beginning of the disease but not if it be a hectick phrensy of any continuance Celsus doth affirme that the face being red and the vaynes swelling a vayne may be opened after the fourth day if strength be sufficient But if it come of a cholerick cause then it should seeme to be ill done to let bloud because as Heurnius obiecteth fraenum bilis est sanguis bloud is the bridle of choler To this he answereth Male sanguinem sine bile educeremus imo plus bilis educimus quà m sanguinis Hardly can we auoyd bloud without choler yea rather by Phlebotomy we do bring out more choler then bloud And if it were done but only for deriuation sake yet were it well done But at what time must this Phlebotomy be vsed Caelius Aurelianus sayth that it must be done within three dayes of the beginning and not beyond because in such diseases the strength of the body is in perill Aretaeus also sayth that it ought to be done either the first or the second day If the phrensy begin after the fourth day then open the vayne after the seauenth day but if it do come in the sixth or seauenth day then let no bloud for that is a criticall phrensey Aâ—tius sayth that if the phrensy do come with an ague any day before the fourth day and signes of plenitude appeare wee may well open the middle vayne When the phrensy is old letting bloud is not safe Caelius sayth that to let bloud after the eight day est iugulare homines is nothing but to murder men The quantity must be according to the cause If it proceede of inflamed bloud you may let bloud vsque ad animi deliquium till the heart begin to fayle For there is a vehement inflammation a very sharp feuer and exceeding great griefe in which three cases Galen alloweth large Phlebotomy But if the bloud be much mixed with choler then sixe ounces shall suffice or if the party be strong tenne ounces Aretaeus his opinion is that if it haue the first beginning from the parts about the midriffe then the party may bleed more largely because thereabouts lyeth the fountayne of bloud What you do you must do at once for the disease doth giue no long truce Trallianus commaundeth the vayne of the forehead to be opened But that Heurnius doth condemne as ministring a further increase to the discase especially if the phrensy come of bloud for both the bloud should turne his course into the head and also the euacuation should be made by the very place affected which should be as he thinketh very inconuenient The course which Heurnius doth best like of is this first to open the midle vayne of the arme and after to open either the vayne of the forehead or the vayne vnder the tongue For the Quinsie or squinancie the swelling of the throate causing difficultie of breathing and hardnesse of swallowing Trincauel doth aduise a speedie letting of bloud yet a glister being vsed before if the disease will giue leaue but if the disease as it is a very sharp disease will giue no space then may we do as Hippocrates sometime did that is first let bloud afterward minister the Clyster Fuchsius willeth vs to open the basilica of the arme of the same side where the swelling is But he will haue it to be done at seuerall times by little and little and not all at once least there should happen a swouning and so a perill of suffocation and besides By two sodaine coolings and by fainting of the heart the matter may be caryed from the iawes vnto the lungs and so bring ineuitable danger Yet must not the incision be made too little least by meanes of the narrownesse of the hole the good bloud should be as it were strained out and the thick part remaine within which is the cause of the griefe If the patient be a woman whose termes are stayed open first the saphena and then the vaine vnder the tongue For the pleurisy how conuenient bloud-letting is for it it is a thing so well knowen to all men that there needeth no proofe thereof But on what side the vayne must be taken whether on the same side that hath the inflammation or on the contrary side seeing that there is amongst learned Phisitions a great controuersie about that matter I haue appoynted one Chapter to wit the Chapter next following wholy for the discussing of that question And for as much as also all the arguments layd open in that disputation do as well concerne the inflamation of the raynes and of the wombe and all other inward inflammations as the plurisy I haue thought it good to speake no more of the particulars heere but rather to conclude with that generall speech of Galen To speake briefly when inflammations do begin we must euacuate them by reuulsion that is pluck it back into the parts furthest distant but when they are of long continuance we must empty them out of the places affected or as neere vnto those parts as we can For at the beginning of inflammations it is good to turne back that which floweth but when they haue remayned a long time we must auoyd and expell that which is impacted and fastened in the part affected CHAP. 7. In these dangerous inflammations aforenamed whether euacuation or reuulsion be more necessary and what is the meaning of Hippocrates his rule 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to worke directly and with a right course of flowing PEtrus Brissotus and Matthaeus Curtius two learned Phisitions the one a Frenchman and the other an Italian haue by many arguments prooued that in a pleurisy the vayne ought still to be opened in the arme of the same side where the griefe lyeth Trincauel in his treatise which he calleth rudimentum hath vndertaken to confute them The first reason of Brissoâ—us is because in such sharp diseases vnlesse you help presently the party dyeth And the first scope in an inflammation is to auoyd bloud out of the place inflamed for the performance whereof the same side is most conuenient Trincauel answereth that when the party hath no full body then that position may well stand But if there be a full body then he holdeth with Galen that the scope and purpose of the Phisition must be to forbid that the bloud shall not flow to the place of griefe For the flux of the bloud doth Galen make to be the cause of the vehement inflammation And this staying of the flowing of bloud he thinketh may best be done by euacuating so that we may also reuell the same by drawing it back to the contrary side Brissotus againe obiecteth that by reuulsion there is often stirred vp a pleurisy on the other side vnto which the reuulsion is made Trincauell doth answere that doth happen by meanes of the fulnesse of the whole body especially of the lower parts when the opening of the vpper vaynes can not auoyd so
there be a heate of the raynes there is made the stone if of the liuer the iaundise and if of the brest the salt rheume Razes doth commend in a rheume letting of bloud But Heurnius doth restrayne it with certaine limits He will not haue it to be vsed vnlesse there do appeare the signes of fulnesse of bloud as the rednesse of the face and eyes and extending of the vaynes and vnlesse the body head appeare to be hote and the rheume salt with a matter not very farre differing from bloud and further vnlesse there be some danger of the instruments of breathing the lungs and the sides then he admitteth bloud-letting but as he saith sparingly and not too much but in a cold rheume the sweet mitigation of bloud is not to be taken away In the Goute Phlebotomy is not to be vsed vnlesse great fulnesse do of necessitie vrge thereunto There may this reason be giuen of it because that thinne distillation which floweth from the braine into the ioynts and being there thickned and setled doth cause the gout doth not fall downe by any vayne as Fernelius sheweth in his answere to the Phisition Bucherius but doth distill from the brayne to the neck shoulders and from thence to the feet partes consecuta subcutaneas hauing gotten for passage the parts vnder the skinne and because it is thinne doth flow vnsensibly Bucherius thought that because in the bloud that he saw drawne out of vaynes there appeared sometimes phlegmatick matter to flow out with the bloud therefore that fleame slipping out of the vaynes might be a cause of the goute But Fernelius doth confute him and sheweth that that which swimmeth so whitish in the basen is a kind of phlegmatick bloud such as doth abound in the disease called Leucophlegmatia and that it is so farre from sliding out of the vaynes into the ioynts that it can not be drawne out of the vaynes by strong medicines For that fleame which is fetched out of the body by purgings and vomits doth not come from the vaynes but it is wholy either from the brayne or from the stomack or from the bowels He addeth I thinke this to be one of the greatest errours of the common sort of people that in all diseases they place the faults of the humours no where else but in the vaynes and when the question is of humours they vnderstand nothing of those which do abound in other places but only of those which are mingled with the bloud in the vaynes Although the cause and nourishmēt of the gout doth not flow from the vaynes yet if the party haue a full body it will be very dangerous for him to omit letting of bloud for that attenuating and resoluing diet which by meanes of his disease he must vse will make his plenitude the more perilous vnlesse hauing first purged his body he do also cause some vayne to be opened The like reason doth Fernelius giue in his curing of morbus Gallicus after that he hath aduised the body to be twise or thrice purged he sayth that also he must be let bloud as his fulnesse shall require and sterngth permit for so not only the inward parts and whole body shall be cooled but also the dangers of plenitude which may be stirred vp by the vse of attenuating and resoluing things shall be thereby auoyded What vayne must be chosen in the gout when bloud-letting is thus found requisite Galen doth declare towards the end of his booke of Phlebotomy In the gout we must open the vain◠in the cubite but in the falling sicknesse and in that swimming in the head which maketh all things seeme to go round we must do it rather in the legs But how doth this agree with that place which I haue alleaged before out of Galen in my seuenth Chapter If one leg haue an inflammation scarify and let bloud in the other Humours do seeme with greater difficulty to ascend then descend and the hollow vayne in the lower part of the body deuiding his branches equally to both the legges it should seeme that the legge is not only the fittest place according to some 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to diuert or reuell but also the meetest place to make euacuation Fuchsius sayth that Galen doth commaund in the gout to let bloud in the arme for two causes first because both the legs in that disease are afflicted though not both at once but per vices one after an other and secondly because in the goute the bloud doth only offend in plenty and is not so putrified and vicious as it is in a hoat and red inflammation But seeing the chiefest intent of Phlebotomy in the gout is to euacuate the fulnesse of the whole body it may therefore seeme especially for that cause most fit to open a vayne in the cubite As for the matter of the disease it is rather auoyded by a good fit diet dry and moderately warme and the vse sometimes of things that do extenuate and resolue then by seeking to draw out either the cause or the nourishment thereof by the vse of Phlebotomy CHAP. 10. Whether letting of bloud be fit for such as haue hoa◠liuers and cold stomacks as also for such as haue itches and scabs and such other faults of the skinne Further whether it be good for the disease called of the seafaring men the scuruy and for the cachexia or bad habit of body and finally what and how many are the drifts and scopes of letting of bloud MOntanus in his conference had with a Doctor called Sonzinus about a man which had bin lately a souldier who was iudged by his busy fierce practises by the rednesse of his face and by the fulnesse of the vaynes about the eyes and other places to haue a hoat brayne a hoat heart and a hoat liuer and by the red sand and heate of vrine appeared also to haue hoat raines and yet hauing so many parts hoa◠had y◠stomack cold by meanes of the heate of the liuer wasting and consuming the fatnesse of the cawle or sew which should conscrue and keepe in the due naturall heate of the bowels and who also by these occasions for want of good concoction had many rheumes distillations making his body very soluble by meanes of their slippery descending which otherwise in regard of so many hoat parts must needs haue bin very costiue he saith Here I would commend principally bloud-letting to take away the heate of the liuer and of the inferiour parts the body being first gently purged by cassia Yet if the infirmitie haue continued long and brought the body to a great weakenesse Trincauel will then in no case admit Phlebocomy For giuing his aduise to one which had a boat and a dry liuer but a moist stomack and who was troubled with plentifull thinne spitting with paines in the ioynts and lassitude of the whole body he sayth In this body so spent with
