dangerous, when both the Ta­bles are hurt or broken; and more dangerous [Page 12] yet, if the Dura Mater, and most dangerous, if the Pia Mater be also hurt. The more Sym­ptoms there are, the less hope of a good event. If the Bone grow black in the beginning, that is a mortal Sign.

Cure.] If the Skin be yet whole, or the wound not large enough, make a cross incision, and di­vide the Pericranium. If under it you find a fis­sure, put some Ink into it, and bind up the wound. The second day, or as soon as the bleeding is ceased, scrape the Skull at once, or at several times, until the Ink with the Fissure is altoge­ther gone, and the Bone grow somewhat bloo­dy, then throw the ensuing Powder upon it.

Take Dragons Blood, burnt Harts-horn, of each one dram and half; Myrrhe half a dram; Frankincense, and Orrise roots, of each a dram; Make it into a very fine Powder.

If the Fissure pass through both Tables, then are you to make use of Trepanning; as likewise in the Contra-fissure, Fracture and Contusion of the Skull, or else you will quickly lose your Pati­ent.

The Incision is healed like the Fissure.

In the Puncture you must put the Trepan just in the middle, and not on the sides of the place hurt.

If you find a Fracture with a Cominution, then take out all the small loose Bones, commit­ting to Nature those that are yet fast to the Peri­cranium, or cannot be taken away without force. And then if the Fracture be so large, that you can free the Brains from the coagulated or corrupted Blood, or from the pricking Bones, Trepanning will be needless; but if it should happen other­wise, [Page 13] you must, with great care, apply the Tre­pan, unless the Patient be strong, and the mat­ter very little. The manner of Trepanning will be taught in another place.

2. In a Fracture of the Nose, what is raised, is to be pressed down; and what is pressed in­ward, to be raised with a Spatule, or other In­strument: afterwards a Pipe or Quill is to be put up, and continually kept there, till the Cure be done, and a Fracture-Plaister is to be laid on without. If the Bone be not corrupted, it will be healed in ten or twelve days.

3. A broken Jaw-bone is restored by ones fin­gers used both within and without the Mouth; and if those be too weak, then one is to draw the Head backward, and the Chirurgeon for­ward, and so to put it in. It is cured in twenty days.

4. The Clavicle being broken, there must be one to draw the Arm backward, and another to draw the Neck or Shoulder forward; the Chi­rurgeon himself, in the mean time, drawing up­wards what was fallen down, and downwards what was raised too high. If a Ball be put into the Arm-pit, and the Elbow be pressed against the Ribs, the Operation will prove more easie. It is cured in twenty four days.

5. If the Shoulder-Blade be broken about the place where it is united to the Arm, then is the hurt for the most part incurable. If it break in the Acromion (which may be easily felt) then let the Arm or Shoulder be pulled down, either with Hands or Ligatures, and in the mean time set it in. If it be broken into several pieces, make an Inci­sion, and take them out, unless they be yet fast to the Peri-estium; in which case, you must leave [Page 14] Nature to her self, which will either make them unite again, or throw them out. It is healed in forty days.

6. The Sternum, or Breast-bone happens ei­ther to be broken, and then you'll find an uneven­ness, which being toucht, will yield to the Fin­gers, and cause some cracking; or to be pressed in, and then you'll feel a bending inwards, which will cause pain, a short breath, coughing and spitting blood. To restore the same, lay the Pa­tient on his Back upon a great stone, pressing both his Shoulders downwards; then press the Ribs backward and forward, until the Bone be reduced again in its right place. This is cured in twenty days.

7. A simple Fracture of the Ribs, which is without any great Contusion, or Inflamation of the neighbouring parts, may be healed in twen­ty days, applying the Fracture-Plaister. If the Ribs stand out, they must with ones Hand be pressed in. If they bend inward, let the Patient keep in his Breath, and so press the Rib outward; in the mean time, assisting him with your hand. If that succeed not, then lay a sticking Plaister upon it, and pull the same off so often, until the Rib return into its place. Cupping-Glasses here are of no use.

8. A simple Fracture of the Joynts of the Back­bone is easily set again with ones finger, and is made whole in twenty days. But if the Marrow of the Back-bone be so hurt or pressed in, that the Arms or Legs of the Patient become lame or senseless, that he cannot retain his Urine, or his Excrement, then he seldom escapeth death. Yet you are to do your utmost; and if one or more [Page 15] small Bones be altogether loose from the Peri­ostium, then make Incision, and take them out.

9. The same is to be understood of the Fra­cture of the Os sacrum, which alone hath this peculiar, that you may put your fingers into the Anus, and restore it to its right place.

10. The Hip-bone being broken, is to be set as soon as possible may be, and then it will heal in twenty four days; otherwise you may expect various accidents. But if it be fractured into ma­ny pieces, then you are forthwith, in the first dressing, to make an Incision; take out the small Splinters, and re-place those that have yet any hold-fast. Yet, by reason of the multi­tude of the Tendons, Muscles, Veins, Arteries and Nerves, that are spread over the whole part, such an Incision cannot be made without great danger.

11. If the upper-Bone of the Arm be broken, first bend the Elbow toward the Breast, then take the lower part of that Bone close to the Elbow, pulling it straight down towards the ground, and so restore it; well observing here, that the Arm, during the whole time of Cure, must re­main in that posture in which it was extended; otherwise the Fracture will, upon the least change of its posture, slip out again. Where yet 'tis to be understood, that the Chirurgeon after the se­cond or third dressing, as often as after that he dresseth the Patient, must stretch out his Arm strait, to the end that the Tendons which run from the Arm, and are inserted below the El­bow, shrinking by the long lying still, may not cause a troublesome stiffness. However, this shrinking of Tendons (which are by pretenders to [Page 16] Chirurgery, ridiculously call'd Nerves) may yet conveniently be cured in two or three months, if you make the Patient to carry every day some weight, and endeavor to relax and mollifie the Tendons with Fomentations and Embrocations, abstaining from the use of any Brandy, or any other corroborating and astringent Medicines. I have always found successful the following Unguent.

Take Man's and Duck's Grease, of each one ounce; Oyntment of Marsh-mallows, half an ounce; Oyl of Earth-worms, white Lilly, and Ca­momile, of each two drams. Make an Oyntment.

This broken Bone is cured in forty days. The restoring of the broken Thigh-bone, hath no­thing different from this.

12. The Elbow hath two Bones; of which, the greater is called Radius, the lesser Ulna; both Fociles: The small Focile being broken, 'tis easie to restore it. The Cure is harder, when the great one is broken; and yet harder, when both are broken: In which case, the extention is to be made the stronger. When they be well set, and bound up, then must the hand be placed a little higher upon the Chest than the Elbow; and after­wards, every second or third day (without pain or violence) the Arm is gently to be stretch'd out, to the end that the Humors flowing thither, and there staying too long, may not cause a concreti­on in the Bones, and a stiffness in the Arm, as not extensible any more. It is cured in thirty days.

13. The Leg hath also two Bones, the greater called Tibia, and the lesser Fibula. Their Cure had nothing different from the next foregoing.

14. If the Patella, or Knee-pan, break cross­ways, [Page 17] the Patient commonly remains lame. If it break long-ways, then by the Muscles that draw upwards, without any great help of the hands, it is almost of it self restored, and cu­red in twenty days.

CHAP. V. Of the Nature, Difference, Signs, Causes, Prognosticks, and Cure of Dislocations in general.

A Dislocation is a forcing of the Bone out of its cavity and natural place into another, hinder­ing voluntary motion.

The Differences are taken, 1. From the man­ner; for sometimes the Bone is altogether forced out of its place, and that is properly called Lux­ation or Dislocation: Sometimes it is got out but a little or half, which is called Sub-laxation, or Elongation. 2. From the Cause; for sometimes it is from an external accident, as by wrestlings, Falls, or Blows, &c. Sometimes from internal Causes, by the afflux of Humors.

The Causes are of two sorts; 1. External, Such as are Falling, Beating, Running, Wrestling, and vehement extention, as it often happens to Women in Labour, through the unskilfulness of Midwives; yea, by a violent stroke or fall, even the Bones of the Infant in the Womb, may be dis­located. 2. Internal, By the afflux of Humors, which falling into the Joints, relax and resolve the Ligaments, and so causeth the Bones to slip out of their places.

[Page 18]The Signs, especially in a lean Body, are mani­fest enough. The Bone causeth in the place to which it is forced, a tumor or rising; and in that whence it is forced, a cavity. If there be a perfect Dislocation, the Member will be drawn up, and shorter (unless the luxation happen by the laxity of the Ligaments, than it becomes longer) the part is painful, chiefly upon motion. In a Subluxa­tion, these Accidents are lesser, and seldom all together.

Prognosticks.] In Children and other tender Bodies, the Bones may be reduced more easily; but are kept in with more difficulty; the contra­ry happens in strong and full grown persons: The Dislocation of the Head is mortal, that of the Vertebra's dangerous; and that which is inve­terate is hard to be cured. That which proceeds from an inward Cause, is of a slower Cure, and does easily return.

Cure.] The Bone forced out, must be reduced to its place, either by the Hands, Ligatures, or Instruments; but by which of these three it shall be performed, the Nature of the affected part will declare. 'Tis certain, that these four Manual Operations ( Extention, Setting, Binding and Well-placing) must here be used as well as in Fractures of Bones.

Extention must be made so great, that there may be a cavity between the Bone that remains well, and that which hath been forced away, to the end that in the setting, the one may not rub against the other; whence afterwards are wont to rise very grievious, and sometimes incurable Ac­cidents.

In the Setting, care must be had not to wrest the [Page 19] Bones nor the Muscles, but to keep their natu­ral figure. Before you proceed to binding up the Member, endeavour to preserve the part from inflammation and flux of Humors, and strengthen it with the following Medicines.

CHAP. VI. Of particular Dislocations.

1. THe Jaw-bone, except it be in young Chil­dren, can hardly be dislocated otherwise than forwards. Sometimes it is only dislocated in one side, and is easily restored; sometimes in both, in which case it is difficult to set, and very dangerous, and often mortal.

It is very seldom luxated from a debility of the Muscles; sometimes from the laxity of the Liga­ments; for the most part, from a too wide open­ing of the Mouth. If it be dislocated but on one side, it stands a-skew, and is turned towards the side hurt; some thing is prominent, the Teeth stand not directly under one another, nor can they be brought together, so that the Mouth re­mains open. You must draw it towards the opposite side, and reduce it to its place, which is not hard to do; yea, by a stiff box on the Ear it hath often been restored.

[Page 21]If it be dislocated on both sides, then does it fall forwards, the Mouth stands open, both the Apophyses are prominent, the lower Teeth stand further than the upper, and the temporal Muscles are distended. In this case, let yout Servant hold the Patient's Head firm, or hold it against a Wall; draw the Jaw-bone first downward, putting both your Thumbs in the Mouth, then backward, and lastly upward.

2. The Collar-bone rarely happens to be luxa­ted, and is seldom set, but it stands somewhat out; whereby it often comes to pass, that the Patient cannot lift up his hand to his mouth, much less to his head. For restoring it, you are to lay the Patient on his back, and a stone under his shoulder; then you must draw his Arm for­ward and backward, as the Dislocation requires; then press the Clavicle, so raised, down into its place.

3. The Great Bone of the Arm (Adjutorium) is never dislocated backward; seldom upwards and forwards, but for the most part downward: a certain sign of it is, if you find it roundish hardness under the Arm-pits, and on the top of the Shoulder a hollowness, and the Arm be longer, and the Patient cannot bring his hand to his Mouth. It may be reduced several ways; but these are the most convenient, and the most sure. 1. Let a strong man hold the Patient fast about the hurt Shoulder, and let another draw the Arm downwards; then lift the upper part of the Arm into its Cavity, and the Bone will be soon restored into its place. 2. Take a strong Ladder, at the foot thereof put a [...]tool for the Patient to stand upon; on the up­permost [Page 22] step, bind something round that may just fit the Arm-pits; put the Patients Arm upon it, and draw it downward, moving the Shoul­der-bone to and fro; let your Servant, mean while, draw the sound Arm downward, and withal, thrust away the Stool from under the Patient, that whilst he is thus pendulous, the Shoulder-bone may be restored. 3. Lay the Arm­pits of the Patient upon the Shoulder of a strong and taller man than himself; draw the disloca­ted Arm downward, so that he lifting up his own Shoulder, the Patient may remain in a pen­dulous posture: In the mean time, press his Shoul­der downward, working the Arm to and fro, un­til it be restored to its due place. 4. The Glossoc [...] ­mium described by Hyppocrates, and approved by Paraeus, is the most convenient of all; to be seen in the Authors themselves.

4. If the Vertebrae of the Neck be out of joint, the Patient is to be set upon a little low Stool, and his Shoulders pressed downward. Af­ter this, his Head is to be lifted up with both hands, turning it to and fro (yet with as little force as may be) and thus they are to be reduced. Whereupon the Patient will presently find himself at ease, and turn his head whithe [...] he pleaseth.

5. If the Vertebrae of the Back be forced outwards, the Patient is to be laid upon his Belly and by two Men and two Ligatures, one tied under the Arm-pits, the other about the Hip he must be strongly stretched out, and the Ve [...] tebroe's be thrust in again. If they be forced i [...] wards, it is mortal.

6. If the Os sacrum be out of joint, put you [...] [Page 23] fingers into the Anus, and press it from within as well as from without, into its place.

7. A Rib dislocated, must not remain long out of its place, lest more grievous Accidents follow. If it be removed out of its Vertebra upwards, then hang the Patient by his Arms over a Door, and so press it in. If it be out of joint downward, the Patient must bend himself, laying his hands upon his Knees, and the Chirurgeon in the mean time, must move to and again the displaced Rib till it be restored to its right place. If it be dislocated inward, lay a sticking Plaister on it, and often pull it away with violence; and thus sometimes it may be restored; if not, it often proveth mortal, not being capable to be reduced by the Hands.

8. The Cubitus may be dislocated forward or backward, inward or outward. And sometimes the Radius is likewise dislocated with it, sometimes it remains in its place; which by handling the part, is easily perceived. If the Cubitus be out forwards, the Arm thereby becomes shorter, & cannot be bent; the Bone stands out forwards, and behind there is a preternatural hallowness. The forced­out Bone must, as well in this, as in all other kinds of dislocation of the Elbow, be speedily re­stored; otherwise there will follow grievous Pain, Inflammation, Feaver, Vomiting of Choler, and sometimes Death it self. Let the Arm be extend­ed obliquely, and so far, that one Bone may not hurt the other in the setting. If the Hands be not strong enough, then bend the dislocated Arm about a Pillar or a Bed-post, and by the help of a Bandage extend it, pressing the Bone backward, until it be replaced. If it be dislocated back-ward, the Arm will then also be shorter, and [Page 24] cannot be bent, the Bone will stand out behind; and before there is a preternatural cavity. If it be inward or outward, there are the like signs; only the Tumor will be in the place, to which the Bone hath been forced; whereas the hollow­ness is there, whence it hath been forced. All these three dislocations may be easily cured by a convenient Extention, if they be not invete­rate. The same is to be understood of the Ra­dius, when forced out of its place.

9. The Hip may be put out of joint four man­ner of ways chiefly; inward, outward and for­ward, but seldom backward. If inward, the Leg is longer, and moveth with difficulty; the Knee is turned outward, and the head of the Thigh-bone by the hands may be perceiv'd in the Groin. As it is difficult to put in, so easily doth it slip out again, whereby the Part affected is wasted, and the Patient lamed. To reduce it to its place, lay the Patient upon the midst of a Bench or Table; between his Legs put a strong stick, wound about with Linnen, and upon it let him stifly stretch out his Leg, and the Chirurgeon in the mean time with his hands set it. If outwardly dislocated, the Leg grows shorter, and the Foot is turned inwards. The Patient can then indeed bend his Leg, but hardly bring it to the ground. Though it be not set aright, yet the pain vanisheth of it self, and the Patient in time is able to go with­out Crutches. Lay him on a Bench or Table as above; let the Leg be strongly extended, either with hands or Bandage, and mean while reduce it into its place. If the Hip be forced out for­ward, the Groin is swoln, and the Buttocks fal­len, the Leg is neither longer nor shorter, nor [Page 25] cannot be bent but with trouble; and the Urine is suppressed. Though it be not set aright, yet the Patient in time will be able to go well enough upon it; though sometimes it falls out, that he must somewhat trail his Leg after him. To restore it, let the Patient lie on his sound side, and strongly stretch out his Leg, press it into its former place; and in case the hand be too weak, thrust it in with your Knee. If it be dislocated backward, the Patient can neither stretch out, nor bend his Leg, nor is he able to bring his Heel to the ground, and if he should force himself to do so, he would fall backward; the Leg is shorter, there is a hol­lowless in the Groins, and if the Buttocks be pressed upwards, you shall find an unusual swel­ling. Though it be not put in, yet the pain will in time vanish, and then the Leg may be bent again, but it remains shorter and straight, nor is the Foot turned inward nor outward. Lay the Patient on his Belly, and strongly extend his Leg; mean time apprehend the Thigh bone a­bove the Knee; stretch it outward from off the sound Leg; press the Head into its Cavity, in which yet it will not stay, if thenceforth the Patient do not keep himself very quiet.

10. The Dislocations of the Tibia and Fibu­la, are cured after the same manner as those of the Cubitus and Radius.

11. If the Knee pan be out of its place, let the Patient stand upright, and press it in again; lay on the side whence it hath been forced away, a hollow Splint, answerable to the shape of the said Pan, and below in the cavity of the Leg, put one or more compressing Splints, binding the whole Leg so stiff, that the Knee may not bend.

CHAP. VII. Of Ruptures.

HAving thus roughly handled the boney and hard parts of the Body, it now follows, that I treat the soft and fleshie more gently, and describe their Synthesis or re-unition again. There­fore I begin with the broken Peritonaeum, which sometimes gives way to the Intestines, at other times to the Cawl, and not seldom to both, to get out of their natural place into the Groins or Scrotum, there causing a Rupture called Entorocele, or Hernia Intestinalis, if the Guts come out; an Epiplocele, or Hernia Omentalis, if the Omentum or Cawl be out.

The Peritonaeum is made up of two strong, but soft Membranes, which do so contain whatsoever is included in the Belly or lowest Cavity, that when sound, nothing can fall out. In Women, the Os Pubis is its utmost Limit. In Men, its outer­most Membrane reaches farther; and consti­tutes the first proper Coat of the Testicles. In the Groins, it comprehends the Seminal Vessels as in a Sheath, called Processus, or Productio Peritonaei. This being stretch'd, or enlarged, or coming to burst, is the proximate cause to the lately men­tioned Ruptures. The Groins therefore are the usual places of Ruptures: But do not imagine, that the Peritonoeum cannot be distended or burst in other places, and there to cause a Rupture. It happens sometimes above the Navel, yet sel­dom: Beneath, and on the side of the Navel, far [Page 27] above the Groins, I have not only seen it often, with many others, but seen it ordered and dres­sed just like an Abscess; the Chirurgeon giving no other reason for his mistake, than that it was not the place of Ruptures; which those that love the Art and their own Honour, may take notice of.

Most times the Ileon falls down, yet sometimes the other Guts come out with it, and fall into the Scrotum; which cannot come to pass by a simple distention of the abovesaid process, but that neces­sarily in all such great Ruptures it must be broken.

The Causes which make the Peritonaeum to burst or to dilate, are Falling, Leaping, Blows, bearing of heavy Burdens, strong Vomiting or Coughing, difficult going to Stool, Winds re­tained, and all vehement Motions of the Body.

Signs.] The Tumor is sometimes bigger, some­times lesser, sometimes altogether vanisht, but with the least Motion returning. Though the Caul or Intestines should be fallen down never so much, they may easily, without any pain, be thrust in again, unless Wind or Excrement hin­der it, in which case the Rupture is very painful.

If the Intestines be full of Wind, the whole bel­ly is tense; you may hear a noise, and the Patient breaks Wind upwards and downwards. If the Excrements be grown hard, the Patient goes with difficulty to Stool, and the swelling, weight and hardness, little by little encreaseth. If the Peritonaeum be only relaxed and widened, then the Tumor from little becomes bigger by de­grees; but if it be broken, it suddenly descends.

Prognosticks.] In little Children, Ruptures are easily cured; in aged people, slowly or not at all, especially if the Peritonaeum be burst. If [Page 28] the Intestines be filled with Wind or Excre­ments, there follows pain; and if that be not suddenly removed, an Inflamation, Gangrene, and at last Death it self.

Cure.] Lay the Patient on his Back with his Legs on high, and a little asunder, by which it often comes to pass, that the Caul or the Inte­stines return of themselves into their former place; but that not happening, press them in gently with your fingers. And if you cannot ef­fect this, by reason of Wind or hardened Ex­crements, then use the following Medicines.

CHAP. VIII. Of the falling down of the Matrix.

