of the ayre doth keepe the spirits from flying too fast out But in the sommer or hoat weather he will haue the orifice to be narrower because the bloud is commonly then more subtile and heate doth helpe much to dilatation passage If it fall out to be temperate weather then to proceede in the meane betwixt both The verses of the Salerline schoole are to be vnderstood of full strength and powers Fac plagam largam mediocâ—â—â—ter 〈…〉 exeat vberius liberiusque cruor Make well and wide thy blow That bloud and fumes may largely flow Hippocrates sayth In places where 〈◊〉 no danger and where the bloud also is grosse vse a broader launcer for so the bloud will passe otherwise not but take heed of going too deepe Fernelius sheweth some dangers Vnder the inward vayne lyeth an artery vnder the middle a sinew and vnder both do lye the tendones of the muscles If any of these be pearced there may ensue much griefe and sometimes great danger The cephalica may be opened with least perill of all the vaynes which appeare in the cubâ—â—e Now for the quantity of bloud how much may be taken at once I haue had occasion to declare much already concerning that poynt when I intreated in my former booke of Phlebotomy in particular diseases I meane not therefore now to stand much vpon it Montanus vpon the fourteenth Canon of Auicen doth appoynt that in old diseases when by long infirmitie the bloud is become grosse we must take but a little bloud at once and reiterate the bloud-letting often and still in the meane time to nourish yâ— patient with a good moistening diet If the bloud appeare to be whitish then as Auicen will haue it you must let out none at all least a cachexia or bad habit or dropsie do thereupon ensue Fuchsius doth giue vnto a Chirurgian three generall notes whereby he shall gesse when is the fittest time to stay the bleeding first by the change of bloud secondly by the force of flowing waxing more faint and thirdly by the change of the pulses The first that is the change of the bloud both in colour and in consistence must then especially be attended and wayted for when the griefe or inflammation for which we let bloud is neere vnto the place where the vayne is opened For Hippocrates sheweth that in a pleurisie the bloud which is nigh vnto the inflammation doth farre differ from that which is conteyned in other parts of the body being by the vehement heate much altered so that if the bloud of the rest of the body be phlegmatick it will be about the inflammation red and if the rest be red it will be about the inflammation adust and burnt This change of the bloud is not alwayes to be taryed for for it may be that either the strength is not able to indure it or else that the phlegmone is such a maligne and impacted humour that it will hardly giue place In these cases wee must cease before the bloud doe change and the rest is to be withdrawne by a second phlebotomy The other note to know when it is time to stay the bloud is by the violence of the flowing now waxen more slow feeble for that sheweth that the strength and powers are ready to decay especially if palenesse of the face and dazeling of the eyes do begin to draw on But the most certaine signe of all when we must stay the bloud is the changing of the pulse for if of thick it become thinne if of great it become little if of vehemently strong it become weake and obscure if of equall it become vnequall it presageth that the powers are now ready to be dissolued The safest way in letting bloud is to be sure to be within compasse what wanteth may easily be supplyed by reiterating but what is taken too much can not so easily be restored Heere an other doubt may arise when either for the toughnesse of the hamour or for the weakenes of the party the bloud is let not at oncâ— but at seuerall times how neere those times ought one to succeede an other Fernâ—lius sayth In diseases that vniuersally afflict the body the best is to let bloud twise in one day but in the griefes of particular parts the reiterating must be longer deferred to wit to the second or third day Ficinus counsaileth such as by studyes are growne melancholick to be let bloud if they feele a plenitude and he appoynteth it to be done twiâ—e in one day in the morning and in the coâ—ning but at either time sparingly for he sayth bloud is the temperer of melancholy the nourisher of the spirits and the treasure of life The like speech hath Auicen in his third canon where he aduiâ—â—th men that are troubled with a long lingring disease not to be too wastfull of their bloud because a long iourney remayneth to them and therefore they had neede to gather store of good strength he addeth this precept Keepe bloud as a pretious treasure In that quartaine ague which commâ—th ex atra bile and in other infirmities comming of the like cause seeing that the atra bilis may come as well of bloud or fleame as of choler or melancholy the black bloud sheweth that it proceedeth of bloud aduâ—t and therefore a more larger Phlebotomy is permitted vnto it then vnto any other atra bilis which shall proceede of choler fleame or melancholy adust But otherwise the common opinion of Chirurgians who thinke that generally the corrupter the bloud is the more plentifully they may let it flow out is vtterly condemned by Fernelius You must not when the bloud is more impure or raw or is estranged and departed from his owne nature then take so much the more away after the manner of common bad Phisitions but by how much more the humours are departed either on this side or beyond the nature of bloud so much the more sparingly and leasurely you must let that bloud sâ—ow and when it shall be found to be very farre from the forme and shape of bloud then must you altogether abâ—taine from Phlebotomy for where there is little good bloud there must needs the strength be weake The corrupt bloud doth seeme very fit to be expelled as Galen sayth That which is corrupt is against nature and that sheweth that it ought to be taken away The constitution therefore of the bodie doth shew that this ought to be our scope and drift to euacuate the matter either by Phlebotomie or by purging but on the other side the weakenesse of the powers will suffer neither of them How must we doe then in these great contrarie occasions Galen maketh answere We must in these contrarie occasions and drifts by little and little auoyd the bad and by little and little restore the good which healing of euill humours is called of Phisitions Epicrasis or good tempering of humours Why doth Galen then
