The first Table. Of Pipes, solid and cutting tools of Iron, whereby Fontanels are made with fire.

THE I. Figure is an Iron Instrument, which Hieron. Fa­britius ab Aquapendente, concerning a Fontanel in the co­ronal suture, calls a small Pipe, and the place of the Fontanel being found and marked with ink, he forci­bly thrusts it on with his left hand; that by the impres­sion, and the natural coldness of the Pipe, the heat of the red hot iron, (Figure II. following) and the pain thence arising, might be palliated; and the parts adjoining might be defended from the injury of the fire.

The II. Figure is a solid and uniform iron instrument, without a handle (yet one of bone or wood may be fitted for it, as the be­fore-mentioned Pipe hath) which being well fired, and with the right hand thrust into the aforesaid Pipe, burns a fontanel. With these two iron instruments Fontanels are made only in the mem­bers of mans body; namely, when the sick are not fearfull of a red hot iron, or the Chyrurgian hath not the capsula of Iulius Casseri­us Placentinus, to hide his actual cautery with.

I

II

III

IIII

V

VI

VII

VIII

VIIII

X

XI

XII

XIII

The III. Figure is also an iron Pipe, yet somewhat deeper then the former, to receive the instrument that followeth next.

The IV. Figure is an instrument plainly hollow and cutting; by which, being made red hot, and thrust into the Pipe preceding, we make a fontanel, where the coronal and sagittal sutures meet; not only burning, but cutting also by the sharp point of the instru­ment, at the end thereof. This when it toucheth the Skul must be turned about, that it may make some print upon the Skul-bone. Many dislike the use of this instrument, not only for the pain they say it causeth, but for fear of the dangerous inflammation in the Pericranium, which afterwards may easily be communicated to the Dura mater which is under it, by the affinity of the sutures; where­fore modern Chyrurgians rejecting this, use instead thereof one that is solid and uniform; (whose form you shall find in the II. Fi­gure of this Table) yet in my judgment the hollow instrument is to be preferred, because that solid instrument may far more easily bring the foresaid inconveniences: I add that burning of the su­tures with a solid instrument proceeds too slowly, by reason of the thickness, hardness, and density of the skin of the head: But ma­nual operations, chiefly those that are performed with a red hot iron, must be done most nimbly.

Figures V, and VI. are iron tools not simply cutting and hollow; but the first hath a star at the end, and the latter is made with teeth; of these two, that by reason of the star cannot at all be turned about; and this by reason of the teeth doth not cut so readily: Wherefore modern Chyrurgians, and amongst them almost the chief, Hierom Fabritius ab Aquapendente, reject these two instruments as unfit for operation.

The Figures VII, VIII, IX, X, XI, XII, XIII, taken as joined together, make the capsula, an instrument to burn Fontanels in parts placed without the head, the best of all, and the most absolute in all respects; which was invented by Iulius Casserius Placentinus, to avoid these three inconveniences; namely, heat, pain, and sight of the fire, which fearfull men, women and children are afraid of. This invention of Placentinus hides the actual cautery; which (be­cause it most suddenly causeth an Escar, so that the Patients can scarce observe it) if it be not to be preferred before potential cau­teries; yet I think, in all right, it ought to be used in their place: For no pain is perceived at all, or burning underneath, by reason of the end of the case, and the harder lying upon it by depression, and the wonderfull swiftness in the operation; for which cause there is not any offence, in the least, to be feared of the parts near unto it.

I

II

III

IIII

V

VI

VII

VIII

VIIII

X

XI

The VII. Figure is a hollow plate of iron, round, and immovable (a. b.) to this, and to the former plate of iron likewise, that is round with a hole in the middle, and movable toward the lower parts, (c) four little wheels are fastned in, which are carried about with a wier of brass, (d) that the Style (Fig. VIII.) that is solid made of Copper, being made red hot, and thrust in [...]o the foresaid Plates, (as you see Fig. IX.) and laid aside into the wooden cap­sula, Fig. X. may be hid by the cover that hath a hole in it, Fig. XI. and by the help of a small pin with a broad head (Fig. XII. and XIII.) may be pressed down.

The II. Table. Of Celsus his Spatha, Rasour knife, the round saws, male and females, the handle to turn them, the Centicular Instrument, the most weak Levitor, the keeper of the membrane, the cross dividing instrument; all which the Chyrurgian hath need of to cure the fractures of the Skul.

FIg. I. is an instrument which Hippocrates lib. 2. de morb. cap. de suppuratâ peripneumoniâ, calls [...]; but Celsus and Paulus call it commonly Spatha; namely, a double little knife sharp on both sides, and in the upper part somewhat broad, which at the end united in one point; with this the wounds of the head are dilated cross wise or triangularly, and Paracentesis is safely made in the Thorax.

Fig. II. is a shaving knife, or straight pen knife, that cuts but of one side, and is blunt on the other, which is used when there is no fear of the parts underneath; namely, in dividing the scalp of the head as far as the skul, and in opening nodes of the French pox, especially upon the shin bone or elsewhere; again where both edges may do hurt, as in cutting the dead child in the womb into many parts, and dividing the caruncles of the matrix; and therefore is it called Scodeghino by the Italians.

Fig III. is the male Trepan, or an instrument made of the best steel, hollow, round, at the utmost brims nicked like a saw, and it hath four shoulders; namely, that part of the Trepan that must be turned about the bone, the Greeks call it [...], but Celsus lib. 8. cap. 3. calls it Modiolus; which hath a pin in the middle, that when it first begins to be turned, it may stand fast upon the cranium, made bare of the Pericranium; and that the parts about it, name­ly [Page 6] the lips of the wound, and the Pericranium, which are parts most sensible, may be preserved the more safe from hurt But if the Trepan to be used had no pin at first, the trepaning of the skul would be performed with the greatest danger, and with vehement pain.

Fig. V. and VI. are female Trepans, of the same bigness with the precedent male; and there is no other difference between these and that; but that these want a pin, and so are called females. Be­fore we use these females we must make some print upon the skul with the male, that the females may stand the faster upon it. Now for to trepan the skull, the Chyrurgian must have at hand at least three Trepans exactly equal one to the other; namely, on [...] male and two females, that he may oft-times change them, and dip them into cold water or oyl of roses, least being full of dust they should hinder the operation; or else being heated by frequent tur­ning about, they might inflame the skul and the membranes that lie under it.

The invention of shoulders that hinder the Trepans from sink­ing down into the membranes of the brain, or into the substance of it, is an argument of the excellent wisdom of Hierom Fabritius ab Aquapendente; for though some of the modern Chyrurgians, as Vid. Vid. lib. Chyrurg. 4. c: 10. and Ioan. Andreas à Cruce lib. 7. de Instrum: make also some mention of the shoulders in Trepans, yet none of them took care to have them so exactly and acurately made as Fabritius did: I used these Trepans never but with good success; and at this time they are used (all the instruments of the Antients being rejected, which they formerly invented to terebrate the skul; the figures whereof are to be seen in the Authours now quo­ted, and in Paraeus lib. 9. cap. 18.) by the Chyrurgians, especially those of Padua, and by the successours of Fabritius in his Practical and Chyrurgical profession; amongst whom yet lives that most famous Physitian, Chyrurgian, and Professour at Padua, Petrus de Marchettis, Knight of the Order of Saint Mark, of the Venetians; who was formerly my much respected School-fellow, for many years, in Anatomy and Chyrurgery; at whose wonderfull dexterity in operation (whereby he almost surpasseth all the Chyrurgians of Italy) not only all Italy, but Schollers coming from all parts are astonished; and innumerable persons, being thereby cured, extol him to the Heavens.

Fig. VI. is the other part of the Trepan, which is called the han­dle, or part to turn it with; and there is a hole cut in it, by means whereof the ends of the Trepans, wrapt about with cotton, are ea­sily [Page 7] put in and taken out, so often as need requires to change these round saws. By this means a Trepan is made of a round saw and the handle, wherewith the skul is quickly, safely and easily perforated.

Fig. VII. is an instrument compounded of a scraping tool (be­cause of th [...] lentel at the end of it called a Lenticular) and a Levi­tor. At the end of the perforation of the skul, this Levitor is thrust in betwixt the lips of the bone cut forth, to move the small bone up and down, that it may grow loose, and may be taken forth by the toothed p [...]rt of the Pinchers, (Table IV. Fig. I.) also it is used to raise up mean depressions of the skul, and hath its sta­bility only in the Chyrurgians hand; the Lenticular serves for all roughness to smooth it, and to scrape it off (which is left behind after terebration, and cutting forth of the bone removed) lest that the membranes of the brain, by reason of their continual mo­tion, should strike against it and receive some hurt.

Fig. VIII is a Lenticular instrument alone, which levigates the brims of the hole made as I said before, lest pricking the mem­branes they might cause pain and inflammation.

Fig. IX is a plate of silver, (for it must never be made of iron, because of the imbred cold thereof, which is hurtfull both to the dura and pia mater that cover the brain) firm, somewhat crooked, and smooth on the outside, which we use in great depressions of the skul, and in fractures, where it is necessary to perforate the skul-bone three or four times with the Trepan, and to cut forth the spa­ces between the holes; for then the Plate is let down between the skul and the dura mater, th [...]t the outward part of it may be nearest to the brain, least by the sharpness of pincers and saws, (the Fi­gures whereof are to be seen underneath, Table V. and VI.) the membranes of the brain should either be pricked or cut unawares: Hence Celsus, who in describing iron instruments for Chyrurgery was very diligent, lib. 8. cap. 3. calls it the preserver of the mem­brane, in Greek [...].

Fig. X. is a cross dividing instrument, whereby the dura mater meanly pressed down, is exactly applied to the skul, that the puru­lent matter, collected between the skul and the membranes, may easily come forth by the hole made with the Trepans.

Fig. XI. is a leaden mallet, which men formerly used when they would separate any part of the cranium with scraping instruments that cut, (whereof there are divers sorts presented in Paraeus l. 9. c. 5.) to avoid the noise, and to hinder the commotion of the brain The modern and more cautious Chyrurgians of this age, use for this operation pincers and small saws; of which a little underneath, Ta­ble IV. and VII.

I

II

IIII

IIII

The III. Table. Of the three-formed Trepan, the stronger Levitor, the Instru­ment called Triploides, and Paraeus his Levitor, wherewith the pricks of the skul are taken away, and the depressions of it are raised up.

FIG. I. is a Tresine, an instrument of only iron, which hath three divers sorts of Trepans, the use whereof is necessary in the pricking of the skul, that doth not penetrate both the Tables, that with them the print made upon the skul may be taken away. The triangular part of this instrument may be used also for the small Trepan, with which Guilhelmus Fabritius H laanus, perfo­rated almost the first table before he applied the Triploides, with a screw.

Fig II. is a Levitor which I use in depressions of the skul, this raiseth with more force then the other described Table II Fig VII, because it hath its firmness, not only in the hand of him that raiseth it, but also in the head.

Fig. III. is an instrument called a Triploides, from the threefold basis that it hath: if the depression of the skul be so great that the precedent Levitors are too weak to serve the turn, I let down the Levitor of the Triploides (b) if there be room enough, and I raise the bone pressed down, upright perpendicularly; but if there be no place for this Levitor, the middle depression must be perforated with the piercer of the Triploides (a,) beyond the Diplois, and be elevated the way mentioned, taking especial care that the wimble perforate not both Tables of the skul, and so prick the dura mater. See Guil. Fabritius Hildanus, centur. 2. obs. 4. where he most acurate­ly describes the manner of raising the depressions of the skul, yet with other instruments that I never used; but with this Triploides I have reduced one or two depressions with good success.

Fig. IV. is a Levitor which is used by others in the greatest im­pressions upon the skul, imitating Coopers who are wont to reduce the bords of their wine vessels that are crusht in, with the like in­strument. Wherefore putting in the crooked end of the Levitor (a) under the bone pressed down, the other arm of the Levitor (b) which is streight, must lean upon the sound bone, that whilest the handle is thrust down with the right hand, that bone which is pressed down may be raised with the crooked part of the instrument. Also Ambros. Paraeus l. 9. c. 5. described and shadowed forth this Levitor.

I

II

III

IV

V

The IV. Table. Of the Puller and Pincer with a Parrats beck, and a Vultures; whereby small bones that prick the membranes of the brain are broken off, and taken forth.

FIG. I. is an instrument very necessary for manual operations, which Paulus Aegineta lib. 6. cap. 23. calls [...], and C: Celsus l. 7. c 30. calls Volsella, a Puller, with the double and toothed end of it. (A) they take forth the peece of the bone which is corrupt and movable, also darts and bullets and the fragments of them; and all tents and hairs, and all extraneous things of that kind, which are found in wounds. The same thing is performed with instruments printed Tab. XI. Fig. III. and VI. either of which is to be used as opportunity serves. Also this part of the puller serves singularly well to pull out hairs from the ey-lids, which prick the eys. Besides the foresaid uses it is good, for it serves for to wait on Physick, that is to make women fair; for with this women, especially that belong to the Court, pull out by the roots hairs in their ey-brows, and from other parts of their bodies. Note that if a small bone, or something that is accidental in the throat, is to be taken forth; this part of the instrument must be made twice as big as it is here printed. The broader part of it (B) serves to spread plaisters upon linnen or leather, for want of a spatula; as also for a safe separation of the Pericranium from the bone, before the Tre­pan and scraping instrument be applied to the skull, when there is a defect of nails of the hands of the thumb and fore-finger a little too short; or there wants a haft of that pen-knife printed under­neath Tab. XII. Fig. IV. Yet with the longer nails, the Pericrani­um is much safer drawn off from the skul, then by the haft of the foresaid pen-knife, or by the parting knife of Paraeus, or by this broad part of the puller.

Fig. II. is a pair of pincers to cut out with a Parrats beck (a) upon which is fastned a screw with a broad head, which will not suffer the bill to go in so far as the dura mater, (for I use it in fractures of the skul) whence not unfitly it may be called [...]: on the lower part it hath a handle (c.) which is turned about the screw (d.) Fig. III.

Fig. III. is a Parrats bill out of its socket (d. Fig. II.) that the Ar­tist may more plainly see the screw of the bill.

I

II

III

IV

V

VI

Fig. IV. is a pair of pincers with a Vultures bill, and it is in its pipe, by whose screw it is carried about.

Fig. V. is a Vultures bill described without its pipe, with these two sorts of pincers, as also with those which I caused to be printed underneath Tab. XI. Fig. I. and II; and Tab. XIX. Fig. I. any smal peece of a bone in the cure of wounds of the head, is taken forth partly by breaking of it, partly by cutting into it: all which differ in magnitude and forms, according to the variety of bones which must be removed.

The V. Table. Of the turning saw, whereby the distance between two holes is cut asunder.

FIG. I. is a turning little saw provided with two wheels with teeth, and it is most usefull to cut out the distances of two or three holes made with the Trepans. For where the Levitors above described and printed, by reason of the narrowness of the chink (which is almost alwaies joined with late impressions made upon the skuls of persons that are at full years) have not space some­times, there is need that two or three holes be made in the skul with Trepans, the distance between them is cut forth with this small saw, without any danger of hurt, whereby the Levitor may be the more commodiously put down, and the small peece of the bone, which oft-times pricks the membranes, may be taken forth. The parts of this instrument which I invented, where they are joined, they are marked with small letters; where they are parted, with great letters.

Fig. II. is a plate of iron A cut forth in the middle long waies, which above hath the handle B, and the hole C in the bending of the plate; but beneath on both sides a sharp edge D, whereby it stands firmly on the naked skul.

Fig. III. is a small pin with a broad head, which is marked with an Asterism, and passing through the hole C, Fig. II. it is fastned in the capsula E. This capsula E, is fastned regularly to the iron plates hole A, Fig. II. by the means of a small latten plate Fig. IV. by two screws, which the capsula hath on the back side, that are correspondent to the latten plate; and by so many little knots, that the Chyrurgian, by help of the small pin, may at his pleasure in his actual operation move the capsula up and down; the axis of [Page 14] the small wheel is put into the hole H, as appears by Fig. V, and the center of the small wheel. The little plate I, is toothed above, and there it receives the wheel, beneath L, it is equal on both sides, that the small saw K, may be fit to move regularly up and down in the capsula, and the fissures of the Fig. V. M, by the help of the wheel and the handle. The latter plate N, is hollow in the mid­dle, and hath two screws O, by means of this plate, the little saw, when the instrument is perfectly set together, is drawn equally hi­ther and thither.

Fig. IV. is a latten plate, with two little mothers, which I called before little knots.

Fig V is a small wheel half toothed P; and the half capsula Q, together with thre [...] holes R: wherewith it receives three screws, Fig. III. fastned with three knots or little mothers.

Fig. VI. is a key whereby the instrument is divided into its parts, and again is set together with the same. The letter T, shews the axeltree, that perforates the capsula and small wheel in the back part; and V is the mark for the handle.

The VI. Table. Of straight saws, and divers scraping tools, wherewith the skul being rotten, or having a fissure, is scraped away.

FIG, I. and II. are straight saws, with which some men cut away the distances between the holes made in the skul with the Tre­pans, and abolish rifts like hairs that do not penetrate, and scrape away the rottenness of the cranium.

Fig III. describes three sorts of scraping tools, of Galen lib. 6. meth. med. cap. 6. the first is hollow which he calls [...], or a scraping instrument to cut out, the figure whereof we see above Table II. Fig. IX. another which in the lower part of it represents a lenticular, which he calls [...]; the use and description where­of we find in the Table newly quoted, Fig. VIII. exactly printed; the third fit to rasp away, which the Greeks call [...]; and the Latines scalprum rasorium, or paring tool, and the illiterate a rasp. The modern Chyrurgians make use of this third sort of scraping instruments, in proving and scraping away the fissures of the skul as small as hairs, or for such that is doubtful whether they penetrate or not; and they have invented divers forms of it, according as the [Page 15]

I

II

III

IV

V

VI

VII

VIII

IX

[Page 16] place or chink may happen to fall out. As for example a hollow one, as you see Fig. III, IV, V, and VI, a half moon, as Fig. VII. sharp pointed as Fig. VIII; lastly a plain one as Fig. IX, and X. The Chyrurgian must have four scraping tools at least, of each form, alwaies ready, lest for want of them he be constrained to de­sire them from others; or may lose the occasion of his operation, which every man knows to be desperate to the danger of his Pati­ent, and loss of his own reputation. When a rotten bone is to be scraped in the extream parts, as the thigh, the shin bone, the shoul­der bone, or the arm bone, greater and stronger rasping tools must be provided for them. Now every rasping instrument is made of most pure steel, that it may have an edge that will perfectly rasp away. The Ancients did fit the proper hafts to every rasping in­strument; but the modern Chyrurgians take a contrary course yet, in my judgment not so right as it ought to be, for they provide but one handle of wood or bones, at the bottom whereof the hole hath a screw, wherewith it receives all the ends of the rasping tools that are turned with screws equally; as you may see clearly by Fig. III. and by the rest.

The VII. Table. Of various instruments to make a seton in the nape of the neck; namely, four kind of Pincers with a needle, and one armed with a seton; of cauteries also, with which the hinder part of the head is burnt into.

FIG. I. is a pair of Pincers, which neer to the upper hole, which is neither too narrow nor too broad, hath a wide and circular ca­vity, and an iron ring, that of it self binds fast the instrument or pincers, which is then necessary when the Chyrurgian hath no servant, which may deliver to him the needle very red hot, to make a seton in the nape of the neck.

Fig. II. is a pair of Pincers which above hath the like cavity; but for want of a ring, it is not closed of it self, but by the Chyrurgian so much as it ought to be. They use these pincers when behind the neck that is to be perforated, the part is very fleshy and fat; by which the skin laied hold on, when it is thick, goes within the circle, that it cannot slip away.

I

II

III

IIII

V

VI

VII

VIII

IX

X

Fig. III. is a pair of Pincers, which hath neither cavity as Fig. I, and II; nor ring as Fig. II. hath; with that the Chyrurgian laies hold of lean peoples necks, untill he hath perforated them with a red hot needle delivered to him by his servant.

Fig. IV. is a needle for the seton; which must neither be too long, least the point should miss the opposite hole; but it is a hand breadth in length, neither is it very small, or gross; but it is an­swerable to the holes of the aforesaid pincers, only a little smaller; and so being made very red hot, it passeth through most nimbly, and makes a seton almost without pain.

Fig. V. is a long narrow point, that hath fastned to it a seton or round line, of purple silk, which draws to the middle is left in the hole; to the point is fastned a small button of wax, that it may pass through without delay or pain.

Fig. VI, VII, VIII and IX are various iron instruments without handles; with which, being made very red hot, infants and chil­dren are burned behind the neck, in whom there appears any to­ken of the Epilepsie, Apoplexy, or Vertigo. The same burning sometimes is a remedy for people grown in years, when they are affected with the same diseases.

Fig. X. is a pair of pincers that fastneth it self, with which the skin is laied hold on, if a seton must be made by incision: This in­strument ought to be half as great again as it is here pictured; but the pen-knife answerable to these pincers, and printed at its just magnitude, is seen underneath, Table XVIII. Fig. IV; and in Guill. Fabritius Hildanus, Cent. 1. Obs. 40.

The VIII Table. Of the Instrument with hair; silver needles fit to couch a cataract; the ring that holds the eye fast: Probes; the crooked Pen-knife; the sharp little hook, and the small vessel of glass to be put upon the eys.

FIG. I. is a hairy instrument, crooked; and the inside is wrapt about with cotton and black lawn; which outwardly, by reason of two buckles and latchets, hath a bolt with a broad head, wherewith the hollow ulcer in the greater canton of the eye is pres­sed together. Hierom. Fabritius, ab Aquapendente, invented this [Page 19]

I

II

III

IIII

V.

VI

VII

VIII

IX

X

[Page 20] instrument; whereof he makes mention, when he treats of Aegy­lops to be cured by Chirurgery.

Fig. II. sheweth two silver needles, that are made to put down a suffusion, which are inserted into a handle of silver which is an octogon, that on both sides hath a perforated glance, or ivory head, through which the silver needies pass.

Fig. III. is that open handle, the needle whereof is inserted in one part; and on the other part, somewhat [...]f, the screw is seen.

Fig. IV. is a needle fitted for the cure of a Cataract, with a haft and case of silver.

Fig. V. is a brazen ring (others commend one of lead) to hold the eye firm for the cutting forth of a haw, and for other operati­ons to be perforated in the eye.

Fig. VI. is a long probe round, and made of silver, that it may be bended upon necessary occasion; the one end whereof is the broader, and the other hath a round knob very well polished. With the broad end of this probe, which Ce [...]sus l [...]b. 7. cap. 7. de aneyloblepharo oculorum vitio, calls the probe toward you; not only the growing together of the eye-lids is cured, but also powders and plagets anointed with ointments are applied to wounds. The round end is used by Chirurgians, to search out the state of wounds and fistulas.

Fig. VII. is a probe made with a broad end for the aforesaid uses, and a sharp pointed screw, which is wrapt over with cotton to wipe away the filth in wounds, ulcers; but chiefly in fistulas.

Fig. VIII. is a crooked Pen-knife that cuts but upon one side, to the point whereof there is fastned a small silver knob. Euclides Tarentinus and Celsus used this knife to part the eye-lids which were grown together with the skins of the eye.

Fig. IX. is a very sharp little hook, and at the point, by de­grees, bent somewhat inward: which is most convenient both to lift up the eye-lids, and to raise up the haw in the eye.

Fig. X. is a small glass vessel for the eys, somewhat long, and is to be made of Crystal, so that it may exactly answer to the ball of the eye; and may contain medicaments poured in by the tunnel, that they cannot run out. Hierom Fabritius ab Aquapendente, inven­ted this ocular instrument, and described it more at large in his tract of suffusion, to which I refer you.

The IX. Table. Of the right and crooked pincers for the Polypus, and the pipes that are put into the nose, with their pin; the in­strument wherewith the Uvula is cut away; the spoon that is to be used when the Uvula is fallen; the dilatory to op [...]n the mouth, and the Cranes bill that is blunt.

FIG. I. is the streight instrument of Hierom. Fabritius ab Aqua­p [...]nde [...]te, for to [...]raw forth a Polypus; it is made of steel, an [...] is convex outwardly, but inw [...]rdly concave, which hath an ed [...]e inwardly bent backward, wherewith we can cut nothing but the [...]o­lypus now laid hold on.

Fig. II. is a bowed instrument, wherewith the Polypus is cut and drawn forth, which by the holes of the nostrils tends in the pa ate to the throat, and threatens to choak a man.

Fig. III. is a solid iron pipe, which is thrust so deep into the no­strils, that it equals the length of the ulcer, which is called ozaena; afterwards a very red hot iron is thrust into this pipe, that is found every where and without any holes; whereby the pipe waxeth hot, and the ulcer is dried up.

Fig. IV. is a pipe with a hole in the side, to consume the hard callous of the wound that is in the side of the nostrils, by an actual cautery, or is most convenient to dry up the bone which is cor­rupted.

Fig. V. is a small pipe with a hole at the top, which is put into the nostrils; when, after the cutting and drawing forth of the Po­lypus, the blood running forth in great aboundance, must be stop­ped by manual operation, by burning: which is also used when the top of the nostrils must be burnt, for the removing of the bone corrupted.

Fig. VI. is a stile of iron, which being made red hot is thrust in­to the aforesaid pipes, and is presently drawn forth again; which thrusting it in and pulling it out, must be repeated so often as need requires. To perform this operation speedily, the Chyrurgian must have by him at least two such pins; which, being heated in their turns, he may thrust into the pipe. But note that the ocular ves­sel of the Table VIII. Fig. X. and these pipes that are to be put into the nostrils, could not be printed in their just magnitude; because [Page 22]

I

II

III

IV

V

VI

VII

VIII

IX

X

[Page 23] they must be made greater or less as the age of the Patient is, and the parts affected are in greatness.

Fig. VII. is an instrument by which the Uvula is cut away; it is made of latten, which in the upper part hath a circle somewhat hollow, A, in the lower part the pipe B, through which the end of the thread C, (after that it is placed into a half knot turned about E, and into the concave part of the ring, that it may not remove here and there) is drawn by means of the stile D perforated above; the other end of the thread is drawn through two rings an­nexed to the circle, and is fastned to the lower ring of the pipe. Guill. Fabritius Hildanus Cent. 2. Observ. 21. was the first that found out this instrument, and described it; with which, being correct, I easily tied the Uvula of one of the Emperour's Souldi­ers, that was infected and corrupted with the French Pox, and I cut it off with good success, at Vlma June 8. in the year 1637.

Fig. VIII. is an instrument to be applied to the Uvula which is fallen; that is likewise of latten, namely a small spoon, but it must be made half so much greater as it is here set forth, whose handle must be hollow, and nine inches long, and is joined to the lower part of the spoon: This spoon is filled with powders that are drying and digesting mingled together, and it is put under the Uvula relaxed: then the Chyrurgian takes the lower end of the pipe in his mouth, and by blowing scatters the powders all about upon the Uvula and the Palate.

Fig. IX. is an instrument to open the mouth wide with a screw; and is printed out of Paraeus his Lib. 9. Cap. 25. wherewith the teeth, fastned and joined forcibly together, are drawn asunder, that meat may be given to the sick, least he should perish by hunger.

Fig. X. is a Cranes bill with teeth, and directed to an obtuse angle; fit to take forth small bullets, and strange bodies, and to draw them forth of wounds.

The X. Table. Of an instrument like to a puller; a pipe to be put into the throat; the Pellican pincers; the Crows bill; Levitors with three divisions, and of the Tunnel.

FIG. I. is an instrument to pull forth small bones in the throat; like that Table IV. Fig. I. namely a pair of pincers bended into a [Page 24]

I

II

III

IIII

V

VI

VII

VIII

VIIII

X

XI

[Page 25] semicircle with teeth, and a small button at the end; wherewith small bones, thorns, and other strange things that stick at the bot­tom of the throat, are wont to be taken forth. When the most famous Hierom. Fabritius, ab Aquapendente, makes mention of this instrument in his Chirurgery concerning the jaws, he understands some kind of instrument that is long and slender, which is twofold, one streight, shadowed forth Table IX▪ Fig. X. another crooked, as this is; yet both of them for their faculty of taking and drawing forth, may well deserve the name of pullers.

