The Chyrurgeons store-house furnished with forty-three tables cut in brass, in which are all sorts of instruments ... useful to the performance of all manual operations ... together with a hundred choise observations of famous cures performed : with three indexes 1. of the instruments, 2. of cures performed, and 3. of things remarkable / written by Johannes Scultetus ; and faithfully Englished by E.B.

THE CHYRURGEONS Store-House : Furnished with Forty three TABLES Cut in BRASS , IN WHICH Are all sorts of INSTRUMENTS , both Antient and Modern ; useful to the performance of all Manual Opperations , with an exact Description of every INSTRUMENT .

Together with a hundred Choise OBSERVATIONS of famous CURES PERFORMED .

With three Indexes . 1 of the INSTRUMENTS . 2 of CURES performed , and 3 of Things Remarkable .

Written by Johannes Scultetus , a famous Physitian , and Chyrurgion of Ulme in Suevia .

And faithfully Englished . By E. B.

LONDON , Printed for John Starkey , at the Miter in Fleet street , near Temple-Bar . 1674.

TO THE Most Magnificent , Most Noble , Most Powerful , Most Knowing , and Most Prudent , The Sheriffs , Consuls , and Senatours of the Renowned Imperial Republick of ULME . My ever Honoured LORDS and PATRONS , all Observance and Happiness . MOST MAGNIFICENT , &c.

WH●soever doth behold clearly with the eyes of his Understanding the wonderful works of the Eternal Moderatour , and Governour of all things , he is mmediately delighted with the sweetness of that Contemplation ; and the more he is delighted , the farther he searcheth into them . By searching daily he learns the more , and is the more ready and willing to consecrate his knowledge to the publick good ; and by the help of drawing and engraving to transmit his experience to all posterity . The Antients discovered much , and yet left much more still to be discovered . My Uncle , of Pious Memory , first led by the admirable direction of God , devoted his mind to the study of Physick from his youth , and without vanity , I may affirm , that he attained to no small glory , in the happy performance of Chyrurgical Operations : and whilst that he chose that stupendious Miracle of Nature , the Fabrick of Mans Body to be his Subject , and did contemplate it with great delight ; he collected every day new Observations , which he committed to Writing intending one day , after having revised them , to make them Publick ; and I wish to God a milder Fate had spared his Life for some years , that those Productions of his might by himself in their due time have been brought forth into the world ; But God disposing it otherwise , upon his untimely departure out of this Life ; and dying intestate , I came to be one of his Heirs ; and having been ever observant to him , and of the same Profession , I thought it would be a high offence , to involve , as it were , in Cimmerian darkness the works of him , to whom I owe my education ; and as his Heir I hold my self obliged to perform the desires of the deceased , which I hope in this work , I have in some measure satisfied : as also the desires of friends , who , by Letters , have earnestly requested the Publication of it , but the chief motion which hath induced me to set it forth is , that I might Dedicate it to you my most honored , &c. Finding it by divers Writings which he left behind him , that it was the intention of my Unkle , if he had continued alive , to Consecrate this work to your Lordships ; and therefore , I should be very much to blame , if I refused too perform this service in honour to his pious ashes .

But that which hath ravished my Unkle and my self with admiration in your fair City of Ulme is , your still more fair order of the Senatours ; which in the three Estates , Ecclesiastical , Civil , and Military , flourisheth in the highest degree of honour ; and as the understanding in the mind , in the body the eye , and in the eye the pupill , or sight : so in Ulme , the eye of Suevia . The Senators Order , as the pupill , and sight of it directeth all things : your most excellent Common-wealth , is free from putting an imperious yoke upon Mens consciences : your Court is free from flattery , and all impartiallity : your Walls are free from forreign Forces ; and in your free City , speech , and all things else are free : who therefore hath not the same Veneration for you , Fathers of your Country , as he hath for the Country it self ? and who doth not testifie all manner of acknowledgement and submission to you . These thirty years Warrs which Christian hath waged against Christian : under the wounds of which , almost all Germany still groaneth , by your directions , under God , have not shaken our Walls , have not violated our Temples , and Altars , and have not ravished our Virgins ; all these your most constant care , your inbard sedulity , and your high prudence , have preserved : you have vouchsafed to allow both my Unkle , and my self , an honourable Sallary out of your ●reasury : without which liberality of yours , I could not have been at the University : especially the Venetian , nor have lived three years there , and followed my Studies . You have since received me into the Counsell of Physitians , and have commanded me to be fellow of their Colledge ; These , and many other benefits heaped up upon us , my Unkle while he was alive , did always most gratefully acknowledge and his quiet Ashes at present do confess them , and I my self who have out-lived him , shall at all times retain a memor● an● due sense of them . Your singular humanity al , and incomparable civil obliging nature , worthy ●enatours hath enboldned me so far , that I have ventured to trouble you with the Dedication of the Chyrurgions Armory , and Store-house , and to defend these Physical Meditations with your Patronage , as with the Shield of Aiax .

I beseech you therefore , Governours of your Country , to accept kindly , this small Pledge of a grateful mind ; which I most humbly present you with , and pray to God to preserve you , protect you , and defend you ever , in peace , happiness , and prosperity ; together with this Common-wealth , and all the Members of it , that you may rule to the benefit and good of ours , and after Ages .

Your most obedient Johannes Scultetus .

THE AUTHORS PREFACE .

THat our first Parents were framed and Created by the Divine Power , in Perfection , strong in Body , blessed with an equal Temperament , Impregnated with a most pure flame of Life in the Oleaginous natural Moisture , and Absolute all manner of ways . This pressing Argument seems to convince , That in the State of Innocency they had power to Regulate their Bodyes without any fear of Death , and fully to restore , in the same goodness , their Radical Moisture , at any time wasted with heat ; and to continue it even to immortality , if they had not been deceived by the Craftiness of the Serpent , and tasted of the forbidden Fruit , whereby they were afterwards obnoxious to death , and their Posterity like unto them .

Those also who lived before the Flood , and were not at so great a distance from their Original , by the Holiness of their Life , and their Innocent and Simple Diet , taken only from Vegetables ; some of them lived neer a thousand years , and others protracted , and extended their term of Life to many Ages ; but after that , when Gluttony , and Intemperance provoked mens appetites , with divers sorts of Dishes , and the unlawful use of Venery did by degrees debilitate their Bodies , and exhaust their Spirits ; the length of their days was very much shortned , and their Lives were terminated in an hundred and twenty years : for as a thick Cloud doth imbibe and obscure the Rays of the Sun , so a vitious habit of body doth Cloud , and Obscure the Light of our Body , and Lamp of Life : and thus daily necessity gave a beginning to the Therapeutical part of Physick , whilst circumspect Fathers of Families were obliged to procure some Domestick helps , and easily acquired Remedies to stop , or retard the too hasty rigour of Death ,

But though many Diseases may extirpated by the strength of Nature , alone , by the due observance of the six Res non Naturales , and the Alternate use of those two great helps , of Altering and Purging Medicines ; yet there are some so obstinate as not to yield to any of these , or to be remedied any other way than by Chyrurgical Operations , by dividing what is united , by uniting what is disjoyned , and by extirpating what is superfluous , according to the true saying of Hippocrates . Diseases which Medicines cure not , the Knife cureth ; what the Knife cures not , Fire cureth ; what the Fire cures not , they are to be esteemed uncurable .

In which Operations of Chyrurgery , both in former times , and at present , almost an infinite number of industrious Promoters of Physick , Aegyptians , Graecians , Arabians , Latines , Italians , French , and of most Nations by reason of the necessity of them , and the benefit accr●…ing to mankind from them , have so diligently tak●… pains all their life-time , that they would leave nothing unattempted , till they could add a perfection to this part of Physick , and by their Writings consecrate it to Posterity . These following forty three Chyrurgical Tables , for the accurate delineation of the Instruments , their Form , and Magnitude , the faithful Demonstration of the manner of Working , and the useful Observations added to them , not unworthy , perhaps , to see light , I have gathered together , for the common good of Mankind ; delivering what with my own eyes , and hands , I have often proved , and experienced : that according to the slenderness of my abilities , and the smalness of my Talent , I might render some service to Posterity ; especially in the Reading of Hieronimus Fabritius , whose words , and footsteps I follow here , and in my Practise . Others hereafter may attempt things more difficult , may supply defects , and publish things more perfect ; for all Envy being far from me , I leave a free , and open field to all Ingenious Persons , desiring earnestly they would set forth something more elaborate than this ; or in the mean time , vouchsafe to use it .

THE TABLE OF INSTRUMENTS . A {αβγδ} of Hippocrates , Tab . 21. Fig. 1. Alphonsus his Instruments , Tab . 15. Fig. 1. 2. & 3. Aquependens his Eye-glass , Tab . 8. Fig. 10. B THE Breast-plate of Galen , Tab . 43. Letter S. Bandage called Cancer . Tab . 31. Fig. 9. Bandage for Issues on the Corronal Suture , Tab . 33. Fig. 6. Bandage of Sostratus , Tab . 38. Fig. 6 Bandage for the Womb , Tab . 41. Fig. 3. Bandage for Members broken and out of joint , Tab . 29. Letters E. F. G. Bandage called Galen's Sling , Tab . 43. Letter A. Bandage for Members , which some part cut off , Tab . 27. Fig. 14. Bandage for the Fundament . Tab . 41. Fig. 7. A Block of Wood , round and high , on which the parts be cut off with a Chizel , must be placed , Tab . 20. Fig. 6. C A Case to place a Leg in that is broken , or out of joint , Tab . 21. Fig. 6. The Capsula , or Casket , of Julius Casserius Placentinus . Tab . 1. Fig. 7. &c. Tab . the last , Letter G. Candles of Wax for fleshy substances growing in the passage of Urine , Tab . 13. Fig. 9. & 10. A Catheter , Tab . 14. Fig. 5. Cauteries actual , to burn the hinder part of the Head , Tab . 7. Fig. 6. 7. 8. & 9. Cauteries made for other parts , Tab . 19. Circles for the Matrix , Tab . 17. Fig. 6. 7. &c. Crows Bills , Tab . 10. Fig. 5. Cranes Bills , Tab . 11. Fig. 6. Cranes Bills , turning , or bending , Tab . 9. Fig. 10. Cizers to Cut grifly , and brauny parts , Tab . 20. Fig. 2. Cap of Silver , Tab . 13. Fig. 8. Celsus his Spatha . Tab . 2. Fig. 1. A Chizel , with which , Fingers , and Hands are Cut off , Tab . 20. Fig. 4. D THE Dilator of the Mouth , Tab . 9. Fig. 9. Dividing Instrument , Tab . 2. Fig. 10. E THE Enterenchyta , to give ones self a Glister withall . Tab . 13. Fig. 5. Engine of Vitruvius , to extend dislocated Joints . Tab . 22. Fig. 1. Ear-Spring , Tab . 13. Fig. 4. Eye-Glass of Aquependens , Tab . 8. Fig. 10. F A Forceps ealled the Parrats Bill , Tab . 4. Fig. 2. Tab . 11. Fig. 1. Forceps to burn a Seton in the Neck , Tab . 7. Fig. 1. 2. & 3. Forceps to cut a Seton in the Neck , Tab . 7. Fig. 10. Forceps to take out the Polypus , and to cut off the Clitoris , both streight , and bended . Tab . 9. Fig. 1. & 2. Forceps to draw out the Teeth , Tab . 10. Fig. 6. & 7. Forceps called the Crows Bill , Tab . 10. Fig. 5. Forceps most ordinary for drawing Teeth , Tab . 10. Fig. 4. Forceps called the Cranes Bill , Tab . 11. Fig. 6. Forceps , or bended Cranes Bill , Tab . 9. Fig. 10. Forceps , or Goose Bill , with a Skrew , Tab . 15. Fig. 4. Forceps , or Goose Bills , without a Skrew , Tab . 15. Fig. 6. Forceps named the Deceitful Forceps , Tab . 17. Fig. 29. A large cutting Forceps , Tab . 20. Fig. 1. A Form from Hippocrates , Tab . 22. Fig. 4. & Tab . 25. Forceps bended in a Semicircle , with Teeth to draw out Bones sticking in the Throat , Tab . 10. Fig. 1. G A Goose Bill with a Skrew , Tab . 15. Fig. 4. Goose Bill without a Skrew . Tab . 15. Fig. 6. Glossocomon of Galen , Tab . 21. Fig. 4. Glossocomon of Hippocrates , Tab . 21. Fig. 1. Glass Vessell for the Eyes . Tab . 8. Fig. 10. Glass with which the Nipples are drawn out , Tab . 16. Fig. 5. Girdle of Hildanus , Tab . 22. Fig. 2. H A Handle for Needles , Tab . 8. Fig. 3. The hairy Instrument , Fab . 8. Fig. 1. A Hook that is sharp , convenient to lift up the Eye-lids , and to raise up the Haw in the Eye , Tab . 8. Fig. 9. In other places you may see double pointed Hooks , as Tab . 34. Fig. 5. & Tab . 30. Fig. 8. A Hammer of Lead , Tab . 2. Fig. 11. Hammer of Wood , Tab . 20. Fig. 5. Hildanus his Remora , Tab . 22. Fig. 3. Hippocrates his Form , Tab . 22. Fig. 4. & Tab . 25. Handle of the Trepan , to turn it with , Tab . 2. Fig. 6. Hildanus his Girdle , Tab . 22. Fig. 2. A Hook to draw forth the dead Child . Tab . 17. Fig. 1. I IRon Instruments , to burn Issues on the top of the Head , Tab . 1. Fig. 2. An Instrument plainly hollow , and cutting , fitted to the Pipe for making Issues on the Coronal Suture . Tab . 1. Fig 4. A Starry Instrument . Tab . 1. Fig. 5. A toothed Instrument . Tab . 1. Fig. 6. A lenticular Instrument called by the Greeks {αβγδ} . Tab . 2. Fig. 8. A dividing Instrument . Tab . 1. Fig. 5. Instrument called Trioploides , Tab . 3. Fig. 3. The Hairy Instrument , for the Cure of an Aegilops . Tab . 8. Fig. 1. An Instrument to cut away the Uvula , Tab . 9. Fig. 7. An Instrument to force open the Mouth , Tab . 9. Fig. 9. An Instrument to take the Stone out of the Passage of Urine , Tab . 14. Fig. 8. An Instrument to Pierce the Belly , of Dropsical Persons , and the Scrotum of those who are troubled with the watry Hernia , Tab . 12. Fig. 17. Instruments to take Bullets out of Wounds , Tab . 14. Fig. 9. 11. Tab . 15. In●●●●ment of Alphonsus . Tab . 15. Fig. 1. 2. & 3. I●●●●●ment to extend a Contracted Leg , Tab . 18. Fig. 1. I●●●●●ment to bind a Stifle Extended Arm , Tab . 18. Fig. 5. I●●● ument to stop the bleeding of the Artery of the Wrist . Tab . 43. ●et . B. Instrument of Hieron . Fabrit . ab Aquapendente , to cure Carun●●● in the passage of Urine , Tab . 40. Fig. 5. K A Knife that is Hooked to cut the Fesh , before the taking off a Member , Tab . 20. Fig. 3. Knife sharp on both sides , Tab . 2. Fig. 1. Streight Knife , Tab . 2. Fig. 2. Knife to separate the Eye-lids grown together , or fastned to the skins of the eye , Tab . 8. Fig. 8. Crooked Pen-Knife , Tab . 12. Fig. 4. Knife to Dilate the Wounds of the Belly , Tab . 14. Fig. 4. Knife to perform the Paracenthesis , in the Belly , and Breast , Tah . 12. Fig. 1. Knife to Dilate Wounds in the Breast , Tab . 12. Fig. 1. Knife sharp on both sides resembling Myrtle Leaves , Tab . 12. Fig. 6. & 7. Knife in a Ring , the chief use of which , is in opening the Breasts of Women suppurated , Tab . 12. Fig. 11. The manner of using it in the Thorax , see , Tab . 37. Fig. 5. Knife to cut a Seton in the Neck , Tab . 18. Fig. 6. L A Lancet to open Vessels to let bloud , to perforate any place , and cut issues . Tab . 19. Fig. 13. Levator or Lever the smallest . Tab . 2. Fig. 7. The stronger Levatory . Tab . 3. Fig. 2. Levator to the Triploides . Tab . 3. Fig. 3. B. Levator of Ambrose Parey . Tab . 3. Fig. 4. Levators divided into three parts . Tab . 10. Fig. 8. & 9. M {αβγδ} or a preserver of the Membrane . Tab . 2. Fig. 9. {αβγδ} or a double edged Knife . Tab . 2. Fig. 1. Mentrenchyta or the Womb Syringe . Tab . 13. Fig. 3. N NIppers , or Pincers , of Celsus , and Paulus Aegineta . Tab . 4. Fig. 1. A Needle to burn a Seton . Tab . 7. Fig. 4. Needle to couch Cataracts . Tab . 8. Fig 2. & 4. Needle to perforate the Belly or Codd of Dropsical persons . Tab . 12. Fig. 17. & 20. Needle to pierce Breasts which are to be cut off . Tab . 12. Fig 8. Needle used in Gelding and in opening depending hollownesses Tab . 14. Fig. 5. Nili Plintheum . Tab . 21. Fig. 5. O THe Otenchyta or Syringe for the Ear . Tab . 13. Fig. 4. P A Pipe to make issues in the Limbs . Tab . 1. Fig. 1. A Pipe to make Issues in the Coronal ●uture . Tab . 1. Fig. 3. Divers Pipes to be put into the Nostrils Tab . 9. Fig. 3. 4. & 5. A Pipe to be put into the Throat . Tab . 10. Fig. 2. Pipes with wings or shoulders usefull in Wounds of the Breast , and in perforating the Belly . Tab . 12. Fig. 12. 13. 14. 15. Pipes to cure the piles , and dry up the Ulcers of Fundament , Tab . 16. Fig. 1. 2. & 3. Pipes to draw out the matter of the Empyema . Tab . 9. and 10. A pipe to mitigate the heat of Urine . Tab . 12. Fig. 16. Parrots Bills , Pincers . Tab . 4. Fig 2. Tab . 11. Fig. 1. Pincers to burn a Seton in the Neck . Tab . 7. Fig. 1. 2. & 3. Pincers to cut a Seton in the Neck . Tab . 7. Fig. 10. Pincers to take out the Polypus , and to cut off the Clitroris both streight and bent . Tab . 9. Fig. 1. & 2. Pellican Pincers . Tab . 10. Fig. 3. Pincers to draw teeth . Tab . 10. Fig. 6. & 7. Pincers called Crows-bills . Tab . 10. Fig. 5. Pincers the most common for pulling out Teeth . Tab . 10. Fig. 4. Pincers called Cranes Bills , Tab . 11. Fig. 6. Pincers or crooked Cranes bills . Tab . 9. Fig. 10. Pincers called Goose-Bills , with a Skrew . Tab . 15. Fig. 4. Pincers called Goose-bills without a Skrew . Tab . 15. Fig. 6. Pincers called the deceitfull Pincers . Tab . 17. Fig. 9. Pincers large a cutting . Tab . 20. Fig. 1. Probe that is broad . Tab . 8. Fig. 6. Probe that is round . Tab . 8. Fig. 6. Probe with a Skrew . Tab . 8. Fig. 7. A Peircer very sharp with which Gun-shot are taken forth . Tab . 15. Fig. 7. Parey his Levator . Tab . 3. Fig. 4. Pincers of Celsus and Paulus Aegineta , Tab . 4. Fig. 1. Pincers bended in a semericle with Teeth to draw out Bones sticking in the Throat . Tab . 10. Fig. 1. R A Ring of Brass to fix the Eye . Tab . 8. Fig. 5. Rasour . Tab . 2. Fig 2. Remora of Hildanus . Tab . 22. Fig. 3. S A Spoon to be applied to the Uvula relaxed . Tab . 9. Fig. 8. A Spoon for the taking a stone out of the passage of Urine . Tab . 14. Fig 8. The Speculum Ani . Tab . 17. Fig. 3. Speculum Matricis . Tab . 17. Fig. 4. Splents . Tab . 29. Leetter K. The Staff . Tab . 14. Fig. 7. Speculum Oris Tab . 11. Fig. 1. Spatha of Celsvs , Tab . 2. Fig. 4 , Saws to cut down the Space between the Trepans . Tab . 5. Fig. 1. Streight Saws . Tab 6. Fig. 1. & 2. Scra●● g Irons . Tab . 6. Fig. 3. &c. Stile 〈◇〉 Iron to be thrust into the Pipes put into the Nostrills . Tab . ● . Fig. 6. Stil●●● Iron to be fitted to the Pipe for the fundament . Tab . 16. Fig 4. Scolopomacheria or crooked Knives . Tab . 12. Fig. 1. 2. 3. & 5. Syringot●ms blunt on the outside , sharp on the inside , to open Fistula's . Tab . 14. Fig. 1. 2. & 3. A common Syringe Tab . 13. Fig. 1. Syringe for the Ear , Tab . 13. Fig. 4. Syringe to give ones self a Glyster withall . Tab . 13. Fig. 5. Sostratus his bandage . Tab . 38. Fig 6. T A Truss for People of full grouth . Tab . 39. Fig 6. Truss for Children . Tab . 29. Fig. 7. Tooth-picker . Tab . 10. Fig. 10. Truss for the Navill . Tab . 38. Fig 8. Triploides with its triple basis or three feet . Tab . 3. Fig 3. A Tunnel . Tab . 10. Fig. 11. Trepan Male , Tab . 2. Fig , 3 , Trepan Female . Tab . Fig. 4. & 5. Trepan of Hier . Fabr . Tab . 2. Fig. 6. Three-formed Trefine . Tab , 3. Fig. 1. V VItruviu his Engine . Tab . 22. Fig. 1. w THe Womb Syringe , Tab . 13. Fig. 3.

NOte that the Figures of the Instruments of this Edition , are diminished by half in proportion to those ingraven at Ulme ; so that taking them to be as big again , you will have exactly the due and just bigness at first delineated by the Author .

A DESCRIPTION Of all sorts of Instruments usefull in CHYRURGERY . Written by Dr. JOHN SCVLTETVS , &c.

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 .

diagrams of surgical cutting instruments TABVLA . I.

III

IIII

VII

VIII

VIIII

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 .

diagrams of surgical scraping instruments TABVLA . II

III

IIII

VII

VIII

VIIII

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 {αβγδ} ; 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 {αβγδ} , 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 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 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 {αβγδ} .

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 .

diagrams of surgical trepanning instruments TAB . III

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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 .

diagrams of surgical trepanning instruments TABVLA . IV .

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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 {αβγδ} , 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 {αβγδ} : 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 .

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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 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 {αβγδ} , 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 {αβγδ} ; 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 {αβγδ} ; 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

diagrams of surgical trepanning instruments TABVLA . VI

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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 .

diagrams of surgical boring instruments TABVLA VII

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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

diagrams of surgical cutting instruments TABVLA VIII

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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 needles 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 palate 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

diagrams of various surgical instruments TABVLA . VIIII .

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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

diagrams of various surgical instruments TABVLA X

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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 {αβγδ} .

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

diagrams of surgical instruments of the mouth TABVLA . XI

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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 {αβγδ} , from the bill of that bird which the Latines call Galinago , — a Woodcock , in Greek {αβγδ} , 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 {αβγδ} .

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

diagrams of scalpels, and various surgical instruments TABVLA XII .

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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 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 .

diagrams of otological surgical instruments TABVLA XIII

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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 .

diagrams of various surgical instruments, and instruments designed to remove bullets TABVLA XIV

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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 , 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 {αβγδ} ; 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 : 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 .

diagrams of instruments designed to remove bullets TABVLA XV

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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 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 .

diagrams of anal cautering pipes TABVLA XVI

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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 .

diagrams of gynecological instruments TABVLA . XVII

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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

diagrams of instruments designed for physical manipulation TABVLA XIIX .

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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 :

diagrams of scalpels and various surgical instruments TAB XIX

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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

diagrams of surgical cutting instruments TABVLA XX

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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 {αβγδ} ; 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 {αβγδ} , 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

diagrams of surgical restraining devices TABVLA XXV

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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 {αβγδ} . 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 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

diagrams of devices designed for physical manipulation TABVLA XXII

III

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 .

diagrams instructing how to set broken bones TABVLA . XXIII .

III

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 {αβγδ} ; 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 {αβγδ} . This Form , besides the four {αβγδ} 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 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 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 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 {αβγδ} ; which the Poet used also , {αβγδ} .

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

diagrams instructing how to set dislocated limbs TABVLA . XXIV .

Fig. I.

III

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 .

diagrams of devices designed to set ankles TABVLA . XXV .

Fig. I.

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

diagrams showing the setting of bones TABVLA XXVI .

Fig I

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 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 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 .

diagrams detailing limb binding TABVLA . XXVIII

III

VII

VIII

VIIII

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 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 cure of a simple dislocation .

IT is done by five Intentions , 1. Extension . 2. Reposition . 3. Deligation . 4. Deposition of the part dislocated . 5. Religation of the part . Now Extension will be easily made if four things be observed : First , Time : Secondly , fit Instruments : Thirdly , Manner : And fourthly , the quantity of the extension . The time is propounded by Hippocrates , de Artic . 64. namely , that it should be done presently after it is put out of joint , whilest the part is yet hot . But if extension cannot be made presently , for want of a Chyrurgian or Physitian , we must do it the second or third day ; unless we be forced to desist , by reason of the inflammation that comes first upon it . But on the fourth day , by reason of great pains , nothing must be attempted ; for it is observed , that if we attempt then to reduce it , it will not succeed well , but many inconveniences will follow it . Whence Fallopius de Luxationibus , Cap. 3. saith , I admonish you that you alwaies have a care to the time ; which , at most , must not exceed three daies ; and if the third day be past , the term of inflammation must be expected ; and the time when there is no danger of inflammation , and that is the seventh day , as Hippocrates warns us 4. de Artic . 65. untill which time the sick man is to be kept very low , with fasting , or rather with a very thin diet . Wherefore if extension cannot be made the first three daies , we must wait till the seventh day . The time when you may reduce , is the first , second , or third day ; or else the seventh , eighth , or ninth day ; but on the tenth , eleventh , twelfth and the rest it is not safe ; because then the callous is bred . But before we come to extension , the joint must be prepared to prevent pain , and to make the reduction easie , by heating , fastning and loosening the parts of the joint ; namely , the Muscles , Tendans and Ligaments ; for if they be fastned , they will be drawn the more easily and without pain . But heating and softning of the joint , is made either by rubbing , or by pouring on much hot water , or water and oil ; or the decoction of Mallows , Marish-Mallows , &c. We use chafing conveniently , upon those places where water cannot be poured easily ; but it must be done with the hand , smeared with some oils or fat matter , as with common oil , or Hogs-grease that is not salted at all . Spigelius in his publick Lectures saith , that for to cure a dislocation , a Bath of sweet water can do so much , that there is nothing better than it .

The Instruments for Extension , are H●nds , Bands and Engines ; Hands are used , if the dislocation be small ; Bands , if mean ; Engines , if great . The hands must be the Chyrurgians or his assistants , as there needs a small or somewhat greater extension ; but bands where it is requisite , by reason of the greater contraction of the muscles , to make a more forcible extension . In which things you must observe first the figure ; namely , how it must be roled ; whereof ( because it cannot be expressed in words ) see Oribasius his book of bands . 2. The matter wh●●h must be strong , soft and tractable ; such is Buck skin so●t and dressed , of which they m●ke breasts ; then they are smeared with unguent Pomatum , that they may be tractable . Some use , for want of leather , linnen cloath a little ru●b●d 3 Where they must be bound ; namely , on the place that is fa●th●st off from the joint dislocated , lest the muscles should be bou●d , or else torn in more violent extension , where under the dislo●a●●on ●here are tw● jo●nts ; besides Hippocrates ties a band abo●t both those joints . See Table XXVI . Fig. I. Mechanick Engines , which are chiefly nec●ssary in old dislocations , or such whi●h are not reduced the first three daies , are 1 the Ladder ( Table XXI . Fig. III . ) 2 The Glossocomum or Ambi of Hippocrates , ( Table XXI . Figure I. ) 3. H●ppocrates Form ( Table XXII . Figure IV )

H ppocrates shews the manner of extension . 1. de fract . 1. when he saith that the ●hyrurgian must make extensions ( which by drawing are made divers waies ) the most streight that possibly he can : Wherefore he must observe a right line , both by reason of the bones , as also of the ligaments and muscles , in respect of the Fibrae : For keeping these parts in a right line , as they lie naturally , extension is made without pain or difficulty .

Also th● Chyrurg●●n shall excellently well know the quantity of extension , when he is not ignorant our of what place it fell ; which way it slipt-forth ; to what place it is fallen , and w●ere it rests : when extension is almost made , the swounding of the Patient , or of the standers by , must not hinder the operation .

The bone is set into its place , by th● hands of the Chyrurgian or his servants , which must be moderately anointed with some soft unguent , or with oil of roses . Reduction is made either by circumgyration , or by forcing it back to the opposite part to which it is fallen . These motions are not alwaies necessary , for sometimes , when extension is made , if the muscles that were before contracted be only relaxed , the joint will easily of its own accord return into its natural place .

Now the signs of a part that are well set , are these : First a natural shape of the part , when there is no hollowness nor swelling that appears about the joint , as there did before it was set ; but in all things it must be like the sound part , or not far unlike by reason of a flux of humours . Secondly , there must be abatement of pain , which is an inseparable sign , for alwaies when the pain is ended , it is a sign that the bone is reduced ; but it follows not on the contrary , the bone is reduced , therefore the pain is ended ; for sometimes the pain may abide , because the muscles were very much hurt at first . Thirdly , as some say , the crack that is perceived by the Patient , and the standers by , when the bone falls into his socket ; but this is a false mark , and never to be wished for , because that crack is sometimes made , when the joints are extended and drawn too far ; ofttimes also the crack is made , when the brims of the bone are broken by the mutual clashing of the bones , after which there succeeds difficulty in motion .

In the first binding and all the rest , two things are principally to be observed ; namely , the figure of the part affected , and the ligature it self ; which will preserve the joint in its socket , and will hinder inflammation that is near at hand .

In the figure we must observe the fashion of the joint , not only that is reduced , but also of the whole part ; for as some figures are natural and without pain , so some are unnatural and painfull : The figure of the arm without pain , is bended , as of the foot extended right forth , Table XXVI . Figure II and III . But note that the said Figure must be ordered to the part before it be bound : namely , that the bands be not too loose , or bound too hard .

The Ligature must be made with linnen bands , because they bind better than those that are made of woollen ; they must be soft , that they may cause no pain : they must be equal , that they may bind equally every where ; and they must be clean , that the humours which issue forth of the joint , may be known by the colours . The latitude of the bands doth vary according to the parts that must be bound ; for the thicker parts require the broader bands ; and the thinner those that are narrower . In the thicker parts ( namely , the thigh and the knee ) they must be four fingers breadth of the sick party , broad ; in the thinner parts ( as the leg , shoulder , arm and hand ) three ; in the most slender parts ( as the fingers ) they must be , at the least , two fingers broad .

Bands are distinguished by Galen into inward bands , such as bind the joint under the plaisters , and are called under-binders ; and outward bands that are put above the plaisters : Hippocrates useth two outward bands , and two inward ; though sometimes one band sufficeth ; namely , when the joint is not easie to slip out .

The length of the bands is divers , in respect of the variety of parts to be bound ; upon the arm the length of the bands must be three cubits ( by a cubit I understand the space from the top of the middle finger of the sick party , so far as the joint of the elbow ) for the legs , they must be four cubits ; for the shoulder , nine ; for the thigh , twelve ; and for the fingers , less by two fingers length . The bands , that beside their binding they may hinder inflammation , must be wet with sharp Wine and oil of Roses mingled together ; because , being dry , they will not stick long fast together . Others moderately anoint the bands , very happily , with the moist cerat of Hippocrates , which Galen describes Lib . 6. de compos . med . per Gen. Cap. 4. It is called Ceratum , from the wax that is mingled with it ; and moist , because it is soft by reason of the oil .

The proportion of the wax and oil , is this : To take one part part wax , and two of oil ; or take one ounce of white wax , and two of oil of Roses . Here we must avoid those medicaments that are made of astringent powders , and the white of an egg ; because they either cool and dry the joint too much , that the bending of it is hindred ; or they hinder the humours , that are flowed into it , to come forth . The binding of the joint dislocated , is common to fractures ; but after what manner it must be made , I shall shew underneath , in the cure of a simple fracture , and Table XXIX .

The Deposition of the part is threefold , Alligation , Suspension , and Collocation : Alligation as according to Paulus , the Arm is bound to the Thorax , in a laxation or fracture of the shoulder or arm . Suspension , as when the arm is hanged , by a linnen cloath put about the neck . Collocation , as when we place the part affected , upon any part of the body , as the Arm upon the Thorax , or upon some furniture laid into a capsula . We use Alligation and Suspension for the upper parts ; but Collocation for the lower parts . But the Deposition must be after the mean figure of the part ; soft ( therefore the case is filled with hards , that the Patient may be at ease ) equal ( for a great inconvenience may arise out of a small inequality ) and it must lie upwards , that the humours may not run to the affected part , and cause inflammation Table XXVI . Figure II and III . After good binding , and deposition of the part , there is required rest also ; for that the Ancients were wont , when the thigh was out of joint or broken , to make a hole in the bed and blankets , that the sick might void their excrements through that hole , that they might not be const●a●ned ●o ●ove .

Religation is necessary ; 1. If the part be n●t ●●gh●l● bound about ; whi●h appears if it be bound too streight , f●om whence a hard tumor ariseth in the extream pa●ts of the par● dislocated ; or too loosely , whi●h is known when there appears a tumor neither good nor bad ; tha● is , neit●et mean , ●or great , no● h●●d . 2. If there be itching or pain , that itching proceeds either f●om things accord●ng to nature , a● from a more ho● tempe●am●nt ; or from thing● preternatural . For this reason , the bands being loos●ned , let fai● water be poured upon the pa●t ; not only that that itching may be ●bated , and the watry humour discuss d , which remained pressed in by the ligature ; but also that the ligaments may be cor●oborated , whilest the water drinks up those moistures collected . Wherefore unless the ligatu●e be ill made , or itching be troublesom , let the pa●t remain unbound untill ●he seventh day . But if the lig●●u e be made too streight ▪ you must let it loose the second day , if i● be too loose the th●●● day ; but if there be an itching , you must let it loose the third or fou●th day at furthest . On the seventh day , which is the term of the infl●mmation past , the ligature must be let loose ag● n : and luke-warm water must be poured on again ( not too ho● , which might loosen the ligaments ) but the bands a●e not any more to be made wet in the aforesaid liquor , nor to be smeared wi●h cerat of roses , because the inflammation is over ; but the seventh day shews the corroboration and consolidation of the joint , and therefore there is need of a medicament that is drying and very astringent . Yet if on the seventh day there is yet suspition of ●nflammation , then until the eleventh day we must forbear the applic tion of strengthning medicaments . Such are : 1. Medicamentum Catagmaticum Moschionis , the description whereof Galen ha●h Lib . 3. de comp . med . sec. gener . cap . 9. 2. Cerat . Diapalma . 3. ●eratum Barbarum , which is excellent in winter time . 4. Emplastrum Catagmaticum Renodaei : These medicaments , before they be applied , must be softned either with the m●●st ce●at of roses , or of myrtils , for a soft chafing of the pa●t affected . Gentle chafing being made , the joint must be moved easily to this or that place , that the humour , bred in the joint , may be pressed forth without p●in These medicaments ( not weak ) when they are spread upon linnen must be applied , and the ligature must be made somewhat streighter than before . After this binding , the part must not be unloosed untill the end of the cure . To know the time when dislocations are cured , you must understand that there are three degrees of joints ; for some are small , and easily to be reduced ; some are mean , and of more concernment ; others are great , and hard to be reduced . The cure of the first joints of any finger , is performed in fourteen daies ; of the second joints of any finger or toe , at the end of the foot or hand , in twenty daies ; but of the third joints of the rest in forty daies : Wherefore the joints of the fingers are soddered together in fourteen daies ; and therefore in the dislocation of such joints , from the seventh or ninth day , untill the fourteenth day , we ought not at any time to untie the bands in the rest ; we must wait for the time of healing , unless itching or small ulcers , or some humour collected between the head of the joint and the cavity , do shew that we must unbind loose ligatures , which must be repeated every third day . After this manner we must proceed untill the part seem to be strong enough , at which time the ligature must be untied ; and the part that was dislocated , must be fomented with a decoction that may strengthen it . Take of Camomile flowers , red Roses , Rosemary , Lavender , leaves of Sage , Betony , Willows , Germander , I●ae Arthriticae , Centary the less , Wormwood , of each half a handfull ; red Wine moderately sharp , six pound ; rhe sweet ly of Barbers , three pound ; let them boil untill a fourth part be boiled away : afterwards laying the cerat on for some daies , without binding , the part restored must be kept in the mean posture , Table XXVI . Figure II and III : Then we must give warning to the Patient , that he shall begin moderately to exercise his usual operations .

The Cure of a dislocation with inflammation , rising before or after setting of the part .

IF inflammation urgeth us before the part be reduced , ther● will be two indications ; one of dislocation , and the other of inflammation ; but because inflammation is most urgent , we must first take care for that ; for if we should first attempt to reduce the part disjointed , there would follow convulsion or a gangrene of the part , to which a sphacelus would succeed . Wherefore in this case we must forbear to reduce the dislocation , and the part must be placed in a mean posture , that is not painfull at all . Table XXVI . Fig. II and III . premising universals , and things preternatural being well disposed ; and the belly being kept loose with glysters , we must lay on the part affected fat wool , and we must continually pour on hot water and oil , wherein there is plenty of hot water , and plenty of oil of Roses . For hot water will discuss the humours , will loosen the parts , and will ease the pain ; oil of Roses will mitigate the pain , and by repelling will hinder the increasing of inflammation . Also the pain will be eased with new shorn greasie wool ; and inflammation is hindred . But because , when inflammation ceaseth , the humours collected are somewhat thickned ; therefore , about the end of the inflammation , we must chafe the part gently with our hands , first anointed with oil of sweet Almonds , or with common oil ; and then we must lay on the Cataplasm of Nilus , or Nileus , which Galen describes Lib . 8. de comp . med . sec. loc . cap . 5. and these are the best when the inflammation declines , by reason of the wax , Ammoniacum , Oil , Saffran and Vineger ; than which there is nothing better to soften , call forth , and to discuss . But since these things are not common in all shops , lay on Emplastrum Oxycroceum Nicolai , which likewise softneth , discusseth and draweth from the bottom ; therefore this is excellent to be used in the place of the former . The inflammation being overcome , let the part be extended , reduced , bound and laied as it ought to be .

If inflammation succeed after it is reduced , which often happens , both by reason of violent extension , and also of perpetual pain ; a slender diet must be ordred , and a vein opened , and a purge taken , and the ligature must be forthwith untied ( though it fall out on the first or second day ) and likewise water and oil very luke-warm must be poured on , untill the Patient find some relief thereby . After this let the part be bound somewhat looser , and with fewer swathes , wet with water and oil . This must be done every day , untill such time as the inflammation declines , which happens for the most part on the fifth day . When the inflammation declines , we must apply the aforesaid Cataplasms , or Oxycroceum Nicolai , to resolve the remainder of the inflammation , with a Ligature yet more loose . But when the inflammation is taken away , you must observe the way of cure prescribed for a simple dislocation ,

diagrams detailing surgical techniques TABVLA XXVII

Fig. I

III

VII

VIII

XII

XIII

XIV

The Cure of a dislocation with a wound , and the bone either onely uncovered , or yet sticking forth a little without the skin .

IF the joint be dislocated , so that it is either uncovered , or a little thrust forth without the skin ; the accident is mortal , and of more danger to be reduced , than if it be not reduced . For if it be not reduced , inflammation will come upon it , convulsion and sometimes death . 2. There will be a filthiness of the part it self . 3. An incurable ulcer , and if perhaps it be brought to cicatrize at all , it will easily be dissolved by reason of the softness of it ; but if it be reduced , it brings extream danger of convulsion , gangrene and death . But some men fear these kind of dangers in great joints only ( namely the Wrist , Arm , Shoulder , Ankle , Knee and Thigh ) which by reason of the strong Tendons , and the greatness of the ligaments and vessels hinder Reduction ; unless the Patient and the standers by , having heard of the great danger , do press to have it done , which the Chyrurgian must attempt either the first , second , eighth or ninth day , that he may not appear to be ignorant in Chirurgery , but not in smaller joints , as the fingers , toes and extremities of the hand ; which Celsus reduceth likewise foretelling the danger , first looking to the inflammation and convulsion , then to the wound and dislocation . Where therefore a greater joint cannot be reduced , first care must be taken for universals and diet , and the part without all extension or binding must be placed in a mean figure , either hanged from the neck , or else gently laied down in a Capsula , that it may remain immovable and feel no pain . Also inflammation and convulsion that are at hand must be hindred , with some medicament that easeth pain , concocts , cools and repels . Such a Medicament according to Hippocrates 4. de Artic . 6. is a cerat with pitch , which is extended upon a plaister that was wet with sharp black wine and warm ; first pressed out , and laid warm to the joint .

The Cure of Convulsion arising after the reduction of the joint .

IF when the bone is set , Convulsion come upon it , the joint must be presently let loose again , and must be very well , for a long time made wet with plenty of warm water or oil : Also the whole body must be heated that it may be forced to sweat , and all the joints may grow hot , because they all sympathize together : Also the beginnings of the nerves must be anointed ; namely , the nape of the neck , back-bone , the grains and arm-pits , with oils and unguents which are proper against Convulsions .

The Cure of a dislocation with a callous , which hinders the reduction and motion of the joint .

IN joints that before or after the reduction are ill handled , a callous easily grows ; especially in those that are not compassed about with much flesh , as the elbow , knee and foot ; other joints sometimes , but not so easily , are troubled with a callous , because they are more fleshy , and they easily discuss the sanguine humour , which falls down for the nourishment , and more facile motion of the joints . Now the callous is either hard , or as hard as a stone , or else not so hard and stony . There are four marks of a stony callous . 1. The joint is seen to be most slender and most dry . 2. The Patient cannot move the joint , nor yet the forcible hand of the Chyrurgian . 3. The slenderness and thinness of the part is continual . 4. There were applied medicaments that were too cold , very astringent and drying , whereby the aforesaid humour was turned into a stony matter . Also there are four marks of a callous simply hard : 1. If the disease be new , for when it grows old , it becomes like a stone . 2. Though the Patient cannot move the part , yet the Chyrurgian can . 3. If fit remedies were applied to the joint . 4. There will be some tumour in the part which is hard , but not so hard as a bone .

The stony callous will not be cured by Celsus his way without danger , wherefore it must be left as it is . But the cure of a soft callous , or not so hard , is this : First , Empty the body by purging and bleeding . 2. Let there be ordred a good rule for diet , and other not natural things . 3. Let the part be softned with oil , or with this medicament following : Take Marshmallow roots 3 ounces . Of wild Cucumbers 2 ounces . Leaves of Mallows , Marshmallows , alike two handfulls . Linseed , Fenngreek . Fat Figs , of each 3 ounces . And one Wethers head .

Boil all these in a sufficient quantity of pure water , untill the flesh of the head part from the bones ; and with the steem of this , let the joint , with a callous , be fomented for some daies ; after fomentation , let the part be chafed for a third part of an hour long , the hands being first anointed with oil of sweet almonds and fresh goose-grease mingled together . After the chafing , lay on the plaister of Nileus , spoken of before ; or Oxycroceum Nicolai , tempered with goose-grease . After three or four daies , for the softning and discussing of the callous , the fume of vineger is commended : Wherefore Galen takes a Fire stone ( or for want of this , a Mill-stone ) which he makes red hot in the fire ; afterwards he pours vineger upon it , wherein some piece of gum Ammoniac is steeped , that the steem rising from it , and received for a third part of an hour , may not only attenuate the callous , but also soften it : Attenuation being made , a Cataplasm must be laid on ; either this that follows , or one that is stronger . Take Barley , Bran and Oxymel simple , what is sufficient to make a Cataplasm . Note that the si●k Patient ( if the joint be reduced ) must move his joint as much as possibly he can , between the use of emollients and discutients ; for by this motion the callous is digested . If the joint be not yet reduced , and a callous arises , this must first be cured , and then the joint must be reduced ; as I said in a simple dislocation .

The Cure of the disl●cation of a joint , which after it is set , slips again , of it self , out of its place .

A Joint slips out for three reasons . 1. When , after a violent dislocation , the joint is ill set , and the ligaments are not wel dried . 2. When some tumour that arises from inflammation , and is ill cured , hinders it , that the joint cannot be contained in its place . 3. When a humour runs to the joint which relaxes the Ligaments . The first cause requires greater driers : The second shews emollients and discutients , of which I speak before : The third is worst of all ; which ( after that the body is purged by medicaments , a vein opened , and a good diet used ) requires adustion , than which there is nothing better . For this cauterizing first consumes all those moistures by a hard crust , which makes a hollow ulcer , which being covered with a cicatrize , contracts the part relaxed ; for by cauterizing we heat , dry and digest the humours . But we must note : 1. To burn the place to which the bone falls ; as if the shoulder fall under the arm-pit , the burning must be made under the arm-pit . If the head of the thigh be out of joint to the fore-part , the fore parts must be burned in many places . 2. The nervous parts , ligaments , veins , arteries and glandulous parts must not be burned , for fire is an enemy to them ; for by reason of their driness a wonderfull convulsion follows . 3. The burning must be made with iron tools , which make no great Escars ; wherefore small iron instruments must be chosen like to Olives , with sharp points , and well fired red hot . 4. That after this burning the joint may rest for many daies , for if it should slip out again , the disease were incurable .

The Cure of the Elongation of a joint .

WHen a joint is lengthned , the more loose ligaments must be bound up with medicaments , not cold ( for these make the joint stiff and unfit for motion ) but hot . And seeing there is no single medicament that hath the force to heat and to bind also , we must apply some compound , as is the plaister of Rams skin . But if the cure succeed not by medicaments , there is but one remedy left ; namely , that the outward skin , on both sides ( taking care then of the parts aforesaid ) must be burned with small iron tools , made excellent well red hot ; afterwards the part must be bound up with bands proper for it .

The Cure of a simple fracture .

A Fracture overthwart or obliquely , is cured in four things . First , By reduction . 2. By preserving the part reduced . 3. By the ingendring of a callous . 4. By correcting the accidents that come upon fractures . Reduction is performed by two things ; namely , Extension and Conformation , either by force , or by fitting the parts together .

Also in Extension we must consider : ● . where . 2. when , 3. the manner . 4. the instruments . 5. the quality . 6. the quantity .

Where there needs Extension ; namely , when the parts of the broken bone do not yet lie right , but one lies over another .

The Time is best , if we extend presently , so soon as we know the fracture ; for if that be not done , there is presently a great flux of humours , by reason of the vehement pain , and the muscles are drawn toward their beginnings , and so extension becomes difficult ; and if we go about it , the broken bones do prick the fleshy parts that lie near unto them , and inflammations , convulsions and other evil accidents follow . Yet extension may be attempted befo●e inflammation come ; namely , on the second or third day ; on the fourth day and the daies following ( until such time as fear of inflammation be over ) Hippocrates forbids to make extension . But the latter Chyrurgians , that they may lessen inflammation , ease the pain , and may soften the muscles that are contracted toward their beginnings , do moisten the broken part with hot water : Others take oil and water , or the decoction of Mallows , Marsh mallows , &c. and with the vapour of these they do foment the part , for a whole hour together . Where you must note that at the beginning of this fomenting , the part affected will swell extreamly ; but when you have fomented a while ; not only the tumour raised by the steem , but also that which was before which hindred the extension , will vanish also . Also the skin of a Calf , newly killed , is an excellent remedy ; or any other creatures skin bound about it whilest it is yet hot , and kept for some hours about the part broken , for it hath a notable digesting force ; softning and easing pain .

The Manner . The broken part is kept in a mean figure , with instruments necessary for extension both below and above the fracture , and it is drawn most rightly both waies ; namely , upward and downward .

The Instruments , sometimes are only the hands of two Assistants that are strong , where the attraction is gentle , Table XXIX . Figure I. Sometimes strings of linnen or leather , where we must draw harder , Table XXIV . Figure I. And sometimes Engines , where we must extend with the greatest force , Table XXV . Figure I.

The Quallty varieth according to the magnitude of the bones and muscles . Whence it is that the radius requires the least extension ; the bones require greater which are in the top of the hands and feet : Yet greater the arm and the Fibula : The shoulder and the leg require greater than they ; and the thigh bone the greatest of all .

Moreover in every bone a stronger extension is indured . 1. In a soft body rather than a hard body . 2. The first day rather than the daies following , when the fear of inflammation remains . 3. An old fracture than a new .

The Quantity ; the part is extended right forth , untill such time as the bones are placed right one against another , and do not touch one the other .

Conformation will be made well ; if , whilest the instruments that extend , are slackned by little and little , and the pa●t is kept in a m●an posture , the parts of the broken bone , which do not yet lie right one against another , are set exactly right , and the prominent parts of them are hid in their proper cavities , by the hands of the Chyrurgian , sweetly and gently without any violence at all . Table XXVI . Fig. I This operation succeeds excellently well , when the member made conformable , is like to the sound member in figure , and we can feel no inequality by handling of it , and the vehement pain is ended or abated .

Conservation of the fracture now reduced , consists in binding and hindring of inflammation , by topical means ; binding is made with Bands , Splents and Ferulaes .

Bands , Tab . XXIX . E F G , are provided of old linnen rags , and such as are worn with using , that they may be the more tractable ; yet they must be strong , lest being extended they should tear ; they must have no seams or knots , that they may bind equally and without pain . But the breadth of the bands is known by the magnitude of the part : for the thicker part requires a broader band , and the thinner those that are narrower .

The length must be as much as is needfull ; namely , that the binding may comprehend a great part of the sound part , both above and beneath the fracture , made with requisite circumvolutions , which must be as many as are requisite to strengthen the broken part .

Splents , Table XXIX . Letter I. are linnen cloaths ( the Antients made them of hards kembed out ) often folded together ; and they are called Splents , because they are like the Spleens of brute beasts , which use to be long and narrow ; others call these cloaths Plagets : The Ancients called them Plumaceolos or Pulvillos , small feather bolsters or cushions , because they made them of feathers sewed between two linnen cloaths . These splents must be so long , that they comprehend all the ligature ; for if they should be shorter , they would not defend all the circumvolutions of the ligature : But the breadth of them must be the breadth of three or four fingers os the Patient . As for their thickness , they must be three , and also sometimes four double , where there is need of more strengthningf And when they must compass the whole part about , so many must be taken as can go round about the part . Whence Hippocrates lib . de offic . medic . Let the length of the Splents , breadth , thickness and multitude be thus . For l●ngth let them be equal to the l●gature ; their breadth must be three ●●●ur fingers broad ; their thickness must be three or four-fold double ; their multitude that they may go round about , and they must be neither more nor fewer . And Galen in his Comment upon this place , in thi● speech which Hippocrates now makes of fractures , first he mentions Plagets and Splents , so called from the likeness of their form to Spleens ; which he commends to be made so long , that they may equal the ligature , for that they are used to defend that ; namely , that they may hold that firm and unmoved ; so broad , as that they may equal three or four fingers breadth of the Patient to be bound ; so thick , that they may be three or four double , four double where the ligature needs more strength ; but where less strength is required , he supposes that thrice double may serve the turn . But he advises to use such a number of Plagets , that they may compass the part bound , round about it .

Ferulaes are l●gh●● hips of wood , Table XXIX . K. ( which are laid upon bones b●oken or out of joint , after that the time of inflammation is past , t●a●●hey may strengthen the fracture the more ( not much unlike to Plagets . The Antients , amongst whom Hippocrates was the chief , made these Ferulaes of the bark of the woody shrub Fennel gigant , or else of the boughs of it divided in the middle , whence they came to be called Ferulae . For this wood is most fit for this purpose , and because it is most hard , and therefore the Antients made wal●●●g staves of it to lean upon : We , for want of this shrub ( because in Germany and colder Climates it cannot be had ) provide , with excellent success , Ferulaes of the lids of Chests which Apothecaries and Merchants use to put their Merchandize in : And if we cannot get those covers neither , excellent Ferulaes are made of old scabbards for swords , which because they are covered with leather , they are hard and smooth . Hippocrates lib . de offic . Medic . sets down the good conditions of Ferulaes : Moreover it is necessary ehat Ferulaes be smooth and equal , and crooked about the ends , and on both parts of the ligature a little shorter : but thickest of all where the fracture breaks forth . He will not have them to be sharp but smooth , that they may be drawn sometime ; upwards , and sometimes downwards , sometimes right out , sometimes obliquely as need shall require ; not wrested aside , which may turn aside the ligature and the part ; but equal , that they may equally compass it about ; they must be flat upwards about the ends , that is at the lower ends lightly pared away , that they may bind the more in the place of the fracture , rather than upon the sound pa●●s , which being pressed will feel pain and be inflamed : At both ends where the ligature is made , somewhat shorter ; for the same reason , that they may not press those parts which are sound at the ends , and so cause pain and inflammation . Galen comm 3. de Chyrurg . offic . text . 11. writes : But it chiefly concerns a fracture , that the Ferulaes be neither sharp nor wrested aside , because both waies they press ; but those that are wrested , have this over and above , that they wrest aside the ligature ; which being wrested , the part broken is wrested aside also . He also counsels to make choice of such Ferulaes which are flat upwards at the ends ; for those that have alwaies the same thickness even to the end , and are equally bound on that part , are better than all others are : But this is not expedient at all to be done , when he will that the Ferulaes shall bind faster in the middle of the Ligature ; and from thence , unto both ends ; they should be more loose , and at the ends loosest of all . He will also that they shall be shorter , for length , than the binding is , that they may not touch the skin beyond the Ligature ; which , because it receives ofttimes the humours pressed out by the bands , becomes more swoln . Also he will have the Ferulaes to be th●eker where they lie upon the fracture ; because that place , above all the rest , stands in need to be pressed down by them .

Inflammation at hand , is hindred by Anodyns and repelling Medicaments , applied outwardly to the part . I , with happy success , alwaies use a Medicament which is compounded of sharp Wine , oil of Roses , and the whites of Eggs beaten together with a spatula , when they are mingled in due proportion : If pain be urgent , I leave out the whites of Eggs , and I mingle Oil with the Wine in greater quantity . When this Medicament is used , I wet my bands in it Table XXIX . E F called subligamina ; and I press it out again , Table XXIX . H , according to the admonition of Avicenna ; who , Lib . 4. Fen . 5. tract . 1. cap . 5. concerning the cure of a dislocation , commands that we should be carefull , that they be not laid on hot and dry . For when they are hot , they heat , and by heating draw out humours ; and being dry , they do not stick fast together .

Wherefore Extension being made , and the fracture composed , all things provided necessary to bind withall , the part which is yet extended divers waies , must immediately be roled about with swathes drawn upward and downward . But at first we must make three circumvolutions of the first band above the fracture , and make so great a compression , as may suffice to strengthen the bones ; then toward the superiour part , namely the sound part , the Ligature must be brought , by little and little diminishing the compression . Table XXIX . Fig. I. When we have taken in sufficient of the sound part , there we ought to end the binding of it . Then we must take another swathe band , that is longer than the former , that it may come to that place where the first band ended ; and one or two circumvolutions must be made ( the contrary way ; for if the former were toward the right hand , this must be toward the left hand ) upon the fracture ; and from thence toward the lower part , the binding must be brought ; diminishing likewise the compression , by degrees , as we did before , But the circumvolutions of this swathe must not be so many , because we do not here fear the extream parts so much ; and when we have taken in sufficient of the sound part , we must then leave off to make any more circumvolutions toward the lower part . Table XXIX . Figure II . the bands return by the fracture , with more seldom circumvolutions , untill they come so far as the end of the first band . But because these two bands , now roled about , are too weak to hold the fracture , Splents must be applied about the fracture , and the whole part ; namely , according to the length of it , to be laid on long waies ; not that one shall be put upon another , but that betwixt one Splent and another , there be so much distance as a fingers breadth of the Patient himself ; these must be made fast with a third ligature from a double end , so that the first circumvolution must be made upon the fracture ; then the other end must be brought toward the upper parts , with more frequent circumvolutions ; and the other end toward the lower parts , and the circumvolutions must not be so many ; then again from the lower parts upward , untill we come to that place where the other end of this swathe came to an end . Yet both ends must be so often roled about , that the ends of the Plagets may stick forth a little at each end . Table XXIX . Fig. III . It shall be the sign of convenient ligature , when the Patient reports that it is bound firmly ; but not pressed , and more upon the part hu●t , than upon the sound part , and least of all toward the extream parts .

After convenient Ligature , there succeeds good Deposition ; which is the middle figure , soft , equal and tending upwards . Wherefore let the part that is bound , be laid in a wooden Capsula that is filled up , being wrapt in kembed hards and linnen , and so let it remain untill the third day ; if the Patient that day he is bound , and the night following , seems to himself to be bound more streight , and on the second day less ; besides this , ●here will be a soft and small tumour on the extream part ; for a great and hard tumour shews that the Ligature is naught , and too streight , and that there is at hand fear of inflammation and of a gangrene ; whereupon the sick must be presently unbound , and be bound again , but more gently .

