must be taken moderately the first and second day after bleeding as Rhases counselleth writing to Almons lib. 7. cap. 21. For the vertue digestiue made weake by bleeding cannot ouercome as yet much meate Herevpon also Isaacus in his dyets writeth thus Meate to such as haue bled is to be withdrawen and diminished but drinke to be augmented for in respect of the meat drink is to be augmented not in regard of his former vse of diet that now he may drinke more than hee was accustomed for in truth he must drinke lesse than hee did before bleeding because the vertue concoctiue as ye haue heard is yet too weak to beare much abundance of drinke The words of Schola Salerni touching this matter are these Spiritus vberiorque exit per Phlebotomiam Spiritus ex potu vini mox multiplicatur Humorumque cibo damnum lente reparatur Abundant spirite with bloud doth passe yet drinke of wine doth it restore By helpe of meate the same alasse will hardly come as twas before Of Revulsion that is pulling backe and deriuation that is turning aside of bloud and Humors by opening of a veine Chap. 6. REvulsion is a prouided remedy for bloud flowing out of the nose or belly or that floweth to any part like them to cause inflammation It is called in the Greek Antispasis That is a turning to the contrary way in Latine Reuulsio that is a pulling backe and as the word impotteth so is it desined a drawing of the running humor into the contrary part Nothing can more speedely keepe backe the force of a Fluxe than this practise Now for to vnderstand which is the contrary part we must note that the Mathematicks call those contraries which be the extremities of one and the selfe same straight line which stand furthest off in a straight proceeding or going forth of the selfe same vein through whose passages the humors haue their course For a veyne beeing opened first the part next the wound is euacuated that euacuated part draweth the bloud out of the further part And forasmuch as opening of a veine doth thus euacuate through the helpe of the small straight veynes which nature hath ordained to allure and draw as shee hath the ouerthwart veynes to expell The same opening of a veyne I say will prouoke more bloud and in shorter time from those parts where the streight veynes are spread then from the rest Yea if the veynes drawe not at all yet the humors voluntarily will flowe in the straight course of the veynes they that are in the right parts followe the right members and they that are in the left partes follow the left members and that course of humors is commended which are carryed straight wise and that discommended when they are carried crookedly and ouerthwart as declaring nature to bee violated and corrupted The names of Phisicall contraries in this practise are these before behinde the right the left vpward downewarde within without Neither are these contraries in revulsion of humors except they bee so placed in a straight course of veines For the left side is not contrary to a left Pluresie or the left leg from the knee downewarde called in Latine Crus contrary to the right leg inflamed For herein this is a common and direct society of veines whereby the left leg beeing opened draweth from the right But from the right side to the left no veyne commeth with straight and right strings Therefore a veyne opened in the same remoueth not a Pluresie on the right side But either leaueth the hurtfull humor in the inflamed part or mingleth it with the pure bloud or bringeth a Pluresie in the left side which often falleth out so For as much therefore as all our indeuours and deuises must tende by opening of a veyne to exhaust bloud abundantly and speedely from the inflamed part take such a veine as is straitly scituated to the affected part So in reason we shall followe nature and imitate Hippocrates who in a Pluresie willed to take the inner veine of the Arme on that side which is grieued Neither onely doth the Phisition open the inner veine of the right arme in a pluresie on the right side but also in inflammation of the liuer and yet all the veins are ioyned to the liuer in felowship If that appeare not we may take Mediana If that neither appeare we goe to Vena humeralis rather than to the inner veine of the left arme attributing so much to those veynes which are directly and straightly scytuated Therefore Revulsion in a streight course bringeth euident and speedy helpe whereas in a crooked or ouerthwart locution it bringeth none at all Moreouer a large veyne opened withdraweth bloud plentifully and speedely from the next places Therefore when there is a great and vehement inflammation of some euill Humor abundantly concurring in some principall member and part of great sense and feeling a large veine must be opened in some neere place vnto it which may abundantly and speedely euacuate from the place affected If the infirmity be but small a lesser veyne may be chosen and in a place further distant to euacuate a lesse quantity and at more leysure Revulsion in this sort not onely stayeth the Fluxe but also exhausteth first from the affected member the rotten and ill bloud before it deale with the good bloud of the other parts and members of the body and then all feare is remooued of any newe Fluxe to insue For when the part affect ed shall bee disburdened more than the other through great euacuation lately made very hardly in reason can the same be grieued with another Fluxe of humors except we go on with a fresh intemperate order of liuing And againe the members far distant couetous as it were because of their great want wil not suffer the bloud in them contained to flow to the others Neither will the member affected except there remaine in the same great dolor and heate allure or sucke any thing from them being now but weake and consequently not requiring great nourishment The opinion therefore of the Arabians concerning opening of a veyne must needes be false VVho suppose that in a Pluresie a veyne opened on the same side doth increase the force of the Fluxe Affirming also that for the plenitude if it be much lest the Flux should increase the same is to bee taken from the lower veyne of the foote After this that the Revulsion must bee made from the inner veyne of the contrary arme Last of all that the reliques and remainder is to bee euacuated out of the same side VVhat discretion I pray you is this so oft to vexe the sicke Patient whom wee may cure at one time For bloud abundantly taken out of the side affected draweth plenty as it were at the well head freeing that part from inflammation without suspition â— orfeare of any newe Fluxe Euacuation made from the ouerthwart veynes onely abateth superfluity of bloud and humors with small quantity of
complexion it quite reiecteth bleeding For Phlebotomy by great cooling so greatly increaseth crudity and rawnes in the body that it can neuer or very hardly bee recouered or amended VVeakenesse of bodilie strength resembleth this foresaide Repletion and therefore also by the selfe same reason reiecteth any large euacuation And in truth is not in this respect to bee dealt withall except the veynes abundantly repleate threaten some great hurt or that necessity so require it and then it must not bee done all at once but by little and little as it hath beene before declared Therefore in each and euery fulnes that is vnpure we are to begin with opening a veyn for without it wee cannot safely afterwardes purge For a vehement purgation especially if bleeding haue not gone before troubling and molesting the full body both with much heate and by force of the attractiue vertue bringeth the Patient into greater hazarde than he was before and therfore to conclude this point the veynes being swollen and filled if moderate bleeding doo no good it can doo no harme at all The otherfulnes quae ad vires which cannot very easily be knowen by signes althogh it cannot ouerstretch or breake the veynes nor ouercome the inward heate yet because it oppresseth the weake forces of nature lest there should insue putrifaction or corruption of humors it may be diminished by opening of a veyne Leauing yet behinde so much as nature may easily rule yea and the same also because it bringeth no doubt of present danger may be profitably taken away with spare dyet or abstinence Of corruption and putrifaction of bloud and humors in the veynes without plenitude called Cacochymia that is fulnes quae ad vires There riseth a great doubt whether the same may aptly bee remooued by bleeding VVee answer that to remoue by bleeding a simple corruption of humors in the veynes is profitable and easie regard beeing had both to the abundance thereof and to the forces of nature in the Patient For albeit when a veyne is opened all humors issue forth equally and that there remaine behind still as there did before one and the selfe same proportion of humors yet because now by bleeding part is abated of that burden wherewithall nature was before oppressed the forces and powers natural waxe not the more feeble but they become more strong and chearefull so that they can beare with the greater ease those humors which as yet remaine still behind and nature hir self gouerneth them with farre lesse trouble than before And herevpon in continuall feuers when there is great crudity and corruption in the veyns bloud being often times detracted the vrine also beeing red troubled and thicke before It appeareth nowe more cleare and sheweth forth euident signes of concoction And note here by the way that the Phlebotomer must be very well exercised in those signes which prognosticate fulnes repletion Yea ye must also know perfectly the place of each particular humor lest after the manner of the vnskilfuller sort when the nose a little bleedeth and the vrine appeare somewhat red by and by yee doo let bloud Whereas bloud often times easily commeth forth not onely by reason of fulnes but vppon diuers other occasions nature her selfe often attempting voluntary eruptions of bloud Hereof it commeth that such persons as haue as it were the small litle mouths of the veines called Oscula eaten or gnawen or that haue a weake and apostumated Liuer and that Hydropicall persons bleede oft at the nose Also vrine waxeth reâ— and bloudy by the fretting of the stone in the Raines Vrine waxeth yeallow in that kinde of yeallow iandies which is simple in Scirrho hepalis That is in the hard part of the liuer and in that kind of dropsie which is called Ascites Yet in these effects we are not to let bloud for Cacochymia proceeding of corruption of the bowels is not that way cured Therefore the certaine knowledge when a veyne is to be opened necessarily is onely gathered of those markes and tokens which manifestly declare abundance of each humor And hereby yee may gather that bleeding alone speedily helpeth that corruption of humors which lyeth in the great veynes and only freeth the Patient from this kind of corruption except the same take beginning from the bowels ill affected and in this kind of corruption purgation is more meete than bleeding And thus it appâ—areth in a generall sort what corruption of humors the opening of a veyne doth remedy A particular rehersall of those diseases present or future which are cured by bleding Chap. 11. FIrst as yee haue heard a veyne is profitably opened in the two plenitudes nature being strong and the age conuenient In the fulnes quaead vires haue speciall regard that the naturall forces be firme But if in this plenitude raw cold and vndigested humors bee greatly gathered together in the body forbeare taking this as a rule that with great abundance of raw humors the strength of the body cannot stand as yee haue already partly heard and as Galen witnesseth lib. de curand ratio per sangui missio cap. 9. Secondly it helpeth diseases present and future and serueth both in the curatiue and preseruatiue intention VVe read that Galen in the spring time did let bloud those persons that were subiect to these diseases following to wite Spitting of bloud A polexies Falling sicknes Peripneumonia Pluresies Anginaes Stoppinges of Hemorroids or Termes Swimmings in the head The Gowt in the feete and in the ioynts All which Auicen also setteth downe in quarta primi cap. de Phlebotomia Thirdly we doo not onely open a veyne in repletion as Menodorus falsly supposeth but also as hath beene said without fulnes when wee feare some inflammation through some fall or other accidentall griefe And moreouer as wee haue already specified wee open a veyne for two purposes sometime to euacuate sometime to pull backe immoderate flux of humors to the contrary part as Galen noteth lib. de Curand ratio per sang missio cap. 11 9. Metho Medend cap. 11. As to stay bloud at the nose we open a veyne in the arme For this cause Galen lib. 13. Metho Medend ca. 21. in Letargus which is a drowsie and forgetfull sicknes rising of impostumation of cold putrified fleame especially in the hinder part of the braine whereby memory and reason almost perisheth and the sensitiue power is greatly hindred causing men commonly to forget their owne names also to shut their mouthes after they haue gaped and by no meanes to stay from sleeping In this disease I say at the first beginning thereof Galen willed to open a veyne albeit the disease bee colde rather as it seemeth to reuoke than to euacuate the matter or Galen so appointed it because fulnes is alwaies concurring with this forgetfull and drowsie disease Herevpon Galen 11. Meth. Meden cap. 15. affirmeth it to bee very healthfull to open a veyne not onely in continuall feuers called Continentes but in all
feuers caused and kindled of a putrifieng humor which should not seeme to bee true especially in intermittant fâ—uers which leaue off for a time as are tertian and quartan agues Forasmuch as in these bloud offendeth not in the veynes but some other humor beside bloud putrifieth without the veyns which by bleeding in reason cannot be euacuated This place of Galen cannot sound to reason or experience except we vnderstand Galen to giue vs aduise to euacuate by bleeding the matter of such intermittant feuers as haue also with the bloud fulnesse and abundance of other humors concurring So that this may bee his meaning Bleeding may bee vsed in intermittant feuers if they fortune to haue abundance of humors ioyned with the bloud For obstruction as Galen sheweth li. 11. Meth. Meden cap. 4. happeneth in rotten and putrified feuers sometime through abundance of humors sometime through the clammines grosnes and thickenes of them Galen therefore counselleth to let bloud in staying and intermittant feuers rather because of the abundance than the rottennes or putrifaction of the humor without the veynes And that this is his meaning appeareth by the words which Galen afterwards vseth saying Forasmuch as nature ruling the body by bleeding is lightned and disburthened of that wherwith she was before oppressed therfore shee will with ease ouercome that which resteth and remaineth behinde which is a 〈◊〉 signe that Plethora or fulnes is also annoxâ—d to such feuers Fourthly in bleeding we are not onely to consider the disease it self which wee determine to remedie but also oft times the cause therof so that whatsoeuer the sicknes be if Phlebotomy may remoue the cause then also it taketh away the griefe it selfe in the ende HereupoÌ„ somtime albeit the disease be cold yet when the cause moueth vs to open a vein we may safely bleede without hurt Hippo. saith Galen sheweth a cure of his done on a woman by letting her bloud in the Ankle This woman after child-birth was not freed ofher seconds then a shaking came vpoÌ„ her This woman I cured saith Hippo. by letting her bloud in the Ankle for all her shaking Shaking is a cold affect bloud is hote and they that must be heated must not haue bloud taken from them He for al that boldly did it he sheweth the reason I considered said he the cause the occasion of the cause He knew the cause of shaking was abundance of bloud kept backe which was a burthen to nature The occasion of the cause was the griefe of the matrix This abundaÌ„ce requiring euacuatioÌ„ the affected part shewing the place most fit for euâ—cuation considering both these things together he let her bloud in the ankle because the wombe or matrix was affected In griefes of the womb or bellie we take the vaine of the ankle knowing by the Anotomie the communion betweene the veines for some veines communicate to some part of the body others to other partes And euacuation is to be made from such veines as haue fellowship with the member affected For as yee heard in the Chapter of Revulsion if we take that veine which communicateth not with the part affected wee hurt the whole bodye do the griefe no easement The profitable vse of this fellowship of veines apeareth especially in revulsion or pulling backe of humors which is both wel speedily done when this coÌ„munitie of veins is obserued as was there declared But let vs return to our former purpose Fiftly by opening of a veine is cured the feuer called Synochus both that which coÌ„meth of ebullition of blod without putrifaction that which is caused with putrifaction of the bloud So are also hereby cured continuing feuers coming of putrifaction in the greater veines And to these diseases reckoned vp of Galen Fig. 2. we may adde these that follow Frensies Opthalmia parotis i. an apostumatioÌ„ about or behind the eares diseases of the Liuer splene Nephritis i. paines of the raines and backe inflammations of the wombe or matrix of the priuie partes arme-holes armes thighes ioynts Finally all inflammatioÌ„s inward or outward which the Greeks call Phlegmonae These inflamations are caused by flowing of bloud to a member when a veine is open broken which bloud there abundantly heaped togither bringeth forth a tumor or swelling To these also are to be added a consumption in the beginning vomiting of bloud bleedings at the nose bely or hemorroids at the beginning of which diseases the opening of a veine greatly profiteth staying the force of the fluxe by revulsion if the veine be opened at the contrary part calling back much of the matter froÌ„ the member affected so that bleeding is a present helpe for those diseases whatsoeuer which take the beginning from too much abundance of good bloud Those sicknesses which come of an vnpure mixt plenitude because they are somewhat neere linked vnto these they may also be cured by bleeding And although the matter of these diseases be vnpure yet either it lyeth in the veines or procedeth from the veines A gaine by bleeding are cured Carbuncles felons moyst scabs outward rednes in the skinne such like all these are cured by this practise Thus also is cured the burning ague called Causus all continuall feuers whose putrifaction is conteined in the greater venies Yet sometime a continuall feuer commeth of an humor heaped togither inflamed about the stomack chiefely about the mouth of the stomack the flat parts of the Liuer which feuer cannot be takeÌ„ away by bleeding Neither can the cause therof by this practise be remoued Pure intermittant feuers whether they be Tertians Quartans or Quotidians because the next matter proper cause of them is not in rhe greater vessels neither floweth from the veines are not conâ—eniently cured hereby And yet sometime in these also we bleede either when the veines swell with immoderat fulnes so that therby some danger at hand may be feared or when any accident of hote inflamed boyling bloud perswadeth vs therto as are namely beating paines of the head tossings mouing of the body this way that way excessiue heat almost stragnling the pacient Howbeit these many times come also of boyling choler about the inward partes called praecordia in the which cases bleeding remoueth neither the feuer nor the cause therof but onely asswageth the vehemencie of those accidents which are present or shortly like to ensue Further concerning perticuler affects cured hereby we may adioyne beating paines of the head Letargus spoken of before fig. 3 and trembling of the heart These with the foresaid are not onely cured hereby when they presently affect and afflict the patient but happening yerely vnto vs so that it is verie likely we shalbe grieued with them in time to come VVe may verie well preuent them by bleeding wheÌ„ we haue once espied plenitude to haue beene in vs the causes of these infirmities For there is one the self-same way of healing common
