Vossius de Philos. c. 12. sect 19 Suidas in 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Let D. M. take notice here that there private Arcana such as the Quacks pretend unto concealing the Medicaments and others by that name published in Print in Crollius Schroder and others In his Preface to the Reader he sayes He doubts not the time will come yea is not far off that a Phlebotomist as he hath characterized him will be looked upon as little better than a Broachotomist a Cut-throat Galen de Sangu miss c. 2. G. Th. of the Blood p. 19 20. Ibid. p. 22. Ibid. p. 1 2 and 34. Ibid. p. 2. Some peoples flesh will not heal upon the least cut notwithstanding this Sanative quality in the Blood Yet are several glandules sweeter to taste than the sanguineous fleshy parts of Animals What becomes of the duumvirate then And may I not ask if the Spirits be nâ—t the immediate Instruments of the Soul Ibid. p. 5. If God and Nature intended the blood for so pure and homogeneous a liquor why did they produce man with such a fabrick that the chyle several ways tinged should mix with it in the sub-clavian veins Ibid. p. 6. C. Hofmann de Ichor sect 12 13.9 Th. Scheuck de sero sangu c. 1. Gâ—isson de hepate c. 45. Charleton Occoâ— Anim. exercit 9. sect 7. a Glisson Anat hepat c. 45. Quippe tota haec Lympha uti experientium compertum est densior minusque pellucens interdum lactis instar albescens aliquanâ—s sufflava non nunquam loturae carâ—is similis Vide Charlton ubi supra b Centies facto experimento vadi semper serum ipsum non modo leviter incrassari sed agglutinari fieriqne membraneum H. Barbat diss de sangu sero pag. 16. c Th. Bartholin Spicileg p. 71. M. Bogdan apolog adv O. Rudbek sect 116. Vide Hofman de Ichoribus sect 71 c. Dr. Willis de â—erment c. 6. Kerger de fermentat sect 1. c. 11. E venis capitis nunquam talem muccaginem affluentem vidimus crebrius è venis brachii è pedum autem venis creberrimè in majori copia Moebius fundam medic de usu Cordâ—â— p 259 p. 87. p. 6 7. p. 18. Vallesius method medend l. 2. c. 4. Horat. Augen de miss sangu l. 9. c. 24. Petrus Castel de abusu Phlebot pag. 73. Alex. Massaria Apolog. l. 11. disp 11. c. 14. Fernel Physiolog l. 6. c. 7. River obs communicatae à Pachequo obs 46. Petr. à Castro de febre malign pag. 90. Fernel Therapent Univ. l. 2. c. 17. Sennert de febr l. 2. c. 1. This be might have learned from Galen in his Comment upon Aphor. 17. l. 2. Hippocr Epid. sect 1. l. 2. Fienus de signis medicis par 2. c. 1. sect 8. Francisc. Rubeus Nocturn exercit in Histor Medic. exerc 6. p. 98 99 100. Prosper Alpin de praesag vita morte l. 7. c. 2. p. 52. Scaliger de subtil exercit 102. sect 5. Fernel Phisiolog l. 5. c. 16. Valles sacr philos c. 5. p. 102. Fernel Physiolog l. 2. c. 1. Plempius sundam medic l. â— c. 1. Botallus de sangu 〈◊〉 c. 34. Id ibid. c. 33 sect 7 8. c. 35. p. 7. Domin de Marchettis Anatom c. 9. Domin de Marchettis Anatom c. 10. Paraus chirurg l. 16. c. 49. Simon Pauli de febr malignis sect 11. p. 89 90. (a) 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Arist. Ethic. l. 10. c. 9. Io. Franc. Ripa tract de peste c. 7. sect 17. Arist. l. 8. Phys. c. 3. t. 22. 1 de ort inter c. 3. t. 59. Steph. Roderic Castrens quae ex quib l. 4. c. 7 8. Iodoc. Lommius de curand febr contin c. 3. With this opinion of J. Lommius doth Citesius agree de usu Phlebotom c. 4. Galen de sang miss c. 14. a Citesius de usu Phlebotom c. 5. Rolfinc meth medic spec c. 4. sect 2. c. 11. b Rolfinc ubi supra Dilect Lusitan de venae sectione cap. 14. Artic. 1. G. Fletcher's History of Russâ—â— c. 28. p. 279. P. Zacchias Qu. Medico legal l. 9. consil 40. Vide I. Franc. Ripia tract de peste c. 7. §. 64 65 78 104. â—â—lles Meth. Med. l. 2. c. 3. Vide Riolan de circulat Sanguin c. xx Vallis meth medend l. 4. c. 2. Pag. 105.106 He should rather have regarded the â—econd then sixth digestion Brune Seidelius de morb incurabit p. 57. Valles meth medend l. 2. c. 3. P. 168 169 Valles in Hippocr de victu in morb anot l. 3. p. 169. Ballonius Epidem ephemerid l. 1. p. 101. Vide Riolâ—n de circulat sang c. xx Hippocrat Epidem l. 5. c. 11. 6. 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 See Antâ—n Bâ—nivenius his medicinal observat c. 44. p. 107 108. Ballonius Epidem l. 2. p. 191 Fallonius Epidem l. 2. p 192 Ballon Epid. l. 2. p. 167. Petrus a Castro de febre malig puncticul p 90. Simon Pauli digress de febr malign §. 12.14 Valles meth medend l. 4. c. 2 Castellus de abusu venaesection p. 60. Forrest de febre l. 12. in Scholio Novae Acad. Florentinae opuscula adv Aviceâ—n p 43 p. â—3 Ibid. p. 99. P. Castellus de abusu Phlebotom p 6 7. p. 101. p. 110. p. 108. p. 109. G. T. understands not what a procatarctick cause is it is here a causa 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Vide Steph. Roder. Castren Ouae ex quibus Valles in Epidem l. 4. p 448. in historia Alcippi ibid. p. 401. in hist. â—omulae emptitiae Hieremias Thriverius Brachelius in lib. 4. Aphor. 57. Valles controvers Medic. l. 8. c. x. Hieron Rubeus in C. Celsum l. 5. sect 4 C. Celsuâ— de Medicina l. 3. c. 9. p. 169. Novâ— Acad. Floâ—ent opuscul p. 21. Io. Riolan in resp ad dubia Anatomica Barthâ—lâ— p. 75. Ar. Rhet. l. 2. c. 4 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Claudinus proposeth frequent Phlebotomy as a remedy for fatness Venae sectio omnino convenit imo fâ—nt qui nihil râ—agis ad detrahendam corporis molem valere existimant quem erebram sectionem venae Empiric rational l. 1. §. 1. c. 4. Io. Fuchsius Compend abus p. 2. c. 7. Primros de vulgi error l. 4. c. 50. Prosper Alpinus de med Egyptiorum l. 3. c. 15 16. Dr. Willis de â—ebr p. 197. Dr. Willis de febr p. 166. edit 1662 Hor. Augen de miss sangu l. 4. c. 19. p. 82. p. 99. p. 81. p. 99. Maebius fundam med de usu ventriculi p. 178. Kerger de fer met §. 3. c. 2. G. T. of the Pest. c. 1. p. 8. Isbrand a Diemerbrook de pest l. 1. c. 7. §. 1. p. 18. edit 1665. Amsterdami Zacchias Qu. medico legal l. 3. tit 3. Qu 1. §. 13 14. G T. of the Pest. c. 3. p. 42. Isbr. a Diemerb de Peste l. 1. c. xii So Van der Mye during the siege of Breda relateâ— causes of such as had
yet the Serum was insipid it is not properly sanguine but pituitous But to resume the discourse I expected to have seen the Minor proved by our Helmontian but although I find that he saith his observation did jump with that of Doctor Willis that Phlebotomy did incline to Feavers Yet my Reader may see that in the first part of the Argument as I have urged it in his own words he reckons amongst the evil consequences of bleeding none that proceed from an opulent and sulphureous blood transcending the dominion of the spirit that remains after Phlebotomy but such as argue an impoverishing of the blood or a cold indisposition I will repeat it again to shew how justly I censure his Logick and so dismiss the Argument If it be so that striking a vein often in a long and tedious disease is a preparatory for a sharp Feaver as we both herein jump right in our observation when am I certain that Phlebotomy repeated in an acute Sickness is a door set open and an in-let for a long infirmity so that this mode of defalcating the vigour of the spirits doth for the most part as I have strictly heeded many years disarm and plunder Nature in such sort that it cannot resist the assaults of every petty infirmity witness those multitudes of relapses or Agues Scorbute Dropsies Consumptions Atrophy Iaundise Asthmaes c. The proof of the Minor here is not only defective but the mischief is that Doctor Willis who judiciously useth Phlebotomy commends it in Feavers both in the beginning and augment of those that are putrid and also in Diaries as the principal remedy inprimis conducit and speaks in the place cited by our Helmontian only of a customary letting blood in time of health Whereas this Bacon-faced Pyrotechnist saith that their Wits jump in this that often striking a vein in a long and tedious disease is a preparatory for a sharp Feaver Let any man read the place and see how he abuseth that excellent Practitioner whose words are Prae caeteris vero observatione constat quod crebra sanguinis missio homines febri aptiores reddat quare dicitur vulgo quibus sanguis semel detrahitur eos nise quotannis idem faciant in febrem proclives esse I am sorry he should seem to give a reason for a vulgar error for once or twice bleeding doth no more create a Custom or dispose Nature to an anniversary commotion in the blood than one Swallow makes a Summer But certain it is I speak of our cold Climates not of those hotter where sweat and transpiration often prevent those determinate motions of nature that such here as are very much accustomed to bleeding keep certain times for it their bodies will require it at that time and if they refrain it they will feel an oppression and dulness or lassitude and may fall into a Feaver but Aches Rheumatisme Gout are more likely except other accidents concur to produce a Feaver if the ebullition be no greater than to produce a Lassitude 't is possible in some bodies that the Scurvy Cacochymy Cachexy Dropsie Asthmaes Cephalalgyes may ensue for the morbifique ferment like the scum boyled into the broth may mix inseparably with the blood and vitiate for ever that great sanguifier with an unexpressible pravity But he that thinks 't will be so in diseases when the Patient is phlebotomised neither understands the motions of nature nor the effects of a sound recovery Instead of Doctor Willis this illiterate Baconist who professeth to be so well versed in the way called Galenical should have as he argues made his recourse to Avicen and his followers who are in many cases fearful of Phlebotomy least it should produce an ebullition yf choler or crudity which two inconveniencies may produce all that G. T. talks of Thus sometimes Tertians have been doubled nay turned into irrecoverable continual Feavers But all the cases relating thereunto concern not an intelligent Physician who understands what is past present and to come and knows when to presume when to fear But I intend not to teach these fellows it were better for the Nation and them too that they were Coblers or day-labourers than Practitioners in Physick a Doctoral Diploma though purchased will not sufficiently qualifie them for the profession and as little doth the title of Experimental Philosophers and Verulamians avail them The next Argument of his that I come unto and which is more than once inculcated as if he thought it a Demonstration is this as I may form it If it be not fitting nor useful to bleed in the Pest which is a Feaver 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 it is not fitting nor useful to bleed in any ill-conditioned Feaver whatsoever But it is not fitting nor useful to bleed in the Pest. Ergo. The Consequence of the Major is thus proved It is no less criminal to suffer the Blood to spin out in any ill-conditioned Feaver whatsoever then in that which is so 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 And Albeit our Phlebotomists do extenuate the matter setting a fair gloss upon it pretending that in malignant Feavers of the inferiour clast Plethorick or Cacochymical indications do manifestly require their utmost assistance before that inconsiderable venome lying occult I must by their favour be bold to tell them they will never solidly and speedily make a sanation of any great Feaver or any other disease till they handle it in some manner like the Plague for there is quiddam deleterium a certain venenosity in most maladies as I can prove ex facto The Minor is thus proved For whosoever at any time upon what pretence soever of caution attempts Phlebotomy for the cure of the Plague takes a course rashly to jugulate the Patient unless some extraordinary redemption happen Certainly here Doctor Willis who allows to persons accustomed to bleeding and in plethorick bodies the humours being very turgent though seldome and with great caution to bleed speaks by rote for had he Anatomised the Pest investigated the nature of that atrocious stroke as I have feeling the smart of it three several times he would as soon allow of piercing a vein in him who hath taken an intoxicated draught as at any time in this case where the Stomach alone is the place from whence the poyson is to be exulated 'T is no wonder if the Galenists strait injoyn bleeding where they find a seeming soulness in the less malignant Feavers when they dare be tampering with it in the greatest The only noted Sluce through which the poysonous matter of all malignant Feavers passes away is the universal Membrane the Skin on which the Stomach hath no small influence governing this Catholick coat at its pleasure in so much that no successful sweat or eruption can be expected as long as the Duumvirate lies prostrate under any insulting calamity Wherefore the Arch-design of the Physician is to cherish corroborate and remove all impediments of this eminent part that
arbitror patet Sudores statim ab initio febris hujus per vim adeo calidorum medicamentorum evocatos non tam utiles esse quam aliqui putant â—iquidem spiritus evacuantur vires dejiciuntur sanguis agitatur turbatur magisque acuitur febris quod subtile est in sanguine excernitur sicque â—rassior intus relicta materia citius facilius interficit Idcirco magis videtur factum consilium eorum approbandum qui ab his medicinis calidis abstinent sive sudent aegri ab initio sive non sudent Certum namque est Sudorem sponte sub initium morbi prodeuntem diaphoreticum symptomaticum non laudabilem criticum esse Thirdly they argue that since there is such danger least the Patient infected should dye for want of strength before the disease be cured and that above all others the vital indication to preserve the strength ought to be most prevalent with a Physician and regulate him in the administring of his remedies since the regard hereunto makes them to quit their usual course of dyet and even compel their Patients to eat plentifully and drink wine 't is no Helmontian Proposal but transmitted to as from Antiquity they conceive it not fit in the beginning of the Plague to debilitate the sick with a violent and tedious sweat perhaps to be reiterated twice or thrice in twenty four hours whereby the spirits will be extreamly dissipated much more than in Phlebotomy the humours good and bad promiscuously evacuated and the blood and grosser humours which are not exhausted by Sweat and in which commonly the Pest is seated as is manifest from the Botches and Carbuncles continue infected still Sane spiritus per sudores affatim copiose vacuari satis indicant prostratae afflictaeque vires post longum sudorem Crasse inquinati sanguinis nihil aut particulam exiguam educi probant accidentia quae fere omnia fiunt post sudorem deteriora Fourthly Though they do very much commend the intentions of such as would presently and without any delay expel the morbific poyson yet they conceive that where the Plague ariseth from previous evil humours congested in the body by an unseasonable year evil diet or the like that then the case differs much from what it is when it is contracted by a forreign contagion and therefore whatever reasons may be alledged in the last case they cannot admit the Method as universal they do apprehend that in the first case the putridity is incorporated and become as it were innate to the mass of blood and is no more to be eliminated by Sweat then mustiness in drink is exterminated by its working out the yeast Besides they do not perceive that the sick receive such benefit when Nature discharges it self into the Skin by the Spots or Tokens that they should imitate that operation by promoting sweat they are afraid that potent sweats may divert Nature from her usual and intended course or discharging it self into the Glandules and whilest a double evacuation is purposed by the Physician the Patient may find the benefit of neither the sweat being so powerful as to disturb that other motion and the humours in which the venome is incorporated being so gross why else should Nature never take the more facile and expedite way of the Skin but the more difficult of the Glandules as not to be exonerated in that manner Lastly Supposing the Plague to be a venenate disease they do not conceive that all poysons are to be cured one way and that by sweat especially as soon as ever they are taken much more if they be of a Septic nature they do not believe sweating to be the remedy for Arsenic or Lapis infernalis should any take them But if it were yet sometimes there is such a plethoric habit of body and the veins are so distended either naturally or through the febrile agitation of humours that 't is imprudent and dangerous to promote sweat till Phlebotomy be premised for thereby the febrile heat will be mitigated obstructions removed the blood ventilated and capable of a further rarefaction in order to sweat and transpiration promoted and Nature inclined to sweat for bleeding doth not draw in the humours or poyson but carries it out to the circumference as experience doth testifie and consequently is rather subservient unto than opposite to the indication that otâ—eâ—s go upon These are the most solid Objections I have met with upon the subject in which whatever is suggested is not so to be understood as if the Galenists did not know that their Adversaries use or pretend to use Cordial and Alexipharmacal Diaphoretickâ— as on the contrary none but this Baconical G. T. would suppose that when a Galenist speaks of Phlebotomy that he intends to use nothing else Those judicious persons do consider the variety of Pests that some of them are by forreign contagion and seise upon healthy bodies in these they are willing that the venome be eliminated presently by sweat except the Plethoric habit make it necessary to bleed first and then they sweat them afterwards immediately taking all imaginable care for to preserve their strength they also know that in such times as the Patients have been used to an ill diet and debilitated through poverty and misery that in such cases even Galen would not allow bleeding for how requisite soever it may be for the disease such persons cannot bear it They know that some Plagues are attended with little or no Feaver yet attended with symptomes dangerous and mortal in these cases they are for Cordial-Alexipharmacal Diaphoreticks and promote sweat as earnestly as any Helmontian in others the Plague is attended with a Synochus and putrid Feaver in these they divide their cures and regard both the Feaver and the pestilential venome c. according as the strength of the Patient will bear they consider not only his present but future strength they proceed to Phlebotomy sometimes they observe the Plague to be so gentle that the infected can go up and down and feels little or no indisposition in himself in this case they only continue the motion of Nature by mild Alexipharmaca that the Botch or Carbuncle do not strike in again and perform the rest by a sollicitous Chirurgery In fine as there is nothing more rational than all their solicitude in cures so they know that in so desperate a disease there is no course to be left unattempted the way by Alexipharmaca and Sudorifics come from them and is properly theirs but they urge no method generally in any disease almost knowing that the same distemper may be cured several wayes by men proceeding upon contrary indications and yet the Art not violated and in the Plague as they know the great variety thereof in specie individuis so their directions leave us in a great latitude upon emergencies They understand that saying of Celsus Nam quo celerius ejusmodi tempestates corripiunt eo
