Physicians as well Auntient as modern to say that it is most necessary to Chirurgions to have the knowledge of it as well for the advantage and profit which one may extract therefrom in severall respects as for the necessity of knowing the concurrence of the Starrs upon the bodies the influence whereof the Chirurgions ought to observe punctually upon our bodies in all his operations especially in that of Phlebotomy And all those who have Treated thereof have observed two times as we have said here before to wit the time of Necessity and the time of Election in which time of necessity the Chirurgion will know how to regulate himself according to the discourse before inserted Now it remains to speak of the time of Election which according to the doctrine of the good Guidon we will divide into two parts to wit the Inferiour root and the Superiour root Observation concerning the time of Election Now the Inferiour root may be thus understood First concerning the concoction of the food it must be throughly performed before you let blood if you have eaten lately before Also if ones blood be grosse it is necessary before bleeding to use a little exercise for the subtilising the blood or at least that one take some kind of things which have the faculty of subtilising it which are the syrup of the herb Calamint and such like In the second place one must consider the force and the strength the temperature and the necessity of him who ought to be blooded to the end that the re-iteration thereof be not perform'd sooner or latter then is necessary choosing a serene day and not subject to inconstancy clear and not dull not rainy in the spring and in Autumne making choice also of a wind which is uncertain as if it be in Winter you should take a day wherein the southwind blowes A Digression But some one may demand here If the winds have any power over our bodies that we need to make observation of them To which I answer that experience lets us see the effects which they produce upon our bodies as the Plague the Coqueluch a new disease which troubled the French in the year 1510 and 1557. Plurisie Aposthumes Catharrs Fluxions small Pox and Scabbinesse or the Itch also so many venemous Creatures as Froggs Toades Locusts Caterpillers Spiders Flyes Hannetons Snayles Serpents Vipers Snakes Efts Scorpions and Asps Yea in all hot and moist times if the Southwind blow Meats will Corrupt or taint in lesse then two houres let them be but fresh wherefore one need not enter into doubt that humane bodies enter in affections contrary to nature when the seasons pervert their qualities by the evil disposition of the Ayre and the winde that is mingled within them Unto this I will adjoyn that which the great Hippocrates hath truly pronounced Hip. in his preface of Prognostick and Galen in his Comment That the Ayre hath I know not what of divine in it self in regard that it doth in blowing through the Universall World incompasse all things contained within it and doth nourish them miraculously sustaines and supports them firmly and entertaines them in an Amicable union the whole Symbolizing with the Starrs into which the Divine providence is infused which changeth the Ayre according to his pleasure gives unto it power as well over the mutations of times as the naturall bodies And therefore the Philosophers and Physicians have expresly commanded us to have respect to the scituation of places and to the Constitution of the Ayre and concurrence of the Starrs when you are in agitation for the preserving of health Or to cure the sick in which cases the motion and change of the Ayre is very powerfull Hip. his third book of Aphorismes Ch. 5. and 17. The same Hippocrates affirmes our bodies do receive great alteration by the vicissitude of the times and seasons of the year as by the Southterne winde which doth render us subjected to all sorts of Maladies which acknowledge moisture for their first cause and it doth infeeble our naturall heat which in the opposite case of a cold and dry winde doth fortifie it self and is rendred more vigorous and doth in like manner render our spirits more Subtill and Active A prety observation upon the winds and our bodies Besides there is ascribed to the four principall windes four Elements four humours four seasons and four ages The South winde or Auster doth in quality participate with Tender years then to fire and Choler and also to Summer Austraphricus or a midle wind betwixt Auster and Africus participates of the stronger years of the Ayre of the blood and the spring Subsolanus or East wind participâ—tes of the more Grave years of water Flegme and Winter Favonius or West wind to the more decrepit and decayed yeares to the Earth the melancholique humour and to Autumn I should have insisted longer upon the property of the windes but that I have treated sufficiently of it in another place In his Book call'd Grande Chirurg and have only spoken of it here to shew how they have power over our Bodies and therefore not out of rule or order if we observe them in Phlebotomie Elective But returning to our purpose we say that if the Veins be small you must stay till ten of the Clock in the morning for at that time they appear better then at six a Clock such are the veins of the Tongue of the hands and the feet observing also to let blood in the winter on the left side or part and in Summer on the right as saith Guidon