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
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
auncient learned Phisicions may seeme as yet hard to the vnskilfuller sort that yet rashly and without skill or regarde of these things vse the practise of letting bloud It will not be lost labour in my poore iudgement with more plaine wordes to illustrate their sayings if it may be to the vnderstanding of all men that are this way studious and yet want the helpe of the Latine tongue Latine writers It appeareth by the premisses what Repletion is vz a superfluous aboundance of humors in mans body which happeneth two waies either in quantitie or in qualitie VVe may also learne that repletion in quantitie is when the foure humors are more in aboundance than is proportionable to the bodie that conteineth them or when one humor much exceedeth the rest in quantitie For the bloud contained in the veines is not simple or of one kind as hath beene said but consisteth of flewme blacke yellow choler and pure bloud mingled together which humors notwithstanding so mingled by comon agreement and continuall vse of speaking we commonly call bloud The iust and agreable proportion of humors is this That in a man throughly healthfull of good temperature there is lesse yelow choler than Melancoly lesse Melancoly than flewme lesse flewme than pure bloud so that that bloud is accounted best not that hath like proportion of all humors but such an equalitie of the foure as hath beene now specified Bloud therfore faulteth in quantitie when the humors being setled in a iust proportion do passe and exceede the agreable measure of Nature for then the whole frame of the bodie swelleth the veines aboue measure are stretched and all the members specially after any exercise are wonderfully retched This constitution of humors though they be good yet it faulteth beclause it is come to an immoderate abundance which accustomably is wont to bring great perill VVhether therefore there be in the bodie abundance of other humors aboue the bloud so that the equabilitie of the proportion be not obserued that waie or that there be too much abundance of pure bloud Yet because the pure bloud in the permixtion greatly exceedeth the other humors it is a â—ault not in the qualitie but only in the quantitie and therfore both of these are conteined vnder this kinde of repletion in quantitie and this is simply absolutely most properly commonly iudged repletion is called Plenitudo ad vasa as is aforesaid because it doth throughly fill the large capacitie of the veines which are termed the vessels or receptacles of the body though it enforce not the powers therof First therefore where al the humors superfluously increase filling extending the receptories of the bodie as the stomacke the veines and the bowels It is most properly called in English fulnesse or repletion in Latine plenitudo in Greeke Plethora as before Repletion in qualitie is when the bloud or other humor is hotter or colder thicker or thinner than is conuenient to the bodie This is the seconde kinde of repletion mentioned by the foresaide auucient writers in Phisicke and which is referred to the force strength and abilitie of the bodie In this repletion although the vessels of the bodie be not so much puffed vp nâ—ither swell as in the other yet they conteine more good bloud and nourishment than the nature of the patient can wel rule or ouercome For a litle nourishment to a weak nature is often troublesome and grieuous and although at the first it be right good yet it doth not long so continue but being forsaken of the bodily heat as not able to concoct the same in protract of time and number of daies it corrupteth and becommeth the causes of diseases This constitution of the Greekes properly called Cacochymia is when the bodie is infarced either with choler yelow or black or with flewme or with watrie humors and of late writers is thus defined Cacochymia est vitiosa humoris qualitas qua is a iusta mediocritase desciscit Cacochymia is a corrupted qualitie of the humors by reason whereof the humor departeth from his iust mediocritie Vnder which Cacochymia is contained all corruption of humors in qualitie wherby the powers of the bodie are hindred from their proper functioÌ„s wherby also the whole bodie waxethfilthie daily decayeth Of this corruption of humors in qualitie one kind is somewhat better and more tollerable as namely when either superfluous humors are excessiuely heaped vp together or when the humors mixt with the bloud do not keepe their iust and naturall concord or proportion the other kind is worse and intollerable when the superfluous humors or iuces in the bodie both primi secundarii both the principal humors and these next the principall are fallen into corruption from their naturall and conuenient temperature which is the destruction and corruption either of the substance or of the temperament Againe both these happen sometime with rottennes and putrifaction sometime without VVhere note moreouer that the name Cachochymia largely taken comprehendeth also the corruption of the excrements Hippocrates Aphoris 15. saith where meate is receiued much aboue nature it causeth sicknes Galon in his Commentaries declaring that place saith more meate then accordeth with natures measure is named Replecion And afterward hee expoundeth that worde aboue nature to signifie too much and superfluously As who would say where the meate is superfluously taken it causeth sickenes Meate but a little exceeding doth not forthwith cause diseases but may yet keepe the bodie within the bounds of health for meat ingendring sickenes must not a little but much exceede the exquisite measure It appeareth by Galen that in his time certaine denied this foresaide diuision of fulnes set downe by the auncient writers and approued of the late practisioners saying that the same was to bee considered onely by the strength of nature granting plenitudo secundum vires but not quo advasae These he confuteth in his booke de plenitud about the beginning in these wordes Qui ex ipsis tantum viribus plenitudinem metiuntur hi videnter nunquam vtres praeter modum repletosvidisse nec se etiamplus quapar est vnquam impleuâ—sse â—ibo ita vt ventriculus inde distenderetur 1. Those that measure Replecion onely according to the forces of nature they seeme neuer to haue seene mens bodies puffed vp like bladders or bottels neither at any time to haue stuffed themselues with meate more than moderation required and whereby the stomacke was ouerstretched Againe others in Galens time graunted onely that plenitude which is quo ad vasa and denied the other quo ad vires These hee confuteth in the same place in these vvordes Itaque subiecimus duas esse tum notiones tum relationes multitudinis alteram ad robur virefque illi us qui defert alteram ad eius qui suscipit capacitatem Idest Therefore vve haue added that there are two notions and reportes of fulnesse one according to the strength of the patient the other
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
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
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
reiterating bleeding which they call Epaphaeresis this is the order First in inflamations great paine hot feuers caused of aboundance of hot bloud a veine must be opened as is alreadie shewed euen presently at the very beginning before the matter be gone to som principal member not only that the aboundance and excessiue quantity of bloud but that much more a great deale euen plentifully and generally may be euacuated yea euen till the patient giue ouer if the strenght of the body so permitte And in diseases caused of fulnes the bodily powers are firme for the mostpart neither doo they shrinke or relent much by this plentifull bleeding And when Hippo. permitted bleeding so long till the patient should giue ouer hee ment it so when the strength therevnto sufficient was able to beare it and not otherwise For if fainting doo happen wheÌ„ the powers of nature are firme and constant it doth only wast the spirits in the arteries those forces remaine still vnhurt and vndamnified which narure hath bred in the hart Liuer or braine And albeit these decay in Lypothimia yet of the setled forces other like presently come in place whereby againe the Patient is reuiued But when the strengh of the bodie is weake and greatly enfeebled because the forces of nature setled and seated in the principall members are also impaired If Lypothimia then chaunce reâ—â—itution wil hardly be made Therefore I say the vertues of nature beeing greatly debilitated beware of ouer comming or fainting And this is the order in great and vrgent sicknesses In small generall diseases as in repletions fulnes feuers and such like whose cause and principall matter is conteined in the veines if bodily strength permit we must presently euacuat wholly at the beginning at one time not till the patient ouercome but so much as is needefull and as the infirmitie or malady requireth And this euacuation without any hurt to the naturall forces withdraweth the matter abounding either before the same do wholly putrify or that it posâ—esâ—e some notable member or before any horrible accidents happen He that for feare or any other cause parteth or diuideth in these the euacuation he continueth the disease long time doth no good but great hurt to the sicke patient But if for imbecillity of strength the whole euacuation can not be accomplished or done seeing it is better in this case to marke the strength of the party then the vehemencie of the disease we are inforced to vse partition in the bleeding and yet with a great circumspection and care and let the partition be within a litle distance of time either by vndooing or vnloosiug of the bound or stay the blod with applying the finger on the wound so long as by the foresaid meanes the forces of the body may bee recouered Sometime an hours space is sufficient sometime more houres â—re required to the restoring of the forces of nature The best way is not to deferre the partition of bleeding past one day yet I say if strength permit that partition must be