If on the third day , after binding the part , the bands seem to be too loose , they must be unbound again ( but we must observe that when we must unbind the Ligature , before the bones be at all knit , the windings about of the bands , are not to be unbound by little and little , but the part must lie still , and the linnen and bands must be cut , untill such time as the upper part being uncovered , you may take all things away , the part not being l●fted from its proper place . For there is no need to lift up the part , and to let it lie pendulous , and so to handle it , for no good can come to the Patient by that , untill the Medicaments be applied , an● the part be again roled about with bands ; and the part that itcheth must be often sprinkled with warm water , that the smoky vapours detained in it may evaporate : After that the part must be bound with a Ligature which is moderate , yet a little streighter ; and let it be laid into the Capsula untill the seventh day , at which time the bands must again be unbound , and the part must be sprinkled with water , and bound again with bands , yet streighter drawn together ; but so that they may suffer life and nourishment to pass to the extream part of the member . Wherefore apply to the broken part the cerat Diapalma , or Emplastrum Catagmaticum Renodaei , either spread upon one broad linnen cloath , or upon many narrow pieces ; and upon this bands having but one end , and wet with sharp wine , and pressed forth again ; and above these must be Plagets , first wet in wine and pressed out , and then wet in the white of an Egg beaten ; and last of all , must be a roler with two ends wet in the same wine These things being duly performed , because at this ●●●e , most commonly , the fear of inflammation ceaseth ; the more to strengthen the fracture , Ferulaes ( which cannot safely be boun● on to preserve the Liga●ure , untill the seventh day be over , fo● fea● of inflammation ) with Plagets round about that stick forth ●t each end of the Ligature above , must be laid on all the length of the part , with bands L roled about them exceeding loosely : In this o●der , that first they must be bound on the upper part : Secondly , on the lower part : Thirdly , upon the fracture , lest the binding should be more forcible upon the f●acture , and should cause pain . Table XXIX . Fig. IV . Als● , in applying Fe●ulaes , care must be had to any bones that may stick forth , and out of the flesh ; for laid upon them , they will cause pain and exulceration : Wherefore , let them be laid on the outsides of them , or let them be shorter . The part so bound must be kept unmoved in the Capsula , untill the twentieth day ; ●nl●s● It●hing , Excoriation , Pain or other accidents require the ba●ds to be unbound , and a convenient application of Medicaments to be made . Notwithstanding , the Chyrurgi●n shall , every third day , come to see his Patient ; and shall gently fasten the loose Ferulaes upon the fracture ; having alwaies tha● before his eys , th●t Ferulaes are put round , not to press , but that they may defend and strengthen the binding that is under them .

But when this term is past , the Ferulaes and Bands must be bound hard ; and the part affected , for the generation or nutrition of the callous , must be fomented with hot water ( untill it swell , and no longer ) then applying a plaister for broken bones , the Ferulaes and Bands must be bound more loosely ( that humours that breed and nou●ish a callous may increase ) and the part laid into a Capsula , must remain there for two daies ; and then must be bound hard again , to try the quantity and quality of the Callous . The bands must be bound every fifth day after this , and the part being sprinkled with hot water , must be dressed with a Cerat , Bands and Ferulaes , looser than before , untill such time as the fracture may be confirmed with a moderate callous ; which is wont to be done in bones of the Arm , for the most part , in thirty daies ; in the bones of the shoulder and leg , in about forty daies ; and for the thigh , in about fifty daies : Yet none of these is certain ; for nature differs much from nature , and age from age .

The Callous is bread of blood , which must not be drawn before the seventh day ; wherefore Emplastrum Oxycroceum is dangerous the first daies , by reason of inflammation present , or near at hand . To breed the Callous , others give broths , wherein the leaves of Agrimony , and the roots of Comfry have been boiled . Others give more glutinous meats . The new Practitioners above sixty years since , have found a stone , which grows in the Palatinate , which is much commended , by the inhabitants of that place , to breed a Callous ; whence they call it {αβγδ} . Concerning which read Guillielmus Fabritius Hildanus Cent. 1. Observ . 90 , 91 & 92. and Sennertus Lib . 5. Institut . part . 2. sect . 1. cap . 7. Outwardly not only Ceratum Barbarum , and Diapalma Galeni are safely applied ; but also Emplastrum Oxycroceum Nicolai , and Catagmaticum Renodaei : Barbarum and Oxycroceum must be laid on in Winter , Diapalma in Summer , and Emplastrum Renodaei Spring and Fall . Sometimes some symptoms follow fractures , as Itching , Excoriation , a Callous greater or smaller , pain , smallness of the parts , or winding aside of it ; all which things require the Chyrurgian's help .

Itching will cease if the part bound be fomented with warm water untill it wax red ; and a little more , that the matter attracted , may be again digested . When the part affected doth not conveniently admit the pouring on of cold water , it is with profit enough held over the fume of the water . Note that the scratching must be forbidden the Patient , when it doth itch , because it is the worst th●ng ; and besides Excoriation will attract humours , and raise v●ry grievous pains .

Excoriation which often arises , when the unloosing of the bands is deferred longer than it ought to be ; and again when the Patients are impatient and scratch , is cured by the pouring on warm water , as I said for the cure of itching ; and by applying unguent de Cerussa , which cools and dries .

Pain is mitigated by fomenting with Water and Oil , or with the decoction of a Wether's head with Camomile flowers .

The Callous is bred greater than it should , when the Patient uses a fuller diet than he ought to do , or the Physitian is more negligent in the cure ; if he do not feel his Pulse , and if he bind the bands too loose . This is prevented if you take away from his diet , and the quality of the callous be sometimes tried , and the bands bound somewhat streighter . It is diminished , first with emollient Medicaments ; and next , with emollient and discutient mingled together ( such as were propounded for the cure of a dislocation with a Callous ) untill it come to a mediocrity . A Callous that is too small , hath contrary causes , and therefore it is to be preserved by contraries . It is augmented with a more thickning diet , and attraction of the aliment to the part affected , by pouring on hot water ( yet with that moderation , that whilest the part is yet lifted up , we do desist before it fall down again ) and by the more loose ligature of the bands .

Extenuation of the part proceeds , either from the too hard binding of the bands , or for want of glutinous nourishment . If binding cause Extenuation , the bands must be bound looser : If want of nourishment be the cause of smallness , let nutriment be attracted by fomenting with hot water , untill the part wax red ; and then lay on some Pitch plaister upon it , spread upon a broad linnen cloath ; and let it be oftentimes duly drawn off , taking heed afterwards that we bind not the bands too hard , which might again repulse the nutriment drawn thither .

Distorsion , or ill conformation of the part , proceeds either from the neglect of the Chyrurgian , when he makes less extension , joining togeth●r or binding than he ought to do ; or it is the fault of the Patient , when he stirs the broken part before the Callous is grown strong , or stands upon it ; or else it is the fault in the fracture , especially when the thigh is broken . For the bones of the thigh , though you do draw them out by force of extension , cannot be held so by any bands ; but when the first Intension slacks , they will run together again ; for here the thick and strong flesh are above binding , and binding cannot keep them down . Hippocrates de fract . which Celsus seems to confirm , Lib . 8. Cap. 10. where he writes of the cure of the legs and thighs . For we must not be ignorant that if the thigh be broken , that it will be made shorter , because it never returns to its former state : And Avicenna Lib . 4 Fen . 5. saith that it is a rare thing for the thigh once broken , to be perfectly cured again . These words admonish us , that we should never promise a perfect cure of the thigh ; but rather , using all diligence , we should foretell , that it is doubtfull that the Patient will be alwaies lame ; lest when this shall happen from the nature of the fracture , or which most frequently falls out , from the impatience of the sick person , it may be imputed to our mistake ; and instead of a reward , bring us a disgrace . Also ill conformation may come by reason of the fracture , when a peece of the bone is contained between both the bones that are broken , which may hinder them to touch one the other . The bones that are dislocated , either by the Physitians or the Patients fault , must not be broken again ( unless it cannot be helped , by reason of the great hurt done to the part in its operations ) if the Patient be old and weak , the Callous be of long standing and hardned , and the bone be great , as are the shoulder and thigh bones . But if the hurt be great , the Patient be young and strong , the Callous new , not above six moneths standing ; let the Callous be softned for fifteen daies , with pouring on of liquid ma●ter , with baths and emplaisters ; then let the part be drawn at both ends , either with mens hands , cords or engines , divers waies , as need requires , untill such time as the Callous shall be broken , and the parts of the broken bones can be fitted together with the palms of the hands : After this , the fracture must be cured as I said b●fore . If any piece of the bone wrest aside the whole part , there must be incision made with a sharp knife , Table II Fig. II . as far as the broken bone ; and the splint of the broken bone , which hinders the joining together , must be pulled out with the Pullers ; and then the fracture must be fitted by extension , bound and laid down , as we deal with a new fracture . In the said Distorsion of the thigh the bone must not be broken ; for it is better for a man to live and be lame , than to indure a dangerous operation , with great torments and fear of the same mischief .

But the Distorsion of the thigh is prevented , if the part be kept extended in the instrument called Glossocomum , Table XX● Figure IV . ( which is appointed for this use in the next place ) ●n● before , and after the binding of it , untill such time as the fracture be perfectly cured .

Of the Cure of a Shingle Fracture .

IN a Shingle Fracture , or that which is made according to the length of the bone , the bands must be bound streighter than in other fractures ; that the bones broken , which are departed broad waies one from the other , may be brought again to a mutual and close touching one of the other , that they may not fall back again . Galen . Lib . 6. Meth Med . Cap. 5. Besides we must do all things which are to be done in an oblique or overthwart fracture , as I said .

And these things shall suffice to have been spoken of the cure of simple ftactures , where the bones do not stick forth , nor yet any wound is joined with them . Now I will briefly declare how a fracture , with a wound , must be cured . There are divers kinds of fractures with wounds ; for either the bone is made naked of the Periostium and the flesh ; or else it is yet covered with them ; in both again we expect that some great part , or small , or no part of the bone shall come forth .

A Fracture with a simple wound .

IN which , neither the bone is made naked of its coverings , nor any part of the bone is come away : it is cured as a fracture without a wound ; namely 1. With convenient Extension , 2. With due joining together , and this is followed by a mutual touching together of the lips of the wound ; and by keeping them so , when they are thus brought together , by linnen cloaths that are Plaisters laid cross waies upon them , and by bands . 3. By Deligation . 4. By Deposition .

Yet here about the cure we must note : 1. That Extension be presently made , by a Chyrurgian , on the first , or at furthest on the second day ; namely , before any great inflammation falls upon the part . If the Chyrurgian be not called seasonably ; but on the third , fourth or fifth day , in which the inflammation is near at hand , or else is begun , then extension must not be attempted until seven or a few more daies be over ; and in the mean while , the Physitian shall use all the force he hath to prevent inflammation ; both by removing the antecedent cause , by diet , and Chyrurgery , and Physick ; as by taking heed to the part affected by Anodyns , Repellers , and convenient Deposition of the part as much as may be ; and by covering the wound with such things as shall cause suppuration . When the danger of inflammation is past , the fracture must be set either by Extension alone , or else by help of the Levitor also ; then it must be bound with three bands , and a sufficient number of plagets , and so laied down easily .

Secondly , The Extension must not be so violent , as in a simple fracture , because the fleshy , musculous and nervous substance , is already torn , bruised and hurt ; for if we do otherwise , extream pains and convulsions will follow , with the greatest danger of the Patient's life .

Thirdly , The first band must be something broader than the wound it self ; espe●ially at the beginning , from whence we begin to wind it about , that it may comprehend the lips of the wound on both sides . For if the band be too narrow , then it would hold the ulcer bound in , and would cause pain .

Fourthly , The bands also must be bound less close than for a fracture without a wound ; lest the wound being pressed , pain and inflammation should arise ; and for the same reason , let them also be more soft than for a simple fracture . Let the part be untied the third day after extension and direction , and be bound again , yet so that the ligature may press it somewhat more ( to make the part more slender ) so long as the fear of inflammation remains , unless pain perswade to do otherwise . But in the second binding let not the ligature be made streighter , but rather looser , that there may be passage left for the blood to come forth , which must be the matter of the callous .

Fifthly , Ferulaes must not be laid to the wound ; and if they must be laid on , they must be placed on the sides of the wound , and the opposite part , untill such time as the wound is cured . But it seldom falls out , that a simple wound in such a fracture is not covered with a cicatrize , at the second or third dressing , or at least not filled up with flesh . When the wound is healed , if the bone be not yet strengthned , we must do as we did for a simple fracture . But if in the mean time , namely on the eighteenth or twentieth day , or upon any other day , the wound grows worse , and the fracture of the bone threatens an impostumation ( for the separation of the bone cannot at first be foreseen alwaies , unless the fracture wants its conformation , or the bone lieth a long time uncovered ) ( which is shewed by much atter , which is not proportionable to the greatness of the wound , by the lips of the wound turned inwards , and by the dull flesh bred in the wound ) we must consider whether the piece of the bone be great or small ? If it be great , the signs propounded are greater ; if small , they are smaller . 2. Whether that piece which must part from the bone be yet parted , or remain upon it still ? That is known , when the Patient , minding of it , finds a secret motion ; or not minding of it , perceives a pricking pain : This , when the Patient finds neither secret , nor yet open motion .

A Fracture with a wound , in which the bone is not made naked ; yet a great piece of the bone , or many pieces ( as in wounds made with gun-shot ) are known that they will come off presently , or else afterwards .

IF they will come off presently , this requires a ligature that is of another fashion , and far different from the former , according to the most sudden separation of the bone , that the part may be daily bound and unbound , without any moving of the fracture . The most approved way of binding , is that of Hippocrates , whereby the matter is not stopt in , the fracture is strengthned , inflammation is hindred , pain is not caused , and the most speedy separation of the bone is procured . To perform all these things , let double Plagets be provided , made of linnen cloath , not narrower than that they may sufficiently cover the lips of the wound ; as for length , let them be somewhat longer then to go once about the part ; and let them be as many in number , as shall suffice to make a hatching ligature . Table XXVII . Figure VIII . These must be wet with a mixture of sharp wine , and oil of Roses , to ease pain , and to hinder inflammation ; they are laid upon a broader linnen cloath , in that order that the middle Plaget may cover the next to it , and these the middle of those that are further off . These things being provided , and the fracture being joined , and a suppurative medicament being laid to the wound ; namely , Galen's Tetrapharmacum , that linnen cloath with the Plagets so disposed , must be laid under the part to be bound , so that the middle Plaget must come under the fracture , Table XXVIII . Figure VIII . Then the Assistant shall hold one end of the middle Plaget streight , and the Chyrurgian shall hold another , which must be so brought about , that far from the ends they may cut one another circularly , and may bind the part that is hurt closely , as far as it is lawfull , rather than necessary , for fractures with a wound , and where a piece of the bone is to come away . The middle Plaget being brought into a circle , let also the first of the upper Plagets be brought about , then the second , then the third , and so forward untill we come unto that part , to which the first band , Table XXIX . Figure I. should ascend if there were no wound . These upper Plagets being fitted , we must likewise order the first of the lowermost , then the second , then the third , then the fourth , and so forward descending as far as the sound part , Table XXIX . Figure II . These medicaments with their Ligature must be applied ( daily wetting the bands only with wine and oil ) untill such time as the term of the inflammation be over ; then by all means we must strive that the bone which is coming off , may be thrust out so soon as possibly it may be , helping n●●ure by an injection of decoctum divinum , and laying on ceratum sacrum of Galen , upon the wound ( that it may only comprehend the l●ps of it ) and a Diapalma about the affected par● . Note , lay on the plaister Diapalma with seven single Splints ( be they more or fewer ) and let their ends be brought round about , beginning at the middle one , and afterwards ascending and descending , as we use to do , with double Plagets . The Splints with the cerat being laied on , lay on the Plagets made of double linnen cloath , and wet in sour wine , that they may stick the faster together .

The bone being thrust out into fight , and it being drawn forth with the Pullers , if it can be done without violence , the wound must be healed with ceratum divinum . But when the wound is brought to cicatrize , the part must be kept in rest , untill the fracture may grow strong , Ferulaes being laied round about it . Note farther , that if it be needfull to remove the bands , either for their foulness or hardness , the part must be lifted up ; but it must be presently laied down again upon a broader cloath of linnen ; upon which those small linnen cloaths doubled were already laid . Table XXIX , Figure VIII .

If the bone appear that it will not presently part , but will come away afterwards , the Ligature ( which is made with three Bands and Splents ) must be changed into a hatching Ligature , described even now , untill the bone do separate . The bone that is great enough ( such as are those printed Table XXVII . Figure IV . and Table XXIX . Figure IX . ) being parted , the circular dressing , with the plaisters ( Table XXVIII . Figure VIII . in the leg ) must be changed into a cross form ( Table XXVII Figure I ) and the Ligature must begin from the lowest Plaget , and must end in the uppermost ( Table XXVIII . Figure X. ) that the moisture , collected in the cavity of the bone separated , may be pressed out of the wound ( which being thrust down , by the Plagets descending , would make a large hollow pla●e ) when the wound is brought to cicatrize , Ferulaes may be laid on to confirm the fracture .

A Fracture with a wound , wherein the bone is made naked of the Periostium , yet it doth not stick without the wound .

THis is cured : First , By moderate extension of the part . Secondly , By convenient joining together . Thirdly , By fitting the lips of the wound to touch one the other . Fourthly , By fit Ligature , Fifthly , By fitting deposition . In binding we must consider , whether any part of the bone will come off or not ? None will come off , if the bone that was made naked , be presently covered with a skin again . Some will come off , if the naked bone be long exposed to the open air . If none , or but a small bone , will come off , the binding must be made with three bands and plaisters , as in a fracture with a simple wound , and wherein there is expected a separation of some small bone . If a great bone be to come off , the part affected must be bound with a hatching Ligature ; as I said , even now , for a fracture where a great bone was to come away .

A Fracture with a wound , where the bone sticks out of the wound .

BEfore it be reduced , we must consider whether the bone , sticking forth , can be brought again to its own place , by help of due extension or not , without violence and danger of convulsion ? And if it can be reduced without danger , let it be reduced ; but if not , let it not be reduced . The signs of dangerous reduction are , great sticking forth , inflammation , and the part grown hard by contraction of the muscles : But easie reduction appears by a small bone sticking forth , when there is no inflamed tumour , and the part is soft . If therefore it cannot be reduced , of two evils the least is to be chosen ; the naked bone sticking forth ( with prediction of the shortness of the part that will be afterwards , lest that should be laid upon the Chyrurgian as his fault ) must be nipped off with a pair of Plncers , Table XX . Figure I. and afterwards the fracture must be joined by moderate extending of the part . For it is better to make the part something shorter , than to leave the bones not join'd together , or to extend them violently ; both of which would bring convulsion and death to the sick Patient . If the bone diminished cannot yet be set , by the moderate extension of the hand ; that extension must be helped , according to Hippocrates , with a levitor or some cutting chizel , put in between the broken bones , Table XXVII . Figure IX . The fracture being composed , the part must be bound as we said for a fracture with a simple wound . But we must cut a hole in the bands and plaisters just over the wound , that we may daily lay on medicaments upon a great wound . The reason why the bands must be made with this hole , is this , because a great wound , and therefore to be cured by the second intention , breeds plenty of Atter , and therefore requires often looking to ; but the bone that is diminished , for fear of a new contraction of the muscles , forbids us to lift up the part often , or to unbind the bands ; wherefore we must take the middle way , that we may satisfie both the fracture and the wound .

I have cured very many with this way of binding ; amongst the chief of them , there is a young man yet living , who about the twentieth year of his age , fell from a high place in the night , and broke both the fostils of his leg in the middle , with a great sticking forth of the minor fostil ; which unless I had cut it off with a pair of pincers , Table XX . Fig. I. I could not possibly have joined the broken bones . This Patient , in four moneths time , began to walk with a staff ; and he went afterwards as if he had never broken his leg , or had lost no part of the bone ; which must be well observed , for it seldom happens that the Patient , with a double fracture , with a wound and loss of the bone , should not halt after he is cured . This kind of Ligature , though it require great diligence of the Chyrurgian , yet oftentimes the Patients cured shew themselves ungratefull : Wherefore it must not alwaies be charged upon the Physitians , that they are Mountebanks , who sometimes begin their cure as Hippocrates dictates , from taking a reward , and require that first , Whilest the pain lasts , that when the sick man's well , What he paid for it he may others tell . when a small bone sticking forth can be reduced , without danger of convulsion and violence : first the part must be extended moderately : then the fracture must be composed ; And if the bones can hardly be united by extension only , for fear of great pain and more dangerous convulsion , let not so strong extension be made ; but let there be put , between the parts extended of the divided bone , the broader and the narrower end of a Levitor , that it , lying under that part of the bone which is most pressed down , and leaning upon that part which is most prominent , may help the extension , untill such time as the bones shall seem to be placed one right against the other ; then , by degrees , let loose the extension , and draw forth the Levitor .

If perhaps the bone , upon which there leans a convenient Levitor , hath in the upper part many broken splints , or something that is sharp , that there is no convenient place for the Levitor , they must be taken off with a sharp chizel , Table VI . Figure III . but this with the pincers , Table XX . Figure I. must be nipped off , that there may be a fit place made for the Levitor . When the bone is reduced ; we must consider whether any part of the bone will come away or not ? If it be reduced presently , nothing will come off ; but if it be not set presently , something may come off . If nothing be to come off , the part affected must be bound ( first laying a suppurative Medicament to the wound ) as I said of a fractuce with a simple wound . But if something be looked for to come off , we must order our Ligature , according to the manner appointed for a fracture with separation of a great bone .

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 .

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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

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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 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 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 .

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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 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 (a) 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

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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 .

Of the most simple wound of the head .

THe wounds of the head with only simple incision of the skin to the Pericranium , yet without any detriment to that , and wanting all symptoms , are either united and so kept , either by stitching or some glutinating medicament ; or are cured by being filled up with flesh . The latter way of curing seems to be safer than the former , because the skin being cut quite through , it is almost impossible but that the Pericranium must be hurt also .

Of a wound of the head , with hurt done to the Pericranium ; with alteration of the skul , and the seat of the instrument .

OTher wounds with hurt done to the Pericranium , or the seat of the instrument , must be cured by ingendring of flesh . They cannot safely be sewed , nor yet glewed together , for three reasons , which Hier . Fabrit . ab Aquapend . lib . 2. Pentateuch . cap . 16. alledgeth ; nor can these , that manual operations , if they were needfull , may be performed without pain . When therefore , the first hour one is hurt , the Chyrurgian is called , to one wounded only by incision of the Pericranium ; he shall presently dilate the wound with little balls made of hemp hards , and wet in whites of Eggs beaten together , that so the flux of blood may be stopped , and also the lips of the wound may be kept asunder : also let him anoint the parts , that are next , with astringent oils made hot , to prevent inflammation ; and let him apply convenient ligature , that which is called Cancer ( Table XXXI . Fig. IX , X. ) with a three double linnen cloath , that the parts hurt , be not more hurt by the ambient air , which is an enemy to wounds of the head ; or that the medicaments laid on upon the wound may not fall off : Concerning the band note here , that the ends of it D , to be fastned behind the head , must be sewed ; because otherwise the not will do much harm , and make pain with watching .

The second day after the hurt done , let the Chyrurgian take off the hards , and all other things that are accidental ; and the blood being stopt , and the hair shaved away round about , he shal dress the wound with lint made up into little pellets , and anointed with a digestive medicament ; applying upon it Emplastrum Diapalma with a hole cut in it with a pair of ciz●●s , and spread over with u●guent linimenti simplicis ; with a Plaget of three double linnen cloath , and a roler , not neglecting also the anointings spoken of before ; and thus we must proceed till the quitter appear to be good , which is white and not stinking .

When that appears , to cleanse the wound , he must daily mingle some detergent medicament with the digestive , untill it be throughly well mundified , continuing the use of the three double cloath , and of the band with unctions , When the wound is cleansed from filth , he must labour to ingender flesh ; wherefore he must lay upon the lips of it a sarcotick ointment spread upon dry lint ; and not oil of Roses as some ignorant Barbers use to do ; upon that he must lay only the Cerat Diapalma , then a three double cloath , wet in red wine , or s●me astringent decoction , and pressed forth again , and next the band about it . These must be used untill such time as flesh is perfectly generated . But if the bare bone be but only altered by the ambient air , ( if it lie but open to it for two hours ) or if it also grow black ; ( if it lie longer open to it ) then we must scrape off all round about , either till the colour be changed , or till blood comes forth of it . Namely , when the quitter appears to be good , and the wound to be cleansed . If the Chyrurgian observe this time , he shall find that the bone which was but once scraped , and cephatick powders strewed upon it , and dressed with dry lint , will be covered with flesh the next day . For Iacob Berengarius Carpensis , is not to be heard , who , lib . de fractur . cran , cap . 42. commands that every day we should pare away , with a rasp , what is superficially altered of the bone ; because that paring away , performed at the time spoken of , is sufficient ; but if it be done before that time , it must be often repeated , and that not without danger of the Patient ; for by this reason the paring instrument will , by degrees , come to the Diplois . They that are more fearfull , leave the bone altered to Natures scaling of it , but they prolong the cure .

The wound filled with flesh , must at last be covered with a cicatrize , either with dry linaments only , or else by laying on also ceratum divinum . By this way of curing , which is both the most safe and most certain , yet universals being premised , and the regiment of things not natural being well observed , I have recovered multitudes of Patients ; of which number there is yet alive Iohan . Petrus Wils of Vlma , who , Anno 1643. on the 13. day of March , besides some fractures of the skul , received three wounds in the Pericranium with clubs ; D. Iohan . Rudolph . Straus of Kafenburg , Steward to the most generous Count of Walnstein , whose Pericranium I found cut athwart near to the coronal suture . Anno 1645. August the 13. day , Melch . Frick a Fuller of Vlma , was wounded the very same year and day : Iohn Bucher a Country man of Achstet , who , near to the temporal muscle , Anno 1642 , on the 13. day of March , received a wound on the Pericranium : And Erhardus Vilseker of Bamberg , Steward of the Lord Governour N. Sals , who , Anno 1645. in Iune , had a wound on his head , was by me at length cured , where he was with the Provost Martial at Vlma , Matthaeus Stalzlinus waiting upon me to assist me .

The seat of the instrument appearing , must be presently pared away with a knife , as soon as the wound is dilated : after that the wound dilated and the skul pared away with paring tools , must be dressed with convenient medicaments .

A wound of the head with the skul made bare , and a rift as small as a hair not penetrating .

IF that a prudent Chyrurgian be called to cure a short wound of the head , with the skul laid bare , he must presently shave away the hairs of the head , moistned with common oil ; and he must most diligently search how the bone doth , either with a Probe or with his sight , or with both together ; and if he find a fracture or a chink , or by the antecedent and present symptoms he have a suspicion of a fracture , or else doubt whether there be a fracture or not , he shall immediately dilate the wound , contrary to the common custom of Barbers , with a streight pen knife ( Table II . Figure II . ) cross waies ( Table XXIX . Figure IX ) or else after the form of a Triangle ( Table XXX . Figure II . ) namely where the sutures and muscles , especially the temporal muscles , will not suffer us to make a cross ; that the bone , being laid naked , may admit the necessary manual operations , by paring tools or Trepans , safely and without any hurt to the sensible parts , But yet if paring or trepanning of the skul be needfull , and may be performed without any dilating of the wound by an iron instrument , then we shall totally abstain from section . The wound being artificially dilated , the Chyrurgian shall forthwith part the lips of it , and the Pericranium also with it , with the nails of his fore finger and thumb of his right hand , from the substance of the skul , and shall lay dry lint upon the bone , and shall fill up the rest of the wound with balls made of hemp hards , wet in the white of Eggs , and strewed over with astringent powder ; not only to stop the blood , but also that the wound may not fall in , and that the next day it may lie wide open with no labour ; upon it let him lay linimentum simplex , spread upon a fine linnen cloath ( that it may only comprehend the lips of the wound ) and above this let him apply the Plaister or Cataplasm of Hippocrates with a decent Ligature ; namely , by that which is called the Cancer ; and by anointing the parts that are near with astringent oils , to prevent inflammation .

The next day , the hards being taken off , the blood being stopped , and the wound being cleansed from all unnatural things , let there be , with a pen , writing ink drawn upon the chink , by the Chyrurgian ; and let him dress the skul with dry lints but the lips of the wound being first anointed with some digestive , he must lay upon that linimentum simplex , and then Hippocrates plaister , and the Ligature called Cancer , together with the aforesaid anointing .

At the third visitation , the wound being bound , and the Patient's ears , according to some mens advice , stopped with wool , and his head being well placed , and underpropt with a bolster , he shall scrape off the chink which hath drunk in the writing ink , or rather printers ink ( which Iulius Caesar Arantius comm . in Hippoc . de vulneribus capitis , prefers before writing ink , by reason of the vitriol in it , which is biting ) with rasping tools , Table XXX . Figure X. according to the length of it , beginning with the larger rasp ; and by degrees proceeding to one that is less , and so to one less than that , untill such time as the chink be quite gone , and the bone under it appear white and sound ; which is a most certain and demonstrative sign , that the chink pared away did not penetrate the skul , When the Chyrurgian useth this operation , he shall often take away the dust from the rasping instruments ; and let him be carefull that he hurt not the skin or the Pericranium with them ; which may be avoided , if the Patient's head lie firm whilest he useth his operation , and the lips of the wound be all convered with small linnen rags , Table XXXI . Figure V. Others do oftentimes wet their rasping tools in oil of Roses , that they may run the easier . But because this anointing is wont to dull the edges of the rasps , I use to change them . When the bone is decently and sufficiently pared , you must lay dry lint upon it ( for when the skul is bare and pared , a digestive is not convenient , nor an unguent , nor any fat thing ) and to the lips of the wound we must apply a digestive spread upon lint , and upon that linimentum simplex , the Cataplasm of Hippocrates , and the band called Cancer , with the usual anointing with oils that keep of defluxions .

When the quitter appears good , we must mingle some detergent with the digestive , untill the wound grow perfectly clean ; when the wound is cleansed , then we must strew cephatick powders upon the pared bone , and we must apply dry lint to it ; but to the lips unguentum sarcoticum , with the cerat Diapalma , with a treble linnen cloath wet in wine of the decoction of corroboratives , and pressed forth , and with a band , leaving out the oils . The wound being filled with flesh , must be brought to cicatrize by noted Epuloticks . After this manner was Iohan . Rudolphus Straus of Kafenburg dressed and cured ; and Caspar Wirth a Miller of the Hospital at Vlma , who both had a rift like a hair , that did not penetrate , near to the coronal suture .

A wound of the head , with a fracture of the skul no bigger than a hair , that doth penetrate .

BUt when the Chyrurgian works with these rasps , to try the wound , and he finds a chink which penetrates the second Table , he must not go about to take that away with his rasps ( because with them the membranes , which cover the brain , may easily be offended ) but laying aside all Chyrurgery , he shall proceed with driers , with which alone oftentimes the Patients are cured ; nor is it to be feared , if we timely begin to pare away the skul , but that Nature may resolve the matter ( which doubtless descends in a small quantity ) to the dura mater ; for after paring of the skul , the dura mater receives in nothing by the chink , which remains in the second Table ; because the excrements of the wound , which are apt to run forth , are continually dried up by the dry lint .

Sometimes the bone pared and dressed with driers , will cast off a scale , that the way for the quitter , collected about the membrane , may be open enough for it to come out . I observed this separation in one George Stuzzel , who , Anno 1639. had a small crack , like to a hair , on the right side of his fore-head , yet it penetrated through both Tables ; after that the chink was scraped away as far as the inward Table , and a scale came off of it self ; he was most happily cured in the Hospital there .

But if great symptoms do accompany a crack in the second Table , which shew that there is much matter collected between the dura mater and the skul ; laying aside the Rasps , the skull must be presently bored through with the Trepan , according to the words of Hippocrates text . 2. de vulneribus capitis . When you have pared the bone with a rasp , if you find necessity to cut the skul open , you must cut it ; and not suffer three daies to pass before you do cut it , but within that time you must do it .

A wound of the head , with an evident yet narrow crack in the skul .

WHen we are certain that the crack goes through , both by reason of the stroke , the quality of the instrument , and the accidents that come upon it ; then truly , the Chyrurgian must try , with great diligence , and consider whether the chink he wide enough for the matter to come forth , which ran down through it to the hard membrane of the brain , or not ? If it be not broad enough , the Trepan must be set on . Wherefore , the Chyrurgian first of all must foreshew the danger , that the prating of idle people may be prevented . For narrow fractures of the skul , have more danger than those that are broader ; for a narrow cleft hinders the matter to come forth . Then he shall presently dilate the wound that is too narrow , either cross waies or with three corners ( as the place hurt will admit ) with a knife , that he may come at the skul to do his operations there ; he shall pull away the lips of the wound and the pannicle of the skull , with his nails , from the bone : which being performed , he shall lay to the bone dry lint ; but to the lips of the wound , lint wet with desiccatives , and then proceed with the rest , as in the cures of wounds in the Pericranium .

The second or , at most , the third day after the hurt perceived , ( where the dura mater is pricked by some splint of the bone ) the skull must be opened with Trepans , whilest the forces of the Patient yet remain ; for after three daies , and so long as inflammation is present or near , the use of the Trepans is dangerous . Neither are they to be hearkned to , who , according to the opinion of Paulus Lib . 60. Cap. 90. in Summer expect the seventh day , and in Winter the fourteenth ; because Trepanning , at that time , brings help too late ; for the forces are then weak , and we may suspect that the pannicles of the brain are already infected by the matter . Wherefore the Chyrurgian , so soon as he is called , shall make hast ( only , according to some mens opinion avoiding the full Moon , because then the brain is augmented , and comes near to the skull ; so that the Chyrurgian , who is not acquainted with Trepans called Abaptistoi , may easily hurt that with the membranes thereof ) with his operation , ( especially where the membranes are pricked and pressed ) because Impostumes soon follow those things , and ill accidents ( as Guido de Cauliac admonishes us concerning the wounds of the head ) when things to be removed are removed out of the wound ; the head being laid unmovable , and the lips of the wound being artificially covered with lint , Table XXXI . Figure V. ( that they may not take cold by the air that comes to them , or be offended by the touch of the instruments ) the skull must be opened with a Trepan near to the chink , Table XXXII . Figure III . in that part that is more declining ( unless the suture hinder it , which for certain reasons must be avoided as much as may be ) for the more easie coming forth of the matter collected upon the hard membrane . But first we must use the male Trepan , in the middle whereof there is a pin , and this must be duly turned about , untill such time as it hath made such a print upon the skul , that the female Trepan may stand fast upon it . Then the male Trepan being taken off , the female Trepan must be fitted to the handle , which must be strongly and equally turned about ( untill it come to the thin Table ) and it must be changed now and then , lest it should grow too hot with often turning about . New Practitioners find fault with dipping the Trepans in oil , which the Antients used , because unctuous things are enemies to the bone , and dull the edge of the instrument . When the Trepan comes to the glassy Table , it must not only be pressed more warily and gently , but it must be taken off , that we may conjecture how much remains of the bone yet to pierce through . Nor must Glandorpius be followed , who proceeds in piercing , untill such time as the part cut forth cleaves to the Trepan ; but if the bone almost cut forth begins to shake , the Chyrurgian must , with the smallest and weakest Levitor of all , Table II . Figure VII . ( putting that between the bone that shakes , and that which is firm ) move it up and down , and pull it forth with the toothed end of the Pullers . Note , that the operation must not be differed by reason of the blood that runs forth of the Diplois , but must be warily hastned . For the blood , after terebration , and taking forth of the bone that is fallen down upon the membrane , must be gently wiped away with cotton wrapt about the spindle of the Probe ; and the hole made with the Trepans , must be stopt with dry lint wrapt close together , and that flux must presently be staied .

When the Trepanning is over , and the blood well stopped , the roughness of the hole must be made smooth with a lenticular instrument , Table XXXI . Figure VII . If one hole made with the Trepan seems not to be sufficient , we must make another ; as it shall appear afterwards in the History of Happelius , Hebichius , and Schneiderus . These things being rightly performed , we must let down , through the hole , a little silken red rag , upon the hard membrane ; or else a white linnen rag , round as a globe , fastned to a thread , ( that it may be drawn out again ) and dipped in compleat oil of Roses made hot , Table XXXI . Figure IX . that it may turn the matter , which falls down , into quitter ; and may defend the membranes , by reason of their motion , from being hurt by the bone . The linnen rag being put in , we must put into the hole a round pellet of dry lint , that the quitter bred in the wound , may not descend to the membrane of the brain ; upon the naked bone we must lay dry lint , the lips of the wound being anointed with some digestive ; and upon this we must lay linimentum simplex ( that it may not stop in the quitter ) with a hole in the middle of it ; then a cataplasm , and a band , with anointing the parts next to the wound , with repelling oils to hinder inflammation . This way of cure must be exactly observed , untill all fear of inflammation be past ; and the Patient must be admonished , that he must daily , when the wound is bound up , promote the coming forth of the matter , that is run to the membranes of the brain , by breathing out at his nose , keeping his mouth shut .

When good quitter appears upon the hard membrane ; in the place of oil of Roses , melrosatum colatum must be let down upon the membrane , with a linnen rag tied to a thread ; upon the bone must be laied dry lint , and upon the lips lint wet with some detergent digestive , to mundifie the hard membrane and the wound also outwardly , we must continue the use of linimentum simplex , Hippoerates plaister , a band , and astringent oils .

If the wound be clean , and the membrane is seen to be cleansed from filth , omitting the silk or linnen rag , and honey of Roses , we must put into the hole , a round pellet of dry lint ; and the naked bone must be strewed with cephatick powder ; also to the bone we must lay dry lint , and to the lips lint anointed with some sarcotick unguent , and above these ceratum Diapalma , with a treble linnen cloath , wet in the decoction of red wine , with capital remedies , and pressed forth again , and they must be fastned with convenient Ligature . With these we must proceed , untill the bone be covered with good flesh , and the wound be filled up with it . Last of all a cicatrize must be made with Epuloticks . This way of cure I found to be the best in George Seiz , a Country-man of Idelhusan , concerning whom see Gregory Horstius his Chyrurgical Observation XX .

A wound of the head , with a fissure in the skul , that penetrates and gapes wide enough .

IF the crack gape , that the matter may freely come forth of it , we need not Trepan the skul , or dilate the wound with an incision knife , which is only appointed for this reason . And therefore Chalmetaeus doth rightly judge that those deserve to be censured and reprehended , who not only in a small fissure of the skul ( though it do not penetrate ) but also in a great fissure are very bold to set on the Trepan ; by which great errour the cure is prolonged very much ; to the great damage of the Patient , and loss of the Chyrurgian's reputation . I am not certain whether these inconveniences ought to be ascribed to the ignorance or covetousness of the Chyrurgian . When therefore a great fissure admits not of the Trepan , what must a cordial and prudent Chyrurgian do in such a case ? Let him follow exactly the cure of a narrow fissure , after the necessary use of the Trepans ( yet omitting the Trepan as needless and hurtfull ) let him let down a long linnen rag upon the hard membrane , answerable to the magnitude of the fissure , and tied to a thread , and wet in oil of Roses , &c. Iohn Anwander , a Lighter-man of Kirchdorf , who is yet living , will commend this way of cure , in whose left side of the forepart of his head ( Anno 1633. in Ianuary ) I found a fissure ( it was so broad that I could easily put in my finger next to the greatest finger ) with a huge inflammation of the dura mater ; which , by premising universals , and by the diligent application of oil of Roses , applied warm with a silken rag . and of Hippocrates Cataplasm , was taken away in three daies .

A wound of the head where the dura mater is hurt also .

LIkewise upon a wound of the dura mater , with a crack in the skull that is wide enough , we must let down a long silken rag , tied to a thread , and wet with oil of Roses : when good quitter appears , a new linnen rag must be anointed with mel rosarum , and must be let down upon the membrane , which being cleansed , the wound of it must be incarnated by unguentum de betonica , melted and poured in warm at the hole . But the bone , and the outward wound , must be dressed as we said before for a fissure of the skull that penetrates , and gapes wide enough . But when the fissure is narrow , that topicals cannot be applied to the dura mater wounded , then the wound must be duly dilated with an incision knife , and the skull must be Trepan'd ; and all other things observed , as I speak before for the cure of a narrow chink .

A wound of the head when the pia mater is wounded , and the substance of the brain .

THe pia mater can hardly be hurt , and the brain that is under it not be hurt also . Wherefore we must forbear the use of all unctions and hot remedies , by reason whereof the substance of the brain will easily corrupt , as Authors write truly : Some also reject mel rosarum , by reason of its acrimony and heat ; and for that they use syrup of Roses . Yet for these kind of wounds , I have used both syrup and honey of Roses often ; but never found any hurt come thereby . But before all other remedies , I cannot sufficiently commend that unguent which Hierom . Fabritius ab Aquapendente describes lib . 2. of his Pentatcuch . cap . 20. and he oftentimes applied it with happy success : I also tried the vertue of it in Michael Schneiderus , of whom afterwards there is a singular observation . We must look to the wound and the crack , as I admonished concerning a wound of the dura mater .

A wound of the temporal muscle , with the hurt of the Pericranium and the vessels .

OF all the wounds of the head , those are the most dangerous where the temporal muscles are hurt ; for they are covered , on the outside , with the Paricranium , which passeth above them and wraps them in ; but on the inside of them they are naked , and lie upon the naked bone immediately . Wherefore , we must observe very well , if the Pericranium ( which wraps in the said muscles , and hath its original from the internal thick membrane of the brain , by the sutures of the skul ) be but lightly inflamed ; for this will presently cause the thick and thin membranes , and the brain under them to consent with it : Also the wounds of the temporal muscles are dangerous , by reason of the flux of blood from the arteries which are cut , and which the most choice astringent can hardly stop . In the like case I never found any thing better than Galen's plaister ( the commendations whereof you shall find in Zacutus Lusitanus , Prax . Med . admirand . lib . 1. observ . 85. ) made of Aloes , Frankincense , and the flue of a Hare well beaten together , and mingled with the white of an Egg ; with this the wound is filled to stop the Arteries : If by this most precious remedy the blood should not be stopped , which boils forth exceedingly by reason of drunkenness or anger , then four grains of sperniolum compositum Crollii are given , with very good success ; and about the neck a plaister is applied ( whereof Iohnstonus makes mention in his Idea Menicinae cap . de haemorag narium ) made of Potters clay compounded with the most sharp vineger of Roses , and laid upon a band that is four fingers breadth , and renewed as often as it is dried , untill such time as the slux of blood , commonly within half an hour , or else sooner , doth stop wonderfully . I thought it fit to mention these three remedies by the way , because they are not only wonderfully forcible to stop the flux of blood from the temples , but it doth infallibly stop a desperate bleeding at the nose , or of the gums , which follows a violent pulling forth of the teeth , as Iohan . Iacobus Mayer a Weaver of Vlma , and Gallus Breittinger a Country man and Huckster at Dornenstat , can testifie . The powder taken at the mouth , stops the boiling forth of the blood . The plaister laid upon the wound , joins together the vessels that are cut ; and that which is applied to the neck , hinders the blood to run to the head . This wound ( as also deeper wounds , yet without any hurt to the skull ) when the blood is stopt , by the first intention must not be cured ; but contrary to Vesalius must be filled with flesh , and after that brought to cicatrize ; taking especial care that inflammation come not upon it , which must be kept away , and driven from it , by Hippocrates plaister .

A superficial wound of the temporal muscle .

FIrst the blood must be stopped , with hards wet in the whites of Eggs , and strewed over with Galen's astringent powder .

The next day , the hards being taken off , the lips of the wound are to be brought to unite together , with linnen rags spread with cerate Diapalma , and laid on crosswise , and the parts about must be anointed with oil of Roses , to hinder inflammation . Also upon these plaisters of linnen , that they may not fall off , a Medicament must be put which hath the force to repel humours ( as is linimentum simplex , or album coctum ) and then the band called Cancer .

A Wound of the temporall muscle , with a narrow chink of the skull .

BUt when the skull is cracked under the temporal muscle , it is not alwaies convenient to incarnate ; but the quantity of the chink must be considered , whether it be broad , narrow , or like a hair ? If the rift be like a hair , and the wound be narrow , then it must be dilated with little pellets made with sponge , as need is , if it be possible ; but if it be not to be done , the skin must be cut with an incision knife , as far as the skull bone ; yet warily that the vessels , nor the fibraes of the muscles be cut a cross . If therefore the Chyrurgian must dilate a wound in the temples , where there is a cleft like a hair on the skull , let him presently foreshew inflammation and convulsion of the opposite part ( then let him make incision according to the streightness of the fibraes ( having first , in vain , tried to make dilatation by a sponge ) lest the aforesaid accidents , if they chance to happen , may be ascribed to the artificial dilatation of the wound . Which Prognostick , especially in Germany , where Chyrurgical operations are not so common as they are in Italy and France , must be diligently observed Wherefore the wound being dilated , according as the fibraes run , and the musculous flesh parted from the bone , and the rift diligently rasped , the Chyrurgian must proceed with the rest , as I said before in the cure of a wound with a narrow , and hair like fissure .

A wound of the temporal muscle , with a crack in the skul that is wide enough .

WHen the wound of the skull gapes sufficiently under the temporal muscle , that the matter , fallen down upon the dura mater , may be sufficiently voided ; then neither must the wound he dilated with an incision knife , nor must the crack be scraped away with rasping tools , nor must the skul be Trepan'd by the side of the crack : For these operations ( for the reasons alledged before , concerning a great fissure ) are not to be allowed in a great crack .

A Contusion of the head , with the rending of the skin , and the skul thrust in , with the suspicion of some crack there .

IT is cured with admirable success , with the skins of beasts new killed , especially of a dog or mouse ; which being applied whilest they are yet hot , and left on for twenty four hours , do wonderfully dissolve them . If the contusion be not wholly discussed with one skin , you must lay on another . But because every man cannot flea a dog , I alwaies chose a lamb skin , which may be got almost alwaies , and is as powerfull to digest as any other .

By this one and most expert remedy ( for it never deceived me ) I cured , besides many boys and young men , a Carpenter's girl four years old , which by reason of a fall from a high place , had a great contusion on the fore-part of her head , which a certain Chyrurgian would have opened with a rasour , unless I , being join'd with him , had disswaded him from opening it , out of Hippocrates sect . 1 : aph . 7. wherein he plainly teacheth , that no affection requires Chyrurgery , unless medicaments were first , in vain , applied to it . When therefore there were no symptoms present to cause incision , nor any topical remedy was yet applied in vain , he neglecting manual operation , laied on a lambs skin , and had the wonderfull trial of it ( not only on this girl , but afterwards often on people of years ) and he oftentimes gave me great thanks for my advice and assistance . Wherefore I exhort young Chyrurgians , that they shall never open contusions or other tumours , unless they find them to refuse help by topicals .

A simple depression of the skul in boys , where the skin is whole above .

SOmetimes the skul is pressed down , only by reason of contusions , and the skin is whole above , nor is there any fissure in the skul ; sometimes there is a fissure alone , and sometimes a depression with a fissure . A depression without a fracture , happens only to children ; but oftentimes , in those of years , there falls out a fissure and a depression together .

The skull pressed down in children without a fracture , and where the covers are not hurt , so that those that touch or look upon it , can perceive a small pit ( and which no ill symptoms follow ) Paraeus lib . 9. cap . 3. a cupping glass that is ordinary , will excellently well reduce into the proper place . Our most ingenious Hildanus , for that purpose , invented two helps ; namely , a horn cup , and a plaister ; and if these cannot prevail , he thinks we must proceed to cutting of the skin , and raising of the bone , by the piercer , upon his Triploides , Cent. 2. Observ . 5. Yet these two operations seem to be neither necessary nor fruitfull . They are not necessary ; for such depressions in children , that press upon the brain and the ventricles of it , that the animal spirits cannot be made ; and being made , cannot be distributed into the whole body ; are incurable . They are not profitable ; because first , according to Hippocrates , simple wounds of the head , and where the skin is only cut , make work for the Chyrurgian , and bring danger to the Patients ; and without doubt that work and danger will be increased , when besides the skin , the Pericranium also , and the bone are cut of set purpose : And secondly , when the Levitor is fastned upon the center of the depression , the pit in the skul is easily made greater . And thirdly , when the screw must be fastned upon the skul , which is yet tender and soft as far as the Diplois , with force ; truly it is to be feared ( because the Levitor of the screw of the Triploides , is not the same with Abaptiston ) lest it should pass through the innermost Table of the skull , and with the point hurt the thick membrane : And fourthly , because the tender bone is exposed to the air , whence it grows black , which is a sign of corruption ; which corruption , if it be left to nature to make separation of it , oftentimes creeps to the inward parts , so that it will require a dangerous scraping of it off with rasps , or cutting out with Trepans ; but manual operation being neglected , the cure of the wound , with danger to the Patient , is prolonged . Yet they that resolve , with rasping tools , to scrape away the skul bone superficially corrupted , must expect that the pit shall grow greater . Wherefore a prudent Chyrurgian must rather omit all manual operation , when he cannot do any good thereby , than to lay an infamy on the rational administration on the Art of Chyrurgery .

I being convinced with these reasons , where childrens skuls are pressed down without any rift , or cruel accidents , use to abstain from all manual operation ; and being confirmed by frequent experience , I cause the hair to be shaved off about the depression . and I apply a hot lamb skin , with convenient ligature of the band called Cancer , anointing the parts about it , especially the temples and the neck , with astringent oils , to hinder the flux of humours to it , and to prevent inflammation . If at the first application the skin do not consume the tumour , I lay on one more , leaving that on again a natural day . When the tumour is discussed , if the pit is found , by touching , to be small , and there are no great symptoms present , which may portend any hurt of the parts under the skul , I put under the lamb skin , the ceratum diapalmae of Galen , spread upon a broad linnen cloath , to coroborate the part affected . That this way of cure is the safest , those Chyrurgians will bear me witness , who have been often my assistants in the like cases ; and amongst the chief at Vlma , are the most experienced before others , George Redlin , and Nicolas Reutte , whom I thought to nominate for to testifie the same . Also young Chyrurgians shall find how , with medicaments safely , and no great pains , they may cure great blows upon the skull , in Iulius Caesar Arantius , at the end of his most learned Commentary upon Hippocrates his book De vulneribus capitis , &c.

A Contusion of the head with a depression , but without any fissure in the skul , where the skin is whole in people of years .

IN people of years pits are most seldom sound , under the whole skin , upon the skul , ( namely , in those only who have a very soft skull by nature ) but yet never without a fissure ; for if , after incision made upon the skin , there appears no chink upon the outward Table of the skul , it is to be feared that the inward Table is crackt ; whereby the matter can fall down upon the brain , but cannot come forth again the same way . Anno 1632. I observed such a fracture , at Vlma , in a Souldier of Sweden , who by reason of a depression of his skul , died the second day after . I , being desirous to know what was the cause of his so sudden death , did with a saw divide his skull ; and I found the inward Table not only crackt , but also a little splint of a bone ( which doubtless did continually prick the membranes of the brain ) that was come from it , and yet the outward Table of the skull was whole . Wherefore , as often as in the heads of men grown up , such a pit is seen , it is a most certain thing that the skull is cleft ; for unless the skul were cleft . saith Hippocrates , the middle could not sink down . Yet supposing , and not granting that there may be a depression of a skull more dry , and without a cleft , that must not be left only to Natures work ( as Foelix Wurts commands ) but the skin must presently be cut with an incision knife , either cross waies , or else triangularly ; the Pericranium must be parted from the skull , and the gaping wound must be kept with pellets open ; not only that the Chirurgian may be more certain whether the skull be cleft ; but also that if there be a chink with the depression ( which is very much to be feared ) a Levitor , that is a convenient instrument , may be made use of .

The next day after the incision of the skin , as far as the skull ( if no chink can be seen in the outward Table , nor by no end of the Probe with a knot can be found out , nor that we suspect any fracture in the inward Table of the skull , by reason of symptoms , this being whole ) we must take the triangular part of the Trefine , noted with a star ( Table III . Figure I. ) wherewith we must gently bore the skull in the center of the depression , yet not beyond the outward Table . Having made a hole with the Trefine , the Piercer of the Triploides must be fastned on , and must be so long turned about by means of the screw above , untill it take a little hold of the inward Table ; then the skull , pressed down , must be raised up perpendicularly , by turning the lower screw of the Triploides back again . The skul being raised that was pressed down , the instrument called Triploides must be removed ; and the wound must be dressed as I shewed before , concerning wounds of the head with the skul laid bare , and for the seat of the instrument .

A Contusion of the head in elder people , with a depression of the skul , and a fracture of the inward Table , without any wound of the skin , or rift in the outward Table .

WHen the skin of the head is artificially cut , and the outward Table appears whole , yet ill symptoms accompany the depression , it is not to be doubted but that the inward Table hath some hurt : Wherefore the skull must not be raised in the middle of the depression , with a Piercer at the end of the Triploides ; but must be opened with a Trepan on the side of the depression , that the matter which is fallen down , by the secret fissure of the inward Table , upon the membranes of the brain , may find a place to come forth ; and the skull that is fallen inwards may be raised up with the necessary help of the Levitor .

In contusions of the head with a pit , in a man of years , the skin that is whole must be cut with a cross , or else a triangle , or the wound there that is not broad enough for a Trepan , or a Levitor to be applied , must be dilated with an incision knife . But in contusions without a pit , we must attempt nothing , nor by Trepans , nor by Levitors , but only a Lamb skin must be laied upon the contusion , unless symptoms follow which shew the skul to be broken , and that there is need to use the Rasps or Trepans .

The depression of the skul , with a broad rift in the middle of the depression .

IF there be a chink apparently join'd with the depression of the skull ( which unless it be wide enough , requires the Pericranium to be pulled off from the skull ) that is either in the middle of the depression , or else it is on one side of it ; that which is in the middle of the depression , is either broad or narrow ; if the crack be broad , and the depression not great , the skull must be raised with a Levitor . Table II . Figure VII . when the crack is broad , and the depression is apparently greater than ordinary , the stronger Levitor must be let down , Table III . Figure II . but if with a broad crack the skull is far gone in , then the said Levitors are to little purpose ; wherefore the Levitor of the Triploides , Table III . Figure III . must be used .

The depression of the skull , with a narrow crack in the middle of the depression .

AT the bounds of the depression , the skul must be cut forth with Trepans ; then the distance between two holes must be taken away with my turning saw , Table V. ( which is done without any fear of danger ) not only that some of the said Levitors may be put under the skull ; but also that the small bones , which sometimes are parted from the inward Table of the skul , and prick the thick or thin membrane like thorns , may be taken forth with the puller .

The depression of the skul , with a crack , which is broad or narrow at the side of the depression .

THe crack in the middle of the depression , is either broad or narrow ; if it be broad , then a convenient Levitor must be he put under the skull ; if it be narrow , the skull must be , evenly terebrated , on that side of the crack that is sound and bare , with a Trepan , and must be lifted up by help of Levitors : if the Levitor let down at one hole cannot raise the skull , we must make another hole , and then cut forth the distance , between these holes , with a turning saw , that in what part soever of the fissure it be needfull , the Levitor may be put down , and the skull raised by it .

A wound of the head , with a smooth chopping away a piece of the skull .

THis requires no manual operation , but it must be covered with flesh as a skull newly raspt with rasps : See underneath the observations of Alphon . Schadaeus , a Senator of Vlma .

A Contra Fissure .

THat which Hippocrates calls a Calamity , when it is found it is cured as the contusion of the skull with a fracture , under the whole skin ; namely , by making incision in the skin with a knife , and separating the Pericranium from the bone , and ( if the crack that penetrates be narrow ) we must perforate the skull with Trepans , &c ,

A prick of the skull not penetrating , and one penetrating .

A Prick on the skull that doth not penetrate , must be taken off with Piercers , Table XXIII . Figure I. but when it penetrates through both Tables , the skull must be opened with Trepans , setting upon the point the pin of the male Trepan , untill it make a print , upon which the female may stand fast : Now that these two operations may be performed quickly , safely and pleasantly , the Pericranium must be separated from the bone .

This way of curing wounds and fractures of the head , far excels that which Foelix Wurts , lib . de cerat . varior . vulnerum , cap . 7 , 8 & 9. so much commends , and our Barbers in Germany every where follow , as if he were Apollo's Oracle ; yet oftentimes with great danger to the life of the Patients . And I wonder not that the cure doth oftentimes not answer expectation , when as the place of Wurtzius that is quoted contains many errours ; which young Chirurgians may observe , if they will take a little pains to compare the short way of Hippocrates , with that of Wurts .

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 .

diagrams of trepanation surgical techniques TABVLA XXXIII

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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 .

Of a suffusion .

A Cataract that is perfect , ripe and compleat , which is grown into a small skin , as they call it ; the last remedy for this is to part it from the circumference of the apple of the eye near which it grows , thrusting in a needle through the cornea ; and if this succeed well , the same moment that the skin is taken away the sight is restored . But the Oculist must consider , before he begins his operation , whether but one or both eys are affected with it : and if , both eys being covered , the Patients are seemingly quite blind , the operation will be easier ; for we can fear no worse though the operation should not succeed well . But when but one eye is hurt , and the sound eye will serve to see withall , we must not so rashly go about it ; especially if the small skin , or web , be not well ripe , which sometimes it will hardly be in three , four , five or more years . Nor yet must the matter that makes this web be any waies made thicker , as Iohan . Baptista Silvaticus , controvers . 56. most elegantly decides this question . And though most Authours require a little thickning of the humour , yet it is apparent by experience , that the Cataract will be more easily couched , when it is grown ripe perfectly . For that which is not ripe , is yet soft and shotty , and resists not the point of the needle ; nor can it be taken away whole , but is cut and grows again , or else it grows harder , or mingled with a watry humour ; that not only the sick can see nothing , but also all hope of cure by a second operation ( for if it be twice couched it is but in vain ) is taken from them ; which also useth to fall out , if the crystalline or vitreous humour , or their coats , be hurt by the point of the instrument ; or but only the uvea , about the apple of the eye , be torn . By these things it is evident , that this kind of remedy is very doubtfull and uncertain ; and by reason of the great difficulty of it , an errour that cannot be mended may easily be committed : wherefore health must never be rashly promised to the Patient , as Mountebanks use to do ( who are never ashamed though they do not perform their promises so they can get by it ) but we must promise to do our best . I , to speak the truth , never tried this manual operation , though I had the instruments ready by me ; but I saw it twice performed by an Italian with good success , upon one eye of a certain Nobleman of Padua , and of a Monk of Verona . But the Artist , who was of Padua , ordered his manual operation thus : The Patient's body being prepared , and God called upon for his assistance , he chose a private chamber , where the light was moderate ; and upon a clear and quiet day , three hours before dinner , he placed the Patient , yet fasting , on a seat near the bed ( at his back there was a bolster or pillow ) so that he might look toward the light ; on the seat that was opposite the Chyrurgian sate , in a chair with his legs open , and the Patient sitting between his legs , and both his hands leaning on both sides upon his thighs ; at the back of the Patient an Assistant ( holding the Patient's head firm and upright with both his hands ) covered his right eye , which was sound , with cotton and a band ( see this Table Figure IV . ) This being done , the Assistant laid some cushions between the Chyrurgian and the Patient , that the Artist's arm might stand steady . See in Fabritius Hildanus Cent. IV . Observ . XVI . an instrument whereon the Chyrurgian's arm leans , as upon a block or pillar . This being likewise done , the Chyrurgian with his right thumb rubbed the eye that was ill , shutting his ey-lids , and then presently opening them again ; and first chewing Fennel seed in his mouth , he did warm the eye with the vapour of it ; then he took a golden needle ( because the Cataract to be couched was white , but a silver needle is requisite , when the congealed humour is black , or of any other colour ) which was long and the handle of it was chamfered and wound about , that he might hold it the faster ; and it was most sharp at the point , and was made less by degrees , Table IX . Figure IV : Wherefore he thrust this in with his left hand , near to the place of the eye , leaning upon the outside of the eye , in the white that is not far distant from the Iris , somewhat above the middle of it ; and this he did not do violently , but winding it about by little and little , untill he penetrated the coat called cornea ; which the Patient easily indured , with very little sense of pain : The needle thus thrust in , he by and by directed it toward the hole of the pupilla , where the Web grew ; and by degrees he brought it to the innermost place of the skin ; which was done the more conveniently , because the golden needle might be seen through the cornea . With this needle thrust thither gently , and that he might remove the Web from the circumference of the hole , having turned it up and down sometimes ( for it doth not alwaies succeed the first time ) he pressed it down ; and when the skin was freed in one part , he did at last separate it with his needle , wheresoever it did yet stick ; and he thrust it downwards into the lowest and obscure part of the eye . When the skin was come below the region of the pupilla , the Chyrurgian shut the eye , and left the needle within it for a quarter of an hour , that the Web might stay in the lower part , into which it was forced , which is known if the skin do not mount up again when the eye is moved . In the mean while heed must be taken that in couching a Cataract we do not cut it into many parts ; for those pieces though they be pressed down , yet will they be easily brought up again to the seat of the eye , and floting there will hinder the sight . All these things being rightly performed , the couching of the Cataract succeeded well also ; the black eye sight began to appear , and the Patient began to see . At length thrusting down the eye-lid , and shutting the eye , he drew out the needle again gently , lest the matter which made the Cataract , should rise up again to its former place , or the vitreous or crystalline humour should be hurt . Nor is there any fear of the watry humour running forth , because the hole made in this thick coat falls down again immediately so soon as the needle is taken out .

