must be taken moderately the first and second day after bleeding as Rhases counselleth writing to Almons lib. 7. cap. 21. For the vertue digestiue made weake by bleeding cannot ouercome as yet much meate Herevpon also Isaacus in his dyets writeth thus Meate to such as haue bled is to be withdrawen and diminished but drinke to be augmented for in respect of the meat drink is to be augmented not in regard of his former vse of diet that now he may drinke more than hee was accustomed for in truth he must drinke lesse than hee did before bleeding because the vertue concoctiue as ye haue heard is yet too weak to beare much abundance of drinke The words of Schola Salerni touching this matter are these Spiritus vberiorque exit per Phlebotomiam Spiritus ex potu vini mox multiplicatur Humorumque cibo damnum lente reparatur Abundant spirite with bloud doth passe yet drinke of wine doth it restore By helpe of meate the same alasse will hardly come as twas before Of Revulsion that is pulling backe and deriuation that is turning aside of bloud and Humors by opening of a veine Chap. 6. REvulsion is a prouided remedy for bloud flowing out of the nose or belly or that floweth to any part like them to cause inflammation It is called in the Greek Antispasis That is a turning to the contrary way in Latine Reuulsio that is a pulling backe and as the word impotteth so is it desined a drawing of the running humor into the contrary part Nothing can more speedely keepe backe the force of a Fluxe than this practise Now for to vnderstand which is the contrary part we must note that the Mathematicks call those contraries which be the extremities of one and the selfe same straight line which stand furthest off in a straight proceeding or going forth of the selfe same vein through whose passages the humors haue their course For a veyne beeing opened first the part next the wound is euacuated that euacuated part draweth the bloud out of the further part And forasmuch as opening of a veine doth thus euacuate through the helpe of the small straight veynes which nature hath ordained to allure and draw as shee hath the ouerthwart veynes to expell The same opening of a veyne I say will prouoke more bloud and in shorter time from those parts where the streight veynes are spread then from the rest Yea if the veynes drawe not at all yet the humors voluntarily will flowe in the straight course of the veynes they that are in the right parts followe the right members and they that are in the left partes follow the left members and that course of humors is commended which are carryed straight wise and that discommended when they are carried crookedly and ouerthwart as declaring nature to bee violated and corrupted The names of Phisicall contraries in this practise are these before behinde the right the left vpward downewarde within without Neither are these contraries in revulsion of humors except they bee so placed in a straight course of veines For the left side is not contrary to a left Pluresie or the left leg from the knee downewarde called in Latine Crus contrary to the right leg inflamed For herein this is a common and direct society of veines whereby the left leg beeing opened draweth from the right But from the right side to the left no veyne commeth with straight and right strings Therefore a veyne opened in the same remoueth not a Pluresie on the right side But either leaueth the hurtfull humor in the inflamed part or mingleth it with the pure bloud or bringeth a Pluresie in the left side which often falleth out so For as much therefore as all our indeuours and deuises must tende by opening of a veyne to exhaust bloud abundantly and speedely from the inflamed part take such a veine as is straitly scituated to the affected part So in reason we shall followe nature and imitate Hippocrates who in a Pluresie willed to take the inner veine of the Arme on that side which is grieued Neither onely doth the Phisition open the inner veine of the right arme in a pluresie on the right side but also in inflammation of the liuer and yet all the veins are ioyned to the liuer in felowship If that appeare not we may take Mediana If that neither appeare we goe to Vena humeralis rather than to the inner veine of the left arme attributing so much to those veynes which are directly and straightly scytuated Therefore Revulsion in a streight course bringeth euident and speedy helpe whereas in a crooked or ouerthwart locution it bringeth none at all Moreouer a large veyne opened withdraweth bloud plentifully and speedely from the next places Therefore when there is a great and vehement inflammation of some euill Humor abundantly concurring in some principall member and part of great sense and feeling a large veine must be opened in some neere place vnto it which may abundantly and speedely euacuate from the place affected If the infirmity be but small a lesser veyne may be chosen and in a place further distant to euacuate a lesse quantity and at more leysure Revulsion in this sort not onely stayeth the Fluxe but also exhausteth first from the affected member the rotten and ill bloud before it deale with the good bloud of the other parts and members of the body and then all feare is remooued of any newe Fluxe to insue For when the part affect ed shall bee disburdened more than the other through great euacuation lately made very hardly in reason can the same be grieued with another Fluxe of humors except we go on with a fresh intemperate order of liuing And againe the members far distant couetous as it were because of their great want wil not suffer the bloud in them contained to flow to the others Neither will the member affected except there remaine in the same great dolor and heate allure or sucke any thing from them being now but weake and consequently not requiring great nourishment The opinion therefore of the Arabians concerning opening of a veyne must needes be false VVho suppose that in a Pluresie a veyne opened on the same side doth increase the force of the Fluxe Affirming also that for the plenitude if it be much lest the Flux should increase the same is to bee taken from the lower veyne of the foote After this that the Revulsion must bee made from the inner veyne of the contrary arme Last of all that the reliques and remainder is to bee euacuated out of the same side VVhat discretion I pray you is this so oft to vexe the sicke Patient whom wee may cure at one time For bloud abundantly taken out of the side affected draweth plenty as it were at the well head freeing that part from inflammation without suspition â— orfeare of any newe Fluxe Euacuation made from the ouerthwart veynes onely abateth superfluity of bloud and humors with small quantity of
complexion it quite reiecteth bleeding For Phlebotomy by great cooling so greatly increaseth crudity and rawnes in the body that it can neuer or very hardly bee recouered or amended VVeakenesse of bodilie strength resembleth this foresaide Repletion and therefore also by the selfe same reason reiecteth any large euacuation And in truth is not in this respect to bee dealt withall except the veynes abundantly repleate threaten some great hurt or that necessity so require it and then it must not bee done all at once but by little and little as it hath beene before declared Therefore in each and euery fulnes that is vnpure we are to begin with opening a veyn for without it wee cannot safely afterwardes purge For a vehement purgation especially if bleeding haue not gone before troubling and molesting the full body both with much heate and by force of the attractiue vertue bringeth the Patient into greater hazarde than he was before and therfore to conclude this point the veynes being swollen and filled if moderate bleeding doo no good it can doo no harme at all The otherfulnes quae ad vires which cannot very easily be knowen by signes althogh it cannot ouerstretch or breake the veynes nor ouercome the inward heate yet because it oppresseth the weake forces of nature lest there should insue putrifaction or corruption of humors it may be diminished by opening of a veyne Leauing yet behinde so much as nature may easily rule yea and the same also because it bringeth no doubt of present danger may be profitably taken away with spare dyet or abstinence Of corruption and putrifaction of bloud and humors in the veynes without plenitude called Cacochymia that is fulnes quae ad vires There riseth a great doubt whether the same may aptly bee remooued by bleeding VVee answer that to remoue by bleeding a simple corruption of humors in the veynes is profitable and easie regard beeing had both to the abundance thereof and to the forces of nature in the Patient For albeit when a veyne is opened all humors issue forth equally and that there remaine behind still as there did before one and the selfe same proportion of humors yet because now by bleeding part is abated of that burden wherewithall nature was before oppressed the forces and powers natural waxe not the more feeble but they become more strong and chearefull so that they can beare with the greater ease those humors which as yet remaine still behind and nature hir self gouerneth them with farre lesse trouble than before And herevpon in continuall feuers when there is great crudity and corruption in the veyns bloud being often times detracted the vrine also beeing red troubled and thicke before It appeareth nowe more cleare and sheweth forth euident signes of concoction And note here by the way that the Phlebotomer must be very well exercised in those signes which prognosticate fulnes repletion Yea ye must also know perfectly the place of each particular humor lest after the manner of the vnskilfuller sort when the nose a little bleedeth and the vrine appeare somewhat red by and by yee doo let bloud Whereas bloud often times easily commeth forth not onely by reason of fulnes but vppon diuers other occasions nature her selfe often attempting voluntary eruptions of bloud Hereof it commeth that such persons as haue as it were the small litle mouths of the veines called Oscula eaten or gnawen or that haue a weake and apostumated Liuer and that Hydropicall persons bleede oft at the nose Also vrine waxeth reâ— and bloudy by the fretting of the stone in the Raines Vrine waxeth yeallow in that kinde of yeallow iandies which is simple in Scirrho hepalis That is in the hard part of the liuer and in that kind of dropsie which is called Ascites Yet in these effects we are not to let bloud for Cacochymia proceeding of corruption of the bowels is not that way cured Therefore the certaine knowledge when a veyne is to be opened necessarily is onely gathered of those markes and tokens which manifestly declare abundance of each humor And hereby yee may gather that bleeding alone speedily helpeth that corruption of humors which lyeth in the great veynes and only freeth the Patient from this kind of corruption except the same take beginning from the bowels ill affected and in this kind of corruption purgation is more meete than bleeding And thus it appâ—areth in a generall sort what corruption of humors the opening of a veyne doth remedy A particular rehersall of those diseases present or future which are cured by bleding Chap. 11. FIrst as yee haue heard a veyne is profitably opened in the two plenitudes nature being strong and the age conuenient In the fulnes quaead vires haue speciall regard that the naturall forces be firme But if in this plenitude raw cold and vndigested humors bee greatly gathered together in the body forbeare taking this as a rule that with great abundance of raw humors the strength of the body cannot stand as yee haue already partly heard and as Galen witnesseth lib. de curand ratio per sangui missio cap. 9. Secondly it helpeth diseases present and future and serueth both in the curatiue and preseruatiue intention VVe read that Galen in the spring time did let bloud those persons that were subiect to these diseases following to wite Spitting of bloud A polexies Falling sicknes Peripneumonia Pluresies Anginaes Stoppinges of Hemorroids or Termes Swimmings in the head The Gowt in the feete and in the ioynts All which Auicen also setteth downe in quarta primi cap. de Phlebotomia Thirdly we doo not onely open a veyne in repletion as Menodorus falsly supposeth but also as hath beene said without fulnes when wee feare some inflammation through some fall or other accidentall griefe And moreouer as wee haue already specified wee open a veyne for two purposes sometime to euacuate sometime to pull backe immoderate flux of humors to the contrary part as Galen noteth lib. de Curand ratio per sang missio cap. 11 9. Metho Medend cap. 11. As to stay bloud at the nose we open a veyne in the arme For this cause Galen lib. 13. Metho Medend ca. 21. in Letargus which is a drowsie and forgetfull sicknes rising of impostumation of cold putrified fleame especially in the hinder part of the braine whereby memory and reason almost perisheth and the sensitiue power is greatly hindred causing men commonly to forget their owne names also to shut their mouthes after they haue gaped and by no meanes to stay from sleeping In this disease I say at the first beginning thereof Galen willed to open a veyne albeit the disease bee colde rather as it seemeth to reuoke than to euacuate the matter or Galen so appointed it because fulnes is alwaies concurring with this forgetfull and drowsie disease Herevpon Galen 11. Meth. Meden cap. 15. affirmeth it to bee very healthfull to open a veyne not onely in continuall feuers called Continentes but in all
feuers caused and kindled of a putrifieng humor which should not seeme to bee true especially in intermittant fâ—uers which leaue off for a time as are tertian and quartan agues Forasmuch as in these bloud offendeth not in the veynes but some other humor beside bloud putrifieth without the veyns which by bleeding in reason cannot be euacuated This place of Galen cannot sound to reason or experience except we vnderstand Galen to giue vs aduise to euacuate by bleeding the matter of such intermittant feuers as haue also with the bloud fulnesse and abundance of other humors concurring So that this may bee his meaning Bleeding may bee vsed in intermittant feuers if they fortune to haue abundance of humors ioyned with the bloud For obstruction as Galen sheweth li. 11. Meth. Meden cap. 4. happeneth in rotten and putrified feuers sometime through abundance of humors sometime through the clammines grosnes and thickenes of them Galen therefore counselleth to let bloud in staying and intermittant feuers rather because of the abundance than the rottennes or putrifaction of the humor without the veynes And that this is his meaning appeareth by the words which Galen afterwards vseth saying Forasmuch as nature ruling the body by bleeding is lightned and disburthened of that wherwith she was before oppressed therfore shee will with ease ouercome that which resteth and remaineth behinde which is a 〈◊〉 signe that Plethora or fulnes is also annoxâ—d to such feuers Fourthly in bleeding we are not onely to consider the disease it self which wee determine to remedie but also oft times the cause therof so that whatsoeuer the sicknes be if Phlebotomy may remoue the cause then also it taketh away the griefe it selfe in the ende HereupoÌ„ somtime albeit the disease be cold yet when the cause moueth vs to open a vein we may safely bleede without hurt Hippo. saith Galen sheweth a cure of his done on a woman by letting her bloud in the Ankle This woman after child-birth was not freed ofher seconds then a shaking came vpoÌ„ her This woman I cured saith Hippo. by letting her bloud in the Ankle for all her shaking Shaking is a cold affect bloud is hote and they that must be heated must not haue bloud taken from them He for al that boldly did it he sheweth the reason I considered said he the cause the occasion of the cause He knew the cause of shaking was abundance of bloud kept backe which was a burthen to nature The occasion of the cause was the griefe of the matrix This abundaÌ„ce requiring euacuatioÌ„ the affected part shewing the place most fit for euâ—cuation considering both these things together he let her bloud in the ankle because the wombe or matrix was affected In griefes of the womb or bellie we take the vaine of the ankle knowing by the Anotomie the communion betweene the veines for some veines communicate to some part of the body others to other partes And euacuation is to be made from such veines as haue fellowship with the member affected For as yee heard in the Chapter of Revulsion if we take that veine which communicateth not with the part affected wee hurt the whole bodye do the griefe no easement The profitable vse of this fellowship of veines apeareth especially in revulsion or pulling backe of humors which is both wel speedily done when this coÌ„munitie of veins is obserued as was there declared But let vs return to our former purpose Fiftly by opening of a veine is cured the feuer called Synochus both that which coÌ„meth of ebullition of blod without putrifaction that which is caused with putrifaction of the bloud So are also hereby cured continuing feuers coming of putrifaction in the greater veines And to these diseases reckoned vp of Galen Fig. 2. we may adde these that follow Frensies Opthalmia parotis i. an apostumatioÌ„ about or behind the eares diseases of the Liuer splene Nephritis i. paines of the raines and backe inflammations of the wombe or matrix of the priuie partes arme-holes armes thighes ioynts Finally all inflammatioÌ„s inward or outward which the Greeks call Phlegmonae These inflamations are caused by flowing of bloud to a member when a veine is open broken which bloud there abundantly heaped togither bringeth forth a tumor or swelling To these also are to be added a consumption in the beginning vomiting of bloud bleedings at the nose bely or hemorroids at the beginning of which diseases the opening of a veine greatly profiteth staying the force of the fluxe by revulsion if the veine be opened at the contrary part calling back much of the matter froÌ„ the member affected so that bleeding is a present helpe for those diseases whatsoeuer which take the beginning from too much abundance of good bloud Those sicknesses which come of an vnpure mixt plenitude because they are somewhat neere linked vnto these they may also be cured by bleeding And although the matter of these diseases be vnpure yet either it lyeth in the veines or procedeth from the veines A gaine by bleeding are cured Carbuncles felons moyst scabs outward rednes in the skinne such like all these are cured by this practise Thus also is cured the burning ague called Causus all continuall feuers whose putrifaction is conteined in the greater venies Yet sometime a continuall feuer commeth of an humor heaped togither inflamed about the stomack chiefely about the mouth of the stomack the flat parts of the Liuer which feuer cannot be takeÌ„ away by bleeding Neither can the cause therof by this practise be remoued Pure intermittant feuers whether they be Tertians Quartans or Quotidians because the next matter proper cause of them is not in rhe greater vessels neither floweth from the veines are not conâ—eniently cured hereby And yet sometime in these also we bleede either when the veines swell with immoderat fulnes so that therby some danger at hand may be feared or when any accident of hote inflamed boyling bloud perswadeth vs therto as are namely beating paines of the head tossings mouing of the body this way that way excessiue heat almost stragnling the pacient Howbeit these many times come also of boyling choler about the inward partes called praecordia in the which cases bleeding remoueth neither the feuer nor the cause therof but onely asswageth the vehemencie of those accidents which are present or shortly like to ensue Further concerning perticuler affects cured hereby we may adioyne beating paines of the head Letargus spoken of before fig. 3 and trembling of the heart These with the foresaid are not onely cured hereby when they presently affect and afflict the patient but happening yerely vnto vs so that it is verie likely we shalbe grieued with them in time to come VVe may verie well preuent them by bleeding wheÌ„ we haue once espied plenitude to haue beene in vs the causes of these infirmities For there is one the self-same way of healing common
both to maladies present and future And those thinges which are to be done when diseases are present may likewise be attempted when the same are but a beginning or nigh at hand And here is to be repeated that which hath bin alreadie said cannot be too often spoken that some time we open a veine not only without fulnesse but euen in emptinesse namely when some euident cause as a bruze ache or heat causeth flux ofhumors bringeth inflammation to the members and this is done not for any greatnes or feare of any present griefe but for some doubt of that which is a beginning as it were at hand Here ariseth a doubt whether it be more vsuall to open a veine the disease being now present or future nie at hand The answere is that when the fulnes is very great dangerous though the disease be not yet caused notwithstanding without hurt the pacient may bleed plentifullie because the bloud offendeth nature in the aboundance thereof And hereby the Pacient is oft made safe and escapeth the daunger of sicknesses approching But when a disease is bred and the forces of nature impaired or lessened either by the presence or long continuance thereof iust euacuation of bloud without hurt can by no possible meanes be made Whereupon Hippo councelleth to preuent by bleeding accustomable impediments rather then to stay their approch and comming Hereuppon also in that kind of feuer called Ephemera which dureth commonly but one day is caused of obstruction In the feuer called Synocris simplex bloud is aboundantly withdrawen before the matter do putrifie Therfore this is the cōclusion of this matter that bloud is let more safely before the sicknes be present already come thē when in truth it is presēt with greater profit are we to see his comming a far off and so beware of him thē to stay til he come thē labour to repel him wherin we are to remember a prety and common verse seruing fitly to this purpose Aegrius eiicitur quam non admttitur hospes If once a guest be enterteind with greater shame we him repell Then if at all we had not him receiued with vs in house to dwell And also this verse of Ouid. Principiis obsta sero medicina paratur Dum mala per long as conualaere moras i. Beginnings stop too late comes cure When once the mischiefs grow in vre Reason imputeth thus much that when sicknes presently possesseth any pacient the same requireth a speedie remedie with a greater necessitie than when as it hath not yet inuaded Wherupon this also followeth that opening of a veine is more necessarie when a griefe is present then when the sam e is but onely approching The crueltie of a present aduersarie vrgeth vs with a greater necessitie than the daunger of an enimie that may come but is not yet present And so I conclude that in a present disease there is a necessitie In a disease onely imminent there is but onely in a manner a securitie For a further instruction to know what diseases in particular are cured by this practise I referre thee to a Chapter hereafter following which declareth in particular what veine is to be opened in ech particular disease What voluntary eruption of bloud profiteth 〈◊〉 sicknes Chap. 12. BLoud voluntarily and of it selfe issueth foorth from the nose the veines called Haemorroidae and the belly and sometime also out of the mouth by coughing and vomitting From other partes of the bodie it commeth not except very seldome and that against nature But from what part soeuer it come if it bleede slowly and sparingly and albeit the same bee according to nature yet we are to account it vnprofitable for it nether remoueth the disease neitheir disswadeth vs from that conuenient euacuation by art which the vehemencie of the disease requireth That voluntarie flux of bloud which is aboundant either in plenitude oppressing natnre or in that feuer called Sinocha is profitale and oft cureth the same in the iudgement day called dies Criticus For in asmuch as then a generall euill equally as it were occupyeth all the veines from whence soeuer abatement of bloud happen it ceaceth these accidents of heuines fulnes But in the feuer Causon and in all other cōtinual feuers in the which other humors putrifie in the greater veines bloud issuing forth neuer so plentifully bringeth not such profit and bleeding at the nose though it watchinges rauinges headach and other such like accidents yet very hardly it remoueth the proper cause and roote as it were of the disease except there fall out some immoderat bleeding euen as it were to the dissolution of the natural forces which in very deed is neuer to be wished or desired For corrupt bloud last of all floweth out of the nose yea and not before there hath passed great store of the good profitable bloud And therefore in these feuers albeit the pacient bleed much oftentimes yet a veine in the arm must be opened Experiēce I say proueth that oft out of the nose commeth good bloud both in colour and substance when vnpure and filthy bloud is drawen out of the arme A boundant flux of bloud in these diseases out of the Hemorroidae veines are out of the belly because it floweth next of all from the holow veine of the loines the same is to be accounted much more profitable thā the abouesaid Yet neither doth this many times take away the verie root of the feuer which lieth lurking in the veines next the hart Wherupon it cōmeth to passe that oftētimes we let bloud in the arme notwithstanding yet but sparingly in flux of termes in womē brought a bed freed of their seconds lest we inflame kindle in them the heat of an ague A like reason and more apparant there is also sometime to let bloud in the arme when the hemeroids flow For inflammation and other diseases of those partes which are aboue the liuer and midriffe are litle or nothing at all eased by fluxe of bloud from the hemoroids or belly Neither those that occupy the lower partes by flux of bloud from the nose Also flux of bloud out of the right nosthril helpeth not affectes on the left side nor contrary And therefore voluntary eruptiō of bloud without reason forbiddeth not that bleeding which is to bee done according to art reason and experience Againe Phlebotomy helpeth diseases either of it self or accidentally Of it selfe it euacuateth or pulleth backe Accidentally sometime it cooleth drawing forth the hotter bloud sometime it openeth obstructions yet only those which proceede of fulnes and it is alwaies to bee vsed in those affectes which it helpeth of it selfe but not alwaies in those which it cureth by accident To helpe hot distemperature of the Liuer by bleeding when there is in the Pacient little bloud is not the best way but rather vse for that purpose such things as are of their owne nature cooling and take proper
remedies for hot distemperature and thus much for this matter How to know by certainâ— signes the greatnes of the disease and the firmenes of the naturall forces wherby coniecture may be made whether the Pacient bee to be let bloud or no. Chap. 13. IN euerie affect wherin bleeding auaileth the same is out of hand to bee done if the disease be vehement and the strength of nature agreeable Touching the disease it is sometime so small that it is cured alone of it sâ—lfe without the helpe of art And although at other times the same be very vehement great yet the forces of nature not onely sceme but also are indeede so weake that they can not tollerat any euacuation Yea vndoubtedly this practise would vndoo disâ—roy dissolue the whole substance of the naturall forces for whose preseruation sake in truth we take the cure in hand Therfore to know thorowly and perfectly how much bloud is to be takeÌ„ in euery disease we must first consider how great and greeuous the sicknes is and how firme and strong the powers of nature are Now a disease is either already caused and in state or is now a beginning or proceeding to state Againe a disease is called great greeuons ether in regard of it selfe or of the cause thereof which consisteth in the humors or in regard of the greuousnes of some accident But first it is great of his owne kinde and nature Thus an inflammation in any meÌ„ber is more greeuous then a simple distemperature in the same member And again the greatnes of a disease is iudged by the great vse and excellency of the meÌ„ber which it possesseth as if it be any principall member namely the hart braine or Liuer and it is contraty when the griefe is in a base vnnoble or no principall member Againe iudgement touching the greatnes of a disease is to be giuen according to the locall placing of the members as they stand next to the principall partes Therefore next the diseates of the hart braine and liuer are to be accompted those of the lunges sides stomacke and splen and wee are otherwise to iudge of those that are in parts further off as namely the bowels raines bladder and the outward limmes consisting of bones flesh and sinewes called in Latine Artus and in all the other members placed in the extremities of the body Againe in this point iudgement may be giuen by the sensiblenes or feeling of the member wherein the griefe is if the diseased member haue a quick sense and a liuely feeling the greater ferre is the danger than if the member were but of a blunt and dull sence The greatnes of the cause in any disease is iudged by the condition and nature of the humour that is gathered to the part affected is there the continual matter of the griefe wherein we are to consider whether the humour be good or bad putrified or not putrified or of what ill quallity it is any maÌ„ner of way And also whether the same humour be too much or too litle if the humor which is the cause of the sicknes be wicked corrupt theÌ„ we may soon iudge the griefe to be great The greatnes of the antecedent cause is perceiued by the fulnes or emptines of the veins bowels of the whole body by the purity or impurity of humours coÌ„teined in the same We iudge the greatnes of the accidents by the intention remission of those things which do chaunce as the increasing or diminishing of paine thirst appetit watchings and such like all which bring down the forces of nature and make the Pacient to languish As for example If any yll disease as namely an inflammation possesse the Liuer braine or parts next the hart and that there be a venomed and putrified humour whâ—â—ewith the veines of the body appeare to bee stuffed and filled so that there insueth in the patient agitation of the bodie ill appetite thirst paine watchinges this sicknes wo may esteeme vehement in the which euacuation may do great good And againe a disease in which these do not concurre but rather their contraries we may iudge a small infirmitie and not requiring any euacuation Betweene these are their interiected sicknesses of a middle sorte which are to bee euacuated more or lesse according to the remission or intention of the disease and the accidents thereof Now let vs come to the estimation of the forces of nature of the natural powers some are setled and bred in particular members and are common and flowing to all partes of the bodie The forces of nature bred and setled in a member haue one and the selfe same essence as it were of the inward heat and they are called one nature and are ingendred as a man might say of the internall spirits and the first begotten moisture whereunto is added as a matter thereunto requisite a sound and whole substance of bodilie members The essence of the common forces of nature haue as it were a threefold originall or beginning or is â—â—threefold spirit diffused and spred into the whole body The force called virtus animalis the animall vertue is diffused from the braine by the sinewes The vitall force from the hart by the arteries The naturall strength from the Liuer by the veines The bodily powers that are bred in ech of these parts the brain the hart and the Liuer are susteined by those common and flowing powers of nature so that the whole liuing creature name ly man is ruled and gouerned of both these vertues Insitae communes setled and common to vse as good english wordes as wee may to make manifest this great point of phisicks skill Therefore if this liuing creature and most excellent creature man bee in perfect health of necessitie these powers of nature must be sound and vncorrupted which they will bee if their substance consist in a iust moderation that is to say in a iust or right quantity and in a good temperament And contrary wise if the quantitie or temperament of their substance be inuerted chaunged turned or altered they must needes suffer hurt and offence and so become weake and enfeebled Whereby their functions are presently hindered the rule of all the bodie is disordered and at length there will follow euen extinction of life it selfe And therefore whether the natures forces are weake or strong may be knowen by their seuerall operations duties Thus raw and vndigested excrementes either by siege or by vriyne when either the one or the other is thinne watrish or like vnto water wherein flesh is washed do shew imbeâ—illity of naturall force so doth holding backe of these excremntes or any other function naturall that is staied or hindered Wee discerne the vitall strength to be enfebled by obscure languishing and smal pulse by breathing hardly and with paine and oftner more quickly thaÌ„ was accustomed by smalnes and faintnes of speach so as the same onely come thereby and not