of the constipation or thicknes of the skinne the spirits and vapours haue lost their accustomable flowing out whereby the spirits are inflamed whether in this ague bloud is to be let or no I answere that according to the iudgement of many excellent Phisitions of our time this ague is best ouercome by causing kindly sweates by medicins loosing obstructions and by vsing fit bathes without letting of bloud But if it do continue more then a day that it be now diaria plurium dierum or as some call it ephemera extensa then all do agree that letting of bloud is very expedient for feare least of an ague not putrified it do become a synochus putrida and so bring greater danger For as diaries or agues of one day do passe into diaries of many dayes vnlesse the obstruction be loosed as Galen sayth Vnlesse the obstruction be cured they fall into agues of many dayes so also the diaries of many dayes do fall into putrified agues and hectick feuers vnlesse they be in time holpen and eased as the same Galen sheweth in the first page of his ninth booke de methodo medendi But concerning letting of bloud Galen doth in the tenth booke generally set downe his iudgement very briefely concerning all diaries caused by obstructions One obstruction commeth by multitude and an other by the quality of the humours being too tough or too thick In that which commeth by multitude letting of bloud is the chiefest manner of curing but in that which commeth by the quality of the humour the vse of the extenuating things is best CHAP. 4. How farre letting of bloud may be allowed in intermitting agues quotidians tertians quartaines MOntanus affirmeth that in a phlegmatick ague if the fleame be thick and of a glassy greene colour as it falleth out in the agues called epialae then in no wise may any vayne be opened because although there be a great boyling yet we haue neede of a great heate that the matter may be concocted and the passages opened and therefore he thinketh that we haue neede rather of frictions But if it be pituita dulcis such a fleame as may easily be conuerted into bloud then he alloweth letting of bloud as a fit help to remoue the obstruction He sheweth in the same place a little before that the chiefest cause why we sometimes vse phlebotomy in quotidians quartaines is to vent the vapours It respecteth not the multitude but the quality because it is done only to help the bubbling of the humour In the tertian he sayth that Phlebotomy is not necessary neither euacuatiue because there is no fulnesse of bloud but only euill humours mixed with the bloud nor yet Euentatiue because the paroxysmes of the tertians continue not aboue twelue howres and haue a great distance of intermission and therefore can not haue so great a boiling as should neede to be vented with so great a remedie as is Phlebotomy And as touching the quartaine he sayth that bloud-letting doth not agree vnto it of it selfe as it dependeth of melancholick humour but per accidens as when it commeth vpon the suppressing of the menstrua or haemorrhodes or when it commeth ratione sanguinis adusti by meanes of burnt bloud then he alloweth the letting of bloud Platerus doth thinke that all intermitting agues do proceede of a putrified cause lying hid in the mesaraick vaynes and therefore if any of them could be opened he supposeth some help might come but seeing those mesaraick vaynes do no where appeare at the skinne it were best not only in quartaines but also in tertians if possibly it may be to cause a flux of y◠haemorrhoids because the haemorrhodiall vaynes are branches of y◠mesaraik vaines He will haue no vayne to be opened there vnlesse it appeare exceeding well because a small wound made there doth bring oftentimes great torments but he will haue either the flux to be procured by some medicine or else leaches to be applied He alloweth not phlebotomy in exquisite tertians and such as are afflicted with most vehement heate by reason of choler inflamed neither doth he thinke it fit in phlegmatick agues in which cases he which shall rashly and vnskilfully let bloud shall not only auoid nothing of the cause lying hid in the mesaraik vaynes but also as he sayth the matter being plucked out of the mesaraick vaynes into the hollow vayne he shall of an intermitting ague make a continuall ague or else the purer bloud by reason of emptying the branches of the hollow vayne being drawne out of the mesaraick vaynes that cholerick and putrified humour which remayneth and whereunto bloud was before a bridle and a meanes to asswage it will now become more fierce Therefore he concludeth that in these kindes of agues more harme is done by admitting Phlebotomy then by omitting it vnlesse some grieuous symotome do happen that by the inflaming of bloud an inflammation also of some of the inward parts be feared or vnlesse there be a plethora or plenitude in the body which may be obserued by the rednes and thicknes of the vrine and by the long continuing of the heate after the fit and when there is no fit then not in the beginning of the ague but about the third or fourth fit in the day of intermission out of that vayne of the arme that appeareth most filled it will do very well to let bloud 5. 6. 7. or 8. oūces In quartains it must be done in y◠left arme somewhat later then in tertians For quartaines are at the beginning gently to be handled least a double quartain or a triple quartain be made and least also the strength should decay which heere we must preserue by reason of the long continuance of the disease Fuchsius in an exquisite tertian which proceedeth of meere choler not mixt with any other humour doth proue out of Galen ad Glauconem that neither letting of bloud nor vehement purging medicine can be conueniēt for it Doctor Bright doth thinke requisite that in the first day of intermission to ventilate the body 6. or 8. ounces of bloud be taken These iudgements do seeme to be contrary but yet the seuerall circumstances being considered they may both be very well reconciled For as Fernelius sheweth the opening of a vayne in respect of it selfe is hurtfull to an exquisite tertian it taketh away the profitable and necessary humour and leaueth behinde the impure and hurtfull Againe in this kind of ague the body is wont to be very thin and of little bloud But the sharp choler which is the matter of the ague and doth abound and boyle vnder the hollow part of the liuer when bloud is taken away doth waxe more fierce Yet he alloweth there letting of bloud in respect of other symptomes such as are headach beating of the temples and heauinesse of the body in corpore plethorico In tertiana notha or the bastard
helpeth much transpiration by meanes whereof it must needes be good to help putrefaction When Montanus affirmeth that to let bloud in putrified agues is to kill the patient he meaneth a liberall euacuating of bloud but otherwise his words before do shew plainely that it may be done moderately to vent the vapours And Platerus sheweth an other cause why it ought to be done because the occasion of putrified agues doth lie hid in the bloud and in the branches of the hollow vayne together with the bloud is auoided some portion of the putrified humour Of the same iudgemeÌ„t is Fernelius The opening of a vaine which may take away both the multitude and also a great portion of the putrified humour doth greatly auayle to the curing of the feuer And an other reason sheweth Galen why this must be done because nature being disburthened of a part shall the more easily ouercome the whole as I haue declared in the Chapter going before in the first vse of Phlebotomy If the ague be that which is called Causo the burning feuer whose matter is not the heate of bloud but the burning of choler and whose signes are tossing of the body an vnsatiable thirst the toong dry and rough either yellow or black a nipping about the stomack and liuer yellow excrements the vrine very thinne and something wanne the pulse swift thick and hard doating a little sweate about the forehead and neck but euery where else the skin very dry and therewithall a little rough letting bloud may also well be vsed at the beginning but in no great quantity only foure or fiue ounces for venting or euentilation are sufficient Auicenna in his curing of the Causo doth affirme that bloud is not to be let in it vnlesse there doe appeare rednesse and thicknesse of vrine but that is not Causo but rather synochus Montanus sheweth that the true continuall burning feuer seeing that the matter which doth putrifie in it to wit choler is most hote and most dry it becommeth in a manner altogether firy Hppocrates teacheth the way of curing a burning feuer by quenching the burning heate by giuing water and mulsa aquosa but he maketh no mention of letting of bloud thereupon Montanus doth conclude that letting of bloud is not to be permitted in a burning feuer But I thinke Montanus his argument in that disputation vpon the eleuenth Canon of Auicenna is of small force For although Hippocrates do not precisely commaund in that place bloud to be let in a burning feuer yet he maketh it in the same place to be a signe of the dissolution of the disease if the patient do bleede at the nose and presently vpon it he vttereth these words At in morbis acutis sanguinem detrahes si vehemens fuerit morbus qui aegrotant aetate florenti fuerint virium robore valuerint Platerus doth require in the Causo or burning feuer that there should be a liberall letting of bloud if strength do permit because he thinketh it not to proceede of pure choler as many other Phisitions haue taught but of bloud putrified and inflamed in the great artery and causing so much the more daÌ„gerous feuer as it is kindled in the trunck of the great artery neerest vnto the heart If Hippocrates do require Phlebotomy in morbis acutis then must it needes be good in the burning feuer which as Trincauell declareth is maximus acutissimus morbus But still in the quantity Hippocrates his rule must be obserued to haue a due regard of the age and strength CHAP. 3. How bloud-letting may be admitted in agues caused by obstructions as Diaries c. GAlen sheweth that by obstructions sometimes the transpiration