The knowledge and exercise of indications befits that surgeon, whom no blinde rashnesse of fortune, but reason; no chance, but counsell directs in the undertaking and performing the workes of his art. For an indication is a certaine safe and short way, which leades the physition, as by the hand, to the attainement of his purposed end, of preserving the sound, or curing the sicke.

For Galen doth define an indication to be a certaine insinuation of what is to be done, or a quick & judicious apprehension of that which may profit or hurt. 

And as Faulconers, Mariners, Plowmen, Soldiers, & all manner of Artizans, have their peculiar termes and words, which are neither knowne, nor used by the vulgar; so this word indication is proper and peculiar to phisitions and surgeons, as a terme of art not vulgar; by consideration of which, as by some signe, or secret token, they are admonished what is to be done to restore health, or repell an imminent danger.

There are three prime and principall kinds of indications, every of which is subdivided into many other. The first is from things natural. The second from these things which are termed not natural. The third from those things which are contrary to nature. Things natural shew they must be preserved by their like, and in the compasse of these are contained all the indications which are drawne from the nature of the patient, that is, from his strength, temper, age, sexe, habit, custome, diet.

Things not natural may be doubted as uncertaine, for one while they indicate the same  things with things natural, that is, they coindicate with the strength, temper and the rest; otherwhiles they content with things against nature, that is, they coindicate with the disease. Wherefore Galen when he saith, that indications are drawn from three things; the disease; the nature of the patient, and the encompassing air, by proposing the familiar example of the air, hee would have us to understand the other things not natural; because wee may shun, or embrace them more or less as we will ourselves, but we must, whether we will or no, endure the present state of the air. Therefore the air indicates something to us, or rather coindicates; for if it nourish the disease, as conspiring with it, it will indicate the same that the disease, that is, that it must be preserved in the same state.

Things contrary to nature indicate they must be taken away by their contraries; therefore that we may more accurately and fully handle all the indications drawne from things natural, we must note, that some of these are concerning the strength of the patient, by care to preserve which, we are often compelled for a time to forsake the cure of the proper disease: for so a great shaking happening at the beginning of an ague or feaver, we are often forced to give sustenance to the patient, to strengthen the powers shaken by the vehemency of the shaking, which thing notwithstanding lengthens both the general and particular fitts of the ague. Other pertaine to the temper, other respect the habite, if the patient be slender, if fat, if well flesht, if of a rare, or dense constitution of body. Other respect the condition of the part affected in substance, consistence, softnesse, hardnesse, quicke or dull sense, forme, figure, magnitude, site, connexion, principallity, service, function and use, from all these, as from notes the skilful surgeon will draw indications according to the time and part affected: for the same things are not fit for sore eyes, which were convenient for the eares, neither doth a phlegmon in the jawes and throat admit the same forme of cure, as it doth in other parts of the body. For none can there outwardly apply repercussives, without present danger of suffocation. So there is no use of reprecussives in defluxions of those parts which in site are neere the principall. Neither must thou cure a wounded nerve and muscle, after one manner. 

The temperature of a part, as moisture, alwayes indicates its preservation, although the disease be moist and give indication of astringent things, although the disease require dissolving, as an obstruction of the liver; for otherwise unless you mixe astringent things with dissolving, you will so dissolve the strength of the part, that hereafter it cannot suffice for sanguification. If the texture of a part be rare, it shewes it is lesse apt, or prone to obstruction; if dense, it is more abnoxious to that disease; hence it is that the liver is oftener obstructed than the spleene. If the part be scituate more deep, or remote, it indicates the medicines must be more vigorous and liquid, that they may send their force so farre. The sensiblenesse, or quicke-sense of the part, gives judication of milder medicines, than paradventur the signes, or notes of a great disease require. For the phisition which applies things equally sharpe to the horny tunicle of the eye being ulcerated, and to the legge, must needs be accounted either cruel, or ignorant. Each sexe and age hath its indications, for some diseases are curable in youth, which we must not hope to cure in old age; for hoarsenesse and great distillations in very old men, admit no digestion, as Hippocrates saith:

The feeble Sire, for age that hardly goes,

Ne’re well digests, the hurtfull Rheume or pose.

Moreover according to his decree the diseases of the Reines, and whatsoever paines molest the bladder, are difficultly healed in old men; and also reason perswades that a Quartaine admits no cure in Winter, and scarse a Quotidian, and ulcers in like manner are more hard to heale in Winter; that hence we may understand certaine indications to be drawne from time; and to increase the credit of the variety and certainty of indications, some certaine time, and seasons in those times command us to make choise of medicines; for as Hipocrates testifies:

In Dogdayes heat it is not good,

By purging for to clense the blood.

