vrine Secondly whether he haue bin wont naturally to abound with many ill and vicious humours and whether any outward signs therof haue appeared by itches pustles ring-wormes swellings inflammations and such like Thirdly whether any accustomed or naturall euacuations haue lately ceased as vomits hemorrhoides fistulaes fluxes bleedings at yâ— nose termes sweats and such like Fourthly whether they hauing bin accustomed heretofore to auoyd superfluities by Phisick and haue of late neglected it and not vsed such purgings vomits and bathes as heretofore they haue done Fiftly to examine not only the vrine but other excrements as egestions spittings sweates for as he sayth a little after The sweate declareth what humour aboundeth in all the body for it is whiter paler or yellower according as the humours be more or lesse phlegmatick or cholerick and if the humours be puâ—rified the sauour of the sweate will greatly bewray it But in matters that do concerne the vaynes as doth especially Phlebotomy Galen will haue vs especially to respect the vrine We haue no effectuall and euident signe to discerne the superfluities that are in the vaynes but only that which is by vrine If the humour be altogether crude and raw the vrine will be thinne and watery and neither haue any hypostasis or sediment nor haue any cloudy matter hanging in the 〈◊〉 but when it is concocted these things do appeare and besides some thinne clowdes do swimme vpon the top If the thinne and thicker parts do quickly deuide and that the sediment be white and smooth and in euery part equall that sheweth that straightway care one can speake the word nature will euercome all If it be longer care the separation be made longer it will be care the humours be ouercome But if in the vrine there be no separation at all but that it remayne still as it was made or else if it do breake it be with a bad sediment then is nature weake and hath neede of some other help to digest the humours Many other signes there are of crudities as the small quantity of vrines signifying that by their rawnesse they are hardly sent out Likewise the thicknes of vrine shewing abundance of raw humours and thereupon depriuation of concoction Further the ill contents in vrine and the inequalitie of the palses but these and many other signes of diseasy crudities must not stay vs from letting of bloud if the greatnesse of the disease do require it and the party haue a full body and sufficient strength but rather as Fernelius sheweth when signes of crudities are we must vse Phlebotomy as the remedy Only touching our food last taken let the stomack bowels and if it may be also the mesaraick vaynes be cleared from raw and corrupt humours and let such a time be chosen wherein also the disease hath most quietnesse from the motions of the paroxysmes The greatest rest is in the middle time of the intermission or remission for so shall we be in no danger of drawing the inflammation into the greater vaynes whereby of an intermitting feuer may be made a coÌ„tinuall and the powers also of the patient shall least be indangered But seeing so often Galen and all Phisitions in the matter of Phlebotomy do still make their prouisoâ—s that the powers be not dissolued a question may here be mooued of what powers they do especially speake and how the strength of those powers shall be knowne Galen describeth three powers in man the first he calleth the naturall or nutritiue power that hath his fountaine in the liuer and conteyneth vnder it the attractiue power the retentiue the expulsiue and the fourth the alteratiue power which is generally to turne the nourishment into substance and particularly to make bloud The second vertue or power is called the vitall power hauing the seate in the heart giuing life to the whole body and conseruing the essence of the vitall spirits The third he calleth the animall or rationall power hauing the seate in the brayne and bringing forth sense motion and vnderstanding Each of these three powers haue their particular instruments to worke by To the naturall power do serue the vaynes to the vitall the arteryes and to the animal the sinewes Now which of these powers in letting bloud must most be respected No doubt there must a care be had of all for as Galen sayth there If any one of them do perish it must needs be that all the rest shall perish also And giuing precepts of letting bloud when he hath taught how we shal try the animall power by the voluntary motions and the vitall by the pulses and the naturall by good or bad nourishment or by good and bad colour he concludeth generally when these powers are strong let bloud So whereas Hippocrates doth bid vs when diseases are in the vigor to rest and not to vse phlebotomy or purging for so Galen doth expound it Galen doth giue the reason there of it because the animall power is then weake and in danger although the vitall and naturall be strong Yet certaine it is that the vitall power is that which chiefely we are to obserue in Phlebotomy as he doth elsewhere at large declare The greatest dignity of all is that which concerneth the actions of the heart and of all most needefull to be considered in them that are sick He doth in that place compare the operations of the liuer and of the brayne with the vitall powers of the heart but he will haue the heart to be principally respected In extreame apoplexies the animal powers are decayed yet because the vitall powers are not extinguished Phlebotomy is allowed and doth often worke good effect That is the cause that Galen doth giue out that precept in his booke of Phlebotomy In all these former rules thou must still haue an eye to the strength of the party touching his pulses By that word touching his pulses he sheweth both that the vitall power is most to be regarded and also doth point out the meanes how we shall take triall of it to wit by the distemperature and the inequalitie of the pulses CHAP. 6. Of the time of the yeare the time of the constellation of the planets and the time of the day most fit for letting of bloud THe best time of the yeare for Phlebotomy is knowne of all men to be the Spring according to that aphorisme of Hippocrates The Spring must be the time of letting bloud and purging The Autumne is in fitnesse the neerest vnto the Spring The extremitie of the heate of sommer is most dangerous as Galen sayth hauing named a little before the canicular dayes They which are sinisterly euacuated in very hoate times of the yeare do perish either with sâ—ounings or with resolutions The extreame cold also of the winter will not permit Phlebotomy or if it do it must be little Montanus giueth the reason because the body is ouermuch cooled and is also