Fig. II. is a pipe of silver, crooked, that it may be put into the throat; it is as thick as a Swans quil, and one foot long and a half, or thereabouts: it is all full of holes, and at the end of it, it hath a sponge that is new, and as great as a small nut, firmly bound to it. Which Guill. Fabritius Hildanus, Cent. 1. Observ. 16. useth with happy success to draw out thorns out of the jaws, and middle of the wesand pipe; where he teacheth the manner of the operation by the pipe here printed. The following iron instruments are used for hollow teeth, or such as are loose, or that are very painfull sometimes, to take them forth when people are in the most bitter pains. Whence

Fig. III. is a pair of Pincers, named a Pellican, because the beck of it is like the bill of the Pellican, a bird so called; but they use it to draw forth the grinding teeth.

Fig. IV. is a common pair of pincers for the teeth, the Italians call it cagnolo, because it holds as fast as a dog bites.

Fig. V. is a pair of pincers that represents a Crows bill; with which the roots of the teeth are drawn forth: Of which Cornelius Celsus (whom, as being admirable in all Chirurgical operations, Fabritius ab Aquapendente counsels us to study in both night and day) Lib. 7: cap. 12. concerning teeth, writes thus; as oft as when a tooth is taken forth, the root is left behind, that must forthwith be drawn out also with a pair of pincers, the Greeks call [...].

Fig. VI and VII. are the patterns of toothed pincers. that serve to pull out teeth, which neither the Pellican nor common pincers can draw forth.

Fig. VIII and IX, are Levitors divided in three parts, because they commonly have three spears to thrust forward and to take out the cutting teeth, and the dog teeth which are fastned in the holes of the gums with one root alone.

Fig. X. is a tooth-picker, with which the gum is separated from the teeth, that they may be pulled out with less danger and trouble. That therefore the drawing out of a tooth may succeed well, observing what must be observed, place the Patient on a low place, with his head lying between the Chirurgian's legs; then the Chirurgian shall cut deep round about the tooth to be pulled out, parting the gum from it with his Tooth-cutter; and if the tooth shake when it is parted from the gum, it must be shaken, and thrust out forward with the Levitor put under it; but if it stick fast, and move not after it is shaken, it must be laied hold on with the toothed pincers, and pulled forth (sometimes this way, sometimes that, as the great­ness, scituation, and figure of the tooth shall seem to require. In the use of these toothed pincers (saith Ambros. Paraeus Lib. 16. cap. 27.) I should desire the Tooth-drawer to be very expert and industrious; for with these, unless a man be very cunning, and know the use of them, it can scarce be avoided, but that at one pull he shall bring out three teeth, and ofttimes leave that tooth un­shaken that causeth the pain.

Fig. XI. is a Tunnel or a pipe of silver, whose narrower part is thrust between the outmost gum of the Patient, who hath his teeth fast shut together, and the broader end receives liquid meats and drinks and lets them down to the oesophagus.

The XI. Table. Of another sort of Pincers with a Parrots and a Crows bill; of the speculum oris; of an instrument to cut away the caruncles of the mouth; and of the streight Cranes bill.

FIG. I. is another pair of pincers with a Parrots bill, which we use in fractures of the skul, when a splint of the bone that must be taken away, either presseth or pricketh down the membranes of the brain.

Fig. II. is an instrument with a Crows bill made artificially for the same end. Yet note that both these pincers must be made a third part greater then they are here described.

Fig. III. what instrument this is, is manifest by Table IX. and Figur. X,

Fig. IV. is called speculum oris, wherewith the tongue and lower chap is pressed down, that the diseases of the mouth may be seen [Page 27]

I

II

III

IV

V

VI

[Page 28] exactly, and handled with convenient instruments and medica­ments. But it was chiefly made to preserve the teeth of furious and astonished men, drawn asunder untill such time as they have swallowed down meat and drink sufficient.

Fig. V. is an incision instrument like to pincers, with which are cut forth tumors. and caruncles of the mouth.

Fig. VI. is a pair of pincers with a Cranes bill, toothed and streight, which may serve instead of a puller.

The XII. Table. Of crooked knives; a knife with two edges; a very long needle; a golden syringe; the Pen-knife with a ring; of pipes with shoulders, and holes through; a golden pipe to be thrust into the Urinary passage; and instruments wherewith the belly and scrotum of hydropical persons is opened.

FIG. I. is a little Pen-knife, called by the Greeks [...], from the bill of that bird which the Latines call Galinago, —a Woodcock, in Greek [...], because the instrument is long and somewhat crooked at the end like a Woodcock's bill; with this incision knife wounds of the Thorax that are too narrow are dilated, and great impostumations are opened. Fabritius ab Aqua­pendente, commends the same for opening the Abdomen of hydro­pical persons under the navel, to let forth the water. Note, that this Pen-knife, for the opening of wounds of the Thorax, requires a small button, (like to that the Pen knife hath of silver, Table VIII. Fig. VIII.) of iron at the point, for fear the lungs should be offended with the point of the knife.

Fig. II. and III. are Pen-knives crooked at the point. and like to the Woodcock's bill knife of the Greeks, wherewith mean Fi­stulaes in the habit of the body are conveniently cut; whence also they are called usually [...].

Fig. IV. is a crooked Pen-knife, which the Italians call gam­maut; and it cuts on the hollow side, and is blunt on the convex side of it. I use this most frequently for all incisions which is com­monly made in every impostume; but principally in small incisi­ons. This knife hath a haft of bone, which is convenient for to [Page 29]

I

II

III

IV

V

VI

VII

VIII

IX

X

XI

XII

XIII

XIIII

XV

XVI

XVII

XVIII

XIX

XX

XXI

XXII

[Page 30] divide and separate any thing from another: Whence it is that Celsus lib. 7. cap. 16. de tumoribus tunicatis, saith, then with the handle of the knife, the coat (which after the cutting of the skin presently shews it self white and stretched out) is to be drawn away from the skin and flesh, and to be cut away with that it contains in it: With this also is the Pericranium parted from the skul, and the haw from the eie.

Fig. V. is a Woodcock's bill without a handle.

Fig. VI. and VII. are double knives, which at the end resemble the fashion of mirtle leaves; we use them to cut off womens breasts that are cancerated.

Fig. VIII. is a most sharp needle, long and double; wherewith breasts to be cut off are pierced through at the root.

Fig. IX. is a pipe made of gold of Hungarie, and perforated with many holes.

Fig. X. is a stile made of the same mettle, which is thrust into the former pipe, that of them both, one instrument may be made, which in the wounds of the Thorax is profitably applied for a sy­ringe, and draws blood out of the Thorax which is not congealed, or thin corruption. This instrument is dactile, and may be bent into a right or oblique angle, and may be thrust into the Thorax, where there is a wound made of purpose, or by accident; that it may reach the blood not congealed, or the thin corruption. Let the Chirurgian draw forth the pin out of the pipe, and presentlie the matter contained in the Thorax will run forth. This way to draw thin matter out of the Thorax succeeds excellent well; where, by reason of debility of forces, or some other cause that hinders it, we may not make incision between the fift and sixt rib, according to Paulus; or between the third and fourth, according to Hippo­crates his rule.

Fig. XI. is that crooked knife which may be hid in a golden ring; with this Apostems are cut in the face or cheeks of children; and in the breasts of timorous women; lest seeing the knife they should be frighted, and so not suffer the impostume to be opened.

Fig. XII, XIII, XIV and XV. are pipes with shoulders, and per­forated with many holes, that they may hold the wounds of the Thorax open; they are made with shoulders, lest being put into the wound, whilest the Patient breaths, they should go into the Thorax; and they have so many holes, that by it through them all, as need requires, the foul matter may issue forth.

Fig. XVI. is a pipe made of the gold of Hungarie, which is thrust into the Urinarie passage, before the making of water, that [Page 31] the Urine may come forth by it; and so that most cruel pain and heat may be abated, which the Patients feel when they make water without the pipe, by reason of an ulcer grown in the Urinary pas­sage, from a virulent Gonorrhaea.

Fig. XVII. is an instrument that consists of a needle with three points (a) and the pipe with shoulders (b) with which the navel of hydropical persons, and the scrotum in a watrie hernia are ope­ned to let out the water. This instrument is thrust in as far as the asterism upon the pipe; after that the needle is drawn out, and the small pipe thrust in as far as the shoulder, is left in the abdomen without all fear or danger.

Fig. XVIII. is the small pipe alone, and printed without the needle.

Fig. XIX. is the needle alone, set without the pipe.

Fig. XX. is a round needle with its small pipe; wherewith, for want of a needle with three points, the navel of hydropical persons is perforated with the like safety; and so is the scrotum of such as have hernias filled with water.

Fig. XXI. is the pipe of the round needle by it self.

Fig. XXII. is the round needle alone.

The XIII. Table. Of the Syringe with a right pipe, and crooked pipe, one for the matrix, and one for the ears; a glister pipe; the silver cap, and wax candles.

FIG. I. is a syringe to draw out, or to squirt any thing in, often usefull; that which hath this crooked pipe join'd to it, may re­ceive the streight pipe Fig. II. when the crooked is not conve­nient to draw forth or cast in any thing.

Sometimes to this syringe there is fitted a pipe Fig. III. that hath many holes perforated in it; which the Greeks, and Galen lib. 9. de compos. medicam. sec. loc. cap. 8. and lib. 5. meth. med. cap. 4. call Metrenchytam; women that will not easily give way to others, for shame, to cast a clyster into their matrix, conveniently use this in­strument; wherewith they can easily inject divers liquors to cure divers affections of the womb, and the cause of it.

I

II

III

IIII

V

VI

VII

VIII

VIIII

X

Fig. IV. is an ear Syringe, called Otenchyta, whereby liquors are injected into the organs of hearing, to cleanse and heal ulcers there.

Fig. V. is called Enterenchyta, namely a pipe of latten crooked like to a Catheter; which let them care to provide, who would rather give themselves a clyster, than receive it from any one else; especially if often use of clysters be needfull, by reason of the disea­ses of the guts; especially of the right gut.

Fig. VI. is the lock of the said crooked pipe B, Fig. V. by help whereof the liquor of the clyster in the bladder, which about the letter A Fig. V. is to be tied after the vulgar manner, is held so long as the Patient pleases, as he will open or shut the pipe.

Fig. VII. is a nail with a broad head (c) Fig. V. which is screwed into the lock B, Fig. V. that nothing of the clyster, in turning the key about, may run forth, which may foul the sheets. This in­strument, as it appears to any man, differs much from that which Iohan. Heurnius in his method ad praxin medicam, Cap. De Clystere; and Guill. Fabritius Hildanus Cent. 1. Observ. 78. caused to be prin­ted for to inject clysters into the belly.

Fig. VIII. is a silver cap and full of holes, which is applied to the ulcerated nipples of the breasts, that nurses may suckle the in­fant without any trouble. This cap is also used for wounds of the Thorax; for after that any one of the aforesaid pipes hath been thrust into the Thorax, and a piece of sponge is put into the orifice of the pipe near the shoulder; this cap is put upon it that the matter, almost every moment, may sweat through the holes of it by de­grees, and without any loss of strength.

Fig. IX and X. are candles made of strong double thread and white wax (to which a little Turpentine is added, that they may not break so soon) and these are to be ready for use when the urine is stopped by a caruncle in the urinary passage, which must be cured. The candle Fig. IX. is broken, lest in the drawing forth of the candle [...], some piece of wax, which sometimes hath no wick in the middle, should be left in the passage, and thereby the difficulty of making water could be greater. Wherefore the Chyrurgian shall cut off, with his pin­cers, that part which is broken at the end of the candle; and then he shall thrust into the urinary passage the said candle, so far as need shall require, first anointing it with oyl of sweet almonds.

I

II

III

IIII

V

VI

VII

VIII

XI

X

XI

XII

XIII

The XIV. Table. Of Syringotomi, and the needle wherewith the scrotum is perforated after the cutting of a Hernia (used at Nur­sia) and the bottom of a more sloping fistula; of the catheter, the directory, and two instruments wherewith bullets are taken forth of wounds made with gun shot.

FIG. I. is a crooked knife, which upon the inside (a) hath an edge, and on the outside (b) it is blunt, namely a Syringoto­mus; which at one end (c) pricks and cuts; this we use in any fistula that hath but one passage, that the end of the fistula may be perforated; and afterwards the space between one hole and another may be cut asunder; at the point hereof we must fasten a button made of white wax, wherewith the pen-knife thrust into the fistula may come to the bottom, without any hindrance, pain or hurt.

Fig. II and III. are pen-knives to cut fistulaes; both of which are blunt at one end, and have a bullet of iron well pollished at the other end. With these the whole passage of deep fistulaes are to be cut.

Fig. IV. is a knife to cut fistulaes, wherewith the wounds of the abdomen are dilated, that the intestines slipt down and swoln with winds may be commodiously thrust back again. It hath a button at one end far greater then the two former knives have, lest being thrust into the wound it should hurt the intestines.

Fig. V. is a needle, or iron instrument, with a double edge; which they of Nursia, in my time in Italy, in this part of Chirur­gery (which cures Hernias with cutting forth the testicle) being excellent well skilled, and in that respect the most famous gelders, thrust the wound of the groin to the bottom of the scrotum; which with the point of the instrument (to which alwaies men ought to fasten a small button of white wax, for the reason abovesaid) they perforate; whereby the corrupt matter, which by the wound of the groin descends to the scrotum, may be purged forth. This operation because it is fearfull enough, and is not without the grea­test danger of life (which the Authours of it knew well; and there­fore they take on those they would cure, but as dead men.) I will open to such that are studious of Chyrurgery, another use of this instru­ment which is very safe. Namely, with this are cut the sloping ends of sinuous ulcers, for which cause fistulaes cannot be cleansed, [Page 36] unless the Patient be so scituated that his head be downwards and his heels upwards, and the corruption may run forth of its own motion. For it is known that such hollow sores which have not yet contracted a callous, whereof also we here speak, can be cured only by glutinative medicaments, and convenient ligature. So the matter collected in the hollow sinews may find a daily passage out. But since that scituation with the heels upward and head downward is troublesom enough, with this instrument, to whose sharp end a small button of wax must be fastned, the bottom of the hollow ulcer is perforated (leaving the partition between the holes untouched) that the matter may run forth by the lower hole, and the partitions between the sinuous ulcers may be glu­tinated.

Fig. VI. is a Catheter or a Probe; by which, being thrust in [...]o the passage of the yard, and into the bladder, we prove the inner­most turnings of the bladder, wherein the stone useth to lie hid, wherewith oftentimes man's nature is tormented. The Greeks call it [...]; and it is used to make the urine come forth when it is stopped. It is made of silver that it may be bent, and it is free from all roughness, lest the part that is most exquisite in feeling, should be affected with the Catheter in the passage, and that it may enter into the bladder without pain: it is perforated with many holes at the end, that the pin being drawn back, the urine con­tained in the bladder may freely come forth by the pipe without any difficulty. Note that the pin is not thrust into the pipe, that as it were by force of vacuum it might draw after it the urine sup­pressed, but that the urine should not presently run forth, whilest the cutter for the stone, or the Physitian seeks after the stone that lies hid. Celsus describes the magnitude of the Catheter, lib. 7. cap. 26. see Table XXXIX. Fig. IX.

Fig▪ VII. is a silver Probe which must be so bent, that its fissure which it hath in the middle, as far as the end of it, may be on the back side or gibbous part thereof: The Latines call it a Directory; because, being thrust into the yard, it doth most exactly shew the neck of the bladder; and upon that must incision be made to take the stone out of the bladder.

Fig. VIII. is a latten instrument, wherewith the stone is taken forth which remains in the urinary passage; namely a Probe, which on that part where it is made hollow like a spoon for the ears, is put into the conduit of the yard, so that it may pass beyond the small stone above it, and may lay hold on it with its lip and con­cavity: [Page 37] this being done, oyl of sweet almonds is poured through the hollow passage of the pin of the Probe, which hath a large orifice, into the Urinary passage, that it may become slippery; afterwards the Probe is gently drawn forth, and the conduit is pres­sed behind the stone with the finger, untill it be driven forth of the Urinary passage.

Fig. IX. is an instrument the most fit to take forth bullets out of a wound. It is made of the best steel, and it consists of three parts; namely, of two small pipes and a piercer. The outward pipe (a) can shut in the innermost pipe; which at one end is di­vided into two spoons of iron (b) that it may fasten the bullet, that it may not turn about with the piercer, which must be fastned into it. The Piercer (c) is most sharp and somewhat longer than its two pipes; which by the hole of the handle (d) may be seen to be thrust into the pipe.

Fig. X. is a Piercer printed without its pipes.

Fig. XI. is the same instrument with the former, (but that it wants a Piercer) wherewith bullets are drawn forth; it consists of two parts of the pipe (a) and the stile (b) which is solid; which at the other end is divided into two spoons which may take in the bullet betwixt them. This instrument doth the very same, that the instrument of Alphonsus in the following Table doth.

Fig. XII. is the pipe of the precedent instrument by it self.

Fig. XIII. is the stile of the instrument which is solid half way; and at one end representing the form of spoons with teeth; at the other end like screws, that are bossed with a hilt and a button.

Fig. XIV. is the hilt of the stile, with its little button, which is round and hollow.

Fig. IX, X, XI, XII, XIII, XIV. of this Table, must be made a third part greater than they are here printed.

I

II

III

IV

V

VI

VII

VIII

IX

The XV. Table. Of other iron instruments fit to take out musket bullets; name­ly, Alphonsus's instrument; the Goose bill pincers, with and without a screw; the little hook; the piercer with a pipe; and the spatula which represents a Goose bill.

FIG. I, II and III. is an instrument called an Alphonsiae, made fit to take out bullets out of wounds; which Alphonsus Terrius, a Physitian of Naples, Lib. 2. de vulner sclopet. cap. 3. describes in these words. Yet that instrument which men call the Cranes­bill, must not be forgotten, for that it is also an excellent instru­ment to draw forth any thing, and commended by all both old and new Chyrurgians; wherewith not only small bullets are taken out of the most difficult places, but also pieces of Armour, and many other things. To this we (that it may be more commodiously and firmly held in the hand, and so bullets and other strange things in wounds may be found out more certainly) have added rings for pincers, after this fashion. The ring A of the first Figure, thrust to the former part of it, shuts the instrument; the ring B of the second Figure being drawn back to the handle, the instrument is opened. The third Figure is the instrument which now holds the bullet.

The Figures of the following instruments, are taken forth of the Treatise of Barthol. Maggius, concerning the cure of wounds made by bullets from great and small guns.

Fig. IV. is a pair of pincers with a Goose-bill, which hath a screw about the handle, that it may lay fast hold of the bullet.

Fig. V. is a little iron hook which serveth to bring forth bullets.

Fig, VI. is a pair of pincers with a Goose-bill, which if it had a screw were like to the former.

Fig. VII. is a most sharp piercer, in its pipe, with which gun­shot are taken forth.

Fig. VIII. is the piercer without the pipe.

Fig. IX. is a spatula with a Goose-bill; provided to receive and take forth small bullets.

The Alphonsine instrument and Goose-bill pincers, must be made a third part greater; but the pipe with the piercer must be as [Page 40] great again. Ambros. Paraeus in his Chyrurgery hath described more instruments to the life, where he treats of wounds by gun­shot; but they are not better for these purposes: and so hath Guill. Fabritius Hildanus, Cent. I. Observat. LXXXIX. Wherefore there are divers sorts of instruments that are good to take out bullets from the wounded parts, according to the variety of the wound, and the fashion of the body that must be taken out: whereof some lay hold and draw out, either as they are sharp and so only stuck into the bullets (Fig. VIII.) or as they are dented at the end; and some are streight (Table IV. Figure I. Table IX. Figure VI. and in this Table Figure I.) and others are crooked (Table IX. Figure X.) to be used as the bullet went in streight or crookedly; some take and receive the bullet in, as they are broader and hollow at the end; (Figure IV, V, VI and IX.) others lay hold and take it in together (Table XIV. Fig. IX.) But if the bullet found by the Probe must be drawn forth by a pair of Pincers, principal care must be had that the lips of the wound, and the inward parts of it (namely the Arteries, Veins, Nerves and Tendans) be not hurt nor laied hold of: for if this be done most cruel pains, and great inflammations, with great danger of life, are produced; besides a most fearfull flux of blood following. Wherefore to prevent such symptoms, let the Pincers never be opened, unless you feel the bullet at the end of it; for then must the Pincers be opened, and the bullet laid hold on by them, and pulled forth.

The XVI Table. Of the Pipe that is all solid; and of Pipes that have holes on the sides; and of their stile, wherewith being put in [...]o the Anus, the Haemerods and Ulcers of the right gut are burnt and dried up; of the glass also by which the niples, hid in the breasts, are drawn out.

FIG. I. is an instrument fit to dry up the Hemrods within, that either swell or superficially exulcerate the intestine; namely, a small iron pipe, which is put up into the fundament; it hath shoulders, and is shut at bottom, lest the red hot iron (Fig. IV.) which is frequently put in and drawn out of the hollow of the pipe, should go in higher then it ought to do.

I

II

III

IV

V

Fig. II and III. are pipes also to thrust into the fundament, but they are perforated on the side (according to the scituation of a callous and deep ulcer, which will not yeeld to topical medica­ments; into these is thrust a red hot iron Fig. IV.) with these pipes the sound parts are defended from the immediate touch of the fire, that only the ulcer most safely may be touched twice or thrice with a red hot iron.

Fig. IV. is the stile which is made red hot, and is thrust into the perforated pipes; and into the solid pipe also to dry up the internal Emrods, and those that are swoln; and to cure the ulcers of the right gut, be they superficial or deep.

Fig. V. is a hollow, long, narrow glass, having a mouth at one end, which is as great as to receive the niple; but at the other end it hath a small hole with a long pipe; wherewith the Patient her self, by sucking, draws forth her nipple that lies secret, so that the infant may lay hold of it with its mouth, and draw out the mothers milk.

The XVII. Table. Of a crook to draw forth the dead Child; of the specula ani; speculum matricis; circles for the womb, and the de­ceitfull pincers.

FIG. I. is an instrument with two crooks, wherewith the dead child is drawn forth of the womb, either whole, or cut in pieces.

Fig. II. is an instrument which men call speculum ani, and of the sheath of the matrix; because by means hereof the ulcers of the right intestine are seen, and of the sheath of the matrix: To know the quantity and quality of them, that part of the speculum marked with A, which is open and called the male, is used for men; but the part that is shut and marked with B, is used for women, and is therefore called the female.

Fig. III. shews the same speculum, and that part which is used for men is shut, and the other part for women is open.

Fig. IV. is a great speculum matricis, which is only used for wo­men, when the dead child is to be cut out, or some ulcer of the matrix must be viewed. These instruments for fight must be made a third part greater then they are printed here.

I

II

III

IV

V

VI

VII

VIII

IX

Fig. V, VI, VII and VIII. are circles for the matrix, which are made of box; which after the womb fallen down is put back again, are thrust into the sheath, that the womb may not fall down any more. On the part A that they look inward with, they are some­thing copped; but on the other part B they are blunt. The Chy­rurgian or Physitian must have alwaies ready at least four rings for the matrix, which must differ only in magnitude, that he may use them as the neck of the matrix is greater or smaller.

Fig. IX. is the deceitfull Pincer; which if it deceive not the Patient, yet it will deceive the Chyrurgian, as it was the opinion of the Ancients, in dilating of hollow places.

The XVIII Table. Of instruments whereby the foot contracted, is by degrees stretched out again; and the elbow grown stiff, is bent by little and little; the artery of the wrist wounded, is pressed together; and a seton is cut in the neck.

FIG. I. is an instrument made of iron, which must be applied to the knee that is crooked and drawn together, which consists of divers parts; namely of the iron Capsula A, which the screw B passes by, and it is fastned to a ring made of a plate of iron, so broad that it may cover the whole knee C; with the latchets D, that it may be shut and opened; with holes in the outside E, that it may be drawn back with the cotton and lint; and last of all with an iron key F, by the means whereof the iron ring may be drawn too, and the leg comes into a right posture.

Fig. II. is the inferiour and half part of the screw B, set forth Figure I.

Fig. III. is the screw B of Fig. I. out of its place, consisting of two parts; of which the upper part (a) after attraction is left fast in the ring; the other part (b▪) is drawn forth.

This instrument differs not a little from that which Guillielm. Fa­britius Hildanus, in his little book de combustionibus, writes that he invented.

Fig. IV. is an instrument made of divers plates of iron, and per­forated with very many holes, that it may be applied with cotton and lint, and fitted to the arm like a sleeve, and may be shut and [Page 45]

I

II

III

IV

V

VI

[Page 46] opened. The artery of the wrist is pressed together with a screw having a broad head, which this instrument is made with, be it open of purpose or by accident, that the Patient may not pour forth his life with his blood.

Fig. V. is an iron instrument which we use when the arm can­not be bent. This instrument is bended by degrees, by means of a screw. The instruments of this Table, Fig. I. IV and V. must be prepared after the proportion of the part affected.

Fig. IV. is a pen knife with two edges, and resembling the form of a mirtle leaf, wherewith a seton is cut in the neck; the pincers of this knife is pictured and described before Table VII. Fig. X.

The XIX Table. Of divers sorts of iron instruments; with which, being made red hot, divers parts of the body are cauterised for divers causes; and of a small Lancet to cut the ves­sels, and to open impostumations in the skin, and to perforate into the passages of the fundament, yard, and preputium that are shut.

FIG. I and II. are iron instruments that are blunt and broad at the upper end; with which, being red hot, not only strange fluxes of blood are stopped, after the amputation of a breast, or a spha­celated part; but also the part remaining is corroborated, that it may receive no new flux of humours to it. Anno 1635. in the time of the Plague, a certain Senatour of Ulma, who is yet alive, was tormented about the fundament with a pestilent carbuncle, which was great and black, which sinking into the inward parts quite vanished away, and it threatned certain death: To draw back this carbuncle, I applied the instruments Fig. I and II. very well fired by course, near the fundament, that it might not be exasperated by the touch of them; but might only feel the force of the fire, that the Patient might well indure it, whereby the carbuncle might be drawn forth again; when I had drawn it forth, I made an escar there. with the iron instrument Fig. III. following; to make the escar fall, I applied a cataplasm that in two daies time made a se­paration of it: [Page 47]

I

II

III

IV

V

VI

VII

VIII

IX

X

XI

XII

XIII

• [Page 48]Take common salt half a dram.
• Pepper 1 dram.
• Fat Figs 3 in number.
• Green Rue leaves a handfull.
• Leven old and sour 1 ounce.

Mingle all these in a mortar most diligently, to the form of a Pultis, which must be renewed twice a day.

Sennertus described this cataplasm; and the Ancestours of Spige­lius, in the low Countries, held it for a secret, because it excel­lently well takes away all Escars. When the Escar was gone, I laid upon the ulcer the unguent citrinum, which hath a force to digest, attract, to ingender flesh, and to resist poison; about the ulcer I applied the plaister called album coctum; at last I cicatrised it with the plaister Diapalma.

Fig. III and IV. are round actual cauteries, wherewith the cor­rupted bone is touched, that it may separate from the sound bone.

Fig. VI and VII. are oval like at the end; wherewith the Hem­rods that run too much, are touched severally.

Fig. VIII, IX, X and XI. are actual cauteries round at the end, which are thrust into hollow teeth to hinder the rottenness of them. The figure marked with a star is a streight Lancet, cutting with both edges. With this the French and Italians very happily open veins to let blood: With this the fundament of children new born, and the yard not perforated is opened: With this, in Germany, fon­tanels of the limbs are made.

The XX. Table. Of the greatest sort of pincers; the cizers that cut Cartila­ges; the crooked knife; and the wooden mallet which we stand in need of besides the pincers, to cut off a part that is sphacelated.

FIG. I. is a pair of pincers, wherewith not only bones are cut off that rise up in fractures with wounds, and cannot be set toge­ther again; but also those which by their sharpness prick the brain; with this pair of pincers also, the fingers of the hand are cut off, and toes of the feet that are superfluous, and cancerated [Page 49]

I

II

III

IV

V

VI

[Page 50] or sphacelated; which must be made as big again as you see it here printed See underneath Table XXVI. Fig. I and VI.

Fig. II. is a pair of cizers to cut, made for grisly and brawny parts.

Fig. III. is a crooked knife wherewith the flesh is cut in so far as the bone which must be saw'd off, and is necessary before the amputation of the Leg or Arm.

