or betwene both The forces of nature being but weake they cannot indure Phlebotomy so forcible an euacuation As Galen 2. Aphorismo Aphorism encipienti In quo morbo c. 4. Simplicis medecinae witnesseth This is one of the principall considerations that are to bee regarded in opening a veyne for either wee must dehort from it if natures forces serue not or incourage to proceede it if they will serue vnto it For it standeth with great reason that bleeding must greatly infeeble and put them in danger that are already weake of nature Yea it oft falleth out that diuers being let bloud carrying very weake bodies can neuer again recouer their former and pristinate strength as Galen lib. de curand ratio per sang missio ca. 6. li. 11. Method meden cap. 14. witnesseth If the body bee strong and that vrgent necessiity so require wee may boldly let bloud If necessity doo not vrge bleede not at all or very litle If vpon great necessity in this case much bloud must bee taken the body being feeble and not able to abide it we are to euacuate now a litle and then a little Yea I giue heere againe aduise especially to regarde this consideration For many times when the age disease and time require this kind of euacuation and the naturall strength cannot brooke it there insueth Sincope that is sowning In the which case we must reiterate bleeding as hath beene said or else stay it putting the finger on the wound which stay the Grecians vsed and called Apphasis The seauenth stay or let is the habite and constitution of the body wherein wee are to regard the whitenes or blackenes leannes or fatnes thicknes or thinnes of the bodies that are to bleede Thinne white leane and soft bodies are not to bleede because many superfluities are resolued from such bodies which being to them sufficient they need not any other euacuation This doth Galen affirm lib. 9. Metho Medend fleshy bodies firme and thicke are subiect nothing so much to dissipation of superfluities therefore may better abide bleeding as for fatte and grosse bodies though they be also lesse subiect to wasting dissipation of humors than other are yet they hardly tollerat Phlebotomy because they haue but small veynes and they being emptied by bleeding the fat of the body wringeth and as it were presseth them down So that it is gretly to bee feared lest by such oppression the heat of nature be quite extinguished In this point of the habit of the body we are also to consider the capablenes of the veyns which being great swollen may better be opened than the narrow and small litle veyns Again we are also here to regard the naturall disposition of the humors For hot and thin humors are flowing and quickly dispersed Thicke and cold humors are not so and because grosse thicke fat bodies haue lesser veynes lesser bloud than leane men that in such persons the very fat of their bodies oft presseth down the veyns so suffocating and choking naturall heate therfore wee see by experience that oftentimes these corpulent fat men die a sodaine death VVherevpon also Hyppocrates 2. Aphoris Aphoris 44. supposed that grosse men die sooner and more sodainly than leane persons This I my selfe obserued certaine yeares past by the death of a Gentleman of good credite in this shiere of Kent one Maister Weldon Esquiere and of the Greencloth VVho died very sodainely beeing a very fat Gentleman at a parish called great Pecham The eighth impediment is the colde temperature of the Patient or the coldnes of the complexion For the bodily constitution beeing already colde by bleeding of force must be made more cold VVhereby frigiditie of the body dayly increaseth And as Isaac saith in Vrinis Sanguis est fundamentum caloris naturalis in quo calor naturalis confortatur Bloud is the foundation of naturall heate whereby naturall heate is strengthened Therefore Phlebotomy euacuating bloud diminisheth the naturall heate and consequently bringeth a dangerous coldneâ— to the whole body The foundation of inward warmth namely bloud being diminished inwarde heate decayeth and the body still by little and little waxeth more colde And this is testefied by Galen lib. de curanda ratio per sanguin missio cap. 6. Yet when the sicke is of a melancholy constitution and is grieued with much Repletion or that Melancholy hath much bloud mixt with it in this case hee may bleede And againe a hot and a moist constitution of body hauing also the bodily substance consisting of found whole and massie members which by reason of inwarde heate is daily much dissolued tollerateth not so plentifull euacuation as other complexions VVhere by the way yee are to note that in Phisicke that body which aboundeth with much humors in the veynes is most properly called Corpus humidum and may best of all away with euacuatioÌ„ by bleeding The ninth is rawnes slownes and clammines of the humors In which case wee are to forbeare bleeding For otherwise crudity of humors will bee increased After Galen 12. Method Medend cap. 2. And this is the cause why in long continuing maladies bleeding is not vsed according to Auicen for if it were there woulde followe Crudity of Humors Debility of Naturall vertue Prolongation of the disease with feare neuer to bee cured And therefore againe as the same Auicen saith further in diseases daily and continuall called Morte Chronici Purgation must goe before bleeding and not bleeding first although we are to vse them both VVhereof looke before Chap. 4. Of crudity of humors there are two speciall causes the first is the excessiue multitude of humors in the body choking the inwarde naturall heare by reason of whose weakenes and suffocation nature not beeing able to ouercome those humors crudiâ—â—es must needes iâ—â—ue in the body Buâ— in thâ— case Phlebotomy may be vsed And Galen lib. 2. cap. de Hydroposi â—aith that bleeding he petâ—â—in the 〈◊〉 of a dropsie which is caused throâ—gh abundance of menstruous bloud or of abundance of hemorroids The reason is for that although these humors abounde in the body yet bleeding stayeth the fluxe of them both of that that is of the menstruous bloude and also of the Hemorroids This also Trallianus affiâ—meth lib. 9. cap. 2. In the cure of Anasarca which is a â—inde of dropsie in these words Omnium curatio a vacuatione incipiendaest sed Ascitis quidem dicti aut Timpaniae a solapurgatione cus autem Arasarca nomeâ—i est ea vena sertionem intâ—rdum ordum requirit vt qui â—x sanguine frigidonascitut The cure of all dropsies must begin at eu cuation But that kind of dropsie called Ascitis or a Timpany must beginne at purging onely That dropsie called Anasarca sometime equireth opening of a veyne as proceeding of colde bloud This he faith not that this Anasarca requireth any further coldnes to be added but because the withdrawing of abundance of humors in this case disburdeneth nature
labour doth Also of passions of the mind some suffocate the spirites and inwarde heate as namely feare and sorrowe some wast and spread them abroade as mirth and gladnes These are the causes which being in exceise do wast consume inward heat the spirites of life strength of the bodie which being so apparant as they are may be vnto vs assured markes signes wherby to know whether the forces of nature haue yet lost or do still retaine their powers vertue strength Those causes which onely oppresse the strength of the bodie are inward hidden not so know en vnto vs as the forsaid and they are these obstructions immoderate abundance of humors which stop the veines arteries because they are thick grosse and slow humors by meanes wherof they keepe in the spirits do not suffer them to be cooled as it were by any kinde of winnowing whereby the vse of the spirits is taken away their vertues are oppressed and grieuously with the inward heat offended which matter verie oft faleth out so in the Lungs Liuer celles of the braine in the arteries finally in the verie habite of the bodie Obstruction caused of too much abundāce of humors doth grieue oppresse somtime ouercome the inward heat and spirites of life Fulnes also proceeding from any obstruction if the repletion be simple or somewhat part-taking with that called Cacochymia it choketh bodily strength as for example Abundance of bloud in a wrastler Flewine in Leucophlegmatica i. the third kind of dropsie cruditie of humors in the other dropsie abundance of choler in the yellow Iaundies As often therefore as the powers of nature are descried to be weak by the excrements the spirites of life by the pulse breathing the animall facultie by her proper functions and by any of the foresaide vehement causes preceeding wee may determine the spirites of nature to be empaired VVhen none of these causes haue gone before and that yet the bodily strength appeareth weake then iudge them to be onely wronged or oppressed Specially if there do concurre signes of pure and simple repletion or of great corruption of wicked humors the causes greeuing and oppressing the spirites of nature being remoued presently their strength is recouered and they come againe vnto themselues except they be beaten downe with the continuance of their oppression Here therefore I make three steppes or degrees of naturall strength weakely affected either the same is a little throwen downe or ouercharged or thirdly altogether weakened whose particuler tokēs apeare by that which hath beene said in the premisses There are some which only marke the pulses as an infallible signe to iudge the bodily strength by which in trueth is a great marke but yet not alone sufficiēt being both doutfull and vnconstant and also because it is troubled with diuers outward things is oftētimes changed Againe euacuation too aboundant affecteth not onely the vitall spirites but also in like manner the other faculties of nature whose decay bringeth death as assuredly as if the vitall power were extinguished and therefore in euacuation it is requisite aswell to marke and obserue the other faculties of nature as the vital powers For if the pacient be sicke of a vehement continuall disease as of Lienteria i. a fluxe of the stomacke or Atrophia i. a kind of consumption or Marasmus i. the endes of the feuer Hectike let him not bloud albeit the pulse be mightie full And therefore I conclude this Chapter affirming that we are in euacuation to consider the ablenes and strength not of one only but of all the three aboue-said running or flowing faculties of nature Neither to consider of these alone but also of the setled faculties in which is conteined the action of life To knowe by the greatnes of the disease the strength of the naturall powers the quantitie of bloud that must be withdrawen Chap. 14. THe knowledge of the quantitie in euery remedie is the hardest matter in al Phisicke and most of all troubleth the carefull and wise Phisition And although to knowe the quantitie be but a coniecturall knowledge yet the same is ioyned with lesse danger and is more secure here than the knowledge of the quantitie in a purgatiue receit The reason is because wee may stoppe the bloud when wee will as Galen witnesseth 2. de ration virt in acutis Commen 11. lib. de curandi rat◠per sangninis missio Chap. 12. But when areceit is in wardly taken the same cannot be againe vntaken Neither is it in our power when it is once in the bellie to take away any part thereof or if neede be to adde vnto it VVhich in bleeding wee may do and therefore lesse danger is in this than in the other The quantitie of the bloud that must be extracted is knowen by the strength of the patient and chiefely by his pulse Therefore while he bleedeth let the Phiebotomer or Phisition seele the Pulseis with his hand and suffer the bloud to passe according to the alteration of the same especially when any great euacuation as euen vnto Syncope is to be made Lest it fall out vnwares that death it selfe doe come in the place of sowning or fainting And except necessitie doe greatlye vrge it is best and safest to abstaine from such plentifull euacuation after Galens councell lib. de Cura rat per sang missionem Chap. 12. If at any time the powers of nature being weake the disease require some plentifull bleeding it is good to deuide the same to open a veine twise or thrise and at eache time to detract a little bloud as ye haue partly heard before and as it shall be shewed more at large hereafter All sicknesse decayeth the strength of nature and so doth in like manner that euacuation which is vsed to helpe nature Lest therefore it might seeme a verie hard dealing in this case more grieuously to afflict one alreadie afflicted and presently grieued the matter is so to be ordered as the substance of the disease may be remoued the forces of nature as little damnified as may be Yea it is a principall poynt in a skilfull practisioner so to worke that the euill may be remedied and the patient brought in hope of a more profitable recouerie for his health than his former Phisick hath been painful vnto him Those hurts which the naturall vertues sustaine by a moderate euacuation are but small and these are againe quieted when the euaacuation is accomplished for nature now freede of those hurtfull humors wherewith shee was before pressed down recouereth her former strēgth Shee renueth that which was drawen from the inward heat and spirites and become almost the conquerour of the disease Shee ouercometh wholly at length yea that which remained behind partly by inward concoction and partly by outward dissipation It wise Hippo councelled to giue a small dyet to the sick patient not fearing thereby more and more to weaken the strength of nature which
after his capablenes The discommodities vvhich happen by Replecion are manifold moistnes thereby is too much increased and naturall heate quenched againe naturall heate resolueth somewhat of the superfluous meate and drinke and of that which is resolued of meate vndigested proceede grosse and vndigested fumes which ascending vp to the heade and touching the rim wherein the braine is wrapped causeth headach trembling of the members dimnes of sight and many other diseases Moreouer the sharpenes of the said fumes pricke and annoy the sensible sinewes whose roots are in the braine and from thence passeth through all the vvhole body The said fumes ingendred of Replecion and piercing the innermost part of the saide sinewes called sensible greatly annoy the animall powers there beeing by occasion whereof Vnderstanding and Reason both as touching the vse of them are vvonderfully let and troubled and likevvise the tongue vvhich is Reasons Expositor is greatly depriued and hindred of his Office As it appearethin them vvhich are miserably drunk and in those vvhich haue most extreame and grieuous paines in their heade proceeding of Replecion Thus much harme commeth to the body by too much nourishment and although the stomacke doo his Office in concoction yet the veins too abondantly filled are spred out diuided stopped and stuffed with winde and greatly grieued It is apparant that of replecion and fulnes of the veines then the which in diseases a more hurtfull thing cannot chance diuers infirmities doo come and the replecion of the belly though the excesse may be expelled by vomit or sedge and so is more tollerable than fulnesse of the veines yet it is likewise to bee disallowed If a man haue at any time too much ingorged himselfe by and by he may assay to vomit for though hee doo well digest it yet there is some danger lest the veines be oppressed with fulnes especially when the party continually liueth intemperately neuer regarding or minding euacuation It is good therefore to vomit first before the meates bee corrupted in the stomacke if any impediment hinder vomiting a sedge by stoole is a present helpe If neither serue sleepe long and oft in drinke vse warme water VVhen the surfet is sufficiently digested chiefly by sedge it is expedient to wash and vse fomentations i. plaisters mittigating paine and a little to tast of salt meates and to drinke wine or beare alaid or tempered with water These things by the way touching remedies for surfetting which in our daies is too vsuall to the great dishonour of God and the certaine destruction of our bodies yea and of our soules also if GOD grantvs not grace speedily to repent and amend But if neither siege nor timely digestion of the meate recemed doo not insue our surfettings then the signes of replecion are to be looked for which are set downe by Oribasius Euporist lib. 1. which are these that followe as Losse of appetite delight in nothing sloughthfulnes dulnes of wit and senses more sleepe than was accustomed crampes in the bodie starting of the members fulnesse of the veines thickenes of the pulsies horror and shroueling of the bodie mixt with heate But the generall signes of abundance of bloud are these bleeding at the nose chiefly forth of the right nosthrill spitting of bloud veines full and great chiefly in the face rednes of colour a ponderous waightines of the whole body vnapt to any motion an vnacustomed drowsines a sluggishnes of minde without any euident cause the skinne stretched pulses very full debilitie of sight grieuous dreames plenty of sweete spittle in the mouth swellings and blushings in the face heauines and painefull wearines in the shoulders as it were after labour or bearing great burthens vrine thicke and red Replecion knowne by these notes except it be ruled by Phlebotomy or otherwise it choketh the naturall heate of the body as Galen saith 1. Aphoris Aphoris 3. Nimia repletio calorem natiuum extinguit Too much fulnes extinguisheth naturall heate Also Metho 13. cap. 6. Plethora tum sanguinis missione curatur tum frequenti balneo exercitatione fictione digerentibus medicamentis Repletion is cured by bloud-letting often bathing exercise rubbing and digestiue medicines Looke more in Galen 3. 6. de tuenda sanita These men therefore in vvhome bloude so aboundeth are to bee holpen by Phlebotomy by opening Mediana or Cephalica or applying of Boxing-glasses with scarrifieng the place first or othervvise as after shall bee declared Remembring by the way that if either purging seeme too long or the opening of a veine cannot bee done accordingly that in these cases Electuarii succi Rosarum are good to purge bloud But hereof there is no place to speake further at this time Finally it is very behouefull to knowe in vvhat place the corruption or ilnes of the contents of the body is placed or where the Repletion is before vvee can addresse our selues fitly to euacuate That fulnes therefore vvhich of the Greekes vve haue said to bee called Plethora is chiefly resident in the veines and habite of the body and this being an abundance of all the Humors in quantitie is euacuated by bloud-setting or opening a veine and with cupping-glasses The Repletion called Cachochymia beeing an abundance in quantity of one Humor is iâ— the whole body or in some particuler part If Cachochymia bee in the vvhole it is euacuated by purgation by generall sweate by abstinence and that kind called insensibilis euacuatio Cachochymia particuler is thus euacuated If it bee in the belly by vomit and by siege If in the entrailes vvith Clisters Suppositors and by siege If in the Liuer by the Vrine If in the Spleene by the Hemorroids If in the Breast by Coughing If in the Heade it is purged through the Nosthrils and roofe of the mouth If in the Raines or Bladder by Vrine If in the Genitals by Venus If in the Skinne by Svveating Resoluing and vvith Cupping Glasses And thus I conclude this first Chapter containing the chiefest and principall points concerning Fulnesse Emptinesse and their diuisions Not intending to vvrite any thing at all of the subtile and abundant definitions and descriptions of Galen in his book De plenitudine and likewise in his Commentaries vppon the Aphorismes of Hippocrates For I hope it hath here sufficed to shew what replecion is the kinds thereof the operations of them good or euill remitting them which be curious and desire a more ample declaration to the most excellent workes of Galen where he may be satisfied if he be not determined to repugne against reason What Euacuation is and of the kinds and differences thereof Chap. 2. FOrasmuch as things contained in the body against nature while they remaine in the body are the inward causes of infirmities which by Art especially are to bee remoued therefore then Euacuation as a most generall remedy is first of al to be attempted Euacuaâ—â—â—â— therefore is an expulsion of those things which are contained in the body against nature There are contained
