LECT. I. Of the definition and parts of Chirurgerie .

MAny learned discourses have beene delivered out of this sear , of sundry points of the renowmed art of Chirurgerie by Master Doctor Gwyn of famous memorie , who by reason of his not vulgar learning , hath left an eternall memorie in the mindes of those who knew him inwardly , to himselfe . God having called him out of this transitorie life , and vale of miserie , to rest from his labours , it seemed good to the Governors of this worshipfull Company to have this exercise performed by the most able of the brethren as it should come to every one according to his place and dignitie . And undoubtedly this office hath beene performed by most , laudably , and f●●itfully to the praise of the Hall , and mutuall communication of skill , for the better performing of duties which so high a calling doth require . And surely if this course had beene continued , it had mightily encreased in readers the theoricall or contemplative part , which doth consist in the knowledge of the precepts , had made them able to give greater contentment to their patients by their rationall discourses , and more emboldened them in particular operations , having sufficient warrant of Art for their practice , and abilitie to convince empyrickes and malitious calumniators . But seeing ( as I understand ) the highest power of this Realm , from whom there is no appeale , hath decreed that this exercise shall be performed by a Doctor of Physicke , and that the worshipfull Company hath for the present made choise of mee , who professe my selfe to bee a member of the Company ; I shall labour by diligence to supply all defects in mee , which sundrie may find in mee , if they compare my weakenesse , with the ablenesse of my predecessor . Howsoever the matter falleth out . I will endevour to deliver what is for the purpose of that subject whereof I reade , although not all peradventure which might bee alledged to the purpose . Neverthelesse I mean not to be so sparing in my discourses , as that you shall have occasion to thinke that any thing absolutely requisite hath beene kept backe . And if it fall out that at any time I checke or controule those authors , who by some are highly esteemed ; I desire that none ascribe this to any ambition or vaine glorie in mee before thy weigh my reasons in the impartiall ballance of judgement . And as it is impossible for any man , who curiously and scrupulously treadeth in another mans footsteps , to compasse a long journey in a day : So let none thinke that ever hee shall bee famous in his art , if hee give himselfe only to imitation of others . The ancients have left not a little to bee found out by the diligence of posteritie . Whosoever is industrious and judicious shall find my words to bee an oracle . Many of them have set down sundrie things not tryed by experience , but imagined by their fancie , which the sickle of tryall will prune . Neverthelesse , in reprehension I will use them respectively , by reason of reverence , which is due to antiquitie . Besides this nothing can bee both invented and perfected . Now seeing in all the discourses and lectures which have beene delivered out of this place , only particular points of the Art have been handled , and none hath taken the paines to touch any Praecognita , or generall notions , which may be instead of an Introduction to the particulars , seeing no subject hath been delivered , or commended to mee , I will briefly though some Introductorie points , which will give no small light to the lectures , which hereafter shall bee read . The Praecognita . The first shall bee of antiquitie and dignitie of Chirurgerie . The second shall be of most famous authors , who have taken the paines to illustrate it , by their writings : The third shall be of its place in the course of Philosophie . The fourth of the definition of it : The fift of the division or parts of it . Which things when I have set downe , I shall shut up this lecture ; permitting election to the Governours , whether they will have mee proceed methodically , through the whole course of Chirurgerie , or scatteredly to handle dispersed parts of the same as hitherto hath beene done . My opinion is , The intention of the autor . that it will bee both more fruitfull and pleasing to intelligent hearers ( if God will grant mee life and health ) to passe through all the points of Chirurgerie methodically : for first the coherence of the parts will help the memorie : And who shall bee assiduous hearers shall not by snatches take a hungrie morsell ; but have a full banquet , fully to answer the appetite . When I come to particulars , I will not only deliver the principles of Hippocrates , and Galen , and their sectators the Arabians : but I will acquaint you with the theorems of the Chimists , and compare the opinions of both , that it may bee known who have beene most familiarly nursed in the bosome of nature . Of the Chymists Paracelsus is the Generall . The chiefe Chymists . He hath sundrie Colonels under him , as Petrus Severinus the Dane , Quercetan , Petreius , and sundrie others , who are oftentimes clouds without raine ; more fraughted with bountifull promises , than reall performances . Now to come to touch the first generall point of Chirurgerie , The antiquity of Chirurgerie . which is the antiquitie of it , I dare bee bold to affirme , that of all arts liberall , it was the first which was invented after the fall : for as for Agricultura and are pastoralis , husbandrie and grazing , they would have beene required of man , if hee had continued in the state of innocencie , to have furnished unto him nourishment , and other things requisite for the enjoying of this life contentedly , untill hee should have beene translated from earth to heaven to enjoy the beatificall vision of his Creator . Now it is most probable , I may say demonstrative , that what strange event did first minister occasion to invent an art , that that art was first enquired for and found out . Such was the wounding and killing of Abel , by his brother Cain , by reason of emulation . This could not but move Adam , and Cain himselfe to studie how they might not only repell violence , but have in readinesse means to cure hurts also , if they should have beene wounded , and their lives spared . All things which were