VVe are here to set downe from what place the evacuation is made for inasmuch as bloud is moyst and flowing that first issueth forth which is next the opened veine then that which is next the same thirdly commeth foorth not onely that which is in the veines and arteries but also that which is in the bowels and whole habite of the body For there is a wonderfull continuation and order of the veines so that a way being once made all the bloud often times floweth out of the bodie and bringeth death to the partie But when the passage is stayed then the bloud is sent foorth by the veines arteries till there be a certain proportion in the whole bodie For the emptied and wanting partes by the long small veines draw bloud forth of the full partes repleated members and so â—â—â—â—or them as it were in their need Againe the full members grieued with too much aboundance vnburthen them-selues on the veines that are emptied Againe the humor being liquide and flowing voluntarily followeth the lower euacuated regions and there continueth whereupon it followeth that whensoeuer bloudletting shall emptie the veines the same also shall euacuat the whole bodie In regard whereof Phlebotomy in the definition thereof is called verie well an vniuersall euacuation and that for two causes First because it withdraweth all humors whereof the bloud consisteth Secondly because it euacuateth from the whole bodie but yet not in like sort Forasmuch as the partes of mans bodie are placed in their order therefore first it exhauseth from the neere partes then from those that are further off And againe forasmuch as some veines are spred into some partes of the bodie and other into other partes therefore bleeding with more celeritie and force draweth from those partes which are rightly and directly placed then from those members which are opposite or ouerthwart Whether Phlebotomie must go before purging or contrarie Chap. 4. IN this place it is a necessarie question to be moued and aunswered whether bleeding or purging must go first in this case which is verie frequent where they are both requisite Some will alwaies haue that when purging is necessarie bleeding must go beforeâ— and they bring out the authorities of Hippocrates and Galen Others contrarily affirme that alwaies some extenuating or lessening receit called barbarously Medicamentum minoratiuum must be first receiued and them Phlebotomie succeede But of these opinions neither is simply true and yet both true as the case may be limitted And for the cases wherein a gentle purgatiue is to proceedâ— Phlebotomie they are in number these sixe First when the stomacke the Mesecaicae veines the great veines the waies passages of the bodie or any of these be stuffed with filth or incombred with crudities or that the excrements are hardened in the bowels although the whole bodie abound with bloud beside yet a gentle easie receit is to be taken as Manna Cassia or a clister but no violent receit which may euacuate from the foresaid veines open the obstructed passages If the bloud should first be drawen forth without some gentle purgation or euacuation in the greater veines then the veines outwardly exhausted by bleeding through their attractiue vertue would drawe vnto them ill iuces specially if the disease require any plentiful bleeding This is affirmed by Auicen Galen 9. Metho cap. 5. who did vse to refraine from Phlebotomie if there were cruditie of meat in the stomake or rawnes in the veines called Mesecaicae til their concoctioÌ„ wer ended the excremeÌ„ts descended Secondly when the bloud is verie viscous clammie grosse we do not only take medicines attenuating but also lessening things a dyet conuenient to prepare bloud and to make the meÌ„ber bleed the better vse a bath for oft it commeth to passe that a veine being opened no bloud issueth forth because of the thicknes clamminesse thereof Thirdly it faleth out in many cholerike bodies that choller contained in the vpper parte of the stomacke is easily moued so boileth causing Lipothymia i. ouercoming in which case it behoueth to vse before some Minoratiue receit also in bleeding to vse somewhat to keepe backe the boiling of choller Fourthly in diseases wherein appeareth a difficultie by reason of Cacochymia or abundance of other humors mixt with the bloud When a practisioner perceiueth that he must vse Phlebotomie yet with some difficultie in this case he may vse some easie purgation or one of some force whereby it may fall out that nature shal thereby so be eased which the siege ease of nature wil shew thee that thou shalt not need bleeding at all but onely preparation of the matter then to renue the educing thereof as before Fiftly remember Auâ—cens saying Sanguis fraenum cholerae existit bloud is the restrainer of choler therfore in diseases mere cholerik it were a rash part to set bleeding before purging which perhaps thou maist be without after the exhibiting of the