The reason thereof is saith he because the humors which at those times we endeavour to evacuate are properly in those parts it being true also that the cold humors do rule most in the left part and the hot humours in the right behold therefore why in Winter which is cold we draw blood from the left part and in the Summer from the right The Region must be observed in blooding In like manner the natural habite of the Body ought to be considered in the emptying it of blood for we do largely empty those who have large veins and who are not too lean nor too whitely or pale nor have their flesh too tender but on the contrary we do less empty those who have but little blood and the flesh tender in like manner you must have respect to the Region for if it be very warm as it is in France the Countrey of Languedoc and Provence in this place you must make no great evacuation the like must be observed in the cold Region because that the natural heat being emptied out with the blood the Region doth chil the body too much and the hot Region by its heat doth debilitate the strength for this very reason the Summer season nor the Winter are not in any wise fit to breathe a vein in but the most proper time is the beginning of the Spring because it is temperate breathing the vein in
I perceive these to scoff at my pen perceiving I treat of an operation which hath been so learnedly deduced before our time by some of the most sublime personages which antiquity hath produced To this I answer that although one would thinke one could say nothing more upon this subject there having been severall Volumes of it yet notwithstanding they are not performed with that method wherewith I treat of Phlebotomy in this place not following the old opinions because that would be nothing but singing the same song again but discovering the fault which people daily fall into in this so important operation I describe a means so to behave ones self that one shall very seldome fall into irrepairable faults Wherein I do assure my self loving Reader that if putting off all Passions thou dost come with a favourable eye to look on these Lines which proceeding from an honest Leasure do run the hazard of Censure thou wilt confesse that it is not without great consideration that I have put hand to pen to a Treatise of this matter Not that I have been provoked thereunto by any vain-glory but possessed with a good desire to serve the Publique And truly I should have beleeved I had faild of my duty if having received something peculiar from the Liberall hand of the Almighty I should not have distrubuted it to the lovers of true Learning To the end that all their and my workes might be to the honour and glory of God for the edification and health of our Neighbour and to the salvation of our souls To which God Father Son and Spirit be rendred all honour and glory for ever Amen A Treatise of Phlebotomy A TREATISE OF Phlebotomy CHAP. I. What Phlebotomy is It s property and of that which is to be observed particularly for the good performance thereof MAny Philosophers both Graecians Latines and Barbarians after they had diligently contemplated all sorts of Animals curiously sought out their manner of living and compar'd their Condition and Nature with ours have writ that amongst all Creatures breathing and moving upon the Earth Man is more miserable then al Animals and the reasons therefore There is not any more Miserable than Man by reason of his unsatiable desire and disorderly Appetite for continually he is hunting after new food and having found any according to his taste he devoureth them after such a fashion that I exceedingly admire that the bellyes of many are not already rotten and infected by that excesse of drunkennesse and debauchery which they do commit I am amazed in thinking of it And what doth there proceed from it except abundance of Rheums Catharrs and infinite other kindes of diseases which do nothing but adulterate change and corrupt this second part of our generation The treasure of life the seat of the Naturall heate the matter or substance of the seed and of the Milke of the Duggs or Papps that is to say the Blood which is so well dispersed and mingled through all the parts of our bodies that there is not any one of those parts which doth not receive its nourishment from it and there is not any good thing in us which is not maintained and supported by It. It is the Mother of the spirits which does impregnate the seat of the faculties for the maintaining the strength of the whole Body which does foment and entertain its primitive moisture It is so replenished with spirits that the conservation thereof is the cause of our life insomuch that some have esteemed that it was the proper seat and habitation of the Life and that therefore our unruly wills accompanied with our more then unreasonable Debaucheries are causes that this continuance of our lives is almost wholly extinguished One shall see nothing else in the Countryes but Doctors and Docteresses for the renewing of this scource of our lives so many bloodings made improperly that I wonder that instead of helping their Patients they do not destroy them The diligence of the Learned Chirurgion praised Not that I would here blame the diligence of the Learned skilful Physitian and Chirurgian who as friends to nature do endeavour with all their might to preserve her in her health or