HARWARDS Phlebotomy Or A Treatise of letting of Bloud Fitly seruing as well for an aduertisement and remembrance to well minded Chirurgians As also to giue a caueat generally to all men to beware of the manifold dangers which may ensue vpon rash and vnaduised letting of Bloud Comprehended in two Bookes Written by SIMON HARVVARD Imprinted at London by F. Kingston for Simon Waterson 1601. ⧠To the Right Honourable his singular good Lord Gilbert Earle of Shrewsbury Baron Talbot Lord Comin of Badenho Valence and Montchency Lord Strange of Blanch-minster of Brimsfeld Corfham Furniuall Verdon and Louctoft Knight and companion of the most noble order of the Garter and one of her Maiesties most honorable priuie Counsell many ioyful and happy yeeres with all increase of Honour IT is a propertie Right Honourable my singular good Lord naturally giuen to euery workman and artificer that be his worke neuer so rude and homely yet would he be loth that his labour should vanish and perish but seeing that it is the best that his abilitie can performe he desireth the same as long as may be to remayne and continue vpon the earth This cause maketh also many to be so forward in publishing their writings in print that when they themselues are taken away by death yet by their works there may still remaine some lasting record and remembrance of the workemen But the especiall cause which hath mooued me at this time to set foorth these my two bookes of Phlebotomy is the sincere affection and desire that I haue to bring some supply and helpe if I can vnto two very great wants and abuses which I dayly perceiue to be now too common and grassant in sundrie corners of this realme For first although in Cities as principallie in the famous Citie of London the people enioy a great blessing of God in hauing so many worthie and expert Phisitions and Chirurgians so neerely dwelling together that at all times the one may be able and readie to aduise and the other also as willing and sufficient to lend a helping hand yet in Countrie townes there are many nowadayes which doe practize the opening of vaynes almost in euery other Village one and most of them neither haue any learned counsaile to direct them neither are of themselues sufficiently instructed in the matter which they take in hand whereby though many of them do meane well and intend all for the best yet in the euent both to the harme of their patients and also to their owne griefe there often insueth more hurt and danger then ease and succour And another as great an occasion there is of many detriments and hinderances to mans health to wit the wilfull temeritie and rashnesse of some ignorant people which for euery small impediment haue recourse presently to letting of bloud and by their vnaduised importunitie do vrge forward the Chirurgian and euen greedily draw vpō themselues those manifold inconueniences from which afterward they can not againe so easily be deliuered and made free For although on the one side the benefits be most excellent which redound by Phlebotomy being rightly duly administred for thereby the fulnesse of the body doth come to a mediocrity griefes which come by extension are pacified the spirits are refreshed naturall heate euented the lims being as it were eased of a great burthen are made more quick ready to execute euery office nature is inabled to concoct what is requisite and to expell the vnprofitable flowing humours are either drawne back or turned aside from the place where they annoy or else are they dispatched and vtterly auoyded narrow and obstructed passages are opened and finally very present help is brought thereby to many dangerous infirmities Yet on the other side great also are the harmes which may ensue by letting of bloud if the same be rashly and vnconsiderately attempted the spirits and bloud are spent and wasted the naturall heate is pluckt away and dispersed the principall parts are made ouercold and vtterly lose their strength old age is hastened on and made subiect to palsies apoplexies dropsies and cachexies or bad habits many the bridle of choler being taken away do in a moment fall into most faint Iaundises many haue the one halfe of their hearing and sight diminished and the one arme and the one side vtterly weakened and many also are brought to an vnrecouerable destruction of their health and life To redresse in some part these most perillous incidents I haue collected out of the most famous Phisitions both auncient and moderne this discourse of Phlebotomy which although it be penned as commonly Phisick treatises are in plaine and familiar words most fit for them to whome it is principally directed yet because it comprehendeth the handling of one of the greatest remedies of corporall griefes as a learned Phisition commenting vpon Galen ad Glauconem doth write Venae sectio in magnis remedijs ab omnibus medicis semper habita est And Messaria the chiefe Doctor and professor of Padua in a treatise of Phlebotomy dedicated to Contarenus a worthy Senatour of Venice sayth Inter medica remedia nullum sanguinis missione nobilius nullum praestantius nullum tutius and doth call it further generosum praesentaneum vitae hominis