vsed bleede twise in the selfe same day in general diseases especially except other impedâ—mâ—ts greatly let euacuacuat in one day asmuch as is expedieÌ„t before the matter come to putrffaction or that other euils do grow But in partiall diseases of particular meÌ„bers chiefly in inflammations the parted or diuided euacuation may be put off a longer time either to the day following or to the day after to morrow that in this space the corrupted humours may goe from the member diseased into the veins exhausted and so by the next incision be euacuated The member of the bodie that is afflicted with griefe or corruption by little and little euen in one day or two daies at the most sendeth downe the humours to the place where the incision was And for asmuch as they are corrupted they are not there to remaine albeit the former paines be mittigated and asswaged But if the inflammation bee pestilent and venomous as is a pestilent botch or carbuncle the euacuation of necessitie must be reiterated euen the selfe same day lest the pestilent infection sticke and stay any long time in the veines to the great hurt of the partie But neither must reiterating of bleeding be vsed For thereby the vitall spirites and in ward heate is diminished and vntimely age is hastened on apace and the same when it commeth is made subiect to greeuous diseases as Chachexia the dropsie gout in the iointes trembling palsies and apoplexies Yea when the naturall heat is immoderatly cooled and naturall moysture wasted the bowels languish crudity and vndigestion beginneth to beare rule whereby are caused great and greeuous euils in the body of man And thus much of the reiterating of bleeding and order thereof But let vs come againe to our former matter of prescription moderat motion easy walking as it was conuement before bleeding to vnloose and make the humours thinne so also the same is necessarie after bleeding to disperse abroad the reliques of those vapors and humours which are left behinde And as bondes of linnen were vsed before bleeding to the intent the veines might waxe bigge appeare full and bee the better perceiued and seene and that the humour with the more facilitie might come to the place appointed for incision so afterward they are also needfull to stay the fluxe of bloud and bind vp the wound It was already said that the partie let bloud must not sleepe that is to say not within the space of eight or sixe houres at the least whereof this is alleaged as a reason that the fumes caused by sleepe bee not carried vp to the head and so offend the braine There may hereof bee aleaged other caused more as namely lest the veine opened should take hurt by tossing of the patient vp and downe in his sleepe which cause was lately aboue specifyed Also lest in sleepe the humors should flow to the member where the incision was made and there apostumat For pained places as Galen affiâ—meth Capit. 95. medicinatiâ— artis lib. de Curand ratio per sang missionem Capit. 7. are by nature accustomed to receiue fluxes and chiefly in sleepe Auicen alleageth this reason Because by sleepe after bleeding for the most part there chaunceth in the members a confraction or bâ—using For while the member is tossed hether and thether with inordinat and vnorderly motion the bondes are vnloosed the wound vnhealed and as it were newly opened notwithstanding the late incision it doth afresh sende foorth immoderat fluxe of bloud the partie in his sleepe not witting thereof whereby as all men know the life commeth into great danger Againe another discommodity by sleeping immediatly after bleeding is that fumous excrementes through sleepe are againe inwardly reuoked to the principall members Againe the vitall spirits and natural heat which by opening of a veine are drawen to the outward partes and members by sleepe are reuoked to the center or middes of the bodie
application of Ventosas particularly in euâ—ry practise Boxing without scarrification are vsed to reuoke and pull backe matter called before revulsion or to turne bloud and humors aside which was called deriuation cap. 6. Thus cupping reuoketh bloud at the nose as yee heard aboue out of Galen by applying the Ventosas vnto the sides that is vpon the Lyuer and right side if out of the right nosethrills contra as before Thus we stoppe fluxe of termes applying a great cupping-glasse to the roote of the Paps as ye heard out of Hyppocrates Thus the falling downe of the wombe or matrix is reuoked by application of the cupping-glasse neere to the nauill Thus to reuoke matter from the head we apply them to the inside of the Thigh where note that this better prouoketh termes than the opening of Saphena vein Thus against stopping of termes we apply them to the inside of the Thigh where note that this better prouoketh termes than the opening of Saphena vein Thus against stopping of hemorroids we apply them to the inside of the Thigh where note that this better prouoketh termes than the opening of Saphena vein Cupping-glasses are not vsed for deriuation sake that is to turne bloud humors aside another way except when the body is first euacuated or when the humors are setled in any part and that the member is swollen in this case for deriuation sake we apply Ventosas to the hinder part of the necke than to the partes called Spatulae which ioine to the necke sometimes also to the but tocks and haunches Boxing with scarrification is vsed when some euacuation of bloud is required standing in steede of Phlebotomy as we said before when certaine occasions hinder the same First in this practise wee apply the Ventosas to the member Afterward we open that very part in many places in the skinne onely with a small penknife for the purpose and so applying the glasses againe wee euacuate bloud But wee must not doo this before the body bee first euacuated chiefly in vncleane and corrupt bodies lest too great abundance of humors bee drawen into that part Boxing with Scarrification is vsed either in the vpper partes in the middle partes or the lower partes of the body Cupping-Glasses applyed to the forepartes of the heade offende the Senses and vnderstanding Applyed on both the middle partes of the necke or vppon Nucham Puppis they stande in steede of opening Vena Nigra and they helpe heauinesse of the browes and lighten the eie-lids they helpe scabbines of the eies they cause both the Parent and the childe begotten by him to bee forgetfull Vuerkerus Ventosas applyed to the lower part of the neckwhich is called Acheal standeth in steed of opening Basilica they helpe pains of the shoulders and gullet that is the place whereby meate and drinke passeth into the stomacke they helpe diseases of the breast caused of bloud the crampe caused of bloud and trembling of the heart Ventosas applyed to the vpper part of the necke that is the very ioyning together of the head and necke are in steed of opening Cephalica and helpe in affects of the head as the shaking and particuler palsie of the head yea and in affects of the parts of the head and therfore it profiteth for toothach paines of the eies and eares but there must goe before purging of the whole body lest matter bee drawen vp againe to the heade and fill the same and so the diseases increase againe as Galen saith 13. Method Medend cap. 4. we must beware here in this case not to apply them thus too oft because they hurt the memory VVhere as a litle before we spake of an applicatioÌ„ which serued in steed of Basilica so we say now that Ventosas applied aboue Spondiles serueth also in steede of Basilica and cleanseth the breast and yet hurteth the mouth of the stomacke and causeth trembling of the heart and therefore they are subiect to these diseases must beware howe they vse them and yet according to Rhases 2. ad Almonson It helpeth in trembling of the heart caused of repletion and with heate But it should seeme that either Rhases meant of application of Ventosas to the lower part of the necke called Acheal which indeede as we said before helpeth trembling of the heart So confounding this application with the former VVhich the rather may so seeme because it is said that they both serue in steede of Basilica or els that this application hurteth the heart is ignorantly added and put to of some vndiscrete writer Ventosas applyed to or vnder the chinne helpeth the teeth the face and the throat clenseth the heade and the Iawes especially they cleanse the face from scabs and itch Ventosas applyed in the ioyning together of Spatula with the necke profiteth in passions of the face as scab or itch and in stincke of the mouth It may be that this application is euen the selfe same which immediatly went before And thus much of particuler application of Ventosas to the vpper parts Now of their application to the middle parts of the body applyed between the two Spatula his hands or hath allanderous tongue can do they help diseases of the brest caused of bloud and a crampe comming of the same case and in these two this application agreeth with that to the lower part of the necke before called Acheal but this last application hath two discommodities for they weaken the stomack and cause trembling of heart VVhere note that this application seemeth one and the selfe same with that Super spondiles and so it is true that was there saide concerning the offence of the stomacke and heart thereby Ventosas applyed aboue or vppon the raines helpe apostumations and pushes of the thighs or haunches scabs gowt and hemorroids leprosie windines of the bladder matrix itchings of the back and all diseases of the lower parts Ventosas applyed vnder those parts called in Latine Cauillas otherwise Alchahab helpeth stopping of termes the gowt in the feete and the Sciatica gowt and thus of application to the middle parts Thirdly concerning their application to the lower parts Ventosas applyed aboue or vppon the thighs or rather the shanke from the knee to the anckle which part of the leg in Latin is called Crus they stande in steede of Phlebotomy they mundefie the bloud prouoke termes and are better than the opening of Saphena to prouoke termes in white soft and weake women Ventosas applyed to the former part of Coxa That is the Thighes or Haunches helpeth apostumations of the testicles and woundes of the Thighes Haunches and Shanks applyed to the hinder part thereof they helpe apostumations of the Arse and Buttocks and goinges out of the fundament and blames and pushes in the same part Ventosas applyed betweene the two Anches That is hypsor buttocks helpeth the two Anches and the two inner partes of the thighs or hâ—unches Also the hemorroids the gowt in the fecte and ruptuâ—s