done before the floud are uncertaine and unknowne , if you except those things which that eminent Prophet Moses , by the inspiration of the Holy Ghost , hath recorded . You may reade of bragging Lamech , Genes 4 23 who boasted of murthering . B●sides this the wickednesse of man increased , Gen. 6.5 . sufficient to set him on , and that there were before the floud , giants and mightie men , vers. 4. and so able to performe by violence of villanie . Shall any man thinke that men unable to resist , did not think upon remedies to cure their hurts , being endued with reason ; but as dogges licked their own wounds , and provided no means for curing contusions , fractures , dislocations , and such accidents as follow after violence offered . As for internall Physicke , being so neere to the creation , Physick not so ancient as Chirurgerie . living long even to 969 yeares , Gen. 6.27 . as Methuselah did , it is like they used none , seeing they had no other sicknes but that of old age : which falleth out , the naturall and accidentall heat exhausting the radicall moysture , and was unavoydable after that the sentence of mortalitie was pronounced against Adam and his posteritie , Gen. 3.10 . Thus wee see that as the practice of Chirurgerie was necessarie before the floud , so wee cannot gather by any obscure conjectures , that that part of Physicke , which cureth by exhibiting internall medicaments , was in use . Yea untill the time of Hiprocrates . Physicke it selfe seemeth to have beene only a knowledge of simples , fit for curing of internall diseases , and outward griefes found out by experience : and that there were but few precepts concerning the art , shewing either the knowledge of particular griefes , or the method of curing of them ; They , who are accompted the autors and inventors of Physick , prove this to bee true : The inventors of Physick . Amongst the Grecians , Apollo the sonne of Iupiter and Latona , is accompted the first , which gave his mind to the studie of Physick and Chirurgery . Or him thus writeth Ovid. 1. Metamorph.

Inventum medicina meum est , opifexque per orbem Dicor , & horharum subjecta potentia nobis .

Physick is my invention & throughout the world ( to me .

Helpfull I am said to be , & the faculty of h●rbs is subject Aesculapius his sonne followed his father , who added much to that which his father invented : wherefore he was accounted amongst the gods . His two sonnes Podalyrius , and Machaon accompanyed the Grecians to Troy , unto whom they did good service in curing the wounded persons . Chiron Achill●s his master is said by Plinie to have had great skill in the knowledge of simples , and that hee was skilfull in dressing of wounds : both his name sheweth , ( for it is likely hee was called Chiron , because hee was skilfull in the manuall part : 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 in Greeke is a hand ) and Achilles his practice in curing wounded persons : for hee cured Telephus king of Mysia , whom he had overcome and hurt , and from him the herb Millefole is called Sideritis Achilaea . Of this , which hath beene spoken , wee may gather that these eminent and worthy men did more practise Chirurgerie , than Physick . Hippocrates is the first wee have , who committed to writing precepts concerning the practice of Physick : Hee did not only practise Chirurgerie himselfe , but wrote sundrie treatises concerning sundrie operations of it : as of fractures , lib. 1. of joynts , lib. 1. of reducing bones by instruments , lib. 1. of ulcers lib. 1. of fistulaes , lib. 1. of wounds of the head , lib. 1. of drawing out of the womb a dead child , lib. 1. All these are in the sixt section of his workes . Galen succeeded him about six hundred years after , a man worthy of eternall memory , who did illustrate Hippocrates with his learned commentaries , and by adding of those things , which were wanting , did perfect the art . In his workes are sundrie Treatises , concerning Chirurgicall subject . The rest of the Greeke writers follow him , as Paulus of Aegina , Aetius , Alex. Trallianus , Oribasius , Actuarius and the rest . Amongst the Latines Celsus excelleth , who hath written acurately of all Chirurgicall operations , whom all modern writers doe exceedingly commend ; as Fallopius de tumoribus praeter naturam , cap. 1. And Fabricius ab aqua pendente in sundry places , and the rest . Of some , who went before him , thus he writeth : lib. 6. c. 1. And in Rome sundrie reasonable good professors ( he meaneth of Chirurgerie , which hee calleth vetustissimam most ancient ) But chiefly of late Triphon the father , and Euelpistus added somwhat to that discipline . The Arabians follow ; amongst whom Avicen is the chiefest , who lived 1100 yeares after Christ : of Chirurgicall matters hee discourseth in the third booke of his canon , and in the fourth part of his Canticles . Rases 2. Continent . Albucasis . Amongst our moderne writers these excell , Guido de Cauliaco , whom Tagaultius hath expressed in good Latine : Fallopius , with whom none is to bee compared : Ambrosius Paraeus , Iohannes de Vigo , Hieronynous Fabricius ab aqua pendente , Guilielmus Fabricius in his centuries & Master Gale , Master Banister , & Master Clowes , while they lived , brethren of this worshipfull companie , who by their writings have commended themselves to all posteritie . So much I thought good to deliver of the antiquitie , dignitie , and of the chiefe professors of Chirurgerie ; which ought to stirre up your diligence in labouring , to excell in the particular operations of it , and to resolve to contemne the obloquies and calumnies of rude and ill bred persons , who shall seeme to slight this excellent art . If you inquire for the beginning of it , it is vetustissima most ancient , according to Celsus in the place above mentioned : If you require certaintie , it is grounded upon experience , and offereth it selfe to the eye : If you aske who did of old practise it , you shall finde that either they were numbred amongst the gods , or were renowmed persons , called heroes , as Hercules , Chiron , Achilles , or men of eminent learning and worth , as Hippocrates , Galen , Avicen , and sundrie others . The subject of Chirurgerie . It hath for its subject the body of man , and in this point no whit inferiour to Physick it selfe . And whereas many will stick to take a dangerous medicament ; yet they will not stick to admit Chirurgicall operations , although they bee full of perill , as incision for the stone , and dropsie , To what part of Philos phie Chirurgerie is to bee referred . dismembring and such like , as wee may see day by day . Now to know to what part of Philosophie Chirurgerie is to bee referred , wee must consider that there bee two parts of Philosophie : whereof the one is speculative , whose end is knowledge ; Parts of Philosophie . The other practick , whose end is practice . Now practice hath two differences , Action , and Effection . Action leaveth no worke behind it . Effection doth . Arist. 