and vapouring out may be intercepted and by the obstructions they which haue bad humours fall into agues as Diaries and such like and in them he requireth as very expedient the opening of a vayne first for venting or euentilation for as he saith vnlesse the bad humour be vented it must needs become putrified and secondly because those things which you shall minister afterward to deliuer from obstructions will worke more effectually For it is best to come to deterge and loose obstructions hauing first by bloud-letting for he speaketh there of Phlebotomy auoyded part of the euill humours For we seeking to deliuer the obstructions before we haue made euacuation it is in danger that we shall impâ—â—t the obstructions more firmely then before How the greatnesse of the obstruction shall be knowne Galen sheweth a little after in the same booke The declaration of the quantity of the obstruction is made manifest by the ague for vpon greater obstructions the ague is greater and vpon lesse obstructions it falleth out to be lesse Montanus being fallen into the consideration of this place of Galen doth make three seuerall kindes of obstructions and sheweth in which of them bloud-letting is requisite and in which not The fyrst obstruction is when in the pores of the skinne in the outward parts the transpiration and vapouring out is stayed and prohibited The second kind of obstruction he calleth coarctatoria when such a multitude of humours is conteyned within the vaynes that the passage of the spirits being stopped they cannot passe thorough the vaynes whereby there commeth a perill of suffocation The third obstruction is called oppilatio wheÌ„ some tough matter doth so stop the conduits and chanels of the vaynes that neither matter nor spirits can passe thorough them In the first kind of obstructions Phlebotomy is good because by it the body is made more thin and humors being without the vaines in the compasse of the skinne are by bloudletting drawne into the vaines and so do passe away as Montanus doth demonstrate out of Galen In the second kind of obstruction letting bloud is also conuenient that the thronging together of humours may cease and that bloud may be vented But in the third kind of obstruction it were ill done to let bloud because the thick humour which is impacted in the first vaynes is not thereby euacuated but rather increased as the same author doth proue out of the same fourth booke of Galen de sanitate tuenda I thinke he hath respect to that position of Galen In a werisome and faint body there is little good bloud and many raw humours Phlebotomies do auoyd the good bloud but as for the ill bloud which is gathered together in the first vaynes especially that which is about the liuer and mid bowels they disperse and spread it throughout all the body How in the two last kinds of obstructions the humour must be prepared and made fluxible before we attempt any letting of bloud it is to be declared hereafter in the third Chapter of the second booke But the question is here only of the first kind of obstructions when in an ague called diaria or ephemera which lasteth not aboue 24. howres by reason either
if it appeare yellow and thin let him straightway suppresse it CHAP. 5. Whether letting of bloud be to be admitted in the plague or pestilent feuer as also in the Pox and such other contagious infirmities and when and how AVicenna in his eeuenth canon concerning bloud-letting as Montanus hath deuided them doth set it downe for a rule that in what agues soeuer there is a most vehement inflammation there must be no letting of bloud Montanus discoursing vpon that place sayth that we must regard not so much what the disease requireth as what the strength can beare In respect of the disease Phlebotomy doth agree but not in respect of the powers He bringeth in an instance of a pestilent feuer and sheweth that bloud is not to be let in it because although of it selfe in regard of the pestilent feuer there is no greater remedie then letting of bloud seeing that by it the body is made apt to vent and vapour out the spirits the inward heate is extinguished and putrified bloud is euacuated yet if bloud be let all do dye and therefore we must absteine from Phlebotomy in the pestilent feuer because in a moment of time the strength vtterly decayeth Platerus sheweth sundry great dangers which letting of bloud doth bring vnto them that are infected with the plague and that little good helpe can be expected thereby I can not see how Phlebotomy can auayle to pluck that venemous quality from the heart or to bring it out of the body together with the bloud seeing that it is rather procured thereby that the infection which from outwardly commeth into the body and doth presently infect the spirits should be drawne more deepely inward And moreouer the motion of nature whereby straightwayes in the first inuasion it goeth about to shake out the poyson by sweates by outward pustles and by botches may be hindred by letting of bloud and the powers thereby weakened which we ought to keepe strong to expell that poyson It neither doth auoyd the cause of the disease neither is there any neede heere of any euentilation of heate seeing it is not heere so vehement Hereupon he concludeth that vpon rash and vnaduised letting of bloud in plague times many meÌ„ are killed Yet he acknowledgeth that when the plague hath taken hold vpon bodies which are summè plethorica vel cachectica full of bloud or of corrupt humours whereby a feuer is kindled then if by opening of a vayne the plenty and putrefaction of the bloud be taken away all the other symptomes will become more tolerable but that must be done sparingly and with a due regard of the strength And if in the beginning strength be decayed then is Phlebotomy not to be admitted though the fulnesse of the vaynes doe require it for of lusty youthes we haue found by experience more to escape in the plague time without letting of bloud then by letting of bloud If Phlebotomy be vsed it must be done rather in respect of the feuer then of the pestilent qualitie seeing that this venome doth not consist in the bloud but comming from outwardly doth sodainely possesse the heart and we do not thinke that it can be expelled or drawne out from it by Phlebotomy And if the case do so stand that by the meanes of the plenitude and feuer a vayne must needs be opened then he sheweth in what order it must be done First it must be done in the beginning for vnlesse the vayne be opened within 24. howres of the beginning it will rather hinder nature then do any good Also it must be considered whether the party be in a sweate or no for in no wise must the sweate be hindered by Phlebotomy But after the party hath sweat and hath bin refreshed with a little meate or some cordiall receipt then may a vayne be opened howsoeuer there hath gone no clyster nor purging before because the time hath not giuen leaue Choose the vayne in that side which is most grieued If any eruption appeare about the flanck open the saphena If in the vpper parts then some vayne in the arme or hand of the same side If vnder the arme-hole take the basilica If about the â—ares the cephalica If in the face open the vayne vnder the tongue And euer to the botches appearing let cupping glasses be fastned that the poyson may abide in the same place and not by Phlebotomy be drawne into the inward parts Trincauel doth accompt it very dangerous to let bloud when pimples do outwardly appeare but when as well by the pulse as by the former manner of diet which the party hath vsed it is found to be expedient then let it be done straight in the beginning before the putrefaction of the pestilent feuer be much increased and before nature do seeke to expell vnto the skin Thus he prooueth out of Galen who commenting vpon one of Hippocrates his patients called Crito who dyed vpon a kind of pestilent feuer he doth excuse Hippocrates and sayth that he did not let him bloud because he was not sent for at the beginning of the disease Which signifieth that if he had bin sent for at the beginning a vaine no doubt should presently haue bin opened Montanus in his epistle to Crato doth allow letting of bloud in the small pocks and such other contagious diseases so that it be in the beginning before signes of putrefaction appeare but when it hath once preuayled then to let bloud he doth call it a pernitious and a deadly thing For nature is then checked when it should wholy be intentiue to expell the venom and infection of the disease Fernelius Hollerius and Syluius three famous and worthie Physitions consulting about the sweating plague called sudor Anglicus did deliuer to the English Embassadour the vse of bloud-letting amongst the meanes to preuent the disease in full bodies the bodies being first orderly purged but the disease hauing once taken hold they aduised no bloud-letting but prescribed good cordials to expell from the heart the venemous infection But in that which is commonly called by the name of Plague although the body be already infected yet if it be corpus pletharicum the notes whereof are in the first Chapter of the booke next ensuing wee may be bold to begin the cure with bloud-letting obseruing as neere as may be the cautions before expressed and especially taking heed as Montanus giueth warning that wee choose the vayne as farre as we can from the principall parts from the heart liuer and braine for if we draw the pestilent humour vnto them he sayth we shall kill the patient CHAP. 6. How letting of bloud is to be vsed in phrensies quinsies plurisies inflammations of the raynes or wombe and other inward inflammations happening often without agues IN the phrensy which is a deprauing of all the principall faculties of the braine caused by the inflammation of the filmes thereof Rhazes doth allow Phlebotomy in the
plenitude for the griefe was but small and the bloud was cast out by spitting now those pleurisies are most gentle in which bloud is spit out 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 in Hippocrates signifieth directly and as it were in a right line a benumming of the thigh right on the same side is a signe of the stone in that kidney so Galen doth expound it 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 it signifieth according to rectitude And in an other place he doth interpret it by the word 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 directnes For a good signe bloud must flowe directly as out of the right nostrill if the liuer or right side be affected and out of the left nostrill if the spleane or the parts thereabouts be greeued The contrary to 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 is 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 as Hippocrates sayth bloud to flow out of the contrary side is an euill signe Good it was for Bion being a splenetick man to bleede out of the left nostrill and good for Herophon after the swelling of his spleene to haue a kernell to rise 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 of the same side So the auctor of the booke de renum affectibus By the benumming of the thigh directly on the same side you shall know which rayne is affected for if there be a benumming in the right thigh then is the stone in the right kidney if in the left thigh then in the left kidney This 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 hath place in the crisis of diseases but Hippocrates doth neuer appoynt Phlebotomies to be made of necessity alwayes 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 directly vpon the same side Fernelius expoundeth this word 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to