either Morning after the rising of the Sun when a man is yet fasting which is simply the best excepting the houres of ♂ and ♄ and choosing the houres of ♃ and ♀ whose nature is most temperate Afternoone after reasonable good or rather perfect digestion and expulsion of of superfluities Herewithall regard must be had of the aire that it bee neither too hote nor too colde or clowdy but milde cleare and temperate the wind being then either Northerly or westerly The Southwind is counted no friend to Phlebotâ—my whereof this is the reason heate looseneth too much cold bindeth too much An Exception NOtwithstanding the premisses of bloud-letting before The Frensie Squinancie Pluresie and Apoplexie or for a continuall headach proceeding of choler or bloud for any hote burning Feuer or other extreme paine and desperate disease A man in such a case may not tarry a chosen time regularly set downe by the Astronomer or Phisition for so the Patient might miscarry in the meane season But incontinently with all conuenient speede hee is this way to seeke his remedy except either he bee very weake or like to sowne or that the Moone bee in the same signe that ruleth that very part of the body VVhere also note that in the foresaid case of extremity bloud is not to bee let in so great a quantity as otherwise it would if a chosen time might conueniently be expected As before bloudletting these circumstances of complexion age and times are to be considered So after the same consideration is to be had of our meats and exercise For meates such must bee taken as are of an easie and light digestion For exercise wee are to abstaine from all exclusiue vntill the fourth day not onely those that be vehement as riding running leaping vawting wrastling fensing tennise c. But also such as are more milde as walking bowling bathing and especially Venerie whereof wee haue spoken in the twentith Chapteer and I doubt not but I may effectually conclude both antecedent and consequent limitations duely and orderly obserued this auncient practise of Phlebotomy to bee very commendable both for the preseruatiue and curatiue intention of Phisicke Conclusio Operis And thus according to my simple skill and poore talent I haue set downe those remedies which withdraw bloud either from the whole body generally as Phlebotomy or from certain parts particulerly as Leeches boxing and scarrification which was my purposed determination at the beginning to doo If any thing bee here set down repugnant to sound skill I craue pardon hauing no skill to iudge because Phisicke is not my profession onely drawen with a delight in this practise First for my pleasure now I trust for orhers profit I haue further trauâ—iled herein than I thought to haue done If any fault or error be in the order methode or disposition I assigne that vnâ—o my selfe 〈…〉 pardon for ought that is amiâ—se protesting in truth which a man may easily discrie tâ—at this booke is rather a collection from others than an inuention of mine owne God graunt that this my trauaile herein whatsoeuer it bee may make vnto his glory and the comfort of his people which are the two impulsiue causes moouing euery good Christian one way or other to imploy his indeuour Deo laus honos gloria in omne aeuum FINIS ¶ The Contents of the seueral Chapters in this Treatise Cap. 1 OF fulnes emptines and their diuisions 2 What euacuation is and the kindes and diffeces thereof 3 What Phlebotomie is and from whence the opening of a veyne doth euacuate 4 Whether Phlebotomie must goe before purging or contrary 5 Of the effects that is the profits disprofits of bleeding 6 Of reuulsion that is pulling back and deriuation that is turning a side of blood and humors by opening of a veine 7 Whether purgation by siedge or inward medicine receiued can not or may not euacuate the blood and the reasons answered that are brought for proofe thereof 8 Of the impediments or lets of Phlebotomy and of the causes requiring and furthering the same 9 Of such persons as are meete or not meete to be let blood 10 What corruption of humors bleeding remoueth from the veynes generally 11 A particular rehearsal of those diseases present or future which are cured by bleeding 12 What voluÌ„tary eruption of blood profiteth in sicknes 13 How to know by certayne signes the greatnes of the disease the firmenesse of the natural forces wherby coniecture may be made whether the patient be to be let blood or no. 14 To know by the greatnes of the disease and strength of the natural powers the quaÌ„tity of blod that must be withdraweÌ„ 15 An obseruation of things present and past and also a foresight of things future needfull and necessary to the further knowledge of the quantity of blood that must be taken 16 Of the times and seasons of the sicknes of the yeare of the day and houre of the day when a man is to bleede or not to bleede 17 Of Astrologicall obseruation in bleeding and of an other obseruation neerely annexed vnto the same shewing what members and parts of the body are to bee opened according to the seueral seasons of the yeare 18 What preparation must goe before bleeding 19 What is to be done in the very time of the incision 20 A prescription or regiment of the patient after bleeding 21 What veynes are to bee opened both in generall and particular diseases 22 A profitable obseruation of the blood extracted 23 A short rehearsal of 8. auncient errors touching bleeding and a sufficient confutation of them by auncient authorities 24 A sufficient confutation of the supposed necessitie of annual bleeding 25 Of incision of the arteries 26 Of particuler euacuation of blood and first of bloodsuckers and Horse-leaches 27 Of cupping or boxing and scarrification the other two particular euacuations of blood 28 A profitable compeÌ„dious table of Phlebotomy or blood letting conteining diuers poynts in this Treatise handled discussed off and setting downe by deuision the generall and speciall considerations thereunto belonging The names of the authors whose help is chiefly vsed in this Collection Aristotle Actuarius Aetius Auicen Alexius Andernacus Auerroes Arnoldus de villa noua Bacchanellus Bullein Anglus Cornelius Celsus Eliota Anglus Fernelius Fuchsius Galenus Gesnerus Hippocrates Rich. Harueius Anglus Hollâ—rius Iohannes de Santo Amando Iohannes de vigo Mesue Oribasius Paulus Aegineta Rhasis Rondoletus Schola Salerni Weckerus LONDON Printed by William Hoskins Iohn Danter dwelling in Feter-Lane 1592. â—yâ—sts i◠〈◊〉 â—* Cephalica Bâ—siliâ—â— Coraâ—â— id 〈…〉 vena Saluatel Domâ—stic◠〈…〉 Silâ—atica 〈◊〉 1. Substanti 2. Serum 3. Spuma â— Pinguedo 8. Subsidentia 7. Grana
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
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
must be taken moderately the first and second day after bleeding as Rhases counselleth writing to Almons lib. 7. cap. 21. For the vertue digestiue made weake by bleeding cannot ouercome as yet much meate Herevpon also Isaacus in his dyets writeth thus Meate to such as haue bled is to be withdrawen and diminished but drinke to be augmented for in respect of the meat drink is to be augmented not in regard of his former vse of diet that now he may drinke more than hee was accustomed for in truth he must drinke lesse than hee did before bleeding because the vertue concoctiue as ye haue heard is yet too weak to beare much abundance of drinke The words of Schola Salerni touching this matter are these Spiritus vberiorque exit per Phlebotomiam Spiritus ex potu vini mox multiplicatur Humorumque cibo damnum lente reparatur Abundant spirite with bloud doth passe yet drinke of wine doth it restore By helpe of meate the same alasse will hardly come as twas before Of Revulsion that is pulling backe and deriuation that is turning aside of bloud and Humors by opening of a veine Chap. 6. REvulsion is a prouided remedy for bloud flowing out of the nose or belly or that floweth to any part like them to cause inflammation It is called in the Greek Antispasis That is a turning to the contrary way in Latine Reuulsio that is a pulling backe and as the word impotteth so is it desined a drawing of the running humor into the contrary part Nothing can more speedely keepe backe the force of a Fluxe than this practise Now for to vnderstand which is the contrary part we must note that the Mathematicks call those contraries which be the extremities of one and the selfe same straight line which stand furthest off in a straight proceeding or going forth of the selfe same vein through whose passages the humors haue their course For a veyne beeing opened first the part next the wound is euacuated that euacuated part draweth the bloud out of the further part And forasmuch as opening of a veine doth thus euacuate through the helpe of the small straight veynes which nature hath ordained to allure and draw as shee hath the ouerthwart veynes to expell The same opening of a veyne I say will prouoke more bloud and in shorter time from those parts where the streight veynes are spread then from the rest Yea if the veynes drawe not at all yet the humors voluntarily will flowe in the straight course of the veynes they that are in the right parts followe the right members and they that are in the left partes follow the left members and that course of humors is commended which are carryed straight wise and that discommended when they are carried crookedly and ouerthwart as declaring nature to bee violated and corrupted The names of Phisicall contraries in this practise are these before behinde the right the left vpward downewarde within without Neither are these contraries in revulsion of humors except they bee so placed in a straight course of