which being hostile to life irritates the Archaeus to frame the Idaea of a disease not as it is meerly provoked by nimiety or plurality but from the pravity of the matter wherefore the case is altered now and the 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 signification or demonstration of evacuating doth in a strait line respect the Cruor or Cacochymy directing the Artist to reform mundifie and rid those impurities contained in the seemingly corrupted marred juyce by proper means sequestring the vile from the precious not to let out indistinctly what comes next at randome to the furtive castration of the Eutony lustiness liveliness and strength of the Patient which is to be preferred before all motives whatsoever T is certainly known to those who are throughly versed in the Analysis and Synthesis of the parts of bodies that ebullition aestuation effervescence of febrile liquors arising from a pleonasme of degenerate Sal. and Sul. c. as they would have it may be appeased and allayed by Remedies assisting the vitals to make separation and afterwards an exclusion every way of what is reprobate reserving what is acceptable This being performed there is no fear that a plenitude simply of it self can do any harm for hereby so expedite a course is taken that the overplus is in a short time sent packing away by vomiting stool urine expectoration and sweat For this reason considering what strict abstinence the Patient is put upon in a Feaver 't is very unlikely a plenitude should be of any duration Is it not then greater prudence in a Physician to minorate what is superfluous by safe profitable wayes of secretion and excretion still advancing the principal Agent then for that end to give vent indiscreetly to what comes next without any election incommodating if not hazarding the loss of the vital principles For believe it whosoever hath any great quantity of blood taken from him either rues it for the present or hereafter Let him that is heterodox prate what he will alledging examples of those sturdy lusty bodies which have hereby received immediate succour I can make good by practise â—nd challenge any one to come to that otherwise let him forbear his Garrulity whosoever is cured by a Lancet in this sort is either prone to relapses or to live more crazy in his younger or elder years although for some short time he may not by reason of a robust ingrafted constitution be sensible of these inconveniences As for Phlebotomy in order to Revulsion he thus explodes it Another pretended waâ— for sanguimission is Revulsion by which they say a violent flux of morbifick liquor into any noble parts is intercepted for this end they use the Lancet in a Pleurisie Peripneumony or any inward inflammation But how far they erre herein is well known to the best Practitioners for although I confess they do sometimes in the beginning suppress and as it were crush the aforesaid diseases yet is it done accidentally very uncertainly rather by way of distraction of the Nature for the loss of its substantial treasure than from any true Revulsion or direct pulling back of what is in flux or already flowed in 'T is true where the vessels are depleted a repletion is forthwith made ob fugam vacui to avoid a vacuity but the supply is from what comes next for as intro as well as intro foras However there is no streight immediate Revulsion intended from the part affected to the Orifice It seems strange to me that any man should pretend thus long to have diligently attended on the practise of Physick and yet never have seen or have the impudence to deny that there can be any such thing as a surcharge of Blood which is that which Physicians call a Plethora or Plenitude But the continuance of these Baconical Philosophers will in time free us from any admiration of this kind In Greece when the Athletae or Wrastlers were publickly maintained the observation indeed was more facile than now but every Countrey almost yields frequent cases of such an indisposition particularly 't is easily to be remarqâ—ed in strong healthy and plethorick Children whose sudden death â—s it often ariseth from no other cause so it astonisheth the vulgar and usually raiseth in them suspicions of Witâ—hcraft Hippocrates and Galen having taken notice of the evil consequences attending this habit of body do advise the owner to attempt the change of it though it be accompanied with the most perfect health and vigour imaginable 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 And this habit of body and fulness of blood which he saith would do Methusalem no harm is observed by those who had daily opportunity to see the sad experience of it to abbreviate the life and occasion many diseases as Apoplexies Cardiacal Syncopes and Ruptures of veins in the Lungs Squinancies Pleurisies c. So that Hippocrates condemns that habit of body again in his book De Alimento and Celsus concurs with him therein Ea corpora quae more eorum Athletarum repleta sunt celerrime senescunt aegrotant i. e. Those bodies which are dieted and brought up to an Athletick habit do soonest of all decline into sickness and premature old age I never read of any Physician who in his directions for health recommended unto his Patient that course of life wherein the Athletae were bred up thereby to acquire such a Plethoric habit and whatever the present sanity were which they injoyed as to strength of body their intellectuals were very dull and the most understanding persons would have thought it prudential in such a case to broach some of the Balsome of life and weaken Nature thereby rather than to live in a perpetual danger of such perillous diseases as that Euexy subjecteth men unto But our Helmontian doth think otherwise If such an habit of body be thus perillous during perfect health how ought a Physician to apprehend it upon the first approaches of sickness Doth not then Nature add to the redundance of blood by a defective transpiration whereas the veins are so full as not to be able to contain more Is not the pulse weak slow and opprâ—ssed and the Heart so debilitated as not to be able to discharge it self of the Blood which flows into it and in danger to stagnate in the Lungs or coagulate in the Ventricles Can there seem any thing more agreeable to common reason in this case than to practise Phlebotomy whereby Nature is at present alleviated the surcharge of blood abated and the imminent dangers prevented Is it not prudential were a little blood so precious a thing and the loss thereof attended with some small irrepairable debility Is it not I say a part of prudence to submit to lesser though certain inconveniences then to run an almost inevitable hazard of the greatest imaginable I read not that the famous Milo arrived to the years of Methusalem nor yet to those of Hippocrates though I am apt to think