made in theÌ„ than in others When the veine is opened we oft also loose the band from the vpper partes that the bloud may runne the better If the bloud run sufficiently let it alone if but slowly that through fault of the incisioÌ„ amend it If throgh grosnes of the bloud or of any other cause let the patient bend his fist hard together or turne the staffe about in his hand or by coughing or lowd speaking let him enforce the sinewes Muskles sydes And if need so require bath the wound with warme water If he be fearefull or faint harted when he seeth the bloud that it be stayed through feare leaue off a while til the strength be recouered by such meanes as we shal declare anon Yea albeit the bloud flow reasonably wel yet it is good in the midst of bleeding to stop it with the finger both to recreat the strength that it be not too much wasted also that the filthie corrupt bloud may with the more speede come from the inmost partes so be expelled The quantitie of bloud passed forth is to be considered as wee shewed before 14 15 Chapters that it may be stayed in due time in this behalfe therof two regards are to be had especially First the necessitie of the disease Secondly the constancie firmenes of natural strength wherof looke in the foresaid places more at large After good bloud apeares bleed no more for feare of the crampe convulsion palsie dropsie such like In a simple plenitude to auoid imminent dangers it shal be sufficient only to abate the abundance albeit a mediocritie stil remain But in an vniuersal disease as is a feuer a mediocritie will not serue but bloud is abated more then so And in inflamations we are not only to regard the quantity but in like maner the alteratioÌ„ of the colour substance of bloud and when great paine or inflamation is in places neere the incision stay not the bloud before the paine begin to asswage or the colour of the bloud to change For alteration of colour sheweth that the same bloud vnlike the other that good is proceeded from the inflamed part If the humor cleaue fast to the member or that by euacuation the strength of nature bee wasted then wee are vrged to stay bleeding before the bloud doo chaunge in colour and to detract that which remaineth by reiterating Phlebotomy either the same day or the day after Hyppocrates 2. vict acuto 10. In the cure of the Pluresie writeth that in the cure of that disease the inner veyne of the arme is speedily to be opened and bloud plentifully to be withdrawen vntill the same appeare far redder than it did at the first or that for pure and red bloud the same appeare swart and blacke which both happen in Plurisies If the bloud were before rawe crude vndigested and that it come from the inflamed place neere an incision it becommeth redder or yeallower because this bloud is horter than that which went before If it were at the first thus coloured namely redde or yeallowish than when it commeth from a member inflamed it turneth to be black and swart thorough adustion and thus you see how to stop the fluxe of bloud by the quantity by the substance and by the colour of the same As wee are to consider the foresaide thinges in the bloud so are wee to consider strength in the Pacient Of defect of strength these are the signes The fluxe of bloud relenting paâ—e colour in the face gapings stretchings noise in the eares webs in the cies and defect of seeing All these shew a decay of the spirits oflife they shewe faintnes of the heart and that the bodily parts are forsaken of inward heate To these may bee added the hicket and a desire to vomit which commeth of fluxe of the humor to the mouth of the stomacke as were already shewed But the most certaine and assured marke is the alteration of the Pulse which changing from thicke to slow from great to little from strong to weake from equall to vnequall prognosticate defect of nature and a perturbation in the body not much vnlike Epilepsia that is the falling sickenes If these come through feare or of humors nipping the stomacke stay bleeding recreate and strengthen the Pacient a while that afterward the residue of the euacuation may be perfected The waies to recouer and fetch strength againe if the same giue ouer before a conuenient and commodious quantity of bloud may be taken are these to cast colde water on the face of the Pacient to sprinckle vppon the face white odoriferous wine to put to the nose of the same party vineger strong wine muske or other aromatick thinges if these helpe not wee must close vp the veyne a while with the finger and if neede be the euacuation is to be imparted or diuided But to auoide all these accidents the remedy is to let bloud the party lying in his bed for so the partes of the body are reduced into one equality of position whereby the principall parts mutually bestow one on an other inward heat and vitall spirits if the Patient bee not brought againe by the foresaide thinges then prouoke vomit by tickling in the throat or by pouring in a litle oile for the force of vomiting stirreth vp strength and draweth away weakenesse of the stomacke and heart and presently after recouery renue the strength of nature with wine iuce of Pomgranats broth of flesh with the receit called Diamoâ—cho and other cordiall things The instrument may bee annointed with oile or other such liquor that it may inflict the wound without paine and for the most part the wounde must bend somewhat aslaunt or crookedly The incision is made two waies as Hyppocrates saith one straight Secundum rectum or Edirecto downeright the other contrary crookedly or a swash In these two waies wee must vse great discretion to vse them as neede requireth and not deceiue our selues vsing the one when wee should the other as many are deceiued in these daies To shewe which of these is to bee preferred would require a long discourse whereof read at large Fuchsius in his Apologie against Brachelius There is newe kinde of instruments to let bloud withall nowe a daies as the Rapier Sword and long Dagger which bring the bloud letters sometime to the Gallowes because they strike too deepe These instruments are the Ruffians weapons more malitious than manly But in this practise the veyne must be opened with a fine Launcet no fleme with a beard like a bloud-iron wherewith Smiths let horses bloud for they will sometime cut a veyn thorough on both sides causing a crampe and deadly convulsion And here I giue aduise that no Surgion except he be very skilfull himselfe open any veyne without the counsaile of the learned Phisition or the iudgement of some others that haue auncient and tried experience in the practise Ignorant Barbers doo great hurt herein
bee obserued A simple Sinochus feuer or a simple feuer putrified or caused through putrifaction of humors requireth to haue the Basilicam of the right side or arme opened So doth an hote pestelenciall feuer simple and not compound So doth a tertian and a continuall quotidian A quartan requireth the inner veyne of the left arme This is also the Methode in pure intermittant and discontinuing feuers if either the plenitude or accidents will haue vs to open a veyne Revulsion of matter from those partes placed betweene the canell bone of the throate and the raines is done from the right Basillica or left as the disease requireth if the right parts be affected open for revulsion Basilicam dextri brachii If the left the other Basilica Open this veyne in the arme if great and speedy bleeding be needefull If a more slacke and remisse bleeding will serue the turne seeke the braunch of it in the hand betweene the little finger and the fourth as some say from the right kidney to the left and passing ouer the bottome of the stomacke Inflammations in the gut called Colon which is a great gut rising from the left side to the right or in which is the disease called the Collick albeit the same be vnder the raines yet they are cured by revulsion opening Basilicam or the inner veyne of the arme For so the beginnings and deriuations of the veynes doo shew In inflamations of the lungs take the Basilica or inner veyne of the left arme rather than of the right because the veynes of the lungs come from the right side of the hart which part of the heart is placed toward the left part of vena caua so by the left wing ruÌ„neth into the left arme This order of incision also helpeth spitting of bloud thorough extreame coughing the disease called Tabes trembling of the heart and such like In a á¹–luresie open the Basilica of the arme according as the paine shall happen in the right or left side In a Pluresie of the right side the right Basilica and so contrary Item the interior veyne is taken in inwarde and outward apostumations of the brest or midriffe and in inwarde Vlcers which cause vs to spit bloud Thus also by opening of Basilica are cured inflamations on the shoulders and vnder the arme holes except they come to the very bought of the arme for then it were very dangerous to open the very part or member inflamed but in this case we open a veyne in the hand e directo that is straight In paines and inflamations of the Liuer wee open the right Basilica and so the left Basilica when the Milt is inflamed grieued or ill affected and in all these wee must take the veyne in the arme if much bleeding be needefull and if not then the veyne in the hand Deriuation from the Spleene is not made as some do think into the veynes called Hymorroide but into the belly So deâ—iuation from the hollownes of the Liuer is made also into the belly A postumations in the Raines when the veynes also all full of bloud are repelled by the right Basilica if the right kidney bee grieued by the left Basilica if the left kidney bee ill affected If excessiue fulnesse doo not vrge in these apostumations the revulsion is better attempted out of the lower veynes which are straight and right as out of the right or left anckle Affects of the belly as immoderate fluxe of termes are stayed by opening Basilica in the arme which draweth the fluxe vpwardes So doo also cupping-glasses applyed either to the paps or nauill That revulsion which is made by opening Basilica in the arme specially the right Basilica is to be accounted generall because it draweth from the Liuer which is the fountaine it selfe from whence all fluxe of bloud commeth whether the same bee fluxe of termes or any other fluxe of bloud Revulsion made from the lower veynes is particuler not euacuating first from the Liuer the fountaine of bloud as the other doth And forasmuch as things vniuersall goe before partiticuler things therefore in inflamations vnder the kidneyes wee must first pull backe with direct opening of Basilica in the arme and afterward wee are to open the lower veynes which also haue some force to reueale but if either the fulnes or the fluxe be great it is not best first to open these v eynes below Finally imminent diseases like to arise thorough plenitude of bloud are kept backe be opening the right Basilica that is the inner veyn in the bought of the right arme The third generall veyne in the arme is the middle veyne called of some very properly and fitly venacommunis of other Cardiaca or Cordiaca venanigra and Mater and of the barbarous Phisitions Mediana It is called Media or Mediana for three considerations First inregard of the scituatioÌ„ hauing in the vpper part of the arme aboue it Cephalica vein in the lower part of the arme beneath it the Basilica veyne and so these being as it were extreames it possesseth the mids betweene them both Yea it is indeede a braunch of them both And for this cause secondly it hath the name Mediana as if it were made of them two as the meane is made or consisteth of the two extreames Thirdly it hath the name Media or Mediana for that it is Media that is in the middle in respect of euacuation Euaeuating both from aboue and from belowe aboue the necke from the necke and from beneath the necke For it springeth I say from the diuision or parting of both the other veynes that is Cephalica and Basilica By opening this veyn there is made a generall euacuation of humors through the whole body A generall or vniuersall euacuation I call it not because it springeth froÌ„ the hart as some affirme but because the fluxe commeth generally from all parts This veyne being a braunch as yee haue heard both of Cephalica and Basilica This veyne is taken when neither of the other appeareth and withdraweth bloud from them both according to the iudgment of some This veyne is the same which is called also Funiâ— brachii Cephalica and Basilica are as it were the Parents of Mediana As often therefore as thou art determined to open Basilica and that the same doo not appeare take rather the Mediana veyne than the Cephalica And if thou purpose to detract bloud from Cephalica and that the same doo not shewe conueniently open rather Mediana than Basilica and being compact of Cephalica and Basilica it withdraweth bloud indifferently from them both both from place and parts beneath and also aboue Some giue aduise vpon what ground I doo not yet see not to open Cardiaca if the Patient feele any weakenes at the heart but if necessiity of bleeding bee vrged the heart beeing enfeebled wee are rather to open Cephalica or Basilica This veyne is opened to cuâ—e â—assions of the whole body especially when they proceede of heate of the heart
of the bodie in this case wee vse Phlebotomie without purging Fourthly we may safely let blond without medicine those that are whole for abundance of bloud only are accustomed to yerely bleeding and that haue in the yere taken little or no Phisicke as it chanceth to many persons in many countries of the North. Fiftly we may open without purging the inner vaine of the arme in women with child if they carrie Corpora Phletorica full bodies that in the 5. 6. or 7. moneth after the conception yea also before they be quicke This practise wee are to vse specially when they being with child waxe verie slowe heauie as it were ouerladen with abundance of bloud we may take Salua tella veine or if plenitude so require the inner veine of the arme for the quantitie respecting a discreete moderation Sixtly we may let those bloud without medicine that haue fallen from some high place taken hurt in the brest and stomacke in whome is to be feared an inconuenience called of the Greekes Egchymosis Seuenthly we speedily let bloud such persons without further Phisick as by reason of their fulnes through some accident as feare or such like waxe domme in which case wee let bloud abundantly so that both armes are opened together Here I am to note a great error in Auicen both repugnant to trueth it selfe and also contrarie to Galen For Auicen affirmeth that when colde and thicke humors are in the bodie first wee must begin with purging and then open a veine Diuers and many waies hath he erred in this First because in flegmatick humors grosse and colde mixt with bloud hee woulde haue Phlebotomie not vsed before purging And in this case by all likelyhood of reason the cure should begin with bleeding Secondly in this hee dissenteth from Galen who 11. Method Chap. 4. though there were obstructions in the bodie of thicke and clammie humors yet first hee would begin the cure with Phlebotomie If Auicens meaning be when flegmatike humors ouercome the bloud in multitude or abundance that then wee must first vse purging then is hee greatly deceiued for as much as hee proponeth a case in which Phlebotomie should not auaile except with those many colde humors there be also some excesse of bloud which chaunceth verie sildome or not at all But it may seeme that Auicen hath reason namely this that the bloud being extracted those humors would waxe more rawe and so by opening a veine the patient is brought to a marueilous cruditie of colde humors This is no reason for by Phlebotomy wee detract bloud not because of obstructions caused of grosse and colde humors but because bloud superaboundeth For the stopping is afterward remoued with other helpes Therefore when obstruction concurreth with abundance of bloud wee must not extract verie much bloud but keepe backe some till the time of the cure as Galen teacheth 11. Method Chap. 14. And thus much of the order betweene Phlebotomie and Purging whereby wee see that a strong purgatiue must followe bleeding and that an easie purgation or clister may go before Of the effectes that is Of the profits and disprofits of opening a veine Chap. 5. Schola Salerni in two verses reckoneth vp three effects of bleeding Exhilerat tristes iratos placat amantes Ne sint amentes Phlebotomia facit It swageth wrath and cheeres the sad Preserues loue-sick from being mad FIrst it maketh glad those that are pensiue Secondly it appeaseth such as are angrie Anger is especially caused through mixture of much yellow choler with bloud And sadnesse by commixture of much Melancoly with bloud And forasmuch as both these humors choler Melancoly are exhausted with the bloud these two effectes must consequently follow Thirdly it preserueth loue-sicke persons from madnesse by drawing humors from the head to the lower partes and so expelling the same Although occasion will hereafter better serue to shewe the causes why wee vse Phlebotomy yet here nowe speaking of the effectes I will briefely shewe fiue causes for which wee vse to let bloud and by the which may be gathered the profitable effectes of this practise of the which fiue causes one onely cause is the direct the other foure are indirect The direct cause of bleeding is euacuation of the bloud But forasmuch as bloud is good for nature therfore Phlebotomy must be vsed â—duissdly that the same bloud only may be expelled which is vnprofitable hurtfull to nature Bloud as you haue partly heard is made vnprofitable to nature two waies either when it doth not throughly keepe the proper qualitie that it cannot so nourish as it did before when it was good or when in quantitie it so increaseth that it either presseth downe the powers of the bodie or stuffeth stoppeth both the veines the arteries In these two cases bleeding is good as one of the direct euacuating helpes Yet in these cases bleeding is not to be vsed indifferently but with this difference in abundaÌ„ce of bloud much may be detracted In little plentie small euacuation serueth Hereupon Galen writeth lib. 9. cap. 10. Method Si sanguis vitiosus in corpore fuerit paulatim quod vitiosum est euacuare oportet paulatim ad in o icem quod salubre est pro eo reponere If corrupt bloud be in the bodie wee must by little little take away the bad and by litle litle procure in the place therof that which is good which way of curing or amending of corrupt bloud the Phisicions call in Greeke Epicrasis And to this Alexander Tralleanus subscribeth lib. 9. ca. 2. The reason why this is not to be done at once is for that the powers of the bodie would relent giue ouer And although that which is euacuated be superfluous yet by a sudden thorough mutation it doth more hurt than good It is better therefore to emptie the bodie safely and by little at once than by making hast to dispatch both the disease the partie diseased And here it appeareth how much they abuse Phlebotomy which detract the ill bloud so long til the good also begin to come wheras it may fall out that all the bloud will flowe forth of the bodie before that the good will appeare It behoueth therefore the euacuatioÌ„ to be little And as Gaelen councelleth in this case before the opening of a veine to vse Epicrasis i. to giue the patient such meat as may cause good bloud that good bloud may still come in place of the bad and then a little after more bloud may be taken This therfore is called the direct bleeding because it is don of it self to euacuate that which by opening a veine ought in deede to be withdrawen namely multitude of humors of bloud of bloud principally of humors secondarily in asmuch as they are mingled with the blod The other are called indirect causes and are vsed only to reuoke or call backe the violent force of humors to the contrary part or
found out yet the same may not be vsed The reason is for that such a medicine specially or rather altogether respecting the bloud would neither euacuate nor attract bloud as the other humors are euacuated with their owne proper and peculiar receits Yea if it happen that it do euacuate bloud as Pulpa Colocynthidis doth according to Auicen without doubt it euacuateth thaâ— bloud which should be still retained for the good health of mans bodie Serapio sayeth that the impropriate or improper humor of a receit is sooner thereby euacuated then the proper humor whereof he rendreth a reason namely that the proper humor to a recâ—it is the best beloued to the receit Wherby saith he it commeth to passe that the improper humor is sooner for saken of nature than the proper The humor improper is quickly drawen to the receit and therby sooner expelled whereas the humor called proper which the medicine most properly respecteth is as it were the most beloued friend and as it were the most natural childe to the euacuating receit and therefore is stil rather reteined than expelled By this reason oâ— Serapio forasmuch as bloud is natures darling more helping than the other humors which are but superfluities in respect of the bloud If there were a receit euacuating respecting bloud that the same were administred the other humors would be attracted cuacuated before the bloud and so great hurt ensue to the bodie And if it were so that onely bloud offended which is not perhaps altogether true yet neither should the bloâ— alone be euacuated as now it hath bin declared Againe according to the Philosopher 4. de Animalibus we are to make choice of the right way and not to seeke crooked wayes Now opening a veine is the righter safer way to euacuate bloud than medicine for Phlebotomy euacuateth all humors at once principally the bloud which most of all aboundeth in the veines and this thing medicine cannot do Againe euacuation is done for two causes either for to remooue the aboundance of the humor or to take away the corrupted qualitie of the homor So euacuation of bloud is practised either because it aboundeth in quantitie or offendeth in qualitie If we open a veine because bloud aboundeth in quantitie then in like sort there is also abundance of other humors For abundaÌ„ceof bloud cometh through good nutriment causing bonuÌ„ ChymuÌ„ i. good â—uce proceeding of meat digested which doth not only bring repletion of bloud but also of other humors as helpers vnto bloud Therefore when bloud thus aboundeth in quantitie with other humors it is better to euacuat them by Phlebotomie than by receit If euacuatioÌ„ of bloud be made for that it corrupteth in the veines then by reasoÌ„ it corrupteth the other humors also seeing bloud is more abounding in quantitie than are the other humors wherupon Galen saith that in the feuer Sinocha there is corruption of all the humors in all the veines therefore bloud is neuer to be euacuated without the other humors together Now other humors may superfluously abound be corrupted in qualitie without the bloud and so consequently may be euacuated without bloud by inward medicine so that it is naturall for the other humors in this sort to be euacuated and vnnaturall so to euacuate bloud which was the cause that Haly vpon Galens authoritie affirmed that