The operation being thus ended , and the eye being well and sound , yet upon both eyes , kept shut for six daies , he did daily three or four times lay on cotton which was wet on one side with Rose-water and Fennel-water , to which be added a little Saffran and Fennel-seed in powder , for greater corroboration . But to prevent inflammation , he applied to the fore-head a linnen cloath moistned with the white of an Egg beaten , on which were strewed Galen's astringent powders ; and above the cotton and the defensative , now mentioned , he bound another linnen cloath with a band . From that time the regiment of the Patient's diet was not large ; but he was alotted a very spare diet . And that the sight , not yet used to much light , should be overcome by it , he commanded that the Patient should stay for a time in the dark , shutting the wooden windows all about , and should by degrees use himself to the light . And also that the spirits might not be carried to the eye with any force , he did forbid all vehement motion , as coughing , sneezing ; crying loud , and great straining when the Patient went to stool , or to make water . He lay on his back when he did eat or drink , neither did he rise to go to stool , but he had a Close-stool of wood set under him . And thus the Patient having regain'd his former sight , by a diligent use of Prophylacticks , and by an issue burned in his Arm , he lived safe and well many years . Also a notable Oculist N. Marianus , by birth a Roman , couched a Suffusion , very fortunately , in both eyes , according to Celsus , when I stood by in Vlma , 1637. in the moneth of December , for Mr. Tobias Neubronnerus , and Mistris Kazenbaeckin . And these things shall suffice concerning a Cataract happily couched , which I have therefore brought out from my Shop of Observations , that such as are studious in Physick , if Mountebanks , who are most commonly trusted to cure these Patients , shall in their presence not proceed as they ought , they might be able to correct them . And since that the manual operation for a Cataract is the most curious of all , Celsus Libr . 7. Cap. 7. De natura Oculorum & corum Suffusione , hath most clearly set it down , to whom I refer the Reader ; and he that desireth more , let him read Platerus , or George Bartisch the Oculist at Dreson . For the discussing of Cataracts first beginning , many descriptions of Collyrium's are found in Authours , to which they attribute most singular effects . I have tried that the gall of a Pike , with a little Sugar mingled together , after I had purged my whole body , and had laied on a Vesicatory behind my ears , being dropped into my left eye by my Brother's Son , it resolved in one weeks space a Cataract that was then beginning : Adrianus Spigelius often used this remedy successefully , who beside this did very much commend unto me the oil of the Liver of a River Weesel ( concerning which see Forestus Lib . 11. Observat . 35. ) and the eye-water of Martin Rulandus , and that other which is like to it , as being very good , and much used at Naples . This was described by Iohn English in his practice , which he calls the English Rose , and Sennertus makes mention of it , Pr. L. 1. p 1. sect . 2. yet leaving out the description , which is this : Take Fennel , Rue , Eybright , Vervain , Tormentil , Betony , Roses , wild Endive , Maidenhair , Chickweed , Pimpernel , Swallow wort , Paper , Piony , Vine leaves , Smallage , Agrimonie , Honey-suckles , of each alike , bruise them ; and the next day , put them thus bruised in white Wine ; the second day in a Boies water who never knew Woman ; the third day in Womans milk ; and the fourth day in the purest honey ; at this time you must distill them , and keep it for your use . I never used these two waters , yet besides my purpose I would propound them to studious young men , that they might trie the effects of them , which were so much commended to me by a most famous Physitian , when they shall have occasion .

Fig. V. shews the hole in the greater cauton of the eie , with a coat of the Impostume ; upon this hole is a pipe set ( a Table I. Figure I. ) that it may defend the eie ; and by pressing the skin near to it , may dull the feeling , whilest the naked or rotten bone is burnt with a red hot iron , made like an Olive ( b Table XIX . Figure VI . ) thrust into the pipe ; then lay fine lint on the bone cauterized , untill the scale part from the bone ; then the hollow Fistula must be join'd together , with a sponge wet in Allum Wine , and pressed forth , and kept down with an instrument with a broad head ; when it is glewed together , the wound must be kept drest with Sarcoticks and Epuloticks .

Fig. VI . shews the right eie fastned with a ring ( c Table VIII . Figure V. ) and a Polypus hanging down from the right nostril , and the cutting of a tumour with a coat under the skin , risen in the upper jaw : whose coat being unawares broken with a Diamond ( d ) the matter being evacuated , I separated it , as far as the root went , with a broad Probe , from the skin and the muscles under it ; which I cut out with a sharp knife ( Table XII . Figure II . ) and I touched the small bone very well with an actual cauterie ( Table XIX . Figure VII . ) this being done I brought the wound together , with plaisters spread upon linnen .

Fig VII . represents a glass vessel ( e Table VIII . Figure X. ) bound to the eie , by the tunnel whereof collyrinous are dropt into the eie by drops ; then it shews the way to draw out a Polypus out of the nostrils , by an instrument invented by Hierom . Fabritius ab Aquapendente ; also the Polypus laid hold of by the Pincers , and placed beyond them . Matthaeus Glandorpius hath written a most elegant Tract of the nature and cure of a Polypus , which those that will cure it shall read with exceeding great profit .

Fig. VIII . shews how the cutting of a tumour with a coat , which grew amongst the muscles of the upper lip , as great as a Hen egg , did absolutelie deform a most honest and most beautifull Matron , not without great pain , her lips , for the cutting forth of the tumour , were drawn one from the other with hooks : See underneath a singular Historie .

Fig. IX . shews an excrescence of flesh like a sponge in the fore-part of the Palate , risen behind the cutting teeth ; it was greater than a Walnut , and as often as it was touched with the finger or tongue , but easilie , it would send forth a great quantitie of blood : Of which accident see underneath an especial observation .

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

diagrams of surgical techniques TABVLA XXXIV .

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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 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 (a) 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 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 how to make it , both in words 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 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 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 .

diagrams of facial surgical techniques TABVLA XXXV

Fol. X

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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 , 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 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 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 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 {αβγδ} , ( 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 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 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 {αβγδ} 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

diagrams of surgical techniques TABVLA XXXVI

Fig. I

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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 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 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

diagrams of surgical techniques TABVLA XXXVII

Fig. I.

III

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 , 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 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 , {αβγδ} and {αβγδ} to signifie presently ; but {αβγδ} 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 , 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 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 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 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 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 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

diagrams of surgical techniques TABVLA XXXVIII .

III

VII

VIII

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 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

diagrams of surgical techniques TABVLA XXXIX

XII

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 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 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 way to cure a Rupture of the Intestine , very often proved by me .

THis consists in three things : 1. Putting back again of the intestine within the Abdomen . 2. By keeping of it so put back , that it may not again , by the groins , fall into the scrotum . 3. By fastning the Peritonaeum relaxed , or healing of it if it be broken . The Chyrurgian who is experienced , shall most diligently consider , before he put in the intestine , whether the rupture be great or small ? whether it be new , or fallen to inflammation ? and also whether the intestine be yet lank , or else filled up with some matter ?

If the rupture be small and new , and the intestine be lank , it will be easily reduced ; if the Patient be laid on his back in his bed , with his head somewhat low , and his feet lifted up ; for thus the intestines falling to the midriff , they draw after them that which descended to the Scrotum .

But if the rupture be great and new , the Chyrurgian must , with his fingers , handle the intestine that is stretched forth with no matter ; and he must , by degrees , softly turn it about , the Patients head being first laid somewhat low , so long till by little and little it go in again within the Abdomen . And if the Chyrurgian be weary with his hand , he ought to have an able Assistant , well informed in this operation , who may help him , and may likewise handle the intestine .

When inflammation is joined with a rupture , which is known by pain , heat , and a Feaver , or winds , the sign whereof are rumbling ; and pain extending without any weight ; or excrements which are known by not going to stool in two or th●ee daies , by great hardness of the scrotum , and most grievous pain ; then we must desist from ●educing the intestine , untill such time as the inflammation is over , the excrements are gone forth and the winds dispersed . This following Cataplasm is proper against the inflammation : Take Barley meal , one pound . Wheat bran , half a pound . Compleat oil of Roses , three ounces . Red Wine what is sufficient , mingle them .

This being laied hot on the scrotum and groin will very much digest , moderately repells the humours , and most effectually strengthens the parts . If the inflammation be not gone after 24. hours , the Cataplasm must be so often renewed and applied , as shall seem needfull to cure the inflammation . When the Cataplasm is over dried by the vehement heat , and so is hard to come off , we must pour on Wine and Oil hot . Also the place inflamed , with the like good success , is fomented with a hot lixivium , as Fallopius appoints , made with Beech ashes boiled in it : Take therefore two bundles of raw thread ( which hath not yet lost the digesting quality of it by Fullers washing ) put them into the kettle , and boil them with half a handfull of Cummin-seeds in a sharp lixivium ; then take one of the bundles out , and crush it out between two dishes , and lay it broad very hot about the scrotum , as hot as the Patient can suffer it ; when it grows luke-warm take it away , and lay on the other ; and do this , changing them so often , untill the inflammation be quite gone ,

When great pain accompanies the inflammation , then adde to the Cataplasm or fomentation , some , or a great part of Oil of Roses .

If with inflammation there be excrements join'd , which hinder the intestine from being put back to its place ; this is truly a most desperate case , yet ( omitting Purgatives given by the mouth , which else would cause a greater flux of humours to the part affected , and hasten the Patients death , as Fallopius testifieth ) we must try to bring forth the excrements with baths or fomentations that loosen distention , and by linitive Clysters cast in in a moderate quantity . In the mean time we must prevent generation of excrements , giving to the sick meats of good juice , and few excrements , such as are thin flesh broth , rere egs and such like .

Also very often winds , without inflammation , fill the intestine ; in which case there is nothing better than a fomentation that is made of a decoction of a sharp lixivium , with Cummin-seeds and raw thread , and by adding a small quantity of strong Mallage wine to it . The inflammation being cured , and the excrements voided forth , and the winds dispersed , let the intestine be thrust back into its proper place , gently , by little and little , thrusting it in with the fingers . After the intestine is thrust in , by reason of the relaxation of the Peritonaeum , slipt into the Scrotum , lay on a binding plaister commended by Hier●●●●●rit . ab Aquapend . which is this : Take Bole Armeniac , Dragons blood , Mastick , Sarcocolla , of each 1 dram . Horse-tongue , Powder of Tyles , of each 3 drams . Rosin of the Pine-tree , 1 ounce and a half . The white of an Egg , Wax , of each alike what may be sufficient to make a plaister . Spread this upon a thin soft piece of leather , as great as the part affected , that it may not be much too big , and lay it on ; first shaving away the hairs from the groin ; and never renew it unless it will no longer stick to the skin . The plaister being laied on , lay over it the Truss , Figure VI . that it may bind close to the groin , Figure IX . that it may press upon the hole of the Peritonaeum , through which the intestines fall down .

If by reason of the breaking of the Peritonaeum , the intestines fall down into the Scrotum , we must mingle glutinatives with astringents : Take the binding Cerate of Hierom . Fabritius ab Aquapendente , Emplastrum Apostolicon Nicolai , of each equal parts . Mingle them and temper them with Oil of Mastick . Spread this on leather , and with a Truss lay it to the groin , to keep the intestine in its place , and to heal the breach through which the intestine finds a way to the Scrotum . For the principal cure consists in outward remedies , and an exquisite Truss to bind it .

When these things do not help , there is need to purge the whole Body , especially from watry and phlegmatick humours , which hinder the consolidation or binding together of the Peritonaeum broken or dilated , which of it self is hard to cure : Adde to this , that since it is necessary not only to use binding remedies outwardly , but also inwardly , if omitting the prescribing of universals , the body should abound with excrementitious humours , the Patient , by the obstruction of the Bowels arising from thence , might fall into Feavers or other diseases , then we must purge with gentle remedies . Premising universals we must flie to binding remedies both internal and external : I hold this following Electuary to be one of the principal things to be taken : Take conserve of Comfry , 2 ounces , Of old Roses , 1 ounce . C●tron pills candied , Orange pills candied , of each half an ounce . Powder of the herb Thorow wax . Rupture wort , Adders tongue , Great Comfry root , of each 1 dram and a half . Plantain seed , 4 scruples . Cichory , Fennel , of each 1 dram . Red Coral prepared , 1 dram and a half . Pea●ls prepared , half a dram . The stone Chrysocolla prepared , 1 scruple . Syrup of Myrtils or Coral , what may be sufficient . Mingle them and make an Electuary . Whereof the Patient , four hours before dinner , and three before supper , shall swallow down the quantity of a Walnut , and drink after it a glass of sharp red wine , or white , wherein this bag hath been infused : Take Strawberry leaves , Middle Comfry , Perwinkle , Horse tail , Adders tongue , Thorow wax , of each 1 handfull . Roots of Solomons seal , 1 ounce and a half . Great Comfry , 1 ounce . Plantain seed , half an ounce . Cichory , 3 drams . Fennel seed , 2 drams . Cummin seed , 1 dram . Cut and bruise them and mingle them for a bag , which must be infused in three measures of white wine . If by reason of a Feaver wine is not allowed alone , the wine must be mingled with water , and altered with the leaves of Alchimilla . Also for Children this following powder is excellent .

Take great Comfry , Hearbs , Adders tongue , Thorow wax , Rupture wort , of each one dram . Plantain seed four scruples . Fennel , Cichory , of each one dram . Red Coral prepared , two scruples . Pearls prepared , one scruple . Stone Chrysocolla prepared , half a scruple . Sugar of Roses in tables , what may suffice to give it a pleasant taste , mingle them and make a powder , whereof morning and evening give a small spoonfull in broth .

The Infant having taken the powder , shall drink of this mixture , or of this following decoction .

Take Plantain water , Strawberry water , of each six ounces , mingle them .

And if you please you may sweeten it with Sugar , or Take great Comfry , Hearb Perwinkle , Bugle , Plantain seed , of each two drams . Cut them , and mingle them in a paper for a decoction .

Amongst the use of inward remedies , a convenient plaister also under a fit truss , must be applied to the groin ; and as oft as there is need to renew it , the place affected ( whilest the Patient lieth on his back in his bed ) must be fomented with the following decoction .

Take roots of great Comfry , Tormentil , of each one ounce and a half . Hearb Perwinkle , Strawberries , Adder's tongue , Horse tongue , Rupture wort , Thorow wax , of each one handful . Red Rose leaves , Wilde Pomegranate flowers , of each half a handful , Pomegranate pills , Acorn cups , Seeds of Sumach , of each two drams .

Cut them and boil them in Red wine .

After this lay on a new plaister , and let it stay on until it will no longer stick to the skin ; and this changing of the plaister , and formenting of the part affected , must be so often renewed , until the dilatation , or rupture of the Peritonaeum be bound up , and glewed fast together again .

But all these remedies , both outward and inward , will do no good , if there be not a right diet observed ; wherefore the sick must avoid all sweet meats , windy , and of ill juice , of which number are all raw herbs , pulse , summer fruits , milk meats , and such like ; he must use to eat bread well baked , with Aniseed or Cumminseed in it , he must also feed on dry meats to bind , and clammy to heal ; for the first purpose , Thrushes , Blackbirds , and Partridges are good ; and for the second , Calves flesh , Gees , and Ducks feet and wings , rather boiled then rosted . His ordinary drink must be Wine , not sweet nor white , but red and astringent , or at least of a taste between both . But meat and drink taken in small quantity , doth much conduce to the timely recovery of his health . The sick lying on his back , with both his head and feet raised , must keep his bed at least forty daies , and must take great care of his truss , and must never rise without it , be the time never so short ; much less must he go to stool , lest the intestines falling down , should open again that which is newly bound and healed . Also care must be had , that the belly be daily loose , least when the excrements are hard , and are voided by straining , that straining should do very much mischief . To loosen the belly that is too much bound , Prunes of Ausburg are very good , if four or five of them be eaten an hour before meals . And it will do no hurt , if once a week the superfluities of the first region be purged forth with Pills of Aloes , prescribed by Hierom Fabrit . ab Aquap . the weight of a scruple taken one hour before supper , or by a Clyster cast in in the evening , which if it be made of a decoction loosning and cooling , Hony of Roses , Lenitivum , and Oyl of Chamomil , it will keep the belly loose for many daies after ; when forty days are past , the sick may rise ; but let him continue his plaister and truss , untill they may be safely taken off . Though none of those that geld men , think that such as have ruptures can ever be cured , without that most dangerous cutting forth of the Testicle , ( Table XL . Figure IX , &c. ) but that there will be a fear left that it may come again ; yet I have cured multitudes , whose Sirnames I willingly conceal , in a long time , and with great care by the said remedies ; and restored them to their former health by using a good Diet , and a good Truss : But such as I could not cure perfectly , by reason of the greatness of the disease , or the long continuance of it ; yet I preserved them so , that the disease did not increase upon them .

Fig. IX . shews how the urine suppressed is drawn forth by a Catheter ; which manual operation is easie to a Physitian that is skilfull ; and on the other side hard and dangerous enough to one that is ignorant . Celsus describes this L. 7. C. 26. but sometimes we are constrained to attempt to bring forth the urine by manual operation , when the sick cannot make water , or else by age the passage of it is fallen down , or because the stone , or some clotted blood are in the way . Also oftentimes a small inflammation , or a Caruncle bred in the urinary passage , will not suffer it to be made naturally . And this is not only necessary for men , but sometimes also for women ; wherefore brazen , or rather silver , pipes are made , which they call Catheters ; which that they may serve for all great and small bodies , the Physitian must have three ready for men , and two for women . For men the greatest is fifteen inches , the middle size is twelve , and the least nine inches . Of those for women the greatest is nine inches , and the least six . They must be crooked ; namely , those for women a little , but for men much more , and they must be all very smooth , and neither too thick nor too thin . Then the Patient must be placed on his back upon a low seat or a bed ; and the Physitian , on the right side , with his left hand must hold the man's yard ; and with his right hand he must gently thrust into the urinary passage a silver pipe E anointed with oil ; and when it comes to the neck of the bladder , he must incline the Catheter with the yard , and so thrust it into the bladder ; and when the water is made by it , take it forth again . Thus far Celsus . In this manual operation great care must be had , lest in thrusting in of a silver pipe , the fleshy folding be not hurt which shuts the orifices of the seminal vessels , that end about the urinary passage ; which is known by the difficulty of thrusting it in , the pain , and blood coming forth . For when these signs appear the Catheter must be drawn back a little , and thrust in again gently , untill , not touching the folding , it go into the bladder , and the urine come forth by it . Others bind to the silver wier , that fits the hollow of the pipe , a lock of cotton , and they thrust it into the cavity of the Catheter , and they force that , with the pipe , into the bladder ; when the Catheter comes into the bladder , they draw the wier out of the Catheter , with the wool at the end of it ; and so they draw forth th● urine , as by a syringe . But neither the cotton nor wier is necessary . Nor the cotton because the urin● comes freely forth by the Catheter that hath holes on the sides : Nor the wier because , for the reason now mentioned , it hinders more than it profits : For whilest they d aw the wier out of the pipe , oftentimes they pull forth the pipe also , with more difficulty to be thrust in again , when the urine is suppressed by reason of inflammation of the bladder , it is not without danger to thrust in the Catheter ; for the neck being torn , the inflammation is augmented ; and when that ceaseth , there follows almost an incurable voiding of water , which the sick cannot hold . Wherefore it is better with a small wax candle , Table XIII . Figure IX somewhat bended , and anointed with common oil , to attempt manual operation at first , than to exasperate the disease by the use of the Catheter . Also where there is difficulty of making water , which comes by reason of the kidneys in fault , the Catheter and wax candle are used in vain , because the urine is not contained in the bladder .

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

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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 , 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 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 ; 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 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

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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 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 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 .

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The cure of Fistulaes in the Fundament that penetrate .

WHen I undertake to cure a fistula , proceeding either from an ulcer of the right intestine , or from some knot growing on the buttocks , and penetrating , and not yeelding to any medicaments , I draw forth a silver probe , ( Figure I. letter b ) having at both ends two round knots , ( c , d ) and I bend it as need requires : To the end hereof ( d ) and to the round button of the Syringotomus ( e ) ( Table XIV . Figure III . ) I tie a double flaxen thread ( f . ) These things being rightly performed , I gently thrust in the probe into the orifice of the pipe ( g ) and I draw that , and the double thread , a●d the round end of the knife , through the orifice of the fundament (a) as it is apparently deciphered Figure II . letters h and i . After this I take in my left hand that part of the instrum●nt called Syringotomus that cuts , and is marked with ( h ) but in my right hand I take the part of it ( i ) and so drawing and driving up and down the instrument , at one stroak , that the sick may not be long tormented with pain , I cut it quite through . This being cut , the blood must be stopt , inflammation hindred , and the callous must be consumed with this medicament , ( take Arsenick prepared , half a dram , Hony of Roses , half an ounce , mingle them ) the new wound must be filled with flesh and skinned . By this means , without any actual cautery , ( which others praise exceedingly to consume hard callous substance in fistulaes ) fistulaes that penetrate are most easily and most safely cured .

The cure of Fistulaes of the Fundament that do not penetrate .

IF there happen to be a fistula in the fundament , which had its original from an ulcer of the right intestine , and yet hath not perforated the common covers : I take in my hand the probe (a) which at one end hath a round head , and a hole to put a silken thread through ( l ) at the other end , for to make incision at the bottom of the fistula , it is sharp , like to a needle with three points , to the top end whereof you must fasten a little wax pellet ( m ) whereby the top of the instrument findes more free access into the bottom of the fistula , and there is no fear that it may hit against the sides of it , to hinder the operation and cause pain ; wherefore having prepared my probe , with the wax put on it , I search for the bottom of the ulcer of the intestine , and when I have found it , by thrusting the probe hard I perforate the skin , ( Fig. III . ) and I draw it all through the fistula , the silken thread hanging down at both holes ( o ) Figure V. when the hollow place is perforated , Cornel . Celsus lib . 7 , cap . 4. de ani fistulis , and others that follow him , bind both ends of the twisted thread , ( ye● one of silk , that were single and of a red colour , by reason of its smalness and tincture , would sooner cut it and eat it away ) and they twist it with an overthwart small stick ( n Figure V. ) very stre●ght , and so they cut all the fistula with a thread ; yet because the incision and cure of the whole fistula by a thread ( Figure V. ) proceeds too slowly , and there is continual pain with it , ( because every operation ought to be done quickly and sweetly ) Hierom Fabrit . ab Aquapend deservedly rejects it , and saith there is no place for this way , but only for fearful people who are afraid of the iron instrument , wherefore I do so demean my self . The fistula being perforated with a probe , and with holes ( by the help of a silken thread streight twisted with a stick for two daies ) for the use of the Syringotomus , ( Table XIV , Figure II . ) which at one end hath a thicker head sufficiently dilated ; I remove the stick ( n ) and the silk , ( Figure V. ) and cut the fistula after that fashion as I have described it before Fig. I , and II . This latter way of curing fistulaes by a thread and edge of the knife , joins into one the opinions of Celsus and the latter Chyrurgians ; and by experience , which is a most faithful witness , it is better then simple incision performed by a thread , and more tolerable , but especially when the orifices are too far asunder , by reason of the length of the fistula . If this operation also seem to be too slow , the Chyrurgian shall satisfie all conditions of good operation , if he presently cut the fistula with that knife called Syringotomus , which cuts at that end where it hath a little button besides . I set forth this instrument before , Table XIV . Figure I. and I applied it , Table XXIX . Figure III . If such fistulaes grow from outward knots , and such as impostumate , they require the same cure , proceeding as I said Figure IV . Note , the sphincter muscle , according to Hippocrates de Haemorrh . may be safely cut any way , without any hurt done to its functions , if only one eighth part of it be left untouched ; otherwise there would follow an excretion of the excrements against a mans will , and at last death it self . Fistulaes in old people , that have run long , are not safely cured , unless an issue be made before they be healed up , three or four fingers above the knees , on the inside , to evacuate the matter that is daily collected . The Emrods that require manual operations , are either external or internal , which first of all the most skilful in Anatomy , Hierom . Fabrit . ab Aquapend . learnedly demonstrated in operat . Chyrurgic . titulo de Haemorrhod .

These appear at first sight , but those , unless you press the Abdomen , and hold your breath , or go to stool , cannot be seen : If they need manual operation , they both do either swell , or run too much .

The cure of the Emrods that swell , by manual operation .

SOmetimes pain , or inflammation , is joined with the swelling of the Emrods ; and then the cure is performed rather by medicaments internall and externall , namely , with the unguent of wilde Flax of Horst . Lib . 4. Observ . 42. or other unguents , ( the basis whereof is Scrophalaria , which onely cleansed from filth , and hanged about the neck , ând worn next the naked body , doth almost miraculously asswage the pains of the Emrods . See Tabern . lib . 2. fol. 431 , and Craton . cons . 207. ) rather then to exasperate this Disease by any manuall operation whatsoever . If they swell much , without pain or inflammation , and lie secret , I take the broad iron tool ( p ) ( fetched out of the nineteeth Table ) and when it is very red hot , I so burn the Emrods , yet not touching them , that is , that they may onely feel the heat of the fire , as the Patient can well endure it : If the Patient , as oftentimes it happens , fear manual operation , with good success also I set on the Leeches prepared , and I draw forth plenty of blood ; after that I put up into the fundament linimentum simplex with a tent ; and I apply a new sponge , wet in black sharp wine , wherein astringents have been boiled , and press it forth again , by this means to corroborate the part .

Hippocrates , for the said manual operation , requireth an iron instrument with a round head , such an one as that is , which is lively set forth Table XIX . Figure V. and in the following Figure , letter q is the mark for it ; with this he drieth them all up , one after another ; yet I think , that a broad head is more effectual here , because the operation is sooner ended with this ; but that of Hippocrates is best , when either of the Emrods that swel , runs ; because this easily passeth by those that bleed ; but the broad one dries up all that run with those that are blind , not without great hurt to the Patients ; which I would needs warn you of from the observations of Spigelius .

Sometimes the Emrods swell so , yet lie so high in the intestines , that they can by no means be seen , and much less be touched by any hot iron be it round or broad . Then if any help be sought for by manual operation , that pipe is necessary to dry them up , which is pictured above Table XVI . Figure III . It is put cold into the fundament , and it is heated with a ●ed hot pin ( Table now quoted , Figure IV . ) often th●ust into the pipe , that being heated , it may by degrees dry up the Emrods .

The cure of the Emrods that run too much , by manual operation .

WHen they bleed too much , they must be touched one by one with that pointed instrument ( Figure VIII . ) leaving only one by which the blood , that is superfluous , afterwards may run for●h . Their bleeding sometimes is so violent , that it is impossible for the most skilfull Physitian to stop it ▪ though he use revulsion and astringent medicaments , as well taken by the mouth as outwardly applied . I had experience of this violence at Venice , ( where I practised Chyrurgery a whole year , and the Emrods come often there to the Physitians to be cured ) upon a certain noble Venetian , who was of the house of the Contareni , a young man of 26. years old , of a sanguine complexion , in the Spring time , it being the first time that ever he was troubled with the outward Emrods ●leeding too much . I being called , I opened the inward vein of his right arm , and I commanded to apply dry cupping glasses to his back , without scarification ; I gave him old conserve of Roses with Crocus Martis , to take by the mouth ( not neglecting the binding of his upper parts ) and I applied to the part affected medicaments that had great force of astringency , tempered with the white of an Egg , and mingled with burnt cotton ; yet for all this the vehement bleeding continued ; and the Patient , otherwise very red , changed to look very pale , so that he was in danger of his life . I propounded to this noble man , and the standers by , to stop the flux of blood , and to save his life ; the cauterizing of the veins according to Hippocr . l. 2. de Haemor . Aetius Tetrab . 4. serm . 2. c . 15. and Sennert . pr . l. 3. p. 2. c . 13. contrary to Hier . Fabrit . ab Aquapend . and I confirmed my proposal by Hippocrat . aph . 6. sect . 1. for an extream disease , an extream remedy must be used ; and aph . 6. sect . 8. Those things that medicaments will not cure , the iron instrument will cure , that the iron instrument cannot , those the fire can ; and of purpose I left out those words , What the fire cannot cure , is incurable ; lest the Patient should take occasion to doubt of his recovery . But the Patient , when he saw death hard by , gave credit to our old Author , and taking me by the hand , promised to me and to the standers by , that he would admit of cauterizing , since there was no other means left . Whereupon I made hast home and furnished my self with instruments needfull ; namely , with pointed instruments ( Table XIX . Figure VII , VIII and IX . ) and coming back , I delivered them to the servant of this noble Patient , that he might make them red hot ; when they were very red hot , I touched severally the small orifices of all the Emrods that bled , and made a hard crust upon them , beginning with the uppermost , lest the blood , running forth of those that were not touched should quench the hot iron . See Ludovic . septal . l. 7. animadver . 112. very worthy to be read over .

The blood being stopped by manual operation , and the best regiment of restoring diet being observed , that noble man was restored to his former health ; and I advised him that every three moneths , he should set on four cupping glasses to his shoulders and back , with scarification ; that nature might not , for the future , be accustomed to send down the superfluous blood to the Emrod veins . These things being rightly observed , he lived ten years free from any bleeding of the Emrods . But if Nature , before this , had been accustomed to open the veins of the fundament in this noble man ; and been used to send the superfluous blood thither , I had left one of the Emrods untouched by the instrument , which afterwards should have been stopt with emplastick and astringent powders ; that it might , either of its own accord , or else by art , be easily opened ; and that the blood , daily abounding in the body , which is wont to be evacuated at set times , might be thus purged away , lest those diseases may follow ( which Hippocrates mentioneth sect . 6. aph . 12. he that is cured of the Emrods that have lasted long , unless one of them be left , is in danger of a Dropsie or a Consumption ; and Epidem . lib . 6. sect . 3. text . 33 and 34. They that are wont to bleed at the veins of the fundament , are neither troubled with inflammation of the Lungs , nor eating ulcer , nor with fellons , nor little swellings , which are called Terminthi , from the likeness of Ciche Peason ; and perhaps not with the Leprosie , nor other diseases of that kind ; but being unseasonable cured , many fall into these diseases , and for that cause are in an ill case . )

Emrods that are ulcerated .

THose that are internal must be dried up , that they do not degenerate into Fistulaes ; wherefore an iron pipe is thrust into the fundament , which hath a hole on the side ( Table XVI . Figure II and III . ) and into this is put a pin very red hot ( Table XVI . Fig. IV . ) and it is often drawn out , with which the ulcers of the Emrods are cauterized , and the parts near are defended . The pain being abated , and the Eschar taken away , the ulcer must be incarnated and consolidated , with sarcotick and epulotick medicaments .

Fig. VIII . shews the application of the Enterenchita or instrument with a pipe ( Table XIII . Figure V. ) to give clysters with at the fundament . In the year of Christ 1639. on the 18. of June , the wife of Bartholomew Abelinus , a Weaver of Vlma , was delivered of a dead child , which in the privy parts had no mark to know it by , whether it were a man or a woman child ; nor did there appear any way whereby this child could void its urine or excrements of the belly . In the Perinaeum there hung down something as long as the little finger , which like to the blind intestine had no passage through it , from the os pubis as far as the heel , both the feet grew most closely together , but in the other parts the child was made very comly .

Fig. IX . In the year after the birth of Christ 1651. on the 5. of July , about six of the clock afternoon , in the Village Winterbach , in the Dutchy of Wurtenberg , the wife of George Langius a Country man , whose name was Anna , brought forth a monstrous child , and so formed , as you see in the picture ; namely with two heads , four feet , as many legs : So soon as this monstrous child was born , a reverend man D. M. Ioan . Riep , the ordinary Pastor of that Parish , did baptize it ; and on the 6. day of July following , in the Church , he named it Christianus and Christiana ; the child died at 6 a clock after noon , on the 7. of July ; the Abdomen of the carkass and the breast were opened by me according to art , in the presence of D. Christopher van Rueff , Schorndorffius Physitian in ordinary , Iacob Guitelin Apotheca●y there , and the Child's father ( ô hard heart ! ) and of many more ; and first I found two stomacks , to both which severally were fastned the small guts , which yet at the beginning of the greater guts , did conclude into one blind intestine , colon , and the right gut . When I had artificially taken forth the intestines , under the right Hypochondre , there was seen but one Liver only ; and on the left side but one Spleen ; but in the Reins three Kidneys , and as many Vreters of equal bigness , with their mouths all gaping into one bladder for the urine . As for the members of generation , there was but one Matrix with all parts necessary for generation ; that which hung behind the fundament had no hole in it ; but was shut up like the blind gut . In the cavity of the Thorax I found two hearts , included in so many Capsulaes , one Med●astinum which so parted the hearts one from another , that one lay on the left side , and the other on the right , the picture of which Monster , the cousin-german , by the brother , caused to be drawn for remembrance to posterity .

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

diagram of surgical techniques TABVLA XXXXIII

●

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 , 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 thee 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 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 . 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 . 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 . 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 ; 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 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 , 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 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. 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 . 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 wounds made with 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 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 .

Of Nodes coming from the French Pox .

NOdes of the French Pox , if they will not be cured by medicaments with sarsa , given by the mouth ( which far more easily and quickly cures all knots and accidents of the French Pox , than guaicum doth ) then this following Cerate , to excellent profit , is applied to them : Take Quick-silver killed with fasting spittle , half an ounce . Powder of Indian Tobacco , half a dram . Plaister Diachylon with gums , Cerat Oxelaeum . Citrinum , of each 1 ounce . Distilled oil of guaicum , 1 dram . Mingle them and make a plaister .

But if for all the use of this remedy , they continually ake , and are not discussed , it is a most certain sign that the bone under the knot is corrupted , and therefore it is necessary to make incision upon the node , along the shin bone , with an incision knife , Table II . Figure II . and the bone being uncovered , must be scraped away with scraping tools where it is corrupted . Such knots as they seldom happen in Germany , so the manual operation for the cure of them is not admitted , but to those only that desire it in their most bitter torments : But in Italy most frequently and happily , men are cured by manual operation : Wherefore though I had many , both noble and ordinary people , under my hands to cure , who were tormented with nodes of the French Pox , yet I was suffered to use manual operation upon very few of them . But because at Padua I have seen this operation so often , where multitudes are alwaies complaining of pains in their shin bones , there I often used it ; and I would needs insert , very briefly , into this work of ours , the way used by those of Padua in performing this operation , that Students in Chyrurgery ( for whose sake I write this ) may know how speedily to help their Patients that earnestly desire manual operation from them , when there is no remedy almost left . The first day they cut the venerious node , with the knife mentioned , upon the length of the shin bone , unto the bone it self ; then they dilate the wound with hempen hards , wet in the white of an Egg beaten ; and they swath the leg about with a convenient ligature , to keep off a flux of humours : On the second day they take off the hards , and lifting up the wound artificially , having first very well defended the sound parts about it that they may take no hurt , they fill it with a caustick ( I could rather wish it were with that which Ambros : Paraeus describeth by the name of Holosericum Lib . 25. cap . 32. ) After this they cover it with a plaister extended all the breadth of it , but not going round about the leg ; and they bind the leg again , with a pressing band , according to Art. On the third day removing all these , they apply things to make the Eschar fall off ; when that is taken away they scrape away the rottenness unto the quick ; and then with drying powders they cover the bone with flesh . They first cut the node , that the caustick may sooner come to act ; yet incision is not alwaies necessary , unless it be for those who will hardly beleeve the Chyrurgian when he tells them that the bone is rotten , untill such time as they see it or touch it themselves .

S represents the Curashier ligature , which borrows the name from the similitude it hath to a Roman breast plate ; and it is profitable for those who must have a band , near the throat , upon the broad shoulder bone , breast , back or sides . But a swath with one end is thus rolled about : First it is put under the arm pit ( Galen l. de Fasciis 79. ) then it is brought slanting over the breast , near that place where the throat is joined with the breast bone ; then by the hinder part of the neck , to the broad shoulder bone of the opposite shoulder ; and so to the arm-pit under that ; and from that to the hinder part of the neck that is above the part ; where the band was first laid on , so that near the hinder part of the neck , there may be made a cross like to the letter X. after this it is carried a slant to the broad shoulder bone on the other side , and to the arm-pit ; and from the arm-pit , to the hinder part of the neck , and upon the vertebra of the neck , it may represent the letter X ; then again it is brought under the arm-pit , and slantingly near to the part where the throat joins with the breast bone ; so that here also there must be made the likeness of the letter X ; and near the hinder part of the neck , and above the broad shoulder bone , and under the arm-pit , that it may represent the letter X four times ; namely once before , once behind and twice near the throat . And by the same reason it is brought about as oft as need is ; then it is wound round about the breast and the sides so , that the whole ligature represents a breast plate .

And thus , by God's permission , in these 43. Tables , I was willing to set before all men that desire to be instructed , and to describe and publish the best way I could , being led by infallible experience , the delineation and proper way of using my Chyrurgical Instruments .

A CENTURY OF Chyrurgical Operations . Confirming and clearing what hath been briefly mentioned in the Description of the foregoing Tables .

OBSERVATION I. Of a wound in the Head with a depression and large Fissure of the Skull .

IN the Year , 1637. The 9th . of January , about seven at night , John Happel of the City of Ulme , a Quartermaster . Being of a hot and moist temperament of body , and in the two and thirtieth year of his age , was wounded in a Duel , by a Trumpeter , receiving seven wounds , one of which was upon the outward part of the Radius of the left arm near the wrist : the other six in his head ; the first of which was behind his left ear , the second about the Coronal Suture , the third near to the Sagittal Suture , the fourth and fifth upon his fore-head cross-wise . These were all superficial , or in the Skin , or at least made only with the edge or point of the sword ; but the sixth was in the temporal Muscle of the right-side and very dangerous : for the sword being turned backward , the wound was made by the hilt , the lesser part of the Pommell driven in , and the Skull or Cranium hereby fractured and depressed . A Chyrurgeon of the City dressed these wounds after the same manner as ordinary wounds use to be .

Upon the tenth by the command of the Consul , I visited him , and made slight of all these wounds , except that in the temporal Muscle ; neither was I deceived in my opinion : for I found the Skull to be depressed with the broad bended probe described ( Tab . IX . Fig. VI . ) whereupon I presently put a piece of new Spunge twisted about into the wound , that it might be dilated ; I sprinkled the powder of Orris , or Flower-de-Luce of Florence , and Birthwort upon the bone , I applied a Digestive to the lips , and upon that Diapalma , and a convenient Cataplafme .

Those wounds about the Coronal and Sagittal Suture , I did also somewhat dilate , putting in Lint with a Digestive , and a Searcloth of Diapalma over it ; I made use of that Bandage , or rowler described , Tab . XXXI Fig. IX , X. The other I dressed as simple wounds ; as to his dyet , his meat was Panado , decocted Barley , and Damask Pruans : his drink this following Magistral Barley-water .

Take of Barley half an ounce . Corinthes , two ounces . Annis seeds a dram and a half .

Boyl these gently two hours in three measures of Fountain water , and before it be cold add two drams of Cinamon , and afterward temper it to the Palate , with tincture of Roses , and Pomgranat wine ; in the evening he used this Glyster to loosen his belly , having been very much bound for five days .

Take of Mallows , Violets , Betony , Pellitory of the wall , of each an handful . Fennil seeds , Citron-seeds of each a dram and half . Flax seeds six drams . Marshmallow Roots , half an ounce .

Boyl this in a sufficient quantity of water to ten ounces : and to it being streined out .

Of hony of Roses an ounce and half . Lenitive Electuary , one ounce . Oyl of Violets . Oyl of Camomile , of each an ounce and half .

Mixing them according to Art , and let them be made into a gentle , Glyster , whereby the Patient may not be too much disturbed .

Upon the twelfth day at ten in the morning , by reason of an unquiet night , and a greater swelling and pain about the wound . I declared to the Patient and the standers by , that it was necessary to dilate the wound in the temporal Muscle with an Incision Knife , and the wound being bound up again as before , I prescribed to the Patient by reason of a bitterness in his mouth this following Syrup to purge Choler .

Take of Loosening syrup of Roses two ounces . Extract of Rubarb a dram and half . Extract of Diacarthamum half a dram . Creme of Tartar one scruple . Black Cherry water as much as sufficeth by mixing to bring it into a liquid syrup .

This gave him five stools of a bilious matter .

The thirteenth day he was somewhat better then the day before , and I bound up the wound the same way as formerly .

Upon the fourteenth day the Patient complained of a great pain in the wound of the temporal Muscle , and therefore together with the Chyrurgion who was called at the first , we determined to dilate the wound with an Incision Knife according to the length of the Fibres of the temporal Muscle , in form of a Triangle , or the letter V. Tab . XXXI . Fig. XI . that the Skull near to its depression might be more conveniently penetrated by the Trepan , and be raised up by the putting in of the Levator , Tab . XXXII .

Upon the 15. and 16. by reason of the painfulness of the wound and the new Moon I bound up the wound as before .

The seventeenth , for the pain which the matter caused which found no way to get out , ( for the wound was too narrow ) he made use of his Lenitive Glyster .

The 18th day the Patient having had an unquiet night , I dilated the wound of the temporal Muscle in the form of the letter V. with a streight Incision Knife , Tab . II . Fig - XI . I separated the Pericranium from the bone with my nails , I filled up the cavity with Balls of Hemp hardes moystned with the whites of Eggs stirred up together , and sprinkled over with an astringent pouder , I anointed the parts about it with Oyl of Roses , and put on a Bolster of Linnen dipped in red Wine and pressed out , and also the rowler or bandage before mentioned .

The nineteenth day the blood being quite stopped after the incision or those parts which cover the Skull , I shewed to the standers by , the depression of the Skull which I foresaw , and declared the necessity of making perforation .

On the twentieth I per●orated the Skull with the Trepan near to the depression and the Coronal Suture , I made the sides ●f the h●le smooth with a lenticular instrument described Tab . XI . Fig. V. II . and putting in a small Leyator . Tab . XXXI . Fig. VII . I lifted up the depression of the Skull , I applyed to the thicker Membr●ne a round piece of red Silk dipped in Oyl of Roses lukewarm fastned to a thread , Tab . XXX . Fig. VIII . To the Skull a Cephalick pouder , and dry Lint ; to the lips Lint cover●d with a Digestive , and over that Diapalma , and the Cataplasm of Hippocrates .

On the twenty first , both the Wound and the Patient were better , and he confessed that he had slept all night , therefore I applyed again to the thicker Membrane red Silk dipped in Oyl of Roses , and fastned to a thread ; to the Skull , Pouder of Round Birthwort and Flower-de-Luce of Florence , to the lips this digestive .

Rozin of Turpentine washed in Betony-water two drams and a half , and the yolk of an Egg ; adding over it Diapalma and the Cataplasm .

From the twenty second to the twenty sixth , the Patient went on well as to his wound .

Upon the twenty seventh , I cut out four pieces of the Skull pressed down , which yeilded not to the Levators delineated in Tab . XI . but with a new Instrument Tab . IV . Fig. XI . and applyed to the thick Membrane by reason of some corruption , the Silk dipped in a Liniment , which consisteth of Syrrup of red Roses , and some drops of Spirits of Wine , and Turpentine , eating away the fleshy excrescense with Pouder of burnt-Allum .

On the twenty ninth for the purging away serous and bilious humours , with which his body abounded , I prescribed this following Infusion .

Tske of the best Rubarb one darm , Agarick newly made into Troches a dram and half . Leaves of Senna of Alexandria , half an ounce . Ginger , and Creme of Tartar , of each half a scruple . Borrage-flowers half a pugil .

Infuse these a whole night in a convenient quantity of black Cherry-water , adding to it being strein'd out , an ounce and a half of the best Manna .

This brought away a great quantity of serous humours

On the twenty ninth and thirtieth , the Wound and the Patient were in good condi●ion . On the third of February by reason of irregul 〈…〉 be fell into violent pains of the Collick , so that he could not sl●● in four days time , yet after the use of this Glyster .

Of the carminative decoction ten ounces . Hony of R●s●s , H●ny of Rosemary-fl●wers , of each an ounce . Leni●ive Elect●ary ten drams . Oyl of sweet Almonds , Oyl of Rue , of each an ounce and half . Mix them f●r a Glyster .

The pain decreased , till the evening , when he made use again of this Gly●●e● ; the wound went on well as in the foregoing days , and red fl●●h grew upon the dura Mater , and in the middle between the two T●bles ●f the Skull . On Febru●ry the ninth , after he had taken a potion m●de of three ounces of Oyl of sweet Almonds , two ounces of Manna , and an ounce of Camomile-water ; the Collick which had much t●rm●n●●d him s mwhat abated : for he had passed the whole night with●●● sleep . On the tenth he used a Bath of fresh water , in which a Bag wi●h th●se ingredients were boyled .

Take of Mallows , C●m mile , Pelli●ory ●f the wall , Sp●●dw●ll , Flax seeds , Cart●i seeds , Bran . of each an handful . Sow them into a Bag .

With this the Patient was better . On the eleventh day he vomited a great quantity of Choller , in the evening the ordinary Glyster was given again , after the coming away of which , the vomiting ( dangerous in wounds of the Head ) and the pains about his Stomach ceased ; but notwithstanding this , he could not sleep : I order●d th●refore four grains of Laudanum Opiate , with the Magisteries to be taken in conserve of Roses , upon which he slept six hours very quietly . I dressed the wound when filled up with flesh , with Lint and Ceratum Divinum , that it might come to skin .

Upon the fourteenth and fifteenth , he was well ; but because he abounded with serous and bilious humours , he took this purging pouder in Wormwood Wine .

Take of , The best Rubarb poudered , two scruples . Of black Mechoacan , half a dram . Creme of Tartar , half a scruple . Mix them , and make them into a Pouder .

Which , gave him seven Stools , and brought away the percant humours . Upon the 16 , and 17. all things were well ; on the 18. the Patient went abroad without leave , and the great coldness of the Air brought his pains of the Collick again ; which , upon using the forementioned Bath , soon ceased . Upon the 19. the Wound being totally healed , cicatrized , or covered with the skin , the Patient being well provided against the injuries of the Cold , walked abroad in publick , without relapsing again any more into the Collick .

OBSERVATION II . Of a Wound on the Head , with an Inflamation of the Pericranium , and a doubtful Fissure of the Skull .

IN the Year 1638. on the 15. of October , by the command of the Consul , I went into the house of John Jacob Hecking , Citizen and Tayler of Ulme , whom I found in bed , afflicted with four Wounds on the head ; of which , one was in the Synciput , or fore part of the head , on the left side , with a great inflammation of the Pericranium , which tended to Corruption , and a fracture of the Skull : the other three were simple wounds : all these were presently dressed by a Barber , as simple Wounds use to be . Upon the 16. ( which was the second day from the hurt ) by reason of the great putrefaction , and inflammation of the Pericranium , and the Fissure of the Skull ; of the penetration of which , we were yet uncertain . I dilated the Wound in the Synciput with an Incision-knife , in the form of a Cross . Tab . XXX . Fig. IX . and bound it up with Astringent Medicines . The third day , the bloud being stopped , I scraped the Fissure of the Skull with my paring Instruments . Tab . XXX . Fig. X. On the tenth , I scraped upon the chink , or crack still deeper , and yet the mark of the ink made with a pen upon the Fissure remained , which with no sort of paring Instruments could be taken out . In the mean time , by reason of his being bound , and of the flux of humours to his breast ; I prescribed this gentle Potion , that the humours might not be stirred too much .

Take of Loosening Syrup of Roses , two ounces . Lenitive Electuary , one ounce . Black-cherry Water , as much as is convenient . Mix , and make them into a Potion .

With this he voided seven times bilious matter . On the fifth day looking upon the wound , and the Patient holding his breath , a kind of serous matter , with some drops of blood , flowed out at the fissure , which was deeply scraped down with the paring Irons . Things being thus ; I called to mind the Golden words of our Old Man , in his book of Wounds , Text 22. who saith , Where the Cleft goeth deep in , nor can be taken out by scraping , is this case , you must proceed to the cutting , or perforating of the Skull . And Text . 28 When any one understanding a Bone to be cleft , broken , or bruised ; and through Errour hath not sawed it away , and perforated it , &c. Amongst the more Modern Anatomists , and Chyrurgions , Hieronym , Fabrit . ab Aguapend . and his Master Fallopius , do judge , that those great and cruel Symptoms are not to he expected ; which our Barbers with so much danger to their miserable Patient , do often very imprudently wait for . Fallopius is not solicitous for contusions made on the outward table of the Skull ; but declareth , That those which reach to the middle , can by no means be without danger : by reason that corrupt bloud may there be gathered together ; which descending upon the thicker Membrane of the brain , may corrode it . For these Reasons therefore , upon the sixth day I made a hole through the Skull with a Trepan , neer the Fiss●re , Tab . XXXI . Fig. V. and the hole being made smooth with a Lenticular Instrument , Tab . XXXI . Fig. VII . I ap●ly'd to the thicker Membrane a round piece of Silk dipped in Oyl of Roses , and fastned to a string , Tab . XXX . Fig. VIII . a Pouder and dry lint to the bone , a Digestive to the lips of the Wound , and over it a Diapalma and a Cataplasm : in the evening the Patient was better than in the morning , for the pain of the Adnata of each Eye was more remiss , of which , before the perforation of the Skull he much complained .

On the seventh day it was well with him ; and he com●lained of nothing but a small Cough , and a heaviness about his Eyes . The Wound being unbound , looking upon the thicker Membra●e of the Brain , there came so great a stink out of the hole made by ●he Trepan , that I could scarce dress him : Having cleansed the Wound with wool , the thicker Membrance was somewhat slimy , a●● corrupted on the top ; for which corruption , Oyl of Roses ●eemed not sufficient ▪ Wherefore in this compound Medicine which might more strongly resist the putrefaction of the Membrane :

Take of , Syrup of Red-roses , two drams . Turpentine washed in Betony water , one dram . Spirit of Wine , six drops . Mix them into the form of a Liniment .

I dipped a circular piece of Linnen , and applyed it lukewarm to the Membrane , Tab . XXXI . Fig. VIII . to the bone , Lint and Pouder of round Birthwoort and Orrice , to the lips a convenient Oyntment , and over it Diapalma ; and a Cataplasm ( which is made of Bean-meal , 〈…〉 - meal , crums of Bread , Red-wine , and Oyl of Roses . ) and also 〈…〉 called Cancer , Tab . XXXI . Fig. X. Upon the eighth 〈…〉 better , and the ill smell of the Membrane was somewhat 〈…〉

On the tenth , he took a Potion which gave him six Stools . On 〈…〉 e ●●elf●h , by ●he continued use of the Liniment , the thicker Mem●rane f the Brain i●clined more towards a red colour , than the day ●●f●re : I drew out that slimy and half-corrupted part of the Dura Mater which was separated on all sides , with the Pincers , Tab . IV . Fig. I. through th● hole . From the fourteenth , to the twentieth he c inued well . On the 20. of November , the Skull threw off a bone , which , because i● was separated from the inward Table of the Skull , I drew out with the Pincers and healed up the Wound by the help of the Ceratum Divinum . On the twenty seventh , the Patient being rest red to his former health , returned me many thanks for the Pains I had taken .

OBSERVATION III . Of a Wound on the Head in the Temporal Muscle , with a very large cleft in the Skull , and Inflammation of the Du●● Mater .

JOhn Anwander , a Barge-man , of Kirchdorff , in the Year 1633. on the third of January in the evening , was wounded with a broad Sword in his left Te●ple , so that the Fissure of the Skull was so large , that I could easily lay 〈◇〉 my fore-finger . The Patient , the next day , was carried into the ho●●● of John George Bauler , a Chirurgion ; where I presently applyed to the inflamed Dura Mater , an oblong piece of Silk dipped in Oyl of Roses ; to the bone , the Cephalick Pouder with dry Lint ; to the Wound , a Digestive , Diapalma , ( Linimentum simplex was also used with benefit ) a Cataplasm , and the Band , called Cancer ; of the Digestive and the Cataplasm applyed , this is the description .

Take of , Rosin of Turpentine washed in Rose water , two drams . Oyl of Roses , one dram . The Yolk of an Egg. Mix it for a Digestive .

Take of , Barly-meal , Bean-meal , of each six ounces . Crums of Houshold-bread , four ounces , Pouder of Roses , half an ounce . Oyl of Roses , three ounces . Oxymel simple , and Red-wine , of each as much as sufficeth . Mix , and make them , upon the fire , into the form of a Cataplasm ,

In the evening the Patient being forced for the Revulsion of the humours , admitted of this following Glyster .

Take of The decoction of the Emollient Herbs , ten ounces . Pulp of Cassia newly drawn out , one ounce . Hony of Pale Roses , an ounce and a half . Oyl of Violets , and Camomile , of each one ounce and a half .

On the third day the Median Vein of the left Arm was opened , and five ounces of blood taken away : his dyet was slender , Panado and boyled Barly ; his drink was the Magistral Barly water , to the which , for the taking off his thirst , he sometimes mingled two or three spoonfuls of the following Syrup .

Take of , The Syrup of the juice of Citrons , Syrup of the sharp Pomegranates , Tincture of Roses , of each three ounces , Mix them in an earthen Pot or Glass .

The Wound being unbound , seing that the inflamation of the Membrane remitted ; we bound it up again with the same Medicines and Bandage .

The 4th for the bitterness in his mouth , of which the Patient much complained , I prescribed this loosening Potion .

Take of , Loosening Syrup of Roses , two ounces and a half . Of Manna , one ounce . The Electuary of the juice of Roses , two drams . Blak-Cherry water , as much as sufficeth . Mix them for a Potion .

With which , the Patient voided very bilious matter . On the fifth , he was better , and the inflammation of the Dura Mater went off . On the 6th I applyed to the Membrane , Linnen Dipped in Syrup of Red-Roses ; and added hony of Roses to the Digestive for the lipps of the Wound , and with there I dressed the Wound and Membrane daily , till both were sufficiently cleansed . On the 10. the Wound and Membrane were very fair , and therefore omitting the Linnen , I incarnated the Wound with Betony Oyntment , and cicatrized it with the Ceratum Divinum , on the six and thirtieth day the Patient began to complain of a pricking pain about the part affected , by reason of a Scale of the bone which nature had separated , which I drew out with the Pincers . By these few remedies the Patient being most dangerously wounded , in a short time , without manual operation , was most happily restored .

OBSERVATION IV . Of a dangerous Wound dividing the Forehead-bone , Cured by the Trepan . I have not made any scruple to transcribe this following Observation from pag . 357. of the later Observations of D. Gregory Horstius .

IN the Year 1626. on the 11th of October , George Seitz . in the Village of Edelhaussen , being about forty years of age , received a great Wound , in the night time , upon the fore-part of his head ; and happening presently upon an Empirick , who not observing the penetration , or Fissure of the Skull ; strove to heal up the Wound , with Sarcotick Medicines , after his fashion . But the Symptoms encreasing daily , by the persw●sion of his Friends , he comes to Ulme : and on the twentieth of October sends for me , and for my most eminent Collegue , D. Johannes Scultetus , a person well versed in Chyrurgical Operations . Considering therefore of the Circumstances , we were afraid of some foul matter under this fair appearance ; whereupon forcing open the Wound , we found the Skull divided through both the Tables , and under it a corrupted matter gathered together ; which , upon stopping the mouth , and blowing through the nose , issued forth . Having made our prognostick , we declared it necessary to apply the Trepan ; encouraging the Patient , seeing he was yet strong enough to admit it . On the 21. of October , being purged the day before with Lenitive Electuary , we ordered the skin to be divided according to the tendency of the fibres of the Muscle of the forehead , or eye-brows ; not cross-wise , as it useth to be , lest by such a division the fibres of the foresaid Muscle being hurt , the upper eye-lid might fall down , as I had observed it on the seventh of March , 1614. upon a fall from a high place ▪ whereby this Muscle , in a certain womans forehead , was bruised . Making therefore a sufficient incision , the skin was separated from the Skull with the fingers , and the Wound bound up with Lint sprinkled with an Astringent Pouder , and moistned a little outwardly with the white of an Egg. On the 22. the bloud being stopped ▪ the Trepan , Tab . XXXI . Fig. V. was applyed by my Collegue . The Dura Mater appeared also somewhat hurt and inflamed , thin corrupted bloud boyling out at a little hole of it : we endeavoured therefore daily to help the inflammation , and to wipe away the corrupted bloud , not neglecting , in the mean time inward gentle evacuations ; as also , the ordinary spare Diet ; by which means he was perfectly recovered after a fortnight , or three weeks , enjoying his health now this three years , as well as before . It is mafest therefore , that the use of the Trepan may be admitted , not only in the beginning , but in the progress of a Disease , if the Patient be not too weak .