warmth and concurrence of the contemporary fabrick for the first blood can neither give a beginning to its self nor is it comprehensible how the weak impulse thereof should shape out all the veins and Arteries in the body according as they are scituated Out of which it is â—vident that the Soul or Plastick form doth at first reside and principally animate in the Spermatic parts so called not that they are delineated out of the Sperme but out of the Colliquament which is Analogous to it and that they are her first work the blood is but the secundary and generated out of the Colliquament for other Materials there are none by the Plastic form which is the proper efficient thereof and besides the Auxilary Heat there are no other instrumental aids but the spermatick vessels wherein the Colliquament at first flows to the punctum album which when blood is generated do become the Heart and sanguiferous Channels This is avowed by Doctor Glissen himself Liquor hic vitalis antequam sanguinis ruborem induit sese a reliquis ovi partibus quibus promiscue commiscetur segregare incipit in rivulos seu ramificationes quasdum excurrere quae postea venas evadunt Rivuli isti in unum punctum colâ—untes in eum locum conveniunt qui postea punctum saliens cor appelâ—â—tur Idque fieri videtur diu antequam sanguinis aliquod vestigium compareat Herewith agree the most exquisite Observations of Doctor Highmore Most certain it is by the History of Generation that no Parenchymatous part hath any operation in the first production of the blood all their â—arenchymas being post-nate thereunto And if the blood be thus generated at first it is but rational for us to imagine that it is alwayes so generated during life For as it is true that the same cause acting in the same manner will alwayes produce the same effect So in this case to argue from the identity of the effâ—ct to the identity of the cause is allowable Est enim causarum identitas quae faâ—it ut effectus sit idem quippe effectus supponitur non esse donec a causis existentiam suam indeptus â—uerit dum existentiam illam largiuntur oportet ipsius quoque identitatem impertiant qua sine effectus ipsemet nequaquam fuerit That the Spermatic vessels in which the blood moves do contribute to â—anguification much seems apparent from hence that the blood is seen in them before it is in the heart And because it is observed that the fluidity of the blood seems to depend much on them and therefore in the dead it doth not coagulate except praeternaturally in the veins though it do commonly in the Heart or wheresoever it is extravasated Manat praeterea aliquid a venis nobis incognitum quod dum earum ambitu sanguis concipitur prohibet â—jus concretionem etiam post mortem in cadaveribus jam perfrigidis nequis hoc colori acceptum ferat quod vero coralliorum instar aliquando repertus est concretus in venis ipsis hoc merito Fernelius ascribit morbo occulto And not only the â—â—uidity but motion of the blood seems to depend much thereon for if by a lâ—gature the impulse and succession of blood be prevented yet will the blood in the veins continue its course and not stagnate Exempto e corpore corde motus tamen sanguinis isque satis câ—ler in sanis videntur Et si vena ulla etiam lactea duobus locis ligetur laxata ea sola ligatura quae cordi propinquior est dum partes adhuc calent semper Chylus ad hepar sanguis ad cor cum movebitur qui nec a corde per Arterias nec ab intestinis per lacteas objecto potuit obice propelli nec stuiditate sua potius sursum quam deorsum movetur The truth hereof seeming undeniable to Pecquet he makes use of a new Hypothesis to solve this motion of the blood as if it arose from compression of other parts or contraction in the vein it self But the Phaenomenon will appear in such cases as admit not this pretence From these reasons it is that the blood doth not need so much as any pulse in the veins and arteries as appears in the first faetus but as soon as it comes to the Heart it does to prevent coagulation the punctum saliens being endowed with no such quality practiseth its systole and diastole when yet no such motion is observable in the Arteries at that time Whence the colour of the blood ariseth is a secret unto me I know that digestion reduceth some Juyces to a redness in some Fruits the â—ire doth the like in some the mixture of acid Liquors begets a Vermilion But here I conceive none of these causes produce the effectâ— the generation of the blood is manifestly an Animal Action and as such unsearchable Whatever I attribute to the veins it is not to be expected that supposing they should instrumentally sanguifie the blood should turn blew from them any more than that water put into new vessels of Oak should turn white whereas it becomes reddish Thus the Plastic form produceth blood at first and whilest thâ—re is no first concoction in the stomack supplieth that defect by that albuiginous Colliquament which is of the same nature with the Chyle we digest our meat into and convey by the Lacteous Thoraciducts into the Heart That it is of the same nature appears hence that it resembles it and that it is extracted from the Blood of the Mother and produceth in the Embryo the like excrements of Choler and Vrine and Mucosities nay it hath been observed by Riolanus to have been tinged yellow How much more may be concluded hence in favour of the Galenical alimentâ—ry humours supposed to constiâ—ute the Blood I leave those to judge who consider the variety of female constitutions and their condition during their being with child perhaps the Hypothesis of a proportionate mixture of the five Chymical Principles will not seem more colourable Having thus related how Sanguification is performed in the Faetus at first I come to give an account how it is performed afterwards and even here it seems an Action perfectly Animal for even Concoction in the Stomach is not the bare â—ffect of Heat elixating the meat nor of acid or saline Ferments dissolving it nor of any other kind of imaginary Fermentation But 't is the effect of an Animal power operating upon the Meat in the stomachs of sundry Men and Animals by several wayes This appears most evidently herein that the same meat eaten by several Persons or different Animals produceth different Blood and different Excrements therefore Chylification is an Animal operation and is modulated by the speciâ—ick and individual constitutions Having thus determined of things that the Soul in all these actions is the Efficient we may consider that the meat being masticated in the mouth and commixed with the salival juyce