of water The Sciatica veine which is one of the middle veines towarde the outside of the foot is next in vse for the disease caled Sciatica in the huckle bone So as first we purge with Hiera and annoynt the place outwardly with oyle of the same And when bloud letting iâ— not conuenient as afterward you shal heare as also in this practise for Sciatica wee may applye boxes with scarification as the place humours and time requires and as affectes in the vpper partes are cured by vpper veines opened in the arme so they in the nether partes are cured by lower veines opened in the hammes and ankles As wee haue hitherto declared the veines in generall particular with their profits in bleeding for manifold diseases So also to the intent that the practisioner may be furnished throughly with knowledge in this point which is the most principal and to know in euery disease what veine to open so not to take Hob for Gib as the prouerb saith it shall not be greatly amisse for the more perfectnes herein to teach this lesson forward and backward as they learne their Gamma vt both waies that intend to be good Musicians so must those be most perfect in this discourse that in this practise of letting bloud will be accounted skilfull and good Phisicions Nowe therefore in a most compendious sort I will first set downe the disease and then the veine that is to be opened for the same And first touching a body that is not yet sick diseased but who that is sicke either in his whole bodie or in some particular member in the spring the beginning thereof he may be let bloud of any veine of the great generall veines so in the preseruatiue intention may be kept backe continuall vniuersall feuers a general or vniuersall gowt if there be doubt of any particular inflamation in any particular member let bloud some veine in some part far off whereby the vâ—e and custome of nature and also the fluxe of bloud may be turned from that member where the daunger is verie likely to rest into some other part farre distant and in these two pointes resteth the whole preseruatiue intention of this practise Concerning a pacient sicke and diseased the curatiue intention of this practise If he be sicke he is diseased also either in the whole bodie or in some particular part If the disease lye in the whole bodie then the Basilica or inner veine of the arme is to be opened which directly answereth vnto the Liuer which is the verie fountaine of bloud If the pacient be sick in any particular part the same is either aboue the necke as in the face or in the head or it is beneath the necke The diseases in the face and head are these 7. a Frensie an Apoplexie the Letargus or sleeping disease the falling sicknesse the Quincie inflamation of the eyes fluxe of bloud from the nose 1 In a Frensie in the beginning thereof bloud must be pulled backe from the head by opening some vaines as will from farre withdrawe the matter alwayes obseruing rectitude with the parte affected and this may best be done from the Cephaliea veine In the state of a frensâ—e or when the force thereof is somewhat abated first take away the repletion of the whole body and then let bloud either in the member it selfe that is affected or member very neere vnto it as in this case the fittest veine is the veine of the forehead or that veine which is betweene the nosethrils 2 In an Apoplexie first in the beginning therofopen Cephalica If that appeare not open Vena communis or Mediana or that veyne which is betweene the thombe and forefingerâ— afterward if the disease be rooted and continue open the veyne vnder the tongue 3 In Letargus or the drowsie disease first open Cephalica afterwards if the same continue long open the veyne of the forehead 4 In the falling sicknes open the selfe same veynes that are opened for apoplexie 5 In Angina or quincie first open Cephalica then the veyne vnder the tongue 6 In inflammation of the eies first open Cephalica then the veyne in the inner angle or corner of the eie 7 In sluxe of bloud from the nose open Cephalica or Mediana the common veyne For diseases beneath the necke they are either aboue the raines in the raines or beneath the raines Aboue the raines are these foure A Pluresie diseases of the lungs inflammation of the liuer inflammation of the spleene 1 In a pluresie the beginning therof open the Basilica or inner veine of the arme on that side that is pained abating and putting backe the aboüdance of bloud so long till the bloud chaunge in colour if so be the strength of bodie in the patient will beare it 2 In diseases of the Lunges Vena Axillaris or the inner veine of the arme is to be opened or if that appeare not the common or middle veine or for the more forcible reuultion wee may take the veine in the hand betweene the ring finger and the middle finger or that veine which is betweene the ring finger and the little finger Alwaies respecting rectitude of opening in the right veine 3 In inflammations diseases of the Liuer doo as is said for the lungs Basilica veine obseruing alwais rectitude of members 4 In inflammations diseases of the splene do also as before obseruing the rectitude on the left side If the diseases be in the rames theÌ„selues that they are inflamed that the same inflammation bee but a beginning open the inner veine or Basilica of the arme If the inflaÌ„mation be in his state or somewhat relenting open the inner veine of the ham or anckle If the diseases be beneth the rains they are either diseases of the wombe or belly or of the bladder or priuy parts or of menstruous termes or of the Hemorroidae veines thigh or haunche 1 In diseases of the wombe or belly if the fluxe be a beginning and that there is repletion in the body open a veyne in the arme to turne the fluxe an other waxe when the fluxe is don and the affect bee not remoued open the inner veyne of the ham or anckle 2 In diseases of the bladder do euen so both in their beginning and in their state 3 In inflammation and diseases of the priuie parts doo likewise euen so 4 In restraint of termes open the veyne of the ham or anckle or scarrifie vpon the anckles 5 In termes immoderately flowing open the veyne of the arme 6 In restraint of hemorroids open a veyne in the hamme or shanke which is from the knee downe to the ancklee 7 In immoderate fluxe of hemorroids open the Basilica in the arme 8 In paine or ach of the thigh or huckle bone called Sciatica first open the inner veyn of the arme to pull backe the matter afterward open the outward veyne of the anckle to euacuate the same Finally remember
Chrisi If it be very dark it betokeneth grosse bloud Greene bloud sheweth perfect adustioÌ„ When the bloud floweth soorthspedely it is suetile and thin when it spinneth not foorth but comes guttatim slowly drop by drop it betokeneth that it is grosse bloud when meanly betweene both then is it a mean bloud betweene grosse and thin Againe sometime it is quickly congeled then is it g rosse bloud somtime slowly compacted and then is it subtile Thicke and grosse bloud sheweth thicke and grosse matter in the bodie or it sheweth great heat and drith which hath consumed the humidity of bloud If it be subtile thin it sheweth want of digestion and abundance of raw vnconcocted humours of hot humours or of cold as the colour shall discrie If the bloud be oily it betokeneth either a future leprosie or too much fatnes in the body for leprosy is caused of extremity of heat in the bloud burning the same and conuerting it into an oily substance Againe take a bat round in the end and set it to the congeled bloud if it withstand it not but giue place vnto it and bee diuided it is an argument of drith If the bloud greatly resist the entrance of the bat then is it a very thicke and viscous bloud If between both then is it a meane bloud And thus of the substance of the bloud which should haue bin inserted before And touching the colour in like sort this briefe obseruation by the way which was also omitted but may come in here yet in good sort a good bloud is of diuers colours according to the diuersitie of the parts for in the vpper parte and in the compasse of the vessell it is of a red colour for the good bloud being light alwaies ascendeth vp to the higher partes in the middes it is red and not cleere in the bottom it is blacke and melancolious For melancoly being heauy resteth alwaies in the bottome Sometime there swimmeth on the toppe of the bloud a certaine fatte or oily matter like a copweb If the body bee very grosse and fat this is caused of the verie bloud which is in such bodies inclining to fat If the body be very leane it declareth the same now to beginne to melt and to languish In the bottom of the clodded bloud there is resident an earthly a filthy substance which being deuided or clouen asunder appeareth in colour either red darke blacke bright or greene whereby we may coniecture the nature of the humour mixt with the bloud yea by the colour much or little we may know how much ech humour aboundeth in the veines Some say if the bloud bee cut or deuided that there bee found in the same certaine grainees like small sande that it noteth leprosie or inclination vnto it which alwaies hath not been found true by certaine that haue obserued it It is sildome that the bloud comming from the veines doth sinke but if it doo the same sheweth corrupt and stinking humours and is a token of vncurable putrifaction and corruption No man doth willingly tast detracted bloud but if by chaunce it come into the mouth and doo tast sweet it is according to nature good and of perfect concoction If it bee bitter in tast it sheweth aboundance of choller if it be sowre sharpe and restringent it denotateth aboundance of melancoly if vnsauery aboundance of flegme if salt the bloud is mixt with salt flegme After obseruation of the substaÌ„ce and colour of the bloud conferre all the smal porringers or vessels of bloud together If they shew all equally good bloud it is to be supposed that the rest in the veines is like vnto it Yet the same is to bee withdrawen if it offend in quantity and greeue the body hurting the sences and causing in the body putrifaction and other euils If bloud appeare corrupt then with a greater profit the same is to be withdraweÌ„ because it hurteth the body two waies both with the quantity and qualitie thereof If it be not sufficiently withdrawen at one time afterward againe a veine must be opened and beside bleeding if Cacochymia concur with plenitud that is that bloud offend both in quantitie and qualitie as wee noted in the 21. Chapter beside bleeding the body must more ouer be purged with inward medicine If that bloud which came first were good and the other corrupt then suppose that yet much such bloud remaineth in the bodie to be auoided by good order of diet and orderly euacuation But if it fall out so in inflamations it is a good signe that the euacuation is absolute and perfect quite taking away the matter of the disease from the affected member The bloud poured into warme water hath thereby his partes and substances deuided the wheyish and watrìe substance is confounded with the water and cannot be knowen from it Also the thinner and more subtile part of the bloud is mingled with the water likewise whereby yet notwithstanding after a sort wee may giue iudgement of the nature of the humor The thicker parte of the bloud resteth in the bottome which is reputed good and naturall bloud if so be it be whitish thinne bright and cohering together If the same be more grosse it sheweth the grosnesse of the bloud that remaineth in the bodie If it be obscure blacke or otherwise coloured after the difference of the colour iudge the bloud to be corrupted or not corrupted with â—ilthinesse of wicked humors If it do not cohere but be distracted and diuided it betokeneth vncurable putrifaction Last of all remember that the more vnpure and vnconcocted the bloud appeareth being altered from the nature of good bloud the same is to be withdrawen in the lesse quantitie and not so plentifully as when the same draweth more nigh the substance of good bloud which is done otherwise and quite contrarie by our common barbors and letters of bloud And looke howe much the humors doe passe and exceede either lesse or more the nature of bloud so much more sparingly are wee to let bloud And when they exceede too farre from the nature of bloud either the one waie or the other then wee are altogether to forbeare bleeding as wee haue noted in a certeine place alreadie A short rehersall of eight auncient errours touching bleeding and a sufficient confutation of them by auncient authorities Chap. 23. FIrst that bloud must not be let but in the morning This is confuted by Galen lib. de Curand ratio per sanguin Missio Capitul 12. saying Feare not to let bloud by night forit is ridiculous that some doe maintaine onely letting bloud from the second houre of the daye to the fifth or sixth and no other time The second errour is that obstruction and putrifaction are the causes of letting bloud Galen also confutes this 2. Metho Med. cap. 14. in these wordes Neither obstruction nor putrifaction is the cause of leâ—ting bloud but abundance of humors for neither can stopping or putrifaction be
may fall away They are with most safety let downe in a reede or a pipe to the affected member lest they might touch together and so by that meanes of ende those partes that are sounde and whole And first before you apply them so presse them and wring them out that they may vtter and cast forth all their venome so as their backes bee greene and their bellies reddish VVee are to choose such Leaches as are not in fowle troubled blacke waters nor such as haue long rayes or strikes in them like roddes called Hyrudines Virgulatae Nor such as are of the colour of Lapis Lazulus for these are venemous But wee are to choose them that bee redde inclining to the colour of the Lyuer hauing two redde lines or strikes or inclining to a certaine greennesse hauing little heads and beeing very slender and had out of cleare flowing waters Let them not bee blacke nor hauing a certaine white hearinesse vppon them as wee see there is vppon certaine hearbes as Clarie and vppon certaine fruites as vpon the Quince but as yee heard before take such as haue greene backes and red bellies To make them fall off if neede require put to their heads Salt Lyme Dust Ashes or Vinegar strawe any of these vppon them and they will fall away if you will haue them off sooner put a horse haire betweene their mouthes and the place and drawe them away when they are off wash the place with a spunge To â—â—nt the bloud after they bee remooued if neede so require for sometime bloud floweth out two houres after the Leaches bee gone straw vppon the place powder of roses or of buâ—nâ—d gaâ—ls or powder of a new tile or powde◠〈…〉 straw a little Sanguis Draconis or lay on the place powder of a spunge and pitch 〈◊〉 or a linen cloth burned or the hearbe 〈◊〉 Pastoris bruised â—fter the fall of the Leaches apply cupping 〈◊〉 to purge the venome and excrements which they haue left behind and to withdrawe 〈◊〉 bloud which they haue drawne somewhat outwardly but haue not quite euacuated Finally I giue aduise that before you vse them to the purposes aforesaid you apply them being hungry which is done thus by keeping them in water a day so that they eate nothing If you will keepe them longer put in the same water some Lambes bloud or such like that so they may be kept aliue some season For further matter herein I referre thee to Galen who hath written a booke De Hirudinibus That is of Bloudsuckers Of Cupping or boxing scarification the other two particular euacuations of bloud Chap. 27. FOrasmuch as it is not conuenient to be let bloud oft times in the yeare for that much of the vitall spirit passeth forth with the bloud and that the blould being taken away the body waxeth colde and the operations of nature become weake and enfeebled as we haue before in a certeine place declared therefore I counsell saith Galen that the baser partes of the bodie as the legges be boxed or cupped which is the most sure remedie as well to conserue health as to repaire the same being decayed For it cureth the eyes annoyed with long distillations It profiteth also the head vpper partes of the bodie as the brest and backe and against sundrie other diseases For in what member so euer the bloud is gathered the bodie being first purged by cupping the griefe may be cured Also Oribasius affirmeth that it helpeth Quincies in the throat dissolueth stoppings of all places Notwithstanding application of boxes about the stomack in hote feuers where reason is troubled are to be eschewed for feare of suffocation Likewise put vnto the head vndiscreetly they hurt both the head and the eyes Boxing helpeth swellings letteth foorth winde stoppeth immoderate Termes and the bloudie flixe helpeth appetite when a woman sowneth it reuiueth her â—pirites againe It draweth foorth water asswageth hard swelling clenseth Melancolie and that chiefely in weak bodies It will remoue humors from place to place as from the head to the necke from the neck to the shoulders Galen wrote a booke intituled de Cucur bitula tâ—aâ— is of the Cupping Glasse and rehâ—arâ—â— hâ—â—pâ—â—nese effectes thereof that boxing doâ—tâ— Non solum materiam euacuare sed etâ—â—m dolorem soluere Phlegmonon minuere insâ—â—tâ—onem discutere appetitum reuocare ventriculo in firmo roburaddere aâ—imi deliquio liberare ex alâ—o fluxiones transferre sanguinis eruptiones cohibere facultates mensium corruptrices extrahere mensesque supprimere i. not onely euacuate the matter but also asswage paine take away inflammations abate swellings recouer appetite strengthen a weake stomacke reuiue those that sowne drawe downe fluxes and stoppe fluxes withdrawe corruption of Termes and also stoppe the fluxe of them VVhich effectes shall hereafter be reheased with their cures by this practise more particular There are three causes which perswade vs to vse this practise and to refraine letting of bloud First because our purpose is to euacuate from some one member and not from another and therefore particular euacuation is done by boxing or Cucurbitulas which they that follow barbarous authors in Pinsicke doe also call Ventosas Nowe particular euacuation cannot be made by Phlebotomy for the same euacuateth and emptieth from the whole bodie Secondly because the strength is weake or the age vnfit to bleed or that there is some other of those impediments spoken of in the 8 Chapter For as Rhazes sayeth in 7 Ventosas drawe bloud but from the little veines and therefore the heat and spirites are thereby but a little diminiâ—hed whereas opening of a veine greatly debilitateth nature drawing from the greater veines with the bloud much heat vitall spirites Thirdly because our intent is to euacuate onely from the baser members Bleeding euacuateth from the most noble members and greater veines Ventosas from the meane members and little small veines which arein the outward bodily partes and lye without the greater veines Of boxings there are two sortes the one gentle without scarification or launcing the other with scarification which both in steede of bloud-letting are vsed when age debilitie the time of the yeare or other considerations will not permit the op ening of a veine Hereby is produced the thinne bloud next the skinne and being presently vsed after scarification when little incisions and holes are made in the member that bloud and humors may easily come foorth it mightily withdraweth by force and flame of heat not onely the thinne flowing humors and spirites which are about the member after scarifying but also that which is in places further distant If the skinne I say be first exasperated with the Iron it doth this that wee heare speake of more manifestly If the skinne be whole and not scarified it prouoketh bloud and humors from the furthest parts into the skinne and bringeth it to that parte whereunto the cupping boxes are applyed The cupping glasse infixed the skinne being incided or launced purgeth the
auncient learned Phisicions may seeme as yet hard to the vnskilfuller sort that yet rashly and without skill or regarde of these things vse the practise of letting bloud It will not be lost labour in my poore iudgement with more plaine wordes to illustrate their sayings if it may be to the vnderstanding of all men that are this way studious and yet want the helpe of the Latine tongue Latine writers It appeareth by the premisses what Repletion is vz a superfluous aboundance of humors in mans body which happeneth two waies either in quantitie or in qualitie VVe may also learne that repletion in quantitie is when the foure humors are more in aboundance than is proportionable to the bodie that conteineth them or when one humor much exceedeth the rest in quantitie For the bloud contained in the veines is not simple or of one kind as hath beene said but consisteth of flewme blacke yellow choler and pure bloud mingled together which humors notwithstanding so mingled by comon agreement and continuall vse of speaking we commonly call bloud The iust and agreable proportion of humors is this That in a man throughly healthfull of good temperature there is lesse yelow choler than Melancoly lesse Melancoly than flewme lesse flewme than pure bloud so that that bloud is accounted best not that hath like proportion of all humors but such an equalitie of the foure as hath beene now specified Bloud therfore faulteth in quantitie when the humors being setled in a iust proportion do passe and exceede the agreable measure of Nature for then the whole frame of the bodie swelleth the veines aboue measure are stretched and all the members specially after any exercise are wonderfully retched This constitution of humors though they be good yet it faulteth beclause it is come to an immoderate abundance which accustomably is wont to bring great perill VVhether therefore there be in the bodie abundance of other humors aboue the bloud so that the equabilitie of the proportion be not obserued that waie or that there be too much abundance of pure bloud Yet because the pure bloud in the permixtion greatly exceedeth the other humors it is a â—ault not in the qualitie but only in the quantitie and therfore both of these are conteined vnder this kinde of repletion in quantitie and this is simply absolutely most properly commonly iudged repletion is called Plenitudo ad vasa as is aforesaid because it doth throughly fill the large capacitie of the veines which are termed the vessels or receptacles of the body though it enforce not the powers therof First therefore where al the humors superfluously increase filling extending the receptories of the bodie as the stomacke the veines and the bowels It is most properly called in English fulnesse or repletion in Latine plenitudo in Greeke Plethora as before Repletion in qualitie is when the bloud or other humor is hotter or colder thicker or thinner than is conuenient to the bodie This is the seconde kinde of repletion mentioned by the foresaide auucient writers in Phisicke and which is referred to the force strength and abilitie of the bodie In this repletion although the vessels of the bodie be not so much puffed vp nâ—ither swell as in the other yet they conteine more good bloud and nourishment than the nature of the patient can wel rule or ouercome For a litle nourishment to a weak nature is often troublesome and grieuous and although at the first it be right good yet it doth not long so continue but being forsaken of the bodily heat as not able to concoct the same in protract of time and number of daies it corrupteth and becommeth the causes of diseases This constitution of the Greekes properly called Cacochymia is when the bodie is infarced either with choler yelow or black or with flewme or with watrie humors and of late writers is thus defined Cacochymia est vitiosa humoris qualitas qua is a iusta mediocritase desciscit Cacochymia is a corrupted qualitie of the humors by reason whereof the humor departeth from his iust mediocritie Vnder which Cacochymia is contained all corruption of humors in qualitie wherby the powers of the bodie are hindred from their proper functioÌ„s wherby also the whole bodie waxethfilthie daily decayeth Of this corruption of humors in qualitie one kind is somewhat better and more tollerable as namely when either superfluous humors are excessiuely heaped vp together or when the humors mixt with the bloud do not keepe their iust and naturall concord or proportion the other kind is worse and intollerable when the superfluous humors or iuces in the bodie both primi secundarii both the principal humors and these next the principall are fallen into corruption from their naturall and conuenient temperature which is the destruction and corruption either of the substance or of the temperament Againe both these happen sometime with rottennes and putrifaction sometime without VVhere note moreouer that the name Cachochymia largely taken comprehendeth also the corruption of the excrements Hippocrates Aphoris 15. saith where meate is receiued much aboue nature it causeth sicknes Galon in his Commentaries declaring that place saith more meate then accordeth with natures measure is named Replecion And afterward hee expoundeth that worde aboue nature to signifie too much and superfluously As who would say where the meate is superfluously taken it causeth sickenes Meate but a little exceeding doth not forthwith cause diseases but may yet keepe the bodie within the bounds of health for meat ingendring sickenes must not a little but much exceede the exquisite measure It appeareth by Galen that in his time certaine denied this foresaide diuision of fulnes set downe by the auncient writers and approued of the late practisioners saying that the same was to bee considered onely by the strength of nature granting plenitudo secundum vires but not quo advasae These he confuteth in his booke de plenitud about the beginning in these wordes Qui ex ipsis tantum viribus plenitudinem metiuntur hi videnter nunquam vtres praeter modum repletosvidisse nec se etiamplus quapar est vnquam impleuâ—sse â—ibo ita vt ventriculus inde distenderetur 1. Those that measure Replecion onely according to the forces of nature they seeme neuer to haue seene mens bodies puffed vp like bladders or bottels neither at any time to haue stuffed themselues with meate more than moderation required and whereby the stomacke was ouerstretched Againe others in Galens time graunted onely that plenitude which is quo ad vasa and denied the other quo ad vires These hee confuteth in the same place in these vvordes Itaque subiecimus duas esse tum notiones tum relationes multitudinis alteram ad robur virefque illi us qui defert alteram ad eius qui suscipit capacitatem Idest Therefore vve haue added that there are two notions and reportes of fulnesse one according to the strength of the patient the other