veines For the left side is not contrary to a left Pluresie or the left leg from the knee downewarde called in Latine Crus contrary to the right leg inflamed For herein this is a common and direct society of veines whereby the left leg beeing opened draweth from the right But from the right side to the left no veyne commeth with straight and right strings Therefore a veyne opened in the same remoueth not a Pluresie on the right side But either leaueth the hurtfull humor in the inflamed part or mingleth it with the pure bloud or bringeth a Pluresie in the left side which often falleth out so For as much therefore as all our indeuours and deuises must tende by opening of a veyne to exhaust bloud abundantly and speedely from the inflamed part take such a veine as is straitly scituated to the affected part So in reason we shall followe nature and imitate Hippocrates who in a Pluresie willed to take the inner veine of the Arme on that side which is grieued Neither onely doth the Phisition open the inner veine of the right arme in a pluresie on the right side but also in inflammation of the liuer and yet all the veins are ioyned to the liuer in felowship If that appeare not we may take Mediana If that neither appeare we goe to Vena humeralis rather than to the inner veine of the left arme attributing so much to those veynes which are directly and straightly scytuated Therefore Revulsion in a streight course bringeth euident and speedy helpe whereas in a crooked or ouerthwart locution it bringeth none at all Moreouer a large veyne opened withdraweth bloud plentifully and speedely from the next places Therefore when there is a great and vehement inflammation of some euill Humor abundantly concurring in some principall member and part of great sense and feeling a large veine must be opened in some neere place vnto it which may abundantly and speedely euacuate from the place affected If the infirmity be but small a lesser veyne may be chosen and in a place further distant to euacuate a lesse quantity and at more leysure Revulsion in this sort not onely stayeth the Fluxe but also exhausteth first from the affected member the rotten and ill bloud before it deale with the good bloud of the other parts and members of the body and then all feare is remooued of any newe Fluxe to insue For when the part affect ed shall bee disburdened more than the other through great euacuation lately made very hardly in reason can the same be grieued with another Fluxe of humors except we go on with a fresh intemperate order of liuing And againe the members far distant couetous as it were because of their great want wil not suffer the bloud in them contained to flow to the others Neither will the member affected except there remaine in the same great dolor and heate allure or sucke any thing from them being now but weake and consequently not requiring great nourishment The opinion therefore of the Arabians concerning opening of a veyne must needes be false VVho suppose that in a Pluresie a veyne opened on the same side doth increase the force of the Fluxe Affirming also that for the plenitude if it be much lest the Flux should increase the same is to bee taken from the lower veyne of the foote After this that the Revulsion must bee made from the inner veyne of the contrary arme Last of all that the reliques and remainder is to bee euacuated out of the same side VVhat discretion I pray you is this so oft to vexe the sicke Patient whom wee may cure at one time For bloud abundantly taken out of the side affected draweth plenty as it were at the well head freeing that part from inflammation without suspition â— orfeare of any newe Fluxe Euacuation made from the ouerthwart veynes onely abateth superfluity of bloud and humors with small quantity of
found out yet the same may not be vsed The reason is for that such a medicine specially or rather altogether respecting the bloud would neither euacuate nor attract bloud as the other humors are euacuated with their owne proper and peculiar receits Yea if it happen that it do euacuate bloud as Pulpa Colocynthidis doth according to Auicen without doubt it euacuateth thaâ— bloud which should be still retained for the good health of mans bodie Serapio sayeth that the impropriate or improper humor of a receit is sooner thereby euacuated then the proper humor whereof he rendreth a reason namely that the proper humor to a recâ—it is the best beloued to the receit Wherby saith he it commeth to passe that the improper humor is sooner for saken of nature than the proper The humor improper is quickly drawen to the receit and therby sooner expelled whereas the humor called proper which the medicine most properly respecteth is as it were the most beloued friend and as it were the most natural childe to the euacuating receit and therefore is stil rather reteined than expelled By this reason oâ— Serapio forasmuch as bloud is natures darling more helping than the other humors which are but superfluities in respect of the bloud If there were a receit euacuating respecting bloud that the same were administred the other humors would be attracted cuacuated before the bloud and so great hurt ensue to the bodie And if it were so that onely bloud offended which is not perhaps altogether true yet neither should the bloâ— alone be euacuated as now it hath bin declared Againe according to the Philosopher 4. de Animalibus we are to make choice of the right way and not to seeke crooked wayes Now opening a veine is the righter safer way to euacuate bloud than medicine for Phlebotomy euacuateth all humors at once principally the bloud which most of all aboundeth in the veines and this thing medicine cannot do Againe euacuation is done for two causes either for to remooue the aboundance of the humor or to take away the corrupted qualitie of the homor So euacuation of bloud is practised either because it aboundeth in quantitie or offendeth in qualitie If we open a veine because bloud aboundeth in quantitie then in like sort there is also abundance of other humors For abundaÌ„ceof bloud cometh through good nutriment causing bonuÌ„ ChymuÌ„ i. good â—uce proceeding of meat digested which doth not only bring repletion of bloud but also of other humors as helpers vnto bloud Therefore when bloud thus aboundeth in quantitie with other humors it is better to euacuat them by Phlebotomie than by receit If euacuatioÌ„ of bloud be made for that it corrupteth in the veines then by reasoÌ„ it corrupteth the other humors also seeing bloud is more abounding in quantitie than are the other humors wherupon Galen saith that in the feuer Sinocha there is corruption of all the humors in all the veines therefore bloud is neuer to be euacuated without the other humors together Now other humors may superfluously abound be corrupted in qualitie without the bloud and so consequently may be euacuated without bloud by inward medicine so that it is naturall for the other humors in this sort to be euacuated and vnnaturall so to euacuate bloud which was the cause that Haly vpon Galens authoritie affirmed that Galen caused one to be hanged which euacuated bloud by inward receit To the former obiections therefore wee answere thus Isaac his saying Quod prodest Choleri prodest sanguini is to bee vnderstood not of euacuating medicines but of altering receits as thus those things that are profitable to alter choler and to extinguish the amitie thereof they worke the same effect in alteration of the bloud Or wee may vnderstand it of euacuation and expound it thus Those things which are profitable to euacuate choler are profitable to mundefie the bloud because by euacuation of choler bloud is mundefied and cleansed To the second we answere that this argument Bloud is naught and offendeth as do other humors therefore it is good to euacuate the same by medicine as other homors offending are euacuated this is a fallax of the consequent or rather figurae dictionis for it followeth not that if bloud offend it must be euacuated by inward medicine because the same may better and more safely be done otherwise namely by Phlebotomie and this may serue for aunswere to the second doubt before moued in like manner To the third may be said that Pulpa being forcible it greatly debilitateth the member and therefore when bloud is superfluous it looseth and euacuateth the same and letteth the bloud conteined in the member to passe away but it doth not attract the bloud and this is verie pernitious to the bodie of man The answere to the fourth is plaine in the premisses VVhere note that although it haue bin declared in this Chapter that bloud is not to be euacuated by siege as other humors are which fluxe of bloud that way we rather account a disease than a remedie as in Dysenteria such like yet this notwithstanding we do not denie but medicines may be verie profitably giuen and receiued to mundifie to purge the bloud Of the impediments or lets of Phlebotomy and of the causes requiring and furthering the same Chap. 8. THere are certeine things which put off bleeding for a while and other things which altogether hinder forbid this practise whereof the first is indigestion of the meat receiued as when a man hath eaten much ouer-night and in the morning feeleth himselfe pained therby feeling still as it were the sent sauour of the meat which he hath eaten remaining still in his stomack whereby the cruditie plainly appeareth In this case except vrgent necessitie otherwise require wee must forbeare bleeding til the digestion be accomplished that is til the rawe humors be concoct also the excrements descended The reason why cruditie and rawnes of humors through too much ingorging of meat stayeth bleeding for the time may be gathered out of Auicen 1. Doctri 6. cap. 3. for that there are three things which attract matter vnto them that is emptines of the place heat of the members the habit and state of the whole bodie If therefore the bodie thus affected wee chaunce to open a veine the bloud vntimely woulde be drawen by the veines first part of this cruditie of humors and the veines being destitute of their proper and conuenient nourishment would drawe vnto them that which is not as yet concocted in the stomack Liuer which vnconcocted matter sent abroad to the othâ—r members of the bodie would not easely be amended For as Galen saith the third dgestion doth not remedie the faults of the second nor the second the curls of the first Si magnum sit peccatum as he saith if the euill be great So that now if by this meanes the matter be turned into the members