6 Ethic. c. ● & li. 1 mag . moral . c. 35● Of the active part of philosophie , there bee three parts ; Ethick , which frameth the manners of a private person : Oeconomick , which sheweth how a family is to bee governed , and Policie , which teacheth how a Commonwealth is to bee ruled : These wee will leave , because they belong not to our purpose : as neither those arts , which are meerly factive , commonly called mechanicall , and so unworthy of a Philosopher . The speculative part of philosophie comprehendeth under it the Metaphysicks , Arise . 6. Metaphys c. 1. naturall philosophie , and the Mathematicks : Of the first and last we will speake nothing , because they belong nothing to that subject which wee have in hand . The subject of naturall philosophie is corpus naturale , or a naturall body : Now of all naturall bodies , the body of man is the chiefest & most excellent , which moved the kingly Prophet to burst out into this resolution : Laudabo te , quia mirabiliter formatus sum : I will praise thee , because I am wonderfully framed : The admirable composition of the body of man drew from Galen himselfe , not the best master of pietie , a hymne to his Creator . Now naturall philosophie considereth the body of man , The parts of Medicine . as it is a species or kinde of naturall body : but medicine as it is curable by art . Of Medicine there are two principle parts , 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 , and 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 . The first teacheth the preservation of health by convenient diet , exercises , and such like : The second teacheth , how health lost may bee recovered : There be two meanes to repaire health : for this is done either by medicaments , or manuall operation . The first is performed by that art , which here is called physick ; the second by Chirurgerie . So that Chirurgerie is the second branch of the curative part of medicine , without the which neither countrie , citie , towne , village , hamlet , yea no private familie can well continue or subsist . This wee must confesse , if we consider unto how many externall injuries the body of man is subject , as to scaldings , fractures , luxations , wounds , ulcers , ruptures , stone , and to what not : So that the use of Chirurgerie is by reason of absolute necessitie more often required , than the ministration of medicaments . And seeing the operation of a Chirurgion is more subject to the eye and other senses , than the exhibition of medicaments is , it behoveth every one to bee well verst in that which he taketh in hand , seeing his practice is more subject to censure : There bee a number of empyricall knaves , filthie bands , and bold queanes , who daylie minister medicaments boldly , who ●●twithstanding dare not meddle with any curious operation in Chirurgerie . Such impure hands dare not touch such a chaste and undefiled Lady . Now it is time to come to the fourth point , IV. Point . which I intended in my proposition : which is to shew what Chirurgerie is : Now there is a double quid , or what , quid nominis , & quidrei : The first sheweth the reason why this tearme was found out to expresse this art : The second delivereth the nature of the art it selfe . The Erymon . Chirurgia is a Greeke terme composed of 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 which signifieth a hand , and 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to worke : Because it restoreth health to the bodies of men by manuall operation . The definition of Chirurgerie . Chirurgerie then may be thus defined : It is a branch of the curative part of medicine , which teacheth how sundrie diseases of the body of man are to bee cured by manuall operation . It is not a science properly , because it resteth not in only knowledge ; but an art as Physick it selfe is : for it leaveth an effect after the operation , to wit , health : So that for the genus , it hath the same with Physick it selfe : Both Physick and Chirurgerie propose to themselves one end : yet the meanes are divers . Physick restoreth health by ministration of medicaments ; but Chirurgerie by manuall operation : Seeing then the definition which I have assigned to Chirurgerie doth consist of genus and differentia , according to schoole termes , it must bee an essentiall definition , fully expressing the nature of it . The fift point whereof I intended to speake of this lecture , V. The parts of Chirurgerie . was of the parts of Chirurgerie , which must bee assigned according to the maine differences of operations . Those are foure in number , and consequently so many parts : for either by Chirurgerie , solution of un●tie is removed , and union restored ; or things unnaturally united are separated & disjoyned ; or things superflous taken away : or last of all defects supplyed . The kindes of solution of unitie . Now solution of unitie is either gathered by reason , or deprehended by sense . In tumors although the parts seeme to the eye united ; yet reason teacheth us , that there is a divulsion of ●hem : The doctrine of tumors therefore ought to bee the first particular treatise . Solution of unitie apparent to the senses , to wit , sight and touch , are either in the soft parts , or in the more solide and hard . In the soft or fleshie parts there bee two differences of solution of unitie : vulnus & ulcus , awound , and an ulcer : In the hard parts there are found a fracture , and a luxation ; two distinct sorts of solution of unitie to fill up the fourth and fift places . This part may bee called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 , or pars compositrix , 1. Part of Chirurgerie . the part joyning together . The second part of Chirurgerie opposite to the first , teacheth to separate parts unnaturally united : where either the comely composition of the body of man is defaced or empaired , or the actions of the same hindred . Sundrie have beene brought into the world with the anus and vulva quite shut up . The consideration of that membrane , which is found in the necke of the matrix of some women , is in this place to bee noted and considered : Seeing there have beene and yet are so many concertations amongst both skilfull Physitians and Chirurgeons . Here also is the cure of the wrie necke to bee set downe . In this griefe the head on the one side by reason of one or more tendons of the muscles of the neck shortened , the head is drawne towards the claves more than on the other wherby it commeth to passe that the face groweth awry and distorted : and so the beautie of the countenance is much impaired . To this part belonged the curing of tongue-tyed children , in whom sucking and speech are hindered . Not only fingers and toes cleave together in the same person : but twinnes also , and double members of one person . The consideration of such doth belong to the historie of Monsters ; not to any art : seeing such things are to bee ranged amongst rarò contingentia , and so belong not to art , which is of things necessarie . 2. Part of Chirurgerie . This part may bee tearmed 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 , or separatrix pars , the separating part . 3. Part. Now followeth the third part of Chirurgerie , which sheweth the meanes to remove from the body things superfluous , which may fitly bee called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 , or ablatrix pars , the nipping or removing part . Things superfluous are such , either by event , or by their own nature . Things superfluous by event are sundrie : And first a dead child in the womb , or staying too long to the prejudice of it own and the mothers life . Here shall bee set the manner how to bring women to bed ( as wee terme it ) artificially and safely . Secondly , a falling of the small guts into the cod by enlarging or renting of the production of the Peritonaeum , which wee call a rupture . When I come to this point , I will set downe the diversities of ruptures , and the meanes of curing of each : which are either incision , or trusse , or application of medicaments , sometimes used solitarie , sometimes concurring most or all together . Thirdly , the amputation of a limme by reason of a mortification , or some other accident . Here shall bee set downe the most accurate method of dismembring . Fourthly , the exstirpation of any part , as the breast , when a cancerous either tumor or ulcer doth possesse it . Here you shall be acquainted with the safest way of exstirpating a cancer and a lupus . Fiftly , bloud offending either in quantitie , or qualitie is drawne by phlebotomie , leeches , ventoses , of all which I will particularly discourse . Things by their owne nature superfluous , are either somwhat familiar to nature , or altogether adverse : Of the first sort , are Wens , and Strumae : when I come to them I will set downe the diversities of them , and how they also are to bee cured . Secondly , the couching of a cataract offereth it selfe . Here I mean to set downe the varietie of cataracts , the prognosticks of them , whereby it shall bee knowne which are curable and which not , and the most exquisite manner of couching of such as are curable . Things adverse to nature , are stones in s●●dr●● parts of the body ; but chieflly in the bladder . The incision for extracting of it , is called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 : of it I meane diligently to discourse , because it is a dangerous operation , and many times scandalous . Last of all , I come to the fourth and last principall part of Chirurgerie , IV. Part of Chirurgerie which is the supplying of the defects of the body , which may be called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 , or additrix the supplying or adding part . Now things which are added , are either of the body it selfe , as restoring of the Nose lost , or curing of the hare lip . Of the first , I will set down the method of the Bononian Physitians , and Chirurgeons : Of the second , my own and other famous mens experiments in curing both the single and the double hare-lip . The matter of things , which is used for repairing of the losses in other parts , as the eye , the eate , arme , and legge , is no wayes of the nature of the body . Neverthelesse when I am come so far , I will make an end of the course of Chirurgerie with touching these so much as shall seem sufficient , to instruct such as have not beene verst in these practices . I have run through those five introductorie points of Chirurgerie , to wit of the antiquitie and dignitie of it : of the professors of it , of its place amongst the liberall arts , of the definition and parts of the same . As concerning the two last points , I have varied from all who have written of this subject : Neverthelesse I have the light of nature on my side , and the experience of all skilfull practitioners . So that it is needlesse to take further paines , either to confirme those things which I have alleaged , or to refute that which hath been said by others ; Seeing I intend rather to frame an able operating Chirurgeon , than to set out a contentions disputing theorician : Besides , reprehending of others doth not so much instruct the hearers in the knowledge of the truth , as sheweth that , which is not to bee learned , but shunned . Neither is a Chirurgeon contented to have performed so many duties to the body of man while it is alive and the instrument of the soule , for performing actions ; but when it is dead the spirit returning to God , who gave it , hee ceaseth not to bee officious to it , in dissecting of it , for the instruction of himselfe and others , and preserving it from putrefaction and annoyance , untill time and place fit for burying of it bee offered : which hee compasseth partly , by encearing of it , partly by embaulming : of the which two last , I meane also to discourse : That the Chirurgeon , which I meane to frame , may bee compleat . I have now presented to the view of the eyes of your understanding , this Chirurgicall Canaan : Into the which I meane to bring you , not to use the native inhabitants hardly , as Ioshua did the Canaanites and their things : but mutually to enjoy the use of those good things which you shall find with them . If I proceed orderly , I must enter into the doctrine of Tumors , which will bee both pleasing and profitable in my first lecture . It is a subject , which is most frequently offered , and from whence the meanest of all the brethren , which practiseth , is not exempted . Wherefore it behoveth every one to bee well grounded in this point : Howsoever I shall be willing that the Governours of the worshipfull Companie set downe the matter , whereof I shall reader :