Neither shalt thou so well prescribe a slender diet in winter, as in the spring, for the air hath its indications. For experience teaches us, that wounds of the head are farre more difficultly and hardly cured, at Rome, Naples, and Rochell in Xantoigne. But the times of diseases yeeld the principall indications, for some medicines are only to be used at the beginning and end of diseases, other at the encrease and vigour of the disease. We must not contemne those indications which are drawn from the vocation of life, and manner of diet; for you must otherwise deale with the painful husbandman (when he is your patient) which leades his life sparingly and hardly, than with the citizen who lives daintily and idlely. To this manner of life and diet may be referred a certaine secret and occult property, by which many are not only ready to vomite at eating of some meats, but tremble over all their bodyes when they heare them but spoken of. I knew a prime nobleman of the French nobility, who was so perplext at the serving in of an eele to the table, at the middle of dinner and amongst his friends, that he fell into a swound, all his powers failing him. Galen in his book de Confuetudine tells that Arius the Peripateticke died sodainly, because compelled by the advise of those physitions he used, he dranke a great draught of cold water in the intollerable heat of a feaver. For no other reason saith Galen, than that, because he knowing he had naturally a cold stomacke from his childhood, perpetually abstained from cold water.

For as much as belongs to indications taken from things against nature; the length and depth of a wound or ulcer indicates one way; the figure cornered, round, equal and smooth, unequal and rough, with a hollownesse straight or winding, indicate otherwise; the site right, left, upper, lower in an other manner, and otherwise the force and violence of antecedent and conjunct causes. For oftentimes the condition of the cause indicates contrary to the disease, as when abundance of cold and grosse humors cause and nourish a feaver. So also a symptom often indicates contrary to the disease, in which contradiction, that indication must be most esteemed, which doth most urge; as for example sake, if swounding happen in a feaver, the feaverish burning shall not hinder us from giving wine to the patient.

Wherefore these indications are the principallest and most noble which lead us, as by the hand, to doe these things which pertaine to the cure, prevention and mitigating of diseases. But if any object, that so curious a search of so many indications is to no purpose, because there are many surgeons, which setting only one before their eyes, which is drawn from the essence of the disease, have the report and samce of skillfull surgeons, in the opinion of the vulgar; but let him know that it doth not therefore follow, that this indication is sufficient for the cure of all diseases; for we do not alwayes follow that which the essence of the disease doth indicate to be done. But chiefly then, where none of the fore-recited indications doth resist or gainesay; you may understand this by the example of a Plethora, which by the indication drawn from the essence of the thing requires phlebotomy; yet who is it, that will draw blood from a child of three months old?

Besides, such an indication is not artificial but common to the surgeon with the common people. For who is it that is ignorant, that contraries are the remedies of contraries? and that broken bones must be united by joyning them together? but how it must be performed and done, this is of arte and peculiar to a surgeon, and not knowne to the vulgar. Which the indications drawn from those fountains we pointed at before, aboundantly teaches, which, as by certaine limits of circumstances, encompass the indication which is taken from the essence of the disease, lest any should think, we must trust to that only. For there is some great and principal matter in it, but not all. For so the meanest of the common people is not ignorant, that the solution of continuity is to be cured by repairing that which is lost. But in what parts we may hope for restitution of the lost substance, and in which not, is the part of a skillful surgeon to know and pronounce. Wherefore he will not vainly bestow his labour to cure the nervous part of the diaphragma, or midriffe being wounded, or the heart, small guts, lungs, liver, stomacke, braine or bladder; and that, I may speak in a word, emperickes are not much more skillfull than the common people, although they do so much extoll themselves above others by the name of experience.

For although aexperience be another instrument to find out things with reason, yet without reason, it will never teach, what the substance of the part in which the disease lyes, may be; or what the action, use, site, connexion, from whence special and proper indications are drawn; with which the surgeon being provided and instructed shall not only know by what means to find out a remedy, but also, lest he may seem to mocke any with vain promises, he shall discerne what diseases are uncureable, and therefore not to be medled withall.

But implicit, or intricate diseases require each to be cured in their several order, except some one of them be desperate, or so urge and presse that the physition think it necessary after a preposterous order, to being with it, although often he be forced to make some one of these diseases incurable, or give occasion of causing some new one, into which straits we are necessarily compelled to fall, when for example we determine to pull, or take away some extraneous body; for the performance whereof we are compelled to enlarge the wound. So we are forced by necessitie to open the necke of the bladder, that so we may draw forth the stone therein contained, with a wound which often degenerates into an uncurable fistula. For that disease which threatens danger of present death is of such moment, that to shun that, it may be counted a small matter, and commodious for the sick to bring in other diseases, though uncurable. For if a convulsion happen by pricking a nerve which we cannot heal by any remedies, then by cutting the nerve asunder we end the convulsion, but deprive the part into which that nerve did go, of the use of some voluntary motion. So if in any great joint there happen a luxation with a wound, because there is danger of convulsion by trying to restore and set right the luxated part, we are forcte for shunning thereof, to attend the wound only, and in the meantime to let alone the luxation. Otherwise in implicite diseases if there be nothing which may urge, or call us from the ordinary cure, we must observe this order, that beginning with that affect, which hinders the cure of the principal disease, we prosecute the rest in the same and their proper order, until all the diseases being overcome we shall restore the part affected to its integrity. Therefore let us take for an example, an ulcer in the leg, a Varix (or big swollen veine) and a phlegmonous tumor round about it; and lastly, a body wholy plethoricke and filled with ill humors; order and reason require this, that using the advise of some learned physition we prescribe a convenient diet, and by what means we may, bring him to an equality by purging and blood-letting, and then we will scarifie in diverse places the part where it is most swollen, then presently apply leaches that so we may free it from the burden of the conjunct matter; then use cauteries to help the corruption of the bone, and in the meantime change the circular figure of the ulcer into an oval, or triangular, then at the length we will undertake the cutting of the Varix, and cure the ulcer which remaines according to arte, and so at the length cicatrize it. In all this whole time the patient shall neither walke, nor stand, nor sit, but lye quietly, having his leg orderly and decently rowled up. 