Fig. IV. is a chizel wherewith not only the tops of the fingers are cut off; but also of the arm and of the radius.

Fig. V. is a hammer made of the hardest wood.

Fig. VI. is a block of wood, which is round and high; upon which the parts to be broken off must be placed.

The XXI Table. Of the instrument which is called by Hippocrates [...]; of the ladder; of that which Nileus calls Plintheum; and of the pipe, and Galen's Glossocomum.

FIG. I. shews the fashion of that instrument which Hippocrates calls [...], with those things that are added to it.

Fig. II. is the instrument called Ambi, divided into its parts, (namely the pillar A; the wooden spatha or Ambi, properly so cal­led, B; and the pin C; which holds the turning Ambi B. in its pillar A) Ambi is thus described by Hippocrates, Sectione 6 De Articulis.

Let the peece of wood B be almost five or four fingers broad, and two fingers thick, or else not so thick; but in length two cu­bits, or somewhat less; whose one end D must be round and very narrow in that part, and exceeding thin; but it must be very high, and in the uppermost part of the roundness it must a little stick out, wherewith it reaches not the side but the top of the arm, that the arm-pit set under it, it may be fitted to the side: I add that this piece of wood must have three holes, through which thongs of leather may be put, wherewith the arm must be fast bound to the wood.

Fig. III. is a ladder, whose uppermost round hath a round body upon it E, which is put under the arm-pit, between the side and top of the shoulder; after this the Chyrurgian draws downward [Page 51]

I

II

III

IV

V

VI

VII

[Page 52] the arm out of joint, but not bound to the spatha; another of the servants laying hold of his neck and top of his shoulder, shall draw likewise on the other side; a third shall lay hold of his whole body and draw downwards also, on the other side of the ladder. See the fashion of this operation in Galen. comm. in Lib. Hippoc. de Articulis. Also this Ladder hath four pullies, for the use of Nileus his Plinthe­um, which shall be explained underneath Fig. V.

Fig. IV. is the form of an instrument called Glossocomon, for the fractures of the thigh and the leg, to hold them fast together when the Patient is removed from his bed, whereon he lieth, into another bed till that be made; and it is exceeding fit for it. The description of this Glossocomon found in Galen, comm. ltb. Hippocr. de Fracturis, is thus: This instrument called Glossocomon was in­vented by the latter Physitians to hold fast, when the thigh or leg is broken; the making of which, and the use of it, I shall an­nex hereunto. And indeed this seems not to me to be invented to no purpose; and if either thigh or leg be broken, it is most con­veniently applied, where the callous may compass it about. It hath at the lower part the Axis A, to which must be tied the ends of the strings that extend divers waies; let the strings be fastned upon the utmost parts of the bone that is cured; and make them so of two bands B and C, that both of them may have four ends, two on the right side F, and as many on the left side G. From those ends, those things which are belonging to the lower string B, must be drawn to the axletree, by the holes made in the lower part of the Glossocomon D; and those things thar belong to the uppermost string, must first proceed to the upper parts; then they also must be put through the perforated sides of the Glossocomon, whereby they are fastned in the holes of the screw F; but on both sides, on the outside of the Glossocomon F and G, the ends of the upper string C must be carried to the axis. For these things being so ordered, one turning about of the axis, will equally ex­tend both strings, that downward which is bound to the lower part of the broken bone; but the other upward so, that where the leg lieth you may afterwards daily correct this stretching of the strings divers waies, by extending more or less forcibly. Therefore the axis extends the string B, which is in the lower part, drawing directly; but that in C, which is in the upper part, it extends by the interceding of another motion; the Greeks say it is done [...]. The Figure shews the extension of the thigh that is diminished; but if the leg be diminished, the upper string C must be fastned below the knee, and the lower above the [Page 53] ankles; and so the leg is to be kept extended divers waies.

Fig. V. is a drawing instrument called Plintheum Nilei; and it is made after the pattern of those which are called long and square wind-lasts. This instrument hath two sides (a) four hands breadth long, and a finger thick overthwart, which at both ends are compacted together with two cross boardi (b) which have in the middle the hole (c) through which the cords (h) are put. The thickness and breadth of the Transorus, is equal to the sides; but the length of them is a full hand breadth: wherefore rightly is such a joining together made, that the sides (a) may be four hands breadth long; and the Transorus (b) but one. The whole instru­ment is made long waies; yet if a man will, he may make the sides shorter then I have said, since the instrument performs its operati­on by one axletree: Therefore the sides, in the middle, are perfora­ted with round holes, through which the axletree (d) passes, whose left end, where it passes without the side, hath a wooden handle (e.) Also in this instrument there are four iron rings (f) fastned to the sides, with as many leather strings hanging down, two at the lower part, and two at the upper part, that it may be fastned to the ladder Fig. III. To both ends of the axletree there are wheels added (g) and to their stops (i) that they may hold firm the axletree turned about by the handle. So that if the arm, out of joint, cannot be re­duced either by a band put under the arm-pit, (Tab. XXIII Fig. II.) nor yet by a linnen cloath wrapt on a heap (Table XXIV. Fig. I.) this instrument must be tied to the ladder; and the arm must be exten­ded after the same fashion and manner, as it is found to be done in Oribasius lib. de Machinament. cap 14.

Fig. VI. is a long, hollow trunk, wherein the leg or thigh, being broken or out of joint is laid; it must be filled with Towhards, for the whole part must be laid in the hollow trunk, rather than half, Hippoc. de offic. medic. This Capsula hath the hole G at the bottom to receive the heel, and at the end a long board for the sole of the foot to rest against.

Fig. VII. represents the best reducing of the shoulder fallen be­neath the arm pit; that is, which Fabritius ab Aquapend. describes thus. The end of the spatha must be set under the arm-pit of the shoulder out of joint, between the side and the top of the shoulder; the rest of the plank must be bound placed all at length, with the arm on the inside; first, immediately under the top of the shoulder disjointed; next above the elbow, and last upon the wrist. This being done the Patient must be set upon a seat E, and his arm bound to the plank must be fitted to the beam or pillar (Fig. II. A) by means [Page 54]

I

II

III

VI

[Page 55] of a pin (Fig. II. C) so that the pillar be between the ribs, and the plank bound to the arm (Fig. VII. F.) The [...]atient and pillar being thus scituated, the Chyrurgian G, on the one side, shall pull the arm downward; and on the other side his servant H, taking hold of the neck and shoulder of the Patient, shall likewise pull him down­ward. For whilest the Chyrurgian pulls the arm downward, the plank, together with the arm, is drawn to the sides; but when the lower end of the plank is brought to the sides, the upper part which is round makes a contrary motion, and so moves the head disjoin­ted to the fore-part; which motion being made, the muscles after that draw easily; or else the Chyrurgian, by force, doth thus reduce the head of the shoulder bone. This manner of using the plank, dif­fers from that which Paraeus describes, lib. 11. cap. 27. How the shoulder may be reduced by the ladder and the spatha together, Paraeus shews the figure lib. cit. cap. 26. The other waies of redu­cing the shoulder out of joint; namely, by the Thessalian seat; the double door; the cross beam, and the Pestle, are found described in Galen; in comm. Hippoc de articulis.

The XXII. Table. Of Vitruvius his drawing Engine; the small girdle and Remora of Hildanus and Hippocrates his form.

FIG. I. is a drawing Engine with a small cord; by which we use to extend joints dislocated, and fractures; it is taken out of Vi­truvius lib. 10. cap. 4.

Fig. II. is a little girdle (wherewith the arm is compassed in above the wrist; the thigh above the knee; and the leg above the ankles) with two small hooks.

Fig. III. is an instrument called a Remora, which in dislocati­ons of the shoulder toward the lower parts, is put under the arm-pit, that the knot of the shoulder may be answerable to the head, and the pin B may fasten the Remora; although this instrument which Guill. Fabritius Hildanus sets forth and describes Cent. 5. Obs. 86. with the way to use it, be highly commended by the latter Chyrurgians; yet the laxations of the shoulder are far more happi­ly reduced by Hippocrates his spatha, if they cannot be set with the hand, than by the Remora or any other instrument.

I

II

III

IV

Fig. IV. is Hippocrates Form, which is most convenient to restore and set again limbs broken or out of joint. The Board A is prepared six cubits long, and two in breadth; it hath nine fingers overthwart in the thickness AE, where it is to be turned upward. This board hath four other boards, which are round in the upper parts; namely two, and again two at both ends B: Hippocrates calls such timber boards [...]; in the breadth they are perforated, and in the holes the axle­trees C pass through, which at the ends have handles D to turn them about; the whole plank, from the middle to the end, hath hollow places E, that are 4. fingers in breadth distance one from the other; whose breadth and depth is equally three fingers broad overthwart, in which a round piece of wood is set F. Hippocrates calls these holes that go not quite through [...]. This Form, besides the four [...] G, at the end hath two other Posts in the middle, which contain the cross piece of timber H, in the upper hole to reduce the thigh slipt forward in the hinder and external part; whereof see Oribasius lib. de Machin. cap. 37 & 38. The Form stands on six feet, that it may be lif­ted up with mens hands, and removed from place to place. To the little wheels of the Form, Remoras may be fitted which may keep the axle-trees ends unmoveable. I shal declare the use of this Form of Hippocrates, underneath Tab XXV. lest young Practitioners may have the same mischance that I knew, in my time, at Padua befel a Chyrurgian and a Physitian, who was otherwise most famous for his skil. This man when he had need of this Form to extend a fracture of the leg; but having borrowed it knew not how to use it, to his great disgrace, was with shame constrain'd to learn the use of the Form, from one of whom he had borrowed it, almost against his wil.

The XXIII Table. Of the setting of a shoulder broken; and the reducing of the shoulder, arm and thigh bones, put out of joint.

FIG. I. teaches how to extend and to set the shoulder bone that is broken; which Hippocrates Sect. 6. de fractur. text 9. describes ex­ecllently. Wherefore the most exact distance of the arm is this. A piece of Timber of a cubit long A, or somewhat shorter, as are the handles of spades, must be bound on both sides with the cord B, and hanged up; but the man placed upon some high stool, must so lean upon it with his hand. that the handle may be so placed [Page 58] under his arm-pit, that he can hardly sit down, but may remain almost hanged up. Then some one firm bolster or many C, being laid under and above it, at that height which may answer to the arm placed at a right angle; it were better to hang by a broad and soft thong of leather, or a broad band tied about it D, some heavy weight E that may gently stretch it, or else some other strong man may forcibly draw the arm downwards at the bending of the arm Fig. II. but the Physitian standing and placing one foot on a higher place, must attempt the cure, and with the palms of his hands set the bone; which truly will be easily done, for this way of extending is commendable if a man use it rightly. Others com­mend the way that Celsus used to extend the shoulders, which he describes very darkly, Lib. 8. cap. 10. but Foesius hath clearly ope­ned the meaning of his words intirely, in his comm. upon the for­mer words of Hippocrates; to which I think fit also to subscribe.

Fig. II. is the reducing of the arm out of joint, according to Hippocrates his mind, where the elbow is slipt forth to the inward or outward part; the distention must be so ordered that the arm may be placed at a right angle with the shoulder. But it behooves us to lift up the arm-pit with the band F put under it; and to lay the arm upon something, and about the joint to hang some weigh­ty matter Fig. I. or else to press it downwards with the assistants hands, as in this Figure. But whilest the joint is hanged up, it is ne­cessary to thrust hard with the fore-part of the palms of the hands. This Figure is convenient, whilest the arm is bound, hanged up and placed. When it slips forth on the hinder side, it must be suddenly exten­ded, and with the fore-part of the palms of the hands forced into its place again, which also must be observed in reducing other bones. When it slips forth into the fore part, laying a linnen cloath upon it, wrapt up in form of a ball, it is necessary at once to bend and reduce it, Table XXIV. Fig. I. But if it slip into the other, or hinder part, when it is reduced, both of these also must be done: See Table XXIV▪ Fig. I.

Fig. III. shews Hippocrates his way of reducing the shoulder slipt under the arm-pit. For though that be the most excellent way of reducing, which was commended a little before, Table XXI. Fig. VI. yet this which follows comes next to it, which our old man seems to commend in these words. Wherefore they whose shoul­ders slips often forth, may for the most part reduce it themselves. For thrusting under the arm-pits the knuckles of the fingers of the other hand, they thrust the joint upward, and they draw the bun­ched part of the arm to their breast. Also after this manner the [Page 59] Physitian shall force it into its place; if the inward part of the joint be slipt forth, putting his finger under the arm pit, he shall set his head to the top of the shoulder and bring it back from the sides; but setting his knees to the binding of the elbow with his arm, he shall thrust it to the sides. But it is necessary that he who reduces it should have strong hands, or else he must do it with his hands and his head; and some other that assists him, must bring the bun­ched part that sticks forth unto his breast.

Fig. IV. is the reducing of the thigh out of joint, which Hippo­crates describes as it here follows. But the hip is thus reduced, whe­ther it slip forward or inward. A ladder is set in the ground, whereupon the man sits with his sound leg lightly extended, and bound about it with the best convenience; but to his leg out of joint G, there is hanged a basket H full of stones, or some earthen vessel full of water: See the Figure of it in Galen, comm. 4. in Hip­pocr. de artic. text. lib. 4.

The XXIV Table. Of the cure of the dislocation of the elbow, of the hand, and of the neck bone.

FIG. I. represents another way of reducing the elbow out of joint, according to Hippocrates his opinion. But it is expedient to put a swathe band wound up together, or a linnen cloath folded hard, yet not very great, laid athwart on that part where the ben­ding of the arm is, then to bend the arm suddenly, and as much as possibly you can, to bring the hand to the head of the shoulder; for this way is very sufficient for those who have it slipt forth for­wards or backwards.

Fig. II. the hand out of joint is reduced. Now the hand slipt forth, either to the inside or outside, but most commonly to the inside. It is a certain sign when it is slipt into the inside, for it cannot be bended; and when to the outside the fingers cannot be extended. In reducing of it place the fingers upon a Form, or up­on a Table. and let them be stretched divers waies by two persons that are assistants. That part of the bone which sticks out, must be repulsed either by the upper part of the Chyrurgians palm of his hand, or with his heel also, and be forced into the former and [Page 60] lower part; but from underneath near the other bone, some soft ball must be put, with the hand downward, where the laxation is on the upper part; but the hand upward, where it is on the lower part.

Fig. III. shews the reduction of the neck bone, which Galen describes, comm. 2. in Lib. Hippocr. de artic. text. 73. If that part of the cavel bone, which is joined with the breast bone, break forth side waies, or toward the lower part, then H [...]ppocrates saith it will be conveniently reduced, if a man be laid on his back, laying a pil­low between his shoulders near the back bone, or else a boulster or some such [...]hing, that by this means the whole breast may bend; this he expressed by the word [...]; which the Poet used also, [...].

Wherefore a man lying in that posture, he commands that the Chyrurgian, with one hand, shall thrust back the top of the shoul­der which is removed to the side, toward the outward part; for so the parts of the neck bone drawn away, will much retire amongst themselves, the bended posture of the breast conducing very much thereunto; and with the other hand he shall set and bring toge­ther, the parts of the neck bone that were dislocated: But the shoulder to be thrust up near the side, sometimes it sufficeth to be joined afterwards.

The XXV Table. Of the reduction of the ankle bone dislocated; of the ex­tension of the leg broken; and directing of the back bone slipt outward.

FIG. I. shews the reduction of the ankle bone, which Oribasius Lib. de Machinamentis cap. 40, describes. The ankle bone some­times slips forth inwardly; sometimes also it is turned toward the hinder part. When it slips into those parts it is convenient to lay a man upon his back (upon Hippocrates his Form) the leg of­fended being stretched forth; and upon the leg (presently under the knee) one must bind about a cord, after the fashion as it is bound on the top Mast of a Ship A, and extend equally, and bring the ends of it on the hinder part to the axle-tree which is above the head; but on the ankle he must tie the knot or sandal B, and bind [Page 61]

Fig. I.

II

III

[Page 62] the ends of it to the nether axletree; and then either draw the part divers waies, or hold it so, and extend from the lower part; and the strings being drawn as much as need is, he must force it back again conveniently, when it is started forth to the inward or out­ward part; but when it is gone to the hinder part, he must draw it out; for now force to draw it forth is ve [...] convenient for that posture.

But if in a fracture of the shin bone, or the minor forrile, or of bo [...]h bones at once, the leg cannot be extended with the hands; let the Patient be placed upon Hippocrates his Form, and let the carchesian ligature A be put about the leg below the knee; but let the sandalian B be bound above the ankles; afterwards let the leg be extended by the bands drawn divers waies, and let the fra­ctur [...] be set together.

Fig. II. sh [...]ws the extension and impulsion of the spina dorsi, disl [...]cated toward the external parts. This is easily prepared, if the ha [...]f Po [...]t G, in the Form of Hippocrates, set forth Table XXII. Fig. IV. be removed with the Priapiscus F, and into the hole of the righ [...] Post A, some hollow piece of wood B be let down, which may receive the Spatha C to be made fast with the pin D, that it fall not out. This being done let the Patient be laied with his face downwards upon the Form; then let two cords be put about his middle, one above E, and the other below F the bunch of the b [...]ck, whose ends must be carried oppositely to the axletree, that being tu [...]ned about they may equally extend the back bone. That piece of Timber which receives the Spatha or cross bar, must have at l [...]a [...]t three square holes, that the cross bar, for the greatness of the bunch on the back, may be fi [...]ted to it, on the upper middle or lowest part of it. Last of all the Spatha, being set upon the b [...]ch of the back, and pressed down with the great violence of the Chyrurg [...]an, the dislocation is forced in. This way of impulsion differs much from that which Oribasius lib. de Machin. cap. 35. des­cribes, in words and manner, very obscurely.

Fig. I.

II

The XXVI Table. Of the extending of the Thigh broken into divers parts, and the setting of it; of the reducing of the knee that is dis­jointed; and of setting the whole foot in a mean posture.

FIG. I. represents the thigh broken extended by bands, when it cannot be extended with the hands, and Hippocrates his Form is not at hand: Let the Sick be laied on a common Form, with his face upwards; let the band be tied under his arm-pits, and put another band in the space that is between his privities and his fun­dament: Lastly, another band must be bound above his knee, and his ankle; these bands must be drawn by strong servants, the uppermost upward A, the undermost downward, till the Chyrur­gian hath set the fracture. In the setting of the knee out of joint, when extension cannot be made with the hands, let the upper bands be bound alike, and the undermost above the ankles.

Fig. II and III. shews the mean figure of the members and muscles of the arm and the whole foot; which is necessary in the extension, setting, binding and placing of a part either broken or dislocated. But I therefore caused the figure of this configuration to be printed here, that young Chyrurgians, when it shall be of­ten pointed at underneath, may at first fight learn it, and may imi­tate the same in their practice.

The XXVII Table. Of the corruption of the bones, of the arm and shin, even as far as the marrow; of the shin bone broken with a wound, and the bones sticking out, and bound with swathe bands brought circularly about; and of the cutting off of the end of the hand or foot.

FIG. I. represents the corruption of the bone, and of the marrow of the shin bone, of Mr. Augustine Mertzen, whom I cured by the following means. The first day, three fingers breadth beneath the Rotula, namely where the right muscle ends that extends the [Page 65]

Fig I

II

[Page 66] shin bone, I cut the leg long waies, with a streight pen knife (described Table II. Fig. II.) as far as the lower end of the shin bone: I found the bone covered with a movable and brawny sub­stance; and I bound the wound with medicaments which stench blood: Secondly, when the blood was stopt, I perforated in three places the callous or grisle, which grew upon the shin bone, with Trepans, (represented Table III. Figure III, IV and V.) and pre­sently I cut through the spaces between the three holes, by the Pin­cers (described Table XX. Figure II.) and I found the shin-bone all rotten and corrupt; which from the knee, as far as the end of it below, was parted from the sound bone, and I drew it forth with my Pullers; then binding the leg with thirteen bands cross wise, I laid it in a Capsula or case filled with hards, as Figure X. of this Table shews you. But I provided thirteen bands that were diffe­rent in length (for the thinner and lower part of the leg needs shorter swathes, but the thicker part requires longer) but they were all three overthwart fingers breadth, which I so fitted for the Capsula, which was to be set under the leg, that part of every lower band, should cover about half the upper band. This being done, I laid the leg which was to be bound into the Capsula co­vered with bands; then I turned the ends of the lowermost band cross waies upwards; afterwards the ends of the band which was next to the lowermost, and so on till I came to the uppermost, whose ends I fastned with a double knot; see Table XXIX. Fig. I. We have need of bands of this kind, when the part affected re­quires often looking into, and to be defended from a flux of hu­mours running to it.

Fig. II. represents a shin bone wholly corrupted and rotten; as it was after the cutting off of the callous, it was covered withall.

Fig. III. represents the place where the corrupt bone was scitua­ted, and was now pulled forth with the pincers. It shews also the hole wherein the head of the minor fostil, is seen more corrupt than the shin bone which I cut forth with Trepans.

Fig. IV. is that shin bone corrupted, which the Patient laid up for a memorial.

Fig. V. shews another fracture in the leg now cured; whereof underneath I have observed a whole History.

Fig. VI. is the bone of the right arm corrupted, and (like the former leg) covered with a certain grisle: Whereupon I cut the skin, on the outside of the arm likewise with a pen-knife, from the wrist to [Page 67] the shoulder; and I dilated the wound laying astringents to it. The next day I twice perforated the callous o [...] grisle with Aqua­pendent's Trepans: I cut out the space between the holes with a pair of cizers, Table XX. Figure II. and I uncovered the band un­der it.

Fig. VII. represents the bone of the arm totally corrupted and sharp; which I also pulled away with the pullers, but by p [...]ces, without any noise or pain.

Fig VIII. shews the place where the corrupt bone of the arm lay, which was now pulled forth, which Nature filled up with a callous; so that the Patient could perform country business with­out any impediment. The Patient was a Country man of [...]appa­tavia, whose arm a Souldier broke in four places, without any wound, Anno 1636. This fracture of the arm was set by me and Nicolas Reuten, as well as it could be; and in our judgement also it was well cured; but we suspecting no harm, the arm began to swell again, and was in great torture; at last it was a little ulcera­ted, with a consumption of the whole body, so that we began to think of the corruption of the bone that was so often broken, which we also afterwards found when we had cut the skin, and cut forth the callous with Trepans; at length we bound the arm about with bands cross wise; and we cured it by remedies which were applied to Mr. Augustine Mertzen.

Fig. IX. is a fracture of the shin bone with a wound, and laying the bone naked, so that the ends of it break forth without the skin; which if they be long, they neither can nor ought to be set by ex­tending only, for fear of pain, convulsion and inflammation hat are like to follow; but either (if it can be) by putting an instru­ment between the ends of the bone, which is like to a cutt [...]ng chi­zel, that they may be joined whilest the leg is extended w [...] hout violence; or if any of the ends so stick forth, that it cannot be set by the cutting chizel A; but rather it tears the parts adjo [...]ning, and causes pain, according to Hippocrates tert [...]o de Fracturis; it must be cut off with the Pincers (Table XX Figure I.) and after­wards the broken bones must be set in their places, when the bone jetting out is cut off▪ that the bone is made shorter, they must tell the Patient before hand that the leg, or other parts, will be shorter: Which pred [...]ction out of Galen and Hippocrates is true, when the thigh or shoulder hath lost a piece of the bone; but when a bone is cut away from the shin bone or arm broken, (the other bones ad­joining not being hurt) the shortness of the limb is not alwaies to [Page 68] be feared; for the bone keeps the sound member stretched out, untill Nature recompenses the defect of the part lost with a certain callous.

Fig. X. is the bone of the shin with a wound, broken, with bones sticking forth, and bound with bands not cross-waies, but circularly brought about, and laied within the Capsula as it ought to be; this hatching ligature which is ascribed to Hippocrates, shall be explained underneath in the cure of a fracture with a wound, in most plain words.

Fig. XI. is a hand affected with a secret Canker, which is cut off in the sound part; namely, at the ends of the radius and cubit bone: But the fleshy substance is cut off, with a crooked knife B, as far as the bones; which afterward [...] are cut off with one drawing of the most sharp saw C. Note that the arm is not tied with a band upon the place to be cut off, that the infected blood may run out of the vessels; lest, being restrained, it should extend the arm.

Fig. XII. is a hand that is sphacelated, which being laid upon the block D, is amputated in the sound ends of the radius and arm-bone, with a chizel E, contrary to Hildanus, with good success. The arm is bound, above the wrist, with a band; not only that the feeling may be abated; but also that the arteries may be bound after the amputati­on of the mortified part, without any great effusion of blood.

Fig. XIII. is a bason filled with oxycrat, in which swims a bladder, which being wet must be applied to the mutilated part.

Fig. XIV. are two swathe bands wrapt together F and G; where­of each hath two ends, to bind the arm, whereof the hand at the end is cut off.

Fig. XV. represents a foot that is sphacelated, which is taken off in the mortified part (according to Hierom. Fabritius ab Aquapendente lib. 1. Pentateuch. cap. 19. and lib. oper. chyrurg: titul. de Sphaceli Chy­rurgia) near to the sound part, with a pair of pincers, Table XX. Fig. I. The mortified part being removed, the rest of the putrifacti­on is consumed with red hot irons (Table XXVIII. Fig. IV.) untill the Patient feels the force of the fire. After this two Plagets are anointed with Hildanus his unguent Egyptiac, which are applied to the Escar; lastly, long plaisters I. being laid upon it, the foot mu­tilated is bound with a wet band K as far as the knee; as the hand is (Table XXVIII. Fig. II. and III.) unto the middle of the arm.

Fig. XVI. are divers sorts of iron instruments (Table XIX.) and made red hot, both to consume the remainder of the putrified part, and are also fit to stop the flux of blood.

Fig. XVII. are two vessels with repelling medicaments; namely, filled with red wine, whites of eggs, and oil of roses, wherewith the ligatures are made wet; whether the part be cut off in a sound or a mortified place, to hinder inflammation.

The XXVIII Table. Of the way of binding mutilated parts, and broken with a wound; of the Trunk for the foot; and of the general cure of dislocations and fractures.

FIG. I. shews how to bind the arm bands, after the hand is cut off; or how the band (F Table XXVII. Fig. XIV.) is applied to the bones of the arm (Table XXVII. Fig. XI and XII.) cut off in the quick. Af that the arteries which bleed, are either drawn forth with a pair of pincers, and bound with a thread, or are touched with red hot irons; there must be an astringent medicament applied to the wound with Plagets; and upon these there must be laid plaisters wet with oxycrate, and pressed forth; then the arm must be rouled with a swathe band, the ends whereof must be brought cross wise twice or thrice, and one must ascend as far as the middle of the arm.

Fig. II. first shews a bladder wet with Oxycrate, and laid over the aforesaid band; secondly, another band (G Table XXVII. Fig. XIV.) which, as the former was often brought cross wise, shall ascend with one end to the bending of the arm, to hinder a flux of humours.

Fig. III. is an arm, whose hand was cut off at the end, and it was cured with astringent medicaments laid upon Plagets; plaisters be­ing applied to it cross waies, bound with the first band was a bladder wet in Oxycrate, then it was bound with a second band. This binding must be observed in every member that is mutilated, whether the opera­tion be made near the quick, or in the quick it self.

Fig. IV. is a foot, which by reason of a sphacelus, was amputated in the mortified part; in which the putrifaction remaining, is con­sumed by iron instruments made very red hot, untill such time as the Patient come to feel the heat.

Fig. VI. is a Bason filled with water and vineger, wherein the plaisters are wet, as also the first band and a new sponge.

Fig. VII. wherewith almost all the arm is moistned, to hinder the flux of blood.

I

II

III

IV

V

VI

VII

VIII

VIIII

X

XI

XII

Fig. VIII. is a fracture of the right thigh, with a wound on the outside. This befell Katherine Bokin of G [...]en, concerning whom underneath is found a singular observation. It shews moreover▪ how upon a leg that is broken with a wound, a hatching ligature (Table XXIV. Fig. X. brought round about; and whereof more shall be said in the cure of the fracture) must be laid under it.

Fig. IX. is a piece of the thigh taken forth of the wound, and printed both on the left and right side of it, that the rottenness of it may be better seen and considered.

