1 Sic igitur medicus ingeniosus in hac operatione ut plura quam in scriptis inveniat agere sciat : quia omnia quæ circa tale opus non possunt ¶ If þat hole for-sope be no3t distant fro pe lure bot by a nynch al-one, pan schal kuttyng be pe moste kynde and sonest cure; þat if it be so, pan tak þe lech Acum 4 rostratam and putte he pe end hauyng pe ei3 thurz þe hole next to pe lure pe lefte fynger yputte, as it is seid, in-to pe lure. And when he felep pe nedle wip his fynger, labor he warly þat he may bring out with his 8 fynger þe heued of pe instrument purz pe lure appliyng and wryping. ¶ Whiche ydo, be per taken a fourfold prede of silk white or of strong lyne or tuyne and it is called ffrenum Cesaris. And be it put in pe eis of pe 12 nedle And with pat prede anoper single threde and at one3 and to-gidre be pe nedle drawen purz pe lure and pe hole of pe fistule. Afterward pe single prede be fest by itself no3t constreynyng, bot pat it go not out 16 pe lech no3t willyng, par-if parauentur frenum cesaris be kutte or brusten pan schal per anoper frenum cesaris mow be brozt in with pe forseid prede with-out any anguisch. Therfor be pe lech witty in pis wirchyng 20 þat he may do, and kon do, tuo things pan he fyndep in wrytyngs, *For al þings þat ow to be done about sich werk may not be expressed in lettres, and perfor it byhoueþ a crafty [lech] to be wise and slyze wele ymagynyng pe 24 subtile þings, þat in pose pings pat pertenep to perfitenes of pis werk and aboue po pings þat he has lerned in pis boke he may availe hym purz benefice of his ovne witte; For Boecius seith ¶ De disciplina scolar28 ium, He is of moste wreched witte pat euer more vseþ pings yfounden and no3t things to be founden.1 ¶perfor pe frene and pe prede ydrawen, as it is seid, pan may pou chese wheper pou will kutte it or fret it with didiceretion. 32 pe pred. ¶ Iff thou will kutte it pan schalt pou take acum rostratam and] 2 putte it þurz pe middez of pe lengþe of þe instrument pat is called tendiculum, bygynnyng at þe gretter ende. After take bope pe endes of freni cesaris, drawen purz pe middes of pe lure and of pe hole of þe genii bene ficio valeat prævalere. Dicit enim Boecius "de disciplina scholarium," 36 "Miserrimni est ingenii qui tantum utitur in ventis et inveniendis." fistule, and purz pe middis of pe hole of pe instrument þat The use of be pai faste y-knettid in proporcionyng pe lengpe of þe 2 MS. Sloane 6, leaf 147, continues. www which is to be tightened by the peg. The end of the snowted fitted into the hole in the spoon or prevent injury to the bowel whilst freni cesaris as it bihoueth, þat is after pe distance of þe hole of pe tendiculi to pe hole of pe fistule; pan take pe tendicule and putte pe snowte of pe nedle in pe hole of þe fistule in-puttyng it strongly. Aftirward take pe wraiste 4 wip freno cesaris, and put it in pe hole of pe tendicule, pat is pe side of it; whiche y-putte in, putte pi fynger in þe lure, and wip pe toper hand prist faste pe tendicule with pe snowt toward þy fynger. And when pou seez 8 tyme, be pe wraist turned aboute pat frenum cesaris hold fast þe tendicule pat it go no3t out. And so labour pe leche vnto pat he bringe out þe poynt of þe snowte by needle to be pe middes of pe lure; and pat he streyne fast þe 12 flesshe festned in pe frene wip þe wraiste and pe frene. protector to Whiche y-do, take pe instrument þat is called coclear— a spone-Of whiche pe holow heued be putte in pe lure agayn þe poynt of pe snowte, so pat pe poynt of pe 16 snowte stand in pe hole pat is in pe spone, not purz persed, & be pat halden of pe felaw of pe leche; pis, forsope, shal defende pe lure pat it be no3t hurt, pruz uncouenable mouyng and sodayn styrryng of þe pacient, 20 wip pe poynt of pe rasour or of pe launcette. As soon aftirward-þe pacient comforted-putte pe leche pe poynt of þe rasour in pe holwnes of pe snowte pat is in þe spone, and, als sone as he may, boldly kutte pe 24 flesshe festened in pe frene aboue pe snowte euen be pe middes; and it y-kutte by pe middes, pe snowte wip pe frene shal lepe out by it-self. If, forsope, per be many holes pat ow to be kutted, be it done