Galen caused one to be hanged which euacuated bloud by inward receit To the former obiections therefore wee answere thus Isaac his saying Quod prodest Choleri prodest sanguini is to bee vnderstood not of euacuating medicines but of altering receits as thus those things that are profitable to alter choler and to extinguish the amitie thereof they worke the same effect in alteration of the bloud Or wee may vnderstand it of euacuation and expound it thus Those things which are profitable to euacuate choler are profitable to mundefie the bloud because by euacuation of choler bloud is mundefied and cleansed To the second we answere that this argument Bloud is naught and offendeth as do other humors therefore it is good to euacuate the same by medicine as other homors offending are euacuated this is a fallax of the consequent or rather figurae dictionis for it followeth not that if bloud offend it must be euacuated by inward medicine because the same may better and more safely be done otherwise namely by Phlebotomie and this may serue for aunswere to the second doubt before moued in like manner To the third may be said that Pulpa being forcible it greatly debilitateth the member and therefore when bloud is superfluous it looseth and euacuateth the same and letteth the bloud conteined in the member to passe away but it doth not attract the bloud and this is verie pernitious to the bodie of man The answere to the fourth is plaine in the premisses VVhere note that although it haue bin declared in this Chapter that bloud is not to be euacuated by siege as other humors are which fluxe of bloud that way we rather account a disease than a remedie as in Dysenteria such like yet this notwithstanding we do not denie but medicines may be verie profitably giuen and receiued to mundifie to purge the bloud Of the impediments or lets of Phlebotomy and of the causes requiring and furthering the same Chap. 8. THere are certeine things which put off bleeding for a while and other things which altogether hinder forbid this practise whereof the first is indigestion of the meat receiued as when a man hath eaten much ouer-night and in the morning feeleth himselfe pained therby feeling still as it were the sent sauour of the meat which he hath eaten remaining still in his stomack whereby the cruditie plainly appeareth In this case except vrgent necessitie otherwise require wee must forbeare bleeding til the digestion be accomplished that is til the rawe humors be concoct also the excrements descended The reason why cruditie and rawnes of humors through too much ingorging of meat stayeth bleeding for the time may be gathered out of Auicen 1. Doctri 6. cap. 3. for that there are three things which attract matter vnto them that is emptines of the place heat of the members the habit and state of the whole bodie If therefore the bodie thus affected wee chaunce to open a veine the bloud vntimely woulde be drawen by the veines first part of this cruditie of humors and the veines being destitute of their proper and conuenient nourishment would drawe vnto them that which is not as yet concocted in the stomack Liuer which vnconcocted matter sent abroad to the othâ—r members of the bodie would not easely be amended For as Galen saith the third dgestion doth not remedie the faults of the second nor the second the curls of the first Si magnum sit peccatum as he saith if the euill be great So that now if by this meanes the matter be turned into the members
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
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
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
must be taken that the bloud comming downe the veine may swell and appeare in sight It must be bounde harder in some than in others as namely in such persons that haue their veines couered as it were with much flesh or fatt By this hard binding the veine is stretched out or swelleth it standeth sure and flyeth not froÌ„ the stroke of the Phebotomer And thirdly the bloud commeth forth with the more force we vse also to binde beneath the place when the quiuering vnconstant veine slippeth aside out of his place from the hand of the Phisicion They that haue a full thick skin narrow veines and deepe in the flesh or great veines couered with fat must be bound both waies and haue the bond tyed faster than those of a contrarie constitution If the veines be verie small little that they do not fully sufficiently apeare by binding as it happeneth in the veines of the hands feet ankles VVe soke them in warme water or pour warme water vpon them that the skin flesh may waxe soft and the veines beseene then we binde them so they bleed the better If the veine yet appeare not wee search for it in the place where it should be with our singars vntil partly thereby partly by the fluxe of blod we wel perceiue the same VVe bind the necke but softly when wee take the veine of the forehead or the veines vnder the tonug Yea many times in these wee take a table napkin putting it about the necke cause the partie himselfe to hold both the endes as he may suffer or indure the same VVhen wee throughly and well perceiue the veine we strike the same softly with the instrument diligently taking heed that he wound not in steede thereof an arterie sinewe or some gâ—istly ende of a muskle called a Tendon lying vnder the veine or some other part neare vnto it For somtime when we bind hard with the bonde there appeareth a place puffed vp with wind there swelleth a thing like a veine that is no veine And sometime an arterie pressed downe doth not moue and so seemeth to be a veine and therefore to be more sure let him with the forefinger feele the place of the incision the veine vnderneath This done let the Phisition take his instrument at the verie fingers ends with a good eye and a good hande and let him not put foorth more of the point than is sufficient to pearce withall And that the veine escape not the instrument in one hand let him hold the launcet and with the thombe of the other hande applyed to the veine that is to be opened let him settle presse and keepe downe the same chat it start not aside and so softly without haste put in the instrument sufficiently and let the Phlebotomer haue good experience to open a veine with both hands for a veine of the right aá¹™me is best opened with the right hand a veine of the left with the left hand The veines in the ioynts in the bending of the arme in the hammes being cut in rectum that is right growe together but slowly because the ioynts with motion do open still the lippes of the wound Neither are we so to cut them except when wee neede to reiterate bleeding Veines without the ioynts as in the head in the hands in the feet opened in rectum are quickly couered with a skarre because the sides doe soone grow together againe There lyeth vnder the inner vaine called Basilica also an arterie and vnder the middle veine a sinewe and vnder both for the most part Tendons of the Muskles Cephalica veine albeit it be heard to take yet it is most safely taken of all the rest For in opening therof a maÌ„ cannot light vpâ—Ì„ any Tendon arterie or sinew VVhen a Tendon or sinew is prickt there followeth great paine astonishment resolution convulsion of the atme with a swelling VVheÌ„ an arterie is prickt the bloud is verie hardly stayed and consequently through effusion of much bloud the strength of nature is wasted Neither doth the arterie heale vp or growe againe togither but part of it is corrupted like Gangraena which is a putrifying or rotting of the flesh by mortifying the sensible parts therof if a sinewe or Tendon be prickt the same is perceiued by great paine convulsion swelling following If there be doubt that a sinewe is prickt let not the wound grow together till it be safe sroÌ„ inflamation that two or three dayes ar ouer passed it may be kept from growing together by bathing of it in warme oyle After three daies if the paine cease that there come no new accidents we may permit the vnion suffer it to grow togethers againe if not then we are to vse opening attracting things such as wil help the pricking of sinewes as namely turpentine putting therto somtime á litle Enforbium VVhen an arterie is wounded there coÌ„meth forth thin bloud red fine spinning out To help this case make a plaister of Aloes Mirrh Frankencense Bol-armoniak the white of an egge haires of an Hare lay ouer these a linnen cloth dipt in Rose-water fasten the plaister wel with a bond that it come not off in 3 dayes then this being gently remoued apply another like vnto it If the arterie will not grow togither with these cut the whole arteriâ— ouerthwart that when the extremities are pulled vp on both sides the place may growe and be couered with soft flesh Touching the maner of the incision quantitie of the wound if we iudge the bloud in the pacient to be thick clammie Melancoly that the constitution of the aire be colde the wound must be reasonaby large wide that the thick bloud grosse fumes may the better issue foorth for the wound in this case being little strait the most thinne bloud alone floweth out the grosse thick bloud remaining still behinde A large wound therefore is best in these three cases First when the bloud is grosse thick Melancoly that it may passe foorth with the more facilitie Secondly when there is great abundance of humors for they are better expelled with a large than a narrowe or small wound Thirdly when the countrey or season of the yere is extreme colde as in Winter in srost and snow for cold maketh the humors thick Contrariwise a narrow or little cut is best when the strength of the bodie is but weake lest the wound being too large the vitall spirites might immoderatly passe foorth with the bloud Also in a hote countrey or season or when euacuation of subtile and thinne bloud is requifite Schola Salerni sayeth Fac plagam largam mediocriter vt cito fumus exeat vberius liberiusque cruor The wound make meane for meanly done The fumes may passe bloud may â—unne Melancoly slegmatike complexions bleede often times guttatim i. drop by drop therefore a larger wound must be
alwaies that when sulnes hath adioined with it in the body corrupt humors or that with increase of much bloud there is also some euill and corrupted iuces as happeneth in that fulnes which is onely Quo ad vires and in continuall feuers ioyned with putrifaction than wee are both to let bloud and to purge as was shewed before in Chapter 4. Certaine very old english verses concerning the veines and letting of bloud taken out of a very auncient paper booke of Phisicke notes YE Maisters that vsen bloud-letting And therewith getten your liuing Here may you learne wisedome good In what place ye shall let bloud In man in woman or in child For euils that be wood and wild There beene veynes thirty and two For wile is many that must be vndo Sixteene in the head full right And sixteene beneath I you plight In what place they shall be found I shall you tell in what stound Beside the eares there beene two That on a child mote beene vndoo To keepe his head from euill turning And from the scale withouten letting And two at the temples must bleede For stopping and aking I reede And one is in the mid forehead For Lepry for sawcesleme that mot bleede Aboue the nose forsooth is one That for the frensie mote be vndone Also when the eien beene sore For the red gowt euermore And two other be at the eien end If they bleeden them to amend And the web that comes thorow smoking I you tell withoutâ—n leasing And at the hole of the throat there beene two That Lepry and straight breath will vndoo In the lips foure there beene Able to bleede I tell it be deene Two beneath and aboue also I tell thee there beene two For sorenes of the mouth to bleede VVhen it is flawne as I thee reede And two in the tongue withouten lie Mote bleede for the quiuancie And when the tongue is ought aking For all manuer of swelling Now I haue tolde of certaine That longer for the head I weene And of as many I will say That else where there beene in fay In euery arme there beene fife Full good to bleede for man and wife Cephalica is one iwis The head veyne he cleaped is The body aboue and the head He cleanseth fâ—o euill and qued In the bought of the arme also An order there must be vndoo Basilica his name is Lowest he sitteth there ywis Forsooth he clenseth the Liuer aright And all other members beneath I twight The middle is betweene the two Corall he is cleppid also That veine clenseth withouten doubt Aboue beneath within and without For Basilica that I of told One braunched veine sty vp ful bold To the thomb goeth that one braunch The Cardiacle he wil staunch That there braunch full right goeth To the little finger withouten oth Saluatell is his name He is a veine of noble fame There is no veine that clenseth so clene The stopping of the Liuer and Splene Aboue the knuckles of the feet With two veines may thou meet Within sitteth Domestica And without Saluatica Domestica clenseth well The bladder euery deal Siluatica withouten doubt He clenseth well for the gout In the hammes a woman shall bleede For stopping of her flours at neede A man shall bleede there also For the Hemotroids to fordo Two veines if thou vse I say The quartane thou maist void away All the veines thee haue I told That clenseth man both yong and old If thou vse them at thy need These foresaid euils they dare not dreed So that our Lord be them helping That all hath in his gouerning So mote it be so say all wee Amen amen for charitee A profitable obseruation of the bloud extracted Chap. 22. WHen the bloud floweth foorth of the wouÌ„d the same is to be receiued in clean wiped porringers of earth glasse tinne or siluer not of brasse lest the same cause alteration of the substance colour or other quallity of the bloud and so our iudgement by that occasion be peruerted corrupted Of these little vessels there must be many in number that in each of them the varietie of the bloud may appeare and be seene and they are to be set in a faire place that no dust smoke winde or Sunne come vnto them The first obseruation is the substance of the bloud which sometime is viscous cleaueth to the fingers like glue this floweth out but softly and slowly because it is thicke and it quickly againe congeleth This kind of bloud is the cause of obstructions in the body and of such diseases as are caused by obstructions That bloud which congealeth not so soon in the porringer is thin bloud And that which waxeth not hard being cold is watrish and putrified bloud Thicke viscous bloud and compacted hard is hardly cut or diuided thin bloud very easily putried bloud not at all but as soone as it is touched with ones finger or a knife it is torne rent as it were into small pieces Whey which is as it were a yellow water swimming on the bloud wehn it is clodded sheweth eitherimmoderat drinking or a weak Liuer as in hidropicall persons or weaknes of the raines and obstruction of the same For these diseases cause aboundance of watry wheyish matter in the veines mingled with the bloud The thicke bloud is verie hardly imparted or distributed among the small veines for thereby they would soone be obstructed Froth swimming on the bloud except the force of the fluxe haue caused it declareth heat and inflammation of that humour which the colour expresseth Red fome sheweth bloud yellowe fome choller white fome â—â—egme swart some melancoly The colour of the congealed bloud being very red in the top sheweth a good profitable qloud The colour red and cleere sheweth hot bloud as that of the arteries An obscure red colour expresseth a mean or mediocritie as is the colour of the bloud in the veines A citrine colour i of the colour of a citron golde or orâ—nge sheweth dominion of choler white colour dominion of flegme green colour superiority of adust choler and a colour swart or like lead sheweth aboundance of hurtful melancoâ—â—e with mortification of the spirites A mixture of diuers colours sheweth aboundance of diuers humours whether the coloured humors be putrified or no the substance of the bloud declareth White colour commeth of good concoction chiefly in those that haue full strength whose vrins appeare well concoct with most white residencies in the bottom The bloud of such persoÌ„s in the veines through concoction waxe white If the bloud be white in colour viscous in substance it signifieth adust flegme by reason of burning heat in the same If it bee not viscous but thin watâ—ish it sheweth natural flegme The best colour in bloud is red inclining to a certaine obscurity or darknes Purple colour very thin cleer sheweth choler as Galen witnesseth inpri de
application of Ventosas particularly in euâ—ry practise Boxing without scarrification are vsed to reuoke and pull backe matter called before revulsion or to turne bloud and humors aside which was called deriuation cap. 6. Thus cupping reuoketh bloud at the nose as yee heard aboue out of Galen by applying the Ventosas vnto the sides that is vpon the Lyuer and right side if out of the right nosethrills contra as before Thus we stoppe fluxe of termes applying a great cupping-glasse to the roote of the Paps as ye heard out of Hyppocrates Thus the falling downe of the wombe or matrix is reuoked by application of the cupping-glasse neere to the nauill Thus to reuoke matter from the head we apply them to the inside of the Thigh where note that this better prouoketh termes than the opening of Saphena vein Thus against stopping of termes we apply them to the inside of the Thigh where note that this better prouoketh termes than the opening of Saphena vein Thus against stopping of hemorroids we apply them to the inside of the Thigh where note that this better prouoketh termes than the opening of Saphena vein Cupping-glasses are not vsed for deriuation sake that is to turne bloud humors aside another way except when the body is first euacuated or when the humors are setled in any part and that the member is swollen in this case for deriuation sake we apply Ventosas to the hinder part of the necke than to the partes called Spatulae which ioine to the necke sometimes also to the but tocks and haunches Boxing with scarrification is vsed when some euacuation of bloud is required standing in steede of Phlebotomy as we said before when certaine occasions hinder the same First in this practise wee apply the Ventosas to the member Afterward we open that very part in many places in the skinne onely with a small penknife for the purpose and so applying the glasses againe wee euacuate bloud But wee must not doo this before the body bee first euacuated chiefly in vncleane and corrupt bodies lest too great abundance of humors bee drawen into that part Boxing with Scarrification is vsed either in the vpper partes in the middle partes or the lower partes of the body Cupping-Glasses applyed to the forepartes of the heade offende the Senses and vnderstanding Applyed on both the middle partes of the necke or vppon Nucham Puppis they stande in steede of opening Vena Nigra and they helpe heauinesse of the browes and lighten the eie-lids they helpe scabbines of the eies they cause both the Parent and the childe begotten by him to bee forgetfull Vuerkerus Ventosas applyed to the lower part of the neckwhich is called Acheal standeth in steed of opening Basilica they helpe pains of the shoulders and gullet that is the place whereby meate and drinke passeth into the stomacke they helpe diseases of the breast caused of bloud the crampe caused of bloud and trembling of the heart Ventosas applyed to the vpper part of the necke that is the very ioyning together of the head and necke are in steed of opening Cephalica and helpe in affects of the head as the shaking and particuler palsie of the head yea and in affects of the parts of the head and therfore it profiteth for toothach paines of the eies and eares but there must goe before purging of the whole body lest matter bee drawen vp againe to the heade and fill the same and so the diseases increase againe as Galen saith 13. Method Medend cap. 4. we must beware here in this case not to apply them thus too oft because they hurt the memory VVhere as a litle before we spake of an applicatioÌ„ which serued in steed of Basilica so we say now that Ventosas applied aboue Spondiles serueth also in steede of Basilica and cleanseth the breast and yet hurteth the mouth of the stomacke and causeth trembling of the heart and therefore they are subiect to these diseases must beware howe they vse them and yet according to Rhases 2. ad Almonson It helpeth in trembling of the heart caused of repletion and with heate But it should seeme that either Rhases meant of application of Ventosas to the lower part of the necke called Acheal which indeede as we said before helpeth trembling of the heart So confounding this application with the former VVhich the rather may so seeme because it is said that they both serue in steede of Basilica or els that this application hurteth the heart is ignorantly added and put to of some vndiscrete writer Ventosas applyed to or vnder the chinne helpeth the teeth the face and the throat clenseth the heade and the Iawes especially they cleanse the face from scabs and itch Ventosas applyed in the ioyning together of Spatula with the necke profiteth in passions of the face as scab or itch and in stincke of the mouth It may be that this application is euen the selfe same which immediatly went before And thus much of particuler application of Ventosas to the vpper parts Now of their application to the middle parts of the body applyed between the two Spatula his hands or hath allanderous tongue can do they help diseases of the brest caused of bloud and a crampe comming of the same case and in these two this application agreeth with that to the lower part of the necke before called Acheal but this last application hath two discommodities for they weaken the stomack and cause trembling of heart VVhere note that this application seemeth one and the selfe same with that Super spondiles and so it is true that was there saide concerning the offence of the stomacke and heart thereby Ventosas applyed aboue or vppon the raines helpe apostumations and pushes of the thighs or haunches scabs gowt and hemorroids leprosie windines of the bladder matrix itchings of the back and all diseases of the lower parts Ventosas applyed vnder those parts called in Latine Cauillas otherwise Alchahab helpeth stopping of termes the gowt in the feete and the Sciatica gowt and thus of application to the middle parts Thirdly concerning their application to the lower parts Ventosas applyed aboue or vppon the thighs or rather the shanke from the knee to the anckle which part of the leg in Latin is called Crus they stande in steede of Phlebotomy they mundefie the bloud prouoke termes and are better than the opening of Saphena to prouoke termes in white soft and weake women Ventosas applyed to the former part of Coxa That is the Thighes or Haunches helpeth apostumations of the testicles and woundes of the Thighes Haunches and Shanks applyed to the hinder part thereof they helpe apostumations of the Arse and Buttocks and goinges out of the fundament and blames and pushes in the same part Ventosas applyed betweene the two Anches That is hypsor buttocks helpeth the two Anches and the two inner partes of the thighs or hâ—unches Also the hemorroids the gowt in the fecte and ruptuâ—s