to turne the fluxe of them aside another way The first indirect cause is for the greatnes of a disease or for vehement inflamation of an impostume for in apostumatioÌ„s of great heat in hote feuers in vehement griefes there is not found a more excellent remedie than opening of a veine The second indirect cause is to allure the matter to the place of euacuation Therefore in stopping of Termes or Hemorroids the veine Saphena is to be opened Fulnes coÌ„ming by suppression of Termes is to be euacuated by the legges from the knee to the anckle whether we cut a veine or vse scarifying or launcing for veines opened in the armes of weomen reuoke draw vpward their naturall purging The third indirect cause is that the humors may be turned to some other place contrary or opposite to the place vnto the which they flow of their own accord Therfore in immoderat fluxe of Termes we open the Basilica veine that is the inward veine of the arme which is also called Hepatitis that the matter being called to a contrarie place may be turned from his fluxe The fourth indirect cause is that some part of the matter being takeÌ„ away by bleeding nature may the more easily ouercom the rest For the vertue of the bodie being weaker then that it can rule such aboundance of humors wee take away by bleeding some portion of them least thorough impotencie and debilitie of nature the same humors should flowe to the weaker members and there breede apostumations and swellings contrarie to nature But of this more shal be spoken at large in the proper place therof namely in the Chapter of reuulsion and deriuation of plucking backe and turning aside of the bloud of humors Touching the vtilitie of bleeding great is the profit therof For Galen reporteth that therewith he hath oft cured feuers and that it is boldly to be taken in hand when necessitie requireth it Therfore we may worthily blame those which in our time contrarie to Galens iudgement against reason al experience speak euil of this profitable practise First it sharpeneth the sight making the same more cleare the reason thereof is for that it diminisheth those humors which thorough their fumes hinder the clearnes of the eies so that consequently the sight thereby is sharpened Secondly it purgeth the braine sharpeneth the wit by the foresaid reason Thirdly it heateth the marrow wasting those superfluous humors by whose commixture flowing the marrow in the bones waxeth cold Fourthly it purifieth all the senses taking away those fumes and euaporations which ascend vp to the head and there trouble the senses Fiftly it purgeth the bowels and entrailes The reason is because nature gouerning the body being disburdened of that bloud which was as it were an oppression to nature and greued her as it were with some heauy burden doth now with ease concoct and ouercome rawe and rude humors deteined in the bowels Sixtly it stayeth vomits and laskes for it draweth the humors from the inwarde parts to the outward parts VVherevnto Auicen agreeth writing thus Phlebotomia propteriae quod ad diuersum trahit naturam secundum plurimum retinet Phlebotomy because it draweth to the contrary part therefore commonly it reteineth nature In which place it is to be vnderstood that in fluxes of the womb the veine of the Arme is to be taken which presently helpeth But if you doo otherwise that is take the veine in the foote or legge it profiteth nothing Sometime it chanceth that the belly by opening of a veine is more flowing than before and that especially chanceth two waies first because nature being disburdened by bleeding strength is increased so that sometime it stirreth vp other euacuations as namely by siege The second way is when through imbecility of the retentiue vertue which imbecility by opening of a veyne is increased so that the wombe is more stirred and prouoked Seauenthly it profiteth against immoderate watching for it emptieth abundance of humors from the which commonly diuers sharpe fumes ascend vp to the head and hinder sleepe Eighthly it taketh away heauines sluggishnes wearines of the body For as hath bin already said before bleeding disburdeneth nature which ruleth our bodies of multitude of humors which before was pressed downe by them oppressed with them And again Melancholly the chiefest cause of heauines is expelled with the bloud as the dregs and grounds thereof Ninethly it cureth difficulty of hearing abating abundance of humors whose thicke slatuous spirits carried vpward into the head stop the hearing port and passege of the eares Tenthly it helpeth the voice taking away superfluous humidiâ—ies which too much moisten the arterie or veyne of the voyce and speaking From which humidities horcenes of speech proceedeth Eleuenthly it refresheth and increaseth the powers and strength of the body For the body beeing freed from a multitude of humors must of necessity haue the vertue and strength thereof augmented These commodities of bleeding are thus set downe in verse by Schola Salerni Lumina clarificat sincerat Phlebotomia Mentes cerebrum calidas facit esse medullas Viseera purgabit stomachuÌ„ ventremque coercet Puros dat sensus dat somnum taedia tolliâ— Auditus vocem vires producit auget It cleareth sight the wits and braine It marrow warmes doth cleane procure The entrailes stomacke this is plaine It stayeth lasks makes senses pure It causeth sleepe expelleth griefe To eare to tongue it brings reliefe To be short these are the commodities of Artificiall bleeding therby the organs of the senses are cleansed weake bodies are made strong if yeares serue By it are helped Repletions Pluresies hot tertians frensies pestilences and dâ—uers other diseases as shall appeare in the Chapter ensuing The onely disprofit in bleeding is this that the vitall spirits thereby are â—havven foorth which thing Galen witnesseth in his booke de Scarrificatione saying to open a veine oft in the yeare I iudge not profitable for with much bloud the vitall spirits are also exhaled which beeing done too often wasteth the whole body making the same cold and causing the liuely operations thereof to waxe worse and worse To frequent bleeding therefore bringeth on old age apace and maketh the same subiect to many diseases as the dropsie gowt shakings palsies falling sickenesses and apoplexies For naturall heate being too much cooled and the principall moysture diminished the bowels languish and crudity ruleth with many flegmaticke humors which are the causes and originall of the foresaid cuils This Schola Salerni remembreth And Auicen in primo testefieth the same The best remedy to recouer vitall spirites decaied is drinking of wine for wine among things nourishing quickly and in short time is the most principall By meats also vitall spirits are recouered in time but not so soone Wherin is to be noted that after bleeding must be taken meate easie of digestion of good iuces and of much nourishment as potched-egs such like which meate easie of digestion
feuers caused and kindled of a putrifieng humor which should not seeme to bee true especially in intermittant fâ—uers which leaue off for a time as are tertian and quartan agues Forasmuch as in these bloud offendeth not in the veynes but some other humor beside bloud putrifieth without the veyns which by bleeding in reason cannot be euacuated This place of Galen cannot sound to reason or experience except we vnderstand Galen to giue vs aduise to euacuate by bleeding the matter of such intermittant feuers as haue also with the bloud fulnesse and abundance of other humors concurring So that this may bee his meaning Bleeding may bee vsed in intermittant feuers if they fortune to haue abundance of humors ioyned with the bloud For obstruction as Galen sheweth li. 11. Meth. Meden cap. 4. happeneth in rotten and putrified feuers sometime through abundance of humors sometime through the clammines grosnes and thickenes of them Galen therefore counselleth to let bloud in staying and intermittant feuers rather because of the abundance than the rottennes or putrifaction of the humor without the veynes And that this is his meaning appeareth by the words which Galen afterwards vseth saying Forasmuch as nature ruling the body by bleeding is lightned and disburthened of that wherwith she was before oppressed therfore shee will with ease ouercome that which resteth and remaineth behinde which is a 〈◊〉 signe that Plethora or fulnes is also annoxâ—d to such feuers Fourthly in bleeding we are not onely to consider the disease it self which wee determine to remedie but also oft times the cause therof so that whatsoeuer the sicknes be if Phlebotomy may remoue the cause then also it taketh away the griefe it selfe in the ende HereupoÌ„ somtime albeit the disease be cold yet when the cause moueth vs to open a vein we may safely bleede without hurt Hippo. saith Galen sheweth a cure of his done on a woman by letting her bloud in the Ankle This woman after child-birth was not freed ofher seconds then a shaking came vpoÌ„ her This woman I cured saith Hippo. by letting her bloud in the Ankle for all her shaking Shaking is a cold affect bloud is hote and they that must be heated must not haue bloud taken from them He for al that boldly did it he sheweth the reason I considered said he the cause the occasion of the cause He knew the cause of shaking was abundance of bloud kept backe which was a burthen to nature The occasion of the cause was the griefe of the matrix This abundaÌ„ce requiring euacuatioÌ„ the affected part shewing the place most fit for euâ—cuation considering both these things together he let her bloud in the ankle because the wombe or matrix was affected In griefes of the womb or bellie we take the vaine of the ankle knowing by the Anotomie the communion betweene the veines for some veines communicate to some part of the body others to other partes And euacuation is to be made from such veines as haue fellowship with the member affected For as yee heard in the Chapter of Revulsion if we take that veine which communicateth not with the part affected wee hurt the whole bodye do the griefe no easement The profitable vse of this fellowship of veines apeareth especially in revulsion or pulling backe of humors which is both wel speedily done when this coÌ„munitie of veins is obserued as was there declared But let vs return to our former purpose Fiftly by opening of a veine is cured the feuer called Synochus both that which coÌ„meth of ebullition of blod without putrifaction that which is caused with putrifaction of the bloud So are also hereby cured continuing feuers coming of putrifaction in the greater veines And to these diseases reckoned vp of Galen Fig. 2. we may adde these that follow Frensies Opthalmia parotis i. an apostumatioÌ„ about or behind the eares diseases of the Liuer splene Nephritis i. paines of the raines and backe inflammations of the wombe or matrix of the priuie partes arme-holes armes thighes ioynts Finally all inflammatioÌ„s inward or outward which the Greeks call Phlegmonae These inflamations are caused by flowing of bloud to a member when a veine is open broken which bloud there abundantly heaped togither bringeth forth a tumor or swelling To these also are to be added a consumption in the beginning vomiting of bloud bleedings at the nose bely or hemorroids at the beginning of which diseases the opening of a veine greatly profiteth staying the force of the fluxe by revulsion if the veine be opened at the contrary part calling back much of the matter froÌ„ the member affected so that bleeding is a present helpe for those diseases whatsoeuer which take the beginning from too much abundance of good bloud Those sicknesses which come of an vnpure mixt plenitude because they are somewhat neere linked vnto these they may also be cured by bleeding And although the matter of these diseases be vnpure yet either it lyeth in the veines or procedeth from the veines A gaine by bleeding are cured Carbuncles felons moyst scabs outward rednes in the skinne such like all these are cured by this practise Thus also is cured the burning ague called Causus all continuall feuers whose putrifaction is conteined in the greater venies Yet sometime a continuall feuer commeth of an humor heaped togither inflamed about the stomack chiefely about the mouth of the stomack the flat parts of the Liuer which feuer cannot be takeÌ„ away by bleeding Neither can the cause therof by this practise be remoued Pure intermittant feuers whether they be Tertians Quartans or Quotidians because the next matter proper cause of them is not in rhe greater vessels neither floweth from the veines are not conâ—eniently cured hereby And yet sometime in these also we bleede either when the veines swell with immoderat fulnes so that therby some danger at hand may be feared or when any accident of hote inflamed boyling bloud perswadeth vs therto as are namely beating paines of the head tossings mouing of the body this way that way excessiue heat almost stragnling the pacient Howbeit these many times come also of boyling choler about the inward partes called praecordia in the which cases bleeding remoueth neither the feuer nor the cause therof but onely asswageth the vehemencie of those accidents which are present or shortly like to ensue Further concerning perticuler affects cured hereby we may adioyne beating paines of the head Letargus spoken of before fig. 3 and trembling of the heart These with the foresaid are not onely cured hereby when they presently affect and afflict the patient but happening yerely vnto vs so that it is verie likely we shalbe grieued with them in time to come VVe may verie well preuent them by bleeding wheÌ„ we haue once espied plenitude to haue beene in vs the causes of these infirmities For there is one the self-same way of healing common
is vnprofitable and superfluous not bringing any commodity but discommoditie and perturbation to the sicke Therfore in this case this must be the practise moderately and often to giue the patient meates of good iuice and nourishment to confirm strengthen and recouer nature and such as haue some vertue in them a proprietate against the present infirmitie may redresse the inward corruption of humors And wheÌ„ thus the naturall forces shall be recouered Phlebotomy may succeed And this practise is much vsed in continual and long sicknesses in sharp diseases called morbi acuti this long stay were doubtfull and dangerous An obseruation of things present past and also a foresight of things future needful necessarie to the further knowledge of the quaÌ„titie of bloud that must be taken Chap. 15. OBseruations of euident causes touching the greatnes of the disease constancy of naturall forces doth greatly further our knowledge in this behalfe Of which euident causes three of them are in ward and bred in our selues as namely the temperament the complexion the age three of them are outward and accidentall namely the coÌ„stitution of the aire according to the seueral seasons of the year the situation of the countrie state of the heaueÌ„s All which are included in one cause as grouÌ„ded al vpon one reason secoÌ„dly former euacuatioÌ„s ether slaid or immoderatly flowing thirdly custome order in diet life or kind of euacuations proceding By knowledge of these forepassed causes we may atteine to the vnderstanding of the strength both of nature of the disease so consequently of the quantity that wee must bleed albeit that the causes present future haue not yet altered either the disease or streÌ„gth of nature yet for asmuch as they begin to dissolue some humours froÌ„ the body to wast the strength of nature they haue some moment in this practise For what these causes present or past can doo ye haue heard in the 8. 