disease and dangerous symptomes that may insue and then the veins are too much distended to facilitate and secure the operation of subsequent Medicines that are used to evacuate the Antecedent Cause and to maturate and expedite the continent morbifick cause Besides it promotes transpiration incredibly gives a new motion to those humours which together with the blood oppress and indanger the internal and principal parts it diverts them from the head and draws them from the heart lungs stomach and bowels into the habit of the body whereby Nature being alleviated prosecutes her recovery by maturation and expulsion of the peccant depraved matter deducing to its proper state that which is semi-putrid and not irrecoverably vitiated and separating first then exterminating what is incorrigible So the Patient recovers Nor is there any thing more true than this which every Practitioner may daily observe in his practise that Of all the Medicaments which are vsed by Physitians there is not any may compare for its efficacy and utility with Phlebotomy so expedite so facile and so universal is it The universality of its use appears herein that it evacuates the redundant it alters the exorbitant Fluxes of the peccant or deviating humours and blood It relaxeth the vessels and pores of the body and refrigerates the habit thereof And therefore is so absolutely necessary in putrid Feavers that though I do not say they are incurable without it yet I pity the languishing condition of such as omit it the violence of the symptomes being increased thereby and the cure procrastinated to the great trouble and hazard of the sick and his great detriment afterwards for you shall ordinarily meet with a slow convalescence and the blood be so depraved by so long and violent an effervescence that it becomes remediless and degenerates into an evil habit of body Scorbute Dropsie c. This being premised which is more clearly proved by Experience than Reason I answer to his Argument that we do not go about only to refrigerate the Patient but to concoct and eject the morbifick matter that we take the most befitting course to exterminate that spinous offensive cause and as upon the prick of a Thorn if part stick in the wound and be buried therein we proceed to maturate and bring to a paculency the vitiated blood and humours inherent in the part affected and with the suppurated matter draw out the fragment of the Thorn so we do in Feavers where the depraved humours are not so easily separated and extirpated as in the prick of a Thorn maturate and eject the morbifick cause and thereby atchieve the Cure And I do profess my self to concurre with the Ancients in their Opinion that there is a great Analogy betwixt the generation of the Hypostasis in the Vrine after a Feaver and the production of purulent matter in an Apostimation and that Feavers are but a kind of Abscesse in the mass of blood for the proof whereof I do remit my Reader to Ballonius de Hypostasi Vrinarum Amongst the Ancients I find two wayes commonly practised to extinguish this Febrile Heat by a course corresponding with the usual wayes of extinguishing a fire which are 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 by substracting the fewel from it thus they did Phlebotomise at once till the Patient did swoone the other 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 by quenching it thus they gave them cold Water to drink largely until the sick grew pale and fell into a shivering this last was not practised till there were manifest signs of concoction But 't is observable that upon either of these Medicaments they did expect that happy issue that Nature thereupon should presently discharge it self by sundry evacuations of the morbifick matter so that they did not thereby intend bare resignation but the extermination of the concocted febrile matter And thus much may suffice in answer to this Objection The last Objection he makes is this as I shall form it The great Indications of the Galenists for Phlebotomy are either Evacuation of the â—edundant blood in a Plethora or the Revulsion and direct pulling back of what is in flux or flowed into any part already But neither of these Indications are valid and oblige them to that practice Therefore the practise of Phlebotomy is not to be continued As to Phlebotomy in a Plethorick body he thus explodes that It by plenitude be meant an excess of pure blood I absolutely deny there is any such 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 or indication for Phlebotomy for during the goodness of this juyce there must needs be perfect Sanity arising from integrity of all the actions of the body so that it may justly be reputed madness to go about to broach this Balsome of life weakning Nature thereby as long as there is health with abundance of strength Imprimis not andum saith Van Helmont in cap. de febr p. 8. ut nunquam vires peccare possint abundantia ne quidam in Methusalem ita nec bonis sanguis peccat minuitate eo quod vires vitales sanguis sint correlativa i. e. We are to take special notice that too much strength can never be offensive to any yea not to Methusalem no more can any one have too much blood for as much as vital strength and blood are correlatives Well then it is plain that whatsoever sickness seems to indicate Phlebotomy upon the account of an 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 sanguineous superpletion must needs come from an apostate juyce generated by vitious digestions which being hostile to life irritates the Archaeus to frame the Idaea of a disease not as it is meerly provoked by nimiety or plurality but from the pravity of the matter wherefore the case is altered now and the 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 signification or demonstration of evacuating doth in a strait line respect the Crâ—or or Cacochymy directing the Artist to reform mundifie and rid those impurities contained in the seemingly corrupted marred juyce by proper means sequestring the vile from the precious not to let out indistinctly what comes next at randome to the furtive castration of the Eutony lustiness liveliness and strength of the Patient which is to be preferred before all motives whatsoever 'T is certainly known to those who are throughly versed in the Analysis and Synthesis of the parts of bodies that ebullition aestuation effervescence of febrile liquors arising from a pleonasme of degenerate Sal. and Sul. c. as they would have it may be appeased and allayed by Remedies assisting the vitals to make separation and afterwards an exclusion every way of what is reprobate reserving what is acceptable This being performed there is no fear that a plenitude simply of it self can do any harm for hereby so expedite a course is taken that the overplus is in a short time sent packing away by vomiting stool urine expectoration and sweat For this reason considering what strict abstinence the Patient is put upon in a Feaver
't is very unlikely a plenitude should be of any duration Is it not then greater prudence in a Physician to minorate what is superfluous by safe profitable wayes of secretion and excretion still advancing the principal Agent then for that end to give vent indiscreetly to what comes next without any election incommodating if not hazarding the loss of the vital principles For believe it whosoever hath any great quantity of blood taken from him either rues it for the present or hereafter Let him that is heterodox prate what he will alledging examples of those sturdy lusty bodies which have hereby received immediate succour I can make good by practise and challenge any one to come to that otherwise let him forbear his Garrulity whosoever is cured by a Lancet in this sort is either prone to relapses or to live more crazy in his younger or elder years although for some short time he may not by reason of a robust ingrafted constitution be sensible of these inconveniences As for Phlebotomy in order to Revulsion he thus explodes it Another pretended way for sanguâ—â—â—ission is Revulsion by which they say a violent slâ—â—x of morbifick lâ—quâ—r into any noble parts is intercepted for this end they use the Lancet in a Pleuriâ—ie Peripâ—eumony or any inward inflâ—mmation But how far they erre herein is well known to the best Practitioners for although I confess they do sometimes in the beginning suppress and as it were crush the aforesaid diseases yet is it done accidentally very uncertainly rather by way of distraction of the Nature for the loss of its substantial treasure than from any true Revulsion or direct pulling back of what is in flux or already stowed in 'T is true where the vessels are depleted a repletion is forthwith made ob fugam vacui to avoid a vacuity but the supply is from what comes next for as intro as well as intro for as However there is no streight immediate Revulsion intended from the part affected to the Orifice It seems strange to me that any man should pretend thus long to have diligently attended on the practise of Physick and yet never have seen or have the impudence to deny that there can be any such thing as a surcharge of Blood which is that which Physicians call a Plethora or Plenitude But the continuance of these Baconical Philosophers will in time free us from any admiration of this kind In Greece when the Athletae or Wrastlers were publickly maintained the observation indeed was more facile than now but every Countrey almost yields frequent cases of such an indisposition particularly 't is easily to be remarqued in strong healthy and plethorick Children whose sudden death â—s it often ariseth from no other cause so it astonisheth the vulgar and usually raiseth in them suspicions of Witchcraft Hippocrates and Galen having taken notice of the evil consequences attending this habit of body do advise the owner to attempt the change of it though it be accompanied with the most perfect health and vigour imaginable 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 And this habit of body and fulness of blood which he saith would do Methusalem no harm is observed by those who had daily opportunity to see the sad experience of it to abbreviate the life and occasion many diseases as Apoplexies Cardiacal Syncopes and Ruptures of veins in the Lungs Squinancies Pleurisies c. So that Hippocrates condemns that habit of body again in his book De Alimento and Celsus concurs with him therein Ea corpora quae more corum Athletarum repleta sunt celerrime senescunt aegrâ—tant i. e. Those bodies which are dieted and brought up to an Athletick habit do soonest of all decline into sickness and premature old age I never read of any Physician who in his directions for health recommended unto his Patient that course of life wherein the Athletae were bred up thereby to acquire such a Plethoric habit and whatever the present sanity were which they injoyed as to strength of body their intellectuals were very dull and the most understanding persons would have thought it prudential in such a case to broach some of the Balsome of life and weaken Nature thereby rather than to live in a perpetual danger of such perillous diseases as that Euexy subjecteth men unto But our Helmontian doth think otherwise If such an habit of body be thus perillous during perfect health how ought a Physician to apprehend it upon the first approaches of sickness Doth not then Nature add to the redundance of blood by a defective transpiration whereas the veins are so full as not to be able to contain more Is not the pulse weak slow and oppressed and the Heart so debilitated as not to be able to discharge it self of the Blood which flows into it and in danger to stagnate in the Lungs or coagulate in the Ventricles Can there seem any thing more agreeable to common reason in this case than to practise Phlebotomy whereby Nature is at present alleviated the surcharge of blood abated and the imminent dangers prevented Is it not prudential were a little blood so precious a thing and the loss thereof attended with some small irrepairable debility Is it not I say a part of prudence to submit to lesser though certain inconveniences then to run an almost inevitable hazard of the greatest imaginable I read not that the famous Milo arrived to the years of Methusalem nor yet to those of Hippocrates though I am apt to think he was so solicitous for to preserve his strength in its vigour as not to have been much Phlebotomized At the Olympic Games being Victor and going to receive the Garland from the judges he fell down dead suddenly and was thence carried to his Grave It is to be supposed according to our Helmontian that in that Euexy of body something so virulent or odious put the Archaeus into such a fury that it ran mad and destroyed him whereas had it been sublimate or Arsenic it would not have been half so exasperated or hasty 'T is a most humoursome and sensless Kitchin boy that no man knows how to please Suppose that the Brain might be in him a little oppressed with a Vertigo or some petty disorder must this capricious Duumvirate immediately produce the Idaea of no gentler a disease than an Apoplexy or Epilepsy But to pass from these phantastic causes the allegation whereof least becomes an Experimental Philosopher I shall instance in the effects of Bleeding in a Plethora Anton. Benivenius Medicinal observat c. 69. Men commonly attribute much to the Pulse in the discovery of diseases If that be weak low and small they frequently presage death or mortal dangers if it be full and strong they give hopes or assurance of recovery Yet we meet with one Philip a drunken and corpulent fellow who lying sick in his bed I found his Pulse so weak that it was scarce perceivable and I should have
I have blooded my self on purpose two hours after dinner to make the tryal and have an hundred times examined the blood of others who have been blooded at such times as we might expect to see that Phaenomenon of his Yet hath the reality of his observation been confirmed unto me by other credible witnesses so that I question not but he may have seen it though I could not in these Ladies who all dined together about one of the clock and had done bleeding by four Neither may I pass by this Observation that of all the Serum which I have tasted I never found any to be bitter though I extracted some once that seemed so bilious that being put into aâ— Vrinal none could know it from urine highly tinged as soon as I set it on the fire it coagulated with a less heat than I imagine it to have had in the veins and it exchanged its hue for the usual white smelling like a roasted Egg. Yet doth Van der Linden say that some have tasted the blood of Icterical persons and found it bitter Actu nihil naturaliter in sanguine amarum est Sed nec esse potest redderet enim sanguinem ineptum suo muneri ceu observare est in Ictericis In his enim sanguinem amaricare accepimus ab iis qui ipsum vena emissum urinam ejus gustarunt Asclepiadio more And Vesalius gives us an account of one Prosper Martellus a Florentine Gentleman much inclined to and troubled with the Iaundise whose Liver was scirrhous but Spleen sound and his Stomach turgid with choler and wheresoever he opened any of his veins they were full of thick choler and the fluid liquor which was in the Arteries did tinge his hands as if it were choler I find the like Oservation in Th. Kerckringius that an Icterical Woman brought forth a dead Child in the eighth moneth which was so yellow all over that it rather seemed a Statue of such wax than an humane Abortion being dissected By him instead of blood in the veins there was nothing but choler and all the bones were tinged with such a yellow that one would have thought them painted The Scholiast upon Ballonius observed that however the blood is naturally sweet even such as upon obstructions from the Menstrua hath regurgitated and discharged it self at the Gums of women as they have told me yet in one that was troubled with the Green-sickness the blood though florid was salt Potest esse floridus color in se esse acrior biliosior unde quaedam mulier 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 ejusmodi praedita temperamento mihi affirmavit siquando vel ex dentibus sanguis affluit vel e capite eum sibi gustum sentiri salsum molestum When I was at Barbadoes we carried off several poor English thence to Iamaica where many of them falling sick and some being well were let blood I observed that in those poor people which live upon nothing almost but Roots and drink Mobby a liquor made of Potatoes boyl'd and steep'd in water and so fermented that their blood did stream out yellow and in the Porringer did scarce retain any shew of red in the coagulated mass yet are they well and strong but look pale and freckled such persons which are frequent in Barbadoes are called Mobby-faces It were infinite at least beyond my present leisure to relate all that variety of morbid blood which hath been observed in sundry diseases and in several persons languishing under the same distemper as in Pleurisies the Scurvey French-pox Hypochondriacal Melancholy and the like wherein if it be true as it is that oftentimes diseases vary in individuals 't is no less certain that the blood doth also vary in them so that oftentimes ignorant Physicians do imagine a greater corruption in the blood and a greater recess from what is natural to the person and a greater danger in the disease or in the practise of Phlebotomy than they need yet in Epidemical or some Sporadical diseases if the Phaenomena be as general as the disease 't is certain then that the resemblance of the blood argues a resembling cause which prevails over the idiosyncrasy of particulars I know it will be expected that I should say something about the Controversie whether the Blood be one Homogeneous liquor the recrements whereof make up the four Galenical Humours which are no otherwise parts thereof than the Lees and Mothers of Wine are constitutive parts thereof Or whether the four Galenical Humours viz. that which is properly Blood Melancholy Choler and Phlegm are the constitutive parts of the Blood in its natural consistence and Crasis I shall say therefore about this point as much as may be requisite to my present purpose First I observe that the Galenists are at a difference whether the Mass of blood contain those Humours actually or only potentially so that one may hold according to them that the blood is as homogeneous a liquor as any Neoteric doth hold it to be though it arise by the mixture of their five principles Amongst others Erastus hath a disputation in which he amply asserts that all those Humours when they are actually in the blood they become excremenâ—itious and are no longer parts thereof but such as the ejectment thereof depurates and perfects the other remaining blood which he confesâ—eth to consist of several parts constituting one body to which they are as essential as the serous caseous and butyrous part are to Milk which if they be deficient 't is no longer Milk Nam ut non potest lac bubulum intelligi sanum perfectum sine tribus suis partibus sero caseo butyro ita non potest sanguis probus animo concipi definiri absque partium illa varietate Fernelius doth compare the generation of Blood to that of Wine wherein the Chyle is supposed to resemble Must which by fermentation separates and throws out such parts as are not actually in that liquor but arise upon fermentation and are ejected several wayes the more crude parts are by time digested and then the noble wine brought to perfection so he supposeth it to be in the blood and thus though all the humours be at once as it were produced in the Chyle yet are they no more parts of the blood than the Tartar and Mothers are parts of Wine Both these Similitudes of Milk and Wine to Blood were first I think introduced by Galen I am sure he made mention of them and so did his Successours to Mercatus Fernelius Platerus Palleriaca then Carolus Piso began to carry the comparison further in his discourse of Feavers and after him Quercetan and since that our learned and judicious Countrey-man Doctor Willis Others held that the blood as it flows in the veins and is designed by Nature for the Aliment and other uses in man is not to be understood as one liquor consisting of some variety of parts yet united
