and lesse cold than other fleshie substances It needeth therefore no euacuation hauing naturally of itselfe how to be purged calore extraneo by a forrein outward and strange kinde of heate And againe Galen sayeth lib 11. of the same worke Cap. 14 speaking of Synochus a kinde of feuer Si in puerum incidat qui 14. annum non hactenus attigit mitti illi sanguis non debet propterea quod tantillis cum praesertim calidi ac humidi sint plurimum corporis substantiae quotidie defluat ac digeratur it a quod ex incidenda vena moliendum nobis fuerat id vltro nobis ex curati corporis natura praestatur i. If this feuer happen to a childe yet not 14 yeares of age he is not to be let bloud because such yong ones being of a hote and moyst constitution haue much of their bodily substance daily dissolued So that the same which we goe about to bring to passe by opening a veyne is done already to our hands by the constitution of the Patient Of this imp e diment namely the age beside old men and boyes are also meant decrepits and very Infants Auicen remembreth in quarta primi cap. 20. this matter writing almost in this manner Thou oughtest to beware of opening a veyne in a complexion too colde in a Country too colde in time of extreme paine in a member after resolutiue bathinges after carnall copulation in young age vnder fourteene and in olde age except thou haue great confidence in the solidity of the Muscles in the largenes and fulnes of the veynes and rednes of the colour such either young or olde boldly may be let bloud Yet those that are young of fourteene yeare olde must bleede orderly by little and little at once and at each time more than before and all this did Auicen take out of Galen So that although in Phlebotomy wee are chiefly to consider these three thinges that is to say the danger of the disease the age and naturall strength of the party yet the age is sometime not wayed when the strength of nature serueth either in old or yong Wherfore Galen lib. de curand ratione per sanguinis missionem cap. 13. willeth to let bloud young sanguine children and olde sanguine men without consideration of age if the disease be vehement and dangerous if the body bee sufficiently strong and that there also bee vehemency of the Pulsies In these cases Necessitas non habet legem Necessity hath no Lawe So in Spaine they let children bloud of three yeares olde and lesse and Auenzoar writeth that hee let his sonne bloud at three yeares of age and so preserued him from death lib. septi cap. tertio Collecta These limits of yeares in this point Hyppocrates did not set downe Galen appointed them from fourteene to seauentie Mooued by the foresaide reasons Rhases in olde decrepite age nothing at all fearing the danger of exhausting the naturall heate that remaineth in the body with the bloud whereof notwithstanding often proceedeth the hazarde of life by vndiscrete bleeding by opening a veyne in decrepite persons did then helpe and did great good in grieuous Pluresies and Perypleumonias And concerning young folke this wee find true by experience that in the fifth or sixth yeares of their age by opening a veyne Pluresies inward inflammations and other grieuous diseases are cured Yea wee see by the very course of Nature that Children and sucking Infantes oft plentifully bleede at the nose without any hurt of body or any diminishing of their naturall strength The age of Childhood hath naturally her strength and bodely forces why therefore may we not euacuate bloud according to the proportion of the same Especially when the childe is plentifully fedde hauing also large veynes and is filled with good concocted bloud Againe if it bee graunted that the forces of nature are impaired by bleeding whether is it better for the childe to periâ—h through plenitude and abundance of humors or to free him of his disease by abating that abundance though the strength of nature be thereby a litle hindered Therefore somtime the necessity of bleeding is great euen in childred as in Pluresies inward inflammations and continuall feuers There is therefore no age in my poore iudgement but may abide some measure of Euacuation by bleeding if the child bee past fourteene yeares of age Yet consideration is to be had of what constitution hee is whether his bodely substance be fat or leane thicke or thin grosse or slender hard or soft of much bloud or of litle In the first we may proceed to open a veyne in the other not and here we most carefully remember that in children because of their hot moist temperature lesse bloud must be taken than the plenitude seemeth to require The fift impediment is an ill disposition of the stomack incident to some men more than other some in whom chollerick humors flow to the mouth of their stomacks and maketh them apt to chollericke vomits although before they haue neither accustomed nor had any desire to vomit In thesemen bleeding is to bee forborne because thereby the troubled humors flowe to the mouth of the stomacke as to the accustomed place and because the stomacke cannot resist so great a Flux of humors being partly weake of it self and more weakened through their comming Hereof diuers great discommodities growe to the body yea this is the very cause that some fall downe and faint in bleeding For the chollericke humors flowing to the stomacke bite and nip the same and so per Simpathia through a certaine kind of compassion that is betweene the stomacke the heart and the braine it causeth Syncope that is sowning VVherefore Galen lib. 12. Method cap. 3. Durst neither purge nor let those bloud which haue the mouth of their stomacke very sensible tender weake and abounding with bitter choler and which persons also abounding with the same when they bleede in the very beginning long afore full euacuation bee made oft fall downe and faint by reason of the foresaide choler and crudity of humors And this is also the counsaile of Galen lib. de curand ratio per sanguin missio cap. 1. and of Auicen in quarta primi cap. 20. Ye may perceiue the mouth of the stomacke to bee very sensible saith Auicen when yee cannot swallowe downe sharpe and bitter thinges without hurt VVeakenes of the stomacke is knowen by losse of Apetite to meate and drinke Abundance of bitter choler is shewed by bitternes of the mouth by subuersion of the stomacke long time connnuing and by oft vomiting vp of choler These signes and tokens discried in any patitient doo dehort from opening a veyne Yea this ill disposition of the stomacke bringeth not onely Sincope but also sometime present death As Galen witnesseth lib. 9. cap. 5. Meden And Auicen in the former cited place The sixt is weakenes of the natural forces Of which there is a threefold condition for they are either firme or weake
cured by bleding but require other remedies The third error That opening of a veine is vnnâ—edefull except the disease be present This also is confuted by Galen de Opt. sect ad Thrasis Cap. 37. For the most part saith hee we vse remedies as purgagion and bleeding when the diseas is not present but future The fourth error That Phlebotomy must be done in the iudgement day of a disease Auicen impugneth this in quart primi chap. de Phlebo saying Neither must bleeding nor purgation be done in the day of the mouing of a disease nor when the same hath Crisim â— iudgement But if it be possible let there be rest This is also proued Aphorism 21. Qua iudicatur vel iudâ—cata sunt c. The fift error That bleeding dulleth the sight Gallen remoueth this error li. de Curand ratio per sangui missio Chapitul 7. Some haue a weake sight hauing aboundauce of bloud Euacuate such either with purgation if there bee other humors beside bloud or by bleeding and so detracting of bloud doth good not dulling but quickening the sight 6 The sixth error is that in fulnes alwaies a veyne must bee opened Gaben confuâ—eth this error 4. de vict in morb acut Commen 19. Plenitude is not alwaies cured by bleeding but by rubbings many and oft batlings and by abstinence 7 The seauenth error is that bloud must be let the wombe beeing very laâ—atiue this Hyppocrates refelleth 4. de vict in morb acut cap. 118. If it bee needefull to withdrawe blâ—ud from any you must stay the wombe and so let bloud and Galen in the same place saith If the belly bee flowing let not bloud lest the fluxe continuing the strength of the body bee cast downe 8 The eighth error is That there is no difference of the times of the yeare to let bloud in Galen contrary to this writeth ad Glanco cap. 14. Those Phisitions which consider not of the state of the times and withdraw bloud they kill men Et 4. de vict in morb acut is Commentar 19. If the Aire be too hote and dry we refraine from bleeding though the sickenes bee vehement and the age of the party youthfull A sufficient confutation of the supposed necessitie of annuall bleeding Cap. 24. THere commeth here to my minde a common opinion among the ignorant people which do certeinly beleeue that if any person be let bloud one yeare he must be let bloud euery yere or else he is I cannot tell nor they neither in how great danger VVhich fonde opinion of theirs whereof so euer the same sprong first it is no more like to be true than if I should say when a man hath receiued a great wound by chaunce in any part of his body whereby he looseth much bloud yet after it is healed he must needs haue the like wounde againe there the next yeare to auoid as much bloud or els he is in daunger of great sicknes yea also in hasard to lose his life which opinion if I did affirme to be true albeit it be most false yet I might vse the like reason authoritie to defend it that the comon people vse in the defence of theirs For they can say nothing if they be asked why they thinke so but that they haue heard many to say so Therefore I would wish that no man should credit this folish opinion being most false vnlesse he can shew some good reason for it which I am sure no man can do This I think that like as bloud letting is not good against al diseases so is it not good in all persons as we haue set it down in the 9 Chapter but only in those that wil be content to vse afterward a moderat conuenient diet Those therefore that do abound with bloud wil be let bloud to preserue themselues froÌ„ the danger of any disease that is like shortly to ensue must long time after be content to vse a moderat diet For intemperat persons gluttons great drinkers wine bibbers they doe not only receiue no commoditie at al by bleeding but often times greater hurt than if they had bin without it For within 3 or 4 dayes after they fill stuffe them selues with more rawe iuices humors by vnmeasurable dyet than they had before and often times these die through convulsion And hereupon we are to note that there is such force in moderat diet to eschew sicknes that without obseruation thereof Phlebotomy is to no purpose And therefore if this coÌ„mon saying of the comoÌ„ people be true in any namely that they must be let bloud ofteÌ„ thâ—r are once let bloud it is only true in such as keep ill diet presently after bleeding Therefore to conclude this Chapter I councell al persons to beware of excesse after opening of a veine Ofincision of Arteries Chap. 25. AS a veine is opened according to our former discourse hitherto so somtime also an arterie is opened that is to say only such a vein wherein the vitall spirites mixed with the blod do runne flowe but for the hard stinting of the fluxe from an arterie Phisicions are in doubt to make insicion thereof and yet some sometime practise it as in the disease called Vertigo If in opening of a veine we chance to stick an arterie we can very hardly by by stint the bleeding and although the matter fall out very well that the wound or incision be brought to a skarre by diuision yet there will be a dilation or spreading abroad of the cut arterie stil as Galen witnesseth lib. de Curand ratio per sang missio Cap 21. 22. The bleeding of an arterie is hardly stayed partly for the heat of the arterial bloud which is very quickly moued by spreading abroad openeth the arterie whereupon incision of an arterie greatly furthereth the bleeding partly because the motion of the arteries neuer ceaseth as Galen witnesseth lib. 2. Cap. 20. de Sanitate tuend whereby also it commeth to passe that the wounds of the arteries are the more slowly cured For such things as are to be healed require rest ease Gal. lib. 5. Cap. 8. metho medend commet 6. lib. 6. Aphoris The opening of an arterie is to be vsed when the body is repleate with thinne windie and verie hote bloud For the seat of subtile thinne windâ—â— bloud whereof the naturall heat and vitall spirites are ingendred is in the arteries and to is the hotest bloud which commeth from the hotest member that is the heart and which is carried into the other members of the bodie conteined likewise in the arteries The receptacles of the thicker bloud wherwith the â—â—eÌ„bers are nourished is in the veines Vpon what occasion Galen did cut an arterie he himselfe sheweth Cap. 22. dv Curand â—at per sanguinis missio being warned saith Galer by certeine dreames of which two among the rest most plainly appeared vnto mee I weâ—t to cut that arterie of the right hande which is betweene the
auncient learned Phisicions may seeme as yet hard to the vnskilfuller sort that yet rashly and without skill or regarde of these things vse the practise of letting bloud It will not be lost labour in my poore iudgement with more plaine wordes to illustrate their sayings if it may be to the vnderstanding of all men that are this way studious and yet want the helpe of the Latine tongue Latine writers It appeareth by the premisses what Repletion is vz a superfluous aboundance of humors in mans body which happeneth two waies either in quantitie or in qualitie VVe may also learne that repletion in quantitie is when the foure humors are more in aboundance than is proportionable to the bodie that conteineth them or when one humor much exceedeth the rest in quantitie For the bloud contained in the veines is not simple or of one kind as hath beene said but consisteth of flewme blacke yellow choler and pure bloud mingled together which humors notwithstanding so mingled by comon agreement and continuall vse of speaking we commonly call bloud The iust and agreable proportion of humors is this That in a man throughly healthfull of good temperature there is lesse yelow choler than Melancoly lesse Melancoly than flewme lesse flewme than pure bloud so that that bloud is accounted best not that hath like proportion of all humors but such an equalitie of the foure as hath beene now specified Bloud therfore faulteth in quantitie when the humors being setled in a iust proportion do passe and exceede the agreable measure of Nature for then the whole frame of the bodie swelleth the veines aboue measure are stretched and all the members specially after any exercise are wonderfully retched This constitution of humors though they be good yet it faulteth beclause it is come to an immoderate abundance which accustomably is wont to bring great perill VVhether therefore there be in the bodie abundance of other humors aboue the bloud so that the equabilitie of the proportion be not obserued that waie or that there be too much abundance of pure bloud Yet because the pure bloud in the permixtion greatly exceedeth the other humors it is a â—ault not in the qualitie but only in the quantitie and therfore both of these are conteined vnder this kinde of repletion in quantitie and this is simply absolutely most properly commonly iudged repletion is called Plenitudo ad vasa as is aforesaid because it doth throughly fill the large capacitie of the veines which are termed the vessels or receptacles of the body though it enforce not the powers therof First therefore where al the humors superfluously increase filling extending the receptories of the bodie as the stomacke the veines and the bowels It is most properly called in English fulnesse or repletion in Latine plenitudo in Greeke Plethora as before Repletion in qualitie is when the bloud or other humor is hotter or colder thicker or thinner than is conuenient to the bodie This is the seconde kinde of repletion mentioned by the foresaide auucient writers in Phisicke and which is referred to the force strength and abilitie of the bodie In this repletion although the vessels of the bodie be not so much puffed vp nâ—ither swell as in the other yet they conteine more good bloud and nourishment than the nature of the patient can wel rule or ouercome For a litle nourishment to a weak nature is often troublesome and grieuous and although at the first it be right good yet it doth not long so continue but being forsaken of the bodily heat as not able to concoct the same in protract of time and number of daies it corrupteth and becommeth the causes of diseases This constitution of the Greekes properly called Cacochymia is when the bodie is infarced either with choler yelow or black or with flewme or with watrie humors and of late writers is thus defined Cacochymia est vitiosa humoris qualitas qua is a iusta mediocritase desciscit Cacochymia is a corrupted qualitie of the humors by reason whereof the humor departeth from his iust mediocritie Vnder which Cacochymia is contained all corruption of humors in qualitie wherby the powers of the bodie are hindred from their proper functioÌ„s wherby also the whole bodie waxethfilthie daily decayeth Of this corruption of humors in qualitie one kind is somewhat better and more tollerable as namely when either superfluous humors are excessiuely heaped vp together or when the humors mixt with the bloud do not keepe their iust and naturall concord or proportion the other kind is worse and intollerable when the superfluous humors or iuces in the bodie both primi secundarii both the principal humors and these next the principall are fallen into corruption from their naturall and conuenient temperature which is the destruction and corruption either of the substance or of the temperament Againe both these happen sometime with rottennes and putrifaction sometime without VVhere note moreouer that the name Cachochymia largely taken comprehendeth also the corruption of the excrements Hippocrates Aphoris 15. saith where meate is receiued much aboue nature it causeth sicknes Galon in his Commentaries declaring that place saith more meate then accordeth with natures measure is named Replecion And afterward hee expoundeth that worde aboue nature to signifie too much and superfluously As who would say where the meate is superfluously taken it causeth sickenes Meate but a little exceeding doth not forthwith cause diseases but may yet keepe the bodie within the bounds of health for meat ingendring sickenes must not a little but much exceede the exquisite measure It appeareth by Galen that in his time certaine denied this foresaide diuision of fulnes set downe by the auncient writers and approued of the late practisioners saying that the same was to bee considered onely by the strength of nature granting plenitudo secundum vires but not quo advasae These he confuteth in his booke de plenitud about the beginning in these wordes Qui ex ipsis tantum viribus plenitudinem metiuntur hi videnter nunquam vtres praeter modum repletosvidisse nec se etiamplus quapar est vnquam impleuâ—sse â—ibo ita vt ventriculus inde distenderetur 1. Those that measure Replecion onely according to the forces of nature they seeme neuer to haue seene mens bodies puffed vp like bladders or bottels neither at any time to haue stuffed themselues with meate more than moderation required and whereby the stomacke was ouerstretched Againe others in Galens time graunted onely that plenitude which is quo ad vasa and denied the other quo ad vires These hee confuteth in the same place in these vvordes Itaque subiecimus duas esse tum notiones tum relationes multitudinis alteram ad robur virefque illi us qui defert alteram ad eius qui suscipit capacitatem Idest Therefore vve haue added that there are two notions and reportes of fulnesse one according to the strength of the patient the other
or whatsoeuer eruption bee made in any other place through the skinne it is likewise a particuler Euacuation Again of Euacuations some are of their owne accord some are done by Art Naturall or voluntary Euacuation is when any thing is expelled out of the body without any medecine this chanceth sometime euen naturally For nature while it is in health rightly gouerneth the state of the body and doth expell thence whatsoeuer supersluously aboundeth or is corrupted this Euacuation is both naturall and conuenient This also chaunceth sometime contrary to nature as when the strength of the body is so infeebled that it cannot gouerne and restraine the Humors of the body but letteth them quite flow forth or when the vertue is strong yet it is somtime so prouoked either with abundance or acuity of the Humor that it permitteth the Humor to passe of his owne accord out of the proper vessels and receptories thereof Both these are accidentall vnprofitable and besides nature because the good bloud commeth forth mingled with the bad without choise or order Artificiall Euacuation is when the same commeth by outward help this is two fold The one right profitable onely Euacuating that which offendeth in iust quantity quality The other contrary to this extraordinary and vnprofitable exhausing the Humor that annoieth not which commeth by the vnskilfulnes of the Phisition Nature by her owne force and by the vertue expulsiue accomplisheth her Euacuation The Phisition doth his by diuers necessary helps prouided for the same And in letting bloud he openeth the veyne either with a fine penkife sleme or lancet or some other applyable medicin Purgation hee attempteth with medicins expelling euil humors from the body either by vomit or by siege Also he expelleth euill humors by breathings euaporations exercise rubbings mouings heat bathings specially sulphurious accidentally by abstinence Also the Physition vseth particular Euacuations in particular parts as ye haue heard Hee purgeth the braine through the nosthrils by medicaments called in Greeke Errhinae And through the palate of the mouth with medecines called Apophlegmatismi which chewed in the mouth bring Humors from the head the brest and lungs with medecines called Berhica The Raines and Bladder with Diuretica The wombe or belly with Hysterica Againe the belly is softned with suppositories and clisters againe euacuation or eruption is made in particular parts by medicines called Digerentia â— resoluing medicins by Suppuratoria â— medicines breeding matter by medicines called Amycticam Caustica Idest burning things by horseleches cupping glasses which drawe bloude with scarrifieng the skinne by launcinges or cuttings by iron red hot All these are vsed of Phisitions The kinds of Euacuation reckoned vp of Fuchlius Phlebotomy Purging  Vomiting Scarrifieng  Boxing Abstinence  Long sleepe Carnal copulation  Fluxe of bloud from the Nose   Termes   Hemorroids Euacuations some are Naturall Phlebotomy  Artificiall Purgation  common partaking of both  What Phlebotomy is and from whence the opening of a vaine doth e uacuate Chap. 3. FOR so much as the bloud in generall is mixed with the foure Humors which are also bedewed as it were with a thin watry substance and that they all are so mingled together through the heat and concoction of the Liuer that neuer an humor can be seene neuer so little to be seuered from the others therefore I saie the retentiue vertue cannot so strongly hold back the bloud in the crooked small veines when a great vaine is opened and that with a sufficient large wound but the same will issue and come foorth If by chaunce it happen that the retentiue vertue go about gredily to suppresse the bloud yet at length it will poure it out plentifully with oft handling rubbing of the veines Neither doth this or that humor by it selfe alone come foorth as in purging but bloud generally that is to saie mixt with other humors in the veines Touching the definition what it is Phlebotomia which is worde for worde out of the Greeke the cutting of a veine is an artificiall eduction of bloud either abounding iu quantitie or offending in qualitie by opening of a veine I call it an artificiall incision because it must not want art and iudgement For in it consideration must be had of the inflicted wound of the quantitie of the bloud of choosing the aptest vaine either to pull backe bloud or to euacuate it quite or to make it onely lesse in quantitie Also for that consideration is to be had whether the veine must be opened streight downe or ouerthwart of the same side of the bodie or of the other with diuers considerations besides whereof we will speake in their proper places Therefore Phlebotomie which is one of the greatest remedies the Phisition vseth is for good cause defined an artificiall kind of educing Galen in his 2. Aphoris Coment 17. defineth it to be an exquisite euacuation of al the humors equally Auicen defineth it vniuersalem euacuationem quae multitudinem humorum euacuat or thus Vena sectio est vniuersalis euacuatio quae anctionem humorum super aequalitatem in venis exuperantium euacuat i. an vniuersal euacuation which taketh away abundance of humors replenishing the veines aboue measure Though the bloud in the veines be in a moderate meane or but little in quantitie yet of the proper mouing vehemencie of it self it issueth out nature litle or nothing at al protruding the same Phlebotomie indifferently euacuateth both good bad humors conteined in the veines with the bloud Neither in diseases proceeding of corrupt constitution of humors can nature so moderat the matter as that that humor alone shal flow forth that aboundeth in quantitie or offendeth in qualitie I confesse that in the iudicials of diseases called Crises many times nature separateth as it were excludeth by wayes conuenient those ill humors prepared before by concoction yet notwiâ—hstanding if then at that instant we open a veine nature cannot therby in so short time expel the hurtfull humor Whereas Auicen saith Phlebotomie euâ—cuateth good bloud the ill remaining behind that he feareth lest opening a veine bring the patient either to abundance of hot chollerik humors or cruditie of flegmatike humors if he mean it of the humors mixt in the veines it is most fals for neither doth the watrie humor issue forth before choler nor choler before flewme or Melancoly nor the bad humor before the good VVhich daily experience proueth to be true for when the bloud commeth forth it appeareth simple of one forme but in the porrenger it loseth his colour euery part therof congeleth seâ—crally in his own region The watrie humor swimmeth aboue not farre vnlike vâ—ine Thinne choler the flowring part of the congealed bloud is also aboue next the water Melancoly abideth in the bottom the red bloud the paler flewme keepe in the middle region So that opening of a veine euacuateth all humors which are in the veines equally
VVe are here to set downe from what place the evacuation is made for inasmuch as bloud is moyst and flowing that first issueth forth which is next the opened veine then that which is next the same thirdly commeth foorth not onely that which is in the veines and arteries but also that which is in the bowels and whole habite of the body For there is a wonderfull continuation and order of the veines so that a way being once made all the bloud often times floweth out of the bodie and bringeth death to the partie But when the passage is stayed then the bloud is sent foorth by the veines arteries till there be a certain proportion in the whole bodie For the emptied and wanting partes by the long small veines draw bloud forth of the full partes repleated members and so â—â—â—â—or them as it were in their need Againe the full members grieued with too much aboundance vnburthen them-selues on the veines that are emptied Againe the humor being liquide and flowing voluntarily followeth the lower euacuated regions and there continueth whereupon it followeth that whensoeuer bloudletting shall emptie the veines the same also shall euacuat the whole bodie In regard whereof Phlebotomy in the definition thereof is called verie well an vniuersall euacuation and that for two causes First because it withdraweth all humors whereof the bloud consisteth Secondly because it euacuateth from the whole bodie but yet not in like sort Forasmuch as the partes of mans bodie are placed in their order therefore first it exhauseth from the neere partes then from those that are further off And againe forasmuch as some veines are spred into some partes of the bodie and other into other partes therefore bleeding with more celeritie and force draweth from those partes which are rightly and directly placed then from those members which are opposite or ouerthwart Whether Phlebotomie must go before purging or contrarie Chap. 4. IN this place it is a necessarie question to be moued and aunswered whether bleeding or purging must go first in this case which is verie frequent where they are both requisite Some will alwaies haue that when purging is necessarie bleeding must go beforeâ— and they bring out the authorities of Hippocrates and Galen Others contrarily affirme that alwaies some extenuating or lessening receit called barbarously Medicamentum minoratiuum must be first receiued and them Phlebotomie succeede But of these opinions neither is simply true and yet both true as the case may be limitted And for the cases wherein a gentle purgatiue is to proceedâ— Phlebotomie they are in number these sixe First when the stomacke the Mesecaicae veines the great veines the waies passages of the bodie or any of these be stuffed with filth or incombred with crudities or that the excrements are hardened in the bowels although the whole bodie abound with bloud beside yet a gentle easie receit is to be taken as Manna Cassia or a clister but no violent receit which may euacuate from the foresaid veines open the obstructed passages If the bloud should first be drawen forth without some gentle purgation or euacuation in the greater veines then the veines outwardly exhausted by bleeding through their attractiue vertue would drawe vnto them ill iuces specially if the disease require any plentiful bleeding This is affirmed by Auicen Galen 9. Metho cap. 5. who did vse to refraine from Phlebotomie if there were cruditie of meat in the stomake or rawnes in the veines called Mesecaicae til their concoctioÌ„ wer ended the excremeÌ„ts descended Secondly when the bloud is verie viscous clammie grosse we do not only take medicines attenuating but also lessening things a dyet conuenient to prepare bloud and to make the meÌ„ber bleed the better vse a bath for oft it commeth to passe that a veine being opened no bloud issueth forth because of the thicknes clamminesse thereof Thirdly it faleth out in many cholerike bodies that choller contained in the vpper parte of the stomacke is easily moued so boileth causing Lipothymia i. ouercoming in which case it behoueth to vse before some Minoratiue receit also in bleeding to vse somewhat to keepe backe the boiling of choller Fourthly in diseases wherein appeareth a difficultie by reason of Cacochymia or abundance of other humors mixt with the bloud When a practisioner perceiueth that he must vse Phlebotomie yet with some difficultie in this case he may vse some easie purgation or one of some force whereby it may fall out that nature shal thereby so be eased which the siege ease of nature wil shew thee that thou shalt not need bleeding at all but onely preparation of the matter then to renue the educing thereof as before Fiftly remember Auâ—cens saying Sanguis fraenum cholerae existit bloud is the restrainer of choler therfore in diseases mere cholerik it were a rash part to set bleeding before purging which perhaps thou maist be without after the exhibiting of the medicine And if thou vse the patient wel let those things suffice which change or repell the sharpnes of choller Yet this is to be added that if there shuld be such abundance of choller as might cause a swelling aboue nature or inflamation then bleding vpon that is a present help Sixthly the same reason may serue in flegmatike constitutions Wherein for many causes although no small fulnesse appeare yet we are not to vse Phlebotomie before purging The cases wherein Phlebotomie preceedeth purging are these First when great fulnes appeareth which either hath caused or is like to cause any vehement disease as Apoplexia which is a sicknes engendred of grosse humors filling the receptories or vessels of the braine and thereby depriuing the partie of feeling speach and mouing as Peripleumonia which is an inflamation or an apostume of the lungs with a vehement Feuer comming sometime of it selfe but most commonly following vpon great and sharpe rewmes squinances pleurisies or such like diseases as Suffocation which is in English strangling then in this case without faile and chiefely if the wombe be laxatiue vse letting of bloud without precedent purgation And this seemeth to agree with Galen lib. 10. de Composi medica secundum locos ca. 2 VVhere he saith if the bodie doe equally abound with humors first let bloud then purge And hereunto Auicen accordeth in quarta primi Cap. 4. This saith he is a truth and the precepts of Hippocrates in lib. Epidemionium that if both bleeding and purging be necessarie and that the purgatiue must be vehement then begin with Phlebotomie Secondly in dangerous fluxes of bloud out of the nose or in spitting of bloud called Hoemoptoicapassio or in bluddie fluxes for to turne the matter a way in full bodies wee presently let bloud without medicine going before Thirdly in wrastlers abounding with bloud to whom the same abundance threatneth some great danger that it is presupposed that there are no ill humors in the circuite or compas