Fig. X. is a broken thigh bound with a hatching ligature brought cross waies, and is to be laid in the long Trunk, Table XXI. Fig VI. For if any man puts a hollow case under it, that goes not higher than the ham, he shall do more harm than good. For it will not hinder the moving of the body nor of the leg, without the thigh moving; but being applied to the ham it will bring trouble, and force one to that there is no need of. For there is no need for the knee to bend. For if any man when his thigh is bound or his leg shall bend his knee, he shall put all the ligature out of order; and then it is necessary that the muscles should change their po­stures, and the broken bones must be moved out of their places. Wherefore, first we must indeavour to extend the ham. Therefore a hollow Trunk will be usefull, which being put under from the hip to the foot, may hold it likewise; and principally, if a loose ligature be put about to the ham with the Trunk, as children use to be swathed in their Cradles. For when the thigh shall be wrinch­ed either to the upper or the lower side, (either whilest the Patient is a sleep, or when he goes to sit down, or staies whilest his bed is made) in such cases it will be better contain'd in a hollow case. Wherefore a hollow case must be made for him from the top to the bottom, or else none at all. Moreover great care must be had for the bottom of his heel, that it may be fitly scituated both in fractures of the leg and thigh. For if the foot hang, when the rest of the leg is fast bound, of necessity the bones must appear in the fore-part of the shin, in the part where it bunches forth; and that the more, the greater a man's heel naturally is. Hippocrates de fracturis femoris, see Table XXVI. Fig. II.

Fig. XI. is an Arm mutilated, in which the artery is drawn forth with an instrument that it may not bleed.

Fig. XII. is the Thumb of the right hand, which, the wrist be­ing first bound with a swathe, is cut off in the quick, by reason of a Sphacelus: See Table XX. Fig. I.

Guillielmus Fabritius Hildanus hath written a most learned work, concerning the cure of a Gangrene and a Sphacelus, which young Chyrurgians must read carefully over and over again very often, (besides the way of ligature by swathe bands about mutilated parts, which I have here set down for their sakes) they shall find there all things necessary for the cutting off of a Limb. He, indeed, la­bours to prove, by many reasons, that a mortified part cannot be taken off quickly, safely, and without pain, if any corruption be left behind, to be consumed by red hot burning irons: Yet in my judgment all those reasons do not prove that the amputation of the part affected, that is taught by Hierom. Fabritius ab Aquapen­dente, doth never succeed well: And far less do they demonstrate, that this amputation should be of less value, than that which is perforated in the quick part; considering, that amputation made in the sound part, cannot be perforated without pain; whether the fleshy parts be cut with a rasour, or with a cautery with a sharp knife: Nor yet safely, because the quick part, bound with a band, easily mortifies; also amputation upon a sound part, cannot al­waies be acurately performed; but that sometimes the parts that lie deeper, shall be left more corrupted than the outward parts; which if it happen, than we must either atrempt to cut again, which were horrible; or else the remaining corruption, must be consumed with red hot irons, according to the latter Practitio­ners. Not quickly, because a longer time is required to draw forth the Arteries with an instrument, and to bind them with a thtead (and if the Ligature be removed, sometimes such a flux of blood follows, that unless the vessels be touched with actual Cauteries, it be­comes the cause of the Patient's death) than to cauterize the wound presently with red hot irons: That I may not say the operation is the more prolong'd, if after the amputation taught by Hildanus and the Ancients, any corruption remains. Wherefore, relying upon reasons and happy experience, I determine that the way of Hieron. Fabritius ab Aquapendente, to cut off any, is to be prefer­red before the operation of other Ancients.

But if the strength of the Patient, by reason of putrid vapours, and a precedent flux of blood, is so weak that we are sure he will faint in the operation; for that time we must abstain from ampu­tation, because it is more excusable to leave the Patient so, than to kill him knowingly. But when there is no hopes left, unless the part be cut off, what must the Chyrurgian do? Let him touch the mortified part, morning and evening daily, with very red hot [Page 73] irons, to drink up the putrid humours, that the sphacelus may not creep up higher; also let him give to the Patient, to take down Medicaments against poison, which may drive the corrupt vapours from his heart, and restore his strength by refreshing his spirits; and also let him apply such things to the external Region of his heart. When his forces are something refreshed (for his former forces are looked for with certain danger of his life) foretelling the danger, let him proceed to his operation desired. For it is better, the forces thus remaining, to try this doubtfull and most misera­ble way of cure, rather than none at all. Whilest I studied Physick at Padua, a certain Lord of Vincen [...]ium, broke both the bones of his right leg in the middle, with a flux of blood till he fainted, and a sphacelus was coming upon it. The sphacelated foot, the most skilfull Petrus de Marchet [...]is refused to cut off, because of his want of forces, by reason of his great loss of blood; but with red hot irons often applied, he hindred the corruption from spreading, and with Medicaments outward and inward he did corroborate him, and refreshed his spirits as much as possibly he could: At last, the Patient being ignorant of it, he cut the mortified part round about with a knife. When that fell down, he consumed the rest of the cor­ruption with actual cauteries; and to remove the Eschar he applied Vnguentum Egyptiacum simplex. The third day after the amputation of the lower part of the foot, as far as the fracture, the Patient complained of an extream pain of his great toe of his right foot; the Chyrurgian smiling, said that he wondred that he should com­plain of the pain of that toe which was buried above three daies be­fore; with these words the Patient was so frighted, that he fell in­to a grievous swound. When the Eschar was taken away, and the muscles, as they use to do, were drawn upwards, the bones stuck out four fingers breadth; which being daily covered with dry thin rags, and drying powders, in two moneths time they were separa­ted from the sound bones. That the precedent Tables, and that which follows next, which treats of the cure of fractures and dis­locations, may be better understood, I shall briefly set down the general cure of them out of Hieron. Fabritius, and his Master Fallo­pius; for he that hath those two hath all.

The XXIX Table. Of the provision to bind a broken Leg, and Hippocrates his way of binding to be observed in dislocations and fractures.

• Letter A. Shews a glass with four Wine, &c.
• B. One filled with oil of Roses.
• C. Three Eggs.
• D. The beating of whites of Eggs.
• E F. Two bands whereof Hippocrates writes, de offic. Med. text. 3. But being there are two under bindings of linnen rolers; one of them E ends from the place upon the superiour part; the other F goes down from the place to the inferiour part.
• G. Is a Roler with two ends.
• H. Shews the wetting of the bands, for it behooves to have the rolers not dry, but wet in some liquor. Hippocr. de offic. Med. text. 16.
• I. Are the four-folded Plagets, with the liquor pressed forth of them.
• K. Are the Ferulaes crooked upward at the end.
• L. Are the Bands, wherewith the Ferulaes are bound on.

I

II

III

IV

FIG. I. shews how Hippocrates, whilest the part is held stretched forth by the Assistants, roles the band E three times toward the right hand, about the part affected; and then brings it up­wards, untill it come to a good part of the lim, with four or five or more windings about it.

Fig II. shews how he winds about the second roler F, which is twice as long as the former, the contrary way (for the first is ro­led about toward the right hand upwards, this is wound about to­wards the left hand downwards) namely, once about the fracture; then again three or four times or oftner, below the fracture, unto some convenient part of the member: The remainder of the band, which the Chyrurgian holds in his left hand, must be wound about upwards, untill it comes to the end of the first band.

Fig. III. explains how he laies the wet Plagets I all at length up­on the fracture (so that betwixt one and the other, there must be not more than two fingers breadth distance) and he binds them with the band with two ends G; winding the end G * upwards; and the other G downwards, after that upwards, untill it come where that ended.

Fig. IV sheweth how, after the seventh day, whereon, for the most part, all fear of inflammation is past, he laies the Ferulaes with the Plagets, and the upper Ligature made by the band G; and binds them fast with three girts. For Hippocrates defractur. text. 23. in these words describes the cure of broken bones; then at length things necessary being first provided; the fracture being join'd; and the part yet being extended in a mean figure) we must bind it with a linnen roler, laying the beginning of the first band upon the fracture, so that it may hold the fracture firm, but yet not press it violently. When you have wrapt the first band about the same place, the se­cond and third time, you must carry it upward, that you may thereby stop the flux of blood from coming to it, and there let that end; and that band, in respect of the second, must not be long in comparison.

Text. 27. The other band, at the beginning of it, being wound about the fracture once, then must it be carried downwards, and not pressing so much, it must take greater distance in roling of it about, so that it may come unto that place where the first did end.

Text. 32. After this, Plagets smeared with some Cerate (or some other convenient medicament) are to be laid on, for so they will stick the faster and smoother. Which then must be so bound on with [Page 104]

Fig. I.

II

III

IV

V

VI

VII

VIII

IX

X

IX

XII

[Page 105] rolers, (but a band with two ends, will perform the office of three bands) changing the order so amongst them, that they may be carried sometimes to the right hand, sometimes to the left hand, and very much indeed from the lower part upwards; and some­times from the upper part they must be carried downwards.

Text. 41. But when, after the fear of inflammation past, you bind the rolers, you must lay on the Ferulaes, and they are to be contained with bands very loose, that they may stay only there; and that the laying on of the Ferulaes may not add any pressure to the part. And this shall suffice to be spoken in gene­ral, of the cure of a fracture and dislocation.

The XXX Table. Of the preparation and manner how to burn a fontanel in the coronal suture, and the binding of it; also how to dilate wounds of the head cross waies, and to scrape away the doubtfull small chinks of the skul.

HEre we should declare, whether the use of an actual cautery be convenient upon the coronal future of the skul? But because Iulius Caesar Claudianus 3. Responsione Medicinali; Tho­mas Fienus Lib. 3. de cauteriis, cap. 22. and Marcus Aurelius Se­verinus, Pyrotechn. Chyrurg. Lib. 2. p. 2. cap. 11. have disputed this question, I will not do it over again, but I will proceed to explain the Figures of this Table.

Fig. I and VII. shew the provision of things necessary, both before, at, and after the operation; namely, divers instruments, a Cabbage leaf smeared with fresh butter; a three-double lin­nen cloath; and a roler having four ends.

Fig. II. the star, shews where the coronal and sagittal sutures meet; which meetings being covered with the hair, a thick skin and a membrane, the Chyrurgian can hardly find. For this most acurate invention, the Chyrurgians, both old and new, used divers waies; all which Fabritius ab Aquapendente recites, de operationibus Chyrurg. fo. 6. I, reducing into one the manners used by the chief of the Arabians, Avicenna; and by Celsus chief of the Latines, do search out the conjunction of the sutures [Page 106] thus: I draw a thread from the middle of one ear, to the middle of the other, and again I draw another from the tip of the nose, to the crown of the head (Fig. III.) where these threads cross one the other, there is the place for the fontanels; which sha­ving off the hair, must be marked with writing ink, as the Fi­gure IV. shews.

Fig. V. teacheth the way of the operation, where the Chy­rurgian holds the instrument in his left hand, (a) not at all hot, wherewith he forcibly presseth the skin marked with ink, for the reasons I alledged before, Table I. Figure I. but in his right hand he holds the instrument (b) very red hot, put into the pipe (a) which because it hath also a cutting force, if it come to the skul, it must be turned about. And it is turned about, not only that there may be passage for the matter to come forth by the pores of the bone; but also that the Pericranium may feel no inflammation; which it will easily do, if the instrument be not turned about.

Fig. VI. is a band with four ends; whose two ends before (h. i.) are knit under the chin; but the hinder ends (k. l,) are to be sewed behind the head with a thread; lest the knot, whi­lest the sick lieth asleep on his back, might wake him by pres­sing that part; and watchings oftentimes are the cause of an in­flammation of the Peticranium, which proves to be mortal.

Fig. VII. here you see a convenient use and binding of the band, to hold on the medicaments which are applied to the fon­tanel, burnt in where the futures meet. But to what end serves that great furniture of the first Figure, if two instruments only be sufficient for this operation? This serves to deceive the Pa­tient; I cause a low seat with joints to be brought, such as Barbers use in their shops, turning the one side, either the right side or the left, toward the light and the windows, but the back toward the dore, and that for this reason; lest the sick sit­ting in this Chair, should perceive the red hot iron, when it is brought out of the kitchin. The Patient being rightly set down, I draw forth, into a wooden dish set upon the Table, the instru­ments. (c. d. e.) but I keep the iron tool (a) close in my bag. The servant secretly delivers the instrument (b) to the Pati­ent's maid; and gives her order to make it very red hot, and not to bring it, untill she be commanded to bring some live coles. These things being done, the servant doth shave away [Page 107] so much hair of the head as is needfull, Figure IV. but I pre­pare the band, Figure VI. and a double linnen cloath (f Fig. I.) and other things necessary to be used after the operation; in the mean while I discourse with the Patient, concerning the excel­lency of this Chyrurgical operation (and if he be desirous to learn it, as it often falls out) I speak of the qualities of the in­struments, and of other things which may keep up his mind from fearing the fire. These things being provided, I speak to my servant openly, that he should hold his temples firm, with both his hands (see Table XXXI. Fig. II.) that I, standing behind the Patient's back, may find the joining of the sutures with the threads (Figure III.) and having found it (Fig. IV.) I may mark it with ink. Whilest the place is marked, I call the maid to bring the fire-pan, and set it on the Table; and that she shall only moderately warm one of the iron instruments (c. d. e.) and I secretly receive from the maid, passing by me and coming to the Table, the iron instrument (b) very red hot; and so the Patient scarce taking notice of it (for he beleeves that the iron instrument, necessary to burn with, is not yet hot) I make a fontanel in the coronal suture. This way of deceit must be observed also, in making other fontanels, to hide the cau­tery, and to take off the fear of the fire.

Fig. VIII. is the furniture to dilate the wounds of the head, and to pare away the chinks, which do not pass through both Tables.

Fig. IX. in wounds of the head, with the skull hurt, first of all the hair must be shaved off, and the head must be moistned with oil of Roses. Yet with this caution, that neither the hair nor the oil go into the wound; for that is ill for any wounds of the head. Then let the wound be dilated in the form of a cross, unless the sutures hinder it: The next day after that it is dilated, let the place for the instrument be made black with writing ink.

Fig. X. The third day after incision, let the blackness made with ink be pared away with paring instruments. Note, that in shaving about the wound, the lips of the wound must be co­vered with linnen cloaths to defend them; as when you set on the Trepan, Table XXXI. Fig. V.

Fig. XI. shews the small chink, in the middle of the place shaved away, which must yet be taken off with paring tools. [Page]

Fig I

II

III

IV

V

VI

VII

VIII

IX

X

[Page 109] If the Chyrurgian be certain that the chink doth not penetrate, he doth not fall to paring again, but he leaves the work to nature; which sometimes is wont to cast off a scale with the chink (n) but if there be any suspicion that this chink doth penetrate, he must pare that away, that it may not be seen at all, and the skull may in all places appear equal.

The XXXI Table. Of the Furniture, and the manner how to cut the wounds of the head triangularly; and to Trepan the skul with Trepans; and to bind the head with a band called Cancer.

F [...]G. I. is the furniture or instruments necessary to dilate the wounds of the head, and to perforate the broken skul.

Fig. II. shews the dilating of the wound triangularly with a knife. Fig. I. (a) for here the coronal future hinders to cut it cross-waies, and so doth the temporal muscle: the section begins from the forehead, for if it be made otherwise the fibraes of the temporal muscle would be cut overthwart. The triangle is sought on the right side of the fissure of the skul, whereby the Trepan, which the coronal suture, on the left side, would not suffer to be set on, may be used: the head is held with mens hands, and is bolstred up with a pillow that it may stand firm.

Fig. III. the wound is seen dilated triangularly, and the skul is uncovered with a narrow chink in it; by which the matter, which descends to the membranes, cannot be voided forth. Wherefore at the side of the chink, noted with a star, the skul must be opened with a Trepan, to let the matter out.

He that goes about to Trepan the skul; must come to the Patient with the instruments printed Fig. I. of this Table; namely, provi­ded with a small piercer; a male Trepan (b) and two females (c d) Probes (e f) a Puller (h) and a Lenticular instrument with a Le­vitor (i:) then he must prepare those things that are laid in the dish, Fig. IV; and the band Fig. X.

Fig. IV. shews a glass full of Rose-water, wherein the linnen cloaths are moistned, which must be laid to the lips of the wounds: (b) is a little piece of red silk, wet in oil of Roses; hanged by a thread (c) the little ball (d) of dry linnen rags, to cover the [Page 110] hole that must be made with the Trepan, that the matter of the wound may not descend to the membranes of the brain; (e e e) shew the little balls that must be applied to the naked skull; for dry things are proper for dry things: also (f f) shew the little balls besmeared with a digestive (g) to digest the lips of the wound; the simple linament spread upon a linnen cloath (h;) and a linnen cloath three or four double (i;) the little bone (k) is thrust with the iron pin (l) out of the female Trepan.

Fig. V. things to be provided being provided; the head being supported, and the lips defended with linnen cloaths, the Chyrur­gian shall set on the Trepan with a pin, and marked with a star, Figure III. wherewith he shall begin to Trepan the skul; which he must end with females. Here Porralius admonisheth young Chy­rurgians, since according to Hippocrates Aph. 1. Sect. 1. experience is dangerous, that they should often exercise themselves in Tre­panning the skuls of dead men; putting under the skul a piece of white paper, to represent the dura mater.

Fig. VI. shews the skull cut out with Trepans, at the side of the chink.

Fig. VII. the brims of the hole are made even with a Lenticu­lar knife.

Fig. VIII. shews a small linnen rag, wet with oil, how it is let down upon the membrane; being fastned with a thread that it may be drawn forth again; when that is drawn out, one that is fresh must constantly supply the place of it.

Fig. IX. is the band called Cancer, which for wounds of the head is the best of all to contain them, and also the most commo­dious; broad in the middle (A) and on both sides having four ends; whereof two begin from the temples, and end in the hin­der part of the head, where they must be sewed (D;) two arise from the hinder part of the head, and are bound together on the fore part of the head (B;) two are turned behind the ears (C,) and as many before them (E) and are fastned under the chin together.

Fig. X. is the head bound about with the band called Cancer. 1. The ends D are united behind the head. 2. C under the chin. 3. D on the fore-part, above the fore-head. 4. E under the chin. Yet let the head be bound delicately, so that the band may hold fast, but not press it.

The XXXII Table. Of the way to raise, with Levitors, the skul pressed down; to break off, with Pincers, the small bones that prick the membranes of the brain; cutting forth, with a turning saw, the distances of the holes made with the Trepans; and of the general cure of the head.

FIG. I. are the depressions of the skul; when, by reason of the narrowness of the chink, they cannot be raised with Levitors, Table II. Figure VII. and Table III. Figure II, III. B. and IV; then the skul is Trepand twice, or as oft as need is, with a Trepan upon the sound side of the chink; and after that the di­stances of these holes are cut out with a turning saw, that the Levitor, that is requisite, may be put under the skul.

Fig. II. a depression of the skul is raised with the piercer of the Triploides, Table III. Fig. III. A.

Fig. III, IV and V. shews the use of the Pincers, wherewih the small bones are partly cut off, and partly broken off, which may prick the membranes of the brain. See underneath the ob­servations of Martin Kunzius, and of Michael Schnerderus,

Fig VI. the keeper of the membrane is put under the small bone, which must be cut off with the Pincers; lest the mem­branes that cover the brain, should be hurt by them.

Fig. VII. the skul pressed down, is raised with Paraeus his Levitor.

Fig VIII. if it fall out so that the Chyrurgian hath not the aforesaid Pincers ready with him, a small bone is safely laid hold on by this pair of Pincers also, and is cut off; first, putting down under it, the keeper of the membranes, as you see Fi­gure V.

Fig. IX. When I was not yet learned how to use the turning saw, I was wont to cut away, and take out the spaces between two holes with this saw.

Fig. X. When the distance of the holes is cut forth, all kind of Levitors may be let down to lift up the skul; yet that is cho­sen which is most convenient. To this Table also belongs Fi­gure I. of the following Table; which shews the use of the [Page 112]

I

II

III

IV

V

VI

VII

VIII

IX

X

[Page 113] Piercer wherewith a prick, that doth not penetrate the skul, is taken away.

But that the Figures, of this and of the following Table, may be better understood, which treat of the wounds of the head; I will briefly, in order, recollect the use of them, running over the diseases of dissolved unity in the skul, the membranes and the brain.

The XXXIII Table. Of the paring off a prick of the skull; the cutting of the tem­poral muscles; the cure of ancytoblepharon; of a per­fect Suffusion, and an Aegylops; of the way to fix the eye.

FIG. I. shews how a prick on the skull, that doth not penetrate is taken away with a Piercer, Table III: Figure I, after that the skin is cut, and the skull is laid bare.

I

II

III

IV

V

VI

VII

VIII

VIIII

Fig. II. The finger, when the hair is shaved away, searcheth the place where the temporal muscles are cut, which is done be­tween the crown, the temporal muscle, and the muscle of the fore-head; it proves also whether the vessel under it be a vein or an artery. If the lower jaw being moved, you feel with your finger the motion of the temporal muscles, you must seek for a vein or artery in a higher place; the vessel is an artery, if you feel pulsati­on; but a vein, if you feel none.

Ancytoblepharon is cured with one hand: Now the ey-lids ei­ther grow together, or else they grow to the white or cornea or to both coats of the eye. The growing of the ey-lids together, is cured by the use of a crooked knife (Table VIII. Figure VIII. to whose point there is fastned a very small and sharp button of silver) which is thrust in at the inward corner, where they never almost grow together, between the eye and the ey-lids (so that you may place the blunt side toward the eye, and the side that cuts to the place where the ey lids join) till you come to the outward angle; then you must prove with your finger the place which must be cut, before you do cut it; and this being found out, you must cut the place where the ey-lids join together. When you have made inci­sion, you must put a liniment between both ey-lids, that they may not grow together again.

Where the ey-lids stick fast to the coats of the eys, the edge of the knife (which is nothing else then the broader part of the Probe Table VIII. Figure VI.) with great moderation must be thrust in between the ey-lid and the coat of the eye, whereby those things that stick together may be separated, without doing any hurt, if possibly it may be so, to either part. But if it be necessary to hurt any one part, let rather the adnata of the ey lid than the eye, be cut. But when the eye is freed from the eye lids, a clean linnen cloath must be put between them, that they may not be glewed together again.

Fig. III. represents a suffusion in the right eye, that, Fig. IV. must be put down with a needle; and moreover, a little swelling with a coat risen between the nose, and the greater cauton of the left eye, and is broken inwardly (which men call an Aegylops) and it cannot be cured by medicaments; wherefore the swelling is laid hold on by the teeth of the Puller, and it is cut at the bottom with a knife (Table II. Figure I.) yet so that something of the spongie substance must be left behind; otherwise there would follow a per­petual running forth of tears by the cheeks.

Fig. IV. shews how before we couch a cataract that is ripe, the sound eye must be shut close with cotton, and a ligature; also it shews the place where the needle is put in (Table VIII. Figure IV.) which Albucasis describes lib. 2. cap. 23. in these following words; put the end of the needle near to the coat cal­led cornea, by the thickness of the radius (or blunt Probe) into the very white of the eye, which respects the lesser or out­ward angle.

The XXXIV Table. Of the cutting forth of the Uvula corrupted; perforation of the sharp Artery; cauterizing the hinder part of the Head; and of the manner of making a seton, with a red hot needle, in the nape of the neck, and tip of the ear.

FIG. I. shews half the Uvula sphacelated, which, before the corruption spread, and infect the whole Uvula and the parts about it, is to be cut off with a thread put to it, and bound about it with a ring (a Table IX. Figure VII.)

Fig. II. The ring being prepared (a Table IX. Figure VII.) the Assistant must put down the tongue with a speculum oris (Table XI. Figure IV.) (Table XXXVI. Figure VII.) But the Chirurgi­an must lay hold, with the ring, on that part of the Uvula which is corrupted, and he shall draw stronglie the thread that is marked (b) either with the left hand or with the right, and so he shall most closelie bind the Uvula; when he hath made a knot by the Uvula, he must cut off the thread (c) with his cizers, and draw­ing out the instrument, he shall leave both the ends hanging out of the mouth, untill the Uvula falls off the second or third day.

If the Uvula grow flaggie by reason of much phlegm running in­to it, the powder of raw Allum mixt with white Pepper, is used with excellent success, blown up to it. The way to blow in such [Page 140]

I

II

III

IV

V

VI

VII

VIII

IX

X

[Page 141] powder, is this: The tongue being thrust down with speculum oris (which the Chirurgian shall hold in his left hand) he shall pre­sentlie with his right hand set the spoon (d) filled with this pow­der to the Uvula; then shall he take the other end of the pipe (e) in his mouth, and blowing shall scatter all the powder in the spoon about the mouth and Uvula, See Guilhel. Fabrit. Hildan. Cent. 2. Observ. 2, of the cure of the Uvula relaxed.

Fig. III. The sharp Arterie, in affections of the Larinx which are readie to choke us, is most safelie perforated by a Chirurgian who is not ignorant of Anatomie, the way following: The Patient's head being inclined backwards, not only that the sharp Arterie may be seen plainlie; but also that it may be made longer, and the mem­branous distinctions in it may appear more exactly, a line must be drawn with ink, by the middle and forepart of the length of the neck, almost as far as the hollow part of the throat. Then, with the finger, we must touch the head of the sharp Arterie; next we must exactlie, with the finger, search out the end of the Larinx on the forepart; this being found out, we must descend untill such time as three or four rings of the sharp Arterie be past over (three in those that have but short necks, and four in those that have long necks; which bounds we know either by sense or by reason; by sense, in a lean neck; but by reason, imagining and conjectu­ring at the largeness of three rings; in which case we must view the sharp Arterie of one that is well) that there incision may be made; yet not immediatelie under the Larinx, lest inflammation, which easilie follows after incision, should be communicated to the La­rinx, that was before shut too much. The membranous place being thus found out, the middle circle, between two grisly cir­cles, must be marked with ink, according to the length of the neck: Afterwards the skin. with the fleshie membrane under it, here and there, being laied hold on with the fingers of the Assistant; namely, with the thumb and fore-finger of both hands, by the length of the line made from the Larinx to the throat (for so there is no danger that any vessels, nerve or muscle should be hurt) it must be cut with a crooked knife (f) so that the overthwart line be in the middle of the incision; and the incision must be made so long, that being dilated it may contain the thumbs breadth, and may admit the use of the double edged knife (g.)

Fig. IV. Incision being made, the lips of the wound must be drawn open with the fingers, and the blood must be wiped away with the sponge (i) that the two muscles which lie immediately [Page 142] upon the sharp Artery, and are called Sternohyoidaei, may appear. Then the muscles which are distinguished by a certain white line, ate to be drawn asunder, at length, with the haft of the knife (h) that the body of the sharp Artery may come to be seen.

Fig. V. When the Artery appears, the distance must be kept open with a blunt hook here and there, untill incision be made overthwart, between one and the other cartilage by the edge of the divided spatha (g.). But the knife must be thrust in so deep, that it may reach the hollow of the sharp Artery; and this is the sign that it is gone in so far, if the breath come forth of the wound with a murmuring noise. Then a pipe of silver (k) with holes in it, and crooked, that is exactly as big as the wound made in the Arte­ry, that is short that it may not touch the insides of the Artery, with shoulders that it may not be suckt in with the breath, and tied with two threads that it may be drawn forth and fastned, must be put into the wound made in the Artery; and there it must be left so long as all fear of inflammation is past. Then the pipe must be drawn forth, and renewing, if need be, the wound of the skin and fleshy membrane by scarification, the lips must be drawn together and stitched; and being so brought together, they must be kept so with plaisters spread upon linnen cloath, and with convenient ligature,

Fig. VI. represents a seton burnt into the tip of the left ear, to intercept the matter that ran thence continually, by a vein pricked through with a needle and burnt, to nourish and augment the tu­mour, which hanging by a thicker basis from the neck, by reason of the angular veins, and the inward branch of the carotick Artery, can neither be cut off, nor yet separated from the skin. The Es­char being taken away with butter, I put first into the seton a ring of lead, untill that was perfectly healed; after that I put in a gold ring with a rich pearl in it, instead of the leaden ring, such a one as your Arabian women hold a great grace to wear in the laps of both their ears: With this putting in of rings, not only the in­crease of the tumour was hindred, but also by accident it grew so small, that the noble Patient, wearing a stomacher, could easily hide it. See Table XXXV. Figure II. of cutting forth and ampu­tating a tumour contain'd in a cover.