medicine And if thou vse the patient wel let those things suffice which change or repell the sharpnes of choller Yet this is to be added that if there shuld be such abundance of choller as might cause a swelling aboue nature or inflamation then bleding vpon that is a present help Sixthly the same reason may serue in flegmatike constitutions Wherein for many causes although no small fulnesse appeare yet we are not to vse Phlebotomie before purging The cases wherein Phlebotomie preceedeth purging are these First when great fulnes appeareth which either hath caused or is like to cause any vehement disease as Apoplexia which is a sicknes engendred of grosse humors filling the receptories or vessels of the braine and thereby depriuing the partie of feeling speach and mouing as Peripleumonia which is an inflamation or an apostume of the lungs with a vehement Feuer comming sometime of it selfe but most commonly following vpon great and sharpe rewmes squinances pleurisies or such like diseases as Suffocation which is in English strangling then in this case without faile and chiefely if the wombe be laxatiue vse letting of bloud without precedent purgation And this seemeth to agree with Galen lib. 10. de Composi medica secundum locos ca. 2 VVhere he saith if the bodie doe equally abound with humors first let bloud then purge And hereunto Auicen accordeth in quarta primi Cap. 4. This saith he is a truth and the precepts of Hippocrates in lib. Epidemionium that if both bleeding and purging be necessarie and that the purgatiue must be vehement then begin with Phlebotomie Secondly in dangerous fluxes of bloud out of the nose or in spitting of bloud called Hoemoptoicapassio or in bluddie fluxes for to turne the matter a way in full bodies wee presently let bloud without medicine going before Thirdly in wrastlers abounding with bloud to whom the same abundance threatneth some great danger that it is presupposed that there are no ill humors in the circuite or compas
of the bodie in this case wee vse Phlebotomie without purging Fourthly we may safely let blond without medicine those that are whole for abundance of bloud only are accustomed to yerely bleeding and that haue in the yere taken little or no Phisicke as it chanceth to many persons in many countries of the North. Fiftly we may open without purging the inner vaine of the arme in women with child if they carrie Corpora Phletorica full bodies that in the 5. 6. or 7. moneth after the conception yea also before they be quicke This practise wee are to vse specially when they being with child waxe verie slowe heauie as it were ouerladen with abundance of bloud we may take Salua tella veine or if plenitude so require the inner veine of the arme for the quantitie respecting a discreete moderation Sixtly we may let those bloud without medicine that haue fallen from some high place taken hurt in the brest and stomacke in whome is to be feared an inconuenience called of the Greekes Egchymosis Seuenthly we speedily let bloud such persons without further Phisick as by reason of their fulnes through some accident as feare or such like waxe domme in which case wee let bloud abundantly so that both armes are opened together Here I am to note a great error in Auicen both repugnant to trueth it selfe and also contrarie to Galen For Auicen affirmeth that when colde and thicke humors are in the bodie first wee must begin with purging and then open a veine Diuers and many waies hath he erred in this First because in flegmatick humors grosse and colde mixt with bloud hee woulde haue Phlebotomie not vsed before purging And in this case by all likelyhood of reason the cure should begin with bleeding Secondly in this hee dissenteth from Galen who 11. Method Chap. 4. though there were obstructions in the bodie of thicke and clammie humors yet first hee would begin the cure with Phlebotomie If Auicens meaning be when flegmatike humors ouercome the bloud in multitude or abundance that then wee must first vse purging then is hee greatly deceiued for as much as hee proponeth a case in which Phlebotomie should not auaile except with those many colde humors there be also some excesse of bloud which chaunceth verie sildome or not at all But it may seeme that Auicen hath reason namely this that the bloud being extracted those humors would waxe more rawe and so by opening a veine the patient is brought to a marueilous cruditie of colde humors This is no reason for by Phlebotomy wee detract bloud not because of obstructions caused of grosse and colde humors but because bloud superaboundeth For the stopping is afterward remoued with other helpes Therefore when obstruction concurreth with abundance of bloud wee must not extract verie much bloud but keepe backe some till the time of the cure as Galen teacheth 11. Method Chap. 14. And thus much of the order betweene Phlebotomie and Purging whereby wee see that a strong purgatiue must