in the same leafe a little before in continuall agues called synochi aduise to let bloud 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 vntill the heart faint as likewise he doth in many great inflammations in his comment vpon Hippocrates He sheweth himselfe the cause in that place where he intreateth of agues he doth appoynt it to quench the vehement inflammation and doth meane that it shall be as much as possibly the strength can beare Montanus discoursing vpon the fifth Canon of Auicenna sayth that Galen doth commaund sometimes to let bloud vsque ad syncopen but I thinke that in that poynt either he was deceiued or else that they which did commit to writing his speeches for he wrote little himselfe did not well remember his words I reade sometimes in Galen that vpon vnseasonable and excessiue letting of bloud or any other immoderate euacuation a syncope or dangerous swouning may ensue but I can no where finde that he appoynteth to let bloud vsque ad syncopen vnto a cutting off of all the powers by swouning The fainting vnto which in some cases he doth require Phlebotomie to be extended is called by Hippocrates and him not syncope but sometimes 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 sometimes 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and sometimes 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Some doe make 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to be more particular faintings of some affections and powers of the heart and brayne and 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to signifie a more generall dissipation of the vitall spirits But Galens words do playnely ouerthrow that fond distinction For hauing named the words 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 hee addeth immediatly 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Phisitions are wont to giue both these names to one thing as they signifie indeede one and the same matter And that they both do differ from syncope hee doth shewe playnely when he teacheth that grosse humours when by their toughnesse they doe obstruct or by their multitude oppresse the passages of transpirations they cause syncopas or swounings But if those grosse humours do neither obstruct nor oppresse then they bring no syncopas or swounings but they bring a certaine faintâ—es 〈◊〉 the Grecians call Leipoplyâ—hia or 〈◊〉 The â—etting of bloud euen vnto fainting which Galen doth allow sometimes in great inflammations and certaine hoat feuers as I haue before declared must be done very warily and with great consideration for many are the harmes and dangers which may ensue thereby if it be rashly or vnaduisedly practised as in one place Galen doth plainely and plentifully lay open vnto vs I saw two men dye in the very hands of the Phisitions fainting indeed away but neuer recouering againe Many although they dye not presently yet afterward they come to it by the decaying of their powers and if they had bin euacuated without dissoluing the strength they should not haue perished And some also their powers being by immoderate euacuation dissolued do fall into a long lingering disease Others for all their life time afterward haue then whole temperature of their body ouer-much cooled being neuer able to recouer that harme which he hath gotten by auoyding too much bloud By which coldnes some haue liued afterward ill coloured and with bad habit of body and easily annoyed with euery small thing and others by the same meanes haue bin taken with deadly diseases dropsies streightnes of breath by stopping of the lights weaâ—â—nes of liuer and stomack apoplexies and dotings There are many vnskilfull Surgeons which doe thinke and defend that for the quantity of bloud how much may be spared they neede no other obseruation but to let the bloud to runne vpon their nayle and so long as they see it to be grosse and corrupt so long to let it flow It they take this course with some diseases they may vtterly ouerthrow the strength of their patient They which haue much corrupt bloud haue little good and they which haue little good bloud must needs haue little strength and such as are of weake powers may soone by a great quantity of bleeding receiue vnrecouerable mischiefes Galen sheweth that when it hapneth that crude humours are gathered in the body a great heed must be taken what quantity the strength will indure For the powers being already dissolued in such constitutions of crude humours are wont by Phlebotomy to fall into such extremities as out of which they can neuer againe be recouered And therefore a little after he sheweth what in this case his owne practise was In them which haue a multitude of raw humours I do auoyd a little bloud and do straightway giue a little water and hony well boyled together with some extenuating thing as hysop wild marierom and sometimes calamint and then I take away a little more bloud sometimes the same day and sometimes the day following in which giuing againe some of the aforesaid medicins I take away bloud