according to their Art nor is it denied but that All of them may atchieve their ends by their several Methods So that it is a gross paralogisme for any one to conclude this or that Physician is mistaken or takes a wrong course because another takes or prescribes a different one All the Physicians in Spain France and Italy do not bleed with equal profuseness In Germany and England some do practise more frequent Phlebotomies than others do and neither of the parties do erre in case the other remaining Method be inviolately observed It is in humane bodies as it is in the body Politick where there is a Method of ruling though it be carried on by several wayes and means and whilst each States-man doth prudentially sway the Government procuring peace and plenty to the subject his conduct though it vary from that of his Predecessour is not to be blamed It is not to be doubted but that many grievous distempers are cured by Nature without the use of any remedies at all Yet will no wise man adventure his life on such incertainties 't is not to be denied but some are cured with fewer Remedies than others are But yet 't is not prudence to put Nature upon too great a stress or to account all means unnecessary which are not absolutely requisite or without which the effect may though with more difficulty and hazard be brought to pass It lyeth upon the Physician therefore to pursue all those means which may secure the life of his Patient to alleviate the disease in its course by preventing all troublesome and mitigating all dangerous symptomes and to facilitate as well as hasten his recovery It is not questioned but Patients have been and may be recovered of Feavers with little or no blood-letting yet when I consider the great hazard they run in that course the vexatious and perillous symptomes which they languish under longer and with more violence than others I cannot approve of the practise nor think the Physician dischargeth his duty and a good conscience in so doing Extrema necessitas in moralibus ut certumest vocatur quando est probabile periculum and the Patient doth offend against himself if he refuse to take a befitting course against dangers that probably are impending and the Physician doth trespass against his neighbour if he do not propose and practise such a course I cannot to use the words of the incomparable Riolanus I cannot without pity to the sick and some resentment against the Physician read in Platerus's Observations how sundry of his Patients were broyled and torrefied with burning Feavers whom he never let blood He doth relate of himself how he was sick of a most burning Feaver yet did he never so much as let himself blood therein albeit that it were requisite in those cases Such are not obliged to their Doctors but peculiarly to the Divine Providence for their recovery It was the mature consideration of that tenderness w ch is requisite in Physicians towards their Patients which advanc'd the present course of Physick to its glory above all other Methods it being endeared to our esteem by all those regards that represent it as prudential It was not introduced by chance or the subtlety of some persons but the choice of all and so established by the Magistracy that to transgress against the traditions of this Art was criminal in a Physician even by our Laws It may in some cases seem to be troublesome and unpleasant yet SAFETY requires it It may seem tedious sometimes by multiplication of Medicines yet Prudence obligeth by all those means to preserve and secure life and if the omission thereof be criminal in a Physician in case of any sinister accident why is not the practise laudable Would Men but seriously consider How much danger they run and How much more they suffer upon the negligence or indulgence of a Physician who leaves all to Nature and adviseth them to wear out a distemper they would rather hate than love such a Man and the apprehension they should have for the unnecessary jeopardy he put them on would extenuate his credit very much The most rash and brutish counsels may succeed well but yet the most prudent are to be preferred Amonst Physitians I do not reckon the Helmontians as any there is no doubt but a Plethorick indisposition requires Phlebotomy Nature being surcharged with blood forceth us thereunto least some vein should break in the Lungs or the Patient be strangled with that excess this is called Plethora quoad vasa when the vessels are so full of blood that there is danger of their breaking or that the blood should stagnate in the Heart Lungs or Head there wanting room for its motion or take some inordinate course and so strangle the Patient There is another redundancy of Blood which is called Plethora quoad vires or such a plenitude of blood as brings along with it no apparent hazard of breaking the vessels yet doth it oppress Nature so as thereby to become redundant It is more than she can bear in the present juncture 't is more than she can rule and it will suddenly fall into an exorbitant motion to the detriment of some principal part in case timely prevention be not used In both these cases in which the blood is not supposed to be much depraved from its natural estate all do allow of Phlebotomy and if it be timely put in execution it may hinder the progress however it expedites the cure of the disease In these cases we consider not only the present plenitude but also the future what may be in a few dayes to the great exasperation of the disease and peril of the Patient For it is possible that in the first beginnings of a disease there may be neither of these plenitudes but they may ensue a little after For when the insensible transpiration shall have been a while abated as inquietude pain and watching will abate it the Blood degenerates and no longer continuing its usual depuration those excrementitious particles which were lodged in the habit of the body and pores do remix with the sanguine mass and become like so many fermentative corpuscles agitating and attenuating the blood so that whereas before there was no plenitude now there is that the excrementitious particles do contract a fermenting heterogeneous quality different from what they had in the Blood appears hence that those which sweat much as the new-comers in the Indies their sweat is less noysome and bilious by far than it is in those that sweat more seldome Thus Soot is a different body from any thing that is burned Hence it is that those particles being reimbibed into the blood are so offensive to the nervous parts and introduce a lassitude as if the body were surcharged with a plenitude Besides these two cases in which Phlebotomy seems to be directly indicated by a Plethora or surcharge of blood It is practised in other cases by way of