as it is 28 Don't try to seid. Or if it be nede, differre it to anopir tyme; ffor in som case pe toper holes beyng outward may be heled wipoute kuttyng or byndyng of prede. shal be seid aftirward, pan it is to do too much at a time. of stopping the bleeding Of whiche it labour to pe 32 The methods staunchyng of blode. ffirst put a spounge wette in a litel warme watre and wele wrongen in pe place of the kuttyng, and hold it per fast to receyue pe blode, and lat it abide per a gode while; perfore when pou 36 trowest pe sponge to be wele ful of blode, remoue it, and if it be nede putte agayn anoper sponge, or pe same ordeyned in þe forseid maner. And when pou hast doon pus, be pe pacient raised vp warly, and make hym 40 by sponge pressure, powders. back] The better have too class not to homely remedies. to sitte fast in a redy place vpon pe forseid sponge; and dout not pat ne it shal be wele staunchid. Aftirward when pou demez dew tyme, be pe pacient put 4 in a dewe place and pe sponge remoued; and whepir pe blode be staunchid, or not, putte in pe kuttyng by styptic puluer of boli, sanguis dracon), aloes epaticus, puluer of hennes feperez y-brent, or of an old lyn clope y-brynt, 8 asshen of heres of hares y-brent, * Iuyse or puluer of leaf 147, walwort, &c., Of whiche it shal be seid aftirward in þair place. But witte pou þat it is no3t required pat al pise at oonez and to-gidre be putte to, but I putte pam here 12 þat a leche, som wantyng or not y-had of pe forseid þingis, may competently spede wip pe toper his nedez or occupacion. ffor why; eueriche of pise medicynes symply by hymself or medled wip pe white of an ey 16 staunchep wele blode per and in opir places. But witte pou þat to worpi men and noble it semep to putte to more noble medicynes and more dere. And witte pou þat þe iuse of walwort or puluer of pe same, if it be had 20 redy, is namely in euery medicyne pat is restrictiue of blode. How, forsope, pe poudre of walwort ow to be made, or pe iuse of it to be kepte, it shall be seid aftirward. be medicyne restrictiue, forsope, y-put to wip stypties to 24 clene stupes and smal, or wip coton wele y-tesed, or wip heres of hares no3t y-brent, and with lynnen cloutis put clean linen. aboue, be it warly bounden; þat is to sey be he girded on pe bare naked wele streit wip a lynnen girdel. After28 ward haue he a list of wolnen clope, and be it How to bounden byhynd at pe bak of pe pacient to be lynnen bandage. girdel, and lat it descende atuix his buttokes vpon pe cloutes couerying þe lure, and be it festned fast to pe 32 girdel vpon pe womb, and lat it abide so stille to pe tyme come þat it be eft-sones remoued. If þe holes, forsope, be in pe buttok somdele remoued fro pe lure, A T-bandpan most it operwise be bounden. And þat þus, haue 36 pe pacient a wolnen girdel or a lynnen, wip pe whiche he be girded in pe flankez, to pe whiche girdel be hongen a lynnen cloute hauyng in brede seuen or 8 ynches, and in lengpetals many or mo; perfore be pe pacient girded 40 þat þe side of þe clout next to be lure lye rizt atuix be applied on small pieces of apply the age is best. A well pe buttokkes upon pe lure; and opir cloutes y-putte atuix, þan be bounden two listis hyngyng about pe pie of pe pacient. And if bope pe buttokkes bene hurt, ordeyne he anoper girdel to pe toper, and be it ordeyned 4 as it is seid afore, and on þe same wise. ffor knowe the bandage aids leche pat competent byndyng shal giffe no3t litte help in curyng. But if medicynez, forsop, may cleue to vnto dew tyme, pe cure shal longer be taried. fforsope when 8 pou seest, in pe secound day or pe prid, pe blode wele Remedies to staunched, pan take pe 30lke of a raw ey, and wip oile applied greatly in the cure. be used on the second or third day when the bleeding is stopped. Arderne's own preparation "Pulv. sine roset or of camomille, or wip sanguis veneris, or, pise defailyng, distempre it wip comon) oile, and put it in a 12 littel bleddre, and wip anastar of tree ich day but oones be it zetted into pe lure, so pat pe wounde be filled perof. And aftirward put aboue lynnen stupez kutted smal wip sherez, and aboue þe stupes a lynnen cloute. 