signifie the rightnes of the fibrae or vills as it were little thready or hairy strings stretched out and running by the longitude of the vaynes But Andraeas Laurentius and Reusnerus vpon Willichius do at large confute that opinion For if Fernelius do make those rectae fibrae helps for euacuation or expulsion then doth he not well for the transuerse fibres and not the right do serue for expulsion and if he make them as they are helps of attraction then must they draw equally as well on the one side as the other because they runne out equally by the length of the vaynes on both sides And the like answere they make to them which would haue the word to signifie the continuing and ioyning together of parts as though all the vaynes of the right side were ioyned one to and in an other amongst themselues and the vaynes of the left side ioyned among themselues and did not rather participate and communicate one with an other But seeing the trunke of the hollow vayne is one the branches thereof on both sides are equally ioyned to the liuer The breaking out of bloud out of the left nostrill doth empty as well the right side as the left and as Reusnerus sayth he saw often by experience that the diseases of the spleane were holpen sometimes by opening the liuer vayne and sometimes by bloud gushing out of the right nostrill And moreouer as Andraeas Laurentius sheweth there is no meeting together betwixt the vaynes of the nostrils and the spleane and yet the spleane being inflamed as you haue heard the bloud that floweth out of the left nostrill doth flow 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 directly And therefore that word of Hippocrates is not to be referred to the ioyning together of the vaynes one in an other but to the rectitude of the whole parts of the body quia dextra dextris sinistra sinistris sunt 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 because the right lims to the right and the left to the left are as it were of one tribe or kinred and therefore like good neighbours do one labour to help an other Maior est vis in forti contentione obsessae partis quà m in venarum situ There is a greater force in the strong contention and striuing of the side that is besieged or set vpon then is in the situation of the vaines And a good criticall signe it is when that side that is impugned can expell part of that wherewith it is ouercharged and oppressed But when for any inflammation a vayne is to be opened we haue many other things to be regarded besides the consideration of the side We must marke well whether the whole body haue a fulnesse of the vaynes whether the humour be flowing or now already flowed and setled whether it doth require euacuâ—tion or reuulsion or diuersion and which of them â—ore then other and how these vses of Phlebotomy and the order thereof shall best be perfourmed of all which points you haue seene already â—hat the best Phisitions of our age haue gathered out of the best Phisitions in times past Only I will adde one obseruation more out of Montanus and so an end of this ouertedious controuersie Montantus will haue in euery inflammation two things principally to be regarded the first membrum mandans the member that doth send the humour and the second membrum recipiens the member or part that doth receiue the humour As he giueth his instance thus of the pleurisy Let there be saith he one of a hoate liuer who hath laboured in the sunne hath dronken strong wine hath inflamed his head hath rested sodainely in a cold place and then as it commeth commonly to passe by the cold the matter is expressed by the vaynes and descending by the vaynes it doth flow downe either to the higher or lower ribs and there followeth a paine Here the member sending is the head and the member receiuing the ribs Let the place of the inflammation be in the right side where must we then let bloud He answereth that seeing the humour is caryed downeward if we should open the basilica of the same side we should draw the humour more downeward and so increase the impostume and indanger the patient The fulnesse is in the head but aboue the head there is nothing if there were we would euacuate from it Therefore either a deriuation must be made to deriue the humour from the head by opening the vaynes which are behinde the eares or by bleeding at the nose which were excellent or by striking the vayne vnder the tongue or else we must follow the expert Arabian Phisitions to let bloud on the contrary side that so by reuulsion the humour may be drawne according to the directnesse of the situation from the right side to the left But if the pleurisy do come of another cause that the flux be not from the head but it be the liuer full of bloud and choler sending humours vnto the ribs by the ascending vayne because there is a plucking of the humours from the lower parts vnto the higher in what vayne then must we let bloud He answereth not from the basilica of the same right side for then we shall draw the humour to the place but as Auicenna doth
teach either wee must draw it downe by opening the saphena of the same side or else we must deale with the opposite side aboue The rest of Montanus his opinion you haue seene before in this Chapter where I haue compared his iudgement with the iudgement of others the most excellent Phisitions of our age CHAP. 8. Whether letting of bloud may be practised in cold diseases as palsies cramps apoplexies and whether it may fitly be vsed in melancholick windes colicks and dropsies FOr the diseases mentioned in this and the two Chapters following I purpose not to shew the censures of many Phisitions but only for euery infirmitie to content my selfe with the auctority of one or two of whom I make best reckoning and so to hasten to those other points which more generally and vniuersally are to be considered in the whole practise of Phlebotomy Although cramps and palsies conuulsions and resolutions be cold diseases yet Aetius Paulus Aretaeus and diuers do appoint to begin the cure with letting of bloud Galen doth allow it but not generally alwayes He only doth admit it in these cases and with these conditions First when these cold diseases haue their beginning by the suppression of the termes or hemorrhodes Secondly if they be with a feuer but then it must be done moderatly sparingly Thirdly if there be great plenty of bloud either in the whole or in the head For as Galen sheweth and also Hippocrates by the ouermuch fulnesse of the vaynes there are made oftentimes epilepsies and apoplexies Trallianus beginneth his cure of a lethargie by letting of bloud if other circumstances do not prohibite Heurnius in his Chapter of conuulsions doth like well of the iudgement of Aretaeus to wit that whether the cramp or conuulsion do come of coldnesse or by a wound or by vntimely birth the vayne in the arme is to be opened especially if bloud be the cause or if it be such a crick that the neck or body can bend no way or if it be an inflammation or a wound Montanus alloweth Phlebotomy in epilepsies and apoplexies when they depend of bloud but he addeth this clause hoc autem faciendum debitis temporibus praecipue vere this must be done in due time especially in the spring time For melancholick winds caused by obstructions of the liuer or spleane Mercurialis giuing aduise in that case to a Noble man of Germany sayth first you must thinke of letting bloud not that the abundance of it doth plainely shew any such matter but because other noble helps can hardly be safely administred vnlesse letting of bloud do go before And in an other place writing counsayle for a woman which had fiue yeares suffered the obstruction of the spleene and was now come to a schirrus or hard swelling he sayth I thinke it were excellent well that she should be let bloud first out of the common vayne then out of the lienaris and last of all out of the vayne of the left foote so that at thrice there be in all taken a pound of bloud Trincauel his iudgement is that we must abstayne from bloud-letting when the melancholick humour is dispersed into the vaynes of the hypochondria and the whole body and that then we must rather purge or procure the hemorrhodes if the party haue had them vsually before For the Colick Auicen doth forbid bloud-letting to be vsed in it Montanus writing vpon the sixth Canon of Auicen giueth the reason of it because the colick commeth of some cold and thick matter and phlebotomy both doth make more cold and also hath no power to auoid the thick and grosse causes of the griefe Yet he addeth this But if the colick do come by the inflammation of the colum one of the lowest guts by meanes of bloud or choler flowing to the place in this case if you let not bloud the patient will dye For the Dropsie Trincauel teacheth that if it come by the suppression of some vsuall flux as the termes the hemorrhodes and bleedings at nose whereby by the superfluous abundance of bloud the naturall heate of the liuer beginneth to be quenched then the first thing in the cure must be phlebotomy But if it come of fleame then omitting bloud-letting we must only seeke to purge the fleame He maketh there an obiection what we must do if the termes be not suppressed and yet the vrine do appeare high coloured whether may we then let bloud or no seeing that Auicen sayth that if the vrine do appeare red and thick a vayne must presently be opened Trincauel answereth that yet we must not let bloud because in this disease that rule of Auicen doth not take place For the red tincture of the vrine doth not come by abundance of bloud but first because little vrine is made in these diseases therefore it is the higher coloured for the thinne iuices of choler and bloud from the which doth come the colour of the vrine being mingled with a little moysture do giue the greater tincture and make it higher coloured And a second cause of the high colour in the vrine he sayth may be the debility of the raynes which by reason of their weakenesse being not able perfectly to separate the bloud from the excrement do let some little portion of bloud passe with the vrine whereby the vrine is dyed red A third reason doth Fernelius giue why the colour of the vrine may often deceiue because when the choler is cast out by the liuer it doth not only colour the thinne part of bloud but maketh the vrine also to looke as though the bloud were inflamed as he giueth an instance by Iaundises and Dropsies and concludeth They do therefore offend which by the vrine being of citrine colour and thicke do iudge straight that bloud is to be let For such an vrine doth not come by the abundance or by the kindling of bloud but by the powring out of choler out of the liuer I will not speake heere of the razing of the stone in the raynes and some other occasions that may be that a little bloud issuing may alter mightely the colour of vrine This which hath already bin spoken may put vs sufficiētly in mind in the matter of bloud-letting not so much to be led by the colour of the vrine as by other euident tokens which shall be hereafter more at large declared But when the vrine doth concurre with other signes then vis vnita munita Et quae non prosunt singula multa iuuant CHAP. 9. Whether in rheumes and distillations and also whether in the Goute and the disease called Morbus Gallicus any benefit may ensue by letting of bloud MOntanus doth make this to be one of the principall and generall vses of Phlebotomy then to take place When any hath some notable heate of some member by means of which heate it doth easily receiue excrements and so fall into a disease as if