about the pâ—iuie parts of men or women Ventosas applyed vpon the buttockes attract from the whole body and the heade and helpeth the bowels also they helpe corruption of menstruous termes and by meanes thereof lighten the body Ventosas applyed vnder the ham behinde the knee helpe beating shaking in the hams caused of an hot humor also wicked pushes corrupt vlcers in the shanks in the feet and thus much of the particuler application of cupping or boxing glasses There is another kind of boxing that we haue not here to deale withall necessary and good sometime to bee vsed as for example sake If you haue any sawsie Lowt or loytering Lubber in your house that is either too busie of nothing but play one of the parts of the foure and twenty orders of knaues there is no pretier medicin for this nor sooner prepared than boxing is three or foure times wel set on a span long on both the cheeks althogh perhaps this wil not alter his lubberly conditions yet I assure you it will for a time change his knauish complexion and helpe him of the greene sickenes and euery man may practise this as occasion shall serue in his owne house to reforme them Because as we haue saide boxing is often vsed together with launcing therefore a word or two of scarrification and so an end Launcing is done with a Lancelot or some instrument called in Greeke Epidermes and in Latine Scalpellum The member is cut by little and litle with this Chyrurginall instrument ometime it striketh but the very skinne sometime it goeth in deeper It euacuateth onely out of the diuided member except by hap it wound and hurt the veyne Scarrification causeth the humor vnderneath to passe forth not forcibly extracting any thing from places distant and further off and the deeper the Instrument goeth in the more aboundant is the effusion of bloud It serueth to purge the skin and helpeth those affects which Leaches doo cure and those which are in the skinne and sticke stifly vnto the same As old inflamations of corrupt matter as the disease called Scirchus mentioned before as Gangraena a cankerous mortification of a member or part of a member as Sphacelus which is when any part or member is mortified thorow inflamation and such like in which diseases naturall heat beeing as it were choked vp and strangled desireth as it were to bee winnowed VVhere note that Launsing doth more plentifully draw bloud if presently vpon it boxing bee vsed as was partly signified before A profitable and compendious Table of Phlebotomy or bloudletting containing diuers points in this Treatise handled and discussed of and setting downe by diuision the generall and speciall considerations thereunto belonging Chap. 28. A principall rule and obseruation AS in other thinges so in bloudletting the cause is first skilfully and circumspectly to be considered as that it bee to purge the body of some vnnaturall naughty and superfluous humor whose substance is either simple or mixt Simple when it doth of it selfe without the admixture of any other degenerate as bloud doth when it putrifieth in the veyne the Pores being stopped mixt when it is mingled with some that is already corrupted as in the dropsie where the bloud is mixt with water The cause beeing thus allowed and certainely knowen for needefull and good to the Patient otherwise letting of bloud is very dangerous and openeth a way to grieuous infirmities as ye haue heard in this treatise There remaineth to be considered how it standesh with the Patient Inwardly For his Complexion For his Age. Outwardly For the time of the yeare and moneth generally For the time of the day and diet particularly 1 Complexion In the complexion is to be considered whether he be Sanguine i. hote and moyst Colericke i. hote and dry Melancolicke i. cold and drie Phlegmaticke i. cold and moyst 2 The Age. In his age whether he be In his youth In his manly middle age In his elderly age In his crooked old age 3 The time of the yeare Concerning the time of the yeare he is to be aduised what partes therof are good as the spring from the middest whereof to the beginning of Summer is simply the best time howbeit some thinke Autume reasonable good as no doubt it is in regard of Summer or VVinter being otherwise in it self rather to be rekoned for bad than good Bad Verie bad as Summer VVinter for the extremitie of heat colde More tollerable as Autumne being somewhat more temperate 4 The time of the Moneth Concerning the time of the Moneth these generall cautions are to be obserued that he be not let bloud in any meÌ„ber with chirurgicall instrument The Moone being in ♉ ♊ ♌ â™ or the last half of ♎ and first of â™ The Sunne the Moone or lorde of the Horroscope being in the sâ—gne that ruleth that member The Moone being in any parte of via lactea or in via combusta or in domo casus sui or being vacua or tarda cursu or in terminis infortuniorum or in the duodenarial diuision of the 12. houses placed either in 1. 6. 8. or 12. place thereof or applying to the lord of the house The dâ—y before the day it self the day after the chaÌ„ge of the Moon Halfe a naturall day that is 12. hours before as many houres after the quarters of the Moone A day before a day after the full of the Moone A day before a day after the coniunction quartile opposition of the ☽ with ♄ or ♂ A day before the coniunction of the ☽ with ☿ ♀ or the head or the taile of the Dragon infortunate and euill The conuenienst time of the yere For the Sanguine the Moone being in any of the signes For the cholericke the Moone being in ♋ or ♓ For the Melancolick in â™’ and first halfe of ♎ For Flegmaâ—ick the Moone being in ♈ or â™ Howbeâ—t some commend ♋ â™’ and ♓ for bloud letting Also the best most laudible aspectes for this purpose are these according to our soundest writers The coniunction of the Moone with ♃ or ♀ are simply the best so that ♀ bee not combust The â–³ or âš¹ of the ☽ with ♃ ☉ ♀ and ☿ are good but especially with ♃ or ☿ The ♊ or ☠of the ☽ with ♃ or ♀ doth well The â–³ or âš¹ of the ☽ with ♂ are indifferent good The time of the Moneth for Youth from the chaunge to the first quarter Middle age from the first quarter to the full Elderly age from the full to the last quarter Old age from the last quarter to the chaunge A reason of this rule is Like reioyseth in his like Howbeit as we haue taught in this Treatise no childe would bee let bloud before fourteene yeares of age nor olde man after threescore and ten vnlesse his strength be the greater and somewhat more than ordinary at those yeares 5 The time of the daie The time of the day must be
either Morning after the rising of the Sun when a man is yet fasting which is simply the best excepting the houres of ♂ and ♄ and choosing the houres of ♃ and ♀ whose nature is most temperate Afternoone after reasonable good or rather perfect digestion and expulsion of of superfluities Herewithall regard must be had of the aire that it bee neither too hote nor too colde or clowdy but milde cleare and temperate the wind being then either Northerly or westerly The Southwind is counted no friend to Phlebotâ—my whereof this is the reason heate looseneth too much cold bindeth too much An Exception NOtwithstanding the premisses of bloud-letting before The Frensie Squinancie Pluresie and Apoplexie or for a continuall headach proceeding of choler or bloud for any hote burning Feuer or other extreme paine and desperate disease A man in such a case may not tarry a chosen time regularly set downe by the Astronomer or Phisition for so the Patient might miscarry in the meane season But incontinently with all conuenient speede hee is this way to seeke his remedy except either he bee very weake or like to sowne or that the Moone bee in the same signe that ruleth that very part of the body VVhere also note that in the foresaid case of extremity bloud is not to bee let in so great a quantity as otherwise it would if a chosen time might conueniently be expected As before bloudletting these circumstances of complexion age and times are to be considered So after the same consideration is to be had of our meats and exercise For meates such must bee taken as are of an easie and light digestion For exercise wee are to abstaine from all exclusiue vntill the fourth day not onely those that be vehement as riding running leaping vawting wrastling fensing tennise c. But also such as are more milde as walking bowling bathing and especially Venerie whereof wee haue spoken in the twentith Chapteer and I doubt not but I may effectually conclude both antecedent and consequent limitations duely and orderly obserued this auncient practise of Phlebotomy to bee very commendable both for the preseruatiue and curatiue intention of Phisicke Conclusio Operis And thus according to my simple skill and poore talent I haue set downe those remedies which withdraw bloud either from the whole body generally as Phlebotomy or from certain parts particulerly as Leeches boxing and scarrification which was my purposed determination at the beginning to doo If any thing bee here set down repugnant to sound skill I craue pardon hauing no skill to iudge because Phisicke is not my profession onely drawen with a delight in this practise First for my pleasure now I trust for orhers profit I haue further trauâ—iled herein than I thought to haue done If any fault or error be in the order methode or disposition I assigne that vnâ—o my selfe 〈…〉 pardon for ought that is amiâ—se protesting in truth which a man may easily discrie tâ—at this booke is rather a collection from others than an inuention of mine owne God graunt that this my trauaile herein whatsoeuer it bee may make vnto his glory and the comfort of his people which are the two impulsiue causes moouing euery good Christian one way or other to imploy his indeuour Deo laus honos gloria in omne aeuum FINIS ¶ The Contents of the seueral Chapters in this Treatise Cap. 1 OF fulnes emptines and their diuisions 2 What euacuation is and the kindes and diffeces thereof 3 What Phlebotomie is and from whence the opening of a veyne doth euacuate 4 Whether Phlebotomie must goe before purging or contrary 5 Of the effects that is the profits disprofits of bleeding 6 Of reuulsion that is pulling back and deriuation that is turning a side of blood and humors by opening of a veine 7 Whether purgation by siedge or inward medicine receiued can not or may not euacuate the blood and the reasons answered that are brought for proofe thereof 8 Of the impediments or lets of Phlebotomy and of the causes requiring and furthering the same 9 Of such persons as are meete or not meete to be let blood 10 What corruption of humors bleeding remoueth from the veynes generally 11 A particular rehearsal of those diseases present or future which are cured by bleeding 12 What voluÌ„tary eruption of blood profiteth in sicknes 13 How to know by certayne signes the greatnes of the disease the firmenesse of the natural forces wherby coniecture may be made whether the patient be to be let blood or no. 14 To know by the greatnes of the disease and strength of the natural powers the quaÌ„tity of blod that must be withdraweÌ„ 15 An obseruation of things present and past and also a foresight of things future needfull and necessary to the further knowledge of the quantity of blood that must be taken 16 Of the times and seasons of the sicknes of the yeare of the day and houre of the day when a man is to bleede or not to bleede 17 Of Astrologicall obseruation in bleeding and of an other obseruation neerely annexed vnto the same shewing what members and parts of the body are to bee opened according to the seueral seasons of the yeare 18 What preparation must goe before bleeding 19 What is to be done in the very time of the incision 20 A prescription or regiment of the patient after bleeding 21 What veynes are to bee opened both in generall and particular diseases 22 A profitable obseruation of the blood extracted 23 A short rehearsal of 8. auncient errors touching bleeding and a sufficient confutation of them by auncient authorities 24 A sufficient confutation of the supposed necessitie of annual bleeding 25 Of incision of the arteries 26 Of particuler euacuation of blood and first of bloodsuckers and Horse-leaches 27 Of cupping or boxing and scarrification the other two particular euacuations of blood 28 A profitable compeÌ„dious table of Phlebotomy or blood letting conteining diuers poynts in this Treatise handled discussed off and setting downe by deuision the generall and speciall considerations thereunto belonging The names of the authors whose help is chiefly vsed in this Collection Aristotle Actuarius Aetius Auicen Alexius Andernacus Auerroes Arnoldus de villa noua Bacchanellus Bullein Anglus Cornelius Celsus Eliota Anglus Fernelius Fuchsius Galenus Gesnerus Hippocrates Rich. Harueius Anglus Hollâ—rius Iohannes de Santo Amando Iohannes de vigo Mesue Oribasius Paulus Aegineta Rhasis Rondoletus Schola Salerni Weckerus LONDON Printed by William Hoskins Iohn Danter dwelling in Feter-Lane 1592. â—yâ—sts i◠〈◊〉 â—* Cephalica Bâ—siliâ—â— Coraâ—â— id 〈…〉 vena Saluatel Domâ—stic◠〈…〉 Silâ—atica 〈◊〉 1. Substanti 2. Serum 3. Spuma â— Pinguedo 8. Subsidentia 7. Grana
THE ENGLISH Phlebotomy Or Method and way of healing by letting of blood Very profitable in this spring time for the preseruatiue intention and most needful al the whole yeare beside for the curatiue intention of Phisick Collected out of good approued authors at times of leasure from his other studies and compiled in that order that it is By N. G. Prouer. 30. vers 15. The horse-leach hath two Daughters which crye giue giue Prouer. 27. vers 9. Balme and sweete incense make the heart mery so sweete is that friend that giueth counsell from the heart ¶ Imprinted at London for Andrew Mansell and are to be solde at his shop in the Royall Exchange 1592. To the right Worshipfull Master Reginald Scot Esqure dayly increase of wealth Worship and wisedom in the true feare of GOD. THIS pleasaunt and profitable practise of blood letting Right Worshipful Sir hath always and that worthely been accompted and called of the auncient and latter Phisitions Vnum è maioribus remedijs one of the greater remedies in the Arte of healing not as I take it for that the same is of gretest charge to the patient his purse a veine being commonly opened for twelue pence but because if the same be done with skill according to Arte it bringeth great profit to health without any great diminishing of wealth How this so great a remedy in both the inteÌ„tions of Phisick Preseruatiue and Curatiue is greatly abused by vagabuÌ„d Horse-leaches trauailing Tinkers who find work almost in euery village through whose wickednes hauing in truth neither learning knowledge witre nor honesty the sober practisioner and cunning Chirurgian liueth basely is despised and accounted a very abiect among the vulgar sorte The whole world with wofull weepings too too plentifully can witnesse and many godly and faythful Christians here and else where with pinching paines and griping griefs euen to the last gaspe haue pitifully felt For these kinde of men are so farre off from repayrers of mennes bodies as they would seeme to bee that they are rather marrers and manglers of men women and children without all care to men whome they ought to tender foster and cherish without all conscience to God to whom they must one day render a reckoning of this their desperate and diuelish dealing No man brought vp among Christian meÌ„ of any practise or calling but hath long sithence learned this lesson how frayle infirme and weake soeuer our mortal bodies are yet it hath pleased God to call them his owne temples his owne instruments and his owne dwelling places an vnspeakable dignitie farre aboue that for which Alexander Magnus so contended when hee would needs bee called the sonne of Iupiter Paul to the Thessalonians willing vs to keepe our vessels viz. our bodies in holynesse and honour suggesteth vnto vs these two poynts first the fragilitie and mortality of our earthly bodyes comparing them to vessels of earth and pots of clay which break with a blow perish with a knock secondly that yet they are not our owne bodyes to vse as wee list to sensuality like bruite beasts but to keepe them carefully as vessels which the Lord hath clensed and washed with his owne blood to his owne glory in all holynes and honour The Priests of Baal cutting and launsing their owne bodies with a vayne and wâ—cked supposal that in so doing they pleased God grieuously sinned as diuers affirme both agaynst nature and godlines against nature because no man euer yet hated his owne flesh but nourisheth and cherisheth it as the Lord doth the Church against godlines because works of pietie and religion in our selues or in others they either quite surcease or are greatly hindered when the bodies of men are decaied in streÌ„gth weakned in vigor languished with sicknes or finally destroyed by death To let passe these things which diuers deliuer out of their pulpits of the excellencie and dignitie of mans body haue not the Philosophers in the schooles called the same Microcosmos Orbiculus a little world most beautiful in forme fayrest in shape excelling farre all other liuing creatures whome the creator hath made In whose braine as in primo mobili is fixed that inesteemable Iewel called Reason no monster or Idole but the mother of all Artes Sciences by whome God guiding the same are wrought inuented marueilous matters by Sea and by land in euery matter of speculation or practise This I haue hitherto discoursed to this drift that those blinde bussards runagate Artists might at length see and consider that they are no way willed or waraÌ„ted like butchers to cut rend and teare the bodies of men without skil either in letting blod or any other practise of Chirurgi but like brethren to cure repayr and amend that which is amisse refusing no paine taking for their own parts nor reiecting due consultation with men experienced that so the noble Science of healing may be generally honored the diseased recouered the skilful workman worthily in fine rewarded To met with this mischief acording to my Mediocritie and that such as are desirous of this practise either for pleasure or profite might be somwhat fraughted with a few pithy instructions and necessary rules in the same and so at length attaine to the most exquisite cunning deep knowledge therof I haue thought it good not onely to publish this my rude collection conteining if I be not deceiued the whole handiwork of Phlebotomy but also to counteruaile my default as rudely yet most huÌ„bly to request your worships fauour for the protection thereof But for as much as Seneca that christian Ethnicke for so dooth Erasmus terme him for his profound wisedome deepe indgement willeth vs in bestowing of any gift to be careful that it be fit for the estate of the giuer and also meete for the condition of the receiuer least in stead of expected thanks disgrace may growe and what the giuer meaneth of good will may perhaps by the receiuer either limping in iudgmeÌ„t or freezing in delight be little regarded lesse countenaunced I am in a worde or two to shew that for my part I haue not as I thinke much swarued from the sound aduise of the Philosopher in making your worship patron of my poore seely paines First for that euen your selfe haue already in print in your booke called The discouery of VVitchcraft openly biterly enueighed against one sort of blood thirsty men as I doo nowe against another sorte namely witchmongers who are daily and hourely without iust cause conuenting before Magistrates and haling to the halter if the Magistrates dexterity in the administration of iustice did not moderate their malice in murthering poore plaine seely and simple innocents and olde women whom by friuolous euidences incredible proofes vayn ghesses preiudicate presumptions meere impossibilityes they would haue condemned and executed for witches These men in mine opinion should farre better please God and much better deserue of the Christian coÌ„mon wealth if they