followe bleeding and that an easie purgation or clister may go before Of the effectes that is Of the profits and disprofits of opening a veine Chap. 5. Schola Salerni in two verses reckoneth vp three effects of bleeding Exhilerat tristes iratos placat amantes Ne sint amentes Phlebotomia facit It swageth wrath and cheeres the sad Preserues loue-sick from being mad FIrst it maketh glad those that are pensiue Secondly it appeaseth such as are angrie Anger is especially caused through mixture of much yellow choler with bloud And sadnesse by commixture of much Melancoly with bloud And forasmuch as both these humors choler Melancoly are exhausted with the bloud these two effectes must consequently follow Thirdly it preserueth loue-sicke persons from madnesse by drawing humors from the head to the lower partes and so expelling the same Although occasion will hereafter better serue to shewe the causes why wee vse Phlebotomy yet here nowe speaking of the effectes I will briefely shewe fiue causes for which wee vse to let bloud and by the which may be gathered the profitable effectes of this practise of the which fiue causes one onely cause is the direct the other foure are indirect The direct cause of bleeding is euacuation of the bloud But forasmuch as bloud is good for nature therfore Phlebotomy must be vsed â—duissdly that the same bloud only may be expelled which is vnprofitable hurtfull to nature Bloud as you haue partly heard is made vnprofitable to nature two waies either when it doth not throughly keepe the proper qualitie that it cannot so nourish as it did before when it was good or when in quantitie it so increaseth that it either presseth downe the powers of the bodie or stuffeth stoppeth both the veines the arteries In these two cases bleeding is good as one of the direct euacuating helpes Yet in these cases bleeding is not to be vsed indifferently but with this difference in abundaÌ„ce of bloud much may be detracted In little plentie small euacuation serueth Hereupon Galen writeth lib. 9. cap. 10. Method Si sanguis vitiosus in corpore fuerit paulatim quod vitiosum est euacuare oportet paulatim ad in o icem quod salubre est pro eo reponere If corrupt bloud be in the bodie wee must by little little take away the bad and by litle litle procure in the place therof that which is good which way of curing or amending of corrupt bloud the Phisicions call in Greeke Epicrasis And to this Alexander Tralleanus subscribeth lib. 9. ca. 2. The reason why this is not to be done at once is for that the powers of the bodie would relent giue ouer And although that which is euacuated be superfluous yet by a sudden thorough mutation it doth more hurt than good It is better therefore to emptie the bodie safely and by little at once than by making hast to dispatch both the disease the partie diseased And here it appeareth how much they abuse Phlebotomy which detract the ill bloud so long til the good also begin to come wheras it may fall out that all the bloud will flowe forth of the bodie before that the good will appeare It behoueth therefore the euacuatioÌ„ to be little And as Gaelen councelleth in this case before the opening of a veine to vse Epicrasis i. to giue the patient such meat as may cause good bloud that good bloud may still come in place of the bad and then a little after more bloud may be taken This therfore is called the direct bleeding because it is don of it self to euacuate that which by opening a veine ought in deede to be withdrawen namely multitude of humors of bloud of bloud principally of humors secondarily in asmuch as they are mingled with the blod The other are called indirect causes and are vsed only to reuoke or call backe the violent force of humors to the contrary part or
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
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
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
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
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
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
complexion it quite reiecteth bleeding For Phlebotomy by great cooling so greatly increaseth crudity and rawnes in the body that it can neuer or very hardly bee recouered or amended VVeakenesse of bodilie strength resembleth this foresaide Repletion and therefore also by the selfe same reason reiecteth any large euacuation And in truth is not in this respect to bee dealt withall except the veynes abundantly repleate threaten some great hurt or that necessity so require it and then it must not bee done all at once but by little and little as it hath beene before declared Therefore in each and euery fulnes that is vnpure we are to begin with opening a veyn for without it wee cannot safely afterwardes purge For a vehement purgation especially if bleeding haue not gone before troubling and molesting the full body both with much heate and by