and 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
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
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
this case let not bloud at all for sufficient is already euacuated from such a body of it selfe and that not obscurely but apparantly In this foresaid constitution thou maist detract a little bloud if it bee winter in a cold country and the wind standing at North and in this mixture of things thou must marke not onely the multitude of the obseruations but the force of them Because one many times exceedeth all the rest in power and sway and he that can neither by art experience nor sound iudgement define the quantity of euacuation according to the aduise of Hyppocrates let him rather euacuate lesse than more than needeth In this place albeit somewhat hath beene spoken before to the same purpose cap. 9. Fig. 7. It may be profitably demaunded whether being with child be to be accounted among these obseruations heere handled shewe of truth and some probability may be alleaged that when women with childe are grieuously sicke we are not to let them bloud because of the young that is in the wombe This is also defended by Hyppocrates saying Mulier in vtero gestans abortit incisa vena idque magis si faetus auctior fuerit that is A woman with child is deliuered before her time if shee bee let bloud specially if the young be much increased and growen in the wombe But this of Hyppocrates is not alwaies true as neither that which hee setteth downe a little before Mulierem in vtero gerentem acuto morbo corripi Lethale est That is it is deadly for a woman with child to be taken with a sharpe disease For seeing a purgation made of wicked and venemous simples standeth with greater danger of the childe than opening of a veyne and that Hyppocrates graunteth that women with child wexed with a disease caused of corruption of ill humors may bee purged in the moneths betweene the third and the eighth moneth truely with much more safety may we let those bloud being grieued with any sicknes caused of Repletion And if in the middle time of the going with childe the same may bee done Much rather in the beginning when the bloud more aboundeth and the yong needeth lesse nourishment Againe if women being with child nature of her selfe oftentimes attempteth euacuation of that which is supersluous with great profit out of the nose by the hemorroids belly and that sometime the Termes flowe healthfully at times appointed why vpon great necessity may we not imitate nature in our Art Yea many women bring vntimely fruit except about the fourth moneth a veyne be opened the young fruit beeing ouercome with plenitude of the Patient neither onely in fulnes but without the same a veyn is opened in the arme of a woman with child when need constraineth as in a Pluresie or other vehement inflammation It is dangerous in deede to open any of the lower veynes in women with child because the fluxe turned downewarde the termes would flowe and so the fruit in the wombe bee deiected and cast downe A veyne is opened very seldome in the eighth or nine moneth without causing of vntimely birth forasmuch as then a woman of euery light cause receiueth hurt and is deliuered before her time through the weakenes and slipperines of the wombe In this case Cornelius Celsuâ— only considered the greatnes of the disease and ablenes of the strength Olde Phisitions saith hee were of opinion that the first and latter age could not brooke bleeding and that a woman with child cured by Phlebotomy should bring foorth vntimely fruit yet experience prooued afterward that none of these were perpetuall but that better obseruations wer to be considered which the Phisition is to remember For the matter is not great what the age bee or what a woman beareth in hir wombe but what her strength is a fierce childe a strong olde man a lusty sanguine woman with child may safely bleede And thus you see howe a great belly in a woman may be an obseruation concerning the quantity of bloud that must bee withdrawen Another obseruation to finde out the iust quantite is to marke the alteration of colour in the bloud So iudged Hyppocrates in Pleuritide secundo de ratione virtus in acutis Commen 10. where hee counselleth to let bloud if the paine in a Pluresie ascend to the arme or the Paps so long till the bloud came forth in colour more red or more yeallow or for pure and red bloud blacke and blewe which both doo happen For bloud in an inflammation differeth in colour from the naturall bloud as more heated and inflamed If the naturall bloud before in the body were crude and vndigested bloud that which is in the inflamed place is a great deale redder and yeallower if it were before redde through adustion it becommeth now more swart and blacke But if the Patient fâ—iâ—t or faile before the bloud alter in colour stay not then for the muâ—ation or change thereof Finally the plenitude in the body admonisheth vs of the quantity more or lesse and thus we conclude touching the knowledge of the quantity how muoh must 〈◊〉 taken Of the time and seasons of the sickenesse of this yeaâ—e of the daie and houre of the daie when a man is to bleede or not to bleede Chap. 16. ALthough it hath beene declared that we are not to let bloud in a season of the yeare too hot or too colde Yet in this Chapter wee purpose more exactly to discusse what time of the sickenesse and what day the same is to bee done Auicen in quartiâ— primi cap. 20. saith that for preseruation a veyne is most safely opened when the disease is not come or yet present disallowing altogether of this practise in the beginning of sickenesse and his reasons to prooue it are these In the beginning of a sickenesse saith he it attenuateth the humors and causeth them to slow throughout all the bodie mingling the bad Humors with the good bloud These wordes of Auicen are neither true nor agreeable to Hyppocrates Galen Hyppoc 2. Aphoris Aphoris 29. writeth that at the beginning of sickenes If any matter be to be remoued the same ought then to be done accordingly and when the euils are in their state then to giue them rest Galen in the Commen saith that bleeding and purging may be vâ—ed at the beginning but neither of them Morbâ— Consistenti that is in the state of tâ—â— disease whereofin the Aphoris following â—yppocrates rendreth a reason at the first and lasâ— â—aith he tâ—ings are more weake than in the middle estate for then all things are most firme and strong Againe why he should stay for concoction in bleeding I see no reason for as much as bloud of his owne nature is alwaies concocted and a veyne beeing opened it floweth out easily of his owne accorde Againe where Auicen in his reasons saith that by bleeding in the beginning that corrupted bloud is not euacuated that should be which afterward puts still the Patient to more pain so
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
taking that which comes to hand first or which appeareth greatest perhaps a sinew for a veyne so letting out the vitall spirits and killing many and when it is done this is all their defence to say the signe was there and he would needs be let bloud Vnction or annointing is oft vsed in this practise sometime we rub the member whose veyne is to be taken with oile that thorough the warmth thereof bloud may bee made the more flowing sometime the instrument is annointed as was saide before to mittigate the paine of the inflicted wound Sometime the wound it selfe is annointed that it may bee the longer time before it bee couered with the Scarre and that the humors left behinde may with the more liberty breath foorth and that the ill humors remaining may bee also the better dispersed Drinke and especially wine may bee very well taken both in the bleeding if Syncope happen and after bleeding to cause good bloud and to recouer againe the vitall spirits Bathing two or three daies before is vsed in some causes as was declared in the former chapter but not the selfe same day The common opinion is that bleeding must be done fasting and vppon an empty stomacke but this is not approoued of the best writers for many of them giue aduise to eate before bleeding a soft or poched egge with a draught of wine about nine or ten of the clocke â—n the forenoone and then presently to open a veyne For nature the stomacke being empty and being altogether destitute of nourishment doth mightily holdfast and retaine the bloud whereas when a little nourishment is taken in small quantitie as is a poched egge a draught of wine shee permitteth the bloud easily to passeforth It hath bin declared before Chapter 16. that if necessitie vrge there is no prescribed time of bleeding but that if the disease require the same may be done at all times yea euen in the night Yet the forenoone of the day is the most vsuall time There is an houre of necessitie which is any houre in the day or night and beside this hora necessitatis there is hora commodiâ—atis which is the morning or forenoone houre viz. Galen de Curan râ—tio per sang missio cap. 13. 20. in praesagio experientia Comprobatâ— cap. 4. Aetium lib. 3. cap. 16. Oribasi lib. 1. cap. 11. Moreouer if a veine opened send forth bloud whitish in coloure stay the same for it appeareth that the humours in the bodie are rawe colde and vndigested through defect of naturall and digesting heate This is affirmed by Aristotle lib. 1. 