should expell the disease by the skinne because such purgations do trouble the motion of nature and yet at the same time doth allow a clyster of barley water one pound and a halfe of oyle of violets foure ounces of butter three ounces of red sugar candy one ounce or of each of them proportionably a lesse quantity if it be for a child and doth there condemne Nicholaus Florentinus for that he forbiddeth the ministring of a clyster at such time as the sayd diseases do begin to breake out for sayth he it is a fond thing to thinke that the motion of nature iâ— hindered by clysters seeing that they do worke only in the bowels and the motion of nature is both neere the skinne and in the vaynes neither do clysters so ouerthrow the poâ—ers that we neede to conceiue any feare Euen so for as much as in letting bloud our drift is especially either to case nature being ouerburdened or to expell some dangerous causes of putred matter by transpirations sweatings euaporatings and such like very expedient it is that we auoyd such purgings as whereby the worke of nature may be either troubled or weakened and content our selues with a more fit preparing brought to passe by glysters It is a great fault amongst very many in England that they are so nice and scrupulous in receiuing of a glyster as seeming to suspect some danger in that which indeede is the most easie and harmelesse remedy of all others And as great a fault it is in many of our countrey Surgeons which so boldly do commonly practise the opening of vaines neither hauing before any direction of learned counsaile neither being themselues stored with those things which should orderly prepare their patient therevnto They which do minister purging potions at that time when nature doth begin to moue say they do it because nature doth moue vnperfectly but to them Mercurialis doth answere intelligere an perfecte moueat in initio non possumus we can not know in the beginning whether nature wil worke perfectly or no. The safest and surest way is by a clyster so to ease the fulnesse and costiuenesse of the body that we do not disease the emptinesse and loosenesse of natures powers If the impurities and crudities be aboue in the stomack then shall it be requisite before Phlebotomy to vse some vomit as to take of the decoction of barley two or three ounces of oyle of sweete almonds and oximel simplex each one ounce of oyle of dill two drams mingle them and giue them for a potion Or if the matter be grosser and colder take of the seeds of rocket leekes radish broome each the waight of a shilling of the rootes of asarabacca and betony each the waight of sixe pence boyle these in water so much as being well boyled will make a good draught and being strayned dissolue into it two ounces of oxâ—mel simplex and drinke it off In hoater diseases the former will be more conuenient Fit vomits and clysters they make a preparation speedily and do nothing trouble the work of nature in expelling to and by the outward parts Pâ—rgations if they be strong they weaken nature if gentle then are they long in working and hauing some hoate qualities in them must needes as well by their heate as by their drawing a contrary way trouble that worke whereunto Phlebotomy is directed Fontanonus a learned Doctor of Mountpelier writing of that synochus or hoat coÌ„tinuall ague which proceedeth of bloud inflamed in the vaynes neere vnto the heart after that he hath appointed to begin the cure with present letting of bloud What houre of the day soeuer it be for feare least the bloud do creepe vnto the lungs and thereupon should come an inflammation of the lungs or least it should slip into the bulk and thereof should arise a pleurisie or finally least it should putrifie and so there should be made a putred ague of a not putred he sheweth after how the body must be made fit for this Phlebotomy not with a purging potion least while the purgation is long in working the patient should receiue harme by the aboundance of boyling bloud but by a clyster made after this sort Take of the foure emollitiues each one handfull the foure emollitiues are as skilful Heurnius doth lot them out 1. mallowes 2. marsh mallowes 3. violets or in stead thereof pellitory of the wall or mercury 4. branck vrsine or in steede thereof beets of endiue and lettise each halfe a handfull tenne prunes boyle all in a reasonable quantity of water vntill the third part be consumed then strayne it and take thereof one pound and a halfe dissolue into it of cassia newly extracted and red sugar-candy each one ounce of salt a little and you haue your clyster In stead of the pulpe or flowers of cassia may be vsed diacassia Mesuae or diacatholicum Nicholai or electuarium lenitiuum Rhasis any quantity betwixt halfe an ounce and an ounce and a halfe according to the strength of the party the most conuenient oyle to be added to them is the oyle of violets In stead of the aforesayde things the clyster may be made of a little soluble chicken-broth goats-milke and the yolke of an egge stirred and mingled and putting into it of manna and fresh butter each an ounce first melted together these be the ingredients most fit for the clysters of such as are to be let bloud And if any Surgeon by reason of his seate and place of abode be so situated that he shall be enforced sometimes to open a vayne before the counsayle of a learned Phisition may conueniently be obteyned let him be carefull to haue some prouision of these things in store as he tendereth either the testimonie of a good conscience in respect of himselfe or sound and perfect health in regard of his patient For as before is shewed many are the harmes and dangers which ensue if at the time of letting bloud there be crude and corrupt humours in the stomack and bowels prest and ready to be suckt and drawne into the vaynes now newly emptyed by the administring of Phlebotomy CHAP. 4. Of the age sexe strength and solubilitie of the party whether old men or children or women being either with child or hauing their termes may be let bloud Also whether any hauing bodies either too soluble or too cosâ—iue may be let bloud FOr the beginning of old age there is no question but that bloud may be let very safely in it if other things be corespondent Trincauel saith that about the fortieth yeare of age that is about the beginning of old age we may most fitly be let bloud But Galen doth make three degrees of old age the first he calleth 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 signifying such as haue a greene and lusty old age such as are able yet to deale in the astayres of the world The second he calleth 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 the middest
or else by ouermuch cooling of the body when by bleeding much of the strength is resolued Fernelius sayth The raw and vndigested flux which hapneth in a burning feuer the stomack being dissolued by the drinking of cold water doth not forbid the opening of a vayne but a regard must alwayes be had of the power Alexander Massaria doth aduise that if the flux do come of venome or any poysoned humour we should not let bloud because the greatest violence is then offered to the powers and the spirits are in danger of sainting CHAP. 5. Of the state of the disease what consideration must be had thereof in bloud-letting and in the examining of the strength of the party which we must regard most the vertue animal or naturall or vitall WHereas euery disease hath foure seuerall times the first is called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 princiâ—ium the beginning which indureth vntill there appeare some signes of concoction the second 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 vel 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 incrementum augmentum vel ascensus the time of the increase so long as the fits or griefes doe waxe more painefull the third 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 vigor status the vigour of the disease when it standeth in one stay and neither increaseth nor decreaseth the fourth 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 declinatio so long as the disease doth decline or decrease It remayneth now to be discussed in how many of these Phlebotomy may take place and to which of these it is most fit and conuenient Montanus deliuereth this for Galens doctrine In letting of bloud there is no time to be attended but at what time soeuer by reason of the fulnesse an euacuation is shewed to be the best drift let the euacuation be made whether the disease be in the beginning or in the increase or in the state so that there be not vndigested meates in the stomack and bowels but he addeth a prouiso dummodo virtus non sit debilis so that the vertue and powers bâ— not weake But for the most part Phlebotomy is most fit in the beginning of the disease That rule of Hippocrates In the beginning of diseases if any thing do seeme sit to be mooued mooue it but when the diseases are at the highest state and vigor it is best then to rest Galen commenting vpon it doth apply it to the two great remedies and especially to Phlebotomy The first canon of Auicenna expounded by Montanus is A vayne is not to be opened in the day of the diseases motion that is when the matter of the disease doth boyle and swell and nature doth striue to concoct or expell it Montanus sayth there is duplex motus morbi two manner of motions of a disease the one particular which consisteth in the fits and paroxysines and the other generall or vniuersall in respect of the whole disease from the beginning to the end and this conteyneth the criticall dayes the fourth the seauenth the eleuenth the foureteenth the seauenteenth the twentieth c. Now we must marke how the matter of the disease is mooued whether in a criticall day or not criticall and whether it be moued because nature goeth about to concoct it or because it is furious If the motion of it be furious we must needs vse euacuation But when the motion of the disease is such that nature doth concoct the matter then is it a day of rest and no euacuation is then to be attempted And that doth he make to be the meaning of Hippocrates that we must rest when the disease is in state and vigour hoc est in die motus morbi seupugnae tempore that is in the day of the diseases motion or the time of the strife betwixt nature and it Some affirme that in the criticall day bloud is not to be letten although it prooue a day of rest But Montanus doth confute them and doth iustifie that rule of Auicenna When nature doth mooue mooue thou nothing but when she mooueth not mooue thou in the time of her motion The time of natures motion it the criticall day and therefore in the criticall day we must stirre the body But therein the Phisition must be very wary and circumspect for if nature haue moued in the fourth day which is the declarer of the seauenth then may we not euacuate in the seauenth day And if in the seauenth there appeare any motion we must not mooue in the eleuenth But if in the criticall day nature do neither mooue nor shew some good token and proofe that she will mooue then may wee indeuour to mooue by Phisick Afterward vpon the twelfth canon Montanus reprooueth them which affirme that bloud is not to be let after the fourth day of the sicknesse and prooueth out of Galen that in some infirmities a vaine may be opened a hundred dayes after the beginning thereof But in sharp feuers we let bloud only in the beginning because after the fourth day the powers do faile and for that cause he sayth Hippocrates doth appoynt In sharp diseases vse euacuations in the beginnings Trincauel likewise doth apply vnto Phlebotomy that other axiome of Hippocrates non esse vacuandum in principio nisi turgeâ—â— morbus that we must not purge in the beginning vnlesse the disease be furious and vehement Turgere dicuntur qui adeo concitato motu agitantur vt prae illorum molestia agrotus non possit quiescere quod magni morbi est indicium those diseases are sayd to rage or swell which are caryed with such violent motions as that the patient can take no rest and qui ad excretionem festinant which would faine breake out He bringeth in the example of Galens owne practise which as he recordeth of himselfe when he was sent for vnto a man sick of the pleurisie when he saw first that he auoyded bloud by spitting and secondly that as the patient being asked did confesse he felt but little griefe on his side he vsed some applications to him but would not let him bloud because it was a most gentle kind of pleurisie But how may the former part of that aphorisme of Hippocrates be applyed to Phlebotomy Purge things concocted and ripe but not while they are raw Is concoction first to be expected before we can vse Phlebotomy Fernelius and Fuchsius do in this poynt bitterly inueâ—gh against Auicen for that he forbiddeth a vayne to be opened vnlesse the humours be first concocted Their reasons are especially these first because in sharp and violent diseases and where there is aboundance of bloud it must needs be dangerous to deferre secondly though the disease be not sharp yet may the multitude of bloud of it selfe do harâ—ne if it be not presently eased thirdly because when signes of manifest concoction do appeare then as Fernelius holdeth we must deale no more by letting bloud but the rest of the cure must be finished either by purging