force of the attractiue vertue bringeth the Patient into greater hazarde than he was before and therfore to conclude this point the veynes being swollen and filled if moderate bleeding doo no good it can doo no harme at all The otherfulnes quae ad vires which cannot very easily be knowen by signes althogh it cannot ouerstretch or breake the veynes nor ouercome the inward heate yet because it oppresseth the weake forces of nature lest there should insue putrifaction or corruption of humors it may be diminished by opening of a veyne Leauing yet behinde so much as nature may easily rule yea and the same also because it bringeth no doubt of present danger may be profitably taken away with spare dyet or abstinence Of corruption and putrifaction of bloud and humors in the veynes without plenitude called Cacochymia that is fulnes quae ad vires There riseth a great doubt whether the same may aptly bee remooued by bleeding VVee answer that to remoue by bleeding a simple corruption of humors in the veynes is profitable and easie regard beeing had both to the abundance thereof and to the forces of nature in the Patient For albeit when a veyne is opened all humors issue forth equally and that there remaine behind still as there did before one and the selfe same proportion of humors yet because now by bleeding part is abated of that burden wherewithall nature was before oppressed the forces and powers natural waxe not the more feeble but they become more strong and chearefull so that they can beare with the greater ease those humors which as yet remaine still behind and nature hir self gouerneth them with farre lesse trouble than before And herevpon in continuall feuers when there is great crudity and corruption in the veyns bloud being often times detracted the vrine also beeing red troubled and thicke before It appeareth nowe more cleare and sheweth forth euident signes of concoction And note here by the way that the Phlebotomer must be very well exercised in those signes which prognosticate fulnes repletion Yea ye must also know perfectly the place of each particular humor lest after the manner of the vnskilfuller sort when the nose a little bleedeth and the vrine appeare somewhat red by and by yee doo let bloud Whereas bloud often times easily commeth forth not onely by reason of fulnes but vppon diuers other occasions nature her selfe often attempting voluntary eruptions of bloud Hereof it commeth that such persons as haue as it were the small litle mouths of the veines called Oscula eaten or gnawen or that haue a weake and apostumated Liuer and that Hydropicall persons bleede oft at the nose Also vrine waxeth reâ— and bloudy by the fretting of the stone in the Raines Vrine waxeth yeallow in that kinde of yeallow iandies which is simple in Scirrho hepalis That is in the hard part of the liuer and in that kind of dropsie which is called Ascites Yet in these effects we are not to let bloud for Cacochymia proceeding of corruption of the bowels is not that way cured Therefore the certaine knowledge when a veyne is to be opened necessarily is onely gathered of those markes and tokens which manifestly declare abundance of each humor And hereby yee may gather that bleeding alone speedily helpeth that corruption of humors which lyeth in the great veynes and only freeth the Patient from this kind of corruption except the same take beginning from the bowels ill affected and in this kind of corruption purgation is more meete than bleeding And thus it appâ—areth in a generall sort what corruption of humors the opening of a veyne doth remedy A particular rehersall of those diseases present or future which are cured by bleding Chap. 11. FIrst as yee haue heard a veyne is profitably opened in the two plenitudes nature being strong and the age conuenient In the fulnes quaead vires haue speciall regard that the naturall forces be firme But if in this plenitude raw cold and vndigested humors bee greatly gathered together in the body forbeare taking this as a rule that with great abundance of raw humors the strength of the body cannot stand as yee haue already partly heard and as Galen witnesseth lib. de curand ratio per sangui missio cap. 9. Secondly it helpeth diseases present and future and serueth both in the curatiue and preseruatiue intention VVe read that Galen in the spring time did let bloud those persons that were subiect to these diseases following to wite Spitting of bloud A polexies Falling sicknes Peripneumonia Pluresies Anginaes Stoppinges of Hemorroids or Termes Swimmings in the head The Gowt in the feete and in the ioynts All which Auicen also setteth downe in quarta primi cap. de Phlebotomia Thirdly we doo not onely open a veyne in repletion as Menodorus falsly supposeth but also as hath beene said without fulnes when wee feare some inflammation through some fall or other accidentall griefe And moreouer as wee haue already specified wee open a veyne