14. chap. to the which I refer you coÌ„cerning the perticulars here onely being contented to rekon theÌ„ vp by name 〈◊〉 the teÌ„perameÌ„t the state of the body the age the countrietthe time of the year the disposition of the aire sky voluntary euacuatioÌ„s custom the rest as appeareth ca. 8 It is the part property of a wife skilful phisition to consider not only the state present of the natural vertues but also to foresee what will be their state in time to come after bleeding The natural powers after euacuation are so to be conserued as that the same may be able afterwardes to take other helps continue out the prolixity of a coÌ„tinuing diâ—eâ—s Yea we must reteine alwaies some bloud for future fits and courses of the disease which are yet to come Lest afterwards vrged thervnto wee begin vnfitly and out of due time againe to nourish the same And this chiefly is to be done in bleeding for corrupted and putrifying feuers whose putrifaction obstruction is not taken away by bleeding but the putrifaction is afterwardes the better ouercome by the strong force of nature when by opening of a veine shee is somewhat relieued Therefore to this purpose alwaies some bloud must be left for natures preseruation as Galen councelleth lib 11. method cap. 14. We may coniecture the future strength of the patieÌ„t partly by the preseÌ„t causes which are also afterwards like to continue partly by accidents which may happen contrary to our opinioÌ„ Among present causes these are the chiefe the state of the heauens the order of mans life If the constitution of the aire hath bene hot dry is like so to coÌ„tinue the bleeding must be lesse than if wee suppose a cold aire to ensue Again if we perceaue that the patient will liue sparingly â—eÌ„peratly either for want of appetite or because the disease will not suffer him to feed as in Augina the Quincie which shutteth vp the Iawes we are to take lesse bloud than wheÌ„ we see he wil liue more frankly and liberallie In these cases we must still reserue some bloud as natures treasure to helpe at a pinch in time of neede Suddaine accidentes and vnlooked for which greatly enfeeble natural strength are these great paine and ach watchinge voluntarie euacuations and chiefly Sincâ—pe into the which many do fall beeing not accustomed to bleede at the first opening of a veine either because they are weâ—ke of nature or strucken with some great feare or because the mouth of the stomake fiâ—â—ed with bitter choler is becom very vnsensible and weake When we suppose that some of these matters wil fall out albeit the strength be firme yet no blood at all or very litle is to be withdrawen except by art wee naue preuented the former accidents It is I say great wisedome to foresee a farre off 〈◊〉 beware of such suddaine and vnlooked for accidents This we will manifest by an example Let the pacient be of a sanguine complexion of body thicke and well set of a florishing age that hath long time led a leacherous life feeding plentifully of good meats and that hath omitted his accustomed exercises and liued at home idely in whom also accustomed eruptions of bloud out of the nose belly or Hemoâ—roids are staâ—ed so that by concourse of these causes the body hath greatly encreased or waxed that the large veines through repletion are greatly filled WheÌ„ soeuer a strong ague or great inflammation shall possesse such a patient presently he must be let bloud and that plétifully Both the greatnes of the disease and of the cause requiring the same Moreouer this is confirmed by obseruation of thinges past if present causes agree to these namely that there bee a sit temperature of aire by occasion of the countrie season of the yeare and the present state of the weather moderatly cold and moist and that the patient bee apt to euacuation also that the sicknesse bee not like to continue long after neither apparant signification of an excessiuely hot temperature of aire to come no thveatning of future paine or of abstinence watchinges voluntarie euacuations If all these thus agree together who may doubt but that a large euacuation may in this case bee made And none at all when the conâ—raryes doo appeare Sometime these obseruations are mingled among themselues and contrary to themselues In which confusion a wise iudgement is needfull by comparison of them to prescribe the iust quantitie of euacuation The consideration of passed matters many times perswade a plentifull bleeding which the obseruation of things present by and by taketh away As for example if the Patient laying aside his accustomed exercise giue himselfe to pleasure and idlenes stuffing himselfe withmeats and hauing some notable euacuation staied in him but his body is waxed fat white of colour loose open soft full of thiniuce and that it be Summer a hot dry country a hot dry constitution of weather without stormes In
throughly vehement passing not the fourth daye which is called of Phisitions Malus peracutus i. thoroughly sharp and of some perperacutus imitating barbarous authors in Phisick The other not exquisite or throughly sharpe vehemeÌ„t whose greatest force wilbe in the seuenth day These diseases being but short at their extreame fits in few daies without any truce presently at the beginning these are to be cured And because they proceed chiefly of hot humours namely of bloud and yellow choler therefore specially they require bleeding Whereupon Hippo. lib. 4. writeth De vict ratione in morbis acutis Aphoris 19. In acutis morbis sanguinem detrahes si vehemens morbus videatur florueritque aegrotanti aetâ—s viriuÌ„ affâ—er it robur In sharpe diseases withdraw bloud if the disease seeme vehement if the age of the patient be florishing and that the naturall forces be firme and strong Schola salerni hath these verses of this very matter Principio minnas in acutis perperacutis Aetatis mediae multum de sanguine tolle Sit puer at que senex tollet vterque parum Ver tollat duplum reliquum tempus tibi simplum In sicknes sharpe let blood with speed take much from men of middle age Not so when child or old men bleede the spring requires the aduantage As there is regard to bee had of generall times so there is also of perticular daies and times in the which diseases come speciallie in those diseases which haue by course an appointed and set time of intermission and remission For euacuation is not to be made when the disease is now fierce but when the same is asswaged Feuer sand especially those that are called intermittents discontinuing agues eueÌ„ naturally at the beginning and their first inuasion cause vomits and at the declining sweats At which times wee may by art prouoke these but in no case vse purging or bleeding In the time of the fit likewise wee must refraine from these as thinges which nature then can not brooke If such accidents of bleeding or of siege come they are but accidental and are caused only of the heat and force of the disease No euacuation can be done safely in such fits seeing they do too exceedingly hurt the powers of nature Also when the humours do so boile with heat that they are perturbed mingled together there can not be made by practise of art any iust diuision of the said humours And if it chaunce that the hurtful matter of the disease be inflamed without the greater veines that in a fit a veine be opened it is to be feared least preseÌ„tly the same corrupted matter passe into the empty veines so of an intermitting feuer wil come a continuall Wheras a veine opened in the most quiet time of a disease troubleth not nature but without any feare of an inflammation taketh the plenitude out of the greater veines The greatest time of quietnes is the time in the middle betweene the remission intermissioÌ„ of the disease If the time between the fits bee much it is an easy matter to perceiue the said middle time If the time bee but little then is it far more hard to discerne the same Because many times no leasure can bee graunted either before or after bleeding by reason of the swift courses of fits to nourish the party Thus you see Phlebotomy is not to be practised in the day of the fit of any sicknes which in Latine is called Crisis or dies Criticus in the which day neither bleeding nor any other euacuation is to be atteÌ„pted lest the matter should be drawen from that place wherevnto nature hath driuen it to be rid or dispatched thereof and therfore like wise neither in the fit it selfe ought the same to bee done Excellently therefore did Galen giue in charge Comment 29. lib. 2. Aphoris that in time of the fit neither bleeding nor purging ought to bee vsed because then the concoctioÌ„ of the disease is chiefly wrought Which is farre better accoÌ„plished in quietnes and rest then in motion or disturbance For what respect the state hath to the whole disease that comparison hath the â—itt to the daies of intermission As therefore in the state of a disease no euacuation is to bee vsed so neither in time of the fit Againe it may profitablie here bee admonished notwithstaÌ„ding the premisses that bleding is not presently to be vsed at the very beginning of a diseas wheÌ„ we iudge the Crisis or iudgement of the sicknes to bee yet far ofâ— For bloud beeing the foundation of inward heat wherwith the same is vpholden natural heat beeing ingendred of bloud as of a materiall cause If bloud should bee detracted at the beginning of a disease the natural heat would bee diminished which should concoct the materiall cause of the sicknes Whereby further it commeth to passe that the disease is longer time protracted and the forces of nature enfeebled through which two namely the continuance of the disease and imbecillitie of nature great feare of death commeth in the end and this is the case wherein Auicens former opinion may stand true There is therfore no prescribed day for certaine appointed to let bloud in Whereupon Galen tooke occasion to deride those lib. de curand ratio per sang missio cap. 12. which from the 2. houre of the day to the 5. or 6. houre onely did let bloud and at none other time And Galen witnesseth ofhimselfe that he did let bloud at all times without any daunger yea euen in the night And 9. method Cap. 5. hee affirmeth it best which hee also him selfe obscrued to mark not the number of the daies but onely the strength of the Patient because by experience wee haue prooued that not onely the sixt or seuenth daies but also in the daies following the sixt or seuenth a veine may bee opened But because as Galen witnesseth Libro de Curand ratio per sanguin missionem Capit. 20. in diuers diseases through continuance of time the strength of nature is greathe abated Therefore the occasion of letting of bloud is not omitted for the number of the daies but for that the naturall strength is wasted So that if the vertues of the bodie seem to be consumed the second day from the beginning of a disease euen then wee forbeare opening of a veine And he thertoo the wordes of Galen Now in diseases which are cured by bleeding when they are present or propelled being but future if they grant leisure so that a choice of an houre to bleede in May bee made in this case I say the fore noone houre is better then the after noone For from the rysing of the Sunne the bloud is quickened reuiued and beareth rule in the body yea in that time of the day it becommeth thin cleere apt to flow Let not the patient sleepe nor slumber in that houre wherin he is to bleed but at lest let him be awake a whole hour before see also that he haue
or whatsoeuer eruption bee made in any other place through the skinne it is likewise a particuler Euacuation Again of Euacuations some are of their owne accord some are done by Art Naturall or voluntary Euacuation is when any thing is expelled out of the body without any medecine this chanceth sometime euen naturally For nature while it is in health rightly gouerneth the state of the body and doth expell thence whatsoeuer supersluously aboundeth or is corrupted this Euacuation is both naturall and conuenient This also chaunceth sometime contrary to nature as when the strength of the body is so infeebled that it cannot gouerne and restraine the Humors of the body but letteth them quite flow forth or when the vertue is strong yet it is somtime so prouoked either with abundance or acuity of the Humor that it permitteth the Humor to passe of his owne accord out of the proper vessels and receptories thereof Both these are accidentall vnprofitable and besides nature because the good bloud commeth forth mingled with the bad without choise or order Artificiall Euacuation is when the same commeth by outward help this is two fold The one right profitable onely Euacuating that which offendeth in iust quantity quality The other contrary to this extraordinary and vnprofitable exhausing the Humor that annoieth not which commeth by the vnskilfulnes of the Phisition Nature by her owne force and by the vertue expulsiue accomplisheth her Euacuation The Phisition doth his by diuers necessary helps prouided for the same And in letting bloud he openeth the veyne either with a fine penkife sleme or lancet or some other applyable medicin Purgation hee attempteth with medicins expelling euil humors from the body either by vomit or by siege Also he expelleth euill humors by breathings euaporations exercise rubbings mouings heat bathings specially sulphurious accidentally by abstinence Also the Physition vseth particular Euacuations in particular parts as ye haue heard Hee purgeth the braine through the nosthrils by medicaments called in Greeke Errhinae And through the palate of the mouth with medecines called Apophlegmatismi which chewed in the mouth bring Humors from the head the brest and lungs with medecines called Berhica The Raines and Bladder with Diuretica The wombe or belly with Hysterica Againe the belly is softned with suppositories and clisters againe euacuation or eruption is made in particular parts by medicines called Digerentia â— resoluing medicins by Suppuratoria â— medicines breeding matter by medicines called Amycticam Caustica Idest burning things by horseleches cupping glasses which drawe bloude with scarrifieng the skinne by launcinges or cuttings by iron red hot All these are vsed of Phisitions The kinds of Euacuation reckoned vp of Fuchlius Phlebotomy Purging  Vomiting Scarrifieng  Boxing Abstinence  Long sleepe Carnal copulation  Fluxe of bloud from the Nose   Termes   Hemorroids Euacuations some are Naturall Phlebotomy  Artificiall Purgation  common partaking of both  What Phlebotomy is and from whence the opening of a vaine doth e uacuate Chap. 3. FOR so much as the bloud in generall is mixed with the foure Humors which are also bedewed as it were with a thin watry substance and that they all are so mingled together through the heat and concoction of the Liuer that neuer an humor can be seene neuer so little to be seuered from the others therefore I saie the retentiue vertue cannot so strongly hold back the bloud in the crooked small veines when a great vaine is opened and that with a sufficient large wound but the same will issue and come foorth If by chaunce it happen that the retentiue vertue go about gredily to suppresse the bloud yet at length it will poure it out plentifully with oft handling rubbing of the veines Neither doth this or that humor by it selfe alone come foorth as in purging but bloud generally that is to saie mixt with other humors in the veines Touching the definition what it is Phlebotomia which is worde for worde out of the Greeke the cutting of a veine is an artificiall eduction of bloud either abounding iu quantitie or offending in qualitie by opening of a veine I call it an artificiall incision because it must not want art and iudgement For in it consideration must be had of the inflicted wound of the quantitie of the bloud of choosing the aptest vaine either to pull backe bloud or to euacuate it quite or to make it onely lesse in quantitie Also for that consideration is to be had whether the veine must be opened streight downe or ouerthwart of the same side of the bodie or of the other with diuers considerations besides whereof we will speake in their proper places Therefore Phlebotomie which is one of the greatest remedies the Phisition vseth is for good cause defined an artificiall kind of educing Galen in his 2. Aphoris Coment 17. defineth it to be an exquisite euacuation of al the humors equally Auicen defineth it vniuersalem euacuationem quae multitudinem humorum euacuat or thus Vena sectio est vniuersalis euacuatio quae anctionem humorum super aequalitatem in venis exuperantium euacuat i. an vniuersal euacuation which taketh away abundance of humors replenishing the veines aboue measure Though the bloud in the veines be in a moderate meane or but little in quantitie yet of the proper mouing vehemencie of it self it issueth out nature litle or nothing at al protruding the same Phlebotomie indifferently euacuateth both good bad humors conteined in the veines with the bloud Neither in diseases proceeding of corrupt constitution of humors can nature so moderat the matter as that that humor alone shal flow forth that aboundeth in quantitie or offendeth in qualitie I confesse that in the iudicials of diseases called Crises many times nature separateth as it were excludeth by wayes conuenient those ill humors prepared before by concoction yet notwiâ—hstanding if then at that instant we open a veine nature cannot therby in so short time expel the hurtfull humor Whereas Auicen saith Phlebotomie euâ—cuateth good bloud the ill remaining behind that he feareth lest opening a veine bring the patient either to abundance of hot chollerik humors or cruditie of flegmatike humors if he mean it of the humors mixt in the veines it is most fals for neither doth the watrie humor issue forth before choler nor choler before flewme or Melancoly nor the bad humor before the good VVhich daily experience proueth to be true for when the bloud commeth forth it appeareth simple of one forme but in the porrenger it loseth his colour euery part therof congeleth seâ—crally in his own region The watrie humor swimmeth aboue not farre vnlike vâ—ine Thinne choler the flowring part of the congealed bloud is also aboue next the water Melancoly abideth in the bottom the red bloud the paler flewme keepe in the middle region So that opening of a veine euacuateth all humors which are in the veines equally