praesidium And seeing also that amongst the high cares and charges which chiefe peeres and gouernours do beare in common wealths this seemeth not to be the least which concerneth so neerely the health the strength and euen the life it selfe of so large a part of the inferiour commons I haue therefore aduentured most humbly here to present and offer this my first part of the great Phisick remedies vnto your Honours patronage and fauourable protection not doubting but that according to your Lordships accustomed clemencie you will vouchsafe the same thereof not so much respecting the poore gift as the good heart of the giuer and according to your prone inclinatiion vnto the truth and to the generall good of the commons your Honor will haue greater regard vnto the graue auctorities of the auctors out of whome these obseruations are collected then vnto the homely phrase and plaine method of the obseruer and collector thereof The eternall God who hath heaped vpon your Lordship all those degrees of honour vnto which your noble Progenitours haue often heretofore bin most worthily aduanced graunt vnto your Lordship with the like good successe as they in former times haue done many prosperous yeares happily to inioy them to your dayly increase of honour and to the good and glory of our English nation euer continuing you in the high fauour of our most gratious Soueraigne and blessing you perpetually both in this world with the loue and hartie affection of the whole Commons and also for euer with the happie societie of the Saints in the life to come From Tanridge in Surrey this 29. of August Anno. 1601. Your Honours most humble in all duties to be commaunded Simon Harward The Preface declaring
the order and contents of these two bookes of Phlebotomy BEing purposed and resolued for the more generall benefit of my countrymen to publish in two english treatises the first whereof I do heere in title Phlebotomy and the other godwilling hereafter as soone as leysure shall serue Cathartice as compandiously and as orderly as doth or shall lye in my power all the chiefest aphorismes and conclusions which haue bin handled and written by the most famous Phisitions of all ages as concerning such cautions and circumstances as are to be obserued in letting of bloud or purging the body of man Although in practise it doth in many cases fall out that purging ought to take place before the opening of any vayne as shall hâ—ereafter more at large appeere in this booke yet for as much as bloud is the most excellent and principall humour that is dispersed in the whole body according to that of Galen 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 the best and most familiar iuice in man is bloud I haue therefore thought good in my methode of declaring how we must deale with these seuerall humours to follow the example of diuers learned men of our time to wit in respect of the disposing of them to giue vnto bloud the first place and preheminence These two remedyes are not onely accompted the chiefest amongst the kinds of euacuations but also amongst all other corporall helps prescribed or inuented for the curing of mans infirmities As well affirmeth Mercurialis Duo magnorum auxiliorum genera reperiuntur purgatio nempe sanguinis missio There are two kinds of great remedyes found out to wit purging and letting of bloud These 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 are called great helps because they are applyed vnto great diseases and also because howsoeuer they beeing abused do bring the greatest harmes yet beeing well and rightlie administred they do bring the greatest and most present cases and remedyes that euer either inwardlie or outwardlie were deuised for mans health This my first part of the Remedia magna in Phisick I haue comprehended in two bookes the summe and contents whereof as also of euery part thereof I haue thought it not amisse first briefely to prefix and lay open to the view of the well willing reader The first booke shewing what Phlebotomy is and to what vse it serueth in seuerall diseases conteyneth tenne Chapters The first what Phlebotomy is and of the foure distinct kinds and vses thereof The second how letting of bloud ought to be vsed in continuall agues as also in burning feuers The third how bloud-letting may be admitted in some kinds of diary agues made by obstructions The fourth how farre letting of bloud may be allowed in intermitting agues quotidians tertians and quartaines The fift whether letting of bloud be to be admitted in the Plague and pestilent feuer as also in the Poxe measels and such other contagious infirmities and when and how The sixt how letting of bloud is to be vsed in phrensies quinsies pleurisies inflammations of the raynes or wombe and other inward inflammations as they are considered in themselues without agues The seauenth in these dangerous inflammations aforesayd whether euacuation or reuulsion be more necessary on whether side the vayne is to be taken for reuulsion and what is the meaning of Hippocrates his rule 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to flow rightly or with a right course The eight whether letting of bloud be to be practised in cold diseases as palsies cramps apoplexies and whether it may fitly be vsed in melancholick windes colicks and dropsies The ninth whether in rheumes and distillations as also in the gout and in Morbus Gallicus any benefit may ensue by letting of bloud The tenth whether letting of bloud be expedient for such as haue hoat liuers and cold stomacks as also for such as haue itches and scabbes and such other faults of the skinne Further whether it be fit for the disease called of sea-faring men the skuruy and for the cachexia or bad habit of body and finally what and how many are the drifts and scopes in letting of bloud The second booke concerning the rules and