moment It was a damnable opinion amongst the Chaldaeans to make the constellations of the starres to be a table of all fatall lawes as though the whole life of man were written therein As Tarutius Firmianus being skilfull in the Chaldaean sciences tooke vpon him by the manner of Romulus his life and death to calculate what time he was borne that because he wrought such actes and dyed in such a manner therefore he must needes be borne such a yeare and such an howre The superstitions of the Chaldâ—eans were such that they would not build a house nor attempt any iourney nor so much as put a new garment vpon them but they would first haue a regard of the constellations and planets These fond and wicked abuses of astronomy I do wholy reiect and disallow But in the vse of Phisick seeing that a great part thereof doth concerne the flowing and issuing the staying and the passing away of humours and that it is found by the termes of women by the fluxes and refluxes of the seas and many other wayes that the moone hath by the maker thereof certaine influences giuen vnto her much auaylable to the auoyding and correcting of humours I do not thinke but if it be found by the experiences of former ages that at sometimes and in some signes or aspects her forces are more violent then at other we may haue some consideration thereof and make choyce of such as are most meetest for our purpose euen as the husbandmen may also take such times for their grafting sowing planting and such like as by the proofes of all nations haue appeared to be fittest for the fruitfull growing and propagation thereof To returne now to our argument of letting bloud seeing that as I haue shewed the signe may sometimes seeme to be good and yet by other aspects the same may be controuled what course is then to be taken when for want of good helps we can not come to the knowledge of the aspects Surely then our best way will be to obserue the manner of the weather When the weather is setled to be very dry then are not humours apt to flow but in open and moyst weather we find them very fluxible Fernelius sayth The north wind vtterly forbiddeth letting bloud only the south wind doth best admit it in the cold time of winter The time of the day is made by Galen and out of him Fuchsius to be the fittest within an howre or thereabouts after the party is risen after the yesterdayes meate is prety well digested and the body eased as well by stoole as by making water Fernelius sayth in suffocante pleuritide angina quouis tempore fiat If the disease be an intermitting ague I haue shewed in the last Chapter that the fittest time is the middle betwixt two fits at what time of the day soeuer it be and the party must a little before be dicted thereafter Montanus sayth If he looke for the fit in the morning let bloud in the euening before Marsilius Ficinus will have schollers who abounding with bloud do vse Phlebotomy to preuent diseases to vse it both morning euening but at either time a little foure ounces in the morning and as many in the euening because it is dangerous to auoyd too much bloud at once but of this in the eight Chapter CHAP. 7. On whether side the vayne is to be taken when we let bloud to preuent diseases or to auoyd or deriue their matter also what vayne must chiefely be chosen for sundry infirmities ON what side the vayne must be taken in great dangerous inflammations where there is cause of reuulsions I haue shewed alreadie in the seauenth Chapter of the former booke It is not denyed but that in some cases it is requisite that the vayne should be opened in the same side where the inflmmation lyeth But if any do vrge a necessitie that it must needs be euer on the arme of the same side Trincauel doth aske one question Si in muliere supprimantur solitae purgationes ex ea occasione superuenerit pleuritis Item si ex retento sanguine ex hamorrhoidibus fluente vt ait Hippocr 6. epid in libro de humor quod quibus sanguis ex haemorrhoidibius fluere solet illi neque pleuritide neque peripneumonia capiuntur quae vena iam secanda illane quae costis affectis communicat an potius alia impellens particula but of this alreadie I hope sufficiently in the Chapter aboue named The doubt is now on what side the vayne must be opened when we do it to preuent diseases the old verse is commonly knowne Aestas Ver dextras autumnus hyemsque sinistras The spring sommer right side vains would haue But autumne and the winter left do craue But here we must take heed that we vse not too much to let bloud on one side for that thereby we see many to be brought to particular palsies and to lose the vse of one eye or care or the strength of one arme or side partly because the longer that superfluous humours haue found a vent in one place the more apt they are to haue recourse to the same place and if they haue not their former passage they will easily either make obstructions or breede some inconuenience and partly because the letting bloud too much on one side may perhaps coole that side more vehemently then is requisite If therefore thou hast bin heretofore let bloud on the one side thy best way is the next time to take the other side and to labour by all meanes that the humours may flow equally and that they may be caryed with no greater force towards thy one side then thy other When there is neede of euacuation and deriuation and not reuulsion then doth Galen appoynt vs to take the vayne alwayes on the same side If the right side of the wombe be grieued auoid bloud out of the right hand or right leg and if the left side be enflamed then take the side that is right with it for that is the meaning of the 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 of Hippocrates to wit that we open the 〈…〉 hepatica and lienaris directly for they arâ— neerest to the affected parts and most right vpon it And in an other place The euacuation out of the neerest vaâ—nes and which are common to the place affected is both best and easiest As concerning what vayne is to be opened this rule is most generally prescribed that if the parts beneath the neck be grieued we must open the inward vayne of the arme called generally inâ—erna or basilica or axiliâ—ris and more particularly if it be in the right arme called recoraria or hepatica in the left henaris this is opened commonly on the left side if the heart lungs or spleene be affected and on the right side if the liuer or stomack be affected If the parts which be afflicted be aboue the neck then we open the
of the ayre doth keepe the spirits from flying too fast out But in the sommer or hoat weather he will haue the orifice to be narrower because the bloud is commonly then more subtile and heate doth helpe much to dilatation passage If it fall out to be temperate weather then to proceede in the meane betwixt both The verses of the Salerline schoole are to be vnderstood of full strength and powers Fac plagam largam mediocâ—â—â—ter 〈…〉 exeat vberius liberiusque cruor Make well and wide thy blow That bloud and fumes may largely flow Hippocrates sayth In places where 〈◊〉 no danger and where the bloud also is grosse vse a broader launcer for so the bloud will passe otherwise not but take heed of going too deepe Fernelius sheweth some dangers Vnder the inward vayne lyeth an artery vnder the middle a sinew and vnder both do lye the tendones of the muscles If any of these be pearced there may ensue much griefe and sometimes great danger The cephalica may be opened with least perill of all the vaynes which appeare in the cubâ—â—e Now for the quantity of bloud how much may be taken at once I haue had occasion to declare much already concerning that poynt when I intreated in my former booke of Phlebotomy in particular diseases I meane not therefore now to stand much vpon it Montanus vpon the fourteenth Canon of Auicen doth appoynt that in old diseases when by long infirmitie the bloud is become grosse we must take but a little bloud at once and reiterate the bloud-letting often and still in the meane time to nourish yâ— patient with a good moistening diet If the bloud appeare to be whitish then as Auicen will haue it you must let out none at all least a cachexia or bad habit or dropsie do thereupon ensue Fuchsius doth giue vnto a Chirurgian three generall notes whereby he shall gesse when is the fittest time to stay the bleeding first by the change of bloud secondly by the force of flowing waxing more faint and thirdly by the change of the pulses The first that is the change of the bloud both in colour and in consistence must then especially be attended and wayted for when the griefe or inflammation for which we let bloud is neere vnto the place where the vayne is opened For Hippocrates sheweth that in a pleurisie the bloud which is nigh vnto the inflammation doth farre differ from that which is conteyned in other parts of the body being by the vehement heate much altered so that if the bloud of the rest of the body be phlegmatick it will be about the inflammation red and if the rest be red it will be about the inflammation adust and burnt This change of the bloud is not alwayes to be taryed for for it may be that either the strength is not able to indure it or else that the phlegmone is such a maligne and impacted humour that it will hardly giue place In these cases wee must cease before the bloud doe change and the rest is to be withdrawne by a second phlebotomy The other note to know when it is time to stay the bloud is by the violence of the flowing now waxen more slow feeble for that sheweth that the strength and powers are ready to decay especially if palenesse of the face and dazeling of the eyes do begin to draw on But the most certaine signe of all when we must stay the bloud is the changing of the pulse for if of thick it become thinne if of great it become little if of vehemently strong it become weake and obscure if of equall it become vnequall it presageth that the powers are now ready to be dissolued The safest way in letting bloud is to be sure to be within