or whatsoeuer eruption bee made in any other place through the skinne it is likewise a particuler Euacuation Again of Euacuations some are of their owne accord some are done by Art Naturall or voluntary Euacuation is when any thing is expelled out of the body without any medecine this chanceth sometime euen naturally For nature while it is in health rightly gouerneth the state of the body and doth expell thence whatsoeuer supersluously aboundeth or is corrupted this Euacuation is both naturall and conuenient This also chaunceth sometime contrary to nature as when the strength of the body is so infeebled that it cannot gouerne and restraine the Humors of the body but letteth them quite flow forth or when the vertue is strong yet it is somtime so prouoked either with abundance or acuity of the Humor that it permitteth the Humor to passe of his owne accord out of the proper vessels and receptories thereof Both these are accidentall vnprofitable and besides nature because the good bloud commeth forth mingled with the bad without choise or order Artificiall Euacuation is when the same commeth by outward help this is two fold The one right profitable onely Euacuating that which offendeth in iust quantity quality The other contrary to this extraordinary and vnprofitable exhausing the Humor that annoieth not which commeth by the vnskilfulnes of the Phisition Nature by her owne force and by the vertue expulsiue accomplisheth her Euacuation The Phisition doth his by diuers necessary helps prouided for the same And in letting bloud he openeth the veyne either with a fine penkife sleme or lancet or some other applyable medicin Purgation hee attempteth with medicins expelling euil humors from the body either by vomit or by siege Also he expelleth euill humors by breathings euaporations exercise rubbings mouings heat bathings specially sulphurious accidentally by abstinence Also the Physition vseth particular Euacuations in particular parts as ye haue heard Hee purgeth the braine through the nosthrils by medicaments called in Greeke Errhinae And through the palate of the mouth with medecines called Apophlegmatismi which chewed in the mouth bring Humors from the head the brest and lungs with medecines called Berhica The Raines and Bladder with Diuretica The wombe or belly with Hysterica Againe the belly is softned with suppositories and clisters againe euacuation or eruption is made in particular parts by medicines called Digerentia â— resoluing medicins by Suppuratoria â— medicines breeding matter by medicines called Amycticam Caustica Idest burning things by horseleches cupping glasses which drawe bloude with scarrifieng the skinne by launcinges or cuttings by iron red hot All these are vsed of Phisitions The kinds of Euacuation reckoned vp of Fuchlius Phlebotomy Purging  Vomiting Scarrifieng  Boxing Abstinence  Long sleepe Carnal copulation  Fluxe of bloud from the Nose   Termes   Hemorroids Euacuations some are Naturall Phlebotomy  Artificiall Purgation  common partaking of both  What Phlebotomy is and from whence the opening of a vaine doth e uacuate Chap. 3. FOR so much as the bloud in generall is mixed with the foure Humors which are also bedewed as it were with a thin watry substance and that they all are so mingled together through the heat and concoction of the Liuer that neuer an humor can be seene neuer so little to be seuered from the others therefore I saie the retentiue vertue cannot so strongly hold back the bloud in the crooked small veines when a great vaine is opened and that with a sufficient large wound but the same will issue and come foorth If by chaunce it happen that the retentiue vertue go about gredily to suppresse the bloud yet at length it will poure it out plentifully with oft handling rubbing of the veines Neither doth this or that humor by it selfe alone come foorth as in purging but bloud generally that is to saie mixt with other humors in the veines Touching the definition what it is Phlebotomia which is worde for worde out of the Greeke the cutting of a veine is an artificiall eduction of bloud either abounding iu quantitie or offending in qualitie by opening of a veine I call it an artificiall incision because it must not want art and iudgement For in it consideration must be had of the inflicted wound of the quantitie of the bloud of choosing the aptest vaine either to pull backe bloud or to euacuate it quite or to make it onely lesse in quantitie Also for that consideration is to be had whether the veine must be opened streight downe or ouerthwart of the same side of the bodie or of the other with diuers considerations besides whereof we will speake in their proper places Therefore Phlebotomie which is one of the greatest remedies the Phisition vseth is for good cause defined an artificiall kind of educing Galen in his 2. Aphoris Coment 17. defineth it to be an exquisite euacuation of al the humors equally Auicen defineth it vniuersalem euacuationem quae multitudinem humorum euacuat or thus Vena sectio est vniuersalis euacuatio quae anctionem humorum super aequalitatem in venis exuperantium euacuat i. an vniuersal euacuation which taketh away abundance of humors replenishing the veines aboue measure Though the bloud in the veines be in a moderate meane or but little in quantitie yet of the proper mouing vehemencie of it self it issueth out nature litle or nothing at al protruding the same Phlebotomie indifferently euacuateth both good bad humors conteined in the veines with the bloud Neither in diseases proceeding of corrupt constitution of humors can nature so moderat the matter as that that humor alone shal flow forth that aboundeth in quantitie or offendeth in qualitie I confesse that in the iudicials of diseases called Crises many times nature separateth as it were excludeth by wayes conuenient those ill humors prepared before by concoction yet notwiâ—hstanding if then at that instant we open a veine nature cannot therby in so short time expel the hurtfull humor Whereas Auicen saith Phlebotomie euâ—cuateth good bloud the ill remaining behind that he feareth lest opening a veine bring the patient either to abundance of hot chollerik humors or cruditie of flegmatike humors if he mean it of the humors mixt in the veines it is most fals for neither doth the watrie humor issue forth before choler nor choler before flewme or Melancoly nor the bad humor before the good VVhich daily experience proueth to be true for when the bloud commeth forth it appeareth simple of one forme but in the porrenger it loseth his colour euery part therof congeleth seâ—crally in his own region The watrie humor swimmeth aboue not farre vnlike vâ—ine Thinne choler the flowring part of the congealed bloud is also aboue next the water Melancoly abideth in the bottom the red bloud the paler flewme keepe in the middle region So that opening of a veine euacuateth all humors which are in the veines equally
of the bodie in this case wee vse Phlebotomie without purging Fourthly we may safely let blond without medicine those that are whole for abundance of bloud only are accustomed to yerely bleeding and that haue in the yere taken little or no Phisicke as it chanceth to many persons in many countries of the North. Fiftly we may open without purging the inner vaine of the arme in women with child if they carrie Corpora Phletorica full bodies that in the 5. 6. or 7. moneth after the conception yea also before they be quicke This practise wee are to vse specially when they being with child waxe verie slowe heauie as it were ouerladen with abundance of bloud we may take Salua tella veine or if plenitude so require the inner veine of the arme for the quantitie respecting a discreete moderation Sixtly we may let those bloud without medicine that haue fallen from some high place taken hurt in the brest and stomacke in whome is to be feared an inconuenience called of the Greekes Egchymosis Seuenthly we speedily let bloud such persons without further Phisick as by reason of their fulnes through some accident as feare or such like waxe domme in which case wee let bloud abundantly so that both armes are opened together Here I am to note a great error in Auicen both repugnant to trueth it selfe and also contrarie to Galen For Auicen affirmeth that when colde and thicke humors are in the bodie first wee must begin with purging and then open a veine Diuers and many waies hath he erred in this First because in flegmatick humors grosse and colde mixt with bloud hee woulde haue Phlebotomie not vsed before purging And in this case by all likelyhood of reason the cure should begin with bleeding Secondly in this hee dissenteth from Galen who 11. Method Chap. 4. though there were obstructions in the bodie of thicke and clammie humors yet first hee would begin the cure with Phlebotomie If Auicens meaning be when flegmatike humors ouercome the bloud in multitude or abundance that then wee must first vse purging then is hee greatly deceiued for as much as hee proponeth a case in which Phlebotomie should not auaile except with those many colde humors there be also some excesse of bloud which chaunceth verie sildome or not at all But it may seeme that Auicen hath reason namely this that the bloud being extracted those humors would waxe more rawe and so by opening a veine the patient is brought to a marueilous cruditie of colde humors This is no reason for by Phlebotomy wee detract bloud not because of obstructions caused of grosse and colde humors but because bloud superaboundeth For the stopping is afterward remoued with other helpes Therefore when obstruction concurreth with abundance of bloud wee must not extract verie much bloud but keepe backe some till the time of the cure as Galen teacheth 11. Method Chap. 14. And thus much of the order betweene Phlebotomie and Purging whereby wee see that a strong purgatiue must followe bleeding and that an easie purgation or clister may go before Of the effectes that is Of the profits and disprofits of opening a veine Chap. 5. Schola Salerni in two verses reckoneth vp three effects of bleeding Exhilerat tristes iratos placat amantes Ne sint amentes Phlebotomia facit It swageth wrath and cheeres the sad Preserues loue-sick from being mad FIrst it maketh glad those that are pensiue Secondly it appeaseth such as are angrie Anger is especially caused through mixture of much yellow choler with bloud And sadnesse by commixture of much Melancoly with bloud And forasmuch as both these humors choler Melancoly are exhausted with the bloud these two effectes must consequently follow Thirdly it preserueth loue-sicke persons from madnesse by drawing humors from the head to the lower partes and so expelling the same Although occasion will hereafter better serue to shewe the causes why wee vse Phlebotomy yet here nowe speaking of the effectes I will briefely shewe fiue causes for which wee vse to let bloud and by the which may be gathered the profitable effectes of this practise of the which fiue causes one onely cause is the direct the other foure are indirect The direct cause of bleeding is euacuation of the bloud But forasmuch as bloud is good for nature therfore Phlebotomy must be vsed â—duissdly that the same bloud only may be expelled which is vnprofitable hurtfull to nature Bloud as you haue partly heard is made vnprofitable to nature two waies either when it doth not throughly keepe the proper qualitie that it cannot so nourish as it did before when it was good or when in quantitie it so increaseth that it either presseth downe the powers of the bodie or stuffeth stoppeth both the veines the arteries In these two cases bleeding is good as one of the direct euacuating helpes Yet in these cases bleeding is not to be vsed indifferently but with this difference in abundaÌ„ce of bloud much may be detracted In little plentie small euacuation serueth Hereupon Galen writeth lib. 9. cap. 10. Method Si sanguis vitiosus in corpore fuerit paulatim quod vitiosum est euacuare oportet paulatim ad in o icem quod salubre est pro eo reponere If corrupt bloud be in the bodie wee must by little little take away the bad and by litle litle procure in the place therof that which is good which way of curing or amending of corrupt bloud the Phisicions call in Greeke Epicrasis And to this Alexander Tralleanus subscribeth lib. 9. ca. 2. The reason why this is not to be done at once is for that the powers of the bodie would relent giue ouer And although that which is euacuated be superfluous yet by a sudden thorough mutation it doth more hurt than good It is better therefore to emptie the bodie safely and by little at once than by making hast to dispatch both the disease the partie diseased And here it appeareth how much they abuse Phlebotomy which detract the ill bloud so long til the good also begin to come wheras it may fall out that all the bloud will flowe forth of the bodie before that the good will appeare It behoueth therefore the euacuatioÌ„ to be little And as Gaelen councelleth in this case before the opening of a veine to vse Epicrasis i. to giue the patient such meat as may cause good bloud that good bloud may still come in place of the bad and then a little after more bloud may be taken This therfore is called the direct bleeding because it is don of it self to euacuate that which by opening a veine ought in deede to be withdrawen namely multitude of humors of bloud of bloud principally of humors secondarily in asmuch as they are mingled with the blod The other are called indirect causes and are vsed only to reuoke or call backe the violent force of humors to the contrary part or
to turne the fluxe of them aside another way The first indirect cause is for the greatnes of a disease or for vehement inflamation of an impostume for in apostumatioÌ„s of great heat in hote feuers in vehement griefes there is not found a more excellent remedie than opening of a veine The second indirect cause is to allure the matter to the place of euacuation Therefore in stopping of Termes or Hemorroids the veine Saphena is to be opened Fulnes coÌ„ming by suppression of Termes is to be euacuated by the legges from the knee to the anckle whether we cut a veine or vse scarifying or launcing for veines opened in the armes of weomen reuoke draw vpward their naturall purging The third indirect cause is that the humors may be turned to some other place contrary or opposite to the place vnto the which they flow of their own accord Therfore in immoderat fluxe of Termes we open the Basilica veine that is the inward veine of the arme which is also called Hepatitis that the matter being called to a contrarie place may be turned from his fluxe The fourth indirect cause is that some part of the matter being takeÌ„ away by bleeding nature may the more easily ouercom the rest For the vertue of the bodie being weaker then that it can rule such aboundance of humors wee take away by bleeding some portion of them least thorough impotencie and debilitie of nature the same humors should flowe to the weaker members and there breede apostumations and swellings contrarie to nature But of this more shal be spoken at large in the proper place therof namely in the Chapter of reuulsion and deriuation of plucking backe and turning aside of the bloud of humors Touching the vtilitie of bleeding great is the profit therof For Galen reporteth that therewith he hath oft cured feuers and that it is boldly to be taken in hand when necessitie requireth it Therfore we may worthily blame those which in our time contrarie to Galens iudgement against reason al experience speak euil of this profitable practise First it sharpeneth the sight making the same more cleare the reason thereof is for that it diminisheth those humors which thorough their fumes hinder the clearnes of the eies so that consequently the sight thereby is sharpened Secondly it purgeth the braine sharpeneth the wit by the foresaid reason Thirdly it heateth the marrow wasting those superfluous humors by whose commixture flowing the marrow in the bones waxeth cold Fourthly it purifieth all the senses taking away those fumes and euaporations which ascend vp to the head and there trouble the senses Fiftly it purgeth the bowels and entrailes The reason is because nature gouerning the body being disburdened of that bloud which was as it were an oppression to nature and greued her as it were with some heauy burden doth now with ease concoct and ouercome rawe and rude humors deteined in the bowels Sixtly it stayeth vomits and laskes for it draweth the humors from the inwarde parts to the outward parts VVherevnto Auicen agreeth writing thus Phlebotomia propteriae quod ad diuersum trahit naturam secundum plurimum retinet Phlebotomy because it draweth to the contrary part therefore commonly it reteineth nature In which place it is to be vnderstood that in fluxes of the womb the veine of the Arme is to be taken which presently helpeth But if you doo otherwise that is take the veine in the foote or legge it profiteth nothing Sometime it chanceth that the belly by opening of a veine is more flowing than before and that especially chanceth two waies first because nature being disburdened by bleeding strength is increased so that sometime it stirreth vp other euacuations as namely by siege The second way is when through imbecility of the retentiue vertue which imbecility by opening of a veyne is increased so that the wombe is more stirred and prouoked Seauenthly it profiteth against immoderate watching for it emptieth abundance of humors from the which commonly diuers sharpe fumes ascend vp to the head and hinder sleepe Eighthly it taketh away heauines sluggishnes wearines of the body For as hath bin already said before bleeding disburdeneth nature which ruleth our bodies of multitude of humors which before was pressed downe by them oppressed with them And again Melancholly the chiefest cause of heauines is expelled with the bloud as the dregs and grounds thereof Ninethly it cureth difficulty of hearing abating abundance of humors whose thicke slatuous spirits carried vpward into the head stop the hearing port and passege of the eares Tenthly it helpeth the voice taking away superfluous humidiâ—ies which too much moisten the arterie or veyne of the voyce and speaking From which humidities horcenes of speech proceedeth Eleuenthly it refresheth and increaseth the powers and strength of the body For the body beeing freed from a multitude of humors must of necessity haue the vertue and strength thereof augmented These commodities of bleeding are thus set downe in verse by Schola Salerni Lumina clarificat sincerat Phlebotomia Mentes cerebrum calidas facit esse medullas Viseera purgabit stomachuÌ„ ventremque coercet Puros dat sensus dat somnum taedia tolliâ— Auditus vocem vires producit auget It cleareth sight the wits and braine It marrow warmes doth cleane procure The entrailes stomacke this is plaine It stayeth lasks makes senses pure It causeth sleepe expelleth griefe To eare to tongue it brings reliefe To be short these are the commodities of Artificiall bleeding therby the organs of the senses are cleansed weake bodies are made strong if yeares serue By it are helped Repletions Pluresies hot tertians frensies pestilences and dâ—uers other diseases as shall appeare in the Chapter ensuing The onely disprofit in bleeding is this that the vitall spirits thereby are â—havven foorth which thing Galen witnesseth in his booke de Scarrificatione saying to open a veine oft in the yeare I iudge not profitable for with much bloud the vitall spirits are also exhaled which beeing done too often wasteth the whole body making the same cold and causing the liuely operations thereof to waxe worse and worse To frequent bleeding therefore bringeth on old age apace and maketh the same subiect to many diseases as the dropsie gowt shakings palsies falling sickenesses and apoplexies For naturall heate being too much cooled and the principall moysture diminished the bowels languish and crudity ruleth with many flegmaticke humors which are the causes and originall of the foresaid cuils This Schola Salerni remembreth And Auicen in primo testefieth the same The best remedy to recouer vitall spirites decaied is drinking of wine for wine among things nourishing quickly and in short time is the most principall By meats also vitall spirits are recouered in time but not so soone Wherin is to be noted that after bleeding must be taken meate easie of digestion of good iuces and of much nourishment as potched-egs such like which meate easie of digestion
there must in the meane season of necessitie be abundance of excrementes remaining in the bodie as the occasion of sicknesses and so at length sicknesses may ensue Yea it is far better as it seemeth to Galen lib. de Curand ratio per sanguinis missionem cap. 6. altogether to absteine from bleeding in vntemperat drinkers gluttonous persons as from such as cannot be cured either by purging or bleeding For by their vntemperat life they gather in short time againe great abundance of rawe vnconcocted humors VVith such it is not best to deale for to what purpose is it to haue the excellent vse of this practise by these mens intemperancie defaced among the common people which hath been so present a helpe to diuers See Galen lib. 11 cap. 9. Method Meden The seconde matter putting off this practise for a time are the excrementes of the bellie Therefore first exonerate the wombe before bleeding if it bee not soluble of it selfe with a Clister of decoction of Mallowes putting thereto Oyle and Salte or with a Suppositorie or with eating a little Cassia fistula The thirde impediment is some other voluntarie euacuation that may be at that present time as in fluxe of Termes in weomen and in fluxe of the Hemorroids whereunto Gaelen likewise consenteth lib. 9. Cap. 5. Method Meden in these words If saith he in time of bleeding it happen that the Termes do flowe or that the veine called Haemorrhois be open if the force of the same fluxe seeme sufficient so that it alone may euacuate that which thou requirest thou shalt leaue the matter wholly to nature if not then thou maist detract so much bloud till by both wayes that be brought to passe which thou wouldest haue done But this is not alwayes to be followed for in euacuation to turne away the matter as in immoderate fluxe of Termes or in the fluxe of the Hemorroides wee practise bleeding as was afore shewed in the Chapter of Reuulsion Againe concerning these voluntarie eruptions of bloud when wee intend to open a veine if the eruption haue been much then stay from further euacuation But if it little or nothing haue withdrawen the matter of the disease it debarreth vs not of further bleeding Therefore if the disease and present necessitie require it that the powers of nature haue not beene damnified by that voluntarie eruption wee may speedily open a veine as in a strong plurisie If there haue been much sweating vomiting or great sieges we are not to let bloud but if these slake and that the naturall powers are a little in time recreated then wee may verie safely bleede For those being but accidents not remouing the cause of the disease can not serue in steed of bleeding So in a hote agew if the wombe be laxatiue and that there happpen Lienteria which is a fluxe of the stomacke when the meate and drinke runneth from a man as he tooke it vtterly without concoction or alteration rising of great weakenes of the stomacke specially in the power retentiue which is not able to keepe the meate till nature in ful time may concoct it through immoderate drinking of colde water from which some cannot refraine in hote feuers This I say doth not hinder bleeding but because thereby natures strength is enfeebled the same considered the bleeding must be the lesse if voluntarie eruption of bloud remoue the matter of the disease or in some reason bring ease to the patient according to discretion commit the matter to nature alone If not take away some bloud that through natures worke and the Phisitions practise togither the cure may be accomplished Those things which nature of her selfe can finish meddle not withall but helpe her with Art in that which shee beginneth and cannot of her selfe make an end therfore I said in a Plurisie in a continual feuer if bloud abundantly flow frō the bellie hemorroids or nose so that the quantie of the euacuation be iust and the patient thereby eased let no further bloud If bloud come but smally from the foresaide and that the sicknesse still continue vehement that which wanteth is to be done by opening a veine yea although the patient be a woman in child-bed yea therefore sometime in a bloudie fluxe a purgation is giuen that the same which commeth foorth but softly and slowly by reson of the vnprepared passages may flowe more abundantly by a more conuenient course The fourth impediment is the age of the partie that is to bleed either being too old or too yong Old folk are not to be let bloud because there is in them little good bloud and much ill bloud bleeding from them taketh away the good and leaueth the bad behinde Olde men after 70 yeares are not to be let bloud except they be of a strong constitutiō of body that the vehemency of the disease require the same But if in these yeres the powers of the bodie be weake that bloud aboundeth not bleeding is not to be in them practised for as Galen saith in men of these yeres there is little good bloud but of rawe humors great plentie so that opening of a veine sendeth forth the good but the ill blod gathered together in the chiefe veines in the Liuer that part called Mesenterion which is the double skin that fasteneth the bowels to the backe or rather the branches of the veine called Porta which conuey the iuce of the meat concocted from the stomake to the Liuer it draweth forth into the whole bodie Consider therfore the strength of the body the vehemencie of the disease for not onely the number of yeres but the constitutiō also of the body is to be marked There are of 60 yeres that are not to bleed being weake old men The age fit for bleeding is at as florens that is after some the 17 yeare of age after some 9. after some 10. after others 14. or 13. Before the 13 yeare after the most approued writers of our time wee are not to let bloud except those youthes haue broad veines be of sanguine complexion and that the disease be dangerous require this practise necessarily In these cases wee may open a veine if the veines well appeare or we may diminish bloud by scarifying the legges or armes Schola Salerni sayeth Denus septenus vix Phlebotomon petit annus The seuenteenth yere of age scarce good To put in proofe letting of blood Children then before they come to 13. or 14. yeares are not to bleede except some great dangerous disease of necessitie require it at nine or tenne yeares the reason is because their flesh and skinne is yet but tender and easie to breath thorow as Galen witnesseth lib. 9. cap. 17. Method Medendi in these words Puerorū substantia omniūfacile digeritur ac dissipatur propterea quod est omnium humidissima est omnium minime frigida The substance or flesh of children is most easie of all resolued or separated because it is most moyst
or betwene both The forces of nature being but weake they cannot indure Phlebotomy so forcible an euacuation As Galen 2. Aphorismo Aphorism encipienti In quo morbo c. 4. Simplicis medecinae witnesseth This is one of the principall considerations that are to bee regarded in opening a veyne for either wee must dehort from it if natures forces serue not or incourage to proceede it if they will serue vnto it For it standeth with great reason that bleeding must greatly infeeble and put them in danger that are already weake of nature Yea it oft falleth out that diuers being let bloud carrying very weake bodies can neuer again recouer their former and pristinate strength as Galen lib. de curand ratio per sang missio ca. 6. li. 11. Method meden cap. 14. witnesseth If the body bee strong and that vrgent necessiity so require wee may boldly let bloud If necessity doo not vrge bleede not at all or very litle If vpon great necessity in this case much bloud must bee taken the body being feeble and not able to abide it we are to euacuate now a litle and then a little Yea I giue heere againe aduise especially to regarde this consideration For many times when the age disease and time require this kind of euacuation and the naturall strength cannot brooke it there insueth Sincope that is sowning In the which case we must reiterate bleeding as hath beene said or else stay it putting the finger on the wound which stay the Grecians vsed and called Apphasis The seauenth stay or let is the habite and constitution of the body wherein wee are to regard the whitenes or blackenes leannes or fatnes thicknes or thinnes of the bodies that are to bleede Thinne white leane and soft bodies are not to bleede because many superfluities are resolued from such bodies which being to them sufficient they need not any other euacuation This doth Galen affirm lib. 9. Metho Medend fleshy bodies firme and thicke are subiect nothing so much to dissipation of superfluities therefore may better abide bleeding as for fatte and grosse bodies though they be also lesse subiect to wasting dissipation of humors than other are yet they hardly tollerat Phlebotomy because they haue but small veynes and they being emptied by bleeding the fat of the body wringeth and as it were presseth them down So that it is gretly to bee feared lest by such oppression the heat of nature be quite extinguished In this point of the habit of the body we are also to consider the capablenes of the veyns which being great swollen may better be opened than the narrow and small litle veyns Again we are also here to regard the naturall disposition of the humors For hot and thin humors are flowing and quickly dispersed Thicke and cold humors are not so and because grosse thicke fat bodies haue lesser veynes lesser bloud than leane men that in such persons the very fat of their bodies oft presseth down the veyns so suffocating and choking naturall heate therfore wee see by experience that oftentimes these corpulent fat men die a sodaine death VVherevpon also Hyppocrates 2. Aphoris Aphoris 44. supposed that grosse men die sooner and more sodainly than leane persons This I my selfe obserued certaine yeares past by the death of a Gentleman of good credite in this shiere of Kent one Maister Weldon Esquiere and of the Greencloth VVho died very sodainely beeing a very fat Gentleman at a parish called great Pecham The eighth impediment is the colde temperature of the Patient or the coldnes of the complexion For the bodily constitution beeing already colde by bleeding of force must be made more cold VVhereby frigiditie of the body dayly increaseth And as Isaac saith in Vrinis Sanguis est fundamentum caloris naturalis in quo calor naturalis confortatur Bloud is the foundation of naturall heate whereby naturall heate is strengthened Therefore Phlebotomy euacuating bloud diminisheth the naturall heate and consequently bringeth a dangerous coldneâ— to the whole body The foundation of inward warmth namely bloud being diminished inwarde heate decayeth and the body still by little and little waxeth more colde And this is testefied by Galen lib. de curanda ratio per sanguin missio cap. 6. Yet when the sicke is of a melancholy constitution and is grieued with much Repletion or that Melancholy hath much bloud mixt with it in this case hee may bleede And againe a hot and a moist constitution of body hauing also the bodily substance consisting of found whole and massie members which by reason of inwarde heate is daily much dissolued tollerateth not so plentifull euacuation as other complexions VVhere by the way yee are to note that in Phisicke that body which aboundeth with much humors in the veynes is most properly called Corpus humidum and may best of all away with euacuatioÌ„ by bleeding The ninth is rawnes slownes and clammines of the humors In which case wee are to forbeare bleeding For otherwise crudity of humors will bee increased After Galen 12. Method Medend cap. 2. And this is the cause why in long continuing maladies bleeding is not vsed according to Auicen for if it were there woulde followe Crudity of Humors Debility of Naturall vertue Prolongation of the disease with feare neuer to bee cured And therefore againe as the same Auicen saith further in diseases daily and continuall called Morte Chronici Purgation must goe before bleeding and not bleeding first although we are to vse them both VVhereof looke before Chap. 4. Of crudity of humors there are two speciall causes the first is the excessiue multitude of humors in the body choking the inwarde naturall heare by reason of whose weakenes and suffocation nature not beeing able to ouercome those humors crudiâ—â—es must needes iâ—â—ue in the body Buâ— in thâ— case Phlebotomy may be vsed And Galen lib. 2. cap. de Hydroposi â—aith that bleeding he petâ—â—in the 〈◊〉 of a dropsie which is caused throâ—gh abundance of menstruous bloud or of abundance of hemorroids The reason is for that although these humors abounde in the body yet bleeding stayeth the fluxe of them both of that that is of the menstruous bloude and also of the Hemorroids This also Trallianus affiâ—meth lib. 9. cap. 2. In the cure of Anasarca which is a â—inde of dropsie in these words Omnium curatio a vacuatione incipiendaest sed Ascitis quidem dicti aut Timpaniae a solapurgatione cus autem Arasarca nomeâ—i est ea vena sertionem intâ—rdum ordum requirit vt qui â—x sanguine frigidonascitut The cure of all dropsies must begin at eu cuation But that kind of dropsie called Ascitis or a Timpany must beginne at purging onely That dropsie called Anasarca sometime equireth opening of a veyne as proceeding of colde bloud This he faith not that this Anasarca requireth any further coldnes to be added but because the withdrawing of abundance of humors in this case disburdeneth nature