must be taken moderately the first and second day after bleeding as Rhases counselleth writing to Almons lib. 7. cap. 21. For the vertue digestiue made weake by bleeding cannot ouercome as yet much meate Herevpon also Isaacus in his dyets writeth thus Meate to such as haue bled is to be withdrawen and diminished but drinke to be augmented for in respect of the meat drink is to be augmented not in regard of his former vse of diet that now he may drinke more than hee was accustomed for in truth he must drinke lesse than hee did before bleeding because the vertue concoctiue as ye haue heard is yet too weak to beare much abundance of drinke The words of Schola Salerni touching this matter are these Spiritus vberiorque exit per Phlebotomiam Spiritus ex potu vini mox multiplicatur Humorumque cibo damnum lente reparatur Abundant spirite with bloud doth passe yet drinke of wine doth it restore By helpe of meate the same alasse will hardly come as twas before Of Revulsion that is pulling backe and deriuation that is turning aside of bloud and Humors by opening of a veine Chap. 6. REvulsion is a prouided remedy for bloud flowing out of the nose or belly or that floweth to any part like them to cause inflammation It is called in the Greek Antispasis That is a turning to the contrary way in Latine Reuulsio that is a pulling backe and as the word impotteth so is it desined a drawing of the running humor into the contrary part Nothing can more speedely keepe backe the force of a Fluxe than this practise Now for to vnderstand which is the contrary part we must note that the Mathematicks call those contraries which be the extremities of one and the selfe same straight line which stand furthest off in a straight proceeding or going forth of the selfe same vein through whose passages the humors haue their course For a veyne beeing opened first the part next the wound is euacuated that euacuated part draweth the bloud out of the further part And forasmuch as opening of a veine doth thus euacuate through the helpe of the small straight veynes which nature hath ordained to allure and draw as shee hath the ouerthwart veynes to expell The same opening of a veyne I say will prouoke more bloud and in shorter time from those parts where the streight veynes are spread then from the rest Yea if the veynes drawe not at all yet the humors voluntarily will flowe in the straight course of the veynes they that are in the right parts followe the right members and they that are in the left partes follow the left members and that course of humors is commended which are carryed straight wise and that discommended when they are carried crookedly and ouerthwart as declaring nature to bee violated and corrupted The names of Phisicall contraries in this practise are these before behinde the right the left vpward downewarde within without Neither are these contraries in revulsion of humors except they bee so placed in a straight course of veines For the left side is not contrary to a left Pluresie or the left leg from the knee downewarde called in Latine Crus contrary to the right leg inflamed For herein this is a common and direct society of veines whereby the left leg beeing opened draweth from the right But from the right side to the left no veyne commeth with straight and right strings Therefore a veyne opened in the same remoueth not a Pluresie on the right side But either leaueth the hurtfull humor in the inflamed part or mingleth it with the pure bloud or bringeth a Pluresie in the left side which often falleth out so For as much therefore as all our indeuours and deuises must tende by opening of a veyne to exhaust bloud abundantly and speedely from the inflamed part take such a veine as is straitly scituated to the affected part So in reason we shall followe nature and imitate Hippocrates who in a Pluresie willed to take the inner veine of the Arme on that side which is grieued Neither onely doth the Phisition open the inner veine of the right arme in a pluresie on the right side but also in inflammation of the liuer and yet all the veins are ioyned to the liuer in felowship If that appeare not we may take Mediana If that neither appeare we goe to Vena humeralis rather than to the inner veine of the left arme attributing so much to those veynes which are directly and straightly scytuated Therefore Revulsion in a streight course bringeth euident and speedy helpe whereas in a crooked or ouerthwart locution it bringeth none at all Moreouer a large veyne opened withdraweth bloud plentifully and speedely from the next places Therefore when there is a great and vehement inflammation of some euill Humor abundantly concurring in some principall member and part of great sense and feeling a large veine must be opened in some neere place vnto it which may abundantly and speedely euacuate from the place affected If the infirmity be but small a lesser veyne may be chosen and in a place further distant to euacuate a lesse quantity and at more leysure Revulsion in this sort not onely stayeth the Fluxe but also exhausteth first from the affected member the rotten and ill bloud before it deale with the good bloud of the other parts and members of the body and then all feare is remooued of any newe Fluxe to insue For when the part affect ed shall bee disburdened more than the other through great euacuation lately made very hardly in reason can the same be grieued with another Fluxe of humors except we go on with a fresh intemperate order of liuing And againe the members far distant couetous as it were because of their great want wil not suffer the bloud in them contained to flow to the others Neither will the member affected except there remaine in the same great dolor and heate allure or sucke any thing from them being now but weake and consequently not requiring great nourishment The opinion therefore of the Arabians concerning opening of a veyne must needes be false VVho suppose that in a Pluresie a veyne opened on the same side doth increase the force of the Fluxe Affirming also that for the plenitude if it be much lest the Flux should increase the same is to bee taken from the lower veyne of the foote After this that the Revulsion must bee made from the inner veyne of the contrary arme Last of all that the reliques and remainder is to bee euacuated out of the same side VVhat discretion I pray you is this so oft to vexe the sicke Patient whom wee may cure at one time For bloud abundantly taken out of the side affected draweth plenty as it were at the well head freeing that part from inflammation without suspition â— orfeare of any newe Fluxe Euacuation made from the ouerthwart veynes onely abateth superfluity of bloud and humors with small quantity of
found out yet the same may not be vsed The reason is for that such a medicine specially or rather altogether respecting the bloud would neither euacuate nor attract bloud as the other humors are euacuated with their owne proper and peculiar receits Yea if it happen that it do euacuate bloud as Pulpa Colocynthidis doth according to Auicen without doubt it euacuateth thaâ— bloud which should be still retained for the good health of mans bodie Serapio sayeth that the impropriate or improper humor of a receit is sooner thereby euacuated then the proper humor whereof he rendreth a reason namely that the proper humor to a recâ—it is the best beloued to the receit Wherby saith he it commeth to passe that the improper humor is sooner for saken of nature than the proper The humor improper is quickly drawen to the receit and therby sooner expelled whereas the humor called proper which the medicine most properly respecteth is as it were the most beloued friend and as it were the most natural childe to the euacuating receit and therefore is stil rather reteined than expelled By this reason oâ— Serapio forasmuch as bloud is natures darling more helping than the other humors which are but superfluities in respect of the bloud If there were a receit euacuating respecting bloud that the same were administred the other humors would be attracted cuacuated before the bloud and so great hurt ensue to the bodie And if it were so that onely bloud offended which is not perhaps altogether true yet neither should the bloâ— alone be euacuated as now it hath bin declared Againe according to the Philosopher 4. de Animalibus we are to make choice of the right way and not to seeke crooked wayes Now opening a veine is the righter safer way to euacuate bloud than medicine for Phlebotomy euacuateth all humors at once principally the bloud which most of all aboundeth in the veines and this thing medicine cannot do Againe euacuation is done for two causes either for to remooue the aboundance of the humor or to take away the corrupted qualitie of the homor So euacuation of bloud is practised either because it aboundeth in quantitie or offendeth in qualitie If we open a veine because bloud aboundeth in quantitie then in like sort there is also abundance of other humors For abundaÌ„ceof bloud cometh through good nutriment causing bonuÌ„ ChymuÌ„ i. good â—uce proceeding of meat digested which doth not only bring repletion of bloud but also of other humors as helpers vnto bloud Therefore when bloud thus aboundeth in quantitie with other humors it is better to euacuat them by Phlebotomie than by receit If euacuatioÌ„ of bloud be made for that it corrupteth in the veines then by reasoÌ„ it corrupteth the other humors also seeing bloud is more abounding in quantitie than are the other humors wherupon Galen saith that in the feuer Sinocha there is corruption of all the humors in all the veines therefore bloud is neuer to be euacuated without the other humors together Now other humors may superfluously abound be corrupted in qualitie without the bloud and so consequently may be euacuated without bloud by inward medicine so that it is naturall for the other humors in this sort to be euacuated and vnnaturall so to euacuate bloud which was the cause that Haly vpon Galens authoritie affirmed that Galen caused one to be hanged which euacuated bloud by inward receit To the former obiections therefore wee answere thus Isaac his saying Quod prodest Choleri prodest sanguini is to bee vnderstood not of euacuating medicines but of altering receits as thus those things that are profitable to alter choler and to extinguish the amitie thereof they worke the same effect in alteration of the bloud Or wee may vnderstand it of euacuation and expound it thus Those things which are profitable to euacuate choler are profitable to mundefie the bloud because by euacuation of choler bloud is mundefied and cleansed To the second we answere that this argument Bloud is naught and offendeth as do other humors therefore it is good to euacuate the same by medicine as other homors offending are euacuated this is a fallax of the consequent or rather figurae dictionis for it followeth not that if bloud offend it must be euacuated by inward medicine because the same may better and more safely be done otherwise namely by Phlebotomie and this may serue for aunswere to the second doubt before moued in like manner To the third may be said that Pulpa being forcible it greatly debilitateth the member and therefore when bloud is superfluous it looseth and euacuateth the same and letteth the bloud conteined in the member to passe away but it doth not attract the bloud and this is verie pernitious to the bodie of man The answere to the fourth is plaine in the premisses VVhere note that although it haue bin declared in this Chapter that bloud is not to be euacuated by siege as other humors are which fluxe of bloud that way we rather account a disease than a remedie as in Dysenteria such like yet this notwithstanding we do not denie but medicines may be verie profitably giuen and receiued to mundifie to purge the bloud Of the impediments or lets of Phlebotomy and of the causes requiring and furthering the same Chap. 8. THere are certeine things which put off bleeding for a while and other things which altogether hinder forbid this practise whereof the first is indigestion of the meat receiued as when a man hath eaten much ouer-night and in the morning feeleth himselfe pained therby feeling still as it were the sent sauour of the meat which he hath eaten remaining still in his stomack whereby the cruditie plainly appeareth In this case except vrgent necessitie otherwise require wee must forbeare bleeding til the digestion be accomplished that is til the rawe humors be concoct also the excrements descended The reason why cruditie and rawnes of humors through too much ingorging of meat stayeth bleeding for the time may be gathered out of Auicen 1. Doctri 6. cap. 3. for that there are three things which attract matter vnto them that is emptines of the place heat of the members the habit and state of the whole bodie If therefore the bodie thus affected wee chaunce to open a veine the bloud vntimely woulde be drawen by the veines first part of this cruditie of humors and the veines being destitute of their proper and conuenient nourishment would drawe vnto them that which is not as yet concocted in the stomack Liuer which vnconcocted matter sent abroad to the othâ—r members of the bodie would not easely be amended For as Galen saith the third dgestion doth not remedie the faults of the second nor the second the curls of the first Si magnum sit peccatum as he saith if the euill be great So that now if by this meanes the matter be turned into the members
there must in the meane season of necessitie be abundance of excrementes remaining in the bodie as the occasion of sicknesses and so at length sicknesses may ensue Yea it is far better as it seemeth to Galen lib. de Curand ratio per sanguinis missionem cap. 6. altogether to absteine from bleeding in vntemperat drinkers gluttonous persons as from such as cannot be cured either by purging or bleeding For by their vntemperat life they gather in short time againe great abundance of rawe vnconcocted humors VVith such it is not best to deale for to what purpose is it to haue the excellent vse of this practise by these mens intemperancie defaced among the common people which hath been so present a helpe to diuers See Galen lib. 11 cap. 9. Method Meden The seconde matter putting off this practise for a time are the excrementes of the bellie Therefore first exonerate the wombe before bleeding if it bee not soluble of it selfe with a Clister of decoction of Mallowes putting thereto Oyle and Salte or with a Suppositorie or with eating a little Cassia fistula The thirde impediment is some other voluntarie euacuation that may be at that present time as in fluxe of Termes in weomen and in fluxe of the Hemorroids whereunto Gaelen likewise consenteth lib. 9. Cap. 5. Method Meden in these words If saith he in time of bleeding it happen that the Termes do flowe or that the veine called Haemorrhois be open if the force of the same fluxe seeme sufficient so that it alone may euacuate that which thou requirest thou shalt leaue the matter wholly to nature if not then thou maist detract so much bloud till by both wayes that be brought to passe which thou wouldest haue done But this is not alwayes to be followed for in euacuation to turne away the matter as in immoderate fluxe of Termes or in the fluxe of the Hemorroides wee practise bleeding as was afore shewed in the Chapter of Reuulsion Againe concerning these voluntarie eruptions of bloud when wee intend to open a veine if the eruption haue been much then stay from further euacuation But if it little or nothing haue withdrawen the matter of the disease it debarreth vs not of further bleeding Therefore if the disease and present necessitie require it that the powers of nature haue not beene damnified by that voluntarie eruption wee may speedily open a veine as in a strong plurisie If there haue been much sweating vomiting or great sieges we are not to let bloud but if these slake and that the naturall powers are a little in time recreated then wee may verie safely bleede For those being but accidents not remouing the cause of the disease can not serue in steed of bleeding So in a hote agew if the wombe be laxatiue and that there happpen Lienteria which is a fluxe of the stomacke when the meate and drinke runneth from a man as he tooke it vtterly without concoction or alteration rising of great weakenes of the stomacke specially in the power retentiue which is not able to keepe the meate till nature in ful time may concoct it through immoderate drinking of colde water from which some cannot refraine in hote feuers This I say doth not hinder bleeding but because thereby natures strength is enfeebled the same considered the bleeding must be the lesse if voluntarie eruption of bloud remoue the matter of the disease or in some reason bring ease to the patient according to discretion commit the matter to nature alone If not take away some bloud that through natures worke and the Phisitions practise togither the cure may be accomplished Those things which nature of her selfe can finish meddle not withall but helpe her with Art in that which shee beginneth and cannot of her selfe make an end therfore I said in a Plurisie in a continual feuer if bloud abundantly flow frō the bellie hemorroids or nose so that the quantie of the euacuation be iust and the patient thereby eased let no further bloud If bloud come but smally from the foresaide and that the sicknesse still continue vehement that which wanteth is to be done by opening a veine yea although the patient be a woman in child-bed yea therefore sometime in a bloudie fluxe a purgation is giuen that the same which commeth foorth but softly and slowly by reson of the vnprepared passages may flowe more abundantly by a more conuenient course The fourth impediment is the age of the partie that is to bleed either being too old or too yong Old folk are not to be let bloud because there is in them little good bloud and much ill bloud bleeding from them taketh away the good and leaueth the bad behinde Olde men after 70 yeares are not to be let bloud except they be of a strong constitutiō of body that the vehemency of the disease require the same But if in these yeres the powers of the bodie be weake that bloud aboundeth not bleeding is not to be in them practised for as Galen saith in men of these yeres there is little good bloud but of rawe humors great plentie so that opening of a veine sendeth forth the good but the ill blod gathered together in the chiefe veines in the Liuer that part called Mesenterion which is the double skin that fasteneth the bowels to the backe or rather the branches of the veine called Porta which conuey the iuce of the meat concocted from the stomake to the Liuer it draweth forth into the whole bodie Consider therfore the strength of the body the vehemencie of the disease for not onely the number of yeres but the constitutiō also of the body is to be marked There are of 60 yeres that are not to bleed being weake old men The age fit for bleeding is at as florens that is after some the 17 yeare of age after some 9. after some 10. after others 14. or 13. Before the 13 yeare after the most approued writers of our time wee are not to let bloud except those youthes haue broad veines be of sanguine complexion and that the disease be dangerous require this practise necessarily In these cases wee may open a veine if the veines well appeare or we may diminish bloud by scarifying the legges or armes Schola Salerni sayeth Denus septenus vix Phlebotomon petit annus The seuenteenth yere of age scarce good To put in proofe letting of blood Children then before they come to 13. or 14. yeares are not to bleede except some great dangerous disease of necessitie require it at nine or tenne yeares the reason is because their flesh and skinne is yet but tender and easie to breath thorow as Galen witnesseth lib. 9. cap. 17. Method Medendi in these words Puerorū substantia omniūfacile digeritur ac dissipatur propterea quod est omnium humidissima est omnium minime frigida The substance or flesh of children is most easie of all resolued or separated because it is most moyst
or betwene both The forces of nature being but weake they cannot indure Phlebotomy so forcible an euacuation As Galen 2. Aphorismo Aphorism encipienti In quo morbo c. 4. Simplicis medecinae witnesseth This is one of the principall considerations that are to bee regarded in opening a veyne for either wee must dehort from it if natures forces serue not or incourage to proceede it if they will serue vnto it For it standeth with great reason that bleeding must greatly infeeble and put them in danger that are already weake of nature Yea it oft falleth out that diuers being let bloud carrying very weake bodies can neuer again recouer their former and pristinate strength as Galen lib. de curand ratio per sang missio ca. 6. li. 11. Method meden cap. 14. witnesseth If the body bee strong and that vrgent necessiity so require wee may boldly let bloud If necessity doo not vrge bleede not at all or very litle If vpon great necessity in this case much bloud must bee taken the body being feeble and not able to abide it we are to euacuate now a litle and then a little Yea I giue heere againe aduise especially to regarde this consideration For many times when the age disease and time require this kind of euacuation and the naturall strength cannot brooke it there insueth Sincope that is sowning In the which case we must reiterate bleeding as hath beene said or else stay it putting the finger on the wound which stay the Grecians vsed and called Apphasis The seauenth stay or let is the habite and constitution of the body wherein wee are to regard the whitenes or blackenes leannes or fatnes thicknes or thinnes of the bodies that are to bleede Thinne white leane and soft bodies are not to bleede because many superfluities are resolued from such bodies which being to them sufficient they need not any other euacuation This doth Galen affirm lib. 9. Metho Medend fleshy bodies firme and thicke are subiect nothing so much to dissipation of superfluities therefore may better abide bleeding as for fatte and grosse bodies though they be also lesse subiect to wasting dissipation of humors than other are yet they hardly tollerat Phlebotomy because they haue but small veynes and they being emptied by bleeding the fat of the body wringeth and as it were presseth them down So that it is gretly to bee feared lest by such oppression the heat of nature be quite extinguished In this point of the habit of the body we are also to consider the capablenes of the veyns which being great swollen may better be opened than the narrow and small litle veyns Again we are also here to regard the naturall disposition of the humors For hot and thin humors are flowing and quickly dispersed Thicke and cold humors are not so and because grosse thicke fat bodies haue lesser veynes lesser bloud than leane men that in such persons the very fat of their bodies oft presseth down the veyns so suffocating and choking naturall heate therfore wee see by experience that oftentimes these corpulent fat men die a sodaine death VVherevpon also Hyppocrates 2. Aphoris Aphoris 44. supposed that grosse men die sooner and more sodainly than leane persons This I my selfe obserued certaine yeares past by the death of a Gentleman of good credite in this shiere of Kent one Maister Weldon Esquiere and of the Greencloth VVho died very sodainely beeing a very fat Gentleman at a parish called great Pecham The eighth impediment is the colde temperature of the Patient or the coldnes of the complexion For the bodily constitution beeing already colde by bleeding of force must be made more cold VVhereby frigiditie of the body dayly increaseth And as Isaac saith in Vrinis Sanguis est fundamentum caloris naturalis in quo calor naturalis confortatur Bloud is the foundation of naturall heate whereby naturall heate is strengthened Therefore Phlebotomy euacuating bloud diminisheth the naturall heate and consequently bringeth a dangerous coldneâ— to the whole body The foundation of inward warmth namely bloud being diminished inwarde heate decayeth and the body still by little and little waxeth more colde And this is testefied by Galen lib. de curanda ratio per sanguin missio cap. 6. Yet when the sicke is of a melancholy constitution and is grieued with much Repletion or that Melancholy hath much bloud mixt with it in this case hee may bleede And againe a hot and a moist constitution of body hauing also the bodily substance consisting of found whole and massie members which by reason of inwarde heate is daily much dissolued tollerateth not so plentifull euacuation as other complexions VVhere by the way yee are to note that in Phisicke that body which aboundeth with much humors in the veynes is most properly called Corpus humidum and may best of all away with euacuatioÌ„ by bleeding The ninth is rawnes slownes and clammines of the humors In which case wee are to forbeare bleeding For otherwise crudity of humors will bee increased After Galen 12. Method Medend cap. 2. And this is the cause why in long continuing maladies bleeding is not vsed according to Auicen for if it were there woulde followe Crudity of Humors Debility of Naturall vertue Prolongation of the disease with feare neuer to bee cured And therefore againe as the same Auicen saith further in diseases daily and continuall called Morte Chronici Purgation must goe before bleeding and not bleeding first although we are to vse them both VVhereof looke before Chap. 4. Of crudity of humors there are two speciall causes the first is the excessiue multitude of humors in the body choking the inwarde naturall heare by reason of whose weakenes and suffocation nature not beeing able to ouercome those humors crudiâ—â—es must needes iâ—â—ue in the body Buâ— in thâ— case Phlebotomy may be vsed And Galen lib. 2. cap. de Hydroposi â—aith that bleeding he petâ—â—in the 〈◊〉 of a dropsie which is caused throâ—gh abundance of menstruous bloud or of abundance of hemorroids The reason is for that although these humors abounde in the body yet bleeding stayeth the fluxe of them both of that that is of the menstruous bloude and also of the Hemorroids This also Trallianus affiâ—meth lib. 9. cap. 2. In the cure of Anasarca which is a â—inde of dropsie in these words Omnium curatio a vacuatione incipiendaest sed Ascitis quidem dicti aut Timpaniae a solapurgatione cus autem Arasarca nomeâ—i est ea vena sertionem intâ—rdum ordum requirit vt qui â—x sanguine frigidonascitut The cure of all dropsies must begin at eu cuation But that kind of dropsie called Ascitis or a Timpany must beginne at purging onely That dropsie called Anasarca sometime equireth opening of a veyne as proceeding of colde bloud This he faith not that this Anasarca requireth any further coldnes to be added but because the withdrawing of abundance of humors in this case disburdeneth nature