againe and the third day likewise twise Galen often when he nameth crudities or raw humours speaketh not of the two first kinds of crudities to wit first meates vndigested and secondly when any hurtfull matter doth not obey the lawes of nature of which two I haue spoken already but of a third kinde of crudities when any thick or cold humours do abound in the body for so doth Galen describe all those humours to be crude or raw which are in the body besides bloud of a thick or cold substance The more they depart from bloud the lesse bloud may be spared and sometimes they depart so farre from bloud as in dropsies and in some agues comming of the abundance of raw humours that there is no place at all left for Phlâ—botomy If in any place Galen doth deny and forbid letting of bloud in abundaÌ„ce of corrupt humours as he doth sometimes allotting vnto them rather purgings then phlebotomie we must accompt it to be done not in respect of the vicious humours for Phlebotomy is coÌ„mon both to good humours ouer-much abounding and to ill humours ouermuch annoying it is as Galen and Auicen do make it a remedy both against the superfluitie of bloud and also against the vices of bloud but Galen doth prohibit it only in regard of the weakenes of the strength for so doth he expound himselfe These three scopes to wit the greatnes of the disease the strength of the powers and slourishing age are sufficient for Phlebotomâ— for when such a multitude of raw humours â—â—gathered that it forbiddeth Phlebotomy yet thâ—â— my former conclusion is not reprooued for in such there is no strength sit for it But as he sayth afterward If these two scopes to wit the greatnes of the disease and thâ— strength of the powers be present there 〈◊〉 no such or so great aboundance of raw humours as that it ought to forbid this remedie of Phlebotomy Auicen although â—n some cholerick diseases he deny letting of bloud and willeth it to be kept for a
helpeth much transpiration by meanes whereof it must needes be good to help putrefaction When Montanus affirmeth that to let bloud in putrified agues is to kill the patient he meaneth a liberall euacuating of bloud but otherwise his words before do shew plainely that it may be done moderately to vent the vapours And Platerus sheweth an other cause why it ought to be done because the occasion of putrified agues doth lie hid in the bloud and in the branches of the hollow vayne together with the bloud is auoided some portion of the putrified humour Of the same iudgemeÌ„t is Fernelius The opening of a vaine which may take away both the multitude and also a great portion of the putrified humour doth greatly auayle to the curing of the feuer And an other reason sheweth Galen why this must be done because nature being disburthened of a part shall the more easily ouercome the whole as I haue declared in the Chapter going before in the first vse of Phlebotomy If the ague be that which is called Causo the burning feuer whose matter is not the heate of bloud but the burning of choler and whose signes are tossing of the body an vnsatiable thirst the toong dry and rough either yellow or black a nipping about the stomack and liuer yellow excrements the vrine very thinne and something wanne the pulse swift thick and hard doating a little sweate about the forehead and neck but euery where else the skin very dry and therewithall a little rough letting bloud may also well be vsed at the beginning but in no great quantity only foure or fiue ounces for venting or euentilation are sufficient Auicenna in his curing of the Causo doth affirme that bloud is not to be let in it vnlesse there doe appeare rednesse and thicknesse of vrine but that is not Causo but rather synochus Montanus sheweth that the true continuall burning feuer seeing that the matter which doth putrifie in it to wit choler is most hote and most dry it becommeth in a manner altogether firy Hppocrates teacheth the way of curing a burning feuer by quenching the burning heate by giuing water and mulsa aquosa but he maketh no mention of letting of bloud thereupon Montanus doth conclude that letting of bloud is not to be permitted in a burning feuer But I thinke Montanus his argument in that disputation vpon the eleuenth Canon of Auicenna is of small force For although Hippocrates do not precisely commaund in that place bloud to be let in a burning feuer yet he maketh it in the same place to be a signe of the dissolution of the disease if the patient do bleede at the nose and presently vpon it he vttereth these words At in morbis acutis sanguinem detrahes si vehemens fuerit morbus qui aegrotant aetate florenti fuerint virium robore valuerint Platerus doth require in the Causo or burning feuer that there should be a liberall letting of bloud if strength do permit because he thinketh it not to proceede of pure choler as many other Phisitions haue taught but of bloud putrified and inflamed in the great artery and causing so much the more daÌ„gerous feuer as it is kindled in the trunck of the great artery neerest vnto the heart If Hippocrates do require Phlebotomy in morbis acutis then must it needes be good in the burning feuer which as Trincauell declareth is maximus acutissimus morbus But still in the quantity Hippocrates his rule must be obserued to haue a due regard of the age and strength CHAP. 3. How bloud-letting may be admitted in agues caused by obstructions as Diaries c. GAlen sheweth that by obstructions sometimes the transpiration and vapouring out may be intercepted and by the obstructions they which haue bad humours fall into agues as Diaries and such like and in them he requireth as very expedient the opening of a vayne first for venting or euentilation for as he saith vnlesse the bad humour be vented it must needs become putrified and secondly because those things which you shall minister afterward to