for two purposes sometime to euacuate sometime to pull backe immoderate flux of humors to the contrary part as Galen noteth lib. de Curand ratio per sang missio cap. 11 9. Metho Medend cap. 11. As to stay bloud at the nose we open a veyne in the arme For this cause Galen lib. 13. Metho Medend ca. 21. in Letargus which is a drowsie and forgetfull sicknes rising of impostumation of cold putrified fleame especially in the hinder part of the braine whereby memory and reason almost perisheth and the sensitiue power is greatly hindred causing men commonly to forget their owne names also to shut their mouthes after they haue gaped and by no meanes to stay from sleeping In this disease I say at the first beginning thereof Galen willed to open a veyne albeit the disease bee colde rather as it seemeth to reuoke than to euacuate the matter or Galen so appointed it because fulnes is alwaies concurring with this forgetfull and drowsie disease Herevpon Galen 11. Meth. Meden cap. 15. affirmeth it to bee very healthfull to open a veyne not onely in continuall feuers called Continentes but in all
feuers caused and kindled of a putrifieng humor which should not seeme to bee true especially in intermittant fâ—uers which leaue off for a time as are tertian and quartan agues Forasmuch as in these bloud offendeth not in the veynes but some other humor beside bloud putrifieth without the veyns which by bleeding in reason cannot be euacuated This place of Galen cannot sound to reason or experience except we vnderstand Galen to giue vs aduise to euacuate by bleeding the matter of such intermittant feuers as haue also with the bloud fulnesse and abundance of other humors concurring So that this may bee his meaning Bleeding may bee vsed in intermittant feuers if they fortune to haue abundance of humors ioyned with the bloud For obstruction as Galen sheweth li. 11. Meth. Meden cap. 4. happeneth in rotten and putrified feuers sometime through abundance of humors sometime through the clammines grosnes and thickenes of them Galen therefore counselleth to let bloud in staying and intermittant feuers rather because of the abundance than the rottennes or putrifaction of the humor without the veynes And that this is his meaning appeareth by the words which Galen afterwards vseth saying Forasmuch as nature ruling the body by bleeding is lightned and disburthened of that wherwith she was before oppressed therfore shee will with ease ouercome that which resteth and remaineth behinde which is a 〈◊〉 signe that Plethora or fulnes is also annoxâ—d to such feuers Fourthly in bleeding we are not onely to consider the disease it self which wee determine to remedie but also oft times the cause therof so that whatsoeuer the sicknes be if Phlebotomy may remoue the cause then also it taketh away the griefe it selfe in the ende HereupoÌ„ somtime albeit the disease be cold yet when the cause moueth vs to open a vein we may safely bleede without hurt Hippo. saith Galen sheweth a cure of his done on a woman by letting her bloud in the Ankle This woman after child-birth was not freed ofher seconds then a shaking came vpoÌ„ her This woman I cured saith Hippo. by letting her bloud in the Ankle for all her shaking Shaking is a cold affect bloud is hote and they that must be heated must not haue bloud taken from them He for al that boldly did it he sheweth the reason I considered said he the cause the occasion of the cause He knew the cause of shaking was abundance of bloud kept backe which was a burthen to nature The occasion of the cause was the griefe of the matrix This abundaÌ„ce requiring euacuatioÌ„ the affected part shewing the place most fit for euâ—cuation considering both these things together he let her bloud in the ankle because the wombe or matrix was affected In griefes of the womb or bellie we take the vaine of the ankle knowing by the Anotomie the communion betweene the veines for some veines communicate to some part of the body others to other partes And euacuation is to be made from such veines as haue fellowship with the member affected For as yee heard in the Chapter of Revulsion if we take that veine which communicateth not with the part affected wee hurt the whole bodye do the griefe no easement The profitable vse of this fellowship of veines apeareth especially in revulsion or pulling backe of humors which is both wel speedily done when this coÌ„munitie of veins is obserued as was there declared But let vs return to our former purpose Fiftly by opening of a veine is cured the feuer called Synochus both that which coÌ„meth of ebullition of blod without putrifaction that which is caused with putrifaction of the bloud So are also hereby cured continuing feuers coming of putrifaction in the greater veines And to these diseases reckoned vp of Galen Fig. 2. we may adde these that follow Frensies Opthalmia parotis i. an apostumatioÌ„ about or behind the eares diseases of the