into one similar body the rest whereof were to be excrements but a more confused Mass of several distinct Alimentary Humours which Nature never intends to unite into one similar body but to continue in a certain more loose mixture each thereof retaining its proper congruity for the continuance of life and health They do confess that there is a pure crimson part sweet and balsomical which they call in rigour Blood but they say Nature never intended this for the sole vital liquor because she never produceth it alone or if it be ever seen so 't is in a morbid condition as in malignant Feavers where the 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 or Blood free from the proportionate mixture of other Humours is reckoned amongst evil signs Qualis sanguis in malignis adurentibusque febribus solet excerni aut e vena tunsa educi And therefore as none of the Humours are ever seen alone any more than Blood is for they hold them all to be excrementitious when separate so they conceive they all together in a certain proportion make up that aggregate called Nutritive Blood and are all actually there because they do observe that all of them at sometimes have their distinct corruptions though they continue still in one mass which they conceive they could not have except they were actually there They do conceive them to be so there that the resemblance betwixt Gall or extravasated Phlegm is but Analogical so that they do not pretend to shew in the Blood a bitter Gall or a pontic arminonious Melancholy They will not allow these to be other than depravations of the Alimentarious Humours and the sincere alimental juyces are no more pretended to be evinced by them then the pure Elements except it be a posteriori by a diversity of effects arguing different causes They saw there was a great latitude in the blood of healthful men yet so as that the blood appeared with different colours and consonant to the colours there seemed a variety in their dispositions and other corporeal qualities they saw the Mass of blood upon perfrigeration to go into several substances and they intellectually disjoyned them more for doctrine-sake obliging themselves to produce each Humour in its imaginary purity when the Chymical fire should exhibite any body not decompounded or the Corpuscularians make more manifest their configurations of Atomes or Texture of Particles Having thus stated the Question with as much perspicuâ—ty as I could I pursue to enquire which is most conformable to the effects in Physick for I will not undertake to determine what God and Nature do in the production or mixture of bodies It is easie for a man to loose himself in those inquiries He that made us can tell how we were made our Argumentations are as vain as if one should assert that a Loaf of bread consisted of Cubes Lozenges or Trapeziums because we can cut it into parts of such a configuration Let us but imagine a subtle Chymist to analyse Chymically our Ale if ever he thereby discover that it is the product of a Barley-corn growing into a stem and grain then turned into Malt grinded boyled with water and fermented I will assent unto the Chymical resolutions of blood Physicians have been alwayes allowed hitherto to be a sort of gross Artisans and I remember Massarias some where calls it an Hippocratical demonstration Indicium autem Curatio To know bodies exquisitely mixed and to mix them intimately is a divine attribute this last is avowed by Galen Miscere corpora tota per tota non Hominis sed Dei Naturae est opus Perhaps it may be replyed that the most ignorant persons may say thus much It is true and if he speak it knowingly I confess I can say no more than he Sed quod dicemus objectioni illi Ignarus aeque ac Philosophus deum causam omnium assignabit Hoc ignarus inscienter Philosophus scienter assignabiâ— quemadmodum Aristoteles ait de Parmenide Melissâ— quemadmodum caecus alicujus tunicam albam esse afâ—erit Nil scimus Dicamus ergo Primarum rerâ—m principiorum aut elementorum cansas reddere nostri non est captus secundarum vero utcunque Id in singulis quaestionibus experiri possumus I say then that notwithstanding any allegations to the contrary it is manifest that a certain proportion of salt sulphur and spirit besides earth and water is neither requisite to perfect sanity nor its defect as to any particular the cause of diseases and this is manifest out of the constitution as well as colour of the blood in morbid and healthy bodies as appears by the burning and distillation of blood There is much of truth that T. T. sayes or may be so Now I am ready to discover in reference to miserable man that the pretended sanguine sulphur or Cacochymy of any in an high Feaver doth afford more salt water and earth each of them than sulphur I have taken that diseased blood termed corrupt which might seem to some to abound with sulphur being clearly conveyed into a Retort with a Receiver joyned thereto I have by a graduated fire regulated very strictly brought over what possibly I could In the upshot upon the separation of the several parts I have found very little sulphur in comparison of each of the rest At another time I procured the purest blood I could get from an healthful person putting it to the same igneous tryal as the former degenerate of equal proportion to it then after sequestration of the parts I could not perceive any considerable difference in the quantity or quality of the several parts of that sound and the seemingly corrupt blood I do say that in the Blood of all persons that are in health there is upon Phlebotomy somewhat that justifieth the supposition of the Galenists but not which confirms the Hypothesis of the Chymists The coagulable serum doth commonly represent their choler in part the florid fluid red their blood which if lightly washed away their is another more darkly-coloured which is proportionate to their Melancholy and if you wash the fibrous mass well it will be white and answerable to their Alimentary Pituita or Phlegm In this last part I have the concurrence of Malpighius who upon washing all the blood from the concrete Mass of blood found the remainder to be a fibrous conâ—texture of a whitish colour which he pitcheth upon as the materials for a Polypus in the Heart And had he taken more particular notice of that fluid blood in the cells of those interwoven fibres he might have discovered two sorts of blood one that readily ascends and is florid the other more black and faeculent which moveth not and both these stain the water they are washed into with different reds the one much brighter than the other That some fibrous concretion in some diseases as Rheumatismes and Plurisieâ— covereth like a pituitous mass the surface of the blood whilest that remains
fluid and bloâ—kish underneath nay I have out of healthful blood in the Spring I am almost convinced that the blood varieth with each quarter of the year cast it up to the surface in just such a mass as covers the top of the blood in those distempers by putting some spirit of Hartshorn into the Porringer before the party bled into it I place the choler in the serum not but that I know that it hath not the taste or consistence of the excrementitious Bile but because it hath frequently the colour of it and the Vrine and Pancreatick juyce not to mention the Lymphaeducts are tinged with it and oftentimes have the Sapor of it I am sure that herein I have the suffrage of Pecquetus thus far that the choler which is separated in the Liver and which tingeth the Vrine is extracted out of the serum of the blood where it circulates first along with it and is percolated out of it in the place aforesaid Et vero nullibi per universas animalium species absque hilis mixtura sanguinem reperius flavescens id serum salsumque testatur nisi forsitan aliquot in suppositis quibus dulcem mitior natura sanguinem concoxit sicut in aliis quibus acciditatis expertem infudit aut nullo prorsus liene instruxit aut sane perexiguo I cite him the more willingly because that If the Galenists seem infatuated for saying the Gall is a constitutive part of the mass of blood whereas they cannot demonstrate signs thereof by its bitterness a great part of the scorn may fall upon Pecquet Backius and Sylvius de le boe and other Neoterics who hold it is incorporated in the Mass of blood But these Controversies can be no better decided than by an Enquiry into the Generation of Blood how that it is at first begun and afterwards continued the knowledge whereof will conduce much not only to the decision of that Question Whether there be in Nature any foundation for those Galenical Humours that they are constitutive parts of the Mass of Alimental Blood But also to the main debate in hand Concerning Phlebotomy There is not anything more mysterious and wonderful in the Vniverse I think then the production of Creatures In so much that Longinus a Paynim doth hereupon take occasion to celebrate the judgment of Moses in that He represented the Creation by a Divine FIAT and God said let there be and it was so The Mechanical production of Animals from so small and tender rudiments out of a resembling substance in all that variety which we see by a necessary result of determinate Matter and Motion is so incomprehensible and impossible that were not this Age full of monstrous Opinions the consequent of Ignorance and Inconsiderateness one would have thought no rational Men much less Christians would have indulged themselves in the promoting and propagating such Tenets 'T is an effect of that Soveraign command that every thing hath its being and faculties Quin nil aliud est Natura quam jussus ille Dei per quem res omnes hoc sunt quod sunt hoc agunt quod agere jussae sunt Hic inquam non aliud quicquam cuique rei suam dedit speciem formam Per hunc non agunt modo pro sua natura hoc est prout preceptum est ipsis res creatae omnes sed per eundem reguntur conservantur propagantur Et nunc etiam quasi creantur This is that which gives a beginning to the Faetus particularly and by unknown wayes contrives the seminal vertue its receptacle or Egg and that colliquament out of which the Body is formed Because the first rudiments of conception are tender and minute such a provision is made in order thereunto that the albuginous substance of ordinary Eggs is no other than what is derived into the female womb And if we may continue the comparison it will seem most rational to imagine that the parts of the whole are contrived at one time though they neither appear all at the same nor in a proportionate bulk for in some their minuteness in others their whiteness and pellucidity conceals them from the Observer But that even then â—â—re are exerted the preludes of those vital operations which are so visible after in Nutrition I doubt not and that as in the Coates of our eyes the minute veins and arteries convey their enclosed liquors though undisernable except in Eyes that are blood-shotten and as in the brain there hath been discovered veins by some drops of blood issuing in dissection though no Eye can see most of the capillary vessels and as even the veins and arteries themselves are thought to be nourished by other arteries and veins rendring them that service which they do to the more visible parts even so it is in the first formation wherein after some progress the vessels begin to appear and blood first discovers it self in the Chorion and thence continues its progress to the punctum saliens or heat and undoubtedly proceeds in its Circle though the smalness of the vessels as in other cases conceal the discovery So that we may imagine that the Plastick form or whatever else men please to call it doth produce the blood out of that albuginous liquor which seems as dissimilar as the blood out of which it is derived though the parts be providentially more subtilised and refined by its own power as it doth the rest through the assistance of warmth and concurrence of the contemporary fabrick for the first blood can neither give a beginning to its self nor is it comprehensible how the weak impulse thereof should shape out all the veins and Arteries in the body according as they are scituated Out of which it is evident that the Soul or Plastick form doth at first reside and principally animate in the Spermatic parts so called not that they are delineated out of the Sperme but out of the Colliquament which is Analogous to it and that they are her first work the blood is but the secundary and generated out of the Colliquament for other Materials there are none by the Plastic form which is the proper efficient thereof and besides the Auxilary Heat theâ—â—â—re no other instrumental aids but the spermatick vessels wherein the Colliquament at first flows to the punctum album which when blood is generated do become the Heart and sanguiferous Channels This is avowed by Doctor Glissen himself Liquor hic vitalis antequam sanguinis ruborem induit sese a reliquis ovi partibus quibus promiscue commiscetur segregare incipit in rivulos seu'rdmificationes quasdum excurrere quae postea venas evadunt Rivuli isti in unum punctum coleuntes in eum locum conveniunt qui postea punctum saliens cor appellatur Idque fieri videtur diu antequam sanguinis aliquod vestigium compareat Herewith agree the most exquisite Observations of Doctor Highmore Most certain it is
this descent of that miscellanes the lacteous vessels do imbibe and convey the Chyle in the shape of Milk to the Receptacle where mixing with the recurring Lympha which is sometimes yellowish it passeth through the Ductus Thoracicus unto the Heart and in the Subclavian vein associating with the Blood it passeth along with it supplying the continual decay of the Blood and yielding Nutriment to the parts and new matter for excrementitious humours yet so as that it is not all transmuted into blood or perfected at one passage through the Heart but by repeated Circulations whereby it comes to loose its lacteous colour and contract a more saline taste as well as a serous limpidity or some more degenerate colour yet it is still coagulable except in a morbid state like to the white of an Egg as the depurated Chyle is It were easie to pursue this discourse so as to demonstrate that neither the separation of the Vrine in the Kidneys nor of the Gall in the Liver nor of the Spittle in the Glandules are other than vital Actions wherein the same form which at first shaped the Body is principal Efficient and that in these Operations there is somewhat more than percolation of corpuscles differently seised But I shall conclude this discourse by accommodating of it to the defence of the Galenical Alimentary Humours supposed to constitute the Blood It is manifest in this History of Sanguification that the Pituitous liquor which is derived into the Mouth by the salival vessels is most agreeable to that which is by the Galenists called Phlegme it is not like the serum in the blood for it is not coagulable as the other 't is insipid and as it makes so considerable â— part of the chyle in the stomach so it may well be presumed to continue its intermixture unto perfect Sanguification As for the Gall as its intermixture in great quantities with the Chyle is undeniable so 't is not improbable that it gives a fluidity to the Chyle beyond what it acquires in the stomach thus Painters to make their colours and oyls more fusile and accommodated to their use do mix Gall therewith That upon the mixture it should loose its bitterness and become sweet and alimentary is most agreeable to the Galenists and no wonder for the sapors as well as colours of liquors are easily altered and 't is manifest that this happens in the descent of the Excrements through the tract of the Intestines and why not in the venae lacteae there are signs of it in the flavidity usually observed in the Arterious blood and 't is remarqued by Judicious Maebius concerning the blood that it is not Homogeneous Habet enim sua stamina nigricantes fibras habet serum salino principio imbutum ad putredinem eludendam habet partem subtiliorem splendente rubore excellentem superâ—iciem in extravasato cruore ambientem Et haec in recessu videtur custodire BILEM ALIMENTAREM flavidine sub insigni rubore abscondita Quae ex rubro nigricant flavedini si misceantur talem splendentem ruborem exhibere cuivis clarum est The bitterness which it hath is produced by the Liver upon its separation there which is not done by meer percolation but an accessional of transmutation there As for Melancholy how much the Pancreatick juyce resembles that when it proves not to be bilious as Veslingius and Virsungus alwayes observed it to be let any man judge by what Regnerus de Graeff hath most ingeniously written thereof besides that the more black part of the blood seems as essential thereunto as the more bright Red. But the Degeneration of the Blood into those Excrementitious Humours seems to evince as muck as the Galenists pretend unto Since every thing is not produced out of every thing but out of determinate matter 't is not incongruous to imagine that in the due constitution of the Blood there is an Analogical difference of Alimentary juyces to make up good Blood since there is such a discrepancy in those depurated from it upon which the Soul by the innate temperament of the parts separating doth so operate that its effects are modified by the nature of the subject matter Hence that variety in the tastes of Vrine which is sometimes so bitter that Gall doth not exceed it sometimes sweet so that Fonseca relates of a Portuguess Peasant who by the sweetness of the Vrine would tell who were infected with the Plague The Gall appeared in great variety to Vesalius Longum sane esset ea que in quibusdam tertiana quartana laborantibus dein suspendio aut capite plexis in furiis mania oppressit obsessis in melancholia morbo effectis ex variis febrium quae continuae fuerunt rigorum sudorâ—m inordinatos circuitus faciebant generibus extinctis faedo ictero eoque vario vexatis malo habitu diu pressis dysenteria cruciatis subinde reperi modo commemorare Sive scilicet hic insignem bilis nunc flammae nunc atramenti quo scribimus in modum atrae sive albicantis propemoâ—um colorem qui fere conterminas partes inficeat sive sluidam aut luti modo aut unguenti cujusdam ex farinis melle terebinthina apparati ritu consistentis substantiam sive varias calculorum effigies sive biliâ— vesiculae molem instar duorum pugnorum ob contenta tumidam sive omnis bilis defectum recenserem Quae omnia me de hujus vesiculae natura adhuc magis quam antea habent solicitum As to the Pancreatick juyce its variety is no less observable So for the Phlegm and Blood it self Having said thus much in behalf of the Ancients against some Dullmen of this Age who laugh at any one that mentions but those Humours I might proceed to demonstrate practically their several motions in diseases and justifie the Medicinal Documents created thereon by such instances as countenance thereunto But the digression would be excessive I return therefore to the principal Discourse and shall from what hath been said erect an Hypothesis concerning Plebotomy which will authenticate the received practise which is so judiciously and happiâ—y followed by all prudent men 1. If it be true that there is so great a Quantity of Blood in the body as I have evinced then may we very well suppose that the loss of a few ounces is no great dammage to the Patient 2. If it be true that so great effusions of Blood have happened to several persons without any subsequent prejudice If it be true that large Phlebotomy even usque ad Lipothymiam hath been succesfully practised then is it evident that our partite and diminute Phlebotomy may be safely continued and that whatsoever ill effects follow thereupon the default is not to be ascribed to Blood-letting but to the indiscretion of him that ignorantly made use of it or the unknown idiosyncracy of the Patient or the over-ruling Providence of God which disappoints
his Patient to alleviate the disease in its course by preventing all troublesome and mitigating all dangerous symptomes and to facilitate as well as hasten his recovery It is not questioned but Patients have been and may be recovered of Feavers with little or no blood-letting yet when I consider the great hazard they run in that course the vexatious and perillous symptomes which they languish under longer and with more violence than others I cannot approve of the practise nor think the Physician dischargeth his duty and a good conscience in so doing Extrema necessitas in moralibus ut certum est vocatur quando est probabile periculum and the Patient doth offend against himself if he refuse to take a befitting course against dangers that probably are impending and the Physician doth trespass against his neighbour if he do not propose and practise such a course I cannot to use the words of the incomparable Riolanus I cannot without pity to the sick and some resentment against the Physician read in Platerus's Observations how sundry of his Patients were broyled and torrefied with burning Feavers whom he never let blood He doth relate of himself how he was sick of a most burning Feaver yet did he never so much as let himself blood therein albeit that it were requisite in those cases Such are not obliged to their Doctors but peculiarly to the Divine Providence for their recovery It was the mature consideration of that tenderness w ch is requisite in Physicians towards their Patients which advanc'd the present course of Physick to its glory above all other Methods it being endeared to our esteem by all those regards that represent it as prudential It was not introduced by chance or the subtlety of some persons but the choice of all and so established by the Magistracy that to transgress against the traditions of this Art was criminal in a Physician even by our Laws It may in some cases seem to be troublesome and unpleasant yet SAFETY requires it It may seem tedious sometimes by multiplication of Medicines yet Prudence obligeth by all those means to preserve and secure life and if the omission thereof be criminal in a Physician in case of any sinister accident why is not the practise laudable Would Men but seriously consider How much danger they run and How much more they suffer upon the negligence or indulgence of a Physician who leaves all to Nature and adviseth them to wear out a distemper they would rather hate than love such a Man and the apprehension they should have for the unnecessary jeopardy he put them on would extenuate his credit very much The most rash and brutish counsels may succeed well but yet the most prudent are to be preferred Amonst Physitians I do not reckon the Helmontian as any there is no doubt but a Plethorick indisposition requires Phlebotomy Nature being surcharged with blood forceth us thereunto least some vein should break in the Lungs or the Patient be strangled with that excess this is called Plethora quoad vasa when the vessels are so full of blood that there is danger of their breaking or that the blood should stagnate in the Heart Lungs or Head there wanting room for its motion or take some inordinate course and so strangle the Patient There is another redundancy of Blood which is called Plethora quoad vires or such a plenitude of blood as brings along with it no apparent hazard of breaking the vessels yet doth it oppress Nature so as thereby to become redundant It is more than she can bear in the present juncture 't is more than she can rule and it will suddenly fall into an exorbitant motion to the detriment of some principal part in case timely prevention be not used In both these cases in which the blood is not supposed to be much depraved from its natural estate all do allow of Phlebotomy and if it be timely put in execution it may hinder the progress however it expedites the cure of the disease In these cases we consider not only the present plenitude but also the future what may be in a few dayes to the great exasperation of the disease and peril of the Patient For it is possible that in the first beginnings of a disease there may be neither of these plenitudes but they may ensue a little after For when the insensible transpiration shall have been a while abated as inquietude pain and watching will abate it the Blood degenerates and no longer continuing its usual depuration those excrementitious particles which were lodged in the habit of the body and pores do remix with the sanguine mass and become like so many fermentative corpuscles agitating and attenuating the blood so that whereas before there was no plenitude now there is that the excrementitious particles do contract a fermenting heterogeneous quality different from what they had in the Blood appears hence that those which sweat much as the new-comers in the Indies their sweat is less noysome and bilious by far than it is in those that sweat more seldome Thus Soot is a different body from any thing that is burned Hence it is that those particles being reimbibed into the blood are so offensive to the nervous parts and introduce a lassitude as if the body were surcharged with a plenitude Besides these two cases in which Phlebotomy seems to be directly indicated by a Plethora or surcharge of blood It is practised in other cases by way of revulsion when the Blood and intermixed Humours flow into any determinate part or are fixed there as in Apoplexies Squinancies and Pleurisies for as upon dissection it is manifest that in such diseases there is a greater efflux of Blood than upon other occasions so it is evident by long experience that Phlebotomy doth alter its course and draw back the blood so as that sometimes after that the first blood hath run more pure and defaecated the subsequent hath been purulent as if the conjunct cause of the Pleurisie or Squinancy had been evacuated thereby In reference to such fluxes of the blood to determinate parts we usually consider what in all probability may happen as well as what is at present urging and therefore for prevention thereof we let blood upon great contusions and wounds It is also practised by way of derivation when we let blood near to the affected part thereby to evacuate part of the imparted matter Thus Van der Heyden did frequently let his Patients blood in the same foot for the Gont Thus in a Squinancy to open the Iugulars it is a derivative Phlebotomy In all these cases all Physicians agree to the received practise but in case that the disease be not meerly sanguine but seem to arise rather from a Cachochymy or redundance of evil humours than any plenitude or exorbitant motion of the Blood here many Physicians cry up that Rule That Plethorick Diseases require Phlebotomy but those that arise from a Cachochymy