Fig. VII. shews the cauterizing of the hinder part of the head, of people in years, with a red hot iron that is round, where there is danger of an Apoplex and other sleepy diseases. But the hollow of the hinder part of the head useth to be cauterized with a red hot [Page 143] iron, especially in children new born, and those that suck the breasts who are frequently troubled with the Falling-sickness, by reason of a cold and moist temper of their brain. For the cure and preservation from this disease, Physick hath found out a present remedy; namely, to burn the hinder part of the neck; which is as it is a most safe way, so it doth most commonly make revulsion, derivation and evacuation of the phlegmatick hu­mours, with apparent good which burthen the head. Hence it is that cauterizing the nape of the neck is so common in some places; that at Florence none or very few children are found, that are not so cauterized presently after they are baptized. The hair therefore being shaved off, we must make an iron instru­ment red hot, which is the oval and long fashioned (Table VII.) fit for the hollow of the hinder part of the head, be­tween the first and second vertebra of the neck; wherewith, when the danger is small in tender age, and when the paroxysm is off, it must be touched only once lightly; but when the danger is greater in riper age, in the paroxysm, and when for many daies the place must be kept open, the iron instrument must be thrust on deeper twice or thrice. Afterwards we must apply to the place cauterized, either butter with Diapalma, or else Triapharmacum, that the Eschar may fall off; which being taken away, the ulcer must be kept open so long as need requi­reth, and must be let run with ceratum sacrum or Diachylon. Last of all let it be brought to cicatrize with ceratum de Cerusta, or some other healing medicament. A Seton in the same place made with three instruments; namely, with the Cizers, a red hot Needle, and a Seton, voids forth the humours that fill the head, by putting them back from the eys to the neck; it makes derivation of those that fall down to the jaws and throat; and it intercepts those which fall on the spina dorsi, and the joints of the limbs. But since there is so great benefit of a seton, I thought good, for the help of Students, to set down the reason and manner hovv to make it, both in vvords and figures.

The Patient must sit on a low seat, and the Physitian with his forefinger must search out the place fit for a seton, or that cavi­ty which is between the first and second vertebra of the neck. When he hath found this, the hair must be presently shaved off, and the place to be bored through must be marked long waies with writing ink, so that the line may be in the middle of the [Page 144] hollow; but that the said middle place may not be missed, the Pa­tient must hold his neck streight to the Chyrurgian; then the Chy­rurgian shall also mark both the holes, that must be made both on the right side and on the left, with writing ink, that the distance between both marks may be one finger and a half broad, more or less as the Patient's skin is thick or thin.

Fig. VIII. The place being marked, and the ink dried, the Pa­tient must so lean back with his head, that the skin and fleshy pan­nicle may be relaxed; then the Chyrurgian shall fi [...]st with his fin­gers draw away the skin and fleshy membrane, from the muscles that are under them, and of the said covers, as much as may be done (yet leaving the muscles of the neck untouched, for fear of convulsion and other ill accidents which may happen) with a pair of Pincers (l or m Table VIII. Figure I, II, III.) that are fit for it, he shall lay hold of them, draw them to him and bind them fast, as hard as the Patient can well indure it, or rather untill it causeth pain; that so the nerves being bound, the part to be bored through may grow senceless almost, and the Patient may less feel the burn­ing instrument, which otherwise is painfull enough: But he shall so lay hold of the skin and membrane with his Pincers, that the line drawn before on the length of the cavity, and the marks of the holes, to be made on both sides, may be seen through the holes of the Pincers exactly. Then he shall thrust in the needle (n Table VII. Figure IV.) very well made red hot, that it may pass through both holes of the Pincers in an instant, and shall sud­denly draw it forth again.

Fig. IX. After this, the Pincers remaining unmoved, he shall pass a pointed instrument through it, which at one end hath a wax­en little pellet, and at the other end a silken thread fastned to it (Table VII. Figure V.) and he shall draw this thread, wet in the white of an Egg, as far as the middle of it smeared with butter, and there shall he leave it.

Fig. X. These things being done, he shall bring both ends of the silk to the foreparts of the neck, and to the breast; and he shall bind the part with a four double linnen cloath wet in Rose-wa­ter and the white of an Egg, to hinder inflammation, and then wrung out again, and with convenient ligature. The daies that follow, commonly untill the sixth day, before he doth draw the silk by degrees, sometimes to the right hand, and sometimes to the left, he must anoint that part of the silk which must be drawn under the skin, with some digestive; and on the outside he shall [Page 154] lay a four double cloath pressed out with the same medicament, untill such time as the ulcer breeds good quitter, and the fear of inflammation is over. Then the silk must be drawn under the skin, with this or the like unguent first being anointed:

• Take Venice Turpentine washed in Mallows water one ounce,
• Syrup of Roses half an ounce,
• Powder of Turbeth and Rheubarb, of each a scruple and a half; mingle them for an unguent.

And lay upon it the plaister for issues, (described Table the last. letter l) so long as you are minded to keep the ulcer open. Last of all let him draw forth the silk by little and little, and glue the skin fast to the muscles under it, laying upon it ceratum divi­num, a four double bolster, and a pressing ligature.

The XXXV Table. Of the cutting of a seton, and the pulling forth of hairs that prick the eys; cutting out of tumours with coats, curing the upper eye lid, namely when it is either relaxed or contracted: of the cure of Staphyloma and Pterygium; of the bringing together of the lips of wounds in the cheek, by means of Plagets that are emplastick; and of the curing Hare-lips.

FIG. I. is the way to make a seton with a pair of pincers (Table [...]II. Figure X.) and with a pen-knife (Table XVIII. Fig. VI.) pictured; which Guillielmus Fabritius Hildanus cent. 1. observ. 40. describeth, and prefers it before the former way of making is with a red hot iron, because the fire both dries and hardens the part, and puts the Patients to pain and horror. But because that driness is corrected with fresh butter, and also heat and some pain are very effectual means to draw to them the pec­cant humours, and the sick are as much afraid of cutting as they are of burning, neglecting Hildanus his arguments; I have bur­ned a seton on the necks of many people with very good success, observing only that way to delude the Patient, which I set down Table XXX. Figure VII.

Fol. X

II

III

IV

V

VI

VII

VIII

Fig. II. shews 1. the pulling forth of the hairs on the ey-lid according to Paulus his way: The ey-lid must be inverted with the fingers, the hairs that prick and hurt the ey must be pulled forth with pullers, and the skin must be cauterized with a little knock at the end of the probe made red hot, that it may be candensed and the hairs may no more grow upon it. 2. The cutting forth of an Atheroma, which bred in the middle of the forehead, and was greater then a Walnut: In this Figure the skin is cut which covers the case of the Atheroma, overthwart with a crooked knife; but in the fourth Figure long waies, that the whole Impostume may be taken forth with its coat. Effects worth consideration do follow the incision made on the forehead overthwart; for the fibras of the muscles of the forehead being cut overthwart, the ey brows hang down, and hinder the opening of the ey-lids; also there follows an incurable palsie of the ey-lids, by reason of the cut­ting of the nerves; which thing was proved by Adrianus Spigelius, upon a small wound only on the nerve of the forehead, as he ob­served in Fabr. corp. hum. lib. 7. cap. 2. But because this kind of Tumor arose in the middle of the muscles of the forehead, and the overthwart incision did hurt to very few fibras of the muscles, there followed upon this no palsie or other inconvenience, which might hinder the eye lids to be lifted up. But that the cutting forth of this Atheroma may be better understood, I shall very brieflie set down the cure of Tumors that are covered with coats.

Tumors with coats; as Meliceris, Atheroma and Steotoma, hang forth either as figs by a slender stalk, (Table XXXIII. Figure II.) or else with a larger root they stick within any part. Those that hang forth are not cut out, but are cut off at the roots in timerous people, a thread being bound about the part to stupifie it, and left there till the swelling falls off; but in stout men they are cut away with a sharp knife. But if the blood runs forth abundantlie after that the Tumor is cut away, or the thread leaves any part of the root behind, then, that we may not fear that it should grow any more, the place must be lightlie touched with a red hot iron, and when the escar is fallen, we must heal it up again. This way of manual operation is most readie, and by reason the ulcer is but small and equal, the cure is soon done. Those that lie upon the parts with a larger basis, they are either small ends or mean ends, or greater, or very great: the small ends are as big as a small nut, the mean ends are as big as a Walnut, the greater as big as an Egg, and the greatest of all are as big as a Pompion. The greatest of all, [Page 148] by reason of veins and arteries, cannot be taken forth, wherefore they must be cut off. But amputation or cutting them off accord­ing to Hierom. Fabrit. ab Aquapend. is done with Pincers, which receive and take fast hold of the whole Impostume as far as the roots of it; which afterwards to hinder the flux of blood, is cut away with red hot knives with sharp edges, all above the pincers, (such a pair of pincers as Guil. Fabrit. Hildan. describes cent. 1. observ. 2.) without drawing the skin from the bag. Then the place must be dressed with digestives, cleansers, sarcoticks and epule­ticks. The rest are cut forth and not cut off; the cutting of them forth is performed thus: First of all the Patient must be placed as commodiously as he can be, either on a seat or on a bed opposite to the clear light and to the Chirurgian; and if it be a fearful child or woman, or one that is faint-hearted, he must be bound with his hands behind him, lest either being impatient of pain, he should divers waies with his hands hinder the Operator in his operation, or being frighted he should toss himself every way, as Marcus Aurel. Severin. out of Hippocrates de offic. Med. warns us L. de abscessib. anon. cap. 23. The Patient being seated, the hairs must be shaved away, (if the Tumor be on the head, or else there is no need to do that) and with ink we must mark out the length we mean to cut, which must be as much as the tumor is in round­ness; sometimes the Tumor requires a double incision, like to a cross on the skin, and then the first incision must be longer then the second. There is made but one incision upon a small and mean Tumor, especiallie when it sticks to the muscle of the fore head or temples, lest their fibras or vessels should be burnt overthwart. A Tumor that is next to a mean, called a greater, requires to be cut like to a cross; and a Tumor that is covered with hair will ad­mit of the same incision also: Yet in a single and cross fashioned incision, we must take care that the bag underneath the skin be not cut asunder, especiallie in Meliceris, for then the humor runs forth, and the tumor falls, so that the bag can hardlie be taken out. And it is necessary that the coat which contains matter like to honie, or to pap, should be taken out whole; for if but the least part of it be left behinde, it will be the occasion to make it grow again: But in Steatoma, whereas that fattie tallow, or the more solid substance of the suet hardlie will run forth, there is not so great danger in hurling the bag; and if the tumor do not fall down, the coat may be pulled away very easilie; wherefore the crooked knife, with which onlie the skin must be cut, must have [Page 149] an edge on the outside that is turned back and blunted, (Fig. II.) incision being made, either but one at length, or two like a cross; the larger part of the probe (Table VIII. Figure VI.) must be thrust in between the skin and the bag, which hath another colour then the skin hath; and with this the bag laid hold on must be parted from the skin which will be easily done, because the bag doth not stick very fast to the skin: But if the bag round about do stick more fast to the skin, it must be parted with the edge of the knife held slanting, (Table II. Figure I.) and it must be separated under­neath with the handle of the knife, (Table XII. Figure IV.) whilst you do make this separation, the blood that runs forth must be con­tinuallie wiped away with a sponge, that it may not hinder the Operator in his work. If the Chyrurgian come to the bottom of the bag, he must cut the vein that brings nourishment to the tumor; with the edge of the knife overthwartly, that not so much as the least part of the bag may be left, to breed the tumor again. This being done, and the bag perfectly drawn forth, he shall join together the lips of the wound, (which if they be very loose, shew that the skin is too much, and he must cut off the skin that is superfluous, letting stitching alone at this time, by reason of the great pains the Patient hath endured already) laying plaisters upon linnen cross wise. Thus did I most happily cure two Athe­romas, that were as big as Goose-eggs, upon the knee of a cer­tain Priest.

But if the bag be already broken, either of it self, or by the carelesness of the Chyrurgian, then it is necessary that either the tumor grow again, or that there remain in that place almost an incurable and stinking ulcer, where we must consider the time when it broke. If it be broken now, we must thrust in between the skin and the bag the greater end of the probe, or handle of the penknife, untill such time as the membrane of the tumour be totallie separated. But if it break long before, it must be con­sumed with septicks in those that are more fearful, or with red hot irons in those that are more stout hearted. This being wasted, the wound must be digested, cleansed, and incarnated and cica­trized. See Aetius Tetrab. 4. serm. 3. cap. 7, 8. and Celsus lib. 7. cap. 6. of the cure of Meliceris, Steatoma and Atheroma by manual operation, which he describes in these words; shaving first all the hair off, if they are covered with hair, you must make incision through the middle, either long ways, or with a cross; but the coat of Steatoma must be cut also, that what is within it may run [Page 150] forth, because that coat is not easilie parted from the skin and the flesh of the muscles under it; but in the rest, namelie Meliceris and Atheroma, the bag must be kept untouched and whole; but forthwith, as the skin is cut, the white coat stretched out shews it self; and then with the haft of the knife the coat must be parted from the skin and flesh, and must be cast out with that is contained within it: Yet if at any time the coat sticks fast to the muscle on the lower part, that that may not be hurt, the upper part of that coat must be cut away with a pair of cizers, and the other part under must be left within; when the whole coat is taken forth, the lips of the wound must be joined, and a band or suture must make them fast, (if the sick can away with it) and above all must be laid a glutinative medicament: when the whole coat, or half, which sticks fast to the muscle, or any part of the coat is left with­in, after corrosives, or a little fire, things must be applied which cause quitter.

Fig. III. Shews the relaxation of the upper eye-lid in the right eye, and the cure of the same in the left; which Hierom Fabrit. ab Aquapend. seems to prefer before the absolute and cruel manual way Celsus used, in these words: But I, when the upper eye-lid covers the eye, lay on a glutinous matter, (or a linnen cloth wet in my glewing medicament,

• Take Dragons Blood,
• Frankincense,
• Sarcocotta,
• Mastich,

Of each one dram, beat all with the white of an Egg, and mingle them, like to the thickness of Honie) bound on with two or three strings all over the upper eye-lid; and another linnen cloth like the former (as for the strings) I lay above the eye-brows on the fore head; then I tie both or all three strings, drawn streight, to the strings underneath, and so the eye is held open: also it comes to pass, that in a convenient space of time, the eye lid re­laxed is cured, by means of the said glew that dries and bindes, and contracts both the fore-head and the eye-lid. This way of cure succeeds singularly well, because it not only dries up what moisture is run in, but it also hinders all new flux of humors; which thing I tried upon a Noble-woman, witness Georgius Bamlerus, who would not believe it, till he saw the effect of it with admiration.

Fig. IV. Represents the cutting of the fore-head in fashion like a cross, above the bag of Atheroma, whereof I spake before [Page 151] Fig. II. making incision upon the skin with a crooked knife; and if the Chirurgian cannot part the coat from the skin with this probe, he must part it with his knife, Table II. Figure I. which that he may do as he should, he must proceed warily; and he must use the knife rather slantinglie then streight out, for the streight way will cut too fast, and must needs hurt the bag. In the right eye a disease is represented called [...], (that is when the upper eye-lid cannot cover the eye) and it is cured in the left, by an invention propounded by Aquapendens, which is is most milde, and if it be continued most certain: Let a linnen cloth wet in my glew be applied to the upper eye-lid, fastened to three strings, (1) and another to the cheek, so that it may be right against the upper cloth, with its strings, (2) the glew being dried, and the cloths sticking fast to the skin, their strings must be bound fast together, and be continuallie tied faster: And if these two cloths do not suffice, a third cloth must be laid on the fore-head above the eye-brow, with its strings, (3) and a fourth to the cheek beneath the second, and answering directly against the third (4) must be laid on, and these also stick fast; the strings must be tied together, and knit with a double knot, so it will be, that the upper eye lid will be stretched, and drawn to the lower eye-lid, and will cover the eye. I never tried this way of cure, but I have often seen it used.

Fig. V. shews the cure of Staphyloma, which sometimes hath a larger basis (b) then all the body of it besides, and sometimes a smaller then the rest, (a) and this is performed by tying of it, called constriction: If the Staphyloma be in the right eye, the Patient is most commodiouslie seated at the feet of the Chirur­gian, and leaning back with his head upon the Chirurgians knees; if the disease be in the left eye, the Patient must sit on a seat op­posite to the Chirurgian.

Celsus lib. 7. cap. 7. describes the constriction of Staphyloma that hath a narrow basis: The eye-lids being drawn asunder at the very roots, through the middle of the basis of the Staphyloma over­thwart, (from that corner which is proper for the right hand to the other) a needle is passed, carrying with it two pieces of flax, or a double thread; the middle of the double thread being cut asunder, and the needle being removed, we must strongly binde together the two ends of the single thread upon the superiour part, and the two ends of the other thread upon the inferiour part, and these cutting by degrees, do cut it out. But this manual operation, and that which follows, is used not to recover the sight already [Page 152] lost (for that is impossible) but that moderate comliness may be repaired to the Patient's content.

Paulus Aegineta lib. 6. dere. med. cap. 19. sets down the cure of Staphyloma that hath a broad ba [...]: wherefore we must pass a needle without a thread, from the lower parts upward, through the basis of the Staphyloma, and another needle drawing after it a double thread, we must pass from that canton of the eye which is to the right hand, to the other, through the bottom of the Staphyloma; and the first needle staying in, which was thrust through without a thread, we must cut the thread in the middle by the needles eye; and the needle being taken away, we must, by the threads, bind one part of the Staphyloma to the upper parts, and the other toward the nether parts. Hierom. Fabrit. ab Aquapend. in both Staphyloma's useth a silken thread not twisted but single; and red, because the colour helps well both for constriction and for section. The thread being tied to­gether in both diseases, the white of an Egg must be beaten, and wool dipt in it laid upon the eye, to keep off inflammation. The next day after the taking off the ligature, the eye must be dressed with gentle medicaments, untill the threads, together with the Staphyloma, fall away.

Fig. VI. shews the cure of Pterygium, which growing first from the internal angle of the eye, extends it self beyond the sight of the eye, and hindring the sight requires manual opera­tion; which being performed by five hands succeeds excellent­ly well, if it be performed that way I now shall shew you. The Patient, as I said concerning Staphyloma, being rightly pla­ced, the Chyrurgian shall apply a glewing linnen cloath both to his upper and under eye-lids, both of which shall have a long string at the end, which the Assistant's hand, being far from rhe eye, shall lay hold of, and shall draw it to himself, that the eye-lids may be drawn asunder; and being so drawn asunder, may be kept in that posture without any inconvenience to the Chyru [...]gian in his operation. Another Assistant shall put the ring, Table VIII. Figure V. upon the eye and hold it firm. The eye-lids being thus drawn asunder, and the eye being held firm by the ring, the Chyrurgian very carefully shall put under his small h [...]ok with the point of it a little crooked, Table VIII. Figure IX. to lift up the Pterygium about the middle of the sight of the eye, that he hurt not the cornea; then he shall thrust a [Page 153] needle a little bent, which hath in it a single silk thread, of a red colour, under the Pterygium which is lifted up by the hook put under it; and he shall take both ends of the thread in his left hand, and he shall separate the Pterygium stretched forth by the thread, by little and little, from the middle as far as the end of it, with the haft of his knife, Table XII. Figure IV. held in his right hand. This being done let him take away the thread, and with his hook lay hold on that part of the haw that is separa­ted; and having laied hold of it, let him stretch it out, and so continue the separation of the haw with the haft of his knife, un­till he come to the great cauton of the eye, where the haw must be so acurately cut forth with the knife, Table XII. Figure II. that nothing may be left of it, which being ulcerated will hard­ly admit of any cure, nor yet any part of the caruncle may be di­minished, lest the disease of the eye called [...] be caused there­by. This manual operation being performed, driers must be applied to the eye, concerning which see Sennertus, Fabrit. ab Aquapendente and Celsus.

Fig. VII. represents a wound of the right cheek that was made by a cut; and the upper lip was cut as far as the fore-teeth in the middle like to a hare-lip.

Fig. VIII. shews the cure of the aforesaid infirmities: The lips of the wound are brought to touch one the other, and being so brought they are kept so by emplastick linnen cloaths, untill they be healed: But the hare-lip must be helped the way here following. The cloven lip must be taken hold of on both sides with small hooks, and must be separated from the gums with a fit knife, Table II Figure I. then a linnen cloath must be thrust in betwixt the lip and the gums, that they may not grow toge­ther again; and glew on both sides with strings that must be ap­plied: this being done the lips of the fissure must be renewed with a pair of cizers; and being renewed they must be brought to touch one the other with stitchings, which will not so soon break forth again, but by the strings drawn together with the glew are kept so, untill the lips may grow perfectly together by the help of Spanish Balsom.

The XXXVI Table. Of the burning of a rotten Tooth, the cutting forth of one that hurts the cheek, of the feeding of the sick when their mouth is fast closed together, of the stopping of a hole made in the Palate preternaturally, of the dangerous in­fusion of liquors into the ears, of the drawing the Teeth asunder which are fast joined together, of the depression of the lower Jaw, of the cutting of the band under the Tongue, and of taking things forth which stick in the Throat.

FIG. I. shews how hollow and rotten teeth, to stop the rotten­ness, are burnt with red hot irons, (fetcht out of Table XIX.) and thrust into them.

Fig. II. shews how a tooth bred out of its place, and offending the cheek, is cut forth with an iron Instrument, Table XI. Fig. II.

Fig. III. represents the Tunnel applied, described and pictured Table X. Figure XI. whose narrow end is put between the out­ward gums, and the broader end receives the liquid nourishment, and lets it through the narrow end to the throat of those whose teeth are very close shut together.

Fig. IV. shews a Palate eaten away with the French Pox, so that the hole passed through into the cavitie of the nose, and hindred the voice from being articulatelie pronounced; this I stopt with a golden Instrument, to which a sponge was fastned, whereby the Patient spake his words plainlie and distinctlie. After the use of the decoction, I touched that hole with red hot irons, which nature, after that some small bones were cast off, filled with flesh; when the ulcer was filled with flesh, I brought it to cicatrize with Gar­garisms and drying Errhius.

Fig. V. admonishes the young Practitioners in Chirurgerie, that in curing the disease of the ears, they should rather gentlie drop in any liquors convenient, than to cast them in violently by a Syringe, least the membrane of the Tympanum break, and there follow incurable deafness.

Fig. VI. draws asunder, with a dilating instrument, (Table IX. Figure IX.) teeth that are closed fast together, that the sick may [Page 155]

Fig. I

II

III

IV

V

VI

VII

VIII

IX

[Page 156] not perish for hunger; where we cannot use the Dilatorie, nourish­ing Clysters are with singular success cast in by the fundament, which I had trial of in Melchior Feith, who by reason of a wound in his stomach, was fourteen daies fed with nothing but Clysters.

Fig. VII. shews the application of speculum oris, very necessary to search the diseases of the jaws, Table XI Figure IV. For the foresaid instrument not onlie depresses the tongue, but it also keeps the nether jaw pressed down, untill such time as the place affected be more nearlie searched out, medicaments may be ap­plied to it, with the spatula set on the side thereof, and perforated with many holes; sometimes only the tongue is put down, that the faults of the mouth may be seen: The more thick excrements of the tongue are scraped away with the crooked side of the Spatula, which has an edge, and these in very hot burning feavers commonlie stick fast to it.

Fig. VIII. shews the way to cut the string under the tongue that is too strait, and as some think hinders mens speech; which Midwives every where tear asunder with their nailes, and our Barbers imprudentlie rend it with a lancer, oft-times with a great flux of blood, and pain, which afterwards proves the cause of other michiefs; which thing Hierom Fabrit. ab Aquap. relates in these words following, annexing withal how we ought to perform this manual operation: Besides the depression of the tongue, and scraping of it, there is a third way of manual operation to be performed about the tongue, when the string under the tongue is cut; of which before I speak, I would give you warning of the rashness of Midwives every where, who in all, making no difference, cut the string under the tongue in every new born child, with the nails of the fore finger, which they ever keep ready and sharp for that purpose; which office if they should not perform, they cannot believe that the childe will ever speak; as if by nature (O the wonderful and not sufficiently to be lamented ignorance of almost all Midwives) a man could not speak, who hath by nature speech given to him as his proper faculty, without any help of any foolish woman to assist her. And I saw a childe new born, whilest he was kept in longer then he might stay for the secondines, he neither cried nor felt any trouble; but after that the Midwife unwisely cut the string of his tongue with her nail, he presently fell to crying for pain that he endured: But this is the smallest matter, that truly is of most concernment, namely, that because of that cutting with the nails, oft-times in­fants [Page 157] cannot lay hold of the nipple of the mother or nurse, nor yet suck the milk, but die for want of it; or else breasts swell that give suck, or which is yet far worse, the parents impute the fault hereof either to hard labor in childe-birth, or coming before the time, or else to the weakness of the childe only to lay hold on the nipple, or to any other cause, rather then to the fault of the Midwife; which being it is the true cause, I much wonder that there is not a provisional Law made to hinder the death of children, which is oft-times procured by Midwives: wherefore I admonish you, that you forbid Midwives to touch the tongues of yours or your friends children with their nails. And if perchance that string under the tongue be greater then it should be, it may be cut at any age, which yet seldom, and very seldom indeed, happens to this string; because Nature would not have made man fit to speak, un­less she had made and granted unto him fit instruments for that purpose: And if of an hundred thousand children one child is born with a greater string, where manual operation is needful, there is no difference whether it be cut presently, or after delivery, or after the childe is weaned, or in longer time, so it be done by a skilful Chyrurgian. If this happen, we use to command the Patient to put his tongue beyond his teeth, which Celsus indeed laies hold on with the toothed part of the pullers, but we do it with the pincers; some­times we cannot lay hold of the tongue either with pullers or pin­cers, as in infants and children, who either will not or know not how to put forth their tongues; for these we must make them cry; then putting a thin and rugged linnen cloth between two fingers, name­ly the fore-finger and thumb of the left hand, whereby the tongue must be laid hold on and pulled forth, and may be pulled upwards and laid crooked, that the strings may appear, which after this we must cut with the right hand: And taking (not the lancer com­monly used by the Barbers, unfit for that purpose) but the penknife that is moderately hooked about the point, we cut the string of the tongue, if it be greater then it should be, overthwart, once, twice, and again, until it be all cut, taking great care that the vessels under it be not hurt, which cannot happen where the Chyrurgian is skilled in Anatomy, who knows exactly the vessels under the tongue, and avoids them with the crooked knife. Thus far Hier. Fab. ab Aquap.

Fig. IX. teaches how a fish-bone, or a bone with corners, or any thing else sticking in the throat, whilest we eat, and not going down into the stomach, may be drawn forth with convenient In­struments, or else forced down into the stomach: These strange [Page 158] things are drawn forth divers waies; if they lie in sight, they are laid hold on with the right pullers, Table IV. Figure I. and are pulled out of the throat, putting in the Speculum oris in the mean time; and if a thorn or bone, or any other things, when the mouth is open, and the tongue is pressed down by the Speculum oris, can­not come to be seen, when they are sunk down deeper into the throat, then being laid hold on with the crooked pullers, Table X. Figure I. they must be drawn forth with the Instrument, Table X. Figure II. thrust into the throat, and hitting against them. Others after meat provoke the stomach to vomit, putting their fingers, or feathers anointed with oil of sweet Almonds, into the throat, that together with the meat, a thorn, or any strange thing, may be cast out of the mouth. But since oft-times the putting forth of bones and thorns is in vain attempted by the said waies or In­struments, Hierom Fabrit, ab Aquapend. takes a candle of white wax, as great as a mans little finger, and somewhat crooked, which he delivers to the Patient, that he may thrust that into his own throat, untill such time as the strange bodie may, being forced, go down into the stomach.

Others for the same purpose command us to swallow down great gobbets; some tie a leaden bullet fast to a thread, and they swallow this often, and pull it forth again, and so what sticks fast in the throat, is thrust into the stomach; when any thing sticking in the throat can neither be taken forth at the mouth, nor forced down into the stomach, Fabrit. ab Aquap. from Paulus and Leo­nides, leaves the whole business to nature and time.