Liuer splene Nephritis i. paines of the raines and backe inflammations of the wombe or matrix of the priuie partes arme-holes armes thighes ioynts Finally all inflammatioÌ„s inward or outward which the Greeks call Phlegmonae These inflamations are caused by flowing of bloud to a member when a veine is open broken which bloud there abundantly heaped togither bringeth forth a tumor or swelling To these also are to be added a consumption in the beginning vomiting of bloud bleedings at the nose bely or hemorroids at the beginning of which diseases the opening of a veine greatly profiteth staying the force of the fluxe by revulsion if the veine be opened at the contrary part calling back much of the matter froÌ„ the member affected so that bleeding is a present helpe for those diseases whatsoeuer which take the beginning from too much abundance of good bloud Those sicknesses which come of an vnpure mixt plenitude because they are somewhat neere linked vnto these they may also be cured by bleeding And although the matter of these diseases be vnpure yet either it lyeth in the veines or procedeth from the veines A gaine by bleeding are cured Carbuncles felons moyst scabs outward rednes in the skinne such like all these are cured by this practise Thus also is cured the burning ague called Causus all continuall feuers whose putrifaction is conteined in the greater venies Yet sometime a continuall feuer commeth of an humor heaped togither inflamed about the stomack chiefely about the mouth of the stomack the flat parts of the Liuer which feuer cannot be takeÌ„ away by bleeding Neither can the cause therof by this practise be remoued Pure intermittant feuers whether they be Tertians Quartans or Quotidians because the next matter proper cause of them is not in rhe greater vessels neither floweth from the veines are not conâ—eniently cured hereby And yet sometime in these also we bleede either when the veines swell with immoderat fulnes so that therby some danger at hand may be feared or when any accident of hote inflamed boyling bloud perswadeth vs therto as are namely beating paines of the head tossings mouing of the body this way that way excessiue heat almost stragnling the pacient Howbeit these many times come also of boyling choler about the inward partes called praecordia in the which cases bleeding remoueth neither the feuer nor the cause therof but onely asswageth the vehemencie of those accidents which are present or shortly like to ensue Further concerning perticuler affects cured hereby we may adioyne beating paines of the head Letargus spoken of before fig. 3 and trembling of the heart These with the foresaid are not onely cured hereby when they presently affect and afflict the patient but happening yerely vnto vs so that it is verie likely we shalbe grieued with them in time to come VVe may verie well preuent them by bleeding wheÌ„ we haue once espied plenitude to haue beene in vs the causes of these infirmities For there is one the self-same way of healing common
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
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
bee obserued A simple Sinochus feuer or a simple feuer putrified or caused through putrifaction of humors requireth to haue the Basilicam of the right side or arme opened So doth an hote pestelenciall feuer simple and not compound So doth a tertian and a continuall quotidian A quartan requireth the inner veyne of the left arme This is also the Methode in pure intermittant and discontinuing feuers if either the plenitude or accidents will haue vs to open a veyne Revulsion of matter from those partes placed betweene the canell bone of the throate and the raines is done from the right Basillica or left as the disease requireth if the right parts be affected open for revulsion Basilicam dextri brachii If the left the other Basilica Open this veyne in the arme if great and speedy bleeding be needefull If a more slacke and remisse bleeding will serue the turne seeke the braunch of it in the hand betweene the little finger and the fourth as some say from the right kidney to the left and passing ouer the bottome of the stomacke Inflammations in the gut called Colon which is a great gut rising from the left side to the right or in which is the disease called the Collick albeit the same be vnder the raines yet they are cured by revulsion opening Basilicam or the inner veyne of the arme For so the beginnings and deriuations of the veynes doo shew In inflamations of the lungs take the Basilica or inner veyne of the left arme rather than of the right because the veynes of the lungs come from the right side of the hart which part of the heart is placed toward the left part of vena caua so by the left wing ruÌ„neth into the left arme This order of incision also helpeth spitting of bloud thorough extreame coughing the disease called Tabes trembling of the heart and such like In a á¹–luresie