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
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
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
is vnprofitable and superfluous not bringing any commodity but discommoditie and perturbation to the sicke Therfore in this case this must be the practise moderately and often to giue the patient meates of good iuice and nourishment to confirm strengthen and recouer nature and such as haue some vertue in them a proprietate against the present infirmitie may redresse the inward corruption of humors And wheÌ„ thus the naturall forces shall be recouered Phlebotomy may succeed And this practise is much vsed in continual and long sicknesses in sharp diseases called morbi acuti this long stay were doubtfull and dangerous An obseruation of things present past and also a foresight of things future needful necessarie to the further knowledge of the quaÌ„titie of bloud that must be taken Chap. 15. OBseruations of euident causes touching the greatnes of the disease constancy of naturall forces doth greatly further our knowledge in this behalfe Of which euident causes three of them are in ward and bred in our selues as namely the temperament the complexion the age three of them are outward and accidentall namely the coÌ„stitution of the aire according to the seueral seasons of the year the situation of the countrie state of the heaueÌ„s All which are included in one cause as grouÌ„ded al vpon one reason secoÌ„dly former euacuatioÌ„s ether slaid or immoderatly flowing thirdly custome order in diet life or kind of euacuations proceding By knowledge of these forepassed causes we may atteine to the vnderstanding of the strength both of nature of the disease so consequently of the quantity that wee must bleed albeit that the causes present future haue not yet altered either the disease or streÌ„gth of nature yet for asmuch as they begin to dissolue some humours froÌ„ the body to wast the strength of nature they haue some moment in this practise For what these causes present or past can doo ye haue heard in the 8. 14. chap. to the which I refer you coÌ„cerning the perticulars here onely being contented to rekon theÌ„ vp by name 〈◊〉 the teÌ„perameÌ„t the state of the body the age the countrietthe time of the year the disposition of the aire sky voluntary euacuatioÌ„s custom the rest as appeareth ca. 8 It is the part property of a wife skilful phisition to consider not only the state present of the natural vertues but also to foresee what will be their state in time to come after bleeding The natural powers after euacuation are so to be conserued as that the same may be able afterwardes to take other helps continue out the prolixity of a coÌ„tinuing diâ—eâ—s Yea we must reteine alwaies some bloud for future fits and courses of the disease which are yet to come Lest afterwards vrged thervnto wee begin vnfitly and out of due time againe to nourish the same And this chiefly is to be done in bleeding for corrupted and putrifying feuers whose putrifaction obstruction is not taken away by bleeding but the putrifaction is afterwardes the better ouercome by the strong force of nature when by opening of a veine shee is somewhat relieued Therefore to this purpose alwaies some bloud must be left for natures preseruation as Galen councelleth lib 11. method cap. 14. We may coniecture the future strength of the patieÌ„t partly by the preseÌ„t causes which are also afterwards like to continue partly by accidents which may happen contrary to our opinioÌ„ Among present causes these are the chiefe the state of the heauens the order of mans life If the constitution of the aire hath bene hot dry is like so to coÌ„tinue the bleeding must be lesse than if wee suppose a cold aire to ensue Again if we perceaue that the patient will liue sparingly â—eÌ„peratly either for want of appetite or because the disease will not suffer him to feed as in Augina the Quincie which shutteth vp the Iawes we are to take lesse bloud than wheÌ„ we see he wil liue more frankly and liberallie In these cases we must still reserue some bloud as natures treasure to helpe at a pinch in time of neede Suddaine accidentes and vnlooked for which greatly enfeeble natural strength are these great paine and ach watchinge voluntarie euacuations and chiefly Sincâ—pe into the which many do fall beeing not accustomed to bleede at the first opening of a veine either because they are weâ—ke of nature or strucken with some great feare or because the mouth of the stomake fiâ—â—ed with bitter choler is becom very vnsensible and weake When we suppose that some of these matters wil fall out albeit the strength be firme yet no blood at all or very litle is to be withdrawen except by art wee naue preuented the former accidents It is I say great wisedome to foresee a farre off 〈◊〉 beware of such suddaine and vnlooked for accidents This we will manifest by an example Let the pacient be of a sanguine complexion of body thicke and well set of a florishing age that hath long time led a leacherous life feeding plentifully of good meats and that hath omitted his accustomed exercises and liued at home idely in whom also accustomed eruptions of bloud out of the nose belly or Hemoâ—roids are staâ—ed so that by concourse of these causes the body hath greatly encreased or waxed that the large veines through repletion are greatly filled WheÌ„ soeuer a strong ague or great inflammation shall possesse such a patient presently he must be let bloud and that plétifully Both the greatnes of the disease and of the cause requiring the same Moreouer this is confirmed by obseruation of thinges past if present causes agree to these namely that there bee a sit temperature of aire by occasion of the countrie season of the yeare and the present state of the weather moderatly cold and moist and that the patient bee apt to euacuation also that the sicknesse bee not like to continue long after neither apparant signification of an excessiuely hot temperature of aire to come no thveatning of future paine or of abstinence watchinges voluntarie euacuations If all these thus agree together who may doubt but that a large euacuation may in this case bee made And none at all when the conâ—raryes doo appeare Sometime these obseruations are mingled among themselues and contrary to themselues In which confusion a wise iudgement is needfull by comparison of them to prescribe the iust quantitie of euacuation The consideration of passed matters many times perswade a plentifull bleeding which the obseruation of things present by and by taketh away As for example if the Patient laying aside his accustomed exercise giue himselfe to pleasure and idlenes stuffing himselfe withmeats and hauing some notable euacuation staied in him but his body is waxed fat white of colour loose open soft full of thiniuce and that it be Summer a hot dry country a hot dry constitution of weather without stormes In