tender habit of body cannot bear a violent transpiration swoon not by bleeding in water though otherwise they do by reason that the great effects of the Air upon the Blood are impeded by the ambient water the like happens in Scarification with Cupping-glasses and in bleeding with Leeches I did suppose that oftentimes in a Plethora quoad vires transpiration being hindered by the change of the texture of the Body the not-exhaling particles remix with the Blood and there also happens a subsidence of the vessels and change of the porosities so that the Fermentation is is not only clogged with morbose particles of several sorts but so hindered by the subsidence or compression of the vessels and alteration of the pores as not to be able to ferment for freedom of room is necessary to Fermentation nor transpire nor continue its due course nor by reason of the charge of porosities confer aliment aright so that a Plethora ariseth hereupon But as soon as the vein is breathed and the Blood as in your common water-pipes when a Pipe is cut acquires a more free passage that way it presently becomes more rapid and its motion also is accelerated by the fuliginous exhalations hastening to the vent together with the natural Fermentation resuscitated and so the whol◠〈◊〉 by a natural coherence and dependance is not only eâ—â—cuated but altered in its minute texture and conformation It is most evident that the Blood in the Veins and Arteries is conveyed as it were in conduit-pipes the Heart being the great Elastic Engine which drives it being fed by the vena Cava and disburthening it self by the Aorta though even the motion of the Heart depend upon a Superiour influence by its Nerves which wherein it consists and how derived from the Brain and Soul is a thing to us incomprehensible I do suppose that the Circulation is continued and carried on principally by Anastomoses betwixt the Capillary veins and Arteries many whereof having been discovered by Spigelius Veslingius and others the rest may well be supposed and perhaps in the coats of the Veins and Arâ—eries there may be a certain texture requisite whereby the transpiration is managed in order to the safe continuance of the digestive fermentation in the Blood and the nutrition of the body The impulse of the Heart together with the pulsation is sufficient to convey the blood to the lesser capillary Arteries and there though the pulse be lost which yet a little inflammation in the extremities of the body will make sensible and in some Ladies as also in Children the least preternatural heat yet it is impelled by the subsequent blood still into the veins and having acquired by the common miscele in the Heart and the digestive fermentation which naturally ariseth in such heterogenious liquors an inclination to expand it self the compression in the Capillary vessels adds to its celerity of motion when the larger veins give liberty for it the Aiery corpuscles of several kinds which are easie to be discovered upon burning by their expansion and contraction adding much thereunto Thus in Water-engines the narrowness of the Pipes do add to the impetus with which the Water issues forth And I do conceive by the Phaenomena which daily appears in practise that the Animal heat in the Blood actuating that heterogeneous miscele and according to the diversity of its parts producing therein with the help of its fermentation a rarefaction of what is aiery and according to the room there is a liberty or inclination to expand and evaporate themselves this is the principal cause of the continuance of the motion of the blood in the veins and of its saliency upon Phlâ—botomy Thus upon Scariâ—ication there is no salience or spurting out of the blood there being no room for such an expansion or for the Aiery halituous parts in which there is as great a difference as in those exhaling from the terraqueous Globe to rush forward out of the continued Arteries and together with themselves to protrude the blood Upon this account the Methodists and old Physicians as also the Aegyptians where the tender bodies and constitutions of Children and Women or Men admit not of or requireth that great relaxation of the pores and texture of the body which a more robust and firm habit wherein as the natural resistance in health is greater so the recess from it in a bad estate is much greater would be cured by they use these Scarifications and prefer them most judiciously to Phlebotomy This constitution of the Body doth evince the great utility of Phlebotomy and best as I suppose explicates the effects thereof which we daily experiment From hence not only is manifest how the Body is evacuated in a Plethora but in case of Revulsion and Derivation It is manifest in Aqueducts and Siphons that the liquors though much differing in nature from the Blood nor so inclined to evaporate does accelerate their motion and issue out so rapidly upon an incision or fracture in one of the Pipes that a lesser in such a case will deplete the greater notwithstanding its free passage in its own entire Canale Thus the most learned and considerate Physician Sir George Ent having observed first thus much Videmus aquam per siphones delatam si vel minima rimula hiscat foras cum impetu prorumpere And Sanguis per aortam ingressus fluit porro quocunque permittitur peraeque sursum ac deorsum quia motus continuus est quemadmodum in canalibus aquam deferentibus contingit in quibus quocunque feruntur aqua continuo pergit moveri Quare nugantur strenue qui protrusionem hujusmodinon nisi in recta linea fieri posse arbitrantur After this He explains the doctrine of Revulsion in this manner Quae postea de revulsionibus dicuntur nullum nobis facessunt negotium Tantundem enim sanguinis a pedibus ascendit per venas quantum ad eosdam delabitur per Arterias Facto itaque vulnere in pectore aut capite revulsio instituitur si modo tam longinqua instituenda sit in crure Quia sanguis alias quoquoversum ruens facto nunc in pede egressu copiosius per descendentem ramum procul a vulnere delabitur Non enim arbitramur sanguinem aeque celeriter sua sponte per arteriam aut venam fluere atque is secta earum aliquo effluit Nec sanguis ad laesum pectus aut caput per venam cavam impetu affluit quia fluxus ille aperta inferius vena intercipitur I do acknowledge that the reading of these passages did first create in me the thoughts I now impart unto you And hereby it is evident how the Ancients with their large Phlebotomies might derive even the morbiâ—ick matter or revell it though impacted Our minute Phlebotomies do seldom produce such an effect for since it is not otherwise done but by a successive depletion out of the Arteries it would seem necessary to extract three or