compasse what wanteth may easily be supplyed by reiterating but what is taken too much can not so easily be restored Heere an other doubt may arise when either for the toughnesse of the hamour or for the weakenes of the party the bloud is let not at oncâ— but at seuerall times how neere those times ought one to succeede an other Fernâ—lius sayth In diseases that vniuersally afflict the body the best is to let bloud twise in one day but in the griefes of particular parts the reiterating must be longer deferred to wit to the second or third day Ficinus counsaileth such as by studyes are growne melancholick to be let bloud if they feele a plenitude and he appoynteth it to be done twiâ—e in one day in the morning and in the coâ—ning but at either time sparingly for he sayth bloud is the temperer of melancholy the nourisher of the spirits and the treasure of life The like speech hath Auicen in his third canon where he aduiâ—â—th men that are troubled with a long lingring disease not to be too wastfull of their bloud because a long iourney remayneth to them and therefore they had neede to gather store of good strength he addeth this precept Keepe bloud as a pretious treasure In that quartaine ague which commâ—th ex atra bile and in other infirmities comming of the like cause seeing that the atra bilis may come as well of bloud or fleame as of choler or melancholy the black bloud sheweth that it proceedeth of bloud aduâ—t and therefore a more larger Phlebotomy is permitted vnto it then vnto any other atra bilis which shall proceede of choler fleame or melancholy adust But otherwise the common opinion of Chirurgians who thinke that generally the corrupter the bloud is the more plentifully they may let it flow out is vtterly condemned by Fernelius You must not when the bloud is more impure or raw or is estranged and departed from his owne nature then take so much the more away after the manner of common bad Phisitions but by how much more the humours are departed either on this side or beyond the nature of bloud so much the more sparingly and leasurely you must let that bloud sâ—ow and when it shall be found to be very farre from the forme and shape of bloud then must you altogether abâ—taine from Phlebotomy for where there is little good bloud there must needs the strength be weake The corrupt bloud doth seeme very fit to be expelled as Galen sayth That which is corrupt is against nature and that sheweth that it ought to be taken away The constitution therefore of the bodie doth shew that this ought to be our scope and drift to euacuate the matter either by Phlebotomie or by purging but on the other side the weakenesse of the powers will suffer neither of them How must we doe then in these great contrarie occasions Galen maketh answere We must in these contrarie occasions and drifts by little and little auoyd the bad and by little and little restore the good which healing of euill humours is called of Phisitions Epicrasis or good tempering of humours Why doth Galen then
in the same leafe a little before in continuall agues called synochi aduise to let bloud 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 vntill the heart faint as likewise he doth in many great inflammations in his comment vpon Hippocrates He sheweth himselfe the cause in that place where he intreateth of agues he doth appoynt it to quench the vehement inflammation and doth meane that it shall be as much as possibly the strength can beare Montanus discoursing vpon the fifth Canon of Auicenna sayth that Galen doth commaund sometimes to let bloud vsque ad syncopen but I thinke that in that poynt either he was deceiued or else that they which did commit to writing his speeches for he wrote little himselfe did not well remember his words I reade sometimes in Galen that vpon vnseasonable and excessiue letting of bloud or any other immoderate euacuation a syncope or dangerous swouning may ensue but I can no where finde that he appoynteth to let bloud vsque ad syncopen vnto a cutting off of all the powers by swouning The fainting vnto which in some cases he doth require Phlebotomie to be extended is called by Hippocrates and him not syncope but sometimes 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 sometimes 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and sometimes 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Some doe make 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to be more particular faintings of some affections and powers of the heart and brayne and 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to signifie a more generall dissipation of the vitall spirits But Galens words do playnely ouerthrow that fond distinction For hauing named the words 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 hee addeth immediatly 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Phisitions are wont to giue both these names to one thing as they signifie indeede one and the same matter And that they both do differ from syncope hee doth shewe playnely when he teacheth that grosse humours when by their toughnesse they doe obstruct or by their multitude oppresse the passages of transpirations they cause syncopas or swounings But if those grosse humours do neither obstruct nor oppresse then they bring no syncopas or swounings but they bring a certaine faintâ—es 〈◊〉 the Grecians call Leipoplyâ—hia or 〈◊〉 The â—etting of bloud euen vnto fainting which Galen doth allow sometimes in great inflammations and certaine hoat feuers as I haue before declared must be done very warily and with great consideration for many are the harmes and dangers which may ensue thereby if it be rashly or vnaduisedly practised as in one place Galen doth plainely and plentifully lay open vnto vs I saw two men dye in the very hands of the Phisitions fainting indeed away but neuer recouering againe Many although they dye not presently yet afterward they come to it by the decaying of their powers and if they had bin euacuated without dissoluing the strength they should not haue perished And some also their powers being by immoderate euacuation dissolued do fall into a long lingering disease Others for all their life time afterward haue then whole temperature of their body ouer-much cooled being neuer able to recouer that harme which he hath gotten by auoyding too much bloud By which coldnes some haue liued afterward ill coloured and with bad habit of body and easily annoyed with euery small thing and others by the same meanes haue bin taken with deadly diseases dropsies streightnes of breath by stopping of the lights weaâ—â—nes of liuer and stomack apoplexies and dotings There are many vnskilfull Surgeons which doe thinke and defend that for the quantity of bloud how much may be spared they neede no other obseruation but to let the bloud to runne vpon their nayle and so long as they see it to be grosse and corrupt so long to let it flow It they take this course with some diseases they may vtterly ouerthrow the strength of their patient They which haue much corrupt bloud haue little good and they which haue little good bloud must needs haue little strength and such as are of weake powers may soone by a great quantity of bleeding receiue vnrecouerable mischiefes Galen sheweth that when it hapneth that crude humours are gathered in the body a great heed must be taken what quantity the strength will indure For the powers being already dissolued in such constitutions of crude humours are wont by Phlebotomy to fall into such extremities as out of which they can neuer againe be recouered And therefore a little after he sheweth what in this case his owne practise was In them which haue a multitude of raw humours I do auoyd a little bloud and do straightway giue a little water and hony well boyled together with some extenuating thing as hysop wild marierom and sometimes calamint and then I take away a little more bloud sometimes the same day and sometimes the day following in which giuing againe some of the aforesaid medicins I take away bloud againe and the third day likewise twise Galen often when he nameth crudities or raw humours speaketh not of the two first kinds of crudities to wit first meates vndigested and secondly when any hurtfull matter doth not obey the lawes of nature of which two I haue spoken already but of a third kinde of crudities when any thick or cold humours do abound in the body for so doth Galen describe all those humours to be crude or raw which are in the body besides bloud of a thick or cold substance The more they depart from bloud the lesse bloud may be spared and sometimes they depart so farre from bloud as in dropsies and in some agues comming of the abundance of raw humours that there is no place at all left for Phlâ—botomy If in any place Galen doth deny and forbid letting of bloud in abundaÌ„ce of corrupt humours as he doth sometimes allotting vnto them rather purgings then phlebotomie we must accompt it to be done not in respect of the vicious humours for Phlebotomy is coÌ„mon both to good humours ouer-much abounding and to ill humours ouermuch annoying it is as Galen and Auicen do make it a remedy both against the superfluitie of bloud and also against the vices of bloud but Galen doth prohibit it only in regard of the weakenes of the strength for so doth he expound himselfe These three scopes to wit the greatnes of the disease the strength of the powers and slourishing age are sufficient for Phlebotomâ— for when such a multitude of raw humours â—â—gathered that it forbiddeth Phlebotomy yet thâ—â— my former conclusion is not reprooued for in such there is no strength sit for it But as he sayth afterward If these two scopes to wit the greatnes of the disease and thâ— strength of the powers be present there 〈◊〉 no such or so great aboundance of raw humours as that it ought to forbid this remedie of Phlebotomy Auicen although â—n some cholerick diseases he deny letting of bloud and willeth it to be kept for a