after his capablenes The discommodities vvhich happen by Replecion are manifold moistnes thereby is too much increased and naturall heate quenched againe naturall heate resolueth somewhat of the superfluous meate and drinke and of that which is resolued of meate vndigested proceede grosse and vndigested fumes which ascending vp to the heade and touching the rim wherein the braine is wrapped causeth headach trembling of the members dimnes of sight and many other diseases Moreouer the sharpenes of the said fumes pricke and annoy the sensible sinewes whose roots are in the braine and from thence passeth through all the vvhole body The said fumes ingendred of Replecion and piercing the innermost part of the saide sinewes called sensible greatly annoy the animall powers there beeing by occasion whereof Vnderstanding and Reason both as touching the vse of them are vvonderfully let and troubled and likevvise the tongue vvhich is Reasons Expositor is greatly depriued and hindred of his Office As it appearethin them vvhich are miserably drunk and in those vvhich haue most extreame and grieuous paines in their heade proceeding of Replecion Thus much harme commeth to the body by too much nourishment and although the stomacke doo his Office in concoction yet the veins too abondantly filled are spred out diuided stopped and stuffed with winde and greatly grieued It is apparant that of replecion and fulnes of the veines then the which in diseases a more hurtfull thing cannot chance diuers infirmities doo come and the replecion of the belly though the excesse may be expelled by vomit or sedge and so is more tollerable than fulnesse of the veines yet it is likewise to bee disallowed If a man haue at any time too much ingorged himselfe by and by he may assay to vomit for though hee doo well digest it yet there is some danger lest the veines be oppressed with fulnes especially when the party continually liueth intemperately neuer regarding or minding euacuation It is good therefore to vomit first before the meates bee corrupted in the stomacke if any impediment hinder vomiting a sedge by stoole is a present helpe If neither serue sleepe long and oft in drinke vse warme water VVhen the surfet is sufficiently digested chiefly by sedge it is expedient to wash and vse fomentations i. plaisters mittigating paine and a little to tast of salt meates and to drinke wine or beare alaid or tempered with water These things by the way touching remedies for surfetting which in our daies is too vsuall to the great dishonour of God and the certaine destruction of our bodies yea and of our soules also if GOD grantvs not grace speedily to repent and amend But if neither siege nor timely digestion of the meate recemed doo not insue our surfettings then the signes of replecion are to be looked for which are set downe by Oribasius Euporist lib. 1. which are these that followe as Losse of appetite delight in nothing sloughthfulnes dulnes of wit and senses more sleepe than was accustomed crampes in the bodie starting of the members fulnesse of the veines thickenes of the pulsies horror and shroueling of the bodie mixt with heate But the generall signes of abundance of bloud are these bleeding at the nose chiefly forth of the right nosthrill spitting of bloud veines full and great chiefly in the face rednes of colour a ponderous waightines of the whole body vnapt to any motion an vnacustomed drowsines a sluggishnes of minde without any euident cause the skinne stretched pulses very full debilitie of sight grieuous dreames plenty of sweete spittle in the mouth swellings and blushings in the face heauines and painefull wearines in the shoulders as it were after labour or bearing great burthens vrine thicke and red Replecion knowne by these notes except it be ruled by Phlebotomy or otherwise it choketh the naturall heate of the body as Galen saith 1. Aphoris Aphoris 3. Nimia repletio calorem natiuum extinguit Too much fulnes extinguisheth naturall heate Also Metho 13. cap. 6. Plethora tum sanguinis missione curatur tum frequenti balneo exercitatione fictione digerentibus medicamentis Repletion is cured by bloud-letting often bathing exercise rubbing and digestiue medicines Looke more in Galen 3. 6. de tuenda sanita These men therefore in vvhome bloude so aboundeth are to bee holpen by Phlebotomy by opening Mediana or Cephalica or applying of Boxing-glasses with scarrifieng the place first or othervvise as after shall bee declared Remembring by the way that if either purging seeme too long or the opening of a veine cannot bee done accordingly that in these cases Electuarii succi Rosarum are good to purge bloud But hereof there is no place to speake further at this time Finally it is very behouefull to knowe in vvhat place the corruption or ilnes of the contents of the body is placed or where the Repletion is before vvee can addresse our selues fitly to euacuate That fulnes therefore vvhich of the Greekes vve haue said to bee called Plethora is chiefly resident in the veines and habite of the body and this being an abundance of all the Humors in quantitie is euacuated by bloud-setting or opening a veine and with cupping-glasses The Repletion called Cachochymia beeing an abundance in quantity of one Humor is iâ— the whole body or in some particuler part If Cachochymia bee in the vvhole it is euacuated by purgation by generall sweate by abstinence and that kind called insensibilis euacuatio Cachochymia particuler is thus euacuated If it bee in the belly by vomit and by siege If in the entrailes vvith Clisters Suppositors and by siege If in the Liuer by the Vrine If in the Spleene by the Hemorroids If in the Breast by Coughing If in the Heade it is purged through the Nosthrils and roofe of the mouth If in the Raines or Bladder by Vrine If in the Genitals by Venus If in the Skinne by Svveating Resoluing and vvith Cupping Glasses And thus I conclude this first Chapter containing the chiefest and principall points concerning Fulnesse Emptinesse and their diuisions Not intending to vvrite any thing at all of the subtile and abundant definitions and descriptions of Galen in his book De plenitudine and likewise in his Commentaries vppon the Aphorismes of Hippocrates For I hope it hath here sufficed to shew what replecion is the kinds thereof the operations of them good or euill remitting them which be curious and desire a more ample declaration to the most excellent workes of Galen where he may be satisfied if he be not determined to repugne against reason What Euacuation is and of the kinds and differences thereof Chap. 2. FOrasmuch as things contained in the body against nature while they remaine in the body are the inward causes of infirmities which by Art especially are to bee remoued therefore then Euacuation as a most generall remedy is first of al to be attempted Euacuaâ—â—â—â— therefore is an expulsion of those things which are contained in the body against nature There are contained
to turne the fluxe of them aside another way The first indirect cause is for the greatnes of a disease or for vehement inflamation of an impostume for in apostumatioÌ„s of great heat in hote feuers in vehement griefes there is not found a more excellent remedie than opening of a veine The second indirect cause is to allure the matter to the place of euacuation Therefore in stopping of Termes or Hemorroids the veine Saphena is to be opened Fulnes coÌ„ming by suppression of Termes is to be euacuated by the legges from the knee to the anckle whether we cut a veine or vse scarifying or launcing for veines opened in the armes of weomen reuoke draw vpward their naturall purging The third indirect cause is that the humors may be turned to some other place contrary or opposite to the place vnto the which they flow of their own accord Therfore in immoderat fluxe of Termes we open the Basilica veine that is the inward veine of the arme which is also called Hepatitis that the matter being called to a contrarie place may be turned from his fluxe The fourth indirect cause is that some part of the matter being takeÌ„ away by bleeding nature may the more easily ouercom the rest For the vertue of the bodie being weaker then that it can rule such aboundance of humors wee take away by bleeding some portion of them least thorough impotencie and debilitie of nature the same humors should flowe to the weaker members and there breede apostumations and swellings contrarie to nature But of this more shal be spoken at large in the proper place therof namely in the Chapter of reuulsion and deriuation of plucking backe and turning aside of the bloud of humors Touching the vtilitie of bleeding great is the profit therof For Galen reporteth that therewith he hath oft cured feuers and that it is boldly to be taken in hand when necessitie requireth it Therfore we may worthily blame those which in our time contrarie to Galens iudgement against reason al experience speak euil of this profitable practise First it sharpeneth the sight making the same more cleare the reason thereof is for that it diminisheth those humors which thorough their fumes hinder the clearnes of the eies so that consequently the sight thereby is sharpened Secondly it purgeth the braine sharpeneth the wit by the foresaid reason Thirdly it heateth the marrow wasting those superfluous humors by whose commixture flowing the marrow in the bones waxeth cold Fourthly it purifieth all the senses taking away those fumes and euaporations which ascend vp to the head and there trouble the senses Fiftly it purgeth the bowels and entrailes The reason is because nature gouerning the body being disburdened of that bloud which was as it were an oppression to nature and greued her as it were with some heauy burden doth now with ease concoct and ouercome rawe and rude humors deteined in the bowels Sixtly it stayeth vomits and laskes for it draweth the humors from the inwarde parts to the outward parts VVherevnto Auicen agreeth writing thus Phlebotomia propteriae quod ad diuersum trahit naturam secundum plurimum retinet Phlebotomy because it draweth to the contrary part therefore commonly it reteineth nature In which place it is to be vnderstood that in fluxes of the womb the veine of the Arme is to be taken which presently helpeth But if you doo otherwise that is take the veine in the foote or legge it profiteth nothing Sometime it chanceth that the belly by opening of a veine is more flowing than before and that especially chanceth two waies first because nature being disburdened by bleeding strength is increased so that sometime it stirreth vp other euacuations as namely by siege The second way is when through imbecility of the retentiue vertue which imbecility by opening of a veyne is increased so that the wombe is more stirred and prouoked Seauenthly it profiteth against immoderate watching for it emptieth abundance of humors from the which commonly diuers sharpe fumes ascend vp to the head and hinder sleepe Eighthly it taketh away heauines sluggishnes wearines of the body For as hath bin already said before bleeding disburdeneth nature which ruleth our bodies of multitude of humors which before was pressed downe by them oppressed with them And again Melancholly the chiefest cause of heauines is expelled with the bloud as the dregs and grounds thereof Ninethly it cureth difficulty of hearing abating abundance of humors whose thicke slatuous spirits carried vpward into the head stop the hearing port and passege of the eares Tenthly it helpeth the voice taking away superfluous humidiâ—ies which too much moisten the arterie or veyne of the voyce and speaking From which humidities horcenes of speech proceedeth Eleuenthly it refresheth and increaseth the powers and strength of the body For the body beeing freed from a multitude of humors must of necessity haue the vertue and strength thereof augmented These commodities of bleeding are thus set downe in verse by Schola Salerni Lumina clarificat sincerat Phlebotomia Mentes cerebrum calidas facit esse medullas Viseera purgabit stomachuÌ„ ventremque coercet Puros dat sensus dat somnum taedia tolliâ— Auditus vocem vires producit auget It cleareth sight the wits and braine It marrow warmes doth cleane procure The entrailes stomacke this is plaine It stayeth lasks makes senses pure It causeth sleepe expelleth griefe To eare to tongue it brings reliefe To be short these are the commodities of Artificiall bleeding therby the organs of the senses are cleansed weake bodies are made strong if yeares serue By it are helped Repletions Pluresies hot tertians frensies pestilences and dâ—uers other diseases as shall appeare in the Chapter ensuing The onely disprofit in bleeding is this that the vitall spirits thereby are â—havven foorth which thing Galen witnesseth in his booke de Scarrificatione saying to open a veine oft in the yeare I iudge not profitable for with much bloud the vitall spirits are also exhaled which beeing done too often wasteth the whole body making the same cold and causing the liuely operations thereof to waxe worse and worse To frequent bleeding therefore bringeth on old age apace and maketh the same subiect to many diseases as the dropsie gowt shakings palsies falling sickenesses and apoplexies For naturall heate being too much cooled and the principall moysture diminished the bowels languish and crudity ruleth with many flegmaticke humors which are the causes and originall of the foresaid cuils This Schola Salerni remembreth And Auicen in primo testefieth the same The best remedy to recouer vitall spirites decaied is drinking of wine for wine among things nourishing quickly and in short time is the most principall By meats also vitall spirits are recouered in time but not so soone Wherin is to be noted that after bleeding must be taken meate easie of digestion of good iuces and of much nourishment as potched-egs such like which meate easie of digestion
there must in the meane season of necessitie be abundance of excrementes remaining in the bodie as the occasion of sicknesses and so at length sicknesses may ensue Yea it is far better as it seemeth to Galen lib. de Curand ratio per sanguinis missionem cap. 6. altogether to absteine from bleeding in vntemperat drinkers gluttonous persons as from such as cannot be cured either by purging or bleeding For by their vntemperat life they gather in short time againe great abundance of rawe vnconcocted humors VVith such it is not best to deale for to what purpose is it to haue the excellent vse of this practise by these mens intemperancie defaced among the common people which hath been so present a helpe to diuers See Galen lib. 11 cap. 9. Method Meden The seconde matter putting off this practise for a time are the excrementes of the bellie Therefore first exonerate the wombe before bleeding if it bee not soluble of it selfe with a Clister of decoction of Mallowes putting thereto Oyle and Salte or with a Suppositorie or with eating a little Cassia fistula The thirde impediment is some other voluntarie euacuation that may be at that present time as in fluxe of Termes in weomen and in fluxe of the Hemorroids whereunto Gaelen likewise consenteth lib. 9. Cap. 5. Method Meden in these words If saith he in time of bleeding it happen that the Termes do flowe or that the veine called Haemorrhois be open if the force of the same fluxe seeme sufficient so that it alone may euacuate that which thou requirest thou shalt leaue the matter wholly to nature if not then thou maist detract so much bloud till by both wayes that be brought to passe which thou wouldest haue done But this is not alwayes to be followed for in euacuation to turne away the matter as in immoderate fluxe of Termes or in the fluxe of the Hemorroides wee practise bleeding as was afore shewed in the Chapter of Reuulsion Againe concerning these voluntarie eruptions of bloud when wee intend to open a veine if the eruption haue been much then stay from further euacuation But if it little or nothing haue withdrawen the matter of the disease it debarreth vs not of further bleeding Therefore if the disease and present necessitie require it that the powers of nature haue not beene damnified by that voluntarie eruption wee may speedily open a veine as in a strong plurisie If there haue been much sweating vomiting or great sieges we are not to let bloud but if these slake and that the naturall powers are a little in time recreated then wee may verie safely bleede For those being but accidents not remouing the cause of the disease can not serue in steed of bleeding So in a hote agew if the wombe be laxatiue and that there happpen Lienteria which is a fluxe of the stomacke when the meate and drinke runneth from a man as he tooke it vtterly without concoction or alteration rising of great weakenes of the stomacke specially in the power retentiue which is not able to keepe the meate till nature in ful time may concoct it through immoderate drinking of colde water from which some cannot refraine in hote feuers This I say doth not hinder bleeding but because thereby natures strength is enfeebled the same considered the bleeding must be the lesse if voluntarie eruption of bloud remoue the matter of the disease or in some reason bring ease to the patient according to discretion commit the matter to nature alone If not take away some bloud that through natures worke and the Phisitions practise togither the cure may be accomplished Those things which nature of her selfe can finish meddle not withall but helpe her with Art in that which shee beginneth and cannot of her selfe make an end therfore I said in a Plurisie in a continual feuer if bloud abundantly flow frō the bellie hemorroids or nose so that the quantie of the euacuation be iust and the patient thereby eased let no further bloud If bloud come but smally from the foresaide and that the sicknesse still continue vehement that which wanteth is to be done by opening a veine yea although the patient be a woman in child-bed yea therefore sometime in a bloudie fluxe a purgation is giuen that the same which commeth foorth but softly and slowly by reson of the vnprepared passages may flowe more abundantly by a more conuenient course The fourth impediment is the age of the partie that is to bleed either being too old or too yong Old folk are not to be let bloud because there is in them little good bloud and much ill bloud bleeding from them taketh away the good and leaueth the bad behinde Olde men after 70 yeares are not to be let bloud except they be of a strong constitutiō of body that the vehemency of the disease require the same But if in these yeres the powers of the bodie be weake that bloud aboundeth not bleeding is not to be in them practised for as Galen saith in men of these yeres there is little good bloud but of rawe humors great plentie so that opening of a veine sendeth forth the good but the ill blod gathered together in the chiefe veines in the Liuer that part called Mesenterion which is the double skin that fasteneth the bowels to the backe or rather the branches of the veine called Porta which conuey the iuce of the meat concocted from the stomake to the Liuer it draweth forth into the whole bodie Consider therfore the strength of the body the vehemencie of the disease for not onely the number of yeres but the constitutiō also of the body is to be marked There are of 60 yeres that are not to bleed being weake old men The age fit for bleeding is at as florens that is after some the 17 yeare of age after some 9. after some 10. after others 14. or 13. Before the 13 yeare after the most approued writers of our time wee are not to let bloud except those youthes haue broad veines be of sanguine complexion and that the disease be dangerous require this practise necessarily In these cases wee may open a veine if the veines well appeare or we may diminish bloud by scarifying the legges or armes Schola Salerni sayeth Denus septenus vix Phlebotomon petit annus The seuenteenth yere of age scarce good To put in proofe letting of blood Children then before they come to 13. or 14. yeares are not to bleede except some great dangerous disease of necessitie require it at nine or tenne yeares the reason is because their flesh and skinne is yet but tender and easie to breath thorow as Galen witnesseth lib. 9. cap. 17. Method Medendi in these words Puerorū substantia omniūfacile digeritur ac dissipatur propterea quod est omnium humidissima est omnium minime frigida The substance or flesh of children is most easie of all resolued or separated because it is most moyst