is conveyed as it were in conduit-pipes the Heart being the great Elastic Engine which drives it being fed by the vena Cava and disburthening it self by the Aorta though even the motion of the Heart depend upon a Superiour influence by its Nerves which wherein it consists and how derived from the Brain and Soul is a thing to us incomprehensible I do suppose that the Circulation is continued and carried on principally by Anastomoses betwixt the Capillary veins and Arteries many whereof having been discovered by Spigelius Veslingius and others the rest may well be supposed and perhaps in the coats of the Veins and Arteries there may be a certain texture requisite whereby the transpiration is managed in order to the safe continuance of the digestive fermentation in the Blood and the nutrition of the body The impulse of the Heart together with the pulsation is sufficient to convey the blood to the lesser capillary Arteries and there though the pulse be lost which yet a little inflammation in the extremities of the body will make sensible and in some Ladies as also in Children the least preternatural heat yet it is impelled by the subsequent blood still into the veins and having acquired by the common miscele in the Heart and the digestive fermentation which naturally ariseth in such heterogenious liquors an inclination to expand it self the compression in the Capillary vessels adds to its celerity of motion when the larger veins give liberty for it the Aiery corpuscles of several kinds which are easie to be discovered upon burning by their expansion and contraction adding much thereunto Thus in Water-engines the narrowness of the â—ipes do add to the impetus with which the Water issues forth And I do conceive by the Phaenomena which daily appears in practise that the Animal heat in the Blood actuating that heterogeneous miscele and according to the diversity of its parts producing therein with the help of its fermentation a rarefaction of what is aiery and according to the room there is a liberty or inclination to expand and evaporate themselves this is the principal cause of the continuance of the motion of the blood in the veins and of its saliency upon Phlebotomy Thus upon Scarification there is no salience or spurting out of the blood there being no room for such an expansion or for the Aiery halituous parts in which there is as great a difference as in those exhaling from the terraqueous Globe to rush forward out of the continued Arteries and together with themselves to protrude the blood Upon this account the Methodists and old Physicians as also the Aegyptians where the tender bodies and constitutions of Children and Women or Men admit not of or requireth that great relaxation of the pores and texture of the body which a more robust and firm habit wherein as the natural resistance in health is greater so the recess from it in a bad estate is much greater would be cured by they use these Scarifications and prefer them most judiciously to Phlebotomy This constitution of the Body doth evince the great utility of Phlebotomy and best as I suppose explicates the effects thereof which we daily experiment From hence not only is manifest how the Body is evacuated in a Plethora but in case of Revulsion and Derivation It is manifest in Aqueducts and Siphons that the liquors though much differing in nature from the Blood nor so inclined to evaporate does accelerate their motion and issue out so rapidly upon an incision or fracture in one of the Pipes that a lesser in such a case will deplete the greater notwithstanding its free passage in its own entire Canale Thus the most learned and considerate Physician Sir George Ent having observed first thus much Videmus aquam per siphones delatam si vel minima rimula hiscat foras cum impetu prorumpere And Sanguis per aortam ingressus fluit porro quocunque permittitur peraeque sursum ac deorsum quia motus continuus est quemadmodum in canalibus aquam deferentibus contingit in quibus quocunque feruntur aqua continuo pergit moveri Quare nugantur strenue qui protrusionem hujusmodinon nisi in recta linea fieri posse arbitrâ—ntur After this He explains the doctrine of Revulsion in this manner Quae postea de revulsionibus dicuntur nullum nobis facessunt negotium â—antundem enim sanguinis a pedibus ascendit per venas quantum ad eosdam delabitur per Arterias Facto itaque vulnere in pectore aut capite revulsio instituitur si modo tam longinqua instituenda sit in â—rure Quia sanguis alias quoquoversum ruens facto nunc in pede egressu copiosius per descendentem ramum procul a vulnere delabitur Non enim arbitramur sanguinem aeque celeriter sua sponte per arteriam aut venam fluere atque is secta earum aliquo effluit Nec sanguis ad laesum pectus aut caput per venam cavam impetu affluit quia fluxus ille aperta inferius vena intercipitur I do acknowledge that the reading of these passages did first create in me the thoughts I now impart unto you And hereby it is evident how the Ancients with their large Phlebotomies might derive even the morbifick matter or revell it though impacted Our minute Phlebotomies do seldom produce such an effect for since it is not otherwise done but by a successive depletion out of the Arteries it would seem necessary to extract three or four pounds of Blood to effect such a matter Neither indeed is it necessary albeit that I believe the most speedy cures but great judgment is requisite in such operations were atchieved thereby for though we do not retract the Humour or Blood unto the place where we Phlebotomise we do revell it from the place whither it was flowing and the course of the Blood and Humours being diverted the Arteries leading to the part affected or depleted and the Flux of Humors which was by them is abated their tenseness there which appears by their pulsation there where they did not beat before is relaxed and so becomes less opportune to extravasate either the Blood or other Humours whereupon Nature it self alone or with a little help of the Physician doth digest and dissipate the impacted matter Whereupon if we add the motion of restitution in the parts affected which is hereby facilitated the great change in the digestive fermentation of the Blood which is manifest by the melioration of the Blood which is seen in repeated Phlebotomies and the relaxation of the whole body in order to the transpiration and other depuration of the Blood by its several Glandules the Kidneys Liver Guts the reason of those prodigious benefits which Patients have had of old and now under our practise is manifest nor do we want a justification for reiterating Phlebotomy or exercising it in different veins and divers manners I designed long ago to set aside some spare
in visceribus aut sanguinis exundantia in vasis quare primo statim morbi insultu deinda erit opera ut evacuatio per vomitum aut sedem si opus fuerit tempestive procuretur pharmacis tantum mitioribus blandis utendum est quae nimirum non irritent aut humores perturbent quare hoc tempore interdum emetica purgantia aut enemata modo haec modo ista locum habent etiam sanguinis missio si plethora adsit bono cum successu celebratur Circa missionem sanguinis instante variolarum eruptione valde ambigitur olim inter nostrates haec res sacra audiebat neque sub ullo necessitatis praetextu Phlebotomia admitti solebat nuper autem experientia duce in quibusdam casibus sanguinem mitti omnino utile necessarium esse comprobatur quae tamen evacuatio si in quavis constitutione indiscriminatur adhibeatur aut quando isthac opus fuerit in quantitate nimis larga peragatur magna saepe incommoda exinde sequuntur These are the words of that intelligent person whereas G. T. seems in the English Text to affix upon him such a sentiment as if he allowed commonly and indiscriminately of Phlebotomy in the very nick of the coming out of the small Pox But it may be replied that he hath done the Doctor justice in the Latine citation but I think not amongst English Readers nor in his vulgar discourses However I shall endeavour to justifie the aforesaid Method of Doctor Willis as Artificial and agreeable to the opinion and happy practise of the best Physicians and that it may be more manifest I will inlarge my work by examining the contrary opinions of some others for G. T. gives my Pen here no employment except it be to tell him that the three noble Personages which he speaks of were not the Doctors Patients as I believe except he be accountable for all that act agreeably to that Method which He and our best Physicians layes down I add that many Actions are warrantable by Art and Prudence which are not successful and to requite his Catalogue I would have him know that when this young King of Spain had the Small Pox he was let blood several times and so was the present Queen of France upon a feaverish indisposition let blood twice in 1663. and two dayes after the Measil◠appeared And this Lewis xiv being sick of the malignant and pestilential Small Pox was thrice blooded by Doctor Vautier and for it received this Elogy from the learned Iacobus Thevart Vt boni omnes Galli palam profiteantur ac praedicent suum se tibi debere Regem charissimum quem nempe malignis ac pestilentibus variolis periculosissime laborantem non cordiacis tantum praesidiis ut Medicastrorum 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 vulgus solet sed ipsa quam in ejusmodi affectibus aversantur ac damnant sanguinis missione ter pro symptomatum urgentium necessitate repetita salvum incolumen restituiste innumeris interim in hac urbe populo sissima pueris hac Epidemica lue e medio sublatis Quod ob facinus tam egregium quae non tibi laudes vir praestantissime quae non soteria debentur Si qui civem Romanum in praelio servaverat quercea corona dignus habitus est Tu certe qui Regem Christianissimum ab hoste tam infenso liberasti auream qualis est ab Atheniensibus Hippocrati concessa meruisti Nec dubito quin si vixisses priscis illis temporibus quibus inter Heroas referebantur quicunque insigni aliquo facinore Rempublicam conservassent adjuvissentve quin inquam ipse Heroum auxisses numerum honoresque prope divinos accepisses I repeat this passage with the more satisfaction because it may serve as example to the English and instruct them with what gratitude and acknowledgments they ought to treat the learned and renowned Physician Sir Alexander Frasier principal Physician to his Majesty for recovering our most gracious Soveraign of the like distemper by the judicious administration of Phlebotomy I could name many other Persons of Honour who do confess that they owe their recovery out of dangerous and malignant Small Pox unto Phlebotomy Of those that have written concerning the Small Pox and are therein professed enemies to Bleeding I shall take only two particularly to task the one is Doctor Tobias Whitaker the other Doctor Thomas Sydenham which I do the more willingly because the one writing in English the other practising at London and endeavouring to insinuate his principles every where with a derogation from the authorised practise of Physicians it must needs seem that all who do not take his course have neither regard to the Patients nor considered seriously the rise and progress of the disease I did at first doubt Whether I ought to reckon them as Distinct Authors because they so for agree in the Regimen and Cure of the disease that the one doth seem to have stollen it from the other As will appear by this Parallel Doctor T. Whitaker of the Cure of the Small Pox p. 22. In the Regimen of this Disease the whole work consists in moderation of Air and Diet without any other mixtures of violence or bland impediments which may altogether pervert or in or by a less force retard Nature in its motion the motion of Nature in this case being from the beginning of the disease to the eruption of the pustules Critical and in Critical motions the least application of any Medicament is so dangerous that no expert Physician will admit of it The Diet is to be Alimentum medicamento sum such as is Milk with Saffron and Marigold flowers Doctor Sydenham doth suppose that it is natural for the Blood of all persons at least once in their lives to undergo a great change and as it were a new form and that there is no peculiar venome or malignity infecting the Blood but all is the result of this inclination in it to exchange its state and in order thereunto some parts are to be expelled and in order thereunto must first be separated This is done by a Feaverish Ebullition in the mass of blood whereby those parts are separated from the residue and discharged into fleshy parts of the Body which Nature looks as requisite in order to the change she is going to make All this is usually done in four dayes and the Blood is recomposed and becomes as calm in its motion as it was before The expelled matter is to be elevated into pustulary abscesses and there maturated and dryed up For the carrying on of all this work it is his judgment that the Physician ought to do nothing But the Patient is to be kept in a moderate heat and temperate diet taking nothing that is cold and not so much as being confined to his bed beyond his ordinary use except necessity require it and then he is to use no more clothes nor warmth than he accustomed himself unto in
quae licet aliquo modo possint convenire non subinde sunt ita secura certa quod eis prorsus fidendum sit i. e. Concerning Blood-letting no man ever did doubt thereof or if he did he did it without any reason except the Patient were so weak that he could not endure it without greater hazards or that the disease were so mild and benign that it seemed better to leave all to the strength of Nature without debilitating any way the sick person or the redundance of blood and peccant humours so inconsiderable that the Cure might be wrought by a diligent attendance and well-ordered diet without employing any of those Remedies which how convenient or safe soever yet according to that fate which disposeth of all humane affairs may sometimes have an evil issue and are not therefore needlesly to be presumed upon In Portugal I find Rodericus a Fonseca to approve of Phlebotomy in this disease As also Stephanus Rodericus Castrensis avoweth its utility upon his own Experience I might add others but that this is the general practise of Spain is so indisputable that I should but abuse the patience of my Reader I now come to Germany and Denmark where the most learned and the most eminent Physicians that we hear of have admitted of this Remedy The beneficialness thereof was experimented by that famed Practitioner Forrestus Solet enim mirifice prodesse in hoc affectu hoc auxilii genus modo tamen fiat in principio antequam morbilli aut variolae egrediantur i. e. It is usually of marvellous benefit to the Patient if he bleed before the Small Pox or Measils do come forth Whereupon he did ordinarily begin his Cures therewith and saith that undeniably it ought to be so if all requisite circumstances concurre Felix Platerus a man of principal esteem in Switzerland and Germany recommends it to our practise Sanguinis detractio per venae sectionem in brachio facta ab initio si Synochi hae sunt febres cu juscunque generis ad sanguinis accensi vel simul putridi vel maligni etiam portionem educendam causamque sic minuendam in adultis plurimnm competet Quae infantibus majoribus cum in minoribus natu non liceat non inutiliter administraretur Quae tamen si jam maculae pustulae eruperint ne naturae motus impediatur omittenda erit i. e. Bleeding in the Arm when it is practised in the beginning if the Feaver be any kind of Synochus arising from the inflammation of the mass of blood or its being putrefied or vitiated by any malignity will be of great benefit to those that are of Age to lessen the morbific matter and abate the violence of the cause of the distemper It might also be done to Children of some bigness not to little ones may be profitably But if the Pox be coming forth it is to be forborn least it cause them to retire in Neither is it a common Elogy for this practise that Gregorius Horstius commends and justifies it And his learned Son Io. Daniel Horstius asserts the the judgment of his Father As cautelous as Sennertus would seem he only doubts concerning Phlebotomy in Children not in others Si tamen in aetate quae venae sectionem perferre possit sanguinis abundantia venae sectionem postulet mox in principio ante quartum diem aut sane prius quam variolaeâ—erumpant dum vires adhuc constant sanguinis tanta copia ad ambitum corporis consâ—uxit vena aperienda ut natura oneris parte levata quodreliquuum est facilius vincere possit Post quartum autem diem ubi maculae erumpere incipiunt abstinendum a venae sectione inprimis si jam aeger melius habere incipiat ne materia ad ambitum corporis tendens ad interiora revocetur i. e. But if the Age of the Patient be such as to be able to endure Phlebotomy and the redundance of blood be such as to make that Remedy necessary a Uein must be opened before the fourth day and whilest yet the Small Pox are not come forth the strength not being yet impaired and the blood so immoderately discharging it self upon the exteriour parts of the body that hereby Nature being disburthened of a part of what molested her may the more easily concoct and subdue the rest But after the fourth day and when they begin to come forth Phlebotomy is not to be used especially if the Patient seem alleviated least thereupon the matter be drawn back which was hastening unto and fixed in the habit of the body To these may be added Baldasser Timaeus Physician to the Elector of Brandenburgh who after thirty six years of practise approved this course and I. Petrus Lotichus as also the younger Sebizius now Professour at Iena and I. Christianus Frommanus a Physician in Saxony and Franciscus Ioel In Denmark I find Bartholinus to be resolute for it before the Small Pox do come out and if they do not come forth kindly but that symptomes of an evil presage multiply upon the Patient he allows a minute bleeding then and sayes many have been happily recovered by these means And so much for Germany In England the paucity of our Writers upon this subject gives me no opportunity to defend Doctor Willis by the citation of any Book 't is enough that since the original and first records of the Disease no other Method than what he pursues hath been commonly proposed that the generality of the world the wisest of Physicians the most able and judicious of our Professors principled by Avicenna do approve thereof 't is not bare complyance with the Mode of France but the Dictates of Reason confirmed by a prosperous success in several to my knowledge I would fain see any man justifie the Rhodomontade of Doctor Whitaker by producing ten Physicians that reject Phlebotomy I remember none but Fracastorius Langius Rolfinckius and Densingius and one or two more and a company of old Wives and Nurses I never yet Phlebotomised any yet 't was because I either had no exigency for it or the Patients were too timorous to admit of it But were my own life concerned I would undergo it and I hope the Baconical Philosophers have not so irrecoverably infatuated this Nation but that we may come to be undeceived in this point as well as we have been in others Although it be not my intention to write an intire Tract about the Small Pox yet that I may demonstrate the Rationableness of their procedure who do let blood in the Small Pox 't is necessary that I acquaint my Reader with those cases wherein they do apprehend themselves obliged to act as they do In the cure of the Small Pox whensoever a Physician employes his thoughts about Phlebotomy he considers the Feaver which attends it and the dangers into which the Patient is likely to fall and the strength he hath to bear them not to