inflammations of the hollow part of the liuer which are knowne by a great payne somewhat lower and by an aptnes to vomiting and loathing of meate but ioyned with an immoderate thirst of drinke are clensed best by the siege The gibbus hepatis or the vpper part of the liuer bending somewhat compasse downeward ioyning to the midriffe out of which the hollow vayne doth issue if it haue an impostume which being very great will appeare to the handling vnlesse the body be ouer-fat or fleshy or else it is knowne by a payne of the right side reaching vp higher towards the throate and causing much griefe in fetching breath is clensed best by vrine The inflammations of the raines which are knowne by a payne neerer the back bone and an astonishment of the loynes and thighs on the same side that the kidney is inflamed together with some vomitings and with vrines often but painefull when they are fit for clensing are clensed also the same way to wit by a moderate vse of the diuretica or things causing vrine as the rootes of garden parsley Petroselinum Macedonicum kneeholme and Sperage or electuarium Iustini but remembring still that if there be an ague you ioyne with them the aforesayd great cooling seeds or the lesse cooling seeds of lettise endiue scariole and purslayne If the inflammations be of the spleene which may be knowne and felt by the swelling of the left hypochondrium about the short ribs on the left side and do suppurate which hapneth very seldome they may clense the same way that the liuer doth but you may do well to adde to the outward receipts the oyle of capers and the oyle of tamariske If the inflammation be a pleurisie which is knowne by a pricking payne ioyned with the shortnes of breathing and a cough and continuall feuer the pulse being hard and rough like a saw you may intermix in the clensing of it such things as doe best auoyd the cause of it For Galen sheweth Aliam pleuritidem ex sanguine aliam ex bile aliam ex pituita ortum habere That some pleurisies do come by bloud some by choler and some by fleame Fuchsius and Trallianus make some to come of melancholy but Trincauel sheweth that that must needs be either neuer or very seldome because melancholy is of a thick and earthly substance and can hardly passe into that thick solide and skinnie membrane which doth vnderbinde the ribs He further declareth that it commeth most often of choler according to that assertion of Galen Plerumque pleuritis fit à bilioso succo peripneumoniae à pituitoso For the most part a pleurisie commeth of a cholerick humour and the inflammation of the lungs of a phlegmatick What things do best help the auoyding of these humours you shall see in the end of the Chapter next following Last of all when the matter and cause of impostumes is clensed away you must vse 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 things that doe conglutinate consolidate heale and cicatrize as inwardly sugar rosate bole armine prepared and a little of the decoction of cumfrey but outwardly oyle roset oyle of myrtils and the white of an egge adding some hypocistis acatia coriars sumach mastick aloe sarcocolla sanguis draconis and frankencense It shall be good also to drinke some of a decoction of vulnerary herbs as sanicle bugle selfeheale herb two pence virga aurea great valerian and padelion strayned and againe boyled with some sugar CHAP. 10. How defects and errours are to be supplyed and amended and how the Phisition or in his absence the Chirurgian may know by the bloud being a little while reserued what course is further to be taken with the patient GAlen sheweth that a certayne young Phisition for according to the french prouerbe Ieunes medecins cymitieres bossus vieux procureurs proces tortus Young Phisitions and old aduocates the one do make vneeuen churchyards and the other many crooked actions when he had bound the arme of his patient and by the binding an artery did appeare high vp he strake the artery in stead of a vayne a yellowish bloud and thinne and hoate did straightwayes shoote out and that with a certaine leaping and skipping Galen when hee vnderstoode thereby that an artery was cut did first apply a fit plaster to stay the bleeding and afterward an other to heale the incision for he defendeth there and auoucheth by his owne experience that a wounded artery may be healed Fuchsius doth interpret that 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 which commeth out of arteryes to be sanguis rubicundus igneus a firy red bloud Fernelius thinketh that the fittest plaster to lay vpon a wounded artery is to be made of aloe myrrh franckencense bole armine and the white of an egge mingled with the haire of a hare Galen appointeth the plaster to remaine on foure dayes without remoouing And in the same place doth charge especially that whatsoeuer is layd to a wounded artery be of a very drying property So much doth the artery require more drying things then the vaynes as it is by nature of a more dry constitution If a sinew or a muscle be pricked there will follow an astonishment and a conuulsion or crampe or else a great payne and some swelling and in this case Fernelius sheweth our course must be not to suffer the wound to grow together vntill it be first deliuered from the inflammation and swelling and the way not to suffer it to grow together is to bath it with warme oyle After three dayes you may suffer it to heale vp putting vppon it a little turpentine mingled with Euphorbe Fernelius immediatly after doth shew as doth likewise Fuchsius how by the bloud hauing a little while rested wee may much perceiue what humour doth most abound in the patient When the sawcers wherein the bloud is conteyned haue bin set vp some little time in a place where neither wind nor sunne beames may come vnto them if the bloud be thick and viscous such as is the cause of obstructions then it will soone congeale together and being touched it will stick somewhat to the finger If it be long in congealing and waxing hard then is the bloud to be accompted very thinne but if when it is cold it waxe not hard at all then is it all together either waterish or putrifyed Much whayish and yellowish water swimming vpon or by the bloud doth shew either too much vse of drinking or the liuer weake or the raynes feeble and obstructed The spume or froth that swimmeth vppon it vnlesse it come by the violence of the flowing it sheweth the heate and inflammation of that humour whose colour it caryeth as the red froth signifieth the heate of bloud the yellow of choler the white of fleame and the blackish and blewish of melancholy The colour of the bloud continuing red is a signe of good and profitable bloud If it be pale it signifyeth choler if white fleame if
diasena Nicholai somewhat more then halfe an ounce or confectio Hamec maior about halfe an ounce or syrupus de pomis Rondeletâ— about an ounce and a halfe If mixt humours do afflict the body then either to mitigate them compound your aforesayd syrupes and decoctions taking one moity of one and an other of an other or otherwise proportionably mingle them as the humours do more or lesse abound or else to purge them do the like by the forenamed purging receipts or take of Diacatholicum somewhat more then halfe an ounce or hiera Ruffi the quantity of a chesnut dissolued in broth or in pills take pillulae aggregatiuae or pillulae de tribus of either one of them about a dramme At what times these and such other like purgings shall be accompted most fit and what seuerall circumstances are to be obserued therein as well at the very instant of the ministring thereof as also in the preparing of the body before and the guiding of it after These are poynts which I do handle at large in the Cathartice or second part of the great Phisick remedies mentioned in my Preface wherein as I haue already gathered most of the chiefest â—xiomes and aphorismes out of many famous Phisitions of all ages concerning these and such like questions appertayning to the purging of humours and in some sort also disposed them so do I purpose also godwilling to deliuer them hereafter to the view of the world as soone as leasure shall permit to transcribe and friends aduise to publish Soli vni trinoque deo sit tota tributa Laus cuius coeptum dextra secundet opus FINIS The Index The questions and matters concerning letting of bloud haue no neede of any Index seeing they are in the Preface to the Reader gathered into a briefe summe and the Chapters poynted out where euery particular is handled But for as much as many diseases and griefes are touched here by occasion and obiter in sundry seuerall places that one place may the better explane an other and sometimes also supply confirme and second one an other and moreouer that the Booke may be more readye for the vse of the reader I haue thought good to adde alphabetically the names of the infirmities and impediments for which in these two bookes are found many counsayles and remedies A. Agues diaries Pag. 13. 4. Agues continuall of bloud inflamed p. 6. 70. 108. Agues burning p. 11. 12. 113. Agues epialae p. 16. Agues quotidians p. 65. 17. 4. Agues tertians exquisite p. 16. 17. 21. 22. Agues tertians bastard p. 19. 22. Agues quartaines p. 18. 16. 21. 23. 4. 107. S. Anthonies fire p. 112. Apoplexies p. 44. Arteries wounded p. 103. lib. 2. cap. 9. B. Bladder insiaâ—ed Pag. 100. 101. Blâ—ck choler and melancholy hâ—w differ p. 20. 19. 1â—â— Bloud abounding how knowne p. 57. 58. Bloud ouergrosse and thick p. 64. 113. Bloud corrupt p. 107. 108. 110. 114. See humours corrupt and raw â—urning feuer p. 11. 12. 113. C. Cacochymia p. 59. See humours corrupt Cachexia p. 52. See habite bad Choler abounding how knowne pag. 58. lib. 2. cap. 10. Choler abounding how auoyded and purged booke 2. Chapt. 10. Choler auoyded by bloud-letting p. 22. 27. 112. 113. Children what to take in steed of letting bloud p. 73. 74. 75. 76. 78. Costiuenesse how holpen by clysters p. 69. 70. 71. Coâ—ick p. 45. Concoction wanting how knowne booke 2. chap. 5. Conuâ—lsions p. 43. Continuall hoate feuer p. 6. 70. 108. Crudities p. 111. See raw humours Crudities how knowne booke 2. chapt 5. D. Diary feuers Pag. 13. 4. Dropsey p. 45. 52. E. Eares payned p. 101. Epiala feuer p. 16. Epilepsies p. 44. Eyes payned p. 10. 1 F. Falling sicknesse p. 44. Feuers of sundry kinds See Agues Fleame abounding how knowne pag. 58. and booke 2. chapt 10. Fleame abounding how auoyded and purged p. 67. 69. and booke 2. chapt 10. Fulnesse or full habit of body p. 2. 57. 98. Fluxes of body p. 79. 80. G. Gall of ill constitution p. 63. Gout p. 47. 48. 49. H. Habite bad p. 52. Heart payned p. 100. 101. Heart fainting See swounings Head-ach p. 101. Head inflamed Pag. 42. 110. Hips payned p. 100. Humours corrupt and raw whether admit Phlebotomy p. 51. 52. 60. 65. 66. 67. 71. 107. 108. 110. 111. I. Iaundise p. 52. Inflammations and impostumes how cured booke 2. chapt 9. Intemperancy p. 60. and booke 2. chapt 9. Itches p. 51. K. Kidneys inflamed causing stone p. 39. 47. and booke 2. chapt 9. Kidneys inflamed p. 100. 101. L. Legs payned p. 28. Liuer hoate and stomack cold p. 50. Liuer inflamed p. 100. 101. Liuer inflamed in cano booke 2. chapt 9. Liuer inflamed in gibbo booke 2. chapt 9. Liuer full of bloud and choler causing pleurisie p. 42. 100. Loosenesse of body p. 79. 80. Lungs inflamed p. 35. 100. 101. and booke 2. chapt 9. M. Melancholy and black choler how differ p. 20. 19. Melancholy abounding how knowne p. 58. and booke 2. chap. 10. Melancholy abounding how purged and auoided p. 107. and booke 2. chap. 10. Melancholy windes p. 44. Mixt humours how purged booke 2. chapt 10. N. Nostrils bleeding sometimes ill p. 75. sometimes good p. 39. 40. 114. O. Old and lingering diseases p. 105. 107. Old age whether to be let bloud or no p. 72. 77. P. Palsies Pag. 43. Phrenzies p. 27. Plague or pestilence p. 23. 25. 26. Pleurisie vpon what seuerall causes it commeth p. 42. and booke 2. chapt 9. Pleurisie when and how let bloud in it p. 31. 35. 37. 72. 98. 99. 106. Pleurisie when not let bloud in it p. 38. 39. Pleurisie how outwardly holpen booke 2. chap. 9. Pulses distempered what signifie p. 9. 10. 11. 106. 7. Q. Quartaine feuers p. 16. 18. 21. 23. 4. 107. Quinsies p. 29. 98. Quotidian feuers p. 65. 17. 4. R. Raynes inflamed p. 100. 101. Raynes inflamed causing stone p. 39. 47. Raw humours whether admit letting-bloud p. 51. 52. 60. 65. 66. 67. 71. 107. 108. 110. 111. S. Scabs p. 51. Scuruy p. 53. Spleane obstruâ—ted p. 44. 53. 100. 101. Spleane inflamed p. 39. 40. booke 2. chap. 9. Splenetick bloud p. 23. 113. 114. Spitting bloud p. 34. 38. Spirits inflamed p. 7. 9. Stone in the raynes p. 39. 101. 100. Squinancies p. 29. 98. Stomack weake and loose Pag. 62. Stomack impure p. 64. 69. Strength fayling p. 109. Sweating sicknesse p. 26. Swounings p. 62. 63. 79. 109. 110. Suffocation p. 2. 35. T. Tertian feuer exquisite p. 16. 17. 21. 22. Tertian feuer bastard p. 19. 22. V. Vomits how to be made when the stomack is impure or molested with corrupt humours p. 64. 69. Vrines betokening crudities booke 2. chapt 5. Vrines deceiuing p. 45. W. Women hauing their flowers or with child whether fit for letting bloud p. 77. 79. Women with flowers suppressed p. 99. Wombe inflamed p. 37. 100. Y Yellow and thinne bloud p. 21. 114. Yellow iaundise p. 52. Faults escaped Page 2.