the followers of Erasistratus upon this subject But above all that ever intermedled I will give this character to Thomson that never did any presume more upon so weak grounds Nor ever was Confidence so poorly mounted and so pittifully be-jaded After much trouble and enquiry the sum of all he sayes in this case amounts to this The promiscuous mass of Bloud which flows in the Veins and Arteries he divides into three parts the one is called by him the Latex the second Cruor the third Sanguis or most properly Blood The Latex so called by Helmont by some Lympha by the Greeks 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 is a diaphanous clear liquor 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 fabricated in the second digestion by virtue of a ferment there residing It is the inseperable companion of the Bloud and closely pâ—rambulates with it through all the wandring Maeandrous pipes in this Microcosme It is the matter of Vrine and Sweat Spittle c. and renders several other considerable services to the body The goodness or pravity of the Latex depends much upon the bloud as it is constituted for albeit it is no essential part thereof yet is it altered for better or worse according to the channels it passeth through the lodging it taketh up and the condition of its associate notwithstanding that it may be sometimes impaired in its due excellency and the bloud withall remain very pure and sincere The second part is called Cruor from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 i. e. Crudus concretus It is the more crude impure part of the bloud the purer part of the chyle being digested into a saline juyce is carried into the milky vessels and veins and mingling at last with that ruddy liquor is called Cruor and at last becomes perfect bloud It undergoes manifold guises and is often the subject matter of a multitude of diseases being sometimes changed into an Ichor Tabum or Sanies The third part is properly called Sanguis or Bloud 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 it is a most pure sweet Homogeneous Balsamie Vital juyce for the most part of a bright Red or Reddish colour made by the Archaeus by virtue of ferments implanted in the ventricles of the heart lungs veins and arteries causing a formal transmutation of the Ckyme or milky substance into this sanguineous liquor ordained to be the seat of Life and and the principal matter for sense motion nutrition accretion and generation It is for good reason called Balsamum seu Condimentum totius corporis â—orasmuch as it hath a sanative power sweetly uniting all the parts of the body for the conspiration of the good of the whole It is a great preservative against putrefaction as long as it remains in its integrity for consisting of many saline particles it seasoneth whatsoever it toucheth with a pleasing sapour It is the proper habitation of the vital spirit the immediate instrument of the soul in which it shines displaying its radiant beams every way that sensation motion nutrition and all other functions may be exquisitely performed God and Nature never intended other then that the bloud should be Homogeneous pure plain symbolical with that single principle of the Vniverse Now these Peripatetick Philosophers deliver to the world that the contexture of this vital juyce is made up of Choler Phlegm Melancholy and Blood which united produce this compounded body which we call Sanguis How grosly erroneous and dangerous this Tenet is most Learned Helmont hath made evident Wherefore we conclude with that noble Philosopher that Bloud is an Vnivocal substance divisible only by some external accidental means as the Air or Fire which cause a various texture and different position of its Atomes whereby it seems to consist of parts which are not really inherent in it as is manifest in its degeneration from its native colour sapour consistence and goodness which it had before it became corrupt in the pottinger or underwent the torture of fire Both of which do strangely larvate and disguise the puniceous Balsome giving occasion to the Galenists to frame their four fictitious humours no where really existent This being the foundation of all his declamations against Phlebotomy before I proceed any farther it may seem requisite that I should make some Animadversions thereon I might take much notice of and dislay his errours as to what he sayes that the Latex is by the Greeks called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 this is the first time I ever read it called so the usual terms being 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 The notion whatever Helmont say is not new at all an hundred Galenists have mentioned and treated of it as the vehicle of the bloud and nourishment But that cruor should come from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 crudus concretus is an opinion singular to the Baconical Philosopher That 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 doth signifie cold I know well and that cruor properly signifies the the bloud of dead people or the mortified bloud issuing from putrefied wounds I no less understand though Authors frequently confound it with Sanguis But that his Latex and the Lympha so called by moderns are the same is news for it is not held that the Lympha in its peculiar form was pre-existent in the Arteries and as such did accompany the Blood through the Maeandrous piteâ— but is generated as it is discharged into the Lymphaeducts and from them is re-mixed with the bloud And if it were yet would not the definition of this Latex agree with it for the Lympha is no inseparable companion of the bloud as appears by its peculiar vessels it is seldome a diaphanous clear liquor being commonly tinged with several colours oftentimes whitish sometimes yellow or as it were stained with bloud And whereas this Latex is devoid of all sensible qualities those who have experimented the Lympha do not find any such thing but a variety of tasts Nor is it true that the Serum which accompanies the Bloud is such a Latex as our Helmontian describes it being never to my taste free from a salsuginous sapour though it retain that with a great Latitude nor devoid of colour so as to be clear and diaphanous and 't is very seldome seen that the said Serum will not coagulate unless preternaturally upon a gentle fire so that it is no more to be termed a Latex than the whites of eggs beaten to the like fluidity In like manner that in the Lympâ—aeducts will coagulate as Bartholin observes and others As for the Cruor that there are graduations of the Bloud as to its crudity and impurity is no doubt amongst the Galenists and that it may oftentimes transcend the state of due maturation and so become degenerate is as easily granted as that it should come short of its desired perfection and when this Blood degenerates any way into a Tabum or sanious matter I must tell him