OBSERVATION V. Of a Wound in the Head , with a very great depression of the Skull .

IN the Year 1634. In April , Martin Kuntz of Durcha in Misnia , received from a Captain , a Wound with a great Chain upon the right side of the hinder part of his Head , near to the meeting of the Coronal and Sagittal Sutures ; which did not only bruise the Pericanium , but also depressed a great part of the Skull : this depression , by reason of the great quantity of blood , was not at first taken notice of by Barbour , and so considerable a Wound as this was 〈◇〉 fourteen days no otherwiset than as a simple one . Upon 〈…〉 cruel Symptoms hapned ; things being thus , they sent for my 〈…〉 ●inent Collegue D. Gregory Horstius , ●nd my self : and 〈…〉 the Wound we found a very great depr●ssion of the 〈…〉 the Sagittal , and Lambdoidal Sutures , accompanied with 〈…〉 ●tal Feaver , and a pain and giddiness of the Head ; upon 〈…〉 therefore we agreed to proceed in the Cure , by ●●ing 〈…〉 skin , and perforating the Skull . In the evening ●he P●ti●n● 〈◇〉 bound , made use of a cooling and moystening Glyster .

On the sixteenth , taking off the dressing , and looki●g upo● he Wound , I touched the depression gently with my Finger , 〈◇〉 ●he P●tient presently complained of a pricking pain , I made a 〈◇〉 in the skin of the Figure of a Cross , and cut it open with a streight 〈◇〉 n-Knife Tab . II . Fig. XI . I separated the P●ricranium from ●he bone with my Fingers , and the Wound being dilated , I bound it up w●ll Hemp hards dipped in a Medicine made of the astringent Pouder described by Galen , stirred up with the white of an Egg.

On the twenty seventh , the blood being stopped , and the stupes removed , we found so great a depression of the Skull , that we were forced to perforate the Skull seven times with the Trepan round about the depression , and to cut out the spares between the holes with a large pair of cutting Pincers Tab . XX . Fig. I. to be seen also in the Skull , Tab . XXXII . These things done , I smoothed the edges of the Skull , on all sides with a lenticular Instrument Tab . XXXI . Fig. VII . I applied to the Dura Mater a round piece of Silk dipped in Oyl of Roses , to the bone , Pouder of the roots of round Birth-wort , and Flower-de-Luce of Florence and dry Lint , to the lips Lint , covered with a Digestive made of Turpentine , washed in Plantain-water , the yolk of an Egg , and Oyl of Roses , and upon these Diapalma , and a Cataplasm , which consisted of the crums of Houshold Bread , Barley-Meal , Bean-Meal , Rose-flowers , Betony-flowers , Oxymel Simple , and Oyl of Roses , and bound it up with the band , termed by Galen Cancer .

On the twenty eight , four ounces of blood were taken away from the Median veine of the left Arm , his Dyet was Panado , and Barley-water , mixed with the juice of Pomegranates .

On the thirtieth , for the bitterness of his Mouth ( of which almost all who are wounded on the Head do complain ) he used this Syrrup .

Take of Loosening Syrup of Roses two ounces . Lenitive Electuary one ounce . Citron seeds half a dram . The decoction of the Flowers and Fruits as much as is convenient . Mix them . and make them into a Liquid Syrup .

Whereby he voyded five times bilious and Froathy matter . Upon the first of May , the Patient slept quietly , and the Dura Mater about the S●gi●●●l suture was slimy , and almost putrified , and therefore I appli d a Li●iment , of Syrup of red Roses , spirit of Wine , and Turpenti●e upon a piece of Silk , and dressed the Wound with the other remedies .

On the second , his thirst being great , he took the following Syrup :

Take of Syrrup of the juice of Citrons one ounce . Syrrup of the juice of Sorrel , Syrrup of Pomegranates with Vinegar of each half an ounce . Black Cherry-water , Strawbery-water , Borrage-water of each two ounces . Mix them together for a draught .

On the third , holding his breath , and stopping his Nose a great quan●i●y of yellow matter flowed out of the Wound ; afterwards the W●und being cleansed , a black piece of bone came in sight near to th● Lambdoial Suture .

On the fourth , his thirst was less , and I extracted the black piece of ●●ne with the Pincers .

On the fifth , I washed the Wound with the Decoctum Divinum , by reason of the stinkingness of the bone .

On the sixth , the ill smell abated , and for the better drying the Wound , I applyed this Digestive .

Take of Turpentine washed in Scordium-water two drams . Pouder of Myrrh , Round Birth-wort , Orris , of each a scruple . Hony of Roses strained as much as sufficeth to make it into the form of a Liniment .

On the seventh , the Patient was well , but his belly not being loose enough , he made use of this Glyster .

Take of The common decoction eight ounces . Electuary of Diacatholicon one ounce . Oyl of Violets . Oyl of Camomile , of each an ounce and half . Mix them together for a Glyster .

From which he had three evacuations . On the eight , the Patient slept quietly . On the ninth , the Dura Mater was very red , out of , which while I wiped it with Cotton , there flowed some drops of blood ; From the tenth to the fourteenth , he went on well . On the fifteenth , being bound , he swallowed Bolus's of Lenitive Electuary one ounce , made up with Sugar , with which he had four stools . On the twentieth , red flesh grew upon the Dura Mater , and between the two Tables of the Skull . On the twenty fourth , all things went well , and for the greater strengthening of his Head I added Red Wine , and Wheat-Bran to the former Cataplasme . On the thirtieth of May , a great scale of the Skull cast off , and I applied to the Wound , now filled with solid flesh , the Ceratum Divinum to cicatrize it . On the tenth of June , the skin covered the Wound . On the eleventh , the Patient went abroad . On the twentieth , being restored to his former health , he laudably exercised his Military imployment .

OBSERVATION VI . Of another Wound on the Head , with a very great going in of the Skull .

IN the Year 1636. On the eighteenth of November , at nine in the morning . A Country-man of Idelhause , of a hot and moist temperament about the thirty second year of his Age : for I know not what contest had before a Judge concerning the limits of a Field , was struck by a Smith with a Mattock , upon the right-side of the fore-part of his Head , so that he not only fell backward to the ground , and the blood gushed out of his Nose , but he lay there as a de●d Man , without sense or motion ; at ten of the Clock the Wife of him that was wounded , fetched a Chyrurgion of Ulme , who bound up the Wound with Galen's Astringent Pouder , and the white of an Egg ; when indeed considering the cause , which was so violent , he should have dilated it cross-wise . On the nineteenth , at four in the Afternoon , he was carryed to Ulme in a Litter , and about seven I found him , with a great pain of his Head , a Feaver , faintings , and a swelling of the right eye ; whereupon I prescribed him a strengthning Water , composed as followeth .

Take of Black Cherry-water , Sorrel-water , Borage-water , of each an ounce and half . The Anhalt Cephalick Spirit , two scruples . Pearl prepared , Red Coral prepared , The Stone of Chrysol prepared . Tablets of Pearl half an ounce . Mix them

Of which he took a spoonful now and then , for thirst and sickness in his Stomach : in the evening he took half of this Julep .

Take of The Syrup of the juice of Violets an ounce and half . Tincture of Roses with the Julep four ounces . Endive water two ounces . Pomegranate-water four ounces . Mix it for two doses .

On the twentieth day , two hours before noon , he complained of a very great pain of the Head ; the bandage being taken off , and the Wound uncovered , and looked into , I diligently searched out the breadth and depth of the Wound , with the round end of the Probe , and found the Skull to be very much depressed .

Whereupon the same day I opened the Wound in the Figure of the Letter X or a Cross with Celsus his Spatha , or Incision Knife sharp on both sides . Tab . XI . Fig. I. and the Membrane being separated from the Skull with the Nails ; for the stopping of the blood , and keeping the Wound open , I applyed a stupe of Hemp-hards moistned in the white of an Egg , beaten up , and sprinkled with the Astringent Pouder ; and for hindring the inflammation , I anointed the whole Head and Neck with Oyl of Roses , and a Bolster of Linnen four times doubled I bound to the Wound with the Rowler , Tab . XXXI . Fig. X. at Night he drank the cooling Syrup , and made use of Barly-water for his Drink , and Panado for his Supper .

On the 21. at ten of the Clock before noon , the bloud being stoped , I took off the Rowler , and removed what was to be removed ; then looked into the Wound , and found not only a depeession in the bone of the Synciput , at the distance of a thums breadth from the Coronal Suture , and two thums breadth from the Sagittal ; but also two branches of a Fissure made by the force of the blow . The former of which , reached from the depression to the right eye , passing through the Coronal Suture ; and the latter reached to the left ear . Things being so confused , I applyed the Pouder of round Birthwort and Orris to the bone ; to the lips , a digestive Oyntment , and over it Diapalma : and for the great Tumour of the right eye , I ordered the following Cataplasm .

Take of , Barly-meal , Bean-meal , of each six ounces . The Crums of Houshold-bread , two ounces and a half . Pouder of Roses , Pouder of Betony , of each six drams . Oyl of Roses , three ounces . Oxymel simple , as much as sufficeth . Mix them .

Two hours before dinner , he took Linitive Bolus's , made of an ounce of Linitive Electuary and white Sugar . On the 23. the inflammation being greater ; as also the pain , giddiness , and swelling of the right eye : I was forced to perforate the Skull with the Trepan , n'er to the Coronal and Sagittal Sutures ; and being perforated , I made the rough parts of the hole smooth with the Lenticular Instrument ; and putting under the Levatorie , I reduced the depressed bone , Tab . XXXII . Fig. II . I put a piece of Silk dipped in the Oyl of Roses upon the Dura Mater , tied fast to a string ; the rest of the Wound I bound up with the Pouder and dry Lint , a Digestive , Diapalma , and the Cataplasm ; not neglecting to anoint the neck , and the parts neer the wound . In the evening the Patient was better than in the morning , before the Skull was perforated ; and he made use of his cooling Syrup . On the 24. at ten in the morning , the Patient being better than he had been the foregoing days : for cooling him , and for revulsion , the Median Vein of the right Arm was opened , and four ounces of bloud taken away . On the 25. the pain being appeased , he took a Potion , to relieve him from being bound , which is very hurtful in Wounds of the head .

Take of , Lenitive Electuary , one ounce . Loosening Syrup of Roses , two ounces . Black-cherry Water , as much as sufficeth . Mix them , and make a Potion almost free from all heat .

The Wound , and right Eye pleased me well : the Patient took his cooling Syrup at night . On the 26. he said that he had slept very quietly the whole night , and found no pain of his head or right Eye . On the 27. he rested quietly again , and found no trouble from the Wound : some drops of a serous matter flowed out at the thicker Membrane of the Brain : for the better drying it up , I applyed a Liniment of Syrup of Roses , Turpentine , and Spirit of Wine upon a peice of Silk , with the Cataplasm ; instead of Oxymel Simplex , I mingled rough Red-wine , the better to strengthen the head . On the 28. the Patient was as well as the day before ; but I perceived the Membrane of the Brain to be black on the outside , by reason of the Contusion . On the 29. being bound , he took his Laxative Potion , which gave him three stools : the Liniment had caused the Membrane to tend to Suppuration , and after the wiping away of the black spot with Cotton , a small effusion of bloud it appeared red . On the 30. he seemed to be very well ; but complained of a beating pain about the forehead , and temporal Muscle . On the 2. of December the pain ceased of it self , and the Patient thought himself strong enough to walk without a staff . The purulent matter which flowed from the Dura Mater , through the hole made with the Trepan , was white , and well concocted . Instead of the Liniment and Digestive , I applyed to the fleshy Membrane and lips of the Wound , Oyntment of Betony mixed with the yellow Cerate .

Take of , The Juice of Betony , three ounces . Burnet , Woodbinde , Great Comfry , of each half an ounce . Malmsy , five ounces .

Boyl away the Wine , and then add , Turpentine , two ounces . Sheeps Suet , Oyl of Roses , of each one ounce . Pouder of Mastick , Myrrhe , Mummie , of each a dram and a half . Virid . Aeris , or Verdigreece , two drams . Wax , as much as sufficeth . Mix them together , and make the Betony Oyntment .

On the third and fourth , the Patient continued well ; and I drew-out with the teeth of the Nippers , a little piece of the Dura Mater , which was separated , and applyed the same remedies as in the foregoing days . On the 5. the Dura Mater was covered over with red flesh , which Celsus accounteth a very good sign , who in his eighth book writeth , That when all goeth well , the flesh beginneth to grow from the Membrane it self . On the 7. day , for the farther drying it , I applyed the Ceratum Divinum to the Dura Mater . On the 8. 9 , and 10. the Patient continued well . On the 11. he slept not at all . On the 12. he complained of pain of his head . On the 13. he slept a little . On the 16. with my Brode somewhat bended , I came between the first and second Table of the Skull ; and separating a part of the bone with the Lenticular Instrument , I drew it out with the Pincers : I took another bone skaled off from the forehead with the toothed Pincers . The 19 , 20 , 21 , and 22. he continued well . On the 23. he complained of a pain on his forehead , with a heaviness , for which he took the former Potion , which wrought five times : But drinking cold water plentifully after dinner , he complained of a pain in his stomach . On Christmass day eating much flesh meat , there came a new flood of humours upon the Wound ; he was feaverish all over , and the flesh appeared black in the Wound : therefore forbidding him flesh-meat , I allowed him only Panado . I purg'd him gently , kept him to a slender diet , and took off the black excrescence of flesh with Burnt-Alum ; and in the space of five days he was better . In the Month of January I Cicatrized the Wound with the Ceratum Divinum , and restored him to his former health with the forementionad Remedies .

The Ceratum Divinum is this .

Take of , Gumme Ammoniacum , Galbanum , Opopanax , Bdellium , The Pouder of Myrrhe , Frankincense , Mastick , Long Birthwort , Verdigreece , Calmey , prepared , Lapis Haematites , of each an ounce . Litharge of Gold , Common Oyl , of each one pound . Yellow Wax , Turpentine , of each six ounces . Mix them , and make them into a Cerate .

This Conglutinates Ulcers very speedily , and hindreth the growing of any bad flesh .

OBSERVATION VII . Of a Contusion of the head , causing Death an hundred days after , by omitting the use of the Trepan .

A Country fellow , very strong , and who had never been sick in his life ; about forty years of age fighting with others at Fifty-cuffs , sustained a great number of violent blows upon his bare head : this was done on the 11th of November , 1630. he did not much regard this ; and for some days went about his ordinary imployment , although he felt no small pain . Upon the 18th day he began to be weaker , and to feel his pains more violent ; the motion of lower Jaw was so difficult that he could scarce open his mou●h , or put in meat ; and at length , without pressing the Jaw down with his hand he could not at all . A Country Barber being sent for , began to cure him with I cannot tell what Remedies ; but all things growing worse , an experienced Chyrurgion was called after four days : viz. upon the 22d of the same month , from one of the Neighbouring Towns . He applyed divers outward discussing Remedies , and did somewhat mitigate , but not remove the pains : which did more and more settle themselves all over the head , and back-part of the neck , and grew so violent , that he could neither move his head , nor lift up his eyes ; besides these , giddiness , want of sleep , sometimes ●aving , and the weakness of all parts did so afflict him , that he could sca●ce stand upon his feet , much less walk , and sometimes not so much as lift up his hands to his head .

At last a Physitian was sent for upon the 7th day of December ; who seeing him taken out of his bed , placed in a chair , and looking so grimly , was not a little surprised , and feared that Convulsions , or other more dangerous Symptoms might presently happen . In the farther search and examination for the discovery of the Signs , and Symptoms of his Disease , he felt about his head , that he might know in what part it most pained him ; and found a softness on the upper , and backward part of his head , which gave way to his fingers , and an evident pit remained in his skin ; and therefore judged that there was an Effusion , and gathering together of congealed putrid bloud under the Musculous coat , which ought to be evacuated by laying open the skin , least the bone of the Skull migh● be corrupted thereby , the Pericranium inflamed , the forementioned Symptoms increased , and Death it self succeed .

This was performed by a Chyrurgion then present , and the skin cut cross-wise with a Rasor , the Incision being made down to the Pericranium , black bloud congealed , and some water , flowed out . By this opening of the skin , the Symptoms were in some measure mitigated , and much of the pains of the head remitted . Concerning this , others , especially ( those who had done him this injury ) began to speak ill , and as if the Incision had not been necessary , and that it had done the head much hurt : at which , the Physitian somewhat moved , who knew him to be in no small danger , by the severity of the Symptoms , suspected also that there might be a Fissure of the Skull made by the blows , ( for he could not be well assured whither they had not made use of Weapons , and Clubs , as well as their Fists . ) or that the blood collecled together under the skin , might infect the Skull ; or that an inflamation rising in the outward parts neer the Sagittal Suture , a part of the corrupted matter might not penetrate i●ward through the Suture ; or whether some Veins in the Brain , or its Membranes were broken , from which the bloud issuing out ▪ and turned into corruption , might not stir up those cruel Symptoms ; and therefore he perswaded them to separate the Pericranium from the Skull , and also to Perforate the Skull if the Symptoms went not off : he desired also , the Conference with another Physitian , one who was much experienced in Chyrurgery ▪ who being sent for , and examining all the circumstances , did totally agree with him ; and advised , for the greater caution , that the P●ricranium should be separated , otherwise they could never promise to themselves any security . Which he confirmed both by reason and experience : but to this , a third Physitian and a Chyrurgion , who were brought in by t●e contrary party , would not consent , because no greater Sympt●ms at that time , nor any manifest sign of the Skull being hurt appeared , and from hence pronounced him free from all danger ; and perswaded them , that the Wound , which for some days had been kept open , should be healed up again , and the others , that they not seem to be willing to add unnecessary afflictions , consented to it . The Wound was therefore healed up : but from that time the Patient began to be troubled with great pains all over the head , but chiefly in the inward part , where the Incision was made , day and night giddiness and great weakness afflict him ; he passeth the nights without sleep , loaths his meat , suffereth a continual heat in his upper parts , while the lower shake and are cold . On the fifth of February , he felt a great Defluxion through the left part of his head , as it w●rm water poured down ; the h●mours slipping down by the throat , and rushing into the breast , where they caused so great a heaviness , that he th●ught presently to be choaked ; but after a few hours they were discussed agai● . A Physitian being present , thought it at last necessary tha● the Wound should be opened and dilated , but another would not consent t● it , but pronounc d it to be free from all dang●r . But the Patient grew every day weaker , and wasting away daily , die h .

Hence two questions arise . First , Whether the opening , and cutting of the Skin on the head , performed by the Chyrurgion , then present , were necessary . The second , Whether blows on the head be dangerous and mortal . To the first I answer , That not only the Incision in the Skin of the Head , made by the Chyrurgion , but also the Dissection of the Pericranium , and the Perforation of the Skull by a Trepan , was extreamly necessary ; by reason of the appearance of those urging Symptoms , which did indicate some hurt under the Skull . To the second , That Contusions , wi●h , or without a Fissure of the Skull , are never to be slighted : we see they are able to cause death after an hundred days ; especially when the Skull being broke , it is not opened with the Trepan , to purge that matter which descends by degrees through the Fissure to the Brain , and Dura Mater . These Questions were proposed to me by the most eminent D. D. Jacobus Eggoldus of Memmimgen , and the four following Observations will confirm my Answer : of which , the two former , as communicated to me , I here Insert .

OBSERVATION VIII . Of a Contusion of the Brain , in the ninth week Destructive on the sudden .

IN the year 1636. in the Month of December , I received an account from the faith●ul Relation of my Collegue , the most eminent D. Johannes Georgius Gockelius , Dr. of Physick , and Phylosophy , and Physitian in Ordinary to the Republick of Ulme , by the occasion of our most grievous German War , ( in which the floods of Generous bloud spilt on both s●●es , have been the occasion of the deserved Prayers , and Tears of the Devout .

A certain Souldier of the Emperour's , an Austrian , in those Excursions , and small Parties , in which they come to Hand-blows , was struck , by a Swedish Horse-man , two great blows , with a Battle-Axe , on the hinder part of his head ; in such sort , that being overcome , and thrown down to the ground , he was taken Prisoner by the contrary Party ; and the Sign being given for their retreat , he , with other of his Fellow-Souldiers , was brought in , half dead , unto the Hospital at Ulme .

All these being put into the hands of the Chyrurgions , and Physitians appointed by our Senate for the benefit of the sick ; among whom , D. D. Gockelius was one who was present , were so well looked after , and provided with necessary food , and with inward , and outward Remedies , that many of them returned home safe and well : but our Patient , of whom we are speaking , being bruised ( but without any bloody wound ) without any Fissure , or any considerable depression of the Skull ; about nine weeks being past over , when he could both go and speak very well ; felt no longer any pain from the Contusion ; and for recreating himself , was often pleased in walking about ; was thinking of returning into his own Country , and upon the first occcasion had determined to go away with the Bark : taking his rest in the night safe and and sound , to all mens thinking , he died in his sleep .

That the cause therefore of so unexspected an accident might not altogether lie hid ; my fore-mentioned Collegue humbly desired the Governours of the Hospital of Ulme , that they would grant him power and liberty of looking more accurately into this matter , and of searching into the foundation and beginning of it , by having the Skull opened by the hands of the Chyrurgions ; by considering the Membranes encompassing , and looking into the substance of the Brain it self .

The Governors willingly granting it ; he caused the Skin to be cut cross-wise , and the Pericranium to be separated from the Skull , according to the usual manner , and the Skull to be sawed round ; then proceeding in his Dissection , by diligent inspection and consideration of all parts , he could not find any Fissure in the Skull , no the least footstep of any Depression whatsoever ; but in the substance of the brain , just under the blow , a large Putrefaction , like rotten Apples , of a fingers breadth , and reaching almost down to the formost Ventricles of the Brain , and some corruption of the Pia Mater : all other parts untouched .

Communicating our opinions in this case , we could no ways doubt of the external cause , and violent percussion , which brought both sickness and death to this Souldier ; but this threw in some doubts and scruples worthy of our Consideration , and Admiration .

First , Why the force of the blow did not hurt the neerer parts , rather than those which were farther off , although many examples of the like nature have been experimentally found true ?

Secondly , How those temperate and clear Animal Spirits can be so highly disturbed , as to admit of , as it were in a moment , a total blasting , and destruction of the Brain ?

And Thirdly , Why that great Putrefaction in the Brain it self , and communicated , to the Pia Mater , should never cause any pain in the inward parts , or any way deprave the inward or outward senses ; but on a suddain , take away all sense , and life it self ?

Let Chyrurgions therefore learn by this Observation , not to make slight of any blows on the head , although they find the parts containing the brain not hurt . Never to promise , in such cases , an undoubted Cure ; nor to permit any irregular diet ; but with cautiousness , and prudent diffidence , so to treat their Patients , that they may be true Lights in our sacred Art.

OBSERVATION IX . Of a going in of the Skull with a pricking of the Dura Mater for want of Inst●uments , destroying the Patient .

THe forementioned D. D. Gockelius declared to me , that in the Year 1633. on the 23d of F●bruary , being sent for to Bibrack , where he was between hope and fear , by reason of the troubles of the War , that a Townsman was plund●r'd in his own house , by the enemy invading him in hope of booty ; and was struck upon the top of the head with the Hil● of a Sword , without a bl●ody Wound ; but so as the bone of the Skull was much depressed , like a deep hole , and did grate upon the Dura and Pia Mater ; and caused a Feaver , with some distraction of his mind . This Physitian in Salary being sent for , attempted to Mollifie the Feaver , and other Symptoms , by a Lenitive Potion , opening a Vein in the arm , and some alterations ● and moreover , contrived all manner of ways to lift up the Depression , and bring it to is natural state with those , with the ordinary Instruments which they had there , but all in vain ; for want of the Trepan : which , by reason of the insecurity of the ways , could not so soon be brought thither : so that this most innocent man the next morning departed this Life .

The defect of those necessary Instruments , delineated and described before , and the administration of the due Manual operation omitted , took away all hopes . We may also take notice , That if the first day he were wounded , the skin had been laid open in the form of a Cross , and , the blood being stopped , the Skull had been perforated with a Trepan the same day , that the bone which pricked the Membranes of the Brain might have been taken out , the Patient probably had not dyed .

OBSERVATION X. Of a Vertigo in a Sheep , proceeding from an abscess in the Brain .

IN the Year 1634. December the 24th . Being in the Shop of Nicholas Kite , he made mention of his Sheep , among which , one was troubled with a Vertigo , or Giddiness , the Germans call it Wirbling : this Disease one who dealt in Sheep affirmed to be incident to the fairest of the Flock ; and that hereby their whole Brain would be turned into Water , and then they would fall down dead on a sudden . The Chyrurgion therefore commanded that one of these Sheep which was weakned with this Giddiness , and turning round , should be killed , and sent me the Head to my House , that I might open it , and diligently search into the reason of this Symptome .

Whereupon opening first the Skull , and looking into both the Membranes , the substance of the Brain , and the first and second Ventric es , I found not one drop of any Water , and then searching into the ●hird and fourth Ventricles , there was also no sign of any Water , but the third was filled with a great quantity of Blood ; afterwards I lif●ed up the Organs of smelling , with the bony handle of my Anatomical Knife , and on the left-side between the Brain and the Pia mater , I found an abscess , like the Bladder of a Fish , full of very clear Water , and near to the left-eye the substance of the Brain black ; I wondred that the Brain it self being affected in this Disease , the Sheep should not labour under an Apoplexy , or a Palsy , rather than a Vertigo .

OBSERVATION XI . Of a Contusion of the Head , upon which hapned a Vertigo , and an Apoplexy .

IN the Year 1645. On the 25th . of January , I dissected the Head of one of my own Sheep , which dyed of the like Vertigo , and taking of the Skull , I examined the substance of the Brain with a●l its bruisings ; and presently on the left-side , as it were of the backward part of the Head , under the Dura Mater , I found a Bag of the thickness of a Fishes Blader , filled with Water , and little Worms , such as are bred in Cheese : for it began to putrifie at the bottom . This Coated Tumour being bigger than a Hens Egg , had so insinuated it self into the substance of the Brain , that it did somewhat press upon the third Ventricle . This Sheep , as the Shepheard reports , turned her self round about towards the night all that day she dyed . That which hapned to Sheep , may happen to Men , and women . I observed together with John Buraus Barber , and George Riedlin Chyrurgion , the same effect in the Brain of Maria Schmarhmaennen , who after a Contusion of the forepart of the Head which I cured , for a whole ye●r complained very much only of a giddiness . And one time siting at Supper , she was taken with a violent Apoplexy , and dyed suddenly . Her Parents desired me that I would open the Skull , either for the taking away , or else for confirming the suspition they had conceived , that one had poysoned her . The Skull being opened , and the Brain looked into , I found a Tumour on the left-side , both as to its coat , and matter contained in it , not unlike the former described , of the bigness of an ordinary Hens Egg , and partly compressing the third Ventricle . I gave this answer to those , who demanded what might be the cause of this Tumour contained in a coat , and perhaps no ill one , that the Brain being violently shaken in that part , had contracted a weakness . and the nourishment flowing toward it , was converted into that Matter , and not into the substance of the Brain ; from whence again it was evident , that blows on the Head were very much to be looked after ; there being scarce any of so perspicacious a Wit and Judgement whatsoever , that the disposition of the inward parts to corruption may not sometimes escape his knowledge .

OBSERVATION XII . Of a Wound of the Head , with an Incision of the Falx , Dura Mater , and Pia Mater .

IN the Year 1635. Michael Schuelder , a Souldier of Ulme , and belonging to the Praesident of Elching , was wounded with a Broad-Sword , by a Souldier of the Emperor's , on the top and back-part of his Head ; the wound on the back-part of the Head was simple , but that on the top of the Head , not only with a Depression and Fissure of the Skull ; but also with injury to the Dura Mater , and Falx , which receiveth the branches of the Carotidal Artery , and Jugular Vein . These two Wounds an unskilful Barber , dressed after his fashion , and cured according to the first intention ; but what becomes of it ? the miserable Patient from hence suffereth most fierce pains , accompanied with a Phrensy , a Convulsion of all parts ; and at length an Apoplexy . Things being thus , six weeks after he was hurt , I was sent for by his Wife yet living , and found him perfectly in an Apoplexy : the cause of which depended upon the obstruction of the Nerves , from a great quantity of Matter , which ought to have been purged through the Wound : and so great was the Mass of black and stinking Matter , that forcing a passage through the Nose , and Palat ; the Apoplexy went off , and gave me certain Indication of the hutt and Fissure of the inward parts : feeling with my Finger upon the solid parts of the top of the Head , I found a great hole , evidently demonstrating the depression of the Skull ; giving my Prognostick therefore , that the Patient was in a great deal of danger . I caused a Lenitive Glyster to be given ; and after that had done working , the Cephalick vein of the Arm to be opened . On the second day I opened the skin , and the Pericranium in the form of a Cross with an Incision Knife , Tab . XI . Fig. I. I applied astringent Medicines to the Wound dilated , which in performing operations of this nature , it is very necessary should be wide enough . The third day the blood being well stopped , I perforated the Skull five times , with the Trepan of Aquapesdens , about the circumference of the Depression , and through every hole , I let down a piece of Linnen dipped in Oyl of Roses , to the Dura Matter , I sprinkled the Bone with the Pouder known to you , and covered the lips of the Wound with a Digestive , Diapalma , and Linnen , thrice doubled , dipped in rough Wine hot , and a convenient Rowler ; on the fifth I cut down the space between the holes , with the turning Saw , Tab . XXXII . Fig. I. This part of the Skull depressed , being now freed from the intire and sound part : this being corrupted from within as farr as the middle b●tween the two Tables , I took out with the Pincers : and , first , by putting under a preserver of the Membrane , I broke of the edges , and rougher parts , with the Pincers , Tab . XXXII . Fig. III , IV , V. This done , with my Cross dividing Instrument , Tab . II . Fig. X. I depressed the Brain gently , and a great quantity of purulent Matter came out that way . To the Dura Mater ( whose Falx being cut transversly , the blood continually issued out ) and to the Pia Mater also , I applied a piece of Linnen answerable to the hole , dipped in the Oyntment of Heir . Fabritius , to the Bone the Pouder and dry Lint , to the lips the Digestive , and over it Diapalma , a Pultiss , and the Rowler . In the evening the Patient was better : and the purulent matter ceased from discharging it self down by the Nose and Palate . On the sixth I looked again upon the Membrane , and Falx , and found that the blood issued out , which by reason of the deep Scituation of the Vessels could not be stopped : for Vessels cut in sunder do require the immediate contract of Astrigent and consolidating Medicines , and some compression ; both of which were inpracticable in this part , for fear of a new Haimorrhagy , and Apoplexy ; whereupon I declared to the Wife , and Kindred of the Patient , that the Wound without danger of his life could not be healed : for the Wound being totally cicatrized , and the matter which used to issue out , being turned into Quitter , it would again excite the same Symptoms , which would be the cause of his death . Giving this praediction , I dressed the Bone , and the lips of the Wound , as I wont , and left open the Wound at the meeting of the Coronal , and Sagittal Sutures , like an Issue in the Head , through which the matter gently came forth ; and the Patient went about his business for half a year together ; but being overtaken with Wine , he neglected the Ulcer , & suffered it in the space of 24 hours to be healed up : so that not one drop of the matter could come out , and the forementioned Symptoms , not immediately happening , both the Patient and his Wife , did not doubt but he was in most secure health . Till after three Months taken with those Symptoms again , he dyed suddenly . After his death if I had opened his Skull with a Saw , without doubt I should have found matter under the Skull : from this observation it doth plainly appear , that the perforation of the Skull may be performed often with great benefit , not only in the beginning , but also a long time after the hurt . It will be also evident by the following Obs●rvation , that bad Symptomes , sometimes appear immediately , and sometimes after a hundred days ; which if the Skull had been opened in the beginning without all doubt never had hapened to the Patient .

OBSERVATION XIII . Of a Wound on the Head cured by the Trepan after twenty eight weeks .

IN the Year 1625. In the Month of December , a Kinsman of D. N. Tishlers General of the Horse , received a Wound on m● H●ad , at Milan ; which a Chyrurgion , by reason there was no appearance of any great Symptoms , healed up in the space of fourteen days . In the Year 1630. In the Month of March he came t● Ulme , complaining of a great pain all over his Head , of a gildiness , dimness in his Eyes , and a Palsy of the right Arm. Upon suspition therefore of a Fissure of the Skull , I cut the skin , and Pericranium in the shape of a Triangle , above ●wenty eight weeks after he was first hurt : and on the twenty first of March , hi the House of Nicholas Reutte ; I perforated the Skull twice , upon the side of a very narrow Fissure , and cut down the space between the holes with my turning Saw : the matter being discharged which descended through the Fissure under the Skull , those Symptoms ceased , and the Patient was thus in the space of one Month most happily restored to his former health .

OBSERVATION XIV . Of a Fissure , and Depression of the inward Table of the Skull ; the outward being sound .

IN the year 1626. in the Month of July , I gave in an account in writing to the Sheriffs of Ulme , how that going to visit Bartholomew Sekaffer , a Souldier of the Emperour's , who had been Wounded on the head by the Boors of Altenstadt , and finding him dead , I diligently enquired into the cause of his death , which happened upon the 20th day , in the presence of many who were there ; and found it to be a Wound on the right side , about the Lambdoidal Suture , with a hurt , and going in of the second Table of the Skull , the first being sound , which had been healed up by Barbers : for seeing that in this hurt of the Skull , the matter which slipped down to the Brain , by a hidden chink , without the help of the operation could not be discharged , and much less the Skull , which contin●ally depressed the Brain , could be raised up again , without fit In●●ruments an Abscess bred under the Skull ; which , first bringing him int● a Fever , and Phrensie , broke into the right Ventricle of the Brain , and filled it , and with sudden Convulsions killed him : whose life , in the beginning of the hurt , by the Perforation , and Elevation of the Skull , ( both which operations are performed daily in Italy , witho●● any danger ) might , without all doubt , have been preserved .

A●d because that in our Territory , not this man alone , but many others formerly have perished , either out of the neglect or ignorance of ●his manner ●f operation , the Senate of Ulme hath given order ; That the Bar●ers , ●s much as possible , should be informed how to beha●●e th●mselves in such dangerous cases , that Patients , for want of this help , may not be compelled to lose their Lives .

OBSERVATION XV . Of a Wound of the Head , Mortal upon drinking of Wine after the opening of the Skull .

IN the Year 1634. on the 19th of May , Henry Hebich was wounded on the Head , by Coopers , about the Coronal Suture , and Temporal Muscle ; which was dressed at the first by Nicholas Reutte , who called me the third day ; out of whose Wound I presently drew a piece of the Skull , being separated on all sides , with the Pincers . On the 4th day , by reason of the great Inflammation of the Wound , I applyed convenient Remedies till the 9th , at what time t● Patient began to complain of a heavy , and pricking pain of his Head , a most certain sign that there was purulent matter under the Skull , and that the Membranes of the Brain were pricked by the bone . On the 10th the Parents of the sick man , sent for the most excellent , and most eminent D. Gregory Horstius to consult with me , who advised to open the Skull with the Trepan , whereby the matter under the Skull might get out , and the Shiver of the Bone might be drawn away . On the first of June , I perforated the Skull in the presence of D. D. Horstius , and found the Membranes of the Brain inflamed . On the 3d day , after the opening of it , the matter not being sufficiently evacuated , by reason of the great Inflammation of the Dura Mater ; by the consent , and in the presence of D. D. Gregory Horstius , and Johannes Regulus Vellinger , I opened another hole with the Trepan , and cut down the space between both the holes with my turning Saw . After the second Perforation , I took out a little bone separated from the inward Table of the Skull , which did continually prick the Brain , and its Membranes : which being taken out , the pricking pain ceased for some days ; till by drinking of a great quantity of Wine , an Abscess was generated in the substance of the Brain , which caused a Fever , with loss of his Reason , and then Convulsions all over , and Death ; for on the 20th of June he departed this Life .

OBSERVATION XVI . Of a Contusion of the head , causing Convulsions at the New of the Moon , three Months together .

MArcus Beck , the Son of Daniel Beck , in Year 1629. upon the 15th of November , fell upon his head , and presently shewed the swelling to his Parents , on the right side of the fore part of his head neer to the Coronal and Sagittal Sutures , which caused pains of the head , and general Convulsions : being sent for , I gave inward Remedies , whereby the Convulsions ceased , and almost dissolved the Tumour by applying to it the Skin of a Lamb newly killed : yet notwithstanding , about the New Moon , the Boy complained of a pain of the head , which was accompanied with the former Convulsions . After two Months the swelling of the head was every day bigger , and the same Symptoms infested the Boy about the New Moon , in the 3d , and 4th Months : being at length sent for by the Parents , I looked upon the Tumour , and declared to the standers by , that these Symptoms in my judgment were caused by a sharp matter which did draw and corrode the Pericranium ; neither was I deceived in my opinion , for making an Incision with my Knife , Tab . II . Fig. II . in the form of a Cross , Tab . XXX . Fig. X. down to the Skull ; and evacuating the matter , I layed open the Wound . The next day , the flux of bloud being stopped , I found the Skull rough , and black . On the 3d , scraping the Skull first , half way through , I applyed the Cephalick Pouder and drie Lint , till it was covered with very good flesh ; but the wound I dressed , first with Digestives , then Cleansers , next Incarnatives , and lastly Cicatrizers . By this means , the Boy being about seven years of age , was restored to his former health in twenty days after the Incision , and an hundred and twenty after he received the hurt , being yet alive , to shew the marks of the Incision .

OBSERVATION XVII . Of a Wound on the head , with a Hewing , or Chopping away of the outward Table of the Skull .

IN the Year 1631. on the 4th of November , a Noble Senator of Ulme , was Wounded on the top , and back part of his head , with the loss of the Skin , and plaining away of the Cranium , to the bigness of a Dollar , or Five-shilling piece of Silver . Nicholas Reutte filled up the Wound presently with Astringents , and I caused six ounces of bloud to be taken from the Cephalick Vein , after the working of a Laxative Glyster . On the 5th , the Wound being unbound , and the bone scraped away to the middle , I sprinkled it with the Cephalick Pouder and put on Lint ; I applyed a Digestive to the lips of the Wound , and over that Diapalma , and a Pultise to hinder any Inflammation . On the 3d day , by reason of a bitterness in his mouth , he took a Potion purging the Gall , and voided often that bilious matter , which made his Mouth , Throat and Stomach bitter . On the 5th he was better . On the 8th , py reason of being bound , he complained much of a pain of the head , about the Wound ; for which , I admitted of a Laxative Glyster , which coming away , his pain also ceased . On the 9th , the Wound digested white and equal quitter ; upon which , I mixed some things cleansing with my Digestive . On the 12th , flesh began to grow upon the Skull ; whereupon I applyed an Incarnative Medicine , made of the Ceratum Divinum , and Oyntment of Betony , till the Skull , by the benefit of this and the Cephalick Pouder , was covered over with solid flesh ; and with these ordinary Remedies ( yet which seldome fail a Chyrurgion , if after , generally he prescribeth a good Rule of living , and be diligent that the Patient content himself with a slender Diet , and abstain from Wine , and Venery , and keep himself loose ) I cured this Noble Person , yet living , and many others , without the Perforation of the Skull .

OBSERVATION XVIII . Of a Thrust into the Skull , penetrating both the Tables .

IN the Year 1631. on the 29th of August , a Souldier of the Emperours , Wounded Jacob Wirth of Aiche , on the top of the Head with a sharp Instrument ; which , a Barber of that place bound up , and healed in a weeks time . On the 18th day after it was healed , the Patient complained of a great swelling , and pain on the head , in the same place . On the 9th , he was brought to Ulme . On the 10th , I opened the Skin , and Pericranium , with the Incision-knife , Tab . II . Fig. I. in the shape of the Letter X. and made the Skull bare . On the 11th I discovered where the Thrust had been made into the Skull ; which , I tryed to take away with the Piercer , Tab . XXXIII . Fig. I. but finding the Thrust to reach the lower Table , and suspecting that it penetrated that also ; on the 12th , letting alone the Piercer , I perforated the Skull with the Trepan , and made way for the matter descended under the Membrane . The matter being evacuated , I put a piece of Linnen dipped in Oyl of Roses upon the Membrane ; to the bone , the Cephalick Pouder , and to the lips , a Digestive , and over that , Diapalma , the ordinary Cataplasm , and the Band called Cancer . On the 13th the pain remitted . On the 14th the Inflammation declined . On the the 30th the Skull throwed off a Skale . And on the 40th the Wound was Cicatrized .

OBSERVATION XIX . Of a Wound on the Head , with two Fungus's , Mortal .

COnrade Schieffelen of Ulme , one of the Emperours Souldiers , about twenty seven years of age , of a hot and drie Temperament , in a most cruel and bloudy Conflict , neer ro Wittinweir , on the 9th of August , 1638. was wounded with a broad Sword on the hinder part of his head , with dammage to the bone . An Empirick dressed this Wound at first as if it had been a single one . On the 24th of December the Patient come to Ulme , and fell again into the hand of some unskilful Barber ; who bound up the Wound as the former till the 31st of January , 1639. at which time the Patient was received into the Hospital , where this Barber searched the Wound , partly healed up , and partly covered with an excrescence of flesh , with a slender Probe , which he thrust the third part of its length streight on , not only through the Fissure of the Skull , and both the Membranes ; but also ( alas how erroniously ) into the substance of the Brain it self : out of which a quantity of matter flowed . On the 1 , and 2d . of February his body being prepared and purged , the Patient complained of the heaviness of his eyes . On the 3d this imprudent Barber , by the order of the Patient , called me to consult with my most eminent Collegue , D. D. Moyses Heldius , and that most experienced Chyrurgion , George Reidlin ; looking upon the Wound , and considering the Circumstances , we suspected some hidden mischief from the first putting in of the Probe so deep : whereupon I presently cut the Skin in the shape of a Triangle , with an Incision-Knife , Tab . XXX . Fig. XI . and bound up the Dilated Wound with Astringents . On the 4th day , the bloud being stopped , looking into the Wound , we found a great broad Fissure of the Skull with two Fungi's . Things being thus , I applyed to the Skull , the Cephalick Pouder and drie Lint ; to the lips , a Digestive , and over that Diapalma , and the Cataplasm of Hippocrates , hindering Inflammation , and a Rouler divided into four parts , Tab . XXXI . Fig. IX , X. On the 6th , the Patient complained of Giddiness of the head , and pain of the right eye . On the 7th he was somewhat better , and took Bolus's made out of six drams of Lenitive Electuary , two drams of the Electuary of the juice of Roses , and Sugar ; whereby he voided bilious matter four times . On the 8th , the Patient complained again of pain of the right eye , and I applyed to him the Fungus , the Aegyptiacum Oyntment of Hildanus , mixed with Pouder of burnt Alum , which notwithstanding , did not eat down the Fungi ; but so cleared them , that I could put my blunt Probe , Tab . VIII . Fig. VI . between them : and seeing that the Fissure was so long and broad , and that so many Errours had been committed by the Barber , I would not come to the Trepan , or Perforation of the Skull , that I might not put an Infamy upon that eminent Operation , which hath been helpful to many , for by their Relation it was evident , that not only both the Membranes of the Brain were hurt , but the Brain it self also suffered . On the 9th day , for pain of the head , the Median Vein of the right Arm was opened , and four ounces of bloud taken away ; in the evening he was better . On the 14th he slept little by reason the Stove was cold , for Wounds on the head require a moderate heat , and coldness of the air is an enemy to them . On the 15th , the lips of the Wound newly made , appeared red without pain , but the Fungi larger : for the drying up the Fungi , I used the Decoctum Divinum .

Take of Malmsey , a Pint and a half . Red Roses , a pugil and a half . Betony , Woodbind , Burnet , Centaury , Arabian Stechas , of each two pugils . The Roots of long Birthwort , Orris , The Bark of Frankincense-tree , of each two drams .

Boyl all these to the Consumption of the third part , only give the Roses but one boyl , and strain them : add to what is strained out , two ounces of Hony of Roses well skummed .

But this produced no effect here , although in many others it hath been a present Remedy : whereupon I cut off a piece of the upper part of the greater Fungus with my Rasour . On the 16th , the Patient seemed well , and complained of his slender Diet . On the 17th he complaintd of a numness all over his right side , and both the Fungus's appeared bigger than the days before . On the 18th the Patient not being content with what Meals I prescribed , his Sister made ready for him a mixed dish of Apples , and other things , which he vomited up again as soon as they were down , and was very ill after it . On the 19th , a great quantity of purulent matter flowed out between the Fungi , and the Skull inclined towards yellowness , the lips of the Wound falling away . On the 20th , all the right side was taken with a Palsie , the Patient slept all night and complained of nothing . On the 21st , both the Fungi appeared white , and the Skull black and blew . On the 22d , the Patient lost his Speech , began to be Apoplectical , and his right arm was moved about by Convulsive motions . The 23d at nine of the Clock in the forenoon the Patient died . On the 24th I looked upon the Wound , and the Fungi were fallen so flat , that I coold easily put my Ring-finger into the Fissure . I opened the Skull with a Saw ; the inward Superficies of the Bone was so corrupted , that the whole bone of the back part of the Head as far as the Lambdoidal Suture was thinner than the Os Petrosum . It is also to be noted , that when there is no depression of the Skull , which may prick the coverings of the Brain , and thereby cause great pain , it is not necessary to cause the Patient to crack Nuts , or the stones of any Fruit , to find out whether there be any Fractare of the S●ull : for this Person cracked Nuts , Philberds , Wallnuts , Cherry-stones , Peach stones ; went about his military employment , and complained not of pain of his head . Afterwards putting my Probe between the Fungus's , I found a great Abscess contained in its proper Coat , which lay hid on the left side of the Brain : then taking away the Membranes of the Brain , I shewed the Brain it self with the Abscess in its bag ; I lifted up the Process of the Dura Mater , which is called the Falx , that the space between the right at left side of the Brain , with its Vessels , and turning winding figure might come in sight . The Brain being cut cross , and a great part of it being taken away without hurting the left Ventricle , the Abscess appeared ; out of which there flowed stinking purulent matter in great quantity : the Abscess being cleansed with Cotton , there appeared about it a thick Membrane which contained this matter : for in the parts about it there appeared no sign of Inflammation or Corruption . Afterwards I shewed the left Ventricle somewhat pressed down , and the right not depressed , but full of clear water : on the left side the Plexus Choroides appeared pale , but on the right side very red .

From hence we have the cause of the Palsie on the right side , of the Giddiness , of the pain of the right Eye , and of the Convulsion the day before : and therefore where the Skull is hurt or fractured , and a Fungous flesh growing underneath , appeareth above the Skull and Flesh ; it is a certain sign that the substance of the Brain , or at least Membranes of the Brain are bruised and turn .

OBSERVATION X. Of a Wound on the Eye , made by thrusting in the end of a Spindle .

IN the Year 1644. on the 21st of March , Rosina Pfeifferin , a Souldiers Daughter , of four years of age , fell upon the point of a Spindle , which hurt not only the Eye-lid , but being thrust into the Orbite , was broken , and left there , so that she could not see in the least . A Barber bound up this , and healed it as a simple Wound ● whereupon the Eye became greater every day , and drew to the inward Membrane of the Eye-lid . Things being thus , I drew the Eye-lid back a little with my Fingers , and separated the Eye-lid from the Eye with the Probe , Tab . XXXIII . Fig II . which being done , I applyed a Cataplasm warm to the Eye , made of the White of an Egg , an Apple , and this following Water .

Ta●e of Plantain Water , Rose Water , of each an ounce . Tuty prepared , one dram . The Stone Chrysol . prepared , one scruple . Crude Alum , half a scruple . Mix them .

And bound up the Eye with Galen's Bandage . On the 22d she took of Laxative Diacydonium , two drams and a half , which gave her five stools : I ordered a Blistering Plaster to be applyed to the Neck : from the use of these Medicines , the pain and swelling of the Inflammation remitted . On the 23d , and 24th she was better . On the 25th she complained of a great pain of her eye : upon which , I unbound the Eye , and with my fingers drawing the Eye-lid from the Eye , I pulled out the end of the Spindle with the Pincers : which being drawn out , all pain presantly ceased . And these are the Remedies with which I most happily restored the Souldiers Daughter to her former health .

OBSERVATION XXI . Of a Convulsion of the Eye from a Concussion of the Brain .

IN the Year 1639. on the fifth of September , at one of the Clock in the Afternoon , George Mercklen , a Souldier of Ulme , was so hurt on the right eye , with a blow of Radish , weighing a pound , thrown at him by his Fellow-Souldier ; that he presently fell to the ground , and lay for dead : in which ease he was brought into the Hospital , and these following things were administred . First , I lifted up his Eye-lids , and found both his Eyes Convulsed upwards ; and the 58th Aphorism of Hippocrates , in the 7th Section , coming into my mind ; which is , that Whosoever hath his Brain , upon any occasion , violently shaken , he must necessarily become Dumb : which also happened so in our Patient ; for revulsion sake I prescribed this following Glister .

Take of Loosening Hony of Roses , two ounces . Hony of Rosemary Flowers , one ounce . The Electuary of the Juice of Roses , half an ounce . Diacatholicon , six Drams . The Carminative Decoction , nine ounces . Mix them .

After the coming away of the Glister , the Median Vein of each Arm was opened , and eight ounces of bloud taken away : in the mean time he often made use of the comforting Water , Mixed with the Anhalt Cephalick Spirit . On the 6th of September , which was the 2d day of his being hurt , general ConvulsionS succeeded his Apoplexy , lasting all the night ; the Patients Pulse was equal ; the Glister made use of again , and the Cephalick Spirit diligently given .

The Glister coming away , he was better ; the Convulsions of his Eyes ceased , and they returned to their natural state : and what is more , he was able both to see and hear me , and the standers by , but could not speak ; without doubt by reason of the compression , and obstruction of the recurrent Nerves . On the 3d , he slept well all night , and complained of nothing but a compression of his Windpipe ; whereupon he took this following purging Potion .

Take of , Loosening Syrup of Roses , Choice Manna , of each six drams . Extract of Rubarb , one dram . Diacarthamum , half a dram . Speedwel , and Burnet Water , of each as much as sufficeth , to make it into a thin Syrup .

After the working of which , at times , he used this following Lambitive .

Take of Syrup of Violets , Oxymel Simple , of each an ounce . Flowers of Benzoin , half a scruple . Speedwel Water , two drams . Mix them .

On the 4th the Patient was better than the day before , and made signs that he would eat an Egg. On the 5th , he went on●y e●l , and by the same way desired to drink Hony and Water ; but his Speech not returning , he took this Potion , an hour before Dinner .

Take of Syrup of Roses , two ounces . Diacatholicon , six drams . Electuary of the Juice of Roses , three drams . The Decoction of the Flowers and Fruits , as much as is sufficient . Mix them .

Four hours after he took this , he spake very plain . On the 7th , he was excellently well ; and being restored to his former health without any outward application , he went abroad .

OBSERVATION XXII . Of a Wound and Fracture of the Nose .

IN the Year 1644. on the of 22d , April the most Worthy D. Wolfgang of Bartenheim , living in the City of Ulme , upon going to 〈…〉 Estate of his in the Countrey , fell from his Horse , the Horse ●●●●ing ●in upon the Nose with his heel in such manner , that he so broke and mangled it , that the lips of the Wound , by reason of the 〈◇〉 flux ●f bloud , and coldness of the part , could scarce be ●●●●g●●●gether . That night John Reidlin , a Chyrurgion , stopped ●●e bloud with Astringent Medicines . On the 23d , being called in , 〈◇〉 ●d the Nose depressed , and very much rent ; and therefore 〈◇〉 ●●mes with a broad Probe , sometimes with a round , I reduced 〈◇〉 ●●ition , and bones of the Nose , and put in a little Tube of 〈◇〉 ●●to the Nostrils , dipped in Diapalma , and the Liniment S●●●●e , that the Bridge , and Bones of the Nose , now reduced , might ●● ept in their place . I brought the lips of the Wound to touch one ●●other without sewing ; and kept them together with long pieces of Linnen , applyed cross-wise , dipped in this following .

The White of an Egg , well stirred up together . P●uder of Tuty prepared , a dram and a half . The Stone Chrys . prepared , half a scruple . Plantain water , half a dram . Mix them .

I bound up the part with Galen's Band for the Nose , by reason of a violent pain of his head , I applyed to his Fore-head and Temples , Hemp-hards , dipped in this liquid Medicine .

Take two Whites of Eggs. Half an ounce of Rose-Vinegar . Four ounces of Rose-water . Two ounces of Oyl of Roses . Mix them .

I Anointed his Neck with Astringent Oyls , and applyed to it l●ng pieces of Linnen dipped in rough Wine , to hinder the Humours flowing to the head , for his faintings , I prescribed this Cordial .

Take of Black-Cherry water , B●rnet Water , Strawberry Water , Rose Water , of each an ounce . Prepared Pearl , half a dram . Magistery of Red Coral , a scruple . Pouder of Chrysol . prepared , half a scruple . Pearl Tablets , half an ounce . Mix them , for a Cordial Water .

Took often of this at times . At nine of the Clock in the Forenoon , he made use of this cooling solutive Glister , to keep the humours from flowing to the head .

Take of The Leaves of Mallows , Burnet , Violets , Borage , Water-Lillies , Flowers of Camomile , of each half a handful . The Seeds of Flax , Melons , Fennel , Citrons , of each a dram . Boil them in a convenient quantity of Water , and to eight ounces of it strained out , add to it Hony of Roses solutive , four ounces . Oyl of Violets , two ounces . Oyle of Camomile , one ounce . Mix them , for a Glister .

With which , he voided twice , very thick and parched matter . At ten of the Clock , the Chyrurgion opened rhe Median Vein of the right Arm , and took away five ounces of bloud , which appeared full of Gall , and half corrupted . In the evening , to extinguish his intolerable thirst . he took a draught of the Mineral Waters of Uberkingen , mixed with Pomegranate Wine . I ordered him a slender Diet ; for his Meat , Boyled Barly or Panado , or sometimes Flesh-Broath , with the yolk of an Egg dissolved in it ; for his Drink , Decoction of burnt Hartshorne mixed with Pomegranate Wine . On the 24th of April , he was stronger , and the pain of his head was less than the day before . I dressed the Wound with Plaisters : and for want of his sleep , and heeat all over , I prescribed this following Decoction , to wash his Feet , and an Emulsion .

Take of The Leaves of Betony , Lettice , Violets , The Flowers of Lillies , Poppies , Roses , of each a handful . Mix them for a Decoction for the Feet .

Take of The Seeds of Melons , an ounce and a half . Of White Poppies , half an ounce , Water-Lilly Water , Strawberry Water , Black-Cherry Water , And Sorrel Water , of each four ounces . Make an Emulsion , to which add , Magistery of Red Coral , half a dram . Prepared Pearl , two Scruples . Syrup of Violets , two ounces . Mix them , for three Doses , taking one after Supper , and after washing his Feet .

On the 25th the Patient being asked , answered , that he had slept a li●tle , and ●●mplained of a great heat , and redness of his right Eye : which , after divers Glisters , this following Cataplasm presently helped .

Take Two sweet Apples , boyled in Milk , and strained . The White of an Egg shaked up . Pouder of Prepared Tuty , a dram and a half . A little Rose Water . Mix them into a Cataplasm , excellent against Rheums and Inflammation of the Eyes .

From the 26th to the 30th of April , I put up little Tubes into the Nose , covered over with Oyntment of Tuty , and hindred the excrescence of the flesh with this Pouder .

Take of Pouder of burned Alum , half a scruple . Prepared Tuty , two scruples . Mix them .

Outward I applyed the Ceratum Divinum , and with these Medicines I consolidated the Wound within and without the Nose : after the healing of the Wound , the Patient himself put in the Tubes , dipped only in Tuty Oyntment , and bound up with the part with Galen's Band , till the b●oken , and depressed Bones were united again with a Callous . With the same outward Remedies I cured Mr. Christopher Schlescher , and Melchior Friet ; who , besides a Wound on the Head and Nose , was so Wounded on the Breast , as to hurt the Stomach , and Midriff : of which , afterward , there is a particular Observation .

OBSERVATION XXXIII . Of a Swelling , with a Bag cut out of the upper Jaw .

IN the Year , 1631. Rosina Stenglerin , of Gieglingen , of a Melancholy Temperament , declared to me , that four years before she had a Caruncle , or little piece of flesh growing upon the left side of her mouth , about the Eye-teeth of the upper Jaw ; being of a red colour , hanging down , and of the bigness of a Nutmeg ; which in the seventh Month , a Barber of that place took out without any preparation of the Body , or Application to the Part . After a few Months it grew again ; being hard , red , full of Veins , and very painful ; and so continued till the fourth year , at which time it was of the bigness of a Goose Egg , and stuck not only to the Jaw , and to the Eye-teeth ; but to the Canini , or Doggs teeth ; and to the Roof of her Mouth ; so as it hindred her in Swallowing , and Speaking : and therefore she desired me presently to cut it out . This Tumour was somewhat exulcerated about the Eye-teeth ; not from its Malignity , but from the sharpness of the Vinegar with which she often wa●●ed her mouth when it smelled ill : And seeing that this Tumour could no otherwise be taken away , but by Manual Operation ; for the preparing of her body , on the 4th of October , I prescribed this :

Take of Mead with Tartar two ounces . Borage Water , four ounces . Saxon Cordial , two Drams . Mix them for one Dose .

This she made use of three days , twice in a day before Dinner , and after Supper . On the 8th , five hours before Dinner , she took these Pills .

Take of The Mass of the Golden Pills , Sine Quibus , Extract of Pill . Cochiae , of each a scruple . Magistery of black Mecoachan , seven grains . Make them into small Pills , with the Syrup of Betony : and let them be gilded .

These brought away at ten Stools , much serous , bilious , and burnt matter . On the 10th , that we might see what bloud she had , the Median Vein of the right Arm was opened , and four ounces taken away , which war serous and burnt : I then ordered a Bag with these Ingredients .