9. de animalibus and Hippocra witnesseth that alwaies womens termes appeare not in their proper colour that by reason of frigiditie and coldnes of white bloud they oftentimesvomit and haue fluxe of tearmes Finally as in purging so in bleeding as wee haue already said wee are to consider the standing of the wind in winter to bleed wheÌ„ the same is Sowtherly in Sommer when the same is Northerly For the North wind with cold tempereth the heat of the time The verses of Schola salerni Hac facienda tibi quando vis Phlebotomari Vel quando minuas fueris vel quaÌ„do minutus Vnctio siue lauacrum potus fascia motus Debent non fragili tibi singula mente teneri Before and after letting bloud all these are meete and requisite Vnguent a bath strong drinke and good with motion mean and bonds most fit Remember all doo none forgit A prescription or regiment of the patient after bleeding Chap. 20. WHen a sufficient quantity of bloud is withdrawen proportionable vnto the greatnes of the disease vnloose the bond and drie the wound lest beeing moistened with clodded bloud either it growe not together againe or bring some doubt of impostumation These thinges not done accordingly enforceth vs sometime the eight day after to open the wound againe If any piece of fat come forth the same must not be cut off but softly put againe into the wound When the wound is wiped cleane drie close vp the veine with linnen dipt in rose water or sweete water or with Oile if wee purpose to bleede againe Let the same bee tyed on with bondes not tooâ—hard for writhing the skinne or lippes of the wound If a sinew or Tendon be pricked yee heard in the chapter before what is to be done If there be doubt of fluxe of bloud or an inflammation through pricking of a sinew we may beside the premisses apply after the practise of others a plaster of Ceruse and in compas about that a Cataplasme of Housleeke Nightshade Plantaine and other cold things After bleeding lye a while on the backe for quietnes sake and to recreate the strength of nature and to recouer the vitall spirits He must not frequent his accustomed affaires nor moue his bodie hastely nor exercise himselfe immoderatly neither must he vse Venus delightes nor yet bath himselfe For the bloud and spirits naturall vitall and animall which haue of late bin vehemently stirred by bleeding are now by rest againe to be setled else the same bloud and spirites would by these outward vehement exercises bee inflamed and so wast and consume away Neither must the party presently sleep lest either the languishing heat be quite extinguished or the lessened spirits altogether ouerwhelmed Let him therefore watch and rest void of contention either in mind or in body When an houre or two is past after bleeding a litle meate may bee giuen him Little I say in quantity but of good iuice to nourish the bodie and profitable also to withstand the present disease when 2. hours are past this short repast he may then sleepe so as his keepers carefully take heed that he tumble and turne not himselfe on the arme that hath bled or that the bond by tumbling and tossing be not remooued which may cause the bloud to slow againe a fresh or some other displeasure to fall out Afterward the diet must bee increased by little and little both in respect of the quantity and of the goodnes of the meat Neither as yet must we hasten to a full diet for the heat of nature being abated by bleeding can not as yet receiue or digest aboundance of meat And againe the veines lately emptied would exhaust out of much aboundance of meat much raw and vndigested matter wherwith the whole bodie is stuffed againe If concoction bee perfected and accomplished so that we may eate great quantity of meat yet vse a moderation for to what purpose is it presently againe to stuffe the bodye with iuices and humours for the abating and taking away wherof we did so lately let bloud Therefore after bleeding the patient is to liue more finely and exquisitly and not to goe to his old intemperat diet againe as the dog to his vomit Neither are these intemperat persons meete men to be let bloud as we prooued and shewed before in the 8. Cap. Fig. 1. Of
Chrisi If it be very dark it betokeneth grosse bloud Greene bloud sheweth perfect adustioÌ„ When the bloud floweth soorthspedely it is suetile and thin when it spinneth not foorth but comes guttatim slowly drop by drop it betokeneth that it is grosse bloud when meanly betweene both then is it a mean bloud betweene grosse and thin Againe sometime it is quickly congeled then is it g rosse bloud somtime slowly compacted and then is it subtile Thicke and grosse bloud sheweth thicke and grosse matter in the bodie or it sheweth great heat and drith which hath consumed the humidity of bloud If it be subtile thin it sheweth want of digestion and abundance of raw vnconcocted humours of hot humours or of cold as the colour shall discrie If the bloud be oily it betokeneth either a future leprosie or too much fatnes in the body for leprosy is caused of extremity of heat in the bloud burning the same and conuerting it into an oily substance Againe take a bat round in the end and set it to the congeled bloud if it withstand it not but giue place vnto it and bee diuided it is an argument of drith If the bloud greatly resist the entrance of the bat then is it a very thicke and viscous bloud If between both then is it a meane bloud And thus of the substance of the bloud which should haue bin inserted before And touching the colour in like sort this briefe obseruation by the way which was also omitted but may come in here yet in good sort a good bloud is of diuers colours according to the diuersitie of the parts for in the vpper parte and in the compasse of the vessell it is of a red colour for the good bloud being light alwaies ascendeth vp to the higher partes in the middes it is red and not cleere in the bottom it is blacke and melancolious For melancoly being heauy resteth alwaies in the bottome Sometime there swimmeth on the toppe of the bloud a certaine fatte or oily matter like a copweb If the body bee very grosse and fat this is caused of the verie bloud which is in such bodies inclining to fat If the body be very leane it declareth the same now to beginne to melt and to languish In the bottom of the clodded bloud there is resident an earthly a filthy substance which being deuided or clouen asunder appeareth in colour either red darke blacke bright or greene whereby we may coniecture the nature of the humour mixt with the bloud yea by the colour much or little we may know how much ech humour aboundeth in the veines Some say if the bloud bee cut or deuided that there bee found in the same certaine grainees like small sande that it noteth leprosie or inclination vnto it which alwaies hath not been found true by certaine that haue obserued it It is sildome that the bloud comming from the veines doth sinke but if it doo the same sheweth corrupt and stinking humours and is a token of vncurable putrifaction and corruption No man doth willingly tast detracted bloud but if by chaunce it come into the mouth and doo tast sweet it is according to nature good and of perfect concoction If it bee bitter in tast it sheweth aboundance of choller if it be sowre sharpe and restringent it denotateth aboundance of melancoly if vnsauery aboundance of flegme if salt the bloud is mixt with salt flegme After obseruation of the substaÌ„ce and colour of the bloud conferre all the smal porringers or vessels of bloud together If they shew all equally good bloud it is to be supposed that the rest in the veines is like vnto it Yet the same is to bee withdrawen if it offend in quantity and greeue the body hurting the sences and causing in the body putrifaction and other euils If bloud appeare corrupt then with a greater profit the same is to be withdraweÌ„ because it hurteth the body two waies both with the quantity and qualitie thereof If it be not sufficiently withdrawen at one time afterward againe a veine must be opened and beside bleeding if Cacochymia concur with plenitud that is that bloud offend both in quantitie and qualitie as wee noted in the 21. Chapter beside bleeding the body must more ouer be purged with inward medicine If that bloud which came first were good and the other corrupt then suppose that yet much such bloud remaineth in the bodie to be auoided by good order of diet and orderly euacuation But if it fall out so in inflamations it is a good signe that the euacuation is absolute and perfect quite taking away the matter of the disease from the affected member The bloud poured into warme water hath thereby his partes and substances deuided the wheyish and watrìe substance is confounded with the water and cannot be knowen from it Also the thinner and more subtile part of the bloud is mingled with the water likewise whereby yet notwithstanding after a sort wee may giue iudgement of the nature of the humor The thicker parte of the bloud resteth in the bottome which is reputed good and naturall bloud if so be it be whitish thinne bright and cohering together If the same be more grosse it sheweth the grosnesse of the bloud that remaineth in the bodie If it be obscure blacke or otherwise coloured after the difference of the colour iudge the bloud to be corrupted or not corrupted with â—ilthinesse of wicked humors If it do not cohere but be distracted and diuided it betokeneth vncurable putrifaction Last of all remember that the more vnpure and vnconcocted the bloud appeareth being altered from the nature of good bloud the same is to be withdrawen in the lesse quantitie and not so plentifully as when the same draweth more nigh the substance of good bloud which is done otherwise and quite contrarie by our common barbors and letters of bloud And looke howe much the humors doe passe and exceede either lesse or more the nature of bloud so much more sparingly are wee to let bloud And when they exceede too farre from the nature of bloud either the one waie or the other then wee are altogether to forbeare bleeding as wee haue noted in a certeine place alreadie A short rehersall of eight auncient errours touching bleeding and a sufficient confutation of them by auncient authorities Chap. 23. FIrst that bloud must not be let but in the morning This is confuted by Galen lib. de Curand ratio per sanguin Missio Capitul 12. saying Feare not to let bloud by night forit is ridiculous that some doe maintaine onely letting bloud from the second houre of the daye to the fifth or sixth and no other time The second errour is that obstruction and putrifaction are the causes of letting bloud Galen also confutes this 2. Metho Med. cap. 14. in these wordes Neither obstruction nor putrifaction is the cause of leâ—ting bloud but abundance of humors for neither can stopping or putrifaction be