and maketh her the more able to ouercome the same Repletion being somewhat lessened in quantity by bleeding It is not therefore repugnant but very agreeable to reason in this case to vse Phlebotomy For we see by daily experience that a small fire is put out by laying on too much wood at once or such wood as is greene and that then it burneth when the woode is remooued which hindered the burning thereof Euen so is inward heate of the bodie choaked with multitude of humors and the same is againe refreshed when some portion of them is withdrawen The second cause of crudity of humors is the debility of the inward naturall heate which happeneth in men of colde Complexions in men that haue beene long sicke and in olde folke in these bleeding is not vsed because bloud being taken away from them which is the restorer and maintainer of the inwarde naturall heate as yee heard before out of Isaacus consequently the body must waxe colde and crudity of humors increase Bloud therfore must remain in these persons to concoct and ouercome the humors in the body And therfore very well saith Auicen Non quotiescunque videris signa Repletionis est facioÌ„dâ— Phlebotomia That is Phlebotomy is not alwâ—ies presently to bee practised whensoeuer wee see signes of Repletion as namely when there is fulnes of raw humors in the body and this doth Galen also affirme lib. 12. Method Medend The tenth impediment is the vnfit disposition of the Aire when the same is too hot too cold too dry or too moist Also when the same is not cleare but troubled And therefore vnder the starre called Canis in the canicular or dogge dâ—ies when thereis excessiue heate and drith it is good to refraine bleeding Except great necessity doo vrge it So likewise in seasons too moist and too colde as in the winter in a state of the Aire temperately hot as when the wind is south or southeast wee may bleede temperarately and sparingly In a more cold state of the Aire as when the North-winde bloweth or North-west winde wee must bleede more sparingly than before In a right temperate and mild state of the heauens we may bleed plentifully especially the Aire not beeing greatly disquieted with great force of tempestious weather And here may be made a profitable collation in this practise by folding vp together as it were in one three impediments here specified The state of the Country being coâ—de the time of the yere beeing cold the present constitution of the Aire beeing colde All which three are outward causes and â—oyne in this third point which is common to them all three that is the Country the Aire and season of the yeare compasse about euery Patient Therefore in a cold Country and in winter and when the Northwind bloweth open no veyne If in a colde Country and in winter the wind blow South and that so necessity require wee may proceede with this practise so in a hot Country and in summer the winde blowing at the South bleede not If necessity in summer require bleeding open a veyne when the North-wind tempereth the immoderate heate of the season For surely these outward causes though obscurely and without any great perceiuing yet they doo either keepe in or disperse abroade and extenuate the substance both of inward heat and also of the inwarde humors And as in a temperature or complexion hot and moist Phlebotomy is vsed best and not to be vsed in complexions hot dry or complexions cold and dry So when the season is hot and moist as in the spring we may bleed safely But not so in a season hot and dry as is the summer or very cold as is the winter The eleuenth let is some great inflammation or extreme ach and paine as appeareth by Galen and Auicen who both forbid bleeding in hot inflamed feuers and in apostumations of great paine In these cases the opening of a veyne doth cause much busines and agitation of humors in the body Bleeding on the one side drawing and emptying humors the inflammation and ach on the other side striuing there against and attracting humors thither For all paine if it be much and all heat which concurreth with paine attracteth and hindereth the fluxe of humors VVhereby it commeth to passe that by bleeding in this case the inflammation is thereby increased and nature more infeebled and the same most chiefly when the bleeding hath beene temperate and done according to Art But in the foresaid cases if the bloud be withdrawen in great quantity euen till the Patient giue ouer and faint it profiteth very much for thereby the abundance of boyling bloud in gâ—eat inflammations is expelled and the inflamed member is cooled so that in vehement paines opening a veyne is a present helpe keeping backe the fluxe of bloud which otherwise would haue recourse to the pained place And here it is not to be forgotten that sometime the expulsiue vertue making hast to expell the cause of the griefe causeth thereby sometime an inflamma â—on The reason is for that the expulsiue vertue hauiâ—g done no good at the first â—nd 〈◊〉 more venemently than before to expeâ—â— that matter which causeth annoyance and doth therewithall wring out forâ—ibly some bloud out of the vpper partes or members into the lower afflicted part as Galen â—heweth at large lib. 23. cap. 3. Method Medend And therefore to keepe backe the saide inflammation bleeding greatly profiteth as yee haue heard before Cap. 6. And this is the intent and meaning of Galen where he saith In ardentissimis febribus si vsque ad animi defectionem sanguis mittatur statim totius corporis habitus refrigeratur febris extinguitur In extreame hot feueâ—s if we bleede euen to giuing ouer and sowning presently the state oâ— the whole body is cooled and so the feuer is extinguished In vehement pâ—ines and grieses therefore there is no better remedy fouâ—de than â—o â—et blouâ— euen tiâ—l the Paâ—â—ent ouercome Reade more hereof in Galen lib. 9. Method Med. cap. 4. lâ—b de curaâ—d Râ—tâ— saâ—g Mâ—ssionem capit vndecim Fuchlium libr. secund sectione quint. cap. quart sext institutionum Medic. The twelfth impediment is the extreame coldnes of the Region a Country which being cold cannot tollerate so large an Euacuatioá¹… as is this kind that wee nowe presently handle The reason is for that the body being before sufficiently cooled through the colde temperament of the place must needes waxe more cold when the naturall heate is drawen forth with the bloud Moreouer a country too hot cannot admit this practise because in such a place extremity ofheate draw eth from the body much inward heat of nature dissoluing of it selfe and dispersing the naturall forces and humors of the body and therefore in hot Countries the naturall powers are lessened there is lesse bloud in the veyns which is the reason that also in extreame hot countries the bleeding must be none at all or very litle A country
And further it commeth to passe not onely that the seedie moysture is drawen from the partes of the bodie through carnall copulation but also the vitall spirites passe out of the arteries with the same And therefore it is no â—â—arucile if such as vse lecherie immoderatly become weake both these being taken from the bodie that is to saye the seedie moysture and the vitall spirite VVhereunto may be added the pleasure of Venus which of it selfe is able to vnloose the vitall firâ—itie of the bodie Yea it is knowen that some haue dyed of too much pleasure in the act Marsilius Ficinus in his booke de Sanitate tuenda Cap. 7. confirmeth in these words aâ—l that hath been hitherto said Venus saith he if it do but little exceede the powers naturall of the bodie presently it exhausteth the spirites and specially those that are most subâ—ile Also it enfeebleth the braine weakneth the stomack and hart-strings yea there cannot be a more hurtfull thing to the witt and memorie VVhy did Hippo. iudge Coitum to be like the falling sicknesse but bâ—cause it woundeth the minde which is diuiâ—e and heauenly The immoderate vse of ust is so hurtfull that as Auicen sayeth in his boode de Animalibus If but a little seede issue foorth more than nature can afoorde it offendeth more than if fouâ—tietimes so much bloud had proceedâ—d And therefore not without some good grounde dâ—d the auncient wâ—iters immagine the nine Muses and Minerua her selfe to be vi giâ—s Reâ—d moâ—e hereof in Galen Chap. 86. Artis Medicinae Pauli Aegnieta lib. 1. Chap. 35. In Aetius lib. 3. Chap. 8. The seuenâ—eenth impediment is long continuance of a disease wherewith the strength of the bodie being wearied a long tract of time the same cannot nowe tolleraâ—e bâ—eeding And forasmuch as now the bodie is more than inongh enfeebled brought lowe thorough a long continuing and languishing sicknesse by bleeding wee maye more easily quite extinguish the patient than remedie the disease Galen de Curand ratio per sanguia missio Chap. 20 And Auicen confirme the same giuing aduiâ—e to forbeare opening of a veine in bodies which haue endured long griefes except corruption of bloud moue vnto it In which case sometime bloud may be detracted from persons that haue continued sicke of long time And Fuchsius councelleth saying People in consumption oâ—de folke weomen with chiâ—de yong chiâ—dâ—en are not lightly to bleede The nineteenth impediment is small quantitie of humors being in the bodie for a good consideration is to be had how the humors offend in the bodie in quantitie or in qualitie VVhether there be many or fewe humors in the pacient And therefore sometime vpon this ground wee open a veine in weomen with child if there be abundance of bloud sufficient both for the mother and the infant in the wombe if the bodily strength be firme and that the greatnes of the disease in them so require it But hereof more at large I meane to write in another place And agâ—ine beside the quantitie the diuersitie of nature in humors is also a profitable consideration in this practise For euen according to the varietie of humors the patient is oft either to be let bloud or not letteÌ„ bloud which Galen seemeth to witnesse li. 4. de Sanita tuend saying Some humors come to perfect nutriment before the bloud some are as it were halfe concocted some altogether rawe and vndigested Some are but little different from the forme of bloud some are wholly changed into bloud some verie litle some more some verie much VVhen humors are a verie little as it were from the nature of bloud as not yet turned into the same or when they haue a verie little exceeded further than the nature of bloud wee may confidently open a veine VVhen the same is more than a verie little either the one way or the other on this side or beyond wee are to deale herein more considerately If the humors want much of or exceed much beyond the nature of blond we are altogether to forbeare bleeding The twentieth let after the small quantitie of the other humors may be the quantitie of the bloud which the wise Phisition in this practise will most wisely regard As for example if there be little good bloud in the body and abundance of other humors wee are to make staie from opening a veine If any of the other three humors be but litle in quantitie and the bloud abundant we may boldly let bloud Yea by diligent obseruation the Phlebotomer shall easily perceiue what hurtfull humor may be withdrawen with the bloud and therfore if there be many cholerike humors in the body of man and yet not mixt with the bloud or that there be many flegmatike and rawe humors and but little bloud by no meanes is a veine to be opened This doth Anicen forbid in quarta primi Cap. 20. If the bloud be good and little and that there be in the same bodie many ill humors also bleeding taketh away the good and leaueth the bad behind And a little after he addeth that the Phisition is diligently to beware lest by vnskilful bleeding in these cases hee bring the patient after he hath extracted the bloud the ill humors still remaining to an excessiue heat of cholericke humors or too much cruditie of colde and vndigested humors And although as ye haue heard before Phlebotomy doth equally euacuate all humors Yet because now so little bloud is in the veines whereof a little portion is withdrawen by bleeding it followeth that but a little bloud and lesse than before remaineth now in the veines with the other humors and that there is great plentie of the other humors forasmuch as they come not out so redily when a veine is opened as the bloud doth and therefore by a necessarie consequent bloud being gone which was as it were a bridle to other humors choler must excessiuely boile and flegme become more colde and vndigested VVhereupon also I gather that those haue done ill and verie vnskilfully which haue reproued Auicen of error in this place seeing he is rather verie highly to be commended then vpon euery small and light occasion to be reprehended Finally wee are to forbeare letting of bloud after continuall vomitings hunger great watchings extreme labours and after all such things as immoderately 〈…〉 body drying and dissoluing the 〈…〉 thereof as Rhases noteth lib. 7. 〈…〉 Almonsorem Touching the causes 〈…〉 ring Phlebotomie they may soone be gathered of their contraries by those impediments here specified And in the fifth Chapter before yee haue heard both the direct indirect causes which may moue to let bloud Vnto the which place I referre the studious reader at this time concluding this Chapter with the verses of Schola Salerni wherin are set downe most of the impediments here spoken of Frigida natura frigens regio dolor ingens Balnea post coâ—tum minor aetas atque senilis Morbus prolixus repletio potus
and had experience once or twise before of aborsion the third moneth if shee had not bled the seconde moneth In the other moneths the fifth and eighth shee was in danger of suffocation except shee had bled againe VVhen women are brought a bed they must not bleede except their seconde birth be suppressed or a Feuer molest them In the which cases also carefully consider in the Patient her naturall strength Those that haue their termes naturally according to the due course of nature and the course of the moneth are not to bee let bloud except in immoderate Fluxes to drawe backe the matter VVhen they breake forth naturally the whole matter is to bee let alone to nature Eighthly bleeding is not good for such persons as are bounde and haue the excrements retained For as yee heard in the eighth Chapter Fig. 2. The veynes beeing emptied they attract matter from the next members and they attract from the stomacke the moystnes of the excrements whereby they become more dried and baked bring diuers waies annoyance to the body In which case the wombe by Art is to be made solluble as appeareth in the place now cited Finally a veyne may and is to bee opened without hurt or daunger whensoeuer wee feele our selues to bee heauy lumpish and stopped or stuffed in our bodies first considering the quantity and quality of the fulnesse which wee may knowe and discerne by certaine tokens whether it bee Plenitudo quo ad vasa or quo ad vires as was shewed in the first Chapter the more heauy and drowsie a man feeleth him selfe to be so much the more it appeareth to bee that fulnesse which is quo ad vires But if hee feele the former stuffing in his body increased than is it that plenitude Quo ad vasa And thus much to know the quantity of the Repletion The quality of the fulnesse is knowen partly by the colours partly by those things which are very neerely ioyned to the nature of the humors But of these signes sufficient hath been spoken before in the first Chapter In these cases of Repletion if the strength of the body shall bee answerable wee are to open a veyne for as much as bleeding is the chiefest remedy to abate fulnesse But if the stuffing and fulnesse of the body bee greatly grieuous and the state of the body not answerable it is not alwaies necessary to let bloud As Galen noteth lib. de Curand ratio per sanguinis missio And againe Phlebotomy is not onely profitable when any of the foresaid fulnesses grieue and oppresse vs But also as hath beene saide in cases without any fulnesse As in the beginning of an inflammation which commeth either of a blow ache paine or weakenesse of the member For paine as was saide draweth the bloud vnto it and of the weakenesse of the bodily parts cause an inflammation without fulnesse Also when the disease is great and vehement we let bloud although no fulnes appear in the Patient yet alwaies hauing a regard to the age and strength of the party as Hyppocrates setteth downe in these wordes 4. Vict. acutorum 17. In acutis morbis sanguinem deâ—rahes â—ivehemens morbus videatur florueritque aegrotanti aet as virium affuerit robur That is in sharpe disease thou shalt let bloud if the sickenes seeme great if the age of the Patient permit and that there be sufficiencie of naturall strength And thus much of the persons that are to bleede concerning the which point more may be easily coniectured and collected of the studious Practitioner from the Chapters precedent What corruption of Humors bleeding remoueth from the veines Chap. 10. IT hath beene said that bleeding generally is the present and proper helpe when Humors offend in the veyns either in quantity or in quality It hath been already declared that some humors it euacuateth other some it reuoketh and pulleth backe which is called revulsion whereof hath beene spoken in a distinct Chapter by it selfe Now order requireth in some briefe sort to shew what corruption of humors generally bleeding euacuateth from the veynes The defect of humors in the veynes is either Plethora or Cacochymia as was shewed in the first Chapter The onely and peculiar remedy of Plethora or abundance of bloud is the opening of a veyne And forasmuch as fulnes of bloud is of two sorts One of fulnes simple and pure consisting of a like proportion of the best humors and the other vnpure and compounded taking part with Cacochymia that is abundance of humors corrupted in the veynes Therefore it is to bee marked that in both these Repletions the opening of a veyn greatly profiteth VVhen so euer therefore the muscles are sounde whole and full the veynes large great and swelling menacing thereby imminent danger to the members presently bloud must bee detracted After which eu cuation these effects will insue mitigation of paines caused by ouermuch retching of the veynes ease vnto the body which seemeth as it were nowe disburdened of a grieuous and waighty ponderousnes a more nimblenes to all exercise and labour than was before an increase and refreshing of the naturall heate an opening of the straight passages and pores of the members Finally there will follow a happy repulse of diuers imminent dangers and diseases wherevnto by all probability in short time the body would haue beene brought For it is greatly tobee feared lest the veynes ouerreatched with fulnesse of bloud should open and breake and through that meanes cause inflammation or lest some generall obstruction should arise which might keepe backe the inwarde heate and so vtterly choke vp the bodily forces wherby might bee caused some vehement hot feuer or as it oft hapneth a sodaine death of the party Now from these daungers can no man bee safely and speedely freed either by purging exercise or abstinence but by bleeding and with the bloud is this Repletion most safely abated That fulnes which is vnpure and compounded is not so safely cured by bleeding and yet the more nigh that it commeth in likenes to that Repletion which is simple and pure the more confidently and the more plentifully we may let bloud And the more vnpure that it is the more carefully and sparingly ought a veyne to bee opened Therefore those persons that haue an il constitution of body and yet haue their veyns abundantly filled or that beeing of a constitution are yet repleat with corrupted meates These I say are to bleede no longer but to auoid the danger of fulnes and the impurities remaining behinde are to bee expelled by Purgation Hot chollericke Repletions of all vnpure constitutions are most safely abated by bleeding because bleeding in this case not onely diminisheth choler but also cooleth the same mightily Melancholly Repletions can nothing so well away with this practise because it doth not so exceede in heate that it neede at all any refrigeration or cooling and the flegmaticke constitution can in no case brooke it for being a very cold
labour doth Also of passions of the mind some suffocate the spirites and inwarde heate as namely feare and sorrowe some wast and spread them abroade as mirth and gladnes These are the causes which being in exceise do wast consume inward heat the spirites of life strength of the bodie which being so apparant as they are may be vnto vs assured markes signes wherby to know whether the forces of nature haue yet lost or do still retaine their powers vertue strength Those causes which onely oppresse the strength of the bodie are inward hidden not so know en vnto vs as the forsaid and they are these obstructions immoderate abundance of humors which stop the veines arteries because they are thick grosse and slow humors by meanes wherof they keepe in the spirits do not suffer them to be cooled as it were by any kinde of winnowing whereby the vse of the spirits is taken away their vertues are oppressed and grieuously with the inward heat offended which matter verie oft faleth out so in the Lungs Liuer celles of the braine in the arteries finally in the verie habite of the bodie Obstruction caused of too much abundāce of humors doth grieue oppresse somtime ouercome the inward heat and spirites of life Fulnes also proceeding from any obstruction if the repletion be simple or somewhat part-taking with that called Cacochymia it choketh bodily strength as for example Abundance of bloud in a wrastler Flewine in Leucophlegmatica i. the third kind of dropsie cruditie of humors in the other dropsie abundance of choler in the yellow Iaundies As often therefore as the powers of nature are descried to be weak by the excrements the spirites of life by the pulse breathing the animall facultie by her proper functions and by any of the foresaide vehement causes preceeding wee may determine the spirites of nature to be empaired VVhen none of these causes haue gone before and that yet the bodily strength appeareth weake then iudge them to be onely wronged or oppressed Specially if there do concurre signes of pure and simple repletion or of great corruption of wicked humors the causes greeuing and oppressing the spirites of nature being remoued presently their strength is recouered and they come againe vnto themselues except they be beaten downe with the continuance of their oppression Here therefore I make three steppes or degrees of naturall strength weakely affected either the same is a little throwen downe or ouercharged or thirdly altogether weakened whose particuler tokēs apeare by that which hath beene said in the premisses There are some which only marke the pulses as an infallible signe to iudge the bodily strength by which in trueth is a great marke but yet not alone sufficiēt being both doutfull and vnconstant and also because it is troubled with diuers outward things is oftētimes changed Againe euacuation too aboundant affecteth not onely the vitall spirites but also in like manner the other faculties of nature whose decay bringeth death as assuredly as if the vitall power were extinguished and therefore in euacuation it is requisite aswell to marke and obserue the other faculties of nature as the vital powers For if the pacient be sicke of a vehement continuall disease as of Lienteria i. a fluxe of the stomacke or Atrophia i. a kind of consumption or Marasmus i. the endes of the feuer Hectike let him not bloud albeit the pulse be mightie full And therefore I conclude this Chapter affirming that we are in euacuation to consider the ablenes and strength not of one only but of all the three aboue-said running or flowing faculties of nature Neither to consider of these alone but also of the setled faculties in which is conteined the action of life To knowe by the greatnes of the disease the strength of the naturall powers the quantitie of bloud that must be withdrawen Chap. 14. THe knowledge of the quantitie in euery remedie is the hardest matter in al Phisicke and most of all troubleth the carefull and wise Phisition And although to knowe the quantitie be but a coniecturall knowledge yet the same is ioyned with lesse danger and is more secure here than the knowledge of the quantitie in a purgatiue receit The reason is because wee may stoppe the bloud when wee will as Galen witnesseth 2. de ration virt in acutis Commen 11. lib. de curandi rat◠per sangninis missio Chap. 12. But when areceit is in wardly taken the same cannot be againe vntaken Neither is it in our power when it is once in the bellie to take away any part thereof or if neede be to adde vnto it VVhich in bleeding wee may do and therefore lesse danger is in this than in the other The quantitie of the bloud that must be extracted is knowen by the strength of the patient and chiefely by his pulse Therefore while he bleedeth let the Phiebotomer or Phisition seele the Pulseis with his hand and suffer the bloud to passe according to the alteration of the same especially when any great euacuation as euen vnto Syncope is to be made Lest it fall out vnwares that death it selfe doe come in the place of sowning or fainting And except necessitie doe greatlye vrge it is best and safest to abstaine from such plentifull euacuation after Galens councell lib. de Cura rat per sang missionem Chap. 12. If at any time the powers of nature being weake the disease require some plentifull bleeding it is good to deuide the same to open a veine twise or thrise and at eache time to detract a little bloud as ye haue partly heard before and as it shall be shewed more at large hereafter All sicknesse decayeth the strength of nature and so doth in like manner that euacuation which is vsed to helpe nature Lest therefore it might seeme a verie hard dealing in this case more grieuously to afflict one alreadie afflicted and presently grieued the matter is so to be ordered as the substance of the disease may be remoued the forces of nature as little damnified as may be Yea it is a principall poynt in a skilfull practisioner so to worke that the euill may be remedied and the patient brought in hope of a more profitable recouerie for his health than his former Phisick hath been painful vnto him Those hurts which the naturall vertues sustaine by a moderate euacuation are but small and these are againe quieted when the euaacuation is accomplished for nature now freede of those hurtfull humors wherewith shee was before pressed down recouereth her former strēgth Shee renueth that which was drawen from the inward heat and spirites and become almost the conquerour of the disease Shee ouercometh wholly at length yea that which remained behind partly by inward concoction and partly by outward dissipation It wise Hippo councelled to giue a small dyet to the sick patient not fearing thereby more and more to weaken the strength of nature which
is vnprofitable and superfluous not bringing any commodity but discommoditie and perturbation to the sicke Therfore in this case this must be the practise moderately and often to giue the patient meates of good iuice and nourishment to confirm strengthen and recouer nature and such as haue some vertue in them a proprietate against the present infirmitie may redresse the inward corruption of humors And wheÌ„ thus the naturall forces shall be recouered Phlebotomy may succeed And this practise is much vsed in continual and long sicknesses in sharp diseases called morbi acuti this long stay were doubtfull and dangerous An obseruation of things present past and also a foresight of things future needful necessarie to the further knowledge of the quaÌ„titie of bloud that must be taken Chap. 15. OBseruations of euident causes touching the greatnes of the disease constancy of naturall forces doth greatly further our knowledge in this behalfe Of which euident causes three of them are in ward and bred in our selues as namely the temperament the complexion the age three of them are outward and accidentall namely the coÌ„stitution of the aire according to the seueral seasons of the year the situation of the countrie state of the heaueÌ„s All which are included in one cause as grouÌ„ded al vpon one reason secoÌ„dly former euacuatioÌ„s ether slaid or immoderatly flowing thirdly custome order in diet life or kind of euacuations proceding By knowledge of these forepassed causes we may atteine to the vnderstanding of the strength both of nature of the disease so consequently of the quantity that wee must bleed albeit that the causes present future haue not yet altered either the disease or streÌ„gth of nature yet for asmuch as they begin to dissolue some humours froÌ„ the body to wast the strength of nature they haue some moment in this practise For what these causes present or past can doo ye haue heard in the 8. 14. chap. to the which I refer you coÌ„cerning the perticulars here onely being contented to rekon theÌ„ vp by name 〈◊〉 the teÌ„perameÌ„t the state of the body the age the countrietthe time of the year the disposition of the aire sky voluntary euacuatioÌ„s custom the rest as appeareth ca. 8 It is the part property of a wife skilful phisition to consider not only the state present of the natural vertues but also to foresee what will be their state in time to come after bleeding The natural powers after euacuation are so to be conserued as that the same may be able afterwardes to take other helps continue out the prolixity of a coÌ„tinuing diâ—eâ—s Yea we must reteine alwaies some bloud for future fits and courses of the disease which are yet to come Lest afterwards vrged thervnto wee begin vnfitly and out of due time againe to nourish the same And this chiefly is to be done in bleeding for corrupted and putrifying feuers whose putrifaction obstruction is not taken away by bleeding but the putrifaction is afterwardes the better ouercome by the strong force of nature when by opening of a veine shee is somewhat relieued Therefore to this purpose alwaies some bloud must be left for natures preseruation as Galen councelleth lib 11. method cap. 14. We may coniecture the future strength of the patieÌ„t partly by the preseÌ„t causes which are also afterwards like to continue partly by accidents which may happen contrary to our opinioÌ„ Among present causes these are the chiefe the state of the heauens the order of mans life If the constitution of the aire hath bene hot dry is like so to coÌ„tinue the bleeding must be lesse than if wee suppose a cold aire to ensue Again if we perceaue that the patient will liue sparingly â—eÌ„peratly either for want of appetite or because the disease will not suffer him to feed as in Augina the Quincie which shutteth vp the Iawes we are to take lesse bloud than wheÌ„ we see he wil liue more frankly and liberallie In these cases we must still reserue some bloud as natures treasure to helpe at a pinch in time of neede Suddaine accidentes and vnlooked for which greatly enfeeble natural strength are these great paine and ach watchinge voluntarie euacuations and chiefly Sincâ—pe into the which many do fall beeing not accustomed to bleede at the first opening of a veine either because they are weâ—ke of nature or strucken with some great feare or because the mouth of the stomake fiâ—â—ed with bitter choler is becom very vnsensible and weake When we suppose that some of these matters wil fall out albeit the strength be firme yet no blood at all or very litle is to be withdrawen except by art wee naue preuented the former accidents It is I say great wisedome to foresee a farre off 〈◊〉 beware of such suddaine and vnlooked for accidents This we will manifest by an example Let the pacient be of a sanguine complexion of body thicke and well set of a florishing age that hath long time led a leacherous life feeding plentifully of good meats and that hath omitted his accustomed exercises and liued at home idely in whom also accustomed eruptions of bloud out of the nose belly or Hemoâ—roids are staâ—ed so that by concourse of these causes the body hath greatly encreased or waxed that the large veines through repletion are greatly filled WheÌ„ soeuer a strong ague or great inflammation shall possesse such a patient presently he must be let bloud and that plétifully Both the greatnes of the disease and of the cause requiring the same Moreouer this is confirmed by obseruation of thinges past if present causes agree to these namely that there bee a sit temperature of aire by occasion of the countrie season of the yeare and the present state of the weather moderatly cold and moist and that the patient bee apt to euacuation also that the sicknesse bee not like to continue long after neither apparant signification of an excessiuely hot temperature of aire to come no thveatning of future paine or of abstinence watchinges voluntarie euacuations If all these thus agree together who may doubt but that a large euacuation may in this case bee made And none at all when the conâ—raryes doo appeare Sometime these obseruations are mingled among themselues and contrary to themselues In which confusion a wise iudgement is needfull by comparison of them to prescribe the iust quantitie of euacuation The consideration of passed matters many times perswade a plentifull bleeding which the obseruation of things present by and by taketh away As for example if the Patient laying aside his accustomed exercise giue himselfe to pleasure and idlenes stuffing himselfe withmeats and hauing some notable euacuation staied in him but his body is waxed fat white of colour loose open soft full of thiniuce and that it be Summer a hot dry country a hot dry constitution of weather without stormes In