deliuer from obstructions will worke more effectually For it is best to come to deterge and loose obstructions hauing first by bloud-letting for he speaketh there of Phlebotomy auoyded part of the euill humours For we seeking to deliuer the obstructions before we haue made euacuation it is in danger that we shall impâ—â—t the obstructions more firmely then before How the greatnesse of the obstruction shall be knowne Galen sheweth a little after in the same booke The declaration of the quantity of the obstruction is made manifest by the ague for vpon greater obstructions the ague is greater and vpon lesse obstructions it falleth out to be lesse Montanus being fallen into the consideration of this place of Galen doth make three seuerall kindes of obstructions and sheweth in which of them bloud-letting is requisite and in which not The fyrst obstruction is when in the pores of the skinne in the outward parts the transpiration and vapouring out is stayed and prohibited The second kind of obstruction he calleth coarctatoria when such a multitude of humours is conteyned within the vaynes that the passage of the spirits being stopped they cannot passe thorough the vaynes whereby there commeth a perill of suffocation The third obstruction is called oppilatio wheÌ„ some tough matter doth so stop the conduits and chanels of the vaynes that neither matter nor spirits can passe thorough them In the first kind of obstructions Phlebotomy is good because by it the body is made more thin and humors being without the vaines in the compasse of the skinne are by bloudletting drawne into the vaines and so do passe away as Montanus doth demonstrate out of Galen In the second kind of obstruction letting bloud is also conuenient that the thronging together of humours may cease and that bloud may be vented But in the third kind of obstruction it were ill done to let bloud because the thick humour which is impacted in the first vaynes is not thereby euacuated but rather increased as the same author doth proue out of the same fourth booke of Galen de sanitate tuenda I thinke he hath respect to that position of Galen In a werisome and faint body there is little good bloud and many raw humours Phlebotomies do auoyd the good bloud but as for the ill bloud which is gathered together in the first vaynes especially that which is about the liuer and mid bowels they disperse and spread it throughout all the body How in the two last kinds of obstructions the humour must be prepared and made fluxible before we attempt any letting of bloud it is to be declared hereafter in the third Chapter of the second booke But the question is here only of the first kind of obstructions when in an ague called diaria or ephemera which lasteth not aboue 24. howres by reason either
if it appeare yellow and thin let him straightway suppresse it CHAP. 5. Whether letting of bloud be to be admitted in the plague or pestilent feuer as also in the Pox and such other contagious infirmities and when and how AVicenna in his eeuenth canon concerning bloud-letting as Montanus hath deuided them doth set it downe for a rule that in what agues soeuer there is a most vehement inflammation there must be no letting of bloud Montanus discoursing vpon that place sayth that we must regard not so much what the disease requireth as what the strength can beare In respect of the disease Phlebotomy doth agree but not in respect of the powers He bringeth in an instance of a pestilent feuer and sheweth that bloud is not to be let in it because although of it selfe in regard of the pestilent feuer there is no greater remedie then letting of bloud seeing that by it the body is made apt to vent and vapour out the spirits the inward heate is extinguished and putrified bloud is euacuated yet if bloud be let all do dye and therefore we must absteine from Phlebotomy in the pestilent feuer because in a moment of time the strength vtterly decayeth Platerus sheweth sundry great dangers which letting of bloud doth bring vnto them that are infected with the plague and that little good helpe can be expected thereby I can not see how Phlebotomy can auayle to pluck that venemous quality from the heart or to bring it out of the body together with the bloud seeing that it is rather procured thereby that the infection which from outwardly commeth into the body and doth presently infect the spirits should be drawne more deepely inward And moreouer the motion of nature whereby straightwayes in the first inuasion it goeth about to shake out the poyson by sweates by outward pustles and by botches may be hindred by letting of bloud and the powers thereby weakened which we ought to keepe strong to expell that poyson It neither doth auoyd the cause of the disease neither is there any neede heere of any euentilation of heate seeing it is not heere so vehement Hereupon he concludeth that vpon rash and vnaduised letting of bloud in plague times many meÌ„ are killed Yet he acknowledgeth that when the plague hath taken hold vpon bodies which are summè plethorica vel cachectica full of bloud or of corrupt humours whereby a feuer is kindled then if by opening of a vayne the plenty and putrefaction of the bloud be taken away all the other symptomes will become more tolerable but that must be done sparingly and with a due regard of the strength And if in the beginning strength be decayed then is Phlebotomy not to be admitted though the fulnesse of the vaynes doe require it for of lusty youthes we haue found by experience more to escape in the plague time without letting of bloud then by letting of bloud If Phlebotomy be vsed it must be done rather in respect of the feuer then of the pestilent qualitie seeing that this venome doth not consist in the bloud but comming from outwardly doth sodainely possesse the heart and we do not thinke that it can be expelled or drawne