about the pâ—iuie parts of men or women Ventosas applyed vpon the buttockes attract from the whole body and the heade and helpeth the bowels also they helpe corruption of menstruous termes and by meanes thereof lighten the body Ventosas applyed vnder the ham behinde the knee helpe beating shaking in the hams caused of an hot humor also wicked pushes corrupt vlcers in the shanks in the feet and thus much of the particuler application of cupping or boxing glasses There is another kind of boxing that we haue not here to deale withall necessary and good sometime to bee vsed as for example sake If you haue any sawsie Lowt or loytering Lubber in your house that is either too busie of nothing but play one of the parts of the foure and twenty orders of knaues there is no pretier medicin for this nor sooner prepared than boxing is three or foure times wel set on a span long on both the cheeks althogh perhaps this wil not alter his lubberly conditions yet I assure you it will for a time change his knauish complexion and helpe him of the greene sickenes and euery man may practise this as occasion shall serue in his owne house to reforme them Because as we haue saide boxing is often vsed together with launcing therefore a word or two of scarrification and so an end Launcing is done with a Lancelot or some instrument called in Greeke Epidermes and in Latine Scalpellum The member is cut by little and litle with this Chyrurginall instrument ometime it striketh but the very skinne sometime it goeth in deeper It euacuateth onely out of the diuided member except by hap it wound and hurt the veyne Scarrification causeth the humor vnderneath to passe forth not forcibly extracting any thing from places distant and further off and the deeper the Instrument goeth in the more aboundant is the effusion of bloud It serueth to purge the skin and helpeth those affects which Leaches doo cure and those which are in the skinne and sticke stifly vnto the same As old inflamations of corrupt matter as the disease called Scirchus mentioned before as Gangraena a cankerous mortification of a member or part of a member as Sphacelus which is when any part or member is mortified thorow inflamation and such like in which diseases naturall heat beeing as it were choked vp and strangled desireth as it were to bee winnowed VVhere note that Launsing doth more plentifully draw bloud if presently vpon it boxing bee vsed as was partly signified before A profitable and compendious Table of Phlebotomy or bloudletting containing diuers points in this Treatise handled and discussed of and setting downe by diuision the generall and speciall considerations thereunto belonging Chap. 28. A principall rule and obseruation AS in other thinges so in bloudletting the cause is first skilfully and circumspectly to be considered as that it bee to purge the body of some vnnaturall naughty and superfluous humor whose substance is either simple or mixt Simple when it doth of it selfe without the admixture of any other degenerate as bloud doth when it putrifieth in the veyne the Pores being stopped mixt when it is mingled with some that is already corrupted as in the dropsie where the bloud is mixt with water The cause beeing thus allowed and certainely knowen for needefull and good to the Patient otherwise letting of bloud is very dangerous and openeth a way to grieuous infirmities as ye haue heard in this treatise There remaineth to be considered how it standesh with the Patient Inwardly For his Complexion For his Age. Outwardly For the time of the yeare and moneth generally For the time of the day and diet particularly 1 Complexion In the complexion is to be considered whether he be Sanguine i. hote and moyst Colericke i. hote and dry Melancolicke i. cold and drie Phlegmaticke i. cold and moyst 2 The Age. In his age whether he be In his youth In his manly middle age In his elderly age In his crooked old age 3 The time of the yeare Concerning the time of the yeare he is to be aduised what partes therof are good as the spring from the middest whereof to the beginning of Summer is simply the best time howbeit some thinke Autume reasonable good as no doubt it is in regard of Summer or VVinter being otherwise in it self rather to be rekoned for bad than good Bad Verie bad as Summer VVinter for the extremitie of heat colde More tollerable as Autumne being somewhat more temperate 4 The time of the Moneth Concerning the time of the Moneth these generall cautions are to be obserued that he be not let bloud in any meÌ„ber with chirurgicall instrument The Moone being in ♉ ♊ ♌ â™ or the last half of ♎ and first of â™ The Sunne the Moone or lorde of the Horroscope being in the sâ—gne that ruleth that member The Moone being in any parte of via lactea or in via combusta or in domo casus sui or being vacua or tarda cursu or in terminis infortuniorum or in the duodenarial diuision of the 12. houses placed either in 1. 6. 8. or 12. place thereof or applying to the lord of the house The dâ—y before the day it self the day after the chaÌ„ge of the Moon Halfe a naturall day that is 12. hours before as many houres after the quarters of the Moone A day before a day after the full of the Moone A day before a day after the coniunction quartile opposition of the ☽ with ♄ or ♂ A day before the coniunction of the ☽ with ☿ ♀ or the head or the taile of the Dragon infortunate and euill The conuenienst time of the yere For the Sanguine the Moone being in any of the signes For the cholericke the Moone being in ♋ or ♓ For the Melancolick in â™’ and first halfe of ♎ For Flegmaâ—ick the Moone being in ♈ or â™ Howbeâ—t some commend ♋ â™’ and ♓ for bloud letting Also the best most laudible aspectes for this purpose are these according to our soundest writers The coniunction of the Moone with ♃ or ♀ are simply the best so that ♀ bee not combust The â–³ or âš¹ of the ☽ with ♃ ☉ ♀ and ☿ are good but especially with ♃ or ☿ The ♊ or ☠of the ☽ with ♃ or ♀ doth well The â–³ or âš¹ of the ☽ with ♂ are indifferent good The time of the Moneth for Youth from the chaunge to the first quarter Middle age from the first quarter to the full Elderly age from the full to the last quarter Old age from the last quarter to the chaunge A reason of this rule is Like reioyseth in his like Howbeit as we haue taught in this Treatise no childe would bee let bloud before fourteene yeares of age nor olde man after threescore and ten vnlesse his strength be the greater and somewhat more than ordinary at those yeares 5 The time of the daie The time of the day must be
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
in the body these three spirits humors and excrements The excrements are the ordure or reffuse of the belly vrine and superfluous humors sent from the braine and the lungs Humors some are superfluous some necessary properly called succi 1. iuces Humors superfluous separated from the bloud by natures force and as vnprofitable for the nutriment of the body are sent a farre off As flegme inhereth in the maw stomacke and about the entrailes yeallow choler in his proper coffer namely the gall Melancholy in the Spleene The iuces are conuerted into the substance of the body nourishing the same Of this kind are those iuces whereof the bloud is compact those otherwise called secundarii humores Nowe each of these are sometime agreeable to nature sometime repugnant to nature They are agreeable to nature when they retaine the right quality and quantity according to the law of nature for conseruation of health They are repugnant to nature when they keepe measure neither in quality nor quantity And therefore whatsoeuer of these manifestly departeth from the iust meane and measure which nature hath appointed because it is the cause of sickenes if otherwise it cannot be amended it is altogether to be taken away and expelled the expulsion whereof is called Euacuation The differences of Euacuations are to bee taken of the scituation of the contents and corruptions which are either Plethora or Cachochymia as was shewed in the Chapter precedent The meats and drinkes receiued into the body if the stomacke and liuer doo their naturall Office bee altered by concoction in such wise that the best part thereof goeth to the nutriment of the bodie the worst being separated by the members Officiall from the residue are made excrementes in sundry formes and substances which excrementes are like in quality to the naturall Humor which then raigneth most in the body These excrements are none other as was saidâ— but matter superfluous and vnsauory which by the powers of nature may not be conuerted into flesh but remaining in the body corrupt the members and therefore nature abhorring them desireth to haue them expelled These excrements are in number three Ordure Vrine Humor superfluous Of Ordure are two sortes one digested which passeth by siege the other vndigested expelled by vomit VVhere I say digested I meane that it is passed the stomack turned into another figure Likewise I call that vndigested which sâ—il retaineth the figure of meat Vrine is the watry substance of bloud like as whey is of the mâ—ke which out of the meate that is altred concoct or boyled in the stomacke is streyned in the veynes called Mesacaicae which proceedeth from the hollow part of the Lyuer and sent by the Raines into the Bladder passeth by the Instrument which is ordained as well for that purpose as for generation Humor superfluous is of three sorts either mixt with any of the foure Humors called naturall or else it is gathered into the braine or is betweene the skinne and the flesh or lyeth among the Synewes Muscles or Ioynts Of Humors some are more grosse and cold some are subtle and hot and are called Vapors Now to expell these excrements there are nine sundry kindes of Euacuations Letting of bloud pargation by siege abstinence vomiting scâ—rrifieng or cupping