The Treatise of Tumors doth deliver things either Generall to all Tumors , and those are in number three . 1. The description of a Tumor . 2. The causes of a Tumor according to the Dogmatists . Chymists . 3. The differences of Tumors . Speciall , belonging to every Tumor particularly . How all Tumors are either Simple , and those are 6. which proceed from either Humors , and those are foure . Phlegmone , caused of bloud . Erysipelas , of choler . Oedema , of flegm . Schirrus , of Melancholie . Or from Water , an aqueous Tumor . Flatuositie , a flatuous Tumor . Compound Now the Combination of the Tumors proceeding from the mixture of the materiall causes , causing the simple , I have set downe in every particular Tumor .

LECT. II. The generall doctrine of Tumors .

SEeing according to Aristotle in cap. 1. lib. 1. physic . acroas . in every methodicall tractation , that which is most generall ought first to bee set downe , then that which is more speciall ; because the generall points being set down , they exceedingly further the knowledge of the particulars : I will begin from those things which are common to all speciall Tumors , and those I make in number three . First , I will declare what a Tumor is . Secondly , which are causes of Tumors : Thirdly , which are the maine differences of Tumors .

The appellations of a Tumor . Before I come to the essentiall definition of a Tumor , I Will set down the denominations of it . A Tumor in Greeke is called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 , that is , a prominence or protuberance in the bodie . And from hence the Latine words uncus a crooke or hooke , and aduncus bended or crooked , are derived : Because things bended cause a sticking out . The Arabians and barbarous Physitians , who follow them , call all Tumors unnaturall Apostemata , in Latine abscessus : this word is derived from the greeke verb 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 , abscedere : Because in apostemes there is a collection of humors in any place , which have left their own proper seat &c. For humors , which cause Apostemes , come from the veines , and so leaving ther own naturall receptacle , seat themselves in other parts of the body , being dependant and weake . And Chirurgeans commonly call Tumors wherein there is collection of matter Apostemes . Tumor , which is a Latine word , and by frequent use made familiar in English conferences and discourses , is derived from the Latine word Tumeo , to bee raised or puffed up : And from Tumor commeth Tumulus a grave : because it is raised up higher than the ground adjacent to it . Now bunchings or stickings out of parts of the body , are threefold : Differences of Tumors 〈◊〉 the body . for either they are naturall , and then they serve for the comelinesse of the body are threefold : for either they are naturall , and then they serve for the comelinesse of the body , and further the actions , as we may see in the head , belly , joints ; the thighs , calves of the legs , and armes : or they only passe the ordinary dimensions of some parts , such are the dugs full of milk , and the bellies of women which are with child : Or they are altogether unnaturall , not only marring the comely composition of that part of the body which they possesse ; but hindering the actions also . Such a tumor , or eminence of the body , is called by Galen 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 , id est , tumor praeter naturam , a Tumor contrary to nature . Having set downe the denominations of a Tumor , I must come to the definition of it . Seeing so many as have written of tumors have set down one definition , or another , if I should set downe all the severall definitions , which are by divers authors set downe , and insist in the refutation of such definitions as offend against the conditions of a good definition , I should rather seeme to the judicious , to make an ostentation of reading , and wit , than a care of the profiting of the hearers . Of all the definitions , two are chiefly to bee noted : the one of Fallopius in his treatise of tumors : c. 3. The other of Hieron . Fabricius ab aqua pendent . in Operibus Chirurgicis , part . 2. lib. 1. de tumorib . cap. 1. That of Fallopius is gathered out of Galen , cap. 1. lib. 13. de method . medendi : and it is thus . It is a disease , whereby the parts lose their naturall bignesse , exceeding it . So that extenuation is contrary to a tumor . Hee will have it to bee a disease of the instrumentorie parts : for quantity is only an instrument , whereby the organicall parts performe their actions , more strongly , or weakly , as wee may see in dwarfs , and tall men . Galen lib. 1. de tumorib praet . nat. c. 1. affirmeth that in tumors contrarie to nature , all dimensions , that is , length , height and breadth are increased . But the former definition cannot bee ascribed to every particular tumor , and so it is not large enough : for in an Erysipelas extreme heat rather offendeth , than the bignes enlarged , which very often cannot bee deprehended by the senses . The definition of Fabricius . The definition set downe by Fabricius ab aqua pendente is this : A Tumor against nature , is a disease for the most part compounded , which is to bee named of that thing , which hindereth the actions . And seeing to a crow , her own birds seem fairest , for if any one set under her , hens egges to bee hatched , that they may have cocks of the game , they must watch for the time of disclosing , lest shee kill them : So hee to make his definition plausible to his readers , will have all to mark some remarkable points in his