circumstances which are to be obserued when for the preuenting or curing of a disease any vayne is to be opened conteyneth likewise ten Chapters The first whether the party that is to be let bloud haue truly that distented plenitude which is called of Phisitions corpus plethoricum and how the seuerall kinds of plenitude may be knowne The second of the consideration of the temperature of the party what it is by manner of diet or by exercises or by place of aboad or by custome or by habit or by constitution of body The third whether the body haue neede to be prepared before letting of bloud The fourth of the age sexe and solubilitie of the party whether old men or children or women being either with child or hauing their termes may be let bloud Also whether any hauing bodies either too costiue or too soluble may be let bloud The fift of the state and time of the disease what consideration is to be bad thereof in bloud-letting and which we must regard most of the powers the animal the naturall or the vitall The sixt of the time of the yeare the time of the constellations of the planets and the time of the day most fit for letting of bloud The seauenth on whether side the vayne is to be taken when we let bloud to preuent diseases or to auoyd or deriue their matter as also what vayne must chiefely be chosen for sundry infirmities The eight what manner of incision must be made how large how small how deepe what quantity of bloud may be taken and therein of the meaning of Galens word to let bloud ad animi deliquium The ninth what order must be taken with them that are let bloud as well in the act it selfe to preuent swounings as also afterward for their gouernment and diet The tenth how defects and errors are to be supplyed and mended and how the Phisition and in his absence the Chirurgian may know by the bloud being a little while reserued what course is further to be taken with the patient Before I enter into the discourse vpon these seuerall arguments I must pray the reader first to giue me leaue briefely to answere certaine doubts and occasions of offences which perhaps might arise vpon the publishing of this treatise First therefore if any because I baning heretofore committed to the pressse certaine Sermons and matters of Diuinity do now begin to set forth a Phisick worke do therefore gather or suspect that I haue conuerted my studies from the scriptures vnto Galen let him know that in this point I am vtterly mistaken by him for most of my phisick obseruations were then collected when first I gaue my mind that way which was long before I published any matter of Diuinity so that if there haue bin any alteration or conuersion of studies it hath
repletion termed quoad vires is rather to be holpen by medicins then by letting of bloud For if raw and vndigested humours do abound in the body the opening of a vayne will draw out much good bloud but as for the bad bloud which is gathered in the first vaynes about the liuer and the middle entrals it will draw it into the whole body as Galen doth at large demonstrate and therefore euacuation by some purging potion shall in this case be more fit then letting of bloud Yet when by the nature of the disease there is euident danger of a corruption and putrefaction of humours to ensue then a little quantitie of bloud drawen shall be much auaylable to anticipate and preuent it if alwayes regard be had how farre the strength will permit and what humour is especially mixt together with the bloud in the vaynes For as Fernelius sheweth there is another way two kinds of repletion or plethora the one is called pure the other impure Montanus maketh also two the one simple and the other compound The pure doth consist of in a manner an equall portion of all the best iuices The impure is an abounding of vicious humours in the vaines If the plenitude come by choler the vayne may the more plentifully make euacuation But if the fulnesse come by fleame or by melancholie then must the euacuation be made by little and little at seuerall times when necessitie requireth and when the vaynes being ouer-full doe threaten danger How all these seuerall kindes of plenitude shall be knowne I shall haue occasion to declare more at large in the first Chapter of the second booke The first vse of Phlebotomy to wit euacuation hath place not onely in pure repletions but also in all dangers of putrefaction according to that of Galen It is good to open a vayne not onely in feuers called synochi which haue one continuall fit and doe proceede of inflamed bloud but also in all other humours that stand in danger of putrefaction when the regard which is had of age and strength doth nothing prohibite For nature which doth dispose and gouerne our bodies being lightened and hauing put off that which aâ— a burthen did ouercharge her will easily ouercome the rest in such sort that it will concoct what is to be concocted and expell what is to be expelled The second vse of letting-bloud is called of Montanus euentatio wherupon he maketh a secoÌ„d kind called Phlebotomia euentatiua which is the venting of any humour that doth boyle and bubble within the vaines For as the former to wit euacuation hath respect vnto the plenitude so this 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 hath properly a relation to the boyling and bubbling So â—ayth he in quotidians and quartans we do often let bloud not because there is any fulnesse or great multitude of ill humours but because we would by venting take away the boyling and bubbling thereof This venting hath place both whether there be any putrefaction in the humour or no. But if our scope and purpose be only simply to vent then is it best to do it by letting a little bloud and often according to the rule of Auicenna Melior est multiplicatio numeri quà m quantitatis Otherwise if the case be compound that both there be a