somwhat colder and moister than this nowe specified keepeth in the humors and inward heate dissoluing very little thereof Therfore men in such countries may bleede more abundantly The contrary to this hapneth in extreme cold countries scituated far Northward For the bloud congeled through extreme colde will not giue place to euacuaâ—ioÌ„ And again if the inward members should be depriued of their natural inward heate they were greatly in danger to perish with extremity of outward cold Look more of this before in the tenth impediment The thirteenth hinderance is the time or season of the yeare which is a matter also in letting bloud to be considered as namely whether it be too hote a season as in Sommer or too colde a season as in VVinter specially when it is frost and snowe For to what purpose is it when the bodie is alreadie sufficiently cooled through the colde season of the yeare to make it more colde by bleeding And for hote seasons if the heat be extreme those that bleede in them oftentimes die by sowning or fainting called Sincope or resolutio for extreme heat enuironing the patient doth ouercome the vital spirites which come foorth with the bloud drying weakening the state of the whole bodie Therefore in seasons extremely note it is a point of wisedome to forbeare bleeding which thing Galen teacheth lib. 11 câ—p 4 Method Medend in these wordes Et omnino quidem non mittes in tempore aestai is regione aestuosa caeli statn calido sicco Thou shalt not at all let bloud in Sommer time in an hote countrey and in an hote and drie state of the aire as vnder the dog-starre and from mid Iuly to mid September or rather to mid August By Galens wordes wee may perceiue that there is the like reason of the countrey and of the time of the yere concerning the heat and coldnes of them both But to put practisioners in â—iâ—de that these rules are not alwayes pâ—eciâ—ely to be obserued I giue aduertisement still as I haue done in other the like cases before that in this circumstance of the extreme colde or the extreme heat either of the time or of the countrey that it doeth not quite exclude bleeding at all time euen in cases of meere necessitiâ— but onely thus farre that these cannot admit so large euacuation by bleeding as their contraries may The Spring therefore beeing the most temperate time of the yeare when the forces naturall humors them-selues most abound is the best time to open a veine to auoide future maladies The next conuenient season is Autumne or Haruest And of the Spring the beginning thereof to be best Hippo setteth downe 7. Aphorism Aphoris 54. But hereof looke more hereafter in his pâ—oper pâ—â—ce and before in the tenth impediment The fourteenth let of Phlebotomy is former bathings or hote washings especially resolutiue bathes VVhich as Galen witnesseth in his booke of the Vtilitie of respiraâ—ion Cap. 7. do so forciblie euacuate the spirites from the whole bodie that it stayeth opening a veine And againe Hippocra writeth in his second booke Aphoris 51. That it is verie perillous much and vpon the sudden presently one after another by diuers euâ—cuations to emptie the bodie The fifteenth is a disposition to vomit of what cause so euer the same proceedeth For in this cause of lothsomnes of stomack if we let bloud the veines by bleeding exhausted do soone drawe vnto them that wicked and lothsome matter which lyeth in about the stomacke whereof looke more in the fifth impediment The sixteenth impediment may be custome or a former order oflife wherein wee are to consider to what meates wee haue beene most accustomed what excrementes are still reteined in the bodye contrâ—rie to former wont For too much former repâ—etion of the bodie with meate and 〈…〉 bleeding as appeareth in the first impediment But if there haue beene before a moderate meane obserued in eating and drinking wherewith the bodie hath beene safely nourished then we may boldly bâ—eed If it be otherwise then forbeare Yeâ— fâ—om this point also is takeÌ„ a sure note of the quantity ofblod that must be extracted For those that haue bin acustomed to be let bâ—od may bleede more in quantitie than they that haue not bin accustomed to bleede In this impediment moreouer consideratioÌ„ must be had whether Hemorroids or Termes are restreined contrarie to former custome Or whether wee still vse our accustomed exercises or no. But although diuers matters herein are to be regarded yet in custome princicipally these three are to be marked The precedent order of dyet the kinde of life that we haue spent before and former euacuations Those that haue liued sparingly either by their owne ordinarie prescription or by occasion of sicknes are to bleede lesse Those that haue liued more frankly may bleede more plentifully He that hath been alreadie let bloud so that the natural powers be not thereby too much enfeebled may as I now said better abide to bleed than they that neuer were let bloud For this is a generall rule Things accustomed yea if they be euill things are the lesse grieuous whereby is confuted the opinion of the vulgar sort who greatly commend the first opening of a veine as a matter greatly healthfull and discommend all the other bleedings making their reconing of this in their most extremities that though they were neuer let bloud before yet now they will send for the Phlebotomer as their last refuge The seuenteenth impediment is carnall copulation presently after which the opening of a veine is also forbidden because Venus so lately embraced hath thrown down and weakened the powers of the bodie and warmed the same more than was conuenient How the powers of mans bodie are loosened enfeebled through venerious actes Galen most excellently declareth lib. 1. de Semine cap. 25. saying In the time of carnall copulation the stones or genitors drawe forth of the veines all such seedie humor as is conteined in them which is not much in quantities and that which is the same is admixed with the bloud in the likenes of dewe and this to do is the office of the Testicles So that first by the genitors hauing more strength than the veines the seedie moysture is violently drawen from them And againe the veines drawe the same from the members next vnto them These partes againe exhaust from those next vnto them in like sort so that this extraction ceaseth not till it haue gone thorow euery part or member of mans body by reason whereof all the bodily partes are depriued of their proper nourishment and always that part which is perfectly throughly euacuated violently taketh from that which is next adiacent and hath more plentie of seedie moysture to be extracted This I say being done alwayes and all partes mutually participating among themselues necessarily all the receptories and partes of the whole bodie must be euacuated till the strongest of all the partes be filled
And further it commeth to passe not onely that the seedie moysture is drawen from the partes of the bodie through carnall copulation but also the vitall spirites passe out of the arteries with the same And therefore it is no â—â—arucile if such as vse lecherie immoderatly become weake both these being taken from the bodie that is to saye the seedie moysture and the vitall spirite VVhereunto may be added the pleasure of Venus which of it selfe is able to vnloose the vitall firâ—itie of the bodie Yea it is knowen that some haue dyed of too much pleasure in the act Marsilius Ficinus in his booke de Sanitate tuenda Cap. 7. confirmeth in these words aâ—l that hath been hitherto said Venus saith he if it do but little exceede the powers naturall of the bodie presently it exhausteth the spirites and specially those that are most subâ—ile Also it enfeebleth the braine weakneth the stomack and hart-strings yea there cannot be a more hurtfull thing to the witt and memorie VVhy did Hippo. iudge Coitum to be like the falling sicknesse but bâ—cause it woundeth the minde which is diuiâ—e and heauenly The immoderate vse of ust is so hurtfull that as Auicen sayeth in his boode de Animalibus If but a little seede issue foorth more than nature can afoorde it offendeth more than if fouâ—tietimes so much bloud had proceedâ—d And therefore not without some good grounde dâ—d the auncient wâ—iters immagine the nine Muses and Minerua her selfe to be vi giâ—s Reâ—d moâ—e hereof in Galen Chap. 86. Artis Medicinae Pauli Aegnieta lib. 1. Chap. 35. In Aetius lib. 3. Chap. 8. The seuenâ—eenth impediment is long continuance of a disease wherewith the strength of the bodie being wearied a long tract of time the same cannot nowe tolleraâ—e bâ—eeding And forasmuch as now the bodie is more than inongh enfeebled brought lowe thorough a long continuing and languishing sicknesse by bleeding wee maye more easily quite extinguish the patient than remedie the disease Galen de Curand ratio per sanguia missio Chap. 20 And Auicen confirme the same giuing aduiâ—e to forbeare opening of a veine in bodies which haue endured long griefes except corruption of bloud moue vnto it In which case sometime bloud may be detracted from persons that haue continued sicke of long time And Fuchsius councelleth saying People in consumption oâ—de folke weomen with chiâ—de yong chiâ—dâ—en are not lightly to bleede The nineteenth impediment is small quantitie of humors being in the bodie for a good consideration is to be had how the humors offend in the bodie in quantitie or in qualitie VVhether there be many or fewe humors in the pacient And therefore sometime vpon this ground wee open a veine in weomen with child if there be abundance of bloud sufficient both for the mother and the infant in the wombe if the bodily strength be firme and that the greatnes of the disease in them so require it But hereof more at large I meane to write in another place And agâ—ine beside the quantitie the diuersitie of nature in humors is also a profitable consideration in this practise For euen according to the varietie of humors the patient is oft either to be let bloud or not letteÌ„ bloud which Galen seemeth to witnesse li. 4. de Sanita tuend saying Some humors come to perfect nutriment before the bloud some are as it were halfe concocted some altogether rawe and vndigested Some are but little different from the forme of bloud some are wholly changed into bloud some verie litle some more some verie much VVhen humors are a verie little as it were from the nature of bloud as not yet turned into the same or when they haue a verie little exceeded further than the nature of bloud wee may confidently open a veine VVhen the same is more than a verie little either the one way or the other on this side or beyond wee are to deale herein more considerately If the humors want much of or exceed much beyond the nature of blond we are altogether to forbeare bleeding The twentieth let after the small quantitie of the other humors may be the quantitie of the bloud which the wise Phisition in this practise will most wisely regard As for example if there be little good bloud in the body and abundance of other humors wee are to make staie from opening a veine If any of the other three humors be but litle in quantitie and the bloud abundant we may boldly let bloud Yea by diligent obseruation the Phlebotomer shall easily perceiue what hurtfull humor may be withdrawen with the bloud and therfore if there be many cholerike humors in the body of man and yet not mixt with the bloud or that there be many flegmatike and rawe humors and but little bloud by no meanes is a veine to be opened This doth Anicen forbid in quarta primi Cap. 20. If the bloud be good and little and that there be in the same bodie many ill humors also bleeding taketh away the good and leaueth the bad behind And a little after he addeth that the Phisition is diligently to beware lest by vnskilful bleeding in these cases hee bring the patient after he hath extracted the bloud the ill humors still remaining to an excessiue heat of cholericke humors or too much cruditie of colde and vndigested humors And although as ye haue heard before Phlebotomy doth equally euacuate all humors Yet because now so little bloud is in the veines whereof a little portion is withdrawen by bleeding it followeth that but a little bloud and lesse than before remaineth now in the veines with the other humors and that there is great plentie of the other humors forasmuch as they come not out so redily when a veine is opened as the bloud doth and therefore by a necessarie consequent bloud being gone which was as it were a bridle to other humors choler must excessiuely boile and flegme become more colde and vndigested VVhereupon also I gather that those haue done ill and verie vnskilfully which haue reproued Auicen of error in this place seeing he is rather verie highly to be commended then vpon euery small and light occasion to be reprehended Finally wee are to forbeare letting of bloud after continuall vomitings hunger great watchings extreme labours and after all such things as immoderately 〈…〉 body drying and dissoluing the 〈…〉 thereof as Rhases noteth lib. 7. 〈…〉 Almonsorem Touching the causes 〈…〉 ring Phlebotomie they may soone be gathered of their contraries by those impediments here specified And in the fifth Chapter before yee haue heard both the direct indirect causes which may moue to let bloud Vnto the which place I referre the studious reader at this time concluding this Chapter with the verses of Schola Salerni wherin are set downe most of the impediments here spoken of Frigida natura frigens regio dolor ingens Balnea post coâ—tum minor aetas atque senilis Morbus prolixus repletio potus
and had experience once or twise before of aborsion the third moneth if shee had not bled the seconde moneth In the other moneths the fifth and eighth shee was in danger of suffocation except shee had bled againe VVhen women are brought a bed they must not bleede except their seconde birth be suppressed or a Feuer molest them In the which cases also carefully consider in the Patient her naturall strength Those that haue their termes naturally according to the due course of nature and the course of the moneth are not to bee let bloud except in immoderate Fluxes to drawe backe the matter VVhen they breake forth naturally the whole matter is to bee let alone to nature Eighthly bleeding is not good for such persons as are bounde and haue the excrements retained For as yee heard in the eighth Chapter Fig. 2. The veynes beeing emptied they attract matter from the next members and they attract from the stomacke the moystnes of the excrements whereby they become more dried and baked bring diuers waies annoyance to the body In which case the wombe by Art is to be made solluble as appeareth in the place now cited Finally a veyne may and is to bee opened without hurt or daunger whensoeuer wee feele our selues to bee heauy lumpish and stopped or stuffed in our bodies first considering the quantity and quality of the fulnesse which wee may knowe and discerne by certaine tokens whether it bee Plenitudo quo ad vasa or quo ad vires as was shewed in the first Chapter the more heauy and drowsie a man feeleth him selfe to be so much the more it appeareth to bee that fulnesse which is quo ad vires But if hee feele the former stuffing in his body increased than is it that plenitude Quo ad vasa And thus much to know the quantity of the Repletion The quality of the fulnesse is knowen partly by the colours partly by those things which are very neerely ioyned to the nature of the humors But of these signes sufficient hath been spoken before in the first Chapter In these cases of Repletion if the strength of the body shall bee answerable wee are to open a veyne for as much as bleeding is the chiefest remedy to abate fulnesse But if the stuffing and fulnesse of the body bee greatly grieuous and the state of the body not answerable it is not alwaies necessary to let bloud As Galen noteth lib. de Curand ratio per sanguinis missio And againe Phlebotomy is not onely profitable when any of the foresaid fulnesses grieue and oppresse vs But also as hath beene saide in cases without any fulnesse As in the beginning of an inflammation which commeth either of a blow ache paine or weakenesse of the member For paine as was saide draweth the bloud vnto it and of the weakenesse of the bodily parts cause an inflammation without fulnesse Also when the disease is great and vehement we let bloud although no fulnes appear in the Patient yet alwaies hauing a regard to the age and strength of the party as Hyppocrates setteth downe in these wordes 4. Vict. acutorum 17. In acutis morbis sanguinem deâ—rahes â—ivehemens morbus videatur florueritque aegrotanti aet as virium affuerit robur That is in sharpe disease thou shalt let bloud if the sickenes seeme great if the age of the Patient permit and that there be sufficiencie of naturall strength And thus much of the persons that are to bleede concerning the which point more may be easily coniectured and collected of the studious Practitioner from the Chapters precedent What corruption of Humors bleeding remoueth from the veines Chap. 10. IT hath beene said that bleeding generally is the present and proper helpe when Humors offend in the veyns either in quantity or in quality It hath been already declared that some humors it euacuateth other some it reuoketh and pulleth backe which is called revulsion whereof hath beene spoken in a distinct Chapter by it selfe Now order requireth in some briefe sort to shew what corruption of humors generally bleeding euacuateth from the veynes The defect of humors in the veynes is either Plethora or Cacochymia as was shewed in the first Chapter The onely and peculiar remedy of Plethora or abundance of bloud is the opening of a veyne And forasmuch as fulnes of bloud is of two sorts One of fulnes simple and pure consisting of a like proportion of the best humors and the other vnpure and compounded taking part with Cacochymia that is abundance of humors corrupted in the veynes Therefore it is to bee marked that in both these Repletions the opening of a veyn greatly profiteth VVhen so euer therefore the muscles are sounde whole and full the veynes large great and swelling menacing thereby imminent danger to the members presently bloud must bee detracted After which eu cuation these effects will insue mitigation of paines caused by ouermuch retching of the veynes ease vnto the body which seemeth as it were nowe disburdened of a grieuous and waighty ponderousnes a more nimblenes to all exercise and labour than was before an increase and refreshing of the naturall heate an opening of the straight passages and pores of the members Finally there will follow a happy repulse of diuers imminent dangers and diseases wherevnto by all probability in short time the body would haue beene brought For it is greatly tobee feared lest the veynes ouerreatched with fulnesse of bloud should open and breake and through that meanes cause inflammation or lest some generall obstruction should arise which might keepe backe the inwarde heate and so vtterly choke vp the bodily forces wherby might bee caused some vehement hot feuer or as it oft hapneth a sodaine death of the party Now from these daungers can no man bee safely and speedely freed either by purging exercise or abstinence but by bleeding and with the bloud is this Repletion most safely abated That fulnes which is vnpure and compounded is not so safely cured by bleeding and yet the more nigh that it commeth in likenes to that Repletion which is simple and pure the more confidently and the more plentifully we may let bloud And the more vnpure that it is the more carefully and sparingly ought a veyne to bee opened Therefore those persons that haue an il constitution of body and yet haue their veyns abundantly filled or that beeing of a constitution are yet repleat with corrupted meates These I say are to bleede no longer but to auoid the danger of fulnes and the impurities remaining behinde are to bee expelled by Purgation Hot chollericke Repletions of all vnpure constitutions are most safely abated by bleeding because bleeding in this case not onely diminisheth choler but also cooleth the same mightily Melancholly Repletions can nothing so well away with this practise because it doth not so exceede in heate that it neede at all any refrigeration or cooling and the flegmaticke constitution can in no case brooke it for being a very cold