if (as it often happens) the temper of the hurt part, be different from the temper of the whole body, the manner of curing must be so tempered, that we increase the Dosis of hot or cold medicines, according to the ratable proportion of the Indications requiring this, or that. Therefore imagine the part ulcerated to be such, as that it is two degrees dryer than the just temper; but the whole body to exceed the same temper in one degree of humidity: reason and Arte will require, that the medicine applyed to the ulcer be dryer by one degree than that which the part would otherwise require if it were temperate; but on the contrary let us suppose thus. The whole body to be one degree more moist than the temper requires, and the ulcerated part to be one degree dryer, truly in this case the medicine that is applyed to the ulcer by reason of the part itself, shall not be encreased in dryness, but wholy composed and tempered to the indication of the ulcer, because the force of the moisture exceeding in the like degree, doth counterpoise the superfluous degree of dryness. But it is more easie by an artificiall conjecture to determine of all such things, than by any rules or precepts.

To these so many and various indications, I think good to add two other; the One  from similitude; the other of a certain crafty device, and as the latter physitions terme it, of a certain subtile stratageme. We draw indication from similitude, in diseases which newly spring up and arise, as which cannot be cured by indications drawn from their contraries, as long as their essence is unknown and hid; wherefore they think it necessary to cure them by a way and art like those diseases, with which they seem to have an agreeing similitude of symptomes and accidents, our ancestors did the same in curing the French pockes, at the first beginning thereof, as long as they assimulated the cure to that of the leprosie, by reason of that affinity, which both the diseases seeme to have. But we follow crafty devices and subtile countfells, when the essence of the disease we meet with is wholy secret and hid, either because it is altogether of a hidden and secret nature, and which cannot be unfolded by manifest qualities, or else resides in a subject which is not sufficiently known to us, nor of a physical contemplation, as the minde. For then we being destitute of indications taken from the nature of the thing, are compelled to turn our cogitations to impostures and crafty counsells; and they say this arte and craft is of cheife use in melancholy affects and fictions, which are often more monstrous and deformed than the chimera so much mentioned in the fables of the ancients; to which purpose, I will not think much to recite two examples. 

A certaine man troubled with a melancholike disease, I know not by what error of opinion, had strongly perswaded himself  that he was without a head; the physitions omitted nothing, by which they might hope to take this madd opinion out of his mind. But when they had in vaine tryed all medicines, at length they devised this crafty, but profitable device, they fastened and put upon his head a most heavy helmet, that so by the paine and trouble of his head nodding and drawne down by that weight, he might be admonished of his error.

It is reported, another molested by the obscurity and darkness of the same disease, did verily believe, that he had horns upon his head; neither could he be drawn or diverted from that absurd and monstrous opinion, until that binding up his eyes, they miserably bruised and scratched his forehead with the bony roughness of the lower parts of an oxes hornes, that so he begun to believe by the painful drawing of the blood that ran down his face, that those bloody hornes, were forcibly plucked from him. Ingenious surgeons in imitation of these examples may in like cases doe the like. For that case requires a man of a quicke apprehension and advice, who may give manifest proofe of his diligence and skill by medicinal stratagems, as who forthwith can politikly device stratagems of diverse sorts.

But, now comming to the end of this our tract of indications, we must chiefly and principally observe, that of indications some are indicative; which absolutely and of themselves command this to be done; other coindicative, which indicate the same with the indicative, and jointly show it to be done, but in some sort fecundarily and not primitively; some are repugnant, which of themselves and their own nature persuade quite contrary to that the indicative primitively did; or which dissuades us from doing that, to performe which the indicative did persuade us; other correpugnant, which give their voyce after the same forme and manner with the repugnant against the indicative, as the coindicative consent to and maintain them. Let this serve for an example of them all.

A plethora, or plenitude of humors of its own nature, requires and indicates bloodletting, the spring-time perswades and coindicates the same, but to this counsell is quite opposite and repugnant, a weake faculty, and childhood is correpugnant.

Wherefore these foure must be diligently waighed and considered when we deliberate what is to be done, and we must rather follow that which the indicative, or repugnant shew and declare, as what the disease and strength of the patient require, than that which the coindicative, or correpugnant shall perswade, because they have a weaker and but secondary power of indicating, and not essential and primitive. But because the kinds of Indications are so many and diverse, therefore that the knowledge of them may be more perspicuous and less confused, I have thought good to describe & distinguish them by this following scheme.