fulnesse and a boyling that we must both euacuate and vent then shall it be most fit to do it at once and plentifully and as long as the strength will permit as is taught at large by Galen in the eight booke of his Methodus medendi And in the same booke speaking of some agues that are like to Diarian feuers and do come of obstructions he doth vse these words That the humour may be vented wee haue neede of the great remedy wee must let bloud the party being of sufficient strength although there be no signes of plenitude How it shal be knowen when the humours do thus boyle and haue neede of venting it shaâ—l be layd open at large in the two Chapters next following The third vse of letting bloud is called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Revulsion Montanus calleth it Phlebotomia diuersina which is a plucking back of humours when they are caried from any one part of the body into an other with force and violent course Euacuation doth respect the fulnesse Venting the bubbling vp and Revulsion the violent course of the humour How this revulsion must be made is discussed in the seauenth Chapter of this first booke The fourth vse of bloud-letting is called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 deriuatio of Montanus Phlebotomia deriuatiua which is a deriuing of a humour from any place where it is settled and impacted into some other neere place by which it may best be ouercome or auoyded It differeth from revulsion two especiall wayes First revulsion is into places farre distant as Hippocrates sheweth We must endeuour to open a vayne distant as farre as may be from the place where the griefe is made or the bloud gathered for so there shall be no danger of a sodaine change and besides the custome being translated an other way thou shalt make that there shall be no more flowing to the former wonted place But deriuation of humours is into the neerest places as by which they may most fitly be auoyded according to that of Galen Deriuation is made into places nigh ioyning but revulsion is made into places plaine opposite Againe an other difference there is that revulsion is of humours now flowing but deriuation is of them that are already settled as is witnessed by the same Author If the flowing be still caryed in his violent course we must vse revulsion to draw it to the contraries but when the humor is setled and impacted in the place then it is better to deriue it He giueth the reason of it for the change is neerer and both the accesse and the drawing force of the purging medicine is more readie when the place is nigh And what there he speaketh of medicins the same he writeth of Phlebotomy Reuulsion is the remedy of fluxes or rheumes still flowing but deriuation is their help when they haue taken hold of any part but both these kindes of euacuation doth Hippocrates commaund to be done by the common vaynes Thus much briefely concerning the first question what Phlebotomy is and of the foure seuerall kinds or rather vses thereof CHAP. 2. How letting of bloud may be vsed in continuall agues called synochi in hote agues and how also in burning feuers BEing now to declare particularly how Phlebotomy is to be vsed in most of the vsuall diseases which coÌ„monly do raigne amongst men seeing there is no kind of infirmitie that hath more sorts of it selfe subiect to letting of bloud then hath the Ague I haue thought it not amisse to begin first with it In the ague synochus which hath one continuall fit seeing that it proceedeth of the inflammation of bloud needs must
the opening of a vayne be very fit and conuenient for it But there are two kinds of it The one is called synochus mitior or ephemera extensa in which only the thinner part of the bloud is kindled it is dissolued very often before the fift day it hath the vrine somewhat reddish and thick the pulse great and thick but not euidently vnequall And the other is called synochus vehementior wherein the whole substance of bloud is inflamed It carieth manifest notes of crudities to wit vnequalnes in the pulse and the vrine red and thick and the tongue waxeth somewhat rough and blackish In either of these synochi letting of bloud is requisite and that as plentifully as strength will permit If at the first it were omitted it may be done in the fourth day or in the seauenth day or after the seauenth day But the best and safest time is euen in the beginning of the infirmity as Fernelius sayth It is more safe to let bloud when the disease approcheth then when it hath already taken possession of vs according to the old verse Aegriùs eijcitur quà m non admittitur hospes It is a more hard thing to cast out a bad guest then it is at the first not to admit him And therefore Platerus willeth vs in these synochi sine putredine wherein the bloud is not putrefied but inflamed to hasten the letting of bloud not only to vent or euentilate the bloud inflamed but also to pluck back the same least breaking out of the vaines into the principall parts it doth stirre vp there most perilous inflammations For Platerus and Fontanonus be both of this opinion that the inflammations in the noble parts do follow these synochi and not go before them And therefore they do aduise in the first beginning to open a vayne and if in the first day it be omitted when the ague is thought to be but an ephemera an inflaming of the spirits for one day yet the next day following when it appeareth plainely that it is no ephemera because it lasteth longer then a day but that it is a playne synochus then let out bloud boldly a good quantity according to the strength of the partie or else take the lesse bloud at once and open the vayne either the same day or the next day againe which is the safest way for such as be weake In this ague doth the second vse of Phlebotomy to wit euentatio or euentilatio greatly shew forth his power according