both to maladies present and future And those thinges which are to be done when diseases are present may likewise be attempted when the same are but a beginning or nigh at hand And here is to be repeated that which hath bin alreadie said cannot be too often spoken that some time we open a veine not only without fulnesse but euen in emptinesse namely when some euident cause as a bruze ache or heat causeth flux ofhumors bringeth inflammation to the members and this is done not for any greatnes or feare of any present griefe but for some doubt of that which is a beginning as it were at hand Here ariseth a doubt whether it be more vsuall to open a veine the disease being now present or future nie at hand The answere is that when the fulnes is very great dangerous though the disease be not yet caused notwithstanding without hurt the pacient may bleed plentifullie because the bloud offendeth nature in the aboundance thereof And hereby the Pacient is oft made safe and escapeth the daunger of sicknesses approching But when a disease is bred and the forces of nature impaired or lessened either by the presence or long continuance thereof iust euacuation of bloud without hurt can by no possible meanes be made Whereupon Hippo councelleth to preuent by bleeding accustomable impediments rather then to stay their approch and comming Hereuppon also in that kind of feuer called Ephemera which dureth commonly but one day is caused of obstruction In the feuer called Synocris simplex bloud is aboundantly withdrawen before the matter do putrifie Therfore this is the cōclusion of this matter that bloud is let more safely before the sicknes be present already come thē when in truth it is presēt with greater profit are we to see his comming a far off and so beware of him thē to stay til he come thē labour to repel him wherin we are to remember a prety and common verse seruing fitly to this purpose Aegrius eiicitur quam non admttitur hospes If once a guest be enterteind with greater shame we him repell Then if at all we had not him receiued with vs in house to dwell And also this verse of Ouid. Principiis obsta sero medicina paratur Dum mala per long as conualaere moras i. Beginnings stop too late comes cure When once the mischiefs grow in vre Reason imputeth thus much that when sicknes presently possesseth any pacient the same requireth a speedie remedie with a greater necessitie than when as it hath not yet inuaded Wherupon this also followeth that opening of a veine is more necessarie when a griefe is present then when the sam e is but onely approching The crueltie of a present aduersarie vrgeth vs with a greater necessitie than the daunger of an enimie that may come but is not yet present And so I conclude that in a present disease there is a necessitie In a disease onely imminent there is but onely in a manner a securitie For a further instruction to know what diseases in particular are cured by this practise I referre thee to a Chapter hereafter following which declareth in particular what veine is to be opened in ech particular disease What voluntary eruption of bloud profiteth 〈◊〉 sicknes Chap. 12. BLoud voluntarily and of it selfe issueth foorth from the nose the veines called Haemorroidae and the belly and sometime also out of the mouth by coughing and vomitting From other partes of the bodie it commeth not except very seldome and that against nature But from what part soeuer it come if it bleede slowly and sparingly and albeit the same bee according to nature yet we are to account it vnprofitable for it nether remoueth the disease neitheir disswadeth vs from that conuenient euacuation by art which the vehemencie of the disease requireth That voluntarie flux of bloud which is aboundant either in plenitude oppressing natnre or in that feuer called Sinocha is profitale and oft cureth the same in the iudgement day called dies Criticus For in asmuch as then a generall euill equally as it were occupyeth all the veines from whence soeuer abatement of bloud happen it ceaceth these accidents of heuines fulnes But in the feuer Causon and in all other cōtinual feuers in the which other humors putrifie in the greater veines bloud issuing forth neuer so plentifully bringeth not such profit and bleeding at the nose though it watchinges rauinges headach and other such like accidents yet very hardly it remoueth the proper cause and roote as it were of the disease except there fall out some immoderat bleeding euen as it were to the dissolution of the natural forces which in very deed is neuer to be wished or desired For corrupt bloud last of all floweth out of the nose yea and not before there hath passed great store of the good profitable bloud And therefore in these feuers albeit the pacient bleed much oftentimes yet a veine in the arm must be opened Experiēce I say proueth that oft out of the nose commeth good bloud both in colour and substance when vnpure and filthy bloud is drawen out of the arme A boundant flux of bloud in these diseases out of the Hemorroidae veines are out of the belly because it floweth next of all from the holow veine of the loines the same is to be accounted much more profitable thā the abouesaid Yet neither doth this many times take away the verie root of the feuer which lieth lurking in the veines next the hart Wherupon it cōmeth to passe that oftētimes we let bloud in the arme notwithstanding yet but sparingly in flux of termes in womē brought a bed freed of their seconds lest we inflame kindle in them the heat of an ague A like reason and more apparant there is also sometime to let bloud in the arme when the hemeroids flow For inflammation and other diseases of those partes which are aboue the liuer and midriffe are litle or nothing at all eased by fluxe of bloud from the hemoroids or belly Neither those that occupy the lower partes by flux of bloud from the nose Also flux of bloud out of the right nosthril helpeth not affectes on the left side nor contrary And therefore voluntary eruptiō of bloud without reason forbiddeth not that bleeding which is to bee done according to art reason and experience Againe Phlebotomy helpeth diseases either of it self or accidentally Of it selfe it euacuateth or pulleth backe Accidentally sometime it cooleth drawing forth the hotter bloud sometime it openeth obstructions yet only those which proceede of fulnes and it is alwaies to bee vsed in those affectes which it helpeth of it selfe but not alwaies in those which it cureth by accident To helpe hot distemperature of the Liuer by bleeding when there is in the Pacient little bloud is not the best way but rather vse for that purpose such things as are of their owne nature cooling and take proper
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
labour doth Also of passions of the mind some suffocate the spirites and inwarde heate as namely feare and sorrowe some wast and spread them abroade as mirth and gladnes These are the causes which being in exceise do wast consume inward heat the spirites of life strength of the bodie which being so apparant as they are may be vnto vs assured markes signes wherby to know whether the forces of nature haue yet lost or do still retaine their powers vertue strength Those causes which onely oppresse the strength of the bodie are inward hidden not so know en vnto vs as the forsaid and they are these obstructions immoderate abundance of humors which stop the veines arteries because they are thick grosse and slow humors by meanes wherof they keepe in the spirits do not suffer them to be cooled as it were by any kinde of winnowing whereby the vse of the spirits is taken away their vertues are oppressed and grieuously with the inward heat offended which matter verie oft faleth out so in the Lungs Liuer celles of the braine in the arteries finally in the verie habite of the bodie Obstruction caused of too much abundāce of humors doth grieue oppresse somtime ouercome the inward heat and spirites of life Fulnes also proceeding from any obstruction if the repletion be simple or somewhat part-taking with that called Cacochymia it choketh bodily strength as for example Abundance of bloud in a wrastler Flewine in Leucophlegmatica i. the third kind of dropsie cruditie of humors in the other dropsie abundance of choler in the yellow Iaundies As often therefore as the powers of nature are descried to be weak by the excrements the spirites of life by the pulse breathing the animall facultie by her proper functions and by any of the foresaide vehement causes preceeding wee may determine the spirites of nature to be empaired VVhen none of these causes haue gone before and that yet the bodily strength appeareth weake then iudge them to be onely wronged or oppressed Specially if there do concurre signes of pure and simple repletion or of great corruption of wicked humors the causes greeuing and oppressing the spirites of nature being remoued presently their strength is recouered and they come againe vnto themselues except they be beaten downe with the continuance of their oppression Here therefore I make three steppes or degrees of naturall strength weakely affected either the same is a little throwen downe or ouercharged or thirdly altogether weakened whose particuler tokēs apeare by that which hath beene said in the premisses There are some which only marke the pulses as an infallible signe to iudge the bodily strength by which in trueth is a great marke but yet not alone sufficiēt being both doutfull and vnconstant and also because it is troubled with diuers outward things is oftētimes changed Againe euacuation too aboundant affecteth not onely the vitall spirites but also in like manner the other faculties of nature whose decay bringeth death as assuredly as if the vitall power were extinguished and therefore in euacuation it is requisite aswell to marke and obserue the other faculties of nature as the vital powers For if the pacient be sicke of a vehement continuall disease as of Lienteria i. a fluxe of the stomacke or Atrophia i. a kind of consumption or Marasmus i. the endes of the feuer Hectike let him not bloud albeit the pulse be mightie full And therefore I conclude this Chapter affirming that we are in euacuation to consider the ablenes and strength not of one only but of all the three aboue-said running or flowing faculties of nature Neither to consider of these alone but also of the setled faculties in which is conteined the action of life To knowe by the greatnes of the disease the strength of the naturall powers the quantitie of bloud that must be withdrawen Chap. 14. THe knowledge of the quantitie in euery remedie is the hardest matter in al Phisicke and most of all troubleth the carefull and wise Phisition And although to knowe the quantitie be but a coniecturall knowledge yet the same is ioyned with lesse danger and is more secure here than the knowledge of the quantitie in a purgatiue receit The reason is because wee may stoppe the bloud when wee will as Galen witnesseth 2. de ration virt in acutis Commen 11. lib. de curandi rat◠per sangninis missio Chap. 12. But when areceit is in wardly taken the same cannot be againe vntaken Neither is it in our power when it is once in the bellie to take away any part thereof or if neede be to adde vnto it VVhich in bleeding wee may do and therefore lesse danger is in this than in the other The quantitie of the bloud that must be extracted is knowen by the strength of the patient and chiefely by his pulse Therefore while he bleedeth let the Phiebotomer or Phisition seele the Pulseis with his hand and suffer the bloud to passe according to the alteration of the same especially when any great euacuation as euen vnto Syncope is to be made Lest it fall out vnwares that death it selfe doe come in the place of sowning or fainting And except necessitie doe greatlye vrge it is best and safest to abstaine from such plentifull euacuation after Galens councell lib. de Cura rat per sang missionem Chap. 12. If at any time the powers of nature being weake the disease require some plentifull bleeding it is good to deuide the same to open a veine twise or thrise and at eache time to detract a little bloud as ye haue partly heard before and as it shall be shewed more at large hereafter All sicknesse decayeth the strength of nature and so doth in like manner that euacuation which is vsed to helpe nature Lest therefore it might seeme a verie hard dealing in this case more grieuously to afflict one alreadie afflicted and presently grieued the matter is so to be ordered as the substance of the disease may be remoued the forces of nature as little damnified as may be Yea it is a principall poynt in a skilfull practisioner so to worke that the euill may be remedied and the patient brought in hope of a more profitable recouerie for his health than his former Phisick hath been painful vnto him Those hurts which the naturall vertues sustaine by a moderate euacuation are but small and these are againe quieted when the euaacuation is accomplished for nature now freede of those hurtfull humors wherewith shee was before pressed down recouereth her former strēgth Shee renueth that which was drawen from the inward heat and spirites and become almost the conquerour of the disease Shee ouercometh wholly at length yea that which remained behind partly by inward concoction and partly by outward dissipation It wise Hippo councelled to giue a small dyet to the sick patient not fearing thereby more and more to weaken the strength of nature which
throughly vehement passing not the fourth daye which is called of Phisitions Malus peracutus i. thoroughly sharp and of some perperacutus imitating barbarous authors in Phisick The other not exquisite or throughly sharpe vehemeÌ„t whose greatest force wilbe in the seuenth day These diseases being but short at their extreame fits in few daies without any truce presently at the beginning these are to be cured And because they proceed chiefly of hot humours namely of bloud and yellow choler therefore specially they require bleeding Whereupon Hippo. lib. 4. writeth De vict ratione in morbis acutis Aphoris 19. In acutis morbis sanguinem detrahes si vehemens morbus videatur florueritque aegrotanti aetâ—s viriuÌ„ affâ—er it robur In sharpe diseases withdraw bloud if the disease seeme vehement if the age of the patient be florishing and that the naturall forces be firme and strong Schola salerni hath these verses of this very matter Principio minnas in acutis perperacutis Aetatis mediae multum de sanguine tolle Sit puer at que senex tollet vterque parum Ver tollat duplum reliquum tempus tibi simplum In sicknes sharpe let blood with speed take much from men of middle age Not so when child or old men bleede the spring requires the aduantage As there is regard to bee had of generall times so there is also of perticular daies and times in the which diseases come speciallie in those diseases which haue by course an appointed and set time of intermission and remission For euacuation is not to be made when the disease is now fierce but when the same is asswaged Feuer sand especially those that are called intermittents discontinuing agues eueÌ„ naturally at the beginning and their first inuasion cause vomits and at the declining sweats At which times wee may by art prouoke these but in no case vse purging or bleeding In the time of the fit likewise wee must refraine from these as thinges which nature then can not brooke If such accidents of bleeding or of siege come they are but accidental and are caused only of the heat and force of the disease No euacuation can be done safely in such fits seeing they do too exceedingly hurt the powers of nature Also when the humours do so boile with heat that they are perturbed mingled together there can not be made by practise of art any iust diuision of the said humours And if it chaunce that the hurtful matter of the disease be inflamed without the greater veines that in a fit a veine be opened it is to be feared least preseÌ„tly the same corrupted matter passe into the empty veines so of an intermitting feuer wil come a continuall Wheras a veine opened in the most quiet time of a disease troubleth not nature but without any feare of an inflammation taketh the plenitude out of the greater veines The greatest time of quietnes is the time in the middle betweene the remission intermissioÌ„ of the disease If the time between the fits bee much it is an easy matter to perceiue the said middle time If the time bee but little then is it far more hard to discerne the same Because many times no leasure can bee graunted either before or after bleeding by reason of the swift courses of fits to nourish the party Thus you see Phlebotomy is not to be practised in the day of the fit of any sicknes which in Latine is called Crisis or dies Criticus in the which day neither bleeding nor any other euacuation is to be atteÌ„pted lest the matter should be drawen from that place wherevnto nature hath driuen it to be rid or dispatched thereof and therfore like wise neither in the fit it selfe ought the same to bee done Excellently therefore did Galen giue in charge Comment 29. lib. 2. Aphoris that in time of the fit neither bleeding nor purging ought to bee vsed because then the concoctioÌ„ of the disease is chiefly wrought Which is farre better accoÌ„plished in quietnes and rest then in motion or disturbance For what respect the state hath to the whole disease that comparison hath the â—itt to the daies of intermission As therefore in the state of a disease no euacuation is to bee vsed so neither in time of the fit Againe it may profitablie here bee admonished notwithstaÌ„ding the premisses that bleding is not presently to be vsed at the very beginning of a diseas wheÌ„ we iudge the Crisis or iudgement of the sicknes to bee yet far ofâ— For bloud beeing the foundation of inward heat wherwith the same is vpholden natural heat beeing ingendred of bloud as of a materiall cause If bloud should bee detracted at the beginning of a disease the natural heat would bee diminished which should concoct the materiall cause of the sicknes Whereby further it commeth to passe that the disease is longer time protracted and the forces of nature enfeebled through which two namely the continuance of the disease and imbecillitie of nature great feare of death commeth in the end and this is the case wherein Auicens former opinion may stand true There is therfore no prescribed day for certaine appointed to let bloud in Whereupon Galen tooke occasion to deride those lib. de curand ratio per sang missio cap. 12. which from the 2. houre of the day to the 5. or 6. houre onely did let bloud and at none other time And Galen witnesseth ofhimselfe that he did let bloud at all times without any daunger yea euen in the night And 9. method Cap. 5. hee affirmeth it best which hee also him selfe obscrued to mark not the number of the daies but onely the strength of the Patient because by experience wee haue prooued that not onely the sixt or seuenth daies but also in the daies following the sixt or seuenth a veine may bee opened But because as Galen witnesseth Libro de Curand ratio per sanguin missionem Capit. 20. in diuers diseases through continuance of time the strength of nature is greathe abated Therefore the occasion of letting of bloud is not omitted for the number of the daies but for that the naturall strength is wasted So that if the vertues of the bodie seem to be consumed the second day from the beginning of a disease euen then wee forbeare opening of a veine And he thertoo the wordes of Galen Now in diseases which are cured by bleeding when they are present or propelled being but future if they grant leisure so that a choice of an houre to bleede in May bee made in this case I say the fore noone houre is better then the after noone For from the rysing of the Sunne the bloud is quickened reuiued and beareth rule in the body yea in that time of the day it becommeth thin cleere apt to flow Let not the patient sleepe nor slumber in that houre wherin he is to bleed but at lest let him be awake a whole hour before see also that he haue
taking that which comes to hand first or which appeareth greatest perhaps a sinew for a veyne so letting out the vitall spirits and killing many and when it is done this is all their defence to say the signe was there and he would needs be let bloud Vnction or annointing is oft vsed in this practise sometime we rub the member whose veyne is to be taken with oile that thorough the warmth thereof bloud may bee made the more flowing sometime the instrument is annointed as was saide before to mittigate the paine of the inflicted wound Sometime the wound it selfe is annointed that it may bee the longer time before it bee couered with the Scarre and that the humors left behinde may with the more liberty breath foorth and that the ill humors remaining may bee also the better dispersed Drinke and especially wine may bee very well taken both in the bleeding if Syncope happen and after bleeding to cause good bloud and to recouer againe the vitall spirits Bathing two or three daies before is vsed in some causes as was declared in the former chapter but not the selfe same day The common opinion is that bleeding must be done fasting and vppon an empty stomacke but this is not approoued of the best writers for many of them giue aduise to eate before bleeding a soft or poched egge with a draught of wine about nine or ten of the clocke â—n the forenoone and then presently to open a veyne For nature the stomacke being empty and being altogether destitute of nourishment doth mightily holdfast and retaine the bloud whereas when a little nourishment is taken in small quantitie as is a poched egge a draught of wine shee permitteth the bloud easily to passeforth It hath bin declared before Chapter 16. that if necessitie vrge there is no prescribed time of bleeding but that if the disease require the same may be done at all times yea euen in the night Yet the forenoone of the day is the most vsuall time There is an houre of necessitie which is any houre in the day or night and beside this hora necessitatis there is hora commodiâ—atis which is the morning or forenoone houre viz. Galen de Curan râ—tio per sang missio cap. 13. 20. in praesagio experientia Comprobatâ— cap. 4. Aetium lib. 3. cap. 16. Oribasi lib. 1. cap. 11. Moreouer if a veine opened send forth bloud whitish in coloure stay the same for it appeareth that the humours in the bodie are rawe colde and vndigested through defect of naturall and digesting heate This is affirmed by Aristotle lib. 1. 9. de animalibus and Hippocra witnesseth that alwaies womens termes appeare not in their proper colour that by reason of frigiditie and coldnes of white bloud they oftentimesvomit and haue fluxe of tearmes Finally as in purging so in bleeding as wee haue already said wee are to consider the standing of the wind in winter to bleed wheÌ„ the same is Sowtherly in Sommer when the same is Northerly For the North wind with cold tempereth the heat of the time The verses of Schola salerni Hac facienda tibi quando vis Phlebotomari Vel quando minuas fueris vel quaÌ„do minutus Vnctio siue lauacrum potus fascia motus Debent non fragili tibi singula mente teneri Before and after letting bloud all these are meete and requisite Vnguent a bath strong drinke and good with motion mean and bonds most fit Remember all doo none forgit A prescription or regiment of the patient after bleeding Chap. 20. WHen a sufficient quantity of bloud is withdrawen proportionable vnto the greatnes of the disease vnloose the bond and drie the wound lest beeing moistened with clodded bloud either it growe not together againe or bring some doubt of impostumation These thinges not done accordingly enforceth vs sometime the eight day after to open the wound againe If any piece of fat come forth the same must not be cut off but softly put againe into the wound When the wound is wiped cleane drie close vp the veine with linnen dipt in rose water or sweete water or with Oile if wee purpose to bleede againe Let the same bee tyed on with bondes not tooâ—hard for writhing the skinne or lippes of the wound If a sinew or Tendon be pricked yee heard in the chapter before what is to be done If there be doubt of fluxe of bloud or an inflammation through pricking of a sinew we may beside the premisses apply after the practise of others a plaster of Ceruse and in compas about that a Cataplasme of Housleeke Nightshade Plantaine and other cold things After bleeding lye a while on the backe for quietnes sake and to recreate the strength of nature and to recouer the vitall spirits He must not frequent his accustomed affaires nor moue his bodie hastely nor exercise himselfe immoderatly neither must he vse Venus delightes nor yet bath himselfe For the bloud and spirits naturall vitall and animall which haue of late bin vehemently stirred by bleeding are now by rest againe to be setled else the same bloud and spirites would by these outward vehement exercises bee inflamed and so wast and consume away Neither must the party presently sleep lest either the languishing heat be quite extinguished or the lessened spirits altogether ouerwhelmed Let him therefore watch and rest void of contention either in mind or in body When an houre or two is past after bleeding a litle meate may bee giuen him Little I say in quantity but of good iuice to nourish the bodie and profitable also to withstand the present disease when 2. hours are past this short repast he may then sleepe so as his keepers carefully take heed that he tumble and turne not himselfe on the arme that hath bled or that the bond by tumbling and tossing be not remooued which may cause the bloud to slow againe a fresh or some other displeasure to fall out Afterward the diet must bee increased by little and little both in respect of the quantity and of the goodnes of the meat Neither as yet must we hasten to a full diet for the heat of nature being abated by bleeding can not as yet receiue or digest aboundance of meat And againe the veines lately emptied would exhaust out of much aboundance of meat much raw and vndigested matter wherwith the whole bodie is stuffed againe If concoction bee perfected and accomplished so that we may eate great quantity of meat yet vse a moderation for to what purpose is it presently againe to stuffe the bodye with iuices and humours for the abating and taking away wherof we did so lately let bloud Therefore after bleeding the patient is to liue more finely and exquisitly and not to goe to his old intemperat diet againe as the dog to his vomit Neither are these intemperat persons meete men to be let bloud as we prooued and shewed before in the 8. Cap. Fig. 1. Of