VVe are here to set downe from what place the evacuation is made for inasmuch as bloud is moyst and flowing that first issueth forth which is next the opened veine then that which is next the same thirdly commeth foorth not onely that which is in the veines and arteries but also that which is in the bowels and whole habite of the body For there is a wonderfull continuation and order of the veines so that a way being once made all the bloud often times floweth out of the bodie and bringeth death to the partie But when the passage is stayed then the bloud is sent foorth by the veines arteries till there be a certain proportion in the whole bodie For the emptied and wanting partes by the long small veines draw bloud forth of the full partes repleated members and so â—â—â—â—or them as it were in their need Againe the full members grieued with too much aboundance vnburthen them-selues on the veines that are emptied Againe the humor being liquide and flowing voluntarily followeth the lower euacuated regions and there continueth whereupon it followeth that whensoeuer bloudletting shall emptie the veines the same also shall euacuat the whole bodie In regard whereof Phlebotomy in the definition thereof is called verie well an vniuersall euacuation and that for two causes First because it withdraweth all humors whereof the bloud consisteth Secondly because it euacuateth from the whole bodie but yet not in like sort Forasmuch as the partes of mans bodie are placed in their order therefore first it exhauseth from the neere partes then from those that are further off And againe forasmuch as some veines are spred into some partes of the bodie and other into other partes therefore bleeding with more celeritie and force draweth from those partes which are rightly and directly placed then from those members which are opposite or ouerthwart Whether Phlebotomie must go before purging or contrarie Chap. 4. IN this place it is a necessarie question to be moued and aunswered whether bleeding or purging must go first in this case which is verie frequent where they are both requisite Some will alwaies haue that when purging is necessarie bleeding must go beforeâ— and they bring out the authorities of Hippocrates and Galen Others contrarily affirme that alwaies some extenuating or lessening receit called barbarously Medicamentum minoratiuum must be first receiued and them Phlebotomie succeede But of these opinions neither is simply true and yet both true as the case may be limitted And for the cases wherein a gentle purgatiue is to proceedâ— Phlebotomie they are in number these sixe First when the stomacke the Mesecaicae veines the great veines the waies passages of the bodie or any of these be stuffed with filth or incombred with crudities or that the excrements are hardened in the bowels although the whole bodie abound with bloud beside yet a gentle easie receit is to be taken as Manna Cassia or a clister but no violent receit which may euacuate from the foresaid veines open the obstructed passages If the bloud should first be drawen forth without some gentle purgation or euacuation in the greater veines then the veines outwardly exhausted by bleeding through their attractiue vertue would drawe vnto them ill iuces specially if the disease require any plentiful bleeding This is affirmed by Auicen Galen 9. Metho cap. 5. who did vse to refraine from Phlebotomie if there were cruditie of meat in the stomake or rawnes in the veines called Mesecaicae til their concoctioÌ„ wer ended the excremeÌ„ts descended Secondly when the bloud is verie viscous clammie grosse we do not only take medicines attenuating but also lessening things a dyet conuenient to prepare bloud and to make the meÌ„ber bleed the better vse a bath for oft it commeth to passe that a veine being opened no bloud issueth forth because of the thicknes clamminesse thereof Thirdly it faleth out in many cholerike bodies that choller contained in the vpper parte of the stomacke is easily moued so boileth causing Lipothymia i. ouercoming in which case it behoueth to vse before some Minoratiue receit also in bleeding to vse somewhat to keepe backe the boiling of choller Fourthly in diseases wherein appeareth a difficultie by reason of Cacochymia or abundance of other humors mixt with the bloud When a practisioner perceiueth that he must vse Phlebotomie yet with some difficultie in this case he may vse some easie purgation or one of some force whereby it may fall out that nature shal thereby so be eased which the siege ease of nature wil shew thee that thou shalt not need bleeding at all but onely preparation of the matter then to renue the educing thereof as before Fiftly remember Auâ—cens saying Sanguis fraenum cholerae existit bloud is the restrainer of choler therfore in diseases mere cholerik it were a rash part to set bleeding before purging which perhaps thou maist be without after the exhibiting of the medicine And if thou vse the patient wel let those things suffice which change or repell the sharpnes of choller Yet this is to be added that if there shuld be such abundance of choller as might cause a swelling aboue nature or inflamation then bleding vpon that is a present help Sixthly the same reason may serue in flegmatike constitutions Wherein for many causes although no small fulnesse appeare yet we are not to vse Phlebotomie before purging The cases wherein Phlebotomie preceedeth purging are these First when great fulnes appeareth which either hath caused or is like to cause any vehement disease as Apoplexia which is a sicknes engendred of grosse humors filling the receptories or vessels of the braine and thereby depriuing the partie of feeling speach and mouing as Peripleumonia which is an inflamation or an apostume of the lungs with a vehement Feuer comming sometime of it selfe but most commonly following vpon great and sharpe rewmes squinances pleurisies or such like diseases as Suffocation which is in English strangling then in this case without faile and chiefely if the wombe be laxatiue vse letting of bloud without precedent purgation And this seemeth to agree with Galen lib. 10. de Composi medica secundum locos ca. 2 VVhere he saith if the bodie doe equally abound with humors first let bloud then purge And hereunto Auicen accordeth in quarta primi Cap. 4. This saith he is a truth and the precepts of Hippocrates in lib. Epidemionium that if both bleeding and purging be necessarie and that the purgatiue must be vehement then begin with Phlebotomie Secondly in dangerous fluxes of bloud out of the nose or in spitting of bloud called Hoemoptoicapassio or in bluddie fluxes for to turne the matter a way in full bodies wee presently let bloud without medicine going before Thirdly in wrastlers abounding with bloud to whom the same abundance threatneth some great danger that it is presupposed that there are no ill humors in the circuite or compas
of the bodie in this case wee vse Phlebotomie without purging Fourthly we may safely let blond without medicine those that are whole for abundance of bloud only are accustomed to yerely bleeding and that haue in the yere taken little or no Phisicke as it chanceth to many persons in many countries of the North. Fiftly we may open without purging the inner vaine of the arme in women with child if they carrie Corpora Phletorica full bodies that in the 5. 6. or 7. moneth after the conception yea also before they be quicke This practise wee are to vse specially when they being with child waxe verie slowe heauie as it were ouerladen with abundance of bloud we may take Salua tella veine or if plenitude so require the inner veine of the arme for the quantitie respecting a discreete moderation Sixtly we may let those bloud without medicine that haue fallen from some high place taken hurt in the brest and stomacke in whome is to be feared an inconuenience called of the Greekes Egchymosis Seuenthly we speedily let bloud such persons without further Phisick as by reason of their fulnes through some accident as feare or such like waxe domme in which case wee let bloud abundantly so that both armes are opened together Here I am to note a great error in Auicen both repugnant to trueth it selfe and also contrarie to Galen For Auicen affirmeth that when colde and thicke humors are in the bodie first wee must begin with purging and then open a veine Diuers and many waies hath he erred in this First because in flegmatick humors grosse and colde mixt with bloud hee woulde haue Phlebotomie not vsed before purging And in this case by all likelyhood of reason the cure should begin with bleeding Secondly in this hee dissenteth from Galen who 11. Method Chap. 4. though there were obstructions in the bodie of thicke and clammie humors yet first hee would begin the cure with Phlebotomie If Auicens meaning be when flegmatike humors ouercome the bloud in multitude or abundance that then wee must first vse purging then is hee greatly deceiued for as much as hee proponeth a case in which Phlebotomie should not auaile except with those many colde humors there be also some excesse of bloud which chaunceth verie sildome or not at all But it may seeme that Auicen hath reason namely this that the bloud being extracted those humors would waxe more rawe and so by opening a veine the patient is brought to a marueilous cruditie of colde humors This is no reason for by Phlebotomy wee detract bloud not because of obstructions caused of grosse and colde humors but because bloud superaboundeth For the stopping is afterward remoued with other helpes Therefore when obstruction concurreth with abundance of bloud wee must not extract verie much bloud but keepe backe some till the time of the cure as Galen teacheth 11. Method Chap. 14. And thus much of the order betweene Phlebotomie and Purging whereby wee see that a strong purgatiue must followe bleeding and that an easie purgation or clister may go before Of the effectes that is Of the profits and disprofits of opening a veine Chap. 5. Schola Salerni in two verses reckoneth vp three effects of bleeding Exhilerat tristes iratos placat amantes Ne sint amentes Phlebotomia facit It swageth wrath and cheeres the sad Preserues loue-sick from being mad FIrst it maketh glad those that are pensiue Secondly it appeaseth such as are angrie Anger is especially caused through mixture of much yellow choler with bloud And sadnesse by commixture of much Melancoly with bloud And forasmuch as both these humors choler Melancoly are exhausted with the bloud these two effectes must consequently follow Thirdly it preserueth loue-sicke persons from madnesse by drawing humors from the head to the lower partes and so expelling the same Although occasion will hereafter better serue to shewe the causes why wee vse Phlebotomy yet here nowe speaking of the effectes I will briefely shewe fiue causes for which wee vse to let bloud and by the which may be gathered the profitable effectes of this practise of the which fiue causes one onely cause is the direct the other foure are indirect The direct cause of bleeding is euacuation of the bloud But forasmuch as bloud is good for nature therfore Phlebotomy must be vsed â—duissdly that the same bloud only may be expelled which is vnprofitable hurtfull to nature Bloud as you haue partly heard is made vnprofitable to nature two waies either when it doth not throughly keepe the proper qualitie that it cannot so nourish as it did before when it was good or when in quantitie it so increaseth that it either presseth downe the powers of the bodie or stuffeth stoppeth both the veines the arteries In these two cases bleeding is good as one of the direct euacuating helpes Yet in these cases bleeding is not to be vsed indifferently but with this difference in abundaÌ„ce of bloud much may be detracted In little plentie small euacuation serueth Hereupon Galen writeth lib. 9. cap. 10. Method Si sanguis vitiosus in corpore fuerit paulatim quod vitiosum est euacuare oportet paulatim ad in o icem quod salubre est pro eo reponere If corrupt bloud be in the bodie wee must by little little take away the bad and by litle litle procure in the place therof that which is good which way of curing or amending of corrupt bloud the Phisicions call in Greeke Epicrasis And to this Alexander Tralleanus subscribeth lib. 9. ca. 2. The reason why this is not to be done at once is for that the powers of the bodie would relent giue ouer And although that which is euacuated be superfluous yet by a sudden thorough mutation it doth more hurt than good It is better therefore to emptie the bodie safely and by little at once than by making hast to dispatch both the disease the partie diseased And here it appeareth how much they abuse Phlebotomy which detract the ill bloud so long til the good also begin to come wheras it may fall out that all the bloud will flowe forth of the bodie before that the good will appeare It behoueth therefore the euacuatioÌ„ to be little And as Gaelen councelleth in this case before the opening of a veine to vse Epicrasis i. to giue the patient such meat as may cause good bloud that good bloud may still come in place of the bad and then a little after more bloud may be taken This therfore is called the direct bleeding because it is don of it self to euacuate that which by opening a veine ought in deede to be withdrawen namely multitude of humors of bloud of bloud principally of humors secondarily in asmuch as they are mingled with the blod The other are called indirect causes and are vsed only to reuoke or call backe the violent force of humors to the contrary part or
and lesse cold than other fleshie substances It needeth therefore no euacuation hauing naturally of itselfe how to be purged calore extraneo by a forrein outward and strange kinde of heate And againe Galen sayeth lib 11. of the same worke Cap. 14 speaking of Synochus a kinde of feuer Si in puerum incidat qui 14. annum non hactenus attigit mitti illi sanguis non debet propterea quod tantillis cum praesertim calidi ac humidi sint plurimum corporis substantiae quotidie defluat ac digeratur it a quod ex incidenda vena moliendum nobis fuerat id vltro nobis ex curati corporis natura praestatur i. If this feuer happen to a childe yet not 14 yeares of age he is not to be let bloud because such yong ones being of a hote and moyst constitution haue much of their bodily substance daily dissolued So that the same which we goe about to bring to passe by opening a veyne is done already to our hands by the constitution of the Patient Of this imp e diment namely the age beside old men and boyes are also meant decrepits and very Infants Auicen remembreth in quarta primi cap. 20. this matter writing almost in this manner Thou oughtest to beware of opening a veyne in a complexion too colde in a Country too colde in time of extreme paine in a member after resolutiue bathinges after carnall copulation in young age vnder fourteene and in olde age except thou haue great confidence in the solidity of the Muscles in the largenes and fulnes of the veynes and rednes of the colour such either young or olde boldly may be let bloud Yet those that are young of fourteene yeare olde must bleede orderly by little and little at once and at each time more than before and all this did Auicen take out of Galen So that although in Phlebotomy wee are chiefly to consider these three thinges that is to say the danger of the disease the age and naturall strength of the party yet the age is sometime not wayed when the strength of nature serueth either in old or yong Wherfore Galen lib. de curand ratione per sanguinis missionem cap. 13. willeth to let bloud young sanguine children and olde sanguine men without consideration of age if the disease be vehement and dangerous if the body bee sufficiently strong and that there also bee vehemency of the Pulsies In these cases Necessitas non habet legem Necessity hath no Lawe So in Spaine they let children bloud of three yeares olde and lesse and Auenzoar writeth that hee let his sonne bloud at three yeares of age and so preserued him from death lib. septi cap. tertio Collecta These limits of yeares in this point Hyppocrates did not set downe Galen appointed them from fourteene to seauentie Mooued by the foresaide reasons Rhases in olde decrepite age nothing at all fearing the danger of exhausting the naturall heate that remaineth in the body with the bloud whereof notwithstanding often proceedeth the hazarde of life by vndiscrete bleeding by opening a veyne in decrepite persons did then helpe and did great good in grieuous Pluresies and Perypleumonias And concerning young folke this wee find true by experience that in the fifth or sixth yeares of their age by opening a veyne Pluresies inward inflammations and other grieuous diseases are cured Yea wee see by the very course of Nature that Children and sucking Infantes oft plentifully bleede at the nose without any hurt of body or any diminishing of their naturall strength The age of Childhood hath naturally her strength and bodely forces why therefore may we not euacuate bloud according to the proportion of the same Especially when the childe is plentifully fedde hauing also large veynes and is filled with good concocted bloud Againe if it bee graunted that the forces of nature are impaired by bleeding whether is it better for the childe to periâ—h through plenitude and abundance of humors or to free him of his disease by abating that abundance though the strength of nature be thereby a litle hindered Therefore somtime the necessity of bleeding is great euen in childred as in Pluresies inward inflammations and continuall feuers There is therefore no age in my poore iudgement but may abide some measure of Euacuation by bleeding if the child bee past fourteene yeares of age Yet consideration is to be had of what constitution hee is whether his bodely substance be fat or leane thicke or thin grosse or slender hard or soft of much bloud or of litle In the first we may proceed to open a veyne in the other not and here we most carefully remember that in children because of their hot moist temperature lesse bloud must be taken than the plenitude seemeth to require The fift impediment is an ill disposition of the stomack incident to some men more than other some in whom chollerick humors flow to the mouth of their stomacks and maketh them apt to chollericke vomits although before they haue neither accustomed nor had any desire to vomit In thesemen bleeding is to bee forborne because thereby the troubled humors flowe to the mouth of the stomacke as to the accustomed place and because the stomacke cannot resist so great a Flux of humors being partly weake of it self and more weakened through their comming Hereof diuers great discommodities growe to the body yea this is the very cause that some fall downe and faint in bleeding For the chollericke humors flowing to the stomacke bite and nip the same and so per Simpathia through a certaine kind of compassion that is betweene the stomacke the heart and the braine it causeth Syncope that is sowning VVherefore Galen lib. 12. Method cap. 3. Durst neither purge nor let those bloud which haue the mouth of their stomacke very sensible tender weake and abounding with bitter choler and which persons also abounding with the same when they bleede in the very beginning long afore full euacuation bee made oft fall downe and faint by reason of the foresaide choler and crudity of humors And this is also the counsaile of Galen lib. de curand ratio per sanguin missio cap. 1. and of Auicen in quarta primi cap. 20. Ye may perceiue the mouth of the stomacke to bee very sensible saith Auicen when yee cannot swallowe downe sharpe and bitter thinges without hurt VVeakenes of the stomacke is knowen by losse of Apetite to meate and drinke Abundance of bitter choler is shewed by bitternes of the mouth by subuersion of the stomacke long time connnuing and by oft vomiting vp of choler These signes and tokens discried in any patitient doo dehort from opening a veyne Yea this ill disposition of the stomacke bringeth not onely Sincope but also sometime present death As Galen witnesseth lib. 9. cap. 5. Meden And Auicen in the former cited place The sixt is weakenes of the natural forces Of which there is a threefold condition for they are either firme or weake