subsequent cure No man can in reason doubt but the best and most direct means to moderate the primary Feaver is to begin betimes for then the distemper is less violent and Nature least debilitated What we are to do then the course of the Disease best teacheth us in which the most enormous vomitings are so far from doing hurt that they are beneficial to the sick It is therefore manifest that a Physician who is to imitate Nature may in the beginning as he sees occasion and upon due pondering of all circumstances◠administer a vomit for it is neither repugnant but congruous to any of those primary Feavers nor contraindicated by the Associate For hereby those excrementitious humours are evacuated which would otherwise in the progress of the disease add to the distemper producing Phrensies Sopors or other malignant symptomes also part of the super-abundant turgent matter is exhausted and the Lungs who are frequently endangered by a Catarrh in the beginning are disburthened as also the eruption of the Small Pox is facilitated Vomits being alwayes held by the Methodists amongst those Medicaments which principally relax the habit of the body In case that there appear urgent Reasons against a Vomit the next thing under consideration is a Minorative purge whereby the Stomach and Intestines being cleansed and part of the Morbifick matter discharged from the Head Lungs and mass of Blood Nature will be better able to overcome and regulate what remains And herein the Physician is guided by Nature which oftentimes alleviates the Patient by a slight Diarrhaea before the Small Pox do come forth Nor is there any danger in such fluxes as our Practitioners observe Si Diarrhaea fuerit in principio non nocebit And most of them allow a gentle befitting purge in the beginning of this Disease not doubting thereby but to make the subsequent course of it to be more benign and safe for the most turgent urgent bilious and accrimonious humors being carried off together with the promiscuous faeculencies of the Intestines 't is not easie to be imagined that any dangerous malignity can reside in the pustules or any dysentery or flux ensue in the state or declination of the Disease at what time it is extreamly perillous I shall not inlarge upon this subject further it not being my present intention but refer my Reader for his more particular instruction to Horatius Augenius Ranchinus Gregorius Horstius Sennertus and Riverius and if he desire Experiments for the happy use of Vomits and Purges and evidence that they do not retract the humors from the circumference to the center Alas 't is not the time of their separation or motion that way or impede their eruption let him consult Angelus Sala and Forrestus I come now to the practise of Phlebotomy about which sundry Questions arise As Whether it may be `administred in the beginng of the Disease and After the Pox come forth In the State and Declination In all which times I do assert that there may happen such circumstances as may make it necessary But in the beginning I think it may frequently be done with great convenience 1. In the beginning of this Disease that which urgeth is the Feaver and its symptomes which if it be so violent that the Patient may be indangered before the Small Pox do come forth or so debilitated that Nature may not be able to command them and concoct them by reason of their multitude or virulency which the extremity of the Feaver as well as habitual cacochymy or the adventitious malignity may create 't is prudence in the beginning to prevent those perils which in a stort space will become remediless If the body be Plethorical with either sort of plenitude 't is indubitably requisite to bleed and our case here is like to those cases which possess the Brewers or Vintners who whilest they attend diligently to the depuration and fermentation of their liquors employ a part of their thoughts upon the preservation of the Cask least it break Nor is the present plenitude only to be considered but the future which will happen upon the increase of the ebullition and attenuation of the blood together with the defective transpiration which alwayes abates proportionably to the greatness of the Feaver and in case any peril threaten from the violence of the Feaver there doth not appear any more ready course in such as are 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 or in the beginning are at their height perhaps there is no other then to let blood whereby the redundancy is diminished the course of the blood diverted from circulating or stagnating in the inward vessels the habit and texture of the body changed in order to the more facile expulsion of the Small Pox and transpiration promoted then which nothing contributes more to the alleviation of the first and precaution of any subsequent Feaver and malignant putrefaction of the Humors in the Pustules Quoties cunque enim corpus ventilaturi nullo modo transpiratio prohibetur facile putridae fuligines per poros exhalantur nec cordi communicantur neque proin sequitur ulla febris unica enim causa legitima immediata febris est prohibita transpiratio uti etiam illis qui a limine salutarunt Medicinam notum est i. e. Whensoever the blood is well ventilated and insensible transpiration free whatever noxious and venenate vapours are contained in the body which might otherwise fly up to the head and cause incurable Phrensies deadly Sopors and Epileptick fits or create Lipothymies in the Heart or difficulty of breathing which is a mortal sign in this Disease in the Lungs or a Diarrhaea and Dysentery in the Intestines or a virulency in the suppurating Pustules and corrode even the bones and ligaments these vapours exhale by the opened dores and the Feaver abates for any one that knows never so little in Physick understands that the sole legitimate and immediate cause of Feavers is prohibited transpiration From what hath been said it is evident that of all Remedies Phlebotomy is the most important in the Small Pox in the first beginning whether the Feaver be a simple Synochus or one that is putrid and malignant and 't is more a wonder that any man should oppose the due administration of it then that all Europe in a manner should agree to the practise thereof Neither is it only to be administred to allay the plenitude which generall occurs in this Malady or to prevent the evils forementioned but frequently for revulsion when the malignant matter begins to affect the Brain Stomach Lungs Intestines For if during the Feaver the Humors seise upon those parts with any violence the Patient is in apparent danger of death there being no way to prevent the suppuration there and little hopes that the Patient will survive the distemper or if he do escape a Consumption or Dropsie afterwards Sunt aliae ita malignae ut non solum carnosum genus adoriantur
percepissem quamvis neque etiam morbi â—emissionem sequenti die tantundem ex altero brachio exhanriri imperitaâ—i quae solo praesidio dei non â—â—nouento â—ot â—nâ— virulentiam e corpore emisi breviâ—â—r me a tetrica pâ—sie expediri atque hostem jugulum petentem plumbeo ut dicunt gladio jugulavi quod salutare Medicamentum plurimi postea adhibentes atque mea vestigia sequentes scilicet sanguinis missionem celebrantes vere e mortis faucibus erepti vindicati sunt In the account of the Small Pox I omitted the opinion of Franciscus Oswaldus Grembs a German Physician of good note and great admirer of Van Helmont who yet allows of bleeding in some cases in the Small Pox. His words are these Fr. Oswaldus Grembs Arbor hominis integra ruinosa l. 2. c. 3. de febr malign The danger of the Small Pox doth consist in two cases First if Nature move the hot and vitious humors and is not able through debility or their tenaciousness or the dense habit of the body to expel them and then the Disease becomes deadly the humours recurring upon the Heart and Vitals Secondly if Nature do protrude them forth and is not afterwards able to regulate them by reason of their multitude or malignity but that the Feaver becomes more malignant then at first and either dispatcheth the sick or destroyes some particular parts with a most faetid corruption therof There are four Indications for the cure of the Small Pox The first is to evacuate what is redundant The second is to prosecute the emotions of Nature The third is to restrain the venenateness of the Disease The fourth is to secure some particular parts And because the Feaver which goes along with the Small Pox is a Synochus it requires Phlebotomy here is no room for purging In Children Scarification in the Armes calf of the Leg and Nostrils or Horse leeches applyed to the Back Breech or Thighs may be used instead of venaesection when the Small Pox do not come forth If the Pox do come forth kindly in the beginning none of these things are to be practised In grown people a minute Phlebotomy is to be practised after the first or second day only when the Humors are protruded 't is dangerous for it draws in the Humours except some new accident as a Pleurisie does render it necessary When they are coming forth Nature is to be aided with Frictions and Alexipharmacal Cordials as Bezoar Vnicorns-horn Electuarium de Gemmis c. A noble Lady of the age of fourteen years fell sick and bled at the Nose she had a nauseousness at Stomach and great pains in her back the Physicians being sent for a Clyster was proposed of Broth with Cassia it came away without any operation her pains and Feaver increased and certain spots appeared behind her Ears which portended the Small Pox one of the Physicians commended Blood letting as the most suitable remedy for a great disease and not inconsistent with her years and strength especially since she was plethorical hereby he said the blood being diminished the vessels would be less distended the malignity repressed and pains mitigated But so it happens frequently that we cannot embrace the most obvious counsils whether it be an imbecillity in our minds which being distracted betwixt hope and fear and sollicitous about the future forgets the present urgency or whether it be the method of Providence which to effect its designs transports us besides our selves The rest of the Physicians seemed astonished at the proposal and neither assenting nor dissenting proceeded only to insinuate the peril of that operation But that they might seem to do something they proposed an anodyne Fomentation to mitigate her pains which having continued ten hours produced no benefit The ensuing night she was very restless and on the morning her strength began to be sensibly impaired thereat the Physicians were much troubled and considering the present exigency they gave her a Cordial of Bezoar and the species de Hyacintho it was not given sooner because there was amongst the number one who was extreamly averse from giving any Cordials in the Small Pox to bring them forth as if thereby the humours were exasperated the ebullition rendered too violent and the Pustules protruded in so great an excess as to strangle the Patient he said that Nature understood her own work and could do it best that she was to be left to her self and needed no incentives And by these suggestions he intrigrued the determinations of the Physicians so as that no Cordial or Alexipharmacon was given sooner The Patient having taken some of the aforesaid Cordial and afterwards avoided a great deal of blood by Urine which yet some suspected to be a Menstruous excretion a little after she vomited up a great deal of blood this same took to be a Critical effort of Nature which had alleviated the violent ebullition of the blood in the greater vessels by discharging a part thereof at the Mouth and ordinary passages in the mean space the malignity of the Disease prevailed above the strength of Nature the whole mass of blood being vitiated and 't was a miserable sight to behold the poor Lady as it were drowned in her own blood and thus destroyed all her back was full of large livid setlings of blood as if she had been bruised or whipped with cords and being dead her body was opened on the same day all her Bowels were sound the Liver in no default only the Lungs were blackish through the adustion of the blood in the Disease And now the Physicians quarrelled one with another one blamed the Clyster which impeded the course of Nature and retracted the humours inwards whose tendency was to the habit of the body Others censured the Fomentation which though anodyne might close the Pores and give occasion to the bloody urine by repercussion of the pustulary matter Thus one Physician inveighed against the errors of the rest whilest indeed all of them ought privately to confess that their great failour was in omitting Phlebotomy and that this was the cause of her death Thus Physicians oftentimes occasion the death of their Patients by not doing what they should and not only by over-acting this last is the default of those who attend on the sick and first try their own pretended Experiments then have recourse to the receipts of the populace or prescriptions of some practising Ladies and thus by doing what they ought not they most officiously kill the sick and prevent the seasonable advise of wise Physicians who ought to have been consulted at first These kind of persons are in as much default as those timorous and cautelous Doctors who dare not administer those Remedies which are necessary in acute diseases but by neglecting their Patients suffer the Disease to prevail over the vital faculties and kill the infirm Thus far the Helmontian but to give him his due judicious Practitioner and I recommend this
AN EPISTOLARY DISCOURSE CONCERNING Phlebotomy In Opposition to G. Thomson Pseudo-Chymist a pretended Disciple of the Lord VERVLAM Wherein the Nature of the Blood and the effects of Blood-letting are enquired into and the practice thereof EXPERIMENTALLY justified according as it is used by Iudicious Physicians In the Pest and Pestilential diseases In the Small Pox In the Scurvey In Pleurisies And in several other diseases By HENRY STVBBE Physician in Warwick Hippocrat l. 1. Aph. 2. VASORVM inanitio si talis fiat qualis fieri debet confert bene tolerant sin minus contra Inspicere itaque oportet regionem tempus aetatem morbos in quibus conveniat aut non Printed in the Year MDCLXXI SIR IN obedience to your Commands I have read over the Treatise of Thomson concerning Blood-letting I never underwent a more difficult task in my life And had the Virtuosi imagined with what reluctancy and constraint I should undertake such a work they would have abandoned all their other stratagems and imposed on me this pennance as the most severe I profess I am not so understanding in the Greek Latine or English Tongues as to comprehend his Language yet I think I am not so much in default therein as He who according to the peculiar fate of the modern Baconists hath either out-lived his Learning or never was endued with any That He should pretend to read or understand Hippocrates is a vanity equal to that with which Ecebolius professeth himself to be versed in the writings of Aristotle and when he blames the Method which the Galenists have used above this sixteen hundred years would not one imagine that the birth and flourishing renown of Galen had preceded those Centuries whereas you must place him in the second Century during the Reign of Marcus Aurelius Commodus Pertinax and Severus or you will contradict the account which Galen gives of himself and the relations of other Historians and at such time as he arose the world was prepossessed with Methodists and Empiricks But I wish his greatest errours lay in his ignorance of these things Alas he understands not any thing of the Rudiments of Physick and to inform him one must write an entire Body of Physick Were it not for a few hard words borrowed from Van Helmont such as Enormon Archaeus Daumvirate c. and his extravagancies about fortifying the vitâ—l spirits ejecting the venome or spina in diseases and that by a diaephoresis generally by the means of certain Arcana more famous for the death than recovery of his patients the man would have nothing to say And do we wonder at the unfortunate cures for which he is blamed or that more than one at White-chappel should suffer by his ill-advised Pepper-drops 'T were strange should one that neither understands humane nature nor the types times motions and terminations of diseases should ever except by accident do any good not that He should frequently do harm But a fool may commit more faults than a wiser man than I and of more leisure can discover I shall confine my present address to the point of Phlebotomy wherein he so traduceth the Hippocratical Physicians as so many murtherers and particularly declaimeth against the most judicious Assembly of our Faculty that Europe ever beheld and who if they be culpable are mis-led by the practice and precepts of that Author Hippocrates whom he himself often cites and to less purpose than I might in this controversie alledge him Some years since I designed to write an enquiry into the original and nature of the Blood and the usefulness of Phlebotomy in several diseases in which abstracting from the single opinions of Writers I purposed to illustrate each point by practical principles and ample Histories out of intelligent and creditable Physicians concerning the bad or good success with which Blood hath been let in diseases according to the several Ages of the disâ—ased and the nature of their maladies whether Epidemical Sporadical or of a less general constitution But the Controversies I have been involved in have so incumbred me that I have not been able to pursue thâ—se intentions nor have I any preparations almost in order thereunto as yet digested into writing But this Antagonist requires not all my strength a less powerful Assault will suffice to overthrow Him 'T is not any kindness to him but indulgence to my self that I do not pursue all his errours even in the generation of blood or go about to convince him of the several mistakes which he is fallen into for want of reading more modern Writers and their discoveries Beyond Helmont or in contradiction to him the man neither does nor will understand any thing And even in that Author he seems so little conversant that he sometimes mistakes him and generally represents things with more obscurity and intricacy then they are expressed in the originals of Van Helmont or Grembs Of those that have opposed Phlebotomy these are not the first which this Century hath produced long ago Galen complained of Erasistratus the sisters son of Aristotle that he was 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 fearful to let his Patients blood before him Chrysippus Cnidius Medius and Aristogenes did reject the usage Also Apaemantes together with Strato are recorded to have contradicted the practice of Phlebotomy by Arguments The strength of that faction in Physick was such at Rome in those times that Galen spent several books against the followers of Erasistratus upon this subject But above all that ever intermedled I will give this character to Thomson that never did any presume more upon so weak grounds Nor ever was Confidence so poorly mounted and so pittifully be-jaded After much trouble and enquiry the sum of all he sayes in this case amounts to this The promiscuous mass of Bloud which flows in the Veins and Arteries he divides into three parts the one is called by him the Latex the second Cruor the third Sanguis or most properly Blood The Latex so called by Helmont by some Lympha by the Greeks 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 is a diaphanous clear liquor 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 fabricated in the second digestioâ— by virtue of a ferment there residing It is the inseperable companion of the Bloud and closely perambulates with it through all the wandring Maeandrous pipes in this Microcosme It is the matter of Vrine and Sweat Spittle c. and renders several other considerable services to the body The goodness or pravity of the Latex depends much upon the bloud as it is constituted for albeit it is no essential part thereof yet is it altered for better or worse according to the channels it passeth through the lodging it taketh up and the condition of its associate notwithstanding that it may be sometimes impaired in its due excellency and the bloud withall remain very pure and sincere The second part is called Cruor from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 i. e. Crudus