the Disease or Feaver be the object of their designs yet As all wise men consider by what means the ends they propose to themselves may be effected so do they deliberate how they shall effect their designs and that is by removing the Cause of the Malâ—dy But as in other designs it frequently happens so here they often meet with impediments which must be removed before they can prosecute their intentions by direct means Upon this account they are forced upon maâ—◠〈◊〉 which they confess are not immediately 〈…〉 of a Feaver which yet they purâ—â—â— because without doing so the indisposition either could not be cured or not with such safety as becomes prudent persons Few of them ever bleed that I know of meerly for refrigeration and the extirpation of the formal heâ—t without regard to the material cause of it which is to be concocted and ejected by Nature Though Phlebotomy be but one operation yet it produceth sundry effects in the body and in order to each of them is both indicated and practised For it evacuateth that redundancy of blood which frequently occasioneth diseases alwayes is apt to degenerate into a vitious morbifick matter during the Feaver and by an indirect and exorbitant motion to afflict some or other principal parts to the great danger if not destruction of the Patient upon this account we do use Phlebotomy in Feavers sometimes to diminish the Plethora and so to prevent the violence of the succeeding disease and dangerous symptomes that may insue and then the veins are too much distended to facilitate and secure the operation of subsequent Medicines that are used to evacuate the Antecedent Cause and to maturate and expedite the continent morbifick cause Besides it promotes transpiration incredibly gives a new motion to those humours which together with the blood oppress and indanger the internal and principal parts it diverts them from the head and draws them from the heart lungs stomach and bowels into the habit of the body whereby Nature being alleviated prosecutes her recovery by maturation and expulsion of the peccant depraved matter deducing to its proper state that which is semi-putrid and not irrecoverably vitiated and separating first then exterminating what is incorrigible So the Patient recovers Nor is there any thing more true than this which every Practitioner may daily observe in his practise that Of all the Medicaments which are vsed by Physitians there is not any may compare for its efficacy and utility with Phlebotomy so expedite so facile and so universal is it The universality of its use appears herein that it evacuates the redundant it alters the exorbitant Fluxes of the peccant or deviating humours and blood It retaxeth the vessels and pores of the body and refrigerates the habit thereof And therefore is so absolutely necessary in putrid Feavers that though I do not say they are incurable without it yet I pity the languishing condition of such as omit it the violence of the symptomes being increased thereby and the cure procrastinated to the great trouble and hazard of the sick and his great detriment afterwards for you shall ordinarily meet with a slow convalescence and the blood be so depraved by so long and violent an effervescence that it becomes remediless and degenerates into an evil habit of body Scorbute Dropsie c. This being premised which is more clearly proved by Experience than Reason I answer to his Argument that we do not go about only to refrigerate the Patient but to concoct and eject the morbifick matter that we take the most befitting course to exterminate that spinous offensive cause and as upon the prick of a Thorn if part stick in the wound and be buried therein we proceed to maturate and bring to a paculency the vitiated blood and humours inherent in the part affected and with the suppâ—â—â—â—â—d mâ—tter drâ—â— out the fragment of the Thorn so we do in Feavâ—â—s where the depraved humours are not so easily sepâ—â—â—ted and extirpated as in the prick of a Thorn maturate the eject the morbifick câ—â—se and thereby atchieve the Cure And I do profess my self to concurre with the Ancients in their Opinion that there is a great Analogy betwixt the generation of the Hypostasis in the Vrine after a Feaver and the production of purulent matter in an Apostimation and that Feavers are but a kind of Abscesse in the mass of blood for the proof whereof I do remit my Reader to Ballonius de Hypostasi Vrinarum Amongst the Ancients I find two wayes commonly practised to extinguish this Febrile Heat by a course corresponding with the usual wayes of extinguishing a fire which are 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 by substracting the fewel from it thus they did Phlebotomise at once till the Patient did swoone the other 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 by quenching it thus they gave them cold Water to drink largely until the sick grew pale and fell into a shivering this last was not practised till there were manifest signs of concoction But 't is observable that upon either of these Medicaments they did expect that happy issue that Nature thereupon should presently discharge it self by sundry evacuations of the morbifick matter so that they did not thereby intend bare resignation but the extermination of the concocted febrile matter And thus much may suffice in answer to this Objection The last Objection he makes is this as I shall form it The great Indications of the Galenists for Phlebotomy are either Evacuation of the redundant blood in a Plethora or the Revulsion and direct pulling back of what is in flux or flowed into any part already But neither of these Indications are valid and oblige them to that practise Therefore the practise of Phlebotomy is not to be continued As to Phlebotomy in a Plethorick body he thus explodes that If by plenitude be meant an excess of pure blood I absolutely deny there is any such 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 or indication for Phlebotomy for during the goodness of this juyce there must needs be perfect Sanity arising from integrity of all the actions of the body so that it may justly be reputed madness to go about to broach this Balsome of life weakning Nature thereby as long as there is health with abundance of strength Imprimis notandum saith Van Helmont in cap. de febr p. 8. ut nunquam vires peccare possint abundantia ne quidam in Methusalem ita nec bonis sanguis peccat minuitate eo quod vires vitales sanguis sint correlativa i. e. We are to take special notice that too much strength can never be offensive to any yea not to Methusalem no more can any one have too much blood for as much as vital strength and blood are correlatives Well then it is plain that whatsoever sickness seems to indicate Phlebotomy upon the account of an 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 sanguineous superpletion must needs come from an apostate juyce generated by vitious digestions