out from it by Phlebotomy And if the case do so stand that by the meanes of the plenitude and feuer a vayne must needs be opened then he sheweth in what order it must be done First it must be done in the beginning for vnlesse the vayne be opened within 24. howres of the beginning it will rather hinder nature then do any good Also it must be considered whether the party be in a sweate or no for in no wise must the sweate be hindered by Phlebotomy But after the party hath sweat and hath bin refreshed with a little meate or some cordiall receipt then may a vayne be opened howsoeuer there hath gone no clyster nor purging before because the time hath not giuen leaue Choose the vayne in that side which is most grieued If any eruption appeare about the flanck open the saphena If in the vpper parts then some vayne in the arme or hand of the same side If vnder the arme-hole take the basilica If about the â—ares the cephalica If in the face open the vayne vnder the tongue And euer to the botches appearing let cupping glasses be fastned that the poyson may abide in the same place and not by Phlebotomy be drawne into the inward parts Trincauel doth accompt it very dangerous to let bloud when pimples do outwardly appeare but when as well by the pulse as by the former manner of diet which the party hath vsed it is found to be expedient then let it be done straight in the beginning before the putrefaction of the pestilent feuer be much increased and before nature do seeke to expell vnto the skin Thus he prooueth out of Galen who commenting vpon one of Hippocrates his patients called Crito who dyed vpon a kind of pestilent feuer he doth excuse Hippocrates and sayth that he did not let him bloud because he was not sent for at the beginning of the disease Which signifieth that if he had bin sent for at the beginning a vaine no doubt should presently haue bin opened Montanus in his epistle to Crato doth allow letting of bloud in the small pocks and such other contagious diseases so that it be in the beginning before signes of putrefaction appeare but when it hath once preuayled then to let bloud he doth call it a pernitious and a deadly thing For nature is then checked when it should wholy be intentiue to expell the venom and infection of the disease Fernelius Hollerius and Syluius three famous and worthie Physitions consulting about the sweating plague called sudor Anglicus did deliuer to the English Embassadour the vse of bloud-letting amongst the meanes to preuent the disease in full bodies the bodies being first orderly purged but the disease hauing once taken hold they aduised no bloud-letting but prescribed good cordials to expell from the heart the venemous infection But in that which is commonly called by the name of Plague although the body be already infected yet if it be corpus pletharicum the notes whereof are in the first Chapter of the booke next ensuing wee may be bold to begin the cure with bloud-letting obseruing as neere as may be the cautions before expressed and especially taking heed as Montanus giueth warning that wee choose the vayne as farre as we can from the principall parts from the heart liuer and braine for if we draw the pestilent humour vnto them he sayth we shall kill the patient CHAP. 6. How letting of bloud is to be vsed in phrensies quinsies plurisies inflammations of the raynes or wombe and other inward inflammations happening often without agues IN the phrensy which is a deprauing of all the principall faculties of the braine caused by the inflammation of the filmes thereof Rhazes doth allow Phlebotomy in the
beginning of the disease but not if it be a hectick phrensy of any continuance Celsus doth affirme that the face being red and the vaynes swelling a vayne may be opened after the fourth day if strength be sufficient But if it come of a cholerick cause then it should seeme to be ill done to let bloud because as Heurnius obiecteth fraenum bilis est sanguis bloud is the bridle of choler To this he answereth Male sanguinem sine bile educeremus imo plus bilis educimus quà m sanguinis Hardly can we auoyd bloud without choler yea rather by Phlebotomy we do bring out more choler then bloud And if it were done but only for deriuation sake yet were it well done But at what time must this Phlebotomy be vsed Caelius Aurelianus sayth that it must be done within three dayes of the beginning and not beyond because in such diseases the strength of the body is in perill Aretaeus also sayth that it ought to be done either the first or the second day If the phrensy begin after the fourth day then open the vayne after the seauenth day but if it do come in the sixth or seauenth day then let no bloud for that is a criticall phrensey Aâ—tius sayth that if the phrensy do come with an ague any day before the fourth day and signes of plenitude appeare wee may well open the middle vayne When the phrensy is old letting bloud is not safe Caelius sayth that to let bloud after the eight day est iugulare homines is nothing but to murder men The quantity must be according to the cause If it proceede of inflamed bloud you may let bloud vsque ad animi deliquium till the heart begin to fayle For there is a vehement inflammation a very sharp feuer and exceeding great griefe in which three cases Galen alloweth large Phlebotomy But if the bloud be much mixed with choler then sixe ounces shall suffice or if the party be strong tenne ounces Aretaeus his opinion is that if it haue the first beginning from the parts about the midriffe then the party may bleed more largely because thereabouts lyeth the fountayne of bloud What you do you must do at once for the disease doth giue no long truce Trallianus commaundeth the vayne of the forehead to be opened But that Heurnius doth condemne as ministring a further increase to the discase especially if the phrensy come of bloud for