and maketh her the more able to ouercome the same Repletion being somewhat lessened in quantity by bleeding It is not therefore repugnant but very agreeable to reason in this case to vse Phlebotomy For we see by daily experience that a small fire is put out by laying on too much wood at once or such wood as is greene and that then it burneth when the woode is remooued which hindered the burning thereof Euen so is inward heate of the bodie choaked with multitude of humors and the same is againe refreshed when some portion of them is withdrawen The second cause of crudity of humors is the debility of the inward naturall heate which happeneth in men of colde Complexions in men that haue beene long sicke and in olde folke in these bleeding is not vsed because bloud being taken away from them which is the restorer and maintainer of the inwarde naturall heate as yee heard before out of Isaacus consequently the body must waxe colde and crudity of humors increase Bloud therfore must remain in these persons to concoct and ouercome the humors in the body And therfore very well saith Auicen Non quotiescunque videris signa Repletionis est facioÌ„dâ— Phlebotomia That is Phlebotomy is not alwâ—ies presently to bee practised whensoeuer wee see signes of Repletion as namely when there is fulnes of raw humors in the body and this doth Galen also affirme lib. 12. Method Medend The tenth impediment is the vnfit disposition of the Aire when the same is too hot too cold too dry or too moist Also when the same is not cleare but troubled And therefore vnder the starre called Canis in the canicular or dogge dâ—ies when thereis excessiue heate and drith it is good to refraine bleeding Except great necessity doo vrge it So likewise in seasons too moist and too colde as in the winter in a state of the Aire temperately hot as when the wind is south or southeast wee may bleede temperarately and sparingly In a more cold state of the Aire as when the North-winde bloweth or North-west winde wee must bleede more sparingly than before In a right temperate and mild state of the heauens we may bleed plentifully especially the Aire not beeing greatly disquieted with great force of tempestious weather And here may be made a profitable collation in this practise by folding vp together as it were in one three impediments here specified The state of the Country being coâ—de the time of the yere beeing cold the present constitution of the Aire beeing colde All which three are outward causes and â—oyne in this third point which is common to them all three that is the Country the Aire and season of the yeare compasse about euery Patient Therefore in a cold Country and in winter and when the Northwind bloweth open no veyne If in a colde Country and in winter the wind blow South and that so necessity require wee may proceede with this practise so in a hot Country and in summer the winde blowing at the South bleede not If necessity in summer require bleeding open a veyne when the North-wind tempereth the immoderate heate of the season For surely these outward causes though obscurely and without any great perceiuing yet they doo either keepe in or disperse abroade and extenuate the substance both of inward heat and also of the inwarde humors And as in a temperature or complexion hot and moist Phlebotomy is vsed best and not to be vsed in complexions hot dry or complexions cold and dry So when the season is hot and moist as in the spring we may bleed safely But not so in a season hot and dry as is the summer or very cold as is the winter The eleuenth let is some great inflammation or extreme ach and paine as appeareth by Galen and Auicen who both forbid bleeding in hot inflamed feuers and in apostumations of great paine In these cases the opening of a veyne doth cause much busines and agitation of humors in the body Bleeding on the one side drawing and emptying humors the inflammation and ach on the other side striuing there against and attracting humors thither For all paine if it be much and all heat which concurreth with paine attracteth and hindereth the fluxe of humors VVhereby it commeth to passe that by bleeding in this case the inflammation is thereby increased and nature more infeebled and the same most chiefly when the bleeding hath beene temperate and done according to Art But in the foresaid cases if the bloud be withdrawen in great quantity euen till the Patient giue ouer and faint it profiteth very much for thereby the abundance of boyling bloud in gâ—eat inflammations is expelled and the inflamed member is cooled so that in vehement paines opening a veyne is a present helpe keeping backe the fluxe of bloud which otherwise would haue recourse to the pained place And here it is not to be forgotten that sometime the expulsiue vertue making hast to expell the cause of the griefe causeth thereby sometime an inflamma â—on The reason is for that the expulsiue vertue hauiâ—g done no good at the first â—nd 〈◊〉 more venemently than before to expeâ—â— that matter which causeth annoyance and doth therewithall wring out forâ—ibly some bloud out of the vpper partes or members into the lower afflicted part as Galen â—heweth at large lib. 23. cap. 3. Method Medend And therefore to keepe backe the saide inflammation bleeding greatly profiteth as yee haue heard before Cap. 6. And this is the intent and meaning of Galen where he saith In ardentissimis febribus si vsque ad animi defectionem sanguis mittatur statim totius corporis habitus refrigeratur febris extinguitur In extreame hot feueâ—s if we bleede euen to giuing ouer and sowning presently the state oâ— the whole body is cooled and so the feuer is extinguished In vehement pâ—ines and grieses therefore there is no better remedy fouâ—de than â—o â—et blouâ— euen tiâ—l the Paâ—â—ent ouercome Reade more hereof in Galen lib. 9. Method Med. cap. 4. lâ—b de curaâ—d Râ—tâ— saâ—g Mâ—ssionem capit vndecim Fuchlium libr. secund sectione quint. cap. quart sext institutionum Medic. The twelfth impediment is the extreame coldnes of the Region a Country which being cold cannot tollerate so large an Euacuatioá¹… as is this kind that wee nowe presently handle The reason is for that the body being before sufficiently cooled through the colde temperament of the place must needes waxe more cold when the naturall heate is drawen forth with the bloud Moreouer a country too hot cannot admit this practise because in such a place extremity ofheate draw eth from the body much inward heat of nature dissoluing of it selfe and dispersing the naturall forces and humors of the body and therefore in hot Countries the naturall powers are lessened there is lesse bloud in the veyns which is the reason that also in extreame hot countries the bleeding must be none at all or very litle A country
somwhat colder and moister than this nowe specified keepeth in the humors and inward heate dissoluing very little thereof Therfore men in such countries may bleede more abundantly The contrary to this hapneth in extreme cold countries scituated far Northward For the bloud congeled through extreme colde will not giue place to euacuaâ—ioÌ„ And again if the inward members should be depriued of their natural inward heate they were greatly in danger to perish with extremity of outward cold Look more of this before in the tenth impediment The thirteenth hinderance is the time or season of the yeare which is a matter also in letting bloud to be considered as namely whether it be too hote a season as in Sommer or too colde a season as in VVinter specially when it is frost and snowe For to what purpose is it when the bodie is alreadie sufficiently cooled through the colde season of the yeare to make it more colde by bleeding And for hote seasons if the heat be extreme those that bleede in them oftentimes die by sowning or fainting called Sincope or resolutio for extreme heat enuironing the patient doth ouercome the vital spirites which come foorth with the bloud drying weakening the state of the whole bodie Therefore in seasons extremely note it is a point of wisedome to forbeare bleeding which thing Galen teacheth lib. 11 câ—p 4 Method Medend in these wordes Et omnino quidem non mittes in tempore aestai is regione aestuosa caeli statn calido sicco Thou shalt not at all let bloud in Sommer time in an hote countrey and in an hote and drie state of the aire as vnder the dog-starre and from mid Iuly to mid September or rather to mid August By Galens wordes wee may perceiue that there is the like reason of the countrey and of the time of the yere concerning the heat and coldnes of them both But to put practisioners in â—iâ—de that these rules are not alwayes pâ—eciâ—ely to be obserued I giue aduertisement still as I haue done in other the like cases before that in this circumstance of the extreme colde or the extreme heat either of the time or of the countrey that it doeth not quite exclude bleeding at all time euen in cases of meere necessitiâ— but onely thus farre that these cannot admit so large euacuation by bleeding as their contraries may The Spring therefore beeing the most temperate time of the yeare when the forces naturall humors them-selues most abound is the best time to open a veine to auoide future maladies The next conuenient season is Autumne or Haruest And of the Spring the beginning thereof to be best Hippo setteth downe 7. Aphorism Aphoris 54. But hereof looke more hereafter in his pâ—oper pâ—â—ce and before in the tenth impediment The fourteenth let of Phlebotomy is former bathings or hote washings especially resolutiue bathes VVhich as Galen witnesseth in his booke of the Vtilitie of respiraâ—ion Cap. 7. do so forciblie euacuate the spirites from the whole bodie that it stayeth opening a veine And againe Hippocra writeth in his second booke Aphoris 51. That it is verie perillous much and vpon the sudden presently one after another by diuers euâ—cuations to emptie the bodie The fifteenth is a disposition to vomit of what cause so euer the same proceedeth For in this cause of lothsomnes of stomack if we let bloud the veines by bleeding exhausted do soone drawe vnto them that wicked and lothsome matter which lyeth in about the stomacke whereof looke more in the fifth impediment The sixteenth impediment may be custome or a former order oflife wherein wee are to consider to what meates wee haue beene most accustomed what excrementes are still reteined in the bodye contrâ—rie to former wont For too much former repâ—etion of the bodie with meate and 〈…〉 bleeding as appeareth in the first impediment But if there haue beene before a moderate meane obserued in eating and drinking wherewith the bodie hath beene safely nourished then we may boldly bâ—eed If it be otherwise then forbeare Yeâ— fâ—om this point also is takeÌ„ a sure note of the quantity ofblod that must be extracted For those that haue bin acustomed to be let bâ—od may bleede more in quantitie than they that haue not bin accustomed to bleede In this impediment moreouer consideratioÌ„ must be had whether Hemorroids or Termes are restreined contrarie to former custome Or whether wee still vse our accustomed exercises or no. But although diuers matters herein are to be regarded yet in custome princicipally these three are to be marked The precedent order of dyet the kinde of life that we haue spent before and former euacuations Those that haue liued sparingly either by their owne ordinarie prescription or by occasion of sicknes are to bleede lesse Those that haue liued more frankly may bleede more plentifully He that hath been alreadie let bloud so that the natural powers be not thereby too much enfeebled may as I now said better abide to bleed than they that neuer were let bloud For this is a generall rule Things accustomed yea if they be euill things are the lesse grieuous whereby is confuted the opinion of the vulgar sort who greatly commend the first opening of a veine as a matter greatly healthfull and discommend all the other bleedings making their reconing of this in their most extremities that though they were neuer let bloud before yet now they will send for the Phlebotomer as their last refuge The seuenteenth impediment is carnall copulation presently after which the opening of a veine is also forbidden because Venus so lately embraced hath thrown down and weakened the powers of the bodie and warmed the same more than was conuenient How the powers of mans bodie are loosened enfeebled through venerious actes Galen most excellently declareth lib. 1. de Semine cap. 25. saying In the time of carnall copulation the stones or genitors drawe forth of the veines all such seedie humor as is conteined in them which is not much in quantities and that which is the same is admixed with the bloud in the likenes of dewe and this to do is the office of the Testicles So that first by the genitors hauing more strength than the veines the seedie moysture is violently drawen from them And againe the veines drawe the same from the members next vnto them These partes againe exhaust from those next vnto them in like sort so that this extraction ceaseth not till it haue gone thorow euery part or member of mans body by reason whereof all the bodily partes are depriued of their proper nourishment and always that part which is perfectly throughly euacuated violently taketh from that which is next adiacent and hath more plentie of seedie moysture to be extracted This I say being done alwayes and all partes mutually participating among themselues necessarily all the receptories and partes of the whole bodie must be euacuated till the strongest of all the partes be filled
And further it commeth to passe not onely that the seedie moysture is drawen from the partes of the bodie through carnall copulation but also the vitall spirites passe out of the arteries with the same And therefore it is no â—â—arucile if such as vse lecherie immoderatly become weake both these being taken from the bodie that is to saye the seedie moysture and the vitall spirite VVhereunto may be added the pleasure of Venus which of it selfe is able to vnloose the vitall firâ—itie of the bodie Yea it is knowen that some haue dyed of too much pleasure in the act Marsilius Ficinus in his booke de Sanitate tuenda Cap. 7. confirmeth in these words aâ—l that hath been hitherto said Venus saith he if it do but little exceede the powers naturall of the bodie presently it exhausteth the spirites and specially those that are most subâ—ile Also it enfeebleth the braine weakneth the stomack and hart-strings yea there cannot be a more hurtfull thing to the witt and memorie VVhy did Hippo. iudge Coitum to be like the falling sicknesse but bâ—cause it woundeth the minde which is diuiâ—e and heauenly The immoderate vse of ust is so hurtfull that as Auicen sayeth in his boode de Animalibus If but a little seede issue foorth more than nature can afoorde it offendeth more than if fouâ—tietimes so much bloud had proceedâ—d And therefore not without some good grounde dâ—d the auncient wâ—iters immagine the nine Muses and Minerua her selfe to be vi giâ—s Reâ—d moâ—e hereof in Galen Chap. 86. Artis Medicinae Pauli Aegnieta lib. 1. Chap. 35. In Aetius lib. 3. Chap. 8. The seuenâ—eenth impediment is long continuance of a disease wherewith the strength of the bodie being wearied a long tract of time the same cannot nowe tolleraâ—e bâ—eeding And forasmuch as now the bodie is more than inongh enfeebled brought lowe thorough a long continuing and languishing sicknesse by bleeding wee maye more easily quite extinguish the patient than remedie the disease Galen de Curand ratio per sanguia missio Chap. 20 And Auicen confirme the same giuing aduiâ—e to forbeare opening of a veine in bodies which haue endured long griefes except corruption of bloud moue vnto it In which case sometime bloud may be detracted from persons that haue continued sicke of long time And Fuchsius councelleth saying People in consumption oâ—de folke weomen with chiâ—de yong chiâ—dâ—en are not lightly to bleede The nineteenth impediment is small quantitie of humors being in the bodie for a good consideration is to be had how the humors offend in the bodie in quantitie or in qualitie VVhether there be many or fewe humors in the pacient And therefore sometime vpon this ground wee open a veine in weomen with child if there be abundance of bloud sufficient both for the mother and the infant in the wombe if the bodily strength be firme and that the greatnes of the disease in them so require it But hereof more at large I meane to write in another place And agâ—ine beside the quantitie the diuersitie of nature in humors is also a profitable consideration in this practise For euen according to the varietie of humors the patient is oft either to be let bloud or not letteÌ„ bloud which Galen seemeth to witnesse li. 4. de Sanita tuend saying Some humors come to perfect nutriment before the bloud some are as it were halfe concocted some altogether rawe and vndigested Some are but little different from the forme of bloud some are wholly changed into bloud some verie litle some more some verie much VVhen humors are a verie little as it were from the nature of bloud as not yet turned into the same or when they haue a verie little exceeded further than the nature of bloud wee may confidently open a veine VVhen the same is more than a verie little either the one way or the other on this side or beyond wee are to deale herein more considerately If the humors want much of or exceed much beyond the nature of blond we are altogether to forbeare bleeding The twentieth let after the small quantitie of the other humors may be the quantitie of the bloud which the wise Phisition in this practise will most wisely regard As for example if there be little good bloud in the body and abundance of other humors wee are to make staie from opening a veine If any of the other three humors be but litle in quantitie and the bloud abundant we may boldly let bloud Yea by diligent obseruation the Phlebotomer shall easily perceiue what hurtfull humor may be withdrawen with the bloud and therfore if there be many cholerike humors in the body of man and yet not mixt with the bloud or that there be many flegmatike and rawe humors and but little bloud by no meanes is a veine to be opened This doth Anicen forbid in quarta primi Cap. 20. If the bloud be good and little and that there be in the same bodie many ill humors also bleeding taketh away the good and leaueth the bad behind And a little after he addeth that the Phisition is diligently to beware lest by vnskilful bleeding in these cases hee bring the patient after he hath extracted the bloud the ill humors still remaining to an excessiue heat of cholericke humors or too much cruditie of colde and vndigested humors And although as ye haue heard before Phlebotomy doth equally euacuate all humors Yet because now so little bloud is in the veines whereof a little portion is withdrawen by bleeding it followeth that but a little bloud and lesse than before remaineth now in the veines with the other humors and that there is great plentie of the other humors forasmuch as they come not out so redily when a veine is opened as the bloud doth and therefore by a necessarie consequent bloud being gone which was as it were a bridle to other humors choler must excessiuely boile and flegme become more colde and vndigested VVhereupon also I gather that those haue done ill and verie vnskilfully which haue reproued Auicen of error in this place seeing he is rather verie highly to be commended then vpon euery small and light occasion to be reprehended Finally wee are to forbeare letting of bloud after continuall vomitings hunger great watchings extreme labours and after all such things as immoderately 〈…〉 body drying and dissoluing the 〈…〉 thereof as Rhases noteth lib. 7. 〈…〉 Almonsorem Touching the causes 〈…〉 ring Phlebotomie they may soone be gathered of their contraries by those impediments here specified And in the fifth Chapter before yee haue heard both the direct indirect causes which may moue to let bloud Vnto the which place I referre the studious reader at this time concluding this Chapter with the verses of Schola Salerni wherin are set downe most of the impediments here spoken of Frigida natura frigens regio dolor ingens Balnea post coâ—tum minor aetas atque senilis Morbus prolixus repletio potus