cause incurable Phrensies deadly Sopors and Epileptick fits or create Lipothymies in the Heart or difficulty of breathing which is a mortal sign in this Disease in the Lungs or a Diarrhaea and Dysentery in the Intestines or a virulency in the suppurating Pustules and corrode even the bones and ligaments these vapours exhale by the opened dores and the Feaver abates for any one that knows never so little in Physick understands that the sole legitimate and immediate cause of Feavers is prohibited transpiration From what hath been said it is evident that of all Remedies Phlebotomy is the most important in the Small Pox in the first beginning whether the Feaver be a simple Synochus or one that is putrid and malignant and 't is more a wonder that any man should oppose the due administration of it then that all Europe in a manner should agree to the practise thereof Neither is it only to be administred to allay the plenitude which generall occurs in this Malady or to prevent the evils forementioned but frequently for revulsion when the malignant matter begins to affect the Brain Stomach Lungs Intestines For if during the Feaver the Humors seise upon those parts with any violence the Patient is in apparent danger of death there being no way to prevent the suppuration there and little hopes that the Patient will survive the distemper or if he do escape a Consumption or Dropsie afterwards Sunt aliae ita malignae ut non solum carnosum genus adoriantur sed ossa quoque dilanient corrumpant quandoque interna membra principalia ut hydropem generent nuper observavimus puellulum quendam D. Donati Profili nepotem mortuum ex hydrope ob variolas morbillos quandoque vidimus alios consumptos ex asthmate ob easdem variolas quandoque vidimus alios diarrhaea dysenteria confectos ex morbillis variolis alios gangrenatos esthiomenatos It is true that Physicians do not alwayes regard the distempers of the brain in this disease because albeit they may be very violent in the beginning yet they afterwards cease of themselves nor do they appear so highly concerned for the animal as vital functions and in such cases great judgment is required in a Practitioner rightly to distinguish betwixt what may affright others and what ought to terrifie him But in case the first approach be accompanied with a violent Cough hoarseness difficulty of breathing the beginnings of Squinancy from a pustulary defluxion into the Glandules of the Throat or with swoonings and perfrigerations of the hand and feet He that thinks Phlebotomy ought not to be administred if other conditions permit understands not himself or complies too much with the prejudicate opinions of the Patient and Relations The Authority of all Physicians almost justifies him the Rules of Art direct him to it the prosperous success which frequently follows thereon imbolden him to it and Nature her self authenticates the practise by her sovereign example for it is usual for Patients in the beginning of the Small Pox to bleed at the nose I have known five or six in one â—amily adult persons that bled of themselves eighteen or twenty ounces with greater benefit whilest I durst not be allowed to take away eight Novimus plures infantes in principio quibus sanguis in copia exnaribus exivit bene habuerunt neque tot tantisque variolis morbillis fuerunt afflicti unde multi autumarunt si puero multa sanguinis copia sponte vel arte exieret usque ad animi deliquium qoad vel non variolabitur vel non in tanta copia nam variolae morbilli vere sunt morbi a sanguine With this Author agrees the most experient Augenius Saluberrimum esse provocare sanguinem exnaribus docuit experientia nam quibus sponte effluxit variolae pauciores salubriores evenerunt Vidi hactenus pueros duos qui ex sluore sanguinis e nare dextra tertio die immunes a febre evaserunt quarto die supervenerunt variolae paucae benignissimae I add the words of Diomedes Amicus who having recommended the applying of Leeches Yarrow or Horse-tail to the Nose thereby to cause a flux of blood prooceeds Haec enim sanguinis evacuatio a naribus vel sponte vel arte factae adeo confert maxime cum adsint signa fluxum sanguinis portendentia cum tamen non fluat ut solo fluxu isto aegrotantes istos sanatos vidisse Rhases dicat eum solum praeservare a nocumento oculos alias faciei partes dixerit Avicenna quae sanguinis evacuatio ex naribus semper medicum excusat ab omni alia evacuatione sicuti facit etiam qui per uterum vel haemorrhoidas fit modo fiat cum alleviatione The consideration of this so beneficial an effort of Nature made Augenius and others to direct that after Phlebotomy in the Arm the Patient should be forced to bleed at the right Nostril in relation to the Liver or at both and in the cure of Antonio Borghese a Nephew of Pope Paulus V. a Colledge of Physicians at Rome did prescribe Leeches to be applyed to his Nostrils and his recovery was principally ascribed thereunto I shall not undertake to prescribe how much blood may be taken away at once nor how often Phlebotomy is to be repeated in the beginning of the disease I should expatiate too much by such a discourse the general Rules are to be found in Augenius Mercatus Horstius Ranchinus Epiphanius Ferdinandus c. and the accommodation thereof to particular cases doth depend wholly upon the judgment of the Physician employed How Children in whom the Disease if they can be ordered is less dangerous commonly and how Men according to their different habits of body and other circumstances it being more perillous in them their flâ—sh being more solid and tenacious their bodies less perspirable and their blood and humors more acrimonious are to be ordered When the Lancet when Leeches when Cupping glasses and Scarifications are to be made use of the wise do know and the ignorant may learn if they will study to improve by study that time which they mis-spend in censuring the prudent actions of their betters Before I proceed to the second Question it will be convenient to decide that Controversie about Phlebotomy Whether it draw from the Circumference to the Center and may hinder the eruption or cause the Pustules to return in or subside That there are some eminent Physicians who do hold that Phlebotomy doth draw the Humors from the Circumference to the Center I do grant and in the case of the Small Pox that it may chance to do so is the suspicion and fear of Avicenna and Hollerius as well as Doctor Whitaker But why the Doctor should be scrupulous here who hath so great a regard for the Ancients though he cite no good Authors is to me a Miracle For besides the Methodists who