this case let not bloud at all for sufficient is already euacuated from such a body of it selfe and that not obscurely but apparantly In this foresaid constitution thou maist detract a little bloud if it bee winter in a cold country and the wind standing at North and in this mixture of things thou must marke not onely the multitude of the obseruations but the force of them Because one many times exceedeth all the rest in power and sway and he that can neither by art experience nor sound iudgement define the quantity of euacuation according to the aduise of Hyppocrates let him rather euacuate lesse than more than needeth In this place albeit somewhat hath beene spoken before to the same purpose cap. 9. Fig. 7. It may be profitably demaunded whether being with child be to be accounted among these obseruations heere handled shewe of truth and some probability may be alleaged that when women with childe are grieuously sicke we are not to let them bloud because of the young that is in the wombe This is also defended by Hyppocrates saying Mulier in vtero gestans abortit incisa vena idque magis si faetus auctior fuerit that is A woman with child is deliuered before her time if shee bee let bloud specially if the young be much increased and growen in the wombe But this of Hyppocrates is not alwaies true as neither that which hee setteth downe a little before Mulierem in vtero gerentem acuto morbo corripi Lethale est That is it is deadly for a woman with child to be taken with a sharpe disease For seeing a purgation made of wicked and venemous simples standeth with greater danger of the childe than opening of a veyne and that Hyppocrates graunteth that women with child wexed with a disease caused of corruption of ill humors may bee purged in the moneths betweene the third and the eighth moneth truely with much more safety may we let those bloud being grieued with any sicknes caused of Repletion And if in the middle time of the going with childe the same may bee done Much rather in the beginning when the bloud more aboundeth and the yong needeth lesse nourishment Againe if women being with child nature of her selfe oftentimes attempteth euacuation of that which is supersluous with great profit out of the nose by the hemorroids belly and that sometime the Termes flowe healthfully at times appointed why vpon great necessity may we not imitate nature in our Art Yea many women bring vntimely fruit except about the fourth moneth a veyne be opened the young fruit beeing ouercome with plenitude of the Patient neither onely in fulnes but without the same a veyn is opened in the arme of a woman with child when need constraineth as in a Pluresie or other vehement inflammation It is dangerous in deede to open any of the lower veynes in women with child because the fluxe turned downewarde the termes would flowe and so the fruit in the wombe bee deiected and cast downe A veyne is opened very seldome in the eighth or nine moneth without causing of vntimely birth forasmuch as then a woman of euery light cause receiueth hurt and is deliuered before her time through the weakenes and slipperines of the wombe In this case Cornelius Celsuâ— only considered the greatnes of the disease and ablenes of the strength Olde Phisitions saith hee were of opinion that the first and latter age could not brooke bleeding and that a woman with child cured by Phlebotomy should bring foorth vntimely fruit yet experience prooued afterward that none of these were perpetuall but that better obseruations wer to be considered which the Phisition is to remember For the matter is not great what the age bee or what a woman beareth in hir wombe but what her strength is a fierce childe a strong olde man a lusty sanguine woman with child may safely bleede And thus you see howe a great belly in a woman may be an obseruation concerning the quantity of bloud that must bee withdrawen Another obseruation to finde out the iust quantite is to marke the alteration of colour in the bloud So iudged Hyppocrates in Pleuritide secundo de ratione virtus in acutis Commen 10. where hee counselleth to let bloud if the paine in a Pluresie ascend to the arme or the Paps so long till the bloud came forth in colour more red or more yeallow or for pure and red bloud blacke and blewe which both doo happen For bloud in an inflammation differeth in colour from the naturall bloud as more heated and inflamed If the naturall bloud before in the body were crude and vndigested bloud that which is in the inflamed place is a great deale redder and yeallower if it were before redde through adustion it becommeth now more swart and blacke But if the Patient fâ—iâ—t or faile before the bloud alter in colour stay not then for the muâ—ation or change thereof Finally the plenitude in the body admonisheth vs of the quantity more or lesse and thus we conclude touching the knowledge of the quantity how muoh must 〈◊〉 taken Of the time and seasons of the sickenesse of this yeaâ—e of the daie and houre of the daie when a man is to bleede or not to bleede Chap. 16. ALthough it hath beene declared that we are not to let bloud in a season of the yeare too hot or too colde Yet in this Chapter wee purpose more exactly to discusse what time of the sickenesse and what day the same is to bee done Auicen in quartiâ— primi cap. 20. saith that for preseruation a veyne is most safely opened when the disease is not come or yet present disallowing altogether of this practise in the beginning of sickenesse and his reasons to prooue it are these In the beginning of a sickenesse saith he it attenuateth the humors and causeth them to slow throughout all the bodie mingling the bad Humors with the good bloud These wordes of Auicen are neither true nor agreeable to Hyppocrates Galen Hyppoc 2. Aphoris Aphoris 29. writeth that at the beginning of sickenes If any matter be to be remoued the same ought then to be done accordingly and when the euils are in their state then to giue them rest Galen in the Commen saith that bleeding and purging may be vâ—ed at the beginning but neither of them Morbâ— Consistenti that is in the state of tâ—â— disease whereofin the Aphoris following â—yppocrates rendreth a reason at the first and lasâ— â—aith he tâ—ings are more weake than in the middle estate for then all things are most firme and strong Againe why he should stay for concoction in bleeding I see no reason for as much as bloud of his owne nature is alwaies concocted and a veyne beeing opened it floweth out easily of his owne accorde Againe where Auicen in his reasons saith that by bleeding in the beginning that corrupted bloud is not euacuated that should be which afterward puts still the Patient to more pain so
that wee are forced oftentimes after wee haue let bloud in the beginning of a sicknes to take medicines purposely to asswage dolors and paine I perceiue not how bleeding can take the good and leaue the bad seeing nature alwaies reserueth to it selfe as a friend good humors good bloud reiecting those that are naught and vnprofitable Also when he saith it attenuateth the humors hee is contrary to himselfe for in quarta primi cap. 4. he iudgeth rather bleeding to make humors thicke than thin The bloud and spirits themselues which attenuate the humors by bleeding being withdrawen Againe this is wonderfull that when the state of the disease is past and the Patient past danger that he would haue then the miserable Patient with a new wound and cutting of a veyne againe tormented If any thinke Auicen to be blameles as being of this iudgement that a veyne is to be opened when nature hath attempted Crisin that is the iudgement of the disease which fallâ—th out to bee vnperfect and litle not able to doo the feat and accomplish the whole force neither doth this defende him For by what reason would yee haue bleeding to euacuate the matter left behind of an vnperfect Crisis The naturall vertue being made so weake by that time with continuall contending and striuing with the disease that it can doo no good or very little in the cure and especially when the rest of that matter is daily vsed to be easily euacuated by purgations In sharp dangerous sicknesses therfore euery one seeth here Auicens error for in these sharp vehement continuall diseases we must bleede or be purged the first day yeâ— stay in these is very dangerous as Hyppo saith 4. Aphoris Aphoris 10. If Auicen meant it of Morbi salubres i. recouerable diseases in these truely neither first nor last nor at any time are we to bleed for then most vsually we let bloud when a disease is vehement and dangerous The opinion of other some in this place is to be â—aughed at who thinketh that Auicen admonisheth not to bleede at the beginning in sicknesses not dangerous as in a tertian because nature is terrefied by the newnes and sodainnes of the disease and these make or imagine nature to be a thing indued with knowledge or an vnderstanding and knowing faculty which is not so But if nature be made afraide in sickenesses not perillous how much more will she be afraide in daungerous diseases in which not withstanding wee hasten to let bloud euen at the very first These matters therefore are full of error Let this therefore bee the conclusion that wee must bleede in the beginning of sickenesses VVherevpon Galen counselleth the disease being come to open a veyne lib. de Curand ratio per sang missio cap. 9. cap. 12. If faith hee there bee repletion of hot boyling bloud whereby a strong ague is inflamed presently euacuat yea euen vnto sowning yet still regarding the strength of nature And this is his aduise prim Aphoris Aphoris 23. VVhat diseases so euer are caused of plenitude or other corruption of humors in the veynes they are at the beginning to bee cured by bleeding for by this meanes the disease likely to grow is kept backe and so much as is already bred nature will easily subdue Thus hot Agues before they are yet inflamed with heate of boyling bloud or by vehement putrifaction are may bee cured Also inward inflammations at the first as long as the flowing humor cleaueth not to the member but followeth the bloud may be cured The said humor issuing forth with the bloud when a veyne is once opened strength at the beginning is firme and constant in the Patient almost like vnto vs that are well in health If therefore at any time bleeding bee needefull the same may best be done at the beginning he that in fulnes of bloud or fluxe of matter will stay from bleeding and vse other helps in a peruerse order of healing he doubleth the griefe and troubleth the forces of nature more than is conuenient Yea let the veyne so timely bee opened as the stomacke and first veynes be not first stuffed with either corruption or cruditie of humors or meats vndigested Thus you haue heard the former words of Auicen to be erronious howsoeuer certain labor to salue them vp yea Auicen seemeth to vnderstand his owne saying not only of particuler diseases in the members but also of all other diseases For afterwards speaking of all Feuers and especially of Febris fanguinea Feuers caused of bloud hee counselleth in them not to let bloud abundantly except there haue gone before concoction and concerning this reason that humors are lessened by bleeding it cannot be so for yee haue already heard that both before bleeding and after there is retained in the body one and the selfe same proportion of humors If any difference or mutation happen seeing the thin humor issueth foorth with the greatest speed and the thick humor but slow it is more likely and probable that opening of a veyne should rather make the bloud and humors thicke than thin A gaine whereas he saith in his reason that the humors thereby are agitated moued and driuen through the whole body how should there bee this agitation of humors seeing rather this practise abateth the multitude of them which was before the cause of perturbation sickenes In reason all things now should become farre more quiet than before VVhereas he saith the ill bloud is mixt in the veynes with the good what inconuenience commeth thereof if a veyne bee opened then no doubt the bad must passe foorth with the good Put the case there bee a strong or vehement sickenes caused of abundance of bloud onely as are both the Synochi Feuers as is the putrified feuer caused through plenitude as are Angina Pleurisis Peripneumonia also inflammations of the Liuer and other partes In these if they bee great and dangerous through much abundance of bloud who will not presently open a veyne who will not while strength serueth take away that fulnes which bringeth a disease and danger of death Hereupon in Synoâ—ha presently at the first we hasten to let bloud euen till the Patient faint and before the matter putrifie But Auicen in a sanguine feuer at the first letteth bloud sparingly more plentifully afterwardes when signes of concoction appeare But what concoction doth hee looke for of good bloud and already well concocted and offending onely in quantity In these sanguine feuers therefore euen as in very sharpe sickenesses either to put off or to stay bleeding it is very ill as Hyppocrates saith if the disease be not so sharpe or vehement yet let bloud at the beginning according to the proportion of the fulnes If wee should in these stay with Auicen till concoction the beginning and state of the disease be past wee should suffer the disease to grow increase and cause for want of skill the Patient to bee cruelly hand'ed
and intreated without helpe of Phisicke which wee may administer if the disease be deadly it will neuer be brought to concoction If it be doubtfull or recouerable called Morbus salutaris as ye haue heard after the state in the declination when the Patient is past daunger what profit doth Phlebotomy then bring as ye haue heard before Nature by concoction separateth the ill humors froÌ„ the good these to conseruation those to expulsion This she doth either by her self or by the help of Phisick But opening of a veine indifferently without choice euacuateth al humors VVherefore then in bleeding shall wee tarrie for this concoctioÌ„ diuision of humors as for example In apostumations if the corupted bloud be made matter or filth it is not then taken away by bleeding but by some other meanes So in feuers whose matter is conteined in the veines when the humor is concoct diuided we vse not to withdraw the same by bleeding but by some other practise in Phisick in which case by that time that concoction is accomplished wee shall haue nature to helpe vs who ofher selfe indeuoureth to expell humors concocted diuided the bad from the good And if nowe after concoction separation of humors we open a veine we do not onely euacuat the bad but also the good and that which is worse those humors which are separated by nature we shal mingle with the pure bloud de filing the same so both confound all disturb the good worke of nature herself Therfore when the apparant signes of concoction shall appeare the cure must be done not any more by opening of a veine but either by purgation or some other help to turne the matter aside some other way except which sometime chanceth there appeare signes of cruditie In feuers when the plenâ—tude is abated and things which putrified are concocted we must assay to euacuat them by siege vâ—ine or sweat Those things which are rotten and turned to filth in a Pâ—urisâ—e or Pâ—ripneumonia we euacuâ—t by spitting Matter putrified in the Liuer passeth through the hollowe veine by the belly Corruption in the â—ines in Gibba passeth by vâ—ine and so eâ—he puâ—rified matter accordingly out of ech member is to be purged by the next places fiâ—test passages If by feare slouth or any other occasion opening of a veine haue not bin put in vre in the beginning of a sicknes the same may be dâ—n at any time yea the twentieth day after if the signes of fulnes câ—uditie still continue and that the bodily strength be answerable not decayed through prolixitie of sicknes But here is the doubt that oft the matter of the disease is digested or the strength of nature wasted But Auicens opinion that in the beginning of a disease a veine is not to be opened seemeth to haue grounde out of Galen Chap. â—7 Artis Medicinalis Comment 22. lib. 4. Aphoris norum saying The Phisition is tâ—e minister of Nature But Nature her sâ—lfe neuer in the beginning of a disease when the humors are yet altogether râ—we and vnconcocted appointeth any euacuation therefore neither must the Phisition at the first when all things are yet vnconcocted attempt any euacuation and so much the lesse because crude and vndigested matter not yelding to euacuation stirreth vp grieuous accideÌ„ts in the bodie Galen li. 1. Aphoris CoÌ„men 22 Again say some in Auicens defence it may be that in the beginning of a sicknes opening of a veine maketh the superfluities of the body thinne so that they may flowe runne thorough out the whole body and so be mingled with the good bloud wherby it fortuneth that the same is not extracted which necessitie requireth to be expelled VVhereby also it happeneth further that the patient must be let bloud againe sometime euen the same day and sometime the day after which too much enfeebleth the powers of the bodie And thus it is contended partly by reason partly by authoritie in the behalfe of Auicen And surely if the words of Auicen might be restringed that verie seldome and onely in the case limitted a veine is not to be opened at the beginning of sicknes it may wel stand to sense reason but Fernelius others gather that Auicens words were spoken more generally than that he can by this speciall case only be defended And because the matter is controuerted as ye see I haue set downe the reasons brought both against Auicen and for him Leauing the depth of the controuersie to be examined discided by others rather as yet inclining for my part for ought that I can see to the aduersarie â—pâ—nioÌ„ to Auicens stil affirming it to be more viual a great deale to open a veine in the beginning of sicknes than to stay a longer time And that this assertion may the rather appeare to be true I will set downe certeine ruâ—es whereby it may truely be manifested approued so by science and experience First when wicked humors greatly swel being as it were excited stirred vp through repletion of their owne accord they perswade to euacuation at the beginning of the disease when the humors are not yet concoct For otherwise the vnconstant humor mouing from place to place and froÌ„ member to member without order might make stay at some principall member to the great hurt of the patient It happeneth in deede but seldome that the humors are moueable flowing from one part to another for coÌ„monly they remaine firme stable in one place Secondly a veine is to be opened in the beginning of a disease when quantitie of matter aboundeth in the veines as Galen saith Com. 29. li. 2. Aphoris Yea in this case also somtime a purgation is taken that nature may easily â—oÌ„coct ouercome the residue of the matter of the disease when the same is lessened by art Thirdly when the disease is great vehement as in verie dolorous apostumations albeit there be not in the bodie much matter antecedent yet the humor that is is to be repelled lest the apostumation open and breake sooner than is conuenient To auoid therefore these grâ—at euil accidents by by at the beginning incision is to be made which Galen teacheth li. 13. Cap. 20. Method Medend in these words In such affects saith he a veine must be opened at the beginning so that none of those things hinder which we haue spoken of i. either the abundance of raw e humors childish yeares the time of the yeare the temperature of the countrey too hote or too cold For not only in sharp diseases inflamations but also in wounds bruses of particular parts specialy being principall bloud is to be taken from the contrarie part to repell the inflamation albeit the bloud be but little in quantitie In the beginning of sharpe diseases called morbiacuti or peracuti opening of a veine is passing good For the better vnderstanding whereof you must remember that a sharp disease is two-fold either exquisite
throughly vehement passing not the fourth daye which is called of Phisitions Malus peracutus i. thoroughly sharp and of some perperacutus imitating barbarous authors in Phisick The other not exquisite or throughly sharpe vehemeÌ„t whose greatest force wilbe in the seuenth day These diseases being but short at their extreame fits in few daies without any truce presently at the beginning these are to be cured And because they proceed chiefly of hot humours namely of bloud and yellow choler therefore specially they require bleeding Whereupon Hippo. lib. 4. writeth De vict ratione in morbis acutis Aphoris 19. In acutis morbis sanguinem detrahes si vehemens morbus videatur florueritque aegrotanti aetâ—s viriuÌ„ affâ—er it robur In sharpe diseases withdraw bloud if the disease seeme vehement if the age of the patient be florishing and that the naturall forces be firme and strong Schola salerni hath these verses of this very matter Principio minnas in acutis perperacutis Aetatis mediae multum de sanguine tolle Sit puer at que senex tollet vterque parum Ver tollat duplum reliquum tempus tibi simplum In sicknes sharpe let blood with speed take much from men of middle age Not so when child or old men bleede the spring requires the aduantage As there is regard to bee had of generall times so there is also of perticular daies and times in the which diseases come speciallie in those diseases which haue by course an appointed and set time of intermission and remission For euacuation is not to be made when the disease is now fierce but when the same is asswaged Feuer sand especially those that are called intermittents discontinuing agues eueÌ„ naturally at the beginning and their first inuasion cause vomits and at the declining sweats At which times wee may by art prouoke these but in no case vse purging or bleeding In the time of the fit likewise wee must refraine from these as thinges which nature then can not brooke If such accidents of bleeding or of siege come they are but accidental and are caused only of the heat and force of the disease No euacuation can be done safely in such fits seeing they do too exceedingly hurt the powers of nature Also when the humours do so boile with heat that they are perturbed mingled together there can not be made by practise of art any iust diuision of the said humours And if it chaunce that the hurtful matter of the disease be inflamed without the greater veines that in a fit a veine be opened it is to be feared least preseÌ„tly the same corrupted matter passe into the empty veines so of an intermitting feuer wil come a continuall Wheras a veine opened in the most quiet time of a disease troubleth not nature but without any feare of an inflammation taketh the plenitude out of the greater veines The greatest time of quietnes is the time in the middle betweene the remission intermissioÌ„ of the disease If the time between the fits bee much it is an easy matter to perceiue the said middle time If the time bee but little then is it far more hard to discerne the same Because many times no leasure can bee graunted either before or after bleeding by reason of the swift courses of fits to nourish the party Thus you see Phlebotomy is not to be practised in the day of the fit of any sicknes which in Latine is called Crisis or dies Criticus in the which day neither bleeding nor any other euacuation is to be atteÌ„pted lest the matter should be drawen from that place wherevnto nature hath driuen it to be rid or dispatched thereof and therfore like wise neither in the fit it selfe ought the same to bee done Excellently therefore did Galen giue in charge Comment 29. lib. 2. Aphoris that in time of the fit neither bleeding nor purging ought to bee vsed because then the concoctioÌ„ of the disease is chiefly wrought Which is farre better accoÌ„plished in quietnes and rest then in motion or disturbance For what respect the state hath to the whole disease that comparison hath the â—itt to the daies of intermission As therefore in the state of a disease no euacuation is to bee vsed so neither in time of the fit Againe it may profitablie here bee admonished notwithstaÌ„ding the premisses that bleding is not presently to be vsed at the very beginning of a diseas wheÌ„ we iudge the Crisis or iudgement of the sicknes to bee yet far ofâ— For bloud beeing the foundation of inward heat wherwith the same is vpholden natural heat beeing ingendred of bloud as of a materiall cause If bloud should bee detracted at the beginning of a disease the natural heat would bee diminished which should concoct the materiall cause of the sicknes Whereby further it commeth to passe that the disease is longer time protracted and the forces of nature enfeebled through which two namely the continuance of the disease and imbecillitie of nature great feare of death commeth in the end and this is the case wherein Auicens former opinion may stand true There is therfore no prescribed day for certaine appointed to let bloud in Whereupon Galen tooke occasion to deride those lib. de curand ratio per sang missio cap. 12. which from the 2. houre of the day to the 5. or 6. houre onely did let bloud and at none other time And Galen witnesseth ofhimselfe that he did let bloud at all times without any daunger yea euen in the night And 9. method Cap. 5. hee affirmeth it best which hee also him selfe obscrued to mark not the number of the daies but onely the strength of the Patient because by experience wee haue prooued that not onely the sixt or seuenth daies but also in the daies following the sixt or seuenth a veine may bee opened But because as Galen witnesseth Libro de Curand ratio per sanguin missionem Capit. 20. in diuers diseases through continuance of time the strength of nature is greathe abated Therefore the occasion of letting of bloud is not omitted for the number of the daies but for that the naturall strength is wasted So that if the vertues of the bodie seem to be consumed the second day from the beginning of a disease euen then wee forbeare opening of a veine And he thertoo the wordes of Galen Now in diseases which are cured by bleeding when they are present or propelled being but future if they grant leisure so that a choice of an houre to bleede in May bee made in this case I say the fore noone houre is better then the after noone For from the rysing of the Sunne the bloud is quickened reuiued and beareth rule in the body yea in that time of the day it becommeth thin cleere apt to flow Let not the patient sleepe nor slumber in that houre wherin he is to bleed but at lest let him be awake a whole hour before see also that he haue
made in theÌ„ than in others When the veine is opened we oft also loose the band from the vpper partes that the bloud may runne the better If the bloud run sufficiently let it alone if but slowly that through fault of the incisioÌ„ amend it If throgh grosnes of the bloud or of any other cause let the patient bend his fist hard together or turne the staffe about in his hand or by coughing or lowd speaking let him enforce the sinewes Muskles sydes And if need so require bath the wound with warme water If he be fearefull or faint harted when he seeth the bloud that it be stayed through feare leaue off a while til the strength be recouered by such meanes as we shal declare anon Yea albeit the bloud flow reasonably wel yet it is good in the midst of bleeding to stop it with the finger both to recreat the strength that it be not too much wasted also that the filthie corrupt bloud may with the more speede come from the inmost partes so be expelled The quantitie of bloud passed forth is to be considered as wee shewed before 14 15 Chapters that it may be stayed in due time in this behalfe therof two regards are to be had especially First the necessitie of the disease Secondly the constancie firmenes of natural strength wherof looke in the foresaid places more at large After good bloud apeares bleed no more for feare of the crampe convulsion palsie dropsie such like In a simple plenitude to auoid imminent dangers it shal be sufficient only to abate the abundance albeit a mediocritie stil remain But in an vniuersal disease as is a feuer a mediocritie will not serue but bloud is abated more then so And in inflamations we are not only to regard the quantity but in like maner the alteratioÌ„ of the colour substance of bloud and when great paine or inflamation is in places neere the incision stay not the bloud before the paine begin to asswage or the colour of the bloud to change For alteration of colour sheweth that the same bloud vnlike the other that good is proceeded from the inflamed part If the humor cleaue fast to the member or that by euacuation the strength of nature bee wasted then wee are vrged to stay bleeding before the bloud doo chaunge in colour and to detract that which remaineth by reiterating Phlebotomy either the same day or the day after Hyppocrates 2. vict acuto 10. In the cure of the Pluresie writeth that in the cure of that disease the inner veyne of the arme is speedily to be opened and bloud plentifully to be withdrawen vntill the same appeare far redder than it did at the first or that for pure and red bloud the same appeare swart and blacke which both happen in Plurisies If the bloud were before rawe crude vndigested and that it come from the inflamed place neere an incision it becommeth redder or yeallower because this bloud is horter than that which went before If it were at the first thus coloured namely redde or yeallowish than when it commeth from a member inflamed it turneth to be black and swart thorough adustion and thus you see how to stop the fluxe of bloud by the quantity by the substance and by the colour of the same As wee are to consider the foresaide thinges in the bloud so are wee to consider strength in the Pacient Of defect of strength these are the signes The fluxe of bloud relenting paâ—e colour in the face gapings stretchings noise in the eares webs in the cies and defect of seeing All these shew a decay of the spirits oflife they shewe faintnes of the heart and that the bodily parts are forsaken of inward heate To these may bee added the hicket and a desire to vomit which commeth of fluxe of the humor to the mouth of the stomacke as were already shewed But the most certaine and assured marke is the alteration of the Pulse which changing from thicke to slow from great to little from strong to weake from equall to vnequall prognosticate defect of nature and a perturbation in the body not much vnlike Epilepsia that is the falling sickenes If these come through feare or of humors nipping the stomacke stay bleeding recreate and strengthen the Pacient a while that afterward the residue of the euacuation may be perfected The waies to recouer and fetch strength againe if the same giue ouer before a conuenient and commodious quantity of bloud may be taken are these to cast colde water on the face of the Pacient to sprinckle vppon the face white odoriferous wine to put to the nose of the same party vineger strong wine muske or other aromatick thinges if these helpe not wee must close vp the veyne a while with the finger and if neede be the euacuation is to be imparted or diuided But to auoide all these accidents the remedy is to let bloud the party lying in his bed for so the partes of the body are reduced into one equality of position whereby the principall parts mutually bestow one on an other inward heat and vitall spirits if the Patient bee not brought againe by the foresaide thinges then prouoke vomit by tickling in the throat or by pouring in a litle oile for the force of vomiting stirreth vp strength and draweth away weakenesse of the stomacke and heart and presently after recouery renue the strength of nature with wine iuce of Pomgranats broth of flesh with the receit called Diamoâ—cho and other cordiall things The instrument may bee annointed with oile or other such liquor that it may inflict the wound without paine and for the most part the wounde must bend somewhat aslaunt or crookedly The incision is made two waies as Hyppocrates saith one straight Secundum rectum or Edirecto downeright the other contrary crookedly or a swash In these two waies wee must vse great discretion to vse them as neede requireth and not deceiue our selues vsing the one when wee should the other as many are deceiued in these daies To shewe which of these is to bee preferred would require a long discourse whereof read at large Fuchsius in his Apologie against Brachelius There is newe kinde of instruments to let bloud withall nowe a daies as the Rapier Sword and long Dagger which bring the bloud letters sometime to the Gallowes because they strike too deepe These instruments are the Ruffians weapons more malitious than manly But in this practise the veyne must be opened with a fine Launcet no fleme with a beard like a bloud-iron wherewith Smiths let horses bloud for they will sometime cut a veyn thorough on both sides causing a crampe and deadly convulsion And here I giue aduise that no Surgion except he be very skilfull himselfe open any veyne without the counsaile of the learned Phisition or the iudgement of some others that haue auncient and tried experience in the practise Ignorant Barbers doo great hurt herein