THe Matrix does not easily fall down by Re­laxation, much less by Laceration of her broad Ligaments, as most Writers imagin; from hard Labour, or by an indiscreet drawing away of the Secundine. Others with me have seen, that the bottom of the Matrix hath been plainly inver­ted in pudendis, so that the inward part shewed it self as the outward. We have also found (espe­cially in those that were subject to Costiveness or Belly-ach) that the membranes of the Puden­da were so far stretcht out, that the unskilful have taken it for the Matrix it self, and do so still. For though many Authors have dared to write, that the Womb may be cut out without danger of life, seems altogether impossible to a skilful Anatomist.

To cure this Disease, lay the Patient on her back, with her Knees on high, and Legs asunder; then take a Wax-Candle of a competent thick­ness, mix therewith some Castoreum or Assa Foeti­da, and with it gently press the Womb inward, and having sastened the Candle with a Bandage, [Page 35] apply outwardly to the Belly the Emplastrum Barbarum, or the following:

Take the Roots of Cyprus, Bistort, of each a dram; Galls, Acacia, of each half a dram: Cy­press-Nuts, Date-stones, Myrtle-Berries, of each one dram; Pitch and Colophony, as much as sufficeth to make it into a Plaister.

Then presently enjoyn the Patient to lie still, with the Legs cross, and to beware of speaking aloud, of scolding, and of whatever may occa­sion coughing or sneezing.

Here great care is to be had, that your Wax-Candle be not too thick, to the end that by its con­tinual friction it may not cause Fluorem Album, whereby the strength of the Body would certain­ly come to decay. Yet because ev'n by the greatest care and circumspection, this inconvenience will hardly be altogether or always prevented; there­fore those do very well and discreetly, that long­ways perforat the Candle, and thereby give a con­venient passage for the humors flowing that way.

CHAP. IX. Of the falling down of the Fundament.

IF the Gut be sunk down, anoint it with Oyl of Rose and Myrtle, mixing a little Powder of Galls amongst it, and with your Fingers and a small Linnen-Rag, put it in. If an Inflamation hinder the reducing it, then bathe the Anus with these Medicines,

Take Flowers of Elder, Camomile, and St. [Page 36] John's-wort, of each a handful; Red Roses, rwo Pugils; the tops of Wormwood and Meli­lot, of each half a handful: Boil therein Milk and Red Wine, and bathe the part.

Here especially care is to be had, that no ex­ternal cold may come to the fallen-out Anus; for then you may sooner than you are aware of, be surprized with a Gangreen. Wherefore do your utmost to put it in again with speed; and in the mean time, endeavor with the above prescrib'd Bathing and warm Linnen Rags, to preserve its natural heat.

There is yet another, though in appearance ridiculous, yet in reality a good way of reducing the Gut. With a strong hand strike five or six times the Patient's Buttocks, and thereby the Muscles, called Ani levatores, will presently draw the Anus into its right place again. But before the Patient be thus chastized, take care that the Gut may first be anointed with Oyl of Roses, or of Myrtle.

CHAP X. Of the second Operation called Diaeresis, or the seperation of what was united together.

HItherto we have joined together again what had been disjoined; now it follows, that we separate what is united, and treat of the second Manual Operation, called Diaeresis, which teach­eth us the manner of Cutting and Burning, and that both in the hard and soft parts of the Body.

[Page 37]In the soft, the Cutting is called Incision. In the hard, it is performed four manner of ways: By Terebration or Perforation; by Rasion or Scra­ping; by Limation, or Filing; by Serration, or Sawing. Burning is done either by an Iron (which is the Actual Cautery) or by Medicaments (cal­led the Potential Cautery) as shall be declared particularly hereafter.

CHAP. XI. Of opening a Vein.

BLeeding (one of the greatest Remedies in the Art of Physick) is sometimes highly neces­sary, but sometimes so dangerous, that it ought not to be used without very urgent Causes. Here therefore I think it will be better somewhat to digress for fuller information, than to leave the unskilful in their error.

The Blood is the darling of Nature, by whose assistance she performeth all her Operations, and which can hardly be drawn from her with­out dammage; yet does Art require, that those who meddle with it, being neither venturous nor timorous, but discreet and couragious, and making out of necessity a virtue, do sometimes proceed to the opening a Vein; yet for no other than these four following causes.

1. In a Plethora, or super-abundance of blood, that by this means Nature may be eased of her too heavy burden, and the innate heat preser­ved from suffocation.

[Page 38]2. For Revulsion-sake, when the blood and the (therein) mingled humors, by flowing too plentifully to this or that part, hinder the Cure: Here you are always to chuse a Vein of the op­posite side, and that sometimes the farthest di­stant, sometimes the nearest.

3. For the Derivation or conveyance of the Blood (which is already got into the part, but is not yet altogether setled there, nor extravasated) into another place; in which case a Vein is to be opened the nearest to the Part.

4. For Refrigeration, when the heat of the Blood is so excessive, that it cannot be allayed by cooling Medicines, or not time enough.

These limits are too narrow for some, who will needs take into those a fifth cause, which they make the Corruption of the Blood, held by them to be as great an inducement for bleeding as any of the four by us recited; to the end, say they, that Nature being rid of part of what is corrupt, may be the better able to correct what remains.

But I much wish, 1. That they could make this discharge without the loss of that strength which is so highly necessary. 2. That they would be pre­sent when their Patient is to bleed, and precisely tell to what degree of corruption his blood is come, that so the Chirurgeon may know how much of it he is to take, and how often; forasmuch as they will not allow, that Bleeding is good in all sorts of the Blood's corruption, but in that only which is not gone considerably far. 3. That they would declare, why they will have cur'd the greater cor­ruption by Purging, and the lesser by Bleeding, since that they give to the one as well as to the o­ther (and that duly) the name of Cacho-Chimia. [Page 39] Let them shew, that things differing only secun­dum Majus & Minus, do differ in specie, and so require specifically different Remedies.

Others proceed yet further, and shed innocent Blood in all sorts of Fevers, without any consi­deration of spots of the Plague, or of Poison it self; thus freeing themselves from a great deal of labor and trouble, otherwise caus'd to the Physitian from the variety of Fevers. But because the nature of all Poyson and Malignant Humors is continually to assault the Heart, and suddenly to prostrate the strength of the strongest Persons; and since Blee­ding doth likewise both, not only diminishing strength, but also drawing the malignity toward the Heart, and driving in again, for the oppression of Nature, what she had thrown out for her relief: I do intreat and warn all the Practisers of our Art, That as they love the quiet of their Mind, and the good of their Patients, they would beware of bleeding in Pestilential and other Malignant Fevers; as also in all cases that may befal People by Poyson, either inward or outward.

The French, Italians, Spaniards and Portugueses (great Blood-letters) will, I expect, tell me; That Nature, when by bleeding she hath vent, and is somewhat discharg'd, shall be better able to throw out the remaining Evil. And this seems to be true, for the blood indeed receives Air, that the Spirits may the better flie away, and is robb'd of that strength which it so necessarily wants; whereup­on Nature exchangeth the Life of the Patient for death, and extorts tears from the By-standers.

Without alledging other Reasons, they ground themselves upon Experience. And it were to be wished they had that ground indeed; for we find [Page 40] such Patients of theirs, who in the morning were in no danger, even after but the taking away of five or six ounces of Blood, to be cold and stiff at night. Whence it may easily be collected, what it is they call Experience, viz. If the Patient by chance escape death, then Bleeding must have the honor of it; but if he die, as for the most part, then the malignity of the Disease was the cause of it. Wherefore I alledge Experience against Ex­perience, and praise God Almighty, that he hath vouchsafed to furnish all those, who without en­vy, passion, or slavish dependance upon others, will duly consider Diseases with surer means.

The more moderate sort of them would have Bleeding only administred in the beginning of the Disease, and before the Malignity appears out­wardly. This I shall willingly allow them; 1. In very hot Countreys. 2. In a Plethorick Body. 3. If the humors flying to the head, cause any grie­vous symptoms there; in which case, bleeding in the Hand or Foot may be, I think, very bene­ficial. Otherwise those that use it in all bodies, and without distinction in these cold and moist parts, will find the ill effects of it, and be puz­led withal to give a reason for their Practice, allowable by Art; the rather because, by their own confession, they dare not use this their Dar­ling of Bleeding at certain times, but find them­selves best in the use of Sudorificks and cooling Drinks. But enough of this.

Now how many Ounces of Blood ought to be taken at once; the degree of the Disease, and the Patients more or less strength, will indicate. And 'tis better too little than too much. I have never taken more from the strongest and most plethoric [Page 41] Person under my Cure, than twelve ounces at once, chusing rather, in case of need, to let out twenty ounces at two times, than fifteen at once; of which method I have found good success.

As to the season of the year, and the hour of the day, little regard needs to be had in those Diseases, wherein bleeding cannot be deferred without danger, as in Plurisies, Squinancies, &c. Otherwise, the Spring and Autumn, and the Morning are best.

The veins that are wont commonly to be open­ed, are these: In the Forehead, the Vena frontis; in the Temples, the Vena Temporalis; in the Mouth, the Vena sublingualis, or Ranularis; in the Neck, the Jugularis externa; in the Arm, the Basilica, under which lieth an Artery; the Me­diana, under which lieth a Nerve, and under both of them a Tendon; and the Cephalica, which hath under, or near it, neither Artery, Nerve, nor Ten­don, and therefore may safely be opened: This last hath but one small Branch that runs outward to the head, whence it hath got the name of the Head Vein. Without this consideration, it little matters which of these three be opened, in regard that about the Arm-pits they all acknowledge no more but one Branch. In the Hand, between the little finger and its neighbour, the Salvatella; in the Foot, the Saphena and Ischiatica.

The manner of Bleeding is so well known, that I think it needless here to describe it; only I could wish, that some of those that let blood, would take care somewhat better to guess of the number of Ounces of Blood they take from their Patients, that so we might not find 12, 16, 18, yea, 22 ounces drawn away instead of 6 or 8, that [Page 42] were prescribed. To prevent so intolerable a mi­stake, I would advise, that small Porringers of Tin or Copper were made, in which the number of ounces were mark'd; though expert Masters do not at all need them, as knowing that Blood is really weightier, than it outwardly seems.

CHAP. XII. Of the opening of Abscesses, or Imposthumes.

THe Humors here and there gathered, do oft­en cause a Swelling, which nature is not al­ways able to dissipate, unless Art do succor her by fit means; which if fruitless, you must use Suppu­ration, and then stay till she of her self make an opening, except there be a necessity to hasten one, or even not to stay for a perfect Suppurati­on: As, 1. When the matter being very sharp or malign, upon which happens a Corrosion of the neighboring parts, and a corruption of the Bones, Tendons or Nerves. 2. When it may affect a no­bler part. 3. When it lieth in the Joynts. 4. When it is cast out by a Crisis.

Before you proceed to the opening, you are to consider, whether the matter be contain'd in its own proper Tunicle, or whether it be without any Tunicle. If without any, then make your aperti­on with a right Line, observing the Fibres of the Muscles. For Example; In the head, according to the position of the Hair, long-ways; in the Eye­lids, transverse; in the Temples, the Nose, Neck, Breast, Back, Arms, Feet, Joynts, long-ways; [Page 43] in the midst of the Abdomen, let it be long-ways; in the sides of it somewhat oblique; in the Groins, transverse; but not very deep, by season of the subjacent seminary Vessels. Al­ways beware of touching any great Vein, Artery or Nerve, though the Fibres be cut a-cross, lest from a lesser evil there should arise a greater.

The properest place for the opening, is the most raised and softest part of the Abscess, if possible in the depending, that the purulent matter may the more conveniently be dischar­ged: To which end also you are with a Tent so long to keep open the wound, until the part, being altogether cleansed of its preternatural Humors, may return to its former Functions.

In the opening, thrust not in the Launcet too deep, nor further into the Cavity than to the mat­ter; and as soon as you perceive that, draw it a little back, and turn the point upward; making your opening through the Skin so big as may af­ford the contained matter a free vent.

If the Abscess be included in a Tunicle, if small, make the Incision long ways; if big, then make a double incision, that is, cross-ways; and beware of touching the Vesicle, otherwise you must expect a foetide and almost incurable Ulce­ration. This being well done, press out with your Fingers the Vesicle, which seldom or ne­ver sticks to the Skin, and easily follows; cut off the little Artery by which it is fed; and have a care, that not the least Particle of the Bag may remain on it, lest it gather again.

Forasmuch as in this Operation I find, that Chi­rurgeons differ in the Instrument they ought to use, some chusing the Launcet, others the Potential Cau­tery, [Page 44] and extol it far above the former: I think my self obliged to declare here what I judge of this matter.

The Potential Cautery hath this Advantage, that it doth not terrifie timorous Patients, nor is painful to the tender; especially joyning with it the present and known good Remedies: For unquenched Lime, mixed with Holland Sope, work­eth deep enough into the flesh, yet much gentli­er than the Corrosive of Ambr. Paraeus. But it hath these Inconveniencies:

1. That according to the tenderness or strength of the Skin or Bodies, sometimes it eats in deeper than needs; for we have found by experience, that in some it hath eaten through the Skin and Muscles, to the very cavity of the Belly; in others irrecoverably wounded the processes of the Peri­tonaeum, together with the seminal vessels therein.

2. Commonly it spreads it self in length and breadth somewhat further than you would have it, especially if it be to be applied under the Arm­pits, in the Groin, or in the Joynts; for it no soon­er grows warm, but it melts, and so spreads a­broad, notwithstanding the Plaister with which the Surgeon designed to bound it.

3. There are necessarily required some hours (in some Bodies more, in others less) before it can perform its Operation; and this the Humor will not always bear, especially if it be malign.

4. And the Scar falls not presently off; and if you would give a present vent to the Humors, you will be obliged still to make use of a Laun­cet. Be as circumspect as you can, I am sure, you will hardly avoid these Inconveniencies.

On the other hand, the Launcet hath this trou­ble, [Page 45] that many people are affrighted at it, and that it is painful: But the fear may be prevented by silence, and the pain is little considerable; mean time you have these Advantages:

1. That with the Launcet, the Apertion may be made as long and as deep as the Chirurgeon desireth.

2. The matter is suddenly discharged, and the Patient hath present relief.

3. The unconcocted remainder may be the sooner concocted, by assisting Nature with con­venient Remedies, both inwardly and outward­ly.

4. You will not be troubled with a long gleet, which if it happens, the fault is assuredly in the Chirurgeon. For almost all Tumors that appear behind the Ears, in the Neck, under the Arm­pits, or in the Groin, spring from indurated Glan­dules, replete with a preternatural humor; these Glandules are all included in their own Mem­branes, which being toucht, either with a Laun­cet, or with Corrosive Medicines, there must needs follow a gleet (for 'tis impossible that the Glandule should be able to preserve it self, or the contained Humor, its Tunicle being divi­ded) which will continue until the whole Glan­dule and Tunicle are both consumed.

CHAP. XIII. Of the Separation of Parts unnaturally joyned.

WIthin the Ear is a thin, but strong Mem­brane called the Drum. This being o­vergrown with another preternatural Mem­brane, or a Caruncle, the Patient loseth his hea­ring; which is not at all to be cured by any Manual Art, and difficultly by Medicines. But if the Cavity of the Ear come to be closed up with a Membrane, and thereby the hearing lost, then is it to be opened with a fit Instru­ment, and as soon as may be, cicatriz'd.

That many have been born with the Anus im­perforated, and the Intestine covered with a Membrane, hath been often observed; which if the Membrane be tender and thin, is to be o­pened with the Fingers; if thick, with a Launcet, long-ways; and afterwards kept open with a small leaden Pipe, and drying Medicines.

The Pudenda Virginum are sometimes also clos'd with a preternatural Membrane, which causeth most grievous Accidents, when they are grown marriageable. Sometimes the part is altogether grown together; sometimes upon an ill-treated Ulcer, coalescunt Labia & Membrum illud ineptum reddunt congressui virili. Sometimes a preterna­tural Caruncle shuts the Os Vulvae. The two first are to be opened long ways with a sharp In­strument, in part wound about with linnen Rags, [Page 47] and then cured according to Art. To the last, which causeth most difficulty, you'l need in the Operation a Speculum Matricis, and in the latter end of the Cure, a small Pipe, perforated through­out in length, to promote the Cicatrizing.

Here we shall take leave to speak something of the Tongue, not of a long and sharp one, for which I have found either none, or at least, no better remedy than contempts, patience and commiseration; but of those, that being short and tied, deprive Children, first, of Sucking, afterwards of Speaking: Which is easily remedi­ed, by loosening the string of the Tongue, by cutting it transverse with a pair of Scissars, and anointing it afterwards with Honey of Roses three or four times a day. In the cutting, the neighboring parts and veins must be carefully shunned; and sometimes the Nerve of the sixth pair of its Branches run so near the String, that by a deep incision they may be easily hurt, and the Patient fall into sad Accidents. Here let the Chirurgeon know, that of an hundred Children, scarce one needs this Manual Ope­ration; and that those Midwives are as rash as ignorant, who in all new-born Babes, do forth­with dilacerate this String, whereby the found parts being hurt, they are often deprived of their necessary Sucking, and, by subsequent sym­ptoms, of their Life.

CHAP. XIV. Of the Paracenthesis.

ALthough the word Paracenthesis, signifies all Punctures, yet custom hath appropriated it solely to the opening of the Belly in a Drop­sie, and to that of the Breast in Empyema, though more to that than to this.

This Manual Operation is ancient, and full of danger; yet sometimes preserves the life of the Patient. Nature and Success have emboldened us now and then to make use of it; but Experience hath taught us, that the greatest difficulty consists herein: 1. That the parts debilitated, and deser­ted of their natural heat, do easily, after open­ing, mortifie. 2. That together with the Water, issues out likewise the Spirits. 3. That the pres­sing water can hardly be so kept in, but it will run out in despight of the Chirurgeon; and if, the better to close the Wound, you do forcibly press in the Pipe, a Gangrene soon and easily ensueth.

Who therefore expects a good issue of this O­peration, must use it only upon a Body that is not emaciated or wasted; in a Dropsie that is recent (or at least, when the Tumor in a short time hath risen to a great bulk) and which, upon the use of proper Remedies, would not presently be removed; in such Patients that are not molest­ed with a Fever, or with difficulty of breathing, and where the noble parts are yet sound and un­corrupted; and in persons of a middle age, since in Children and in old people it succeeds not so prosperously.

[Page 49]As to the Place; if the Navel stands out, seek for no other, but make your opening therein: But if that be much drawn in (as it commonly hap­pens to be in Hydropical Persons) it is not pro­per for it: In which case you must take for your place three inches beneath the Navel, not in the white-Line, which, to my wonder, I find propo­sed by some; but, on the side of the right Muscle, in the Muscle called Oblique Descendens: Mark it first with Ink, and then make a small Apertion through the Skin, Muscles, and Peritonaeum, ta­king great care that the Omentum, or Guts, be not wounded; which also, by reason of the inter­posing Water, cannot easily be hurt. He that will be very careful of the opening, must make it ac­cording to the Ductus of the Fibres, a little ob­liquely downwards (according to this \) in the left side; and (according to this, /) in the right side.

As soon as you perceive Water to come forth, take a Golden, Silver, or Leaden small Pipe, that is, 1. Smooth. 2. Furnisht at the Head with a Button or Wing. 3. Perforated on the sides with three or four holes. 4. No longer than the thickness of the dissected part, that is, an inch broad. 5. Somewhat crooked at the end. 6. Ex­actly fitting the size of the Orifice. Put this into the Apertion, lay over it a sticking-Plaister (o­thers take a Spunge, or a four double linnen Rag) bind up the Patient, and let him rest two or three hours; then open the Bandage again, and take away one, two, three, seldom or never more pints of Water, and so repeating it once or twice a day, till the water be almost all discharged. You must not take away all at first, for the chilness of [Page 50] the parts, following so great an Evacuation, very often causeth death. The Pipe is not to be taken out, but must remain all the time of the cure in the Wound, which you must at length heal up according to Art.

For the opening of an Hydropical Belly, this is the safest as hitherto practised way, that is left us by the Ancients; but the industry of their Po­sterity hath invented for us a much convenienter Instrument, whereby we not only do avoid ma­ny of the above-mentioned difficulties, but also with less trouble preserve the lives otherwise in­curable Patients, freeing them from stretching, pain and trouble, according to our pleasure, or the degree of their strength.

This never enough commended Instrument was first of all brought out of Italy; by the experi­enced Chirurgeon of this City, Mr. Jacob Block, and by him put into practice, to the great bene­fit of many Patients.

Commonly he chuseth the place lately pointed out by us, viz. about three inches below the Na­vel, and perforates the Skin, Muscles and Perito­naeum, unto the very Water, taking away no more at once than a quart.

That done, he draws out his Instrument again, puts nothing upon the made hole but dry Lint and a sticking-Plaister, whereby he sufficiently hinders the running out, against your Will, of even a drop of Water; for, upon the withdraw­ing of the Instrument, the opened Skin, Muscles and Peritonaeum are easily by their natural moti­on so far drawn asunder, that the holes cannot any more exactly close upon one another.

This being once performed, we regulate ourselves [Page 51] according to the strength of the Patient, staying two, three or more days, before we re­peat this Operation; then either the first Orifice is to be opened, or again a new one to be made, especially if the Chirurgeon finds, that the Wa­ter may be more conveniently drawn away in a­nother place.