Take of The roots of Fennel , two drams , Polypody half an ounce , The toppes of Roman wormwood . one Pugil . The leaves of Betoney , Speedwell , Agrimony , of each half a pugil . The leaves of Borage , one pugil . Leaves of Senna without the stalks , an ounce and half . The roots of black Mechoacan , two drams . The best Rubarb , three drams . Hermodactyls , Turbith , of each a dram and a half . Seeds of Carthamum , the husk taken off , six drams . Anis Seeds , Fennel seeds , of each half a dram . Crem of Tartar , three drams . Ginger , Cinamon ▪ of each a scruple . These being cut and bruised , put them into a Bag and infuse them into a measure of Neckar Wine .

Of this , every other day , two hours before Dinner , she took four ounces . By using this Purging Wine , her frequent spitting abated ; which led us to the inspection of her bloud and purgation : in the mean time the Patient did not neglect to keep a good Diet ; and instead of Wine , drank a Decoction of Sarsaparilla . On the 20 , and 21st , in the Morning , Afternoon , and after Supper she took as much as would lie upon a knives point , of this following Mixture .

Take of Conserve of Borage , Conserve of Roses , of each an ounce . Preserved Citron Pill , two drams . Preserved Nutmeg , one dram . Magistery of red Coral , Pearl , of each a scruple . Lapis Haematitis , half a scruple . Syrup of the Juice of Citrons , as much as sufficeth . Mix them .

On the 23d , the Patient being better upon the use of this ; for the preserving her strength , she often took a spoonful or two , of this comfortable Water .

Take of Black Cherry Water , Borage Water , Rose Water , of each an ounce . The Anhalt Cephalick Spirit , one dram . Prepared Pearl , Magistery of Coral , Lapis Haematitis , Chrysolit prepared , of each a scruple . Pearl Tablets , half an ounce . Mix them , and put them into a glass .

And that nothing might be wanting , I prescribed this sweet smelling Water .

Take of Fuchsius his odoriferous Water , Rose Water , of each an ounce . Rose Vinegar , six drams . Mix them .

After this Preparation , her mouth being opened , and her head held fast by the standers by ; I separated the Tumour , before and behind , and beyond the Eye-teeth ; and cutting it off in the middle with the Pincers , Tab . XI . Fig. V. I drew it out . After the extraction of the Tumour , for the stopping of the bloud , the Patient often washed her mouth with this following Mixture .

Take of Plantain Water , Self-heal Water , Rose Water , of each three ounces . Rose Vinegar , an ounce . Mix these , and wash the Mouth with them .

But seeing that after often washing of the Mouth the bloud stopped not , I touched the Veins and Arteries with a red hot Iron Instrument , Tab . XIX . and applyed burnt Spunge , and the Astringent Pouder of Galen , and a piece of Linnen dipped in Whites of Eggs , and Red Wine , and pressed out . I bound up the Jaw on the out side , with Linnen four times doubled , and a Rowler with two heads . In the Evening the Patient was better , and the bloud being stopped , a great quantity of serous matter flowed out of the mouth . On the 24th , the Patient complained of a great pain of her head ; but the Medicines were left in her Mouth , for fear of a new Flux of bloud . On the 25th , the bloud being altogether stopped , I took out the burnt Spunge , and Linnen , and prescribed thir following Gargarism .

Take of Plantain Water , Self-heal Water , Speedwel Water , Rose Water , Cinquefoyl Water , of each three ounces , Hony of Roses strained , two ounces . Tincture of Roses , an ounce and a half . Mix them .

The mouth being washed , I applyed to the Ulcer , Lint dipped in the White of an Egg , and an Oyntment made up with the Astringent Pouder of Galen , and bound up the Jaw outwardly with a Boulster and Rowler .

In the Evening , by reason of her being bound , she admitted of this Laxative Glister .

Take of The Carminative Decoction , eight ounces . Hony of Roses solutive , two ounces and a half . Diacatholicon , an ounce . Oyl of Camomile , an ounce and a half . Oyl of sweet Almonds , an ounce . Mix them for a Glister . Which gave her six stools .

On the 26th , she said she slept very quietly all the night , without pain of her jaws . On the 27th , the Medicines being taken out which I applyed two days before , there appeared a little slimy part about the Palate , and Eye-teeth ; which I touched with a Probe , wound about with Wool , moistned with Spirit of Vitriol ; and ordered the Mouth to be washed with the ordinary Gargarism . On the 28th , the dressing being again taken out , all was very fair about the Palate , and Eye-teeth . On the 29th , the Eschar which the Fire made , being taken off , she washed her mouth often in a day with this .

Take of Hony of Roses strained , Tincture of Roses , of each an ounce and a half . Mix them ,

On the 30th , by reason of a pain of her head , she made use again of the Cepha●ick Pills ; upon which , all pain ceased . On the 31st , I Cicatrized the Ulcer , and the Patient began to speak without any Hesi●ation . On the first of Decembe● she was well , but for the farther drying up the part ▪ she drank a Decoction of Sarsa . On the 22d , I looked in , and found almost all parts of her mouth skinned ; and to prevent any relapse , I advised her to make use again of the purging Wine . On the 3d , the Ulcers being totally healed , the Patient went abroad very joyfully .

OBSERVATION XXIV . Of an Excrescence of Flesh on the Roof of the Mouth .

IN the fore part of the Roof of the Mouth , behind the fore-teeth , there is a remarkable cavity , through which , a Vein , and Artery , together with the skin of the Roof of the mouth , pass into the cavity of the Nose ; out of this hole for three months there had grown an excrescence of flesh , like a Fungus , in the mouth of a Noble Matron , Wife to D. Albert Sleichers ; out of which , a great quantity of bloud flowed , as often as she did but gently touch it with her tongue : at length this Fungus , or Excrescence of flesh grew to the bigness of a Walnut , so as it hindered her speech ; and she made use of a Barber , who applyed some Medicines but in vain . Being sent for , upon the 10th of March , in the Year 1641. I looked upon the part affected , and touching the bottom of the Excrescence with a Probe , the bloud presently flowed out : considering this , it was manifest that the original of this evil , came through the forementioned hole ; and therefore she sometimes made use of Aquapendens his Pills , which purged her head very well , and kept a good Dyet . I touched the Excrescence with rectified Spirit of Vitriol , Juice of Purslain , and Tincture of Roses mixed together , and diminished it ; and at length extracted the rest with an Instrument which I use to draw out a Polipus . So in the space of ten days , she was restored to health , to the admiration of all . For two years before this began , she was troubled with deafness , and pain of her ear ; but since the effusion of bloud , she heareth without pain , so , as I conjecture , the Disease was cured by Mutation , or Transposition .

OBSERVATION XXV . Of a callous Hollowness , and Corruption of the Palate bone .

THe most Noble and Reverend Dean , D. à Croneburg , in the Year 1626. complained of a Periodical pain of the teeth , and a troublesome hollowness in the roof of his mouth ; and by that eminent Physitian of Ausburg , Johannes Wolfgangus Beer , desired my advise and help : and this Disease taking its original from the suppression of the Haemorrhoides ; I advised that the most Reverend Patient w●uld be pleased , after a sufficient quantity of bloud taken out of the Basilica of the left Arm , to purge away the superfluous , ar● excrementious humours , with a purging Wine ; to open the Haemorrohides with Leeches , and to make an Issue in the left thigh : whereby those humours which ascended to the head , and part affected , encreasing the pain of the teeth , might be evacuated by revulsion , and discharged by the Issue ; for preventing the force of the pain , I proposed the operation in the Anthelix ; which the forementioned Physi●ian did most dexterously perform with my Iron Instrument , red hot : thi● being done , we took care to draw out the rotten tooth , whereby the injections of the Decoctum Divinum , used in the cure of rotten bones , might pass through the Cavity which the tooth left , and reach the fistulous hollowness in the roof of the mouth ; but seeing the Cavity about the tooth , and the callous hollowness of the Pa●ate did not close , nor was there hopes that the Patient should be cured wi●hout the help of fire ; I asked him if he would trie the efficacy of this only Remedy left , which we might do ●ith great hopes of recovery : and he admitting of it , I sent the Instrument described , Tab . I. Fig. IV . to Ausburg , to D. Beer , with which , being made red hot , he cut down the rottenness of the Palate , to the hollowness of the tooth , without the loss of the least drop of bloud ; and turning this Instrument round , he made a notable impression upon the bone . The Eschar being taken off , the rottenness of the Palate bone came in sight ; which being touched three or four times with the Iron Instruments red-hot , Tab . XIX . Fig. VIII , and IX . and nature being assisted by the taking of drying Medicines , made a separation , and the Ulcer being consolidated , the Patient recovered his former health , and kept open the Issue in his thigh for many years with great benefit .

OBSERVATION XXVI . Of another Tumour in the upper Jaw , contained in a Bagg .

IT is evident , both by seeing it , and the Determination of Physitians , that the griefs of which the most Noble , and Honorable Lady Maria Cordula Trappin complaineth of , are a Hemicranium or pain of one side of the Head , and a Tumour under the skin of the upper Jaw , containing a matter like to Fat or Hony ; the cause of these effects , is a pituitous matter , thin , and mixed with Gall ; and as the Gall hath its original from the heat of the Liver , and the obstruction of the Spleen , so it cometh partly from the head , partly from the Stomach , and Womb : and for the curing of this , it is necessary , that the pituitous and bilious humours be evacuated , the ●iver cooled , the Spleen free'd from obstructions , the Head dried , the Stomach & Womb strengthened , to hinder these humours from being generated , or gathering together , so as to flow to the head . Upon these Indications , I believe I shall satisfie in my Prognostick : and considering this indisposition of the Head , and also of the lower parts , the Cure must needs be difficult . Notwithstanding ( lest in the space of some few months the Disease may not grow worse , which certainly it will , unless fit Remedies upon the first occasion be made use of ) I will propose what ought to be done in this case ; and according to my judgment , the Cephalick Vein of the right Arm should be opened , and six or seven ounces of bloud let out . This being done , for revulsion , and derivation sake , the Lady should admit a Seton to be made between the first and second Vertebra of the Neck ; or instead of it , apply a blistering Plaster to the Neck every third month , and make an Issue four fingers above the left knee , Tab . XLIII . Let . I. and in the most convenient place of the right Arm , Tab . XLIII . Let . H. As to the hard Tumour , before the use of the Acid Mineral Waters , and the Decoction of Sarsa , I would not apply any thing . Let her Body be prepared and purged with these gentle Remedies . Let her make use of this purging Syrup .

Take of Syrup of Manna , one ounce . Extract of Rubarb , a dram . Diacarthamum , two scruples and a half . Crem . of Tartar , one scruple . Black-Cherry Water , as much as sufficeth . Oyl of Mace , two drops . Mix them into a liquid Syrup .

Then let her take Hydromel with Tartar , and afterwards be purged with the infusion of Agarick , Rubarb , leaves of Senna , Syrup of Roses solutive , and Manna . Let the heat of the Liver be tempered , and the obstruction of the Spleen opened by the use of the Acid Waters ; then for the purging of the whole body , and particularly the head , by reason of the pain on one side , let her take these following Pills .

Take of , The Mass of the Golden Pills , Cochiae Pills , of each half a dram . Magistery of Jalop , seven grains . With Syrup of Betony , form them into one and twenty Pills , and gild them .

Afterwards let the Head be cleared with gentle Masticatories , and sneezing Remedies , lest the humours too much stirred up , be thrown upon the eyes and breast , let the head be strengthned with a Cephalick Spirit ; of which , to take fifteen drops morning and evening in a few spoonfuls of Black-Cherry Water . In the Autumn , after general purging , cooling the Liver , opening the Spleen , and strengthning the head , there is nothing better to dissolve the Tumour in the upper Jaw than a Decoction of Sarsa , which hath this Prerogative to digest , and dissolve all hard Tumours , but let it be so prescribed that it heateth not the blood .

Take of The roots of Sarsa , two ounces . Guaiacum , for the strengthning the Stomach , half an ounce . Fountain Water eight Pints . Infuse them for four and twenty hours , and the boil half away , and strain it .

Take five ounces of this five hours before dinner ; and four hours before Supper , and every morning sweat gently in bed , after the taking of it let there be a second Decoction made for ordinary drink , boyling the Ingredients of the first Decoction in ten pints of Water , till the third part be boyled away , adding at the latter end , two ounces and a half of Raisons , continue the use of these Decoctions thirty days , renewing every second day the second Decoction , in using this Sudorifick there must be care taken that she be not bound ; and therefore every other day let her make use of a Glister , or a laxative Potion . Once in a Week let her take the forementioned Pills , or something equivalent to them : and abstain that day from the use of the first Decoction . For the weakness of her Stomach , let her take half a spoonful of the following Spirit of Mastick .

Take of Mastick , three ounces . Galanga , one ounce . Cinamom , two drams . Infuse them in Spirit of Wine , and distill them .

To the outward part of the Stomach apply a Cere-cloath of Caranna , and Tacamahaca , and the like : and if the Tumour doth not yield to these Remedies , it must at last be cut , and these few thing● , the most Noble Patient , may safely use ; but I leave them all to the judgment of the most famous , and excellent Physitian upon the plac● . From Ulme in Schwaben-land , Aug. 20. 1642.

The Cure of the foresaid Tumour .

This Tumour , of which I wrote in my advise , was on the upp●● Jaw on the right side , bigger than a Hens Egg , white , unmove●●le , and hard . The Last Autumn ( her body being prepared , and bloud taken away , ) the Patient made use of the Decoction of Sarsa , by which means the Tumour was almost discussed , as appeareth by the Letters written to me fr●m the Lady .

The Extract of a Letter written at Heilbrun , March 7. 1643.

The Tumour upon the right Jaw , after the use of the Decoction of Sarsa , was decreased , and almost disappeared ; and it pleased Almighty God so to direct the Cure , that I thought it had been perfectly well : but unhappily , after Christmas Holy-days , by the consent and advise of a Physitian , I went into an ordinary Bath , and was scarce come out of it before I felt an alteration , and increase of the Tumour , and from hence I feell daily a greater compression , not without pain , as in former time , &c. from hence , the benefit of the Decoction of Sarsa is evident .

But after some months , using the Bath , and her head being heated , the Tumour , upon much grief , and continual shedding of tears , increased to the former bigness . Things being thus , the Patient came from Heilbrun to Ulme , to be cured . Consulting therefore with the most excellent D. D. Christopher Eysenmenger , Physitian to the Republick of Heilbrun : we gave our Prognostick , hoping for very good success if the bone was not hurt . She being therefore purged and let bloud ; upon the second of May , 1643. we placed the Lady in her bed , binding her hands to her side . Then one of the standers by , drew the upper lip , upward , with a hook , that with my separating Knife I might come conveniently between the Tumour , and the first Muscle , which lifteth up the lip . I passed this Knife as far as the Suture of the Os Jugale , and separated the Tumour from the foresaid Muscle ; but lower , neer to the grinding Teeth , and the Gum , I found the coat of the Tumour Cartilagineous , and in vain attempted to bring it from the fourth bone of the upper Jaw ; so that I was forced to cut the bag ; which being cut , there flowed out a thick yellow matter like to honey , and the Tumour subsided : the matter being taken out , and the Cartilage cut off with the Pincers , I bound up the Wound with the white of an Egg , the Pouder of Chrysolite prepared , and the Astringent Pouder of Galen . The next day the blood being stopped , I found a little swelling neer the second Muscle , which draweth away the lip , under which there was a hole , through which I could easily pass a blunt Probe into the hollowness of the bone . On the 12th day , in the presence of Dr. Eysenmenger , I cut into the swelling , and dilated the hole . On the 13th , after the departure of Dr. Eysenmenger , I found , neer to the Dog-tooth , another swelling , hard as a bone ; which also I cut out with the Pincers , Tab . XI . Fig. II . The space where the bag was , between the last grinding tooth , and the dog tooth , was so consolidated , that not one drop of matter came out , but I kept the hole open , till the bone might skale by the help of the decoction of Sarsa , and the bone being taken way , I healed up the Wound .

OBSERVATION XXVII . Of a Gun-shot Wound in the lower Jaw .

IN the Year 1634. on the 27th of August . a Swedish Commander of Horse , was wounded , at the Battle of Nordlingen , into the lower Jaw , a little below the right Ear , with two Bullets , both of whi●h hurt the Tongue , and brake the opposite part of the Jaw ; spoiled ●he Tonsils . and all the Grinding-teeth , causing a great flux of bloud , Faintness , and a Feaver ; by reason of which , the fifth day I prescribed these things following .

Take of The Syrup of Juice of Citrons , The Rose Julep with the Tincture , of each an oun●e and a half . Endive Water , Plantain Water , of each two ounces . Mix them into a Syrup .

At night he made use of this Cordial Potion .

Take of , Prepared Pearl , Red Coral prepared , of each seven grains . The Chrisolite stone prepared , seven grains . Rose Water , Plantain Water , Black-Cherry Water , of each an ounce . Syrup of Coral , two drams , Syrup of Citron Juice , a dram and a half . Mix them for a Potion .

This being done for revulsion sake , I prescribed a cooling Glister .

Take of Loosening Hony of Roses , Oyl of Violets , of each three ounces . The Emollient Decoction , ten ounces . Mix them .

With this he voided thrice a black matter , mixed with bloud . After the use of the Glister , and the stopping of the bloud , I unbound the Wound , and found not only the lower Jaw broken on both sides , but the Tongue also wounded , with a great Inflammation , and loss of speech , and therefore I presently prescribed an Astringent Gargarism ; and his mouth being washed inwardly and outwardly , I put in a little burnt Spunge , dipped in the white of an Egg , stirred up , s●rinkled over with the Astringent Pouder of Galen , and prepared Chrysolite ; and the parts about it being anointed with Oyl of Roses , I bound it up : and by this means that violent flux of bloud was stopped . The next day he was something better ; but complained of a great pain of the head , and a beating pain of the right side , for which , the Median Vein of the same side was opened , and four ounces of bloud taken away : an hour after , he took Barly Broth , injected through a Tunnel , Tab . XXXVI . Fig. III . On the 3d day , he made signs with his fingers of a great pain upon the Temporal Muscle ; whereupon this Cataplasm was applyed .

Take of Barly Meal , Bean Meal , of each six ounces . The Crum of Houshold-bread , four ounces . Oyl of Roses , three ounces . Red Wine , and Oxymel Simple , as much as sufficeth . Mix them upon the fire into the form of a Cataplasm .

At night he took Panado , through the Siphon , and a little Barly Water : at midnight he took this Draught , Syrup of the Juice of Citrons , and Pomegranate Wine , of each an ounce and a half ; with two ounces of Black-Cherry Water . On the 4th day , he pointed with his finger , and wrote down , that he felt a great pain in his mouth , about the Uvula . The bloud being stopped , I unbound the Wound , out of which , the matter flowed with so great a stink , that I could not endure it ; but the inward parts of the mouth being washed with this following Gargarism .

Take of Plantain Water , two ounces . Self-heal Water , one ounce . Bole Armenick , one scruple . Sal . Prunella , two scruples . Alum , one scruple . Syrup of Myrtles , one ounce . Mix them .

I looked about the Uvula , and with my Probe touched somewhat that was hard and loose , or a piece of bone which had pricked the parts about it , and caused pain about the throat : this piece of bone I pulled out with the teeth of my Pincers : in the evening , being bound , he used the former Glister . On the 5th day , he was somewhat better ; and unbinding the Wound , a great deal of half-digested matter came out . On the 6th , he took this medical Potion .

Take of Loosening Syrup of Roses , an ounce and a half . Extract of Rubarb , one dram . Plantain Water , as much as sufficeth . Chrysolite prepared , six grains . Mix them .

Which gave him four stools : and the Wound was bound up with this Digestive .

Take of , Turpentine washed in Scordium Water , two drams . Pouder of Orris , and Round Birthwort , of each half a dram . S●rup of dryed Roses , two drams . Mix them for a Digestive .

Outwardly , there was applyed a Tent dipped in Oyl of Violets , and Oyl of Earth-worms : there was nothing used to the Tongue but Rose Water , and the Gargarism . On the 7th day , he began to stutter , and pointed with his finger , signifying that his throat was sore . I looked in , and drew out a piece of the bone , and then bound up the Wound as the day before . On the 8th , he complained of the Colick ; but after the use of the ordinary Glister , to which , a portion of Oyl of sweet Almonds was added , he was much better .

OBSERVATION XXVIII . Of a Periodical Pain of the Teeth , most happily Cured .

ALthough the Pill of Herlicius held in the Mouth doth wonderfully appease all pain of the Teeth , which is made out of the Seeds of Parsly , Henbane , Opium , and Syrup of Poppy .

Take of The Seeds of Parsly , two grains . Henbane , Opium , of each four grains . Syrup of Poppy , as much as sufficeth . Mix them , and make them into one Pill .

Yet for the curing , or hindering the Periodical return of the Pain , which hath often deceived the most excellent Remedies ; D. D. Spigelius , with most excellent success , did use to cut that part of the Anthelix , which doth immediately touch the upper part of the Tragus , with a long sharp Iron Instrument , red-hot , Tab . XII . Fig. I. and then healed up the Wound again . By this new way of Chyrurgery , that little branch of the Carotidal Artery , which passeth from the Anthelix of the Ear , to the Teeth , is cut in pieces , cross-wise : so that the Afflux of the Humours being intercepted , the pain returns no more . The wonderful efficacy of this Operation , the Author experienced first , in himself ; and afterwards , in my presence , and in not a few others .

OBSERVATION XXIX . Of a strong Apoplexy , upon breeding Teeth .

IN the Year 1638. upon the 27th of February , about eight at night , Ordolphus , Son of the Illustrious , and generous Baron Ferdinand Geizkofther , between the 12th and 13th month of his age , upon the difficulty of breeding Teeth , dyed of a strong Apoplexy . Four days days before his decease , I proposed to his Parents , the burning of the hinder part of his head , which had helped many others , as I had often experienced : but the Parents refusing it ; I made use of such Remedies , as are used in these great swellings , and itching of the Gums , Fever , and Catarrhe . Notwithstanding which , without any manifest Convulsions of the parts , any noise , or grinding of the Teeth ; he , who was the last hope of this Family , being taken with an Apoplexy , departed this life . But that this time of breeding Teeth , is very dangerous , especially when they breed the Dog-teeth , about the thirteenth month , is evident from the 25th Aphorism of Hippocrates , in the third Section : and from the Common saying .

Parents are of their Children ne're assur'd , 'Till they 'ave the cutting of those Teeth endur'd .

OBSERVATION XXX . Of the String of the Tongue , ill broken with the Nails .

IN the Year 1628. on the 2d of March , the Wife of Jacob Zimmermans brought forth a fine Boy , the Ligament of whose Tongue a Midwife ( whose name I spare ) cut in pieces with her Nails , that he might afterwards speak the more articulately : but so great a pain and inflammation succeeded this Operation , that it hindered the Child from taking hold of the Nipple , or rather from sucking . The Parents ascribed this inability of sucking to the string of the Tongue ; and thinking the Nurse had not sufficiently delivered the Tongue from its Ligament , sent for a Chyrurgion , who with the like Imprudence , cut in pieces both the Ligament , and Vessels of the Tongue ; out of which , the bloud flowed to the Wind-pipe , and the third day choaked the Child . The Child being dead ; the Mother began to complain of swelled Breasts , by reason of the concretion of the Milk ; and the right breast being ill handled , at last degenerated into an Ulcerated Cancer : and the Woman , after suffering most grievous pains , died .

A Girl new born , after that a Chirurgion had cut the string of her tongue with a common Lancet , by reason of the pain she was able to suck very little of her Mothers Milk , and the right breast growing hard , she put her Child to the left ; and the pain under the tongue being mitigated , the Milk returned into both Breasts ; but the hard Tumour would not be softened without the Child sucking it ; and she perceived already , that the Vertebrae of the Childs back were distorted towards the right side , occasioned by applying the Child always to one Breast . From these two Examples it is apparent how dangerously the string of the Tongue is often rent by the Midwives Nails , and the Chyrurgions Lancet ; and how much the lawful and just manner of doing it is to be esteemed : which , with many cautions , is proposed to us by Fabritius ab Aquapendente : concerning which , see Tab XXXVI . Fig. VIII .

OBSERVATION XXXI . Of the Kings-Evil , covering the whole Neck .

IN the Year 1631. in the Month of January , the Wife of Joseph Keonigs , troubled with the Kings-Evil all about her neck , sent for me to advise her ; to whom I prescribed a Pouder , mixed of equal parts , of Sugar , Ginger , and Turbith , which doth peculiarly purge Phlegm , the cause of these Scrophulous Tumours , from the deepest , and remotest parts , , according to Avicen , Lib . 4. Fen . 3. Tract . 2. C. 10. But because it was against the nature of this Worthy Person to drink pouder in Wine ; I prescribed this following Mixture three times , which she took without offending her Stomach .

Take of Turbith Poudered , four scruples . Preserved Ginger , as much as sufficeth . Mix them into an Electuary .

The Body being sufficiently purged from thick humours , I applyed to the part affected , the Ceratum Oxeloeum , softned with Oyl of Lizards ; the description of which is this .

Take green Lizards alive , as many as you please ; boil them in common Oyl till the Lizards be burnt , and the Oyl be black ; what is strained out , put into a glass , and set in the Sun , till the dreggs fall down , and the Oyl cleareth , and becomes of a brown colour : and I exhibited for thirty days together , every morning , six drams of the Electuary which Hercules Saxonia , and Johannes Prevotius esteemed as a great secret , and certain Remedy in the Cure of the Kings-Evil , and prepared it thus .

Take common Lizards , or green Lizards , the heads and tails cut off , and the inwards taken out , infuse them by themselves in very sharp White-Wine Vinegar , and made without Pepper , for four days , then drie them , and steep them in other Vinegar , and drie them again , either in the Shade , or Sun , and Pouder them ; this being done , mix an ounce of the Pouder with four ounces of Hony : which is to be taken for thirry , or forty days : two drams is the dose for children , but for men or women , half an ounce , six drams an ounce at highest .

These Remedies being given , and applyed , our Patient Recovered in the space of a Month . Johannes Riolan . l. 2. Anthropographiae , 15. de Mesenterio , writeth , that scrophulous Tumours never break out in the body unless the Mesentery be Scrophulous , which also Guido , and Ingrassias do testifie , such a Mesentery filled with innumerable kernels , I found in the body of the Noble Lady Altesheimem , which I opened because the body was full of these Scrophulous Tumours , and I sought after the cause of the Dropsie .

I have experienced the Vertue of that marvellous Oyntment which Fabritius ab Aquap . l. 1. Pentateuch . c . 21. commendeth in the Kings-Evil when broken out , in Nun , and in a young Maid , one having Ulcerated Tmmours in a the Breast , the other in the Neck .

OBSERVATION XXXII . Of a Quinsie , hindering Swallowing and Breathing .

A Noble Woman of Ulme , on the 7th of July , 1627. while her Courses were upon her , in the evening , was taken with a dangerous Quinsie , which made her breath with difficulty , and hindered her from swallowing either Meat or Drink : being called to her , I presently order'd a Laxative Glister , and that being come away , six ounces of blood to be taken out of the Median Vein of the Arm. On the 8th of July , a stronger Glister was given her , and after it had done working , she sitting up in her Bed , a Barber opened the Veins under the Tongue , and applyed Cupping-Glasses , without Scarification , to the inside of her Thighs : which he had also done the day before , with a great deal of Fire , not only lest the Menstruous Purgations should be stopped , but also to hinder the Humours flowing to the part affected . Afterwards I removed the Cupping-Glasses , and prescribed the Patient a Gargarism ; which , in all dangerous Quinsies , in the beginning of the Augmentation , is highly commended to wash the Throat therewith often in a day .

Take of Mustard Poudered , half a dram . Sharp Wine-Vinegar , one ounce . Plantain Water , three ounces . White Sugar , two drams . Mix them .

Which in the space of fourteen hours , partly by Repelling , and partly by Dissolving the Humours , delivered the Patient from the Jaws of Death .

OBSERVATION XXXIII . Of a Face burnt with Gun-Pouder .

IN November , 1634. A Grocers Son had placed in his Shop , a pan of live Coals , so neer to a Chest in which there was laid up ten pound of Gun-Pouder , that the great South-west Wind blowed a spark out of the pan into the Chest , which was not covered , whereby the Gun-Pouder being set on fire , it burnt the Boy's Face so , who was warming his hands , that he could neither lift up his Eye-lids , nor take Meat and Drink into his hands , nor receive it with his mouth . The Boy's Parents being very solicitous to restore him , desired my advise the first hour he was hurt ; for whose greater satisfaction , I prescribed this singular good Liniment , with which the Chyrurgion anointed the parts four times in a day , and in a weeks time healed that great burning without any Skarr .

Take of Fresh Butter , nine times , or oftner , melted , and washed in Distilled Frog-spawn water , six ounces . Oyl of the Yolks of Eggs , two ounces . Mix them , and make them into a Liniment .

Which , in any Burning takes out the Fire , mitigates the Inflammation , hinders Blisters , and takes away the Pain .

OBSERVATION XXXIV . Of a Gutta Serena , or Blindness , Cured by a Seton burned in the Nape of the Neck .

IN the Year 1639. Maria Re●thin , born in the Teritory of Ulme , about the 26th . Year of her Age , upon the suppression of her Terms , complained of that which is commonly called , a Gutta Serena of both her Eyes , and being taken into the Hospital . I opened the Vena Saphena of the right Foot , and took away six ounces of blood , and then prescribed these uterine cephalick Pills .

Take of Pills of Castor two scruples . Extract of Cochiae one scruple . Magistery of Jalap six grains . Mugwort . water as much as sufficeth . Make them into XXI . Pills .

And a purging Wine to purge her Head , and whole mass of humours . After the use of these Purgers , I burnt an Issue in the right Thigh , four Fingers above the Knee ; and after a month her courses began to flow , but in small quantity , and therefore I prescribed to the Patient , a Dose of Ammoniacal Pills , whereby they were very evidently encreased .

About the third New Moon , she had only a show of them , and therefore I repeated the use of the Pills , upon which they came down well . The fourth month she had them in due time , and quantity ; but was extremely sad , that she had not recovered her sight : and seeing that I had formerly in the Wife of John David Commerel , and John Conrade Ehinger , found a Seton made in the Neck , to be most excellent in these obstructions of the Nerves , I made a Seton , and kept the Ulcer open for twenty days , till the Patient most joyfully recovered her sight , and her courses coming duly , she healed up the Issue in her Thigh , and enjoyed perfect health from that time till , 1645.

OBSERVATION XXXV . Of a Venerial Excressence of flesh in the Nose .

A Country-man of Jungingen , was troubled with a Venereal Sore in the Nose , and an Excrescence , which stopped up the Nostrils in such manner , that he could not breath through them : for which I prescribed him a sweating Drink of Guaicum ; which being ended , I consumed the Excrescence of the Nose with this following Oyntment .

Take of The Liniment prescribed by Prevotius in his Medicines for the Poor against Caruncles in the Urinary passage one ounce . Mercury precipitate a dram and half . Mix them into the form of an Oyntment .

In which dip your Tents which are to be put into the Nose . The Caruncles being eaten away , I put Leaden Tubes into the Nostrils , dipped in the Ceratum Divinum , till the Ulcers were consolidated ; in those Ulcers some commend a mixture of the decoction of Sassafras , Hony of Roses , Praecipitate poudered , and Aloe of Zoccotara , with which they wash the Nostrils often in a day , and heal them .

With this most excellent Oyntment after a sudorifick course , I freed a Weaver of Ulme from the same Disease , without any pain , in a weeks time .

OBSERVATION XXXVI . Of an incureable Gutta Serena , of both the Eyes .

IN the Year 1642. Johannes Hegelen an Apparitor of Ulme , complained of an Amaurosis , which the Modernes call a Gutta Serena ; and being brought into the Hospital , he took often these Pills for the Eyes .

Take of — The mass of Pil . Lucis , Pil . sine quibus , of each half a dram . Magistery of Jalap , six grains . Distilled Oyl of Fennil two drops . Eye-bright-water , as much as sufficeth . Make them up into twenty seven Pills .

But receiving no benefit at all by them . I ordered first a blystering Plaister , and then a Seton to be made in the Neck : both which remedies being made use of without any perceivable advantage to the Patient , I called to mind that which I had inserted amongst my collection of Observations in the Year 1620. The Body of a certain poor Woman of Padoa ( who had been troubled with an Amaurosis for twenty years together , coming by degrees upon her , and at last with an inward Cancer upon the Left Breast , which by repelling Medicines was driven in and killed her ) was brought into the Anotamical Theatre ; where , in the presence of many Students , I sought for the true cause of this blindness ; and opening the Skull , I found the first and second Ventricle of the Brain , sunk down , and glued together ; so that the Animal Spirits could not be carried through them to the Eyes : upon which by degrees , the Optick Nerves withered away ; for they appeared as little again , as in others . Thus the Amaurosis came upon her , the eye it self being not at all hurt , but still well nourished by the Artery coming to the root of it , which was full and fair , and sometime suffered an Inflammation from the regurgitating of the courses . The most excellent Spigelius added in his Anatomical Lecture ( Reading upon the head of this poor Woman ) that this blindness could no ways be Cured , although Pausanius affirmeth , that a Wound on the Forehead did once take away such a Gutta Serena . From hence also it is evident , that this Disease doth not always arise from the obstruction of the Optick Nerves ; but doth only insinuate such a disposition . Neither is it to be wondered at , if it yield not to the most Experienced , and Methodical way way of Curing .

OBSERVATION XXXVII . Of a Depression of the Skull of a Woman with a Fissure .

IN the general cure of Contusions of the Head , I formerly took notice , that the Skull of those who were grown up , is seldome Depressed without a Fissure , either in the inward , or outward Table , unless in those , whose Skulls are naturally softer than ordinary . This is confirmed by this Observation of a Serving-Maid of Michael Rietmans , who in the thirtieth year of her age , carrying a Vessel of Water upon her head , fell down , and hurt the right side of the fore-part of her head : which being much swelled , Nicholas Reutte was sent for , who applyed a Lamb-skin warm to the part : the next day the Skin being taken off , perceiving a hollowness , I declared to the standers by , that there was a Depression of the Skull , and the necessity of dividing the Skin ; which being granted , I cut the skin with an Incision-Knife , into the form of a Cross , and presently perceived a small Depression on the outward Table of the Skull , without any Fissure . The Wound being bound up , I was very doubtful whether the inward Table was intire , because the fall was from a high place ; and therefore I proposed the use of the Trepan , but the Patient would not admit of it , declaring then , that this Wound or Depression , if there were a Fissure in the inward Table , could not well be healed , without Perforating the Skull ; but if that were intire , the Patient might with less danger be Cured . I kept the Wound open 12 days , and not any one Symptom happening , which did argue either the Fissure of the Skull , or any other hurt of the Brain , I healed it up .

OBSERVATION XXXVIII . Of a Capillary penetrating Fissure on the Head , Cured both in a Boy , and in a man .

IN the Year 1644. a Cart with two Horses empty ran over David Heilbrou●er , and hurt the Synciput on the left side , leaving the Bone bare , and causing a Fissure on the Skull ; which being observed , and shown to the Parents , Ezekiel Vogel a Chyrurgion dilated the Wound , applying a Stupe , dipped in an Astringent , whereby the requisite scraping of the Skull might be safely performed . The next morning , being sent for , I found the Skull freed from the Pericranium , and fractured with a doubtful Fissure ; and being provided with Scraping-Irons , I presently scraped down the Fissure below the space between the two Tables , where I perceived the inward Table of the Skull to have only a capillary Fissure : whereupon , removing the Scraping-Irons , I dressed the Wound , and the Bone , with my accustomed Dressings , and happily restored the Boy in the space of 24 days : who , without the use of the Scraping-Irons , as frequent Experience testifieth , might have perished . The reason why I did not Perforate the Skull , may be seen in my Discourse upon a Capillary , and Penetrating Fissure of the Skull , Tab . XXXI .

In the same manner I restored John George Hornung , who on the 28th of December , 1635. received a Wound on the Temporal Muscle , with a penetrating Fissure of the Skull , but Capillary .

OBSERVATION XXXIX . Of a Contusion on the hinder part of the Head , helped by the Scraping-Irons .

IN September , 1637. Mary Lutzen , being miserably handled by the Bavarian Souldiers , complained of a violent pain on the hinder-part of her bead , caused by an Empirick , who presently digested the Tumour with Suppurative Medicines , and then applyed Dissolvents for fourteen days ; till the Purulent matter not finding a passage , by reason of the thickness of the Coats , Corroded the Skull , and the Pericranium ; from whence these pains proceeded : and separated from the bone , the Insertions of those Muscles which are called Splenij , and Recti , and serve to extend the head . The Patient being received into the Hospital of Ulme , desired the Chyturgions help : wherefore , after Generals , and a slender Diet , I cut the outward Skin with an Incision-Knife , in the shape of a Triangle , down to the Bone , taking care , lest the Fibres of the foresaid Muscles should be cut in pieces ; and hereby making a passage for the included mater to flow out , I found the bone rough , and corroded with the matter : which being evacuated , I filled up the lips of the Wound with an Astringent Medicine well down ; and the next day scraped the rough bone all about with the Scraping-Irons : this Operation being performed , I sprinkled the Cephalick Pouder upon the Skull , and applyed a Digestive to the Wound ; till that within two days time the Skull was covered over with solid Flesh : the Bone being covered , I Incarnated the Wound with Betony Oyntment , and Cicatrized it with the Certaum Divinum . Twenty days after the scraping , the Skull threw off some Skales , and the pain of the Head returned : but pulling out the little bones , with the Pincers , the pain presently ceased . Hereby young Chyrurgions are to be admonished ; if the Contusions of the head suppurated , yield not to dissolving Medicines , so long time applyed , they are not to continue the use of them : but rather , without any delay , or fear of danger , to cut open , in due manner , the Coverings of the Skull ; lest the Quitter continuing a long while , under a very thick Coat , become Malignant , and Corrode the Skull , and Pericranium : See Tab . XXXII . a Contusion of the Head , without hurting the Skin or Skull .

OBSERVATION XL . Of a Fistula on the Breast , with Corrosion of the Neck-Bone .

ON the 10th of November , 1627. Sabina , the Wife of John Majer , Citizen , and Victualler of Ulme , came to me , and shewed me a Tumour with a Fistula , above the left Clavicle , the Orifice of of the Fistula being so narrow , that it would scarce receive the point of a pin .

Enquiring into the cause of this , she informed me , that half a year before , she laboured under a violent Fever , which terminated in an Abscess upon this part . This Abscess the Physitian , otherwise very experienced , and Matthew Memminger , a Barber , after Suppuratives , opened with a Caustick , not very pleasingly , ( for it being applyed for 36 hours , it caused very sharp pains , and frequent faintings ) and took out the Eschar , which was about the bigness of a Dollar , with a Lancet ; which being violently taken away , there flowed out a yellow stinking matter , but in small quantity . This Ulcer they kept open four weeks , and at length healed it up , but there remained a considerable Tumour and hardness , which they committed to Nature to dissolve . After six weeks this Tumour grew bigger than the former ; which after means to soften , and ripen it , they opened with a Raser , to exclude the matter , which again was little and bilious ; and this being voided , they healed it up ag●in , and so the third and fourth time they cut it open , and conglutinated it again ; not at all suspecting any injury done to the bone , which so many relapsis might easily have indicated : so that at last the abscess degenerated into a Fistula : so that as often as the Patient moved her left arm , or either of her feet , she suffered most fierce pains , and fainted way . Upon this , her Relations desiring my assistance , I prescribed Remedies to evacuate bilious humours abounding in her body : the abundance of which , the hot and dry consti●ution of her body did demonstrate ; as also the yellow matter discharged through the Orifice of the Fistula , her yellow colour all over , and the foregoing Fever . Her body being prepared , and purged several times very well , I dilated the narrow Fistula ( not with Iron Incision-knives , by which , not only the Pectoral Muscle , already hurt by the former Incisions might be more offended , but also the jugular Veins come to be hurt or cut , to the l●ss of life , as well as bloud , ) but with a Tent , made of the Root of Gentian prepared ( that is , cut into the shape of a Tent , dryed upon a Stove , and a thred fastened to one end of it ) which I put into the hole , keeping it in with a Plaister of Diapalma , and the Bandage of the Brest-plate , in the last Table , Letter S. keeping it in four and twenty hours . The next day I drew out the Root with the Pincers , it being swelled up with a bilious undigested matter , and black at the end ; and searching the cavity to find out the cause of this colour , I found the bone rough and moveable : for the greater dilatation therefore of the hole , I put in a bigger Root , with the Plaister Diacalcitis , and the former Bandage to keep in the Root , and anointed the parts about it to hinder any Inflammation , which the pain , arising from the Dilatation , although it were not vehement , might easily cause . The third day I put in another bigger Root , and so gradually I encreased daily the bigness of the Tent , till the hole was big enough to take out the bone , which was almost separated . The sixth day I filled up the Fistula with Buttons , made of Spunge , fastened to a thread ▪ so as the thread hanged out of the hole , and put over them a Plaster , and the Breast-plate Bandage , and anointed the parts about .

The preparing of the Buttons is thus .

Take a new Spung which hath never been dipped in water , and put it into an equal quantity of Wax and Rosen melted together ; then press it out in a strong press , and drie it in the shade : out of this dried Spunge cut round Buttons , and fasten them to a thread .

The seventh day , the Spunges being taken out , the Fistula was very open through ; which , taking hold of the bone with the Pincers , I drew it out without any great pain . The eighth day , the bloud being stooped , I sprinkled upon the sound bone uncovered , this following Pouder .

Take of , The Roots of Orris , Birthwort , Hoggs Fennel , of each half a dram . Euphorbium , half a scruple . Myrh a scruple . Mix them .

Which I applyed with dry Lint , till the bone was covered over with firm flesh . I cleansed the Ulcer daily , with sprinkling the Pouder of refined Sugar upon i● which doth also mitigate the acrimony of the Gall , and at length I cicatrized it with the Plaister of Diapalma . To the remaining hardness I applyed the Plaister Oxelaeum , with Linnen thrice doubled dipped in Wine of the decoction and pressed out , that the reliques might be discussed , and any new Flux of humours to the weak part be prevented : by this means in the space of fourteen days , I delivered this Woman from a most dangerous and troublesome affliction , as she her self is still ready to testifie , who now hath lived in excellent health ten years together , with a second Husband , George Hebich , a Dyer .

OBSERVATION XLI . Of a Wound on the Breast , with a Fracture of the Rib .

JOhannes Vande●eisen of Augsburg , a Graver in Brass , and a publick Champion of the Feathered Party , at the Rose-Inne in Ulme , at eleven at night , received a Wound from a Baker , addicted to the Martiate Faction , upon the left side , about the fourth Short-rib : the Cartilaginous part being cut in pieces , the Kell coming out with a great loss of blood , attended by divers Symptoms ; as Fainting , Vomiting , and a great pain and swelling about the Midriff . Being called , I presently put in the Omentum , or Kell intire , and put a Tent into the Wound , with Hemp-hards dipped in the Yolk and White of an Egg beaten up together , sprinkled over with an Astringent Pouder , and fastened to a thread , and over it the Diapalma Cerate , and the Bandage of Sostratus . On the 4th of January , about six in the m●rning , I went to the Patient , that I might unbind , and look upon his Wound ; but it not being expedient , by reason of his weakness , and for fear of his bleeding again ; I gave him Chicken Broth , mixed with Astringents ; and for the Colick , I applyed a Cataplasm to his Belly , made of such Ingredients , as digest , dissolve , and take away pain ; and for the stopping of the bloud , and preserving his strength ; I prescribed this Electuary .

Take of Old Conserve of Roses , Conserve of Comfrey , of each half an ounce . Trochies of Amber , Sealed Earth , Red Coral prepared , of each a scruple . Pearl prepared , half a scruple . Syrup of Myrtles , as much as sufficeth to make an Electuary ; of which , he took a dram often in a day .

For the streightness of his Breast , and difficulty of Respiration , I ordered this following Lohoch ; by the frequent use of which , he spit up a thick and tough matter .

Take of Syrup of Maidenhare , Liquerice , of each six drams . Folefoot , Speedwel , of each half an ounce . Tablets of Diatragacanthum , three drams . Violet Water , as much as sufficeth . Mix them , and make them into a Lohoch .

For the Pain , Swelling , and Inflammation about the Wound , I applyed the former Cataplasm . On the fifth day of the month , the Pain , and Swelling somewhat abated , and the bloud being stopped , I unbound the Wound , and put in a Tent dipped in a Digestive , and fastened to a thread , and over it the same Cerate Cataplasm , and Bandage as before . The same day I gave him Broth made with Burnet , Setfoile , Comfrey , Horsetail , Speedwel , Strawberry leaves , and Melon seeds , that the matter contained in the Belly might be discharged by the Urinary passages , mixing Astringents with them , lest without the use of these , he should bleed a fresh . Towards the evening he complained of an itching in the Urinary passage , a sign that the matter in the cavity of the Belly , by the benefit of the Diureticks , was voided by Urine .

On the sixth day of the month the pain went off , and the swelling about the Wound vanished ; and the Patient saying that he felt a greater itching when he made water , I looked upon the Urine , and found a great deal of matter mixed with it .

On the 7th day the Patient complained of a pain upon the right Shoulder , and towards the evening , of a pain of the Liver , Fever , and dry Cough .

And upon the 8th , the former pains , and Feverish heat increasing , I took four ounces of blood out of rhe Basilica of the right arm ; which being done , the pains ceased after an hour or two , and the Fever decreased .

Upon the 9th , the matter was digested , and the Patient was otherwise well ; so that I began to consolidate the Wound , diminishing the Tent daily , till it came to be Cicatrized ; but the Patient in the night feeling pains like to the Colick , about the Os Sacrum , or Ramp bone , and the Region of the Bladder ; I prescribed , upon the 10th day , this following Potion .

Take of Oyl of sweet Almons fresh drawn , three ounces . The best Manna , two ounces and a half . Camomile Water , as much as sufficeth . Mix them into a Potion .

Upon taking this , he vomited up a great quantity of Choler , and had twenty Stools , voiding with them much bilious matter , which had been the cause of these pains : after this evacuation , the Patient was better , and the pains altogether abated , till the 23d day ; at what time , keeping a bad Diet he fell into a bilious loosness , and by the perswasion of some Women , he fed eagerly upon Sloes , which gave him the Colick , with a continual desire of going to stool , without being able to do it . For which , on the 24th , I gave him , in Succory water , a dram of Rubarb poudered ; and two hours after his taking the Rubarb , this following Potion .

Take of Oyl of Almonds newly drawn , The Decoction of Camomile , of each three ounces . Mix them .

The ●l●●er b●ing sufficiently evacuated , about eleven a Clock in the m ●ni g , both the Colick , and Tenesmus ceased . On the 28th the W●u●d was Cicatrized with the Ceratum Divinum , so that the Patient ●●t complaining of any pain about that part , or any difficulty of br●a●hing ; on the 29th he went abroad , and drunk with his Compa●i●ns til●●●dnight : on the 4th of February , being perfectly well , n● prepared for his journey homeward with his Wife , and being anger'd for a small matter handsomly Cudgell'd her . Hearing of which , I admonished him , that for the future , he should , as much as possibly , keep himself from passion .

OBSERVATION XLII . Of a dangerous Wound on the Breast .

ON the 9th of February , 1633. the Noble Nicholas Dietrick , Sirnamed Sphereiter , received two Wounds in a Duel , from the Generous Rittwein , a Swedish Serjeant Major ; the first of which was on the left Wrist , running down to the hand , the Veins and Tendons being hurt . The other upon the right Breast , a fingers breadth below the Pap , which penetrated into the cavity of the Thorax , hurt the Intercostal Vessels , and caused spitting of bloud . By reason of these dangerous Symptoms , and faintness especially , he was carried home in a Coach with four Horses , where all things requisite for the Wound were proposed : amongst others , I judge this worthy to be noted , before the first binding up of the Wound , some out of that great throng of standers by said , they would suck out the bloud which was within the Thorax ; and being permitted , they did suck indeed , but it was not bloud , but rather Gold ; and one while he was sucking stole privately a Diamond Ring from off the Patients finger , but being found out , he restored it again . Being sent for , I looked upon the Wound on the Breast , and putting a blunt Probe through the hole into the cavity , I found it filled with bloud ; and from his spitting of bloud , suspected that the Lungs were wounded ; and therefore I cast in with a Siphon , through the Wound with the White of an Egg , with the Astringent Pouder of Galen , Chrysolite prepared , and a little Plantain Water . I put also into the Wound , a Tent made of Hemp-hards dipped in the same , and tied to a string . I anointed the parts about it with Oyl of Roses , and put over it a Cerate of Diapalm . and bound it up with Linnen thrice doubled , dipped in Red-wine , and pressed out , and the Bandage of Sostratus , Tab . XXXII . Fig. VI . To the Wound in the Wrist , the same Remedies were applyed for the stopping of the blood ; and to preserve his strength , and to stop the bloud in the Breast , he often took this following Water .

Take of Burnet Water , Black-Cherry Water , Rose Water , Plantain Water , Speedwel Water , of each an ounce and a half . Cinamon Water , a dram and a half . Spirit of Lilly in the Valley , a dram . Pouder of Chrysolite prepared , Lapis Haematites , Red Coral , of each half a dram . Bezoar , seven grains , Prepared Pearl , a scruple . Pearl Tablets , half an ounce . Mix them .

For his thirst , he drank Barly water mixed with Syrup of Coral , and Tincture of Roses ; strictly observing a slender Diet . For his Fever , and spitting of bloud , both for Revulsion , and Ventilation sake , I ordered the Liver Vein to be opened of the same side , and four ounces of bloud to be taken away . This being done , he took nothing but the Decoction of Barly , mixed with the Tincture of Roses , and Barly Ptisan for his Supper . The next morning he complained that he had slept little or nothing in the night , and therefore at eight a Clock in the morning he took this following Glister .

Take of The Roots of Sorrel , Marshmallows , , of each half an ounce . The Leaves of Burnet , Agrimony , Sorrel , Mallows , Violets , Speedwel , of each half a handful . Flax Seed , half an ounce . Fennel Seed , Citron Seed , of each a Dram . Boyl them in a convenient quantity of Water to ten ounces , and add to it , when it s strained out , Hony of Violets , three ounces . Oyl of Violets , two ounces . Oyl of Camomile , one ounce . Mix them .

This Glister wrought thrice , and after that , I unbound the Wound ; out of which there flowed a little bloud . At the same time the Patient complained of a great Pain , and Heat of that side which was wounded , by reason of the heat of the bloud gathered together within the Thorax : and seeing that the bloud could not get out , by reason of the streightness of the Wound , although the Patient were placed in the same Posture in which he was Wounded : it was necessary to make way for the bloud , either by dilating the Wound with the Incision-knife , Tab . XII . Fig. I. and Tab . XXXVII . Fig. V. or by a new Section between the third and fourth Rib , beginning to reckon from the lowermost , according to Hypocrates his way , who began his account from the last or twelfth ; because this may easily be felt with the fingers , and it is the same , as to say , between the ninth , and tenth Rib , beginning to reckon from the uppermost . The Dilatation of the Wound had been in vain attempted ; because the greatest part of the bloud contained in the Breast , was gathered together about the Midriff : nor could I make the Paracentesis to any advantage , either on the right , or left side ; in the left it had not been convenient , because the matter was gathered in the right ; nor could it be performed in the right , by reason of the great swelling and pain of the Back and Liver ; and to expect the evacuation of it , by spitting , or Urine , would be too dangerous , by reason of the great quantity of matter , w●ich threatned the suffocation of the natural heat . Whereupon , I bound up the Wound as the day before , concluding with my self to proceed to another Operation , and provide a Pipe , or Canale , with a Stopper of Gold , to be made , Tab . XXXVII . Fig. IV . A. which might easily be bent into the shape of a Triangle , or Semicircle . This Instrument bent like a Triangle , I put gently into the Cavity of the Thorax ; and drawing out the Style , a great quantity of bloud ( without any sucking with the mouth ) flowed through the the Pipe . After this Evacuation of the bloud , I put in the winged Pipe of Gold , Tab . XII . Fig. XII . covered over with Galen's Astringent Pouder , prepared Chrysolite , and the White of an Egg , and over that a Plaster of Diapalma , a new Spunge dipped in Red-wine , and pressed out , Linnen doubled , and the Bandage of Sostratus . Upon this Evacuation , the Patient rested better the whole night . The third day after he was wounded , I put the Instrument again , into his Bread , and took out a Pint and a half ; which Evacuation he bore very well , to the admiration of the standers by . After his Dinner , which was made of Ptisan , and the Decoction of Barly , he took at night this Emulsion .

Take of Melon Seeds , half an ounce . Poppy Seeds , a dram . Strawberry water , Burnet water , Speedwel water , Water-Lilly water of each two ounces . Make an Emulsion , to which add , Chrys●lite prepared , Prepared Pearl , Red Coral prepared , of each nine grains . Syrup of Violets , an ounce . Mix them .

After the use of this he rested well all the night . On the 4th day , making water , he felt a very sharp pain in the Urinary passage ; I looked upon the water , which was thick and stinking , a certain sign that the matter contained within the Breast , did tend towards the Urinary Vessels . In the evening , by reason of his being bound , he used this Glister .

Take of The following Decoction , ten ounces . Hony of Violets , two ounces . Cassia newly drawn , half an ounce . Oyl of Violets , three ounces . Mix them .

From which he had two Stools .

Take of Speedwel , Burnet , Self-heal , Plantain , Agrimony , of each half a handful . Whole Barley , half a pugil . Boyl them in a sufficient quantity of water , and small Wine , to a Pint , adding to it when it is strained out , two ounces of Hony of Roses . Mix them for a cleansing , and healing Injection .

This Decoction being injected by the Seringe , Tab . XXXVII . Fig. IV . and Evacuated again , I put the hollow Pipe of Gold . Tab . XII . Fig. XII . dipped in the Digestive into the Wound , and over it the Cerate of Diapalma , and a Linnen Bolster dipped in Red-wine , and pressed out . In the mean time the Wound in the Wrist was not neglected , but dressed every other day , and bound up . On the sixth day , for a bitterness in his mouth , I prescribed this purging Potion .

Take of Solutive Syrup of Roses , an ounce and a half . Extract of Rubarb , one dram . Diacarthamum , one scruple . Crem . of Tarter , half a Scruple . Succhory water , as much as sufficeth . Mix them for a Potion .

On the seventh day I mixt this following Decoction , with this ordinary Drink .

Take of Speedwel , Agrimony , Periwinkle , Self-heal , Strawberry Leaves , of each a handful . The Ashes of Crevis , one ounce . Boyl them in a sufficient quantity of small Wine , to a pint and a half , adding Hony of Roses strained two ounces . Mix them .

On the 8th day , the Patient , and the Wound on the Wrist were better , and he made use of this Cordial Pouder .

Take of Chrysolite prepared , Magistery of Pearl , Red Coral , of each four grains . Mix them with a convenient quantity of Syrup of Violets , and Syrup of Coral .

The 9th day the Patient was better , and a little digested matter came out of the Wound on the Breast ; therefore omitting the injection , I put in only the Pipe with the Digestive . To the Wound on the Wrist , instead of Diapalma , I applyed the Ceratum Divinum , to Cicatrize it .

On the 10th , nothing at all came out of the Wound on the Breast , but the Patient complained of a cough , which ceased upon taking these Pectoral Trochies with Musk and Amber .

Take of The Species Diair , two scruples . Diambra , C. Pouder of Orris , of each a scruple . Trochies of Gallia Moschata , two and twenty grains . Starch , a dram . White Sugar , an ounce and a half . White Sugar-Candy , Penidice , of each six drams . Ambras , Gris . six grains . Mucilage of Gum Tragacanth , made in Rose Water , as much as sufficeth , Make them into Troches .

His Urine was still thick , and his making Water painful . On the 11th , the Patient being in good health , and nothing more coming out of the Cavity of the Breast ; lest the Wound should degenerate into a Fistula of the Breast , omitting the Pipe , I put in a Tent fastened to a string , covered with the Betony Oyntment , and over it the yellow Cerate .

On the 12th , 13th , and 14th , the Patient complained not , and said he was strong enough to walk without a staff .

On the 15th , 16th , and 17th , the Wound appeared clean and neat , and I put in daily a shorter tent , and the flesh began to grow from within . On the 17th , the Wound on the Wrist was Cicatrized , by the help of the Ceratum Divinum .

From the 18th to the 22d , the Patient was excellently well ; so that I took out the Tent , and applyed instead of it a Plegit of Lint , covered with Betony Oyntment , and bound up the Wound with a n● Spunge dipped in Red-wine , and pressed out ; and with a compressing Bandage , called the Breast-plate , in the last Table S.

On the 28th . I Cicatrized the Wound with the Ceratum Divinum , the Patient being restored to his former health .

On the 34th . he complained of a violent pain on his left-foot , which took its original from the disturbances of his mind , but his body being purged of bilious humours , it ceased .

OBSERVATION XLIII . Of a Wound on the Breast , requiring the Paracentesis .

IN the Month of April , 1622. Anthony the Waggoner of Padoa , was wounded in the Back , the Sword piercing as far as the right Breast , so that there was two Wounds : which caused him to fall to the ground in a swound , loosing his voice , being in a cold sweat , with an intermitting pulse , and vomiting of blood : which gave suspition of the Heart , or Stomach being Wounded . I bound up the Wound on both sides ; but first I Dilated the Orifice in the Breast , with a hooked Knife , Tab . XXXVII . Fig. V. E. and put into both of them a Tent of Hemp-Hards , dipped in the white of an Egg , and fastned to a String ; and omitted nothing that was necessary to be done to such Wounds . The Wound being bound up , by reason of his great weakness , the use of Wine was granted him : and yet for a whole day , I could not perceive with my Fingers , any Pulse of the Arteries in his Wrist .

The next day , although a great quantity of blood flowed out of the Wound ▪ yet no Pulse could be perceived , unless the Patient turned himself from place to place , or from side to side ; the same day he took Panada , which he vomited up presently , from whence I concluded his Stomach to be Wounded .