taking that which comes to hand first or which appeareth greatest perhaps a sinew for a veyne so letting out the vitall spirits and killing many and when it is done this is all their defence to say the signe was there and he would needs be let bloud Vnction or annointing is oft vsed in this practise sometime we rub the member whose veyne is to be taken with oile that thorough the warmth thereof bloud may bee made the more flowing sometime the instrument is annointed as was saide before to mittigate the paine of the inflicted wound Sometime the wound it selfe is annointed that it may bee the longer time before it bee couered with the Scarre and that the humors left behinde may with the more liberty breath foorth and that the ill humors remaining may bee also the better dispersed Drinke and especially wine may bee very well taken both in the bleeding if Syncope happen and after bleeding to cause good bloud and to recouer againe the vitall spirits Bathing two or three daies before is vsed in some causes as was declared in the former chapter but not the selfe same day The common opinion is that bleeding must be done fasting and vppon an empty stomacke but this is not approoued of the best writers for many of them giue aduise to eate before bleeding a soft or poched egge with a draught of wine about nine or ten of the clocke â—n the forenoone and then presently to open a veyne For nature the stomacke being empty and being altogether destitute of nourishment doth mightily holdfast and retaine the bloud whereas when a little nourishment is taken in small quantitie as is a poched egge a draught of wine shee permitteth the bloud easily to passeforth It hath bin declared before Chapter 16. that if necessitie vrge there is no prescribed time of bleeding but that if the disease require the same may be done at all times yea euen in the night Yet the forenoone of the day is the most vsuall time There is an houre of necessitie which is any houre in the day or night and beside this hora necessitatis there is hora commodiâ—atis which is the morning or forenoone houre viz. Galen de Curan râ—tio per sang missio cap. 13. 20. in praesagio experientia Comprobatâ— cap. 4. Aetium lib. 3. cap. 16. Oribasi lib. 1. cap. 11. Moreouer if a veine opened send forth bloud whitish in coloure stay the same for it appeareth that the humours in the bodie are rawe colde and vndigested through defect of naturall and digesting heate This is affirmed by Aristotle lib. 1. 9. de animalibus and Hippocra witnesseth that alwaies womens termes appeare not in their proper colour that by reason of frigiditie and coldnes of white bloud they oftentimesvomit and haue fluxe of tearmes Finally as in purging so in bleeding as wee haue already said wee are to consider the standing of the wind in winter to bleed wheÌ„ the same is Sowtherly in Sommer when the same is Northerly For the North wind with cold tempereth the heat of the time The verses of Schola salerni Hac facienda tibi quando vis Phlebotomari Vel quando minuas fueris vel quaÌ„do minutus Vnctio siue lauacrum potus fascia motus Debent non fragili tibi singula mente teneri Before and after letting bloud all these are meete and requisite Vnguent a bath strong drinke and good with motion mean and bonds most fit Remember all doo none forgit A prescription or regiment of the patient after bleeding Chap. 20. WHen a sufficient quantity of bloud is withdrawen proportionable vnto the greatnes of the disease vnloose the bond and drie the wound lest beeing moistened with clodded bloud either it growe not together againe or bring some doubt of impostumation These thinges not done accordingly enforceth vs sometime the eight day after to open the wound againe If any piece of fat come forth the same must not be cut off but softly put againe into the wound When the wound is wiped cleane drie close vp the veine with linnen dipt in rose water or sweete water or with Oile if wee purpose to bleede againe Let the same bee tyed on with bondes not tooâ—hard for writhing the skinne or lippes of the wound If a sinew or Tendon be pricked yee heard in the chapter before what is to be done If there be doubt of fluxe of bloud or an inflammation through pricking of a sinew we may beside the premisses apply after the practise of others a plaster of Ceruse and in compas about that a Cataplasme of Housleeke Nightshade Plantaine and other cold things After bleeding lye a while on the backe for quietnes sake and to recreate the strength of nature and to recouer the vitall spirits He must not frequent his accustomed affaires nor moue his bodie hastely nor exercise himselfe immoderatly neither must he vse Venus delightes nor yet bath himselfe For the bloud and spirits naturall vitall and animall which haue of late bin vehemently stirred by bleeding are now by rest againe to be setled else the same bloud and spirites would by these outward vehement exercises bee inflamed and so wast and consume away Neither must the party presently sleep lest either the languishing heat be quite extinguished or the lessened spirits altogether ouerwhelmed Let him therefore watch and rest void of contention either in mind or in body When an houre or two is past after bleeding a litle meate may bee giuen him Little I say in quantity but of good iuice to nourish the bodie and profitable also to withstand the present disease when 2. hours are past this short repast he may then sleepe so as his keepers carefully take heed that he tumble and turne not himselfe on the arme that hath bled or that the bond by tumbling and tossing be not remooued which may cause the bloud to slow againe a fresh or some other displeasure to fall out Afterward the diet must bee increased by little and little both in respect of the quantity and of the goodnes of the meat Neither as yet must we hasten to a full diet for the heat of nature being abated by bleeding can not as yet receiue or digest aboundance of meat And againe the veines lately emptied would exhaust out of much aboundance of meat much raw and vndigested matter wherwith the whole bodie is stuffed againe If concoction bee perfected and accomplished so that we may eate great quantity of meat yet vse a moderation for to what purpose is it presently againe to stuffe the bodye with iuices and humours for the abating and taking away wherof we did so lately let bloud Therefore after bleeding the patient is to liue more finely and exquisitly and not to goe to his old intemperat diet againe as the dog to his vomit Neither are these intemperat persons meete men to be let bloud as we prooued and shewed before in the 8. Cap. Fig. 1. Of
reiterating bleeding which they call Epaphaeresis this is the order First in inflamations great paine hot feuers caused of aboundance of hot bloud a veine must be opened as is alreadie shewed euen presently at the very beginning before the matter be gone to som principal member not only that the aboundance and excessiue quantity of bloud but that much more a great deale euen plentifully and generally may be euacuated yea euen till the patient giue ouer if the strenght of the body so permitte And in diseases caused of fulnes the bodily powers are firme for the mostpart neither doo they shrinke or relent much by this plentifull bleeding And when Hippo. permitted bleeding so long till the patient should giue ouer hee ment it so when the strength therevnto sufficient was able to beare it and not otherwise For if fainting doo happen wheÌ„ the powers of nature are firme and constant it doth only wast the spirits in the arteries those forces remaine still vnhurt and vndamnified which narure hath bred in the hart Liuer or braine And albeit these decay in Lypothimia yet of the setled forces other like presently come in place whereby againe the Patient is reuiued But when the strengh of the bodie is weake and greatly enfeebled because the forces of nature setled and seated in the principall members are also impaired If Lypothimia then chaunce reâ—â—itution wil hardly be made Therefore I say the vertues of nature beeing greatly debilitated beware of ouer comming or fainting And this is the order in great and vrgent sicknesses In small generall diseases as in repletions fulnes feuers and such like whose cause and principall matter is conteined in the veines if bodily strength permit we must presently euacuat wholly at the beginning at one time not till the patient ouercome but so much as is needefull and as the infirmitie or malady requireth And this euacuation without any hurt to the naturall forces withdraweth the matter abounding either before the same do wholly putrify or that it posâ—esâ—e some notable member or before any horrible accidents happen He that for feare or any other cause parteth or diuideth in these the euacuation he continueth the disease long time doth no good but great hurt to the sicke patient But if for imbecillity of strength the whole euacuation can not be accomplished or done seeing it is better in this case to marke the strength of the party then the vehemencie of the disease we are inforced to vse partition in the bleeding and yet with a great circumspection and care and let the partition be within a litle distance of time either by vndooing or vnloosiug of the bound or stay the blod with applying the finger on the wound so long as by the foresaid meanes the forces of the body may bee recouered Sometime an hours space is sufficient sometime more houres â—re required to the restoring of the forces of nature The best way is not to deferre the partition of bleeding past one day yet I say if strength permit that partition must be vsed bleede twise in the selfe same day in general diseases especially except other impedâ—mâ—ts greatly let euacuacuat in one day asmuch as is expedieÌ„t before the matter come to putrffaction or that other euils do grow But in partiall diseases of particular meÌ„bers chiefly in inflammations the parted or diuided euacuation may be put off a longer time either to the day following or to the day after to morrow that in this space the corrupted humours may goe from the member diseased into the veins exhausted and so by the next incision be euacuated The member of the bodie that is afflicted with griefe or corruption by little and little euen in one day or two daies at the most sendeth downe the humours to the place where the incision was And for asmuch as they are corrupted they are not there to remaine albeit the former paines be mittigated and asswaged But if the inflammation bee pestilent and venomous as is a pestilent botch or carbuncle the euacuation of necessitie must be reiterated euen the selfe same day lest the pestilent infection sticke and stay any long time in the veines to the great hurt of the partie But neither must reiterating of bleeding be vsed For thereby the vitall spirites and in ward heate is diminished and vntimely age is hastened on apace and the same when it commeth is made subiect to greeuous diseases as Chachexia the dropsie gout in the iointes trembling palsies and apoplexies Yea when the naturall heat is immoderatly cooled and naturall moysture wasted the bowels languish crudity and vndigestion beginneth to beare rule whereby are caused great and greeuous euils in the body of man And thus much of the reiterating of bleeding and order thereof But let vs come againe to our former matter of prescription moderat motion easy walking as it was conuement before bleeding to vnloose and make the humours thinne so also the same is necessarie after bleeding to disperse abroad the reliques of those vapors and humours which are left behinde And as bondes of linnen were vsed before bleeding to the intent the veines might waxe bigge appeare full and bee the better perceiued and seene and that the humour with the more facilitie might come to the place appointed for incision so afterward they are also needfull to stay the fluxe of bloud and bind vp the wound It was already said that the partie let bloud must not sleepe that is to say not within the space of eight or sixe houres at the least whereof this is alleaged as a reason that the fumes caused by sleepe bee not carried vp to the head and so offend the braine There may hereof bee aleaged other caused more as namely lest the veine opened should take hurt by tossing of the patient vp and downe in his sleepe which cause was lately aboue specifyed Also lest in sleepe the humors should flow to the member where the incision was made and there apostumat For pained places as Galen affiâ—meth Capit. 95. medicinatiâ— artis lib. de Curand ratio per sang missionem Capit. 7. are by nature accustomed to receiue fluxes and chiefly in sleepe Auicen alleageth this reason Because by sleepe after bleeding for the most part there chaunceth in the members a confraction or bâ—using For while the member is tossed hether and thether with inordinat and vnorderly motion the bondes are vnloosed the wound vnhealed and as it were newly opened notwithstanding the late incision it doth afresh sende foorth immoderat fluxe of bloud the partie in his sleepe not witting thereof whereby as all men know the life commeth into great danger Againe another discommodity by sleeping immediatly after bleeding is that fumous excrementes through sleepe are againe inwardly reuoked to the principall members Againe the vitall spirits and natural heat which by opening of a veine are drawen to the outward partes and members by sleepe are reuoked to the center or middes of the bodie
precordiall partes and the hart it selfe in whose opening no daunger is to bee feared onely with warme water as yee heard we must both subtiliat and make thinne the bloud cause the small veine the better to appeare in sight Although as yee heard in Saluatella that this name Axillaris of some writers bee giuen to the veine Saluatella And that the veine called Sceilen of the Arabians is also of some called Vena Axillaris yet in truth we following the most approued authors take here Axillaris to be a braunch of Basilica that it appeareth in the bending of the arme downwards for Phisicke helpes is iudged to remedy those diseases which are cured by opening of Basilica Funis brachii is like Cephalica is a branch of Cephalica descending and the iudgement thereof in phisicke helps is as the iudgement of Cephalica aforesaid Arteries as in whom is the greatest danger they are placed of nature far more inwardly the veines are more outward to keepe the body from dangerous hurts Of Arteries wee purpose anone to speake in a distinct chapter now here wee are yet to proceed further to more particular veines Item there are two veines in the hinder part of the head good to bee opened against the frenâ—y swimminges in the head astonishment and other passions of the head Item there are 2. veins of the temples of the head which are opened in the cure of Hemicrani or the mygraÌ„ in great contintal head-ach in distillations of humours to the eies in impediment of sight in diseases of the cars Item in the middes of the forehead betweene the two browes is a veine whose incision profiteth in heauines of the head specially the hinder part of the head for infirmities in â—he face as rednes morphues itch scabs and in affectes of the eies Cephalica first beeing opened Item a veine in the higher part of the forehead is opened in all diseasâ—s of the head and braine speciallie if they bee of long continuance also it cureth the new begun leprie Item in the nose is a veine in whose incision you must tye the necke with a napkin vntill the partes of the head swell and the veine appeare this must also be done when the veine in the forehead is opened This veine in the tip of the Nose is opened against apostumations of the head rewmes and fluxes of the Eies it purgeth the braine and comforteth memory This veine must bee sought for very suerly and wisely for it lyeth deepe and therefore he that will be sure of it must find it euen in the very mids betweene the 2. sides of the nose end The 2. veins within the nosthrils are opened against heauines of the head Item there are veines between the lâ—ppes gums which are opened in apostumatioÌ„s of the mouth gums Cephalica being first opened IteÌ„ ther are veins vnder the toung opened in diuers affects chieflie in Angina the Cephalicâ— being first opened there are â— of them in number they are also opened in fluxes of the head palsies squinances or quinsees scroplules apoplexies coughs pains of the mouth â—eeth and gums impediments of speech generally in all diseases of the brest hart lunges and arteries Item there are 2. veines within the mouth which be opened in diseases of the head tooth-ach paines of the iawes mouth and throat also against freckles of the face IteÌ„ there are 4. veines in the roofe or pallate of the mouth which are opened in tothaches reumes catarres of the head flowing to the teeth causing the tothach these veins are manifest enough IohaÌ„ de Sancto Amardo an old practisioner setteth downe a cure that hee dâ—d on a woman grieued with tothach First â— vsed percussiues to stay the rewme and it did no good theÌ„ things mitigatiue they did as little theÌ„ maturatiues nether did they any good Then I let her bloud in Cephalica first and opened saith he these â—oure veines when the matter of the fluxe was digested and so shee was cured but if the matter be not digested the opening of these helpeth not Item there are câ—rtâ—i â—e veines in the watrie angles of the eies toward the brow which are opened in passions of the eyes paines of the head Opthalmia that hath long continued and in watâ—ie distiâ—lations of the eyes the Cephalica first opened Item hereby are cured webs spots clouds mistes pearle rednes cornes such other infirmities of the eyes with weakenes of sight Item there are two veines in the concauities hollownes of the eares which being opened heale shaking of the head swimming of the eies disâ—ines pypings sounding in the eares vncleannes of the mouth a new begun deafnes Item there are two veines behind the eares which are opened to preserue memorie to clense the fâ—ce to take away the rewme disâ—â—llations from the head generally in all deseases of the mouth gummes Item in the temples neare the eares are veines opened in the diseases called Vertigo the Migram and in great continual paines of the head This incision maketh a man barren as Hipp. affirmeth lib. de Genitura in lib. de aere aquis locis in these words Quibusdam iuxta aures venae sectae sunt Hiâ— cocunt quidem geâ—ituram emitâ—unt verum mancaÌ„ debilem infaeâ—undam Some haue certeiâ—e veines cut not far from their eares wâ—icâ— do the act of generation giue forth seede but the same is vnperfect weake barren Neither is this coÌ„trarie to reason for most of the seedie moysture descendeth from the head into the marrow of the back Hippo. also afâ—irmeth that the noble men of Scythia by incision nigh their eares become vnfrutfull These veines Auicen called Iuueniles Item there is a veine between the chin the neithet lip which is opened in a stinking breth Item there is a veine lying right vnderneath the chin which is opened also against a stinking breath also in diseases of the head brest Polipus in the nose paines in the cheekes stinking of the nosthriâ—s spots about the face Item there are two veines in the neck one before another behinde that are opened in a plurisie in a new begun leprosie shaking of the members humors and distillations from the head too much stifnes oflimmes The Greâ—ians call these veines Sphagitidas the Latines Iugulares they are veines of the throat The Arabians cal them Guidez the barbarous Phisicions call them Subeticae wee may call them Venae apoplecticae or the sleepie veines because being wrung hard or pressed down they bring an heauie sleepe and a certeine drousines like the disease called Apoplexia To speake plaine English these veines of the necke or throat being hard tyed bring Iudas disease i. verie hanging These are opened I say in the beginning of leprosie when the breath is verie short in the beginning of Angina in the disease called Asthma in horcenes of voice in apostumation of the lungs in Dyspnaea i.
THE ENGLISH Phlebotomy Or Method and way of healing by letting of blood Very profitable in this spring time for the preseruatiue intention and most needful al the whole yeare beside for the curatiue intention of Phisick Collected out of good approued authors at times of leasure from his other studies and compiled in that order that it is By N. G. Prouer. 30. vers 15. The horse-leach hath two Daughters which crye giue giue Prouer. 27. vers 9. Balme and sweete incense make the heart mery so sweete is that friend that giueth counsell from the heart ¶ Imprinted at London for Andrew Mansell and are to be solde at his shop in the Royall Exchange 1592. To the right Worshipfull Master Reginald Scot Esqure dayly increase of wealth Worship and wisedom in the true feare of GOD. THIS pleasaunt and profitable practise of blood letting Right Worshipful Sir hath always and that worthely been accompted and called of the auncient and latter Phisitions Vnum è maioribus remedijs one of the greater remedies in the Arte of healing not as I take it for that the same is of gretest charge to the patient his purse a veine being commonly opened for twelue pence but because if the same be done with skill according to Arte it bringeth great profit to health without any great diminishing of wealth How this so great a remedy in both the inteÌ„tions of Phisick Preseruatiue and Curatiue is greatly abused by vagabuÌ„d Horse-leaches trauailing Tinkers who find work almost in euery village through whose wickednes hauing in truth neither learning knowledge witre nor honesty the sober practisioner and cunning Chirurgian liueth basely is despised and accounted a very abiect among the vulgar sorte The whole world with wofull weepings too too plentifully can witnesse and many godly and faythful Christians here and else where with pinching paines and griping griefs euen to the last gaspe haue pitifully felt For these kinde of men are so farre off from repayrers of mennes bodies as they would seeme to bee that they are rather marrers and manglers of men women and children without all care to men whome they ought to tender foster and cherish without all conscience to God to whom they must one day render a reckoning of this their desperate and diuelish dealing No man brought vp among Christian meÌ„ of any practise or calling but hath long sithence learned this lesson how frayle infirme and weake soeuer our mortal bodies are yet it hath pleased God to call them his owne temples his owne instruments and his owne dwelling places an vnspeakable dignitie farre aboue that for which Alexander Magnus so contended when hee would needs bee called the sonne of Iupiter Paul to the Thessalonians willing vs to keepe our vessels viz. our bodies in holynesse and honour suggesteth vnto vs these two poynts first the fragilitie and mortality of our earthly bodyes comparing them to vessels of earth and pots of clay which break with a blow perish with a knock secondly that yet they are not our owne bodyes to vse as wee list to sensuality like bruite beasts but to keepe them carefully as vessels which the Lord hath clensed and washed with his owne blood to his owne glory in all holynes and honour The Priests of Baal cutting and launsing their owne bodies with a vayne and wâ—cked supposal that in so doing they pleased God grieuously sinned as diuers affirme both agaynst nature and godlines against nature because no man euer yet hated his owne flesh but nourisheth and cherisheth it as the Lord doth the Church against godlines because works of pietie and religion in our selues or in others they either quite surcease or are greatly hindered when the bodies of men are decaied in streÌ„gth weakned in vigor languished with sicknes or finally destroyed by death To let passe these things which diuers deliuer out of their pulpits of the excellencie and dignitie of mans body haue not the Philosophers in the schooles called the same Microcosmos Orbiculus a little world most beautiful in forme fayrest in shape excelling farre all other liuing creatures whome the creator hath made In whose braine as in primo mobili is fixed that inesteemable Iewel called Reason no monster or Idole but the mother of all Artes Sciences by whome God guiding the same are wrought inuented marueilous matters by Sea and by land in euery matter of speculation or practise This I haue hitherto discoursed to this drift that those blinde bussards runagate Artists might at length see and consider that they are no way willed or waraÌ„ted like butchers to cut rend and teare the bodies of men without skil either in letting blod or any other practise of Chirurgi but like brethren to cure repayr and amend that which is amisse refusing no paine taking for their own parts nor reiecting due consultation with men experienced that so the noble Science of healing may be generally honored the diseased recouered the skilful workman worthily in fine rewarded To met with this mischief acording to my Mediocritie and that such as are desirous of this practise either for pleasure or profite might be somwhat fraughted with a few pithy instructions and necessary rules in the same and so at length attaine to the most exquisite cunning deep knowledge therof I haue thought it good not onely to publish this my rude collection conteining if I be not deceiued the whole handiwork of Phlebotomy but also to counteruaile my default as rudely yet most huÌ„bly to request your worships fauour for the protection thereof But for as much as Seneca that christian Ethnicke for so dooth Erasmus terme him for his profound wisedome deepe indgement willeth vs in bestowing of any gift to be careful that it be fit for the estate of the giuer and also meete for the condition of the receiuer least in stead of expected thanks disgrace may growe and what the giuer meaneth of good will may perhaps by the receiuer either limping in iudgmeÌ„t or freezing in delight be little regarded lesse countenaunced I am in a worde or two to shew that for my part I haue not as I thinke much swarued from the sound aduise of the Philosopher in making your worship patron of my poore seely paines First for that euen your selfe haue already in print in your booke called The discouery of VVitchcraft openly biterly enueighed against one sort of blood thirsty men as I doo nowe against another sorte namely witchmongers who are daily and hourely without iust cause conuenting before Magistrates and haling to the halter if the Magistrates dexterity in the administration of iustice did not moderate their malice in murthering poore plaine seely and simple innocents and olde women whom by friuolous euidences incredible proofes vayn ghesses preiudicate presumptions meere impossibilityes they would haue condemned and executed for witches These men in mine opinion should farre better please God and much better deserue of the Christian coÌ„mon wealth if they
That he onely worketh miracles That he onelie maketh thunder lightning and tempest and restraineth thē at his pleasure That he onely sendeth life death sicknes health wealth woe c. And as he is most wrongfullie wickedly adiudged a Papist who detecteth the abomination of their Idolatries their pestilēt practises of knauerie cousonage their absurdities in opinion and impurities of life al which much more then I here now speake of or can call to memorie are extāt in print so in the sight of the whole world if men would not be wilfully blinded so by this little labour beside the exercises of my peculiar profession it may euidently appeare what loue liking I haue alwaies borne to good godlie and profitable studies and how I loath loytering and so consequentlie lust which is an vnseparable companion of Idlenes slouth how I haue rather passed as I hope with commendation from Paul his Epistles to Galen de Sanitate tuenda for publike profit than to Ouid his de Arte Amandi with condemnation for my priuate pleasure Good Sir as you haue been hitherto euē as I may saie zealous for my preferment and likewise iealous ouer my credit an assured testimony of your true loue toward me so I beseech you take in good worth at my hands this poore gift which I offer of pure good will which if I once perceiue that you do I shal think my trauail sufficientlie recompensed and my selfe enforced during life to the accomplishment of your good pleasure so far forth as my tenuitie shall be able anie waie to extend Your Worships vnfayned welwiller to command in what I may Nicholas Gyer minister of the word The English PHLEBOTOMY OR Methode and way of healing by letting of bloud Of fulnesse emptinesse and their diuisions Chap. 1. THat this treatise of bloud-letting may haue an orderly proceeding we must begin with Fulnesse Emptinesse which haue betweene them selues a mutuall relation Abundance or fulnes therfore is called of the Grecians Pleonexia and after Galen in his booke De plenitudine it is two fold One fulnesse is in qualitie as namely when the bare qualitie exceedeth without Humor The other is of quantitie as aboundance of meat or of Humors Aboundance of meat is called of the Grecians Plesmone of the Latines Sacietas wher we are to note that some interpreters translate verie ill for Plesmone repletio as in the second of the Aphorismes Aphoris 22. Quicunque morbi ex repletione fiunt curat euacuatio when it should be thus conuerted Quicunque morbi ex satiaetate fiunt c. All those diseases that come of fulnes euacuation doth cure Abundance of meat called of the Latines Satietas is also two-fold according to Galen in his 2. booke of Aphorisines Comen 17. One according to the great largenes or capacitie of the veines or vessels called of the Latines quo ad vasa as when such abundance of meat is receiued as thereby the stomacke is ouerstretched the other abundance is according to natures strength called quo ad vires as when more meate is eaten then natures force can well ouercome Abundance of humors is also of two sorts One of all the humors called in Greeke Plethos or plethora in Latine plenitudo or multitudo whereof Galen writeth in his 13. booke Metho cap. 6. Vbiautem aequaliter inter sesucci ad aucti sunt idem plethos plethoram Graecivocant nos succerum plenitudinem seu redundantiam dicimus VVhen as the humors are equally increased betweene themselues that the Grecians cal plethos or plethora we call it abundance of humors Now whereas Galen saith in his 2. booke de Composi Medic. secundum locos cap. 1. That to be abundance of humors when onely bloud is increased wee are to vnderstand that bloud there signifieth impure bloud such as is mixt with other humors called bloud of that which principaly there aboundeth For it can not be that only pure good bloud should be conteined in the veines without sommixture of choller flewme or Melancholie which must be so likewise vnderstood where it is saide that any other humor aboundeth the same is not pure alone without mixture of othets but that humor ioyned with others aboundeth in the vessels The second abundance of humors is called in Greeke Cacochymia in Latine Vitium succi or vitiosus succus and it is when one humor alone aboundeth Hereof also Galen speaketh 13. Meth. cap. 6. Vbi flaua bile nigra vel pituita vel serosis humoribus repletū corpus fuerit Cacochymia i. succorum vitiū dicimus VVhen the bodie is replete with yellow or black choler with flewme or watrish humors we cal it Cacochymia i. corruption of humors And in the end of his booke de Plenitudine he saith Plenitudo est copia humorū in vniuerso animalis corpore Fulnes is abundance of humors in the whole bodie a little after he plainly sheweth the differēce between Cacochymia Plethora Plenitude or fulnesse of humors is also two-fold one in regard of natures strength called Quo ad vires or virtutem which is when the humors so abounde that they oppresse and much grieue the naturall forces of the body And although there be not such aboundance of bloud in this fulnes quae ad vires as is in the other quo ad vasa yet those humors which are in the body oppresse the powers of nature whereupon nature being oppressed and not able to gouerne those humors they being as it were forsaken of nature lose their goodnes and offorce putrifie And of this fulnesse these are the signes heauines stretchings a sensible werines hauing a feeling like an vlcer of which Galen sayeth 2. Aphoris Aphoris 5. Spontaneae lassitudines morbos praenunciant Voluntarie wearines forsheweth diseases The second fulnes of humors called Quae ad vasa is when there is such aboundance of humors or of bloud that the veines and vessels are greatly extended or stretched so that it is to be feared least the veines themselues breake And therefore Hippo in the firste booke of Aphorisines Aphoris 3. woulde haue in wrestlers this dangerous fulnes speedily euacuated that the bodie might begin againe to be nourished And this plenitude quae ad vasa is either of pure bloud only or of all humors with the bloud And this fulnesse hath these markes rednesse of color swelling veines full stretched Of these two Plenitudes and their signes speaketh Galen in his booke De Plenitudine reckoning vp these markes swelling and stretching of the veines rednesse lumpishnes of the bodie a slouthfulnesse in motion of the bodily members Also Method 9. Cap. 5. He reckoneth these signes of repletion quo ad vasa obstructions stretchings swelling rednesse Of this twofold read Auicen Secunda primi doct tertia cap. 3. Also Galen in his booke De Plenitu Metho 9. Cap. 5. 10. lib. eiusdem Cap. vltimo Because these pointes taken out of the bookes of