and maketh her the more able to ouercome the same Repletion being somewhat lessened in quantity by bleeding It is not therefore repugnant but very agreeable to reason in this case to vse Phlebotomy For we see by daily experience that a small fire is put out by laying on too much wood at once or such wood as is greene and that then it burneth when the woode is remooued which hindered the burning thereof Euen so is inward heate of the bodie choaked with multitude of humors and the same is againe refreshed when some portion of them is withdrawen The second cause of crudity of humors is the debility of the inward naturall heate which happeneth in men of colde Complexions in men that haue beene long sicke and in olde folke in these bleeding is not vsed because bloud being taken away from them which is the restorer and maintainer of the inwarde naturall heate as yee heard before out of Isaacus consequently the body must waxe colde and crudity of humors increase Bloud therfore must remain in these persons to concoct and ouercome the humors in the body And therfore very well saith Auicen Non quotiescunque videris signa Repletionis est facioÌ„dâ— Phlebotomia That is Phlebotomy is not alwâ—ies presently to bee practised whensoeuer wee see signes of Repletion as namely when there is fulnes of raw humors in the body and this doth Galen also affirme lib. 12. Method Medend The tenth impediment is the vnfit disposition of the Aire when the same is too hot too cold too dry or too moist Also when the same is not cleare but troubled And therefore vnder the starre called Canis in the canicular or dogge dâ—ies when thereis excessiue heate and drith it is good to refraine bleeding Except great necessity doo vrge it So likewise in seasons too moist and too colde as in the winter in a state of the Aire temperately hot as when the wind is south or southeast wee may bleede temperarately and sparingly In a more cold state of the Aire as when the North-winde bloweth or North-west winde wee must bleede more sparingly than before In a right temperate and mild state of the heauens we may bleed plentifully especially the Aire not beeing greatly disquieted with great force of tempestious weather And here may be made a profitable collation in this practise by folding vp together as it were in one three impediments here specified The state of the Country being coâ—de the time of the yere beeing cold the present constitution of the Aire beeing colde All which three are outward causes and â—oyne in this third point which is common to them all three that is the Country the Aire and season of the yeare compasse about euery Patient Therefore in a cold Country and in winter and when the Northwind bloweth open no veyne If in a colde Country and in winter the wind blow South and that so necessity require wee may proceede with this practise so in a hot Country and in summer the winde blowing at the South bleede not If necessity in summer require bleeding open a veyne when the North-wind tempereth the immoderate heate of the season For surely these outward causes though obscurely and without any great perceiuing yet they doo either keepe in or disperse abroade and extenuate the substance both of inward heat and also of the inwarde humors And as in a temperature or complexion hot and moist Phlebotomy is vsed best and not to be vsed in complexions hot dry or complexions cold and dry So when the season is hot and moist as in the spring we may bleed safely But not so in a season hot and dry as is the summer or very cold as is the winter The eleuenth let is some great inflammation or extreme ach and paine as appeareth by Galen and Auicen who both forbid bleeding in hot inflamed feuers and in apostumations of great paine In these cases the opening of a veyne doth cause much busines and agitation of humors in the body Bleeding on the one side drawing and emptying humors the inflammation and ach on the other side striuing there against and attracting humors thither For all paine if it be much and all heat which concurreth with paine attracteth and hindereth the fluxe of humors VVhereby it commeth to passe that by bleeding in this case the inflammation is thereby increased and nature more infeebled and the same most chiefly when the bleeding hath beene temperate and done according to Art But in the foresaid cases if the bloud be withdrawen in great quantity euen till the Patient giue ouer and faint it profiteth very much for thereby the abundance of boyling bloud in gâ—eat inflammations is expelled and the inflamed member is cooled so that in vehement paines opening a veyne is a present helpe keeping backe the fluxe of bloud which otherwise would haue recourse to the pained place And here it is not to be forgotten that sometime the expulsiue vertue making hast to expell the cause of the griefe causeth thereby sometime an inflamma â—on The reason is for that the expulsiue vertue hauiâ—g done no good at the first â—nd 〈◊〉 more venemently than before to expeâ—â— that matter which causeth annoyance and doth therewithall wring out forâ—ibly some bloud out of the vpper partes or members into the lower afflicted part as Galen â—heweth at large lib. 23. cap. 3. Method Medend And therefore to keepe backe the saide inflammation bleeding greatly profiteth as yee haue heard before Cap. 6. And this is the intent and meaning of Galen where he saith In ardentissimis febribus si vsque ad animi defectionem sanguis mittatur statim totius corporis habitus refrigeratur febris extinguitur In extreame hot feueâ—s if we bleede euen to giuing ouer and sowning presently the state oâ— the whole body is cooled and so the feuer is extinguished In vehement pâ—ines and grieses therefore there is no better remedy fouâ—de than â—o â—et blouâ— euen tiâ—l the Paâ—â—ent ouercome Reade more hereof in Galen lib. 9. Method Med. cap. 4. lâ—b de curaâ—d Râ—tâ— saâ—g Mâ—ssionem capit vndecim Fuchlium libr. secund sectione quint. cap. quart sext institutionum Medic. The twelfth impediment is the extreame coldnes of the Region a Country which being cold cannot tollerate so large an Euacuatioá¹… as is this kind that wee nowe presently handle The reason is for that the body being before sufficiently cooled through the colde temperament of the place must needes waxe more cold when the naturall heate is drawen forth with the bloud Moreouer a country too hot cannot admit this practise because in such a place extremity ofheate draw eth from the body much inward heat of nature dissoluing of it selfe and dispersing the naturall forces and humors of the body and therefore in hot Countries the naturall powers are lessened there is lesse bloud in the veyns which is the reason that also in extreame hot countries the bleeding must be none at all or very litle A country
And further it commeth to passe not onely that the seedie moysture is drawen from the partes of the bodie through carnall copulation but also the vitall spirites passe out of the arteries with the same And therefore it is no â—â—arucile if such as vse lecherie immoderatly become weake both these being taken from the bodie that is to saye the seedie moysture and the vitall spirite VVhereunto may be added the pleasure of Venus which of it selfe is able to vnloose the vitall firâ—itie of the bodie Yea it is knowen that some haue dyed of too much pleasure in the act Marsilius Ficinus in his booke de Sanitate tuenda Cap. 7. confirmeth in these words aâ—l that hath been hitherto said Venus saith he if it do but little exceede the powers naturall of the bodie presently it exhausteth the spirites and specially those that are most subâ—ile Also it enfeebleth the braine weakneth the stomack and hart-strings yea there cannot be a more hurtfull thing to the witt and memorie VVhy did Hippo. iudge Coitum to be like the falling sicknesse but bâ—cause it woundeth the minde which is diuiâ—e and heauenly The immoderate vse of ust is so hurtfull that as Auicen sayeth in his boode de Animalibus If but a little seede issue foorth more than nature can afoorde it offendeth more than if fouâ—tietimes so much bloud had proceedâ—d And therefore not without some good grounde dâ—d the auncient wâ—iters immagine the nine Muses and Minerua her selfe to be vi giâ—s Reâ—d moâ—e hereof in Galen Chap. 86. Artis Medicinae Pauli Aegnieta lib. 1. Chap. 35. In Aetius lib. 3. Chap. 8. The seuenâ—eenth impediment is long continuance of a disease wherewith the strength of the bodie being wearied a long tract of time the same cannot nowe tolleraâ—e bâ—eeding And forasmuch as now the bodie is more than inongh enfeebled brought lowe thorough a long continuing and languishing sicknesse by bleeding wee maye more easily quite extinguish the patient than remedie the disease Galen de Curand ratio per sanguia missio Chap. 20 And Auicen confirme the same giuing aduiâ—e to forbeare opening of a veine in bodies which haue endured long griefes except corruption of bloud moue vnto it In which case sometime bloud may be detracted from persons that haue continued sicke of long time And Fuchsius councelleth saying People in consumption oâ—de folke weomen with chiâ—de yong chiâ—dâ—en are not lightly to bleede The nineteenth impediment is small quantitie of humors being in the bodie for a good consideration is to be had how the humors offend in the bodie in quantitie or in qualitie VVhether there be many or fewe humors in the pacient And therefore sometime vpon this ground wee open a veine in weomen with child if there be abundance of bloud sufficient both for the mother and the infant in the wombe if the bodily strength be firme and that the greatnes of the disease in them so require it But hereof more at large I meane to write in another place And agâ—ine beside the quantitie the diuersitie of nature in humors is also a profitable consideration in this practise For euen according to the varietie of humors the patient is oft either to be let bloud or not letteÌ„ bloud which Galen seemeth to witnesse li. 4. de Sanita tuend saying Some humors come to perfect nutriment before the bloud some are as it were halfe concocted some altogether rawe and vndigested Some are but little different from the forme of bloud some are wholly changed into bloud some verie litle some more some verie much VVhen humors are a verie little as it were from the nature of bloud as not yet turned into the same or when they haue a verie little exceeded further than the nature of bloud wee may confidently open a veine VVhen the same is more than a verie little either the one way or the other on this side or beyond wee are to deale herein more considerately If the humors want much of or exceed much beyond the nature of blond we are altogether to forbeare bleeding The twentieth let after the small quantitie of the other humors may be the quantitie of the bloud which the wise Phisition in this practise will most wisely regard As for example if there be little good bloud in the body and abundance of other humors wee are to make staie from opening a veine If any of the other three humors be but litle in quantitie and the bloud abundant we may boldly let bloud Yea by diligent obseruation the Phlebotomer shall easily perceiue what hurtfull humor may be withdrawen with the bloud and therfore if there be many cholerike humors in the body of man and yet not mixt with the bloud or that there be many flegmatike and rawe humors and but little bloud by no meanes is a veine to be opened This doth Anicen forbid in quarta primi Cap. 20. If the bloud be good and little and that there be in the same bodie many ill humors also bleeding taketh away the good and leaueth the bad behind And a little after he addeth that the Phisition is diligently to beware lest by vnskilful bleeding in these cases hee bring the patient after he hath extracted the bloud the ill humors still remaining to an excessiue heat of cholericke humors or too much cruditie of colde and vndigested humors And although as ye haue heard before Phlebotomy doth equally euacuate all humors Yet because now so little bloud is in the veines whereof a little portion is withdrawen by bleeding it followeth that but a little bloud and lesse than before remaineth now in the veines with the other humors and that there is great plentie of the other humors forasmuch as they come not out so redily when a veine is opened as the bloud doth and therefore by a necessarie consequent bloud being gone which was as it were a bridle to other humors choler must excessiuely boile and flegme become more colde and vndigested VVhereupon also I gather that those haue done ill and verie vnskilfully which haue reproued Auicen of error in this place seeing he is rather verie highly to be commended then vpon euery small and light occasion to be reprehended Finally wee are to forbeare letting of bloud after continuall vomitings hunger great watchings extreme labours and after all such things as immoderately 〈…〉 body drying and dissoluing the 〈…〉 thereof as Rhases noteth lib. 7. 〈…〉 Almonsorem Touching the causes 〈…〉 ring Phlebotomie they may soone be gathered of their contraries by those impediments here specified And in the fifth Chapter before yee haue heard both the direct indirect causes which may moue to let bloud Vnto the which place I referre the studious reader at this time concluding this Chapter with the verses of Schola Salerni wherin are set downe most of the impediments here spoken of Frigida natura frigens regio dolor ingens Balnea post coâ—tum minor aetas atque senilis Morbus prolixus repletio potus
escae Si fragilis vel subtilis sensus stomachi sit fastiditi tibi non sunt Phlebotomandi Complexion cold the countrie so Great griefe bathings and veneric Too yong too old long sicknes to Stomacke sicke and fastiditie Cannot abide Phlebotomy diligen◠〈…〉 ding 〈◊〉 persons as are meâ—te or vnmeete to be â—â—r he loud Chap. 9. IN this Chapter I wil be but briefe because I was prolixe in the other before from whence many things concerning this point may be verie well and with great profit taken Neither determined â— at the first to haue made hereof a distinct Chapter but that in certaine Latine writers I found the like done before whom I thought good to imitate First therefore this practise is best for delicate idle and corpulent persons which vse to feed plentifully on the best nourishing meates without taking any great paine as Auicen witnesseth in prim Secondly for such as haue abundance of bloud which is knowen by many vnfallible signes and specially by thicknesse of vrine For abundance of bloud maketh the vrine thicke as aboundance of yellow choler maketh the same thinne Thirdly for such as abounde with Melancholy hauing in their bodies much naturall Melancoly running with the bloud because bloud is not throughly purified from it in the Liuer And therefore in this case Phlebotomy must go before purging and not contrane as hath beene aforesaide And here is to be noted that Melancolie is two-folde One kinde is naturall another kinde is not naturall Naturall Melancoly is the refuse of bloud And when the same aboundeth it runneth about in the bodie with the bloud and to euacuate it a veine must be opened and so this kinde of Melancolie passeth with the bloud because bloud and the refuse thereof that is naturall Melancolie commeth of one and the selfe same temperate heate And when euacuation is thus done a purgatiue may be vsed But let purgation succeede Phlebotomie after some space namely when the concoction is finished Fourthly bleeding is much profitable to those in whome is to be feared some extraordinarie heat shortly to followe or some extraordinarie boyling either of bloud or of humors or some other perturbation of bodie through too much aboundance of these Such persons as feare or feele any of these things are presently to haue a veine opened VVhere note that this rule yet oft deceiueth diuers practisioners For when their pacients doe feele any heate or calefaction presently they iudge it some ebullition of humors and so let them bloud whereas the same may come through heate and inflammation of yellow choler in which case it is so farre off by bleeding that the heat ebullition should be allayed that they are the rather thereby encreased and stirred vp For bleeding as hath beene tolde you before prouoketh the humors to runne thorow out the whole bodie with the greater violence In such a case therefore opening of a veine should not be vsed except the same heat and ebullition came altogether of aboundance of humors which is knowen through abundance of sweat chiefely that sweat which is in the morning For some do not sweate but when they haue neede of euacuation Fiftly it is to be practised on them also especially whose bodily powers are firme and strong and that are of a sanguine complexion that is hote and moyst and not colde and drye Rhazes lib. 7. ad Almonso Chap. 21. sayeth Corpora quae venas habent amplas conspicuas quaeque hirsuta sunt colore inter rubrum fuscunqne medio adolescentum nimirum iuuenum senum non decrepitorum Phlebotomiae presidia magis tollerare possunt pueris vero infirmis vena secanda non est nisi maxima incumbente necessitate i. Such bodies as haue large and manifest veines that are hairie and of colour betweene red and browne specially of stripplings yong men and olde men not decrepites may most safely awaye with the helpe of bleeding But wee are not to open a veinein children and weake folke except great necessitie so require Sixtly this practise is with great heede to be vsed or rather not at all to be vsed after the paine of the cholicke or rather immoderat perturbation of the bowels either aboue or beneath whether it be Cholica passio or Illiaca For the Humors as ye haue heard in the Chapter before being mooued by bleeding the chollericke humor would flowe vnto the stomacke and inflame the same nor yet after strong vomits For the like euent woulde followe nor after a laske These and such like extremities vehemently heating rhe bodie and greatly dissoluing the same if they should concurâ—e with Phlebotomy they would too much inflame the bodie excessiuely moue the humors and mightily weaken the forces of Nature as appeareth in the Chapter before Fig. 20. Seuenthly weomen with child or hauing their termes are not to be let bloud In weomen with childe this is the reason because naturall heat seruing for digestion woulde thereby be diminished and so nutriment would be with-holden from the child which were verie dangerous if the mother were farre gone with child The fruit in the womb is nourished by the Termes and not hauing whereby to be nourished it must of force in the wombe hauing life and wanting nourishment die for hunger And againe being losened from the naturall staies in the womb it falleth out of the naturall boundes and so causeth aborsion This I say sooner happeneth when the yong frute in the wombe is growen much and the mother farre gone therewith for then it needeth the more nourishment which it can neither finde nor haue the bloud being diminished Fulchsius writeth more hereof 31. Coment lib. 5. Aphoris Hippon But here I am to adde that albeit in auncient time it was accounted perilous to let bloud weomen with childe as appeareth by that which hath beene now said yet out of the Chapter precedent Fig. 19. it partly appeareth that this practise may be done discreetely and safely in weomen with childe if necessitie so vrge chiefely if bloud be abundant in them if the bodie be firme and strong I affirme that they may bleede But because it hath beene reputed dangerous wee must carefully see that we take not from them much bloud To take a little after the fourth or fifth moneth of conception hurteth not Yea experience prooueth that women thereby are made merry and light whereas before they were very melancholly feeling alwaies about them an vnaccustomed heauines yea through a little bleeding they are inabled with the more facility to beare their burden to the due and iust time of their deliuerance Againe some women being with child require twise to bleede that is to say when they are halfe gone and in the beginning of the eighth moneth but hereof take great heede except the woman greatly abound with bloud I haue seene saith Guinterus a woman with child that hath beene let bloud three times in the second the fifth and eighth moneth because shee was very sanguine
and had experience once or twise before of aborsion the third moneth if shee had not bled the seconde moneth In the other moneths the fifth and eighth shee was in danger of suffocation except shee had bled againe VVhen women are brought a bed they must not bleede except their seconde birth be suppressed or a Feuer molest them In the which cases also carefully consider in the Patient her naturall strength Those that haue their termes naturally according to the due course of nature and the course of the moneth are not to bee let bloud except in immoderate Fluxes to drawe backe the matter VVhen they breake forth naturally the whole matter is to bee let alone to nature Eighthly bleeding is not good for such persons as are bounde and haue the excrements retained For as yee heard in the eighth Chapter Fig. 2. The veynes beeing emptied they attract matter from the next members and they attract from the stomacke the moystnes of the excrements whereby they become more dried and baked bring diuers waies annoyance to the body In which case the wombe by Art is to be made solluble as appeareth in the place now cited Finally a veyne may and is to bee opened without hurt or daunger whensoeuer wee feele our selues to bee heauy lumpish and stopped or stuffed in our bodies first considering the quantity and quality of the fulnesse which wee may knowe and discerne by certaine tokens whether it bee Plenitudo quo ad vasa or quo ad vires as was shewed in the first Chapter the more heauy and drowsie a man feeleth him selfe to be so much the more it appeareth to bee that fulnesse which is quo ad vires But if hee feele the former stuffing in his body increased than is it that plenitude Quo ad vasa And thus much to know the quantity of the Repletion The quality of the fulnesse is knowen partly by the colours partly by those things which are very neerely ioyned to the nature of the humors But of these signes sufficient hath been spoken before in the first Chapter In these cases of Repletion if the strength of the body shall bee answerable wee are to open a veyne for as much as bleeding is the chiefest remedy to abate fulnesse But if the stuffing and fulnesse of the body bee greatly grieuous and the state of the body not answerable it is not alwaies necessary to let bloud As Galen noteth lib. de Curand ratio per sanguinis missio And againe Phlebotomy is not onely profitable when any of the foresaid fulnesses grieue and oppresse vs But also as hath beene saide in cases without any fulnesse As in the beginning of an inflammation which commeth either of a blow ache paine or weakenesse of the member For paine as was saide draweth the bloud vnto it and of the weakenesse of the bodily parts cause an inflammation without fulnesse Also when the disease is great and vehement we let bloud although no fulnes appear in the Patient yet alwaies hauing a regard to the age and strength of the party as Hyppocrates setteth downe in these wordes 4. Vict. acutorum 17. In acutis morbis sanguinem deâ—rahes â—ivehemens morbus videatur florueritque aegrotanti aet as virium affuerit robur That is in sharpe disease thou shalt let bloud if the sickenes seeme great if the age of the Patient permit and that there be sufficiencie of naturall strength And thus much of the persons that are to bleede concerning the which point more may be easily coniectured and collected of the studious Practitioner from the Chapters precedent What corruption of Humors bleeding remoueth from the veines Chap. 10. IT hath beene said that bleeding generally is the present and proper helpe when Humors offend in the veyns either in quantity or in quality It hath been already declared that some humors it euacuateth other some it reuoketh and pulleth backe which is called revulsion whereof hath beene spoken in a distinct Chapter by it selfe Now order requireth in some briefe sort to shew what corruption of humors generally bleeding euacuateth from the veynes The defect of humors in the veynes is either Plethora or Cacochymia as was shewed in the first Chapter The onely and peculiar remedy of Plethora or abundance of bloud is the opening of a veyne And forasmuch as fulnes of bloud is of two sorts One of fulnes simple and pure consisting of a like proportion of the best humors and the other vnpure and compounded taking part with Cacochymia that is abundance of humors corrupted in the veynes Therefore it is to bee marked that in both these Repletions the opening of a veyn greatly profiteth VVhen so euer therefore the muscles are sounde whole and full the veynes large great and swelling menacing thereby imminent danger to the members presently bloud must bee detracted After which eu cuation these effects will insue mitigation of paines caused by ouermuch retching of the veynes ease vnto the body which seemeth as it were nowe disburdened of a grieuous and waighty ponderousnes a more nimblenes to all exercise and labour than was before an increase and refreshing of the naturall heate an opening of the straight passages and pores of the members Finally there will follow a happy repulse of diuers imminent dangers and diseases wherevnto by all probability in short time the body would haue beene brought For it is greatly tobee feared lest the veynes ouerreatched with fulnesse of bloud should open and breake and through that meanes cause inflammation or lest some generall obstruction should arise which might keepe backe the inwarde heate and so vtterly choke vp the bodily forces wherby might bee caused some vehement hot feuer or as it oft hapneth a sodaine death of the party Now from these daungers can no man bee safely and speedely freed either by purging exercise or abstinence but by bleeding and with the bloud is this Repletion most safely abated That fulnes which is vnpure and compounded is not so safely cured by bleeding and yet the more nigh that it commeth in likenes to that Repletion which is simple and pure the more confidently and the more plentifully we may let bloud And the more vnpure that it is the more carefully and sparingly ought a veyne to bee opened Therefore those persons that haue an il constitution of body and yet haue their veyns abundantly filled or that beeing of a constitution are yet repleat with corrupted meates These I say are to bleede no longer but to auoid the danger of fulnes and the impurities remaining behinde are to bee expelled by Purgation Hot chollericke Repletions of all vnpure constitutions are most safely abated by bleeding because bleeding in this case not onely diminisheth choler but also cooleth the same mightily Melancholly Repletions can nothing so well away with this practise because it doth not so exceede in heate that it neede at all any refrigeration or cooling and the flegmaticke constitution can in no case brooke it for being a very cold
complexion it quite reiecteth bleeding For Phlebotomy by great cooling so greatly increaseth crudity and rawnes in the body that it can neuer or very hardly bee recouered or amended VVeakenesse of bodilie strength resembleth this foresaide Repletion and therefore also by the selfe same reason reiecteth any large euacuation And in truth is not in this respect to bee dealt withall except the veynes abundantly repleate threaten some great hurt or that necessity so require it and then it must not bee done all at once but by little and little as it hath beene before declared Therefore in each and euery fulnes that is vnpure we are to begin with opening a veyn for without it wee cannot safely afterwardes purge For a vehement purgation especially if bleeding haue not gone before troubling and molesting the full body both with much heate and by force of the attractiue vertue bringeth the Patient into greater hazarde than he was before and therfore to conclude this point the veynes being swollen and filled if moderate bleeding doo no good it can doo no harme at all The otherfulnes quae ad vires which cannot very easily be knowen by signes althogh it cannot ouerstretch or breake the veynes nor ouercome the inward heate yet because it oppresseth the weake forces of nature lest there should insue putrifaction or corruption of humors it may be diminished by opening of a veyne Leauing yet behinde so much as nature may easily rule yea and the same also because it bringeth no doubt of present danger may be profitably taken away with spare dyet or abstinence Of corruption and putrifaction of bloud and humors in the veynes without plenitude called Cacochymia that is fulnes quae ad vires There riseth a great doubt whether the same may aptly bee remooued by bleeding VVee answer that to remoue by bleeding a simple corruption of humors in the veynes is profitable and easie regard beeing had both to the abundance thereof and to the forces of nature in the Patient For albeit when a veyne is opened all humors issue forth equally and that there remaine behind still as there did before one and the selfe same proportion of humors yet because now by bleeding part is abated of that burden wherewithall nature was before oppressed the forces and powers natural waxe not the more feeble but they become more strong and chearefull so that they can beare with the greater ease those humors which as yet remaine still behind and nature hir self gouerneth them with farre lesse trouble than before And herevpon in continuall feuers when there is great crudity and corruption in the veyns bloud being often times detracted the vrine also beeing red troubled and thicke before It appeareth nowe more cleare and sheweth forth euident signes of concoction And note here by the way that the Phlebotomer must be very well exercised in those signes which prognosticate fulnes repletion Yea ye must also know perfectly the place of each particular humor lest after the manner of the vnskilfuller sort when the nose a little bleedeth and the vrine appeare somewhat red by and by yee doo let bloud Whereas bloud often times easily commeth forth not onely by reason of fulnes but vppon diuers other occasions nature her selfe often attempting voluntary eruptions of bloud Hereof it commeth that such persons as haue as it were the small litle mouths of the veines called Oscula eaten or gnawen or that haue a weake and apostumated Liuer and that Hydropicall persons bleede oft at the nose Also vrine waxeth reâ— and bloudy by the fretting of the stone in the Raines Vrine waxeth yeallow in that kinde of yeallow iandies which is simple in Scirrho hepalis That is in the hard part of the liuer and in that kind of dropsie which is called Ascites Yet in these effects we are not to let bloud for Cacochymia proceeding of corruption of the bowels is not that way cured Therefore the certaine knowledge when a veyne is to be opened necessarily is onely gathered of those markes and tokens which manifestly declare abundance of each humor And hereby yee may gather that bleeding alone speedily helpeth that corruption of humors which lyeth in the great veynes and only freeth the Patient from this kind of corruption except the same take beginning from the bowels ill affected and in this kind of corruption purgation is more meete than bleeding And thus it appâ—areth in a generall sort what corruption of humors the opening of a veyne doth remedy A particular rehersall of those diseases present or future which are cured by bleding Chap. 11. FIrst as yee haue heard a veyne is profitably opened in the two plenitudes nature being strong and the age conuenient In the fulnes quaead vires haue speciall regard that the naturall forces be firme But if in this plenitude raw cold and vndigested humors bee greatly gathered together in the body forbeare taking this as a rule that with great abundance of raw humors the strength of the body cannot stand as yee haue already partly heard and as Galen witnesseth lib. de curand ratio per sangui missio cap. 9. Secondly it helpeth diseases present and future and serueth both in the curatiue and preseruatiue intention VVe read that Galen in the spring time did let bloud those persons that were subiect to these diseases following to wite Spitting of bloud A polexies Falling sicknes Peripneumonia Pluresies Anginaes Stoppinges of Hemorroids or Termes Swimmings in the head The Gowt in the feete and in the ioynts All which Auicen also setteth downe in quarta primi cap. de Phlebotomia Thirdly we doo not onely open a veyne in repletion as Menodorus falsly supposeth but also as hath beene said without fulnes when wee feare some inflammation through some fall or other accidentall griefe And moreouer as wee haue already specified wee open a veyne for two purposes sometime to euacuate sometime to pull backe immoderate flux of humors to the contrary part as Galen noteth lib. de Curand ratio per sang missio cap. 11 9. Metho Medend cap. 11. As to stay bloud at the nose we open a veyne in the arme For this cause Galen lib. 13. Metho Medend ca. 21. in Letargus which is a drowsie and forgetfull sicknes rising of impostumation of cold putrified fleame especially in the hinder part of the braine whereby memory and reason almost perisheth and the sensitiue power is greatly hindred causing men commonly to forget their owne names also to shut their mouthes after they haue gaped and by no meanes to stay from sleeping In this disease I say at the first beginning thereof Galen willed to open a veyne albeit the disease bee colde rather as it seemeth to reuoke than to euacuate the matter or Galen so appointed it because fulnes is alwaies concurring with this forgetfull and drowsie disease Herevpon Galen 11. Meth. Meden cap. 15. affirmeth it to bee very healthfull to open a veyne not onely in continuall feuers called Continentes but in all