The XXXVII Table. Of cauterizing the nostrils for ozaena, and chiefly after the cutting forth of a Polypus; and of Paulus and Hippo­crates his way of ordering Paracentesis in the Thorax; of the dilating and curing wounds of the Thorax, brest and Abdomen, and to bring forth the nipples of such as give suck.

FIG. I. teaches how the nostrils ulcerated onlie, or where there is also corruption of the bone, are cauterized by hot burning irons thrust through pipes. To this join those things which were [Page 159]

Fig. I.

II

III

IV

V

VI

[Page 160] spoken before, Table IX. Figure III, IV, V and VI. I cured a Tailor at Padua who kept the house by reason of an ozaena from the French pox, which after the inward use of the decoction of gnaicum, for two whole years was dressed by a principal Barber of that place, with medicaments prepared with Antimony and Mercury. But when these could do no good, the Patient by the Chyrurgian sought the advice and help of D. D, Spigelius; but Spigelius at that time was sick and could not go forth to see the Patient, wherefore he joined me with that Chyrurgian in ordinary, and he commanded me to make a tent of fine lint. and that I should thrust that into the nostril that was ill, and that I should leave it there for a natural day, that so we might learn the scituation, quantity and quality of the ozaena; I obeyed his command and pulled forth the tent, which I found near the point, and on the right side, foul with a round spot, and stin­king exceedingly, and I shewed this to Spigelius, who so soon as he saw this, said that the ulcer was in the supream part of the nostrils; namely upon the grisly part, and that on the right side not very great, but it was join'd with corruption of the bone, which required cauterizing. When I asked him the reason of what he had said, he gave this which follows; because the tent is foul almost at the point, the ulcer hath its scituation in the top of the nostril; and because the tent is only spotted outwardly, of necessity the left side only is affected, yet with no very great ulcer, because the spot is small; but the bone is also corrupted with it, because the tent is black and stinks exceedingly; there is need of manual operation, because for so long time, untill now, such medicaments have been applied in vain, which had not the bone been corrupted also, would have brought the ulcer to cicatrize long since. He left this manual operation or burn­ing the nostril through a pipe unto my care, as being very easie and the first of my manual operations; wherefore I chose a pipe (for Spigelius had divers) fit for the purpose (namely that which had a hole in the side, described Table VII. Figure IV.) and I wrapt that in lint pressed out with sharp black wine to de­fend the parts that were sound; this I thrust into the nostril that was ulcerated, that the hole of the said pipe might equal the ul­cer; the pipe being thus prepared and thrust into the nostril, I took the iron instrument, Table IX. Figure VI. made very red hot, and this I thrust through the pipe unto the place affected, [Page 161] and I drew the same presently forth again; and thus I did pulling the red hot iron out, and putting it in again, four or five times at the most; but I did this very suddenly, and therefore two red hot irons are requisite, as I admonished in the place quoted. After cau­terizing, Nature, (the pain being first abated, and the eschar taken off) being helped by medicaments, separated the scale from the bone in fourteen daies; and the ulcer, with drying things applied to it, was brought to cicatrize,

I tried this manual operation afterwards, in many, with happy success (though the Germans, and chiefly those of Ulma, do exceedingly abhor all caute [...]izing by fire) alwaies closing both the Patient's eys with cotton and a band over it, to hinder them from the sight of the red hot iron.

An Ozaena of the nostrils be it with or without suspicion of the French Pox, but without any rottenness of the bone, if it cannot be cured with medicaments, requires a pipe that is all solid, Table IX. Figure V. which, to speak the truth, I never used myself, neither did I ever see any man else do it. But a certain Student of Millan told me that Hierom. Fabrit. ab Aqua­pendente, did with most happy success cauterize him with a red hot iron thrust through a pipe that was all solid.

Without doubt the way he went was that which the Authour hi [...]self describes. An iron pipe must be thrust in (that is all so­lid, Table IX. Figure V. not wrapped u [...] in lint, but smeared over well with the white of an Egg beaten together) it must be so long that it may equal the length of the ulcer, and the hol­low of the nostrils may be equalled by it; and through this must a red hot iron be thrust which shall touch nothing but the pipe. It must be so done that the red hot iron may heat the pipe, and the pipe the nostrils and the ozaena; yet I desire not that the no­strils should feel any pain by this heat, but that the place ulce­rated might be healed without feeling any pain, as hot only as the Patient can well indure it; when you find that, then must the pipe presently be pulled forth of the nostrils, and then thrust in again; and so often must the red hot iron be thrust in and pul­led out, which may only heat untill such time as the part is suf­ficiently tried; for by often doing of it, and the heat [...]enewed still without pain, supplies the room of cauterizing, namely by drying and corroborating the part, and digesting the tumours, and so healing the ulcer.

Fig. II. shews the ribs of the Thorax laid bare, that young Chyrurgians may better unde [...]stand what is said underneath con­cerning the perforation of the Thorax; wherefore (♀) shews Paulus his place, and (☉) the place somewhat lower then Pau­lus used, and (♃) shews Hippocrates his place; for in these places mentioned the Thorax useth to be opened for all sorts of impostumes.

Fig. III. (☿) shews a threefold thread, wherewith Paulus his place, and the place beneath it is found: (♄) shews the i [...] ­cision of the skin alone, above the muscles between the ribs; and this is done only with the instrument called the Woodcocks bill.

Fig. IV. shews 1. How in wounds of the Thorax that pe­netrate into the cavity, the blood is drawn forth by a pipe (des­cribed A Table XII. Figure IX.) 2. What pipe is ne [...]essary after the cutting of the Thorax (♂) (B Table XII. Figure XII. &c.) a silver cap (Table XIII. Figure VIII.) a sponge (D) and a syringe must be used for the casting in of convenient liquors into the [...]horax, (☽ Table XIII. Figure II.) 3 How the Thorax must be perforated, and what we must do after we have opened the Thorax either as Paulus or as Hippocrates teach­eth us. But before we open the Thorax fou [...] things must be considered: 1. Whether we shall use manual operation or not? 2. At what time. 3. In what place. 4. After what fashion. Four things will signifie whether it be to be done or not? 1. The disease. 2. The time of the year. 3. The forces of the Patient. 4. The greatness of the disease; namely whether much matter must be voided forth.

I. The Disease if it be in the cavity of the Thorax, so that ei­ther corruption run forth of the wound into the Thorax, from some impostume of the Lungs, or from a Plurisie, or cholerick matter from an Erysipelas of the Lungs. or a watry humour from a Dropsie of the Thorax, or bloody moisture like to the washing of raw flesh or blood: we know this collection of mat­ter; First by breathing, which is only difficult in drawing in the breath; because the Lungs, by reason of the matter colle­cted, cannot dilate themselves; but not when we put forth our breath, when the matter by its weight presse h [...]he Lungs. Secondly, from the Pulses, that are more quick, vehement, fre­quent, small, unequal, unordinate. Thirdly, by a Feaver go­ing [Page 163] before, with more vehement accidents. Fourthly, b [...] [...]e difficult lying on the sound side, because the fau [...]ty matter li [...]th upon the Lungs, which burthens them that they cannot move freely he [...]e and there. Fifthly, from a waving up and down, perceived to be in the hollow of the Tho [...]ax. Sixth [...]y, to these we may add a cough, which yet is not a [...]waies present in every impostume of the Lungs; but only thee when the ma [...]ter is con­tained in the pipes of the Lungs, which provokes the inward coat of the sharp Artery, and the head of it (parts that a [...]e of exquisite feeling) either by the quantity or acrimony of it, and so makes a man cough.

II. The time of the year; Hippacrates bids us avoid the Win­ter and Summer Solstices, because in those times there is made the greatest and almost sudden change of the Air; or else when alwaies after i [...]cision made, some air passeth into the Thor [...]x; but especial [...]y when the matter comes forth by the newly made wound, the aforesaid times must be avoided as much as possibly may be.

III. The Forces: For unless the forces stand firm or mode­rately good, this manual operation must be omitted for a time, lest this noble remedy of opening the Thorax otherwise, might be defamed by [...]he death of the Patient. Now Physicians com­monly measu [...]e the Patients forces by the Pulses, which yet in this case may deceive them, because such matter collected in the Thorax maketh the Pulses small, quick, frequent and unor­dinate; but the most certain sign of forces remaining, is when the sick can sit or walk by the help of natures strength, or with the help of a staff.

IV. The Quantity: for if there be but a small quantity of matter in the Thorax, we have no need to open it, for [...]a [...]ure will either digest it, or else send it forth by the urinary passages, or some other waies, but if there be much matter, we must presently without any delay fall to make incision, lest the sick should be choaked with quantity of matter, or the Lungs should be corrupted with the ill quality of it.

But at what time? Hippocrates seems to have intimated that unto us, Lib. 6. epid. sect. 7, text. 9. we must presently open those whose Thorax is hydropical; but we must presently cau­terize, with hot irons, those which are in Consumptions. In­terpreters have interpreted both words, [...] and [...] to sig­nifie [Page 164] presently; but [...] here, signifies less; as if Hippocrates had said, that those that are hydropical must not be so soon opened or cauterized; but those that consume must be presently opened or cauterized. The reason is, because where men are hydropical, the matter is collected in the Thorax by little and little, and there­fore there is no need to make incision presently at the beginning; for so at length that collection will do hurt when it is in great quan­tity But such as are in Consumptions, having impostumes in their Lungs, do as it were at one time collect all the matter when the impostume breaks, wherefore the Thorax must be presently opened. 1. That the Patient may not be choaked by reason of the dilating of the Lungs, hindred by the quantity of the corrupt matter. 2. Lest that from the corroding corruption, any ulcer should breed in the Lungs or other part of the Thorax, which can hardly, or not at all, be cured afterwards.

In what place? The place must be such wherein incision may be safely made; now the places are many, before, behind, on the sides, above or below; but neither before nor behind is the open­ing of the Thorax good or safe, by reason of the muscle of the breast, and the muscles of the back, which are full of nerves, which are very dangerous to be cut; wherefore it remains that the opening must be made on the side, and that below or above, for on the side the muscles do not stick so fast to the breast, yet before sometimes; namely on the region of the Sternon; if the matter be collected between the mediastinum, apertion is wont to be made. Wherefore Paulus lib. 6. cap. 4. opens the Thorax in the upper part of the side: But Hippocrates lib. 2. de Morbis, in the lower part. In the upper part between the fifth and sixth rib, counting from above; (Table XXXVII. Figure II. (♀:) in the lower part, be­tween the third and fourth rib. counting from the lower ribs (Ta­ble XXXVII. Figure II. (♃.)

Paulus found his place by numbring the vertebraes of the Tho­rax, beginning from the uppermost, between the fifth and sixth vertebra, he puts a thread on the point of the spina dorsi; and he brings it to the middle of the sternum: then he takes the third part of the thread, which he measureth from the sternum to the spina dorsi; and whither the end of the threefold thread reacheth, that place he marks with ink; which being so marked makes a right and p [...]rpendicular line with the nipple of the breasts (Table XXXVII. Figure III. ☿.)

Hippocrates openeth the breast between the third and fourth rib, [Page 165] counting from the lower ribs; and the reason is, because by this means the matter and other things contained in the Thorax will run forth the better; and he chuses the place where there is that eminence and binding of the ribs, to which the muscles grow; but not upon it, or backwards towards the back, because the nervous muscles there, hinder the opening of that place; but it must be done a little forward, or toward the Sternum; (Table XXXVII. Figure II. ♃) There seems indeed in this place to be danger, by reason of the Diaphragma, least that should be hurt; yet there is no danger, because the Diaphragma, where it sticks to the ribs, doth not rise so high, (for it is kept down by the matter) that it cannot be hurt; but where the matter is collected, there we must attempt to open the part. If it be on the left side, let the Thorax be opened on the left side; if it be on the right side, open on the right side; if on both, open both sides. But of these places mentioned, that of Hippocrates is to be chosen; because the cor­ruption of strange matter collected in the Thorax, by reason of the more declining situation of the part opened, will come forth better then it will where Paulus appoints the orifice to be made; yet this is not simply to be despised, for if the matter be more dili­gently considered, and the orifice be to be made on the right side, the place Paulus appoints is better then the place of Hippocrates; because on the right side, the liver with its gibbous part drives the Diaphragma upward; but on the left side the place of Hippocrates is best made choice of, because the Diaphragma, by reason of the more low situation of the spleen, and plenty of matter, may be thrust down towards the lower parts; wherefore Hippocrates saith, L. 2. de Morbis, It were to be wished, that the matter would alwaies lie down on the left side to be evacuated, or lower then Paulus his place, namely, between the sixth and seventh rib, (☉ Table XXXVII. Figure II.) for the Diaphragma doth not ascend so high in those that are living, as in those that are dead; wherefore in these places, the Thorax is opened without offence done to the Pericranium, Lungs, or Septum Transversum.

But the way is this; The opening of the Thorax is performed either by incision, burning or perforation. Hippocrates makes mention of incision and burning, Sect. 7. Aph. 47. when he saith, Whoever are impostumated, must either be burnt or cut, &c. but he speaks of cauterizing, L. 2. de Morbis. In all these three waies, we must consider the Patient's lying down, his breathing, the in­struments and the operation. After his lying down, both the [Page 166] body and arm of the Patient, on that side must be opened, must ha [...]e a middle figure, that the muscles be not contracted too much; wh [...] [...]f [...]re in Paulus his way, let the sick lie on his back, but in H [...]ppo [...]ra es his way upon his belly. As for his breathing in Hippo­crates method, the [...]atient must breathe out, that the Lungs may fall down; but in Paulus his method, he must hold his breath, t [...] h [...] Diaphragma may be thrust lower. The instruments vary, a [...] waies of operation are divers. For incision Hippocrates useth a sharp knife, described Table II. Figure I. and that instrument which is ca [...]led S [...]atha; but Paulus opens the Thorax with a Wood­cocks bill; namely, with a long little sword, and somewhat crooked at the point, (Table XII Figure I.) but the new Practitioners use both knives. For cauterizing Hippocrates useth a long iron instru­ment, and not very thick; because that after cauterizing, the hol [...] may be made larger then the thickness of the instrument was; Hippocrates also perforates the side with a hollow piercer, made with a screw fashioned, (not one that is solid, such as Coblers use when they m [...]ke holes in shooe soles to draw their threads through.) These three operations must be used according to the diversity of the matter contained in the Thorax; for since one kind of matter is thick, and another is thin, that requires a greater hole to come forth by, and this a lesser; wherefore in thick matter, wh [...]n the corrup [...]ion is collected, incision must be made; but where the matter is thin and watry, as where there is a dropsie of the Thorax, Paulus and Hippocrates both think that the breast must be opened, either by burning the muscles or perforating the side. The latter Practitioners prefer incision before cauterizing or per­foration, which they make less for a dropsie of the Thorax, and greater for an Impostume, and greatest of all where there is a col­lection of phlegmatick matter. Incision of the Thorax is per­formed thus; The place being found, and noted with ink, the sick must be placed in a middle posture; then with a pen-knife (Table XII. Figure I. and of this Table Figure III. ♄.) it must be cut oblickly toward the superior and inferior parts; then the pen-knife, (Table II. Figure I) bound about with a white wollen cloth, (so that the point at the top of it may stick forth no more th [...] the breadth of the nail of the great finger, least being thrust in deeper then it should, it may do any hurt) being applied to the outward muscles between the ribs, must be thrust in by little and little by degrees, untill it penetrate into the hollow of the Thorax, (of this Table Figure IV. ♂.) But if this wound, be­sides [Page 167] our expectation, be too narrow, and the matter too thick, then either it must be dilated with a pen-knife (Table XII. Fig. I. and of this Table F [...]gure V. E.) which cannot hurt the Lungs, by reason of the obstacle placed at the end of it; or else to make the matter more liquid, honie and water must be cast into the Thorax by a Syringe, of this Table Figure IV. ☽) incision being made, the matter contained in the Thorax must be let out, (yet not all at one time, least the Patient's forces fail, or something worse succeed it; if we would let it all forth at once, th [...]n n [...]ture, which is accustomed almost to the matter collected, will feel some va­cuum, to avoid which, she will send all the humors almost in the body for a supply, whence there will arise a greater Impostu­mation then there was before) daily six ounces, or as much as the Patient's forces will suffer. This quantity of matter being let fo [...]th, the wound must be stopped every day with a tent made of hards, or raw flax, and tied by a thread untill the tenth day, when almost all the matter is let out; for five daies wine and oyl warmed, must be poured in by a pipe, (of this Table Figure IV. ☽) that the lungs which are used to be moistned, should not grow dry suddenly. Then a silver pipe (of this Table Figure IV. B.) must be put in, that the liquor poured in morning and evening may be let forth, (for that which is poured into the Thorax in the morning, will come forth by the evening; and what is poured in at evening, will come forth by morning) After the fifteenth day that incision hath been made, instead of a silver pipe, put in a tent of lint smeared with white wax, hollow, least the wound de­generate into an incurable fistula, or the matter remain in the Thorax. When the Thorax is wholly dried, put in a hollow tent of lint, made up with wax, that for length and thickness must daily be made less, untill such time as the wound filled with flesh may be covered with a cicatrize. But where the matter is watry, or thin corruption, presently after that the Thorax is opened, a pipe must be put into the hole, that fits it exactly; and into the pipe a tent tied to a thread, that the water or thin corruption may not run forth all at once, and the sick die, (as Hippocrates admo­nishes Sect. 6. Aph. 27.) but that so much of the matter only may be let forth, as the Patient's forces can suffer. But if by reason of the coldness of the Ague, or any other cause, it be not con­venient to let out the matter once or twice a day, we must put a small sponge into the pipe, found in this Table Figure W. D. and the small cap (of this Table W. C) must be put upon it, that the [Page 168] matter almost every moment may sweat through the holes of i [...] by degrees, and without any loss to the Patient's forces.

Fig. V. represents the dilating of wounds of the Thorax, and of the Abdomen, which must be performed with sharp knives.

A wound upon any part of the Thorax, either penetrates and perforates the Pleura, or it doth not penetrate nor prick that: Again, it is either a narrow wound or a broad; and both of these either with hurt done to the parts within, or with no hurt done to them.

A wound of the Thorax received below the sixth rib, and pene­trating into the cavity, and not hurting the inward parts, yet is broad enough, it must never be stitched or cured by the first in­tention, least the passage for the matter to come forth, which is run into the hollow of the Thorax, may be stopt up, with danger to the Patient's life; but first a tent must be put in, made of raw lint, tied to a thread, (least when the breath is drawn in, it be suckt into the Thorax) and wet in such things as stop blood, that the wound may remain open; on the second and the daies follow­ing, the wound must be digested with a tent made of a linnen cloth a little worn, and anointed with medicaments that move corruption; and it must be kept open, that the matter collected within may freely come forth.

And if the matter collected in the Thorax be gross, and not fit to come forth by the wound, it must be attenuated by injecting lotions for some daies, made of the decoction of Barly, Raisins, and Hony of Roses, and a silver pipe must be put into the wound, (of this Table Figure IV. B) anointed with a digestive, and stopt with a sponge, (of the same Table Figure IV. D) and covered with a little cap C, of the same Table, that the matter and the decoction cast in may be purged forth by little and little; when the corrupt matter is conveniently purged forth, instead of the silver pipe with shoulders, a tent must be put in made of waxed lint, and hollow, and wet with a sarcotick medicament, which must every day, as I said before, be made less and shorter, that it may not hinder the breeding of the flesh; when the said wound is narrow, it must be presently dilated with the sharp knife, (E of this Figure) to let forth the matter. A wound piercing in above the fifth rib of the Thorax, be it large or narrow, must be kept open with a tent wet in desiccating medicaments, and tied by a thread, that the same day or the next, the blood which is not yet congealed in the Thorax, may be let forth by a pipe put into it, of this Table Figure IV. A.

But if the matter, by reason of its thickness or higher scitua­tion of the wound, cannot come forth by this pipe, we must in time propound the opening of the Thotax; and when the Pati­ent, or his kinsfolk that stand by, yeeld unto it, it must be done after the manner delivered more at large in the explication of the Figure III. and IV. of this Table. This help of manual operation being not presently admitted; when the matter can­not run forth by the hole, either of it self [...]road enough, or in vain dilated with an incision knife, we must try, foreshewing the danger of the Patient's life, to void it forth by diureticks given at the mouth, rather than to expectorate it by lohostes.

In wounds of the Thorax with a small incision of the Lungs or Diaphragma in the fleshy part, we must not only attempt to drive out the matter by the wound, either of it self large enough, or dilated by an incision knife, or by some new hole made, or by the urinary passages; but we must pour into the Thorax, by a syringe, first a decoction that binds the bleeding veins: Se­condly, one that attenuates the thick matter: Thirdly, one that cleanseth the inward wound: And lastly in the fourth place one that will heal it.

When a wound pierceth into the Abdomen, the caul or the intestines slip forth; if the caul be slipt forth, we must consider whether it be yet sound or corrupted; if it be sound, then it must be presently washed in hot wine, and be gently put in again with ones fingers; then the lips of the wound must be drawn together again till they touch one the other; and being so drawn it must be kept so with stitchings, described Table XXXIX. Figure V. But if the Siphac be corrupted, it must be drawn forth, and must be tied very strongly with a single red silk; and then the part that is corrupted, that is bound, must be cut off above the thread, with a sharp knife; but the rest which is sound must be washed in hot wine, and must be gently reduced into the Abdomen, the long thread hanging forth without side; then the wound must be joined with sutures now mentioned; yet so that some space may be left where the thread hangeth forth: but if the Intestines be come forth, they must presently, before they be filled with wind, be thrust in again gently with the fingers, without violence, and so be hid under the Abdomen. If the hole or wound of the Abdomen be narrow, and the intestine is fallen forth, and by long stay­ing [Page 170] without the belly, by the cold air coming to it, it be filled with wind, and so swoln that it is impossible to put it in again with our hands, then let it be long fomented with a sponge wet in hot wine, and pressed forth again; or with a bundle of raw flax boiled in a ly that is sharp, that the winds may be dis­persed; then let it be reduced, and let the wound of the Ab­domen be stitched up as it ought to be. If by this means the intestine cannot be re [...]uced, the wound must be dilated with a knife, called Syringotoma, (G and F) that the intestine may be let in, and the wound, dilated according to Galen's rule, may be sewed up again.

Fig. VI. H. But if under a wound that pierced into the Ab­domen, the intestines be wounded by cutting, then th [...]y must be gently drawn forth, and sewed the same way that Furriers few their skins, leaving behind a piece of the threak spun from flax, that it may hang forth without the wound of the Abdo­men; after that let them be washed with warm wine, and be gently put back into their own place. Lastly, on the sutures of the guts put in again, you must strew powders of Frankin­cense, Mastick, Pellitory of Spain, &c. and the wound of the Abdomen must be united with latchets.

The nipples of those that give suck (I) are oftentimes so hid within the breasts, that the Child new born can neither take hold of them with its mouth, nor suck any milk out of them. In such a case let either the childs nurse set either the bot­tom of the glass (pictured Table XVI. Fig. I.) to the nipple that lies hid, and lay hold of the mouth of the pipe with her mouth, and draw forth the nipple by sucking; or one that is of years shall set the long glass (K) to the nipple, and with a band shall bind it fast to the breast; and when this is done, let her take the narrower end of the glass between her lips, and drawing as before, let her suck forth the nipple that lieth hid. Amatus Lusitanus silleth a glass with a narrow mouth L with scalding water, which he poureth forth again when the glass is made very hot with it, and he presently claps the mouth of the glass to the nipple; for this presently sticks fast to the nip­ple, and draws it out so forcibly, that the Child may easily lay hold of it with its mouth. Moreover these instruments not only draw out the nipples, but milk also. But if there be no need to draw forth milk with the nipple, a thumb­stall [Page 171] made of Ivy wood, is most safely set on to draw forth the nipples.

The XXXVIII Table. Of the cutting off of a breast with an ulcerated Canker in it; of the perforation of the bottom of Fistulaes creeping under the ribs; of Celsus his way to bind the navil, and of a girdle for the navil.

FIG. I. represents a breast affected with an ulcerated Canker, the basis whereof is thrust through with two needles (Ta­ble XII. Figure VIII.) drawing after them a twisted flax­en thread.

Fig. II. shews how the Chyrurgian takes hold, with his left hand, of the ends of the threads that were thrust through, and with his right hand he takes the knife, Table XII. Fi­gure VII. and with that he cutteth the Canker out by the roots.

Fig. III. shews a Canker cut from the breast, weighing six Physical pounds.

Fig. IV. shews how the Chyrurgian, after the cutting off of a breast ulcerated, doth lightly cauterize the place with a red hot iron, (see underneath a singular History) at least to cor­robora [...]e the part,

Fig. V. is the instrument of Hierom. Fabritius ab Aquapendente, whe [...]ewith a Fistula of the Thorax is perforated, which, from the space above between the ribs, doth insinuate it self under one or two ribs or more; namely between the Pleura and the ribs, untill such time as it ends in some space of the ribs under­neath. The point is thrust into a silver pipe that is crooked (a) as far as the bottom of the Fistula, that it may look outwards; then through the pipe thrust into the Fistula a long needle is for­ced (b) which far from the point hath an eye and carrieth a th [...]ead with it, that the bottom of the Fistula may be perforated, and the thread may come forth at the upper and lower end of the Fistula; when the bottom of the Fistula is perforated, let the needle be taken forth by the new hole made in the Fistula, and let the ends of the thread be tied together, that the holes of the [Page 172]

I

II

III

IV

V

VI

VII

VIII

[Page 173] Fistula may be kept open, and the corrupt matter may run forth beneath, untill such time as this Fistula under the ribs may be either filled up with flesh, or be made grow toge her. Concer­ning other Fistulaes of the Thorax, see undernath Tab. XXXIX. Figure IV.

Fig. VI. is Sostratus his band, which is most convenient where the breast is affected with any disease that requires binding. Galen lib. de Faseiis, cap 81. d [...]scribes this; it is most convenient where we desire to bind the middle of the breast, or the back, or sides, or Thorax; especially for a wound of the Thorax, or fracture of the ribs: wherfore we cast two small bands, three fingers broad, and of a fit length, over the upp [...]r points of the shoulders, and we suffer the two right ends of them to hang down; then with the band fol­ded together, or with one end we bind the whole Thorax, and the sides that they may be covered; and we tie the end of the band with a knot; but the ends that hang down both before and behind, are to be sewed to the circumvolutions of the band; and if they be too long, we turn them upwards and there gather them together where the throat is join'd with the broad bone of the shoulders.

Fig. VII. shews how Celsus cured the sticking forth of the navil by manual operation. The body of the Patient being laid upwards (that whether the intestine or the caul, or both be slipt forward by the navil oftentimes dilated, it may be put in again) he t [...]kes hold of the navil with a pair of pincers, and draws it to him, and he passeth quite through it, at the basis, a needle that draws after it two single silk threads uncoloured; then he cuts off the threads, by the needles eye, with a pen-knife, and tying together the ends of both the threads, he binds the root of the navil, lifted up, very strongly; that the part of it, above the band, may die and fall away. Yet because the sick will not so easily admit of the said manual operation of Cclsus, there is a more gentle way found out by Hierom. Fabrit. ab Aquapend. which I have often proved, which he performs with a medicament and a truss of the following figure.

Upon this occasion I thought fit to inse [...]t, not undeservedly, a most [...]are relaxation of the navil in an infant; and a preternatural falling fo [...]wa [...]d of the intestines hanging forth of the body, by reason of a sudden impression from the Mothers imagination; which I received the 14. of Ianuary, Anno 1643. from the most [Page 174] famous Doctor, Dr. Iohan, Georg Cocklius, ordinary Phylosopher to our Republick, and diligent Physitian, and my most honored Colleague; A certain Countrey woman of Berenstate, (so the words were) in the jurisdiction of Vlma, wife to Iacob Hicker, in the time of harvest before, but in the first months of her being with child, whilest she followed her business in the Country, and gathered the gleanings of corn that were scattered up and down the field, under one of them she suddenly perceived a heap of vipers creeping, and clapping her hand upon her navil, she did so strongly imagine concerning their motion and shape, that al­though she was well all the time she was with childe, yet yester­day about twilight in the evening, she brought forth a daugh­ter, christened presently by the name of Barbara, and lively in all other respects; but by reason of that imagination im­printed in her, she was not well formed; for all the intestines of this childe, which naturally otherwise, should be hid in the lower part of her belly, here preternaturally, by reason of the navel relaxed, stuck without the body, as hid in a great wallet, and were covered only with the peritonaeum, and so were apparent to be seen; which moreover, being now placed out of the belly, (and wanting the natural and preferring heat) were hurt by the cold air that came to them, (and so bound up) that neither by the help of a warm stove, nor by warm clothes, nor yet by any help of the Physitian, could be kept in their natural state; wherefore two daies being past, the next Lord's day, having scarcely seen the world, she departed to the place of the blessed.