reiterating bleeding which they call Epaphaeresis this is the order First in inflamations great paine hot feuers caused of aboundance of hot bloud a veine must be opened as is alreadie shewed euen presently at the very beginning before the matter be gone to som principal member not only that the aboundance and excessiue quantity of bloud but that much more a great deale euen plentifully and generally may be euacuated yea euen till the patient giue ouer if the strenght of the body so permitte And in diseases caused of fulnes the bodily powers are firme for the mostpart neither doo they shrinke or relent much by this plentifull bleeding And when Hippo. permitted bleeding so long till the patient should giue ouer hee ment it so when the strength therevnto sufficient was able to beare it and not otherwise For if fainting doo happen wheÌ„ the powers of nature are firme and constant it doth only wast the spirits in the arteries those forces remaine still vnhurt and vndamnified which narure hath bred in the hart Liuer or braine And albeit these decay in Lypothimia yet of the setled forces other like presently come in place whereby againe the Patient is reuiued But when the strengh of the bodie is weake and greatly enfeebled because the forces of nature setled and seated in the principall members are also impaired If Lypothimia then chaunce reâ—â—itution wil hardly be made Therefore I say the vertues of nature beeing greatly debilitated beware of ouer comming or fainting And this is the order in great and vrgent sicknesses In small generall diseases as in repletions fulnes feuers and such like whose cause and principall matter is conteined in the veines if bodily strength permit we must presently euacuat wholly at the beginning at one time not till the patient ouercome but so much as is needefull and as the infirmitie or malady requireth And this euacuation without any hurt to the naturall forces withdraweth the matter abounding either before the same do wholly putrify or that it posâ—esâ—e some notable member or before any horrible accidents happen He that for feare or any other cause parteth or diuideth in these the euacuation he continueth the disease long time doth no good but great hurt to the sicke patient But if for imbecillity of strength the whole euacuation can not be accomplished or done seeing it is better in this case to marke the strength of the party then the vehemencie of the disease we are inforced to vse partition in the bleeding and yet with a great circumspection and care and let the partition be within a litle distance of time either by vndooing or vnloosiug of the bound or stay the blod with applying the finger on the wound so long as by the foresaid meanes the forces of the body may bee recouered Sometime an hours space is sufficient sometime more houres â—re required to the restoring of the forces of nature The best way is not to deferre the partition of bleeding past one day yet I say if strength permit that partition must be vsed bleede twise in the selfe same day in general diseases especially except other impedâ—mâ—ts greatly let euacuacuat in one day asmuch as is expedieÌ„t before the matter come to putrffaction or that other euils do grow But in partiall diseases of particular meÌ„bers chiefly in inflammations the parted or diuided euacuation may be put off a longer time either to the day following or to the day after to morrow that in this space the corrupted humours may goe from the member diseased into the veins exhausted and so by the next incision be euacuated The member of the bodie that is afflicted with griefe or corruption by little and little euen in one day or two daies at the most sendeth downe the humours to the place where the incision was And for asmuch as they are corrupted they are not there to remaine albeit the former paines be mittigated and asswaged But if the inflammation bee pestilent and venomous as is a pestilent botch or carbuncle the euacuation of necessitie must be reiterated euen the selfe same day lest the pestilent infection sticke and stay any long time in the veines to the great hurt of the partie But neither must reiterating of bleeding be vsed For thereby the vitall spirites and in ward heate is diminished and vntimely age is hastened on apace and the same when it commeth is made subiect to greeuous diseases as Chachexia the dropsie gout in the iointes trembling palsies and apoplexies Yea when the naturall heat is immoderatly cooled and naturall moysture wasted the bowels languish crudity and vndigestion beginneth to beare rule whereby are caused great and greeuous euils in the body of man And thus much of the reiterating of bleeding and order thereof But let vs come againe to our former matter of prescription moderat motion easy walking as it was conuement before bleeding to vnloose and make the humours thinne so also the same is necessarie after bleeding to disperse abroad the reliques of those vapors and humours which are left behinde And as bondes of linnen were vsed before bleeding to the intent the veines might waxe bigge appeare full and bee the better perceiued and seene and that the humour with the more facilitie might come to the place appointed for incision so afterward they are also needfull to stay the fluxe of bloud and bind vp the wound It was already said that the partie let bloud must not sleepe that is to say not within the space of eight or sixe houres at the least whereof this is alleaged as a reason that the fumes caused by sleepe bee not carried vp to the head and so offend the braine There may hereof bee aleaged other caused more as namely lest the veine opened should take hurt by tossing of the patient vp and downe in his sleepe which cause was lately aboue specifyed Also lest in sleepe the humors should flow to the member where the incision was made and there apostumat For pained places as Galen affiâ—meth Capit. 95. medicinatiâ— artis lib. de Curand ratio per sang missionem Capit. 7. are by nature accustomed to receiue fluxes and chiefly in sleepe Auicen alleageth this reason Because by sleepe after bleeding for the most part there chaunceth in the members a confraction or bâ—using For while the member is tossed hether and thether with inordinat and vnorderly motion the bondes are vnloosed the wound vnhealed and as it were newly opened notwithstanding the late incision it doth afresh sende foorth immoderat fluxe of bloud the partie in his sleepe not witting thereof whereby as all men know the life commeth into great danger Againe another discommodity by sleeping immediatly after bleeding is that fumous excrementes through sleepe are againe inwardly reuoked to the principall members Againe the vitall spirits and natural heat which by opening of a veine are drawen to the outward partes and members by sleepe are reuoked to the center or middes of the bodie
Chrisi If it be very dark it betokeneth grosse bloud Greene bloud sheweth perfect adustioÌ„ When the bloud floweth soorthspedely it is suetile and thin when it spinneth not foorth but comes guttatim slowly drop by drop it betokeneth that it is grosse bloud when meanly betweene both then is it a mean bloud betweene grosse and thin Againe sometime it is quickly congeled then is it g rosse bloud somtime slowly compacted and then is it subtile Thicke and grosse bloud sheweth thicke and grosse matter in the bodie or it sheweth great heat and drith which hath consumed the humidity of bloud If it be subtile thin it sheweth want of digestion and abundance of raw vnconcocted humours of hot humours or of cold as the colour shall discrie If the bloud be oily it betokeneth either a future leprosie or too much fatnes in the body for leprosy is caused of extremity of heat in the bloud burning the same and conuerting it into an oily substance Againe take a bat round in the end and set it to the congeled bloud if it withstand it not but giue place vnto it and bee diuided it is an argument of drith If the bloud greatly resist the entrance of the bat then is it a very thicke and viscous bloud If between both then is it a meane bloud And thus of the substance of the bloud which should haue bin inserted before And touching the colour in like sort this briefe obseruation by the way which was also omitted but may come in here yet in good sort a good bloud is of diuers colours according to the diuersitie of the parts for in the vpper parte and in the compasse of the vessell it is of a red colour for the good bloud being light alwaies ascendeth vp to the higher partes in the middes it is red and not cleere in the bottom it is blacke and melancolious For melancoly being heauy resteth alwaies in the bottome Sometime there swimmeth on the toppe of the bloud a certaine fatte or oily matter like a copweb If the body bee very grosse and fat this is caused of the verie bloud which is in such bodies inclining to fat If the body be very leane it declareth the same now to beginne to melt and to languish In the bottom of the clodded bloud there is resident an earthly a filthy substance which being deuided or clouen asunder appeareth in colour either red darke blacke bright or greene whereby we may coniecture the nature of the humour mixt with the bloud yea by the colour much or little we may know how much ech humour aboundeth in the veines Some say if the bloud bee cut or deuided that there bee found in the same certaine grainees like small sande that it noteth leprosie or inclination vnto it which alwaies hath not been found true by certaine that haue obserued it It is sildome that the bloud comming from the veines doth sinke but if it doo the same sheweth corrupt and stinking humours and is a token of vncurable putrifaction and corruption No man doth willingly tast detracted bloud but if by chaunce it come into the mouth and doo tast sweet it is according to nature good and of perfect concoction If it bee bitter in tast it sheweth aboundance of choller if it be sowre sharpe and restringent it denotateth aboundance of melancoly if vnsauery aboundance of flegme if salt the bloud is mixt with salt flegme After obseruation of the substaÌ„ce and colour of the bloud conferre all the smal porringers or vessels of bloud together If they shew all equally good bloud it is to be supposed that the rest in the veines is like vnto it Yet the same is to bee withdrawen if it offend in quantity and greeue the body hurting the sences and causing in the body putrifaction and other euils If bloud appeare corrupt then with a greater profit the same is to be withdraweÌ„ because it hurteth the body two waies both with the quantity and qualitie thereof If it be not sufficiently withdrawen at one time afterward againe a veine must be opened and beside bleeding if Cacochymia concur with plenitud that is that bloud offend both in quantitie and qualitie as wee noted in the 21. Chapter beside bleeding the body must more ouer be purged with inward medicine If that bloud which came first were good and the other corrupt then suppose that yet much such bloud remaineth in the bodie to be auoided by good order of diet and orderly euacuation But if it fall out so in inflamations it is a good signe that the euacuation is absolute and perfect quite taking away the matter of the disease from the affected member The bloud poured into warme water hath thereby his partes and substances deuided the wheyish and watrìe substance is confounded with the water and cannot be knowen from it Also the thinner and more subtile part of the bloud is mingled with the water likewise whereby yet notwithstanding after a sort wee may giue iudgement of the nature of the humor The thicker parte of the bloud resteth in the bottome which is reputed good and naturall bloud if so be it be whitish thinne bright and cohering together If the same be more grosse it sheweth the grosnesse of the bloud that remaineth in the bodie If it be obscure blacke or otherwise coloured after the difference of the colour iudge the bloud to be corrupted or not corrupted with â—ilthinesse of wicked humors If it do not cohere but be distracted and diuided it betokeneth vncurable putrifaction Last of all remember that the more vnpure and vnconcocted the bloud appeareth being altered from the nature of good bloud the same is to be withdrawen in the lesse quantitie and not so plentifully as when the same draweth more nigh the substance of good bloud which is done otherwise and quite contrarie by our common barbors and letters of bloud And looke howe much the humors doe passe and exceede either lesse or more the nature of bloud so much more sparingly are wee to let bloud And when they exceede too farre from the nature of bloud either the one waie or the other then wee are altogether to forbeare bleeding as wee haue noted in a certeine place alreadie A short rehersall of eight auncient errours touching bleeding and a sufficient confutation of them by auncient authorities Chap. 23. FIrst that bloud must not be let but in the morning This is confuted by Galen lib. de Curand ratio per sanguin Missio Capitul 12. saying Feare not to let bloud by night forit is ridiculous that some doe maintaine onely letting bloud from the second houre of the daye to the fifth or sixth and no other time The second errour is that obstruction and putrifaction are the causes of letting bloud Galen also confutes this 2. Metho Med. cap. 14. in these wordes Neither obstruction nor putrifaction is the cause of leâ—ting bloud but abundance of humors for neither can stopping or putrifaction be
cured by bleding but require other remedies The third error That opening of a veine is vnnâ—edefull except the disease be present This also is confuted by Galen de Opt. sect ad Thrasis Cap. 37. For the most part saith hee we vse remedies as purgagion and bleeding when the diseas is not present but future The fourth error That Phlebotomy must be done in the iudgement day of a disease Auicen impugneth this in quart primi chap. de Phlebo saying Neither must bleeding nor purgation be done in the day of the mouing of a disease nor when the same hath Crisim â— iudgement But if it be possible let there be rest This is also proued Aphorism 21. Qua iudicatur vel iudâ—cata sunt c. The fift error That bleeding dulleth the sight Gallen remoueth this error li. de Curand ratio per sangui missio Chapitul 7. Some haue a weake sight hauing aboundauce of bloud Euacuate such either with purgation if there bee other humors beside bloud or by bleeding and so detracting of bloud doth good not dulling but quickening the sight 6 The sixth error is that in fulnes alwaies a veyne must bee opened Gaben confuâ—eth this error 4. de vict in morb acut Commen 19. Plenitude is not alwaies cured by bleeding but by rubbings many and oft batlings and by abstinence 7 The seauenth error is that bloud must be let the wombe beeing very laâ—atiue this Hyppocrates refelleth 4. de vict in morb acut cap. 118. If it bee needefull to withdrawe blâ—ud from any you must stay the wombe and so let bloud and Galen in the same place saith If the belly bee flowing let not bloud lest the fluxe continuing the strength of the body bee cast downe 8 The eighth error is That there is no difference of the times of the yeare to let bloud in Galen contrary to this writeth ad Glanco cap. 14. Those Phisitions which consider not of the state of the times and withdraw bloud they kill men Et 4. de vict in morb acut is Commentar 19. If the Aire be too hote and dry we refraine from bleeding though the sickenes bee vehement and the age of the party youthfull A sufficient confutation of the supposed necessitie of annuall bleeding Cap. 24. THere commeth here to my minde a common opinion among the ignorant people which do certeinly beleeue that if any person be let bloud one yeare he must be let bloud euery yere or else he is I cannot tell nor they neither in how great danger VVhich fonde opinion of theirs whereof so euer the same sprong first it is no more like to be true than if I should say when a man hath receiued a great wound by chaunce in any part of his body whereby he looseth much bloud yet after it is healed he must needs haue the like wounde againe there the next yeare to auoid as much bloud or els he is in daunger of great sicknes yea also in hasard to lose his life which opinion if I did affirme to be true albeit it be most false yet I might vse the like reason authoritie to defend it that the comon people vse in the defence of theirs For they can say nothing if they be asked why they thinke so but that they haue heard many to say so Therefore I would wish that no man should credit this folish opinion being most false vnlesse he can shew some good reason for it which I am sure no man can do This I think that like as bloud letting is not good against al diseases so is it not good in all persons as we haue set it down in the 9 Chapter but only in those that wil be content to vse afterward a moderat conuenient diet Those therefore that do abound with bloud wil be let bloud to preserue themselues froÌ„ the danger of any disease that is like shortly to ensue must long time after be content to vse a moderat diet For intemperat persons gluttons great drinkers wine bibbers they doe not only receiue no commoditie at al by bleeding but often times greater hurt than if they had bin without it For within 3 or 4 dayes after they fill stuffe them selues with more rawe iuices humors by vnmeasurable dyet than they had before and often times these die through convulsion And hereupon we are to note that there is such force in moderat diet to eschew sicknes that without obseruation thereof Phlebotomy is to no purpose And therefore if this coÌ„mon saying of the comoÌ„ people be true in any namely that they must be let bloud ofteÌ„ thâ—r are once let bloud it is only true in such as keep ill diet presently after bleeding Therefore to conclude this Chapter I councell al persons to beware of excesse after opening of a veine Ofincision of Arteries Chap. 25. AS a veine is opened according to our former discourse hitherto so somtime also an arterie is opened that is to say only such a vein wherein the vitall spirites mixed with the blod do runne flowe but for the hard stinting of the fluxe from an arterie Phisicions are in doubt to make insicion thereof and yet some sometime practise it as in the disease called Vertigo If in opening of a veine we chance to stick an arterie we can very hardly by by stint the bleeding and although the matter fall out very well that the wound or incision be brought to a skarre by diuision yet there will be a dilation or spreading abroad of the cut arterie stil as Galen witnesseth lib. de Curand ratio per sang missio Cap 21. 22. The bleeding of an arterie is hardly stayed partly for the heat of the arterial bloud which is very quickly moued by spreading abroad openeth the arterie whereupon incision of an arterie greatly furthereth the bleeding partly because the motion of the arteries neuer ceaseth as Galen witnesseth lib. 2. Cap. 20. de Sanitate tuend whereby also it commeth to passe that the wounds of the arteries are the more slowly cured For such things as are to be healed require rest ease Gal. lib. 5. Cap. 8. metho medend commet 6. lib. 6. Aphoris The opening of an arterie is to be vsed when the body is repleate with thinne windie and verie hote bloud For the seat of subtile thinne windâ—â— bloud whereof the naturall heat and vitall spirites are ingendred is in the arteries and to is the hotest bloud which commeth from the hotest member that is the heart and which is carried into the other members of the bodie conteined likewise in the arteries The receptacles of the thicker bloud wherwith the â—â—eÌ„bers are nourished is in the veines Vpon what occasion Galen did cut an arterie he himselfe sheweth Cap. 22. dv Curand â—at per sanguinis missio being warned saith Galer by certeine dreames of which two among the rest most plainly appeared vnto mee I weâ—t to cut that arterie of the right hande which is betweene the