feuers caused and kindled of a putrifieng humor which should not seeme to bee true especially in intermittant fâ—uers which leaue off for a time as are tertian and quartan agues Forasmuch as in these bloud offendeth not in the veynes but some other humor beside bloud putrifieth without the veyns which by bleeding in reason cannot be euacuated This place of Galen cannot sound to reason or experience except we vnderstand Galen to giue vs aduise to euacuate by bleeding the matter of such intermittant feuers as haue also with the bloud fulnesse and abundance of other humors concurring So that this may bee his meaning Bleeding may bee vsed in intermittant feuers if they fortune to haue abundance of humors ioyned with the bloud For obstruction as Galen sheweth li. 11. Meth. Meden cap. 4. happeneth in rotten and putrified feuers sometime through abundance of humors sometime through the clammines grosnes and thickenes of them Galen therefore counselleth to let bloud in staying and intermittant feuers rather because of the abundance than the rottennes or putrifaction of the humor without the veynes And that this is his meaning appeareth by the words which Galen afterwards vseth saying Forasmuch as nature ruling the body by bleeding is lightned and disburthened of that wherwith she was before oppressed therfore shee will with ease ouercome that which resteth and remaineth behinde which is a 〈◊〉 signe that Plethora or fulnes is also annoxâ—d to such feuers Fourthly in bleeding we are not onely to consider the disease it self which wee determine to remedie but also oft times the cause therof so that whatsoeuer the sicknes be if Phlebotomy may remoue the cause then also it taketh away the griefe it selfe in the ende HereupoÌ„ somtime albeit the disease be cold yet when the cause moueth vs to open a vein we may safely bleede without hurt Hippo. saith Galen sheweth a cure of his done on a woman by letting her bloud in the Ankle This woman after child-birth was not freed ofher seconds then a shaking came vpoÌ„ her This woman I cured saith Hippo. by letting her bloud in the Ankle for all her shaking Shaking is a cold affect bloud is hote and they that must be heated must not haue bloud taken from them He for al that boldly did it he sheweth the reason I considered said he the cause the occasion of the cause He knew the cause of shaking was abundance of bloud kept backe which was a burthen to nature The occasion of the cause was the griefe of the matrix This abundaÌ„ce requiring euacuatioÌ„ the affected part shewing the place most fit for euâ—cuation considering both these things together he let her bloud in the ankle because the wombe or matrix was affected In griefes of the womb or bellie we take the vaine of the ankle knowing by the Anotomie the communion betweene the veines for some veines communicate to some part of the body others to other partes And euacuation is to be made from such veines as haue fellowship with the member affected For as yee heard in the Chapter of Revulsion if we take that veine which communicateth not with the part affected wee hurt the whole bodye do the griefe no easement The profitable vse of this fellowship of veines apeareth especially in revulsion or pulling backe of humors which is both wel speedily done when this coÌ„munitie of veins is obserued as was there declared But let vs return to our former purpose Fiftly by opening of a veine is cured the feuer called Synochus both that which coÌ„meth of ebullition of blod without putrifaction that which is caused with putrifaction of the bloud So are also hereby cured continuing feuers coming of putrifaction in the greater veines And to these diseases reckoned vp of Galen Fig. 2. we may adde these that follow Frensies Opthalmia parotis i. an apostumatioÌ„ about or behind the eares diseases of the Liuer splene Nephritis i. paines of the raines and backe inflammations of the wombe or matrix of the priuie partes arme-holes armes thighes ioynts Finally all inflammatioÌ„s inward or outward which the Greeks call Phlegmonae These inflamations are caused by flowing of bloud to a member when a veine is open broken which bloud there abundantly heaped togither bringeth forth a tumor or swelling To these also are to be added a consumption in the beginning vomiting of bloud bleedings at the nose bely or hemorroids at the beginning of which diseases the opening of a veine greatly profiteth staying the force of the fluxe by revulsion if the veine be opened at the contrary part calling back much of the matter froÌ„ the member affected so that bleeding is a present helpe for those diseases whatsoeuer which take the beginning from too much abundance of good bloud Those sicknesses which come of an vnpure mixt plenitude because they are somewhat neere linked vnto these they may also be cured by bleeding And although the matter of these diseases be vnpure yet either it lyeth in the veines or procedeth from the veines A gaine by bleeding are cured Carbuncles felons moyst scabs outward rednes in the skinne such like all these are cured by this practise Thus also is cured the burning ague called Causus all continuall feuers whose putrifaction is conteined in the greater venies Yet sometime a continuall feuer commeth of an humor heaped togither inflamed about the stomack chiefely about the mouth of the stomack the flat parts of the Liuer which feuer cannot be takeÌ„ away by bleeding Neither can the cause therof by this practise be remoued Pure intermittant feuers whether they be Tertians Quartans or Quotidians because the next matter proper cause of them is not in rhe greater vessels neither floweth from the veines are not conâ—eniently cured hereby And yet sometime in these also we bleede either when the veines swell with immoderat fulnes so that therby some danger at hand may be feared or when any accident of hote inflamed boyling bloud perswadeth vs therto as are namely beating paines of the head tossings mouing of the body this way that way excessiue heat almost stragnling the pacient Howbeit these many times come also of boyling choler about the inward partes called praecordia in the which cases bleeding remoueth neither the feuer nor the cause therof but onely asswageth the vehemencie of those accidents which are present or shortly like to ensue Further concerning perticuler affects cured hereby we may adioyne beating paines of the head Letargus spoken of before fig. 3 and trembling of the heart These with the foresaid are not onely cured hereby when they presently affect and afflict the patient but happening yerely vnto vs so that it is verie likely we shalbe grieued with them in time to come VVe may verie well preuent them by bleeding wheÌ„ we haue once espied plenitude to haue beene in vs the causes of these infirmities For there is one the self-same way of healing common
both to maladies present and future And those thinges which are to be done when diseases are present may likewise be attempted when the same are but a beginning or nigh at hand And here is to be repeated that which hath bin alreadie said cannot be too often spoken that some time we open a veine not only without fulnesse but euen in emptinesse namely when some euident cause as a bruze ache or heat causeth flux ofhumors bringeth inflammation to the members and this is done not for any greatnes or feare of any present griefe but for some doubt of that which is a beginning as it were at hand Here ariseth a doubt whether it be more vsuall to open a veine the disease being now present or future nie at hand The answere is that when the fulnes is very great dangerous though the disease be not yet caused notwithstanding without hurt the pacient may bleed plentifullie because the bloud offendeth nature in the aboundance thereof And hereby the Pacient is oft made safe and escapeth the daunger of sicknesses approching But when a disease is bred and the forces of nature impaired or lessened either by the presence or long continuance thereof iust euacuation of bloud without hurt can by no possible meanes be made Whereupon Hippo councelleth to preuent by bleeding accustomable impediments rather then to stay their approch and comming Hereuppon also in that kind of feuer called Ephemera which dureth commonly but one day is caused of obstruction In the feuer called Synocris simplex bloud is aboundantly withdrawen before the matter do putrifie Therfore this is the cōclusion of this matter that bloud is let more safely before the sicknes be present already come thē when in truth it is presēt with greater profit are we to see his comming a far off and so beware of him thē to stay til he come thē labour to repel him wherin we are to remember a prety and common verse seruing fitly to this purpose Aegrius eiicitur quam non admttitur hospes If once a guest be enterteind with greater shame we him repell Then if at all we had not him receiued with vs in house to dwell And also this verse of Ouid. Principiis obsta sero medicina paratur Dum mala per long as conualaere moras i. Beginnings stop too late comes cure When once the mischiefs grow in vre Reason imputeth thus much that when sicknes presently possesseth any pacient the same requireth a speedie remedie with a greater necessitie than when as it hath not yet inuaded Wherupon this also followeth that opening of a veine is more necessarie when a griefe is present then when the sam e is but onely approching The crueltie of a present aduersarie vrgeth vs with a greater necessitie than the daunger of an enimie that may come but is not yet present And so I conclude that in a present disease there is a necessitie In a disease onely imminent there is but onely in a manner a securitie For a further instruction to know what diseases in particular are cured by this practise I referre thee to a Chapter hereafter following which declareth in particular what veine is to be opened in ech particular disease What voluntary eruption of bloud profiteth 〈◊〉 sicknes Chap. 12. BLoud voluntarily and of it selfe issueth foorth from the nose the veines called Haemorroidae and the belly and sometime also out of the mouth by coughing and vomitting From other partes of the bodie it commeth not except very seldome and that against nature But from what part soeuer it come if it bleede slowly and sparingly and albeit the same bee according to nature yet we are to account it vnprofitable for it nether remoueth the disease neitheir disswadeth vs from that conuenient euacuation by art which the vehemencie of the disease requireth That voluntarie flux of bloud which is aboundant either in plenitude oppressing natnre or in that feuer called Sinocha is profitale and oft cureth the same in the iudgement day called dies Criticus For in asmuch as then a generall euill equally as it were occupyeth all the veines from whence soeuer abatement of bloud happen it ceaceth these accidents of heuines fulnes But in the feuer Causon and in all other cōtinual feuers in the which other humors putrifie in the greater veines bloud issuing forth neuer so plentifully bringeth not such profit and bleeding at the nose though it watchinges rauinges headach and other such like accidents yet very hardly it remoueth the proper cause and roote as it were of the disease except there fall out some immoderat bleeding euen as it were to the dissolution of the natural forces which in very deed is neuer to be wished or desired For corrupt bloud last of all floweth out of the nose yea and not before there hath passed great store of the good profitable bloud And therefore in these feuers albeit the pacient bleed much oftentimes yet a veine in the arm must be opened Experiēce I say proueth that oft out of the nose commeth good bloud both in colour and substance when vnpure and filthy bloud is drawen out of the arme A boundant flux of bloud in these diseases out of the Hemorroidae veines are out of the belly because it floweth next of all from the holow veine of the loines the same is to be accounted much more profitable thā the abouesaid Yet neither doth this many times take away the verie root of the feuer which lieth lurking in the veines next the hart Wherupon it cōmeth to passe that oftētimes we let bloud in the arme notwithstanding yet but sparingly in flux of termes in womē brought a bed freed of their seconds lest we inflame kindle in them the heat of an ague A like reason and more apparant there is also sometime to let bloud in the arme when the hemeroids flow For inflammation and other diseases of those partes which are aboue the liuer and midriffe are litle or nothing at all eased by fluxe of bloud from the hemoroids or belly Neither those that occupy the lower partes by flux of bloud from the nose Also flux of bloud out of the right nosthril helpeth not affectes on the left side nor contrary And therefore voluntary eruptiō of bloud without reason forbiddeth not that bleeding which is to bee done according to art reason and experience Againe Phlebotomy helpeth diseases either of it self or accidentally Of it selfe it euacuateth or pulleth backe Accidentally sometime it cooleth drawing forth the hotter bloud sometime it openeth obstructions yet only those which proceede of fulnes and it is alwaies to bee vsed in those affectes which it helpeth of it selfe but not alwaies in those which it cureth by accident To helpe hot distemperature of the Liuer by bleeding when there is in the Pacient little bloud is not the best way but rather vse for that purpose such things as are of their owne nature cooling and take proper
thorow fault of the lunges and brest as sometime it doth in whom notwithstanding the vitall force may be sufficiently strong The contraries to these declare firme strength of the vitall vertue These thinges declare the animall po wers to be enfebled tumblings and tossings of the bodie the senses offended watchinges rauings and other principal actions hindered The contraries hereunto shew the contrarie that is firmnes strength of the animal vertue By these functions then you see how it may be coniectured what power in nature is hurt or offended Againe these powers are offended or seem enfebled two waies either because they are outwardly oppressed or because they languish inwardly of themselues in the euacuation it helpeth greatly to know the one from the other for the forces oppressed require large euacuatioÌ„ the other none at al. And the distinction of these is to bee sought out of their euident causes If causes haue gone before which haue already altered or wasted the substance of the forces naturall then wee may iudge them that they are faint and languished If these causes haue not been precedent but that the Patient is only troubled with an vnaccustomed ponderosity then these are but wronged and oppressed The euident and outwarde causes which alter the temperament of the setled vertues are burning Agues which melt the bodily moystures or whatsoeuer els that excessiuely heateth cooleth moysteneth or dryeth the sounde massiue strong and solide parts of the bodie The substance of these parts is wasted by very long sicknes which bringeth the Patient into an Atrophia that is a kind of consumption wherein the body consumeth away with leannesse and is not nourished albeit the sicke continually eate his meate Or into Tabes which is an other kinde of consumption wasting the body by long sickenes and lacke of nourishment consuming and putrifieng the Lites drying away the Patient for want of naturall moysture hauing matter and bloud mixt together The threefold spirit of the flowing humor is altered ether through some distemperature or some poisoned qualitie of the aire which compasseth vs about or through the il quallity of other thinges which violently breake in vppon vs or through some wâ—cked disposition of the bowels or other humours The heate of the aire not onely of that which outwardly compasseth vs about but also that which wee draw into our bodies by breathing inflameth first the lunges then the hart all the spirits so far till often times a feuer is kindled and caused thorow the same Thorow which distemperature of the spirits needs must the strength of the body languish becom enfeebled yea by this excessiue heat of the air the spirits are not only subiect to alteration of temperament but besides they are also thereby greatly wasted diminished Euen so in like maner immoderat cold outwardly the same receiued inwardly into the body by breathing weakneth the spirits inward heat yea soÌ„time altogether put out and extinguish the saá¹e The aire venemous pestilent drawen into the bodie with an infection quite ouerturneth the spirits of life and ofnature wherof â—nsuâ—th grieuous sicknesses to the body no litle decay of bodily strength yea life it selfe is taken away by the so daine disease commonly called the plague Now much more apparantly are the spirites infected with biâ—ings of Scorpions mad dogs and venemous beasts than by the contagion of the Aire Moreouer they are inwarde and hidden causes which doo greatly alter the spirits and whensoeuer any principall part of the bodie is troubled with any distemperature vpon any occasion If the same proceed far it must of necessity goe to the spirites there bred and ingendred And so by offending of them will lessen the strength and vertue of nature Also if any corruption of humor rule in the body the spirits are disperced and offended by the corruption or distemperature of the same humors Therefore when abundance of rawe humors passeth either the whole body or the stomacke and chiefly the mouth of the stomacke the substance both of inward heate and of the spirits waxe cold the Patient languisheth yea sometime hee giueth ouer the Ghost and soundeth Herevppon also when hot choler burneth as it were the inwarde spirits with immoderate heate or nippeth and pricketh the mouth of the stomacke it is the cause of no small euils in the body of man Sometime also it falleth out that some one or other humor in the body is mixed besprinckled or bedewed as it were with some kinde of venemous filth as when the seedy moysture is kept in and putrifieth Or menstruall termes in weomen longer retained than is their due course or when any clodded bloud remaineth behind and is not expelled the vapour of these and such like infecting and decaying the spirits bringeth sometime Sincope sometime suffocation of the wombe sometime the falling sickenes and such other mischiefes which greatly annoy the forces of nature And thus diuersly are the spiriets offended through distemperature Againe the substance of the spirits and naturall forces is diminished sometime euen of it self and as a man may speak voluntarily of his owne accord for the substance being of it selfe thin and wastable and included in an hot thin and open body Therefore of it selfe it dissolueth vaniâ—heth away Sometime the same is decayed by occasion of outwarde and euident causes as are namely these The aire which compasseth vs round hot and dry immoderate euacuations vehement motion affects of the minde paines watchinges great emptines and all vnprofitable excrements which cannot but carry with them from the body as they passe a great quantity or portion of the vitall spirits seeing their substance is spread ouer the whole body and also flowing with other humidities whereby it commeth to passe that whether the belly be very laxitiue by nature or by medecin or that the vrine bee made immoderately as in the infirmity called Diabete or that matter or water go plentifully forth of the brest stomack belâ—y or any great apostumation thereby of necessity the forces of nature must be mightely decayed Much more manifestly must it so fall out when there is any great euacuation of bloud or good humors whether the same pas forth of a wound the nose hemorroids Piles belly or other place In like maner abstinence which taketh away from the body needefull nourishment enfeebleth nature Labor likewise and heat disperseth the substance of the spirits by vapors sweat And therfore they which liue continually in labor about furnaces hot baths because daily some of their substance decayeth doo not commonly so abound with excrements as those that leade a slouthfull delicate and idle life Moreouer they that liue very incontinently haue also for the most part very enfeebled bodies able almost to abideno Phisick by a continuall decay of seedy moystures they haue their spirits mightely consumed wherof look before in the 8. cap. Fig. 17. Great ach paine worketh the same effect more than
was otherwise but weake let vs so esteeme of euacuation But as in dyet so in euacuation we must beware lest the vertues of nature extremely enfeebled do quite giue ouer and be altogether extinguished in regard whereof we are circumspectly to foresee how farre the patient can or may endure the same For in truth a iust quantitie withdrawen without any great hurt taketh away and cureth the disease And this point of the iust quantitie is knowen by a comparison of the disease and of the strength of nature for persons firme and strong may bleed as much as the sicknes requireth They that are not so strong may bleede lesse they that are quite cast downe are not to bleede at all And here a profitable question may be moued whether naturall strength may so greatly be enfeebled that it cannot or may not away with any euacuation be it neuer so little VVee see many times that in great of decayd strength there fall out voluntarie euacuations which do much good and procure health And againe it seemeth that to ech diminution of strength be the same great or smal the quantitie of the euacuation may be proportionated accordingly Neither is it credible that an vnce or half an vnce â—â—blod taken can doe no great hurt to the naturall vertues albeit they bee alreadie much decayed These matters seeme somewhat obscure but that the question may be explaned and all ambiguities of auncient writers taken out of the way we answere by distinction affirming that there are three degrees of quantitie in euacuation The first degree is when the same euacuation is thorow perfect and absolute taking away either all or the greatest part of the matter that causeth or continueth the disease The second degree is a profitable euacuation but not so perfect and absolute as the other which taketh away onely some part of the sicknes making that which remaineth more easie and tollerable than it was before The third step is so small little an euacuation that the pacient therby is not one whit eased or relieued Now to come to aunswere the former question the naturall strength is seldome so greatly deiected except the same be altogether ouercom past all hope of recouerie but that it may abyde some little euacuation But hereof the auncient writers haue made no mention at all being as it were a matter altogether vnprofitable seeing it is so little not procuring reilefe to the â—â—cke patient but rather bringing more daunger to tâ—â— naturall forces aire die decayed And in fiâ—e they haue decreede and set downe that in this case no euacuation should be vsed Therefore the naturall powers being firme and strong require an absolute and perfect euacuation The same but meane and somewhat enfeebled an euacuation more vnperfect and yet profitable altogether decayed they require none at all If the disease be verievehement so that it cannot either at all or well be cured without bleeding it requireth necessarily abundant euacuation The same but meane and not sowehement it requireth a more moderate bleeding but yet the same greatly profitable because the cure may afterwardes be accomplished with the more celeritie and safetie If the disease be small it requireth small euacuation or none at all Now let vs make comparison of the greatnes of the disease and firmenesse of the strength together VVhen the strength is verie firme and the disease meane and not verie vehement bleeding is not altogether necessarie but onely profitable in which case bloud may be safely taken and as much as the disease needeth There is no feare to diminish a little the bodily forces so as the roote of the disease may be pulled vp For they are againe verie speedily and redily recouered VVhen the strength is firme and the disease daungerous replenishing the veines with an immoderate fuldesse as it falleth out in the bodily constitution of wrestlers and in feuers called Synochi a plentifull euacuation is to be appointed answerable to the greatnes of the disease Yea it profiteth sayeth Hippo to bleede euen vnto Syncope If the patient maye abide it in which place Hippocrates meaneth not that sowning which commeth of feare or of cowardlinesse or of sharpnesse of humors pricking and prouoking the mouth of the stomacke but onely that which commeth of abundant euacuation For so in an extreame disease Hippo. appointed as a rule and iust order of euacuation And this defect of minde and strength is called Lipothymiae or Liposychia in which the partie speaketh heareth seeth and knoweth them that are present Nowe Syncope is as it were a suddeine decay of all naturall strength as in the falling sicknes in the which the patient neither seeeth heareth or doth any outwarde action Lipothymia is more easie than Syncope and accustomably goeth before the same In the foresaide affectes therefore wee let bloud euen vntil Lipothymia come vpon vs and yet rashly or without iudgement Now when the powers of nature begin to quaile and giue ouer through euacuation we must stay the bloud Neither are wee to proceede so farre as vnto Sincope for then the partie escapeth but daungerously albeit the strength of the body be reasonably firme In consideration whereof wee are to withdrawe the abounding humor as the bodily forces will permit And whensoeuer they are wasted albeit some of the offending humor remaine still behinde yet wee are presently to desist and this shalt thou most certainly vnderstand if thou diligently marke and obserue the Pulsies how they alter from great to little from equall to vnequall from strong to weake from apparant to obscure and by marking how the force of the fluxe of bloud beginneth to relent and the patient to waxe weake That practisioner which setteth by his credite and will auoide ill speaches must neuer through bleeding bring his Patient to Syncope because the same being as it were an image of death terrifieth the standers by and putteth the Patient in a great hazarde of his lyfe Yea and it is better to let the patient still remaine in griefe than to take away with the disease life it selfe And hetherto we haue shewed what is to bee done touching the quantitie that must be withdrawen when the powers of nature are firme and constant If the disease be but meane and the bodily powers but indifferent the euacuation must be moderated which may remoue the whole cause of the sicknesse with little or small hurt to the strength of nature VVhich albeit it be but a small and moderate bleeding yet the same is verie profitable as ye haue heard before If a great sicknesse concurre with strength alreadie decayed and that the same also require some large euacuation yet because the powers of nature cannot tollerate it the same must not be done wholy at one time but by iteration as yee haue beene tolde lest wee take away both the disease and the partie diseased Natures forces being quite ouerthrowen albeit the disease so require yet the bodie can permit little or no euacuation for it
is vnprofitable and superfluous not bringing any commodity but discommoditie and perturbation to the sicke Therfore in this case this must be the practise moderately and often to giue the patient meates of good iuice and nourishment to confirm strengthen and recouer nature and such as haue some vertue in them a proprietate against the present infirmitie may redresse the inward corruption of humors And wheÌ„ thus the naturall forces shall be recouered Phlebotomy may succeed And this practise is much vsed in continual and long sicknesses in sharp diseases called morbi acuti this long stay were doubtfull and dangerous An obseruation of things present past and also a foresight of things future needful necessarie to the further knowledge of the quaÌ„titie of bloud that must be taken Chap. 15. OBseruations of euident causes touching the greatnes of the disease constancy of naturall forces doth greatly further our knowledge in this behalfe Of which euident causes three of them are in ward and bred in our selues as namely the temperament the complexion the age three of them are outward and accidentall namely the coÌ„stitution of the aire according to the seueral seasons of the year the situation of the countrie state of the heaueÌ„s All which are included in one cause as grouÌ„ded al vpon one reason secoÌ„dly former euacuatioÌ„s ether slaid or immoderatly flowing thirdly custome order in diet life or kind of euacuations proceding By knowledge of these forepassed causes we may atteine to the vnderstanding of the strength both of nature of the disease so consequently of the quantity that wee must bleed albeit that the causes present future haue not yet altered either the disease or streÌ„gth of nature yet for asmuch as they begin to dissolue some humours froÌ„ the body to wast the strength of nature they haue some moment in this practise For what these causes present or past can doo ye haue heard in the 8. 14. chap. to the which I refer you coÌ„cerning the perticulars here onely being contented to rekon theÌ„ vp by name 〈◊〉 the teÌ„perameÌ„t the state of the body the age the countrietthe time of the year the disposition of the aire sky voluntary euacuatioÌ„s custom the rest as appeareth ca. 8 It is the part property of a wife skilful phisition to consider not only the state present of the natural vertues but also to foresee what will be their state in time to come after bleeding The natural powers after euacuation are so to be conserued as that the same may be able afterwardes to take other helps continue out the prolixity of a coÌ„tinuing diâ—eâ—s Yea we must reteine alwaies some bloud for future fits and courses of the disease which are yet to come Lest afterwards vrged thervnto wee begin vnfitly and out of due time againe to nourish the same And this chiefly is to be done in bleeding for corrupted and putrifying feuers whose putrifaction obstruction is not taken away by bleeding but the putrifaction is afterwardes the better ouercome by the strong force of nature when by opening of a veine shee is somewhat relieued Therefore to this purpose alwaies some bloud must be left for natures preseruation as Galen councelleth lib 11. method cap. 14. We may coniecture the future strength of the patieÌ„t partly by the preseÌ„t causes which are also afterwards like to continue partly by accidents which may happen contrary to our opinioÌ„ Among present causes these are the chiefe the state of the heauens the order of mans life If the constitution of the aire hath bene hot dry is like so to coÌ„tinue the bleeding must be lesse than if wee suppose a cold aire to ensue Again if we perceaue that the patient will liue sparingly â—eÌ„peratly either for want of appetite or because the disease will not suffer him to feed as in Augina the Quincie which shutteth vp the Iawes we are to take lesse bloud than wheÌ„ we see he wil liue more frankly and liberallie In these cases we must still reserue some bloud as natures treasure to helpe at a pinch in time of neede Suddaine accidentes and vnlooked for which greatly enfeeble natural strength are these great paine and ach watchinge voluntarie euacuations and chiefly Sincâ—pe into the which many do fall beeing not accustomed to bleede at the first opening of a veine either because they are weâ—ke of nature or strucken with some great feare or because the mouth of the stomake fiâ—â—ed with bitter choler is becom very vnsensible and weake When we suppose that some of these matters wil fall out albeit the strength be firme yet no blood at all or very litle is to be withdrawen except by art wee naue preuented the former accidents It is I say great wisedome to foresee a farre off 〈◊〉 beware of such suddaine and vnlooked for accidents This we will manifest by an example Let the pacient be of a sanguine complexion of body thicke and well set of a florishing age that hath long time led a leacherous life feeding plentifully of good meats and that hath omitted his accustomed exercises and liued at home idely in whom also accustomed eruptions of bloud out of the nose belly or Hemoâ—roids are staâ—ed so that by concourse of these causes the body hath greatly encreased or waxed that the large veines through repletion are greatly filled WheÌ„ soeuer a strong ague or great inflammation shall possesse such a patient presently he must be let bloud and that plétifully Both the greatnes of the disease and of the cause requiring the same Moreouer this is confirmed by obseruation of thinges past if present causes agree to these namely that there bee a sit temperature of aire by occasion of the countrie season of the yeare and the present state of the weather moderatly cold and moist and that the patient bee apt to euacuation also that the sicknesse bee not like to continue long after neither apparant signification of an excessiuely hot temperature of aire to come no thveatning of future paine or of abstinence watchinges voluntarie euacuations If all these thus agree together who may doubt but that a large euacuation may in this case bee made And none at all when the conâ—raryes doo appeare Sometime these obseruations are mingled among themselues and contrary to themselues In which confusion a wise iudgement is needfull by comparison of them to prescribe the iust quantitie of euacuation The consideration of passed matters many times perswade a plentifull bleeding which the obseruation of things present by and by taketh away As for example if the Patient laying aside his accustomed exercise giue himselfe to pleasure and idlenes stuffing himselfe withmeats and hauing some notable euacuation staied in him but his body is waxed fat white of colour loose open soft full of thiniuce and that it be Summer a hot dry country a hot dry constitution of weather without stormes In