In an Hydrocele (when the water is fallen into the Scrotum) the said Chirurgeon doth by this In­strument so dexterously discharge the Water out of the Scrotum, that the next day you shall not, or hardly be able to find where the Hole was.

The Perforation seems to me a little inconveni­ent, wherefore I have caused this Instrument so far to be altered, as that I make the end not to be wrought round, but sharp on both sides, Launcet­wise, by which means it may be sooner thrust through the Muscles. But then, his may be made of Silver, mine must be of Steel.

To the end that you may the better compre­hend what we say, we shall represent to your view the Instrument, and the Operation it self, in the ensuing Figures.

[Page]

CHAP. XV. Of the Opening of the Breast.

THere is sometimes collected in the Cavity of the Breast a water or purulent matter.

The Water gathers either by some Lymphatick Vessels burst, or from an unconcocted watriness of the Blood. The purulent Matter follows upon In­flammations of the Throat, or Lungs, or a Pleu­risie, &c.

If it be Matter that is collected, it is called Em­pyema; if Water, Hydrops pectoris vel pulmonis, the Dropsie of the Breast or Lungs.

The Marks of the Water are, a dry Cough, a painful heaviness, a difficulty of breathing, even to Suffocation, great Thirst, little Appetite, a pale Look and sometimes a swelling of the Legs, now and then accompanied with a Feaver; and when the Patient turns himself, you may perceive a rumbling noise.

The collected Sanies may be known by the fol­lowing Signs; When the Inflamation of the Lungs or Pleura, will not, upon Bleeding, or o­ther convenient means, be sufficiently removed, then may you apprehend a collection of such mat­ter to come within a fortnight. Between the thirti­eth and fortieth day the Tumor commonly breaks. The Patient shall find a great heaviness in his Chest without considerable pain; and in case it is ac­companied with pain, then you are to Expect a new Flux, which you must divert by Bleeding. The [Page 55] Patient hath a difficulty in breathing; in motion, he hears a rumbling, at least he is sensible that the matter changeth place, and the side affected is to the touch, hotter than the other. He casts up, with violent coughing, a purulent matter, having a con­tinual Fever; he finds an anxiety at his heart, and hath little stomach to his meat.

If we cannot expel these Humors by Expecto­rating, nor by Diureticks, nor Diaphoreticks, nor by purging Medicines, then are we forc'd to come to Manual Operation.

This cannot be done without danger, and is not to be attempted in case the Patient be weak, and the inward parts already corrupted. Howe­ver, this Operation hath less danger than the next foregoing, and people oftner recover upon it; yea, Learned Writers assure us, that by this O­peration, and the use of Injection, they have cu­red many of Ulcers of the Lungs.

Concerning the Place of Opening, Authors are not agreed in it; the reason whereof is obvi­ous: For, the Diaphragma runs higher in some persons than in others; whence it comes to pass, that the collected Humors in some Patients, lie higher than in others. Secondly, the Chest is raised in some, flat in others; which here much alters the case. Besides, the Lungs do often grow so fast to the Pleura, that the sanious matter can­not easily be carried into the Cavity of the Breast: In which case it would be ill done, to chose the place of Opening lowest, in respect of the Dia­phragma. And in regard that in this, as in other swellings, the most eminent place is, esteemed the most convenient for opening, it cannot be otherwise but that one Chirurgeon hath made [Page 56] choice of this place, and another useth that place as the best. Upon which account, Hyppocrates Guido, Amatus Lusitanus, &c. do make the aper­tion between the third and fourth Rib, counting from beneath upwards: Fienus, Riverius, and ma­ny others, between the fourth and fifth; Paulus Aegineta, Vidus Vidius, Fabritius ab Aquapendente, Sennertus, &c. between the fifth and sixth; which place, in my opinion, is the safest; for, if higher, the Pericardium, if lower, the Diaphragma may be wounded, of which there have been many sad Examples. But in this difference of dissenting Writers, what hath been said, will direct you to pass into the safest Haven.

All things therefore well considered, chuse the place where to make your Apertion; not the fore­part (for, before, the Sternum or Breast-bone will hinder your operation here; nor in the back-part, for the Ribs are so close to one another, that with­out hurting some Vessels, you cannot make any Apertion there) but on the side, four or five inch­es from the Sternum: Neither ought the Incision to be so near to the upper Ribs, as to the lower, because the intercostal Vessels, viz. the Vein, Arte­ry and Nerve, lie in the lower part of each Rib, where Nature hath assigned them a place, branch­ing themselves into the middle of the intercostal Muscles; which dissemination nevertheless hin­ders not, but that the Incision may be made in the middle between the two Ribs.

After you have marked the place with Ink, charge the Patient to breath forth as long as possi­bly he can, without taking it in, and in the mean time make an oblique, but small Orifice, and put into it a Silver or Leaden Pipe, and take forth four [Page 57] or five ounces of Matter to run out in a day. In case the Matter does not come forth well, place your Patient on the wounded side, and make him to cough; if by reason of its toughness it will not yet come forth, then inject into the cavity some abstersive, exsiccating and healing Medicines; As,

Take Goats whey, eighteen ounces; Honey of Roses, four ounces; the Juice of Celandine and Smallage, of each six drams: Mingle it.

Or,

Take the Roots of Comfrey the greater, an ounce; of Sanicle, half an ounce; the Leaves of Betony, Agrimony, Periwincle, Burnet, of each half a handful; the Cordial Flowers, two pugils; the Seed of St. John'swort, Holy-Thistle, Ro­man-Nettle, of each half a dram: Boil them in Water and Honey to a pint and half; strain it, and keep it for your use.

Of this Injection, the Patient may also drink a little twice or thrice a day.

It is yet further to be observed, that the colle­cted Matter is often contained in a Membrane of its own, and by its rising, manifests it self from without; and then the Latines call it Vomica Pul­monis: In which case, you must not stay till the Membrane breaks of its self; for by delay, the Matter flowing up and down is more difficulty to be got out of the Breast; but open it presently, taking no other place, but the most raised part of the swelling.

Now, since an Empyema for the most part fol­lows upon a Pleurisie, and 'tis dayly found, that ignorant Chirurgeons take all kind of pain in the Sides, Belly and Breast, although caused from Winds only, for a Pleurisie; thereupon immedi­ately [Page 58] opening a Vein; I thought therefore neces­sary to write in this place of the Pleurisie, as much as is necessary for a Chirurgeon to know, for the preventing such mistakes.

The Pleurisie then is an inflammation of the Pleura, and commonly of the Lungs themselves, caused from afflux of Blood, accompanied with Pain Cough, spit­ting of Blood, shortness of Breath, continual Feaver, strong and quick Pulse.

The Cause is the Blood, sometimes alone (when a true Pleurisie) sometimes mixt with other Hu­mors then it occasions a Bastard one.

The Signs, as may be seen in the Description, are so evident, that those who know not how to distinguish it from a Cholick, are not worthy of any excuse.

The Prognosticks.] The sooner the matter is concocted, and the whiter and easier 'tis ejected, the quicker and safer is the Issue. If the Cough, and difficulty of breathing lessen not by a copious Expectoration, 'tis an ill sign. If the Patient come not to spit the third or fourth day, then will he scarce see the seventh. If upon Bleeding, and other fit means, the pain cease not, the Patient must ei­ther die, or the Pleurisie will turn to a Consump­tion, or an Empyema.

The Cure.] In this case, Bleeding is one of the most necessary and safest means of Cure; and if used in time, the Patient, in the very Operation, and before the Vein be closed, will find relief, and sometimes be altogether freed of the pain. Nor do I know any Disease, in which there may, to the Patient's benefit, be so much Blood taken a­way at once, as in this.

There are different Opinions concerning what [Page 59] side the Patient is to bleed on: But those have had little Experience of this sickness, who have not found, that Patients (at least in these Coun­treys) are relieved much more and sooner, when they are bled in the Arm of the same side where the Pain is, than when it is done in the opposite side.

The Pain not ceasing in four and twenty hours, we are necessitated to bleed twice or thrice, most commonly in the same Arm; but here you must well observe the Patient's strength.

After letting Blood, sometimes Purging, Swear­ing and Expectorating Remedies, are very neces­sary. One only Medicine I cannot conceal from you, because of its Excellency. The Industrious Physitian Dr. Hadden in his Cure of the Pleurisie, hath much commended it, and I have, after once Bleeding, always in the beginning used it with great success, viz.

Take the Juice of Dandelion, an ounce and half; the Water of Plantane, two ounces; of Ho­ly-Thistle and Scabious, Syrup of Poppies Erra­tick, of each an ounce; Crabs-Eyes, a scruple and half: Mix it.

Let the Patient every half hour take down a spoonful or two of it, until the Flux be stopped: After which you are to use other Remedies.

CHAP. XVI. Of Removing a Cataract of the Eye.

A Cataract (by the Greeks called Hypochyma by the Latines, Suffusio; in the German and Belgick Tongue, De Staer) is a concretion of superflu­ous Humors, by little and little generating a preterna­tural Membrane betwixt the Cornea and the Cry­stalline Humor, covering either totally, or in part, the Pupil of the Eye, and so depriving the Patient, of his sight, or hindring it.

Difference.] It is either Imperfect, when the Hu­mor is thin, or the Apple of the Eye not totally covered; or Perfect, when it is changed into a Membrane, or the Pupil is quite covered. Some­times 'tis white, gray, yellow, green, sometimes of a leaden colour, &c. according as the green, yel­low or black Choler is mingled amongst it.

The Seat of it is between the Cornea and the Crystalline humor, being sometimes nearer to this, sometimes to that.

The Cause is a Phlegmatick Humor, either collected there by the weakness of the Eyes, or by the Brain transmitted thither by reason of its abundance.

Signs.] In the beginning, the Patient sees every thing double, and of many colours; the Air seems to him full of Flies, Nets and Clouds, and can­not endure a great light. Thereupon his sight lessens, and all things appear as Spots, and at length there follows blindness. If it be just in [Page]

[Page] [Page 61] the Center of the Pupil, yet covers not the whole Pupil; but leaveth round about the sight some place free, and then all the Patient sees, seems per­forated. If the Pupil spreads it self, when you rub the Eye with your Fingers, then is it yet imper­fect; if it remains unmoved, there is no doubt of its being perfect.

The Prognosticks.] The imperfect Cataract may easily be cured in the beginning, by convenient External and Internal Medicines, in sound Bo­dies, and in Patients of a middle Age. The less the Pupil is dilated, the less hope of Cure. The nearer the Suffusion is to the Crystalline Humor, the more dangerous. If the Eye be turned to the Sun, and the Patient then sees no glimmering of Light, there is no benefit to be expected from the Manual Operation. If the Humors of the Eye be commixt by the Needle, though the Membrane be removed, then blindness will certainly remain. If in the Operation you happen to touch the Mem­brane of the Eye, called the Retina, the Patient will after that always see the Air, as if full of small Hair and Flies. A Cataract commonly remains so soft unto the third year, that it will not follow the Needle; after the third or fourth year, it is so firm and hard, that it can by no Art be loosned. The Blood spilt by the use of the Nee­dle, causeth no danger, and soon ceaseth of it self. Though the Cataract be not altogether suppres­sed, but divided into several pieces, the sight doth often perfectly return within six or eight weeks, though before that time the whole Ope­ration should seem to be fruitless; which I speak from manifold Experience.

The Cure.] The Imperfect Cataract requires [Page 62] solely the Aid of the Physitian, who by Medi­cines and strengthening the Stomach and Head, have done much; to which purpose the conserve of Marjoram, Rosemary, Beteny, Pulv. Diambre, &c. are very good. And outwardly use the fol­lowing means.

Take Gum Tragacanth dissolved in Eyebright water, two drams; Burnt Allom, one scruple: Make a Collyrium.

Or,

Take Celandine water, an ounce and half; White wine, half an ounce; Spirit of Wine, two drams; White Vitriol, six grains; Prepared Tut­ty, a scruple; Glass of Antimony, five grains; Sugar-Candy, two drams and an half; Camphire, six grains: Mix it, and make a Collyrium.

Or,

Take Juyce of Fennel, of Celandine, of each two ounces; Leaves of Rue and Marjoram, of each a Pugil; Eye-bright, one handful; of the Gall of an Oxe, four ounces; the Gall of Hens; an ounce; Red-Myrrhe, Aloes, of each a dram and half; Sarcocols, half an ounce; Camphire, two scruples: Mingle them, and let them be dilled in B. M.

If the Cataract be confirmed, then let the Ma­nual Operation be your only refuge; but beware of attempting the Operation, if the Patient have long before complained, and still complains of Head ach or pain of his Eyes; if the Body hath not been cleansed in general, nor the Head in particular; and if the Patient be yet molested with a Fever, Sneezing, Coughing or Vomiting.

Having chosen a convenient season of the year, some morning in the decrease of the Moon, and a [Page 63] clear and serene Air, set the Patient in a Chair, and against him let the Operator sit in one some­what higher than his, bind up his sound Eye, and make him clap his hand about your waste, without stirring them at all as long as you are busie in the Operation. Let some body hold his Head fast be­hind, and hold you asunder his Eye-lids, charging him to turn the Eye towards his Nose, which when he doth, quickly thrust your Needle into the Cor­nea, half a straws bredth from the Iris, and bring it unto the hollow of the Eye; when the Needle hath toucht the Cataract, endeavour therewith to press it gently, and so long from above downwards until it remains there; if it be stubborn, in springing up again and again, divide it into several parts, and keep these particles, or the whole Cataract a little while under, that it may not return again before the Pupil of the Eye; then draw out the Needle, and bind up as well the sound as the unsound Eye, with Linnen-cloths moistened in some Rose water, the White of an Egg, and a little Allom mixed toge­ther. Beware in the Operation, of hurting the Crystalline Humor, and the sound Tunicles.

CHAP. XVII. Of Leeches.

LEeches more advantagious than Scarification, and safer than Bleeding, may with benefit be applied, as well in strong as in weak Bodies, they only draw Blood from the Cutaneous Vessels, by which they cure light Diseases, if only apply­ed [Page 64] to the Skin; but if applyed to some greater Vessel, they draw also Blood from the Internal Parts, and so remove internal and more despe­rate Diseases.

There is great care required in the choice of Leeches, for those with great Heads, and that are green and shining, with hair or blew stripes on their Backs, are not without Poyson; as also those that live in standing or putrid Waters: But those are to be chosen that are slender and long, with lit­tle heads, and red Bellies, and such as are nourish­ed in clear running Water: They are never to be applied to the Part new taken, but after they have been taken a day or more in fair Water, and fed with a little Blood, that they may be cleansed of all their impurities; the place where they are to be applied, is to be rubb'd till it be red; and if they fasten not, 'tis to be moistened with Cream, or with Blood fresh taken from a Pigeon, or the part it self to be prickt with a Needle till it bleed; if they draw sluggishly, cut their tails off with a pair of Scissars. After they have suckt a sufficient quantity of Blood, and they fall not off them­selves, put upon their Heads a little Ashes or Salt, and they will suddenly desist from their work: they are not to be pull'd off by force, lest they leave their heads behind them, from whence incurable wounds, and oftentimes Death succeeds. 'Tis to be noted, that they rather draw Arterial Blood than Venal, therefore they ought to suck the less.

CHAP. XVIII. Of the Cutting in the Hard Parts.

THe Section which is used in the Hard and Bony Parts, is of four kinds, viz. Scraping, Filing, Sawing and Perforating, that is, Trepanning.

Scraping is used in a Fissure and foul Bone, in the Teeth also, when they are crusted over with a Tar­tarous black substance; the Bones are to be scra­ped till you come to the sound part, which is white and solid, and a little blood cast forth; and to the Bone thus scraped, some drying Powder is to be applied; the Pericranium and Periostium must first be seperated from the Bone, before you go about this Operation; for by no means are they to be touched with the Instrumenr, neither like­wise the lips of the Wound.

Filing is used in the Teeth; for when they un­naturally stand forth, and either in Eating or Speaking, are any hinderance to a man; then that which thus sticks forth, is with a File to be taken off, which must be done carefully, without any injury to the neighouring parts, and by degrees, neither with two great a Violence, lest it loosen the Tooth.

The use of the Saw is in a mortified part, when the Bone is to be cut a sunder; concerning which Operation I shall suddenly speak.

Perforating or Trepanning is of great use, when the Bones are extreamly soul, but 'tis of greatest use in those effects, which the Fissure or a Fra­cture [Page 66] of the Skull, or a Contusion may produce: Seeing therefore this Operation is so full of dan­ger, 'tis diligently to be enquired in what Cases 'tis necessary, and in what 'tis not; for a Fissure as a Fissure, as likewise a Fracture as a Fracture, re­quires not the Trepan as an operation without which they cannot be cured: In like manner a slight Contusion doth not always occasion such dangerous symptoms, that the Trepan may not cause worse; for oftentimes a small quantity of extravasated Blood, in Robust People, is often discussed by the work of Nature her self; except the innate heat be weakened by external Cold, which in the use of the Trepan, let what care possibly be had, cannot be totally avoided; be­sides this, the Blood is more often extravasated between the two Membranes, the Dura-Mater and the Pia Mater, there the Trepan can seem to pro­mise but little good; but in this case I would not much matter to divide the Dura Mater; Experi­ence having taught us, that by the help of Art and Nature, hath an Incision, nay, Gangrene of the Part it self been cured: Therefore for the most part but in three cases is the Trepan required.

1. Where the loose pieces of the Bones prick and wound the Meninges; which is to be known by the continual pricking pain presently from the ve­ry hurting perceived, granted the Patient be sen­sible; but if not, he is always feeling the Part affected wirh his hands: There happens likewise Contusions of the Eyes, and Convulsions of the Limbs: Besides, the quality of the Instrument which the Fracture hath made, will more plain­ly demonstrate it.

2. Where the first Table is only depressed, but the [Page 67] second broke; there being no way to give passage to the pieces, how well soever by Art or Nature separated. The Signs of this, are, a Dimness, a Giddiness, a Fever, Vomiting, and sometimes an Apoplexy; a feeble small Pulse, and especially about the Temples, the depressed Bone in some manner obstructing the Circulation of the Blood in the Brain.

3. Extravasation of Blood, upon which follows Putrefaction, and if not remedied, Death it self: The Signs which declare this Putrefaction, is a continued Fever, a great Heat in the Head, unqui­et Sleep, Watchings, Inflammation of the Eyes, and light Delirium; and moreover, the Tempe­raments of Bodies are diligently to be consider'd; for in Plethorick People, to those above-named Symptoms are joyned, a Laughing, Talking idly, and Redness of [...]he whole Face. In the Chole­rick appears a yellowness of the Face and Eyes, great Heat, and Madness. In the Phlegmatick, all the Symptoms are less; but sometimes it is ac­companied with a Palsie, sometimes with an Apo­plexy. In Melancholy men, a dread impertinent Talk, and Laughing is usual.

Where the Trepan is necessary, apply it as soon as possible, lest the putrifying Blood causeth greater evils, that is, on the third, fourth, or fifth day.

The manner of Trepanning is thus, The Hair being shav'd, Let the Skin be divided with a double In­cision, inform of a Cross to the Pericranium, avoid­ing with the greatest diligence always the tem­peral Muscles, and the Sutures of the Head; this done, bind up the Wound, except the Hemo­rage be small (which very often is so violent, [Page 68] that it hinders the Chirurgeon for some days from any further Operation) if it will then give leave, to divide likewise the Pericranium from the Skull: After some few hours (the Skull already bar'd of its Pericranium) the Patient well plac'd, his Head must by some Person be firmly held, his Ears be­ing stopt with Cotton; then set on the Trepan with a Pin, which must neither be upon the Fracture, nor upon the Sutures (although there are some that venture to apply it upon the very Sutures them­selves) the Surgeon holding in his left hand the Instrument, and with his right, let him gently turn about the Trepan until it hath taken good hold round; then take out the Pin, and set the Trepan on again without it, moving it still about, and if you see any small Filings of the Skull, take off the Trepan and wipe them away; and the Trepan it self is sometimes to be dipt in the Oyl, that it may the easier be turned about; and some­times in Water, that it grows not hot. If any Blood appears, you may be certain that the Tre­pan had past the first Table, then are you to have a greater care, lest the Trepan should unawares slip in, and wound the Meninges, from whence oftentimes follows sudden Death: For the Dura Mater invests the inside of the Scull, in the same manner as the Pericranium doth the out-side, but yet not so strongly joined to it, but that by a fall or blow, it may be easily separated from the Skull.

When the piece of Bone, separated by the Tre­pan, begins to be loose, you must with a little In­strument put in, between the Skull and the Tre­pan'd part, and free it from the whole, and so gent­ly take it out with a pair of Forceps.

[Page 69]If there remain any inequality from Trepan­ning, in the inside of the inward Table, that may cause injury to the Meninx, 'tis to be taken away with an Instrument called Lenticula.

And that there may be a discharge given to the coagulated Blood and Matter, the Dura Mater is to be compressed with an Instrument called a Decus­sorium. To effect the same, 'tis commended that the Patient (if sensible) his Mouth and Nose be­ing shut, hold his Breath, so that the Brain being raised upward, the concreted and corrupted Mat­ter may be thrown forth; but very seldom is the Matter discharg'd by this only remedy; for the Chirurgion hath need enough of the Decussorium, Spunges, Lint, and the like Instruments; the de­scription and delineation of the which, you may find in Joh. Andr. à Cruce, Paraeus, and others. Read the 4 th. Chapter of this Chirurgery, where Fractures of the Skull is described.