definition . And first of all , in that he calleth a Tumor against nature morbus , or a disease , he will not have pushes in the face , and such small eminences of the skin to be Tumors , because they hinder not the actions : hee cannot deny that the equalitie of the skin is altered , and besides this , the action of the skin , which is perspiration , in that place is hindered . Let no man think it harsh , that I ascribe action unto the skin , being a simple and similary part of the body : it cannot bee denied that all similary parts have an use , which use sometimes is an action , as this of the skin ; to send out by the pores of it fuliginous vapors , and superfluous serositie of the bloud by insensible perspiration and sweat . And although such small eminences commonly are denied to bee diseases , because they hinder not the actions ; yet they be passions , and affections , which require the skill of the Physitian and Chirurgean : yea those pushes of the face are somtimes more hard to be cured than great Tumors , and Artists many times gaine more by those , than these : besides this , by reason of the matter they are to be referred to one or other of the maine Tumors . Howsoever they are not to be neglected . According to Aristotle 1. Rhetoric . c. 5. & Galen . ad Thrasibulum , Three gifts of the body . there be three gifts of the body , to wit , Health , Strength , and Beauty , all which medicine is to direct : Health is preserved by holesom nourishment , Strength by convenient exercises : of the which 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 intreateth , whereof Hieron . Mercurialis hath written a volume ; 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 hath care of the beauty : now seeing by reason of the face , a man is called beautifull or ugly , who can deny that they deserve the care of the Physitian , and Chirurgean . He addeth that a Tumor is a disease most commonly compounded ; if hee had said ever compounded , hee had spoken a truth : for in every one of these Tumors , there is a Tumor conspicuous or latent ; or a solution of unitie , either sensible or imaginary . In an Erysipelas it self , wherein there appeareth neither quantity of part increased , nor solution of unity procured ; yet in it there are undoubtedly both : for the first , seeing there is so great a heat in the part possessed with this griefe , the Humors must bee rarified , and the part dilated , which will require a more spatious place than it had before , which is an evident argument , that the quantity is inlarged . As for the second , the parts before arctly united must be somwhat separated by stretching : Reason must teach us that which cannot bee deprehended by the senses . The last clause of the definition , That the Tumor is to bee named from that which hindereth the action , as Erysipelas a disease of distemperature , because heat doth most hinder the action of the part : this is frivolous , because not heat only , but the bedewing of the skin with choler , by the which it is stretched , hindered the contraction and extension of the skin , and so by a necessary consequence , the hindering of the motion of the part organicall , wherein it is seated . To conclude , this definition may bee applyed to other griefes than a Tumor , as to the head-ache , which is a disease most commonly compounded of distemperature of the humors , and solution of unitie , and may have its denomination from the diversity of the humor causing it . Wherefore , seeing neither the definition of Fallopius out of Galen , nor the definition of Fabricius ab aqua pendente , can abide the triall of the lawes of a good definition , wee must assay to give another , which shall be this : A Tumor against nature is most frequently a disease , somtimes a light affection , for the most part incident to the organicall parts , increasing their quantity above nature , by reason of receiving of superfluous humors sent from other parts . Here I will labour to yeeld a reason for every point of this definition . The genus is a griefe , The definition of the author . because it hindereth the actions , somtimes it is a passion or light affection , which hindereth not the action of the part , as appeareth in small adomatous Tumors , and scirrhosities : and therefore these modifications frequently , and somtimes are added . The subject of a Tumor is a part organicall , somtimes by its own nature organicall , as a finger or toe , somtimes organicall only by office , as when the use of a similarie part is performed by an action : as it appeareth in the skin , one of the uses whereof , is to send forth by its pores insensible perspirations , fuliginous vapors , superfluous serosity of the bloud by sweat , and ichors of humors in the beginning of Tumors , and declination by discussive and resolutive medicaments . The forme of a Tumor is quantitie increased , whereby it differeth from all other griefes . The cause of quantity increased . The cause of increase of quantitie , is receiving of superfluous humors , which is done two manner of wayes , to wit , affluxion , and congestion . Affluxion is , Affluxion . when a humor offending either in quantity or quality , suddenly with violence seizeth upon any member , either by reason of the weaknesse of it , the rarity , loosenesse , dependancy , heat , or pain , or because the whole body is full , or cacochymicall , and the parts sending strong . Congestion is , Congestion when a humor is collected in any part by little and little , by reason of the weaknesse of the concocting and expelling faculty of the same : so that a Tumor against nature is a disease alwayes compounded , against Fallopius in his Treatise of Tumors , c. 3. For there is alwayes a solution of unity , either manifest , or latent and occult , and this hee granteth ; for hee saith , & de hoc conveniemus : we shall agree concerning this . Besides this , the quantity is increased , and that alwayes to reason and imagination , although not to the sense , as hath beene said of an Erysipelas . Moreover , you shall hardly finde a Tumor without some distemperature , either simple , or compounded . I have insisted somewhat too long in clearing the Probleme of the definition of a Tumor against nature , because there is great contention concerning it amongst Authors , both ancient and moderne .

