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
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
remedies for hot distemperature and thus much for this matter How to know by certainâ— signes the greatnes of the disease and the firmenes of the naturall forces wherby coniecture may be made whether the Pacient bee to be let bloud or no. Chap. 13. IN euerie affect wherin bleeding auaileth the same is out of hand to bee done if the disease be vehement and the strength of nature agreeable Touching the disease it is sometime so small that it is cured alone of it sâ—lfe without the helpe of art And although at other times the same be very vehement great yet the forces of nature not onely sceme but also are indeede so weake that they can not tollerat any euacuation Yea vndoubtedly this practise would vndoo disâ—roy dissolue the whole substance of the naturall forces for whose preseruation sake in truth we take the cure in hand Therfore to know thorowly and perfectly how much bloud is to be takeÌ„ in euery disease we must first consider how great and greeuous the sicknes is and how firme and strong the powers of nature are Now a disease is either already caused and in state or is now a beginning or proceeding to state Againe a disease is called great greeuons ether in regard of it selfe or of the cause thereof which consisteth in the humors or in regard of the greuousnes of some accident But first it is great of his owne kinde and nature Thus an inflammation in any meÌ„ber is more greeuous then a simple distemperature in the same member And again the greatnes of a disease is iudged by the great vse and excellency of the meÌ„ber which it possesseth as if it be any principall member namely the hart braine or Liuer and it is contraty when the griefe is in a base vnnoble or no principall member Againe iudgement touching the greatnes of a disease is to be giuen according to the locall placing of the members as they stand next to the principall partes Therefore next the diseates of the hart braine and liuer are to be accompted those of the lunges sides stomacke and splen and wee are otherwise to iudge of those that are in parts further off as namely the bowels raines bladder and the outward limmes consisting of bones flesh and sinewes called in Latine Artus and in all the other members placed in the extremities of the body Againe in this point iudgement may be giuen by the sensiblenes or feeling of the member wherein the griefe is if the diseased member haue a quick sense and a liuely feeling the greater ferre is the danger than if the member were but of a blunt and dull sence The greatnes of the cause in any disease is iudged by the condition and nature of the humour that is gathered to the part affected is there the continual matter of the griefe wherein we are to consider whether the humour be good or bad putrified or not putrified or of what ill quallity it is any maÌ„ner of way And also whether the same humour be too much or too litle if the humor which is the cause of the sicknes be wicked corrupt theÌ„ we may soon iudge the griefe to be great The greatnes of the antecedent cause is perceiued by the fulnes or emptines of the veins bowels of the whole body by the purity or impurity of humours coÌ„teined in the same We iudge the greatnes of the accidents by the intention remission of those things which do chaunce as the increasing or diminishing of paine thirst appetit watchings and such like all which bring down the forces of nature and make the Pacient to languish As for example If any yll disease as namely an inflammation possesse the Liuer braine or parts next the hart and that there be a venomed and putrified humour whâ—â—ewith the veines of the body appeare to bee stuffed and filled so that there insueth in the patient agitation of the bodie ill appetite thirst paine watchinges this sicknes wo may esteeme vehement in the which euacuation may do great good And againe a disease in which these do not concurre but rather their contraries we may iudge a small infirmitie and not requiring any euacuation Betweene these are their interiected sicknesses of a middle sorte which are to bee euacuated more or lesse according to the remission or intention of the disease and the accidents thereof Now let vs come to the estimation of the forces of nature of the natural powers some are setled and bred in particular members and are common and flowing to all partes of the bodie The forces of nature bred and setled in a member haue one and the selfe same essence as it were of the inward heat and they are called one nature and are ingendred as a man might say of the internall spirits and the first begotten moisture whereunto is added as a matter thereunto requisite a sound and whole substance of bodilie members The essence of the common forces of nature haue as it were a threefold originall or beginning or is â—â—threefold spirit diffused and spred into the whole body The force called virtus animalis the animall vertue is diffused from the braine by the sinewes The vitall force from the hart by the arteries The naturall strength from the Liuer by the veines The bodily powers that are bred in ech of these parts the brain the hart and the Liuer are susteined by those common and flowing powers of nature so that the whole liuing creature name ly man is ruled and gouerned of both these vertues Insitae communes setled and common to vse as good english wordes as wee may to make manifest this great point of phisicks skill Therefore if this liuing creature and most excellent creature man bee in perfect health of necessitie these powers of nature must be sound and vncorrupted which they will bee if their substance consist in a iust moderation that is to say in a iust or right quantity and in a good temperament And contrary wise if the quantitie or temperament of their substance be inuerted chaunged turned or altered they must needes suffer hurt and offence and so become weake and enfeebled Whereby their functions are presently hindered the rule of all the bodie is disordered and at length there will follow euen extinction of life it selfe And therefore whether the natures forces are weake or strong may be knowen by their seuerall operations duties Thus raw and vndigested excrementes either by siege or by vriyne when either the one or the other is thinne watrish or like vnto water wherein flesh is washed do shew imbeâ—illity of naturall force so doth holding backe of these excremntes or any other function naturall that is staied or hindered Wee discerne the vitall strength to be enfebled by obscure languishing and smal pulse by breathing hardly and with paine and oftner more quickly thaÌ„ was accustomed by smalnes and faintnes of speach so as the same onely come thereby and not
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
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
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
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