CHAP. XIX. Of Ʋstion, or Burning.

ENough hath been said of Cutting, now a little of Burning; when neither Medicine nor Knife bring relief, we must then come to the Fire, as well in the soft as hard parts: In all Burning, great care is to be taken that the neighboring parts be not hurt; therefore it is very necessary to de­fend them against it with Lint: That burning is certainest, which is made by an actual Cautery, viz. a red hot Iron, than that which is performed [Page 70] a Potential, that is, by Corrosive Medicines; yet for the most part, the Patients fearfulness makes choice of this; whichsoever you use, beware of applying Oyl alone, or Butter, to remove the Es­car, for it hath been observed not once only to to have occasioned a Gangrene, Diapalma Plaister, or Lint, wet in Wine, will be sufficient.

CHAP. XX. Of Issues.

ISsues are little Ulcers made by Art in a sound part of the Body by a red-hot Iron, Launcet, Scissars, or corrosive Medicine, to evacuate superfluous humors, and so either to cure or prevent Diseases.

These troublesome Guests are rarely courted, and are chiefly prescribed when we see gentler Medicines to profit nothing, and after the Body hath been well purged.

In what part soever they are made, it is always to be observ'd they never ought to be inserted in the beginning, middle or end of a Muscle, but al­ways in the space between two Muscles, which re­quireth the knowledge of Anatomy, except ac­cording to the example of Quacks, whose custom hath taught them to find out a place ev'n blindfold. In the Head, the place is the middle of the Coro­nal Suture, made oftner by other Nations than is a practice amongst us. In the Neck they are not so often made, how necessary soever they may ap­pear. The Italians use to make them between the Shoulders with success. In other places they are either very troublesome or inconvenient.

[Page 71]The Manner of making Issues is divers: If you make use of the Potential Cautery, apply a Plaister to the part, having a hole in the middle about the bigness of a Pea, in which lay a little Costick, and over that a Bolster and another Plaister; and after three or four hours, take off the Plaisters, and lay­ing on the Escar a Plaister of Diapalma; dress it twice a day, that it may the sooner separate.

Those which desire it rather by Incision, the Skin being taken up either by the Forceps, or by the Hand, divide it with a pair of Scissars or Laun­cet. If Burning be preferred before the other ways, burn the Skin, but not the subjacent Mus­cles; for indeed the Skin it self is not to be wholly penetrated, oftentimes the touching only the Su­perficies of it is enough.

When the Scar falls off, take little hard Dossels made of Lint, spred upon them some Detersive Medicine, and press them into the Ulcer, until they have made a sufficient Impression; then af­terward keep in this Cavity a Ball of Wax, Wood, or Silver, or a Pea, which is to be often taken out, and another put in, and so is to be continued till the Disease be cured, or Weakness hinder.

CHAP. XXI. Of the Seton

ALthough the application of a Seton be with greater trouble than an Issue, yet it brings much greater advantage to the sick Patient; for what two Issues cannot remove, oftentimes is per­formed by one Seton.

[Page 72]It may be made in the Arms and Legs, and ma­ny other parts of the Body; but in the Nape of the Neck, between the first and second Vertebra, or second and third; yea, between the third and fourth, is only in use amongst us, but I could wish it was more frequent.

There are three Instruments necessary to perform this Operation; A pair of Forceps, a Needle, and String. The Forceps which are to hold up the Skin, must be perforated of each side; the Needle must be three-pointed, and answer to the hole of the Forceps, which it must pass through. The String is to be of Silk, not exceeding the thickness of the Needle: Let the Chirurgion take up the Skin with the Forceps and gripe it hard, which being somewhat stupified, the Patient will feel the less pain; then let him pass the Needle red-hot through both the holes of the Forceps, Skin and all; after which, with another Needle let him bring through the thread: The first day, to ease pain, apply to the Part Lint dipt in Whites of Eggs and Rose­water mixt together: Afterward let Digestion be procured by the use of convenient Medicines; when digested, let the String be drawn every day, sometimes to this side, sometimes to that, so that the mattery part may hang out of the Wound. Thus the Operation being perfected, the Ulcer may be kept open as long as occasion re­quires, or the Patient pleaseth.

After this manner many Authors, both Antient and Modern, order the making the Seton; but this Oparation is much easier perform'd, if in the right place the Chirurgion take up the Skin with one hand, and his Servant with another, and so pass it through with a sharp-pointed Needle, but [Page 73] not made hot; the String being of Thread, not Silk, of convenient Thickness, and rubb'd with Wax.

CHAP. XXII. Of the drawing forth of Bullets.

NOw we are come to the Third Part of Chi­rurgery call'd Exeresis, which removes things superfluous: They are of a two-fold Nature, either they are generated in the Body it self, or else brought thither by Accident.

We treat of the last first, to wit, The Extraction of Bullets out of the Body; which is not difficult, if it appears whether it be nearer to the part where it made its entrance, or to the opposite to which it hath penetrated.

If it be observed to be near the Orifice; let it be drawn forth with a convenient Instrument; if nearer to the opposite part, let the Incision be made upon it, and there taken forth: But if the Bullet cannot be found out by a Probe, the Mem­ber is to be so placed, that the Bullet by its own weight may come forth; which if it happens not to do, the Wound is to be cured; and let the Chirurgeon expect until the Bullet shews it self near the Skin, which very often requires a long time.

CHAP. XXIII. Of the Extraction of a Dead Child and the Secundine.

THat the Birth may be Natural, it is necessary, That the Infant the whole time of its conti­nuance in its Mothers-womb, lies in such a posture, that the Arms and Feet being contracted, the Head downwards, having the Face towards the Mothers Back; the whole Foetus lying transverse in the bottom of the Womb; until requiring grea­ter room, which happens in the seventh, sometimes in the eighth or tenth, for the most part in the ninth Month, the head of the Infant descends to­wards the mouth of the womb; the Limbs which were before contracted, being extended, it breaks through the Membranes wherein it was included, by which the water that is contained in them, flows forth, which serve to make the parts slippery, and so is convenient to facilitate the Birth.

If any one of these be wanting, then one of these four things necessarily happens; either, 1. Both the Mother and the Child, although they may live, yet there follows no Exclusion. 2. Or the Mother lives, and the Child dies. 3. Or the Child lives, and the Mother dies. 4. Or both the Mother and Infant dies.

Causes hindering Labour] are, 1. When the Pains of the Birth are none, or not sufficient. 2. The great weakness of the Mother. 3. The greatness and strength of the Child; and on the contrary, the [Page 75] slender and tender Constitution of the Mother, or when the passages are so straight that the Infant can­not come through them. 4. The number of Children, especially if they endeavor to come forth at the same time. 5. The transverse, or any other preterna­tural posture of the Child. 6. If the Child in the Birth it self be fallen down with its Head upon the fore-port of the Ossa-Pubis: which case Authors of the grea­test account, whom I know, and our Midwives have not at all observed; so by how much the greater the Pains of the Birth are, there is so much the less hope of coming out, except the Head be first a little raised, and the Foetus be turned to­wards the back, and so into its true passage by the hand of the Midwife. 7. The Weakness of the Child it self, which makes it not able to add any thing towards its Exclusion. 8. The Death of the Child. 9. The not sufficient recesses of the Hip-bones towards the Back; for the Ossa-Pubis, except in the very hardest Labours, and then but very seldom do divide.

CHAP. XXIV. Of the Extirpating of a Mortified Part.

WHen a Dead Part altogether becomes useless, that it may not do any injury to the neigh­boring Parts, it is to be taken away: But in what place? Most convenient is the Joynt; but the cure by such Extirpation is render'd more difficult, and the use of the Part altogether lost; therefore the Extirpation is better to be made two, or three, or more fingers breadth below the Joynt, except the Mortification hath extended it self to the up­permost part of the Arms or Thighs; for then we are forced to take the Joynt it self: But again in what Part: whether in the whole or Mortified? The Amputation is more safe in the sound Part, although accompanied with greater Pain.

CHAP. XXV. Of the Fleshy Rupture.

SArcocele, which is a Fleshy Rupture, is a Tumor be­sides Nature, produced from impure Blood, flow­ing in too great quantity itno the Testicles, and there de­generated into Flesh.

In this Definition, received by the best Physiti­ans and Chirurgeons, I note two things: 1. The cause of this Tumor, not to be impure Blood, seeing the best, may produce it; not simply abounding in quantity, because it also happens in wasted Bodies, though 'tis not so soon generated, nor arrives to such a greatness in these, as in those Bodies; but the true cause is the Erosion, Rupture or Dilatation of the Membranes which close the Mouths of the Capil­lary Vessels, that the nutritious Blood may not flow too suddenly into the Part; from whence, more Blood flows into the Part than what is required for its nourishment; and Nature changeth that Blood which otherwise would purifie into a fleshy Substance. 2. This flesh sometimes grows to the se­cond of the common Tunicles of the Scrotum, and not to the Testicles, in which case it may be taken a­ways, [Page 81] without either hurting, or cutting of them out.

Signs are, the hardness, and slow encrease of the Tumor, which is rather more troublesome than painful, except accompanied with sharp Humors; no appearance of any Tumor in the Groin.

Prognosticks.] A Sarcocele is hardly cured by the help of Medicines, and seldom by manual O­peration, without taking off the Testicle, if it extends it self into the Groins, for the most part incurable.

Cure.] In the beginning, when the Membranes of the Vessels being eroded, broke or dilated, do give leave for too much leave to issue forth, Bleeding, and the use of Repelling and Restringent Medicines profit much; but when it hath begun to augment, then we may use these following means: Let there be made a little Orifice into the Scrotum, rather in its Superior then Inferior Part, through which, by the help of Plegets let Suppurating Medicines be applied, so that if possible, to waste the Flesh, every dressing diligently wiping away the Matter, but not at all, that the remaining Flesh may be the better consumed.

If these things succeed not, draw forth the Te­sticle, and by Incision take off as much Flesh as may be done without injury to it; then restore it again into its place, and the remainder of the Flesh endeavor to consume by Suppuration.

But if there be no hope of curing this Rupture by the recited means, draw forth the Hernious Testi­cle as far as you may, then pass once or twice a Silken Thred above the Tumor by the Pro­cess of the Peritonaeum; then pass both ends of the Silk through the Orifice it self, so that which [Page 82] was on the right side, may be on the left, and that of the left, on the right; and having ordered that the process of the Peritonaeum may be tied with a knot, then cut off the Testicle, letting both the ends of the Silk hang out of the Scrotum, and so cure it as another Wound.

I cannot here but friendly advise, 1. The Chi­rurgeon ought to consider well of the Cause, before he comes to the Operation it self; for sometimes the Parastates are so swell'd, especially the Testicles being Scirrhous, that they may easily deceive a very curious Examiner. 2. The Ligature ought to be made as near to the Tumor as possible, for by how much the higher part of the Process of the Peritonaeum be perforated, it is observed to be so much the thicker, which thing will retard the Sup­puration and the falling of the Thread; in the mean time Convulsions coming on, denounce death. 3. The Spermatick Vessels detain'd in the Scrotum, oftentimes by Natures variety, exceed the Testi­cles themselves in greatness, which causes no other inconvenience but only Fear, which I have obser­ved to be true, in more than one.

CHAP. XXVI. The Extraction of the Stone out of the Bladder.

THe Stone is a hard Body concreted from Slimy, Salt or Earthy Matter, by a peculiar Lapidi­fying quality, causing Pain, Obstruction; and other Symptoms in the place where it is detained.

[Page]

[Page]

[Page 83] The Cause is a Pituitous, Salt or Earthy Matter, which neither by heat nor cold, by a peculiar la­pidifying quality is changed into a Stone.

Signs.] The Urine is white, slimy, crude and troubled, suddenly adhering to the Urinal; some­times it is bloody, sometimes sandy or gravelly; sometimes full of little Threads, and not seldom supprest; a great thirst, a frequent making of U­rine, but with pain and by drops: The Patients place themselves with their Thighs across, al­ways holding their Privy-Parts in their hands, pressing the bottom of their Belly; the Privy-Part is always erected, very painful to go or walk, in the Region of the Belly a weight per­ceived, the Patient seldom making Water with­out going to Stool, the Intestine commonly falls out, especially in young People.

Although all these Signs seem plain, yet they may sometimes deceive a Phisician; it was former­ly the Custom with a Catheter passed through the Ureter into the Bladder, then thrusting in one or two fingers into the Anus, not only to search for the Stone, but also understand its greatness. But this searching was so very painful, that it was diffi­cult, through fear of pain, to have it permitted a se­cond time; and this thing gave occasion to have rea­dy at the second time of searching, all Instruments necessary for cutting out the Stone; but the Omni­potent and great Prince of Physicians hath now granted to those miserable Patients, those Chirur­geons, who not only without Catheter, but also without pain, both in old People and Children, which can most certainly find out the Stone; and for this Reason they Excel the so much Esteem'd French-men. I wish other places may may enjoy the same Artists.

[Page 84] Prognostick.] A crumbling Stone seldom, a hard Stone can never be wasted by Medicines, what­soever boasting persons may say; sometimes it is so soft, that by the very Catheter it self it may be broke to pieces in the neck of the Bladder, and be brought forth; sometimes through its smalness it comes forth whole; sometimes it sticks in the Ure­thra, out of which, without danger and great pain it cannot be removed; if it sticks in the Tunicles of the Bladder, or grows to the Superficies of the Interior Coat, it cannot be taken away by Secti­on, without the death of the Patient: By how much the greater the Stone is, the Operation is the more dangerous and painful. Stones are often drawn forth out of Womens Bladders about the bigness of an Olive, or a Walnut, without Inci­sion: but this way by Dilatation, of Extracting the Stone, is so dangerous, that it ought not to be performed but by experienced Chirurgeons.

Cure.] Stones generated in the Kidneys, Blad­der, or other parts of the Body (for, they may in any) in general, require the assistance of the Phy­sician; but we in this place treat only of the man­ner of drawing them forth out of the Bladder by Incision. There are several ways by various Au­thors proposed; but that which follows, is the most common, and most sure.

Let the Chirurgeon place his Patient on a soft Pillow in a strong mans Lap, after he has three or four times jumpt from a high place, then let him tie both his hands to the soles of his Feet, and let two standers by hold each Knee, extending them as far as may be one from the other; then let him take the first Finger of his left-Hand, or if neces­sity requires, the two first, anointed with Oyl of [Page 85] Lillies, Roses, or fresh Almonds, and thrust them up the Fundament, with his right hand gently com­pressing above the Os Pubis, so that the Stone may slip down under the Os Pubis, into the Perinaeum, which when brought thither by the foresaid Fin­gers, let him make Incision with a sharp Knife in the left side between the Testicles and the Anus, near to the Suture of the Perinaeum, cutting to the very Stone it self; and if it comes not out of the Wound it self, nor by the thrusting forth of the Fingers which are in the Intestinum rectum, let him draw it forth with a pair of Forceps, or which is better, with the Lapidillum or Spoon. The Stone being taken out, and all the Ligatures loosed, let the Wound be bound up according to Art, apply­ing Medicines, stopping Blood, viz. of Meal and Bole, &c. with the greatest care to consolidate it as soon as possible, lest the Patient labour with a dropping of his Urine through the wounded part: And this is the manner of drawing forth the Stone, which Chirurgeons use to call Apparatus Minor, which chiefly is used in Children, although there are those which proceed thus in People of full growth: But in our Country always this Incision is made by them whose Fingers are fitted for this Operation,

But in People of full Age it is sometimes very difficult to reach the Stone by the Fingers put up into the Fundament, and after the same manner to bring it down into the Perinoeum, if not altoge­ther impossible, as many think it; therefore there is another way found out, which they call Appa­ratus Major; the Patient is put on a Table, and bound, and held as above, the Chirurgeon through the Uretra passeth a Director into the [Page 86] Bladder to the Stone, then Incision being made as obove, in the hollow of the Director, puts in the Conductor, taking the Director out of the Ure­tra, he passeth into the Wound the Forceps, the Lapidillum, or other Instrument convenient for drawing out the Stone, by which he may both lay hold of it, and draw it forth, not making use of his Fingers in the Anus, except great necessity com­pel him to it. Where the Stone is bigger than the Orifice, and cannot come forth, the Wound is to be enlarged, or the Stone to be broken into pieces by the Forceps, and so drawn forth in parts: This done, the Binding and Consolidating the Wound, ought to be the same as in Children, giving it a stitch if it be too great, putting in a Silver-Pipe for two or three days, that may give passage to the Concreted Blood, Slime and Sandy Urine.

The manner is the same in Women, but only the Fingers are not put into the Anus, but into the Privy-Parts, and the Catheter must not be crooked, but straight, and much shorter than the other.

There is likewise another manner of drawing forth the Stone; the Chirurgeon thrusting his Fin­ger into the Anus, presseth the Stone upwards to the Belly; then through the Wound made in the right Muscle above the Os Pubis, according to the ductus of its Fibres, by the assistance of the Lapi­dillum or Forceps draw forth the Stone; by this way is never observed any coming forth of the Urine, and the place supposed convenient to draw forth the Stone: But this Operation in it self is dangerous and troublesome, and if the Lips of the Wound made in the Bladder unite not to the Muscles of the Abdomen, there follows an Ulcer of the Bladder, more painful, but less cureable [Page 87] than the Stone it self; which inconveniences have caused it not to be reckoned among other Ope­rations by true Practisers.

CHAP. XXVII. Of the Hare-Lip.

THe fourth and last Part of Chirurgery call'd Anaplerosis, which restores what is deficient, is chiefly used when any part of the Nose, Lip, or Ear is wanting, whether it be from the Birth, or from an External Cause,

As to the Lip, in a little defect, let it be first separated from the Gums, then let the edges be scarified and joined together with a Needle, laying over it an aglutinating Plaister, and so in a short time the Cure will be performed.

In a greater Defect, let the Lip be seperated from the Gums, then put a Linnen Cloth between, and let the Extremities be brought together by Bandage, after some few days, convenient Scari­fication being made, by the help of a Stitch, and Plaisters, let the ends be united.

The Nose and Ears being depriv'd of any part, after what manner they are cured, Taliacotius in a particular Treatise hath largely set down; to the which I refer the Reader.

CHAP. I. Of Tumors in general.

A Tumor besides Nature, is a Disease in which the Parts of the Body are indecently inlar­larged and extended, so that they are ren­dred unfit to perform its Actions.

The Differences of Tumors are taken, 1. From the Part affected; as an Inflammation of the Eyes, Jaws, &c. 2. From the Causes.

The Causes are, 1. The Parts of the Body remo­ved out of their Natural place. 2. The Four Hu­mors, [Page 89] as well Natural as Preternatural, viz, Blood▪ Choler, Phlegm, Melancholy, to which likewise we add Serum and Wind.

Tumors for the most part are generated from the Humors, and that either by Congestion, or Fluxion.

They come by Congestion, when the Natural heat of the Part being diminished, the good Humors are ill concocted, or the vicious are not sufficient­ly evacuated.

By Fluxion, from a two-fold Cause, External, viz. a Fall, Blow, External Heat, too great Moti­on, &c. Internal, viz. Pain, Superabundancy, Thinness, Acrimony of Humors, &c.

The Signs of Tumors are, an Extention of the Part, Pain, Redness, Heat, Hardness, &c. But these are better explained in particular Tumors, than in general.

The times of Tumors (for all curable Tumors have four) are as followeth, Beginning, when the Part begins to swell; Increase, the swelling, pain, and other Symptoms are augmented; State, the Symptoms stand at a stay, and grow not worser; Declination, when the Symptoms are diminished.

Prognostick.] Tumors produced from Phlegm or Melancholy, are hard of Cure. Those are dan­gerous, which are generated from corrupt Blood or Choler, which seizeth the Internal Parts, which shew themselves about the greater Vessels, Joynts, Nerves, and the Membranous or Noble Parts: Those that are of great bigness, and that happen in Cacochymick Bodies.

They are Terminated four ways; 1. By Dis­sipation, which the lessening of the Symptoms do declare. 2. By Suppuration, wherein the Pain [Page 90] and Pulsation is increased together with a Fever. 3. By Induration, which the too often and immo­derate use of Repelling and Dissipating Medicines hath caused. 4. Degenerating into a Gangrene, from the defect of Natural Heat.

The Cure is performed two ways: 1. By hin­dering any further Flux to the Part. 2. In removing that which is already gathered in the Part.

We stay the Flux of Humors, 1. By Intercepting. 2. By Repelling. 3. By Revelling. 4. By Derivation. 5. By Corroborating the Part it self.

The Matter already gathered, is taken away, 1. By Astringing and Repelling Medicines, to wit, when 'tis thin, and sticks not too firm to the Parts. 2. By Resolvents, when it is thick, and adheres more firmly to the Part. 3. By Suppuratives, when the other are too weak. 4. By Fire and Cutting, when other means effect nothing.

CHAP. II. Of Inflammation.