On the third day the Patient breathed with difficulty , and felt a great pain near to the Diaphragme , on the Wounded side , scarce a drop came out of the Wound , and what is very much , the Pulse was very deficient ; For this cause , between the third and fourth Rib ( Tab . XXXVII . Fig. II . ♃ ) according to Hippocrates , the breast was opened , to this intent : that the matter contained in the Thorax might be evacuated , least the natural heat should be choaked , and the substance of the Lungs putrified : the Perforation being made , scarce three , or four drops of blood came out of the Wound ; which I think is worthy to be noted ; because say some , there will be a great Flux of blood from the Incision of the Intercostal Vessels . I do not deny , but that somtimes , and that in bilious Bodies , such a Flux of blood may fall into the Cavity when the Vein , or Artery is cut ; but this may easily be avoided with the Incision-Knife , Tab . XI . Fig. I. and supposing the Intercostal Vein , or Artery were cut , what matter is it ? little , or no blood from a fresh Wound , made between the third and fourth Rib , can be retained within the Cavity of the Thorax ; and if it be retained , the next day , when the Wound is dressed ag●in it will come 〈◇〉 . The Breast therefore being opened , a full pound of matter , like ●o the washing of Flesh came out ; which being evacuated , I manifestly perceived the Pulse , and put a Tent into the Wound , covered with the white of an Egg , and the Astringent Pouder of Galen . In the evening I unbound the artificial Wound , and again took out a pound of blood , mixed with a third part of matter : after that a Tent was put into the Wound , made of Linnen rowled together , and anointed over with this Digestive .

Take of Oyl of St. Johns-wort half an ounce . Turpentine an ounce . Hony of Roses streined half an ounce . Mix them for a Digestive .

And over that a Cerate of Diapalma , Linnen four times doubled , pressed out of red Wine , and a convenient Bandage .

On the 4th I bound up the upper Wound ; and drew out of that which I made in his side a Glass of matter , the fourth part being blood . About the lips of the new Wound , there appeared an inflamation : whereupon I forbad the use of Wine , and prescribed Barly-water for his ordinary Drink . His Pulse was most manifest , and from the upper Wounds a purulent matter , in some small quantity issued out ; I therefore prescribed him this following Syrup , to drink four ounces of it early in the morning , and towards the evening , two hours before Supper ,

Take of French Barly one handful . Strawberry Leaves , Leaves of Bugle , Burnet , Succory , Foles-Foot , Mous-Ear , Horse-Tail , Vervain , of each half a handful . Roots of Madder two ounces . Liquerice one dram . Fountain-water four pints . White-Wine two pints : boyl away half , and in the end of the Decoction add Hony streined two ounces . Mix them for a vulnerary Syrup .

On the 5th . day , there came out a Glass of quitter somwhat stinking rather inclining to yellow ▪ then white : out of both holes of the old Wound there came out a matter , like mouldy Cheese ( as I have often seen in a Peripneumonia ) and in small quantity . The lips of the new Wound were black and blew , the Pledgits black , by reason of the great impurity of his Body , and the Feaver higher than ordinary .

On the 6th . day , in the morning , and evening , there came out half a Glass of matter , so stinking , that no body was able to endure the Room , and under the Pledgits , and Bolsters , matter almost black , I prescribed this following Decoction .

Take of Scordium one handful . Hony of Roses streined one pound . Common Water six pounds .

Boyl away the third part , and let a pint of it streined out , be cast in through a Seringe . Tab . XIII . Fig. II , after the injection , I put in a Tent , dipped in the former Digestive . If a silver Probe be put into the Quitter , and being drawn out , according to Hippocrates , a●peare●h ●lack , the Patient will hardly escape : in imitation of Hippocrates I laid a Probe in the Quitter ; and seeing it had contracted no blackness , but remained very white , I hoped well of his recovery .

The 7th . day , the Patient had a higher Feaver , then the days before , and the Quitter came out in a greater quantity , but not smelling so ill , as up●● the 5th . and 6th .

On the 8th . the lips of the Wound , made between the third and fourth Ribs inflamed . Upon which the Patient suffered greater pain , and a higher Feaver .

On the 9th . day , the stinking of the Purulent matter did evidently abate , but in the evening there appeared about the new Wound . St. Anthonies Fire , the hole being larger , and the third Rib bare .

On the 10th . the artificial Wound appeared larger than the day before . The cause of which Dilatation , in my judgement , was the bilious humour , which corroded the fleshy substance with its Acrimony ; in the night he felt great pains about the Baster'd Ribs , by reason of the Eresypelas , and the Intercostal Nerve inserted into the descending Muscle of the Belly .

On the 11th . day he was better , and slept all night : he would not admit of the Siphon , by reason of the soreness of the Pleura , or Membrane , stretched under the Ribs .

On the 12th . He felt as great pain as the day before , therefore omitting the Tent , I applyed a piece of Spunge , pressed out of the Vulnerary Decoction , in the night he sweat twice , all over his Body .

On the 13. He was better , and white Quitter came out . In these cases , there is no better remedy , then not to purge the Body : for if any Purge be given , all the humours flow to the Guts ; the Body is extenuated , and many bad Symptoms happen upon it .

On the 14th . He slept well , and the matter came out of the Wound in a small quantity . In the evening there came more away , and the Pulse seemed greater than ordinary .

On the 15th . His Feaver was higher then the day before ; because the Patient had rested on his left-side , which was sound , and not on his right-side , which was Wounded : so that the matter contained in the Thorax encreased the Feaver . In the evening a Tent was put into the Wound in his side , because the Flesh grew too fast .

On the 16th . For a bitterness he felt in his mouth , three or four days together , he took Rubarb , and voided four times bilious excrements , after which he was better .

On the 17th . I gave him the ordinary Decoction , in the evening white Quitter came out , in a very small quantity . Whereupon the Decoction was not injected with the Seringe : his Cough left him , he slept well in the night , but the Feaver was somwhat higher than the day before .

On the 18th . I neither injected the Decoction , nor put a Tent into the Wound , but only Pledgits , with Betony Oyntment , and over it the Ceratum Barbarum . The Quitter inclined rather to green than white : he slept in the night , but quarrelled in his sleep , a sign of the abundance of bad humours in the Body .

On the 19. He sweat all the night , the Quitter was fomwhat green still : four hours before Dinner , he took an ounce and a half of Cassia newly extracted , dissolved in Broth , in which Succory , Borage , Burnet , and Speedwell , were boyled , which Purged him thrice , the excrements being very bilious ,

On the 20th . Half an ounce of Quitter came out . A Pipe of Tin was put into the Wound , made by Art , it being Dilated by the Tent , with a Spunge pressed out of Red Wine . The 20th . He could not sleep all the night , because the Pipe pressed upon the Ribs , and Membrane .

On the 21st , nothing came out of the Wound , yet the Pipe was put in as the day before . Then he took the Cassia dissolved in the former Broth , with pouder of Rubarb , black Mechoacan , and Crem of Tarter : he drunk no longer of the Vulnerary Decoction , but of broth made with some Herbs , as Succory , Borage , Sowthistle , Strawberry Leaves , and Peruinckle , the Wound in the Breast was healed up .

On the 22d , he took the same Broth again . On the 23d , the Vulnerary Decoction was once again Injected , and a little quitter came out ; which , because it was somewhat green , the Patient took the Purging Pouder again .

On the 26th , 27th , 28th , I did not Inject the Vulnerary Decoction , and bound up the Wound once a day ; after two days the Fever decreased .

On the 29th , the Patient took his Broth , the quitter white , and the Patient almost out of danger .

On the 36th , when I looked again upon the Wound , a great quantity of matter flowed out , and the Lips were swelled ; a sign that he had committed some error in his Diet ; and being asked , he confessed he had eaten of some Milk-dishes which were forbidden : from which , he abstained after that , and was in a short time very happily restored .

OBSERVATION XLIV . Of a Fistula in the Breast , Perforated with a Needle .

IN the Year 1630. an Officer of the Emperours being desperately Wounded , three fingers breadth below the right Clavicle , and almost cured at the sign of the Plough in Ulme ; upon some error committed in his Diet , was troubled with an Inflammation , which suppurated , and degenerated into a large hollowness under the skin : the bottome of which , descended as low as the eighth Rib ; so that neither the Chyrurgion , nor the Physitian could purge the matter out of this hollowness , unless they daily set the Patient upon his head , with his heells upward : but seeing that the Consolidating of this hollowness was delayed , and the Patient much disturbed every day , by the turning up his body , he commanded me to be sent for , being recommended to him by the Host of the House . Coming to him , and perceiving what it was I proposed the cutting open the hollowness , which useth to succeed very happily , being performed with the Scolopomachaerion ; but this Operation not being permitted ; I thought of a way , whereby , without laying open the hollowness , the matter might find a passage : therefore the Orifice being Dilated with Gentian , I put in an Instrument , Tab . XIV . Fig. V. to the sharp end of which , a little ball of Wax was fastened , and without the Patients knowledg , ( for he thought I was only searching the quality of the hollowness . ) I presently perforated the bottome , and drew out the Needle . The matter being evacuated by the passage opened , I put a Tent into the lower Wound , besmeared over with a whole Egg ; and to the upper , one dipped in Betony Oyntment , and putting on a Diapalma Plaster , and Linnen four times doubled , I bound up the whole breast with the Bandage of Sostratus , and afterwards kept open the Wound for some days , with a sharp hollow Tent made out of Linnen , covered over with the wax , till I consolidated the upper with the Ceratum Divinum , and cleansed the sides of the hollowness with Water and Honey , applying a new Spung pressed out of Red-wine , and with the Bandage that Galen calls the Breast-plate , in the last Table S. being straitly bound , it conglutinated , the hollowness growing together . I every day diminished the hollow Tent , and at last Cicatrized the Ulcer . This Operation doth best succeed when the hollowness hath not contracted any Callus , otherwise it doth not answer our desires .

OBSERVATION XLV . Of an Empyema in the Breast , Cured by opening it .

IN the Year 1645. Nicholas Rohler , Waterman and Citizen of Ulme , was wounded with a Bakers Knife upon his back , between the 4th , and 5th Rib , reckoning from above , and his Lungs hurt , so that the Patient presently , besides spitting of bloud , complained of a great difficulty of breathing , being sent for the first hour that he was hurt , I injected with the Seryinge an Astringent mixture into the Cavity of the Thorax , and kept the Wound open with a Tent ; for preserving his strength , and stopping the bloud . I prescribed an Electuary , ( whose Ingredients may be seen in Observation 41. ) and a slender Dyet . At my going away , I declared to the standers by , that the Patient would certainly die , unless there were very suddenly a new Wound made below the other , but they would not permit it . In the morning I proposed to the Patient , the Paracentesis of Hippocrates , who presently consented to it ; and by that means , not neglecting other Remedies , he was very happily recovered , and hath lived divers years since in very good health .

OBSERVATION XLVI .

IN the Year 1631. Valentine Dettelbacher , a Baker of Ulm● , at the Sun Inn , thrust a Knife into his own Breast , a little below the left Pap , but without hurting the Parts conta●●ed within . Whereupon I put in a Tent , covered over with the common As●●●ngent , and Linnen dipped in black rough Wine , and pressed out , and bound it up with the Bandage of Sostratus . Which being done , I gave him a Laxative Glister , and ordered bloud to be taken from his right Arm. Afterwards , the matter beeing evacuated , partly by the Wound , and partly by Urine ; I consolidated the Wound , by the help of inward , and outward Remedies formerly mentioned ; as Injections , Oyntments , Emulsions , and Vulnerary Decoctions .

OBSERVATION XLVII . Of a Wound on the Breast , penetrating through the Midriff , into the bottom o● the Stomach .

ON the 12th . of August , 1645. Melchior Frick a Fuller of Ulme , was Wounded by a certain Gardiner , not only in the Head , and Nose , of the Cure of which see , Tab . XXXII , and Observation XXII . But also in the Breast , five Fingers breadth below the left Pap . The Wound on the Head , and Nose , Elias Walther a Chyrurgion , did presently bind up with Astringents , And per●●iving a third Wound on the Breast , he ordered them to se●d for me ; being com● , and about to search the Wound made upon the Breast , I could by no means get into the Cavity of the Thorax : For the Wound was closed up , by reason that the Scituation of the Muscles was changed , which were Wounded . While I was searching the Wound , he Vomited up a great quantity of blood ▪ and fainted away ▪ so that he seemed rather to stand in need of Divine , than Humane assistance . This Vomiting did indicate to me , that the Stomach was Wounded ; and consequently the fleshy part of the Diaphragme , and that the ●●●●st was 〈◇〉 ▪ Whereupon making known the ●ange● to the ●●anders by , I p●● a Tent into the Wound , with th● 〈◇〉 A●●●●●●ent , and applyed the simple Liniment . I bound up the Thorax w●th the Bandage of Sostratus , Tab . XXXVIII . Fig. VI .. O● the second day , at five in the morning , the Patient Vomited again two measures of blood mixed with Wine ; and after that , all that he had taken down . It was therefore demanded ( seeing that the Wound of ehe Nose did not Penetrate into the Nostrils , so that the blood might run down through the Palate to the Throat , and into the Stomach . ) from whence that Vomiting of the blood and meat , should proceed . To which I answered , that although the Wound being closed did not admit of any passage into the Breast , discoverable by the Probe ; and that although there was no apparent Wound in the Belly , yet those Symptoms which hapned upon the Wounding of the B●●ast , did sufficiently prove , that the Sword did Penetrate into the S●omach through the Intercostal Muscles , and the fleshy part of the Midri●● ( and if the Nervous part had been Wounded , greater Symptoms would have afflicted the Patient . ) That the Pleura was Perfo●ated , was evident from the Flux of blood inward into the hollow part of the Breast , and from the cleanness of his Shirt : for if the Breast had not been Perforated , he would without doubt , have ble● out●ardly , which must have tinctured his Shirt of a very red colour : neither doth it make any thing against this Conjecture , that the Patient ●●ver complained of any streightness of his Breast , or cough : for the blood which might cause Symptoms , passed through the Wou●d of the Midriff , into the Cavity of the Belly , where being di●●sted , it strove to find a passage by siege . The Wound of the Sto●●ch was indicated , by the Vomiting of blood , and what was taken 〈◇〉 by the loss of Appetite , and pain about that Region . For th●●e ●●●sons I took greatest care of the Stomach , not neglecting the other ●ounds , and gave him often in small quantity Consolidating Drink , and Medicines ; least by two great a quantity his Stomach might be di●●●nded , and Vomiting provoked . I kept up his strength , with two G●i●●e●s every day , made of fat flesh Broth , and the yolk of an ●gg● 〈…〉 was Pomgranate-Wine , and his Medicine , old conserve of 〈◇〉 , mixed with Pouder of Mastick .

Take of Old Conserve of red Roses four ounces . Choice ●●stick in fine Pouder half an oun●● ▪ ●●r●p o● Comfrey as much as sufficeth . Mak● the●●y in●o an Electuary .

Of which he ●ook the ●●antity of a Walki●● , ●●o●●ng , and ●●●●ing , I anointed the outward region of the Stomach , with Astringent Oyl● .

Take of Oyl of Roses , Oyl of Mastick , Oyl of Quinces , of each half an ounce . Oyl of Worm-wood three drams . Mix them .

And cured the Wound in the Breast as a simple Wound .

On the 7th . day , the Patient had a stool of Purulent matter ▪

On the 8th . the Wound on the Breast was consolidated .

On the 14th . and afterwards the Patient drank Consolidating Liquots , and kept them without pain .

OBSERVATION XLVIII . Of a Fistula in the Breast , Cured by Corrosives .

IN the Year 1643. John Jacob Welf , a young man of Heilbr●● , had a hard Swelling on the right side of his Breast ; which coming to suppuration , and being ill cured , degenerated into a Fistula , which the Chyrurgions of Heilbrun left as desperate . The Patient coming to Ulme , desired my advise and help , which I promised ▪ and after Generals , for discovering of the quality of the Fistula , I dilated the narrow Orifice with the Pith of Elder strongly wreathed , till it would admit of the round Probe ; Tab . VIII . Fig. VI . wherewith I felt the Bone rough . To consume the hardness of the Fistula , I put in a Style , dipped in this following Oyntment .

Take of Henbane-seeds poudered one scruple . Burnt Alum , Burnt Vitriol , of each half a dram . Butter washed in Plantain-water , as much as sufficeth ▪ Mix and make them into an Oyntment .

The Callus being extirpated , I put a Tent into the Fistula : the ●op of which ▪ being moystned in the Decoctum Divinum , I sprinkled over with Euphorbium poudered : the rest of it I covered with this Oyntment .

Take of Betony Oyntment one ounce . Aegyntiacum half an ounce . Mix ,

And make them into an Oyntment , hindring the breeding of any Callous substance . Af●er two months the Rib threw off Scales , which being taken out , I diminished the Tent every day dipped only in Betony Oyntment , till the Ulcer being incarnated , it was requisite to Cicatrize it with the Ceratum Divinum ; with these outward Medicines , and a purging Wine , the Patient recovered his former health , and left Ulme .

OBSERVATION XLIX . Of a Wound on the Breast Dilated with the Knife .

ON the 22th . of November , John George Costnitzer a Cloak-bag-maker of Ulme received a Wound on the left-side of his Breast , between the sixth and seventh Rib , without hurting of the inward parts , but so narrow that a Tent could not be put in . Being sent for , I pr●sently Dilated the Wound with a Knife , Tab . XII . Fig I. or Tab . XXXVII . Fig. V. E. whereby blood slipped into the Cavity , and causing the streightness of the Breast may be conveniently evacuated : as much blood being evacuated as his strength would bear , I put a Tent into the Wound , made of raw Flax , dipped in a Medicine , to stop the blood , and fastned to a long Thread : after a laxative Glister , a Chyrurgion took away blood from him , out of the Median Vein of the left arm . The following days , morning , and evening , I unbound the Wound ; and letting out a convenient quantity of blood , I put in a Tent , dipped in the former Digestive : till all being evacuated , the Wound digested good matter . Afterw●rds I put in a little hollow Pipe , made of Linnen , covered over with Wax , and anointed with a Sarcotick , which I made every day l●ss●r , and shorter , than other , till the Wound being filled up with Flesh , it was sit to be Cicatrized with the Ceratum Divinum .

OBSERVATION L. Of another Wound on the Breast , Dilated with the Knife .

ON the 5th . of December , Adam N. a Barber , came to me , and told me , that the most Reverend Mr. Snitzer , Parish Priest , in the Vilage of Eingen ; the day before , about Supper-time , had been Wounded by a Souldier of the Emperors , with two Wounds ; of which , one was on the right-side of the lower Jaw : the other on the Back , near the Back-bone , between the third and fourth Rib , ( in that place in which Hippocrates used to make , the Paracentesis ) of the right-side , Penetrating into the Cavity , as far as the uppermost Rib of the same side , a little lower , than where the Clavicle is connected to the top of the Sternon , Wounding the Lungs , and the intercostal Vessels . Upon which , these Symptoms followed , great faintness , difficulty of breathing , cold sweats , and very great pains about the Breast . The wound in the Back , a Barber dressed with a Tent , dipped in the white of an Egg. putting in only an Ear-Spoon , between the fleshy Membrane and the Muscle ; and applying the Stictick Plaster of Crollius . The Wound in the lower Jaw was simple , but the difficulty of breathing was very troublesome ; and the pains very great on the Breast , both before , and behind ; by reason that the intercostal Vessels were Wounded . I searched the Wound which was narrow , with a blunt Probe , and went into the cavity of the Thorax : a sign there was great quantity of blood collected therein .

Whereupon I presently cast in this following mixture , with a Syringe , into the Cavity of the Breast , to stop the blood .

Take of The Astringent Pouder of Galen one dram . Chrysolite prepared one scruple . Four whites of Eggs. Plantain-water , as much as sufficeth . Mix them for an injection .

And put a Tent into the Wound , to keep it open , done over with a thick Astringent ; and over it applyed Linnen pressed out in Red Wine , and the Bandage of Sostratus , Tab . XXXVIII . Fig. VI . to keep in the Tent , and hinder inflamation ,

For the stopping the blood , and keeping up his strength , this Confection .

Take of Conserve of Comfrey six drams . Old Conserve of Roses one ounce . Trochies of Sealed Earth . Trochies , of Amber , of each a scruple . Bole-Armenick prepared , two scruples . Prepared Pearl half a scruple . Tablets of Sugar of Roses , and Syrup of Pomgranates , as much as sufficeth . Mix them , and let the Patient take often of it in a day .

For his thirst I prescribed a cooling , and Astringent Julep .

Take of Syrup of Pomgranates , Syrup of Myrtles , of each an ounce and half . Speedwel-water , Plantain-water , Self-heal-water , Succory-water , of each three ounces . The Species of Diarnargariton ●rigidum half a dram . Mix them .

In the Afternoon , he took some Grains of the Opia●e L●●●●●●um , with the Magisteries ; which caused him to sleep our hours quietly . On the third , the Patient took for a pain in his Belly this An●●int , and Laxative Glister .

Take of The Roots of Marsh-mallows , Setfoyl , of each half an ounce . The Leaves of Mallows , Agrimony , Speedwel , Violets , Flowers of Camomile , of each an hand Seeds of Flax , Fenugreek , of each four drams . Annis , Fennil , of each a dram and half ▪ Raisons half an ounce ▪

●oyl them in a convenient quantity of Fountain water to 〈◇〉 ounces , add to it being streyned out , Solutive hony of Res●● 〈◇〉 o●●●● , Oyl of Violets two drams and a half . Mix them , for a Glister .

With this he voyded twice bilious and serous matter . After the ●●●ing away of the Glyster , the liver vein was opened on that side he was hurt , and four ounces of blood taken away . At 3. of ●●e Clock in the Afternoon , I took out the tent , but nothing came out by reason of the narrowness of the wound , which I dilated with the incision knife , Tab . XXXVII . Fig. V. So that the matter collected i● th● Th●●●x found a free passage . After the dilating the wound in pint ●f ●l●●d flowed out , so hot , that it burnt the Patient more a coming out , than if it had been a lighted Candle . A pint of blood ●●ing taken out ; I injected in a mixture to stop the bleeding veins , ●●d ●●t●ry● : and put into the Wound a tent , tyed to a thread ; and 〈◇〉 ov●r with a convenient Medicine ; for miti●●●●●● 〈◇〉 of ●is breast I ordered this oyntment .

T●●e of The Pectoral Oyntment , one ounce . Oyl of sweet Almonds . Oyl of Camomile . Oyl of Earth-worms of each a dram and half . M●●●hem ,

On ●he 4th . day . By reason of the bloud contained in the T●●●●● ▪ the ●eaver was greater than the days before ; Loosening the banda●● of Sostratus ; and taking out the tent , a pint of blood came out ; and at seven of the Clock at night , a pint and a half more , about ten 〈◇〉 night , he took this following Emulsion , upon which he slept again three hours .

Take of Melon seeds , one ounce . Lettice seeds , White poppy seeds , of each a ●●●●ple . Strawberry water , Burnet water . Speedwell water , of each four ounces .

Make an Emulsion , to which add half a dram of the S●●●●●● o● Di●●●gariton Frigidum , and two ounces of Syrup of Viole●● .

Mix them for two doses .

●or his difficulty of breathing , and pain of the breast ( which was ●●●●●d by the great loss of Blood ) he often took a spoonful of this fol●owing mixture .

Take of Speedwel water , three ounces . Burnet water , Succory Water Plantain water . Black-Cherry water , of each half an ounce . Bezoar stone , eight grains . Lapis Haematitis or blood-stone , half a scruple Sealed earth , one Scruple Red Corall . Magistery of Pearl , of each half a scruple . Pearl tablets half an ounce . Mix them , and put them into a glass .

On the 5th day , the wound being unbound a pint and a half of blood flowed out again , his breathing was more free than the days before : therefore I prescribed this vulnerary Decoction .

Take of - Whole barly half a pugill , The leaves of Strawberies . Peruinkle . Bugle . Burnet . Speedwell . Succory . Folesfoot . Mouse-ear . Vervain . Horse-tail , of each half a handful . Madder roots . Tormentill rootes , of each half an ounce . Liquorice , a dram . Fountain water six pints . White-wine two pintss

Boyl them half away , and in the end , add to ounces and a half of hony of Roses streyned . Streyn it out , and take four ounces every morning , at seven of the Clock , and three ounces at four in the Afternoon ; his drink was Barly water boyled with the Vulnerary herbs . On the 7th . he was somwhat better and a pint of blood flowed out . In the evening for a pain about his navel , the Glyster above described was injected , I covered over the tent to be put into the Wound , with this digestive ,

Take of Turpentine washed in Plantain Water a dram and a half . Oyl of earth Worms one dram , The yolk of an Egge . Mix them , into the form of a Liniment .

On the 7th . day , his pulse was equal and both in the Morning , and Afternoon , nine ounces of Matter and bloud mixed together , came out .

On the 8th . day , a Pint of pure Matter came away : the Patient complained of a Cough , for which I precribed this Lohoch .

Take of , The Lohoch of Fox Lungs . The sound , and well experimented Lohoch of each six drams . Syrup of Folesfoot Syrup of Red Roses , and Syrup of speedwell , of each an ounce . Syrup of Hysop , half an ounce . Pouder of Hysop , an ounce and an half . Flower of Brimstone , two scuples . Trochies of Spodium , half a dram . Mix them , to be taken with a Liquorish stick .

In the mean time for the stinking of the matter , Injections of the decoction of Scordium , Barly , and hony of Roses Streyned , were not neglected , On the 10th a Pint of digested matter came out of the cavity of the Breast , and the Patient was better than the day before . On the 11th . half a Pint of very good digested matter came out of the Wound . with some pieces of the lungs , in which some branches of the Aspera Arteria were distinctly to be seen .

On the 12th . and 13th . The matter which came out was digested , the Patent for a Cough , and bitterness in his mouth , took this following Bolus two hours before Dinner .

Take of Cassia newly drawn one ounce ▪ Speciers Diamargariton Frig . half a Scruple . Fro●●●●● of ●ugatick two Scrupl●● , Rubarb one dram . Make it into a Bolus with sug●● .

Th●● g●ve him three or four stooles . On the 14th . He w●● be●●●● than the daye before . On the 15th . Four ounces of stinking 〈◇〉 f●owed out ; and therefore , I washed the Cavity of the Thorax 〈◇〉 the former injection . On the 16th . It came out in a lesser quanti●●●●d the stink was not so great , On the 17th . The Urine ceased to 〈◇〉 bilious , the Patient complaining of a Cough I ordered him 〈◇〉 Lambitive .

Take of Comfty root● boyled , bruised , and passed th●ough a five ; two ounces , The Species of Diat●agacanium Frigidum . Juice of Liquorice . Penidice of each four drams . Syrup of Liquorice . Syrup of Violets of each as much as sufficeth .

M●x them . On the 18th . The Cough and stink abated ▪ so th●● the injection came out unaltred . On the 19th . The Patient ●as Letter , the Urine also was good . On the 30th . The Patient co●plained of a pain of the wound , and looking into it , I found the pipe thrust out , by very good flesh ; for that reason therefore and because there came out no more matter , I removed the pipe and put in a tent dipped in Betony Oyntment , and injected twice a day of the following decoction to consolidate and strengt●●●● the in●ard pa●●● .

T●●● o● Whole Barly half a Comfry roots . Setfoil roots of e●●● Of these herbs , Speedwell , Burnet . Mouse-car . Ladies-mantle . Saracens Con●o●● Hugle . Vervain ▪ Horseta●l . Peruincle , S●●●●beries ▪ Scordium of each half a handfull . The seeds of Succory half an ounce . Fountain-water six pints . White-wine one pint . Boyl away a third part , and in the end add . Hony of Roses streined , an ounce and half . Mix them for an injection ..

On the ●6th . The wound was consolidated , and the pa●●●●●tered to his former health , went abroad .

OBSERVATION LI . Of the happy Cure of an Empye●● , by Diur●●icks .

ON St. John Baptists day the 24th . of June , 1638. At seven in the evening , Captain Musc●que having Drunk h●●d , was Wounded in a Duel , by Mr. Gr●e●● , a Commissary , upon the right Pectoral Muscle , two Fingers breadth below the C●avicle . The Wound Penetrating ( through the Cephalick and Breast-vein ) into the Cavity of the Thorax , with great loss of blood , Swounding● ▪ Convulsion , Snorting , cold Sweats , no Rulfe ; and that particular Convulsion of the Muscles on both sides of the Mouth , called the Surd●nian Laughter ; and so he lay for above half an hour , without sense , or motion . In which dangerous Case , by reason of the forementioned Symptoms , I could do no less , than tell his dear Wife and Daughter , that these were the forerunners of death . And the 9th . Aphorism of the seventh Section of Hippocrates came into my mind , loss of the understanding , or Convulsions after bleeding a●● d●ngerous a yet I ordered these remedies .

Take of Black-Cherry-water four ounces . The Anhalt Cephalick Spirit one dra● . Bezoar Stone one scruple . Red Corral prepared half a dram . Crysolite prepared one scruple . Pearl Sugar half an ounce Mix them .

For Rev●lsion sake , I caused a sharp Suppository to be ●ut up , and applyed to the Nostrils and Pulse , the sweet sm●lling 〈…〉 ●sius , and Rue Vinegar . I bound up the Wou●d with 〈…〉 Flax dipped in the white of an Egg , and spri●●●l●● over 〈…〉 stringent Pouder , and Linnen pressed out in Red Wi●e , an● 〈…〉 Bandage for the Clavicle ; and being so bound up , he pa●●● 〈◇〉 whole night quietly , and slept out his Drunkenness . The n●●●●●y for a streightness on the right side , and pain about the Region of the Diaphragme , the Median Vein on the same side was opened , and four ounces of blood let out : in the evening for a sharpness of Urine , he took half this Emulsion .

Take of Melon-seeds an ounce . Burnet-water , Strawberry-water , Speedwel-water , of each two ounces and a half . Black-Cherry-water two ounces . Red Corral prepared half a dram . Pearl prepared a scruple and a half . Chrysolite prepared ten Grains . Sugar-candy , and Syrup of Violets , of each an ounce . Mix them for an Emulsion .

I put a Tent into the Wound , covered with a Digestive , which was made of the yolk of an Egg , and Turpentine washed in Rose-water , sprinkled over with prepared Crysolite , and over that a Bolster , pressed out hot in Red Wine , and the Bandage of Galen . On the third day he took this following Glister .

Take of The Leaves of Mallows , Violets , Pelitory of the Wall , Speedwel , Flowers of Camomile . Mallows , of each half a handful . Flax-seed half an ounce . Melon-seeds , Citron-seeds of each three drams .

Boyl them in a sufficient quantity of Water to eight ounces ; and add to it being streined out , Hony of Violets two ounces . Lenitive Electuary one ounce . Oyl of Violets , Oyl of Camomile , of each an ounce and half . Mix them for a Glister .

From this he had four stools . I dressed the Wound , by reason of a Flux of blood , with prepared Chrysolite , and the Astringent Pou . der of Galen , in the white of an Egg , by reason of faintness , the Patient took often in a day , a few Grains of the Confection of Alkermes , which did relieve him .

In the evening after the taking of his Emulsion , he complained of heat of Urine , and looking upon it in a Glass , I found Purulent matter at the bottom . The pain and heaviness about the Liver , and Midriff , ceased , and he slept quietly all the night . On the 4th . The Feaver abating , and the matter in the Cavity of the Thorax tending towards the Passages of Urine . I thought it expedient to prescribe this Vulnerary Decoction .

Take of The Ashes of Crevis a handful and a half . Burnet , Peruinkle , Speedwel , of each two handfuls . Strawberry-water one Pint . Small Wine seven Pints .

Boyl away the third part , and add in the end two ounces of Hony of Roses streined .

This Decoction was mixed morning and evening , with the Emulsion ; which did wonderfully derive the blood in the hollow part of the Breast , to the Passages of Urine . Out of the Wound there flowed clotted blood ; and I injected into the Cavity of the Breast with a Syringe , the Astringent and healing Decoction , descirbed in the 50th . Observation .

Then I put into the Wound , a Pipe made of Linnen , and yellow Wax ; and over it the Cerate of Diapalma , and a Spunge filled with Red Wine , pressed out , and the Bandage . On the 5th . and 6th . The Patient was better again ; But on the 7th . he slept not , and complained of a pain of the Wound , and of all that side , looking upon the Wound , the Pipe , or hollow Tent made of waxed Linnen , was out of the Wound : so that the matter contained in the Breast , caused pain , and found no passage ; but the matter being evacuated , the pain decreased The Patient complained of a bitterness in his Mouth : for which I prescribed this Syrup .

Take of The best Ma●aan ounce and half ▪ Extract of Rubarb one dram . Crem of Tartar two scruples . ●peedwel-water , as much as sufficeth , Mix them into a Liquid Syrup .

With this he voided thrice bilious matter : in the evening , when the pains about the Wound , the Liver , and Midriff , remitted ; we lookt upon , and felt the lower Belly , which was distended with Wind ; and therefore he made use of the former Glister , which agreed well with him , and he slept the whole night accordingly . On the 8th . The Urine was troubled , and like to that , of those who have Catarrs : from whence it seemed that the pain the day before , ●ook its original from the Head , rather than from the Wound . On the 9th . He used the Emulsion , with the Vulnerary Decoction : the Wound was dressed as the days before ; only that the Tent was covered with the former Digestive , sprinkled over with the Pouder of Aloe , Frankincense , and Chrysolite , a Vulnerary Decoction , being first injected . On the 10th . 11th . 12th . and 13th . He went on very well . On the 15th . His Urine was clear , and he rested well all the night : good white matter came out of the Wound ; and therefore I drew out the Pipe , or Tent , made of waxed Linnen , dressed it with Betony Oyntment , and put in again . On the 16th . He rose up , and walked about a little , and some white digested matter came out of the Wound . In the evening he made use of a Vulnerary Decoction , and an Emulsion of Melon-seeds . On the 17th . and 1●th . He went on well , and little or no matter came out of the Wound : Therefore I took out the Tent , and applied Lint , and the ●●●ace of Diapalma , and a new Spunge pressed out in Red Wine . On the 2●th . and 22d . I Cicatrized the Wound .

OBSERVATION ●II . Of an Ulcer a●d Cancer , of the Brest c●● off w●● the Knife .

THE most Religious Lady , Anno Sibylla , Abbess , of U●●●●g about 47. years of Age , of a hot , and somwhat dry tempe●●ment , five years since began to be troubled with a suppression of those , upon which there arose , a hard black painful swelling up●● her left Breast ; so that she was forced to desire the help of a Barb●●● who not understanding the cause , endeavoured to dissolve the ha●●ness with moistning and softning medicines ; by which means he w●● so farr from doing her any good , that he rather praecipitated the miserable Lady into a greater calamity ; and Sennertus affirms that ● Cancer by Emollients is exasperated . And seeing the tumour ga●● not way , The Barber proposed the cutting of it out ; and while ●e was cutting , seeing the blood flow out of the breast , he ran aw●y more fearful than a hare , and left the Abbess all bloody and almo●● dead ; so that the sisters of the monastery , were forced to stop the blood as well as they could , and keep up her Spirits with Cordiall waters . Upon this incision the whole breast began to be ulcerated and to swell into a prodigious bigness ; with a smell as if vinigar and flesh were mingled together , by reason of the nearness to her heart , her feaver was high , her pain extreme ; which she could not ●●●ler any longer , but came to S●ffling , and sent for me , and the ●●st eminent Dr. Johannes Regulus Vellinger , my most honoured relation , and desired our advice , and help . Upon our first visit and looking upon it ; from the smell , the humour , and orginal , we judged it to be a Cancer , and that it could not be otherwise cured , than by cutting off the whole breast . And gave the Abbess notice of it , encouraging her to sustain it resolutely , hoping for a certain cure ( seeing that it had not taken too deep root ; and the time os having her terms was now past with her . )

Upon her consenting to it I washed the ulcerated breast with the divine Decoction , by reason of its great stinking , putrefaction , and ●●●n ; ond sprinkled upon it a pouder made of burnt Alume , prepa●●● Tury , Chrystolite , and Scordium , and over in the Ceratum 〈…〉 the simple linim●●t● .

Take of The ceratum Oxelaeum L●●●mentum simplex , of each an ounce . Oyl of Myrtles two drams . Mix them , in a leaden morter .

The description of the Linimentum simplex .

Take of The juice of Nightshade newly pressed out . Oyl of Roses , of each twenty ounces . Boyl them according to Art till the juice be Boyled away , and add to it streyned out , Litharge of Gold . Ceruss , of each a pound . Mix them , according to Art into the form of a Liniment .

The Cerate of Oxelaeum is thus prepared .

Take of Common old Oyl one pound . Sharp Wine Vinegar , Litharge of Gold , of each half a pound . Mix them upon a gentle Fire , till they come to the consistence of a Cerate

We prescribed a Laxative Wine of ingredients , to bring away Water , and Gall : with which at several times , the bad humours were Purged out . Then the Median Vein was opened in her left Arm , and a small quantity of blood taken out , that we might see of what quality , or consistence it was ; which we found watery , and half putrified , without a due concretion of Fibres ; and therefore she made use of an Electuary of Trochies of Vipers .

Take of Conserve of Borage an ounce and half . Trochies of Vipers half an ounce . Syrup of Corral as much as sufficeth Mix them .

So that the serous and malignant matter being brought from the Center to the circumference , the Patient grew better upon the diligent use of these remedies ; and the ill smell and corruption ceased . Her Body being thus prepared and Purged ; the Lady Abbess did earnestly desire her Breast might be cut off ; and least that by any longer delay , the Ulcer might spread inwardly . Upon the 25th . of June , 1641. I prepared all things necessary for the Operation , and the next day appointed it to be cut off : giving the Patient a draught of Cordial Waters , Cinamon , and Alkermes , we went about the work ; and although in cutting off the whole Breast , a long sharp two-edged Needle should be made use of , carrying two Threads , to be passed through the bottom of the Breast ; and then the Threads on both sides to be tyed strongly together : and if that be not sufficient , another Needle to be passed through , and the Threads tyed in the like manner , as is plain to be seen in , Tab . XXXIIX . Fig. I. Yet to avoid this great pain which ariseth from this double passing of the Needle ; and understanding the Anatomy of the Part . I invented a new Ligature with divers heads : with which , without the passing of the Needles , having marked out the circumference of the Tumour with Ink , at once drawing ( least that might happen to me , which afterwards in the 54th . Observation you will hear hapned to the Cutter for the Stone ) I took off the Breast , with a very sharp Knife , from the Pectoral Muscle , Root and all ▪ and did not presently stop the blood ; but after that all the black and burnt blood , had flowed out of the Neighbouring Veins , and Arteries : only to strengthen the Part , I lightly touched it with a red-hot Iron ; and then applyed the Astringent Pouder of Galen , and prepared Chrysolite , made up with the white of an Egg shaked together , and spread upon Lint , and the Bandage which Galen , and other Greek Authors , Name the Cataphracta , or Breast-plate . On the 27th . of June , the blood being stopped , I did not apply any Digestive , by reason of the moistness of the Part , but the Ceratum Divinum . On the 28th . she had no pain , nor any sign of inflamation ; yet upon the 29th . she took a draught of Purging Wine ; and on the 30th . part of the Electuary of Vipers , to dissipate , and carry off the Reliques of the bad humours . On the 30th . of June , she was brought to Ulme : where she went on very well , till the 4th . of August , and complained of no bad Symptoms . On the 6th . I observed some white Caruncles ; and asked the Lady if she had not committed s●me faul● in her Dyet ? She answered , that upon the perswasion of the Hous keeper , she had taken a draught of Wine , which was prohibited . On the ●8th . Her Voice was hoarse ; and presently that of Hippocrates came into my mind , in his Book of the Glandules : That those , w●o by a Dis ase , or any other Calamity , have their Breast taken away , their Voice is harsh , and rough . On the 9th . Being bound , she made use again of the Purging Wine , mixed with Manna . On the 13th . For diversion-sake , she Knit Cotton Gloves ; and upon the continual motion of her Arms , an Herpes Miliaris , seased upon the lower part of her Breast . Upon which this sort of exercise was forbidden , and the Patient took Purging Wine , that the bilious , and sharp matter , might be brought from the Circumference , to the Center ; and that way carried out of the Body . On the 14th . of August , least these sharp humours might fall upon any of the Principal Parts of the Body . I ordered an Issue to be made for revulsion sake , in her left Leg above the Knee , and one in the right Arm. On the 16th . By reason of the great heat of the weather , and the itching of the Herpes , there came forth a fleshy excrescence : she took this Syrup .

Take of Syrup of Roses , two ounces . Extract of Rubarb , three scruples and a half . Diacarthamum , two scruples . Crem of Tartar , one scruple . Succory water as much as sufficeth to make it into a liquid Syrup .

This gave her nine Stools , and brought away plenty of gall : I applyed to the fleshy excrescence , a powder made of four scruples of Roche Alume , and a dram of Tuty , and Chrysolite , upon Lint ; and to the Herpes , by reason of it 's great itching , after fomenting it with the decocti●n of Mallow● in fair Water : the Ceratum Citrinum ; by the use of which remedies , the excrescence was consumed and the Herpes , with all the itching , vanished . On the 7th . of September both the i●sues performed their office . From the 9th to the 15th . she to k the Aloe Pills of Hie● . Fabrit . ab Aquapendente for a pain of ●er hea● , and being bound : and afterwards was in very good health , and the part effected was cicatrized . On the 28th . of September , a vein was opened to see what manner of blood she had ; which was very good , and red without any corruption , On the 6th . of October , she left Ulme in very good health , and very joyful .

OBSERVATION LIII . Of a Wound in the groin , and yard , made by a Bullet , Cured .

IN the month of July 1633. N. N. a Cornet of Horse was wounded in a fight , with a Pistol Bullet in the right thigh near to the groin , in the passage of Urine , and in the left thigh ; for the Bullet perforating at the root of the yard , ran along the Urinary passage and hurt , the left thigh also . Being sent for on the third day , and the Patient complaining of the laceration of the passage of Urine , of the inflammation of the yard , and of a Priapism , for fear of a gangraene I ordered him a lenitive Glyster ▪ and a spare diet . ( which doth much avail in preventing and curing all inflamations ) Into the Wound on the right side of the groin , in the Yard , and in the left thigh , I injected , through a siphon , Oyl of Violets seven times washed in Carduus water , and water of Mallows ; mixed with a small quantity of hony of Roses streined : and put in Tents dressed with the same Medicine ; and applyed over it , the Linimentum simplex , and a Cataplasm , made of Barly Meal , Bean Meal , Crums of bread , simple oxymel , oyl of Roses , and oyl of Violets ; and bound up the wounded parts with a convenient bandage ,

On the 4th . day , for a great inflammation of the yard , and a Feaver , the liver vein of the right Arm , was opened , and six ounces of Blood let out . On the same day , in the afternoon , the Saphena , of the right foot , was opened , and five ounces of Blood taken away . At night for a great pain in the Yard , and almost a suppression of thine , he used this Emulsion .

Take of Melon Seeds , six drams , Lettice seeds . Poppy seeds , of each one dram . Seeds of the Chaste Tree , two scruples . Water-Lilly Water . Strawberry water . Sorrel water , of each three ounces . Make an Emulsion , to which add an ounce and a half of Syrup of Violets . Mix them .

The 5th . day , he complained of a very great pain upon making water ; and an eschar began to separate in the Urinary passage , and in the other wounds : therefore I cast in this mixture with the siphon .

Take of Rose water . Mallow water . Carduus water , of each two ounces . Bole-Armonick prepared . Burnt Harts-horn , of each a dram . Chrysolite prepared ( for the stopping of the Blo●d ) half a dram . Oyl of Violets one ounce . Mix them .

Into the wound of the Urinary passage , instead of a tent , I put through the orifice of the Glans , a Golden Catheter . Tab . XII . Fig. XVI . daubed over With the Linimentum simplex : I applyed to the groin , being anointed with Oyl of Roses , fat wool ; and ordered the loyns to be anointed with this oyntment .

Take of The cooling oyntment of Galen , two ounces . The oyntment of the Countess , half an ounce . Oyl of Roses , two drams . Mix them .

On the 6th . by reason of an obstruction of the Urinary passage , from part of the Eschar , the Patient could not make water through the Yard , therefore I took hold of it with the tee●h of my pincers and extracted it . On the 7th . the pain abated , and the Patient was somwhat better than the days before . On the eighth the Patient drank Wine , and played with the Maids . At night he complained of a Priapism , and inflaming pain of the Yard : for which , and for bleeding , he made use of his Glyster , and Emulsion . I anointed his reins with the astringent Oyntment , cast in a Mixture into the Yard ; and put the pipe before mentioned covered with linnen and the linimentum simplex , into the passage of Urine . After the injection , I applyed oyl of Violets , and oyl of Roses , to the Wound of the thigh and groin . On the 9th . the inflammation continuing the saphena of the left foot was opened again , and all Medicines were applyed as the day before , On the 10th . the patient was better and the Eschar being taken away I injected , with the siphon , this following liquor into the passage of the Urine ,

Take of Plantain-water , Self-heal-water , Rose-water , Carduus-water , of each an ounce . Prepared Tuty two drams . Lapis Haematatis one scruple Bole-Armenick prepared half a dram . Mix them .

I dressed the Wound in the Thigh and Groin , with Digestives , Mundificatives , Sarcoticks , and Epuloticks . He passed the 11th . day without any pain , or trouble . On the 12th . being bound , he took Bolus's .

Take of Cassia newly drawn one ounce , Manna two drams , Pouder of Liquirice one ounce . White Sugar as much as sufficeth to make them up .

These gave him four Stools . On the 13th . For the Gonorrhea , I prescribed this confection .

Take of Conserve of Mallows , Violets , And Succory-flowers , of each an ounce . Seeds of the chaste Tree a dram and half . Letice-seeds one dram White Poppy-seeds four scruples . Syrup of Poppies as much as sufficeth to make it up .

Of which he took morning and evening , before the Emulsion , the bigness of a Chesnut . On the 14th . A thick slimy matter obstructed the Yard , near to the Glans , so that the Urine came out at the Wound in the Groin : therefore I pulled out the tough matter with the Pincers ; and after the injection of the Liquor last prescribed , I put in the Pipe , dipped in the Linimentum Simplex , and bound it in with a Thread , least it should fall out . On the 15th . 16th . 17th . 18th . and 19th . He received much benefit from his Medicines ; and white , soft , equal matter came out of the Wounds , in small quantity . Upon which , red Flesh began to grow . On the 22th . and 23. instead of the Pipe , Tab . XII . Fig. XVI . I daubed over a Wax Candle with the Ceratum Divinum ; and , putting it in , consolidated the Urinary Passage . In the time his Dyet was of Meat not hard of digestion , and made use of the cooling Emulsion . On the 27th . The Urinary Passage was consolidated , and the outward Wounds of the Thigh , and Groin , were Skinned .

OBSERVATION LIV . Of a Cancer in the Breast , ill cut off .

ON the 9th of December , 1643. By order of the Senate , I went with George Riedlin , and John George Bauler , Chyrurgions , to visit the Wife of Matthew N. who having a great pain on the left Arm , told us that N. N. a Lithotomist , in the third week after she was brought to Bed , without any preparation , or evacuation , cut with a Ra●o● , a hidden Cancer out of her left Breast : in the presence of a certain Ph●●●cian of Ulme , and left two large Tumours , under the Arm-Pit , to be dissolved by outward Medicines . After twelve days the Chyrurgion applied a Caustick , made of Arsenick , to the former of them , which not quite eat it out ; but caused such pains , that the humours coming to it fr●m al parts , the Arm was distended strangely . Things being thus , I signified to her Husband , and the standers by , that she should not be recovered , either by Medicines , or by Instruments ; but would certainly perish , those Tumours being left ; which hapned in a short time : for her strength failing upon those Pains , would not admit of Purging , nor could the pain be mitigated , by any Anodine Medicine . Both the Physitian therefore , and the Lithotomist did ill . First that they went about the Cure of a Cancer in the time of her Lying Inn , when they could not Purge the Body of melancholly humours . Secondly in that they did not totally extirpate it ( being ignorant of Hippocrates his thirteenth Aphorism of the second Section ; What is left of Diseases causeth Relapses ; but rather exasperated it with dangerous Arsenick , the Purgations of the Womb being diverted ; and thirdly that they did not commit the care of it to Persons skilful in Anatomy ( who after general remedies could have cut out Tumours , which are not deeply rooted without hurting the Vessels , or fear of a Relaps ; or else would have excused themselves with the 38th . Aphorism of Hippocrates in the 6th . Section : Who are troubled with hidden Cancers it is better not to heal them , for being healed they dye the sooner , and not being healed , they Spin out their Life the longer .

OBSERVATION LV . Of a small hidden Cancer in the Breast , discussed with Medicines .

IN the Month of September , 1634. Barbara Heylerin a Country-woman of Bermaringen , shewed me a Tumour in her left Breast , caus●d by the suppression of her Courses : which seemed not capable of being extirpated by any remedies , but only by the Knife : for it had all the signs of the Cancer ; as hardness , a sharp pain , roundness , inequality , black and blew , heat , and a Protuberance of black Vessels . The Patient refused to have it cut out ; and Amatus Lusitanus will not have a Cancer touched with any outward Medicines : yet because I had known some , who by the use of choice remedies , had been delivered from hidden Cancers , I prescribed the Patient this to Purge melancholly .

Take of The Confection of Hamech six drams . Extract of black Hellebore one scruple . Crem of Tartar , half a scruple . The Decoction of the Flowers and fruits as much as sufficeth . Mix them .

Begining to have pains in her Back , I ordered six ounces of blood to be taken out of the Saphena of the left foot . And this done , I Purged her Body , being as it were , Tinctured with black humours , with the Magistral Decoction in the last Table , Let . E. And after exact Purging , I applied to her Brest , the Cerate of Johannes Praevotius .

Take of Millet-Meal two ounces . Oyl of Roses stirred up in a Leaden Morter three ounce● . Pouder of Crude Lead half an ounce . Golden Rod , Sow-Thistle , and Night shade Poudered , of each two drams . New Wax two ounces six drams . Pine Rozin ten drams . Mix them and make a Cerate .

Which in three Months space did insensibly dissolve the Tumour : in the mean time , seeing that her Courses , which had been stopped for two years , could not be brought down by remedies : I made her an Iss●● on the inward part of each Thigh ; to the end that the offending matter might be brought down to the lower parts ; and kept them ope● a year , least the humours should gather together again , and offend some other Part . The next year thinking her self to be very well , she unhapily healed up the Issues ; and began ●o complain again of the Tumour on her right Breast ; which being taken out with Instruments , she repeated the use of the Decoction , and renewed the Issues ; which I ordered her to keep it open as long as she lived , but whether she doth I know not .

OBSERVATION LVI . Of the pains of a Cancer mitigated .

THE Wife of Peter Hielbronner , had a small hidden Cancer in her right Breast , and a great Ulcerated one in the left . The hidden one after the use of the Magistral Decoction , was diminished with the Ceratum Oxelaeum stirred up in a Leaden Morter ; and the sharp pains of the Ulcerated Cancer were mitigated , with that most excellent Anodine for a Cancer , as long as she lived , to wit , with a mixture of the Linimentum Simplex , the Ceratum Oxelaeum , and Oyl of Myrtles . The same Patient complained every year , of a very troublesome galling on the Hips caused by her being so fat : for when she walked , especially in Summer time , those Parts were rubbed , together excoriated , and inflamed . This excoriation the Patient her self cured , by often washing it in fresh water , in which , Mallows were boyled , and besprinkling it with this Pouder easie to be had .

Take of Pomgranate Flowers , Red Roses , Red Sanders , of each three drams . Campher half a dram . Mix them

And make them into a Pouder , which doth also most speedily cure the inflamation , and excoriation in Children , proceeding from the sharpness of the Milk .

OBSERVATION LVII . Of an ulceration and pain on the Breast mitigated by an Issue in the Thigh .

A Water-man of fourscore years of Age , complained of a great streightness , a violent pain , and blisters on the right side of his Breast . The Patient sent for a Chyrurgion , and desired him again , and again , to heal up those little Ulcers , which were very troublesome to him . Those Ulcers being healed ; the pain , and streightness about his Breast returned ; which went off upon the breaking out of his Breast . Things being thus , and being sent for to advise about it , I asked the old Man whether he had not formerly had old Ulcers in his Legs ? to which he answered , that for ten years together he had a large Ulcer on his right Thigh , without any hindrance to him in going ; and from the time that it was healed up , he was first troubled with a streightness , then a pain , next with blisters , and at last with little Ulcers about his Breast : for the revulsion therefore of these humours , I ordered an Issue to be made in that Thigh which was first Ulcerated , with the Instrument of Julius Cessarius Placentinus : about which there began to be an inflamation the next day ; so that I encouraged the Patient to hope for a good recovery . The Eschar being come out , and the Issue performing its duty : the pain of ●he Breast , and difficulty of breathing abated : so that in thirty days the Patient was free from those Symptoms ; and long after that enjoyed the health of an old Man , and went about his business , without any hindrance . From this I would have young Chyrurgions learn how dangerous it is , to heal up Ulcers of long continuance , especially in old Age ; and with how great benefit Issues are made , on the inside of the Thigh ; if by the error of the Patient , or Chyrurgion such Ulcers which free the Body from impurities , have been healed up .

OBSERVATION LVIII . Of a Gunshot Wound in the back .

ON the 27th . of January , 1644. At three of the Clock in the afternoon Balthaser Steiger a Country-Man , of G●gglingen as he was carrying home his Wife from Ulme , A Souldier that was durnk shot at them , and at once wounded not ●nly the Country-Man but his Wife also : so as they were forced to be carried back again to Ulme ; Where a Chyrurgion bound up the Wounds till the day following . On the 28th . of Janua●y , the pain of the Wound being very great ; I was called in by the Patients Friend , and found the Country-Man wounded with thre● Bullets : of which the first stuck obliquely in the hinder part of the head , about the L●mbdiodal Suture . The second was drawn out about the eighth Rib of the Breast . And the third went so deep in a little above the Os Sacrum ; that it could no ways be drawn out . We Dilated the Wound somewhat on the hinder part of the Head with Li●t . The Wound on the Breast being of little moment , we dressed as a simple one ; but the Wound near to the Os Sacrum , being very painful , caused so great an inflammation , that it did also affect the privy parts ; and for stopping of the Blood we injected into it the white of an Egg ▪ stirred up with a Spatula : with the astringent Pouder of Galen , prepared Chrysolite , and Plantain water : for revulsion sake , a cooling Glyster was put up , and Blood taken from the Median vein of the right Arm. In the evening , the Patient took some spoonfuls of this Cordial water , and a cooling Syrup .

Take of Black Cherry-water , Burnet water , and Rose water , of each an ounce , Cinnamon water , three drams . The Anhalt Cephalick spirit , two scruples and a half . Red Coral , prepared , half a dram . Chrysolite prepared . half a scruple . Pearl Tablets , four drams . Mix them , and put them into a glass . The cooling Syrup was this .

Take of Syrup of Vinegar one dram . Syrup of Juice of Citrons . Endive water . Water Lilly water , of each an ounce . Prepared Pearl powdered , half a scruple , Mix them , for one dose .

The Country-Man's wife was wounded with five Bullets , of which one entred below the left Ear , and passing under the skin , went out about the bone of the lower Jaw ; the Second , Third , and Fourth a stuck in the Back between the Shoulders ; but the fifth entred about the inward part of the Shoulder , and went out about the bending of the Arm. We dressed the wounds between the Shoulders , and about the Jaw-bone as simple , but that in the Arm as a Compound Wound : and for the great inflammation of the whole Arm , I put in tents dressed with this following digestive ,

Take of Turpentine washed in plantain water , one dram , Oyl of Earth Worms , one dram . A litle of the yolk an Egg. Mix them ,

Casting in first oyl of Violets and oyl of earth worms ▪ and applyed Diapalma spread upon streight linnen covered over with the Linimentum simplex , and bound up the whole Arm with a catlaplasm which was made of Barly meal , Bean meal , Crums of Bread , Oyl of Roses , Camomile , and Earth-Worms , and red Wine ; those Medicines we made use of till the seventh day , at which time the Eschar fell off , in the mean time she observed a very good diet , and took preparing and altering remedies .

On the 8th . day , she was better ; and the pain and inflammation of the whole Arm ceased , and therefore we put Tents into the Wounds covered with this Liniment .

Take of Turpentine washed in plantain-water , one dram . Pouder of Myrrhe . Aloes , of each one scruple . Chrysolite prepared half a scruple , Hony of Roses streyned , a dram and a half . Balsom of Peru an ounce and half . Syrup of Red Roses as much as sufficeth , Mix them and make them into a Liniment .

We applied the Cerate of Diapalma , and a Spunge pressed out in Red Wine , and bound it up fitly with a Rowler , with two heads : the simple wounds began now to Cicatrize . On the 14th . The Wound on the Arm , and all the other were skinned ; and the Patient being hapily recovered , went away to Gegglinge .

On the 3d . day , Although the hollowness in the hinder part of the Head of the Country-man was larger than the day before , yet we Dilated it with a Spunge twisted ; washing the Wound , by reason of the ill smell , with the Decoctum Divinum . The pain and inflamation about the Os Sacrum , by the help of the Cataplasm above described , and the frequent use of Glisters , much abated . On the 5th . day the quitter of the Wound about the Os Sacrum was white , and digested . The Wound on the hinder part of the Head was deep , and the Patient complained of a great pain of the Head , about the Fore-head . On the 7th . day the pain and swelling about the Os Sacrum ceased ; and upon bleeding at the Nose , the pain on the Fore-head went off . On the 8th . we put a Tent into the Wound of the Os Sacrum , dipped in the white of an Egg stirred up with this Pouder .

Take of Prepared Chrysolite , Lapis Haematites , Aloe , Bole-Armenick prepared , of each an ounce and half . Mix them into a Pouder .

And bound over it the white Plaster . On the 9th . all pain ceased , and the Patient rested quietly the whole night . We put in a shorter Tent into the Wound about the Os Sacrum ; and to the sides a Spunge pressed out in Red Wine lukewarm , and bound it up streightly with the Bandage . The Wound on the Occiput being still hollow , sent out serous matter without pain .

On the 10th . The Patient said that he had passed the night quietly , and the Wound about the Os Sacrum was better ; and the matter generated was white , digested , and in a small quantity ; he complained of a heavy pain about the Eyes , and a few hours after he bled at the Nose , whereby that heaviness abated ; and the Patient said he was accustomed to this bleeding .

On the 11th . day , The Wound about the Os Sacrum was cicatrized .