concretus It is the more crude impure part of the bloud the purer part of the chyle being digested into a saline juyce is carried into the milky vessels and veins and mingling at last with that ruddy liquor is called Cruor and at last becomes perfect bloud It undergoes manifold guises and is often the subject matter of a multitude of diseases being sometimes changed into an Ichor Tabum or Sanies The third part is properly called Sanguis or Bloud 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 it is a most pure sweet Homogeneous Balsamie Vital juyce for the most part of a bright Red or Reddish colour made by the Archaeus by virtue of ferments implanted in the ventricles of the heart lungs veins and arteries causing a formal transmutation of the Ckyme or milky substance into this sanguineous liquor ordained to be the seat of Life and and the principal matter for sense motion nutrition accretion and generation It is for good reason called Balsamum seu Condimentum totius corporis forasmuch as it hath a sanative power sweetly uniting all the parts of the body for the conspiration of the good of the whole It is a great preservative against putrefaction as long as it remains in its integrity for consisting of many saline particles it seasoneth whatsoever it toucheth with a pleasing sapour It is the proper habitation of the vital spirit the immediate instrument of the soul in which it shines displaying its radiant beams every way that sensation motion nutrition and all other functions may be exquisitely performed God and Nature never intended other then that the bloud should be Homogeneous pure plain symbolical with that single principle of the Vniverse Now these Peripatetick Philosophers deliver to the world that the contexture of this vital juyce is made up of Choler Phlegm Melancholy and Blood which united produce this compounded body which we call Sanguis How grosly erroneous and dangerous this Tenet is most Learned Helmont hath made evident Wherefore we conclude with that noble Philosopher that Bloud is an Vnivocal substance divisible only by some external accidental means as the Air or Fire which cause a various texture and different position of its Atomes whereby it seems to consist of parts which are not really inherent in it as is manifest in its degeneration from its native colour sapour consistence and goodness which it had before it became corrupt in the pottinger or underwent the torture of fire Both of which do strangely larvate and disguise the puniceous Balsome giving occasion to the Galenists to frame their four fictitious humours no where really existent This being the foundation of all his declamations against Phlebotomy before I proceed any farther it may seem requisite that I should make some Animadversions thereon I might take much notice of and display his errours as to what he sayes that the Latex is by the Greeks called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 this is the first time I ever read it called so the usual terms being 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 The notion whatever Helmont say is not new at all an hundred Galenists have mentioned and treated of it as the vehicle of the bloud and nourishment But that cruor should come from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 crudus concretus is an opinion singular to the Baconical Philosopher That 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 doth signifie cold I know well and that cruor properly signifies the the bloud of dead people or the mortified bloud issuing from putrefied wounds I no less understand though Authors frequently confound it with Sanguis But that his Latex and the Lympha so called by moderns are the same is news for it is not held that the Lympha in its peculiar form was pre-existent in the Arteries and as such did accompany the Blood through the Maeandrous pipes but is generated as it is discharged into the Lymphaeducts and from them is re-mixed with the bloud And if it were yet would not the definition of this Latex agree with it for the Lympha is no inseparable companâ—on of the bloud as appears by its peculiar vessels it is seldome a diaphanous clear liquor being commonly tinged with several colours oftentimes whitish sometimes yellow or as it were stained with bloud And whereas this Latex is devoid of all sensible qualities those who have experimented the Lympha do not find any such thing but a variety of tasts Nor is it true that the Serum which accompanies the Bloud is such a Latex as our Helmontian describes it being never to my taste free from a salsuginous sapour though it retain that with a great Latitude nor devoid of colour so as to be clear and diaphanous and 't is very seldome seen that the said Serum will not coagulate unless preternaturally upon a gentle fire so that it is no more to be termed a Latex than the whites of eggs beaten to the like fluidity In like manner that in the Lymphaeducts will coagulate as Bartholin observes and others As for the Cruor that there are graduations of the Bloud as to its crudity and impurity is no doubt amongst the Galenists and that it may oftentimes transcend the state of due maturation and so become degenerate is as easily granted as that it should come short of its desired perfection and when this Blood degenerates any way into a Tabum or sanious matter I must tell him that Aristâ—â—le and his followers acquainted us therewith before that Helmont was ever heard of whose Cruor bred in the Liver and distinct from the Bloud impregnated with vitality is such a piece of non-sense as ought not to be mentioned in this Age but to Baconical Philosophers who not only connive at but applaud any Hypothesis Concerning the Blood when I read the Elogies he bestowes upon it as the Seat of the Soul by which sensation motion nutrition generation are performed I thought â—pon the opinion of Aristotle and his zealous sectators â—mongst the Physicians who have denied all Animal spiâ—its fixed the principality of the Members in the Heart and from thence derived even the nerves If G. T. will defend the generality of his Assertion I assure him that Hofman Van der Linden and Harvey will be more serviceable to him than Van Helmont But this consideration hath little influence upon the present Controversie that which follows hath nothing of Truth in it that the Bloud is an Homogeneous pure body for nothing homogeneous can ferment But it is most evident that the bloud is in a perpetual fermentation and that it is such a liquor as is constantly generating constantly depurating and constantly expending it self so that nought but Imagination can represent unto us such a thing as pure bloud and I hope the specious pretences of a Real Philosophy will not terminate in Speculation and Phansie When the bloud either naturally issues forth or upon incision of a vein it representeth unto
Medicinam inculpate exercere contra facies quanto enim magis sanguinem videbis à propria natura discedere tanto minorem quantitatem vacuabis aliquando nisi copia urgeat cacochymiae permista à venaesectione prorsus abstineto Nor is this the judgment of a single writer hundreds are of the same opinion the Learned L. Septalius Animadv Medic. l. 4. sect 2. is of the same judgment In sanguine detrahendo cavendum maxime ne quanto putriorem deterioris conditionis sanguinem è vena profluere viderimus tanto majorem quantitatem effluere sinamus quod plurimos facere observamus tali enim existente sanguine pauciores subesse spiritus constat vires facillime solent collabascere Even Galen and Avicen are alledged for it And it ought with less reason to be objected in England because our Physicians generally as likewise are the Germans seem not so prodigal of the bloud of their Patients as to make a Cacochymie much less a 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 or total corruption of the sanguineous mass to be the proper indication for bleeding nay most that hold Blood-letting in great diseases arising from Cacochymie to be a necessary remedy not indicated by the depravation of the bloud but violence of the disease they are cautious in the quantity which they take away because in such an habit of body the strength of the patient is seldom great enough to bear much Out of which it is manifest that what he sayes about the impurity of the bloud in the porringer that 't is an excuse or imposture used by the Galenists in defence of Phlebotomy it is a fiction of his own not made use of directly by any but the followers of Botallus the rest will give him other reasons for their practice than a Cacochymie alone or total corruption of the mass of bloud A farther mistake it is in him that he represents the Galenists as such pittiful fellows that should not know but that each corruption of the bloud is incorrigible and therefore let it out It is true that we do hold that it is possible for the bloud to be so vitiated as to be incorrigible and that one may assoon hope to see the regress from a total privation as it restored This hath been observed in pestilential diseases sometimes and in sphacelated parts and perhaps I may be allowed to reckon as such the bloud of that person in Fernelius which was universally coagulated in the veins so as to be taken out as 't were branches of coral And that Woman 's in the observations of Pachequus whose bloud in a continual fever did issue out upon Phlebotomy as cold as Ice or Snow the like to which in the spotted fever is taken notice of as a fatal prognostick by Petrus à Castro If Plempius give me leave I would reckon in putrid fevers that bloud to be incorrigibly depraved which doth not coagulate and is destitute of its fibres since Fernelius and others esteem of such as an evident testimony of the highest putrefaction It is also true that we do hold that where diseases are ordinarily or frequently curable yet by accident from the idio-syncrasie of the patient or some other intervening cause the bloud may be continued in such a vitiated estate as to be incorrigibly corrupted and yet its essential form not lost as in case of Cancers Hypochondriacal and Scorbutical distempers Scirrhosities of the Liver Spleen and Mesentery Leprosies knotted Gout calculous indispositions c. I might mention other cases but they relate not to the present controversie and I have already said enough to shew the ignorance of this Baconist To come nearer to the main matter It is true that we do hold that in many distempers as in the Scurvey putrid Fever and some others the mass of bloud is so putrified and corrupted that even that which is termed more stricktly Blood is depraved sundry wayes for if the vessels that generate and convey the Chyle and the Chyle it self be corrupted 't is impossible but that which is produced and supplied daily out of the Chyle should participate of it pravity and so much the more in that they flow intimately commixed in the same Arteries and Veins But that in such cases we hold the Blood to be so depraved as to have lost its formal essence totally and irrecoverably is most notoriously false and any man may see hence that this Ignoramus understands not the Galenical way but deserted it before he had acquainted himself therewith We do hold that the blood and associated humours may come to a partial putrefaction and yet be recovered again and 't is this recovery and redintegration that we design by our practice and if we cannot effect it totally yet that we aim at is to concoct the several humours so that what there is of them that is alimentary and agreeable to nature may be mitified and retained and the rest so digested as that it may be with ease and safety ejected the body and so the Mass of bloud regain its former lustre and amicableness This being the grand intention of the received Method of Physick 't is one thing to debate whether blood-letting practiced according to Art for we are not otherwise concerned in the Quarrel be a suitable proper means to atchieve our purposes And another to say that we pierce poor mans skin and rashly throw away the support of life out of a vain apprehension that it is totally corrupt and depraved of its former being and no wise capable of being retrograde This cannot be said without an apparent injury unto us We know the variety and fallaciousness of colours and by our rules can well conjecture how far the Humours are vitiated what may be concocted in order to the nutriment and benefit of nature and what maturated to a convenient ejectment And we do utterly deny the consequence of this Argument though we grant the Assumption Viz. If the bloud be of such a nature that it may be recovered to its pristine colour and vigour without Phlebotomy then ought not men to use Phlebotomy But the Bloud like Mercury may be polymorphised and changed into divers shapes and at length be reduced to the same state and condition as when it was in its primitive essence Ergo. The Assumption I can grant but not where such a practitioner as G. T. is made use of I doubt not but the followers of Erasistratus could effect it by their Fastings Frictions Bathes and other remedies used by such judicious men I grant that robust nature doth daily produce such rectifications of the bloud in many that make no use of a Physician But as willing as I am to gratifie my Adversary I should not yield thus much to Helmont or such as practice with Arcana and commanding Medicaments To the sequele of the Major I reply that albeit that Nature may oftentimes do miracles yet are not miracles to be presumed upon It is
possible for the sick to recover without any means yet are means to be used the omission thereof is imprudent and criminal but the use thereof if the Physician be knowing and discreet safe and as secure as the condition of our mortality permits any thing to be A few dayes or hours of the encreasing distemper will more impair the strength of the sick than the loss of a little blood which in the condition it is adds not to the vigour or nutriment of the diseased the dammage will be easily repaired and perhaps all this nicety will be to no purpose for after a multitude of vexatioâ—s sometimes dangerous symptomes Nature may produce in the almost exhausted patient a violent eruption of bloud and thereby terminate that malady which might have been alleviated or allayed before Fluxus sanguinis largi ex naribus solvunt multa ut Heragorae Non agnoscebant medici The Bloud for which they are so sollicitous Nature her self is not so careful to preserve it but that frequently in the beginning and progress of diseases she alleviates her self by discharging it out of the nose and that in greater quantities of more florid blood than the Lancet would take away This evacuation is of all the most facile the most easie to be regulated by the Physician since he can stop it when he will and the most innocent in the beginning and increment of diseases Sanguinis eruptiones haemorrhagiae hanc habent praerogativam prae aliis evacuationibus quod ipsae etiam in principio in aliis temporibus etiamsi non adsint signa bonae coctionis possunt esse magis utiles quam aliae evacuationes quae fere semper sunt malae ex eo quod sanguis semper per apertas partes fluunt semper libere commodum exire possit nec eget praeparatione concoctione sicut alii humores qui per alias evacuationes excerni debent In evacuatione quae per venas apertas fit nullam merito expectamus concoctionem hinc Medici secta vena in morbis acutis in principio mittunt sanguinem hinc spontinae sanguinis vacuationes bonae erunt Addatis sanguinis eruptiones copiosas nedum utiles fieri propterea quod sanguis malus una excernatur sed etiam quoniam ejusdem sanguinis evacuatio universum corpus refrigerat caloremque transpirabilem corpus difflabile facit Quare hac ratione excretiones sanguinis optimae erunt quae in statu apparent plene cocto existente morbo sed neque ea quae cum cruditatis signis fiunt erunt plane abhorrendae timidae In fine that prudence which obligeth us to self-preservation obligeth us to the most probable courses in order thereunto and What can seem more rational than that which NATVRE directs us unto that whereby she so happily mitigates and concludes diseases that which so many Ages have recommended unto us and in the use whereof not only Greece and Rome but all Nations universally as well barbarous as Civil are agreed on And thus much shall suffice for an answer to his first Argument I now proceed to the second The Blood is the support of Life and we are taught by Divine Writ that in the Bloud that Spiritus rubens is Life I answer That the Scripture in the places aimed at cannot be understood literally and properly for then the words infer that the Beasts have no other soul than the bloud Deut. 22.23 onely be sure that thou eat not the bloud for the bloud is the soul and thou mayest not eat the soul with the flesh Thus it runs in the Original though our Translation renders it Life And so Levit. 17 10 14. in which last place 't is said that the bloud is the soul of all flesh Nay in Genesis c. 9. v. 5. Concerning man 't is said The bloud of your souls will I require It remains then that deserting the literal sense we fly to some that is Analogical And hence it is that most Divines take the word 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 for Life Thus Exod. 21.23 Thou shalt give life for life is not incongruously rendred instead of Thou shalt give soul for soul. Thus the Civil Lawyers frequently stile Loss of Life by the phrase of Animae amissio But however these passages may be popularly current yet in Phylosophy and Physick when we would speak distinctly and argue firmly 't is not to be allowed of for Truth that the Blood or Spiritus rubens as our Helmontian most non-sensically terms for as great a Pyrotechnist as he would seem 't is past his Art to demonstrate that it is a Spirit or Chimically to educe a Spiritus rubens out of it is Life for Life is nothing else but the union of the soul with and its presence in the body or to declare it by its effects 't is the conservation of all those faculties and actions which are proper to the animated creature as Death is the extinction of them Out of which 't is evident that Blood is no more properly called Life than 't is possible for the Definition of Life to be acmodated to Blood that is not at all But since common discourse doth allow us often to fix the principal denomination upon the chief instruments and that the Scripture explains it self Levit. 17.11 and what my Adversary in one place calls the LIFE in another he terms it the principal support of Life let us consider how far that is true That the Bloud is not so much as a part of the body but the Aliment thereof is the assertion of most Authors it is not continuous to the rest of the body but floateth as Liquor in a vessel and in vulgar speech no man takes the loss of bloud for a mutilation or dismembring and there are sundry distempers and phaenomena which conclude in favour of the spirits or what is Analagous to them and the Nerves to assert their pre-eminence above the Blood and its Vessels and whatever may be said concerning Generation which is very disputable 't is a certain mistake in our Helmontian to make the Bloud the principal matter for sensation whereas sanguine persons are not the greatest wits and the senses are most quick in women during their lyings in after a great effusion of bloud as also in dying persons or motion which is not in paralytick members though the Bloud flow unto them continually as it was wont before I add that there is not any convincing Argument to prove that the Bloud is animated I confess the conjunction of the soul and Body and operations consequent thereunto are most mysterious unto me and I think it no less true that our Life is a constant miracle then that we are at first wonderfully framed nor can I determine what particular use the soul makes of all the parts and ingredients of our humane bodies But this appears unto us daily that the conjunction betwixt the Soul and Blood and the