A Phlegmon or Inflammation is a Tumor be­sides Nature, from Blood thrown forth into the Skin or Subjacent Muscles, causing Heat, Redness, Pain, Pulsation and Tension.

Difference.] 'Tis Perfect, when from Blood alone: Imperfect, when Choler Phlegm, or Melancholy is mix'd with the Blood, and then 'tis called Phleg­mone, Erysipelatodes, Oedematodes, Schirrhodes.

[Page 91]The Cause is sometimes Blood alone, sometimes mixt with other Humors.

Signs, are Heat, Redness, Pain, Pulsation, Shi­ning, Tension, Hardness, Renitency.

Prognosticks.] An Inflammation of the External Parts frees the Internal from many Diseases; al­ways wholesome, except from its too great Ex­tention it produceth a Gangrene; dangerous and of hard cure is that which seizeth on the Eyes, Jaws, Penis, Pudendum Muliebre and Joynts. In a young Person, and in Summer soon cured; lon­ger of Cure, in a fat, than a lean Body.

The Cure hath four Indications. The first of these respects a good Diet; let him chuse a clear Air, his Meat and Drink little, and that cooling; all hot, sweet and fat things, as Pepper and Ginger, are hurtful; as also the motion of the Body, espe­cially of the Part affected; Sleep is very conve­nient: All Costivenefs, Anger and Venery are noxious,

Second, that stops the further Flux of the Hu­mor, which may be performed by Revulsion, De­rivation, Repelling and Interception; therefore let a Vein be opened as soon as possible, it being most necessary: Revulsion is made in the Oppo­site and most Remote part, Derivation in the nea­rest: If you may not open a Vein, you must use Leeches and Scarifications. Whilst these things are done, seeing the Body is seldom clean, but that always there are ill Humors mixt with the Blood, by Purging rightly used, and often repeated, as al­so Bleeding, we effect much.

In the mean time, the Part affected requires Repelling Medicines, from which we must ab­stain, Where, 1. The Noble Parts send the Hu­mors [Page 92] to convenient places, and to the Glandules. 2. Where the Humors are Malignant. 3. When Critical. 4. When the Body is very impure. 5. When the part affected is very weak or painful. 6. Where the Inflammation is about some Noble Part.

CHAP. III. Erysipelas.

ERysipelas is a Tumor besides Nature, from Cho­ler, thrown forth for the most part only into the Skin it self, sometimes on the subjacent Muscles, cau­sing Pain, Heat and other Symptoms.

Difference.] 'Tis perfect, when sprung from Choler alone; as it is imperfect, when Blood, Phlegm or Melancholy is mixt with it; from whose Appellation it likewise takes its name, and is called Erysipelas, Phlegmonodes, Oedematodes, Scirrhodes; sometimes an Ulcer is joined with it, which sometimes consumes only the Skin, other times the Flesh it self.

Cause is Choler, seldom alone, sometimes mixt with Phlegm and Melancholy, but oftentimes with Blood or Serum; whence, those Medicines that are proper for a Phlegmon, oftentimes do good in an Erysipelas.

Signs.] Great heat, sharp pain, Redness mixt with Yellowness, easily giving way to the touch, but as suddenly returning; the Swelling and Ex­tention of the part little, and the Pulsation lesser: which last gave occasion to Authors, of question­ing whether an Erysipelas ought to be reckoned amongst Tumors. It is accompanied always with a Fever, except from an External Cause.

Prognosticks.] An Erysipelas is seldom dangerous, except the Matter be repell'd from the Exter­nal parts to the Internal; yet more dangerous, [Page 96] when it seizeth on the Noble Parts and Jaws; and when a Wound; Fracture, Dislocation or Putre­faction are join'd with it.

Cure.] What concerns Diet here, is first and chiefly to be considered; Air, Meat and Drink must be cooling; all sharp, hot, fat and sweet things hurt; as likewise do too great Motion of the Body, Watchings, Costiveness, Venery and Anger.

Purging is very necessary, therefore those Me­dicines described in the third Chapter of the first Part, are here convenient.

A perfect Erysipelas admits not of Bleeding; for the fatness of the Blood bridles the sharpness of the Choler: But if the Fever be vehement, the Flux great, and any Blood (which for the most part happens) be mingled with the Choler, 'tis convenient to bleed, especially in Plethorick Bo­dies: In delicate and weak Bodies, Cupping-Glasses, with Scarification or Leeches, if things should require, will serve,

These being thus done, to provoke Sweat, is the best of all other Remedies.

Outwardly to the affected part, ought not to be applied, 1. Oyl, or any fat thing; as those things which yield matter to the Choler, easily increase Putrefaction: But if yet it is your pleasure to use them, they must be tempered by mixing them with other Medicines. 2. Repellents, except the Ery­sipelas be very little, the Part affected remote from the Noble Part, and the Humors be yet flowing, and then they ought not to be used without Resolvents mixt with them.

The Cataplasms described in the foregoing Chapter, may for the most part be applied here with success.

[Page 97]The Plaister of Diapalma dissolved in Vinegar, is in dayly use; the leaves of Tobacco, Colewort, and Henbane applied to the part affected, strong­ly draw forth the heat. There are those which use Sheeps dung boiled in Wine-Vinegar; as also the Flowers of Camomil, Mellilot, and Elders, boyl'd in new Milk.

Chalk powdred, put upon the Part, laying Cap­paper over it, quickly and safely Cures.

The following Fomentations I have experien­ced to be of great Virtue.

Take Red Myrrhe powdred, two drams; Sac­carum Saturni one dram; Camphire a Scruple, Opium 25 grains, White-Wine six ounces: Let Linnen Clothes be dipt in it, and applyed warm to the Part, often renewing them, when dryed, or cold.

Another,

Take the white Troches of Rhasis one dram, Camphire one Scruple, Spirit of Wine an ounce, Elder-water six ounces: Mingle and apply it as before.

Fumes of Mastick, and Frankincense may likewise be used five or six times a day, especial­ly if the Erysipelas be in the Face.

CHAP. IV. Of Oedema.

OEdema, is a Tumor beside Nature, arising from Pituitous Matter, white, soft, without pain, oftner caused by Congestion, than by Fluxion.

Difference.] It is perfect, when it proceeds only from Phlegm: Imperfect, when mixt with other Humors; Thus Oedema, Phegmonodes, Erysipelato­des, Schirrhodes.

Cause is Phlegm, sometimes alone, sometimes confused with other Humors; for the most part it is produced from the ill disposition of the Lim­phaeducts.

Signs are Whiteness, Softness, yielding to the Fingers; little Pain, and less Pulsation.

Prognosticks.] If an Oedema degenerate into a Scirrhus, or Abscess, it is hard of Cure. It is dan­gerous if a Consumption, or Dropsie accompany it: it oftner happens in old People, Phlegmatick bodies in the Winter time, and in all those who with immoderate eating and drinking continual­ly, debilitate the natural heat.

Cure.] This, as the precedent Tumors, requires a good Diet Meat and Drink, as also the Air must be moderately hot and dry: Rosted Meat is bet­ter than Boiled; Fruit, Cheese, and Fish hurt; as also too great a quantity of Meat and Drink: Wine, either of it self,, or altered with hot Herbs is good; moderate Exercises of the body before Meals, is as profitable, as much Sleep, especially [Page 99] diurnal is prejudicial; Costiveness, Rest, and Sad­ness are Noxious.

Bleeding is altogether here unprofitable, and very seldom used; but Sweating and Purging very necessary, sometimes Vomiting: Always regard must be had to the Stomach.

To the Tumor it self. In the beginning we ap­ply Repelling Medicines mixt with Discussives, but so, that the Discussives exceed; afterwards we use only Discussives, though sometimes stron­ger, sometimes weaker, according to the condi­tion of the Disease.

Take Aloes three drams; Bole-armenick half an ounce; Acacia, Dragons blood, Cyprus Roots powdered, of each two drams; Saffron half a dram, Rose-Vinegar an ounce and half; Oyl of Mirtle and Earth-worms, of each an ounce; Wax, as much as is sufficient to make it into a Linament.

Another stronger.

Take Crude Brimstone, Ashes of Vine Bran­ches, Sal-Gemme, of each two drams; Bean­meal two ounces, Vinegar an ounce, Oyl of Nuts a dram, Turpentine, and Wax, as much as sufficeth either to make it into the Consistence of an Ointment, or Cerat.

Another yet stronger.

Take Laudanum, an ounce and half; Frankin­cense an ounce; Styrax-Camitis half an ounce; Brimstone six drams; Alom, Salt-peter, Ashes, of each two drams; Cows-dung half an ounce; Oyl of Rue an ounce; Turpentine, and Pitch, as much as sufficeth to make a Plaister.

CHAP. V. Of Scirrhus.

SCirrhus is a Tumor besides Nature, sometimes ge­nerated of Tough, Viscous Phlegm; sometimes of Melancholy, hard, not yielding to the touch, nor painful.

Differences; It is perfect when sprung from Me­lancholy, or Phlegm alone: Imperfect, when o­ther Humors are unnaturally mixt with it.

Cause, is Melancholy, or tough Phlegm.

Signs, great hardness void of pain, of a white colour, if from Phlegm; if from Melancholy, Livid.

Prognostick.] A Scirrhus, where there is no pain, and upon which the hair grows, is alto­gether incurable, and if Livid, it is very dange­rous, and often degenerates into a Cancer: An imperfect, small, and painful one, by means sometimes (although very rare) may be cu­red.

Cure.] If the Scirrhus be produced from Phlegm, the same manner of Diet is to be obser­ved as in an Oedema; but if from Melancholy, you must chuse a clear Air, moderately hot, and [Page 102] moist; the Meat of the saxe quality, and of easie Digestion; all sharp things, and those that are hot in the third or fourth degree, hurt: Let the Drink be neither thick nor strong, but warming▪ Sadness, Anger, Cares, Venery, much Sleep, hurt­ful; but moderate Exercises very necessary.

Bleeding is scarce ever administred with any success, but Sweating, and Purging with great.

Amongst the External Remedies are Discussives and Emollients; but yet the whole course of the Cure must be mixt, now increasing the quantity of the one, then of the other.

The use of Suppuratives in the Cure of Schir­rhus, hath seldom any good event.

There are those which try cutting out, and burning which must be attributed to their rash ignorance, except contained in a proper Tuni­cle, and then the name of Schirrhus is ill attribu­ted to that Tumor.

CHAP. VI. De Tumore Aquoso, or Watry Tumor.

TUmor Aquosus is a Collection of a Watry Hu­mor in the whole body, or in some one part; soft, and without pain, yielding to the Fingers, but suddenly returning.

Difference. Sometimes the whole body is swell'd with water; which Tumor is call'd Anasarca, some­times the lower Belly only, or with the Legs, and then it is called Ascites; if Wind, mixing with the water, extends the Belly like to a Drum, it is call'd Tympanites: These are three kinds of Dropsies, whose Cure rather appertains to the Physician than Chirurgion; Water collected in the Head, is call'd Hydrocephalos; in the Breast, a Dropsie of the Lungs; in the Navel, a Hydromphalos; in the Cods, Hydrocele.

Cause is Serum, to wit Salt-water, produced from the lost heat of the parts that serv'd to San­guification, and Chylification.

Signs; This Tumor is softer then Oedema, and more yielding to the Fingers, without pain, with some itching, and if you look on it by Candle­light, very shining.

[Page 104] Prognosticks.] Watry Tumors are not dange­rous, if the principle parts that feed it, are not too much debilitated, yet all are of difficult Cure, especially those in and about the Joynts.

Cure. Diet is here the same as in Oedema: All Salt things indurated with Smoak, and too great a quantity of Drink, are very hurtful; as al­so Spirit of Wine and Pepper; otherwise hot and dry Aliments are best.

Purging is very necessary, provided it be not too great, lest the parts already weak, are more weak­ned: provoking Sweat and Urine, here are very profitable.

Bleeding, by experience I know it to be hurt­ful to all Hydropick People.

CHAP. VII. Of the Flatuous, or Windy Tumor.

THe Flatuous Tumor is a Disease produced of Wind, not yielding without resistance to the Fingers.

Difference. Some are without pain, others with it; in the one, the wind is in motion, in the other, quiet.

Causes of Wind, are Phlegm, especially when mingled with Choler, which, as Ferment doth froth, so it proceedeth wind; it always happens upon a debility of the Parts, by reason of which, although endeavoring to concoct the Humors, yet are notable.

Signs are Inflation, with a resistance yielding to the Fingers, a rumbling noise, especially if shaken.

Prognosticks.] It seldom comes is fleshy parts; in other parts it brings many inconveniencies, in weak and Cacochymick bodies, it's of difficult and tedious Cure.

Cure.] The same Diet in here to be observed as in an Oedema: Pease, Beans, Turnips, Chest­nuts, and all Crude Fruit do extreamly hurt; On the contrary, Wine, and other things moderate­ly warming, profit; as also Spices, and those things which disperse Wind, as Nutmegs, Mace, Anise, Carraways, Lovage.

The Stomach, and the whole Body require [Page 108] purging and corroborating Medicines, always mixing with them those that disperse Wind, and sometimes also where Corroboratives are used, Anodines, Laudanum; Opiatum cautiously used (that is, half a grain, or a grain for a Dose) is here excel­lent: For besides that it ceaseth pain, it also by its Diaphoretick quality removes the Cause of the Disease: To cause Sweat, is as necessary as Bleed­ing is unnecessary.

CHAP. VIII. De Herpete.

HErpes is a Tumor besides Nature, sprung from yellow Choler, disfiguring the Skin with corro­ding and spreading Pustules.

Difference.] Where Choler solely predominates, it produceth Herpes exedens, but where Phlegm is mixt with Choler, a Herpes Miliaris.

Cause is sometimes Choler alone, sometimes mixt with Phlegm; and I see not why the serum of the Blood may not often be here taken as a Cause: For the Lymphaeducts being out of order, do produce Mutations in mans body, heretofore unknown.

Signs.] Are little Pustules, like to Millet-seed; a heat, itching; and after rubbing, a moistness, and little Ulcers.

Prognosticks.] Herpes is of difficult Cure, but of little danger, unless so rendred by the immoderate use of Repellents.

Cure.] The same Diet is here required, as in an Erysipelas. Moreover, Purging is here very necessary; Bleeding not to be allowed of; the use of Baths is excellent, and their Waters taken at fit [Page 110] times, safely Cure this Disease: The Decoctions of China, Salsa, &c. also benefit much.

Outwardly.] Fasting-Spittle oftentimes doth good, because if it should be repelled to the In­ternal parts, it causeth a Feaver, and other ill Symptoms.

With great success many times, have I seen ap­plyed the Powder of Lapis Scisilis, mixt with Vi­negar; some used Mustard boyl'd in Butter; to which they add some Gunpowder. Lye also, and Urine have helpt many; Unguent, Fuscum, of Felix Wurtz is excellent here; as also the follow­ing Plaister.

Take Sarcocols, Crude Brimstone, of each two drrms; Mastick, Frankincense, Lapis Calaminaris, of each half an ounce; white Troches of Rhasis, Litharge of Gold, Myrrhe, of each three drams; Goats Suit, half an ounce; Wax and Turpentine, so much as is sufficient to make it into a Plaister, according to Art.

Take the Powder of Chalk mixt with Cream, and anoint the part, fomenting it before with the hot Lees of White-wine.

CHAP. IX. Of Atheroma, Steatoma, and Meliceris.

A Theroma is a Tumor besides Nature, contained in a proper Cist, caused from a Humor like to the Pap of a sodden Barley, without pain, of the colour of the skin, not yeilding to the singers, nor when they are removed, suddenly swelling out again.

Steatoma is a Tumor besides Nature, contained in its own proper Tunicle, caused from a Matter like to Suet, and of the same colour, soft, from a small be­ginning, by degrees increasing, difficulty yielding to to the Fingers, but they being removed, returning again to its former greatness.

Meliceris is a Tumor besides Nature, included in its proper Tunicle, engendered from a Humor, like to Hony, without pain, round, easily yeilding to the Fin­gers, which being removed, returns again to its first Figure.

Differences.] This Matter like to Honey, Suet, or Pap, if gathered about the Joynts, is call'd a Gan­glion; if about the Glandules of the Neck, a Glandu­la, Scrophula, or Struma; if in the Arms, Legs, or Head, Turberculum; if from the Pox, Tophus.

Cause of these Tumors is Phlegm, in the one more, in the other less, receding from its Natural Constitution; and sometimes, but very seldom, mixt with Melancholy.

Signs are declared in their Definition.

Prognosticks.] They are scarce ever cured, but by Manual Operation: If the Vesicle be broken, [Page 112] or not all taken out, there remains a Fistula, or a foul Ulcer: The Cure of which will be both difficult and tedious.

Cure.] They are sometimes, but very rare, re­moved by strong Resolvents: I have Cured some with Balsom of Peru; some use Oxicroceum Plai­ster, or the following:

Take Laudanum an ounce; Red Myrrhe, three drams; Camphire a dram: Mix them; and make it into a Plaister according to Art.

Another,

Take Gum Sagapenum, Ammoniacum, of each half an ounce; Roots of Pellitory, Euphorbium, of each a scruple and half; Brimstone three drams; Oyl of Amber a dram: Make it into a Plaister.

If it break, and the Matter discharge out of the Tunicle, then must you use Corrosives, for other Medicines are too weak.

CHAP. X. Of Scrophula, Struma, or King's-Evil.

STruma or Scrophula are Tumors besides Nature, contained in a proper Tunicle of their own, from a Melancholick or Pituitous Humor; shewing them­selves in manner of Tubercles in the Neck and adjoyn­ing Parts.

Difference.] They are sometimes noveable, sometimes fixt; sometimes but one, sometimes many.

Cause, is Melancholy or Phlegm, or both mixt together.

Signs.] Are Hardness, Inequality, and seldom painful.

Prognosticks.] These Tumors are of long and difficult Cure; especially if many, or fixt; they are dangerous when they grow painful, and threaten to become cancerous; or if fixt to any great Nerve or Vein, sometimes they are Here­ditary, and sometimes peculiar to a Region or City; when cured, they for the most part leave behind them great Skars; where the recurrent Nerve is divided, the Speech is lost, and often­times Life it self.

[Page 114] Cure.] Diet must be here the same, as in a Oe­dema or Scirrhus.

Purging is necessary, but not Bleeding: provo­king Sweat, by the same way and means as in the French-Pox, effects much; yea, it alone cures the King's-Evil.

Sometimes they are consumed by Internal Remedies, that have appropriated Qualities of curing Scrophulas.

Such are these:

Roots of round Birthwort, Briony, Sow-Bread, Dropwort, Devil's-bit, Orrise, Pimpernel, Pellitory of Spain, Squills, Vervain, Figwort, Leaves of Cypress, Bawm, Rue, Savory, Flow­ers of Broom, burnt Crabs, burnt Egg-shells, Sal Gemmae, Spunges.

New Spunges are much commended, if boil­ed in Ale; drinking thereof three or four times a day; or calcined, and taking half a dram of the Powder Morning and Evening. The fol­lowing Powder is likewise very much praised:

Take the Ashes of Sea-Spunges, Os Sepiae, Long Pepper, Cinamon, Sal Gemmae, Pellitory of Spain, Cypress-Nuts, Galls, Red-Rose Leaves, of each half an ounce: Make a Powder. Dose, two Scruples or a Dram.

Or,

Take of Spunge-stone, three drams; Sal Gem­mae, two drams; Salt of Tartar, a dram: Make a Powder. Dose, two scruples, or a dram.

Outwardly Resolving and Emollient Medicines are applied; which if they effect it not, then use Suppuratives; when 'tis suppurated, it is to be cured as a malignant Ulcer.

But if the above-named Medicines signifie no­thing, [Page 115] then we come to corrosive Medicines, and to the Incision-Knife.

CHAP. XI. Of a Bubo.

BUbo is a Tumor besides Nature, of the Glan­dules, from impure Blood, Red, Painful and hard.

Difference.] Where little, and not painful, and easily brought to Suppuration, 'tis called Phyma; but where there is more of Choler in it Phygeton; in the Arm-pits, Panus; behind the Ears, Parotis: The one Malign or Pestilential, the other not; sometimes contracted from unchaste Embraces, then 'tis called a Venereal Bubo.

Cause is Blood, never alone, but always mixt with some other preternatural Humor.

Signs, are Redness about the Glandules, pain, heat, tension, hardness, pulsation, and sometimes a Fever.

The Liver and Spleen, according to the opini­on of the Ancients, discharge themselves into the Groins; the Breast and Heart, at the Arm-pits; the Brain, at the Glandules of the Ear; but now far other use is attributed to the Glandules. Of which there are several Tracts written, and we shall give our Opinion in another place.

Prognosticks.] The Bubo that is not Malign, is [Page 117] not dangerous, except it be long discussing, or sup­purating, and then fear lest it Fistulate: In the Arm-pits it is sooner brought to maturity than in the Groins; and here sooner than behind the Ears: On the contrary, a Malign is for the most part a sign of sudden Death, although all outward signs may appear well.

The Venereal is not mortal, but of hard Cure, and for the most part precedes the Pox; chiefly when by Bleeding, or the use of repelling Me­dicines, the Matter is returned from the External, into Internal parts.