integrity And that by purging and cleansing or evacuation which last is not to be done but by incision of a Veine This is called Phlebotomy 〈◊〉 word Compounded of the Greek words 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 which signifies a Veine and 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 that is to say division of whole parts The derivation of the word Phlebotomy Behold therefore why in particular this word is taken for making incision of a Vein by which evacuation is made of blood and other humors contained with it Galen 13. Method Ch. 6. You must take notice that there are severall sorts of bloodings As of a Veine of an Artery Scarrifications and others we will speak especially as to Phlebotomy For what causes one should open a Vein We make bloodings for six principall causes The first To Evacuate Secondly To divert turn back or make Revulsion Thirdly To Attract Fourthly To Change Fifthly To preserve And sixthly to alleviate which is according as all those who have treated of this matter have defined it But let us content our selves with these two Causes to wit Plethorall and Chachochymicall the one consists in nothing but too great quantity of humors the other in the evil quality How far Phlebotomy doth extend its self But the benefit of Phlebotomy doth not extend it self only to the evacuation of the fulness which ought to be made according to the kinde or difference of it but also to divert and to drain which are the three sorts of evacuation It serves also for great and extream paines principally when they proceed from Tention insomuch that all the learned Physitians and Chirurgions do hold that blooding is a most excellent assured remedy if the rules requisite thereunto be therein well observed yea more ready and secure then Laxative Physick which being taken works immediately and forceth its operation it not being in our power to hinder it Phlebotomy more safe then purging Physick But Phlebotomy the Reines of the Conduct whereof we hold doth nothing but what seems good unto us forasmuch as we do stopp it and draw it forth when we please And in truth among all Chirurgicall operations blooding holds the first Ranke because it is the Common remedy of diseases which proceed from Plethore and Cacochymie as we have said before both which are the Antecedent causes of diseases What Plethore and Cacochymy is Let us then define what Plethore and Cacochymie is and then we will appropriate unto them Revulsion and Derivation Plethore is nothing else then a repletion of all the humors equally increased or else of the blood onely Cacochymie is a repletion of Choller Melancholy or Phlegme Plenitude hath two kindes the one Ad vires and the other Ad vasa there is another added unto them called Supra
their life or if they be not killed thereby they have fallen into a prolonged weaknesse and their bodies are thereby cold wan and discoloured and all this by the ignorance of the operant who will put himself to the performance of this so noble help of Nature without being provided of all those things which are Necessary for him as well gifts of the body and minde as other externall Instruments Condition of the Phlebotomist As to be young well sighted to have a steady hand and exercised unto Phlebotomy a good Anatomist to know the scituation of the veines and of other parts of the body for without that he will be like unto a blinde man which cleaves wood But it will not be from the matter to note here that if the veines should not be apparent in the morning you must not breath them until about one a Clock in the day and then those who are able to walk let them use a little Exercise and then the most occult and Invisible veines as one would say will appear But I have not mentioned this here except onely concerning those who have small veynes and covered either with flesh or fat Also shall I not instruct the Chirurgion to fill the veines by rubbings or bathing of the Member in warme water Ligatures and assuring the sick party not to put them to any pain for it would be too Triviall What Instruments are to be used in Phlebotomy But I shall say to return to our purpose that the externall Instruments by which this opeation is to be accomplished shall be good Lancets of several fashions Ligatures Swathes Boulsters Red pouder burnt lint to stop the blood if there be need of it or with Cotton Pulverised according as we have shewn in our Chirurgie Chymique Default in Phlebotomists This default especially is found in the greatest part of the Phlebotomists of our age viz. That of the knowledge of that so excellent wonderfull Astrologie without which it is as it were impossible to be able well to exercise Physick or Chirurgery upon our bodyes which are by good right called a little world for their having a great Sympathy with the great one as I shall shew hereafter by the help of God as also the observation that ought to be made in the Concurrence of the Starres and the influence of them upon our bodyes to the end that we may avoid those unhappy accidents which we see daily to happen to the share of those who have been blooded so inconsideratly That which hath withdrawn me from picking and culling out all the conditions requisite in this operation as well for the Chirurgion as for the sick person and other things requisite thereupon is I not having intended to treat on this subject except of the two