On the 12th . I searched the Wound on the Occiput with an obtuse Probe ; and coming in obliquely between the Cucular and patient Muscle downward , I told the Patient and the Chyrurgion , that this Wound , by reason of the great Contusion , was still dangerous . Having rested again very well the whole night . On the 13th . Because that Souldiers Wintered in his House , he Rode home , the Wound in his Head not being yet consolidated : in the mean time the Chyrurgion visited him every day , and dressed the Wound . After ten days the Chyrurgion desired me to prescribe the Patient a Purging Potion , which I did ; and it gave him divers stools . The next day the Chyrurgion came again , telling me , that he was forced to lay open the Wound ; and that he very well understood the manner how to do it . February the 28th . he opened it , but with what Knife I know not . On the 29th . The Patient had a Feaver ; and on the first of March he took this purging Syrup .

Take of Syrup of Roses an ounce and half . Of Manna six dram● Extract of Rubarb , Diacarthamum , of each half a dram . Magistery of Tartar , one scruple , Black Cherry-water , as much as sufficeth . Mix them and make a Liquid Syrup .

Which he Vomited up presently , and was not once Purged therewith . On the 4th . The Patient being worse , I was sent for to Gegglingen , and found him weak ; the Wound covered with an Erysipelas , the hollowness not laid open above the third Part , by the Chyrurgion : a little below it , a great hollowness , having escaped his knowledge ; and was untouched by the Knife . The Pericranium so Putrified , that with a blunt Probe , it might be easily separated from the Skull . The Wound being bound up , and the Patient recovering some strength , the Cephalick Vein on the same side was opened : out of which there came serous and half Putrified blood . Things being thus , I advised the Patient to be brought to Ulme again , in a Litter . On the 4th . Being in the City , I unbound the Wound , and found that the Erysipelas had spread it self , not only about the Wound , but all over the fore-part , and hinder-part of the Head ; so that , the Patient complained of a great pain of his Head , and could by no means open his Eyes .

On the 5th . For a great pain and inward heat , he took this cooling Glister .

Take of Sorrel Roots , Marsh-mallow Roots , of each half an ounce . The leaves of Water Lillies , Violets , Mallows , Bettony , Flowers of Camomile , of each half a handful . Seeds of Flax , Citrons , Fenel , of each a dram . Raisins half an ounce .

Boyl them in a sufficient quantity of Water , and strain them , then add of , Hony of Roses four ounces . Oyl of Violets , Oyl of Camomile , of each an ounce and half . Mix them for a Glister .

In the evening he took the cooling Syrup . On the 6th . He had a quiet night , and complained of Heart-burning , and great weakness ; and therefore I prescribed this .

Take of Conserve of Roses Vitriolated , Conserve of Violets , of each as ounce . Con●ection of Alkermes one dram . Citron Pill preserved , one dram . Syrup of the Juice of Citrons , as much as sufficeth . Mix them and make them up into an Electuary .

Of this he took a little often in a day . The Wound cast out matter half bloody , and the Pericranium appeared almost Putrified : although this Wound required a greater Dilatation , by reason of its hollowness : yet because of his weakness , it was not convenient to Dilate it ; in the mean time , for the streightness of his Breast , and want of sleep , he made use of this Emulsion .

Take of Melon-seeds half an ounce . Poppy-seeds one dram . Sweet Almonds two drams . Black Cherry-water . Water Lilli-water , Strawbery-water , of each three ounces . Make an Emulsion , to which add , Magistery of Coral half a dram . Pearl Sugar half an ounce . Put them into a Glass .

On the ●●th . day the Patient was better , the swelling of the H●●d , and Face ●●●ed . The Wound sent out digested matter : the lips were f●●● , an●●herefore the Oyntment of Aegyptiacum was applied ; and seeing the ●●r●●ranium was still Putrid , we dressed it with Syrup of Red Roses , mixed with Spirit of Wine : For his thirst and pain of the He●d , he took the Glister prescribed two days before .

On the 8th . The heat of th● Feaver somwhat abated ; but because the Patient c●mplained of a heat and pain of the Wound , about the Os Sacrum , which was now healed up , he made use of the ordinary Glist●r , and the Emulsion of Melon-seeds . To the Wound still Sordi● , we ●pplied the Oyntment Aegyptiacum ; and to the Pericranium alm●● c●rrupted , the Syrup of Red Roses , mixed with Spirit of ●i●e , 〈◇〉 our Decoctum Divinum . On the 9th . He said that he had sle●t si● hours : matter tending to greenness flowed out of the Wo●●d in 〈◇〉 qu●●tity ; in the evening he was better , and all his heat went of .

O● the 〈…〉 the evening , he complained of a great heat of his Bac● 〈…〉 pain of the Head : saying he could not sleep , for dream 〈…〉 him ; and therefore he made use of his ordinary 〈…〉 he voided thrice bili●us matter .

O● 〈…〉 be ter , and spent all the night quietly . On the 12th . 〈…〉 ●5th . He went on well , and the inward hollowness genera●● 〈…〉 ●sted matter .

On th● 〈…〉 well , but by reason he abounded with Choller , he took thi● 〈…〉 Syrup .

Take of Loosening Syrup of Roses two ounces . Extract of Rubarb four scruples and a half . Diacarthamum one scruple . Magistery of Tartar , half a scruple . Black Cherry-water as much as sufficeth . Mix them .

On the 13th . Seeing that the lower hollowness could no ways be Consolidated , by reason of the hole above it , I advised to open it , that the matter contained in it , might get out ; but seeing it had been attempted once before in vain , he was very much against it ; therefore in the evening I put in a Wax candle , to the bottom of the hollowness , and left it there all night : in the morning I drew out the Candle , and put into the cavity , instead of that , a Needle , ( Tab . XII . Fig. VIII . ) carrying Thread at one end , or the Armed Seton . ( Tab . VII . Fig. VII . ) and to the other end a piece of Wax , was fastned ; and unknown to the Patient , I suddenly Perforated the skin at the bottom , and left the Thread in the hollowness , as in a Seton . On the 30th . He being Purged again , and the median Vein of the right Arm being opened , he was better ; and the upper hole was Consolidated as far as the Thread , On the 6th . of April , being very well , he left Ulme . On the 8th . day The Thread was drawn out , and on the 10th . the Wound was Cicatrized .

OBSERVATION LIX . Of a Wound in the Breast mortal , upon neglecting the Paracentesis .

ON the 10th . of March , 1645 , At eight of the Clock in the evening , a certain young Man received a very narrow Wound in the Back , two Fingers breadth below the right Shoulder Bone , and four Fingers breadth from the Back Bone ; which Penetrated into the Cavity . A Chyrurgion otherwise not unskilful , ( whom the wounded Person sent for immediately upon his being hurt , ) dressed this as a simple Wound ; and as if it had not Penetrated : so that the blood flowed out of the Intercostal Vessels which were wounded , into the Cavity of the Breast , and caused such a streightness , that the Parents ordered them to send for me . About twelve a Clock at night , I unbound the Wound , which by reason of the Figure of the Sword , the Posture of the Breast changed , and the applying of Astringent Medicines , was so narrow , that we could neither come into the Cavity with a Probe , nor inject Medicines to stop the blood , through the Siphon , nor apply them upon the Tent . Wherefore I declared to the Parents and the standers by , the danger the Patient was in ; and proposed the Paracenthesis to be made without delay , in the place assigned by Hippocrates , Tab . XXXVII . Fig. II . {rum} . which might give a Discharge to that matter , which did threaten certain Suffocation ; But seeing that the Parents would not admit of this ( witnout doubt ) necessary operation in this Patient , and the matter , by giving Diureticks , could not so suddenly be evacuated by the Passages of Urine ; the Patient being choaked up , dyed on the sixth day ; who very probably , if the Dilacation of the Wound had not been neglected at the begining , might have been preserved : for his Lungs were not hurt , because the Patient never did spit blood , nor the Gullet , because he swallowed his Meat , and Drink , without difficulty : his Heart was not wounded , nor yet the Vena Cava , nor great Artery : because if so , the Patient would not have lived so long after his being wounded . The Pericardium or case to the Heart ●as intire ; for the Heart deprived of it 's moisture , doth suddenly fai● ; the Diaphragm was not concerned ; because these Symptoms did not appear which all writers in Chyrurgery declare to accompany that Wound . But the Patient complained only of a streightness of the Breast , caused by a copious collection of Blood ; hence I would have young Chyrurgions learn , when they they are called to the cure of a Wound on the Breast : to search diligently with their Probe ( placing the Patient , if it can be , in the same posture as when he was hurt ; ) to see if the Wound hath penetrated or no ; if i● hath , to pronounce it dangerous : if it be narrow , by the consent of the Patient , and the standers by , to dilate it with a Knife . Tab . XXXVII . Fig. V. E. That the matter collected in the Breast may flow out of it 's own accord , or be brought out by putting in a pipe . Tab . XXXVII . Fig. VI . But if it be wide , for the reasons abovesaid to keep it open : and if the matter will neither be evacuated through the Wound , by reason of the deep situation of it ; nor be drawn out through the Pipe by reason of it 's thickness : nor be driven to the Urinary passages by reason of it 's great quantity : To propose the only remedy l●ft , to wit ; the perforation of the Breast whilest the Patient hath yet strength : and this whether it be granted or refused : that neither the Patients Friends , nor he who gave the Wound , if the Patient dye , may have any reason to blame them for negligence or ought else ▪

OBSERVATION LX . Of the taking off a Yard .

IN the Month of July 1635. a certain Citizen of Ulme having his Yard mortified , I cut it off near the live part with a knife , Tab . XII . Fig. VI . and to stop the Blood touched the Veins and Arteries with hot Irons till I had taken off all the Gangrene , and the Patient was sensible of the fire : the Operation being done , and a pipe . Tab . XII . Fig. XVI . Put into the passage of Urine : I applyed to the burnt place , the Egyptiacum Oyntment of Maesue , to make the Eschar fall off : which being taken away : I soon Cons●lidated the Ulcer with the Ceratum divinum : and the Pa●●e●● was healed . I knew a little old Man , whose Yard was c●●●●ff , for the ●●es Ve●erea ; by the ordinary Chryrurgion of the Hos●●●●● , of 〈◇〉 ▪ And by applying convenient Medicines the Ulcer was Cicu●rized .

OBSERVATION LXI . Of Incurable Cancers proceeding from the Obstruction of the passage of Bladder and Gall .

IN the Year 1622. I opened the Body of a French Gentleman who died of very sharp pains in the Colick : and I found a hidden Cancer in the gut called the Colon ; the cause of which , in my Jud●ment was the Obstruction of the passage of Gall : for that part of it where it is inserted into the Duodenum was so obstructed with a stone of the bigness of a Pea ; that not the least quan●i●y of Gall could be discharged through it : Yet nature did not , ( as for the most part she doth in such cases ) throw that quantity of Gall , into the whole habit of the Body , but carried it to the Colon . On the 24. of January 1624. In the body of Mrs. Katharine N. a Venetian , who died of an Ulcerated Cancer in the Womb , I found the Bladder of Gall filled and distended with a Stone transparent like Chrystall : so that it was not fit to receive any Gall , yet Nature did send that Gall , which was daily generated to the circumference of the body , but to the Womb . From these two accounts two things may be noted . First that the Jaundise doth not always happen upon an obstruction of the passage or bladder of Gall ; but the Gall may sometimes derived to the Guts , the Womb , or some other Noble part . Secondly , the Lecture which the most excellent Spigeleus had upon th●se . If at Cancer in these persons had had bred in the Breast , or Limbs , after it had been rooted out with the Knife , the Wound would scarce have been brought to heal ; or if it had been healed up the malignant matter would have invaded the principal parts , and destroyed the Patient within three or four years : The reason being evident , because the cause of the Disease could not be taken away , which was the obstinate obstruction of the Bladder of Gall . I took notice of an incurable obstruction of the spleen in a Woman who while she lived , for some years had a painful Ulcer in her foot , which as often as she healed up , she was troubled with a Quartan Ague : till the humour , seeing the collection of it could not be hindred , was daily evacuated by a● Issue made in her Thigh , and by this means , both the Quartan Agne , and the breaking out of the Ulcer in the Legg , were remedied .

OBSERVATION LXII . Of the left Shoulder Blade corrupted .

IN the Month of March , 1632. I Cured the left Scapula of the Major's Son of Burlingfing , which was very much corrupted , by casting in daily at the two Orifices of the hollowness , this Decoction kept open with Tents , dressed with Betony Oyntment ▪

Take of The Roots of O●rice , Round Birth-wort , Great Comfrey , of each an ounce ▪ The Leaves of Speedwell , Mouse-ear , Burnet , Vervain , Peruinkle , Strawberries , of each a handful . Seeds of Plantain , Succory , of each half an ounce . Fountain-water six Pints . White-wine two Pints .

Boyl away the third part , and add to it streined out , four ouncer of Hony of Roses , mix them for an iniection , till the Scapula separated so great a Scale of the Bone , that by reason of the narrowness of the Orifice , I could not draw it out ; and theref●re I cut open the distance between the Orifices with the Incision-Knife , Tab . XIV . , Fig. II , or III . and took out the separated Scale with the Pincers and conglutinated the sides of the hollowness with the Shoulder-blade , by applying a new Spurge dipped in Red Wine , and pressed out ; and binding on streight the Breast-plate Bandage described in the last Table , Let . S.

OBSERVATION LXIII . Of a Stone taken out of the Urinary passage , without the Probe or Incision .

IN the month of Febuary , 1639. A young Man of Leipheeme , was received into the Hospital of Ulme , not being able ro hold his water , from a laceration of the Neck of the Bladder , by a Stone w●ighing six ounces ; which the famous cutter for the stone of Augsburg , Angelus Merian , drew out with the Forceps ; but , because the Disease was incurable , being furnished with Medicines to mitigate the sharpness of Urine , and the galling of the parts , he went from Ulme . The same year , in the month of May , this Person was troubled with a stoppage of Urine , from a Stone that obstructed the Urinary passages ; he d●sired my advice , and having received it by Letter , he took morning and evening , a Dose of this Julep .

Take of Fernelius his Syrup of Marsh-mallows four ounces . Mallows-water eight ounces . Mix them for two Doses .

And set often in a softning Bath , till the Stone being round like a hard flint , and weighing almost three drams , being driven down by Urine to the end of the Yard , I took hold of it with the Teeth of the Pincers , and so without the Incision of the Urethra , ( propounded by Senertus , Iustit . Lib . 5. Part 1. Sect . 2. c . 13. out of Fabrit . Hildan . his Treatise about Cutting for the Stone in the Bladder , or the Ta● . XIV . Fig. VIII . I drew it out .

OBSERVATION LXIV . Of the pricking of a Nerve .

IN N●●es pricked , or cut , after general Purgation , some Physi ian● cut the skin at right angles , that the corrupt matter may c●me o●● freely , and the Medicines applied may come at the puncture of the N●●●● ▪ O●hers after a cross Incision , cut the Nerve also in sunder 〈◇〉 g●●d success , before that they apply outward remedi●s , whe● 〈◇〉 ●h●●●●lux of humours is hindred , which encreaseth the pain , and ●●e c●use of the inflamation , and convulsion ; But becaus● this cut●●●g ●f the skin , or dissection of the wounded Nerve , Patients wi●l seld●me admit off : for the benefit of Barbers , who divers times when they open a Vein with a Lancet , do unskilfully hurt the N●rv●s , which are near it , or lye under it . I will set down this appr●●●d remedy .

Take of The best Euphorbium one scruple . Turpentine half an ounce . Wax as much . Mix them into an Oyntment .

Which is to be spread upon Linnen , and applied hot . Wi●h this alone presently applied , I have safely cured divers such punc●●res of the Nerves , as the most eminent , and my most dear Kinsman and ●o●league D. Johannes Sehasti●nus Blosius , and Nicholas Reu●te Chyrurgion will testifie .

OBSERVATION LXV . Of a Venereal Node , cured by Chyrurgery .

MArtin Fischer complained of a Venereall Node on th● left Leg , which would neither yeild to a sudori●●ck c●ur●● , nor to ●n Cerate recommended under the Letter R. Tab . XLIII . And theref●● 〈◇〉 ove●●d the Shin-bone , where it was foul with a Caustick , 〈…〉 ●way to the quick , with the scraping Irons . The ope●● 〈…〉 ●●●●hed , I applied a drying Pouder to the Bone , and dry 〈…〉 ●he Ulcer with common Medicines to incarnate and 〈…〉 ●●●●ly recovering upon this operation , and 〈…〉 his health many years , and afterwards dyed 〈…〉 . Some●imes the virulency of this disease is such , 〈…〉 Shin-bone to the Marrow , in which case , the use 〈…〉 is i● not sufficient ; but besides these , Trepans , and 〈…〉 are ●ecessary to the rooting and consuming the remain● 〈…〉 ●●ines● if it , will not be seperated , by sprinkling the Pou●● 〈…〉 ●●●●um upon it . This sort of virulency , I observed at 〈…〉 ●●●le old Woman of fourscore years of Age : out of whose 〈…〉 ●abritius often drew out Bones , of the bigness of the fore●●●● .

OBSERVATION LXVI . Of a Meliceris in the Shoulder , and Knee .

IN the Year , 1629. Andreas Fischer , Coachman of Ulme , complained of a troublesome Meliceris on his right Shoulder ; which after preparing and purging his Body , I applied the Cerate Diasinapios , described in the last Table , under the Letter C. The peculiar efficacy of this Cerate against Melicerides , I lately experienced in Waldburga Heiglerin , who by my advice , applied it to a Meliceris in the right Knee , of the bigness of a Goose Egg : which it totally discussed in a months time , and all those humours which were gathered to the part at the begining , by neglect of general remedies .

OBSERVATION LXVII . Of ●●●renness from a Rupture ill reduced .

T●E A●abaptists in Moravia , in curing the Rupture , after the Cut i● r●duc●d , stop up the hole of the Peritoneum with the Te●●●●●s B●● 〈◇〉 way of curing , skilful Chyrurgions do no ways co●● 〈…〉 , ●f the Testicle be less then the hole , it is easily excl● 〈◇〉 ●●in , ●nd if it be bigger , it is so streightned , and painful : 〈…〉 , barrenness , or death , may succeed ; therefore let yo●ng ●●●r●●●i●ns observe in the putting up the Gut , to leave the Sto●●● 〈◇〉 S●rotum , least being thrust into the hole , it should bec●m●●●●ul , and hinder Coition . I have known some , that from this c●u●● alone , being married , have lived a fruitless and quarrelsom● l ●e ; As also the Baker's Son , who what a Husband he will prove , time will shew .

OBSERVATION LXVIII . Of an Erysipelas , or St. Anthonie's fire .

I have most happily cured a great number of Erysipelas's by the use of the Linimentum Simplex , often changing it while it is fresh , and not rancid ( as it is described in the 52. Observation ) and not neglecting general and inward cooling remedies . In defect of this Liniment , I never found any thing better than Oyl of sweet Almonds newly drawn , washed nine times with Nightshade-water in a Glass Vessel : with which the part effected is to be anointed cold till it 's violent heat be abated . Others commend Balsome of Saturn , made with Linseed Oyl to anoint the part therewith often with a Feather .

OBSERVATION LXIX .

〈◇〉 ●●ar 1634. Johannes Philippus Schmid Captain of the 〈◇〉 at Ulme ; was wounded with a Bullet through the shoul●● 〈◇〉 in the ba●tel near Nordlingen : and coming to Ulme fell into 〈◇〉 ●ds of an unskilful Chyrurgion , who kept open the orifices of 〈◇〉 ●●und , not with tents but with a seton passed through , omitting 〈◇〉 purgation , which caused so great a pain , that a Gangreen fol● wed upon th● inflammation , to whom , coming ●y chance , I pre●e●t●● removed the Seton , and applyed a Cataplasm made of the Meal ●f Mallows and Rose-water , and keeping his belly open with a ●●nitive Glyster , for revulsion sake , I took away seven ounces of bloud from his left Arm ; which was bilious and serous ; and the 〈◇〉 day the Gangreen amending , the Patient took a potion to purge Ch●ller . which gave him ten stools .

Take of Solutive Syrup of Roses , two ounces . Extract of Rubarb , one dram . Diacarthamum , two scruples . Magistery of Tartar , half a scruple . Burrage water as much as sufficeth to make a potion .

〈◇〉 the third day , the Gangreen disappeared : on the days follow● 〈◇〉 the putrified flesh about about the Wound , with the 〈…〉 Oyntment of Hildanus : and in a months time most 〈◇〉 made a cure of this Wound . The wonderfull efficacy of this 〈◇〉 ●●alm , the Patient being recovered thinks he can never enough commend , and ascribeth to it the sole preservation of his Arm.

OBSERVATION LXX . Of a Herpes Miliaris corroding .

THE burning Ulcers of a corroding Herpes Miliaris after the use of medicines cooling and purging Choller , often repeated , and washing the part effected with a decoction of Mallows in fair waters , I have cured in a short time with that excellent Cerate of Tobacco : the description of which I have inserted into the last Table , under the letter C. taken out of Fabricius ab Aquapendente Peneteuch . Chyrurg . but if the Ulcers have crept in too deep , let the former Cerate be reduced into the form of an Oyntment .

Take of The yellow Cerate , one ounce . As much Oyl of Myrtles as sufficeth to make it into an Oyntment .

Which being spread upon Lint is to be applyed , and least it fall off to be kept on with the Cerate of Ceruss applyed over it .

OBSERVATION LXXI . Of an Ulcerated Erysipelas .

ON the 24th . of August 1645. The worthy Dr. Nicholas Dicterich surnamed Spereiter complained of an Ulcerated Erysipelas on both Leggs with a very great itching , and flux of the sharp matter through the pores of the skin : and seeing this effect totally depended upon the boyling of the Blood , and the abundance of Choller , first giving him a laxative and cooling Glyster .

Take of The Species for the Carminative Decoction , one ounce . Violets one handfull . Boyl them in fair water , and to nine ou●ces of it , ●●oyned out , add , Hony of Roses solutive , two ounces and a half . Cassia newly drawn , one ounce , Oyl of Violets , two drams . Mix them .

I ordered six ounces of Blood to be taken from the Liver vein and to temper his heat in the Evening I prescribed this Julep .

Take of The Decoction of Candied Succory roots , eight ounces . Succory water as much as sufficeth . Mix them , for two doses .

His drink was Barly water , mixed with the Tincture of Roses , ●nd his meat cooling and refreshing , for the mitigating of the itching of the part , and hindring an aflux of humours a Chyrurgion of the Army applyed often in the night linnen thrice double pressed out of this following Decoction hot .

Take of Mallows , one handful . Speedwell , half a handful . Crude Alume powdered , one dram . Boyl them in a sufficient quantitity of River water , and keep what is streyned out in a pot .

On the 25th . the itching and flux of sharp matter through the Skin ceased : whereupon I applied to the Ulcerated parts of the Leggs , Mynsich'ts , Plaster of Saturn mixed with the Linimentum simplex , and spread upon a large Cloath : and the Patient to Purge serous , and bilious humours , took this following potion .

Take of Solutive Syrup of Roses three ounces . Extract of Rubarb Diacarthamum , of each two scruples . Endive water as much as sufficeth . Mix them , make it up for a draught .

From this he had ten stools . On the 26th . by reason of great disturbance of mind so violent an inflammation invaded his leggs , that it threatned an immediate Gangreen : for preventing which , I applyed hot my most approved Cataplasm , Observ . 69 , And as often as it dried I commanded another to be layed on . On the 27th . The inflammation remitted , and on the 28th . it ceased , and therefore I again applyed to the Ulcers this mixture .

Take of Mynsicht's Plaster of Saturn . Linimentum Simplex , of each equal parts .

Till that on the 9th . of September they were Consolidated , and the Patient complained no longer of any pain or heat .

On the 12th . for preventing a relapse , I prescribed a purging Wine , after the successful use of which I burned an Issue in the right Arm , and ordered an Electuary to rub the Teeth with , for the strengthning the Roots of the Teeth , and cleansing their impurity .

Take of Porcelan Powdered , four ounces . Wood of Aloes . Yellow Sanders , of each an ounce . Musk , half a scruple . Orice Roots , two ounces and a half . Crude Alume two drams . The best Hony two pintes , Mix them upon the Fire into the form of an Electuary .

OBSERVATION LXXII . Of Oedematous Tumours .

WIth the noble Lime water , made use of for some days , I discussed obstinate Oedematous Tumours . Take a peice of quick Lime of the bigness of a Wallnut ; put into boyling water til it be dissolved ; which done , stirr them up together , and let them settle : then pour off the clear water into another Vessel : and dipp into it a new Spunge which still participates of a nitrous quality : then press it out and apply it hot to the part , but take notice that the part affected is first to be anointed with Oyl of sweet Almonds or Hogs-grease ; for it may easily happen that a piece of the Lime which is very sharp and corrosive , may pass into the water transfused , and applyed together with the Spunge may Fret and Corode the part : the same praise a Spunge dipped in Water , and Vinegar deserveth ; If the disease be be in the beginning or Augmentation .

OBSERVATION LXXIII . Of Vomiting Blood Mortal .

A Person of 40. Years of Age , of a hot and dry temperament complained that four Months before , being Feaverish , he had Vomited much Blood , which ceased then upon rubbing the extreme parts , and applying Remedies to cool the Liver : but that now again about twelve a Clock at night , he had first vomited up blood , and then his supper , I ordered him this powder to be taken in Plantain water .

Take of The powder of Burnet Roots . Of Great comfry Roots , of each two scruples . Mix them , for one Dose .

The next day , upon the Patients Vomiting ten ounces of Blood again , I ordered Cupping Glasses , to be applyed without scarification to his his back and Limbs : and this Domestick Glyster to be injected .

Take of The Decoction of the Herb Mercury , ten ounces . Hony , two ounces . Lenitive Electuary , one ounce . Mix them , for a Glyster .

The third day , he complained of a bitterness of the Mouth , and afterwards Vomited Gall in great quantity , being asked whether he ever had any Ulcers in his Leggs : he answered , that he had had Exulcerations on both his Leggs , which were cured with outward Remedies , and that an Erysipelas succeeded upon the Consolidation of these Ulcers , which also disappeared upon drinking the Decoction of Guoiacum . The Consolidation of these Ulcers , was without doubt the cause of his vomiting blood : for revulsion therefore of the humours , I made an Issue , in both Thighs , with the Cautery of Placentinus , four Fingers above the Knee : for harein , in my judgement , consisted the preservation of the life of the Patient : who otherwise would soon dye ; But upon these Issues , seeing there was no Feaver hapned as it is wont , nor no inflamation , nor Erysipelas , which might signifie that the matter tended from the Center to the Circumference , and extream parts , it was a certain sign that the matter was fixed in the Body , and that the Patient was like to dye . On the 5th . day , he vomited blood again plentifully ; and on the 6th . he dyed in Convulsions .

OBSERVATION LXXIV . Of an Hernia Carnosa .

IN the month of August , 1634. A certain Gentleman complained of a great fleshy swelling , on the left Testicle , which after general remedies , and keeping a good dyet , I dissolved with this following Plaister , and the Pouder of the Roots of Rest-harrow , which Petrus Matthiolus in his Comment upon Dioscorides , L. 2. C. 18. commendeth unto us .

Take of Gum Ammoniacum , Galbanum , Bdelium , of each half an ounce . To this dissolved in Vinegar add , Ducks fat melted and streined , an ounce and half . Yellow Wax two ounces . Oyl of white Lillies , Marrow of an Oxes Leg , of each ten drams . Mix them into the form of a Plaister .

Being spread upon Linnen , apply it to the Codd , and renew it every fourth day .

He took every morning a dram of the Pouder of Rest-harrow , in a draught of Wormwood-Wine ; and permitted an Issue to be made in the inward part of his Thigh , four Fingers above the Knee , for the derivation of the humours , and continued the use of these remedies : so that in four months time , he received his former health . In the Year , 1641. George Clacer was taken into the Hospital of Ulme , living at Reichenbach , and was hapily cured with the same remedies . Besides these many others have by degrees recovered by the help of this Pouder alone , whose names with many others , afflicted in such parts , many of them also being still alive , I willingly omit .

OBSERVATION LXXV . Of a Fistula in the right Breast .

A Certain Country Woman being lately delivered , suffered an inflamation , and concretion of the Milk , in her right Breast ; which being hardned with two many Discutients , and inconvenient Medicines applied , degenerated , first into an Abscess , and at length into a Fistula , very deep , callous , and with a narrow Orifice ; wherefore , I perswaded the Ordinary Chyrurgion to the Patient , that after having purged her with general Purgers , he would sufficiently Dilate the Orifice of the Fistula , with Tents made of Gentian and then consume the Callus , with a Linnen Tent once put in covered over with this Medicine .

Take of Mercury Praecipitate , Burnt Alum , Virid . Aeris , Salt Peter , of each equal parts . Whites of Eggs a convenient quantity . Mix and make an Oyntment .

Which doth presently extirpate the Callus of Fistula's ; but not so pleasantly , nor safely , in Parts that are nervous , or endowed with exquisite sense . The Callus being consumed , I mundified the Ulcer with the Aegyptiacum Oyntment of Mesue ; and being mundified , I incarnated it with Betony Oyntment , and Consolidated it , with the Ceratum Divinum , and dissolved the Relicks of the hard Tumour , with the Ceratum Oxelaeum ; and thus the Chyrurgion taking my counsel , the Patient recovered her so much desired health .

OBSERVATION LXXVI . Of a Relaps into the Piles , from the use of Scammony .

A Butcher of Ulme , yet living , was freed from continual pains of the Hemorrhoides by the Pipe and Stile , Tab . XVI . Fig. III . and IV . But relapsed as often as he took in at the Mouth any purging Medicine , in which Senna , or Scammony was an ingredient . Whereupon being forbidden by my self and other eminent Physitians , the use of Sene , or Scammony , he hath lived many years free from this cruel pain of the Piles , in very good health .

OBSERVATION LXXVII . Of the Fundament not sufficiently Perforated .

IN the Year , 1640. Jacob Neubronner , Citizen and Shear-man of Ulme , had a Son born , whose Fundament was not sufficiently Perforated , but so streight , that it would scarce admit of the end of an ordinary Pin . Being sent for , I proposed the operation described , Tab . XLI . Fig. VI . which the Parents would not admit off , and therefore I attempted the necessary Dilatation of it with sharp Tents , made of the Roots of Gentian , which being besmeared with Oyl , I put up into the Orifice of the Fundament , and left it there : that being swelled , it might sufficiently Dilate the Part . This manner of proceeding with the Gentian Roots may be seen before in the 40th . Observation , and the manner of binding it , that the Tents fall not out , Tab . XLI . Fig. VII . I knew a Midwife at Padoa : who Perforated the Anus totally stopped up with a common Needle , and enlarged the hole mad by putting in tents of Gentian .

OBSERVATION LXXVIII . Of the bringing forth of a dead Child .

WHen the dead Child cannot be brought out by inward remedies , of which there is mention made , Tab . XLI . Fig. V. a suffumigation taken into the lower parts often in a day , made of putrid Grapes is much commended . The efficacy of which , I admired at Ulme , in the Person of a Noble Matron yet living , who at that time would rather have dyed , than admitted of that safe relief from the Chyrurgions hands , or from the Hook , or other Instruments , ( which to speak the truth , I never saw used to the living ) but dead Children , from the retention of which those in Labour dye ; I have drawn intirely out of three Bodies , with Hooks Delineated , Tab . XVII . Fig. IV . And without the least Laceration of the Womb , or Vagina , and I observed in them , that their opinion is true , who write that the Bones of the Os Pubis , in a hard labour are separated one from nother .

OBSERVATION LXXIX . Of a virulent Gonorrhea .

A Certain German Noble Man , of about twenty years of Age , of a hot and dry Temperament , three days after impure Coition , began to complain of a virulent Gonorrhea ; for the Cure of which , I purged him divers times with this Bolus .

Take of Venice Turpentine washed in Mallow-water ; four scruples . Cassia newly drawn six drams . Mercurius Dulcis fourteen grains . Mix them , and with Sugar make them into a Bolus .

Then for ordinary Drink , I prescribed this appropriated Decoction .

Take of Whole Barly one Pugil . Melon-seeds , both bruised , one ounce . Leaves of Horse-tail half a handful . Fountain water eight pints . Boyl them to the Consumption of half , and in the end add a dram of Liquerice thinly sliced .

For mitigating the heat of the Reins , I ordered this following cooling Oyntment .

Take of The Cerate of Sanders , Oyntment of Roses , Comitissae , of each six drams . Oyl of Water Lillies , Oyl of Viclets , of each half an ounce . Camphire poudered half a scruple . Mix them for an Oyntment .

And every morning three hours before Dinner , I gave him the mixture which Johannes Petrus Faber commendeth made of an ounce of Juice of Lemmons , and a scruple of Spirit of Campher : with which remedies the Patient was recovered in six days time , without injections , ( which some use with wonderful success , made of the Juice of Plantain , Hony of Roses , Mercury dulcified , and Aloe of Zoccotora ; with Quercetan's-water , for the Gonorrhea , given divers days after Mercurial Purgers , I have cured many .

OBRERVATION LXXX . Of the Corrosion of the Stomach healed .

IN the Year 1622. I opened the Body of a Monk at Padoa , who was reported to have died of pains of the Colick : and searching after the cause of his death , I found that he had a burning inflammation in the bottom of the Stomach , which had corroded to the Middle Coat . In curing the like inflammations , and corrosions of the Stomach : The most excellent Spigelius saith there is nothing better than Terra Sigillata taken in at the Mouth , the slimyness of which sticketh fast to the corroded Coat of the Stomach ( no otherwise then as the Cerate of Diacalcitis applyed to an inflamed Foot . ) And drieth up the Corrosions . The value of this Remedy I afterwards experienced to my great admiration in violent Pains of the Stomach , which could not be mitigated by any Remedies , inwardly or outwardly applyed : but with this Terra Sigillata mixed with the Syrup of great Comfry .

OBSERVATION LXXXI . Of a Shin bone corrupted .

ON the 8th . of June , 1633. Ds. Agustin Wotz a Merchant of Ulme , complains of a large Ulceration and great pain of his right Leg , his body being extenuated , looking upon the Ulcer , we found not only the Shin-bone corrupted from the superficies to the middle of it , but also the lower head of the fibula injured . Consulting therefore with the most famous and eminent Dr. Gregory Horstius , and Dr. John Regulus Villenger , we thought it fit that the Shin-bone should be taken out ; but seeing that the Body wanted Blood by reason of its extenuation , we doubted how we could bring it to Cicatrize again : and if we should upon the Patients desire , remove the corrupted part , by scraping or burning , yet we might attempt this in vain , if the nourishment were deficient which the bones receive from the Marrow , and Blood ; for a bone scraped or burnt , without nourishment , can neither be covered with flesh , nor throw off Skales ; and therefore we unanimously consented , that at that time , we could not conveniently cut out the corrupted bone : his Body being first prepared , upon the 6th . of July , his Leg being placed streight on and held by the standers by , on each side , I cut the skin with an I●sicion Knife . Tab . II . Fig. II . Almost to the lower appendix , of the Shin-bone . Tab . XXVII . Fig. I. and shewed to my Colleagues and the standers by , how the Shin-bone was very much corrupted , and half the Head of the Fibula putrified : Upon the Shin-bone there grew a Cartilage in such manner that the bone under it might be drawn up and down as a Sword in a Scabbard . ( Tab . XXVII . Fig. II . letter A. ) and therefore I bound up the Wound with Lint , The Astringent Pouder of Galen , and the white of an Egg stirred up . On the 7th . of July , the Blood being stopped I unbound the Wound , and shewed the corrupted Tibia in its cartilagineous sheath . ( Which I perforated with Trepans . Tab . II . Fig. III . & IV . Down to the corrupted Shin-bone . Tab . XXVII . Fig. I. letter B. And afterwards cut out the space between the Holes with the Pincers . Tab . IV . Fig. II . & Tab . XX . Fig. I. This being done , I took out the corrupted Tibia , Tab . XXVII . Fig. II . and saw the corroded Head of the Fibula , Tab . XXVII . Fig. III . which I also cut off with the Trepan , and took away down to the lower Head . This done , I sprinkled on the Pouder of long Birth-wort , Orice , and Chrysolite ; and then applied Lint , the Cerate of Diapalma , and Linnen pressed out in Red Wine , and Oyl of Roses , I bound up the Leg with the divided Bandage , Tab . XXVII . Fig. I. Crosswise , Tab . XXVIII . Fig. X. and put it into its Case , Tab . XXVI . Fig. III . The third day after the cutting it , the pain somewhat remitted , and the Patient being bound in his Body , made use of this following cooling and moistening Glister .

Take of The Decoction of Sorrel , Mercury , Pellitory of the wall , Borrage , and Sow-thistle , of each eight ounces . Solutive Hony of Roses , three ounces and a half . Oyl of Violets two ounces . Mix them for a Glister .

His Dyet was slender and cooling , of Barly Ptisan , Bread and Water , Pruans , Barly-water , and Pomgranate Wine . On the 4th : day , I washed the Wound with the Decoctum Divinum , by reason of the remaining putrifaction of the flesh , and applied Lint dipped in this Digestive .

Take of Turpentine washed in Plantain and Scordium water , half an ounce . Pouder of Orice , Long Birrh-wort , Scordium of each one dram . Frankincense , Aloes , of each one scruple . Syrup of Red Roses as much as suff●ceth . Mix them into the form of a Digestive .

And over that the Cerate of Diapalma , and the Bandage wound up crosswise .

On the 5th . day , I prercribed these purging ingredients .

Take of Mastick Wood , Roots of Sorrel , of each three drams . Sarsa six drams . Leaves of Senna an ounce and half . Roots of black Mechoacan half an ounce . Turbith , Hermodactils of each two drams . Carthamum-seeds beaten six drams . Annis-seeds , Fennel seeds , of each a scruple . Crem of Tartar half an ounce . Ginger and Galanga , of each half a dram .

Being cut and bruised , infuse all these put into a Bag in a measure of Barly-water , and make a Claret .

Of this infusion the Patient took four ounces , every other day , three hours before Dinner . On the 6th . after a draught of this the Patient was better , and the Leg being unbound , the matter tended to whiteness , and the ill smell of the Bone remitted ; and therefore I bound up the Wound , or rather the Ulcer every day with the same Medicines , till the 12th .

His Body being purged from bad humours on the 13th . I prescribed this following Decoction .

Take of Roots of Sars● an ounce and half . China an ounce . Red Sanders half an ounce . The Bark of Guaicum a dram .

Infuse them into a convenient quantity of Fountain-water , and bo●l away the third part , in the end of the Decoction add an ounce of Raisins , and strein it out .

Of this Decoction he took morning and evening four ounces , four hours before Meat : at Dinner and Supper he Drank of the second Decoction . The Wound went on well , and we put a Wax Candle of the bigness of a Finger , into the Cavity of the Tibia , and Head ●f the Fibula : red flesh began to grow at the extremities of the Shin-bone , both below and above ; and laudable Quitter came out of the Wound . On the 15th . 16th . and 17th . The Patient went on well , and I drew out with my Pincers , a black piece of Bone , half putrified about the upper end of the Cavity . On the 20th . he took a Glister , to keep his Body soluble , the Wound sent forth digested matter , and to the excrements of the Tibia , for the greater drying of them . I applied Pouder of long Birth-wort , Orice , Scordium , Frankincense , and white Sugar , of each equal parts . Red flesh grew to the Head of the Fib●la , and the lips of the Ulcer : for the greater drying of which , I a●plied the Ceratum Divinum . Upon the use of the Decoction prescribed ▪ the Patient went on well , and the leanness of his Body was som●what amended ; yet every other day from the 24th . to the 30th . he made use of the Laxative Claret , and the Decoction of China .

On he 31st . I drew out some pieces of the Bone , with the Teeth of the P●●cers , from the inward Head of the Tibia : for the excrescen●e of slem of the Wound , I applied the Ceratum Divinum , a●d b●u d up the whole Leg with the ●ivided Bandage , and put it into its c se . The Wound was dressed with these Medicines , till the one and fourtieth day . From the 42d . to the 50th . The Patient was in good health , and moved his Instep , and the Bones of his Foot up and down : for the Muscles which bend the Foot , as the Tibeus before , and the second Poroneus , and those which extend it ; as the inward Gasterocnemius remained unhurt in the operation ; and least any one should wonder at it and , think this impossible to be done without a Prop ; it is to be understood , that the Callus which was generated by this time , and the Fibula , did sustain this motion . On the 60th . He passed the night unquietly , and complained of a bitterness in his mouth : upon which he took this following Pouder in Broth , in which Succory was boiled .

Take of The best Rubarb powdered , three scrupls and a half , Cinamon half a scruple . Crem of Tartar one scruple . Mix them .

From this he voided five times bilious matter , the Wound being unbound , the Patient was indifferently well , only a little Bone which Nature had separated pricked the Skin ; and that bone being drawn out he was very well . On the 70th . Nature expelled a very little Bone out of the hole of the Fibula ; and filled up the hole with very good flesh . On the top and bottom of the Tibia red flesh bred , and the sides began to cicatrize .

On the 80th . The whole Wound was cicatrized the length of the Fore-finger , and he could move the whole Foot , and the Toes without any hindrance .

On the 81st . This following Oyntment was applied .

Take of , Oyl of Earth-worms , Oyl of Camomile , of each half an ounce . Nerve Oyntment , and Oyntment of Eva , of each an ounce . Mix them .

On the 84th . We gave order for an Instrument to be made out of a Plate of Iron , which on the upper part , was like to a Spatula , on the lower to a Stirrup , and was covered over with Cotton , and Linnen , and put on to the Leg ; and the Patient leaning upon Crutches , began to walk . On the 94th . Laying aside his Crutch , staying himself with his left hand , he went out of doors without inconvenience : the Wound being still open a Thumbs breadth , and not yet cicatrized : by reason of an Erisipelas , to which he was subject ; he took every month Pouder of Rubarb in Broth , in which Succory was boyled .

Take of — The best Rubarb poudered one dram . Jalap one scruple . Crem of Tartar half a scruple . Mix them .

On the 120 day he was well ; but upon weariness his Leg was troubled with an Erisipelas , and taking the Pouder of Rubarb prescribed , and applying the Linimentum Simplex , the fourth day it went off , and the Patient walked again without a Staff ; and so continued well , till the 200. When going into the Market to buy Fish , stepping I know not how , he broke the Callus of the Tibia . Looking upon the Fracture I dilated the Wound which was still open , with the Incision-Knife , without any pain , and found two Fissures , between which there was a piece of a Fingers breadth , Tab . XXVII . Fig. V. broken so as I could move it up and down with a Probe . Things standing thus , and there being no pain , or inflamamation : I perforated the broken Piece with the Trepan , and cut the space between it with the Instrument , Tab . XX . Fig. I. and took it out piece by piece , and then scraped both parts of the Tibia , both above and below , wi●h the scraping Irons , and app●ied Pouder of Birth-wort , and Orice , to the Callcus parts ; I bound up the Wound with the Cerate of Diacalcitis , and the divided Bandage , and placed the Leg in its case : so that keeping a very strickt Dyet ; and using the Pouder of Rubarb , the Callus grew again , and he was restored again to his former health ; and in the Year , 1645. when I wrote these , could walk without a Staff .

OBSERVATION LXXXII . Of fleshy Excrescences .

FLeshy Excrescences on the Fingers and Toes are soon consumed with this Pouder applied with Lint .

Take of The Caput Mortuum of Vitriol , Burnt Spunge , of each a dram . Mix them into a Pouder .

And being taken away they may de cicatrized with the Ceratum Divinum . A young Man of eighteen years of Age , complaind of a great Excrescence on the upper Gum , which after purgation , I cut off , by putting a Thread about it , tyed and drawn close together by degrees . The flesh being taken away the Patient rubbed hi● Teeth every morning for eight days with this Magistral Pouder , to an ounce of which , there was added a dram of Crude Alum .

Take of Porcelan Earth four ounces . Aloe Wood , Yellow Sanders , of each an ounce Musk a scruple . Orice an ounce . Mix them for a Pouder for the Teeth .

And washed his Mouth with the following Decoction .

Take of Roche Alum two drams . Pomgranate Flowers , Red Roses , Myrtil , of each half a Pugil . Bugle one Pugil .

Boyl them in a convenient quantity of rough red Wine , to a pint and half , and streine it out , to wash the Mouth .

OBSERVATION LXXXIII . Of Kibes and Chilblains ulcerated .

I Have seen a great number of Kibes and Chilblains healed , and I my self have cured very many , with this following Liniment , which Johannes Prevotius doth deservedly commend in his Medicines for poor People .

Take of The Leaves of Tobacco , The middle Bark of Elder , of each a handful . Roots of white Asphodel thinly sliced one ounce . Common Oil one pint .

Boyl away the moisture upon a gentle Fire , and press them out strongly , to which add , Frankincense finely poudered half an ounce , Yellow Wax six drams . Mix them into a Liniment .

Which presently healeth ulcerated Kibes , or Chilblains , on the Nostrils , Ears , Hands , or Feet .

OBSERVATION LXXXIV . Of a Steatoma on both hands .

IN the Year , 1628. Johannes my Brother Martin's Son , had a little swelling , near his Fore-finger on the outward part of his left Hand , at first rising appearing like a Ganglion ; but I bound a ●late of Lead over it , without any benefit . In the Year , 1629. 〈◇〉 Youth sweat in a publick Bath at Christmas time ; and coming home was taken with a great inflamation all over his Hand ; which being put into a warm Lambskin ( which otherwise powerfully discusseth ) came to suppuration , and required the operation with the Knife , Tab . XII . Fig. IV . The Abscess being duly opened , and a purulent and tallowy matter coming out , I incarnated the Wound , and healed it up . In Autumne the same Year , another Tumour appeared about the same place , but nearer to the Wrist : which also degenerated into an Abscess to be cured by the Knife ; which being cut , there came out in li●e manner Quitter mixed with Tallow , and the Wound was soon cured again , with Sarcotick , and Epulotick , Medicines . In 1630. About the Vernal Aequinox , there arose tallowy Tumours on the back of both Hands , which were insensibly dissolved , without applying any thing to the part , upon the taking of a Sudorifick Decoction , whose chief ingredient was Sarsa . In the Year , 1631. Swellings arose on the Wrists , and on both sides of the back of the Hands , to the bigness of a Walnut , causing inflamation , and an Absces ; which , being opened with the Knife , cast out the same matter as the former . In the Year , 1632. These Tumours invaded both Arms , and therefore I advised a Cure by sweating ; which the Patient being difficult to sweat , was totally against . Being suppurated , therefore I opened them with the Knife , and the matter coming away by degrees , I kept the Wounds open with Tents , for two months ; in the mean time , washing the Hands every day , an hour , in the Water of the Stribiline well near Ulme ; heated and bound them up with Spunges dipped in the same Water , till the reliques being discussed , the parts recovered their former strength , by the help of this Water , the Youth out of whose Hands I had taken divers pieces of corupt Bones , and opened four and twenty Abscesses , was preesrved from any further Relaps , and performs all Offices with his Hands , without the least impediment ; taking every three months a Pouder to purge Phlegm .

OBSERVATION LXXXV . Of a Fracture of the Thigh-bone , with a Wound .

ON the 22d . of October , 1642. A sack of Corn fell from the top of a high-house , belonging to the Worshipfull Dr. Erhaod Schadaeus , at Ulme , and broke the Thigh-bone , of Katharine Beckhin of Giengin as she passed by , just in the middle , so that the lower part of the Bone broke through the skin ; and the patient , with the great pain of her Thigh , and Back , fell into a Swound , and being brought into the Hospital her Spirits were recovered by inward and outward medicines .

Take of Black-cherry water , three ounces , Rose water , Burrage water , of each an ounce . Cinamon water , two drams . The Anhalt Cephalick Spirit , one dram . Magistery of Corral half a dram . Pearl Tablets , half one ounce . Mix them

Put them into a glass , and call it the strengthning water .

Take of The sweet smelling water of Fuchsius , one ounce . Rose water , half an ounce . Rue Vinegar , two ounces . Mix them , for a water , to be applipd to the nostrills and pulse .

And Extension of the thigh being made . Tab . XXIX . Fig. I. I set the broken parts without the help of the scraping Iron .

The Fracture being composed I applied to the broken bone , powder of the Roots of Orrice and round Birthwood : I put a tent into the Wound made of hemp hards and an astringent Oyntment , which I made of the astringent Powder of Galen , and the white of an Egg stirred up . I bound up the Thigh outwardly with three rowlers and a sufficient number of Plagets . see Tab . XXIX . And thus garded I put it into its case . Tab . XXVII . The member being thus well composed , by reason of the great pain of the whole leg and back , and the eminent danger of an inflammation , the Chyrurgion ro the Hospital opened the Median vein of the left Arm , and took away four ounces of Blood . On the 2d . and 3d . day , she complained of a pain of the Back , and heat of Urine . On the 4th . and 5th . the Patient answered to what was asked , without complaining , but because her body was bound , the ordinary Phisitian to the Hospital prescribed her some Bolus's to be made , out of an ounce of Lenitive Electuary , and while they were making up her courses began to flow . On the 6th . 7th . and 8th . she did not complain of any pain about the Fracture , only of a little Cough , and a great itching about the private parts ; and therefore she took often in a day Syrup of Violets , of Liquorice and Tincture of Roses mixed together : to the Back and private parts , for their itching , I applied after a Fomentation with fair water , white Oyntment and the Linimentum Simplex . On the 10th . day , I unbound the Wound , and bound it up again , with the Cerate of Diapalma perforated , and three rowlers passed through it : and a sufficient number of Bolsters and Splents ; The bolsters Being first pressed out in red-Wine ▪ and by this means , upon occasion , I could look upon the part every day , without taking off the rowlers ; her lower Belly was very much swelled , and very hard from the Navel downward , to which I applyed , three days together , a Cataplasm made of the Powder of Mallows , crums of Bread , Milk , and fresh Butter . On the 14th . the swelling and hardness decreased , and remitted . The Patient upon an Abscess coming to suppuration in her Buttock , complained of a Strangury and very sharp pain about the Os Sacrum . On the 20th . the Abscess being broken and the Ulcer cleansed , the Strangury and pain went away , but because the Ulcer on the Buttock did require dayly applications , the broken part could not be kept in rest till the 30th . day , at which time the Patient complained of nothing . On the 40th . a new Abscess arose under the Ham , which coming to suppurate , was very painfull , and upon breaking cast out a very stinking matter , and therefore I injected , through a siphon , a Decoction of the Roots of Orice , round Birthwort , Scordium , Speedwell , Carduus , and Hony of Roses ; upon which the Violent pain and stinking ceased . I dressed the Fracture again with Medicines convenient for the Bone and Wound , with the Cerate of Diapalma , with rowlers with holes through them , and long bolsters , and splents . On the 60. she complained of so great a pain about the Wound that she could scarce speak without sheeding of tears ; and said that for divers Nights she had seen a Spirit which was falsly reported , to walk in that Cloister , and that it caused her whole Body and the Bed to shake , and was the cause of her pain , but I suppose , that the pain took its Original partly from the Ulcer on the Buttock , which was cleansed every day and so moved , discomposed and troubled the broken part : and partly from a Portion of the Bone , which in such cases , used to Skale off about this time . On the 18. of January 1643. she complained of terrible pains about the Wound on the Thigh , and unbinding it , and looking upon the Wound , I found out with my Probe a sharp peice of Bone , which continually pricked the flesh , and excited these great pains ; therefore I presently dilated the Wound sufficiently with my incision Knife . And on the 19th . I took hold of that part of the bone which was separated with the teeth of my pincers and drew it out . Tab . XXVIII . Fig. IX . On the 20th . day , the whole Thigh was less than the days before , and the pricking pain intermitted . After the taking away of the Bone , I bound up the thigh with the cross bandage . Tah . XXVII . Fig X. Untill the Wound was perfectly healed . In the Month of February , The Ulcer of ●he Ham not being yet consolidated , the Patient by help of an Iron instrume●t , began to walk , a little halting . On the 18th . of March 1645 A part of the Bone as big as the Ring-Finger came a way . On the 3 th . the Ulcer was Cicatrized .

OBSERVATION LXXXVI . Of a Spina Ventosa .

THE most excellent Spigelius cut off the Thumb of the left hand , a certain Monk of Bolonia , it being corrupted with a Spina Ventosa , with the Pincers described . Tab . XX . Fig. I. And applied to the Mutilated part to stop the blood , and hinder an inflamation , Plegets dipped in an Astringent , and a Bladder dipped in Water and Vinegar , and bound the Arm up with Rowlers , as high as the Elbow . The blood being stopped , he cleansed the Ulcer , and healed it .

OBSERVATION LXXXVII . Of a broken Leg with a Wound .

AT seven of the Clock on the 5th of December , 1643. In the evening , Matthew Ritter Junior , fell out of a Gallery , and broke his left Leg , four Fingers bredth , above the lower end ; with a Wound laying the Bone bare , and a prominence forward . The Leg being set by extension only ; the pain which was very violent before , did presently abate . I bound it up with three Rowlers , Tab . XXIX . E. F. C. And with Boulsters the same Table H. and placed it duly in its Case , Tab . XXVI . Fig. II . In binding it up , the Patient being faint , took oftentimes a spoonful of this Cordial Water .

Take of Black Cherry-water two ounces . Burnet-water , Rose-water , of each an ounce . Cinamon-water a dram . The Anhalt Cephalick Spirit , half a dram . Magistery of red Corral poudered half a dram . Prepared Pearl one scruple . Prepared Chrysolite half a scruple . Pearl Tablets three drams . Mix them and put them into a Glass .

On the 6th . of December , the pain of the Fracture , upon the use of remedies , went quite off ; and the Patient went on well to the fourth day of his lying down . On the 9th . The Wound being unbound and inspected there was no sign of any inflamation , or pain ; and therefore I applied to the Bone of the Tibia , dry Lint , and to the lips of the Wound , a Digestive .

Take of Tu●pentine washed in Plantain-water , half an ounce . Pouder of the Roots of long Birth-wort , Orice , of each two scruples . Syrup of Red Roses two drams ; and As much yolk of Egg , as sufficeth . Mix them

And over it the Cerate of Diapalma , and Rowlers , and Splents .

On the 10th . day , the Patient made use of a Laxative Glister , and went on well , till the seventh day of his lying down .

On the 13th . The Wound being unbound , there appeared good digested matter , without pain , or inflamation ; which otherwise are wont to accompany these Fractures , and therefore I continued to dress it with the same Medicines ; Cerate , Bolsters , Plagets , Splents , because the time of fearing an inflamation was past ; and placed it in its Case , Tab . XXIX . Fig. VI . On the 16th . The Wound being again unbound and looked upon , all things went on well , not any pain or Tumour appeared ; and laudable matter , and in a small quantity , came out of the Wound ; and therefore I sprinkled upon the Bone which had lost its membrane , a Pouder of the Roots of long Birth-wort and Orice , I applied to the Wound a Sarcotick , and bound up the Leg again with the Diapalm , the Rowlers , Boulsters , and Splents . This day he played at Cards , and moved the Case up and down , and distorted the the whole Shin-bone to the left . On the 17th . In the morning , he complained of the Case pressing upon the outward part , under his Knee , below the Head of the Fibula ; and looking upon the Leg , I found an Extuberance , and therefore unbinding the Wound , I touched it , and perceived a Fracture of the Fibula , which without doubt Nature would have Consolidated , if he had kept his Leg always unmoved .

On the 20th . I applied an Iron Plate , that it might somewhat drive in the Extuberance of the Fibula towards the Tibia , which it did , but I foretold that a piece of the Bone would come away . I put upon the Fractured Tibia which went on well ; the Pouder of Orice , with dry Lint , and put the whole Leg into its Case , being bound up with the Cerate of Diapalm , the Rowlers , Boulsters , Splents . On the 25th . The Patient complained of the Fracture of the Fibula ; which being looked upon , I found a Bone which did somewhat prick the Skin , and therefore I drew the Cerate , Bandage , and Boulster , somewhat to the right , to provide against the pain , caused by the pricking of the Bone . On the 6th . of January , 1644. The Fractured Tibia began to be confirmed , and the little Bone of the Fibula came in sight ; to which I applied the Pouder of Orice , and long Birth-wort with Lint ; and bound up the Leg , with the Cerate of Diachalcitis , the Boulsters , Iron Plate , and Rowlers : that the Leg might acquire its former streightness . On the 16th . of January , I applied to the Wound of the Tibia , Lint , Diapalma , the Rowlers , Boulsters , and Splents . The Fracture of the Fibula fent forth white digested matter , I took out a little sharp Bone with the Pincers , and bound up the Leg , as the days before . On the 5th . of February , Nature had separated a little Bone of the Fibula ; and the flesh began to grow : therefore I bound up the Ulcer slackly , with Lint , The Ceratum Divinum , and the Rowlers , and put the Part affected into the Case . On the 25th . For an excrescence of flesh , I sprinkled Pouder of burnt Alum upon the Ulcer ; which being consumed : March the 4th . I drew out another piece of Bone , and dressed the Ulcer with dry Linnen , and the Cerate Divinum ; and placed the whole part , bound up as the days before . On the 24th . Upon irregular Dyet , the matter was green , and the Ulcer spread it self ; and therefore I ordered this Laxative Wine .

Take of The Roots of Grass , Of Orice , of each a dram and half . The Leaves of Betony , Speedwel , The lesser Centaury , Borage , Worm-wood , of each half a Pugil . Senna one ounce . The best Rubarb three drams . Trochies of Agarick two drams . Hermodactils , Turbith , of each a dram and half . Carthamum-seeds beaten two drams and a half . Anis-seeds , Fennel-seeds of each half a dram . Crem of Tartar three drams . Ginger , Galanga , of each a scruple .

Being cut and bruised put them into a bag , to be infused in a measure of Wine , the Patient took of this infusion every other day , two hours before dinner , three ounces and a half . Upon the use of this Wine . The Patient grew better , the Ulcer generated digested matter , white , and not in the least stinking . On the 14th . of Aprill , the Patient was very well and the Wound coming to Cicatrize , he began to walk by the help of Crutches . On the 4th . of May , the Patient very joyfully laid aside his Crutches , and walked without halting .

OBSERVATION LXXXVIII . Of an Atheroam on the outside of the Legg , cured .