but the Small Pox are of a grosser substance and come not forth with equal facility It is also to be considered that as a large evacuation by sweat may happily terminate a Synochus so although the Patient do abound with blood Nature may sometimes so expel and regulate the matter that the party may avoid the imminent perils but he that trusts thereunto must well ponder not only how plentifully the Pox come forth but whether it be proportionate to the exigencies of Nature for whatever is not such is minute and what alleviation insues not to mention other things And as when sweat doth not appear in due time due quantity with due qualifications the Patient doth nevertheless dye So we daily observe it to fall out in the coming forth of the Small Pox. And therefore I do assent unto the directions of Avicenna and Augenius that in case of this urgency Phlebotomy be judiciously made use of and whatsoever danger may seem to be in it 't is prudence to submit thereunto rather than to incurre greater Hitherto I have treated of Phlebotomy as 't is an evacuative and relaxing Remedy but there is oftentimes occasion for it by way of Revulsion when not only the Eyes are in great hazard to be spoiled or the blood stagnates about the Heart Lungs and Thorax or that the Small Pox very much affect the Stomach and Entrails or occasion a Diarrhaea or Dysentery For in these cases 't is most probable that the Patient either will not live to the state of the disease or dye then 'T is a received tradition from Avicenna dâ—â—nwards that in case the Patient in the Small Pox do brâ—â—th freely and suffer no defect in his voice there is litâ—le or no danger unless some accident introduce a Dysentery Because that is a sign that the Throat and parts relating unto respiration are secure But in case it appeâ—â— that the inward parts are infested by the Pox and that swoonings vomitings difficulty of breathing a soar throat and great hoarsness trouble the Patient 't is most manifest that he ought to be blooded for revulsion least in the State of the Disease the Pustules coming to maturation may by their purulent stench annoy or by their growth and inflammation suffocate Nature or exulcerate and apostemate the Lungs It is usually seen that people dye of the Small Pox in the State of the Disease on the sixteenth seventeenth nay twentieth day though they have seemed plentifully and kindly to come out and the reason is I abstract from all errors because a due regard hath not been had to those that infested the inward parts for they have exulcerated the Intestines and created Fluxes they have occasioned in their maturation a new and perillous Feaver a Squinancy a Pleurisiâ— and particularly by affecting the membranes of the Stomach they have created Vomitings and Lipothymies c. And this will seem credible to any that by considering what happens in the surface of the body apprehend what must ensue upon their maturation within and those Ignorants who have admired at these events in the state and declination will cease to wonder when they assume these thoughts of Physicians and weigh attentively the Augment State and Declination of the Pustules To conclude this discourse who hath not seen in the Augment of the Small Pox large eruptions of blood at the Nose as also menstruous Fluxes ordinately and inordinately to intervene without any peril sometimes to the great benefit of the sick About fourteen years ago I accompanied an eminent Physician to a Patient of his in whom the Small Pox were come out well coloured and plentifully yet did the Feaver continue together with a deliriousness want of sleep and restlessness to all which a great Hemorrhagy at the Nose of above fourteen ounces did put a period and of the latter case I had amongst many others an happy Instance lately at Warwick Instances of the happy success of Phlebotomy in the Augment of the Small Pox after they were come forth § 7. The illustrious Lord of Poyrin a strong young man was seised with a violent putrid Feaver on the third day he was taken with a looseness which resembled what Physicians call a Diarrhaea on the day following the Feaver and Flux continued with the same violence and a multitude of red spots appeared all over his body with a little protuberancy on the fifth day all symptomes persisted in the same violence or rather encreased whereupon I being present caused him to bleed eighteen ounces after which operation all those perillous symptomes did so abâ—te that within two dayes there was not any thereof remained § 8. On the same day that the aforesaid Lord was let blood and in the same house there was a Servant of Mr. Barrussa who was sick of the same distemper but he had no Flux he had been sick four dayes and two dayes were passed since the Small Pox appeared He was of the Age of eighteen years I took from him a pound of blood whereupon all his distemper left him and he went about his business attending on his Master on the day following which was the fifth day of his sickness § 9. Such Phlebotomy did also recover Mr. Clermont from a Feaver and the Small Pox as also Villard one of the Queens Pages and another Page of the Duke of Alencon's and many others were cured by me in that manner Also that learned Physician Pietreus told me that he practised this course with good success upon his own Son I come now to the third Question Whether in the State of the Small Pox Phlebotomy may be administred I call that the State of the Small Pox when they are come to their full bigness and become white and replenished with suppurated matter or in case they are malignant or deadly Pox I call that the State when the Pustules being green blewish or black are exulcerated the subject parts corroded and a stinking black or greenish purulency issues And here I avow that a Physician may sometimes according to the Rules of Art and with great judgment administer Phlebotomy 'T is most true that I cannot to my knowledge defend this practise by the Authority of any one Writer in Physick except it be I. Frommannus who finds some cases in which he justifieth it in the State of the Measils 'T is also true that the common Precept amongst us is not to disturbe Nature in the State when she is busied most about Concoction but rather to supersede from the great Remedies But I have learned from our Masters that there is scarce any Rule in our Art the Obligation whereof is not suspended by urgency and that they conclude us in the ordinary not enforced procedures Necessity is absolved from all Laws and Wisdome it self prescribes that we should not alwayes take its counsels 't is certain she meddles not with the regulation of extremities nor with the conduct of Despair She in some encounters dispenseth us