to that of Galen writing of the hoat ague called synochus In whom soeuer the body in the multitude of humours being made vnapt to vent and breath out hath gathered such a heate that now it is come to a feuer the party must be let bloud as much as strength can endure knowing that if this remedie be not taken they which are so affected shall either be strangled by suffocations or suffer syncopies and very dangerous sâ—ounings wholy to ouerthrow them Montanus writing vpon the thirtenth Canon of Aâ—icenna concerning bloud-letting doth make three seuerall sorts of this hote ague comming of bloud inflamed and sheweth in which of them bloud may best be let The first is called Homotona which from the beginning to the end doth keepe the same tenour The second Epacmastica which increaseth more and more vntill it come to state and vigor The third Paracmastica which alwayes decreaseth In the first and the last he admitteth boldly to let bloud but in the second sparingly least strength and power fayling the disease should ouercome nature So also if it be febris putrida or synochus cum putredine a feuer wherein the humor is putrified he doth require a little before in the same booke that we should not let bloud in any great quantity Because where the humour is already putrified although though we should let bloud euen till the strength fayle yet should we not auoyde the putrefaction for putrified bloud is become earthly and therefore can not be expelled And if we let bloud in a great quantity the putrefaction will still remaine and the vertue and strength will be made so weake that we shall not be able to remoue that putrefaction which remayneth He obiecteth the example of Galen his practise who in a certain seruant hauing this synochus cum putredine did let bloud pleÌ„tifully to swouning or fainting But he answereth to that place that when Galen came to that seruant the humour was not fully putrified but only that there appeared some signes of putrefaction and in the second day he opened a vayne So that when the signes of putrefaction did begin he let bloud and not when the humour was alreadie putrified and further it was a feuer alwayes declining But he coÌ„cludeth there I say playnely that of the feuer should be with a putrefaction and a vaine should be opened the patient should be killed The most certaine signe to know when the ague is faulty only by meanes of the inflammation and when it is faulty by the putrefaction is as Trincauel in his explanation vpon Galen doth shew by the systole and diastole of the pulses For there is a double vse of the pulse the one for cooling of the spirits and to that doth serue the diastole or enlarging of the artery for when the artery is enlarged a more cooling ayre being drawne in doth temper the heate of the spirits The other is that the smoaky vapour which must needes be engendred by the force of heate working vpon moysture may be so let out that the spirits may be purified and to this vse serueth systole the contraction or compression of the artery For while the artery is drawne and prest togither the hote ayre and smoky vapours are expelled and auoyded Now it must needes be that betwixt these two contrary motions a rest must of necessitie goe betweene them When there is neede of cooling there the diastole or enlarging of the artery is swifter and the inward pawse or rest is shorter but where there is more neede of auoyding moyst and putrifyed excrements there the systole or contraction of the artery is swifter and the outward pawse is shorter And this later he maketh to be the most certayne note to know all putrifyed agues in which the humours rotting many smoky vapours must needes be engendred this he calleth so proper familiar inseparable and certaine a signe to know and discerne putrified agues from others that it neither doth nor can deceiue An other signe there is of a putrifyed ague when exspiratio est inspiratione insignior when the breathing out is more euident then the breathing in because there is more neede of exhaling putrified vapours then of cooling Alex. Massaria pag. 134. sheweth sundry causes why letting bloud should be good in putrified agues first it cooleth and dryeth and all cooling and drying things are good for putrefactions Againe it is good in respect of the ague and last of all it
helpeth much transpiration by meanes whereof it must needes be good to help putrefaction When Montanus affirmeth that to let bloud in putrified agues is to kill the patient he meaneth a liberall euacuating of bloud but otherwise his words before do shew plainely that it may be done moderately to vent the vapours And Platerus sheweth an other cause why it ought to be done because the occasion of putrified agues doth lie hid in the bloud and in the branches of the hollow vayne together with the bloud is auoided some portion of the putrified humour Of the same iudgemeÌ„t is Fernelius The opening of a vaine which may take away both the multitude and also a great portion of the putrified humour doth greatly auayle to the curing of the feuer And an other reason sheweth Galen why this must be done because nature being disburthened of a part shall the more easily ouercome the whole as I haue declared in the Chapter going before in the first vse of Phlebotomy If the ague be that which is called Causo the burning feuer whose matter is not the heate of bloud but the burning of choler and whose signes are tossing of the body an vnsatiable thirst the toong dry and rough either yellow or black a nipping about the stomack and liuer yellow excrements the vrine very thinne and something wanne the pulse swift thick and hard doating a little sweate about the forehead and neck but euery where else the skin very dry and therewithall a little rough letting bloud may also well be vsed at the beginning but in no great quantity only foure or fiue