MArgaret a Noble Virgin whose sirname for honour sake I omit of about thirty Years of Age , of a hot and dry temperament , complained eleven Years of a hard tumour without pain , bigger than a Hens Eeg ; on the outside of the right Thigh between the Muscle called the Glutaeus and the skin ; and this Tumour being contained in a Coat ; it would not yield either to outward or inward remedies ; giving my Prognostick therefore that this Tumour could not be cured without manual operation , I first prepared and purged her Body . And on the 26th . of May , 1641 , I took out the tumour after this manner . First ▪ I made a cross upon the skin with Ink , and the Ink being dried I cut the skin upon the marke into four right Angles . Tab . II . Fig. I. Till the bag come in sight . The skin being cut crosswise , and the Blood wiped away with a Spunge . I separated the four corners of the skin with my Probe from the Coat of the tumour under them , to the basis , where there was a vein which I cut in pieces ; and drew out the whole tumour in its coat with rhe Pincers : the bag being taken away without any hurt : I presently brought the lips of the Wound to touch one another , and applied the white of an Egg stirred up , with the astringent Powder of Galen , the wound being bound up , I disected the bag , and found a matter contained in it , like to Pap . On the 28th . of July , the Wound was Cicatrized , and the Patient restored to her former heath .

OBSERVATION LXXXIX . Of a Wound on the Wrist hurting the Artery .

IN the Month of December , 1631. John Moser a Taylor , of about twenty four years of Age , of a hot and moist Temperament , was Wounded with a Knife , by his Man , upon the Wrist and Radius of the left Arm : so that not only the Vein , but the Artery also was cut cross . Upon which , a Flux of blood followed , and other cruel Symptoms . This Wound Nicholas Reutte a Chyrurgion did presently bind up , according to Art. The second day , it bled so copiously , that for want of Vital Spirits , his whole Body was shaken with convulsive motions . Towards night , he took a Lenitive Glister , which gave him three Stools . On the 3d . day , the Liver Vein of the right Arm was opened , and four ounces of blood taken away . On the 4th . when the Wound was dressed , no blood came out . On the 5th . For a bitterness of his mouth , the Patient used this following purging Syrup .

Take of Solutive Syrup of Roses two ounces and a half . Extract of Rubarb one dram . Diacarthamum a dram and half . Crem of Tartar half a dram . Succory-water as much as will make them into a Liquid Syrup .

This gave him two Stools . On the 6th . day , he complained of pain at his Stomach , and Giddiness ; and therefore took Syrup of the Juice of Citrons , mixed with Pomgranate Wine , Burnet-water , and black Cherry water ; in faintness he found relief from the use of Pomgranate Wine . On the 7th . He was unquiet all night ; and said , he had been fighting with the young Man , who Wounded him ; and then complained of the charges , and was so melancholy for them ; and disturbed : that he ran up and down about the Chamber . Upon which the blood boiling sprang out of the wounded Artery , so violently , that it could by no means be stopped ; And therefore , compressing the Arteries wtih my Fingers , I took out a great quantity of concreted blood out of the Wound , about the middle part of the Radius . At length , I applied to the wounded Artery , a burnt Spunge , and Pouder of prepared Chrysolite , and the Astringent Pouder of Galen , with the white of an Egg ; and bound it up with a convenient Bandage , and put into it . the Instrument made of a Plate of Mettal , Tab . XLIII . Letter B. Which is to be Locked , and compresseth the Artery with a Scrue ; without any danger , or inconvenience . On the 8th . & 9th . days , his Arm to the middle part of the Cubius , and Radius . was inflamed ; and in the evening took a Glister . On the 10th . day he was better , and yellow matter issued through the Rowlers . On the 11th . he slept well all the night . On the 12th . the Wound being unbound , white matter flowed out ; and the Wound appeared larger , by reason of the concreted blood taken out , as in an Aneurism , and the putting in of the Spunge . The Tendons of the Muscles , called Perforantes , came in sight , inflamed , painful , and tending to putrifaction . The Wound therefore being cleansed , without taking out of the Spunge , I applied the former remedies to the Artery ; and the Wound being bound up with the Bandage , I shut it up with the Pin of the Instrument . In the mean time , cooling , and moistening Syrups were not omitted : Emulsion . of Waters , and appropriated Seeds , Magistery of red Corral , and Syrup of Violets .

On the 13th . and 14th . The Patient was somewhat better : for the inflamation , and pain , of the wounded Arm , somewhat abated . On the 15th . day , White matter came out of the Wound , the pain of his Hand seemed more remiss , and the swe●ling was less , the Tendons recovered their natural heat . On the 16th . I pulled out half the Spunge , which stuck to the Orifice of the wounded Artery , with my Pincers ; and left the other half still in the hole . On the 17th . I drew out the rest of the Spunge , and applied to the Wound the former Medicines ; and the yellow Cerate covered over with the Linimentum Simplex ; to the Wrist bound up conveniently , I put on also the Instrument . On the 18th . I found the Orifice of the Artery conglutinated , and the Tendons covered with solid flesh . On the 24th . The Wound being consolidated with th● Ceratum Divinum , the Patient was restored to his former health .

OBSERVATION XC . Of a Concussion of the Brain .

IN the Month of November , 1627. John Semlin , of Oppingen , near Ulme . A Country-man's Servant , of a hot and moist Temperament , a month before , was in Mark Feyels House ; in which the Maids and young Wenches were Spinning , and doing their Tasks . This John at that time , was playing with some of the young Maids , and the rest called to him to leave his tricks . In conclusion they set him upon his Head , with his heels upward ; and then turned him over suddainly again . and then shaked the Ground with his Head again ; which they did so often to him : that the blood came out of his Nose and Ears ; and he fell down upon the Ground , as dead . The young Wenches seeing him in this doubtful condition , sprinkled Water upon his Face , to recall his Spirits ; which being done , h● stood up , as if he had risen from the dead , and went away with a g●eat pain of his Head and Arm. The 2d . day , notwithstanding t is pain of his Head and Arm , he Fanned Corn . The 3d . & 4th . He was worse ; so that , by reason of a Feaver , and Convulsive motio●s he was forced to keep his Bed . On the 6th . day , He went in a Cart to Oppingen . On the 7th . His Mother sent for Chyrurgions . On the 11th . 12th . 13th . & 14th . He was troubled with his Convulsive motions . On the 15th . His Mother sent his water to the eminent Dr. Kaleb Sattelius , an industrious Physitian of Geslingen : who prescribed the Pouder against inward bruises , to dissolve the grumous blood , with Syrup of Wood Sorrel , Juice of Citrons , and Burnet Water . Afterward , he was dumb , and deaf ; and was under a Coma , till the 24th day . Of which loss of speech , Hippocrates i● the 58th . Aphorism of the 7th . Section , doth thus foretell . Whosoever have their Brains , upon any occasion , violently shaken , they will necessarily become dumb . A loosness followed his loss of speech , and hearing , which lasted three days ; at which time , he could hear ot●ers speak , and spake himself , and complained of a great pain of the left Arm , about the Deltoides Muscle . On the 29th . By order from the Republick of Ulme , I went to Oppingen , where I found John very much complaining of a great pain of the Head , about the Coronal , and Sagital Suture , thirst , a great Feaver , heat , and blackness of his Tongue , a Palsy , Odematous , and Schirrous Tumour , all over his Arm , which much afflicted the Patient ; and about the Deltois Muscle tended to suppuration , whereupon I presently for revulsion sake , prescribed this Glyster .

Take of The common Decoction for Glysters , nine ounces . Hony of Roses solutive , two ounces and a half . Diacatholicon , one ounce . Oyl of Cammomile , two ounces . Mix them , for a Glyster .

With this the Patient voided five times bilious and serous excrement

To the top of his Head being swelled , I applied this strengthning and digesting Cataplasm .

Take of The crums of Houshold-Bread , three ounce● , Wheat meal . Barly meal , of each two ounces . Flowers of Betony powdered . Roses powdered , of each half an ounce . Oyl of Roses , three ounces . Red Wine a convenient quantity . Common salt a dram . Mix them , upon the fire into the form of a Cataplasm .

To the Tumour on his right Arm , there was applyed a Cataplasm made of Houshold bread , Meal , of Flax-seeds , Mallows , Marsh Mallows and Oyl of Cammomile . For his thirst he used .

Syrup of the juice of Citrons . Of Wood Sorrel . Pomgranates of each two ounces . In Barly water .

Morning and Evening he drank a dish of Clarified whay made of Goats Milk : his meat was boyled Barly , and a Panada , made of the Crums of Bread , Meat-broath , and Butter , his drink at meals was Barly-water . The matter in his Arm , after some days coming to suppuration easily to be perceived by the touch , I opened the Abscess with an incision Knife , between the Biceps and Deltois Muscle ; and a great quantity of purulent matter flowed out , I applyed to the Orifice which was cut , to mitigate the pain , a tent dipped in the yolk and white of an Egg , and over it Diachylon simplex to suppurate rhe relicks , the next day the Wound being unbound , I searched the Ulcer with the Globular end of the Probe , and found the Shoulder-bone corrupted , therefore I dilated the hole somewhat with a twisted Spunge and put in a Tent covered with this digestive .

Take of Turpentine washed in Scordium water , two drams and a half . As much of the Yolk of an Egg. Pouder of round Birthwort . Orrice , of each half a dram . Hony of Roses streined , a convenient quantity . Mix them .

In the mean time his body wes purged with these following ingredients .

Take of The roots of Polipody of the Oak , two drams . Orrice Roots . Succory Roots of each two drams and a half . Leaves of Agrimony . Betony Speedwell . Selfheal . Wormwood , of each half a pugill . Senna without the stalks an ounce and a half . The best Rubarb , half an ounce . Fresh Trochies of Agarick three drams . Carthamum-seeds picked half an ounce . Anise seeds . Fennel seeds , of each half a dram . Creme of Tartar three drams and a half . Cinnamon . Ginger , of each half a dram . Raisins , three drams .

Being Cut and Brused put them into a sack and infuse them in four Pints of water , and hony ; of which he took every other day four ounces , two hours before dinner : for the greater drying of the Bone , I injected by the siphon the Decoction divinum , Powder of round Birthwort and Flower-de-luce of Florence ; outwardly I divers times bound on a Spunge dipped in Salt-water and Red-wine , and pressed out .

On the 20th . day , for the pain of his Head he used these following Pil .

Take of The Mass of Pilulae Aureae two scruples . Extract of Cochiae Pills , one scruple . Magistery of black Mechoacan , seven Grains , With Syrup of Betony , make them into small Pills , and guild them . Which gave him ten stools .

On the 60th . I took hold of a piece of the Bone thrustout , and drew it forth with the Pincers , and afterwards Cicatrized the Ulcer .

OBSERVATION XCI . Of a Hand cut off for a Spina Ventosa .

WHen I studied Physick at Padoa and practised Chyrurgery , a Gentleman who was a sttudent there was , troubled for some Months with an Oedema on the left hand , which upon the use of very good outward and inward Remedies , was not at all diminished , but began to be Ulcerated in the palm of the hand : and therefore we called into consultation the most excellent Spigelius , who after he had searched the Ulcer with a Probe , and touched the corrupted Bone , he presently pronounced it a Spina Ventosa , which is an incurable disease , and requires the amputation of the part effected , it proceedeth from an humour , which by its hidden and Malignant quality , corrodes the Bones without any hurt or pain to the periostium , and then causeth an Oedematous tumour , which is not painfull , but after some Months Ulcerates the part , having obtained leave of the Patient , I cut off the hand above the ends of the Cubitus and Radius , with a hooked Knife and a Saw . Tab . XXVII . Fig. XI . XIII . & XIV . And having bound up the Arm , with Bolsters , a Bladder , and Rowlers , Tab . XXVIII . Fig. I. II . III . IV . I found in the hand which was cut off , the Bones of the Metacarp corrupted , but still covered every where with the Periostium , except in that place where the Ulcer was .

OBSERVATION CXII . Of a dangerous Wound on the Arm.

ON the 24th . of June 1638. On the Feast of St. John Baptist , at seven of the Clock in the Evening , the Noble Frede●ick , of Degenam , was Wounded in a Duell by the most Noble D. N. of Betenderff , two fingers breath below the bending of the right Arm passing through and through the whole Arm , between the Cubitus and the Radius , hurting the veins , and tendons of the Muscles : with great pain and flux of Blood : the first day it was dressed by no unskillful Chyrurgion , Johanes Georgius Bauler . On the second day before and after the unbinding of the Rowler , the Patient complained of a most Violent pain as well inward as outward , about the Orifice of the Wound , as is usual in all Wounds of the Joynts , and for revulsion sake he used this following Glyster .

Take of Lenitive Electuary one ounce . The Emollient Decoction eight ounces . Electuary of the Juice of R●ses two drams . Oyl of Cammomile . Oyl of Violets , of each an ounce and a half . Mix them , for a Glyster .

And had two stools . Three Hours after the Glyster came away , the Median vein of the left Arm , was opened , I put a small tent of Linnen into the Orifices of the Wou●d covered with a Medicine , of which this is the description .

Take of Aloe of Zocotora . Frankincense . Bole Armenick . Lapis Haematitis . Prepared Chrysolite , of each half a Dram . Terra Lemnia . Prepared Tuty , of each two scruples . Dragons Blood , a dram .

Powder these , and Mix them , with the white of an Egg into the form of an Oyntment .

I anointed the Arm with Oyl of Roses , and Oyl of Earth-W●rms warm , and bound it up with Bolsters , pressed out in Red-Wine , and a double headed Rowler ; and applied to the top of the Shoulder the defensive Oyntment of Fernelius , which is the best of any : and after two hours sprinkled all the Arm over with Vinegar and water mixed : his drink was Barly water made pleasant with Pomegranate Wine . His Meat was Barly boyled and Calf-Foot gelly . On the third day the Patient was better , and the Wound for fear of a new flux of Blood , was not unbound , but the whole member besprinkled as before and anointed with the former Oyls . The fourth day , I unbound the Rowlers , but took not the but Tent out of the Wound , but applied Lint covered with an Oyntment made of the white and yolk of an Egg , and the forementioned Powder , I anointed the Arm and used a Bolster dipped in Red-wine and the rowler . In the evening the Patient was better , and had for his supper Cream of Barly dressed with Endive , Pomgranate Wine , and Oyl . On the 5th the Patient complained of nothing , I unbound the Wound , and took out the Tent , the Blood being stopped , I covered a shorter Tent with the Yolk of an Egg , besprinkled with the former Powder , and put it into the Orifice . I applyed a defensative to the Armpit and to the top of the Shoulder , and anointed the Arm with Oyls and bound it up with wet Linnen and the two headed Rowler . On the 6th . the Patient being bound , and having a pain about the bending of the Arm took this Lenitive Syrup .

Take of Solutive Syrup of Roses , two ounces . Cassia newly drawn , one ounce . Citron seeds Powdered , half a dram , Succory water , as much as sufficeth . Mix them , and make a Liquid Syrup .

With this he voided five times bilious and serous matter , the Wound was dressed as the day before . On the 7th . a little digested matter , appeared about the Wound , and therefore I added a half part of Fra●kincense to the Oyntment for stopping Blood , th●t flesh might grow in the Wound .

Take of The Powder before described . Frankincence , of each half a dr m . Of the yolk of an Egg , as much as sufficeth . Mix them into an Oyntment .

In which the Tents are to be dipped . From the 8th to the 10th . The Patient went on evry well . On the 11th . He said , that he had not slept the night before ; and by reason of his inquietude , he had moved his Arm up and down , so as some blood came out of the outward Orifice . The blood being stopped , I dressed the Wound , as the day before ; and ordered the Patient this following Purging Syrup .

Take of Solutive Syrup of Roses two ounces and a half . Extract of Rubarb a dram and half . Magistery of Tartar one scruple . Black Cherry-water , as much as sufficeth . Mix them into a Liquid Syrup .

On the 12th . 13th . & 14th . The Patient slept very well , and complained no more of pain in the bending of the Arm ; and the outward Orifice , which upon the motion of the Arm had bled , did now generate Digested matter . On the 16th . Instead of the Tent , I applied dry Lint , and bound on a new Spunge , dipped in red Wine hot , and pressed out , with the Rowler with two Heads . On the 19th . I Cicatrized the Orifices .

OBSERVATION XCIII . Of a great Excrescence on the Thigh .

JOhannes Ferher of Hamburg , a Swedish Souldier , about the 24th . Year of his Age ; had a swelling arose in the inward part of his right Thigh ; which in the space of two years , grew to such a bigness : that it was as big as three Mens Heads , and hindred his going . This Excrescence , a certain Empirick , corroded with a Caustick , that the matter might get out , designing afterwards to Consolidate the Ulcer ; but finding no fluid matter , the Empirick fled away , and left the Patient destitute of all help . In the Year , 1634. The Patient came to Ulme , and desired help of Johannes Georgius Bauler , a Chirurgion ; who when he could not Consolidate this foul Ulcer , with any Medicines . By my advice , and the advice of George Riedlin , he took hold of the painful ulcerated swelling , with the Pincerrs , and cut it out with a Knife red hot , and the Eschar coming out , the Ulcer was fairly Cicatrized with the Ceratum Divinum , see , Tab . XXXV . Fig. II . Looking into the substance of the swelling cut off , which was fleshy and full of Veins , and Arteries . We enquired of the Patient , whether he were naturally so lean , or no ? he answered , that before the rising , and encrease of this swelling , he was rather full bodied , whereby we were informed , that this swelling had received , and detained , most of the Aliment , which should have nourished the whole Body . Being recovered and about to leave Ulme , I advised him to use a slender Dyet ; and every month to apply six Cupping Glasses to his Back , with scarification : till by degrees , the habit of the Body might be accustomed to assimulate the blood to it self , which before Nature was accustomed to transmit for the nourishment of the Tumour . The young Man observed these directions diligently for half a year , and lived in good health to the Year , 1644. At which time , being in the Bavarian Army , he visited me , and gave me many thanks for my advice .

OBSERVATION XCIV . Of a Gun-shot Wound with a broken Leg .

ON the 31st . of May , 1644. About six in the evening Leonardus Henseler a Heards-man of Ulme , was wounded with a Leaden Bullet ; which did not only break his left Leg a little below the Knee , so as the Bone stuck out of the Wound , but went through the right Leg also , without hurting the Bone . Things being thus , at the first visit , for want of other Medicines , these following were applied . I injected with a Siphon into the Wound of the right Leg , Oyl of Violets , mixed with the white of an Egg , and put in small Tents , done over with the same Medicine ; over that I applied the Cerate of Diapalm , and a Cataplasm made of Barly-Meal , Mallows-meal , White-bread and Milk , and the Rowler with two Heads . Then I set the left Leg , as well as it was possible , and poured in the white of an Egg , and Oyl of Violets , shaken up together ; and put into the holes Tents of dry Linnen wreathed , and over that , Diapalm , and the for-mentioned Cataplasm , and bound it up with the divided Bandage ( Tob . XXVII . Fig. I. & Tab . XXVIII . Fig. X. ) and placed it in a Case . On the 1st . of June , I cut off a piece of the Bone , which pricked the skin , and made the Patient unquiet all night , with the Pincers , Tab . XX . Fig. I. And the Bone being cut off , I cut down the space between the holes with the Syringotomus , ( Tab . XIV . Fig. II C. and filled up the Wound , which was thus Dilated , with this Digestive .

Take of Turpentine washed in Plantain-water three drams . Oyl of Earth-worms a dram and a half . The yolk of an Egg. Hony of Roses streined as much as sufficeth . Mix them for a Digestive .

Take of Roots of round Birth-wort . Orice , of each a dram and half . Mix them into a Pouder .

I sprinkled this Pouder upon the Bones , and applyed dry Lint , but to the Flesh the Digestive ; then I covered the lips of the Wound , with the Cerate of Diapalm , and bound up the Leg with the Cataplasm , and the divided Bandage , and then placed it in the Case . In the mean time the Patient , by reason of his fainting took often a spoonful , or two of this Cordial-water .

Take of Black Cherry-water two ounces . Borage-water , Rose-water , of each an ounce . Cinamon-water two drams . The Anhalt Cephalick Spirit half a dram . Magistery of red Coral two scruples . Pearl Tablets half an ounce . Mix them .

For his thirst , I prescibed this cooling Syrup .

Take of Syrup of Vinegar , Syrup of sharp Pomgranates , Syrup of the Juice of Citrons , of each an ounce and half . with which he mixed the Barly-water ordered for his Drink : then for the present pain , and for fear of an inflamation , he took a cooling and moistening Glister : which being come away , a Chyrurgion opened the median Vein of the right Arm , and took away six ounces of blood . On the 2d . of June , the Patient was somewhat better . On the 3d . of June , having rested ill the night before , by reason of another piece of Bone , which very much pricked the fleshy parts . I cut that out also , and sprinkled upon the Bone remaining , the former Pouder , and applied a Digestive to the lips of the Wound . The Patient the same day , upon his being bound , and a great Flux of humours to the wounded part , took this purging Potion .

Take of Syrup of Roses two ounces , Lenitive Electuary six drams . Electuary of the Juice of Roses a dram and half . The Decoction of the Flowers and Fruits , as much as sufficeth . Mix them , and make a Potion according to Art.

With this he voided five times bilious and serous matter . On the 4th . day , he was better than the day before . On the 5th . he complained of the Cholick , and therefore I gave him two ounces and a half of Oyl of Almonds , in a Decoction of Flowers of Camomile , and the pain ceased . On the 6th . his Belly being bound , he took the Potion last prescribed ; after the working of which , he slept very well . On the 7th . when the Eschar was fallen off , I bound up the Wound with a Digestive without Oyl ; and instead of the Cataplasm , I wrapped up almost the whole Leg , in the Cerate of Diapalm , with holes made in it ; and with the divided Rowler . On the 8th . I applied this following Digestive to the Wounds .

Take of Turpentine washed in Scordium water three drams . Roots ef Orice poudered , Round Birth-wort of each a dram . Aloe , Myrrhe , Olibanum , Bole-Armenick prepared , of each a scruple . Balsom of Peru one dram . Syrup of Red Roses , and Hony of Roses streined , of each as much as sufficeth . Mix them into the form of a Liniment .

On the 9th . The Patient as to his Leg , was well ; but at the same time complained of the Chollick , which ceased after a spontaneous evacuation of the bilious matter , by reason of the stinking of the Wound , I injected the Decoctum Divinum .

On the 10th . The Patient was better , and the Wound in the left Leg sent forth Digested matter . Under the Tibia I observed a small putrid piece of Bone , which I washed with the Decoctum Divinum , and covered with the Pouder ; and then bound up the wound with the Liniment prescribed , and the Cerate of Diapalm . From the 15th . to the 30th . The Patient went on well ; at which time , the Bone in the Superficies of the left Leg scaled off on the outside of it . The Wound on the right Leg began to Cicatrize . On the 27th . of July , I drew out a piece of the separated Bone with the Pincers : The Wound on the right Leg was Cicatrized . On the 15th . of August , upon irregular Dyet , he complained of a great pain of the left Leg , two Fingers breadth above the Knee ; the Wound being unbound , I found an Abscess , which , upon pressing with my Finger , sent forth a great quantity of matter . On the 26th . The Patient took this Pouder , for a bitterness in his mouth .

Take of The best Rubarb a dram , Crem of Tartar half a dram . Black Mechoacan one scruple . Mix them into a Pouder .

This made him void bilious matter often , after which he was better . On the 25th . of August , I took a piece of bone out , of the bigness of my little Finger . On the 14th . of September , there appeared another hollowness under the Knee , about the forepart of the Patella , which could not be evacuated by the hole above ; and therefore I perforated it with the end of the instrument covered with Wax , Tab . XIV . Fig. V. and the matter being evacuated , I agglutinated it with a Spunge pressed out in Red-Wine and , the Rowler with two Heads . After the agglutination of the hollowness , I Cicatrized the Wound in few days by the help of the Ceratum Divinum . So that the Patient on the 4th . of October , could walk without Crutches . and in December , went about his business without any hindrance .

OBSERVATION XCV . Of a broken Thigh .

ON the 24th . of December , 1644. Johanes Kriesinger a Victualer of Ulme , as he was bringing fuell out of the Woods , a Cart laden with Wood , broke , and Wounded his left Thigh , after which he was brought to Ulme , where John Meckenried , and George Riedlin , bound up his Thigh . Upon the 27th . upon the great pain and inflammation I was called in , and at my first coming to the Patient , I inquired , whether the Wound was made by the broken bone , or by a Billet of Wood , informing them that this was very materiall to know in the Cure of his Thigh , and it might be known by his Breeches , for if they were rent the Wound came from without , if not from within : but there could be no hole found in his Breeches , so that it was evident that the Wound was made by the broken Thigh-bone ; and therefore I composed the Fracture of the extended Thigh , and bound up the whole Thigh with three perforated rowlers that the large Wound might dayly be discharged , dipped in a convenient Medicine , ( viz. ) Oyl of Roses , Rose-water , and the white of an Egg , stirred up together , to mitigate the inflammation , and pain , and layed it into its case . On the 28th . by reason of an unquiet night and bitterness in his mouth he made use of this thin Syrup .

Take of Syrup of Roses solutive two ounces . Extract of Rubarb , four scruples . Diacarthamum , two scruples . Magistery of Tartar , one scruple . Succory water , as much as sufficeth . Mix them , for a potion .

With which he voided divers times bilious matter . On the 29th . The Median vein , of the left Arm was opened , and seven ounces of Blood taken away , in the Evening the Patient took a draught of an Emulsion , sweetned with Syrup of Violets , he passed that night very quietly , and the inflammation and pain ceased , the inflammation being cuted , I procured the generation of the Callus by Ligatures , externall Medicines , and convenient diet , yet the Patient healeth to this day , because being naturally inclined to anger he never held his Leg still in the case , but moved it up and down , nor is it to be wondred at , for as I have formerly taken notice of it , Men of any years , although they be very obedient are seldome cured of broken Thighs , so as not to halt : unles the Thigh be kept Extended by the instrument called the Glossocomon of Galen . Tab . XXI . Fig. IV . If not all the time of the Cure , at lest , while the Patient goeth to stool , or the Bed be made .

OBSERVATION XCVI . Of a Worm on the Head , and convulsion of the Arm.

A Certain Virgin of Ulme , of twelve Years of age , upon stopping the Bleeding at the Nose , which she was accustomed to , was troubled with an immoderate flowing of the courses , and that being stopped she complained of a Tinea on the Head , and a very troublesome convulsion of the left Arm , her body being purged by taking often of Trallianus his Pills of Salt-Peter , and her courses returning again , I anointed her Head once every day , with the Liniment of the incombustible flax : which I prepared out of Anclmus Boetius , his History of Stones , and Jewels . L. 2. C. 204. And anointed the Arm twice a day , with the Oyntment of Eve , or the Polychreston of Spigelius , the description of which may be seen . Tab . XLIII . And with these Oyntments the Patient in a short time was most hapdily cured .

OBSERVATION XCVII . Of the Leprosie of the Greeks .

ON the 17th . of December 1641. I went with my most dear relation the most eminent Dr. Johannes Regulus Villinger , to visit a Lady of Ulme , who was in so miserable a condition , and had so sad an Aspect ; that I want words to express it sufficiently . for first , she could not stand upon her feet , unless she were held up by two Maid-servants , she looked pale , her Forehead was full of wrinkles and Skales , her Eyes hollow , her Eye-brows bald and smooth , her Nose filled up within with scabbes , and covered with scurfes and Skales without , her Mouth swelled , her Lipps black and blew , her Head hanging down , her Breast bent , consumed away , and beset about with Scabbes , no Hair under her Arm-pits or upon her belly , her Arms and Leggs lean , and covered with Scales and Scabbs , the topps of her Fingers and Toes had no sense nor felling , by reason of a great corrosion , and the thickness of the Seabbs , and her whole Body sent forth a most stinking smell , all the Symptomes being well considered , we named this Disease not an Elephantiasis , or Leprosie ; but Lepra Graecorum , or Leprosie of the Greeks ; and had great hopes to cure it , both because the Patient would spare no charges , and would be very obedient , she did so earnestly desire her health ; and therefore we prescribed there following Ingredients , to purifie her blood .

Take of The Roots of Polipody of the Oak , Enula Campana , Succhory , of each half an ounce . Of the Leaves of Fumitary , Speedwel , Bor●ge , Spleen-wort , Dandelion , Be●●ny , of each a Pugil . Se●na wi●●out the stalks one ounce . Choise Rubarb half an ounce . Tr●chies of Agarick three drams . Black Mechoacan two drams . Roots of black Hellebore a dram and half . Carthamum-seeds four scruples . Ginger , Cinamon , of each a scruple .

Being cut and bruised , mix them and put them into a Sack to be infused 24 hours in a measure of Hony and Water : of which afterwards let her take seven ounces two hours before Dinner , and the third day abstain from this purging Medicine , and take a part of this Electuary , four hours before Dinner , and three hours before Supper .

Take of Conserve of Borage , Conserve of Enula Campana , of each six drams . Prepared Pearl , Red Coral prepared , of each half a dram . Trochies of Vipers half an ounce . Syrup of Coral , as mdch as sufficeth to make it into an Electuary . And drink after it , a draught of Clarified Whay , made of Goats milk .

After the repeating of these purging Ingredients , she bathed her self an hour in a Bath made of fair water ; in which Fumitary , Mallows , Speedwel , and Enula Campana , were boiled : afterwards , her Body being wiped , she anointed her self with this following Oyntment .

Take of Pomatum two ounces , Balsom of Peru two drams . Flower of Brimstone two drams and a half . Oyl of Tartar two ounces . Mix them into an Oyntment .

Upon the use of these Medicines , the great stink , and continual itching of the whole Body remitted , and the Scales fell off from the tops of her Fingers and Toes : for the generating new Flesh where it was eaten away , in those parts I applied and Oyntment made of the yellow Cerate , and Oyl of Myrtles : the Maid-servants anointed her Back with Vipers fat .

She drank a Decoction of China for her ordinary Drink . But here some may demand why this Patient , who laboured under a Consumption of all parts , should make use of Vipers Flesh ? to which it may may be answered , that seeing that Diseases of the whole substance will not be cured , but by Medicines which work by a secret way , and by their whole substance ; and the Leprosie of the Greeks being such a Disease ; it will not be cured , but by Medicines , which Act by an cccult Propriety , amongst which , Vipers Flesh doth not hold the lowest Rank . On the 6th . of January , 1642. The median Vein of the left Arm was opened , and four ounces of blood taken away : the top of which , appeared white , greenish , and putrid ; but the bottom black and not concreted , and the Chyrurgion who let her blood , said that he smelled a great stink when the blood came out . This being done , she made use of the purging Ingredients the third time , and the Electuary , to which I added a quantity of Trochies of Vipers .

Take of Conserve of Borage ten drams . Trochies of Vipers four drams . Red Coral prepared , Prepared Pearl , of each half a dram . Syrup of Coral , as much as suffieth to make it into an Electuary .

Which with great efficacy doth expell the malignant matter from the Center to the Circumference : when the filthines abated , the Patient began to sleep , and drank no longer Whay of Goats-milk . After the taking of the Electuary in a fortnights time she took these Pills twice .

Take of The mass of the Golden Pills two Scruples . Extract of Cochie Pills half a scruple . Magistery of black Mechoacan seven Grains . Extract of black Hellebore half a scruple . With Syrup of Betony , make them up into one and twenty Pills , and guild them .

Which gave her ten Stools ; after the second using of these Pills , the Hair began to grow again upon the Eye-brows , under the Arm-pits , and else where . Things being thus , we forbad the further use of remedies , the time of her Courses being near , and advised her for the future if they came down in too small a quantity , or too slowly , to promote them with a dram of these Ammoniacal Pills

Take of Aloe extracted in Endive-water , Gum Ammoniacum dissolved in Vinegar of Squills , Myrhe prepared , of each a dram . Mastick , The Species of the three Sanders's , of each one scruple . Salt of Worm-wood a dram . Syrup of the Juice of Roses , as much as sufficeth . Mix them into a Mass for Pills .

With these remedies the Lady recovered her former health .

OBSERVATION XCVIII . Of Oedematous and Erisi-pelaslike inflamations .

In inflamations that are both Oedematous , and like to St. Anthony's Fire , which for the most part invade the Limbs , and are often very troublesome , both to Physitians , and Chyrurgions , I never experienced any thing better , than this following remedy , which a German Chyrurgion , communicated to the most excellent Spigelius , for a rare secret , and so certainly it was .

Take of The Lye of the Ashes of Vine Branches one pint . Salt-Peter a dram and half . Common Salt an ounce . The best Wine Vinegar an ounce . Mix them

And after general remedies ; dip a double Linnen Cloath in this luke-warm , and apply it to the Part affected , binding it on with Rowlers : this doth wonderfully drink in , and discuss , in three , or at most , in four days time , great dangerous swelling , threatning mortifications .

OBSERVATION XCIX . Of the Shin bone corrupted , and scraped with the scraping Irons .

A French Soldier who had been troubled wirh a Virulent Gonorhea , which was unseasonably stopped by injections , fell afterwards from his Horse upon the Stones so as the Skin came off of his Legg . This Ulcer being dressed with ordinary Medicines became malignant and corroded the Shin-bone , for the cure of which I proposed a sudorifick course , and that being finished I made an incision with my Knife , right down the Legg , and dilated the Wound with astringents , and then scraped the Bone with the scraping Irons , and covered it with Cephalick Powders . I incarnated the Ulcer with the yellow Oyntment , which doth most excellently and wonderfully well in corroding Ulcers , and Cicatrized it with the noted Cerate , See . Tab . XLIII . under the . letter R the Observation of Martin Smith , who for such a corrosion of the Legg , and Shin-bone very successfully underwent this manner of cure with the scraping Irons .

OBSERVATION C. Of a Leprosie taking its Original upon the eating of Leprus flesh .

IN Autumn 1637. A Butcher of Ulme , in the middle of his journey towards Vienna , was entertained at his Inn by an Hostess who was a sorceress , with the boyled flesh of a Man lately dead of the Leprosy ; upon eating of which the whole mass of his Blood was presently infected , which sent out Malignant Boyls to the superficies of his Body , and first of all to his Head , and hearing the report that this wicked Woman was burnt publickly for many other and several offences . he was very melancholly and began to despair of the recovery of his health , but least he should seem to be wanting to himself , he consulted with a Chyrurgion otherwise experienced enough , who not pondering the business sufficiently , attempted to restore the Patient , but in vain , only with outward Oyntments , till at length he did most earnestly intreat my most eminent Collegue Dr. Johannes Georgius Gockleius , divers times cited in our Observations , and from whose Communication I had this cure , that he would assist him in this affair , and try his uttermost .

The Dr. according to his usuall humanity demonstrating to the Patient and the Chyrurgion , by solid reasons , that without the freqent taking of inward Remedies , and preparing of the mass of Blood , and depurating of it : the use of purgers , and bleeding the discussing of the communicated malignity by sudorificks , the strengthning of the Liver , and at last , the orderly anointing of the outward parts , this Disease , although not yet rooted in , could never be Remedied , the Patient promised all obedience in the cure , and the Dr. assured him of his care , and diligence and after this manner went about the cure .

First a regular Diet was ordered , Meats of good digestion prescribed , and free from all sharpness as in the cure of the French-Pox ; for his drink he ordered a Decoction of Guaicum and Sassafras to be prepared with Anise-seeds , and Fennell seeds ; a stronger Decoction , to provoke sweat : and a weaker to quench his thirst .

Secondly , he prepared his Body for purgation two days together , with this digestive .

Take of The Syrup of the two opening Roots , an ounce . Hony of Roses streyned , half an ounce . Cream of Tarter powdered , one scruple . Asparagus water . Fumitary water , of each two ounces . Mix them , for one Dose .

Thirdly , he removed the vitious humours of his Stomoch , by this following Medicine , taken in Wine .

Take of The best Mercurius dulcis , one scruple . Crocus metallorum , six grains . Cambogium , seven grains . Mix them . into a powder

Fourthly , he ordered the Median Vein of the right Arm to be opened , and five ounces of Blood to be taken away .

Fifthly , after some days r●sting he prepared his Body again , four times with this powder in Broth .

Take of The Tartarum Vitriolatum , powdered half a dram . Give four Doses of this at several times .

Sixthly , he most happily proceded to the cleansing of his Blood with these Specifick Pills .

Take of Crollius his Panchimag . two scruples . Mercurius dulcis , one scruple . Cambogium seven Grains . With Black-cherry water , make them into ordinary Pills , for one Dose .

Seventhly , he proceeded to Sudorificks in which the Patient being very regular he took dayly in a draught of the stronger Decoction of Sassafras a Dose of this following .

Take of The Golden Diaphoraetick sulphur , From twelve grains to fifteen , Make it into Powder for one Paper .

And for a month together in the Morning keeping his bed for two hours he sweat very plentifully , except every seventh day , when he repeated the taking of the Pills before described . Eightly , being let blood upon this , the blood which came out of his left Arm was much more pure than the former . Ninthly , the impurity remaining ( upon his skin , was wiped off in a stove , and his Head was cleansed with this Lye , made on purpose .

Take of The Roots of Bryony one ounce . Dock Roots half an ounce . Leaves of Hore-hound , Crisp Mint , Wild Marjeron . Betony , of each half a handfull . Camomile flowers . Roots of Asarabacca with the whole plant , of each two pugils . Crude Aggarick half an ounce . Cut them grosely and boyl them in common Lye .

Tenthly . Some sores remaining in his Head and other parts of his Body , were healed , and all outward uncleanness , was finally taken away with this Oyntment

Take of The white Oyntment with Camphir one ounce . Mercurius Dulcis two drams . Grind them well together , and put them into a Pot .

So by the Divine favour , the Patient very well known to me , was in ten weeks time most happily restored : he continued the use of the Decoction of Sassafras for his ordinary Drink for some time , and the Disease never broke out again in the least , all the days of his life .

FINIS .

THE TABLE OF THE OBSERVATIONS . A AN Apoplexy upon breeding Teeth page 279. Atheroma cut out of the Forehead . page 147. An Atheroma on the outside of the Leg cured . page 367. St. Anthonie's fire . page 343. St. Anthonie's fire Ulcerated . page 345. B A Broken Thigh . page 381. The bringing forth of a dead Child . page 252. Blood Vomited up mortal . page 348. Barrenness from a rupture ill reduced page 343. A broken Leg with a Wound page 364. C A Contusion of the Head causing Death an hundred days after , by omitting the use of the Trepan . page 243. A contusion of the Brain the ninth Week destructive . page 244. A contusion of the Head upon which hapned a Vertigo , and an Apoplexy . page 248. A contusion of the Head causing convulsions at the New-moon . page 254. A Convulsion of the Eye from a concussion of the Brain . page 260. A Callous hollowness and corruption of the Pallate-bone . page 270. A Contusion on the hinder part of the Head helped by the scraping Irons . page 287. A Cancer of the Breast cut off with the Knife . page 319. A Cancer in the Breast ill cut off . page 326. A Cancer in the Breast discussed . page 327. The Corrosion of the Stomach healed . page 353. Chilblains and Kibes Ulcerated . page 360. Cancers incurable proceeding from Obstructions of the Gall . page 338. A Concussion ●f the Brain . page 370. A Convulsion of the Arm and Worm on the Head . page 382. D A Depression of the Skull with a pricking of the Dura mater . page 247. A De●r●ssion of the Skull of a Woman with a fissure . page 286. A 〈◇〉 Child brought forth . page 352. E AN Excrescence of flesh on the roof of the Mouth . page 270. An Empyema in the Breast cured by opening it . page 304. An ●mpyem● evacuated by Urine . page 305. An Empyema cured by Diureticks . page 315. Excrescences of flesh . page 359. An Erysipelas or St. Anthonie's fire . page 343. An Erysipelas Ulcerated . page 345. An Excrescence on the the Thigh . page 376. F THe Fundament not sufficiently perforated . page 351. A Fistula in the right Breast , page 350. Fleshy Rupture or Hernia carnosa . page 349. A Fractur● of the Thigh-bone with a Wound . page 361. Fleshy Excresencies . page 359. A fistula in the Breast cured by corrosives . page 307. A Fi●tula in the Breast perforated with a Needle . page 303. A Fi●tula on the Breast with a corrosion of the Clavicula . page 288. Fiss●r● on the head cured in a Boy and a Man . page 287. A Face Burnt with Gun-powder . page 282. A Fissure and depression of the inward Table of the Skull the outward being sound . page 251. G A Gunshot Wound on the lower Jaw . page 275. A Gutta Serena or blindness cured by a Seton . page 283. A Gutta Serena of both the Eyes incurable . page 285. A Gunshot Wound in the Back . page 330. A Gunshot Wound with a Gangrene . page 344. A Gonorrhea Virulenta . page 352. A Gunshot Wound with a broken Leg . page 377. H A Hand cut off for a Spina Ventosa . page 373. A Herpes Miliaris corroding . page 345. A Hernia Carnosa . page 349. K KIbes and Chilblains Ulcerated . page 360. The Kings evil covering the whole Neck . page 280. L A Leg broken with a Wound . page 364. The left Shoulder-blade corrupted . page 339. The Leprosy of the Greeks . page 383. A Leprosy from eating Leprous flesh . page 388. M A Meliceris in the Shoulder and Knee . page 342. N A Nerve pricked , page 341. A Node Venereal cured by Chyrurgery . page 341. O OEdematous Tumours . page 347. Oedematous and Erysipelas-like Tumours . page 386. P A Periodicall pain of the teeth most happily cured . page 278. The pains of a Cancer mitigated . page 328. A pain and Ulceration of the Breast mitigated by an Issue . page 329 The Pricking of a Nerve . page 341. The Piles relapsed into from the use of Scammony . page 351. Q A Quinsy very dangerous cured . page 282. R A Rupture fleshy or Hernia Carnosa . page 349. A Rupture ill reduced causing barrenness . page 343. A repalse into the Piles from the use of Scammony . page 351. S THE Shin-bone corrupted scraped with the Scraping Irons . page 387. Scammony causing a repalse into the piles . page 351. A Stone taken out of the Urinary passage without Probe or Incision . page 340. The Shouldertblade corrupted . page 339. A Spina Ventosa . page 364. A Steatoma on both Hands , page 360. A Shin-bone corrupted . page 354. The Stomach corroded . page 353. The String of the Tongue ill broken with the Nails , page 279. A Swelling with a bag cut out of the upper Jaw . page 265. T A Thrust into the Skull , penetrating both the Tables . page 255. A Tumour in the upper Jaw contained in a Bag . page 271. The Thigh bone fractured with a Wound . page 361. Tumours Oedematous . page 347. The Thigh fractured . page 381. V A Virulent Gonorrhea . page 352. Vomitting Blood Mortal . page 348. An Ulcerated Erysipelas . page 345. A Venereal Node cured by Chyrurgery . page 341. An Ulceration in the Breast mitigated by an Issue in the Thigh . page 329. An Ulcerated Cancer of the Breast cut off with the Knife . page 319. A Venereall excrescence of flesh in the Nose . page 284. A Vertigo in a sheep from an Abscess in the Brain . page 247. w A Wound on the Head with a depression and large fissure of the Skull . page 225. A Wound on the Head with an inflammation of the Pericranium , and a doubtfull fissure of the Skull . page 230. A Wound in the Temporal muscle with a very large cleft in the Skull , and inflammation in the Dura mater . page 232. A Wound dividing the Fore-head-Bone cured by the Trepan , page 234. A Wound on the Head with a very great depression of the Skull . page 235. Another Wound on the Head with a very great going in of the Skull . page 238. A Wound on the Head with an Incision of the Falx , Dura mater , and Pia mater . page 250. A Wound on the Head cured by the Trepan , after twenty eight Weeks . page 251. A Wound on the Head mortal upon drinking Wine after the opening of the Skull . page 252. A Wound on the Head and the outward table cut away . page 255. A Wound on the Head with two Fungi mortal . page 256 A Wound on the Eye made with the end of a Spindle . page 259. A Wound and Fracture of the Nose . page 262. A Wound on the Breast with a fracture of the Rib . page 290. A Wound on the Breast dangerous . page 293. A Wound on the Breast requiring the Paracentesis . page 299. A Wound on the Breast penetrating through the midriff , into the bottome of the Stomach . page 305. A Wound on the Breast dilated with the Knife . page 308. Another Wound on the Breast dilated with the Knife . page 309 A Wound on the Groin and Yard by a Bullet . page 322 A Wound on the Breast mortal upon neglecting the Paracentesis . page 336. A Wound on the Wrist hurting the Artery . page 368. A Wound on the Arm dangerous . page 374. A Worm on the Head , and Convulsion of the Arm. page 382. Y The Yard taken off . page 337.

A TABLE OF THINGS REMARKABLE . A AN Aegylops cured , Tab . 33. Fig. 3 , & 5. An Ancyloblepharon cured , Tab . 33. Fig. 2. The Apparatus for Dilating Wounds on the head , Tab . 30 , 31. The Apparatus for Perforating the Skull with the Trepan , Tab 31. Fig. 1. The Apparatus for making an Issue on the top of the head , Tab . 30. Fig. 1 , & 7. The Ankle-bone Dislocated how reduced , Tab . 25. Fig. 1. An Atheroma cut out of the forehead , Tab . 35. Fig. 2 , & 4. An Arm out of joint , how to be set , Tab . 23. Fig. 2. & Tab . 24. Fig. 1. The Application of the Tunnel , Tab . 36. Fig. 3. B BArly Water , 226 , & 294. Bandage to be brought round , Tab . 28. Fig. 18. in the Leg . Bandage brought round , Tab . 27. Fig. 10. Bandage cross-wise , Tab . 28. Fig. 10. in the thigh . Bandage after Amputation , Tab . 28. Fig. 1 , 2 , 3. Bandage for an Issue on the Head , Tab . 30. Fig. 6. Bandage for an Issue in the Arm , 217. Bandage for an Issue in the Thigh , 218. Bullets taken out of Wounds , Tab . 43. N. A Breast cut off for a Cancer , 38. Fig. 1. Bones pricking the Membranes of the Brain , broken off with Pincers , Tab . 32. Fig. 3 , 4 , 5 , 8. The Breasts of those who give suck drawn out , Tab . 37. Fig. 6. The Back-bone slipped outward , reduced , Tab . 25. Fig. 2. Bolsters , 86. The Betony Oyntment , 241. C A Caruncle in the Urinary passage , extirpated , Tab . 40. Fig. 5. A Cataplasm to take off an Eschar , Page 48. A Cataplasm against Inflammation of the Eyes , 265. The Cerate of the Duke of Tuscany , 219. The Cerate Astringent , 182. The Ceratum Diasinapi or of Mustard , 212. The Ceratum Citrinum , 213. The Cerate for Nodes in the French Pox , 223. The Ceratum Divinum , 242. The Cerate of Hippocrates of Roses , 77. The Ceratum Oxelaeum , 320. The Cerate of Joannes Praevotius , 327. The Clitoris cut off , Tab . 41. Fig. 1. Contusions on the head of divers kinds 125 , 126 , 128 , 129. A Contra-Fissure of the Skull , 131. A Cancer of the Breast cut off , Tab . 38. Fig. 1. The Cauterizing of the Nostrils , Tab . 37. Fig. 1. The Cauterizing of the hinder part of the head . A Cataract couched , Tab . 33. Fig. 3 , 4. A Cataplasm excellent against a Gangrene , 345. D OF Dislocations , and their Cure in General , 73. Of a single or simple Dislocation , 74. Of the five Intentions in the cure of a Dislocation , viz. 1. Extension . 2. Reposition . 3. Deligation . 4. Deposition . 5. Religation , 73 , 74 , 75. Of a Dislocation with Inflammation , 79. A Dislocation with a Wound and the bone uncovered , 81. A Dislocation with a Convulsion , 81. A Dislocation with a Callus , 82. A Dislocation after it is reduced , that slips again , 83. A Dislocated hand reduced , Tab . 24. Fig. 2. The Depression of the lower Jaw , Tab . 36. Fig. 7. The Decoctum Divinum , 258. The Decoctum Magistrale , 207. The Dead Child drawn forth , Tab . 41. Fig. 5. The Depression of the Skull , with a broad rift in the middle , 129. A Depression of the Skull , with a narrow crack in it , 130. A Depression of the Skull , with a crack on the side of the Depression , 130. The Distance between the holes in the Skull , cut away with a Saw , Tab . 32. Fig. 1. E EXcrescencies large , their general Cure , 148. The upper Eye-lid contracted , how cured , Tab . 35. Fig. 4. The upper Eye-lid relaxed , how to be cured , Tab . 35. Fig. 3. The Eye fastned with a Ring , Tab . 33. Fig. 6. An Electuary for a Rupture , 183. The Elongation of a joynt , Page 84. Extention necessary in Dislocations , and Fractures , 74 , & 84. An Electuary for the Kings-Evil , 281. F THe Fundament inspected , Tab . 41. Fig. 6. The Fundament of Children closed , is Perforated , Tab . 41. Fig. 6. Ferulae , 87 how used , 89. A Fistula of the Breast creeping under the Ribs , cured by perforating it at the bottome , Tab . 38. Fig. 5. An outward Fistula of the Breast cut , Tab . 39. Fig. 2 A Fistula in the Fundament penetrating , cured , 199. A Fistula in the Fundament not penetrating , cured , 202. Of Fractures , the general Cure , 84. Fractures simple , transverse and oblique , 84. A Fracture , how to be composed , 86. A Fracture set , how to be bound up , 89. A Fracture bound up , how to be placed , 90. A Fractured part , how to be unbound , 90. A Fracture right down , or a shingle Fracture cured , 94. A Fracture with a simple Wound , 95. A Fracture with a wound , in which the bone is not naked , yet a great piece of the bone is expected to come off , 97. A Fracture with Wound wherein the bone is made naked , yet it doth not stick without the Wound , 99. A Fracture with a Wound where the bone sticks out of the Wound , 99. A Foot cut off , Tab . 27. Fig. 15. G A Glyster to be given to ones self , Tab . 42. Fig. 8. A Gargarism for a Quinsie , 282. The Gut called the right Gut fallen down put up again , Tab . 41. Fig. 7. H HAemorrhoides that swell , curred by manual operation , 201. Haemorrhoides running too much , cured manually , 202. Haemorroides ulcerated , cured by Instruments , 204. The Hymen hindering Coition , cut , Tab . 40. Fig. 15 , 16. A Hand out of joint , reduced , Tab . 24. Fig. 2. A Hare-lip cured , Tab . 35. Fig. 8. The Holes made with the Trepan , smoothed , Tab . 31. Fig. 7. Herticius his Pills for pain of the Teeth , 278. Hairs which hurt the eye , pulled out , Tab . 35. Fig. 2. A Hand cut off , Tab . 27. Fig. 11. 12. I ISsues where to be made on the head , Tab . 32. Fig. 2. Issues where to be placed in the Arm , Tab . 43. F. Issues where made in the thigh , Tab . 43. I. An Issue in the legg , Tab . 43. K. Injections into the ears dangerous , Tab . 36. Fig. 5. The Inspection of the Matrix , Tab . 41. Fig. 4. K THe Knee out of joint , how to be reduced , 64. L A Leg broken , how bound up , Tab . 29. A Liniment excellent against Caruncles in the passage Urine , 190. A Liniment for burnt places , 283. The Linimentum Simplex , 320. A Liniment for Kibes and Chilblains ulcerated , 360. Lizard Oyl , 281. The Lime-water most excellent , 347. M THe Middle posture of the Aarm and Leg , Tab . 2 Fig , 2 , 3. The Matrix inspected , Tab . 41. Fig. 4. The Meeting of the Coronal , and Sagittal Sutu● how to be found , Tab . 30. Fig. 2. N NOdes in the French Pox , how Cure● 22. The Neckbone out of joint , reduc● Tab . 24. Fig. 3 The Nostrils Cauterized for an O●● and after the Polypus is drawn out , Tab . 37. Fig. 1. O THe Oyntment yellow , or Unguentum Citrinum , 345. The Oyntment for Wounds of the Nerves , 341. An Oyntment to consume the hardness of a Fistula , 307. An Oyntment to hinder the breeding of a Callus , 308. The Oyntment of Eva , or Unguentum Evae , 212. The Oyntment of Betony , 241. Oyl of Lizards , 281. P A Plaster to stop bleeding at the nose , 123. The Paracentesis of the Belly , Tab . 39. Fig. 2 , 3. The Paracentesis of the Breast Tab . 37. Fig. 2 , 3 , 4. The Perforatron of the Yard , having no hole , Tab . 40. Fig. 6. The Pills of Herlicius for pain of the Teeth , 278. Pills to provoke the Terms A Polypus pulled out , Tab . 33 , Fig. 7. A Pterygium cured , Tab . 35. Fig. 6. A Powder for Parts galled , 328. A Powder for fleshy Excrescencies , 359. A Pouder for the Teeth , 359. 〈◇〉 Prick on the Skull taken away with the Piercer , 132. Tab . 33. F. 1. P●toral Trochies with Musk and Amber , 282. R TH●●educing of the Back-bone slipped outward , Tab . 25. Fig. 2. Th● reposing a member Fractured , or Disloacated into its case , Tab . 2 Fig. 2 , 3. The Rig● gut fallen down , reduced , Tab . 41. Fig. 7. The Rupt● e of the Navil , Celsus his way of Cure , Tab . 33. Fig. 7. Rupture of e Navil , Fabritius his milder way , Tab . 38. Fig. 8. Tab . 39. Fig. 1. The Rupture ●he Guts , the Nursine way of Cure , Tab . 40. Fig. 8. to the 14th . The Rupture of t● Intestines , a milder Cure , Tab . 38. Fig. 6 , 7 , 8. S SHarpness of Urine . tigated , Tab . 40. Fig. 4. Stone in the Bladd●●earched for , Tab . 40. Fig. 1 , 2. Stone in the Urinary pa● e taken out , Tab . 40. Fig. 3. The Skull Perforated with ●epans , Tab . 31. Fig. 5. The Skull being depressed , w it is raised again , Tab . 32. Fig. 2 , 7. The Scraping of the Skull fo● Fissure , or Corrosion , Tab . 30. Fig. 10. The Skull , part of it chopped ●ay , 130. Splents , 87 , how to be used , 89. Th● Shoulder-bone out of joint , reduced , Tab . 21. Fig. 7. Tab . 23. F. 3. The Shoulder-bone broke , composed , Tab 23. Fig. 1. A Seton burnt in the tip of the ear , Tab . 34. Fig. 6. A Seton burnt in the nape of the neck , Tab . 34. Fig. 8 , 9 , 10. A Sparadrap for Issues , 219. Spirit of Mastick , 273. Sutures Coronal , and Sagittal , how to know where they meet , Tab . 30. Fig. 2. A Suffusion cured by the Needle , Tab . 33. Fig , 3 , 4. A Staphyloma cured , Tab . 35. Fig. 5. Symptomes happening upon Fractures , amended , Page 92 , 93. Symptomes happening upon a Rupture of the Intestines , 180 , 181. The Scraping of the Shin-bone , 90. Where note , that the lips of the Wound are to be covered over with Linnen , as in the scraping of the Skull , Tab . 31. Fig. 5. Suppression of Urine helped , Tab 39. Fig. 9. T THe Tuty Oyntment , 209. Tumours contained in Coats , how cured , 147 , 148. A Tumour in a Bag , broke with a Diamant , Tab . 33. Fig. 7. A Thumb cut off , Tab . 28. Fig. 12. The Tunnel applyed Tab . 36. Fig. 3. The Taking out of things stiticking in the Throat , Tab . 36. Fig. 9. A Tooth hurting the Cheek , cut out , Tab . 36. Fig. 2. Teeth , how pulled out , Page 25. Teeth that are rotten , how burned , Tab . 36. Fig. 1. Teeth set fast in the head , how opened , Tab . 36. Fig. 6. A Thigh out of joint , Reduced , Tab . 23. Fig. 4. A Thigh broken , set again , Tab . 26. Fig. 1. The Tapping of the Belly , Tab . 39. Fig. 2 , 3. The Tapping of the Breast , Tab . 37. Fig. 2 , 3 , 4. Trochies with Musk and Amber , Pectoral , 282. V THe Uvula Corrupted , cut off , Tab . 34. Fig. 1 , 2. Unguentum Evae , or Oyntment of Eve , 212. The Vessels on the Temples , how found , Tab . 33. Fig. 2. Venereal Warts , how extirpated , Tab . 40. Fig. 7. Ulcers in the right gut dried up with Pipes , Tab . 41. Fig. 8. Urine suppressed , drawn out , Tab . 39. Fig. 9. w THe Wind-pipe perforated , Tab . 34. Fig. 3 , 4 , 5. Warts on the Yard in the French Pox , how cured . Tab . 40. Fig. 7. Wounds on the Belly , 169. Wounds on the Belly dilated , Tab . 37. Fig. 5. Wounds on the Belly sewed up , Tab . 39. Fig. 5. Wounds in the Guts sewed up , Tah . 37. Fig. 6. Wounds on the head Dilated in the shape of a Triangle , Tab . 31. F. 2. Wounds on the head Dilated cross-ways , Tab . 30. Fig. 9. The Womb fallen down , Reduced , Tab . 40. Fig. 18. Wounds of the head , of all sorts , 111. A Wound on the head , the most simple , 113. A Wound on the head , with hurt done to the Pericranium , 113. A Wound on the head , with alteration of the Skull , 113. A Wound on the head , with a capillary Fissure , not penetrating , 115. A Wound on the head , with a capillary Fissure , penetrating , 117. A Wound on the head with an evident , yet narrow crack in the Skull , 118. A Wound on the Head , with a Fissure in the Skull , large , and penenetrating , 121. A Wound on the head , where the Dura Mater is hurt also , 122. A Wound of the head , where the Pia Mater is hurt , and the substance of the Brain , 122. A Wound of the Temporal Muscle , hurting the Pericranium , and the Vessels , 123. A Superficial Wound of the Temporal Muscle , 124. A Wound of the Temporal Muscle , with a narrow chink of the Skull , 124. A Wound of the Temporal Muscle , with a large Fissure of the Skull , 125. Wounds in the Breast , 162 , 163. A Wound in the Breast Dilated , Tab . 37. Fig. 5. E. A Wound in the Thigh united with loops , Tab . 43. P. A Wound on the Cheek united with Emplastick Linnen Cloaths , Tab . 35. Fig. 8. The Womb opened , Tab . 40. Fig. 17. FINIS .