open the Basilica of the arme according as the paine shall happen in the right or left side In a Pluresie of the right side the right Basilica and so contrary Item the interior veyne is taken in inwarde and outward apostumations of the brest or midriffe and in inwarde Vlcers which cause vs to spit bloud Thus also by opening of Basilica are cured inflamations on the shoulders and vnder the arme holes except they come to the very bought of the arme for then it were very dangerous to open the very part or member inflamed but in this case we open a veyne in the hand e directo that is straight In paines and inflamations of the Liuer wee open the right Basilica and so the left Basilica when the Milt is inflamed grieued or ill affected and in all these wee must take the veyne in the arme if much bleeding be needefull and if not then the veyne in the hand Deriuation from the Spleene is not made as some do think into the veynes called Hymorroide but into the belly So deâ—iuation from the hollownes of the Liuer is made also into the belly A postumations in the Raines when the veynes also all full of bloud are repelled by the right Basilica if the right kidney bee grieued by the left Basilica if the left kidney bee ill affected If excessiue fulnesse doo not vrge in these apostumations the revulsion is better attempted out of the lower veynes which are straight and right as out of the right or left anckle Affects of the belly as immoderate fluxe of termes are stayed by opening Basilica in the arme which draweth the fluxe vpwardes So doo also cupping-glasses applyed either to the paps or nauill That revulsion which is made by opening Basilica in the arme specially the right Basilica is to be accounted generall because it draweth from the Liuer which is the fountaine it selfe from whence all fluxe of bloud commeth whether the same bee fluxe of termes or any other fluxe of bloud Revulsion made from the lower veynes is particuler not euacuating first from the Liuer the fountaine of bloud as the other doth And forasmuch as things vniuersall goe before partiticuler things therefore in inflamations vnder the kidneyes wee must first pull backe with direct opening of Basilica in the arme and afterward wee are to open the lower veynes which also haue some force to reueale but if either the fulnes or the fluxe be great it is not best first to open these v eynes below Finally imminent diseases like to arise thorough plenitude of bloud are kept backe be opening the right Basilica that is the inner veyn in the bought of the right arme The third generall veyne in the arme is the middle veyne called of some very properly and fitly venacommunis of other Cardiaca or Cordiaca venanigra and Mater and of the barbarous Phisitions Mediana It is called Media or Mediana for three considerations First inregard of the scituatioÌ„ hauing in the vpper part of the arme aboue it Cephalica vein in the lower part of the arme beneath it the Basilica veyne and so these being as it were extreames it possesseth the mids betweene them both Yea it is indeede a braunch of them both And for this cause secondly it hath the name Mediana as if it were made of them two as the meane is made or consisteth of the two extreames Thirdly it hath the name Media or Mediana for that it is Media that is in the middle in respect of euacuation Euaeuating both from aboue and from belowe aboue the necke from the necke and from beneath the necke For it springeth I say from the diuision or parting of both the other veynes that is Cephalica and Basilica By opening this veyn there is made a generall euacuation of humors through the whole body A generall or vniuersall euacuation I call it not because it springeth froÌ„ the hart as some affirme but because the fluxe commeth generally from all parts This veyne being a braunch as yee haue heard both of Cephalica and Basilica This veyne is taken when neither of the other appeareth and withdraweth bloud from them both according to the iudgment of some This veyne is the same which is called also Funiâ— brachii Cephalica and Basilica are as it were the Parents of Mediana As often therefore as thou art determined to open Basilica and that the same doo not appeare take rather the Mediana veyne than the Cephalica And if thou purpose to detract bloud from Cephalica and that the same doo not shewe conueniently open rather Mediana than Basilica and being compact of Cephalica and Basilica it withdraweth bloud indifferently from them both both from place and parts beneath and also aboue Some giue aduise vpon what ground I doo not yet see not to open Cardiaca if the Patient feele any weakenes at the heart but if necessiity of bleeding bee vrged the heart beeing enfeebled wee are rather to open Cephalica or Basilica This veyne is opened to cuâ—e â—assions of the whole body especially when they proceede of heate of the heart
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