Fig. VIII. A. is a truss for the navil, made of a double cotton linnen cloth, which on that part E, which covers the navil, was a buckler, made like to a hard cake, in the centre whereof there was a little round knob of lint wrapt together, which goes into the dilatation of the navil, that it may hinder the intestine or caule, or both to come forth again; but first there must be laid on a binding cerat, spread upon soft leather, after that, the truss being ap­plied, the Abdomen must be bound; some to the girdle for the navil A, add the bands to pass over the shoulders B. C, which must be fastned together with three overthwart straps D, and so they fasten the girdle of the shoulders that it may not fall down, but may stick fast upon the region of the navil; but they are not ne­cessary, because the hanch bones hinder the girdle to fall down­wards, and the straps underneath F, G, will not let it rise upwards.

The XXXIX Table. Of the girdle applied to the sticking forth of the navil, and of the way to perforate the Abdomen; of cutting the ex­ternal Fistulas of the Thorax, stit [...]hing the wounds of the Abdomen; of applying the Truss, and provoking urine suppressed.

FIG. I. shews the girdle for the navil, of the former Table Figure VIII. applied to a man, with which alone I have cured many navils sticking forth, where they did not come forth very much, both in men and women, children and others of full years, and I hindred these tumors from growing any greater.

Fig II. and III. shew the place, the manner, and the instru­ments for to use the paracentesis, performed upon the Abdomen of hydropical people. Also about this manual operation there are four things to be considered: 1. Whether it be to be done? 2. At what time? 3. In what place? 4. After what manner? Whether it be to be done, is signified by the disease and the forces of the Pa­tient, whether the disease be Ascites only, or water be mingled with the other kindes of dropsies; namely, if the tumour of the Abdomen, especially from the much drinking of water, came in a short space to a huge magnitude, and medicaments given at the mouth help not, because the vertue of them cannot be brought into act, the natural heat being oppressed with the plenty of humor. The forces must be firm, which may be known when the sick can stand upright, or sit on a seat and finde no inconvenience; there­fore where the disease is old, and the forces are weak, (the judi­cations whereof are old age, child hood, coughs, scouring, cachoxia, a burning fever preceding, and a schirrus, and corruption of the bowels) manual operation hath no place there. The time is pre­sently; namely, before the humor shut up in the Abdomen, hath brought any notable hurt to the bowels and other inward parts. The place where Paracentesis is made, is either in the navil or under the navil, three or four fingers broad of the Patient being put between, and that on the right side or left side, but never in the middle of the Abdomen by a white line; where the navil is so relaxed or swoln, that between the outward part, and the in­ward cavity and water, only a very thin skin passeth, which is [Page 176]

I

II

VI

V

VI

IX

XII

[Page 177] perceived by the touch alone, or by pressing it with the finger, and by the clearness, there the Abdomen is most conveniently opened in the navil; but if that loosness of the navil appears not, then that part of the Abdomen under the navil, on the right side, must be opened where the spleen is faulty, and on the left side, if ascites grew from the fault of the liver.

The manner comprehends the situation of the Patient, the in­struments and reason of the operation: The Patient, who by reason of water hath his paunch much swoln and stretched forth, must be laid in his bed upon his back, or else must sit upon a low seat. The instruments wherewith the bellies of hydropical people are most commodiously opened, are of two sorts; namely, either the instrument consisting of a pipe with shoulders, H, and a needle, I, Table XII. Figure XVII. to perforate the navil with, or the pen-knife K a little blunted at the point, and having an edge only on one side, Table XII. Figure I. to open the Abdomen below the navil. The navil is most safely perforated, if the instrument with a pipe, Table XII. Figure XVII. be sewed to a band, and that be thrust into the middle of it L, untill it come to the star marked upon it; after this the needle must be taken forth of the pipe, and the pipe must be thrust into the Abdomen as far as the shoulder of it, and must be left there. Incision when it is needful below the navil varieth much: Fallopius makes his incision thus; first he cuts the skin overthwart the Abdomen an inch broad with a crooked knife, and that is blunt on the other side; this being cut, he cuts the rest warily with a pen knife, wherewith the Germans open a vein to let blood, namely with a common lancet. Hierom Fabrit ab A­quapend. useth the same knife Fallopius doth; but he puts that into the skin a little slanting, untill he penetrate as far as the hollow region, and have also perforated the peritonaeum. That the knife penetrated as far as the hollow part, not only is shewed by the water coming forth, but it is known by a Chyrurgian exercised in opening impostumes, when as nothing resists when he presseth; when incision is made, he pulls forth his knife, and puts in a small pipe of silver well polished, with shoulders, and with holes in the sides of it, longer the first time (and afterwards shorter N, which may only go into the cavity) at the end slanting, exactly fitted to the knife, and tied to a band, that it may not slip out of the hole O; by this pipe he lets out the watry humor, not all at one time, but so much as the Patient's strength will suffer, which is known most perfectly and certainly by the pulse. The wat [...]y [Page 178] humor being let forth in a due quantity, he doth not draw forth the pipe, but leaves it in the Abdomen; and he shuts it with a tent of lint P, that he may again let forth the water afterwards. Hydropical persons perforated, must be kept most diligently, that the band may not be loosed, they not being sensible of it, and the pipe fall out, and so the water run all out at one time, and kill the Patient, for so this only remedy of so great a disease may be dis­graced. Following Fabritius, An. 1625. on the 7. day of August, I opened the Abdomen of a certain noble Virgin at Ulma, who was sick of an Ascites, Anasarca, and Tympany, and she lived one year and a half very sound after this perforation; afterwards she died sick only of a perfect Tympany.

Fig. IV. represents the incision of a Fistula of the Thorax, which was done suddenly and almost in a moment, with a Syringotomus, which at one end hath an edge Q, Table XIV. Figure I. and the point of it was wrapt about with a small button of wax R, that when it was thrust in, it might not rend the flesh; then it is thrust into the Fistula, and when it comes to the bottom of it, it is forced through the skin and flesh above, with the right hand; so that the bottom of wax remaining in the ulcer, the point of the knife may come forth by the hole made, which being laid hold on by the fingers of the left hand, the distance between both holes is cut asunder at one stroke. It shews also a wound of the Abdomen dilated to thrust in the intestines, which is the next Figure. ac­cording to the opinion of Galen. L. 6. Meth. Med. cap. 4. is stitched, namely the Peritonaeum with the muscles, and the muscles again with the Peritonaeum.

Fig. V. shews the manner how the lips of the wound of the Ab­domen are brought to touch one the other; and being so brought, are kept so by stitching or clasps. The intestines being put in again, the Assistant shall take hold of the lips of the wound with his hands, and he shall draw forth so great a part of the wound to the Chyrurgian, as is necessary to be stitched; but he sticks in a needle, (i) which draws after it a twisted flaxen thread, from the lower and outward parts, (u) inwardly through the skin, (a) and the muscles (b) that lie under it, as far as the Peritonaeum, (c) after this the Peritonaeum being not touched (c) of this part, he thrusts the needle through the Peritonaeum of the other part, and also through the muscles, from the inward parts to the outward; then taking forth the needle, he ties both ends of the thread, and makes a point; then (z) leaving a space of a fingers breadth, he [Page 179] thrusts the needle through the Abdomen of the same part, from the upward and outward parts (x) inwardly, not touching the Peritonaeum; after that he thrusts the needle through the Peri­tonaeum, the muscles, and the skin, from the inward parts out­ward, and he makes a point, and so he goes forward, sometimes perforating, sometimes skipping over the Peritonaeum, untill there are made so many stitches as are necessary in sewing the Ab­domen. This way of stitching is also to be observed, when the Abdomen, after the Caesarian birth, is to be united with clasps.

Fig. VI. is a truss, or a stay for a Hernia, to be applied to the left groin of people of full growth. The girdle of the truss (a) and the under band (b) perforated with many holes, that it may be shut and opened again, it is made of thin leather, or double cotton linnen; the truss (y) is filled with goats hair, that it may be pretty hard, and may hinder the falling forth of the intestines or the caule; let it also have a fastning before, least the under band passing through may waver from it.

Fig. VII. is a truss to be applied to children, and it is made of the same matter that the former is; but it differs in this, because the girdle of this is not to be fastned on the side, nor the under ligature before; but both must be fastned behind, that children may not so easily untie it.

Fig. VIII. represents a truss applied to the left groin. All things being put in again that ought to be put in, and a convenient cerat being applied upon the part affected, the target, or cushion, must be stuft with goats hair, or wool, two or three fingers length, and applied; which that it may stick fast, and may not easily be re­moved from its place, it is pressed on with a girdle before to the groin, which comes about the loins, and is fastned on at the side, (a) and also with the broader under band, (b) (which being behind fastned to the girdle, and drawn downwards, and so coming under the twist is turned up again) passing by the middle of the cushion, and that knitting before, which is therefore joined to the cushion, that the under band may not flag from it, and passing through, it is bound streight to the girdle before.

The XL Table. Of the placing of the sick to try and take forth a stone out of the bladder and urinary passage; the abating of the heat of urine by manual operation; the extirpation of a Caruncle bred preternaturally in the passage of the urine; of the per­foration of the yard; of binding venerious Warts upon the Praeputium; of the cure of Hernias with the loss of the Te­sticle; of incision made upon the Hymen that is whole; of opening the Matrix that is shut, and of the keeping the Womb slipt out beyond the Abdomen, and put in again, in its natural place.

FIG. I. shews the placing of the sick troubled with the stone; for in this case they search for the stone of the bladder, thrusting [Page 188]

F I

III

IV

V

VI

VII

VII

VIIII

X

XI

XII

XV

XVII

XVIII

[Page 189] the Catheter A through the conduit of the yard, and put­ting the forefinger into the fundament.

Fig. II. shews, besides the way of searching for the stone, the incision of the Perinaeum B, upon the Director C, thrust into the bladder, performed by the pen-knife (Table II. Fi­gure II.) Incision being made the Stone-cutter draws out the Directors, and he thrusts in the Catheter by the wound made in the Perinaeum, that the Dilator, or Speculum Vesicae above the pipe, may come into the bladder without any hurt. The Dilator being applied he draws forth the Catheter, he dilates the neck of the bladder, and laying hold of the stone with a fit instrument he pulls it out, &c. Read Ambros. Paraeus lib. 17. from chap. 35 to 48. concerning the drawing out of a stone: and that exquisite Treaty of Guill. Fabrit. Hildan. of cutting for the stone in the bladder.

Fig. III. a stone is taken forth of the urinary passage without cutting; because if the stone came out of a more narrow place; namely out of the neck and orifice of the bladder, it will much more easily be taken out of a larger place, as is the conduit of the yard. I take the Probe of Aquapendens, which at the end is made hollow like a spoon D, as an ear picker, this I thrust into the passage, so that it may pass beyond the small stone E, and may in a manner comprehend it in its hollow place; then through the pin of the Probe that is hollow, I pour in oil of sweet Almonds into the urinary passage, and I draw the Probe gently to me, for so the stone is by degrees drawn forth; both pressing of it with the fingers, and drawing it with the Probe; see Table XIV. Figure VIII. Also I have often observed such stones that are fallen into the urinary passage, to come forth of themselves, without cutting or help of the spoon; if the Pa­tient sit frequently in an emollient bath, and take medicaments that are moderate to break the stone, or will suffer them to be dropped into the conduit of the urine.

Fig. IV. doth asswage the heat of urine, which in a virulent Gonorrhaea is so vehement when a man makes water, that the Patients had rather die than make water. When therefore such heat and pain is felt in making water, that it cannot be asswaged by any medicaments taken at the mouth, or poured in, the Pa­tient shall put a silver most smooth pipe into the passage of the yard, tied by threads (F) which he must hold in his hand, [Page 190] least the pipe by force of the urine coming forth, should be driven out again from the urinary passage; but that it may stay fast in, until the urine run forth through it without pain, not so much as touching the conduit of the yard.

Fig. V. Oftentimes a caruncle is bred in the urinary passage from an ulcer, and it sometimes grows so great, that it stops the water. This is taken away and cured by manual operation, and fit medicaments that have a corroding power; but that no other parts but only the caruncle in the passage may be eaten away, or the water should wash away the medicaments that are applied, Hierom. Fabrit. ab Aquapend. invented an instrument, by means whereof nothing but the caruncle is eaten off, and also it hinders that the medicament applied to the caruncle, is not washed away by the water that is frequently made. For a pipe (G) is made of linnen, smeared over with white wax, (in length a fingers breadth, and so broad that it may be equal to the silver Catheter I) which hath a long thread hanging at it. This pipe, first smeared with­out with a convenient medicament, as for example;

• Take Hony calcined to ashes,
• Tutty prepared,
• Fresh Butter washt in Planten water,
• Turpentine so washt also,
• Yellow wax, of each half an ounce,
• Burnt Allum, half a dram.

Mingle them and make a Liniment; which, as I have found by common experience, will consume the caruncles of the urinary passage without pain, or excoriation of the parts that are sound. Some highly commend the experiment of Rochus Cervierus;

• Take powder of quick Sulphur,
• Mercury precipitate,
• Verdigreas,
• Crud Antimony, of each three drams,
• White Wax, one ounce.

Mingle them according to art in a leaden Mortar, to the form of an unguent. The pipe being anointed with one of these medica­ments, it must be fitted to the wier H, that comes forth be­yond the silver pipe; and together with the silver pipe and wier, it must be thrust into the urinary passage, until it meet with the caruncle; and when it is come to the place of the caruncle, the silver pipe with its wier must be drawn back; but the pipe made of linnen, smeared over with wax and put in, must be left in the [Page 191] passage, that the urine may come forth by it; and this also hin­ders, that the medicament applied to the caruncle cannot be washed away by the urine.

Fig. VI. Sometimes it happens that infants are born without any hole in the top of their yard to make water by; this must be presently cured with a sharp knife that hath a narrow point. The sick must be laid on his back, and the yard must be taken hold on near to the glans with the left hand, and with the knife held in the right hand, the hole that is shut must be opened; when this is done, a tent of lead must be thrust into the hole, that is small and solid, and anointed with some healing medicament; which must be taken forth when the sick makes water, and then thrust in again, and this for three or four daies, until the lips of the hole be skinned. But if children be born with a very narrow hole in the glans, that must be presently enlarged by thrusting in a small tent, (made of the pith of Elder, and anointed with unguent of Roses) that it may swell by the moisture it drinks in, and being swoln may enlarge the hole.

Fig. VII. shews pocky excrescences of flesh in the glans and praeputium, and the way to cure them, which is done most com­modiously by binding; for since that these caruncles have a nar­row basis, they are tied with a single small red coloured silk thread, and they will fall off in two daies; sometimes they are touched most profitably with Oil of Antimony or Logadorum; sometimes they are as well laid hold on with the pullers, and are cut off with a pen-knife; after that the place is cauterized with a very red hot iron, that the blood may not taint the parts near unto it.

Fig. VIII, IX, X, XI, XII, XIII, XIV. represent a most horri­ble Chyrurgery, wherewith at Nursium, in my time, the most famous Gelders of Italy did cure Hernias of the Intestines. The sick lies on his back, and is bound upon a table; then the whole dilatation in the groin is marked oblikely with ink; the Assistant, at the bottom of the Abdomen, presses together the Intestines, that they may not come forth; then the Chyrurgian, with a crooked knife, making an oblike incision of the skin, Figure VIII. (that the progress of the Peritonaeum may be seen, Figure IX.) he cuts the Peritonaeum with the same knife, Figure X. and by the hole Figure XI. he forces the Testicle out upwards; after this with his fore finger he pulls away all the membranes, and sepa­rates them from the Scrotum; and first of all he draws forth the sheath membrane dilated, Figure XII. * and the testicle with it; [Page 192] then he laies hold of the spermatick vessels, and the sheath coat, with a convenient pair of pincers, and he fastens them together; then he cuts forth the testicle above the future with a knife, and casts that away; (others tie the spermatick vessels and the coat in two places, and laying hold of the ends of the lower thread, they cut forth the distance with a pair of cizers, and cast away the testicle) but he cauterizes with a red hot iron all the vessels that bleed, and puts them in, leaving a long thread hanging without; and lastly he puts in an iron instrument (L, Figure XIV.) by the hole of the groin, which hath a ball of wax at the point of it, as far as the bottom of the Scrotum, that he may make a hole through it to purge forth the matter, which daily falls into the Scrotum from the wound in the groin; and he keeps the hole open by a tent put into it, untill such time as the wound in the groin be cured.

Fig. XV. represents a membrane going overthwart the womans privities within, which the Antients took for hymen.

Fig. XVI. The membrane called hymen, which hinders copu­lation, but it is perforated above, to let forth the menstruall blood, with a crooked knife (Table XII. Figure II. to whose point a little button of wax is fastned) it is cut asunder, that the woman may be made most fit for man. And if that little skin do alwaies cover the sheath of the matrix, Paulus lib. 6. cap. 27. cuts it with Celsus his Spatha, Table II. Figure I.

Fig. XVII. Teaches how Hierom. Fabrit. ab Aquapend. where the lips of the womb cleave together, uses manual operation according to Paulus: He laies the woman on her back, (in this manual opera­tion, and that of the precedent Figure) so that her legs are drawn up as high as her belly, and her thighs before stradling wide; he also puts her arms under her hams, and binds them to her neck with fit ligature; then with a knife made to cut fistulas, either with a Syringotomus sharp at one end, (Table XIV. Figure I) or with a Woodcocks bill, Table XII. Figure I, II, III, and V. he cuts the lips that grow together, being first marked with ink all the length of them. The lips being parted, and the flux of blood stopt, a leaden pipe is anointed with some healing medicament, and thrust into the matrix, till the cure be perfected, that the lips may not grow together again.

Fig. XVIII. treats of the matrix falling forth without the Ab­domen, which thing happens to women, when the membranous ligaments of the womb are either stretched or broken. The cure [Page 193] of this disease requires three things; the placing again of the womb, fallen forth, in its proper place; then to keep it there in its place; and lastly, to knit or consolidate the ligaments.

Before we repose the womb in its place again, we must con­sider whether the falling forth of the Matrix be single, or whe­ther there be not inflammation or a cold humour join'd with it; for when these appear we must not attempt to put it back to its place, untill such time as the diseases be gone. A Cataplasm or lump of raw flax boiled in a sharp lixivium, and w [...]ung forth, will stop the inflammation; concerning which see the cure of a rupture of the intestines, Table XXXIX. Figure VIII. A fo­mentation of the decoction of Mallows, Marsh-mallows, Ca­momil flowers, &c. will dissolve a cold tumour. The said tumours being cured, and the belly excrements voided by Cly­ster, and water being made (that the Matrix may be free from all compression) the Chyrurgian, or some experienced Mid­wife, must lay the woman on her back, so that her hips may lie higher, and her hams may be bended inward, and her legs may li [...] stradling; then he must take the Candle O (which must have a basis) made of Wax and Assa faetida, and is as thick as the sheath of the Matrix; and with this, not using any violence, he must thrust inward all that which fell down, untill the whole lump be reduced into its place.

This being done the Patient shall fasten the candle with a three double cloath dipped in red wine, and pressed forth again, and with the band, Table XLI. Figure III. for eight or nine daies let her lie with her legs stretched forth and joined close together, so that one may lie upon the other; let her bind an Eagle stone to her arm, and let her put sweet smelling things to her nostrils, unless she be subject to suffocation of the womb. The Matrix being put back into its place, which fell down by relaxation of the ligaments, the body must be purged from watry and phleg­matick humours; and (after the applying of cupping glasses, without sca [...]ification, with a great flame, under the navil and kidneys, and amongst the use of inward astringent medicaments) upon the region of the Matrix, and near the groins an ast [...]ingent plaister must be laid; and the ring of Box P must be thrust in­to the sheath, and there left untill the cure be perfect. The woman must every third or fourth day remove the plaister, and shall thrust the pipe or Metrenchytes, Table XIII, Figure III. into the sheath of the womb; then, for an hours space, let her [Page 194]

I

II

III

IV

V

VI

VII

VIII

[Page 195] fit in a bath made of moderate astringents (for if they be too strong they stop the Tearms) and let her lay on a new plaister. She must observe a due regiment of things not natural, which was prescribed to those that have Hernias in the quoted place. To women not yet well purged, after child birth, the use of astringents is most dangerous. When the membranous liga­ments of the Matrix are broken, we must mingle, with an astrin­gent cerat, Emplastrum Nicolai or some other healing plaister.

The XLI Table. Of the shortning of the Clitoris or womans yard unprofitably aug­mented; of Metrenchyta, Speculum ani, and Matricis; of drawing forth the dead child, and putting back again of the fundament fallen down.

FIG. I. teacheth how Hierom. Fabritius ab Aquapendente, with an instrument made for a Polypus, cuts off the unprofitable increasing of a Clitoris, which is a common disease amongst the Aegyptians and Arabians. A shews the Clitoris laied hold of with the pincers: B shews the body of the Clitoris cut off, and placed beyond the pincers.

Fig: II. represents a syringe for the Matrix, that is fastned to the syringe, Table XIII. Figure I. that it may be put into the hollow Matrix, to inject by it such liquors as are conve­nient.

Fig. III. shews the Truss which keeps on the medicaments laid upon the outward orifice of the Matrix.

Fig. IV. teacheth how to use the Speculum Matricis, pictu­red Table XVI. Figure IV. which Paulus lib. 6. cap. 73. de­scribes in these words following: Let the woman be placed on her back in a chair, drawing up her knees to the top of her bel­ly, but her thighs stradling; let her arms come below her hams, and with fit bands let them be bound to her neck. But the Chy­rurgian, sitting on the right side, shall search with a proving instrument, called a perspective, fit for the age of the Patient; and by his Probe he shal measure the depth of the Womans Ma­trix, lest if the pipe of the Dioptra be too long, the Matrix [Page 196] might be pressed by it. And if the pipe of the perspective be longer then the hollow of the matrix, linnen clothes folded must be put into the brims of the privy parts, that the Dioptra may be placed upon them; you must warm the pipe, anointing it with conve­nient oil▪ and so gently thrust it in, having a screw at the upper end of it; the Dioptra must be held by the Chyrurgian, and the screw must be turned about softly without violence by the Assistant, that thereby the plates of the pipe being drawn asunder, the hollow matrix may be laid open, to find out that which requires manual operation.

Fig. V. The dead child is drawn forth with crooks, (namely, when the child, by reason of its preternatural situation, cannot be driven forth with Horse stones prepared, which Horatius Au­genius commends to us, or by drinking the milk of another wo­man) Table XVII. Figure IV. pictured out of Andreas à Cruce, and put into both cavities of the eyes; if it cannot be taken forth whole, it must be cut with the knife, (Table II. Figure II.) and observing what must be observed, it must be taken forth by pieces, See more in Hierom. Fabrit. ab Aquapend.

Fig. VI. The ars gut of children newly born being shut, is per­forated with a lancer: After the operation, you must apply such things as were prescribed in the perforation of the yard and the matrix.

Fig. VII. Shews the reposing again of the right gut fallen down; it must be done gently, and attempted with the fingers of the Chyrurgian, (but others commend the Patients fingers) with a four double linnen cloth D, and with a band to hold on the medi­caments, and to keep the intestine in its proper place.

Fig. VIII. The right gut is looked into with a dioptra, Table XVII. Figure II. made something hot, and anointed with oyl, that it may be made slippery, to search out the quality of the Emrhods. Also we know exactly the condition of ulcers, by putting a tent into the fundament, and leaving it there an whole day, and then pulling it forth again. The ulcers of the right gut being seen, are most safely cured with a pipe (having a long handle, and perforated on the side, Table XIV. Figure I.) covered with a linnen cloth wet in sharp wine, and pressed forth again, with a hole in it; (for a solid pipe, Table XVI. Figure I. is only smeared with the white of an egg) and thrust into the fundament, it must three or four times receive the iron wier pin made very red hot, Table XVI. Figure IV. and Table XXXVII. Figure I. as we said before for the manual operation of ozaena. The operation being [Page 197] ended, the place affected must be dressed with medicaments poured in, and laid to it, untill it be perfectly cured.

The XLII Table. Of Incision for F [...]stulaes; cure of the Emrods; application of Enteren hyta; and of two Monsters.

THe fistulaes of the fundament are of two sorts; some rise from an ulcer of the right intestine, which hath divers causes, as salt flegm, sharp choler, and the French Pox, (especially in hotter Countries) which by corroding produce fistulaes in the fundament; others rise from some knot (by riding or by some fall) breeding outwardly about the fundament, and coming to suppuration; and if the quitter of it cannot find a way out, it will make a deep hole.

The Antients either eat away the right intestine, and withal they perforate the four common covers, that so the corrupted matter, or rather bloody atter may come forth outwardly by the skin, or else they rest abou [...] the musculous parts, and such as are next the skin. Also the latter Chyrurgians perforate the intestine, or else they proceed only to the outward coat of the right intestine.

Aquapend. L. 3. Pentateuch cap. 12. doth exactly handle the signs of the fistulaes spoken of. I have seen all these fistulaes cut with iron instruments neatly, and happily cured, by the most excellent Physitian and Chyrurgian, Adrian Spigelius, my most honoured Master (whose Anatomical Preparator I was, and whose Assistant I was, in performing manual operations, for ten years) for seven years, namely from the year 1616, to the year of our Lord 1623. I practised in the most eminent and famous University of Padua, which is held to be almost the principal of all Universities, not only in Italy, but also in Europe and elsewhere, by reason of the splendor of most famous Doctors, the authority of the most an­tient Studies, and the rare Monuments of all Learning and all Vertues. Nor are there wanting to me men of great name, who with great courage following the wars, were troubled with fistulaes in the fundament coming from the French Pox, these I cured in my own Country, relying upon the frequent experience of my Master, by the way following.

I

II

III

IV

[...]

VI

VII

VIII

IX

The last Table. Of Galen's sling, a Canker of the lips; compression of the Artery cut; distending of the foot contracted; binding of the arm that is stiff; the opening of a great Fistula in the thigh; the places and bands for fontanels; the taking out of Musket bullets from wounds; the cutting of melancholy veins, called Va [...]ees; the bringing together of the lips of wounds by clasps; the scraping away of the shin bone that is rotten; and of the ligature of the breast, which Galen calls Cataphracta.

A Is Galen's sling, Lib. de Fasc. cap. 62. namely a band divi­ded into four parts, prepared to bind up the under lip: The description of this I was willing to transcribe, for the good of those that are studious in Chyrurgery; but especially for Bar­bers who have not the opportunity to see that book concerning [Page 206]

A

B

C

D

[...]

F

G

H

I

K

L

M

N

O

Q

[Page 207] bands, that they may know that this band, and the way of using it, is both the most p ofitable and most necessary for Chyrurgi­ans to know, to cure the diseases of the lips, and principally th [...] Canker ulcerated. The middle, that is whole, lay upon the lower lip; but bring the upper parts to the chin, and from thence to the hinder part of the head; and there draw them like to the figure X, one passing above the other, to the top of the head; and between it and the fore-head, and deliver it to the Assistant; but the other two parts bring under the lower part of the ears, and d [...]aw them up to the fore-head, after the fashion of the letter X; and so bind these, and those delivered to the As­sistant, all together.

E shews the lip ulcerated, and bound with the sling band according to Galen's mind. The Patient was Gallus Sigman, a Country man of Langenavia, in the Jurisdiction of Vlma▪ who had an ulcerated Canker in his lips; who when, to his g [...]ief, he perceived, by many skilfull Chyrurgians, that he could not be cured of that mischief, unless it were cut forth by the roots: Being a poor man, he desired humbly from the famous Senate of that Republick where he lived, that he might be taken into the Hospital; and that the Canker might be cut forth, with an iron instrument, by the hand of the well experienced Chyrur­gian George Riedlin; when it was cut off with the pincers, and the ulcer was almost cicatrized, it grew up again. The famous Senate being better informed of this growing of it again, com­mitted the Patient to my care. This man, by reason of the pains of his head and limbs in the night, was much suspected by me, and so was carried to the Hospital appointed for those that are sick of the French Pox. He drank the decoction of Guaicum, whereby the pains of his head and outward parts ceased, But the Canker, being dressed with topical remedies, did yet pitifully afflict the poor man. Then I thought fit to cool his body with drinking Goats whey clarified, because it was over heat with sweating medicaments; and then to purge him from melancho­ly humours, by tempring of them with this Magistral decoction following:

• Take River water, 15 pounds.
• Whole Barley, 1 pugil.