ounces for venting or euentilation are sufficient Auicenna in his curing of the Causo doth affirme that bloud is not to be let in it vnlesse there doe appeare rednesse and thicknesse of vrine but that is not Causo but rather synochus Montanus sheweth that the true continuall burning feuer seeing that the matter which doth putrifie in it to wit choler is most hote and most dry it becommeth in a manner altogether firy Hppocrates teacheth the way of curing a burning feuer by quenching the burning heate by giuing water and mulsa aquosa but he maketh no mention of letting of bloud thereupon Montanus doth conclude that letting of bloud is not to be permitted in a burning feuer But I thinke Montanus his argument in that disputation vpon the eleuenth Canon of Auicenna is of small force For although Hippocrates do not precisely commaund in that place bloud to be let in a burning feuer yet he maketh it in the same place to be a signe of the dissolution of the disease if the patient do bleede at the nose and presently vpon it he vttereth these words At in morbis acutis sanguinem detrahes si vehemens fuerit morbus qui aegrotant aetate florenti fuerint virium robore valuerint Platerus doth require in the Causo or burning feuer that there should be a liberall letting of bloud if strength do permit because he thinketh it not to proceede of pure choler as many other Phisitions haue taught but of bloud putrified and inflamed in the great artery and causing so much the more daÌ„gerous feuer as it is kindled in the trunck of the great artery neerest vnto the heart If Hippocrates do require Phlebotomy in morbis acutis then must it needes be good in the burning feuer which as Trincauell declareth is maximus acutissimus morbus But still in the quantity Hippocrates his rule must be obserued to haue a due regard of the age and strength CHAP. 3. How bloud-letting may be admitted in agues caused by obstructions as Diaries c. GAlen sheweth that by obstructions sometimes the transpiration and vapouring out may be intercepted and by the obstructions they which haue bad humours fall into agues as Diaries and such like and in them he requireth as very expedient the opening of a vayne first for venting or euentilation for as he saith vnlesse the bad humour be vented it must needs become putrified and secondly because those things which you shall minister afterward to deliuer from obstructions will worke more effectually For it is best to come to deterge and loose obstructions hauing first by bloud-letting for he speaketh there of Phlebotomy auoyded part of the euill humours For we seeking to deliuer the obstructions before we haue made euacuation it is in danger that we shall impâ—â—t the obstructions more firmely then before How the greatnesse of the obstruction shall be knowne Galen sheweth a little after in the same booke The declaration of the quantity of the obstruction is made manifest by the ague for vpon greater obstructions the ague is greater and vpon lesse obstructions it falleth out to be lesse Montanus being fallen into the consideration of this place of Galen doth make three seuerall kindes of obstructions and sheweth in which of them bloud-letting is requisite and in which not The fyrst obstruction is when in the pores of the skinne in the outward parts the transpiration and vapouring out is stayed and prohibited The second kind of obstruction he calleth coarctatoria when such a multitude of humours is conteyned within the vaynes that the passage of the spirits being stopped they cannot passe thorough the vaynes whereby there commeth a perill of suffocation The third obstruction is called oppilatio wheÌ„ some tough matter doth so stop the conduits and chanels of the vaynes that neither matter nor spirits can passe thorough them In the first kind of obstructions Phlebotomy is good because by it the body is made more thin and humors being without the vaines in the compasse of the skinne are by bloudletting drawne into the vaines and so do passe away as Montanus doth demonstrate out of Galen In the second kind of obstruction letting bloud is also conuenient that the thronging together of humours may cease and that bloud may be vented But in the third kind of obstruction it were ill done to let bloud because the thick humour which is impacted in the first vaynes is not thereby euacuated but rather increased as the same author doth proue out of the same fourth booke of Galen de sanitate tuenda I thinke he hath respect to that position of Galen In a werisome and faint body there is little good bloud and many raw humours Phlebotomies do auoyd the good bloud but as for the ill bloud which is gathered together in the first vaynes especially that which is about the liuer and mid bowels they disperse and spread it throughout all the body How in the two last kinds of obstructions the humour must be prepared and made fluxible before we attempt any letting of bloud it is to be declared hereafter in the third Chapter of the second booke But the question is here only of the first kind of obstructions when in an ague called diaria or ephemera which lasteth not aboue 24. howres by reason either