dependance of our Life thereon is not so great or intimate as that upon the effusion of a little no nor of a great deal of the bloud Death or any debility extraordinary and durable should ensue unavoidably and if it happen but sometimes 't is apparent thereby that 't is but accidental and not a proper consequence of that effect 'T is manifest that the operations of the Soul are not restrained to one determinate proportion of bloud in every body nor to the same in any albeit that there seem requisite in all Animals that there be some bloud or what is equipollent thereunto 'T is also manifest that this Bloud for which some are so sollicitous doth continually expend and waste it self in nutrition and that even the nourished parts are in a continual exhaustion so that without supply it would degenerate â—nto choler except in those miraculous fasts and diminish to little or nothing as appears upon great fastings and several diseases 'T is no less manifest that upon great evacutions of bloud by wounds or otherwise when the Bloud hath been so exhausted that very little can be imagined to remain yet in a few dayes the veins and arteries do fill again and nature is so replenished and vigorated that this lost bloud seems not only as good in order to the functions of life but better in order to health and strength since the production of this last in the end of diseases is accompanied with convalescence whereas the precedent did not hinder the indisposition Out of what hath been said the Answer to this Objection is facile viz. The Blood is not so the seat and residence of the Soul nor so absolutely necessary to Life granting all that can be desired of us as that some of it may not be let out without present danger or irreparable detriment so that if the motives for Phlebotomy be cogent or so probable as to render the Action prudential no difficulty can arise from this scruple It is written in Deut. 24.6 No man shall take the upper or nether milstone to pledge for he taketh a man's life or soul to pledge Here the milstone is called the life or soul of a man as much and as properly as ever the Blood is any where else But though there be a prohibition for a man to deprive his poor neighbour thereof as of the support of his Life yet undoubtedly none was ever interdicted by virtue of this precept to help the distressed Miller to pick and dress his Milstones His third Argument is this Moreover one would think it should put a stop to their prodigal profuse bleeding if they did but consider with what difficulty Nature brings this Solar Liquor to perfection how many hazards of becoming spurious and abortive it passes through how easily it is stained by an extraneous tincture how often intermixed with something allogeneous and hostile to it how many elaborate circulations digestions and refinings it undergoes before it be throughly animated and made fit for the right use of the immortal Soul One would imagine by this Objection that the Generation of the Bloud were as difficult a work and required as much of sollicitude as the Philosophers stone and that the least errour would disappoint the process and eject the poor soul out of its tenement and mansion But there is not any such thing he that considers the perpetual supply of Chyle by the Ductus Thoracicus and with how much ease it is transformed a great part into Blood by the similar action of that which pre-existed in the veins together with the concurring aid of the Heart and sanguiferous emunctory vessels and the previous alterations in the stomach and intestines will imagine neither the production of Bloud nor the reparation of it to be so tedious and hard a matter Nor is it true that the Bloud is so easily stained with hostile tinctures since it is a liquor that is in perpetual depuration and hath the convenience of so many out-lets to discharge it self by Neither will every crudity in the immature Chyle or bloud render the blood unfit for the use of the immortal soul there is extraordinary and unimaginable difference betwixt the bloud of one person and another as appears upon distillation burning and mixing it with other liquors yet are all these within the latitude of Health and with equal perfection exercise the operations of Life Nor doth every allogeneous mixture vitiate or deprave the bloud for the Chyle Bloud and Flesh retain some particles of the original food taken into the stomach hence it is that sheep fed with pease-straw though as fat as others yield a flesh differently tasted from other mutton the like is to be observed in the feeding of other Animals generally Nor is this more evident in other Animals than 't is in Men for not to mention those Medicaments which by the alteration they make in the Vrine do demonstrate they have passed along and been once mixed with the bloud as Cassia Rhubarb Annise-seeds c. In fonticulis observavi quod si praecedente die aliquis allium aut cepam comederit pus quod in fonticulo est odorem allii aut cepae obtinebat sanguis autem qui per fonticulum expurgatur non nifi per venaâ— expurgari potest unde possumus dicere quod sanguis acutum odorem detinere possit The like phaenomenon is to be observed in wounds and ulcers which feel detriment according to the various food and drink of the patient Nay in pleurisies and other wounds it hath been taken notice of that the purulent matter hath discharged it self by the veins re-mixing with the bloud into the intestines and by urine The Bloud of some persons in perfect health hath been observed to stink worse than rotten eggs even as it was issuing from the arm upon Phlebotomy yet when it was cold it did not stink nor seemed to differ from the best bloud except that it was of a more beautiful red than is usual I conclude therefore that in this Argument many falsities are contained and there is nothing of such force as to deterr a prudent Physician who understands the rules of his Art and those cautions which are suggested to us in Phlebotomy to let his Patient bloud and emit some of this solar Liquor His fourth Argument They should never attempt yea rather abhorr to enervate in the least by the Lancet the strength with its correlative bloud and spirits without which there is no hopes of attaining a desired Cure For it is a most established verity taught by Hippocrates that Naturae sunt morborum medicatrices the most assured means of sanation is to keep up the vital pillars without which all falls to ruine So that Van Helmont is without controversie in the right when he sayes utcunque rem verteris ignorantiae plenum est procurata debilitatu sanare velle i. e. make the best you can thereof It savours of gross ignorance
it bilious melancholy or phlegmatick We do also say that in diseases the blood may be corrupted in its substance and vitiated and yet the colour amended or not altered Saepe ad speciem visum purus est sanguis qui alioqui 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 malus est ut contra impurus cernitur specie qui non ita 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 malus est And Iacob Thevart his Scholiast doth observe that several times in 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 sanguis laudabilis ipsa sectione apparet qualitatibus alienis praeditus est est enim acriusculus biliosus nimis Nay we are so far indefinitely from pronouncing a cure upon the ruddy colour of the blood that in malignant Feavers we make a quite contrary prognostick Pessimum signum est in febre maligna puncticulari timoris plenum cum sanguis vena scissa extrahitur si purus rubicundus inculpatus educatur venenositatem superare indicium est aut putredinem in penitioribus cordis latitare In meipso olim observarem nam ter per hanc febrem misso sanguine nulla prorsus nota putredinis apparebat aliis signis immani ferocitate saevientibus The same is asserted and illustrated by fatal instances in Simon Pauli which it would be too long to transcribe here Having demonstrated unto him these errors I say further that we do not hold the blood to be putrified in all Feavers as in Diaries nor many of us in intermittent not to mention others and in those Feavers wherein 't is said the Blood doth putrifie we do let blood often to prevent putrefaction and not alwayes to cure it by Phlebotomy and we do it in order to cure the putrefaction we do not pretend to emit all the putrified blood thereby but only to alleviate nature of a part thereof that so she may better overcome the rest especially being assisted by other Medicaments So that the whole assertion is false if it import that any intelligent Physician designs to cure a putrid Feaver solely and directly by letting out the putrid blood by repeated venae section I will not deny but some in France and Spain have gone about to do it but the practise is generally condemned by Physicians of the best repute and therefore ought no more to be charged on us especially in England then the miscarriages of any bold Experimentor or Baconical practitioner at London upon the Colledge of Physicians This insolent Disciple of my Lord Bacon understands not the iudiments of our Physick nor knows what we aim at in the use of Phlebotomy there being sundry occasions why we use it and sundry effects that we expect from it Neither is he less deceived in saying that Phlebotomy duly administred overthrows the strength of the Patient I mean that strength which is necessary to the concoction of the disease and so thereby wholly disappoints the Crisis For it is manifest that by those profuse Phlebotomies of the Ancients the Crises were accelerated and in ours promoted This is not only manifest out of Hippocrates and Galen but confirmed unto us by the certain experience of Forrestus and those learned Florentine Physicians who composed the Academy there for the renewing of the Hippocratical and Galenical Method in opposition to the most prevalent Avicennists Nos igitur Galeno fisi quoniam sic conducit magis dum vires ferant sanguinem misimus plurimum nam bilibre pondus trilibre in acutis febribus aut magnis aliis morbis superavimus atque id non modo impune sâ—d tanta aegrorum tolerantia ut nil supra eligi potucrit Quam rem abunde nobiscum experientia nosti ut nos quoque aliquantisper experientiam ostentemus ut qui praeter caetera quorum Paulo ante mentio fuit venae quoque sectione abunde usi sumus atque id citra discrimen quin et exactam illam vivendi formulam veteribus quidem familiorem neotericis vero ne nomine quidem ipso notam instituimus Quo factum est ut jam crises multae appareant ac velut novus naturae ordo aegris faelicissime faveat Cum antehac vel pharmacis agitata velintem-pestivo victu impedita nullas ostenderet aut admodum raras easque non nisi in rusticis atque infima plebe qui nec pharmacorum multitudine neque ciborum aut potionum fatigari aut impediri quirent I have more willingly cited this passage because the renown of that Academy was such that it gave a check to the grandieur and prevalence of the Arabian Method and the truth of what they say cannot be questioned by any that knows the persons and the revolution they brought about in Europe and hence we may learn the reason of that difference which seems frequently to occur betwixt the ancient diseases and their critical motions and terminations and what we generally find It ariseth not from any such great change in the nature and types of maladies as some have ignorantly writ of late nor as this Bacon-face talks because we reiterate moderate Phlebotomy but because we do not follow at all the Method of Hippocrates and Galen in the curing of diseases However we pass for Galenists and Hippocratical Physicians yet in truth we are not such our practise is made up most out of the Arabian Method and Medicaments and is a mixture of the Grecian and Sarracenical Physick together with those accessionals which improved Chymistry hath introduced and since we disturb Nature with our vomits and minoratives in the beginning and neither bleed dyet or otherwise Physick our Patients according to the ancient prescriptions do we wonder to see another face and issue of maladies than was heretofore Or doth not he rather deserve to be wonder'd at that should expect in so different circumstances for resembling effects I believe our Helmontian with his Emeto-cathartis and exquisite Arcana so far transcending all the shop-medicaments or received Chymical preparations doth see as few Crises as any Phlebotomist and may not I then retort upon him that he by his practise wholly disappoints a Crisis Nay doth not he tell us that in his way there will be no need to stand gaping for a crisis sith that may be anticipated and all secnred before that time if there be a regular procession And may not the present Galenists justifie themselves in the same manner since they can better warrant their process and Medicaments by a longer succession of Experiments happily made by judicious men then this ignorant Helmontian Innovator Another Argument of his is this If it be so that striking a vein often in a long tedious disease is a preparatory for a sharp Feaver as Doctor Willis and I both herein jump right in our observation then am I certain that Phlebotomy repeated in an acute sickness is a door set open and an in-let for a long infirmity so that this mode of defalcating the vigour of the
by the History of Generation that no Parenchymatous part hath any operation in the first production of the blood all their Parenchymas being post-nate thereunto And if the blood be thus generated at first it is but rational for us to imagine that it is alwayes so generated during life For as it is true that the same cause acting in the same manner will alwayes produce the same effect So in this case to argue from the identity of the effect to the identity of the cause is allowable Est enim causarum identitas quae facit ut effectus sit idem quippe effectus supponitur non esse donec a causis existentiam suam indeptus fuerit dum existentiam illam largiuntur oportet ipsius quoque identitatem impertiant qua sine effectus ipsemet nequaquam fuerit That the Spermatic vessels in which the blood moves do contribute to sanguification much seems apparent from hence that the blood is seen in them before it is in the heart And because it is observed that the fluidity of the blood seems to depend much on them and therefore in the dead it doth not coagulate except praeternaturally in the veins though it do commonly in the Heart or wheresoever it is extravasated Manat praeterea aliquid a venis nobis incognitum quod dumearum ambitu sanguis concipitur prohibet ejus concretionem etiam post mortem in cadaveribus jam perfrigidis nequis hoc colori acceptum ferat quod vero coralliorum instar aliquando repertus est concretus in venis ipsis hoc merito Fernelius ascribit morbo occulto And not only the fluidity but motion of the blood seems to depend much thereon for if by a ligature the impulse and succession of blood be prevented yet will the blood in the veins continue its course and not stagnate Exempto e corpore corde motus tamen sanguinis isque satis celer in sanis videntur Et si vena ulla etiam lactea duobus locis ligetur laxata ea sola ligatura quae cordi propinquior est dum partes adhuc calent semper Chylus ad hepar sanguis ad cor cum movebitur qui nec a corde per Arterias nec ab intestinis per lacteas objecto potuit obice propelli nec stuiditate sua potius sursum quam deorsum movetur The truth hereof seeming undeniable to Pecquet he makes use of a new Hypothesis to solve this motion of the blood as if it arose from compression of other parts or contraction in the vein it self But the Phaenomenon will appear in such cases as admit not this pretence From these reasons it is that the blood doth not need so much as any pulse in the veins and arteries as appears in the first faetus but as soon as it comes to the Heart it does to prevent coagulation the punctum saliens being endowed with no such quality practiseth its systole and diastole when yet no such motion is observable in the Arteries at that time Whence the colour of the blood ariseth is a secret unto me I know that digestion reduceth some Juyces to a redness in some Fruits the fire doth the like in some the mixture of acid Liquors begets a Vermilion But here I conceive none of these causes produce the effect the generation of the blood is manifestly an Animal Action and as such unsearchable Whatever I attribute to the veins it is not to be expected that supposing they should instrumentally sanguifie the blood should turn blew from them any more than that water put into new vessels of Oak should turn white whereas it becomes reddish Thus the Plastic form produceth blood at first and whilest there is no first concoction in the stomack supplieth that defect by that albuiginous Colliquament which is of the same nature with the Chyle we digest our meat into and convey by the Lacteous Thoraciducts into the Heart That it is of the same nature appears hence that it resembles it and that it is extracted from the Blood of the Mother and produceth in the Embryo the like excrements of Choler and Vrine and Macosities nay it hath been observed by Riolanus to have been tinged yellow How much more may be concluded hence in favour of the Galenical alimentary humours supposed to constitute the Blood I leave those to judge who consider the variety of female constitutions and their condition during their being with child perhaps the Hypothesis of a proportionate mixture of the five Chymical Principles will not seem more colourable Having thus related how Sanguification is performed in the Faetus at first I come to give an account how it is performed afterwards and even here it seems an Action perfectly Animal for even Concoction in the Stomach is not the bare effect of Heat elixating the meat nor of acid or saline Ferments dissolving it nor of any other kind of imaginary Fermentation But 't is the effect of an Animal power operating upon the Meat in the stomachs of sundry Men and Animals by several wayes This appears most evidently herein that the same meat eaten by several Persons or different Animals produceth different Blood and different Excrements therefore Chylification is an Animal operation and is modulated by the specifick and individual constitutions Having thus determined of things that the Soul in all these actions is the Efficient we may consider that the meat being masticated in the mouth and commixed with the salival juyce or spittle is prepared in order to Chylification then it descends into the stomach and is there sometimes in a longer sometimes in a shorter space reduced into a cremor which is so far from being acid as Helmont saith that it is generally rather saline as are also the recrements of it that remain in the empty stomach It is true that according to the stomachs of Individuals and the meat they eat it happeneth so that this Cremor hath no certain taste nor colour Undoubtedly it must have been bitter in that Marriner and such as he of whom Vesalius writes that the Gall did naturally discharge it self into his stomach yet did he digest very well and never was apt to vomit or to be so much as sea-sick From the stomach the Cremor descends into the Intestines not all at once but as it is digested and there undergoes a second digestion receiving into its mixture the Gall and Pancreatick juyce I shall not speak of the variety that hath been observed in those two liquors nor trouble my self about the manner how they operate on the Chyle It is manifest that upon that mixture the Chyle suffers a great alteration if not some effervescence and some parts are coagulated and as it were precipitated and by a succession of changes the several particles are so blended and refracted in their qualities that the excrements at last are neither acid nor bitter but in dogs both sapors are extinguished In the mean time during
frequently the most rational and best Methods of curing Quaedam ejus sunt conditionis ut effectum praestare debeant quibusdam pro effectu est omnia attentasse ut proficerent Si omnia fecit ut sanaret peregit Medicus partes suas etiam damnato reo Oratori constat eloquentia officium si omni arte usus sit 3. If it be true that there is so great a variety and discrepancy in the Blood then is there no secure judgment to be made of the Blood issuing out of the vein either to the continuing or stopping its Flux But the Physician is to proceed according to the Rules of Art and accordingly as they direct him may he promote stop or repeat the evacuation A seeming Cacochymy in the Blood doth not impede venae-section nor call for purging and rectifying Nothing is evil that is natural to a man but real Cachochymy or redundance of Humours offending Nature this doth call for our assistance and requires sometimes Phlebotomy and sometimes other Medicaments 4. If it be true that Sanguification is an Animal Action if it be true that the Plastick form is in being before the Blood and produceth it and the whole Fabrick and subsequent operations and that the motion of the Heart is proved by Doctor Lower to depend upon the Nerves during life then is there no such strict connexion betwixt the Soul Life and Blood as G. T. doth fancy 5. If it be true that the Blood doth continually waste and spend it self in Nutriment and Excrements then is it manifest not only that the loss of a little Blood partitely taken away is not the loss of life or prejudicial thereunto Neither doth it follow that the loss of Blood in a moderate quantity is any imminution of the vital Nectar it is neither the chief residence or seat of the Soul nor in a determinate quantity requisite to the continuance of Life but comes under a great latitude It abounds more in some seasons of the year and times than at others and why may not Artists imitate Nature in diminishing its redundance upon occasion as she does As long as he proceeds not to exhaust all or too much The loss is easily repaired upon convalescence and the qnantity is more than can be governed by Nature in sickness 't is but the observation of a Geometrical proportion in such a Phlebotomist The same Agent will produce the same effects if Nature be corroborated and the vitiated tonus of the concocting and distributing vessels be amended there is no fear of wanting a new supply proportionate to the exigence of the Patient The Blood we take away is no other than what would be expended or exhausted naturally within a few hours or dayes as the Staticks shew and it must needs be considering the quantity of Chyle which flows into the veins upon eating and drinking 6. If it be true not only that Nature doth thus expend in transpiration and Excrements as well as Nourishment much of the Blood and repairs her defests by a new supply whereby Life is continued not impaired so as that the melioration of the following Blood is rather evident in his first years by his growth vigour strength and intellectuals But also that She doth of her self make men and women apt to bleed at some times ages and seasons which is known to all then is not the effusion of this solar liquor so unnatural a thing nor so homicidial an Act as 't is represented 'T would seem a strange Law that should punish every Boy that breaks the Head or Nose of another as a Bronchotomist or Cut-throat