Let them boil in a close vessel till the Barley split: Then add

• Leaves of Borage,
• Cichory,
• [Page 208]Betony,
• Carduus,
• Sow thistle, of each 1 handfull.

And let them boil again till 12. pound remain, casting away the herbs: In the strain'd liquor infuse for 24 hours,

• Roots of Polypoe, 3 ounces.
• Pulip of Coloquintida tied up in a rag, 2 drams.
• Roots of black Ellebore prepared, half an ounce.
• Our Orris root,
• Crud Agarick, of each 1 ounce.
• Raisins, 6 drams.
• Aniseed, half a dram.

Mingle them all, and let them boil till half be consumed, and at the end for one boiling add

• The best Cinamon, 2 drams.
• Nutmeg sliced, 1 dram.
• Senna leaves without stalks, 1 dram and a half.

The strained liquor is divided into nine doses, that one dose must be seven ounces, each of them was kept in a glass, oil being pou­red on it to swim a fingers breadth above it; and it was given every other day early in the morning; after which the Patient lay in his bed, well covered, untill his body grew moist; and an hour after he took some broth, and because of the Coloquintida the potion was somewhat bitter; presently after the taking of it, he swallowed a little of a rosted apple, or half an ounce of Raisins. This Purga­tive doth easily attract, not only the humour that may flow to it, but also that which is already come thither. And note that by the frequent use of this decoction, many have been freed from Can­kers ulcerated; and more have been cured that were not ulcerated. Thus much by the by concerning this decoction.

His body being prepared, I was so won with the Patient's intrea­ting me, to cut off his lip, that I did it, at first sight, with very good success; but the next day I observed a small knot, which the Pincers left, which is an instrument very inconvenient for such ma­nual operation.

I attempted to consume this knot with that caustick powder, which Aquapendens got of an Empirick, and describes it Lib 1. Pentateuch; but this would do no good: Whereupon I began to doubt of any certain cure, and to fear that the disease would come again, being there was so great appearance of it. But the Patient, as I commanded, fell to drink again of his purging decoction, every fourth day; and when the ulcer, by the help of this following un­guent

• [Page 209]Take Oil of Roses compleat,
• Of Myrtils, of each 1 pound.
• Suet of a Calf gelded, 6 drams.
• Juice of garden Night-shade,
• Plantain, of each 10. drams.
• Wine of Pomgranates, 4 ounces.

Let them boil untill the juices be consumed, then strain them, And

• Take Ceruss in powder, 10 drams.
• Lytharge prepared, 2 ounces and a half.
• Lead burnt and washt,
• Antimony prepared, of each 5 drams.
• Tu [...]ty of Alexandria, 5 drams.
• Camphir, 5 drams.

Mingle all in a leaden Mortar, and make an unguent.

guent of Tutia, was almost whole (for there remained nothing but that small knot) by a good regiment of diet, and well pro­vided with outward and inward remedies, having great hope of a sudden cure, he returned homewards with great joy. But that which I feared before, when half a year was past, came indeed; namely, a new relapse, a mischief far worse than the former. But I think this relapse is to be imputed unto the Pincers only, whereby I performed the operation; for this in­strument was the most unfit for this operation. Wherefore if a Canker be run over the whole lip; let the Chyrurgian, taught by mine and Riedlinus his errour, take heed that he cut it not off with a pair of Pincers; for it is almost impossible but that it will leave some root behind, from whence the disease will grow up again.

I remember that I have sometimes heard the most excellent Adrian Spigelius give this caution in his publick Lectures, yet I regarded it not, untill such time as I found the experience of it in this Country man and another; that this caution not being observed, the Patients are in danger of their lives, and the Chyrurgian to lose his credit. The sick man being the second time fallen to a relapse before, now comes the third time to de­sire my help in manual operation; and I had performed it accor­ding to Aquapend. his direction, with a peece of silver money, having a very sharp edge, and dipt in aqua fortis, unless the vessels round about had been so extreamly swoln, that I had cause to think this would be but labour in vain.

B is the use and application of that Instrument which I described before, Table XVII. Fig. III. and caused the picture of it to be set down. I have found this to be the most useful in wounds, or rather for pricks of the Arteries of the wrist, which easily happen in a duel, for to stop the bleeding, as it shall be made appear under­neath by a singular observation. Others take silver money, which they binde over the wound; but because that ligature must be very straight, (for if it be too loose it will not stop the flux of blood) by reason of a gangrene ready to fall upon the end of the hand, and sphacelus upon that, (for the vessels are so pressed down, that nourishment and vital and animal spirits cannot come to them) it seemeth to be very dangerous, wherefore I think they would provide better for mens safety, if all Chyrurgians would have such an Instrument in readiness, to use when necessity requireth it. At Padua, where the use of Anatomy and Chy­rurgery hath been in great esteem, and flourished for many years, in my time there was a most experienced man to open an Artery, who for the cure of the most bitter pains of the head, by per­swasion of the Physitians, oftentimes cut the Artery of the wrist, and making an evacuation of as much blood as he was ordained to do, he pressed the wound so close with the foresaid Instrument, that not one drop of blood could come forth against the will of the Chyrurgian, nor yet any symptome otherwise to be feared followed upon this compression.

It often hapned at Vlma, that by unskilful Quacksalvers, and men not worthy of the name of Chyrurgians, the Artery that accompanieth the vein Basilica, was opened by mistake instead of it, whence oftentimes there was made too great evacuation of blood, or a great aneurisma, which ill cured caused death: wherefore if hereafter accidentally any such errour happen, for the remedy of it (besides that remedy the most famous Colledge D. D. Gregory Horstius propoundeth in the first of his Chyrurgical Observations, which is most worthy to be read) such an In­strument, which by pressing the Artery, will stop the bleeding of it, that it may be applied to the Artery of the arm being hurt, in my opinion would be very convenient. In Helvetia they hap­pily press down the Arteries of the temples, that are broken or cut by chance or by Art, with the convex part of the middle shell of the Walnut.

C sheweth the application of the iron Instrument (which I took care to be printed before Table XVII. Fig. I. out of Guil. Fabri. Hild. [Page 211] his book of burnings) serving to extend the knee contracted. Iacobus Murdel, Son to Iohn Butcher, being but five years old, stum­bled and fell upon the earth paved with flints, as he ran after his Father, and he walked up and down afterwards, and never com­plained of any pain untill the fourth day after, when he began to halt, and to complain of his knee that was lame; his Mother, careful enough of the boy, sendeth for a Barber, called Iohan. Andreas, who presently applied a Cataplasme against bleeding of Foelix Wurts his prescription, and the next day (to discuss as I sup­pose) he applied a three fold linnen cloth wet in hot wine and pressed forth again. The boy thus drest, fell into a most sharp fever, which by convenient remedies rightly prescribed by a Physitian, ended on some critical day, by an Impostume in his foot that was affected, namely an Erysipelas inflammation, which went over all his leg and thigh, also as far as his groin, that vehemently afflicted the childe with heat, redness and pain. The inflam­mation being cured, there remained upon the knee that was bruised before the Fever came a huge swelling, which when it re­sisted all resolving means, they tried to bring it to suppuration, and they opened the knee both on the outside and inside with a caustick medicament, and no matter, or else very little came forth. The business being thus, the ordinary Physitian departed, and left all the business of the cure to the Barber And [...]eas; this man dressed the childe with the best skill he had, and healed up the ulcers made with the caustick, and hardned the tumor exceedingly. The Mother being now more careful then ever, and finding the good man not sufficient for this cure, and also doubtful, she sent for me to ask my counsel. These things were by relation, but when I came, I found the tumor in his knee not unlike to that which they call Glidch swam, and the boy so contracted, that he could not extend his knee. Having made this prognostick, that this disease would be doubtful and of long cure, I began the bu­siness thus: To soften and discuss the tumor, I did daily, for a quarter of an hour, foment the part with a sponge wet in the fol­lowing decoction.

• Take Herbs,
• Mallows,
• Mullens,
• Betony, of each one handful and a half.
• Mallow flowers, one handful.
• [Page 212]Linseed, one ounce.
• Marsh-mallow roots, two ounces.

Cut and bruise them, and put them in a paper.

After fomentation, I laid on the cerat Diasinipi, which Hierom. Fabrit. ab Aquapend. describeth cap. de Meliceride, and Doctor Spigelius corrected thus.

• Take Sal Gemmae,
• Lytharg of Gold
• Ceruss, of each four ounces.
• Wax and Turpentine, of each two drams.
• Galbanum,
• Opoponax, of each half an ounce.
• Mustard-seed powdered, two ounces.
• Old Oyl, nine ounces.
• Sharp Vineger what is sufficient.

Make a liniment, or a soft cerat according to Art.

Under the hams and on the sides; I anointed the knee with this following unguent.

• Take Unguentum Evae, two ounces and a half.
• Nervinum, six drams.
• Cerat Citrinum, one ounce.
• Oyl of Earth-worms, six drams.
• Of Foxes, two drams.

Mingle these for an unguent.

• Take Oyl of Olives, one pound.
• Marrow of an Ox leg,
• Yellow wax.
• Rosin of the Pine tree, of each two ounces.
• Fresh Butter, three ounces.

Mingle them and make unguentum Evae, or A­nodyne, which Foscarinus brought with him out of Turky.

• Take juice of Tobacco six ounces.
• [Page 113]Yellow wax very new, four ounces.
• Rosin, three ounces.
• Turpentine, two ounces.
• Oyl of Myrtles what is sufficient.

Make a soft cerate.

I have the description of this out of the first Book Pentateuch. Chyrurgic. Hierom. Fabrit. ab Aquapend. cap. de herpete miliari.

The knee abated of the swelling, by the continued use of the fomentation and cerate; but by anointing the ham, the Patient found no remedy for the extending the part, where­fore I applied this Instrument, wherewith by degrees the leg might be extended. It was an iron; which the Patient (after he hath first applied to strengthen his knee Ceratum Barbarum, mingled with the Magistral Diasinapi, and anointed his ham, and laid this Sparadrap upon it.

• Take the cerate Citrinum before described, two ounces and a half.
• The newest yellow Wax, two ounces.
• Rosin and Turpentine of the Pine tree, of each one ounce,

Mingle all at the fire, and dip your cloth in it.)

wore night and day, every day turning the screw of the In­strument a little, untill the leg was become streight, so that in one year the Patient could walk without a staff. The cause of the contraction was the ill situation of the foot, which they should have prevented with a wooden capsula, which you may see Table XXI. Figure VI.

An. 1636. on the 10. day of October, I was called to come to a boy whose name was Martin Gravius of Leishmens, who shewed me his leg contracted toward the hinder parts, from a ganglion in his knee, which, premising universals, I brought to stand right in eight moneths by the same Instrument, and with topicalls applied.

D. Table XVIII. Figure V. sheweth the use of the In­strument; [Page 214] for as for the extension of the arm, there is nothing better then to carry a heavy stone in a mans hand, so to bend it by degrees; I have found nothing better then this Instrument. The Patient was a Souldier's boy, who had his arm out of joint, and by reason of ill situation he could not bend it; this boy, as I did the others before, I daily anointed, applying the Sparadrap, and I bade him wear the Instrument, and he grew well within two months; and he could for his need bend his arm without any pain or hindrance at all. Wherefore let young Chyrurgians take heed, that they place broken members as they should be placed; for oftentimes, besides the contraction of the part, inflamma­tion will follow an ill figure. See Table XXVI.

E. An. 1626. on the 19. day of November, my brother Mar­tin called me to his father in law, Iohn Wolventer, a Mariner of Vlma, and most skilful to sail in the Danow: This very man, whom my most famous Colleague, D. D. Greg. Horstius, cured in his Chyrurgical Observations IX. shewed unto me a Fistula in his left thigh, (which from a contusion was brought to suppuration, and being care [...]esly dressed, came to this pass) and asked help from me. I trying the bigness of the Fistula with my probe, found it to be only superfic [...]al, and long and broad enough: But because these sloping Fistulaes are very seldom made to solder to­gether, as it is well known, the next day I attempted to cut it with the cizers called Deceptoria, spoken of before Table VII. Figure IX. (not being at that time skilled in the Instruments ca led Syringotomi, described Table XII. Fig. I, II, III. and Table XIV. Figure I.) when the Patient was not aware of it, think­ing to fill it up with flesh afterwards: But when that operation pro­ceeded too slowly by the cizers, the Mariner, perceiving the In­strument, removed his thigh, and with his hand thrust off my right hand; whereupon, laying aside the cure by this Instrument, I bound up the Fistula, a little dilated (as you may see in the Figure) with the white of an Egg beaten, and some carded flax; when the blood was sto [...]ped, every third or fourth daies I syringed it with Hydromel to wash the cavity; and on the fifth, sixth and seventh daies, I injected sharp black Wine wherein Flowers of wilde Pome­granates were boiled, and Pomegranate pills, &c. and I bound on a new sponge wet in the same liquor, and pressed forth again, with a long roller that was three fingers broad (for a broader will not bin [...]e it so well;) I began my ligature from beneath, on the [Page 215] lower parts, and I ended it above the Fistula on the sound part; with these medicaments, that have an huge glewing quality, and the mnaner of ligature, my Brother's Father in law was most luckily cured in one week: And from that time I never used any manual operation, unless medicaments to cure were used first in vain; and never after that time did I use those deceitful cizers, called Deceptoria, because they deceive the Chyrurgian and not the Patient.

F sheweth the place for Issues on the arm. Fontanels are made in divers places, but those that are made by caustick on the arms are the best, and seem to be most convenient; and therefore Phy­sitians make choise of them before the other, namely to make evacuation of all those humours which may offend mans head; because these have the middle place exactly between the parts above and the parts below, and they hinder the rising up of the humours unto the head; and they most commodiously make re­vulsion of them, and derive them that are flown up to the head, by reason of their convenient distance: and they do not onely help much for the diseases of the head, eyes, ears, nostrils, mouth, jaws and throat, but also for the diseases of the thorax, heart and lungs. And though these Issues for the said diseases do help much, and are most commodious for the sick, and that the rather, because they can look to them, and dress them with their own hands; yet there are multitudes of men who condemn all Issues, despising their own healths, because these Issues require care and labour; others hate them because they stink; and some are afraid to have them burned, because they fear the fire. I answer these men, that they cannot put off and on their clothes evening and morning without labour and care, nor can they void their excrements without stink; but as this or that is necessary for mans life, so are Issues for some people to live in health, and enjoy their lives most needful: And as no man repenteth his labour to put off and on his clothes, so no man complaineth of these Issues, but taketh great pleasure to dress them, either from the delight they finde when they itch, or because from day to day they clearly see the evacuation of the matter, which was bred by errours committed, and being kept in the body would produce much hurt; or rather because hereby men regain their healths which they had lost: and therefore oftentimes men are not con­tented with one Issue, but will have two or three, or more made, [Page 216] as they finde cause. Add to this, that Fontanels, if they be guided by Art, do not stink, and made in a convenient place will cause no pain.

The place for Issues requireth four conditions. First, That the Patient can see it. Secondly, That it be sit for ligature. Thirdly, That it may have a vein. Fourthly, That it be made between two muscles, to prevent pain, wherewith motion is easily hindred.

This place is easily found, if the Chyrurgian doth variously turn and bend, and extend the Patient's arm, untill he finde the due separation of the muscle Deltoides and Biceps: Many make the Issue upon the Deltoides it self, some at the end of it, others on the upper part of it; but I, for the said conditions, make choice of the place marked with the letter F; namely, the distance between the muscles Deltoides and Biceps; and that rather on the upper part, which is less sensible, then on the lower part, and the humour runs in short time to it.

Having found the place for the Issue, the way must be con­sidered on; for a Fontanel is made with a lancet, a potential or an actual cautery: But since a red hot iron is most usual with the Inventours of this manuall operation, I do not like potentiall cauteries, because they work slowly, and oftentimes with great pain; nor are they so safe, because we do not exactly know their force in working; but sometimes, besides our expectation, we finde them weaker or stronger then we imagined. Also I refuse a cutting Instrument, or lancet, for the reasons now alledged; to which I add, that cutting of an Issue will make it bleed, and many cannot endure to see their own blood. The Antients, with great dexterity, used the red hot iron which was crooked, and had a long handle, (described Table I. Figure I.) But when they found that that Instrument did not only burn the flesh, marked before by the Chyrurgian, but also heated the parts that are near to it, they invented another Instrument besides this, that had a pipe to it that defended the parts adjoining, see Table I. Figure I. through this pipe, not heated, and thrust hard upon the skin, they thrust in a solid red hot iron, that it may enter as far as the Chyrurgian will have it, sometimes deeper, sometimes not so deep. Iulius Casserius Placentinus invented an Instrument described [Page 217] before Table I. and here it is marked with the Letter G, which hides the fire, and defends the parts near adjoining from being hurt: And above all other instruments to burn fontanels, that are without the head, it is the most convenient, and the most safe. A­bove six hundred Patients will testifie that I have done this to them, to the admiration of the standers by, and to the laugh­ter of the Patient; and so many are now alive who have issues of my making.

H is the ligature to bind upon the issues of the Arm; it is most commodious, because it is easily put on by the Patient; most profitable, because it preserves the issue in its place; and it is most fair, because being made of white linnen, it may be washed; neither is this like other bands so easily seen or felt.

I is the place for issues in the Thigh (which must be sought for four fingers breadth above the knee, between the muscle Sartorius and Vastus Internus) most fit for ligature; and be­cause the vein Saphena joins to it, where an issue is most pro­fitably made for hysterical passions, to make revulsion and derivation. I have cured Women this way, whose names I conceal, who by the stopping of their Courses, were trou­bled with Furor uterinus and other symptoms; and more that had ulcers upon their shins hard to be cured; there by revul­sion, but here by intercepting and deriving.

K is an instrument that I made most happily, about the beginning of the muscle Gastrocnemius, against the pain of the hip. Truly the most excellent Physitian Adrian Spigelius, Lib. 5. Cap. 9. in Human. Corp. Pabric. commendeth the ma­king of an issue, in the Calf of the Leg, with an actual cautery, by reason of the passage of the Ham vein; or for the meeting to­gether of the beginnings of the muscle Gasterocnemius; which Daniel Bucretius, upon Iulius Casserius Placeutinus his Anatomical Tables (which I bought, with Spigelius his money, from the heirs of Casserius) marked L. 1, Table 2. with the Greek letter π. But because that place, by reason of its sloping downwards, is very inconvenient to bind; I, according to Andreas Vesalius in Corp. Human. Fabric. Lib. 2. Table 10. [Page 218] De Musculis, chose a place somewhat higher, and that not without good reason. For an issue in this place hath all the conditions of a good issue that I speak of before. 1. The Ham vein, which both the Antients and latter Chyrurgians, with very good success opened for pains of the hip; and for ma­ny more diseases which Aurelius Severinus hath collected Lib. de Angeologia, Cap. 26. 2. Here is the distance between the beginnings of the muscle of the Calf of the Leg; for that no­ted nerve, that runs under the knee, is not in danger to be hurt; for where the issue is made, that nerve going for­ward hath already crept deeper, that it cannot be offended with a red hot iron. 3. For the Ligature that standeth fast. 4. The Patient himself can govern and dress it when he pleases. It is a most certain thing that he who is troubled with pains of the hip, cannot easily be freed from them; that he can promise, that for the future, he shall never be troubled with those pains any more. Yet I can rightly say, that after the use of the Bath at Thalfengens, commonly called Sosunbrun, lying in the Country of Vlma, by help of this issue, I cured myself, for nine years, from this pain; and may be longer, if it please God I live, taking my farewell from all opening of the hip vein, and all purgatives and sweating medicaments, and from all topicals, which I used, for a whole year, by the advice and prescription of the most famous Physitians. Where­fore if hereafter, for such continued pains of the hip; out­ward and inward remedies be used to no purpose: by my coun­sel let men flie to this manual operation, with good hope of recovery, as unto a sacred anchor; namely, to burn a fon­tanel in the place marked, for I doubt not but the Patient will have his health, and the Chyrurgian shall obtain great praise by it.

L is the Band for issues in the Thigh and Calf to be bound with; and it is the best of all bands. How fontanels made should be kept and rightly ordered, we might learn out of that leaf of Aquapendens, where he speaks of it, in his work of ma­nual operations, under the Title of Fontanels; unless that by the carelessenesse of the Printer, to whom the Authour delivered the sheet to print, it had been lost: Wherefore, this being wanting, let men read that most elegant Treatise, which Hie­rom. [Page 219] Capivacius writ, concerning the right ordering of fontanels; and Dominicus Galvanus, a Physitian at Athestin, to whom, I con­fess, I am obliged for my Sparadrap:

• Take of the Cerate of white Lead, or album coctum Au­gus. 12 ounces.
• Powder of Ceruss, 4 ounces.
• Frankincense,
• Gum Dragant, of each 6 drams.
• Orris Florentine,
• Benjamin, of each 5 drams.
• Storax liquid,
• Sweet Oil of Spike, of each 2 drams.
• Venice Sope, 2 ounces.
• Wax, what may suffice, or 2 ounces.

The Chyrurgians at Verona when they use it for men, they add a little Musk to it, to make it smell the sweeter.

Mingle them according to Art, and with a new linnen cloath make a Sparadrap; with which, for twenty and two years, I have preserved above a thousand issues from all evil symptoms, to the admiration of those that used it.) de Fantanellis Lib. 2. Cap. 13, 14, 15, 16 and 17. which I am certain was writ most ex­actly (according to the mind of his Master Aquapendent) yet in Italian, being worthy to be turned into Latine.

Some mightily extoll that Cerate that the great Duke of He­truria, keeps his issues free by, from all symptoms that might fall upon them:

• Take juyce of Ivy, 3 pound.
• Tobacco, 1 pound.
• Turpentine,
• Pine Rosin,
• Unguent of Roses Mesue,
• Yellow wax, of each 1 pound.
• Oil of Nutmegs, 2 ounces.
• Powder of sweet Cyprus, 1 ounce.
• Choice Ceruss, 1 pound.

Mingle them and make a Cerate.

M is the Pincers for wounds with Gun-shot, to draw out the bullets that lie deep in; it is handsomelie made, and I described it before to the life, Table XIV. Figure IX.

N sheweth the use of the said Pincers, and the way to ap­ply it, which is this: Pull forth the wimble, and let down the outward pipe toward the spoons, so that the Instrument may be shut, and may resemble the form of an Instrument, printed Table XIV. Figure XI. This being done, the outward pipe must be anointed with Oil of Roses, and the Instrument must be gentlie thrust into the wound with the Chyrurgians right hand, untill such time as the toothed end of the spoons lay hold of the bullet; then the Chyrurgian shall hold the Instrument between his fore­finger and thumb of his left hand, and with that he shall presse against the bullet as hard as the Patient can endure it, that it may not fall off from the Pincers; after this, with the fingers of his right hand, he shall put in the Piercer by the hole of the round cover, so far as to the bullet, and he shall turn that about, and by degrees fasten it in the bullet: But so soon as the Chyrurgian knoweth that the Piercer sticketh fast in the bullet, he shall by little and little draw up the outward pipe, and shall presentlie put it down again, that the spoons opening may take in the bullet, and by holding it fast when it is in, may help the Piercer to bring it forth. These things being rightlie performed, the Piercer and both Pipes, and the whole Instrument, with the bullet stick­ing and received in, must be drawn out by the way the Figure re­presenteth unto you.

Note, that many make mention of and commend the Instru­ments, whose Figures you find pictured before Table XV by which, if the bullet falleth off, a nerve, vein or arterie is easilie hurt; wherefore they that have not at hand those two Instruments, Table XIV. Figure X, XI. (which for above twenty two years, during the German wars, I happily used in curing many Souldiers) shall do excellently well, who for other Pincers use the right Cranes bill, Table XI. Figure VI. or the blunt one with an angle beat backwards, Table IX. Figure X. for with these the Chy­rurgians at Padua do frequently take forth bullets out of wounds, not doing any hurt. Read the most exact Book of Francis Plazzon, of vvounds made vvith Gun shot.

O sheweth the cutting of the melancholy veins called Varices, according to the minde of Aquapendens, which yet though it be horrid to our Germans, so ill symptomes may easily arise from it. Whilest I studied at Padua, I saw a Country-man in St. Francis Hospital, endure this manual operation with great profit, under the hand of the most excellent Spigelius.

I once, in imitation hereof, tried the like manual operation in my Country; but by an error of the Patient (who stirred too much, whereas he should not stir at all) there followed great in­flammation and vehement pain, which forbids me to use it, be­cause the event did not answer my desire; and the Patient and his Parents wished that I might be taken and tormented with the like inflammation: Having once suffered ship-wrap of my credit, ever after I dressed these varices upon the extream parts, with only topical means, laid under stockings made with dogs skin.

P sheweth a wound made very deep in the thigh with a Persian dart, and it is united with four stitches or loops, and in the most sloping part of it, having a hole, into which is thrust the tent Q, to keep it open for the matter to come forth.

R sheweth how to scrape away the rotten shin bone with rasps, described Table VI.

Marsin Schmidt of Oellingen, a boy of eleven years of age, com­plained of a most vehement pain in his right shin bone, and that by two holes the stinking matter ran forth; one of these was about the inward ankle-bone▪ and the other about the out ward ankle-bone. This sore was dressed by the ordinary Barber of that Village, for a dislocation of the foot. In the year 1640. upon the 16. day of December, the sick boy was taken into the Hospital at Vlma; and I, at the command of the famous Senate, did visit him; and I presently found, that this infirmity was no dislocation, but the corruption and eating away of all his shin-bone, which I intended to cure. The first day therefore I prescribed him a good regiment of diet, and this following potion.

• Take Syrup of Roses solutive, one ounce and a half.
• Electuary Linitivum, six drams.
• Decoction of Flowers and Fruits what may suffice.

Mingle all for a small potion.

By this he had five stools of very watry matter. On the 22. of December I cut his leg with an incision knife, from the head of the shin-bone as far as the inward ankle-bone, doing no hurt [Page 222] to any vein, artery, nerve or tendon; and with the nails of my fingers I separated the Periostium from the bone; and I bound up the wound with Hemp hards, spread with an astringent medi­cament, made of the white of an Egg beaten with Rose-water, and the astringent Powder of Galen, and with a band having two ends. On the 23 day, when the blood was stopt, I unbound the wound, and looked into it, and I saw that my judgement did not fail me in it; for not only the fore part of the shin-bone was corrupted out­wardly, but the hinder part was corrupted as far as the marrow of it; and after that I presently took forth some pieces of the shin-bone corrupted with my pullers, and I bound up again the wound with my medicament and ligature, by reason of the vehement crying out of the Patient. On the 24. day I scraped the corrupted bone with my scraping Instruments, and I found the lower end of the shin-bone very much corrupted and stinking: wherefore I purged the shin-bone with Decoctum Divinum, and I strewed upon it the Powder of Birthwort, and Orris Florentine, and I bound up the wound covered with Ceratum Diapalma. On the 25. and 26. daies, I scraped the bone by reason of the great cor­ruption, and I drew forth with my pullers many pieces of the rotten bone. On the 29. day, I cut off with my cizers, Table XX. Figure I, from the lower and inward end of the shin-bone, a great part that was rotten. On the 30. day, the stink of the bone did somewhat abate, by the using of Decoctum Divinum, On the 31. day, after that the pain of the foot and stink was abated, I fed the Patient with glewing diet, to breed a callous; and I laid upon the wound Ceratum Divinum to bring it to cicatrize. From this time, untill the 4. of Ianuary of the year 1641. from the lower end of the shin-bone, or external ankle-bone, rotten matter ran forth. On the 6. day there appeared solid flesh about this hole. On the 7. day the wound was handsome; and Nature wholly separated the shin-bone from the lower part unto the middle of it, where it was rotten; when the bone was separated, the wound grew well in a moneths time.