this case let not bloud at all for sufficient is already euacuated from such a body of it selfe and that not obscurely but apparantly In this foresaid constitution thou maist detract a little bloud if it bee winter in a cold country and the wind standing at North and in this mixture of things thou must marke not onely the multitude of the obseruations but the force of them Because one many times exceedeth all the rest in power and sway and he that can neither by art experience nor sound iudgement define the quantity of euacuation according to the aduise of Hyppocrates let him rather euacuate lesse than more than needeth In this place albeit somewhat hath beene spoken before to the same purpose cap. 9. Fig. 7. It may be profitably demaunded whether being with child be to be accounted among these obseruations heere handled shewe of truth and some probability may be alleaged that when women with childe are grieuously sicke we are not to let them bloud because of the young that is in the wombe This is also defended by Hyppocrates saying Mulier in vtero gestans abortit incisa vena idque magis si faetus auctior fuerit that is A woman with child is deliuered before her time if shee bee let bloud specially if the young be much increased and growen in the wombe But this of Hyppocrates is not alwaies true as neither that which hee setteth downe a little before Mulierem in vtero gerentem acuto morbo corripi Lethale est That is it is deadly for a woman with child to be taken with a sharpe disease For seeing a purgation made of wicked and venemous simples standeth with greater danger of the childe than opening of a veyne and that Hyppocrates graunteth that women with child wexed with a disease caused of corruption of ill humors may bee purged in the moneths betweene the third and the eighth moneth truely with much more safety may we let those bloud being grieued with any sicknes caused of Repletion And if in the middle time of the going with childe the same may bee done Much rather in the beginning when the bloud more aboundeth and the yong needeth lesse nourishment Againe if women being with child nature of her selfe oftentimes attempteth euacuation of that which is supersluous with great profit out of the nose by the hemorroids belly and that sometime the Termes flowe healthfully at times appointed why vpon great necessity may we not imitate nature in our Art Yea many women bring vntimely fruit except about the fourth moneth a veyne be opened the young fruit beeing ouercome with plenitude of the Patient neither onely in fulnes but without the same a veyn is opened in the arme of a woman with child when need constraineth as in a Pluresie or other vehement inflammation It is dangerous in deede to open any of the lower veynes in women with child because the fluxe turned downewarde the termes would flowe and so the fruit in the wombe bee deiected and cast downe A veyne is opened very seldome in the eighth or nine moneth without causing of vntimely birth forasmuch as then a woman of euery light cause receiueth hurt and is deliuered before her time through the weakenes and slipperines of the wombe In this case Cornelius Celsuâ— only considered the greatnes of the disease and ablenes of the strength Olde Phisitions saith hee were of opinion that the first and latter age could not brooke bleeding and that a woman with child cured by Phlebotomy should bring foorth vntimely fruit yet experience prooued afterward that none of these were perpetuall but that better obseruations wer to be considered which the Phisition is to remember For the matter is not great what the age bee or what a woman beareth in hir wombe but what her strength is a fierce childe a strong olde man a lusty sanguine woman with child may safely bleede And thus you see howe a great belly in a woman may be an obseruation concerning the quantity of bloud that must bee withdrawen Another obseruation to finde out the iust quantite is to marke the alteration of colour in the bloud So iudged Hyppocrates in Pleuritide secundo de ratione virtus in acutis Commen 10. where hee counselleth to let bloud if the paine in a Pluresie ascend to the arme or the Paps so long till the bloud came forth in colour more red or more yeallow or for pure and red bloud blacke and blewe which both doo happen For bloud in an inflammation differeth in colour from the naturall bloud as more heated and inflamed If the naturall bloud before in the body were crude and vndigested bloud that which is in the inflamed place is a great deale redder and yeallower if it were before redde through adustion it becommeth now more swart and blacke But if the Patient fâ—iâ—t or faile before the bloud alter in colour stay not then for the muâ—ation or change thereof Finally the plenitude in the body admonisheth vs of the quantity more or lesse and thus we conclude touching the knowledge of the quantity how muoh must 〈◊〉 taken Of the time and seasons of the sickenesse of this yeaâ—e of the daie and houre of the daie when a man is to bleede or not to bleede Chap. 16. ALthough it hath beene declared that we are not to let bloud in a season of the yeare too hot or too colde Yet in this Chapter wee purpose more exactly to discusse what time of the sickenesse and what day the same is to bee done Auicen in quartiâ— primi cap. 20. saith that for preseruation a veyne is most safely opened when the disease is not come or yet present disallowing altogether of this practise in the beginning of sickenesse and his reasons to prooue it are these In the beginning of a sickenesse saith he it attenuateth the humors and causeth them to slow throughout all the bodie mingling the bad Humors with the good bloud These wordes of Auicen are neither true nor agreeable to Hyppocrates Galen Hyppoc 2. Aphoris Aphoris 29. writeth that at the beginning of sickenes If any matter be to be remoued the same ought then to be done accordingly and when the euils are in their state then to giue them rest Galen in the Commen saith that bleeding and purging may be vâ—ed at the beginning but neither of them Morbâ— Consistenti that is in the state of tâ—â— disease whereofin the Aphoris following â—yppocrates rendreth a reason at the first and lasâ— â—aith he tâ—ings are more weake than in the middle estate for then all things are most firme and strong Againe why he should stay for concoction in bleeding I see no reason for as much as bloud of his owne nature is alwaies concocted and a veyne beeing opened it floweth out easily of his owne accorde Againe where Auicen in his reasons saith that by bleeding in the beginning that corrupted bloud is not euacuated that should be which afterward puts still the Patient to more pain so
that wee are forced oftentimes after wee haue let bloud in the beginning of a sicknes to take medicines purposely to asswage dolors and paine I perceiue not how bleeding can take the good and leaue the bad seeing nature alwaies reserueth to it selfe as a friend good humors good bloud reiecting those that are naught and vnprofitable Also when he saith it attenuateth the humors hee is contrary to himselfe for in quarta primi cap. 4. he iudgeth rather bleeding to make humors thicke than thin The bloud and spirits themselues which attenuate the humors by bleeding being withdrawen Againe this is wonderfull that when the state of the disease is past and the Patient past danger that he would haue then the miserable Patient with a new wound and cutting of a veyne againe tormented If any thinke Auicen to be blameles as being of this iudgement that a veyne is to be opened when nature hath attempted Crisin that is the iudgement of the disease which fallâ—th out to bee vnperfect and litle not able to doo the feat and accomplish the whole force neither doth this defende him For by what reason would yee haue bleeding to euacuate the matter left behind of an vnperfect Crisis The naturall vertue being made so weake by that time with continuall contending and striuing with the disease that it can doo no good or very little in the cure and especially when the rest of that matter is daily vsed to be easily euacuated by purgations In sharp dangerous sicknesses therfore euery one seeth here Auicens error for in these sharp vehement continuall diseases we must bleede or be purged the first day yeâ— stay in these is very dangerous as Hyppo saith 4. Aphoris Aphoris 10. If Auicen meant it of Morbi salubres i. recouerable diseases in these truely neither first nor last nor at any time are we to bleed for then most vsually we let bloud when a disease is vehement and dangerous The opinion of other some in this place is to be â—aughed at who thinketh that Auicen admonisheth not to bleede at the beginning in sicknesses not dangerous as in a tertian because nature is terrefied by the newnes and sodainnes of the disease and these make or imagine nature to be a thing indued with knowledge or an vnderstanding and knowing faculty which is not so But if nature be made afraide in sickenesses not perillous how much more will she be afraide in daungerous diseases in which not withstanding wee hasten to let bloud euen at the very first These matters therefore are full of error Let this therefore bee the conclusion that wee must bleede in the beginning of sickenesses VVherevpon Galen counselleth the disease being come to open a veyne lib. de Curand ratio per sang missio cap. 9. cap. 12. If faith hee there bee repletion of hot boyling bloud whereby a strong ague is inflamed presently euacuat yea euen vnto sowning yet still regarding the strength of nature And this is his aduise prim Aphoris Aphoris 23. VVhat diseases so euer are caused of plenitude or other corruption of humors in the veynes they are at the beginning to bee cured by bleeding for by this meanes the disease likely to grow is kept backe and so much as is already bred nature will easily subdue Thus hot Agues before they are yet inflamed with heate of boyling bloud or by vehement putrifaction are may bee cured Also inward inflammations at the first as long as the flowing humor cleaueth not to the member but followeth the bloud may be cured The said humor issuing forth with the bloud when a veyne is once opened strength at the beginning is firme and constant in the Patient almost like vnto vs that are well in health If therefore at any time bleeding bee needefull the same may best be done at the beginning he that in fulnes of bloud or fluxe of matter will stay from bleeding and vse other helps in a peruerse order of healing he doubleth the griefe and troubleth the forces of nature more than is conuenient Yea let the veyne so timely bee opened as the stomacke and first veynes be not first stuffed with either corruption or cruditie of humors or meats vndigested Thus you haue heard the former words of Auicen to be erronious howsoeuer certain labor to salue them vp yea Auicen seemeth to vnderstand his owne saying not only of particuler diseases in the members but also of all other diseases For afterwards speaking of all Feuers and especially of Febris fanguinea Feuers caused of bloud hee counselleth in them not to let bloud abundantly except there haue gone before concoction and concerning this reason that humors are lessened by bleeding it cannot be so for yee haue already heard that both before bleeding and after there is retained in the body one and the selfe same proportion of humors If any difference or mutation happen seeing the thin humor issueth foorth with the greatest speed and the thick humor but slow it is more likely and probable that opening of a veyne should rather make the bloud and humors thicke than thin A gaine whereas he saith in his reason that the humors thereby are agitated moued and driuen through the whole body how should there bee this agitation of humors seeing rather this practise abateth the multitude of them which was before the cause of perturbation sickenes In reason all things now should become farre more quiet than before VVhereas he saith the ill bloud is mixt in the veynes with the good what inconuenience commeth thereof if a veyne bee opened then no doubt the bad must passe foorth with the good Put the case there bee a strong or vehement sickenes caused of abundance of bloud onely as are both the Synochi Feuers as is the putrified feuer caused through plenitude as are Angina Pleurisis Peripneumonia also inflammations of the Liuer and other partes In these if they bee great and dangerous through much abundance of bloud who will not presently open a veyne who will not while strength serueth take away that fulnes which bringeth a disease and danger of death Hereupon in Synoâ—ha presently at the first we hasten to let bloud euen till the Patient faint and before the matter putrifie But Auicen in a sanguine feuer at the first letteth bloud sparingly more plentifully afterwardes when signes of concoction appeare But what concoction doth hee looke for of good bloud and already well concocted and offending onely in quantity In these sanguine feuers therefore euen as in very sharpe sickenesses either to put off or to stay bleeding it is very ill as Hyppocrates saith if the disease be not so sharpe or vehement yet let bloud at the beginning according to the proportion of the fulnes If wee should in these stay with Auicen till concoction the beginning and state of the disease be past wee should suffer the disease to grow increase and cause for want of skill the Patient to bee cruelly hand'ed
throughly vehement passing not the fourth daye which is called of Phisitions Malus peracutus i. thoroughly sharp and of some perperacutus imitating barbarous authors in Phisick The other not exquisite or throughly sharpe vehemeÌ„t whose greatest force wilbe in the seuenth day These diseases being but short at their extreame fits in few daies without any truce presently at the beginning these are to be cured And because they proceed chiefly of hot humours namely of bloud and yellow choler therefore specially they require bleeding Whereupon Hippo. lib. 4. writeth De vict ratione in morbis acutis Aphoris 19. In acutis morbis sanguinem detrahes si vehemens morbus videatur florueritque aegrotanti aetâ—s viriuÌ„ affâ—er it robur In sharpe diseases withdraw bloud if the disease seeme vehement if the age of the patient be florishing and that the naturall forces be firme and strong Schola salerni hath these verses of this very matter Principio minnas in acutis perperacutis Aetatis mediae multum de sanguine tolle Sit puer at que senex tollet vterque parum Ver tollat duplum reliquum tempus tibi simplum In sicknes sharpe let blood with speed take much from men of middle age Not so when child or old men bleede the spring requires the aduantage As there is regard to bee had of generall times so there is also of perticular daies and times in the which diseases come speciallie in those diseases which haue by course an appointed and set time of intermission and remission For euacuation is not to be made when the disease is now fierce but when the same is asswaged Feuer sand especially those that are called intermittents discontinuing agues eueÌ„ naturally at the beginning and their first inuasion cause vomits and at the declining sweats At which times wee may by art prouoke these but in no case vse purging or bleeding In the time of the fit likewise wee must refraine from these as thinges which nature then can not brooke If such accidents of bleeding or of siege come they are but accidental and are caused only of the heat and force of the disease No euacuation can be done safely in such fits seeing they do too exceedingly hurt the powers of nature Also when the humours do so boile with heat that they are perturbed mingled together there can not be made by practise of art any iust diuision of the said humours And if it chaunce that the hurtful matter of the disease be inflamed without the greater veines that in a fit a veine be opened it is to be feared least preseÌ„tly the same corrupted matter passe into the empty veines so of an intermitting feuer wil come a continuall Wheras a veine opened in the most quiet time of a disease troubleth not nature but without any feare of an inflammation taketh the plenitude out of the greater veines The greatest time of quietnes is the time in the middle betweene the remission intermissioÌ„ of the disease If the time between the fits bee much it is an easy matter to perceiue the said middle time If the time bee but little then is it far more hard to discerne the same Because many times no leasure can bee graunted either before or after bleeding by reason of the swift courses of fits to nourish the party Thus you see Phlebotomy is not to be practised in the day of the fit of any sicknes which in Latine is called Crisis or dies Criticus in the which day neither bleeding nor any other euacuation is to be atteÌ„pted lest the matter should be drawen from that place wherevnto nature hath driuen it to be rid or dispatched thereof and therfore like wise neither in the fit it selfe ought the same to bee done Excellently therefore did Galen giue in charge Comment 29. lib. 2. Aphoris that in time of the fit neither bleeding nor purging ought to bee vsed because then the concoctioÌ„ of the disease is chiefly wrought Which is farre better accoÌ„plished in quietnes and rest then in motion or disturbance For what respect the state hath to the whole disease that comparison hath the â—itt to the daies of intermission As therefore in the state of a disease no euacuation is to bee vsed so neither in time of the fit Againe it may profitablie here bee admonished notwithstaÌ„ding the premisses that bleding is not presently to be vsed at the very beginning of a diseas wheÌ„ we iudge the Crisis or iudgement of the sicknes to bee yet far ofâ— For bloud beeing the foundation of inward heat wherwith the same is vpholden natural heat beeing ingendred of bloud as of a materiall cause If bloud should bee detracted at the beginning of a disease the natural heat would bee diminished which should concoct the materiall cause of the sicknes Whereby further it commeth to passe that the disease is longer time protracted and the forces of nature enfeebled through which two namely the continuance of the disease and imbecillitie of nature great feare of death commeth in the end and this is the case wherein Auicens former opinion may stand true There is therfore no prescribed day for certaine appointed to let bloud in Whereupon Galen tooke occasion to deride those lib. de curand ratio per sang missio cap. 12. which from the 2. houre of the day to the 5. or 6. houre onely did let bloud and at none other time And Galen witnesseth ofhimselfe that he did let bloud at all times without any daunger yea euen in the night And 9. method Cap. 5. hee affirmeth it best which hee also him selfe obscrued to mark not the number of the daies but onely the strength of the Patient because by experience wee haue prooued that not onely the sixt or seuenth daies but also in the daies following the sixt or seuenth a veine may bee opened But because as Galen witnesseth Libro de Curand ratio per sanguin missionem Capit. 20. in diuers diseases through continuance of time the strength of nature is greathe abated Therefore the occasion of letting of bloud is not omitted for the number of the daies but for that the naturall strength is wasted So that if the vertues of the bodie seem to be consumed the second day from the beginning of a disease euen then wee forbeare opening of a veine And he thertoo the wordes of Galen Now in diseases which are cured by bleeding when they are present or propelled being but future if they grant leisure so that a choice of an houre to bleede in May bee made in this case I say the fore noone houre is better then the after noone For from the rysing of the Sunne the bloud is quickened reuiued and beareth rule in the body yea in that time of the day it becommeth thin cleere apt to flow Let not the patient sleepe nor slumber in that houre wherin he is to bleed but at lest let him be awake a whole hour before see also that he haue
wel digested the meat he did eate the day before so that the excrements be descended that the body haue done his accustomed dutie both by siege by vrine And these must most principally be done when a great veine is to be opened And they are not so greatly to bee obserued when we withdraw bloud from the smâ—ller veines from whence the bloud floweth but slowly If the patient be in health let â—im do some work or goe first an houre about his businesse in his shop warehouse market sâ—hole or other place as his vocation is and then bleed choosing out for the purpose the 〈◊〉 houâ—e that may be vide Auicen 4. prinâ—â—cap 20. And thus much of the time of the sicknes and of the day Of the time of the yeare best to bleed in it is agreed generally the same to bee the beginâ—â—â—g of the spring which is a temperat time 〈…〉 too hot nor too cold Therefore Hippo. 〈◊〉 Aphoris 54. writeth Quibus a venis sanguiâ—â—â—â—ttere confert iis vere secare venaÌ„ oportet Those that must haue a veine opened must â—aue the same done in the spring And Galen lib. de Cura ratio persang missio saith that â—ee by letting bloud in the beginning of the spring cured many of the gout and other diseases There are 3. moneths belonging specially to the Mone as some say viz. May April Septeber in which there are also certaine daies which are not good to bleed in as some authors not contemptible in mine opinion do affirme namely the first of May and the thirtieth of the two other moneths This for all these sayinges of wise Clarkes is not alwaies so found for euen in these daies if other thinges agree a veyne may be opened which I my selfe haue done without hurt insuing In like case that is false which is set downe by some that the eating of Goose on any the foresaid e three daies is perillous which seemeth to bee taken from the custome and superstition of the Iews Men in their flourishing yeares of a sanguine complexion may bleede euery moneth of the yeare if necessity vrge by occasion of great dangerous sickenes and that bloud abound in the veynes For in these substance of humors is not easily wasted or dispersed abroad But for conseruation of health bleeding is best vsed in one of these three moneths Aprill May September And yetnot all alike for in Aprill and May the Lyuer veyne is to bee opened for abundance of bloud in the spring and in September the veyne of the Milt because in haruest Melancholly aboundeth more than any other humor and I would wish persons greatly subiect to diseases caused of fulnes of bloud and that are cured by bleeding to bleed these two times in the yeare that is to say from the Lyuer veyne on the right arme in the spring and from the veyne of the Milt on the left arme in September Those that thinke that if they bee let bloud one yeare they must be so euery yere Shall herafter in the twenty foure Chapter bee shewed to the contrary for as one swallowe makes not the spring So Phlebotomy practised once or twise doth not import an annuall bleeding and so we must iudge of boxing The verses of Schola Salerni concerning these matters insue Tres insunt istis Maius September Aprilis Et sunt Lunares sunt velut hydrae dies Prima dies primi postremaque posteriorum Neâ— sanguis minui nec carnibus anseris vti Sit senium aetque iuuent a licet si sanguis abundat Omni mense probe confert incisio venae Hi sunt tres menses Maius September Aprilis In quibus eminuas vt longo tempore viuas In May September and Aprill There be three daies are very ill The first in May of rest the last In which ne bleede nor of Goose tast Though old or young if bloud abound In each moneth bleede this rule is sound But three be best and farre excell September May and eke Aprill A Table of the things specified in this Chapter following An accideÌ„t apper taining to the consideration of bloudletting in generall is the time which is of the yeare whereof looke Cap. 8. Fig. 13. and in this present Chapter Of the day or houre for in Persons not sicke for the Preseruatiue intention the morning is best an houre or two after sleepe when the body is disburthened by siege by vrine Sicke and hauing their fit vpon them who are to bleede when the fit of the feuer is off or not hauing fits by intermission as in continuall feuers and inflammations who may bleede presently at any houre of the day or night if the disease be vehement and daungerous and the bodelie strength firme but if the disease vrge not choose as for persons not sick the morning houre Of Astrologicall obseruation in bleeding and of an other obseruation neerely aanexed vnto the same shewing what members and parts of the bodie are to bee opened according to the seuerall seasons of the years AStrologicall obseruation of the newe and full of the Moone and other considerations heere set downe as follow are to bee regarded in light and small sickenesses but not so if the same bee vehement and dangerous For the heauenly causes are very farre off neither did Hyppocrates make reckoning of them 4. Aphoris Aphoris 10. The first day wee must helpe saith he in sharpe diseases And Galen de Cura ratio per sanguin missio cap. 12. saith that those persons are presently to be euacuated in whom appeareth abundance of hot bloud before the same begot to some principall part as ye heard before so that these things are not to be obserued in a vehemeÌ„t pluresie In Angina the quincie Inimmoderat flux of bloud In great plenitude of the vessels neither in discoÌ„tinuing agues or feuers that come by fits In which the time of rest remission stay is farre better than the morning time In which wee let bloud at what houre so euer it be of the night or the day if the fit be off and other things answerable Therefore I say in these we are not strictly to obserue these rules Astrologicall obserue them as matters of some force in healthfull Patients which bleede onely for preseruation and in light and small infirmities if then it happen that thou do bleede To come to these Astrologicall obseruations we are not to let bloud in the new or full of the moone nor else except the moone bee in these signes ♈ ♋ and the first halfe of ♎ the last halfe of Scorpio or in â™ â™’ ♓ Also not in the day of the change the day next before or day next after Nor when the signe is in the place where the incision should be made Another obseruation is this to open a veyne in flegmaticke persons when the ☽ is in ♈ sauing in the heade In a melancholly man the moone beeing in the first halfe or first fifteene degrees of ♎ except in the hips or when the moone is in â™’
a pound If the humor gine downward expell it by siege Cassia is not strong enough to purge the humor from the stomack as not being sufficieÌ„t to expel by siege such clammie cleauing humors For Cassia hath but a meane vertue and that onely to asswage and mollifie Rubarb or Senna or some other gentle medicine according to the qualitie of the humor and not so vehement as to molest the state of the whole bodie And these we may vse not once or twise but oftener if neede require After all this preparation then we are to let bloud VVhen the corruption of humors is spread throughout all the bodie euery particular part so that the whole body is vnpure then we must obserue this order that is we must purge euerie part orderly as first the greater veines and this called Mesentericae venae which are branches of the great carrying veine called Porta by which both the guttes are nourished and the iuice of meat concocted is conueyed from the stomacke to the Liuer to be made bloud Yea these veines are the second time to be purged before wee euacuate the whole habite of the bodie and not contrarie that is from the first veines to the greater and from them to bring the humor into the state of the bodie which were not to purge the noysome humor but to infect and hurt the whole bodie therewith But this is the course to drawe the humor from the habite of the bodie into the greater veines from them into the first veins and then to bring it into the bely Yea this great corruption of humors not onely stayeth bleeding for a time but often times altogether And therefore wee let not bloud in the dropsie in Cacheria in hard apostumations of the Liuer and splene The third matter of the preparation before bleeding was aboue said to be either the sensibilitie or imbecillitie of the stomack For those persons haue notable quick feeling whose veins sent from the brain are soft tender open redie to occur and meete with any matter so that these persons without hurt cannot eate anye sharpe sower or salt things as vinegar pepper mustard Imbecilitie of the â—tomake proceedeth either of distemperature or of a verie thinne placing and standing of the small veines in the same place And this is knowen by losse ofappetite when meat cannot abide in the stomack but that there will be always paine of the stomack a promptnes still to vomit Those persons that are thus affected are troubled greatly euen with the hasard of life of euerie small occasion as fasting anger sorrow feare also by bleeding Phlebotomy in these I say wasteth greatly the vitall spirits greatly moueth the other humors of the bodie beside the bloud whereupon there befall to them when they haue bled conuulsions the falling euill sownings other feareful accidents which are caused hereby In such therfore we must haue a foresight corroborat the mouth of the stomacke with things repelling the sharpnes influence of humors as with iuice of a Pomegranate a Quince Malum medicum with iuice of Citrons Lymons iuice of Barbaries sower grages viniger or syrops made of these If there be doubt of a cold distemperature vse hote aromatike things chiefely syrop of Mynts Diacydonion sower or sharpe wine or ypocras Take a little of these wines or a morsel of good bread dipt in them and when the patient hath a little rested vpon it open a veine and this is the preparation if the disease permit it A vehement disease â—asteneth bleeding and cannot stay for this preparation as repletion in wrastlers in whom present suffocation or breaking of veines is to be feared as a great Plurisie a fernent agewe a great fall or bruse In the which wee are more to feare the present danger of the disease than the hurt by defect of the preparation If we thinke the humors in the bodie to be thicke and that they will not flow for which cause also we vse to walke before bleeding wee may enter into a bath to make the humors subtile not the same daye in which we bleede but a day or two before Not in the selfe same daye because it maketh the skin soft thinne and so in the stroke the skinne slippeth starteth from the Phlebotomer which is verie dangerous For this cause also wee giue a little syrupus acetosus certaine dayes before bleeding to subtiliate the matter And again that the humors may passe with the more facilitie become subtile to prepare theÌ„ to this purpose we vse frication of the meÌ„ber to rub the arme or other parts the members next vnto the place that is to receiue incision Also we giue before bleeding to such persons as haue weak sensible stomacks nipped with sharpnes of choler flowing to the mouth of the same some portion of meat yet not all meates with indifferencie but meates of good digestion as a morsell of bread dipt in Syrupus acetosus which comforteth the stomacke through the ponticitie to vse the old barbarous word the sharpnes or â—owernes thereof which also letteth the fluxe of humors keepeth them back from the stomack by reason of a certeine frigiditie For as soone as choler sloweth to the stomack so soone by the sharpnes hereof the same is repressed repelled What is to be done in the verie time of the incision Chap. 19. THe pacient is to bleede lying in the greatest quiet that he may both of body of mind especially if the strength of the bodie be infirme that there be doubt of Sincope let him sit vp in his bed lift vp his head aboue the pillowes for while we stand or sit that facultie which beareth vp the bodie is in a kinde of trauell and the entrailes bowels hanging of the precordiall partes do enforce the vitall natural powers By lying therfore specially some what vpright the bodily strength is preserued according to Galen prima particula prognosticorum And as dead bodies are layde forth vpon their backs so the lying of sicke and weake bodies must be vpon their broadest part which is the back Againe the back bone is the stronger part of the body being acording to Auicen the foundation of the bodie as the keele or bottome of a ship is the ground worke of all the shipwrights labor If the partie that is to bleede be fearfull turne his face away to the contrarie side let his minde be drawen by other talke of the standers by from the present practise of the Phlebotomer The member that is to be opened must hang downward that the course of the bloud may be direct and easie for that part which we desire most to euacuat Then that part of the member which we meane to take as of arme thigh hande or foote must bee rubbed to drawe the bloud vnto that part euen vntill it waxe hote Next wee take a strong bond binde it next aboue the place whose veine