16 And pan be it bounden as it pertenep, and lat it so lye vnto pe morne. And pis cure ow to be kepte by 8 or 9 dayes; whiche, forsope, y-fulfilled, panne owe pe leche to putte in pe kuttyng of my poudre pat I, Iohn Arderne, 20 pare" to be made, whiche I called 'puluer sine pari,' an[d] on frenssh, 'poudre saun pere.' I wist neuer, forsope, ne knew poudre like to it, Of whiche it shal be seid aftirward in [Sloane Ms. his place.1 Aboue pe poudre, forsop, put coton or stupez 24 and bynd it. And so by tuo hole natural daies be it no3t moued, bot if voydyng of þe wombe make it2; bot warne pe lech pe pacient that he dispose hym so pat he remoue nozt þe medycyne in any maner in als-mich as 28 he may abstene. Ellez pe fruyte and pe vertue with pe effecte of the medycyne schal be annulled. pacient for-sop may no3t abstene hym fro pe pryue *In used about the eighth or ninth day. 277, leaf 68, moved for [* leaf 68, back, col. 2] but the cleansed and motion. If þe þe mornyng be it clensed with hote watre and a sponge 32 wound to be and be it dryed and eft sone; be putte in of pe forseid dried after a poudre, And be it ordeyned as on pe day afore. And zitte be he comaunded for to abstene as afore, pat if he do no3t eft-sonez pe prid tyme be it ordeyned with pe 36 same poudre as afore, And 3itte he be amonysched to Unguentum abstine. Afterward wheper he abstene or not, pe ful applica place wele yclensed and dried, be pe lure enoynted with 1 The MS. Sloane 6 is again defective, and the missing folios are again supplied from Sloane MS. 277. viride a use 2 nisi ventris evacuatio cogerit. modi un guentum omnino pruritum 2 et ut dictum est præparetur. tion for skin. chapped An enema to through a clyster pipe. be injected wooden on 24th-26th day. pe fynger dipped in vnguento viridi hard molten in ane ostree schell att þe fyre. And on ich aside about the wounde and within the lure and where-so-euer he seep 1 Nam hujus 4 pe skynne flayne. For why; pis enoyntment dope away alle smertyng and fleyng. And pis enoyntment ist called Salus populi, pe making of which shal be schewed afterward. ¶ Which enoynted, be per zetted in as by8 fore with a nastare of tree of pe 30lke of an ey and oile. And as it is seid in þe place afore, be it reparaled in al pings, renewyng eueryday onez first with pe forseid oyntment molten in a schell. And be per zette in with 12 a nastare of tree oile with an ey. And pis wirchyng be continued by 9 daies at the lest. About the twenty Treatment day, forsoth, or 24 or 26, eft-sonez if pou see nede, pan it is gode pat pou putte bisily within pe lure of poudre 16 sine pari, and fille pe place of pe fistule within and without and as it is seid be it redied. When forsop þe wonde is remoued. eft-sonez as it is seid afore be it wasched and dried and be it anoynted about with Salus 20 populi And after be caste in by a nastare oyle and pe 30lk of ane ey And, if pe pacient may abstene hym fro þe pryue, be it nozt remoued by two daies. *Ellez forsop [ leaf 69, when it is nede be it remoued. And considere pe lech 24 bisily be wounde ymundified if it be wele tretable and with-out hardnes and bolnyng and yuel colour: and som what for to cesse pe superflue moistnes which pe wonde sent out first. pan witte pe lech pat at pe next he may 28 putte to cicatrizatiues as bene pise, Puluer of alum zucarin combust, 'bole armenic,' sanguis draconis, Aloe, mirra, sarcocolla, meele of barly and of beenez, puluer of gallez and psidie 3 and puluer tanny, gummy arabic, terra 32 sigillata, &c. Suppose no3t pe lech pat it byhouep him to haue in one receyte al thise forseid togidre for used. þai ar sette here togidre. Bot it is to vnderstand pat pai ar named here togidre pat a lech know al to be of 36 þe same vertu in regeneracion of flesch an[d] cicatrizacione and þat þai bene al stiptik. And to pise may be added ceruse and litarge of gold and of siluer. ¶ Iff pe lech want any of pem take of pe toper pat he may fynde, 40 For nouper it byhouep here ne in none oper place, pat 3 pulvis gallarum quercuum. col. 1] The means to complete the healing process. Many reme dies suggest ed but only some to be |