in the body these three spirits humors and excrements The excrements are the ordure or reffuse of the belly vrine and superfluous humors sent from the braine and the lungs Humors some are superfluous some necessary properly called succi 1. iuces Humors superfluous separated from the bloud by natures force and as vnprofitable for the nutriment of the body are sent a farre off As flegme inhereth in the maw stomacke and about the entrailes yeallow choler in his proper coffer namely the gall Melancholy in the Spleene The iuces are conuerted into the substance of the body nourishing the same Of this kind are those iuces whereof the bloud is compact those otherwise called secundarii humores Nowe each of these are sometime agreeable to nature sometime repugnant to nature They are agreeable to nature when they retaine the right quality and quantity according to the law of nature for conseruation of health They are repugnant to nature when they keepe measure neither in quality nor quantity And therefore whatsoeuer of these manifestly departeth from the iust meane and measure which nature hath appointed because it is the cause of sickenes if otherwise it cannot be amended it is altogether to be taken away and expelled the expulsion whereof is called Euacuation The differences of Euacuations are to bee taken of the scituation of the contents and corruptions which are either Plethora or Cachochymia as was shewed in the Chapter precedent The meats and drinkes receiued into the body if the stomacke and liuer doo their naturall Office bee altered by concoction in such wise that the best part thereof goeth to the nutriment of the bodie the worst being separated by the members Officiall from the residue are made excrementes in sundry formes and substances which excrementes are like in quality to the naturall Humor which then raigneth most in the body These excrements are none other as was saidâ— but matter superfluous and vnsauory which by the powers of nature may not be conuerted into flesh but remaining in the body corrupt the members and therefore nature abhorring them desireth to haue them expelled These excrements are in number three Ordure Vrine Humor superfluous Of Ordure are two sortes one digested which passeth by siege the other vndigested expelled by vomit VVhere I say digested I meane that it is passed the stomack turned into another figure Likewise I call that vndigested which sâ—il retaineth the figure of meat Vrine is the watry substance of bloud like as whey is of the mâ—ke which out of the meate that is altred concoct or boyled in the stomacke is streyned in the veynes called Mesacaicae which proceedeth from the hollow part of the Lyuer and sent by the Raines into the Bladder passeth by the Instrument which is ordained as well for that purpose as for generation Humor superfluous is of three sorts either mixt with any of the foure Humors called naturall or else it is gathered into the braine or is betweene the skinne and the flesh or lyeth among the Synewes Muscles or Ioynts Of Humors some are more grosse and cold some are subtle and hot and are called Vapors Now to expell these excrements there are nine sundry kindes of Euacuations Letting of bloud pargation by siege abstinence vomiting scâ—rrifieng or cupping sweat vrine spytting sternutation bleeding at the nose bleeding by the Hemmorroids exercise and in women there naturall purgations But in this Treatise I will onely handle that Euacuation which is done by opening of a veyne by Cupping-glasses and by Leaches shewing the commodities which by the discrete vsing of these come vnto the body of man And that the way of Euacuation may bee the more easie wee may deuide the body of man into three general Regions which being inclosed in their proper limits haue not onely diuers receptories of superfluities but also diuers waies to purge the same One and the first Region is extended from the meat pipe called Gula to the middle part of the Liuer wherein are contained the maw the stomacke the venies Mesecaicae as many as come to the entrance the hollow or inner part of the Liuer the Spleene and Pancreas that is a thing betweene flesh and kernel lying betweene the stomacke and the Liuer The 2. Region runneth from the middle of the Liuer through the thin small veines of all and singuler partes comprehending the outward part of the liuer and euery hollowe veine and the greater artery placed by it and vvhatsoeuer is betweene the Armehole and the flanks The 3. Region comprehendeth the muscles the vppermost skinnes the bones and the whole masse of the body which extendeth from the very entrance and lesser veines through euery part and the outmost skinne it selfe Great is the diuersity of these Regions for so much as they are so inclosed within their owne limits that there is betvveene them no fellowship at all But the greatest diuersity is in their owne proper operations hauing concoctions excrements and waies of purging diuers one from the other By obseruation and marking whereof vve shall the better proceede in Euacuation Beside these generall and vniuersall Regions of the body there are some more speciall and particular hauing also excrements yet not retching so far nor following through the whole body of which sort are the braines lungs raines and belly Hereof are deriued tvvo differences of Euacuations one generall the other particular That is a generall Euacuation which draweth matter vniuersally from the vvhole body Of this sort are Svveate Bleeding Vomits Euacuation by siege Each of these thogh specially for the most part they euacuate one RegioÌ„ or part of the body Yet these also empty other partes though not so abundantly As vomit first and chiefly euacuateth the stomacke if it continue long it purgeth also the bovvels and the greater veines last of all the state of the whole body Euacuation by siege or purging chiefly and most of all purgeth the entrailes stomacke bowels and the first veines then the greater veines Last of all the small veines and the state of the vvhole body Opening a vaine first exhauseth the veines and arteries ioyned vnto them then the body and all the bovvels euen til it proceede to the first veins Euacuation by svveat called in Latine perspicatio or dissipat io per cutem First dissolueth from the habite or state of the body Secondly from the greater veines and arteries Lastly from the bowels and inwarde Region of the body Particuler Euacuation doth onely alleuiate some particuler part loden vvith Excrements Of vvhich sort are purging of the braine through the palate and nosthrils spitting of fleame vvhereby diseases of the brest and lungs are eased Pissing forth of sand and matter from the raines Passage of bloud by the belly or Hemmorroids the one cleansing first the lower part of the body called Podex the other the belly and both of them the hollow veyne called Vena caua VVhen the wombe therefore is prouoked either with a Clister or a Suppository
VVe are here to set downe from what place the evacuation is made for inasmuch as bloud is moyst and flowing that first issueth forth which is next the opened veine then that which is next the same thirdly commeth foorth not onely that which is in the veines and arteries but also that which is in the bowels and whole habite of the body For there is a wonderfull continuation and order of the veines so that a way being once made all the bloud often times floweth out of the bodie and bringeth death to the partie But when the passage is stayed then the bloud is sent foorth by the veines arteries till there be a certain proportion in the whole bodie For the emptied and wanting partes by the long small veines draw bloud forth of the full partes repleated members and so â—â—â—â—or them as it were in their need Againe the full members grieued with too much aboundance vnburthen them-selues on the veines that are emptied Againe the humor being liquide and flowing voluntarily followeth the lower euacuated regions and there continueth whereupon it followeth that whensoeuer bloudletting shall emptie the veines the same also shall euacuat the whole bodie In regard whereof Phlebotomy in the definition thereof is called verie well an vniuersall euacuation and that for two causes First because it withdraweth all humors whereof the bloud consisteth Secondly because it euacuateth from the whole bodie but yet not in like sort Forasmuch as the partes of mans bodie are placed in their order therefore first it exhauseth from the neere partes then from those that are further off And againe forasmuch as some veines are spred into some partes of the bodie and other into other partes therefore bleeding with more celeritie and force draweth from those partes which are rightly and directly placed then from those members which are opposite or ouerthwart Whether Phlebotomie must go before purging or contrarie Chap. 4. IN this place it is a necessarie question to be moued and aunswered whether bleeding or purging must go first in this case which is verie frequent where they are both requisite Some will alwaies haue that when purging is necessarie bleeding must go beforeâ— and they bring out the authorities of Hippocrates and Galen Others contrarily affirme that alwaies some extenuating or lessening receit called barbarously Medicamentum minoratiuum must be first receiued and them Phlebotomie succeede But of these opinions neither is simply true and yet both true as the case may be limitted And for the cases wherein a gentle purgatiue is to proceedâ— Phlebotomie they are in number these sixe First when the stomacke the Mesecaicae veines the great veines the waies passages of the bodie or any of these be stuffed with filth or incombred with crudities or that the excrements are hardened in the bowels although the whole bodie abound with bloud beside yet a gentle easie receit is to be taken as Manna Cassia or a clister but no violent receit which may euacuate from the foresaid veines open the obstructed passages If the bloud should first be drawen forth without some gentle purgation or euacuation in the greater veines then the veines outwardly exhausted by bleeding through their attractiue vertue would drawe vnto them ill iuces specially if the disease require any plentiful bleeding This is affirmed by Auicen Galen 9. Metho cap. 5. who did vse to refraine from Phlebotomie if there were cruditie of meat in the stomake or rawnes in the veines called Mesecaicae til their concoctioÌ„ wer ended the excremeÌ„ts descended Secondly when the bloud is verie viscous clammie grosse we do not only take medicines attenuating but also lessening things a dyet conuenient to prepare bloud and to make the meÌ„ber bleed the better vse a bath for oft it commeth to passe that a veine being opened no bloud issueth forth because of the thicknes clamminesse thereof Thirdly it faleth out in many cholerike bodies that choller contained in the vpper parte of the stomacke is easily moued so boileth causing Lipothymia i. ouercoming in which case it behoueth to vse before some Minoratiue receit also in bleeding to vse somewhat to keepe backe the boiling of choller Fourthly in diseases wherein appeareth a difficultie by reason of Cacochymia or abundance of other humors mixt with the bloud When a practisioner perceiueth that he must vse Phlebotomie yet with some difficultie in this case he may vse some easie purgation or one of some force whereby it may fall out that nature shal thereby so be eased which the siege ease of nature wil shew thee that thou shalt not need bleeding at all but onely preparation of the matter then to renue the educing thereof as before Fiftly remember Auâ—cens saying Sanguis fraenum cholerae existit bloud is the restrainer of choler therfore in diseases mere cholerik it were a rash part to set bleeding before purging which perhaps thou maist be without after the exhibiting of the medicine And if thou vse the patient wel let those things suffice which change or repell the sharpnes of choller Yet this is to be added that if there shuld be such abundance of choller as might cause a swelling aboue nature or inflamation then bleding vpon that is a present help Sixthly the same reason may serue in flegmatike constitutions Wherein for many causes although no small fulnesse appeare yet we are not to vse Phlebotomie before purging The cases wherein Phlebotomie preceedeth purging are these First when great fulnes appeareth which either hath caused or is like to cause any vehement disease as Apoplexia which is a sicknes engendred of grosse humors filling the receptories or vessels of the braine and thereby depriuing the partie of feeling speach and mouing as Peripleumonia which is an inflamation or an apostume of the lungs with a vehement Feuer comming sometime of it selfe but most commonly following vpon great and sharpe rewmes squinances pleurisies or such like diseases as Suffocation which is in English strangling then in this case without faile and chiefely if the wombe be laxatiue vse letting of bloud without precedent purgation And this seemeth to agree with Galen lib. 10. de Composi medica secundum locos ca. 2 VVhere he saith if the bodie doe equally abound with humors first let bloud then purge And hereunto Auicen accordeth in quarta primi Cap. 4. This saith he is a truth and the precepts of Hippocrates in lib. Epidemionium that if both bleeding and purging be necessarie and that the purgatiue must be vehement then begin with Phlebotomie Secondly in dangerous fluxes of bloud out of the nose or in spitting of bloud called Hoemoptoicapassio or in bluddie fluxes for to turne the matter a way in full bodies wee presently let bloud without medicine going before Thirdly in wrastlers abounding with bloud to whom the same abundance threatneth some great danger that it is presupposed that there are no ill humors in the circuite or compas
the corrupt bloud and lesse ease to the pained part Or els the corrupted bloud remooued from the affected member is mingled in the veyns with the good bloud and so the euill that was to be remedied is made worse VVhen a veyne is opened in a right and straight course e directo as they call it it both euacuateth pulleth the humor backe and turneth it aside And as a slowe and continuall running doth most safely pull backe from the furthest partes and remooue a fluxe that might possibly insue So also the bloud being turned into a long tract as it were of a new way by litle and litle with Revulsion it turneth from the old course without offending the naturall powers any thing at all Now that this Reuulsion or calling backe of flowing humors to the contrary part may be practised with the greater profit I am to giue here aduertisement that foure conditions are therein to bee respected as Auicen setteth downe in quarta primi cap. 1. First we are to consider the diuersity of the member and still to draw to the contrary part as from the right part to the left from the lower member to the hyer from before to behinde c. This consideration to bee very needfull Hyppocrates prooueth by experience For 5. Aphoris Apho. 68. hee writeth that paine in the binder part of the head is cured by opening a veyne in the forehead which Hyppocrates practised to auert the matter as Galen noteth in the Commentary This auersion or turning to the contrary is done either according to longitude that is aboue and belowe or latitude that is from the right to the left or according to the altitude that is before and behind The second condition is to haue a care of the fellowship and community of the veyns therefore in abundant fluxe of termes wee pull backe applying the Cupping-glasses to the Paps VVhich Hyppocrates most learnedly witnesseth 5. Aphoris Aphor. 50. For there is a kind of Affinite betweene the veynes of the wombe and the veynes of the Paps Thirdly care must be had of the rightnes and straightnes of the veynes which care being had great profit insueth The fourth condition is to obserue the farnes of the distance But of these two conditions especially are to be obserued That is to say the fellowship of the veynes with their rectitude or rightnes And therefore Hyppocrates counselleth to open the inner veyne of the same side or arme and not of the contrary arme VVhich also Galen affirmeth li. de cura ratio sanguinis missione ca. 16. whatsoeuer Auicen would otherwise in tertia primi Therefore they are to be blamed that in a Pluresie of the right side open a veyne in the left as Galen teacheth lib. artis medic cap. 95. There are three waies of auersioÌ„ or turning away and a side of humors called Deriuatio One by repelling things that beat backe the matter another by thinges reuelling which pull the matter cleane away and draw it forth to the contrary part And the third way is by thinges transmissiue which sende the matter from one member to another So Diuersio or Deriuatio is as it were genus to Revulsion If therefore as yee haue heard there be great inflammation or a sodaine and hasty Fluxe of humors open a great veyne of the same side might e dâ—recto as these rermeit I say a great or large veyne because if the euacuation be in the greater vessels it is done with the more speede As Galen saith libri primi artiâ— medic cap. 95. And it is saide rightly in the same side for this is the counsaile of Galen lib. 13. Metho cap. 11. But if the Fluxe of humors be slowe not hasty as in the other or that a veyne must be opened for preseruation onely A veyne further off may bee taken according to the iudgement and discretion of the Phisition as ye haue partly heard before But forasmuch as the Liuer is the Fountaine and originall of all the veynes and Phlebotomy cuacuateth bloud it seemeth that bloud should neuer be abated either for Euacuation or Revulsion vnlesse the veyne of the right arme bee taken which chiefly doth euacuate and pull backe from the fountaine that is the Liuer VVhich also may be prooued by that notable man Hyppocrates his authority affirming our whole body to be Conspirabile That is of one agreement and of a common and generall accorde together one member with another and Confluxibile that is alwaies running together and so allied that each part thereof suffereth with the other This beeing so it seemeth that rectitude is not at all to be regarded in Revulsion For what veyne soeuer wee open because of the consent of the whole body with the parts the like profit will insue For the Solution hereof we make answere that as it is now said it would follow in effect But that nature a prouident dame hath so placed the midriffe as it diuideth the stomacke from the lower bowels and hath separated the right parts from the left Lest one part being hurt the other part should also sodainely perish And this is the cause that therefore rather the right with right than with the left and the left with the left rather than the right doo accord together and mutually suffer one with the other And therefore also Hyppacrates said well Sanguinis reuulsionem secundum rectitudinem cat a Ixin fieri debere That Revultion of bloud must bee done according vnto rectitude If therefore a veyne be thus opened wee shall soone see the apparant vtility if wee doo otherwise or the contrary it profiteth nothing This is seene euen by naturall eruptions of bloud For if in swelling of the Spleene nature expell bloud out of the right Nosthrill or in swelling of the Liuer from the left Nosthrill no helpe insueth But if the bleeding bee according to rectitude called in Greeke Cata Ixin as speniticke persons out of the left Nosthrill and in diseases of the Liuer out of the right euident profit will appeare The contrary profiteth not but oft hurteth diminishing the strength of the body without helpe to the disease as saith Galen de curand rati per sang missio cap. 15. VVherefore as it were following nature in that which shee doth well and those thinges which come voluntarily and of themselues and are yet good and profitable to stoppe bleeding at the nose from the left Nosthrill wee apply cupping-glasses to the left Hypocondrium which is the compasse of the side neere the breast and Paps and if from the right Nosthril to the right Hypocondrium The rectitude therefore as an especiall matter is to bee obserued in Revulsion yea and more account is to bee made thereof than of the differences of the members neither are the parts of the body to bee iudged contrary each to other except one bee opposite to the other according to rectitude An Obiection It seemeth that Galen respected not the location of grieued members according to this
found out yet the same may not be vsed The reason is for that such a medicine specially or rather altogether respecting the bloud would neither euacuate nor attract bloud as the other humors are euacuated with their owne proper and peculiar receits Yea if it happen that it do euacuate bloud as Pulpa Colocynthidis doth according to Auicen without doubt it euacuateth thaâ— bloud which should be still retained for the good health of mans bodie Serapio sayeth that the impropriate or improper humor of a receit is sooner thereby euacuated then the proper humor whereof he rendreth a reason namely that the proper humor to a recâ—it is the best beloued to the receit Wherby saith he it commeth to passe that the improper humor is sooner for saken of nature than the proper The humor improper is quickly drawen to the receit and therby sooner expelled whereas the humor called proper which the medicine most properly respecteth is as it were the most beloued friend and as it were the most natural childe to the euacuating receit and therefore is stil rather reteined than expelled By this reason oâ— Serapio forasmuch as bloud is natures darling more helping than the other humors which are but superfluities in respect of the bloud If there were a receit euacuating respecting bloud that the same were administred the other humors would be attracted cuacuated before the bloud and so great hurt ensue to the bodie And if it were so that onely bloud offended which is not perhaps altogether true yet neither should the bloâ— alone be euacuated as now it hath bin declared Againe according to the Philosopher 4. de Animalibus we are to make choice of the right way and not to seeke crooked wayes Now opening a veine is the righter safer way to euacuate bloud than medicine for Phlebotomy euacuateth all humors at once principally the bloud which most of all aboundeth in the veines and this thing medicine cannot do Againe euacuation is done for two causes either for to remooue the aboundance of the humor or to take away the corrupted qualitie of the homor So euacuation of bloud is practised either because it aboundeth in quantitie or offendeth in qualitie If we open a veine because bloud aboundeth in quantitie then in like sort there is also abundance of other humors For abundaÌ„ceof bloud cometh through good nutriment causing bonuÌ„ ChymuÌ„ i. good â—uce proceeding of meat digested which doth not only bring repletion of bloud but also of other humors as helpers vnto bloud Therefore when bloud thus aboundeth in quantitie with other humors it is better to euacuat them by Phlebotomie than by receit If euacuatioÌ„ of bloud be made for that it corrupteth in the veines then by reasoÌ„ it corrupteth the other humors also seeing bloud is more abounding in quantitie than are the other humors wherupon Galen saith that in the feuer Sinocha there is corruption of all the humors in all the veines therefore bloud is neuer to be euacuated without the other humors together Now other humors may superfluously abound be corrupted in qualitie without the bloud and so consequently may be euacuated without bloud by inward medicine so that it is naturall for the other humors in this sort to be euacuated and vnnaturall so to euacuate bloud which was the cause that Haly vpon Galens authoritie affirmed that Galen caused one to be hanged which euacuated bloud by inward receit To the former obiections therefore wee answere thus Isaac his saying Quod prodest Choleri prodest sanguini is to bee vnderstood not of euacuating medicines but of altering receits as thus those things that are profitable to alter choler and to extinguish the amitie thereof they worke the same effect in alteration of the bloud Or wee may vnderstand it of euacuation and expound it thus Those things which are profitable to euacuate choler are profitable to mundefie the bloud because by euacuation of choler bloud is mundefied and cleansed To the second we answere that this argument Bloud is naught and offendeth as do other humors therefore it is good to euacuate the same by medicine as other homors offending are euacuated this is a fallax of the consequent or rather figurae dictionis for it followeth not that if bloud offend it must be euacuated by inward medicine because the same may better and more safely be done otherwise namely by Phlebotomie and this may serue for aunswere to the second doubt before moued in like manner To the third may be said that Pulpa being forcible it greatly debilitateth the member and therefore when bloud is superfluous it looseth and euacuateth the same and letteth the bloud conteined in the member to passe away but it doth not attract the bloud and this is verie pernitious to the bodie of man The answere to the fourth is plaine in the premisses VVhere note that although it haue bin declared in this Chapter that bloud is not to be euacuated by siege as other humors are which fluxe of bloud that way we rather account a disease than a remedie as in Dysenteria such like yet this notwithstanding we do not denie but medicines may be verie profitably giuen and receiued to mundifie to purge the bloud Of the impediments or lets of Phlebotomy and of the causes requiring and furthering the same Chap. 8. THere are certeine things which put off bleeding for a while and other things which altogether hinder forbid this practise whereof the first is indigestion of the meat receiued as when a man hath eaten much ouer-night and in the morning feeleth himselfe pained therby feeling still as it were the sent sauour of the meat which he hath eaten remaining still in his stomack whereby the cruditie plainly appeareth In this case except vrgent necessitie otherwise require wee must forbeare bleeding til the digestion be accomplished that is til the rawe humors be concoct also the excrements descended The reason why cruditie and rawnes of humors through too much ingorging of meat stayeth bleeding for the time may be gathered out of Auicen 1. Doctri 6. cap. 3. for that there are three things which attract matter vnto them that is emptines of the place heat of the members the habit and state of the whole bodie If therefore the bodie thus affected wee chaunce to open a veine the bloud vntimely woulde be drawen by the veines first part of this cruditie of humors and the veines being destitute of their proper and conuenient nourishment would drawe vnto them that which is not as yet concocted in the stomack Liuer which vnconcocted matter sent abroad to the othâ—r members of the bodie would not easely be amended For as Galen saith the third dgestion doth not remedie the faults of the second nor the second the curls of the first Si magnum sit peccatum as he saith if the euill be great So that now if by this meanes the matter be turned into the members