and had experience once or twise before of aborsion the third moneth if shee had not bled the seconde moneth In the other moneths the fifth and eighth shee was in danger of suffocation except shee had bled againe VVhen women are brought a bed they must not bleede except their seconde birth be suppressed or a Feuer molest them In the which cases also carefully consider in the Patient her naturall strength Those that haue their termes naturally according to the due course of nature and the course of the moneth are not to bee let bloud except in immoderate Fluxes to drawe backe the matter VVhen they breake forth naturally the whole matter is to bee let alone to nature Eighthly bleeding is not good for such persons as are bounde and haue the excrements retained For as yee heard in the eighth Chapter Fig. 2. The veynes beeing emptied they attract matter from the next members and they attract from the stomacke the moystnes of the excrements whereby they become more dried and baked bring diuers waies annoyance to the body In which case the wombe by Art is to be made solluble as appeareth in the place now cited Finally a veyne may and is to bee opened without hurt or daunger whensoeuer wee feele our selues to bee heauy lumpish and stopped or stuffed in our bodies first considering the quantity and quality of the fulnesse which wee may knowe and discerne by certaine tokens whether it bee Plenitudo quo ad vasa or quo ad vires as was shewed in the first Chapter the more heauy and drowsie a man feeleth him selfe to be so much the more it appeareth to bee that fulnesse which is quo ad vires But if hee feele the former stuffing in his body increased than is it that plenitude Quo ad vasa And thus much to know the quantity of the Repletion The quality of the fulnesse is knowen partly by the colours partly by those things which are very neerely ioyned to the nature of the humors But of these signes sufficient hath been spoken before in the first Chapter In these cases of Repletion if the strength of the body shall bee answerable wee are to open a veyne for as much as bleeding is the chiefest remedy to abate fulnesse But if the stuffing and fulnesse of the body bee greatly grieuous and the state of the body not answerable it is not alwaies necessary to let bloud As Galen noteth lib. de Curand ratio per sanguinis missio And againe Phlebotomy is not onely profitable when any of the foresaid fulnesses grieue and oppresse vs But also as hath beene saide in cases without any fulnesse As in the beginning of an inflammation which commeth either of a blow ache paine or weakenesse of the member For paine as was saide draweth the bloud vnto it and of the weakenesse of the bodily parts cause an inflammation without fulnesse Also when the disease is great and vehement we let bloud although no fulnes appear in the Patient yet alwaies hauing a regard to the age and strength of the party as Hyppocrates setteth downe in these wordes 4. Vict. acutorum 17. In acutis morbis sanguinem deâ—rahes â—ivehemens morbus videatur florueritque aegrotanti aet as virium affuerit robur That is in sharpe disease thou shalt let bloud if the sickenes seeme great if the age of the Patient permit and that there be sufficiencie of naturall strength And thus much of the persons that are to bleede concerning the which point more may be easily coniectured and collected of the studious Practitioner from the Chapters precedent What corruption of Humors bleeding remoueth from the veines Chap. 10. IT hath beene said that bleeding generally is the present and proper helpe when Humors offend in the veyns either in quantity or in quality It hath been already declared that some humors it euacuateth other some it reuoketh and pulleth backe which is called revulsion whereof hath beene spoken in a distinct Chapter by it selfe Now order requireth in some briefe sort to shew what corruption of humors generally bleeding euacuateth from the veynes The defect of humors in the veynes is either Plethora or Cacochymia as was shewed in the first Chapter The onely and peculiar remedy of Plethora or abundance of bloud is the opening of a veyne And forasmuch as fulnes of bloud is of two sorts One of fulnes simple and pure consisting of a like proportion of the best humors and the other vnpure and compounded taking part with Cacochymia that is abundance of humors corrupted in the veynes Therefore it is to bee marked that in both these Repletions the opening of a veyn greatly profiteth VVhen so euer therefore the muscles are sounde whole and full the veynes large great and swelling menacing thereby imminent danger to the members presently bloud must bee detracted After which eu cuation these effects will insue mitigation of paines caused by ouermuch retching of the veynes ease vnto the body which seemeth as it were nowe disburdened of a grieuous and waighty ponderousnes a more nimblenes to all exercise and labour than was before an increase and refreshing of the naturall heate an opening of the straight passages and pores of the members Finally there will follow a happy repulse of diuers imminent dangers and diseases wherevnto by all probability in short time the body would haue beene brought For it is greatly tobee feared lest the veynes ouerreatched with fulnesse of bloud should open and breake and through that meanes cause inflammation or lest some generall obstruction should arise which might keepe backe the inwarde heate and so vtterly choke vp the bodily forces wherby might bee caused some vehement hot feuer or as it oft hapneth a sodaine death of the party Now from these daungers can no man bee safely and speedely freed either by purging exercise or abstinence but by bleeding and with the bloud is this Repletion most safely abated That fulnes which is vnpure and compounded is not so safely cured by bleeding and yet the more nigh that it commeth in likenes to that Repletion which is simple and pure the more confidently and the more plentifully we may let bloud And the more vnpure that it is the more carefully and sparingly ought a veyne to bee opened Therefore those persons that haue an il constitution of body and yet haue their veyns abundantly filled or that beeing of a constitution are yet repleat with corrupted meates These I say are to bleede no longer but to auoid the danger of fulnes and the impurities remaining behinde are to bee expelled by Purgation Hot chollericke Repletions of all vnpure constitutions are most safely abated by bleeding because bleeding in this case not onely diminisheth choler but also cooleth the same mightily Melancholly Repletions can nothing so well away with this practise because it doth not so exceede in heate that it neede at all any refrigeration or cooling and the flegmaticke constitution can in no case brooke it for being a very cold
remedies for hot distemperature and thus much for this matter How to know by certainâ— signes the greatnes of the disease and the firmenes of the naturall forces wherby coniecture may be made whether the Pacient bee to be let bloud or no. Chap. 13. IN euerie affect wherin bleeding auaileth the same is out of hand to bee done if the disease be vehement and the strength of nature agreeable Touching the disease it is sometime so small that it is cured alone of it sâ—lfe without the helpe of art And although at other times the same be very vehement great yet the forces of nature not onely sceme but also are indeede so weake that they can not tollerat any euacuation Yea vndoubtedly this practise would vndoo disâ—roy dissolue the whole substance of the naturall forces for whose preseruation sake in truth we take the cure in hand Therfore to know thorowly and perfectly how much bloud is to be takeÌ„ in euery disease we must first consider how great and greeuous the sicknes is and how firme and strong the powers of nature are Now a disease is either already caused and in state or is now a beginning or proceeding to state Againe a disease is called great greeuons ether in regard of it selfe or of the cause thereof which consisteth in the humors or in regard of the greuousnes of some accident But first it is great of his owne kinde and nature Thus an inflammation in any meÌ„ber is more greeuous then a simple distemperature in the same member And again the greatnes of a disease is iudged by the great vse and excellency of the meÌ„ber which it possesseth as if it be any principall member namely the hart braine or Liuer and it is contraty when the griefe is in a base vnnoble or no principall member Againe iudgement touching the greatnes of a disease is to be giuen according to the locall placing of the members as they stand next to the principall partes Therefore next the diseates of the hart braine and liuer are to be accompted those of the lunges sides stomacke and splen and wee are otherwise to iudge of those that are in parts further off as namely the bowels raines bladder and the outward limmes consisting of bones flesh and sinewes called in Latine Artus and in all the other members placed in the extremities of the body Againe in this point iudgement may be giuen by the sensiblenes or feeling of the member wherein the griefe is if the diseased member haue a quick sense and a liuely feeling the greater ferre is the danger than if the member were but of a blunt and dull sence The greatnes of the cause in any disease is iudged by the condition and nature of the humour that is gathered to the part affected is there the continual matter of the griefe wherein we are to consider whether the humour be good or bad putrified or not putrified or of what ill quallity it is any maÌ„ner of way And also whether the same humour be too much or too litle if the humor which is the cause of the sicknes be wicked corrupt theÌ„ we may soon iudge the griefe to be great The greatnes of the antecedent cause is perceiued by the fulnes or emptines of the veins bowels of the whole body by the purity or impurity of humours coÌ„teined in the same We iudge the greatnes of the accidents by the intention remission of those things which do chaunce as the increasing or diminishing of paine thirst appetit watchings and such like all which bring down the forces of nature and make the Pacient to languish As for example If any yll disease as namely an inflammation possesse the Liuer braine or parts next the hart and that there be a venomed and putrified humour whâ—â—ewith the veines of the body appeare to bee stuffed and filled so that there insueth in the patient agitation of the bodie ill appetite thirst paine watchinges this sicknes wo may esteeme vehement in the which euacuation may do great good And againe a disease in which these do not concurre but rather their contraries we may iudge a small infirmitie and not requiring any euacuation Betweene these are their interiected sicknesses of a middle sorte which are to bee euacuated more or lesse according to the remission or intention of the disease and the accidents thereof Now let vs come to the estimation of the forces of nature of the natural powers some are setled and bred in particular members and are common and flowing to all partes of the bodie The forces of nature bred and setled in a member haue one and the selfe same essence as it were of the inward heat and they are called one nature and are ingendred as a man might say of the internall spirits and the first begotten moisture whereunto is added as a matter thereunto requisite a sound and whole substance of bodilie members The essence of the common forces of nature haue as it were a threefold originall or beginning or is â—â—threefold spirit diffused and spred into the whole body The force called virtus animalis the animall vertue is diffused from the braine by the sinewes The vitall force from the hart by the arteries The naturall strength from the Liuer by the veines The bodily powers that are bred in ech of these parts the brain the hart and the Liuer are susteined by those common and flowing powers of nature so that the whole liuing creature name ly man is ruled and gouerned of both these vertues Insitae communes setled and common to vse as good english wordes as wee may to make manifest this great point of phisicks skill Therefore if this liuing creature and most excellent creature man bee in perfect health of necessitie these powers of nature must be sound and vncorrupted which they will bee if their substance consist in a iust moderation that is to say in a iust or right quantity and in a good temperament And contrary wise if the quantitie or temperament of their substance be inuerted chaunged turned or altered they must needes suffer hurt and offence and so become weake and enfeebled Whereby their functions are presently hindered the rule of all the bodie is disordered and at length there will follow euen extinction of life it selfe And therefore whether the natures forces are weake or strong may be knowen by their seuerall operations duties Thus raw and vndigested excrementes either by siege or by vriyne when either the one or the other is thinne watrish or like vnto water wherein flesh is washed do shew imbeâ—illity of naturall force so doth holding backe of these excremntes or any other function naturall that is staied or hindered Wee discerne the vitall strength to be enfebled by obscure languishing and smal pulse by breathing hardly and with paine and oftner more quickly thaÌ„ was accustomed by smalnes and faintnes of speach so as the same onely come thereby and not
thorow fault of the lunges and brest as sometime it doth in whom notwithstanding the vitall force may be sufficiently strong The contraries to these declare firme strength of the vitall vertue These thinges declare the animall po wers to be enfebled tumblings and tossings of the bodie the senses offended watchinges rauings and other principal actions hindered The contraries hereunto shew the contrarie that is firmnes strength of the animal vertue By these functions then you see how it may be coniectured what power in nature is hurt or offended Againe these powers are offended or seem enfebled two waies either because they are outwardly oppressed or because they languish inwardly of themselues in the euacuation it helpeth greatly to know the one from the other for the forces oppressed require large euacuatioÌ„ the other none at al. And the distinction of these is to bee sought out of their euident causes If causes haue gone before which haue already altered or wasted the substance of the forces naturall then wee may iudge them that they are faint and languished If these causes haue not been precedent but that the Patient is only troubled with an vnaccustomed ponderosity then these are but wronged and oppressed The euident and outwarde causes which alter the temperament of the setled vertues are burning Agues which melt the bodily moystures or whatsoeuer els that excessiuely heateth cooleth moysteneth or dryeth the sounde massiue strong and solide parts of the bodie The substance of these parts is wasted by very long sicknes which bringeth the Patient into an Atrophia that is a kind of consumption wherein the body consumeth away with leannesse and is not nourished albeit the sicke continually eate his meate Or into Tabes which is an other kinde of consumption wasting the body by long sickenes and lacke of nourishment consuming and putrifieng the Lites drying away the Patient for want of naturall moysture hauing matter and bloud mixt together The threefold spirit of the flowing humor is altered ether through some distemperature or some poisoned qualitie of the aire which compasseth vs about or through the il quallity of other thinges which violently breake in vppon vs or through some wâ—cked disposition of the bowels or other humours The heate of the aire not onely of that which outwardly compasseth vs about but also that which wee draw into our bodies by breathing inflameth first the lunges then the hart all the spirits so far till often times a feuer is kindled and caused thorow the same Thorow which distemperature of the spirits needs must the strength of the body languish becom enfeebled yea by this excessiue heat of the air the spirits are not only subiect to alteration of temperament but besides they are also thereby greatly wasted diminished Euen so in like maner immoderat cold outwardly the same receiued inwardly into the body by breathing weakneth the spirits inward heat yea soÌ„time altogether put out and extinguish the saá¹e The aire venemous pestilent drawen into the bodie with an infection