both the bloud should turne his course into the head and also the euacuation should be made by the very place affected which should be as he thinketh very inconuenient The course which Heurnius doth best like of is this first to open the midle vayne of the arme and after to open either the vayne of the forehead or the vayne vnder the tongue For the Quinsie or squinancie the swelling of the throate causing difficultie of breathing and hardnesse of swallowing Trincauel doth aduise a speedie letting of bloud yet a glister being vsed before if the disease will giue leaue but if the disease as it is a very sharp disease will giue no space then may we do as Hippocrates sometime did that is first let bloud afterward minister the Clyster Fuchsius willeth vs to open the basilica of the arme of the same side where the swelling is But he will haue it to be done at seuerall times by little and little and not all at once least there should happen a swouning and so a perill of suffocation and besides By two sodaine coolings and by fainting of the heart the matter may be caryed from the iawes vnto the lungs and so bring ineuitable danger Yet must not the incision be made too little least by meanes of the narrownesse of the hole the good bloud should be as it were strained out and the thick part remaine within which is the cause of the griefe If the patient be a woman whose termes are stayed open first the saphena and then the vaine vnder the tongue For the pleurisy how conuenient bloud-letting is for it it is a thing so well knowen to all men that there needeth no proofe thereof But on what side the vayne must be taken whether on the same side that hath the inflammation or on the contrary side seeing that there is amongst learned Phisitions a great controuersie about that matter I haue appoynted one Chapter to wit the Chapter next following wholy for the discussing of that question And for as much as also all the arguments layd open in that disputation do as well concerne the inflamation of the raynes and of the wombe and all other inward inflammations as the plurisy I haue thought it good to speake no more of the particulars heere but rather to conclude with that generall speech of Galen To speake briefly when inflammations do begin we must euacuate them by reuulsion that is pluck it back into the parts furthest distant but when they are of long continuance we must empty them out of the places affected or as neere vnto those parts as we can For at the beginning of inflammations it is good to turne back that which floweth but when they haue remayned a long time we must auoyd and expell that which is impacted and fastened in the part affected CHAP. 7. In these dangerous inflammations aforenamed whether euacuation or reuulsion be more necessary and what is the meaning of Hippocrates his rule 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to worke directly and with a right course of flowing PEtrus Brissotus and Matthaeus Curtius two learned Phisitions the one a Frenchman and the other an Italian haue by many arguments prooued that in a pleurisy the vayne ought still to be opened in the arme of the same side where the griefe lyeth Trincauel in his treatise which he calleth rudimentum hath vndertaken to confute them The first reason of Brissoâ—us is because in such sharp diseases vnlesse you help presently the party dyeth And the first scope in an inflammation is to auoyd bloud out of the place inflamed for the performance whereof the same side is most conuenient Trincauel answereth that when the party hath no full body then that position may well stand But if there be a full body then he holdeth with Galen that the scope and purpose of the Phisition must be to forbid that the bloud shall not flow to the place of griefe For the flux of the bloud doth Galen make to be the cause of the vehement inflammation And this staying of the flowing of bloud he thinketh may best be done by euacuating so that we may also reuell the same by drawing it back to the contrary side Brissotus againe obiecteth that by reuulsion there is often stirred vp a pleurisy on the other side vnto which the reuulsion is made Trincauell doth answere that doth happen by meanes of the fulnesse of the whole body especially of the lower parts when the opening of the vpper vaynes can not auoyd so
should expell the disease by the skinne because such purgations do trouble the motion of nature and yet at the same time doth allow a clyster of barley water one pound and a halfe of oyle of violets foure ounces of butter three ounces of red sugar candy one ounce or of each of them proportionably a lesse quantity if it be for a child and doth there condemne Nicholaus Florentinus for that he forbiddeth the ministring of a clyster at such time as the sayd diseases do begin to breake out for sayth he it is a fond thing to thinke that the motion of nature iâ— hindered by clysters seeing that they do worke only in the bowels and the motion of nature is both neere the skinne and in the vaynes neither do clysters so ouerthrow the poâ—ers that we neede to conceiue any feare Euen so for as much as in letting bloud our drift is especially either to case nature being ouerburdened or to expell some dangerous causes of putred matter by transpirations sweatings euaporatings and such like very expedient it is that we auoyd such purgings as whereby the worke of nature may be either troubled or weakened and content our selues with a more fit preparing brought to passe by glysters It is a great fault amongst very many in England that they are so nice and scrupulous in receiuing of a glyster as seeming to suspect some danger in that which indeede is the most easie and harmelesse remedy of all others And as great a fault it is in many of our countrey Surgeons which so boldly do commonly practise the opening of vaines neither hauing