sweat vrine spytting sternutation bleeding at the nose bleeding by the Hemmorroids exercise and in women there naturall purgations But in this Treatise I will onely handle that Euacuation which is done by opening of a veyne by Cupping-glasses and by Leaches shewing the commodities which by the discrete vsing of these come vnto the body of man And that the way of Euacuation may bee the more easie wee may deuide the body of man into three general Regions which being inclosed in their proper limits haue not onely diuers receptories of superfluities but also diuers waies to purge the same One and the first Region is extended from the meat pipe called Gula to the middle part of the Liuer wherein are contained the maw the stomacke the venies Mesecaicae as many as come to the entrance the hollow or inner part of the Liuer the Spleene and Pancreas that is a thing betweene flesh and kernel lying betweene the stomacke and the Liuer The 2. Region runneth from the middle of the Liuer through the thin small veines of all and singuler partes comprehending the outward part of the liuer and euery hollowe veine and the greater artery placed by it and vvhatsoeuer is betweene the Armehole and the flanks The 3. Region comprehendeth the muscles the vppermost skinnes the bones and the whole masse of the body which extendeth from the very entrance and lesser veines through euery part and the outmost skinne it selfe Great is the diuersity of these Regions for so much as they are so inclosed within their owne limits that there is betvveene them no fellowship at all But the greatest diuersity is in their owne proper operations hauing concoctions excrements and waies of purging diuers one from the other By obseruation and marking whereof vve shall the better proceede in Euacuation Beside these generall and vniuersall Regions of the body there are some more speciall and particular hauing also excrements yet not retching so far nor following through the whole body of which sort are the braines lungs raines and belly Hereof are deriued tvvo differences of Euacuations one generall the other particular That is a generall Euacuation which draweth matter vniuersally from the vvhole body Of this sort are Svveate Bleeding Vomits Euacuation by siege Each of these thogh specially for the most part they euacuate one RegioÌ„ or part of the body Yet these also empty other partes though not so abundantly As vomit first and chiefly euacuateth the stomacke if it continue long it purgeth also the bovvels and the greater veines last of all the state of the whole body Euacuation by siege or purging chiefly and most of all purgeth the entrailes stomacke bowels and the first veines then the greater veines Last of all the small veines and the state of the vvhole body Opening a vaine first exhauseth the veines and arteries ioyned vnto them then the body and all the bovvels euen til it proceede to the first veins Euacuation by svveat called in Latine perspicatio or dissipat io per cutem First dissolueth from the habite or state of the body Secondly from the greater veines and arteries Lastly from the bowels and inwarde Region of the body Particuler Euacuation doth onely alleuiate some particuler part loden vvith Excrements Of vvhich sort are purging of the braine through the palate and nosthrils spitting of fleame vvhereby diseases of the brest and lungs are eased Pissing forth of sand and matter from the raines Passage of bloud by the belly or Hemmorroids the one cleansing first the lower part of the body called Podex the other the belly and both of them the hollow veyne called Vena caua VVhen the wombe therefore is prouoked either with a Clister or a Suppository
cured by bleding but require other remedies The third error That opening of a veine is vnnâ—edefull except the disease be present This also is confuted by Galen de Opt. sect ad Thrasis Cap. 37. For the most part saith hee we vse remedies as purgagion and bleeding when the diseas is not present but future The fourth error That Phlebotomy must be done in the iudgement day of a disease Auicen impugneth this in quart primi chap. de Phlebo saying Neither must bleeding nor purgation be done in the day of the mouing of a disease nor when the same hath Crisim â— iudgement But if it be possible let there be rest This is also proued Aphorism 21. Qua iudicatur vel iudâ—cata sunt c. The fift error That bleeding dulleth the sight Gallen remoueth this error li. de Curand ratio per sangui missio Chapitul 7. Some haue a weake sight hauing aboundauce of bloud Euacuate such either with purgation if there bee other humors beside bloud or by bleeding and so detracting of bloud doth good not dulling but quickening the sight 6 The sixth error is that in fulnes alwaies a veyne must bee opened Gaben confuâ—eth this error 4. de vict in morb acut Commen 19. Plenitude is not alwaies cured by bleeding but by rubbings many and oft batlings and by abstinence 7 The seauenth error is that bloud must be let the wombe beeing very laâ—atiue this Hyppocrates refelleth 4. de vict in morb acut cap. 118. If it bee needefull to withdrawe blâ—ud from any you must stay the wombe and so let bloud and Galen in the same place saith If the belly bee flowing let not bloud lest the fluxe continuing the strength of the body bee cast downe 8 The eighth error is That there is no difference of the times of the yeare to let bloud in Galen contrary to this writeth ad Glanco cap. 14. Those Phisitions which consider not of the state of the times and withdraw bloud they kill men Et 4. de vict in morb acut is Commentar 19. If the Aire be too hote and dry we refraine from bleeding though the sickenes bee vehement and the age of the party youthfull A sufficient confutation of the supposed necessitie of annuall bleeding Cap. 24. THere commeth here to my minde a common opinion among the ignorant people which do certeinly beleeue that if any person be let bloud one yeare he must be let bloud euery yere or else he is I cannot tell nor they neither in how great danger VVhich fonde opinion of theirs whereof so euer the same sprong first it is no more like to be true than if I should say when a man hath receiued a great wound by chaunce in any part of his body whereby he looseth much bloud yet after it is healed he must needs haue the like wounde againe there the next yeare to auoid as much bloud or els he is in daunger of great sicknes yea also in hasard to lose his life which opinion if I did affirme to be true albeit it be most false yet I might vse the like reason authoritie to defend it that the comon people vse in the defence of theirs For they can say nothing if they be asked why they thinke so but that they haue heard many to say so Therefore I would wish that no man should credit this folish opinion being most false vnlesse he can shew some good reason for it which I am sure no man can do This I think that like as bloud letting is not good against al diseases so is it not good in all persons as we haue set it down in the 9 Chapter but only in those that wil be content to vse afterward a moderat conuenient diet Those therefore that do abound with bloud wil be let bloud to preserue themselues froÌ„ the danger of any disease that is like shortly to ensue must long time after be content to vse a moderat diet For intemperat persons gluttons great drinkers wine bibbers they doe not only receiue no commoditie at al by bleeding but often times greater hurt than if they had bin without it For within 3 or 4 dayes after they fill stuffe them selues with more rawe iuices humors by vnmeasurable dyet than they had before and often times these die through convulsion And hereupon we are to note that there is such force in moderat diet to eschew sicknes that without obseruation thereof Phlebotomy is to no purpose And therefore if this coÌ„mon saying of the comoÌ„ people be true in any namely that they must be let bloud ofteÌ„ thâ—r are once let bloud it is only true in such as keep ill diet presently after bleeding Therefore to conclude this Chapter I councell al persons to beware of excesse after opening of a veine Ofincision of Arteries Chap. 25. AS a veine is opened according to our former discourse hitherto so somtime also an arterie is opened that is to say only such a vein wherein the vitall spirites mixed with the blod do runne flowe but for the hard stinting of the fluxe from an arterie Phisicions are in doubt to make insicion thereof and yet some sometime practise it as in the disease called Vertigo If in opening of a veine we chance to stick an arterie we can very hardly by by stint the bleeding and although the matter fall out very well that the wound or incision be brought to a skarre by diuision yet there will be a dilation or spreading abroad of the cut arterie stil as Galen witnesseth lib. de Curand ratio per sang missio Cap 21. 22. The bleeding of an arterie is hardly stayed partly for the heat of the arterial bloud which is very quickly moued by spreading abroad openeth the arterie whereupon incision of an arterie greatly furthereth the bleeding partly because the motion of the arteries neuer ceaseth as Galen witnesseth lib. 2. Cap. 20. de Sanitate tuend whereby also it commeth to passe that the wounds of the arteries are the more slowly cured For such things as are to be healed require rest ease Gal. lib. 5. Cap. 8. metho medend commet 6. lib. 6. Aphoris The opening of an arterie is to be vsed when the body is repleate with thinne windie and verie hote bloud For the seat of subtile thinne windâ—â— bloud whereof the naturall heat and vitall spirites are ingendred is in the arteries and to is the hotest bloud which commeth from the hotest member that is the heart and which is carried into the other members of the bodie conteined likewise in the arteries The receptacles of the thicker bloud wherwith the â—â—eÌ„bers are nourished is in the veines Vpon what occasion Galen did cut an arterie he himselfe sheweth Cap. 22. dv Curand â—at per sanguinis missio being warned saith Galer by certeine dreames of which two among the rest most plainly appeared vnto mee I weâ—t to cut that arterie of the right hande which is betweene the