Cure.] Diet the same as in a Phlegmon: In a Benign, Purging is necessary, provided it be not with too strong Medicines: Bleeding, except a great Fever, or a Plethora require, I admit no more of it here, than of Repellent Medicines; for 'tis unseemly that Natures Assister should return that into the interior parts, which Nature her self did eject (which for the most part is Critical.) Sweating in all Buboes, profits much: Scarification hath no place here, except in Malignant, nor Leeches, but where very much inflamed.

The External Cure is to be managed so, that the Humor may be dissipated with Resolvents, which by reason of the frigidity of the Glandules, are required the stronger; adding also Attractives to them; for in all, I suspect lest the Matter be not perfectly thrown forth: But in a painful Bubo, 'tis first necessary to ease the pain, before you come to any other Medicines.

CHAP. XII. Of the Carbuncle.

A Carbuncle is a Tumor besides Nature, from adust Blood, corrupting the Part where it is collected.

Difference.] 'Tis called by the Greeks, Anthrax; by the Latines, Ignis Persicus; by the Germans, Een Kool: Some endeavour a Difference between an Anthrax and Carbuncle, but lose their Labour. There is is no other Difference, but sometimes it is bigger, sometimes lesser, sometimes more Ma­lignant, other times less.

Cause is adust Blood, assuming the Nature of black Choler, and so apt to putrifie.

Signs are, sometimes but one great Pustule, sometimes many litttle ones; which being open­ed, appear black, and all about enflamed: The Crust being removed, instead of Matter, you find spungy Flesh; the Part affected is very painful, a Fever present and Watchings.

Prognosticks.] Very dangerous, when black, especially in Plague time; when near to to a principal part, if great, and suddenly vanishing.

Cure.] Strong Purging Medicines I much mi­strust; Clisters or loosening Medicines will suffice; viz. Cassia Fistula, Manna, Tamarinds, Cream of Tartar, &c. But more suspicious to me is Bleeding to fainting (as Galen writes) and in its room, Leeches or Cups with Scarification will be suffi­cient. But I rely most upon Sudorifick and Re­frigerating [Page 122] Medicines; using outwardly the same Medicines as in the Plague.

This Plaister is much commended to make a separation of the Eskar.

Take old Thereacle, Mithridate, of each half an ounce; Leaven, Turpentine, of each two ounces; Honey of Roses, an ounce and a half; Fresh Butter, two ounces; White Vitriol, an ounce; Soot, two ounces and half; Black-sope, three ounces; Saffron, three drams; Yelks of Eggs, N ^o iij. Mix them, and make a Plaister ac­cording to Art.

The External Medicines ought often to be changed: Here is no need of Suppuratives; for the Humors are easily corrupted of themselves; in the place of which, the Eskar being separated, may be used Ung. Fuscum of Felix Wurtz, Aegyp­tiacum, and Honey of Roses, &c.

CHAP. XIII. Of a Cancer.

A Cancer is a Tumor besides Nature, sprung from Black Choler, round, hard, livid, painful, full of turgid Veins, resembling the feet of a Crab.

Difference.] Where not exulcerated, by the Greeks it is named Carcinoma; when ulcerated, Plagedaena, by the Greeks; and by the Germans, De Wolf.

Signs.] In the beginning difficultly known, scarce equalling a Pea in bigness; then sometimes increasing suddenly, sometimes slowly; it makes [Page 123] it self, by its grievous Symptoms, easily enough to be known: The Tumor is hard, painful, hot, livid, or black, round with some inequality, full of swell'd Veins.

Prognosticks.] A Cancer is seldom Cured by Medicines, often by Chirurgery, but not with­out danger; sharp Medicines exulcerate it: It is imprudence to attempt an occult Cancer, or that is detained in any Cavity of the Body, except it be very little, and may easily be taken away by Incision.

Cure.] Diet the same as in Schirrhus; frequent Purging convenient; be cautious in Bleeding, as also in Scarification. The Moneths flowing in Women, and in Men, the Hemorrhoids, are ve­ry beneficial.

Externally, Suppuratives and strong Discuti­ents are hurtful; the following, good.

CHAP. XIV. Of a Gangrene and Sphacelus.

A Gangrene, is a beginning Mortification of the the soft Parts of the Body, most commonly following a great Inflammation, or ill cured.

Sphacelus, Necrosis, Syderatio, is a perfect Mortifica­tion, not only of the soft, but of the hard parts also.

Differences.] In a Sphacelus, the parts are altoge­ther dead; but in a Gangrene, they begin but to die, and the sense is not perfectly abolished; there the Skin is first pallid, suddenly livid, then black; here in a manner red; greater stink in that, than in this.

The Causes of both are six. 1. The External Cold of the Air, or Repelling Medicines. 2. Ex­ternal Heat, from burning, or use of Corrosive Medicines. 3. A Defect of Nutriment, as in an Atrophia, either by the compression or obstructi­on of the Vessels, by reason of which straightness the Blood cannot pass to the Part. 4. The stopping of the Pores, or Perspiration hindred; from whence comes a Suffocation of the Natural Heat. 5. Ma­lign Humor, either begotten in the Body, or con­tractee from venomous Beasts, or Medicines. 6. The Scurvy, which by a peculiar property, causeth the Parts sometimes to mortifie.

Signs.] A Sphacelus is easily to be known, the Part looks black; Spungy Flesh; Sense, Heat, and Pulsation abolish'd.

[Page 127]But the Signs of a Gangrene vary according to the variety of the Causes: If contracted from Cold, a great pricking Pain is felt in the affected Part: First, 'tis red, then pale, at length black: The Natural heat by degrees is extinguished, and there happens a shaking, not unlike that in a Quar­tane Ague.

If caused from an External Heat, or stopping of the Pores, the Redness is changed into White, then into Black; Pulsation and Pain cease; the Senses lessened; and at last there appear some Pustules, from whence issue a gleety Humor.

If from defect of Aliment, there is neither Pain, Inflammation or Tumor; the Body waxeth cold, and for the most part seizeth upon the Joynts.

If from a venomous Creature or Humor, great Pain and Fever always accompany it; frequent Faintings, and oftentimes Deliriums: Here ari­seth a Pustule, under which appears a black Spot, which spreads it self over the whole part.

If from the Scurvy, it for the most part begins at the Toes, it shews it self outwardly with black­ish spots and lines, which degenerates into a dry Crust; upon which follows a Numness of the Part, and at length a Mortification it self, with­out any Stink: Sometimes without pain, other times very great, especially in them that are given to Passion or Sadness.

Prognosticks.] Except a Gangrene be suddenly stopt, it degenerates into a Sphacelus; easilier cu­red in young, than old People: The Humors continually flowing to the part affected, bring danger with them, and that very great, if they are Malignant: In the Cavities of the Body, to wit, in the Mouth, Privy Parts, and Fundament, &c. [Page 128] a Gangrene is always difficult of Cure, as also that which happens among the Nerves and Ten­dons; in Hydropicks always mortal: That which happens from the Scurvy, may be spun out from many Months, but seldom cured.

A Sphacelus is not cured but by the Knife and Fire.

Cure.] Diet must be good, the Air, Meat and Drink generally cooling and drying: But seeing the Causes are various, we leave it to the Physi­tian to prescribe what is convenient; who also must well distinguish concerning Bleeding and Purging, when to be used with advantage or dis­advantage. Sudorisicks and Cordials are of great use here; and because that in this, and other Diseases, they are often used, I thought it conve­nient to set them down in this Place.

CHAP. XV. Of a Paronychia.

PAnaritium, or Paronychia, is a Tumor very painful, in the end of the Finger, from a sharp Malignant Humor, corroding the Tendons, Nerves, Periostium, and Bone it self.

Cause is a sharp humor, proceeding from Cho­ler or Serum.

Signs are, an intollerable pain about the Nail, tormenting the Patient day and night; an Inflam­mation, oftentimes extending over the whole Arm: A Fever for the most part, and sometimes Delirium.

Prognostick.] By how much the Humor is the more malignant, the greater Symptoms it raiseth, corrupting sometimes the Bone, the Finger, the whole Hand, and sometimes from extream pain, it occasions the death of the Patient.

Cure.] Foment the Finger a while in this De­coction.

Take Flowers of Camomile, Mellilot, Elder, of each half a handful; Linseed and Fenugreek, each two drams: Boil them in Milk.

Or, let this Cataplasm be applied.

Take Flowers of Dill, Elder, Leaves of Hen-Bane, of each a handful; Poppy-seeds and Lin­seed, of each three drams; Marsh-mallow-powder, an ounce and half.

[Page 134]Boil them in Milk, to the consistence of a Ca­taplasm.

Then make Incision upon the Part affected, ac­cording to the length of the Finger; and for the most part there appears one or more red spots, containing a sharp Matter, but little in quantity, which is the cause of the Disease.

After the Apertion of the Tumor, at the first dressing, apply to the Finger Treacle dissolv'd in Spirit of Wine, and a Defensive to the whole Hand; so in a day or two, the Cure will be per­fected.

But if this Part should be gangren'd or Sphace­lated, either by the neglect of Patient or Chirur­geon, let it be taken off: Except you will com­mit the business to Nature, which oftentimes se­parates, and throws out this Bone. A great In­flammation sometimes here produceth a Fleshy Ex­crescency, occult and sensless; this is removed by Knife, or exeding Medicines: Then cure accor­ding to Art.

But if being too late call'd you find a great col­lection of Humors, let Discussives or Suppuratives be applied; then the Tumor being either broke, or opened, take great care, lest the Tendons (which do very easily) putrifie, or incline to putrefaction: Separation is here necessary, whether it be by Medicines, or a cutting Instrument: Repellents in this case, greatly hurtful.

CHAP. XVI. Of an Aneurism.

ANeurisma is a Tumor besides Nature, from a Rupture of an Artery, continually beating, easily yielding to the Fingers, and as suddenly re­turning.

Cause.] All Arteries, except those that are dis­persed, through the Brain and upper parts, consist of a double Tunicle; the inmost of which being either corroded or broke, the External may be ex­tended so much (without a Rupture of it, what­soever others say) as to cause an Aneurism: Never­theless, where the Tumor is of the bigness of ones Fist, it cannot be but that the External also must be either corroded or broke. Anatomy doth con­firm this Opinion, which the Studious in the Art of Chirurgery may enquire into.

This Tumor also may be caused, where an Ar­tery be divided; so that the External Tunicle u­nited to the Muscles, the Internal, by reason of the continual pulsation, remains open.

Signs.] A Swelling increasing by degrees, of the same colour as the skin; a continual Pulsation: If the Tumor be little, it easily yields to the Fin­gers, so that it altogether disappears, but sudden­ly returns again; but if great, not so easily yielding to the touch, not so strong a Pulsation: but there is a noise observed, as of boiling Water; yet in the Head and Jaw, I have found after death an Aneurism, which while the man was alive, [Page 136] there could be no Pulse perceived: In the hard parts is greater Circumspection to be used, than in the soft and fleshy.

Prognosticks.] It is difficultly cured; if great, not at all, except with the taking off the Member; for the most part it is a long Disease, although I have seen it kill, without any other accidental Cause, within two years: If Incision be made, Death suddenly follows.

Cure.] In the beginning there may be some Hopes. Astringents and Repellents, and convenient Ligatures, by which we do not seldom administer something of Remedy to the Patient; as also the applying a piece of Lead straightly bound on, have sometimes cured little Aneurisms.

But where the Tumor is encreased, there are some would have the Skin divided, and the Artery tied both above and below, and cut out the middle with the Tumor, and loosen not the Ligatures, till the Wound is perfectly cured, and there is no fear of an Hemorrage; but this Operation is dange­rous, painful and troublesome, and oft-times of little Benefit: But to preserve Life, I would take off the Member.

CHAP. XVII. Of Opthalmia.

OPthalmia is an Inflammation of the Mem­branes of the Eye from Blood, with Redness, Pain, and shedding of Tears.

[Page 137] Difference.] A light Inflammation, and which depends from external Causes, is called a Bastard- Opthalmia, Taraxis, or Epiphora; but a great In­flammation, accompanied with pain and tears, a true Opthalmia. And if it be so great, that the Eye-lids are so inflamed, and as it were turned inward, 'tis called Chemosis.

Causes are two. 1. Internal, as Blood, oft-times mixt with Serum or Choler; seldom with Phlegm or Melancholy. 2. External, as Smoak, Dust, &c.

Signs vary according to the variety of Causes: If it proceed from too great a quantity of Blood, the Face looks red, and the Vessels of the Eyes are extended: If either from more of Serum or Choler, the Redness of the Face is less, but the Tears are more sharp, and the pain greater; if from more of Phlegm, the reddish pain, Heat and Acrimony of Tears are more remiss; and the Eye-lids at night are as it were glewed together: If from any thing of Melancholy, there are but few Tears, and the Eye-lids are not closed together, the Inflammation is not great, but stubborn.

Prognosticks.] An Opthalmia is flower cured in Children, than in old people. Continual pain menaceth Blindness, by how much greater the In­flammation is, so much the more dangerous it is.

Cure.] The Diet must be the same as in a Phleg­mon; all sharp things are carefully to be avoided; as Garlick, Radishes, Mustard, &c. little or no Suppers profit: Purging, the use of Glisters, Bleed­ing ought to be oft-times re-iterated; as also Cup­ping-Glasses, Leeches, Blisters; sometimes also Sea­tons, Issues, and Artereotomy it self, which is not to be done by any but an expert Chirurgeon; [Page 138] Sneezing is hurtful; Provoking of Sweat is sometimes necessary, sometimes not; which the Physician must distinguish: Dieureticks are of great use, pro­vided they are not too hot.

External Remedies vary according to the varie­ty of Causes; if from Smoke or Fire, let them be extinguished.

If from Dust, or any thing got into the Eyes, 'tis to be taken forth, which is often performed by blowing, or by the spurting in of Rose-water.

If from the inversion of the Eye-lids; the Hairs are to be cut off, or wholly to be pull'd out.

If the Eye-lids are glew'd together, they are to be separated, with Butter, Beer, or Cream, the Rheum is gently to be wiped; and let the Pati­ent have a Care, lest by the rubbing of his Eyes, he increaseth his Disease.

Fat things are here hurtful: Repellent Medicines, except in the very beginning, are not to be used, or in a very slight Opthalmia.

CHAP. XVIII. Of a Quinsie.

A Quinsie is a Tumor of the Jaws, from Blood, hindring Deglutition and Respiration.

Difference.] 'Tis divided into three species; the first is called Cynanthe, when the Muscles of the Larinx are inflamed: the Symptoms here are ve­ry dangerous, although neither internally nor ex­ternally appear any Tumor; the Patient puts forth his Tongue like a tired Dog, to fetch his breath. Second is Synanche, when the Tumor shews it self within the Jaws; the Symptoms are likewise here great, but much less than in Cynanthe. Third is, Parasynanche, when the Tumor appears more Externally than Internally; and in this the Sym­ptomes are least of all.

Cause is Blood, for the most part mixt with Se­rum or Choler; seldom with Phlegm or Melan­choly.

Signs of an approaching Quinsie, are, a stiffness of the Neck, swallowing and breathing somewhat hindred, an unusual heat and pain in the Jaws, e­specially when Quinsies are Epidemick.

Signs of a present are, a suffocating Asthma: swallowing hindred, which often increaseth to so great a heighth, that Drink taken in at the Mouth, comes forth again through the Nostrils, Pain, Redness, Tumor for the most part, also a conti­nual Fever; the Tongue likewise swell'd, and the Voice altered.

[Page 142] Prognostick.] A perfect Quinsie never wants danger, but sometimes suffocates the Patient the first day, generally before the fourth: If the Mat­ter be not suddenly concocted and thrown forth, it is desperate; if the Vertebraes be laxated, death is near at hand; foaming at mouth is a sign of pre­sent death; if the Patient be taken with a pain of the Head, a Delirium, raving and death it self suddenly follows.

Cure.] Bleeding in this case effects much, both by taking away of the Inflammation, and by hin­dering its increase, which is to be performed at first sight therefore let the Median or Cephalick Vein of the side most affected be opened, though in Women with Child, then the Vein under the Tongue: Cupping Glasses with Scarification may also be applied to the Neck about the second Ver­rebra, Shoulders and Breast; Leeches, Cauteries, and Blisters do much good, especially in them that are Subject to Quinsie: In the mean time, if the Patient can swallow, let some purging Me­dicines be given him; if not, let a Clister be cast in, with Bleeding, which must be often reitera­ted as occasion requires.

Gargarisms then, and other External Medicines are to be used; which in the beginning are to be more Repelling, afterwards more Discussing; for Experience and best Authors have taught, 1. Re­pellents never are to be used alone, except in the beginning, and in a light Quinsie. 2. That Repel­lents ought always to be mixt with Resolvents; for Repellents destroy the heat of the Part; Re­solvents cause Fluxion.

CHAP. I. Of the Practical Anatomy. THE PREFACE.

THou which desirest to know thy self, come hither and view; the little World will de­clare how thou oughtest to value the great one. The Architecture of thy Creator, by no Art to be bettered; the Essence of thy Soul, not to be [Page 202] reach'd by the greatest strength of thoughts, and the fragility of thy Terrestrial Mansion will teach thee, to esteem those things more that are above thee, to use bet­ter those things that are within thee, and to carry thy self with a more compassionate mind towards thy Neigh­bour, although thou walkest here as a stranger; the con­sideration of these things will shew thee, that thou oughtest not to be a stranger in the most necessary know­ledge of thy Duty, by which thou mayest use it to the greater good of thy self; so of others, if thou dilli­gently require, of what parts the Fabrick of thy Body consists; to this end, first we will shew the simple parts and their use; then after the division of the whole Bo­dy, the compounded Parts.

CHAP. II. Of the Parts in general·

A Part (properly so call'd) is a firm, limited Bo­dy, which is nourished by other living Parts but doth not nourish; having a peculiar use and operation for the advantage of the whole.

It is distinguished, 1. Into the Principal Parts, or or those not so: Principal are those that perform some Noble Operation common to the whole Bo­dy as the Heart, Liver, Brain, Testicles: Those not so, are those that serve the Principal, and whence they are call'd their Servants, as the Eye, Ear, Hands, &c.

This distinction pleased some Anatomists many years since, whom I much esteem; yet not me: For if the Liver and Heart are numbred amongst the Principal Parts because they elaborate the Blood for the advantage of the whole Body, why is not the Tongue accounted a Principal Part also? which is not only an Instrument of Speech, by which we are distinguished from Beasts, but also of Tastes, by whose assistance we chuse those A­liments which are best; which if wanting, how the Heart and Liver could supply the Body with good Nutriment, I see not. The Brain governs all, but how I beseech you? If the Intestines did not perform their Orifice aright, what would it ef­fect? How should we be esteem'd, if, like an Oi­ster, we should want Eyes and Ears? How despi­sed are the Feet and Hands, yet in how many con­ditions [Page 206] do they serve? For those not stirring, both Chilification would be impaired, and the Blood and the Spirits rendred thicker, and the Brain made unfit for all actions: In how short a time would the Limpha of our Body be corrupted, if, besides its own motion, it was not also moved with the whole Body? All things in our Body are joyned together as in a Clock, one cannot be without the other; neither is the most despicable Wheel less necessary than the Hand of the Clock itself, with­out which, it cannot be accounted a Clock.

2. Into similar Parts and dissimilar: A similar, which divided into many parts, yet, whose sin­gle parts be of the same Nature with the whole.

Dissimilar are made up of more or less similars, as the Hand, Fingers, Feet.

There are ten Similars found in the Body; a Bone, Cartilage, Ligament, Membrane, Fibre, Nerve, Vein, Artery, Flesh, Skin; the eight for­mer are made of Seed; Flesh, of Blood alone, the Skin of both.

This Division is subject to greater difficulties than the former; but seeing it is not convenient to reject it, without the greatest confusion in the practice of Physick, let us consider the thing it self, committing the Disputes concerning the Name, to the Schools.

CHAP. III. Of Bones.

A Bone is a Similar Part, cold and dry, composed of Seed, that it might afford strength to the Bo­dy, and help its motion.

Naturally, 1. It is hard. 2. Covered with a Membrane. 3. White, with some Redness, 4. Hollow, or Spungy. 5. About the Extremi­ties covered with a Cartilage. 6. Smooth. 7. Moi­stened with a fat Humor.

It is nourished by Blood brought from the Arte­ries (every where so small, excepting the lower Jaw, that Writers of great esteem have denied them to the Bones) but especially contained in the Marrow.

The Marrow is invested with a Membrane, it self is altogether insensible; in the Cavities of great Bones, 'tis White mixed with Red; in the [Page 208] lesser, White; in the Spungy Bones, soft and juicy

Its Sense it borrows from the covering Tunicle for the most curious Observer never saw Nerves.

The Bones are joined together, partly for the greater firmness, partly for the better Motion.

That Conjunction which is for their firmness, is called Symphysis, and is six-fold.