Causes of Tumors . Now order of doctrine requireth , that we speake somewhat of the causes of Tumors : these are either externall , or internall ; Externall . The causes externall are in number eight . I. The aire , if it be contagious , it causeth Tumors , as Carbuncles , and Botches in the plague time . II. The touching of things exceeding temperature in the active qualities , as we see in the application of Veficatories , and sitting long upon any cold seat . III. Too hard binding of the part , which causeth sometimes Gangrenes . IV. The application of an attracting instrument to the body , as Cupping-glasses , and Hornes . V. Whatsoever may cause solution of unitie , as wound , fracture , luxation , or contusion . VI. Biting of beasts , whether they be venomous or no. VII . Taking inwardly things offensive to nature , whether it be by the excessive quantity , as when by too liberall drinking wine , an Erysipelas seazeth upon the head , or by a maligne qualitie , as we may see fall out after the taking of Arsenicke or Mercury sublimate . VIII . Immoderate motion , whereby immoderate heat is procured , whereby the Humors become more subtill , and the passages to the weaker part more patent .

Causes of the weaknesse of a part . Now the part is weake : First , by nature , and that either by reason of its substance , it being spungeous , and loose as Glandules : so wee see frequently Parotides behinde the eares , and Bubones in the groynes , or by reason of the naturall humidity of the part ; so Tumors more often appeare in the flesh than in the spermaticke parts . A part also naturally is weake by reason of the situation , for the dependant parts are more apt to receive influence of humors , as the more high are to receive Halitus ; so it is often seene , that it rising from the stomacke , or some inferiour part , causeth in some the falling sicknes . A part , secondly , is weak by accident , and that by reason of errours committed in the things not naturall , as aire , meat and drinke , exercise , and such like , whereof much is spoken in that part of Physicke which is called Physiologia . Things required in a Tumor . So that to the causing of a Tumor in a part , there be required , the weaknesse of the part which receiveth , patent passages , preparation of the Humor , and the strength of the part sending .

The internall , causes of Tumors are either Humors or Flatuosities : The Humors are either naturall or unnaturall : Internall The naturall are either sincere , as choler , flegme and melancholy ; or mingled , as some of these with blood , for blood is no where sincere , but according to the humor mingled with it , which is predominant , it is called cholericke , phlegmaticke , or melancholy blood . The Humor unnaturall is water , as in the dropsie , for it never can become nourishment . Of Tumors which are caused by reason of strange things , as wormes , lice , bones , nailes , haire , grissy substances , and such like , I will speake when I come to the third part of Chirurgerie , called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 or Ablatrix , which taketh away superfluities . But time admonisheth to come to the setting downe of the principall differences of Tumors . In this matter I will leave all needlesse and fruitlesse distinctions of Tumors , from time , as that some are new , some old , some short , some long enduring : from the quantity , as that some are small , some great , some of a meane bignesse : from the condition of them , as that some are milde , some maligne , some curable , some uncurable , and such like ; which either doe not greatly further the knowledge and curation of Tumors , or else are to bee set downe to some purpose in the explication of every particular Tumor . Onely now in my generall discourse of Tumors , which is to shew light unto that which shall hereafter be spoken in the speciall doctrine of each , I will meddle with the differences taken from the materiall cause of Tumors , from whence spring the maine principall Species of Tumors , unto which all other may be reduced .