must be taken that the bloud comming downe the veine may swell and appeare in sight It must be bounde harder in some than in others as namely in such persons that haue their veines couered as it were with much flesh or fatt By this hard binding the veine is stretched out or swelleth it standeth sure and flyeth not froÌ„ the stroke of the Phebotomer And thirdly the bloud commeth forth with the more force we vse also to binde beneath the place when the quiuering vnconstant veine slippeth aside out of his place from the hand of the Phisicion They that haue a full thick skin narrow veines and deepe in the flesh or great veines couered with fat must be bound both waies and haue the bond tyed faster than those of a contrarie constitution If the veines be verie small little that they do not fully sufficiently apeare by binding as it happeneth in the veines of the hands feet ankles VVe soke them in warme water or pour warme water vpon them that the skin flesh may waxe soft and the veines beseene then we binde them so they bleed the better If the veine yet appeare not wee search for it in the place where it should be with our singars vntil partly thereby partly by the fluxe of blod we wel perceiue the same VVe bind the necke but softly when wee take the veine of the forehead or the veines vnder the tonug Yea many times in these wee take a table napkin putting it about the necke cause the partie himselfe to hold both the endes as he may suffer or indure the same VVhen wee throughly and well perceiue the veine we strike the same softly with the instrument diligently taking heed that he wound not in steede thereof an arterie sinewe or some gâ—istly ende of a muskle called a Tendon lying vnder the veine or some other part neare vnto it For somtime when we bind hard with the bonde there appeareth a place puffed vp with wind there swelleth a thing like a veine that is no veine And sometime an arterie pressed downe doth not moue and so seemeth to be a veine and therefore to be more sure let him with the forefinger feele the place of the incision the veine vnderneath This done let the Phisition take his instrument at the verie fingers ends with a good eye and a good hande and let him not put foorth more of the point than is sufficient to pearce withall And that the veine escape not the instrument in one hand let him hold the launcet and with the thombe of the other hande applyed to the veine that is to be opened let him settle presse and keepe downe the same chat it start not aside and so softly without haste put in the instrument sufficiently and let the Phlebotomer haue good experience to open a veine with both hands for a veine of the right aá¹™me is best opened with the right hand a veine of the left with the left hand The veines in the ioynts in the bending of the arme in the hammes being cut in rectum that is right growe together but slowly because the ioynts with motion do open still the lippes of the wound Neither are we so to cut them except when wee neede to reiterate bleeding Veines without the ioynts as in the head in the hands in the feet opened in rectum are quickly couered with a skarre because the sides doe soone grow together againe There lyeth vnder the inner vaine called Basilica also an arterie and vnder the middle veine a sinewe and vnder both for the most part Tendons of the Muskles Cephalica veine albeit it be heard to take yet it is most safely taken of all the rest For in opening therof a maÌ„ cannot light vpâ—Ì„ any Tendon arterie or sinew VVhen a Tendon or sinew is prickt there followeth great paine astonishment resolution convulsion of the atme with a swelling VVheÌ„ an arterie is prickt the bloud is verie hardly stayed and consequently through effusion of much bloud the strength of nature is wasted Neither doth the arterie heale vp or growe againe togither but part of it is corrupted like Gangraena which is a putrifying or rotting of the flesh by mortifying the sensible parts therof if a sinewe or Tendon be prickt the same is perceiued by great paine convulsion swelling following If there be doubt that a sinewe is prickt let not the wound grow together till it be safe sroÌ„ inflamation that two or three dayes ar ouer passed it may be kept from growing together by bathing of it in warme oyle After three daies if the paine cease that there come no new accidents we may permit the vnion suffer it to grow togethers againe if not then we are to vse opening attracting things such as wil help the pricking of sinewes as namely turpentine putting therto somtime á litle Enforbium VVhen an arterie is wounded there coÌ„meth forth thin bloud red fine spinning out To help this case make a plaister of Aloes Mirrh Frankencense Bol-armoniak the white of an egge haires of an Hare lay ouer these a linnen cloth dipt in Rose-water fasten the plaister wel with a bond that it come not off in 3 dayes then this being gently remoued apply another like vnto it If the arterie will not grow togither with these cut the whole arteriâ— ouerthwart that when the extremities are pulled vp on both sides the place may growe and be couered with soft flesh Touching the maner of the incision quantitie of the wound if we iudge the bloud in the pacient to be thick clammie Melancoly that the constitution of the aire be colde the wound must be reasonaby large wide that the thick bloud grosse fumes may the better issue foorth for the wound in this case being little strait the most thinne bloud alone floweth out the grosse thick bloud remaining still behinde A large wound therefore is best in these three cases First when the bloud is grosse thick Melancoly that it may passe foorth with the more facilitie Secondly when there is great abundance of humors for they are better expelled with a large than a narrowe or small wound Thirdly when the countrey or season of the yere is extreme colde as in Winter in srost and snow for cold maketh the humors thick Contrariwise a narrow or little cut is best when the strength of the bodie is but weake lest the wound being too large the vitall spirites might immoderatly passe foorth with the bloud Also in a hote countrey or season or when euacuation of subtile and thinne bloud is requifite Schola Salerni sayeth Fac plagam largam mediocriter vt cito fumus exeat vberius liberiusque cruor The wound make meane for meanly done The fumes may passe bloud may â—unne Melancoly slegmatike complexions bleede often times guttatim i. drop by drop therefore a larger wound must be
made in theÌ„ than in others When the veine is opened we oft also loose the band from the vpper partes that the bloud may runne the better If the bloud run sufficiently let it alone if but slowly that through fault of the incisioÌ„ amend it If throgh grosnes of the bloud or of any other cause let the patient bend his fist hard together or turne the staffe about in his hand or by coughing or lowd speaking let him enforce the sinewes Muskles sydes And if need so require bath the wound with warme water If he be fearefull or faint harted when he seeth the bloud that it be stayed through feare leaue off a while til the strength be recouered by such meanes as we shal declare anon Yea albeit the bloud flow reasonably wel yet it is good in the midst of bleeding to stop it with the finger both to recreat the strength that it be not too much wasted also that the filthie corrupt bloud may with the more speede come from the inmost partes so be expelled The quantitie of bloud passed forth is to be considered as wee shewed before 14 15 Chapters that it may be stayed in due time in this behalfe therof two regards are to be had especially First the necessitie of the disease Secondly the constancie firmenes of natural strength wherof looke in the foresaid places more at large After good bloud apeares bleed no more for feare of the crampe convulsion palsie dropsie such like In a simple plenitude to auoid imminent dangers it shal be sufficient only to abate the abundance albeit a mediocritie stil remain But in an vniuersal disease as is a feuer a mediocritie will not serue but bloud is abated more then so And in inflamations we are not only to regard the quantity but in like maner the alteratioÌ„ of the colour substance of bloud and when great paine or inflamation is in places neere the incision stay not the bloud before the paine begin to asswage or the colour of the bloud to change For alteration of colour sheweth that the same bloud vnlike the other that good is proceeded from the inflamed part If the humor cleaue fast to the member or that by euacuation the strength of nature bee wasted then wee are vrged to stay bleeding before the bloud doo chaunge in colour and to detract that which remaineth by reiterating Phlebotomy either the same day or the day after Hyppocrates 2. vict acuto 10. In the cure of the Pluresie writeth that in the cure of that disease the inner veyne of the arme is speedily to be opened and bloud plentifully to be withdrawen vntill the same appeare far redder than it did at the first or that for pure and red bloud the same appeare swart and blacke which both happen in Plurisies If the bloud were before rawe crude vndigested and that it come from the inflamed place neere an incision it becommeth redder or yeallower because this bloud is horter than that which went before If it were at the first thus coloured namely redde or yeallowish than when it commeth from a member inflamed it turneth to be black and swart thorough adustion and thus you see how to stop the fluxe of bloud by the quantity by the substance and by the colour of the same As wee are to consider the foresaide thinges in the bloud so are wee to consider strength in the Pacient Of defect of strength these are the signes The fluxe of bloud relenting paâ—e colour in the face gapings stretchings noise in the eares webs in the cies and defect of seeing All these shew a decay of the spirits oflife they shewe faintnes of the heart and that the bodily parts are forsaken of inward heate To these may bee added the hicket and a desire to vomit which commeth of fluxe of the humor to the mouth of the stomacke as were already shewed But the most certaine and assured marke is the alteration of the Pulse which changing from thicke to slow from great to little from strong to weake from equall to vnequall prognosticate defect of nature and a perturbation in the body not much vnlike Epilepsia that is the falling sickenes If these come through feare or of humors nipping the stomacke stay bleeding recreate and strengthen the Pacient a while that afterward the residue of the euacuation may be perfected The waies to recouer and fetch strength againe if the same giue ouer before a conuenient and commodious quantity of bloud may be taken are these to cast colde water on the face of the Pacient to sprinckle vppon the face white odoriferous wine to put to the nose of the same party vineger strong wine muske or other aromatick thinges if these helpe not wee must close vp the veyne a while with the finger and if neede be the euacuation is to be imparted or diuided But to auoide all these accidents the remedy is to let bloud the party lying in his bed for so the partes of the body are reduced into one equality of position whereby the principall parts mutually bestow one on an other inward heat and vitall spirits if the Patient bee not brought againe by the foresaide thinges then prouoke vomit by tickling in the throat or by pouring in a litle oile for the force of vomiting stirreth vp strength and draweth away weakenesse of the stomacke and heart and presently after recouery renue the strength of nature with wine iuce of Pomgranats broth of flesh with the receit called Diamoâ—cho and other cordiall things The instrument may bee annointed with oile or other such liquor that it may inflict the wound without paine and for the most part the wounde must bend somewhat aslaunt or crookedly The incision is made two waies as Hyppocrates saith one straight Secundum rectum or Edirecto downeright the other contrary crookedly or a swash In these two waies wee must vse great discretion to vse them as neede requireth and not deceiue our selues vsing the one when wee should the other as many are deceiued in these daies To shewe which of these is to bee preferred would require a long discourse whereof read at large Fuchsius in his Apologie against Brachelius There is newe kinde of instruments to let bloud withall nowe a daies as the Rapier Sword and long Dagger which bring the bloud letters sometime to the Gallowes because they strike too deepe These instruments are the Ruffians weapons more malitious than manly But in this practise the veyne must be opened with a fine Launcet no fleme with a beard like a bloud-iron wherewith Smiths let horses bloud for they will sometime cut a veyn thorough on both sides causing a crampe and deadly convulsion And here I giue aduise that no Surgion except he be very skilfull himselfe open any veyne without the counsaile of the learned Phisition or the iudgement of some others that haue auncient and tried experience in the practise Ignorant Barbers doo great hurt herein
taking that which comes to hand first or which appeareth greatest perhaps a sinew for a veyne so letting out the vitall spirits and killing many and when it is done this is all their defence to say the signe was there and he would needs be let bloud Vnction or annointing is oft vsed in this practise sometime we rub the member whose veyne is to be taken with oile that thorough the warmth thereof bloud may bee made the more flowing sometime the instrument is annointed as was saide before to mittigate the paine of the inflicted wound Sometime the wound it selfe is annointed that it may bee the longer time before it bee couered with the Scarre and that the humors left behinde may with the more liberty breath foorth and that the ill humors remaining may bee also the better dispersed Drinke and especially wine may bee very well taken both in the bleeding if Syncope happen and after bleeding to cause good bloud and to recouer againe the vitall spirits Bathing two or three daies before is vsed in some causes as was declared in the former chapter but not the selfe same day The common opinion is that bleeding must be done fasting and vppon an empty stomacke but this is not approoued of the best writers for many of them giue aduise to eate before bleeding a soft or poched egge with a draught of wine about nine or ten of the clocke â—n the forenoone and then presently to open a veyne For nature the stomacke being empty and being altogether destitute of nourishment doth mightily holdfast and retaine the bloud whereas when a little nourishment is taken in small quantitie as is a poched egge a draught of wine shee permitteth the bloud easily to passeforth It hath bin declared before Chapter 16. that if necessitie vrge there is no prescribed time of bleeding but that if the disease require the same may be done at all times yea euen in the night Yet the forenoone of the day is the most vsuall time There is an houre of necessitie which is any houre in the day or night and beside this hora necessitatis there is hora commodiâ—atis which is the morning or forenoone houre viz. Galen de Curan râ—tio per sang missio cap. 13. 20. in praesagio experientia Comprobatâ— cap. 4. Aetium lib. 3. cap. 16. Oribasi lib. 1. cap. 11. Moreouer if a veine opened send forth bloud whitish in coloure stay the same for it appeareth that the humours in the bodie are rawe colde and vndigested through defect of naturall and digesting heate This is affirmed by Aristotle lib. 1. 9. de animalibus and Hippocra witnesseth that alwaies womens termes appeare not in their proper colour that by reason of frigiditie and coldnes of white bloud they oftentimesvomit and haue fluxe of tearmes Finally as in purging so in bleeding as wee haue already said wee are to consider the standing of the wind in winter to bleed wheÌ„ the same is Sowtherly in Sommer when the same is Northerly For the North wind with cold tempereth the heat of the time The verses of Schola salerni Hac facienda tibi quando vis Phlebotomari Vel quando minuas fueris vel quaÌ„do minutus Vnctio siue lauacrum potus fascia motus Debent non fragili tibi singula mente teneri Before and after letting bloud all these are meete and requisite Vnguent a bath strong drinke and good with motion mean and bonds most fit Remember all doo none forgit A prescription or regiment of the patient after bleeding Chap. 20. WHen a sufficient quantity of bloud is withdrawen proportionable vnto the greatnes of the disease vnloose the bond and drie the wound lest beeing moistened with clodded bloud either it growe not together againe or bring some doubt of impostumation These thinges not done accordingly enforceth vs sometime the eight day after to open the wound againe If any piece of fat come forth the same must not be cut off but softly put againe into the wound When the wound is wiped cleane drie close vp the veine with linnen dipt in rose water or sweete water or with Oile if wee purpose to bleede againe Let the same bee tyed on with bondes not tooâ—hard for writhing the skinne or lippes of the wound If a sinew or Tendon be pricked yee heard in the chapter before what is to be done If there be doubt of fluxe of bloud or an inflammation through pricking of a sinew we may beside the premisses apply after the practise of others a plaster of Ceruse and in compas about that a Cataplasme of Housleeke Nightshade Plantaine and other cold things After bleeding lye a while on the backe for quietnes sake and to recreate the strength of nature and to recouer the vitall spirits He must not frequent his accustomed affaires nor moue his bodie hastely nor exercise himselfe immoderatly neither must he vse Venus delightes nor yet bath himselfe For the bloud and spirits naturall vitall and animall which haue of late bin vehemently stirred by bleeding are now by rest againe to be setled else the same bloud and spirites would by these outward vehement exercises bee inflamed and so wast and consume away Neither must the party presently sleep lest either the languishing heat be quite extinguished or the lessened spirits altogether ouerwhelmed Let him therefore watch and rest void of contention either in mind or in body When an houre or two is past after bleeding a litle meate may bee giuen him Little I say in quantity but of good iuice to nourish the bodie and profitable also to withstand the present disease when 2. hours are past this short repast he may then sleepe so as his keepers carefully take heed that he tumble and turne not himselfe on the arme that hath bled or that the bond by tumbling and tossing be not remooued which may cause the bloud to slow againe a fresh or some other displeasure to fall out Afterward the diet must bee increased by little and little both in respect of the quantity and of the goodnes of the meat Neither as yet must we hasten to a full diet for the heat of nature being abated by bleeding can not as yet receiue or digest aboundance of meat And againe the veines lately emptied would exhaust out of much aboundance of meat much raw and vndigested matter wherwith the whole bodie is stuffed againe If concoction bee perfected and accomplished so that we may eate great quantity of meat yet vse a moderation for to what purpose is it presently againe to stuffe the bodye with iuices and humours for the abating and taking away wherof we did so lately let bloud Therefore after bleeding the patient is to liue more finely and exquisitly and not to goe to his old intemperat diet againe as the dog to his vomit Neither are these intemperat persons meete men to be let bloud as we prooued and shewed before in the 8. Cap. Fig. 1. Of
reiterating bleeding which they call Epaphaeresis this is the order First in inflamations great paine hot feuers caused of aboundance of hot bloud a veine must be opened as is alreadie shewed euen presently at the very beginning before the matter be gone to som principal member not only that the aboundance and excessiue quantity of bloud but that much more a great deale euen plentifully and generally may be euacuated yea euen till the patient giue ouer if the strenght of the body so permitte And in diseases caused of fulnes the bodily powers are firme for the mostpart neither doo they shrinke or relent much by this plentifull bleeding And when Hippo. permitted bleeding so long till the patient should giue ouer hee ment it so when the strength therevnto sufficient was able to beare it and not otherwise For if fainting doo happen wheÌ„ the powers of nature are firme and constant it doth only wast the spirits in the arteries those forces remaine still vnhurt and vndamnified which narure hath bred in the hart Liuer or braine And albeit these decay in Lypothimia yet of the setled forces other like presently come in place whereby againe the Patient is reuiued But when the strengh of the bodie is weake and greatly enfeebled because the forces of nature setled and seated in the principall members are also impaired If Lypothimia then chaunce reâ—â—itution wil hardly be made Therefore I say the vertues of nature beeing greatly debilitated beware of ouer comming or fainting And this is the order in great and vrgent sicknesses In small generall diseases as in repletions fulnes feuers and such like whose cause and principall matter is conteined in the veines if bodily strength permit we must presently euacuat wholly at the beginning at one time not till the patient ouercome but so much as is needefull and as the infirmitie or malady requireth And this euacuation without any hurt to the naturall forces withdraweth the matter abounding either before the same do wholly putrify or that it posâ—esâ—e some notable member or before any horrible accidents happen He that for feare or any other cause parteth or diuideth in these the euacuation he continueth the disease long time doth no good but great hurt to the sicke patient But if for imbecillity of strength the whole euacuation can not be accomplished or done seeing it is better in this case to marke the strength of the party then the vehemencie of the disease we are inforced to vse partition in the bleeding and yet with a great circumspection and care and let the partition be within a litle distance of time either by vndooing or vnloosiug of the bound or stay the blod with applying the finger on the wound so long as by the foresaid meanes the forces of the body may bee recouered Sometime an hours space is sufficient sometime more houres â—re required to the restoring of the forces of nature The best way is not to deferre the partition of bleeding past one day yet I say if strength permit that partition must be vsed bleede twise in the selfe same day in general diseases especially except other impedâ—mâ—ts greatly let euacuacuat in one day asmuch as is expedieÌ„t before the matter come to putrffaction or that other euils do grow But in partiall diseases of particular meÌ„bers chiefly in inflammations the parted or diuided euacuation may be put off a longer time either to the day following or to the day after to morrow that in this space the corrupted humours may goe from the member diseased into the veins exhausted and so by the next incision be euacuated The member of the bodie that is afflicted with griefe or corruption by little and little euen in one day or two daies at the most sendeth downe the humours to the place where the incision was And for asmuch as they are corrupted they are not there to remaine albeit the former paines be mittigated and asswaged But if the inflammation bee pestilent and venomous as is a pestilent botch or carbuncle the euacuation of necessitie must be reiterated euen the selfe same day lest the pestilent infection sticke and stay any long time in the veines to the great hurt of the partie But neither must reiterating of bleeding be vsed For thereby the vitall spirites and in ward heate is diminished and vntimely age is hastened on apace and the same when it commeth is made subiect to greeuous diseases as Chachexia the dropsie gout in the iointes trembling palsies and apoplexies Yea when the naturall heat is immoderatly cooled and naturall moysture wasted the bowels languish crudity and vndigestion beginneth to beare rule whereby are caused great and greeuous euils in the body of man And thus much of the reiterating of bleeding and order thereof But let vs come againe to our former matter of prescription moderat motion easy walking as it was conuement before bleeding to vnloose and make the humours thinne so also the same is necessarie after bleeding to disperse abroad the reliques of those vapors and humours which are left behinde And as bondes of linnen were vsed before bleeding to the intent the veines might waxe bigge appeare full and bee the better perceiued and seene and that the humour with the more facilitie might come to the place appointed for incision so afterward they are also needfull to stay the fluxe of bloud and bind vp the wound It was already said that the partie let bloud must not sleepe that is to say not within the space of eight or sixe houres at the least whereof this is alleaged as a reason that the fumes caused by sleepe bee not carried vp to the head and so offend the braine There may hereof bee aleaged other caused more as namely lest the veine opened should take hurt by tossing of the patient vp and downe in his sleepe which cause was lately aboue specifyed Also lest in sleepe the humors should flow to the member where the incision was made and there apostumat For pained places as Galen affiâ—meth Capit. 95. medicinatiâ— artis lib. de Curand ratio per sang missionem Capit. 7. are by nature accustomed to receiue fluxes and chiefly in sleepe Auicen alleageth this reason Because by sleepe after bleeding for the most part there chaunceth in the members a confraction or bâ—using For while the member is tossed hether and thether with inordinat and vnorderly motion the bondes are vnloosed the wound vnhealed and as it were newly opened notwithstanding the late incision it doth afresh sende foorth immoderat fluxe of bloud the partie in his sleepe not witting thereof whereby as all men know the life commeth into great danger Againe another discommodity by sleeping immediatly after bleeding is that fumous excrementes through sleepe are againe inwardly reuoked to the principall members Againe the vitall spirits and natural heat which by opening of a veine are drawen to the outward partes and members by sleepe are reuoked to the center or middes of the bodie