before any direction of learned counsaile neither being themselues stored with those things which should orderly prepare their patient therevnto They which do minister purging potions at that time when nature doth begin to moue say they do it because nature doth moue vnperfectly but to them Mercurialis doth answere intelligere an perfecte moueat in initio non possumus we can not know in the beginning whether nature wil worke perfectly or no. The safest and surest way is by a clyster so to ease the fulnesse and costiuenesse of the body that we do not disease the emptinesse and loosenesse of natures powers If the impurities and crudities be aboue in the stomack then shall it be requisite before Phlebotomy to vse some vomit as to take of the decoction of barley two or three ounces of oyle of sweete almonds and oximel simplex each one ounce of oyle of dill two drams mingle them and giue them for a potion Or if the matter be grosser and colder take of the seeds of rocket leekes radish broome each the waight of a shilling of the rootes of asarabacca and betony each the waight of sixe pence boyle these in water so much as being well boyled will make a good draught and being strayned dissolue into it two ounces of oxâ—mel simplex and drinke it off In hoater diseases the former will be more conuenient Fit vomits and clysters they make a preparation speedily and do nothing trouble the work of nature in expelling to and by the outward parts Pâ—rgations if they be strong they weaken nature if gentle then are they long in working and hauing some hoate qualities in them must needes as well by their heate as by their drawing a contrary way trouble that worke whereunto Phlebotomy is directed Fontanonus a learned Doctor of Mountpelier writing of that synochus or hoat coÌ„tinuall ague which proceedeth of bloud inflamed in the vaynes neere vnto the heart after that he hath appointed to begin the cure with present letting of bloud What houre of the day soeuer it be for feare least the bloud do creepe vnto the lungs and thereupon should come an inflammation of the lungs or least it should slip into the bulk and thereof should arise a pleurisie or finally least it should putrifie and so there should be made a putred ague of a not putred he sheweth after how the body must be made fit for this Phlebotomy not with a purging potion least while the purgation is long in working the patient should receiue harme by the aboundance of boyling bloud but by a clyster made after this sort Take of the foure emollitiues each one handfull the foure emollitiues are as skilful Heurnius doth lot them out 1. mallowes 2. marsh mallowes 3. violets or in stead thereof pellitory of the wall or mercury 4. branck vrsine or in steede thereof beets of endiue and lettise each halfe a handfull tenne prunes boyle all in a reasonable quantity of water vntill the third part be consumed then strayne it and take thereof one pound and a halfe dissolue into it of cassia newly extracted and red sugar-candy each one ounce of salt a little and you haue your clyster In stead of the pulpe or flowers of cassia may be vsed diacassia Mesuae or diacatholicum Nicholai or electuarium lenitiuum Rhasis any quantity betwixt halfe an ounce and an ounce and a halfe according to the strength of the party the most conuenient oyle to be added to them is the oyle of violets In stead of the aforesayde things the clyster may be made of a little soluble chicken-broth goats-milke and the yolke of an egge stirred and mingled and putting into it of manna and fresh butter each an ounce first melted together these be the ingredients most fit for the clysters of such as are to be let bloud And if any Surgeon by reason of his seate and place of abode be so situated that he shall be enforced sometimes to open a vayne before the counsayle of a learned Phisition may conueniently be obteyned let him be carefull to haue some prouision of these things in store as he tendereth either the testimonie of a good conscience in respect of himselfe or sound and perfect health in regard of his patient For as before is shewed many are the harmes and dangers which ensue if at the time of letting bloud there be crude and corrupt humours in the stomack and bowels prest and ready to be suckt and drawne into the vaynes now newly emptyed by the administring of Phlebotomy CHAP. 4. Of the age sexe strength and solubilitie of the party whether old men or children or women being either with child or hauing their termes may be let bloud Also whether any hauing bodies either too soluble or too cosâ—iue may be let bloud FOr the beginning of old age there is no question but that bloud may be let very safely in it if other things be corespondent Trincauel saith that about the fortieth yeare of age that is about the beginning of old age we may most fitly be let bloud But Galen doth make three degrees of old age the first he calleth 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 signifying such as haue a greene and lusty old age such as are able yet to deale in the astayres of the world The second he calleth 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 the middest