quite ouerturneth the spirits of life and ofnature wherof â—nsuâ—th grieuous sicknesses to the body no litle decay of bodily strength yea life it selfe is taken away by the so daine disease commonly called the plague Now much more apparantly are the spirites infected with biâ—ings of Scorpions mad dogs and venemous beasts than by the contagion of the Aire Moreouer they are inwarde and hidden causes which doo greatly alter the spirits and whensoeuer any principall part of the bodie is troubled with any distemperature vpon any occasion If the same proceed far it must of necessity goe to the spirites there bred and ingendred And so by offending of them will lessen the strength and vertue of nature Also if any corruption of humor rule in the body the spirits are disperced and offended by the corruption or distemperature of the same humors Therefore when abundance of rawe humors passeth either the whole body or the stomacke and chiefly the mouth of the stomacke the substance both of inward heate and of the spirits waxe cold the Patient languisheth yea sometime hee giueth ouer the Ghost and soundeth Herevppon also when hot choler burneth as it were the inwarde spirits with immoderate heate or nippeth and pricketh the mouth of the stomacke it is the cause of no small euils in the body of man Sometime also it falleth out that some one or other humor in the body is mixed besprinckled or bedewed as it were with some kinde of venemous filth as when the seedy moysture is kept in and putrifieth Or menstruall termes in weomen longer retained than is their due course or when any clodded bloud remaineth behind and is not expelled the vapour of these and such like infecting and decaying the spirits bringeth sometime Sincope sometime suffocation of the wombe sometime the falling sickenes and such other mischiefes which greatly annoy the forces of nature And thus diuersly are the spiriets offended through distemperature Againe the substance of the spirits and naturall forces is diminished sometime euen of it self and as a man may speak voluntarily of his owne accord for the substance being of it selfe thin and wastable and included in an hot thin and open body Therefore of it selfe it dissolueth vaniâ—heth away Sometime the same is decayed by occasion of outwarde and euident causes as are namely these The aire which compasseth vs round hot and dry immoderate euacuations vehement motion affects of the minde paines watchinges great emptines and all vnprofitable excrements which cannot but carry with them from the body as they passe a great quantity or portion of the vitall spirits seeing their substance is spread ouer the whole body and also flowing with other humidities whereby it commeth to passe that whether the belly be very laxitiue by nature or by medecin or that the vrine bee made immoderately as in the infirmity called Diabete or that matter or water go plentifully forth of the brest stomack belâ—y or any great apostumation thereby of necessity the forces of nature must be mightely decayed Much more manifestly must it so fall out when there is any great euacuation of bloud or good humors whether the same pas forth of a wound the nose hemorroids Piles belly or other place In like maner abstinence which taketh away from the body needefull nourishment enfeebleth nature Labor likewise and heat disperseth the substance of the spirits by vapors sweat And therfore they which liue continually in labor about furnaces hot baths because daily some of their substance decayeth doo not commonly so abound with excrements as those that leade a slouthfull delicate and idle life Moreouer they that liue very incontinently haue also for the most part very enfeebled bodies able almost to abideno Phisick by a continuall decay of seedy moystures they haue their spirits mightely consumed wherof look before in the 8. cap. Fig. 17. Great ach paine worketh the same effect more than
was otherwise but weake let vs so esteeme of euacuation But as in dyet so in euacuation we must beware lest the vertues of nature extremely enfeebled do quite giue ouer and be altogether extinguished in regard whereof we are circumspectly to foresee how farre the patient can or may endure the same For in truth a iust quantitie withdrawen without any great hurt taketh away and cureth the disease And this point of the iust quantitie is knowen by a comparison of the disease and of the strength of nature for persons firme and strong may bleed as much as the sicknes requireth They that are not so strong may bleede lesse they that are quite cast downe are not to bleede at all And here a profitable question may be moued whether naturall strength may so greatly be enfeebled that it cannot or may not away with any euacuation be it neuer so little VVee see many times that in great of decayd strength there fall out voluntarie euacuations which do much good and procure health And againe it seemeth that to ech diminution of strength be the same great or smal the quantitie of the euacuation may be proportionated accordingly Neither is it credible that an vnce or half an vnce â—â—blod taken can doe no great hurt to the naturall vertues albeit they bee alreadie much decayed These matters seeme somewhat obscure but that the question may be explaned and all ambiguities of auncient writers taken out of the way we answere by distinction affirming that there are three degrees of quantitie in euacuation The first degree is when the same euacuation is thorow perfect and absolute taking away either all or the greatest part of the matter that causeth or continueth the disease The second degree is a profitable euacuation but not so perfect and absolute as the other which taketh away onely some part of the sicknes making that which remaineth more easie and tollerable than it was before The third step is so small little an euacuation that the pacient therby is not one whit eased or relieued Now to come to aunswere the former question the naturall strength is seldome so greatly deiected except the same be altogether ouercom past all hope of recouerie but that it may abyde some little euacuation But hereof the auncient writers haue made no mention at all being as it were a matter altogether vnprofitable seeing it is so little not procuring reilefe to the â—â—cke patient but rather bringing more daunger to tâ—â— naturall forces aire die decayed And in fiâ—e they haue decreede and set downe that in this case no euacuation should be vsed Therefore the naturall powers being firme and strong require an absolute and perfect euacuation The same but meane and somewhat enfeebled an euacuation more vnperfect and yet profitable altogether decayed they require none at all If the disease be verievehement so that it cannot either at all or well be cured without bleeding it requireth necessarily abundant euacuation The same but meane and not sowehement it requireth a more moderate bleeding but yet the same greatly profitable because the cure may afterwardes be accomplished with the more celeritie and safetie If the disease be small it requireth small euacuation or none at all Now let vs make comparison of the greatnes of the disease and firmenesse of the strength together VVhen the strength is verie firme and the disease meane and not verie vehement bleeding is not altogether necessarie but onely profitable in which case bloud may be safely taken and as much as the disease needeth There is no feare to diminish a little the bodily forces so as the roote of the disease may be pulled vp For they are againe verie speedily and redily recouered VVhen the strength is firme and the disease daungerous replenishing the veines with an immoderate fuldesse as it falleth out in the bodily constitution of wrestlers and in feuers called Synochi a plentifull euacuation is to be appointed answerable to the greatnes of the disease Yea it profiteth sayeth Hippo to bleede euen vnto Syncope If the patient maye abide it in which place Hippocrates meaneth not that sowning which commeth of feare or of cowardlinesse or of sharpnesse of humors pricking and prouoking the mouth of the stomacke but onely that which commeth of abundant euacuation For so in an extreame disease Hippo. appointed as a rule and iust order of euacuation And this defect of minde and strength is called Lipothymiae or Liposychia in which the partie speaketh heareth seeth and knoweth them that are present Nowe Syncope is as it were a suddeine decay of all naturall strength as in the falling sicknes in the which the patient neither seeeth heareth or doth any outwarde action Lipothymia is more easie than Syncope and accustomably goeth before the same In the foresaide affectes therefore wee let bloud euen vntil Lipothymia come vpon vs and yet rashly or without iudgement Now when the powers of nature begin to quaile and giue ouer through euacuation we must stay the bloud Neither are wee to proceede so farre as vnto Sincope for then the partie escapeth but daungerously albeit the strength of the body be reasonably firme In consideration whereof wee are to withdrawe the abounding humor as the bodily forces will permit And whensoeuer they are wasted albeit some of the offending humor remaine still behinde yet wee are presently to desist and this shalt thou most certainly vnderstand if thou diligently marke and obserue the Pulsies how they alter from great to little from equall to vnequall from strong to weake from apparant to obscure and by marking how the force of the fluxe of bloud beginneth to relent and the patient to waxe weake That practisioner which setteth by his credite and will auoide ill speaches must neuer through bleeding bring his Patient to Syncope because the same being as it were an image of death terrifieth the standers by and putteth the Patient in a great hazarde of his lyfe Yea and it is better to let the patient still remaine in griefe than to take away with the disease life it selfe And hetherto we haue shewed what is to bee done touching the quantitie that must be withdrawen when the powers of nature are firme and constant If the disease be but meane and the bodily powers but indifferent the euacuation must be moderated which may remoue the whole cause of the sicknesse with little or small hurt to the strength of nature VVhich albeit it be but a small and moderate bleeding yet the same is verie profitable as ye haue heard before If a great sicknesse concurre with strength alreadie decayed and that the same also require some large euacuation yet because the powers of nature cannot tollerate it the same must not be done wholy at one time but by iteration as yee haue beene tolde lest wee take away both the disease and the partie diseased Natures forces being quite ouerthrowen albeit the disease so require yet the bodie can permit little or no euacuation for it
that wee are forced oftentimes after wee haue let bloud in the beginning of a sicknes to take medicines purposely to asswage dolors and paine I perceiue not how bleeding can take the good and leaue the bad seeing nature alwaies reserueth to it selfe as a friend good humors good bloud reiecting those that are naught and vnprofitable Also when he saith it attenuateth the humors hee is contrary to himselfe for in quarta primi cap. 4. he iudgeth rather bleeding to make humors thicke than thin The bloud and spirits themselues which attenuate the humors by bleeding being withdrawen Againe this is wonderfull that when the state of the disease is past and the Patient past danger that he would haue then the miserable Patient with a new wound and cutting of a veyne againe tormented If any thinke Auicen to be blameles as being of this iudgement that a veyne is to be opened when nature hath attempted Crisin that is the iudgement of the disease which fallâ—th out to bee vnperfect and litle not able to doo the feat and accomplish the whole force neither doth this defende him For by what reason would yee haue bleeding to euacuate the matter left behind of an vnperfect Crisis The naturall vertue being made so weake by that time with continuall contending and striuing with the disease that it can doo no good or very little in the cure and especially when the rest of that matter is daily vsed to be easily euacuated by purgations In sharp dangerous sicknesses therfore euery one seeth here Auicens error for in these sharp vehement continuall diseases we must bleede or be purged the first day yeâ— stay in these is very dangerous as Hyppo saith 4. Aphoris Aphoris 10. If Auicen meant it of Morbi salubres i. recouerable diseases in these truely neither first nor last nor at any time are we to bleed for then most vsually we let bloud when a disease is vehement and dangerous The opinion of other some in this place is to be â—aughed at who thinketh that Auicen admonisheth not to bleede at the beginning in sicknesses not dangerous as in a tertian because nature is terrefied by the newnes and sodainnes of the disease and these make or imagine nature to be a thing indued with knowledge or an vnderstanding and knowing faculty which is not so But if nature be made afraide in sickenesses not perillous how much more will she be afraide in daungerous diseases in which not withstanding wee hasten to let bloud euen at the very first These matters therefore are full of error Let this therefore bee the conclusion that wee must bleede in the beginning of sickenesses VVherevpon Galen counselleth the disease being come to open a veyne lib. de Curand ratio per sang missio cap. 9. cap. 12. If faith hee there bee repletion of hot boyling bloud whereby a strong ague is inflamed presently euacuat yea euen vnto sowning yet still regarding the strength of nature And this is his aduise prim Aphoris Aphoris 23. VVhat diseases so euer are caused of plenitude or other corruption of humors in the veynes they are at the beginning to bee cured by bleeding for by this meanes the disease likely to grow is kept backe and so much as is already bred nature will easily subdue Thus hot Agues before they are yet inflamed with heate of boyling bloud or by vehement putrifaction are may bee cured Also inward inflammations at the first as long as the flowing humor cleaueth not to the member but followeth the bloud may be cured The said humor issuing forth with the bloud when a veyne is once opened strength at the beginning is firme and constant in the Patient almost like vnto vs that are well in health If therefore at any time bleeding bee needefull the same may best be done at the beginning he that in fulnes of bloud or fluxe of matter will stay from bleeding and vse other helps in a peruerse order of healing he doubleth the griefe and troubleth the forces of nature more than is conuenient Yea let the veyne so timely bee opened as the stomacke and first veynes be not first stuffed with either corruption or cruditie of humors or meats vndigested Thus you haue heard the former words of Auicen to be erronious howsoeuer certain labor to salue them vp yea Auicen seemeth to vnderstand his owne saying not only of particuler diseases in the members but also of all other diseases For afterwards speaking of all Feuers and especially of Febris fanguinea Feuers caused of bloud hee counselleth in them not to let bloud abundantly except there haue gone before concoction and concerning this reason that humors are lessened by bleeding it cannot be so for yee haue already heard that both before bleeding and after there is retained in the body one and the selfe same proportion of humors If any difference or mutation happen seeing the thin humor issueth foorth with the greatest speed and the thick humor but slow it is more likely and probable that opening of a veyne should rather make the bloud and humors thicke than thin A gaine whereas he saith in his reason that the humors thereby are agitated moued and driuen through the whole body how should there bee this agitation of humors seeing rather this practise abateth the multitude of them which was before the cause of perturbation sickenes In reason all things now should become farre more quiet than before VVhereas he saith the ill bloud is mixt in the veynes with the good what inconuenience commeth thereof if a veyne bee opened then no doubt the bad must passe foorth with the good Put the case there bee a strong or vehement sickenes caused of abundance of bloud onely as are both the Synochi Feuers as is the putrified feuer caused through plenitude as are Angina Pleurisis Peripneumonia also inflammations of the Liuer and other partes In these if they bee great and dangerous through much abundance of bloud who will not presently open a veyne who will not while strength serueth take away that fulnes which bringeth a disease and danger of death Hereupon in Synoâ—ha presently at the first we hasten to let bloud euen till the Patient faint and before the matter putrifie But Auicen in a sanguine feuer at the first letteth bloud sparingly more plentifully afterwardes when signes of concoction appeare But what concoction doth hee looke for of good bloud and already well concocted and offending onely in quantity In these sanguine feuers therefore euen as in very sharpe sickenesses either to put off or to stay bleeding it is very ill as Hyppocrates saith if the disease be not so sharpe or vehement yet let bloud at the beginning according to the proportion of the fulnes If wee should in these stay with Auicen till concoction the beginning and state of the disease be past wee should suffer the disease to grow increase and cause for want of skill the Patient to bee cruelly hand'ed