and so very often partly through a commotion made by incision and partly through that retraction made by sleepe such a boiling happeneth in the humours of the body that oft therby at length a feuer is caused and kindled It is therefore apparant that sleepe presently after bleeding is not good and chiefly if in the meane season the patient haue receiued no meat If after taking of meat hee sleepe an houre or two or more disposition so seruing it hurteth not at all or verie little But for as much as the commotion of humours can not fully be setled in short space after bleeding it is far safer to forbeare sleepe as we haue proued by sundry reasons If necessity dispotition vâ—ge sleepe let the same bee short and with a dâ—ligent circumspection that the bonds bee not vnlosed and so the Patient brought in perill of his life Some bring in a further reason yet of the fore said namely why we should not preseÌ„tly sleep after bleeding that is because the matter through sleep waxeth thicke and so a brusing or a confraction that way happeneth in the members as is accustomed in a quartan through the thicknes coldnes of the matter Againe the veines sinewes after bleeding being now emptied are becom cold so the fumes which are brought vnto the veines and sinewes in sleepe do also be come thicke and waxe colde because by sleepe the whole naturall heat of the bodie is drawen euen into the depth and profunditie of the bodily partes And when the veines and sinewes are become cold partly for defect of bloud partly through cold fumes brought by sleepe vnto them they doo participate grosnes coldnes confraction to the other members for it is a principle Simile a simili facile afficitâ—r Like of the like is easily affected And thus much of sleepe after bleeding which is to bee vnderstood of sleepe onely following immediatly after and not otherwise The verses of Scola Salerni concerning this point are these Sanguine subtracto sex horis est vigilandum Ne somni fumus laedat tibi sensile corpus Ne neruum laedas non sit tibi plaga profunda Sanguine purgatus ne carpas protinus escas Sixe houres sleepe not when bloud is let The fume by sleepefull hurtfull is It hurtes the veine if stroke be great To feede streightwaies is farre amisse The patient is a while after bleeding to abstaine from meat till the motion of humors be appeased For in this case rawe iuices and meat not yet concected is drawen with the bloud to aid the member afflicted Looke Galen lib. 4. Cap. 10. de Sanitate tuenda Milke meates made of milke after bleeding are to be eschewed for certeine of those humors which were troubled and moued in opening the veine flowe vnto the stomack and forasmuch as milke is otherwise of it selfe subiect to corruption being nowe in this case inwardly receiued mingled with the foresaide humors it is verie soone putrified and because of the sweetnes thereof though it be vnconcocted rawe yet it is mightily sucked vp and drawen in of the emptie veines Irem all cold things either in wardly taken or outwardly applyed are to be auoided of which sort are chiefely cold meats cold drinks cold bathings washings cold aire thinnesse of clothes bare sitting vpon stones coldnes of the head feete for by these the body would be immoderatly cooled natural heat being alreadie diminished through bleeding Item mistie cloudie aire is to be eschewed for such weather ingendreth Melancholie bloud maketh a heauie mind He must therfore walke in cleare bright faire weather for thereby the spirits of life are refreshed Item immoderat motion is to be forborne a temperat quietnes to be imbraced both of body of mind For vehement mouings do yet more more stil disturb the humors of the body before excited stirred vp by bleeding so consequently the same weaken too much the bodily forces wheras quietnes rest soon appeaseth this commoâ—on of humors Item eating of salt fish is to be auoided after incision for these salt meates often times cause itchings scabs Simeon Sethi depiscibus The verses of Schola Salerni in these matters Omnia de lacte vitabis rite minutus vitet potum Phlebotomatus home Frigida vitabit quia sunt in mica minutis Interdiclus eritq minutis nubulus aier Spiritus exultatque minutis luce per auras Omnibus apta quies motus sâ—pe nociuus VVhite meates eschew d ink not too much Cold things forbeare as ill for such VValke not abrode in clowdie daies cleare aire doth cheare the spirits alwaies Be wholly quiet at all assayes Item Beware of much meat the first or second day And let the meat be of good digestion and causing good blood as soft egges good wine chickens and such like Therefore Isaac in dietis saith of such as are let bloud that their meat must be lessened and drinke increased that is the drinke must be more in respect of his meat that he eateth daily not in regard of that custome which he obserued before bleeding Yea he must nowe drinke lesse than he did before Some after letting bloud are verie drye in the mouth which happeneth through the great motion of the humors and by abundance and ebullition of choler whose fumes arise vpward to the mouth other parts These are to drink Barlie water to mitigate the acuitie sharpnes heat of choller so must they do in like maner that are in doubt of inflammation of the Liuer and stomake through abundant boiling of chollericke humors specially if it be red choller that aboundeth in them If through hard binding of the arme before or after bleeding paine doe ensue and so consequently sluxe of humors to the place causing apostumation in the arme then according to Auicen let bloud in the other arme or according to Rhazes aboue the place in the same arme and apply to the place repercussiues to keepe backe the matter The wound in the arme after bleeding somtime healeth but slowly because the instrumeÌ„t was annoynted with oyle as wee said before that the same might enter the better do lest hurt to the pacient as Galen saith 9. Method The cause now of this slowe healing is for that the healing is much hindered by reason of the oyle which is betweene the sides or the lippes of the wound For as the same Galen other authors affirme a wound is not cured or healed as long as there is any thing betweene the sides or lippes of the same Another cause why after bleeding the wound closeth but softly is that there hath bin too much euacuation of bloud whereby the force of nature is debilitated which hindereth the continuatioÌ„ or consolidation of the wound A third reason hereof may be the oft mouing of the arme for wounds do neuer heale except the member enioy rest where they are inflicted Therfore let this fault be remedied by
contraries as thus Let not the instrument be oyled euacuat not too much â—loud lastly forbeare exercise motion of the arme What veines are to be opened both in generall particular diseases Chap. 21. SOmetime are opened veines sometime arteries Of opening of an arterie wee purpose to speake afterward in a Chapter by it selfe And now of opening onely of a veine which is vsed in many members Sometime in the arme called Manus magna somtime in the hand called Manus parua somtime in the feete somtime in the nose somtime in the forehead lipps toung palat or roofe of the mouth sometime in the corner of the eye toward the forehead sometime in one place sometime in another as this discourse following doeth plainly teach It is knoweÌ„ to those that haue seen Anatomies that there are in the bodie of man two sortes of veines Generall speciall Fiue veines are opened in Manu magna in the great hande that is ab ascellis vsque ad cubitum that is from the elbowe forwarde or downward as Rhazes faith in 7. ad Almonsor Chap. 21. and Auicen in quarta i. Chap. 20. VVhere note that Phisicions by the great hande do meane the whole arme together with the hand as by the foot the whole legg from the hippes or huckle bone to the soale of the foote The common or generall veines which appeare in the middest of a mans arme are these The first is Humeraria or Humeralis in Greek called Omiata because by the shoulder it commeth to the hande It is also called in Latine Vena exterior the outward veine because it goeth along on the outside of the arme It is againe called Cephalica or the veine of the head This veyne is most apt and fit and most safe to bee opened for diseases of the vppâ—r parts of mans body it is lesse dangerous than the rest because there is no sinew or artery vnder it to hinder or indanger the opening thereof If a man chaunce not to touch it at the first stroke he may be bold to strike it againe for there is I say no ieoperdy to cut any muskle It is opened with a long cut to let out grosse bloud and albeit there be no feare of any sinew artery or Tendon vnderneath it yet wound it not too deepe for feare of apostumation This veyne is taken when the parts aboue the breast or necke as the face or heade are discased Therefore it is opened profitably for passions of the heade as Hemicrania the Mygrame and Mania Madnesse which commeth of too much abundance of good bloud hauing recourse vnto the heade And such other like hote passions of the head proceeding of hoâ—e matter Also Cephalica is taken in headach watchings and paines of the eies If it bee opened for headach purge a day before with a certaine quantity of Pils of Hiera simplex according as the learned Phisition shall appoint thee to take If you cannot finde out this veyne in the arme take his braunch about the thombes ende Galen cap. decimo sextode Curand raâ—io per sanguin missio Cephalica opened cuacuateth and pulleth backe from those parts which are aboue the canell bone of the throat called Clauicula and this it doth with the more celerity and greater speede if it be opened in the arme more weakely and with lesse speede if it be taken but in the braunch thereof that is betweene the forefinger and the thombe Inward and outward affects of the head whether they be but yet a beginning or that they are in Statis maximo in the greatest force are cured and drawen backe by opening Humeraria veyne in the right arme if the affects be on the right part or side of the heade or in the left arme if the paine be on the left side This practise may be done not so speedily but at more leysure only to preuent the foresaid cuils to come by opening the braunch of Caephalica iust betweene the thombe and the forefinger These affects are oft remoued without opening of a veyne as are also sometimes frensies rauinges apoplexies euen by scarrification of the shoulders by boxing and bleeding at the nose Item eies inflamed and burned with sharpe droppinges and cies that water are remedied First by opening of Humeraria on that side where the paine is most and afterward the matter of these affects is pulled backe by applying cupping-glasses to the hinder part of the necke and shoulders The second generall veyne in the arme is the inner veyne of the same called of the Greekes Haepatitis Of the Latins Fecoria or Lienaris late Phisitions call it Basilica or Regia in the right arme it is called Hepatica the veyne of the Liuer and in the left arme Pulmatica the veine of the lungs it is also called vena interior and it commeth or groweth thorough the armehole Fuchsius calleth it Axillaris that is the veyne comming from the liuer to the arme hole Of Axilla which is the arme hole or hollow place vnder a mans arme where the haire doth grow The opening of this veyne is very doubtfull and dangerous both for the artery and muskle that lyeth vnder it and alfo for the manifold and vncertaine course of the sinewes in that place specially it maketh a man more doubtfull in the inner bought of the arme than in other places because there the arme is lesse fleshy Ignorant Barbers thinking to open Basilica open oftentimes a great sinew hard by it which is like a veyne and so the vitall spirits and life it selfe oft runneth out together with the bloud and this doo ignorant Barbers take in cure for headach and want of sleepe when they should take Cephalica of whose dangerous boldnes we spake before Chap. 19. This veyne emptieth from those parts which are beneath the necke as are the breastes sides lungs heart liuer spleene and marrow yea it emptieth from the middle part of the body vsque ad Clauiculam to the canell bone of the throate and iâ— opened to helpe passions of the brest stomacke spleene and liuer and also to helpe Pluresies of the sides If ye cannot spie it in the arme seeke the braunch of it betweene the fourth and the little singer the liuer and heart are the roots of this veyne Seuerall fulnes being no affect of any particulâ—r part without choice may be withdrawen from any veyne yet most commonly it is done with greatest profit from the inner veyn of the right arme which principally euâ—cuateth from vena caua the hollow veyne and the liuer So also is fulnes of choler taken fromthe inner veyne of the right arme as melancholly repletion is abated from the inner veyne of the left arme according to the sâ—ituation of the Milt In which regard the Basilica of the left arme is called aboue Lienaris That repletion which commeth of a filthy gathering together of raw and crude humors must equally bee taken out of both armes In the cure of Feuers this order of bleeding is to
bee obserued A simple Sinochus feuer or a simple feuer putrified or caused through putrifaction of humors requireth to haue the Basilicam of the right side or arme opened So doth an hote pestelenciall feuer simple and not compound So doth a tertian and a continuall quotidian A quartan requireth the inner veyne of the left arme This is also the Methode in pure intermittant and discontinuing feuers if either the plenitude or accidents will haue vs to open a veyne Revulsion of matter from those partes placed betweene the canell bone of the throate and the raines is done from the right Basillica or left as the disease requireth if the right parts be affected open for revulsion Basilicam dextri brachii If the left the other Basilica Open this veyne in the arme if great and speedy bleeding be needefull If a more slacke and remisse bleeding will serue the turne seeke the braunch of it in the hand betweene the little finger and the fourth as some say from the right kidney to the left and passing ouer the bottome of the stomacke Inflammations in the gut called Colon which is a great gut rising from the left side to the right or in which is the disease called the Collick albeit the same be vnder the raines yet they are cured by revulsion opening Basilicam or the inner veyne of the arme For so the beginnings and deriuations of the veynes doo shew In inflamations of the lungs take the Basilica or inner veyne of the left arme rather than of the right because the veynes of the lungs come from the right side of the hart which part of the heart is placed toward the left part of vena caua so by the left wing ruÌ„neth into the left arme This order of incision also helpeth spitting of bloud thorough extreame coughing the disease called Tabes trembling of the heart and such like In a á¹–luresie open the Basilica of the arme according as the paine shall happen in the right or left side In a Pluresie of the right side the right Basilica and so contrary Item the interior veyne is taken in inwarde and outward apostumations of the brest or midriffe and in inwarde Vlcers which cause vs to spit bloud Thus also by opening of Basilica are cured inflamations on the shoulders and vnder the arme holes except they come to the very bought of the arme for then it were very dangerous to open the very part or member inflamed but in this case we open a veyne in the hand e directo that is straight In paines and inflamations of the Liuer wee open the right Basilica and so the left Basilica when the Milt is inflamed grieued or ill affected and in all these wee must take the veyne in the arme if much bleeding be needefull and if not then the veyne in the hand Deriuation from the Spleene is not made as some do think into the veynes called Hymorroide but into the belly So deâ—iuation from the hollownes of the Liuer is made also into the belly A postumations in the Raines when the veynes also all full of bloud are repelled by the right Basilica if the right kidney bee grieued by the left Basilica if the left kidney bee ill affected If excessiue fulnesse doo not vrge in these apostumations the revulsion is better attempted out of the lower veynes which are straight and right as out of the right or left anckle Affects of the belly as immoderate fluxe of termes are stayed by opening Basilica in the arme which draweth the fluxe vpwardes So doo also cupping-glasses applyed either to the paps or nauill That revulsion which is made by opening Basilica in the arme specially the right Basilica is to be accounted generall because it draweth from the Liuer which is the fountaine it selfe from whence all fluxe of bloud commeth whether the same bee fluxe of termes or any other fluxe of bloud Revulsion made from the lower veynes is particuler not euacuating first from the Liuer the fountaine of bloud as the other doth And forasmuch as things vniuersall goe before partiticuler things therefore in inflamations vnder the kidneyes wee must first pull backe with direct opening of Basilica in the arme and afterward wee are to open the lower veynes which also haue some force to reueale but if either the fulnes or the fluxe be great it is not best first to open these v eynes below Finally imminent diseases like to arise thorough plenitude of bloud are kept backe be opening the right Basilica that is the inner veyn in the bought of the right arme The third generall veyne in the arme is the middle veyne called of some very properly and fitly venacommunis of other Cardiaca or Cordiaca venanigra and Mater and of the barbarous Phisitions Mediana It is called Media or Mediana for three considerations First inregard of the scituatioÌ„ hauing in the vpper part of the arme aboue it Cephalica vein in the lower part of the arme beneath it the Basilica veyne and so these being as it were extreames it possesseth the mids betweene them both Yea it is indeede a braunch of them both And for this cause secondly it hath the name Mediana as if it were made of them two as the meane is made or consisteth of the two extreames Thirdly it hath the name Media or Mediana for that it is Media that is in the middle in respect of euacuation Euaeuating both from aboue and from belowe aboue the necke from the necke and from beneath the necke For it springeth I say from the diuision or parting of both the other veynes that is Cephalica and Basilica By opening this veyn there is made a generall euacuation of humors through the whole body A generall or vniuersall euacuation I call it not because it springeth froÌ„ the hart as some affirme but because the fluxe commeth generally from all parts This veyne being a braunch as yee haue heard both of Cephalica and Basilica This veyne is taken when neither of the other appeareth and withdraweth bloud from them both according to the iudgment of some This veyne is the same which is called also Funiâ— brachii Cephalica and Basilica are as it were the Parents of Mediana As often therefore as thou art determined to open Basilica and that the same doo not appeare take rather the Mediana veyne than the Cephalica And if thou purpose to detract bloud from Cephalica and that the same doo not shewe conueniently open rather Mediana than Basilica and being compact of Cephalica and Basilica it withdraweth bloud indifferently from them both both from place and parts beneath and also aboue Some giue aduise vpon what ground I doo not yet see not to open Cardiaca if the Patient feele any weakenes at the heart but if necessiity of bleeding bee vrged the heart beeing enfeebled wee are rather to open Cephalica or Basilica This veyne is opened to cuâ—e â—assions of the whole body especially when they proceede of heate of the heart
pursines or stoppings of the lungs caused of much hot bloud in griefs of the Splene side Vide librum Anatomiae viuorum Galeno adscriptum Cap. 28. Rhazen Auicen Item there are two veines vnder the arme-holes which are opened in streitnes of the brest paine of the midrife the lungs in difficultie of breathing called Asthma Item there are two veines aboue the elbowes which are opened in all diseases of the brest swimming of the head spalme the falling sicknes Item there is a veine called Vena purpureâ— or the purple veine lying in the right arm next Hepatica or Basilica toward the hand which is opened against diseases of the spirituall members and of the bowels Item there is a veine called Illiaca next vnto the purple veine which being wel takeÌ„ is good to heale paines of all the inward members Item there is a veine called vena pulsatilis or the beating veine which is opened in treÌ„blings of the heart sowning Cordiaca passio Item there are two veines in the thombes which are opened in diseases of the head bleared eyes in most feuers Item there is a veine between the forefingar and the thombe which is opened in stopping of the head to purge superfluitie ofcholer also in agewes diseases of the eyes Item there is a veine between the ringfingar the little fingar which is opened in diseases of the head lungs splene Item there is in th right hand betweene the little fingar the next adioyning a veine caled Saluatella whereof before Item Saluatella in the left hand looke also before Item there is a v eine in the right side opened in Lienteria Dysenteria dropsies other infirmities of cold matter Item there is a veine in the left side which is opened in apostumations excoriâ—tions of the bladder paines of the loynes swellings stoppings of the splene Item there is a veine in the belly which is opened in diseases of the raines and to purge out the Melancoly bloud Item there are 4 veines about the place called Pecten i. the place where the haire groweth about the priuie members on either sides which may bee opened in superfluous issues of the Hemorroids to asswage paine and diseases in the bladder secret places to stop bleeding at the nose and other members to heale Lyenteria Stranguria Item there is a veine ouer the fore-skin of the yard which is opened against the dropsie and all diseases of the same member Item there is a veine vnderneath the saide fore-skin which is opened for the crampe spalme collick swelling of the coddes strangurie Dissuria the stone in the raines bladder Item there are two veines in the thighes which are opened in diseases of the raines and bladder Item there are two veines in the legges which are opened in dropsies paines apostumation of the bladder raines and priuie parts in the gowt swelling of the knees Item in the feete there are three vaines Ischiatica Saphena Vena poplitis the veine of the hamme behind the knee These we open to reuoke bloud downward as in prouoking of menstruous Termes But among all these the veine in the ankle is most conuenient as Auicen saith For vena poplitis being more nigh vnto the wombe it draweth bloud better froÌ„ thence than either Saphena or Ischiatica When the plenitude in the bodie is not great it is better to detract the same from the right lower veines of the hammes the ankle Vena poplitis opened prouoketh Termes so doth it fluxe of Hemorroids for the force of the bloud tending downwardes as it were openeth the womb prouoketh consequently both Termes Hemorroids If there be any inflamation in or about the bely at the biginning thereof draw the matter vpward and that directly For from aboue as from the head the fluxe proceedeth Neither in this case are we to feare in weomen stopping of Termes by opening a veine in the arme if presently therewithall we open a direct veine in the hamme or ankle which is the waye to turne them aside as we hane said alreadie But if first you should opeÌ„ a veine below the force of the inflammation would therhy be incresed Affects in any part vnder the raines are most speedily cured by opening the greater veines of the hamme the same are cured slowly and with lesse speede by opening Saphena in the ankle The raines are in the middle betweene the vpper parts the lower Yet I prescribe appoint not the position so much by order of the member as by the original productioÌ„ of the veines passing into that part And therfore inflamations in the right muskles of that part called AbdemeÌ„ aboue the nauile i. in the outward vpward part of the bely or panch are reuoked by opening a veine below and inflamations beneath the raines in the gut Colon are pulled back by opening the inner vaine of the arme as before Saphena is opened to withdrawe bloud from the raines matrix womb stones yard froÌ„ all meÌ„bers placed below Saphena Ischiatica are braunches of one veine as Galen saith 6. Aphoris Saphena on the inner side of the legge is opened in stopping of termes griefe of the matrix raines hippes and priuie members of men or of women Ischiatica corrruptly called Sciatica beginneth aboue at the huckle bone or haunch called Ischias This veine may be called the outward Saphena descending from thence on the outside of the legges It draweth froÌ„ the raines lower members that are outwardly placed is opened in paines of the huckle bone caled Sciatica in griefes of the bladder bowels gout of the hands feete paines of the ioynts palseyes in the disease called Vaux .i. when a crooked veine swelleth with Melancoly blod in the temples bellie or legges in leprosie IteÌ„ there are two outward veines in the ankles which are opened in stopping of Termes sicknesses of the Splene paines in the backe strangurie and stone Item there are two veines vnder the little toa which are opened to purge superfluities of the matrix in scrophules on the face and legges Item there are two veines adioyning to the litle toe which being opened cure apoplexies yellow Iaundies and choler palsies and diseases of the raines Item there are two veines in the lesâ—er ioynt of the little toe which are opened in olde coughes pustles Opthalmia Item there are two veines in the middle toe which are opened inscrophuls diseases of the face spots rednes pimples watrie eies canker knots stopping of the Termes Item there is a veine on the left ioynt in the great toe which is opened in Opthalmia spots of the face legges â—â—ch euil vlcers supersluitres of the matrix Finally I conclude with Venatalii the ankle veine called also Saphena that of the lower veines it is of great profit and to be opened in paines stoppings swelling of the matrix or yard is opened the foote being put in a vessel
of water The Sciatica veine which is one of the middle veines towarde the outside of the foot is next in vse for the disease caled Sciatica in the huckle bone So as first we purge with Hiera and annoynt the place outwardly with oyle of the same And when bloud letting iâ— not conuenient as afterward you shal heare as also in this practise for Sciatica wee may applye boxes with scarification as the place humours and time requires and as affectes in the vpper partes are cured by vpper veines opened in the arme so they in the nether partes are cured by lower veines opened in the hammes and ankles As wee haue hitherto declared the veines in generall particular with their profits in bleeding for manifold diseases So also to the intent that the practisioner may be furnished throughly with knowledge in this point which is the most principal and to know in euery disease what veine to open so not to take Hob for Gib as the prouerb saith it shall not be greatly amisse for the more perfectnes herein to teach this lesson forward and backward as they learne their Gamma vt both waies that intend to be good Musicians so must those be most perfect in this discourse that in this practise of letting bloud will be accounted skilfull and good Phisicions Nowe therefore in a most compendious sort I will first set downe the disease and then the veine that is to be opened for the same And first touching a body that is not yet sick diseased but who that is sicke either in his whole bodie or in some particular member in the spring the beginning thereof he may be let bloud of any veine of the great generall veines so in the preseruatiue intention may be kept backe continuall vniuersall feuers a general or vniuersall gowt if there be doubt of any particular inflamation in any particular member let bloud some veine in some part far off whereby the vâ—e and custome of nature and also the fluxe of bloud may be turned from that member where the daunger is verie likely to rest into some other part farre distant and in these two pointes resteth the whole preseruatiue intention of this practise Concerning a pacient sicke and diseased the curatiue intention of this practise If he be sicke he is diseased also either in the whole bodie or in some particular part If the disease lye in the whole bodie then the Basilica or inner veine of the arme is to be opened which directly answereth vnto the Liuer which is the verie fountaine of bloud If the pacient be sick in any particular part the same is either aboue the necke as in the face or in the head or it is beneath the necke The diseases in the face and head are these 7. a Frensie an Apoplexie the Letargus or sleeping disease the falling sicknesse the Quincie inflamation of the eyes fluxe of bloud from the nose 1 In a Frensie in the beginning thereof bloud must be pulled backe from the head by opening some vaines as will from farre withdrawe the matter alwayes obseruing rectitude with the parte affected and this may best be done from the Cephaliea veine In the state of a frensâ—e or when the force thereof is somewhat abated first take away the repletion of the whole body and then let bloud either in the member it selfe that is affected or member very neere vnto it as in this case the fittest veine is the veine of the forehead or that veine which is betweene the nosethrils 2 In an Apoplexie first in the beginning therofopen Cephalica If that appeare not open Vena communis or Mediana or that veyne which is betweene the thombe and forefingerâ— afterward if the disease be rooted and continue open the veyne vnder the tongue 3 In Letargus or the drowsie disease first open Cephalica afterwards if the same continue long open the veyne of the forehead 4 In the falling sicknes open the selfe same veynes that are opened for apoplexie 5 In Angina or quincie first open Cephalica then the veyne vnder the tongue 6 In inflammation of the eies first open Cephalica then the veyne in the inner angle or corner of the eie 7 In sluxe of bloud from the nose open Cephalica or Mediana the common veyne For diseases beneath the necke they are either aboue the raines in the raines or beneath the raines Aboue the raines are these foure A Pluresie diseases of the lungs inflammation of the liuer inflammation of the spleene 1 In a pluresie the beginning therof open the Basilica or inner veine of the arme on that side that is pained abating and putting backe the aboüdance of bloud so long till the bloud chaunge in colour if so be the strength of bodie in the patient will beare it 2 In diseases of the Lunges Vena Axillaris or the inner veine of the arme is to be opened or if that appeare not the common or middle veine or for the more forcible reuultion wee may take the veine in the hand betweene the ring finger and the middle finger or that veine which is betweene the ring finger and the little finger Alwaies respecting rectitude of opening in the right veine 3 In inflammations diseases of the Liuer doo as is said for the lungs Basilica veine obseruing alwais rectitude of members 4 In inflammations diseases of the splene do also as before obseruing the rectitude on the left side If the diseases be in the rames theÌ„selues that they are inflamed that the same inflammation bee but a beginning open the inner veine or Basilica of the arme If the inflaÌ„mation be in his state or somewhat relenting open the inner veine of the ham or anckle If the diseases be beneth the rains they are either diseases of the wombe or belly or of the bladder or priuy parts or of menstruous termes or of the Hemorroidae veines thigh or haunche 1 In diseases of the wombe or belly if the fluxe be a beginning and that there is repletion in the body open a veyne in the arme to turne the fluxe an other waxe when the fluxe is don and the affect bee not remoued open the inner veyne of the ham or anckle 2 In diseases of the bladder do euen so both in their beginning and in their state 3 In inflammation and diseases of the priuie parts doo likewise euen so 4 In restraint of termes open the veyne of the ham or anckle or scarrifie vpon the anckles 5 In termes immoderately flowing open the veyne of the arme 6 In restraint of hemorroids open a veyne in the hamme or shanke which is from the knee downe to the ancklee 7 In immoderate fluxe of hemorroids open the Basilica in the arme 8 In paine or ach of the thigh or huckle bone called Sciatica first open the inner veyn of the arme to pull backe the matter afterward open the outward veyne of the anckle to euacuate the same Finally remember