principall points of this operation under which two may be Comprehended all the rest whosoever will explain them Notwithstanding I shall content my self to have traced this little path for some one who indued with a more high Style and accompanyed with a greater knowledge provoked by one lesse then himself shall have had a desire to have the knowledg of this science appear above the small knowledge which it hath pleased the divine goodnesse to give me and to make the desires and lovers of true and perfect Chirurgery partakers thereof Provoked I say by this desire doth stretch out his sayles of Eloquence to steere in a higher or greater Sea then I do But winding up the thread of my discourse I shall content my self I say with these two principal Points that is to say the time of Necessity and the time of Election The time of necessity from whence taken That of Necessity is in all times and seasons and at all houres without considering any thing which may hinder provided that the Necessity be certainly known to be the most strong or pressing as I shall mention in its place The time of Election from whence taken That of Election is taken either from the nature of the body of the party who ought to be blooded or of superiour and external things which ought to be a fair clear and clean day and not Rainy not by no meanes at new Moon nor very near to the full And rather in the spring then any other season I shall declare also upon what parts of our bodyes the Planets and heavenly Signes do particularly rule also in what day or hour in what time or season To the end that having the knowledge of these things one may not commit so many errours in this operation as are committed by the ignorant Protestation of the Authour Protesting that I have not writ this Tract possessed with any other desire but to assist and help so many diseased persons who dye for want of being well comforted by this excellent remedy and not to receive any glory thereby But if I shall receive some one spark I do Consecrate and dedicate it from hence forward to the Authour of all things To whom Father Son and holy Spirit be glory honour and praise for ever and ever Amen CHAP. II. How the Chirurgion ought not to be Ignorant of Astrologie and the profit that proceeds therefrom as well for Phlebotomy as for all the diseases which happen to humane bodies The Sympathy of the Starres therewith and other discoveries most profitable to Chirurgions FOr good cause did the Comique Poet pronounce this Sentence which is worthy of great consideration to wit That there is nothing more unreasonable then the ignorant man who esteems nothing good but the things which he doth himself and of which onely he hath knowledge The which I make mention of here by reason of a Crue of Sophisters who dare contradict the force which the superiour bodyes have upon inferiours alleadging that the Ancients never took heed to these foolish fancies as they call them which they urge being ignorant that the great Hippocrates did Prognosticate the plague which was to happen to the Iyllnians And that onely by the knowledge which he had of this Admirable and divine science of Astrology By that meanes preserving a great number of the Inhabitants of Greece who in acknowledgement of one so great benefit did give and attribute unto him great honours which he dedicated to Hercules Besides having not read that the same Hippocrates restoring and increasing Physick did so far praise and respect Astrologie that he hath demonstrated by knowledge and concluded by reason that Physick is maimed without the knowledge of Astrology insomuch that the Athenians after his death caused his image to be engraven after they had built the Notable Colledges for Physick and Astrology Lectures Plin. Lib. 7. Ch. 37. And particularly for one Berosus a great Astrologian after the death of whom was erected in the Colledg of Athens a Statue having a tongue of Gold by reason of his Eloquence and great knowledge in Astrology St. Jerome in his Epistle to Paulinus affirmes the profit of Physick Astronomy and Astrology for the
sick person in the Rigor of the seavor for he that doth it is the Cutter of his throat But if the feavour doth not increase and also doth not decrease and we do not hope for any declination of it in such a case you must not lose this onely occasion of blooding although it be worse then in the declination of the fit In the hand-gout and the foot-gout one may open the veins of the foot or the hand for the Migren the Arteries and veines of the Temples and by this evacuation of the blood which floweth with the Arthritique powers and the boyling spirits which evacuate the pain presently ceaseth But in the intermitting feavour blooding ought to be not after the third accesse or fit as Galen would have it but in the beginning but this evacuation of the blood ought to be understood to be if there be Plethory in the body and fulnesse of the vessells and for the breathing and refreshing of the Masse of humors for otherwise there should be no evacuation of the blood because it is the bridle of the Choler In the quartain feavour or again if the blood do abound you must take some from the Mediane or Basilique of the left Arme or from the splenique veine with this Caution that if the blood do shew it self black and dull or thick you may let it run but on the contrary you must stop it preâ—ently if it shew