the words of Galen Therefore by the disease and the age and the powers we know that bloud is to be let but the quantity of the euacuation is to be gathered not only by these but by all the other intentions The second booke of Harwards Phlebotomy concerning the rules and circumstances which are to be obserued when for the prenenting or curing of a disease any vayne is to be opened The first Chapter Whether the party that is to be let bloud haue that dâ—â—bented plenitude which is called of Phisitions corpus plethoricum and how the feuerall kindes of plenitudes may be knowen THe principall thing whereof consideration is most to be had in letting of bloud is named of most writers to be magnitudo morbi the greatnesse of the disease of which I haue no purpose now to write seeing it is in a manner the whole matter subiect of the booke already ended When it is found by the nature of the disease that a vayne is to be opened then we are next to examine the constitution of the party from whom the bloud is to be taken and especially by all signes and tokens exactly to waigh whether he haue corpus vere plethoricum a body ouercharged with the fulnesse of the vaynes or rather with excesse of humours ouer the whole body as Galen doth define it Plenitude is an abundance or an excesse of humours thoroughout all the body There are two sorts of plenitude the one is called ad vasa in respect of the vessels conteyning and the other ad vires in respect of the power not to be able to beare those humours that are The plenitude quoad vasa is made by Galen to be of two sorts the first he calleth simply a plenitude which he defineth to be the foure humours being proportionably increased The second kinde he calleth a plenitude with an addition or a plenitude compound when some other humour besides bloud doth abound more then it ought These I will not stand vpon because I haue already deciphered them in the first Chapter of the first booke There remayneth only heere to set downe the marks and euident signes whereby they may best be knowne when the patient commeth in presence If there be a fulnesse of bloud in respect of the vaynes and other vessels then the colour both of the face and the whole body will be much enclined to red after any strong motion the vaynes will swell and the arteryes beate a sweate will easily breake out a wearinesse doth oppresse the body and lims which are loth to moue by reason of their owne waight the hand can hardly be clutched together the drawing breath will be very thick after exercises In the fulnesse in respect of ouercharging the powers and strength these things do happen the motions of the body lims are somewhat slower the sleepe is heauie but troublesome the partie doth often dreame that he is ouer-charged with some burthen and that he can not stirre himselfe and he feeleth likewise a wearinesse and heauines as is in the former but it is without those full and distented vaynes If the bloud do particularly exceede in these plenitudes then some do adde moreouer these signes the pulse thick full and soft the laughters great the head enclined to aches the body somewhat costiue the spittle sweete the vrine red and thick the dreames either of colours red or of things amorous and in women their termes vsually in the first quarter of the moone When any other humour doth abound it is called a cacochymy A cacochymy is an abounding of any other humour but bloud If choler do abound the colour of the face and eyes and whole body will be pale or yellow or of a citrine or tawny colour the party will be watchfull and of little sleepe griefes will be most on the right side vomitings will be often the thirst much and the appetite to meate faint the pulse will be slender hard and swift in the mouth sometimes a bitternesse the vrine of a firy colour and with little ground or sediment the dreames will be much of matters of fire and the termes vnto women happen most in the second quarter of the moone If fleame do abound the colour of the face and body will be white the body it selfe waighty fat soft and cold the tast weake the griefes most about the ribs stomack or the hinder part of the head the pulse slow soft and weake the vrine pale or white sometimes thinne and sometimes thick with much grounds or sediment the sleepe sound and much the dreames either of drowning or watery matters and the termes vnto women vsually in the old of the moone If melancholy do exceede the colour of the face and whole body will be browne dusky and blackish sometimes equally and sometimes somewhat bespotted feares will come needelesly and sorowes without cause the pulse will be hard the vrine will be thinne and white and sometimes when melancholy doth auoyd it will be thick and black or black and blew or somewhat greenish the sleepe troublesome and full of fearefull dreames and the termes to women commonly after the full I could here rehearse many other signes whereof Leuinus Lemnius doth make mention drawne from the fashions studyes and manner of life of the party to make tryall of euery one by the manner of his gate by the deuises of his braine and by the performance of his actions but then I should perhaps make some to thinke too well and some too ill of themselues although in deede hardly will any thinke too ill and I should increase this latter booke into a greater quantity then is now my purpose to performe Briefely I conclude this first poynt concerning the plenitudes with the censure and iudgement of Galen who when he hath brought them all to two generall heads When the humours are equally increased they call it in Greeke plethos or plethora but when the body is full of yellow or black choler or of sleame or of thinne whayish moystures then they call it not plethora but eacochymia He doth presently after shew how they must be holpen and amongst the remedyes of plethora he maketh letting bloud the principall Plethora is cured by letting of bloud but for cacochymia he maketh the chiefest remedy to be purging But cacochymia is cured by that purging which is proper and peculiar to euery seuerall abounding humour If this cacochymia be also with a disâ—ented fulnesse then must also Phlebotomy be vsed but sparingly only so much as may ease the plenitude and rather as Fernelius doth aduise ex interuallis detrahendo quà m vniuersim affatim vacuando sublata plenitudine praecipiti periculosa reliqua impuritas cacochymia purgatione eximenda est But of this already in the last Chapter of the former booke CHAP. 2. Of the consideration of the temperature of the party what it is by manner