Chrisi If it be very dark it betokeneth grosse bloud Greene bloud sheweth perfect adustioÌ„ When the bloud floweth soorthspedely it is suetile and thin when it spinneth not foorth but comes guttatim slowly drop by drop it betokeneth that it is grosse bloud when meanly betweene both then is it a mean bloud betweene grosse and thin Againe sometime it is quickly congeled then is it g rosse bloud somtime slowly compacted and then is it subtile Thicke and grosse bloud sheweth thicke and grosse matter in the bodie or it sheweth great heat and drith which hath consumed the humidity of bloud If it be subtile thin it sheweth want of digestion and abundance of raw vnconcocted humours of hot humours or of cold as the colour shall discrie If the bloud be oily it betokeneth either a future leprosie or too much fatnes in the body for leprosy is caused of extremity of heat in the bloud burning the same and conuerting it into an oily substance Againe take a bat round in the end and set it to the congeled bloud if it withstand it not but giue place vnto it and bee diuided it is an argument of drith If the bloud greatly resist the entrance of the bat then is it a very thicke and viscous bloud If between both then is it a meane bloud And thus of the substance of the bloud which should haue bin inserted before And touching the colour in like sort this briefe obseruation by the way which was also omitted but may come in here yet in good sort a good bloud is of diuers colours according to the diuersitie of the parts for in the vpper parte and in the compasse of the vessell it is of a red colour for the good bloud being light alwaies ascendeth vp to the higher partes in the middes it is red and not cleere in the bottom it is blacke and melancolious For melancoly being heauy resteth alwaies in the bottome Sometime there swimmeth on the toppe of the bloud a certaine fatte or oily matter like a copweb If the body bee very grosse and fat this is caused of the verie bloud which is in such bodies inclining to fat If the body be very leane it declareth the same now to beginne to melt and to languish In the bottom of the clodded bloud there is resident an earthly a filthy substance which being deuided or clouen asunder appeareth in colour either red darke blacke bright or greene whereby we may coniecture the nature of the humour mixt with the bloud yea by the colour much or little we may know how much ech humour aboundeth in the veines Some say if the bloud bee cut or deuided that there bee found in the same certaine grainees like small sande that it noteth leprosie or inclination vnto it which alwaies hath not been found true by certaine that haue obserued it It is sildome that the bloud comming from the veines doth sinke but if it doo the same sheweth corrupt and stinking humours and is a token of vncurable putrifaction and corruption No man doth willingly tast detracted bloud but if by chaunce it come into the mouth and doo tast sweet it is according to nature good and of perfect concoction If it bee bitter in tast it sheweth aboundance of choller if it be sowre sharpe and restringent it denotateth aboundance of melancoly if vnsauery aboundance of flegme if salt the bloud is mixt with salt flegme After obseruation of the substaÌ„ce and colour of the bloud conferre all the smal porringers or vessels of bloud together If they shew all equally good bloud it is to be supposed that the rest in the veines is like vnto it Yet the same is to bee withdrawen if it offend in quantity and greeue the body hurting the sences and causing in the body putrifaction and other euils If bloud appeare corrupt then with a greater profit the same is to be withdraweÌ„ because it hurteth the body two waies both with the quantity and qualitie thereof If it be not sufficiently withdrawen at one time afterward againe a veine must be opened and beside bleeding if Cacochymia concur with plenitud that is that bloud offend both in quantitie and qualitie as wee noted in the 21. Chapter beside bleeding the body must more ouer be purged with inward medicine If that bloud which came first were good and the other corrupt then suppose that yet much such bloud remaineth in the bodie to be auoided by good order of diet and orderly euacuation But if it fall out so in inflamations it is a good signe that the euacuation is absolute and perfect quite taking away the matter of the disease from the affected member The bloud poured into warme water hath thereby his partes and substances deuided the wheyish and watrìe substance is confounded with the water and cannot be knowen from it Also the thinner and more subtile part of the bloud is mingled with the water likewise whereby yet notwithstanding after a sort wee may giue iudgement of the nature of the humor The thicker parte of the bloud resteth in the bottome which is reputed good and naturall bloud if so be it be whitish thinne bright and cohering together If the same be more grosse it sheweth the grosnesse of the bloud that remaineth in the bodie If it be obscure blacke or otherwise coloured after the difference of the colour iudge the bloud to be corrupted or not corrupted with â—ilthinesse of wicked humors If it do not cohere but be distracted and diuided it betokeneth vncurable putrifaction Last of all remember that the more vnpure and vnconcocted the bloud appeareth being altered from the nature of good bloud the same is to be withdrawen in the lesse quantitie and not so plentifully as when the same draweth more nigh the substance of good bloud which is done otherwise and quite contrarie by our common barbors and letters of bloud And looke howe much the humors doe passe and exceede either lesse or more the nature of bloud so much more sparingly are wee to let bloud And when they exceede too farre from the nature of bloud either the one waie or the other then wee are altogether to forbeare bleeding as wee haue noted in a certeine place alreadie A short rehersall of eight auncient errours touching bleeding and a sufficient confutation of them by auncient authorities Chap. 23. FIrst that bloud must not be let but in the morning This is confuted by Galen lib. de Curand ratio per sanguin Missio Capitul 12. saying Feare not to let bloud by night forit is ridiculous that some doe maintaine onely letting bloud from the second houre of the daye to the fifth or sixth and no other time The second errour is that obstruction and putrifaction are the causes of letting bloud Galen also confutes this 2. Metho Med. cap. 14. in these wordes Neither obstruction nor putrifaction is the cause of leâ—ting bloud but abundance of humors for neither can stopping or putrifaction be
forefinger and the thombe and I let it bleede till it stayed of it selfe for â—o saith Galen I was warned by my dreame and there fl owed out not a whole pound and the continuall paine ceased that was specially in that part where the Liuer lyeth in the midriffe I knowe one long troubled with continuall paine in the side freede thereof by opening an arterie in the arme the same also being attempted through the warning of a dreame It is verie dangerous either willingly or vn willingly to cut the greater arterie vnder the veine in the arme or vnder the veine in the hammes For the bloud being thinne hote forcebly issuing out will hardly bee stopped and many haue dyed of Gangraena rising in the member where the incision hath beene as did a Gentleman of new Rumney in Kent a yeare or two past and so much the sooner commeth this putrifieng rotting and mortification to the member when the Phlebotomer goeth about with a band to stay Haemorrhagiam That is the dangerous fluxe of the arteriall or vitall bloud If the bloud bee stayed the wound cannot bee brought to a skarre without Aneurisma by reason of the continuall pulse and the thicke and hard tunicles in the same place If necessitie so require it is best to cut the whole greater artery ouerth wartly for the bloud is soonest staid when the ends and extremities of the artery cut asunder bee pulled vp whereon the plaister of Aloe before spoken of Cap. 19. is to be applied VVithout these dangers we may cut the lesser arteries which are in the outwarde lims or members as in the head hands and feete For these may bee fastened together chiefly in soft moist bodies as of women and children These are opened in continuall and great paines about the vppermost skinne of any member which paine is like a pricking or kinde of shooting because of sensiblenes and much feeling of the Membrana or outmost skinne and it is therewithall a beating paine by reason of the moouing of the arteries The cause of these pricking paines is abundance of much thinne hot bloud inclosed in the arteries of the pained place and the same is taken away when the outward arteries are found out and cut which proceede from those inwarde affected members Fewe in our daies cut arteries because they are not manifest to appeare in sight nor easie to come by Arteries cut in the temples doo remedy hote biting humors and fluxes of the eies in which cases these arteries are wholly cut and burnt with an hote iron or some burning medicine Arteries behinde the eares are cut in swimmings and continuall paines of the head caused of winde and of heate Also in rednes of the face and in other long continuing affects of the head The artery betweene the thombe and fore-finger is opened with continuall paines of the sides betweene the bowels and the Midriffe An artery about the anckle is opened in long continuing paines of the huckle bones alwaies chose that artery which is direct to the affected member as wee aduised before in opening of veynes Of particuler euacuation of bloud and first of bloudsuckers or horseleaches Chap. 26. TO this discourse of opening a veyne which is a generall euacuation of bloud is to bee added the particuler euacuation thereof by leaches and ventosas whereof wee will briefly speake in these two Chapters and so conclude this our present Pamphlet VVhen bloud is so in any member that it cannot be pulled backe by opening of a veyne or by some other practise the same is to bee withdrawen from the affected member by such remedies as may outwardly abide vpon the griefe and so free the same of the present euill Of this sort are Leaches Launsing cupping or boxing which apparantly drawe bloud from the member affected Leaches or bloudsuckers are wormes found in waters which applied outwardly to the member draw forth bloud They make a three square wound which penetrateth not only the skinne but also more deepely if the skinne bee tender as is the skin of children and infants These being empty and well applied sucke out bloud greedily and safely and that so long till they swell with fulnesse and so fall off And sometime when they are off the bloud still followeth plentifully especially if they were fixed vpon so open and manifest veyne In which case they stand in steede of Phlebotomy Thus applied to the hemeroide veynes sometime they doo so prouoke bloud that to stoppe the same we are necessarily forced to vse thinges astringent yea and applied to the arme of children they are equall to bleeding And that extraction which is thus drawen from a hollo we veyne is to bee accounted for an vniuersall euacuation But when they are fixed to the hard skinne vnder which there is no great veyne they onely empty that place that these touch extracting very litle from the neerer parts and nothing at all from the members far off And therefore leaches are onely vsuall in corruptions of the vppermost skinne as in the scab in Vitiligo which is a fowlenes of the body with spots of diuers colours whereof are three kinds In Impetigo a disease which wee call the Ringworme In the disease called Panus which after Celsus is a kind of kernell growing in the grind of a man or behinde his eares In rednes of the nose and face and little swellinges in leaprous persons So oftentimes wee apply them to the Arse-hole called Anus against melancholly diseases caused of the stopping of hemorroids In scabs itch and wicked wounds they are very profitable the body beeing first euacuated by letting of bloud Yea the drawing of horse-leaches is more conuenient in fulnes of bloud than scarrifieng is Forasmuch as they fetch bloud more deepely and also that which is withdrawen by Leaches is more of the substance of bloud Albeit the opinion of some is that they drawe no bloud but corrupt bloud and such as is not agreeable and proportionable vnto our bodies And therefore in griefes which happen betweene the skin and the flesh of bloud corrupted these are more conuenient than scarrifieng The attracting of bloud by Ventosas and horseleaches hath this difference that these drawe more deepely from the body Ventosas but from the superficiall partes Therefore let Leaches bee applyed to those places from whence we would drawe humors more deepely Their vse and application is this First before they bee put to any part of the body they must be kept all one day before and nourished with a little bloud which wee may giue them in a little piece of fresh flesh then we must put them and keepe them in cleane water somewhat warmed and before we vse them with a spunge wipe away the skinne that is about them Rubbe the part of the member affected whereto you will apply them with salt or scratch the same till it looke red or annoint the same with a little fresh bloud Some lay on them a spunge that when they be full they
may fall away They are with most safety let downe in a reede or a pipe to the affected member lest they might touch together and so by that meanes of ende those partes that are sounde and whole And first before you apply them so presse them and wring them out that they may vtter and cast forth all their venome so as their backes bee greene and their bellies reddish VVee are to choose such Leaches as are not in fowle troubled blacke waters nor such as haue long rayes or strikes in them like roddes called Hyrudines Virgulatae Nor such as are of the colour of Lapis Lazulus for these are venemous But wee are to choose them that bee redde inclining to the colour of the Lyuer hauing two redde lines or strikes or inclining to a certaine greennesse hauing little heads and beeing very slender and had out of cleare flowing waters Let them not bee blacke nor hauing a certaine white hearinesse vppon them as wee see there is vppon certaine hearbes as Clarie and vppon certaine fruites as vpon the Quince but as yee heard before take such as haue greene backes and red bellies To make them fall off if neede require put to their heads Salt Lyme Dust Ashes or Vinegar strawe any of these vppon them and they will fall away if you will haue them off sooner put a horse haire betweene their mouthes and the place and drawe them away when they are off wash the place with a spunge To â—â—nt the bloud after they bee remooued if neede so require for sometime bloud floweth out two houres after the Leaches bee gone straw vppon the place powder of roses or of buâ—nâ—d gaâ—ls or powder of a new tile or powde◠〈…〉 straw a little Sanguis Draconis or lay on the place powder of a spunge and pitch 〈◊〉 or a linen cloth burned or the hearbe 〈◊〉 Pastoris bruised â—fter the fall of the Leaches apply cupping 〈◊〉 to purge the venome and excrements which they haue left behind and to withdrawe 〈◊〉 bloud which they haue drawne somewhat outwardly but haue not quite euacuated Finally I giue aduise that before you vse them to the purposes aforesaid you apply them being hungry which is done thus by keeping them in water a day so that they eate nothing If you will keepe them longer put in the same water some Lambes bloud or such like that so they may be kept aliue some season For further matter herein I referre thee to Galen who hath written a booke De Hirudinibus That is of Bloudsuckers Of Cupping or boxing scarification the other two particular euacuations of bloud Chap. 27. FOrasmuch as it is not conuenient to be let bloud oft times in the yeare for that much of the vitall spirit passeth forth with the bloud and that the blould being taken away the body waxeth colde and the operations of nature become weake and enfeebled as we haue before in a certeine place declared therefore I counsell saith Galen that the baser partes of the bodie as the legges be boxed or cupped which is the most sure remedie as well to conserue health as to repaire the same being decayed For it cureth the eyes annoyed with long distillations It profiteth also the head vpper partes of the bodie as the brest and backe and against sundrie other diseases For in what member so euer the bloud is gathered the bodie being first purged by cupping the griefe may be cured Also Oribasius affirmeth that it helpeth Quincies in the throat dissolueth stoppings of all places Notwithstanding application of boxes about the stomack in hote feuers where reason is troubled are to be eschewed for feare of suffocation Likewise put vnto the head vndiscreetly they hurt both the head and the eyes Boxing helpeth swellings letteth foorth winde stoppeth immoderate Termes and the bloudie flixe helpeth appetite when a woman sowneth it reuiueth her â—pirites againe It draweth foorth water asswageth hard swelling clenseth Melancolie and that chiefely in weak bodies It will remoue humors from place to place as from the head to the necke from the neck to the shoulders Galen wrote a booke intituled de Cucur bitula tâ—aâ— is of the Cupping Glasse and rehâ—arâ—â— hâ—â—pâ—â—nese effectes thereof that boxing doâ—tâ— Non solum materiam euacuare sed etâ—â—m dolorem soluere Phlegmonon minuere insâ—â—tâ—onem discutere appetitum reuocare ventriculo in firmo roburaddere aâ—imi deliquio liberare ex alâ—o fluxiones transferre sanguinis eruptiones cohibere facultates mensium corruptrices extrahere mensesque supprimere i. not onely euacuate the matter but also asswage paine take away inflammations abate swellings recouer appetite strengthen a weake stomacke reuiue those that sowne drawe downe fluxes and stoppe fluxes withdrawe corruption of Termes and also stoppe the fluxe of them VVhich effectes shall hereafter be reheased with their cures by this practise more particular There are three causes which perswade vs to vse this practise and to refraine letting of bloud First because our purpose is to euacuate from some one member and not from another and therefore particular euacuation is done by boxing or Cucurbitulas which they that follow barbarous authors in Pinsicke doe also call Ventosas Nowe particular euacuation cannot be made by Phlebotomy for the same euacuateth and emptieth from the whole bodie Secondly because the strength is weake or the age vnfit to bleed or that there is some other of those impediments spoken of in the 8 Chapter For as Rhazes sayeth in 7 Ventosas drawe bloud but from the little veines and therefore the heat and spirites are thereby but a little diminiâ—hed whereas opening of a veine greatly debilitateth nature drawing from the greater veines with the bloud much heat vitall spirites Thirdly because our intent is to euacuate onely from the baser members Bleeding euacuateth from the most noble members and greater veines Ventosas from the meane members and little small veines which arein the outward bodily partes and lye without the greater veines Of boxings there are two sortes the one gentle without scarification or launcing the other with scarification which both in steede of bloud-letting are vsed when age debilitie the time of the yeare or other considerations will not permit the op ening of a veine Hereby is produced the thinne bloud next the skinne and being presently vsed after scarification when little incisions and holes are made in the member that bloud and humors may easily come foorth it mightily withdraweth by force and flame of heat not onely the thinne flowing humors and spirites which are about the member after scarifying but also that which is in places further distant If the skinne I say be first exasperated with the Iron it doth this that wee heare speake of more manifestly If the skinne be whole and not scarified it prouoketh bloud and humors from the furthest parts into the skinne and bringeth it to that parte whereunto the cupping boxes are applyed The cupping glasse infixed the skinne being incided or launced purgeth the
outmost parts of the body more mightily than if to the affects wee onely vsed either scarification or only leches Boxings without scarification which are called easie cuppings do not apparantly withdrawe bloud but only the spirites yet it doth pull backe vnto it humors and forcible fluxes and applyed to the contrarie part it stayeth effusion of bloud in any place wheresoeuer chiefely when infirmitie of strength will not permit revulsion by opening of a veine Moreouer it stayeth fluxes of the wombe or of humors and applyed to the member where the fluxe of humors is it turneth the same anothet way Also it prouoketh outwardly that fluxe of humors which lyeth deep in the bodie therfore it serueth as a remedie in astonishmentes palsies in veterat paines it wasteth winde spirites included in any member and therefore quickly stayeth tremblings or pantings of the heart or else-where within the bodie the hicket colick paines of the raines And this present kind of remedie is without daunger neither hurting the bodie nor weakening the strength That easie light boxings are best for revulsion as to pull back Termes appeareth by Hippo. 5. Aphoris Aphoris 50. Simulieri menstrua sistere volueris Cucurbitulam quam maximam sub mammis defige If thou wouldst stay Termes in a woman apply a good great cupping glasse neare or aboue her pappes And Galen 5. lib. Ther. Metho with easie boxing applyed Hypocondiis i. the sides short ribbs aboue the nauill where the Liuer lyeth on the right side and the Splene on the left affirmeth bleeding at the nose to be stayed being applyed on the Liuer or right Hypocondrion if the fluxe come foorth of the right nosthrill and on the left Hypocondrion and on the Splene if from the left and vpon them both if it proceed from both the nosthri's Againe gentle cupping is vsed in such persons as are alreadie euacuated in stuffed bodies wee vse them not nor in inflamed members nor in the beginning of other affectes but where as nothing else hath beene before or where the bodie hath beene alreadie euacuated In this case of revulsion by cupping without scarification as in fluxe of Termes as ye heard out of Hippo and in fluxe of bloud from the nose as ye heard out of Galen be verie circumspect to apply the cupping glasses on the member set ouer against the place from wheÌ„ce wee purpose to pul-backe according to rectitude of position that the place cupped may haue agreement with the place from whence wee purpose to reuoke Otherwise wee doe no good as we shewed before speaking of revulsion in bleeding Chap. 6. Againe gentle cupping is vsed without scarification when wee will drawe humors from deepe and inward partes of the bodie to the outward members Therefore Galen 13. Method Medend saith that it is caeteris attractiuis fortius stronger than any other attractiues thus in harde apostumations it draweth the matter outward yea and by it hard apostumations may be remoued if generall euacuation haue gone before according as the fulnesse in the patient requireth Againe it is vsed without scarification when we stay any member or bring a member to his proper place Thus when the bowels fal down we applie Ventosas aboue the bellie to reteine them or bring them back Also it is vsed without scarification to dissolue windines as in the collick so a cer em fat woman troubled with the collick tooke two narrow mouthed pots did put them magret brasen vessel she did put the vessel of brasse to the fire afterward applyed the two hot pots to her bellie first couering the same with alynnen cloth so shee was healed Item it is vsed without scarification to mittigate paines that in all apostumations and colliks generally whether the same be cauâ—ed of cholenke matter stegme or windines Galen lib. 13. Metho Medond Cap. aâ—firmeth 〈◊〉 it wasteth wind so careth the cause iâ— it come thereof or it mittigateth the pâ—ine aâ—beit it doe not perfectly cure it of what matter so euer it come VVith scarifying it is vsed in inflamed members stuffed or vexed with paine in the disease called Scirrhus which is a haâ—dâ—â—â—s growing in the fleâ—h within the skinne called commonly kirnels in fluxes that are stayed in a certaine place Also when the parts are filled with sharp matter or outwardly infected with venome or when we will draw the matter from one member to another Also it is vsed with scarification in sharpe diseases when the strength is weake and nature not able to tollerate bleeding And thus you haue heard in what cases boxing is vsed without scarifying with scarifying which is a worthie and profitable obseruation The difference betweene Ventosas Phlebotomy is that Phlebotomy euacuateth the grosse bloud and the other subtile and thinne bloud Againe Ventosas are called attraction per vacuum and differeth froÌ„ attractions made by medicine or not made per vacuum Attractiue medicines which do purge attract euacuat some certeine determined humor Phlebotomy all the humors indifferently and Ventosas or attraction per vacuum that humor that is most subtile and thinne among them all in that part The difference betweene the attraction made by Ventosas and that made by leaches is this that the leaches drawe humors from the profound and deepe places and Ventosas but from the superficiall partes Item fat persons are not to vse cupping for it is with them as with water pypes in the ground which being filled and stopped with earth or other matter stay the water course that it cannot run so the veynes in the body are like those water pipes and are sometime so filled with fleshy fat that the bloud cannot haue his course thorow them and therefore the veynes in fat folke beeing either so strict or so stopped the Ventosas cannot withdrawe from them but with great violence and if they attract any thing it is the most subtile bloud the grosse bloud cannot passe thorow the stopped places Concerning the time they are not to bee vsed at the new of the moone because then the humors are quiet and so hardly drawen nor in the last quarter for this season being cold the humors are not easily attracted but in the middle season when the humors are flowing and are not too colde and vse them in the third houre of the day for then by reason of heate the poores are opened and the bloud beeing then easily mooueable is with the more facility attracted to the members and from the members After bathings we are not to vse them for there were to bee feared too great a fluxe of bloud yet if we can perceiue the bloud to bee too grosse wee may to subtiliate the same vse bathing before in such a case as was saide in the rules of Phlebotomy That these pointes thus generally spoken of me hitherto may in particulâ—r with more profit yet now be set downe wee will before we conclude proceede therein a â—itle further to the
of the bodie in this case wee vse Phlebotomie without purging Fourthly we may safely let blond without medicine those that are whole for abundance of bloud only are accustomed to yerely bleeding and that haue in the yere taken little or no Phisicke as it chanceth to many persons in many countries of the North. Fiftly we may open without purging the inner vaine of the arme in women with child if they carrie Corpora Phletorica full bodies that in the 5. 6. or 7. moneth after the conception yea also before they be quicke This practise wee are to vse specially when they being with child waxe verie slowe heauie as it were ouerladen with abundance of bloud we may take Salua tella veine or if plenitude so require the inner veine of the arme for the quantitie respecting a discreete moderation Sixtly we may let those bloud without medicine that haue fallen from some high place taken hurt in the brest and stomacke in whome is to be feared an inconuenience called of the Greekes Egchymosis Seuenthly we speedily let bloud such persons without further Phisick as by reason of their fulnes through some accident as feare or such like waxe domme in which case wee let bloud abundantly so that both armes are opened together Here I am to note a great error in Auicen both repugnant to trueth it selfe and also contrarie to Galen For Auicen affirmeth that when colde and thicke humors are in the bodie first wee must begin with purging and then open a veine Diuers and many waies hath he erred in this First because in flegmatick humors grosse and colde mixt with bloud hee woulde haue Phlebotomie not vsed before purging And in this case by all likelyhood of reason the cure should begin with bleeding Secondly in this hee dissenteth from Galen who 11. Method Chap. 4. though there were obstructions in the bodie of thicke and clammie humors yet first hee would begin the cure with Phlebotomie If Auicens meaning be when flegmatike humors ouercome the bloud in multitude or abundance that then wee must first vse purging then is hee greatly deceiued for as much as hee proponeth a case in which Phlebotomie should not auaile except with those many colde humors there be also some excesse of bloud which chaunceth verie sildome or not at all But it may seeme that Auicen hath reason namely this that the bloud being extracted those humors would waxe more rawe and so by opening a veine the patient is brought to a marueilous cruditie of colde humors This is no reason for by Phlebotomy wee detract bloud not because of obstructions caused of grosse and colde humors but because bloud superaboundeth For the stopping is afterward remoued with other helpes Therefore when obstruction concurreth with abundance of bloud wee must not extract verie much bloud but keepe backe some till the time of the cure as Galen teacheth 11. Method Chap. 14. And thus much of the order betweene Phlebotomie and Purging whereby wee see that a strong purgatiue must followe bleeding and that an easie purgation or clister may go before Of the effectes that is Of the profits and disprofits of opening a veine Chap. 5. Schola Salerni in two verses reckoneth vp three effects of bleeding Exhilerat tristes iratos placat amantes Ne sint amentes Phlebotomia facit It swageth wrath and cheeres the sad Preserues loue-sick from being mad FIrst it maketh glad those that are pensiue Secondly it appeaseth such as are angrie Anger is especially caused through mixture of much yellow choler with bloud And sadnesse by commixture of much Melancoly with bloud And forasmuch as both these humors choler Melancoly are exhausted with the bloud these two effectes must consequently follow Thirdly it preserueth loue-sicke persons from madnesse by drawing humors from the head to the lower partes and so expelling the same Although occasion will hereafter better serue to shewe the causes why wee vse Phlebotomy yet here nowe speaking of the effectes I will briefely shewe fiue causes for which wee vse to let bloud and by the which may be gathered the profitable effectes of this practise of the which fiue causes one onely cause is the direct the other foure are indirect The direct cause of bleeding is euacuation of the bloud But forasmuch as bloud is good for nature therfore Phlebotomy must be vsed â—duissdly that the same bloud only may be expelled which is vnprofitable hurtfull to nature Bloud as you haue partly heard is made vnprofitable to nature two waies either when it doth not throughly keepe the proper qualitie that it cannot so nourish as it did before when it was good or when in quantitie it so increaseth that it either presseth downe the powers of the bodie or stuffeth stoppeth both the veines the arteries In these two cases bleeding is good as one of the direct euacuating helpes Yet in these cases bleeding is not to be vsed indifferently but with this difference in abundaÌ„ce of bloud much may be detracted In little plentie small euacuation serueth Hereupon Galen writeth lib. 9. cap. 10. Method Si sanguis vitiosus in corpore fuerit paulatim quod vitiosum est euacuare oportet paulatim ad in o icem quod salubre est pro eo reponere If corrupt bloud be in the bodie wee must by little little take away the bad and by litle litle procure in the place therof that which is good which way of curing or amending of corrupt bloud the Phisicions call in Greeke Epicrasis And to this Alexander Tralleanus subscribeth lib. 9. ca. 2. The reason why this is not to be done at once is for that the powers of the bodie would relent giue ouer And although that which is euacuated be superfluous yet by a sudden thorough mutation it doth more hurt than good It is better therefore to emptie the bodie safely and by little at once than by making hast to dispatch both the disease the partie diseased And here it appeareth how much they abuse Phlebotomy which detract the ill bloud so long til the good also begin to come wheras it may fall out that all the bloud will flowe forth of the bodie before that the good will appeare It behoueth therefore the euacuatioÌ„ to be little And as Gaelen councelleth in this case before the opening of a veine to vse Epicrasis i. to giue the patient such meat as may cause good bloud that good bloud may still come in place of the bad and then a little after more bloud may be taken This therfore is called the direct bleeding because it is don of it self to euacuate that which by opening a veine ought in deede to be withdrawen namely multitude of humors of bloud of bloud principally of humors secondarily in asmuch as they are mingled with the blod The other are called indirect causes and are vsed only to reuoke or call backe the violent force of humors to the contrary part or