and lesse cold than other fleshie substances It needeth therefore no euacuation hauing naturally of itselfe how to be purged calore extraneo by a forrein outward and strange kinde of heate And againe Galen sayeth lib 11. of the same worke Cap. 14 speaking of Synochus a kinde of feuer Si in puerum incidat qui 14. annum non hactenus attigit mitti illi sanguis non debet propterea quod tantillis cum praesertim calidi ac humidi sint plurimum corporis substantiae quotidie defluat ac digeratur it a quod ex incidenda vena moliendum nobis fuerat id vltro nobis ex curati corporis natura praestatur i. If this feuer happen to a childe yet not 14 yeares of age he is not to be let bloud because such yong ones being of a hote and moyst constitution haue much of their bodily substance daily dissolued So that the same which we goe about to bring to passe by opening a veyne is done already to our hands by the constitution of the Patient Of this imp e diment namely the age beside old men and boyes are also meant decrepits and very Infants Auicen remembreth in quarta primi cap. 20. this matter writing almost in this manner Thou oughtest to beware of opening a veyne in a complexion too colde in a Country too colde in time of extreme paine in a member after resolutiue bathinges after carnall copulation in young age vnder fourteene and in olde age except thou haue great confidence in the solidity of the Muscles in the largenes and fulnes of the veynes and rednes of the colour such either young or olde boldly may be let bloud Yet those that are young of fourteene yeare olde must bleede orderly by little and little at once and at each time more than before and all this did Auicen take out of Galen So that although in Phlebotomy wee are chiefly to consider these three thinges that is to say the danger of the disease the age and naturall strength of the party yet the age is sometime not wayed when the strength of nature serueth either in old or yong Wherfore Galen lib. de curand ratione per sanguinis missionem cap. 13. willeth to let bloud young sanguine children and olde sanguine men without consideration of age if the disease be vehement and dangerous if the body bee sufficiently strong and that there also bee vehemency of the Pulsies In these cases Necessitas non habet legem Necessity hath no Lawe So in Spaine they let children bloud of three yeares olde and lesse and Auenzoar writeth that hee let his sonne bloud at three yeares of age and so preserued him from death lib. septi cap. tertio Collecta These limits of yeares in this point Hyppocrates did not set downe Galen appointed them from fourteene to seauentie Mooued by the foresaide reasons Rhases in olde decrepite age nothing at all fearing the danger of exhausting the naturall heate that remaineth in the body with the bloud whereof notwithstanding often proceedeth the hazarde of life by vndiscrete bleeding by opening a veyne in decrepite persons did then helpe and did great good in grieuous Pluresies and Perypleumonias And concerning young folke this wee find true by experience that in the fifth or sixth yeares of their age by opening a veyne Pluresies inward inflammations and other grieuous diseases are cured Yea wee see by the very course of Nature that Children and sucking Infantes oft plentifully bleede at the nose without any hurt of body or any diminishing of their naturall strength The age of Childhood hath naturally her strength and bodely forces why therefore may we not euacuate bloud according to the proportion of the same Especially when the childe is plentifully fedde hauing also large veynes and is filled with good concocted bloud Againe if it bee graunted that the forces of nature are impaired by bleeding whether is it better for the childe to periâ—h through plenitude and abundance of humors or to free him of his disease by abating that abundance though the strength of nature be thereby a litle hindered Therefore somtime the necessity of bleeding is great euen in childred as in Pluresies inward inflammations and continuall feuers There is therefore no age in my poore iudgement but may abide some measure of Euacuation by bleeding if the child bee past fourteene yeares of age Yet consideration is to be had of what constitution hee is whether his bodely substance be fat or leane thicke or thin grosse or slender hard or soft of much bloud or of litle In the first we may proceed to open a veyne in the other not and here we most carefully remember that in children because of their hot moist temperature lesse bloud must be taken than the plenitude seemeth to require The fift impediment is an ill disposition of the stomack incident to some men more than other some in whom chollerick humors flow to the mouth of their stomacks and maketh them apt to chollericke vomits although before they haue neither accustomed nor had any desire to vomit In thesemen bleeding is to bee forborne because thereby the troubled humors flowe to the mouth of the stomacke as to the accustomed place and because the stomacke cannot resist so great a Flux of humors being partly weake of it self and more weakened through their comming Hereof diuers great discommodities growe to the body yea this is the very cause that some fall downe and faint in bleeding For the chollericke humors flowing to the stomacke bite and nip the same and so per Simpathia through a certaine kind of compassion that is betweene the stomacke the heart and the braine it causeth Syncope that is sowning VVherefore Galen lib. 12. Method cap. 3. Durst neither purge nor let those bloud which haue the mouth of their stomacke very sensible tender weake and abounding with bitter choler and which persons also abounding with the same when they bleede in the very beginning long afore full euacuation bee made oft fall downe and faint by reason of the foresaide choler and crudity of humors And this is also the counsaile of Galen lib. de curand ratio per sanguin missio cap. 1. and of Auicen in quarta primi cap. 20. Ye may perceiue the mouth of the stomacke to bee very sensible saith Auicen when yee cannot swallowe downe sharpe and bitter thinges without hurt VVeakenes of the stomacke is knowen by losse of Apetite to meate and drinke Abundance of bitter choler is shewed by bitternes of the mouth by subuersion of the stomacke long time connnuing and by oft vomiting vp of choler These signes and tokens discried in any patitient doo dehort from opening a veyne Yea this ill disposition of the stomacke bringeth not onely Sincope but also sometime present death As Galen witnesseth lib. 9. cap. 5. Meden And Auicen in the former cited place The sixt is weakenes of the natural forces Of which there is a threefold condition for they are either firme or weake
thorow fault of the lunges and brest as sometime it doth in whom notwithstanding the vitall force may be sufficiently strong The contraries to these declare firme strength of the vitall vertue These thinges declare the animall po wers to be enfebled tumblings and tossings of the bodie the senses offended watchinges rauings and other principal actions hindered The contraries hereunto shew the contrarie that is firmnes strength of the animal vertue By these functions then you see how it may be coniectured what power in nature is hurt or offended Againe these powers are offended or seem enfebled two waies either because they are outwardly oppressed or because they languish inwardly of themselues in the euacuation it helpeth greatly to know the one from the other for the forces oppressed require large euacuatioÌ„ the other none at al. And the distinction of these is to bee sought out of their euident causes If causes haue gone before which haue already altered or wasted the substance of the forces naturall then wee may iudge them that they are faint and languished If these causes haue not been precedent but that the Patient is only troubled with an vnaccustomed ponderosity then these are but wronged and oppressed The euident and outwarde causes which alter the temperament of the setled vertues are burning Agues which melt the bodily moystures or whatsoeuer els that excessiuely heateth cooleth moysteneth or dryeth the sounde massiue strong and solide parts of the bodie The substance of these parts is wasted by very long sicknes which bringeth the Patient into an Atrophia that is a kind of consumption wherein the body consumeth away with leannesse and is not nourished albeit the sicke continually eate his meate Or into Tabes which is an other kinde of consumption wasting the body by long sickenes and lacke of nourishment consuming and putrifieng the Lites drying away the Patient for want of naturall moysture hauing matter and bloud mixt together The threefold spirit of the flowing humor is altered ether through some distemperature or some poisoned qualitie of the aire which compasseth vs about or through the il quallity of other thinges which violently breake in vppon vs or through some wâ—cked disposition of the bowels or other humours The heate of the aire not onely of that which outwardly compasseth vs about but also that which wee draw into our bodies by breathing inflameth first the lunges then the hart all the spirits so far till often times a feuer is kindled and caused thorow the same Thorow which distemperature of the spirits needs must the strength of the body languish becom enfeebled yea by this excessiue heat of the air the spirits are not only subiect to alteration of temperament but besides they are also thereby greatly wasted diminished Euen so in like maner immoderat cold outwardly the same receiued inwardly into the body by breathing weakneth the spirits inward heat yea soÌ„time altogether put out and extinguish the saá¹e The aire venemous pestilent drawen into the bodie with an infection quite ouerturneth the spirits of life and ofnature wherof â—nsuâ—th grieuous sicknesses to the body no litle decay of bodily strength yea life it selfe is taken away by the so daine disease commonly called the plague Now much more apparantly are the spirites infected with biâ—ings of Scorpions mad dogs and venemous beasts than by the contagion of the Aire Moreouer they are inwarde and hidden causes which doo greatly alter the spirits and whensoeuer any principall part of the bodie is troubled with any distemperature vpon any occasion If the same proceed far it must of necessity goe to the spirites there bred and ingendred And so by offending of them will lessen the strength and vertue of nature Also if any corruption of humor rule in the body the spirits are disperced and offended by the corruption or distemperature of the same humors Therefore when abundance of rawe humors passeth either the whole body or the stomacke and chiefly the mouth of the stomacke the substance both of inward heate and of the spirits waxe cold the Patient languisheth yea sometime hee giueth ouer the Ghost and soundeth Herevppon also when hot choler burneth as it were the inwarde spirits with immoderate heate or nippeth and pricketh the mouth of the stomacke it is the cause of no small euils in the body of man Sometime also it falleth out that some one or other humor in the body is mixed besprinckled or bedewed as it were with some kinde of venemous filth as when the seedy moysture is kept in and putrifieth Or menstruall termes in weomen longer retained than is their due course or when any clodded bloud remaineth behind and is not expelled the vapour of these and such like infecting and decaying the spirits bringeth sometime Sincope sometime suffocation of the wombe sometime the falling sickenes and such other mischiefes which greatly annoy the forces of nature And thus diuersly are the spiriets offended through distemperature Againe the substance of the spirits and naturall forces is diminished sometime euen of it self and as a man may speak voluntarily of his owne accord for the substance being of it selfe thin and wastable and included in an hot thin and open body Therefore of it selfe it dissolueth vaniâ—heth away Sometime the same is decayed by occasion of outwarde and euident causes as are namely these The aire which compasseth vs round hot and dry immoderate euacuations vehement motion affects of the minde paines watchinges great emptines and all vnprofitable excrements which cannot but carry with them from the body as they passe a great quantity or portion of the vitall spirits seeing their substance is spread ouer the whole body and also flowing with other humidities whereby it commeth to passe that whether the belly be very laxitiue by nature or by medecin or that the vrine bee made immoderately as in the infirmity called Diabete or that matter or water go plentifully forth of the brest stomack belâ—y or any great apostumation thereby of necessity the forces of nature must be mightely decayed Much more manifestly must it so fall out when there is any great euacuation of bloud or good humors whether the same pas forth of a wound the nose hemorroids Piles belly or other place In like maner abstinence which taketh away from the body needefull nourishment enfeebleth nature Labor likewise and heat disperseth the substance of the spirits by vapors sweat And therfore they which liue continually in labor about furnaces hot baths because daily some of their substance decayeth doo not commonly so abound with excrements as those that leade a slouthfull delicate and idle life Moreouer they that liue very incontinently haue also for the most part very enfeebled bodies able almost to abideno Phisick by a continuall decay of seedy moystures they haue their spirits mightely consumed wherof look before in the 8. cap. Fig. 17. Great ach paine worketh the same effect more than
was otherwise but weake let vs so esteeme of euacuation But as in dyet so in euacuation we must beware lest the vertues of nature extremely enfeebled do quite giue ouer and be altogether extinguished in regard whereof we are circumspectly to foresee how farre the patient can or may endure the same For in truth a iust quantitie withdrawen without any great hurt taketh away and cureth the disease And this point of the iust quantitie is knowen by a comparison of the disease and of the strength of nature for persons firme and strong may bleed as much as the sicknes requireth They that are not so strong may bleede lesse they that are quite cast downe are not to bleede at all And here a profitable question may be moued whether naturall strength may so greatly be enfeebled that it cannot or may not away with any euacuation be it neuer so little VVee see many times that in great of decayd strength there fall out voluntarie euacuations which do much good and procure health And againe it seemeth that to ech diminution of strength be the same great or smal the quantitie of the euacuation may be proportionated accordingly Neither is it credible that an vnce or half an vnce â—â—blod taken can doe no great hurt to the naturall vertues albeit they bee alreadie much decayed These matters seeme somewhat obscure but that the question may be explaned and all ambiguities of auncient writers taken out of the way we answere by distinction affirming that there are three degrees of quantitie in euacuation The first degree is when the same euacuation is thorow perfect and absolute taking away either all or the greatest part of the matter that causeth or continueth the disease The second degree is a profitable euacuation but not so perfect and absolute as the other which taketh away onely some part of the sicknes making that which remaineth more easie and tollerable than it was before The third step is so small little an euacuation that the pacient therby is not one whit eased or relieued Now to come to aunswere the former question the naturall strength is seldome so greatly deiected except the same be altogether ouercom past all hope of recouerie but that it may abyde some little euacuation But hereof the auncient writers haue made no mention at all being as it were a matter altogether vnprofitable seeing it is so little not procuring reilefe to the â—â—cke patient but rather bringing more daunger to tâ—â— naturall forces aire die decayed And in fiâ—e they haue decreede and set downe that in this case no euacuation should be vsed Therefore the naturall powers being firme and strong require an absolute and perfect euacuation The same but meane and somewhat enfeebled an euacuation more vnperfect and yet profitable altogether decayed they require none at all If the disease be verievehement so that it cannot either at all or well be cured without bleeding it requireth necessarily abundant euacuation The same but meane and not sowehement it requireth a more moderate bleeding but yet the same greatly profitable because the cure may afterwardes be accomplished with the more celeritie and safetie If the disease be small it requireth small euacuation or none at all Now let vs make comparison of the greatnes of the disease and firmenesse of the strength together VVhen the strength is verie firme and the disease meane and not verie vehement bleeding is not altogether necessarie but onely profitable in which case bloud may be safely taken and as much as the disease needeth There is no feare to diminish a little the bodily forces so as the roote of the disease may be pulled vp For they are againe verie speedily and redily recouered VVhen the strength is firme and the disease daungerous replenishing the veines with an immoderate fuldesse as it falleth out in the bodily constitution of wrestlers and in feuers called Synochi a plentifull euacuation is to be appointed answerable to the greatnes of the disease Yea it profiteth sayeth Hippo to bleede euen vnto Syncope If the patient maye abide it in which place Hippocrates meaneth not that sowning which commeth of feare or of cowardlinesse or of sharpnesse of humors pricking and prouoking the mouth of the stomacke but onely that which commeth of abundant euacuation For so in an extreame disease Hippo. appointed as a rule and iust order of euacuation And this defect of minde and strength is called Lipothymiae or Liposychia in which the partie speaketh heareth seeth and knoweth them that are present Nowe Syncope is as it were a suddeine decay of all naturall strength as in the falling sicknes in the which the patient neither seeeth heareth or doth any outwarde action Lipothymia is more easie than Syncope and accustomably goeth before the same In the foresaide affectes therefore wee let bloud euen vntil Lipothymia come vpon vs and yet rashly or without iudgement Now when the powers of nature begin to quaile and giue ouer through euacuation we must stay the bloud Neither are wee to proceede so farre as vnto Sincope for then the partie escapeth but daungerously albeit the strength of the body be reasonably firme In consideration whereof wee are to withdrawe the abounding humor as the bodily forces will permit And whensoeuer they are wasted albeit some of the offending humor remaine still behinde yet wee are presently to desist and this shalt thou most certainly vnderstand if thou diligently marke and obserue the Pulsies how they alter from great to little from equall to vnequall from strong to weake from apparant to obscure and by marking how the force of the fluxe of bloud beginneth to relent and the patient to waxe weake That practisioner which setteth by his credite and will auoide ill speaches must neuer through bleeding bring his Patient to Syncope because the same being as it were an image of death terrifieth the standers by and putteth the Patient in a great hazarde of his lyfe Yea and it is better to let the patient still remaine in griefe than to take away with the disease life it selfe And hetherto we haue shewed what is to bee done touching the quantitie that must be withdrawen when the powers of nature are firme and constant If the disease be but meane and the bodily powers but indifferent the euacuation must be moderated which may remoue the whole cause of the sicknesse with little or small hurt to the strength of nature VVhich albeit it be but a small and moderate bleeding yet the same is verie profitable as ye haue heard before If a great sicknesse concurre with strength alreadie decayed and that the same also require some large euacuation yet because the powers of nature cannot tollerate it the same must not be done wholy at one time but by iteration as yee haue beene tolde lest wee take away both the disease and the partie diseased Natures forces being quite ouerthrowen albeit the disease so require yet the bodie can permit little or no euacuation for it
must be taken that the bloud comming downe the veine may swell and appeare in sight It must be bounde harder in some than in others as namely in such persons that haue their veines couered as it were with much flesh or fatt By this hard binding the veine is stretched out or swelleth it standeth sure and flyeth not froÌ„ the stroke of the Phebotomer And thirdly the bloud commeth forth with the more force we vse also to binde beneath the place when the quiuering vnconstant veine slippeth aside out of his place from the hand of the Phisicion They that haue a full thick skin narrow veines and deepe in the flesh or great veines couered with fat must be bound both waies and haue the bond tyed faster than those of a contrarie constitution If the veines be verie small little that they do not fully sufficiently apeare by binding as it happeneth in the veines of the hands feet ankles VVe soke them in warme water or pour warme water vpon them that the skin flesh may waxe soft and the veines beseene then we binde them so they bleed the better If the veine yet appeare not wee search for it in the place where it should be with our singars vntil partly thereby partly by the fluxe of blod we wel perceiue the same VVe bind the necke but softly when wee take the veine of the forehead or the veines vnder the tonug Yea many times in these wee take a table napkin putting it about the necke cause the partie himselfe to hold both the endes as he may suffer or indure the same VVhen wee throughly and well perceiue the veine we strike the same softly with the instrument diligently taking heed that he wound not in steede thereof an arterie sinewe or some gâ—istly ende of a muskle called a Tendon lying vnder the veine or some other part neare vnto it For somtime when we bind hard with the bonde there appeareth a place puffed vp with wind there swelleth a thing like a veine that is no veine And sometime an arterie pressed downe doth not moue and so seemeth to be a veine and therefore to be more sure let him with the forefinger feele the place of the incision the veine vnderneath This done let the Phisition take his instrument at the verie fingers ends with a good eye and a good hande and let him not put foorth more of the point than is sufficient to pearce withall And that the veine escape not the instrument in one hand let him hold the launcet and with the thombe of the other hande applyed to the veine that is to be opened let him settle presse and keepe downe the same chat it start not aside and so softly without haste put in the instrument sufficiently and let the Phlebotomer haue good experience to open a veine with both hands for a veine of the right aá¹™me is best opened with the right hand a veine of the left with the left hand The veines in the ioynts in the bending of the arme in the hammes being cut in rectum that is right growe together but slowly because the ioynts with motion do open still the lippes of the wound Neither are we so to cut them except when wee neede to reiterate bleeding Veines without the ioynts as in the head in the hands in the feet opened in rectum are quickly couered with a skarre because the sides doe soone grow together againe There lyeth vnder the inner vaine called Basilica also an arterie and vnder the middle veine a sinewe and vnder both for the most part Tendons of the Muskles Cephalica veine albeit it be heard to take yet it is most safely taken of all the rest For in opening therof a maÌ„ cannot light vpâ—Ì„ any Tendon arterie or sinew VVhen a Tendon or sinew is prickt there followeth great paine astonishment resolution convulsion of the atme with a swelling VVheÌ„ an arterie is prickt the bloud is verie hardly stayed and consequently through effusion of much bloud the strength of nature is wasted Neither doth the arterie heale vp or growe againe togither but part of it is corrupted like Gangraena which is a putrifying or rotting of the flesh by mortifying the sensible parts therof if a sinewe or Tendon be prickt the same is perceiued by great paine convulsion swelling following If there be doubt that a sinewe is prickt let not the wound grow together till it be safe sroÌ„ inflamation that two or three dayes ar ouer passed it may be kept from growing together by bathing of it in warme oyle After three daies if the paine cease that there come no new accidents we may permit the vnion suffer it to grow togethers againe if not then we are to vse opening attracting things such as wil help the pricking of sinewes as namely turpentine putting therto somtime á litle Enforbium VVhen an arterie is wounded there coÌ„meth forth thin bloud red fine spinning out To help this case make a plaister of Aloes Mirrh Frankencense Bol-armoniak the white of an egge haires of an Hare lay ouer these a linnen cloth dipt in Rose-water fasten the plaister wel with a bond that it come not off in 3 dayes then this being gently remoued apply another like vnto it If the arterie will not grow togither with these cut the whole arteriâ— ouerthwart that when the extremities are pulled vp on both sides the place may growe and be couered with soft flesh Touching the maner of the incision quantitie of the wound if we iudge the bloud in the pacient to be thick clammie Melancoly that the constitution of the aire be colde the wound must be reasonaby large wide that the thick bloud grosse fumes may the better issue foorth for the wound in this case being little strait the most thinne bloud alone floweth out the grosse thick bloud remaining still behinde A large wound therefore is best in these three cases First when the bloud is grosse thick Melancoly that it may passe foorth with the more facilitie Secondly when there is great abundance of humors for they are better expelled with a large than a narrowe or small wound Thirdly when the countrey or season of the yere is extreme colde as in Winter in srost and snow for cold maketh the humors thick Contrariwise a narrow or little cut is best when the strength of the bodie is but weake lest the wound being too large the vitall spirites might immoderatly passe foorth with the bloud Also in a hote countrey or season or when euacuation of subtile and thinne bloud is requifite Schola Salerni sayeth Fac plagam largam mediocriter vt cito fumus exeat vberius liberiusque cruor The wound make meane for meanly done The fumes may passe bloud may â—unne Melancoly slegmatike complexions bleede often times guttatim i. drop by drop therefore a larger wound must be
and so very often partly through a commotion made by incision and partly through that retraction made by sleepe such a boiling happeneth in the humours of the body that oft therby at length a feuer is caused and kindled It is therefore apparant that sleepe presently after bleeding is not good and chiefly if in the meane season the patient haue receiued no meat If after taking of meat hee sleepe an houre or two or more disposition so seruing it hurteth not at all or verie little But for as much as the commotion of humours can not fully be setled in short space after bleeding it is far safer to forbeare sleepe as we haue proued by sundry reasons If necessity dispotition vâ—ge sleepe let the same bee short and with a dâ—ligent circumspection that the bonds bee not vnlosed and so the Patient brought in perill of his life Some bring in a further reason yet of the fore said namely why we should not preseÌ„tly sleep after bleeding that is because the matter through sleep waxeth thicke and so a brusing or a confraction that way happeneth in the members as is accustomed in a quartan through the thicknes coldnes of the matter Againe the veines sinewes after bleeding being now emptied are becom cold so the fumes which are brought vnto the veines and sinewes in sleepe do also be come thicke and waxe colde because by sleepe the whole naturall heat of the bodie is drawen euen into the depth and profunditie of the bodily partes And when the veines and sinewes are become cold partly for defect of bloud partly through cold fumes brought by sleepe vnto them they doo participate grosnes coldnes confraction to the other members for it is a principle Simile a simili facile afficitâ—r Like of the like is easily affected And thus much of sleepe after bleeding which is to bee vnderstood of sleepe onely following immediatly after and not otherwise The verses of Scola Salerni concerning this point are these Sanguine subtracto sex horis est vigilandum Ne somni fumus laedat tibi sensile corpus Ne neruum laedas non sit tibi plaga profunda Sanguine purgatus ne carpas protinus escas Sixe houres sleepe not when bloud is let The fume by sleepefull hurtfull is It hurtes the veine if stroke be great To feede streightwaies is farre amisse The patient is a while after bleeding to abstaine from meat till the motion of humors be appeased For in this case rawe iuices and meat not yet concected is drawen with the bloud to aid the member afflicted Looke Galen lib. 4. Cap. 10. de Sanitate tuenda Milke meates made of milke after bleeding are to be eschewed for certeine of those humors which were troubled and moued in opening the veine flowe vnto the stomack and forasmuch as milke is otherwise of it selfe subiect to corruption being nowe in this case inwardly receiued mingled with the foresaide humors it is verie soone putrified and because of the sweetnes thereof though it be vnconcocted rawe yet it is mightily sucked vp and drawen in of the emptie veines Irem all cold things either in wardly taken or outwardly applyed are to be auoided of which sort are chiefely cold meats cold drinks cold bathings washings cold aire thinnesse of clothes bare sitting vpon stones coldnes of the head feete for by these the body would be immoderatly cooled natural heat being alreadie diminished through bleeding Item mistie cloudie aire is to be eschewed for such weather ingendreth Melancholie bloud maketh a heauie mind He must therfore walke in cleare bright faire weather for thereby the spirits of life are refreshed Item immoderat motion is to be forborne a temperat quietnes to be imbraced both of body of mind For vehement mouings do yet more more stil disturb the humors of the body before excited stirred vp by bleeding so consequently the same weaken too much the bodily forces wheras quietnes rest soon appeaseth this commoâ—on of humors Item eating of salt fish is to be auoided after incision for these salt meates often times cause itchings scabs Simeon Sethi depiscibus The verses of Schola Salerni in these matters Omnia de lacte vitabis rite minutus vitet potum Phlebotomatus home Frigida vitabit quia sunt in mica minutis Interdiclus eritq minutis nubulus aier Spiritus exultatque minutis luce per auras Omnibus apta quies motus sâ—pe nociuus VVhite meates eschew d ink not too much Cold things forbeare as ill for such VValke not abrode in clowdie daies cleare aire doth cheare the spirits alwaies Be wholly quiet at all assayes Item Beware of much meat the first or second day And let the meat be of good digestion and causing good blood as soft egges good wine chickens and such like Therefore Isaac in dietis saith of such as are let bloud that their meat must be lessened and drinke increased that is the drinke must be more in respect of his meat that he eateth daily not in regard of that custome which he obserued before bleeding Yea he must nowe drinke lesse than he did before Some after letting bloud are verie drye in the mouth which happeneth through the great motion of the humors and by abundance and ebullition of choler whose fumes arise vpward to the mouth other parts These are to drink Barlie water to mitigate the acuitie sharpnes heat of choller so must they do in like maner that are in doubt of inflammation of the Liuer and stomake through abundant boiling of chollericke humors specially if it be red choller that aboundeth in them If through hard binding of the arme before or after bleeding paine doe ensue and so consequently sluxe of humors to the place causing apostumation in the arme then according to Auicen let bloud in the other arme or according to Rhazes aboue the place in the same arme and apply to the place repercussiues to keepe backe the matter The wound in the arme after bleeding somtime healeth but slowly because the instrumeÌ„t was annoynted with oyle as wee said before that the same might enter the better do lest hurt to the pacient as Galen saith 9. Method The cause now of this slowe healing is for that the healing is much hindered by reason of the oyle which is betweene the sides or the lippes of the wound For as the same Galen other authors affirme a wound is not cured or healed as long as there is any thing betweene the sides or lippes of the same Another cause why after bleeding the wound closeth but softly is that there hath bin too much euacuation of bloud whereby the force of nature is debilitated which hindereth the continuatioÌ„ or consolidation of the wound A third reason hereof may be the oft mouing of the arme for wounds do neuer heale except the member enioy rest where they are inflicted Therfore let this fault be remedied by