1. Suture, as in the Bones of the Skull.

2. Harmony, whigh is by a right or oblique Line, as in the upper Jaw.

3. Gomphosis, as the Teeth in the Jaws.

4. Sinchondrosis, which is by an interposing Cartilage, as in the Os Pubis, or the Sternum.

5. Syneurosis, which is by the assistance of a Ligament, as the Thigh-Bone with the Hips.

6. Syssarcosis, which is by the accession of flesh, as in the Os Hyodis.

That Conjunction which is for Motion, is call'd Articulation, and is twofold.

1. Diarthrosis, to wit, a loose Articulation: And 2. Synarthrosis, to wit, a straighter Articulation.

And both is performed by three manner of ways. 1. Enarthrosis, When the Cavity receiving the Bone is great, and the process of the Bone to be received also great, as in the joining of the Thigh-bone with the Hips.

2. Arthrodia. When the Cavity is superficial, and the Process little, as in the hinder part of the Head, with the first Vertebra of the Neck.

3. Gynglymus, When one Bone takes into its Cavity the process of another, and contrariwise the other Bone receives into its Cavity the Pro­cess of the former; as the Bone of the Thigh with the Tibia, and the Shoulder-bone, the Ulna.

[Page 209]The number of Bones is greater in Children than in adult People; for by years, many of them so grow together, as that they cannot be separated any more; also their number is much lessened, when consideration of the Processes and small Bones is not had; from hence it is that some reckon 360. some, 304, others, 249,

The use of the Bones, is, 1. To be a stay or sup­port to the Body. 2. Together with the flesh, to give it its shape. 3. To help motion. 4. To de­fend several Parts.

Although the Bones ought to be described in particular by us in their proper places, yet an A­natomist cannot be perfect, that is ignorant of the Bones; therefore, before we begin the Exami­nation of other parts, we think it convenient to exhibit to you the Skeleton in this place.

The Bones of the Head, we divide into the Skull and Jaws.

The Skull consists of eight Bones; which are, 1. The Bone of the Forehead. 2, and 3. Bones of the fore part of the Head. 4, and 5. Bones of the Temples, 6. The Bones of the hinder part of the Head. 7. Os Sphoenoides. 8. Os Ethmoide.

The upper Jaw consists of eleven Bones, to wit, five of each side, and one common; of these,

1, 2. Os Zygomaticum. 3, 4. Os Lachrymale. 5, 6. Os Maxillare, 7, 8. Bones of the Nose. 9, 10. Bones of the Palat. 11. Vomer.

The under-Jaw hath only one Bone, except the Cavity for the Teeth, of which are num­bered 32.

Four Fore-Teeth, two Dogs or Eye Teeth; all the rest are Grinders.

In the Internal parts of the Ear are four Bones, [Page 210] which are called, 1. The Hammer. 2. The Anvil. 3. The Stirrup. 4. The round Bone.

The Mouth hath only one Bone, called Os Hyodis.

The Neck is composed of seven Vertebra's; of these, 1. Is called Atlas. 2. Epistropheus. 3. Axis; the rest want Names.

The Bones of the Breast, in the upper parts, are,

The two Collar Bones; on the sides, fourteen true Ribs, ten Bastard, in all 24. On the fore-part, the Sternum, with the Sword-like Cartilage.

In the upper part of the Back are two Shoul­der Blades; in the middle twelve Vertebra's.

The hinder part of the Abdomen exhihits five Vertebra's of the Loins, to which are joined the Os Sacrum, and to it is joined the Os Coccygis.

On the side of Os Sacrum there is the Os Inno­minatum, or Bone of the Hip, which is divided, 1. Into Os Ilium, which is the greatest. 2. Os Ischi­um, the lowest. 3. Os Pubis, in the fore-part.

The Arm consists of only one Bone, which is called the Shoulder-Bone.

The Cubit of two, the uppermost of which is the Ulna, the lowest, the Radius.

The Metacarpus contains eight Bones, to which as yet there are no Names given; the Carpus four.

The Fingers 10, each of which consisting of three Joints.

Besides these, about the Joints of the Fingers. are sound the Ossa Sessamoidea, 10, 12, 15, or 20.

The Thigh hath only one Bone.

The Leg consists of two, one of which is the innermost, called Tibia; the other, which is outer­most, the Fibula.

[Page 211]Between these, and the Bone of the Thigh, is placed forward the Knee-Bone.

The Tarsus hath seven Bones, which are, 1. Tar­sus, or, Astralagus, 2. Calx. or the Heel-Bone. 3. Os Naviculare, or, Cimbiforme. 4. Os Cuboides, or, Tes­serae. 5, 6, 7. Ossa Cunciformia, or Sphoenoidea.

The Metatarsus hath five Bones.

The Bones of the Toes are 14; for there's only two in the great Toe.

The Ossa Sessamoidea are found here also, 10, 12, sometimes 15, or 20.

CHAP. IV. Of a Cartilage.

A Cartilage is a similar, spermatick Part, drier and harder than a Ligament, but moister and softer than a Bone, rendring the Articulation the more pliable, and defending several parts from external in­juries.

Difference.] Some are softer, especially about the Joynts; others harder, and differing not much from the nature of a Bone.

'Tis nourish'd by little Arteries.

It is endowed neither with Nerves, nor Mem­branes, and by consequence without sense.

Its use is to facilitate motion, and to defend some Parts from external injuries, whereupon it is scarce subject to any.

CHAP. V. Of Ligaments.

A Ligament is a Similar, Spermatick, dry part, adhering firmly to the Bones, tying the parts of the Body mutually together.

Difference.] Some are Broad and Membranous, some Round and Nervous. 'Tis here to be obser­ved, [Page 218] that the Names Membranous and Nervous, are much used both by Writers and Practitioners, and hath deceived many of them; for 'tis requi­site to know that here it hath regard only to their external form, not their internal essence; for the Ligaments, both the Membranous and the Nervous are void of Sense, which they would not be, if they were composed of their true substance of Nerve or Membrane.

There is no Ligament hollow, if you except the slender Ligaments of the Womb; and are all de­stitute likewise of Sense of Motion, as from them­selves.

Use is to connect the parts of the Body, espe­cially the Bones, and preserveth them from con­tinual Luxation.

CHAP. VI. Of Membranes.

A Membrane is a Similar, Spermatick Part, broad, soft, dilatable, white, investing the Parts, and carrying sense to them.

Difference.] Some are very thin, others thick; some fleshy, but for the most part not.

The Parts which invest, are properly call'd Membranes; those which contain the Humors, Tunicles; and those which cover the Brain, Me­ninges.

It is endued with sense from itself, for all Mem­branes are sensible; yea, the Nerves themselves owe their sense to the Membranous substance of them.

Membranes therefore only are the true Organs of feeling, they serving the Animal Spirits to this purpose.

Use is, 1. To invest the Parts of the Body 2. To defend it from Injuries. 3. To keep them [Page 220] united. 4. To strengthen them. 5. To give them sense. 6. To close the Mouth of the Vessels, that the Nutritious Blood be not carried too suddenly into the Part, or out of it, into the Vein it self 7. To separate the Parts.

CHAP. VII. Of Fibres.

A Fibre is a Similar, Spermatick Part, dispersed through the Skin, Flesh and Membranes, to make them the stronger, and being naturally distend­ed, to contract again into the same manner.

Differences are, right, oblique and transverse, and some round; the right attract, the oblique thrust forth, transverse retain, round constrain; but this they do not so by their own singular virtue, as by the common virtue of the Member which they serve, and from whom they have their sense and nourishment, for of themselves they are senseless.

Use, is, to strengthen the Membranes, Skin, [Page 221] and Muscles, and when dilated, to reduce them into their natural state.

Whether the Blood it self hath Fibres, as many have delivered, and as it seems very probable to us, shall be explained in another place.

CHAP. VIII. Of Veins.

A Vein is a Similar, Spermatick, Membranous, long, hollow Part, every where joined by Ana­stomoses to the Arteries, receiving the Blood, want­ing further Concoction from them, and carrying it to the Heart and Liver.

Difference.] Veins of a four-fold condition are found in the Body.

1. Vena Cava. 2. Vena Porta. 3. Vena Pulmona­lis. 4. Vena Lacteae.

Of the last of which, a more convenient occa­sion will be offered to treat of in the following.

The Venae Cava and Porta take their beginning from the Liver. There are those which would [Page 222] have them come from the heart, from a weak Ar­gument taken from unborn Embrio's. But where I find many Branches inserted in the Liver, few or none in the Heart; yea, I have observed, that it hath not entred into the Heart it self, but only to be joined to its right Auricle: I rather embrace the old Opinion, willingly granting those honours to the Liver that I think belongs to it.

That the Roots of the Vena Cava and Porta were united by mutual Inosculations, the old Anatomists perswaded themselves; but the curious Inquisition of the Moderns hath both found out and clearly demonstrated, that they mutually touch one ano­ther, but not so united, that the Blood can pass out of one into the other; for the extremities of the foresaid Vessels, by means of the Parenchyma of the Liver, do so mutually consent, that Milk or any liquid thing cast into the Vena Porta with a Syringe, finds an easie passage into the Vena Ca­va, without either an injury of the Veins or the Parenchyma. Concerning which, read Glisson. Anatom. of the Liver, pag. 272.

Veins have only one Tunicle with many Valves within, especially in the external Joints.

They are nourished with Blood from the little Arteries, not that contained within themselves.

They are endowed with feeling, both from themselves, and sometimes from the Nerves.

Use is, to receive the Blood not sufficiently ela­borated from the Arteries, and return it to the Heart and Liver, there to be more perfectly con­cocted.

For the better Methods sake in the following, we must be forced to describe all Veins here par­ticularly, and divide them into their Branches.

[Page 223] Vena Cava taking its beginning in the Liver, as is before said, is separated into the ascending Trunk, and descending.

The Ascending, which is the greater, perfo­rates the Diaphragm, and is divided into four Branches, of these,

1. Phrenica, which disperseth it self through the Diaphragma and Pericardium.

2. Coronaria, appropriated to the Basis of the Heart, proceeds from the Trunk it self, after it hath penetrated the Pericardium, and inwardly united it self by a large fleshy Orifice to the right Auricle of the Heart.

3. Azygos, or sine pari, coming from the right side of the same Trunk, when ascending, it hath passed the upper part of the Pericardium, affording chief Branches to the eight lower Ribs, then about the fleshy appendices of the Diaphragm, it enters the Cavity of the lower Belly, where, on the left side 'tis inserted into the Emulgent Vein, on the right into the Trunk of the Cava.

4. Subclavia, from whom comes forth several Branches which go both upward and downward:

The Superiors are,

1. Muscula Superior.

2. Jugularis, externa & interna; that on both sides (sometimes single, sometimes double) goes to the Neck, Head and Face; this to the thick Meninx of the Brain, to whose third Sinus its greater Branch is united.

The Inferiors are,

1. Intercostalis, serving the four upper Ribs, and their Intercostal Muscles.

2. Mammaria, which is carried to the Breasts.

3. Mediastina, which goes to the Mediastine and Thyme.

[Page 224]4. Cervicalis, which goes to the Neck.

5. Muscula inferior, which goes to the Muscles of the Neck.

6, 7. Thoracica, inferior, and superior, which goes to the Muscles of the Breast.

The Subclavials being come out of the Breast, are called Axillares, then go to the Arms, where they are divided into 3 great branches, which are,

1. Cephalica, in the hand between the little Finger and its next; 'tis named Salvatella: Its Branches are variously mixt with the Branches of the Median.

2. Basilica, or Liver-Vein.

3. Mediana, which proceeds with other bran­ches from the Basilica.

The descending Trunk, which is the lesser, and is undivided till it comes to the fourth Vertebra of the Loins, then it communicates,

1. Adipsosa, to the Membranes of the Kidneys.

2. Emulgens, to the Kidneys themselves.

3. Spermatica, to the Testicles.

4. Lumbares, two, three or four, to the Loins, and to their Vertebra's.

Nearer to the Os Sacrum, it is separated into two Branches called Illiaci. Before they go to the Feet; the Trunk it self presents,

1. Muscula Superior, which goes to the Mus­cles of the Loins and Peritonaeum.

2. Sacra, sometimes single, sometimes double to the Os sacrum.

3. Muscula Media, to the Buttocks.

4. Hypogastria, to the Bladder and its Neck; to the Sphincter Ani, to the Penis, and to the neck of the Womb.

5. Epigastrica, to the Muscles of the Abdomen, and to the Peritonaeum.

[Page 225]6. Pudenda, to the privy Parts.

7. Muscula Inferior, to the joint of the Hips.

The Iliack Branches, as soon as they have left the Cavity of the Belly, are called Crurales.

From these proceed,

1. Ischiatica minor, which goes to the Skin, and Muscles of the Hip.

2. Ischiatica major, to the Hip, then to all the Toes.

3. Proplitea, to the Ham.

4. Suralis, to the Muscles of the Calf of the Leg.

5. Saphena, To the Knee, Ankle, and to the upper part of the Foot, and to the great Toe.

The Vena Cava, where it comes out of the Heart, receives three Valves, called Tricuspidales, looking internally, for this purpose, that the Blood may freely enter into the Heart, but to hinder its return.

The Use of the Vena Cava is, to receive the cruder Blood from the Arteries, and remit it to the Heart.

Vena Porta, much lesser and looser than the Ve­na Cava, ariseth from the Umbilical Vein, and with many Roots is inserted into the Liver; without the Liver, it is divided into Trunk and Branches, all which are distributed into several Parts contain'd in the lower Belly.

From the Trunk proceeds,

1. Gastroepiplois, which goes to the Caul and Stomach.

2. Intestinalis, to the intestine Duodenum.

3. Cysticae Gemellae, to the Gall.

4. Gastrica minor, to the left side of the Sto­mach.

[Page 226]Then this Trunk is divided into two great bran­ches, the Splenick and Mesenterick.

Ramus Splenicus, sometimes joyning to the Sweet-bread, sometimes passing through it, di­vides into four little Branches, as soon as it hath left it; which are these,

1. Vena Gastrica major, which goes to the Spleen, communicating from thence three or four small Veins to the Stomach: These being blown up in living and dead Bodies, manifestly declare, nothing at all can enter into the Cavity of the Stomach, & so by consequence no Humor coming from the Spleen, as long since Learned Men have imagi­ned, taught and writ, seeing they terminate in the Coats of the Stomach, and open not into the Ca­vity it self.

2. Epiploica dextra. 3. Coronaria stomachi. 4. Epiploica sinistra.

Mesenterious ramus is also divided into four o­thers; of these, the

1. Retains its old name, and is distributed with fourteen or more Branches through the Mesen­tery.

2. Vena Haemorrhoidalis, and goes to the Spleen, the Womb, and the right Intestine.

3. Vena Coecalis, to the blind Intestine.

4. Ramus Mesocolicus, and goes to the Intestine call'd Colon.

The Use of the Vena Porta is, to take the Blood not sufficiently elaborated, from the Arteries, and carry it to the Liver, for the perfecter con­coction, and for the separation of the Choler.

Venis pulmonalis (which the Ancients corruptly call'd Arteria venosa, seeing that it hath but only one Tunicle, beats not of it self, nor returns the [Page 227] Blood) coming out of the left Ventricle of the Heart, with a wide Orifice goes to the Lungs, to receive the more imperfect Blood from the Pulmo­niack Artery, and carries it to the Heart.

About its egress from the Heart▪ it hath two Miter-like Valves, hindring the regress of the Blood to the Lungs.

Its Use is, to carry the Blood received from the Pulmoniack Artery, into the left Ventricle of the Heart.

CHAP. IX. Of Arteries.

AN Artery is a Similar, Spermatick, Membra­nous, round, cavous Part, joined every where to the Veins, by the assistance of its Oscultations, con­taining the Nutritious Blood with the Vital Spirit, carrying it to all the Parts of the Body.

Difference is two-fold, the great Artery or Aor­ta, and Pulmoniack.

The great Artery comes from the left Ventricle of the Heart; which except in the Brain and other softer parts, every where else consists of a double Coat; the outermost of which is of the thickness of the Veins; but the inmost is five times thicker, lest by continual pulsation about the hard and so­lid Parts, it might incur an incurable Rupture.

It receives three Valves, call'd Sigmoides, look­ing outwardly.

Coming out of the Ventricle of the Heart, with a great Orifice before it, perforates the Pericardi­um, it affords to the Heart it self the Coronary Artery; when past the Pericardium, it is divi­ded [Page 229] into the Ascending and Descending Trunk.

The Ascending Trunk, which is the lesser, resting upon the Wind-pipe, is separated into the two Subclavials, from which, being yet within the Breast, proceeds,

1. Intercostalis superior, proper to the four up­per Ribs.

2. Mammaria, to the Breasts.

3. Cervicalis, to the Muscles of the Neck.

4. Carotis, externa & interna, proper to the Larinx, Tongue, Neck, Head and Brain.

When they have left the Thorax, they are cal­led Axillares, and carry Nourishment to the out­ward part of the Breast.

1, 2. By the Thoracica superior & inferior. 3. By the Scapularis. 4. By the Humeraria.

Then they approach the Arm, where they accompany the Branches of Vena Cava, and are call'd by the same name as they are.

The Descending Trunk, which is the greater, being yet within the Breast, sends,

1. The Intercostalis superior, to the eight lower Ribs.

2. The Phrenica, to the Diaphragm and Peri­cardium.

Then having perforated the Diaphragm, it communicates.

1. The Coeliaca, to the Stomach, from which proceeds the Splenica and Gastro Epiploica dextra.

2, 3. Mesenterica superior & inferior, to the Mesentery.

4. Emulgens, to the Kidneys.

5. Spermatica, to the Testicles.

6. Lumbaris, to the Loins.

7. Muscula superior, to the Muscles of the Ab­domen.

[Page 230]Then at length it is divided into the two Iliac Branches: About this Division exhibiting,

1. Muscula superior. 2. Epigastrica. 3. Hypoga­strica. 4. Umbilicalis. 5. Pudenda.

Out of the Abdomen they change their names, and are call'd Crurales; and so they descend in­to the Feet, and all along accompanied with the Veins, from whom they borrow their Names.

Use is, to carry the nutritious Blood with the Vital Spirit into all parts.

Arteria Pulmonalis, (which the Ancients did falsly call Vena Arteriosa, seeing it hath Pulsation, is made up of a double Coat, and contains the Nutrious Blood) issuing out of the left Ventriti­cle of the Heart, with a double Branch enters the Lungs, and is distributed through them by many little Branches, carrying to them the Nutritious Blood: And then what in the Blood is not suffi­ciently concocted into the Pulmoniack Vein, by whose means 'tis returned into the left Ventricle of the Heart.

It hath three Valves called Sigmoides, which look outward, lest the Blood that having entred it, should slide back again into the Ventricle of the Heart.

Its Use is, to convey the Blood out of the right Ventricle of the Heart, into the Lungs, by which they are nourished, and what remains above, then serves for their Nutriment, is brought back again by the Pulmoniack Vein, into the left Ventricle of the Heart.

Here it pleaseth the curious Observers of Ana­tomy, to take notice of (besides the eleven Valves which we have declared to be disposed in the four already named Vessels) that many others are [Page 231] found in the Heart, which as yet want any certain name.

CHAP. X. Of Nerves.

A Nerve is a Similar, Spermatick, Membranous, round, white, hollow part, serving for the carriage of the Animal Spirits to the Parts for Sense and Motion.

The Nerves take their Original from the Brain, and are divided within the Skull into eight Parts, without the Skull, to wit, those that come out of the Spinal Marrow, into thirty Pares; seven of which proceed from the Vertebra's of the Back, five from the Vertebra's of the Loins, six from the Os Sacrum.

The eight Pare within the Skull, proceeding from the Brain, are,

1. Smelling pare, which adheres to the Mam­millary Processes.

2. Optick pare, which is the greatest, and uni­ted in the middle.

3. The pare that moves the Eyes.

4. The Tasting pare.

5. The second tasting pare.

6. The hearing Pare.

7. Par vagum, which is vested with strong Membranes; it descends through the Orifices of the Bone of the hinder part of the Head to the Throat, afterwards sending Branches to the Neck of the Larinx, to the Muscles of the Tongue, and Os Hyodis; then is divided of each side into the external and internal Branch.

[Page 134] The right External Branch, having sent some Branches to the Muscles of the Breast, makes the right recurrent Nerve; this contributes to the Voice, as also to the feeling in the Pleura, the Coat of the Lungs, the Pericardium, and to the upper O­rifice of the Stomach, seeing all those Parts ob­tain Branches from it.

The left external Branch constitutes the left recur­rent Nerve, which goes to the same Parts, as we have declared the right doth; being brought to the said Orifice of the Stomach, it is joined to the right recurrent, and so goes to the lower O­rifice of the Stomach, and to the lower part of the Liver.

The right internal Branch sends Branches to each intercostal Muscle; then having perforated the Di­aphragm, furnisheth all the parts of the lower Bel­ly with a Nerve, ending about the Os Sacrum.

Of the left Internal Branch is the same Distri­bution.

8. The Part moving the Tongue.

The Nerves have a Cavity, but so little, not to be distinguished by the sight, except in the Optick Nerves, and those of the Pudendum.

Use is, to carry the Animal Spirits for sense and motion of the whole body.

CHAP. XI. Of the Flesh.

THE Flesh is a similar, Bloody, Soft, Thick part, together with the Bones, to yield a strengthening to the Body, and to cover the spermatick Parts.