made so thinne that the cold doth strike into the inward parts whereby are brought diseases of very long continuance Galen will haue them which are vsually sick in the spring time to be let bloud in the beginning of the spring but such as most commonly haue their sicknes in the sommer time he would haue them to open a vayne in the end of the spring a little before sommer begin The fittest time for letting bloud is when the signe as we call it or the moone is in Aries Sagittarius Cancer Libra Scorpio Aquarius or Pisces vnlesse in any of these signes the moone do predominate in that place that is to be let bloud as in Aries the head Taurus the neck Gemini the shoulders and armes Cancer the breast stomack and ribs Leo the heart and back Virgo the belly and bowels Libra the raynes and loynes Scorpio the secrets bladder Sagittarius the thigh Capricornus the knees Aquarius the legs Pisces the feete There must also a regard be had of the age of the party that is to be let bloud for to them which be growing or yong the first quarter of yâ— moone is most meete To middle aged people the second quarter To the declining age the third quarter and to old age the last quarter The complexion also must be respected If the party be cholerick let him bloud when the moone is in Cancer Scorpio or Pisces If phlegmatick let the moone be in Aries Sagittarius or Pisces If melancholick then let the moone be in Libra Aquarius or Pisces It is ill to let bloud when the moone is in the full or in the change or within three dayes either before or after It is ill also when the moone is in coniunction or opposition with Saturne or Mars Further it is ill when the moone is in coniunction or opposition with Venus or Mercury combust or in a quadrate aspect with Saturne Sol or Mars vnlesse the aspect be passed at the least eight degrees But it is good to let bloud when the moone is in a trine or sextile aspect with Iupiter Sol Venus and Mercury but especially with Iupiter and Venus with whome all aspects are good prouided that they be not combust In cases of extremitie there is no staying for signes or aspects for the necessitie of the disease compelling I haue my selfe opened a vayne the signe being in the same place and yet with good successe But if a man haue liberty to make his choyce of the time I hold him vnwise that will not take it as neere as he can agreeable to the auncient grounds and principles of Astronomy It appeareth very many wayes that God hath giuen a power to the heauens and an influence to the Starres and Planets which doe mightily worke in the things here below not to induce any necessities but to dispose the inclinations so farre as God hath appoynted and determined Consider how all the times and temperatures of the yeare do alter and change according to the course of the sunne and what difference there is betwixt the operation of Phisick and the dangers of diseases assaulting vs in the spring and such other as do befall vnto vs in the canicular dayes Marke the operation of the Moone in such plants as are set and such seeds as are sowne in the seuerall times of her age Waigh the force also of the moone in those which in the scripture are called lunatick Origen doth report the iudgement of Phisitions Humida moueri in capite secundum aliquam compassionem ad lumen lunare quod humidam habet naturam That moyst things are mooued in the head according to the sympathie of the moone which hath a moyst nature but he thinketh rather that some vncleane spirit doth obserue the diuisions of the situations of the moone and worke by them But Serenus and after him Mercurialis do giue this the reason because they which are conceiued or borne in the wane of the moone are much subiect to the falling sicknesse Howsoeuer it is it is sure not without some cause that they are called lunatick that is moonish or mooned And behold also the power of the Moone in the ordinarie flowers of women who are otherwise also sometimes too much subiect to that variable and tempestuous planet See what force it hath likewise in the sea concerning the ebbings flowings thereof as also in respect of cockles and diuers other shell-fishes waxing fuller or lesser according to the age and proportion of the moone Let also the experiences of mariners somewhat preuaile which finde the whole leas to be caryed by the course of the firmament from the East vnto the West whereupon they which trauaile to the west Indies do better passe thither in one moneth then they can returne againe in three besides the trials which they haue of their loadstone poynting towards the North and their needles and compasses answering thereunto In Phisick the criticall dayes falling out either in hard or benigne constitutions of the planets do dayly giue vnto vs abundant testimonies In histories what auctor can you almost reade but you shal finde therein the troublesome alterations which haue followed vpon great eclipses In diuinitie see how Iob doth attribute vnto the Pleiades a sweete influence to cause the kindly spring and to Orion a power to cause raines and showers but so that God doth loose or hold back the bridle at his only will and pleasure And waigh those words spoken in the creation of the Sunne Moone let them be said God for signes and for appointed times and for dayes and for yeares I do vtterly condemne the abuses of Astronomy as first when men will make them signes of southsaying to foretell things to come and so to take that vnto them which is proper to God only as it is in the Prophet Shew vs the things that are to come that we may know that ye are gods God sayth I wâ—ll destroy the tokens of the sâ—othsayers and make the wise coniecturers fooles The will of God is free and soueraigne ouer all his creatures in euery moment to order alter rule and dispose them as seemeth best to his heauenly wisedome Fata mouere deus tollere fata potest We see in one battayle or in one time of pestileÌ„ce God being angry with sinne or permitting the Diuell to rage many thousands do dye at one time which no doubt most of them were borne in diuers manners of constellations of planets Weaker natures are subiect to the stronger and particular causes are subiect to the generall Saint Augustine sayth In the liues of them which are borne twinnes in their actions casualties professions preferments and in their very death there is so great a diuersitie that many meere strangers are more like one to another then those which in birth were separated with a very small distance of time and sowen as it should seeme by coniunction in one and the selfe same