it self fresh and well coloured In the cure of the Fehris Synochus a continuall feavor the benefit of Phlebotomy causes the opening of the belly and the sweatings to issue forth very abundantly a thing much to be wished in this kinde of feaver which moved Galen to say that one ought to bleed in this case even untill Lipothemie but notwithstanding fearing that one should let slip the soul with the blood one ought rather to reiterate it severall times as much as the strength of the sick party can bear it even in the burning feaver espece de Tierce continue one ought to blood in a good quantity if the powers the age and other Circumstances do permit In like manner you ought to blood in the quartain feaver Glistering first for the doing whereof Artificially you must open the veine of the left Arme which hath more Communication with the Spleen to which the most part of this feaver is often heaped We say also that in Pestilent feavers we must not indifferently as is done presently when they see the person strook with the plague prescribe him blooding which hath been often times the cause of the death of an infinite Number of persons but if the matter be urgent in quantity quality and Motion I must draw a conclusion That in the Plague occasioned by the viciousnesse of the Ayre with fulnesse of blood and humors Blooding I say together with purgation are there necessary which is held sorth by the saying of Celsus Cels Lib. 3. Ch. 7. That forasmuch as the Plague is an Active and Tempestative disease you must quickly use remedyes even with rashness Wherefore you must consider if the person infected hath a burning feaver and great repletion in the Conduits and that the virtue be strong which may be known by the veins being full and stretched the eyes and the face greatly inflamed also sometimes in spitting blood with great beating of the Arteries of the Temples pain in the throat pain or difficulty in breathing pricking or shooting throughout the body with exceeding heavinesse and dulnesse the waters or urine being red thick and troubled in such case you must blood presently to help nature to discharge her-self least the naturall heat be suffocated by the aboundance of blood Then you must rather breathe the Basilique veine of the left side then the right because the heart and the spleen are much affected in this disease and take abundance of blood thence according as you shall see necessary alwaies having respect to the power and virtue of the sick person and taking heed not to blood whilst the shivering of the feaver is upon him Observations in blooding for the difference of the disease But you must here take notice that in such a repletion of blood blooding must be otherwise performed in a simple Pestilent seaver than in that which is accomplished with a Bubon or Carbuncle for if the one or both together be conjunct with the great and furious seaver then it is requisite to open the veine nearer to the Apostume or plague soare and according to the rectitude of feavers to the end that thereby the blood may be draw a forth and evacuated directly in regard that all retraction and Reâ—ulsion of infected blood towards the Noble parts is prohibited by all good Physitians and Chirurgions But enough of the feaver untill we speak of Symptomatiques And beginning at Tumors in generall I say that if there be repletion in the whole body you must purge and blood and besides makes frictions and Bathings As in the Cure of the true Phlegmon you must divert the flux which will be turned away if we take away the cause thereof to wit the Chachochimie or Plethory which is to be done by purging first but chiefly by Phlebotomy Come we now to the Erisipela for if it be in the face and doth possesse it very much Phlebotomy is very necessary to it which must be performed upon the Cephalique veine in like manner Phlebotomy is necessary if there be some portion of blood mingled with the Choller but if it be in any other part and be not in great quantity and be made of pure Choller Phlebotomy is not necessary because the blood is the Bridle of the Choller as we have made mention before besides the Cancre is cured most commonly by purging and Phlebotomy For the Tumors in particular being a Parotide we say that Phleb is therein very necessary specially when there is rednesse in the part which demonstrates great inflammation abundance of blood also for the kernells great and swelled you must purge but specially purge and apply Cupping-glasses behind the shoulders with scarifications to the end to obviate the accidents which may come thereupon as suffocation and consequently Choaking The same remedy is necessary to the Tumor or inflammation and relaxation of the Vvula called by the Latines Collumella Also for Esquinancy the Chirurgian ought to be ready and prompt in reguard this disease doth not give great Leasure wherefore he must blood the sick parts on the Basilique on that side where the fluxion is and the same day on the veines under the tongue to evacuate the Conjunct matter Let us speak of Fellons or whitlows the curing whereof consists onely in blooding and purgations but yet notwithstanding further according to the prudence of the good Chirurgion Come we now to Wounds wherein for the Little ones there is no great necessity of blooding but in the great where there is danger of fluxion or where the body is repleate as in wounds of the