sauing in the legs In a chollerick body when the ☽ is in ♋ sauing in the breast The last halfe of Scorpio except in the priuy members or in ♓ sauing in the feete Sanguine men may bleed in any of the signes so the sign be not in that member Againe after the Mathematicke this is the constellation or election of time In fiery signes it is good for flegmaticke persons to bleede as in ♈ â™ Leo is excepted being the house of the Sunne in the which there must be no bleeding In Airie Signes good for Melancholly men as ♎ â™’ ♊ is excepted and the last seauenteene degrees of Libra because ♊ respecteth the hands and the armes in which commonly wee let bloud In watry signes good for chollericke men as in ♋ ♠♓ In earthly signes it is ill to bleed as in ♉ ♠♑ The generall rules of Ptolome for Phlebotomy in 30. of Centiloquium is this Tangere ferro membrum cum Luna in signo illius membriest periculosum It is daungerous to open a member with a chirurginal instrument when the moone is in the signe belonging to that member Good aspectes in bleeding are these ♂ ☽ and ♃ also ☽ ♀ so as ♀ be not coÌ„bust ■☽ ♃ âš¹ ☽ ♃ âš¹ ☽ ♀ â–³ ☽ ♃ â–³ ☽ ♀ â–³ âš¹ ☉ ♃ or ☽ also â–³ ☽ ♂ or âš¹ ☽ ♂ Againe this is an other obseruation from the new of the moone to the first quarter for pueri i. those that are in their childhoode from the first quarter to the full for Iuuenes that is young men from the full to the last quarter for Viri that is those that are of mans state and begin to grow in yeares and from that time to the new againe for old growen folke Looke more hereof in a Table hereafter following 28. Chapter Another obseruation how particuler members are to be taken according to the particuler times and seasons of the yeare is this In the spring and summer time the veynes of the right side of the body are to be opened namely of the right hand right arme and right foot But in haruest and in winter the veynes of the left hande arme or foote In the spring time bloud increaseth In the Summer yeallow choler therefore in the spring time and in Summer those veynes are to be opened which most abound with bloud and yeallow choler that is specially the right raines for in the right part of the body is scituated the member causing bloud that is the Lyuer and Choledochos the Cofer of yeallowecholer that is the gall In haruest is ingendred melancholly which is not dissolued but increased in the winter therfore in haruest and winter those veynes must haue incision in which melancholly chiefly raigneth that is the left veynes for the Spleene thereceptacle of melaÌ„cholly is placed on the left side Moreouer these foure members the head hart feete and Lyuer are to be euacuated according to the foure seasons The heart in the spring the Lyuer in Summer the head in winter the feete in haruest Of which matter you shall heare speake Schola Salerni Ver aestas dextras autumnusque hyemsque sinistras quatuor haec meÌ„bra hepar pes Cephae cor vacuadâ— Aest as habet hepar ver cor sicque ordo sequetur The right the spring and summer haue The left autum and winter craue The Summer hath the Lyuer his The Spring also claimeth the heart The head the winter doth dismis O fayling foote thou Autums Art Preparation before bleeding Chap. 18. AS occasion of the time is to bee taken so there must be vsed before some preparation of the body The neglecting whereof would bring great hurt to the party and surely the chiefest preparation is this To purge and cleanse the members that are in the first Region of the body touching this preparation many things are to be regarded whereof mention is made in the eighth Chapter from whence I purpose to take foure principall considerations in this behalfe being vrged thereto for perspicuity sake leauing the rest to thine owne discretion to be scanned There are therefore as there wee did set downe foure things especially which stay and put backe bleeding That is to say first crudity of the stomacke and first veynes Secondly a filthy gathering together of hurtfull humors Thirdly the belly bound with dry and baked excrements Fourthly the mouth of the stomacke weake and very sensible These doo not altogether put off bleeding but stay the same for a while till by Art they may be withdrawen or remedied If a veyne be opened while cruditie ruleth in the stomacke this euill will follow that many rawe vnconcocted vndigested humors wilbe congested gathered together in the place of bloud In hardnes of the wombe this mischiefe ensueth that the Liuer exhausted veines suck out of the excrements silthie iuices vncleane substance in regard whereof it is most conuenient to stay so long as the rawe matter may be concocted till the excremeÌ„ts descend And if they cannot vtter of themselues as ye heard cap. 8. They are to be prouoked with suppositors or clysters and the womb is to be made laxatiue with prunes or Cassia Cruditie indigestion is knowen by the qualitie quantitie of meates receiued Also by the time in which they were eaten and also by ponderousnes raw belchings of the stomack Againe corrupt humors abounding in the stomack or partes neare vnto it whether the same be bred there or that they proceede from the head Liuer or splene they perswade the putting off of bleeding til they may be purged els this corruptioÌ„ of humors drawen into the veins would be more daungerous to the bodie than cruditie it self and infect the veines farre with much more vncleannes whereof do come obstructions or a consumption proceeding of the ill disposition of the body or the diseases which we would cure grow greater their accidents â—â—rre worse yea and because these corrupt humors are stirred they become more fierce and hurtfull nipping the stomack the parts called praecordia i. the fleshie skin called the Midriffe which separateth the heart lungs from the stomack Liuer other bowels whereby is caused appetite to vomite convulsions Lypothimia Syncope and other fearsull accidents The signes whereby to know whether the bodily partes are possessed with corruption of humors are these loathing of meat aptnes to vomit vomiting vp the noysom offensiue humor oft going to the stoole heauines paine in the stomack fulnes swelling of the stomack precordial parts If these apeare in the patient without cruditie of meats then are we to expell the offensiue humors out of the first region of the body which hath bin the cause of the foresaid euils If the humor of himself giue vpwards assay the expulsion by vomit drinking a draught either of warm water or of HydrelaeuÌ„ warmed that is water mixt with oyle wherof take the quantitic of halfe
a pound If the humor gine downward expell it by siege Cassia is not strong enough to purge the humor from the stomack as not being sufficieÌ„t to expel by siege such clammie cleauing humors For Cassia hath but a meane vertue and that onely to asswage and mollifie Rubarb or Senna or some other gentle medicine according to the qualitie of the humor and not so vehement as to molest the state of the whole bodie And these we may vse not once or twise but oftener if neede require After all this preparation then we are to let bloud VVhen the corruption of humors is spread throughout all the bodie euery particular part so that the whole body is vnpure then we must obserue this order that is we must purge euerie part orderly as first the greater veines and this called Mesentericae venae which are branches of the great carrying veine called Porta by which both the guttes are nourished and the iuice of meat concocted is conueyed from the stomacke to the Liuer to be made bloud Yea these veines are the second time to be purged before wee euacuate the whole habite of the bodie and not contrarie that is from the first veines to the greater and from them to bring the humor into the state of the bodie which were not to purge the noysome humor but to infect and hurt the whole bodie therewith But this is the course to drawe the humor from the habite of the bodie into the greater veines from them into the first veins and then to bring it into the bely Yea this great corruption of humors not onely stayeth bleeding for a time but often times altogether And therefore wee let not bloud in the dropsie in Cacheria in hard apostumations of the Liuer and splene The third matter of the preparation before bleeding was aboue said to be either the sensibilitie or imbecillitie of the stomack For those persons haue notable quick feeling whose veins sent from the brain are soft tender open redie to occur and meete with any matter so that these persons without hurt cannot eate anye sharpe sower or salt things as vinegar pepper mustard Imbecilitie of the â—tomake proceedeth either of distemperature or of a verie thinne placing and standing of the small veines in the same place And this is knowen by losse ofappetite when meat cannot abide in the stomack but that there will be always paine of the stomack a promptnes still to vomit Those persons that are thus affected are troubled greatly euen with the hasard of life of euerie small occasion as fasting anger sorrow feare also by bleeding Phlebotomy in these I say wasteth greatly the vitall spirits greatly moueth the other humors of the bodie beside the bloud whereupon there befall to them when they haue bled conuulsions the falling euill sownings other feareful accidents which are caused hereby In such therfore we must haue a foresight corroborat the mouth of the stomacke with things repelling the sharpnes influence of humors as with iuice of a Pomegranate a Quince Malum medicum with iuice of Citrons Lymons iuice of Barbaries sower grages viniger or syrops made of these If there be doubt of a cold distemperature vse hote aromatike things chiefely syrop of Mynts Diacydonion sower or sharpe wine or ypocras Take a little of these wines or a morsel of good bread dipt in them and when the patient hath a little rested vpon it open a veine and this is the preparation if the disease permit it A vehement disease â—asteneth bleeding and cannot stay for this preparation as repletion in wrastlers in whom present suffocation or breaking of veines is to be feared as a great Plurisie a fernent agewe a great fall or bruse In the which wee are more to feare the present danger of the disease than the hurt by defect of the preparation If we thinke the humors in the bodie to be thicke and that they will not flow for which cause also we vse to walke before bleeding wee may enter into a bath to make the humors subtile not the same daye in which we bleede but a day or two before Not in the selfe same daye because it maketh the skin soft thinne and so in the stroke the skinne slippeth starteth from the Phlebotomer which is verie dangerous For this cause also wee giue a little syrupus acetosus certaine dayes before bleeding to subtiliate the matter And again that the humors may passe with the more facilitie become subtile to prepare theÌ„ to this purpose we vse frication of the meÌ„ber to rub the arme or other parts the members next vnto the place that is to receiue incision Also we giue before bleeding to such persons as haue weak sensible stomacks nipped with sharpnes of choler flowing to the mouth of the same some portion of meat yet not all meates with indifferencie but meates of good digestion as a morsell of bread dipt in Syrupus acetosus which comforteth the stomacke through the ponticitie to vse the old barbarous word the sharpnes or â—owernes thereof which also letteth the fluxe of humors keepeth them back from the stomack by reason of a certeine frigiditie For as soone as choler sloweth to the stomack so soone by the sharpnes hereof the same is repressed repelled What is to be done in the verie time of the incision Chap. 19. THe pacient is to bleede lying in the greatest quiet that he may both of body of mind especially if the strength of the bodie be infirme that there be doubt of Sincope let him sit vp in his bed lift vp his head aboue the pillowes for while we stand or sit that facultie which beareth vp the bodie is in a kinde of trauell and the entrailes bowels hanging of the precordiall partes do enforce the vitall natural powers By lying therfore specially some what vpright the bodily strength is preserued according to Galen prima particula prognosticorum And as dead bodies are layde forth vpon their backs so the lying of sicke and weake bodies must be vpon their broadest part which is the back Againe the back bone is the stronger part of the body being acording to Auicen the foundation of the bodie as the keele or bottome of a ship is the ground worke of all the shipwrights labor If the partie that is to bleede be fearfull turne his face away to the contrarie side let his minde be drawen by other talke of the standers by from the present practise of the Phlebotomer The member that is to be opened must hang downward that the course of the bloud may be direct and easie for that part which we desire most to euacuat Then that part of the member which we meane to take as of arme thigh hande or foote must bee rubbed to drawe the bloud vnto that part euen vntill it waxe hote Next wee take a strong bond binde it next aboue the place whose veine
and so very often partly through a commotion made by incision and partly through that retraction made by sleepe such a boiling happeneth in the humours of the body that oft therby at length a feuer is caused and kindled It is therefore apparant that sleepe presently after bleeding is not good and chiefly if in the meane season the patient haue receiued no meat If after taking of meat hee sleepe an houre or two or more disposition so seruing it hurteth not at all or verie little But for as much as the commotion of humours can not fully be setled in short space after bleeding it is far safer to forbeare sleepe as we haue proued by sundry reasons If necessity dispotition vâ—ge sleepe let the same bee short and with a dâ—ligent circumspection that the bonds bee not vnlosed and so the Patient brought in perill of his life Some bring in a further reason yet of the fore said namely why we should not preseÌ„tly sleep after bleeding that is because the matter through sleep waxeth thicke and so a brusing or a confraction that way happeneth in the members as is accustomed in a quartan through the thicknes coldnes of the matter Againe the veines sinewes after bleeding being now emptied are becom cold so the fumes which are brought vnto the veines and sinewes in sleepe do also be come thicke and waxe colde because by sleepe the whole naturall heat of the bodie is drawen euen into the depth and profunditie of the bodily partes And when the veines and sinewes are become cold partly for defect of bloud partly through cold fumes brought by sleepe vnto them they doo participate grosnes coldnes confraction to the other members for it is a principle Simile a simili facile afficitâ—r Like of the like is easily affected And thus much of sleepe after bleeding which is to bee vnderstood of sleepe onely following immediatly after and not otherwise The verses of Scola Salerni concerning this point are these Sanguine subtracto sex horis est vigilandum Ne somni fumus laedat tibi sensile corpus Ne neruum laedas non sit tibi plaga profunda Sanguine purgatus ne carpas protinus escas Sixe houres sleepe not when bloud is let The fume by sleepefull hurtfull is It hurtes the veine if stroke be great To feede streightwaies is farre amisse The patient is a while after bleeding to abstaine from meat till the motion of humors be appeased For in this case rawe iuices and meat not yet concected is drawen with the bloud to aid the member afflicted Looke Galen lib. 4. Cap. 10. de Sanitate tuenda Milke meates made of milke after bleeding are to be eschewed for certeine of those humors which were troubled and moued in opening the veine flowe vnto the stomack and forasmuch as milke is otherwise of it selfe subiect to corruption being nowe in this case inwardly receiued mingled with the foresaide humors it is verie soone putrified and because of the sweetnes thereof though it be vnconcocted rawe yet it is mightily sucked vp and drawen in of the emptie veines Irem all cold things either in wardly taken or outwardly applyed are to be auoided of which sort are chiefely cold meats cold drinks cold bathings washings cold aire thinnesse of clothes bare sitting vpon stones coldnes of the head feete for by these the body would be immoderatly cooled natural heat being alreadie diminished through bleeding Item mistie cloudie aire is to be eschewed for such weather ingendreth Melancholie bloud maketh a heauie mind He must therfore walke in cleare bright faire weather for thereby the spirits of life are refreshed Item immoderat motion is to be forborne a temperat quietnes to be imbraced both of body of mind For vehement mouings do yet more more stil disturb the humors of the body before excited stirred vp by bleeding so consequently the same weaken too much the bodily forces wheras quietnes rest soon appeaseth this commoâ—on of humors Item eating of salt fish is to be auoided after incision for these salt meates often times cause itchings scabs Simeon Sethi depiscibus The verses of Schola Salerni in these matters Omnia de lacte vitabis rite minutus vitet potum Phlebotomatus home Frigida vitabit quia sunt in mica minutis Interdiclus eritq minutis nubulus aier Spiritus exultatque minutis luce per auras Omnibus apta quies motus sâ—pe nociuus VVhite meates eschew d ink not too much Cold things forbeare as ill for such VValke not abrode in clowdie daies cleare aire doth cheare the spirits alwaies Be wholly quiet at all assayes Item Beware of much meat the first or second day And let the meat be of good digestion and causing good blood as soft egges good wine chickens and such like Therefore Isaac in dietis saith of such as are let bloud that their meat must be lessened and drinke increased that is the drinke must be more in respect of his meat that he eateth daily not in regard of that custome which he obserued before bleeding Yea he must nowe drinke lesse than he did before Some after letting bloud are verie drye in the mouth which happeneth through the great motion of the humors and by abundance and ebullition of choler whose fumes arise vpward to the mouth other parts These are to drink Barlie water to mitigate the acuitie sharpnes heat of choller so must they do in like maner that are in doubt of inflammation of the Liuer and stomake through abundant boiling of chollericke humors specially if it be red choller that aboundeth in them If through hard binding of the arme before or after bleeding paine doe ensue and so consequently sluxe of humors to the place causing apostumation in the arme then according to Auicen let bloud in the other arme or according to Rhazes aboue the place in the same arme and apply to the place repercussiues to keepe backe the matter The wound in the arme after bleeding somtime healeth but slowly because the instrumeÌ„t was annoynted with oyle as wee said before that the same might enter the better do lest hurt to the pacient as Galen saith 9. Method The cause now of this slowe healing is for that the healing is much hindered by reason of the oyle which is betweene the sides or the lippes of the wound For as the same Galen other authors affirme a wound is not cured or healed as long as there is any thing betweene the sides or lippes of the same Another cause why after bleeding the wound closeth but softly is that there hath bin too much euacuation of bloud whereby the force of nature is debilitated which hindereth the continuatioÌ„ or consolidation of the wound A third reason hereof may be the oft mouing of the arme for wounds do neuer heale except the member enioy rest where they are inflicted Therfore let this fault be remedied by