Difference.] Flesh is three fold.

1. Musculous. 2. Glandulous. 3. Viscerous.

Musculous is soft, red, and is properly call'd flesh, and for these many ages hath come under the name of Muscles.

But yet a Muscle is not a Similar Part, but com­pounded of many others, to wit, Fibres, Tendons, Nerves, a Membrane, Veins, Arteries, that it might be a fitter instrument of voluntary motion, to which the Fibres, Tendons and Nerves do chiefly contribute.

It hath a Tendon in its begining and end, some­times round, sometimes broad, sometimes but one, sometimes double.

Its end is in that place where the Tendons are greater and more.

Its Head, or beginning, where the Nerve is in­serted, the middle, where the flesh swells out.

Use is, to promote voluntary motion, which [Page 238] is performed after a three-fold manner.

1. When the Contraction of the Muscle is so, that the end comes to the beginning, and then its Antagonist is quiet.

2. When the Motion is Tonick, so that being contracted, it remains for some time in the same condition.

3. When it relaxeth, so that it is restored into its former seat and quiet, by its Antagonist.

The Glandulous flesh is white, thick and spungy, formed of seed (from whence it cannot properly be call'd flesh) to this purpose ordained, 1. To prop up the Vessels. 2. To receive the superflu­ous Humidities; whence they are called the Emu [...] ­ctories of the noble Parts.

Some Anatomists make strange diversities of them, but it will appear to any one that diligently enquires into all the Glandules, that they differ not so much in substance, as in their Use and Humor.

The Viscerous flesh, or the Parenchemick is red, hard, convenient to prop the Vessels, and to serve for many particular and various operations; this is the flesh of the Lungs, Heart, Liver, Spleen, which shall be treated of in their places.

CHAP. XII. Of the Skin.

THe Skin is a similar, spermatick part, having some Blood mixed with it, reddish, white, loose, investing the Body, and serving for feeling.

'Tis covered by a Scarf-skin, for the greater de­fence, every where perforated with Pores, to give vent to the useless Fumes and Vapors; endued likewise with manifest Perforations, as are the Mouth, Nostrils, Ears, &c. whose use is suffici­ently known.

It hath Cutaneous Veins and Arteries, as also Nerves.

Its Use is, to cover the Body, as moreover it is the Instrument of feeling.

CHAP. XIII. Of the Fat, Nails and Hair.

IT hath been long disputed, whether the Fat, Hair and Nails ought to be accounted Parts of the Body, or Excrements. I neither think them Excrements, nor Parts properly so call'd.

Not Excrements, for they are Bodies, enjoying with the rest Life and Nourishment, but not nou­rishing others, and are of singular use for the pub­lick good.

They are not Parts properly so call'd, being desti­tute of any certain bounds, and have no particular operation: Fat nourisheth in Famine; the Hair and Nails, without injury to the whole, may be cut off.

Adeps, or Fat, is a similar, soft, white, insensi­ble part, made to preserve the Natural Heat, to help Chylification, to facilitate Motion, to moisten the Parts, and to nourish the Body in Famine.

Hair is a similar Part, produced by the worst part of the Blood, covering some Parts, and in some man­ner adorning them.

'Tis outwardly four-square, inwardly hollow; the variety of Colour it owes to the Temperament & Age of Men, to the Constitution of the Air or Country.

The Nail is a similar part, sprung also from the impurest part of the Blood, flexible, hard, defend­ing the Fingers from external injuries, as also adorning them. Its Root is joyned to a Liga­ment, [Page 248] and is very sensible by reason of the neigh­bouring Tendons.

CHAP. XIV. Of the Generation of the Blood, and its Circulation.

WE have hitherto treated of the Similar Parts, properly and improperly so call'd; from whom are the Dissimilars compounded. The Blood serves to their Conservation, as doth the Spirits to the Actions from thence proceeding; but how the Blood is generated in our Body, and how many Spirits are there found, is not as yet suffici­ently understood by us. In this thing Writers differ among themselves, so that the very Truth seems to lie hid in the profoundest darkness; yet the love and desire of searching out the Truth exactly, gives me freedom to declare my Opinion, yet still giving place to a better.

Sanguification I conceive to be performed after this manner: The harder Meat received in by the Mouth, chawed by the Teeth, and by the Spittle moistened, is in some manner prepared to be made Chyle.

This Spittle, from whence it hath its beginning, no man as I know of, hath rightly demonstrated: Those that derived it from the Veins and Arteries, it is upon this reason, because they communicate several Branches to the Maxillerary Glandules, through which the late invented Ductus Salivales pass; and moreover, a Salivation raised by Art, seems to confirm this Opinion.

But how the Arteries and Nerves can separate [Page 251] so great a quantity of Spittle, as we have often known to have been thrown forth in so short a time, seems not possible to me, I do rather derive it from the Stomach and Limphaducts, which I sup­pose to adhere to the Salivals, upon the following Reasons.

1. As often as voluntary swallowing is design­ed, we observe the Spittle to ascend as it were from the Stomach into the Mouth it self, especi­ally if the Meat be moistened by Drink.

2. The Tongue, Mouth and the whole Sto­mach have inwardly a common Tunicle.

3. The Meat in the Mouth, as in like manner in the Ventricle, ought to be mixt with Spittle.

4. It would be very troublesome continually to drink in eating; for it is very easie for some time to keep the devoured Liquor in the Stomach, and then sensibly to communicate some part of it to the Mouth.

5. The Limphaducts are dispersed through the whole Body, and they go both unto the Stomach and Tongue.

6. I judge no Humor to be thrown out of our Body, except by peculiar passages; and so for se­veral reasons, I think the Tears also to be shed though particular Channels, which a more accu­rate hand (whether mine or others) may sometimes find out: Yea, the most Noble Lewis Bills, the great Anatomist, attests to have already discover'd them and promiseth to demonstrate them in the Body, and in Figures to the Favourers of Truth.

If you enquire of me of what nature Spittle is, I answer, that it is Salt; yet 'tis not always neces­sary that this saltness be perceived by the Tongue, which those that Understand the Nature [Page 252] of Artificial Salts, sufficiently know: It is certain that there is some natural Salt in all Meats and Drinks; 'tis also certain, that Salt not only helps the commixing and concoction of the Meat, but also contributes much to the fermentation of the Humors.

The Ductus Salivales, which we have now made mention of, have but one strong Tunicle, not un­like the Ureters, but that they are lesser.

Of each side one.

They take their Original, endued with many Roots, from a certain great Glandule, lying under the Tendon of the Musculus Digastricus, not far from the upper Part of the Jaw; then they run under the Tongue, above the great Nerve of our eighth Pare, to the more inward parts of the mouth, where, in the two ranine Glandules, near the bridle of the Tongue, they terminate; from whom being variously perforated, issues out the Spittle into the Mouth; of which, the enquiring Reader may more largely satisfie his curiosity, out of the Writings of Glisson and Van-Horn.

The Meat thus chewed by the Teeth, and pre­pared by the Mouth, through the Gullet, by the assistance of proper Muscles, is carried into the Stomach, which that it may the better keep it, it presently purseth it self together, so that the upper Orifice is close shut, but the lower not so straight, that though very lightly pressed, may there find passage.

The Meat received by the Stomach, and moi­stened by Spittle, Drink, and its own humidity, forthwith by the heat of the Stomach, begins to be concocted; the Order is not observed here, which was in the eating of the Meat; yet in the begin­ning [Page 253] I have observed the Meat to be disposed in the same order, as it was devoured by the Animal that was dissected; but afterwards the Stomack continually digesting, first sends away that Meat which is of easiest Digestion, to the Guts, and it doth not detain it, whilst the other is also con­cocted, which Loosnesses and Vomiting evident­ly enough declare, if you look into the Excre­ments.

The Meat being concocted, assumes a white­ness like to Cream, and this is called Chile.

The Chile out of the stomach through the Pylorus enters the Intestines, in which passage there is a nota­ble Peristaltick motion: Out of this the Venae Lacteae suck what is useful to nourish the parts; and the unuseful is cast out through the Belly: The Venae Lacteae consist of one very thin Tunicle, but are endowed with several Valves, extended from the Liver towards the Glandules, they are distributed through all the Mesentery, and so are carried for the most part to the small Guts, especially the Je­junum; but yet the great Guts are not altogether destitute of them, that none of the Nutriment may be lost.

From the Intestine, both these Vessels and the Chile contain'd in them, go to the three Glandules of the Chile, the greatest of which is in the middle of the Mesentery, called by Asellius, Pancreas; the two lesser are call'd the Lumbar Glandules, situate near the left Kidney.

Each of these Glandules send forth a Branch, which joining above the left Kidney, constitutes a Vessel called Vena Lactea, about the bigness of a great quill.

This great Lactean Vein, lying between the Arte­ria [Page 254] aorta, and the Vertebra's of the Loins, cover'd with Fat, runs upwards, and above the Heart, as­cends by the Gullet, and so hastens to the left Sub­clavial Vein, where it ends in one, two or three branches; here a most thin valve occurs at the very end of the Vein looking inwardly, that the Chyle might not return back again, or run further into the Arm; out of this Subclavial they descend by the ascending Trunk of Vena Cava into the right Ventri­cle of the Heart, that there by the help of the heat, and natural quality, it may be changed into Blood.

Being converted into Blood, it passeth by the Pulmoniack Artery to the Lungs, which are by part of it nourished, and the rest of it goes through the Pulmoniack Vein to the left Ventricle of the Heart, that it may be more perfectly elaborated; thence by the great Artery is carried to all the parts of the Body, communicating to them nou­rishment for the preservation of Life.

These ways of Conveyance is displeasing to some, who would rather retain that by the Mesa­raick veins known, and so greatly cried up by the Ancients, than admit of a new Truth; therefore they say that the Chile, together with the Blood, may by this way be most conveniently carryed to the Liver, seeing that the Venal Blood is carried not from the Liver to the Guts (which was the false Opinion of the Ancients) but from the Guts to the Liver, and so not here to be allowed a con­trary motion of each Liquor, already sufficiently known.

But in truth these Opinions they defend, rather by a probable Ratiocination, out of their old affe­ction to the Liver, than that they can make it out by natural or demonstrative Arguments, or answer these Queries following.

[Page 255]1. What is the use of the Lacteal Veins?

2. Why is their rise in the Guts?

3. Why the Valves are so placed, that they may hinder the regress of the Chile into the Guts.

4. Why do they all go together with the Chile to the Glandule of the Chile, and none of them to the Liver?

5. Why are the great Lacteal Veins joyned to­gether?

6. For what end doth the Chile pass into the Subclavial Veins? All which can be made ap­pear in the Body to the sight.

That part of the Blood which is not altogether useless, yet not fit for Nutrition, passeth out of the Arte­ries, ever joyned together by Inosculations with the Veins, into the Vena Cava and Porta, and so by their means is brought again into the Liver and Heart, that it may be amended, and again con­cocted.

I do not only say that the Blood is carried by the Vena Cava into the Heart, but also by the Vena Porta into the Liver, which I prove by these Rea­sons.

1. The Liver is the biggest of all the Viscera; not that I would infer its pre-eminence from its great­ness (see Chap. 2.) but I suppose Nature would ne­ver have created so great a Body, but for the performing of some extraordinary operation.

2. Its greatest Vein, coming out with a large Ori­fice, forthwith goes to and enters the Heart. What necessity is there for the Vena Cava to be distribu­ted with such numerous Branches through the Li­ver, and so presently to ascend into the Heart; for indeed it ought to convey back the Blood not [Page 256] amended. Its Trunk likewise, and that of the Ar­teria Aorta might ascend directly up the Body to the Heart, without concerning it self with the Li­ver, especially when the Vena Porta, near the Li­ver, may also yield sufficient ways for freeing all the Blood from Choler: It ought to receive the Blood concocted in the Liver, and convey the same to the Heart.

3. Its colour is red. I well know that it is some­times observed to be white, pallid, yellow, green; but this colour is to be ascribed to the Disease, not to its natural Constitution; for in all Bodies per­fectly sound, it is found red.

What wonder is it, that the Liver being red, in weakness should contract a whiteness; doth not a red face grow pale, when the Body is affected with sickness? How easily likewise that the Liver sepa­rating the Choler, should be died with a yellow or green colour? 'Tis also observed in the first xx or xxx days after conception, it is naturally white, neither becomes red before the maternal Blood (concerning which, some of the Moderns have far otherwise ascribed) comes to the nourishment of the already formed parts, which is the same in all Spermatick parts, even in the Heart it self: But will you conclude from hence, that this red colour only happens to the Liver, and is not more pro­per to it, than it is to the Muscles, which yet therefore do not make Blood? To this I answer, that the affluent Blood is so necessary here, and so appropriated to the Liver, that without it it cannot be called a perfect Liver; but both the colour, sub­stance and number of Vessels are so difierent in a Muscle, and in the Liver, that in no wise the parts deserve to be said to be like one another; and what [Page 257] absurdity is it to say; that a Muscle sanguifies, when even the Heart it self by the principal A­natomists and Philosophers, is acknowledged a Muscle.

4. The Maternal Blood comes first up the Umbili­cal Vein to the Liver, ere it goes to the Heart of the Infant: And the Valves and Ligatures evidently demonstrate, that the Arterial Blood is carried by the Umbilick Arteries from the Child to the Womb, but the Venal by the Umbilick Vein from the Womb to the Child; but whether the Infant is nourished by the Maternal Blood, or by an External Humor, like as a Chicken in the Egg, is to me all one; when 'tis evident, the Blood, which either coming from the Mother or Infant, passeth first to the Liver, before it enters the Heart.

5. The Choler is separated from the Blood in the Liver; for every one knows, that there can no se­paration be made, without there be first a Con­coction.

From all these Arguments I cannot gather any thing, but that the returning Blood is carried by the Vena Porta to the Liver, that it may there be purified, and in some manner concocted, in which its operation, that the Blood may be rendred more perfect, 'tis carried to the Heart, especially when by reason of its continual and necessary Pulsa­tion, the Blood cannot remain long in the Heart: and for this reason I judge, the whole Blood must needs be moved about with a circular mo­tion.

The Blood made in the Liver, as is declared but now in the eighth Chapter, enters the Vena Cava, and from thence into the Heart.

[Page 258]And thus the Royal Liver, at the same time, when Kings are taken away, may yet use a limited power, and may remain with honour in its own Kingdom.

But what shall we do with the Melancholick Spleen, which makes many laugh? It hath many accusers, and not fewer excusers.

1. It was never accounted by Hippocrates the Learned Greek, a receptacle of the Excrements; or is it any where to be found in him, that he call'd the Spleen another Liver.

2. The great number of Veins and Arteries, and so by consequence the abundance of Vital Spirits, do not permit the Excrements to be col­lected here.

3. It hath not any convenient Cavity wherein the Melancholy, Faeculent Juice can be recei­ved.

4. And if you imagine that there is no necessi­ty here of a Cavity, its Parenchyma is too thick, and not porous enough, therefore unfit for the re­ception of so thick a Humor; which also is never naturally found in it.

5. It is too great a Bowel to perform so vile an Office.

6. In dead men, where Melancholiness hath been the cause of their death, upon the examina­tion of the Internal parts, there none of them less recede from its natural state than the Spleen, the Heart only excepted, whom the Vital Spirits do so greatly defend, that it is less affected than other parts, which seldom happen to the Intestines, Kidneys, Gall and Bladder.

What is therefore its Use? It elaborates the Acid Humor, which is very necessary, but not [Page 259] Excrementitious, and mingles it as a Ferment with the Blood, by which it becomes more perfect, and fitter for Circulation.

In my judgment the Salt of the Blood affords matter to this Humor, which it greatly requires that it may not be corrupted; but this Salt which proceeds from the Meat and drink, is never so pure, but that it hath need to be brought to a more perfect state in our Body. But this is my Opinion.

The Supremest of the Kings is the Heart; to this are two others subject, the Liver and Spleen (I beseech you give me leave to make use of this Si­militude in favour of the Ancients) the Heart makes the Blood, the Liver repeats the Concocti­on, and separates the Choler; the Spleen from its own Salt, by an innate vigor, produceth an Acid Humor, which as a Ferment by the Venal Sple­nic Branch, it mixeth with the Blood, to render it the perfecter, and the more fit for Circulation; if any Excrementitious part should be there sepa­rated, it is all by the Caeliack Artery, and the Hae­morrhodal Vessels sent to the Guts.

If it appears to any one to be a contradictory, that by Salt a Humor should be made Acid, we advise that person to taste some Spirit of Salt.

About sixteen years since, the great Anatomist Franciscus Sylvius put forth some particular things concerning the use of the Spleen; he was of opinion, that the Blood was not made in the Ven­tricles of the Heart, neither that it was carried from the Heart by the Arteries to all the parts of the Body, for nourishment-sake alone, but that it likewise underwent some other Mutati­on in the rest of the Viscera's, particularly that the [Page 260] Spleen further concocts the Arterial Blood, and brings it to a higher degree, yea that it more then perfects it, so that the Blood in a manner in this place assumes the nature of Ferment, by whose means in a short time, a great quantity of Mass may become acid; in the same manner he affirms, that the Blood more and more concocted in the Spleen there receives strength, by which it restores the returned and weakned Blood, and preparing together with it the Chile, that it may the sooner be turned into Blood: The Reasons which he produceth for it, are these:

1. The Spleen receives a much greater quan­tity of Blood from the Heart, than is necessary, for its nourishment.

2. That it can be returned back again to the Heart, by no other way than by the Branches of the Vena Cava and Porta; for what hath hither­to been delivered of the short Vessel, are to be accounted but ridiculous Fictions, as may most evidently be made appear in dissected Bo­dies.

3. Seeing this Blood is continually mix'd with the returned Blood and Chile in its passage to the Heart, it ought not to be an Excrement; for so the Noble Parts, and the whole Body would not be purged, but the more injured.

4. Chymistry hath long since taught us, that such mutations happen daily in Nature.

The Remaining Part of the Blood unuseful to the Body, therefore Excrementious, is thrown out through the Guts, Ureters, and Parts of the Skin, &c. concerning which it is not necessary to add more here; but now we are forced to de­scribe those new watry passages, which the studi­ous [Page 261] in Anatomy have long and diligently inqui­red into. The watery passages, the Lymphatick Ves­sels have their rise both from the Liver, and from the Joints, and receive the liquid Juice from the Arteries with which they correspond.

Those which come from the Liver, embrace the Vena Porta, and so pass to the Misaraick Glan­dules of the Chile, as do those also that ascend from the Feet; thence they discharge their Water into the great Lacteal Vein, which as we have already declared, carries the Chile to the Heart.

Those which proceed from the Arm, both lie above and under the Veins, until they come to the Subclavial Vein, which they enter about the same place; where the great Lacteal Vein doth, being furnished with a particular Valve just at their entrance, and so altogether they carry the Water to the Heart.

This Water is Sweet, not being as Urine is, Salt.

These Vessels consist of a very thin Tunicle, whence they are soon broke.

Use of them in my opinion, is to take the su­perfluous Water from the Arteries, and carry it to the Glandules of the Chile, and Lacteal Vein, by which the Chile being made more Liquid, may the more conveniently be conveyed through the narrower passages, thence to return the same to the Arterial Blood, making it fitting to serve to the nutrition of the moist parts, and to the cool­ing and moistening of the hot.

But that it may the more clearly appear, in what manner I conceive, how what hath already been said, is perform'd in our Body; observe that the Meat is converted in the Stomach into Chile, [Page 262] to which part of the Drink is mingled, this mix­ture is carried through the Glandules of the Chile, and the great Lacteal Vein into the Heart, where it is changed into Blood, which is by means of the Arteries to be conveyed through the whole Body; every part of this Blood nourisheth those parts which are of the like temperament with it self; the Hot part of it nourisheth the Hot; the Dry, the Dry; the Moist, the Moist, &c. that which is here not well concocted, must be brought back again to be perfected. Why we say that the Veins are not sufficient, and the passages not commodious enough to perform the same, whose Office we know is to bring back to the Heart the Blood not sufficiently concocted; the Reason is that the Water always remaining in the Vessels, rendered the Blood too thin, so deprived it of its natural consistence and strength.

From all those so clearly and distinctly laid down, it sufficiently appears what the CIRCU­LATION OF THE BLOOD is, to wit, a con­tinual motion of the Blood out of the Arteries into the Vena Cava and Porta to the Liver and Heart, that in them it may be fitted for the Nutrition and the life of the whole Body.

Out of the subtilest part of the Blood are the SPIRITS produced, which are two-fold:

1. Vital, which begotten in the Heart, carry life to the parts of the Body.

2. Animal, who out of the Vitals elaborated in the Brain, impart Sense and Motion to the Body.

The Natural at the same time that the Circula­tion of the Blood was found out, vanished.

CHAP. XV. The Division of the Body.

MAn's Body is most conveniently divided in­to the Venters, or Regions, and Joynts.

There are three Venters.

1. The Head, or the supream Region or Ca­vity, to it is joined the Neck, which is its prop.

2. The Thorax, Breast, or middle Region.

3. The Abdomen, lower Belly, or lower Region.

The Joynts are the two Arms, and the two Legs.