The maine differences of Tumors . All Tumors then are either simple or compounded . The simple are caused either of Humors or Flatuosity : the humors are either naturall , or unnaturall : the naturall Humors are foure , Bloud , Choler , Flegme and Melancholy : If blood , which neither in the veines , nor without , is found sincere and unmixed ( as hath beene said ) cause a Tumor , it is called Phlegmone , or Inflamatio , according to Galen lib. 2. ad Glaucon . cap. 1. Of the divers kindes of it , which have their denominations from their places , and of the diversities which arise from the complication of it with other Humors , I meane to discourse when I come to the particular tractation of it : for I meane not to confound particulars with generals , because this would breed confusion , and so deprive the memory of fruit of that which is delivered . Of all other Tumors a Phlegmone deserveth the first place , because it is caused of bloud , which is the son of nature , first begotten , and the treasure of life . If choler cause the Tumor , it is called Erysipelas ; these two are hot Tumors . If flegme cause a soft and white Tumor like it selfe , it is called Oedema , unto which divers pituitous Tumors are reduced , of the which I will speake in their proper places . If a Tumor very hard be produced of the melancholy juice , and without paine , it is called Scirrhus ; these two last are cold Tumors . If a Tumor be caused of water contained in any part , it is called Tumor aquosus : If from flatuosity Emphysoma ; these two last Tumors are the off-springs of crudity , caused by the weakenesse and defect of the naturall heat . And seeing these have the materiall cause different from that of others , I will speak of these in severall Lectures , as was done in every other particular Tumor . Besides this , they require other medicaments than the rest of the maine Tumors doe , as shall bee shewed when we come to the curation of them . Differing then from the rest , I see no reason why they may not bee accounted severall Tumors ; one cannot truly say that either Hernia aqu●sa , or flatuous Tumors of the joynts , can bee reduced to the aforesaid foure principall Tumors , or that they can bee cured by the same indications of curing , and medicaments which are applied to the other . You see how I have set down six simple Tumors , for fewer I cannot , if you consider either the diversity of the materiall causes , or the diversity of the topicall applications , or the evidence of doctrine . The combination of these beget the compound Tumors ; in these compound Tumors , Compound Tumors . what Humor is predominant , that carrieth away the denomination : As for example , if bloud abound more than choler , the Tumor is called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 . If choler be predominant , it is called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 , and so in all other combinations of Humor in Tumors , which shall be presented to your view . When you have noted the Pathognomonical signes of each of the simple principall Tumors , it is an easie matter at the first sight to discerne the kinde of Tumor , and what compound medicaments are to be applied to it . Hitherto have I declared unto you the opinion of Hippocrates , Galen , and of the rest of the Grecians , as also of the Arabians concerning the materiall causes of Tumors . Now to fulfill my promise , I will shew you what Paracelsus and his followers thinke of this point : First then they acknowledge but two elements , water and earth ; for if they should not grant so much , they could not be accounted in the number of the faithfull ; for in the very first Verses of Genesis mention is made of both . Secondly , The Humors are not parts of the body . they account the Humors parts of the body , and so the causes of no griefes , but erroneously , for if they were parts , they would bee endued with life , which they are not . Thirdly , they would have some action , whereof they also are deprived : onely they have an use , which is to nourish the parts . Besides this , they maliciously dissemble the doctrine of the rationall Physitians and Chirurgeons , for they make each Humor , contained in the masse of bloud , either naturall , or against nature : the naturall they make , either alimentary , which nourisheth the parts , or superfluous , which nature reserveth for some other uses : of this abounding , diseases proceeding of fulnesse are ingendred , called Plethora : of the Humor against nature , causing impurity , Cacochymia is caused ; so choler in the veines and arteries is naturall , and alimentary . In the Cystis fellis , and in the Porus biliarius , the superfluous is contained : if it leave the appointed receptacles , and passe to the habit of the body , it causeth the yellow jaundize ; if by adustion , it become Bilis atra , it procureth Cancers and Wolfes ; What Humors cause diseases . so that they hold not the naturall , but those that are unnaturall to be causes of diseases .

The principles of all things according to Paracelsus and his followers . The Paracelsians appoint three principles of all things , Sal , Sulphur , and Mercurie , and not onely by resemblance , or allegorically , but really : By Sulphur , they understand the fattie substance ; by Mercurie , the waterish substance ; by salt , the earthy substance : Distill Cloaves , there come two humidities , the oile and spirit : in the bottome the earthy substance stayeth , which hath two parts , Terra repurgata , the crystalline salt , and Terra mortua , the blacke earth . The life of the salt is a strong water , The life of salt . which if it be by distillation drawne , it leaveth but a Terra damnata , onely fit for the dunghill . The effect and benefit of salt . This salt preserveth the body from putrifaction , wherefore Christ called his Disciples the salt of the earth , because by the preaching of the Gospell , and administration of the healthfull Sacraments , they procured to the unfaithfull the life of grace , who before were but Terra damnata ; and by a wonderfull transmutation of terrestriall creatures , made them spirituall , representing the Angels , yea God himselfe , by restoring his image . From defects in these three , The causes of diseases according to the Chymists . they will have all diseases to proceed : and concerning Tumors against nature , the hot they will have to proceed from Sulphur and Mercurie , and the hotter it is , the more Sulphur to concurre . The cold Tumors they will have to proceed from Mercury and Salt , and according to the loosenesse , or firmenesse of the Tumor , the more Salt or Mercurie to be required , as in Oedema more Mercurie , in Scirrbus more Salt . This is their doctrine concerning the materiall causes of Tumors , in my judgement it is the salfest course to insist in the foot-steps of the ancient , for their way is plain and easie ; no man can deny that there are foure Humors in the masse of bloud , as may appeare when it is drawne out of the veines : Choler swimmeth about the bloud , which is known by its bright rednesse ; Melancholy is in the bottome , which is deprehended by its grossenesse and blacknesse ; now Flegme uniteth these two last Humors , and maketh them tough . The Paracelsian doctrine is full of difficulties , which hee maketh more obscure by coyning strange words , as his Reader will perceive ; so that his discourses are but a kinde of canting Philosophie . Neverthelesse , I thought good in plaine termes to acquaint you with it , that when any Empericke shall make a shew of learning , by using these termes , you may finde him out , and esteeme of him as he is : that is , like that head which the Wolfe afarre off espied , representing the head of a living man , but comming neere , and seeing it but curiously carved , affirmed it to be Pulchrum caput , sed sine scientia , A comely head , but without wit .