If it be true that Nature doth oftentimes alleviate even in the beginning and in the end cure Diseases by spontaneous evacuations of Blood at the Nose and Vterus by vomiting and stool then a Physician whose business it is to imitate Nature in her beneficial Operations is sufficiently authorised and impowered to practise due Phlebotomy by the best of Presidents Hâ—ving premised these Conclusions which are all either proved in the foregoing discourse or evident in themselves to all understanding men I shall proceed to give an account of the Reasons why Physicians do so frequently and in so many Diseases practise Blood-letting and those deduced from its variety of effects in Humane bodies For it is not a single Remedy subservient unto one Indication or End but conducing to many and therefore made use of upon several occasions to different intentions Vtile est id remedium ad quamplurima vix-potest in ullo magno morbo non esse aliquid cujus gratia utile sit Before I come to particulars it is necessary I tell you that in the cure of all diseases Physicians propose unto themselves sundry considerations they regard the disease the antecedent causes and the symptomes which attend or will ensue thereupon either generally or in such an individual constitution they employ their cares to prevent some inconveniences as well as to redress others Some remedies they make use of because they are necessary of some because they are beneficial yet may the disease 't is granted be cured oâ—herwise in case the Patient have a reluctancy thereto or for some private reasons the Physicians esteem it fitting to alter their course Upon this account 't is assented unto that many distempers may be cured without Phlebotomy which yet are ordinarily cured with it or may be so And herein the disagreement of Physicians or different procedures are all according to their Art nor is it denied but that All of them may atchieve their ends by their several Methods So that it is a gross paralogisme for any one to conclude this or that Physician is mistaken or takes a wrong course because another takes or prescribes a different one All the Physicians in Spain France and Italy do not bleed with equal profuseness In Germany and England some do practise more frequent Phlebotomies than others do and neither of the parties do erre in case the other remaining Method be inviolately observed It is in humane bodies as it is in the body Politick where there is a Method of ruling though it be carried on by several wayes and means and whilst each States-man doth prudentially sway the Government procuring peace and plenty to the subject his conduct though it vary from that of his Predecessour is not to be blamed It is not to be doubted but that many grievous distempers are cured by Nature without the use of any remedies at all Yet will no wise man adventure his life on such incertainties 't is not to be denied but some are cured with fewer Remedies than others are But yet 't is not prudence to put Nature upon too great a stress or to account all means unnecessary which are not absolutely requisite or without which the effect may though with more difficulty and hazard be brought to pass It lyeth upon the Physician therefore to pursue all those means which may secure the life of
to be long or short Whether the Patient do expectorate or not If be do what colour and what consistence or taste the evacuated matter hath Whether the disease be upon a recrudescence or not These are circumstances which he ought well to understand for as to the time of phlebotomy 't is one in a long disease when the beginning is protracted to seven ten or seventeen dayes and another in that which will terminate in seven dayes the urgency is one in an incoct Pleurisie when nothing is in due time expectorated and another when blood or purulent but benign matter is avoided and another when the matter is black livid very yellow or stinking or sweet to the taste the case alters when Nature doth ease her self by a propitious looseness and when it is an importune Diarrhaea when it turns to an Empyema and when it proceeds to an amicable Crisis These things are to be pondered by the Physician and his repute is not to be questioned for his actings by such as understand not the case or apprehend not by what exigences and presidents the intelligent Practitioner is guided Men ought not to judge of Diseases by their names only and condemn a knowing man for doing that in one disease at one time which neither they nor he would adventure in another and since it is not allowed us to abandon our Patients in some cases according to the adivce of Hippocrates give us leave to make use of that Apology which Celsus doth suggest unto us Fieri tamen potest ut morbus quidem id desiderat corpus tamen vix pati posse videatur Sed si nullum tamen appareat aliud auxilium periturusque sit qui laborat nisi temeraria quoque via fuerit adjutus in hoc statu boni Medici est ostendere quam nulla spes sine sanguinis detractione sit faterique quantus in hac ipsa remetus sit tum demum si exigatur sanguinem mittere De quo dubitare in ejusmodi re non oportet Satius est enim anceps auxilium experiri quam nullum Let the World rest assured that an understanding Galenist doth nothing rashly that he considers of all circumstances and knows their case better than themselves that he hath as great a regard to the preservation of their vital strength as they can wish and apprehends when to desist and when to operate and in what manner but these are mysteries to the Baconists and I can give no better directions to the sick than that they would apply themselves to a prudent Physician rather than Quacksalvers and refer themselves to his judgment without imposing their own or that of ignorant Experimentators and Arcanists And so much concerning Phlebotomy in Pleurisies the more exact handling whereof and the accommodating of the Method of Rulandus to that of the Galenists must be the subject of another discourse I add only that Nature it self doth teach us the use of Phlebotomy in Pleurisies for they are often accompanied with a bleeding at the nose in the beginning which is beneficial to the Patient Larvi sanguinis fluxus ex naribus multa solvunt ut Heragorae Non agnoseebant Medici Though it happen symptomatically yet is it frequently advantageous even in Pleurisies nay 't is an accident we may commonly expect in them Quibus febricitantibus rubores in facie capitis vehemens dolor venarumque pulsus iis ut plurimum fluor fit sanguinis and in a Pleurisie 't is alwayes the most mild and safe if the Patient begin his Anacatharsi◠by a sub-cruent sputation In fine she usually terminates this Feaver by an Haemorraghy at the Nose which if it be small doth portend evil but if it be large is beneficial Pleuritis larg◠haemorrhagia enaribus judicare potest stillatione non potest And this good fortune did recover Demosthenes out of an incurable Pleurisie as he relates it himself Febres me continuae sequebantur cruciatus totius corporis perquam vehementes atroces imprimis vero laterum imi ventris neque cibum capere poteram ut Medicus quidam affirmabat nisi mihi doloribus afflicto jam desperata purgatio sanguinis ultro copiosa supervenisset me saniosum 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 factum fuisse periturum nunc is sanguis recessu mihi suo saluti suit I have not the original by me to consult the Text but whether it were at the Nose or by Stool I believe the former it is all one to the present purpose but it may seem pertinent to observe that those which bleed much at the Emeroids are not incident to Pleurisies The subject of my next discourse must be concerning Phlebotomy in the Small Pox My Adversary blameth Doctor Willis for allowing of Phlebotomy in the Small Pox upon the nick of their eruption but by way or Argument against the judgment of that eminent Practitioner he alledgeth nothing but this Make this good by fact that 't is profitable and necessary in any such case to open a vein for 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 will never carry with me then I shall forthwith become a Proselyte to your Method Assuredly this I am certain of it was neither profitable nor necessary for the Nation that we should by this means loose three persons of the noblest extract I have alwayes looked on the discourse of that Learned man concerning Feavers as one of the most judicious Writings that ever our Faculty produced 't is succinct without obscurity and without the omission of any circumstances that frequently or rarely fall under the consideration of a Physician and the practise as well as Dedicaments so safe so authenticate according to the Rules of Art and practical Observations which we preserve that 't is above all the effects of Envy and Malice It is a great abuse to the Doctor which this Bacon-faced Helmontian put upon him as if he approved generally and indefinitely of bleeding in the Small Pox upon the nick of their eruption It appears there not to be his practise but upon urgent cases and he on purpose relates an History of its evil effects thereby to deterr others from using Phlebotomy rashly in that disease I shall repeat his words and method of curing it as far as relates to the beginning of the disease Quoad primum intentio sit ut naturae impedimenta quaevis auferamus quo sanguis variolarum fermento inquinatus coagulari aptus adhuc motum aequabilem in corde vasis stagnatione retineat ac effervescens portiones cum veneno gelatus for as expellat interim cautio sit ne fermentationis seu effervescentiae opus ullatenus cohibeatur aut nimium proritetur hoc enim cruoris massa plus debito in portiones congelatus agitur isto restringitur nimis in motu nec particulae venenatae cum cruore gelato for as emandantur natura a secretionis expulsionis opere impedire solet nimia excrementorum congerie
health not so much as being obliged to keep his armes in Bed On the fourth day he gives them one very gentle Cordial to promote their eruption and abandons them to Saffron and Milk to be given twice a day and ordains that he be kept in a constant moderate warmth such as is natural and usual to the Patient This is the sum of his Method except I add that when they are upon maturation he gives a mild Cordial twice each day morning and evening And in case that during the time of the decumbiture of the Patient by any accident a new Feaver arise then is the Patient to be kept still in such a proportionate heat as is usual to him in health if the season be temperate he is not to have a fire to be dieted with small Beer and Water-gruel stewed Apples or the like but to have no Cordial not so much as Harts-horn posset-drink By this Method Doctor Sydenham doth not doubt but this disease which so afrighteth people and is so frequently mortal will pass off with much gentleness ease and safety Betwixt these two there is a little discrepancy in their Method of curing the disease though there be some in their expressions and Doctor Sydenham doth seem the Comment the other the Text. Both of them oppose Phlebotomy Vomits Purges and Glysters as well as Sudorifics Though they differ in the râ—ason for their rejecting Phlebotomy For Doctor Whitaker doth avow that it draws from the Circumference to the Center But Doctor Sydenham yields that it produceth a quite contrary motion and causeth the Small Pox to come out Doctor Whitaker doth avow that this course of his is the old English Method and the ancient national and successful government of our Nation But Doctor Sydenham would seem to erect his practise upon his own Observations though all he propose in a manner be no more than the common actings of Countrey-people except when by any accident the Feaver be exasperated in the beginning or progress that he prohibits Cordials and what I belive was derived from Avenzoâ—r and Fracastorius Of these Writers it is remarkable that Doctor Whitaker doth never allow that there can be any malignity in the Small Pox so great and urgent as to induce a Physician to intermeddle beyond a moderate Diet and temperate Air because the Motion being Critical admits of no violence But this is a great Errour in the fundamentals of Physick For first in Diseases complicated with malignity not only the prognosticks but the issues are very uncertain as to life or death and the Critical evacuations deceitful so as that oftentimes they bring a momentany alleviation oftentimes notwithstanding those evacuations the distemper increases and the Patients dye This every man understands who is conversant in our accounts of Malignant Feavers so that to grant at any time that there is a malignity or venenate indisposition in the sick and to abandon him to a temperate Air and Diet relying upon Saffron and Milk is a practise never to be justified in Physick But alas we are not to be afrighted with the bug-wâ—rd Critical motion nor half an Aphorisme out of Hippocrates viz. Quae judicuntur sinere oportet These general sentences neither qualifie a Doctor in Law nor a Physician It becomes us to consider in a Critical motion several things First Supposing it to happen in its due time we must consider whether it be only a Motion or whether it be proportionate to the Disease for no evacuation that is diminute is properly Critical If therefore the pathognomonies of the Disease be such as argue a multitude of the Small Fox to be requisite for the recovery of the sick and only a few come out the Physician is obliged to assist Nature Secondly Supposing that they do come out plentifully yet if they be not such as should come out but black livid green or interspersed with purple spots not to mention other circumstances which every Nurse can tell 't is certain that the evacuation how critical soever doth not oblige the Physician to stand an idle Spectator No more ought he to be in case that all symptomes increase upon the critical motion and his Feaver and dangers multiply thereupon 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Thirdly It is requisite that the Critical evacuation be per loca conferentia by such wayes as are necessary to the disease But if the Small Pox during their eruption be attended with a dysentery bloody urine or other pernicious excretion that scrap of Hippocrates will not excuse the Physicians negligence for it supposeth that all the conditions requisite to a good evacuation be found in that which the Physician is not to intermeddle with I need say no more to intelligent persons 't is not my present work to turn Institutionist Whether Doctor Sydenham intend to ascribe sense appetite and judgment unto the Blood I cannot well tell but either He canteth in Metaphors or explaineth himself in his general Hypothesis about Feavers as if his meaning were such Quinimo nec mea sententia minis liquet febrilem sanguinis commotionem saepe ne dicam saepius non alio collineare quin ut ipse sese in novum quendant statum diathesin immutet hominemque etiam cui sanguis purus intaminatus perflat febre corripi posse sicuti in corporibus sanis evenire frequenti observatione compertum est in quibus nullus apparatus morbificus vel quoad plethoram vel quoad cacochymiam fuerit nulla insalubris aeris anomalia quae febri occasionem submiâ—nistraret Nihilominus etiam hujusmodi homines praecedente insigni aliqua aeris vel victus caeterarumque rerum non-naturalium ut vocant mutatione identidem febre corripiuntur propterea quod eorum sanguis novum statum conditionem adipiscigestit qualem ejusmodi aer aut victus postulaverint minime vero quod particularum vitiosarum in sanguine stabulantium irritatio febrim procreet 'T is true he did not pen it in Latine but another Mr. G. H. for him and perhaps his skill in that tongue may not be such as to know when his thoughts are rightly worded But it seems strange and irrational to attribute such an understanding to the Blood and to transmute a natural Agent into one that is spontaneous and which is more having represented it as such to make it so capricious as not to know when it is well but to run phantastically upon such dangerous changes as occur in putrid Feavers and the Small Pox for even in this last ariseth from a desire the Blood hath to change its state Since natural Agents demean themselves uniformly and of them 't is most true Idem quatenus idem semper facit idem I was surprised to see these new principles and to see effects of this nature arise without any cause It doth not seem possible for him ever to demonstrate that there is no Plethora or Cacochymy or obstipation of the pores of the body
antecedent to a Feaver nay the contrary seems evident to all Physicians nor ever was there any whereunto they did not attribute some procatarctick cause Besides he doth not alledge any Reasons or Experiments to shew that there is any alteration in the blood before and after the Small Pox or a Feaver or any difference betwixt the Blood of such as have had those diseases and of those which have not had them So great a supposition ought not to be made without ground And since it is natural and Nature is constant why is not the Disease more ancient and universal than it appears to be For if there be any grounds to think the Small Pox to be of long continuance 't is certain 't is but seldom spoken of by any old Writer perhaps once by Hippocrates yet so as never to be understood by any that hath not seen the indisposition and never by Galen It may be imagined to have come from Aegypt by contagion and might have been called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Quia urbi Bubasti Aegyptiae familiaris hic morbus It infesteth some places more than others In Graecia non adeo frequens Ideo antiquiores Medici vix ejus meminerunt In the West-Indies it was not heard of till the Spaniards came thither and they as also the English there seldome have it I believe the Disease to be novel and of no longer date than the Sarracenical revolution I could instance in the nature of such great alterations that they have ever been preceeded and accompanied with many petty changes in other things and if ever I have so much vacant time as to make political reflexions upon the rise of Mahomet I may declare much to this purpose This is that invidious subject about which Ecebolius Glanvill makes so much noise as if to avow that Mahomet were a Gentleman of noble extraction married to one who for birth riches and beauty might have been a Princess and accomplished with that sober Vertue Wit Eloquence and Education by much travel for he travelled all over Aegypt Africk and Spain as to render himself one of the most considerable of his Age or to say that the Christians were so ignorant and debauched and perfidious and addicted to Legends more than to the sound Doctrine of the Gospel at that time that most of the Fables in the Alcoran were accommodated to the honour of the times more than to truth and so Mahamet told them or to say He pretended to revive Ancient Christianity were to be an Apologist for the Mahometans and an abettor of the Alcoran Whereas none but the Illiterate can deny these things and the Age our Virtuoso speaketh of is the Age of Apostacy according to the Doctrine of our Church Oh Heavens to what an height is Impudence and Ignorance arrived Or what can be safe if so prudential and generous a design as I had must be calumniated by such a R in this manner Bâ—t to resume my discourse in the behalf of my opinion concerning the novelty of this disease besides what the learned Mercurialis hath said I shall conclude with the words of Rodericus a Fonseca which are these Si ex nativitate esset ab initio mundi fuisset aut saltem ita frequenter tunc ut nunc solet esse et licet antiqui aliquam de his pustulis mentionem fecissevisi sint ea certe exigua est dubia ut certum sit vix illis temporibus fuisse talem morbum negligentissimi certe habendi essent si tam ingens commune frequens malum illotis manibus silentio involuissent cum morbus sit puerilis Hippocrates eas numerasset inter aetates 3. Aphor. ubi diligentissime puerorum morbos connumerat tamen nullam hujus mali fecitmentionem sed illud satis demonstrat hunc morbum novum esse quod in multis mundi partibus nunquam visus fuit ubi nunquam apparavit nisi postquam Hispani eo pervenere siquidem per contagium Aethiopis cujusdam illuc delati magnam Indorum partem sustulit I might here insist upon the Hypothesis of Doctor Sydenham concerning the Inclination of the Blood to change its state I cannot believe but that the Physicians understood themselves as well before he writ when it was said that there was in every one that was born something of impurity in the body which was naturally to be purged out by an ebullition in the blood and such an effervescence as terminated in those Abscessus called the Small Pox. Quandoque accidit in sanguine ebullitio secundum semitam putredinis cujusdam de genere ebullitionum quae accidunt succis talia quidem accidentia fiunt per eam ita ut partes eorum ab invicem discernantur Et de hoc est cujus causa est res quasi naturalis faciens ebullitionem sanguines ut expellatur ab eo illud quod ad miscetur ei de reliquis nutrimenti sui menstrualis quod erat in hora impraegnationis aut generatur in eo post illud ex cibis faeculentis malis de illis quae rarificant substantiam ejus faciant eam ebullire donec fiat substantia recta fortior prima magis apparens sicut illud quod natura efficit in succo uvae ita quod rectificat ipsum faciendo vinum similis substantiae jam expulsa est ab eo spuma aerea faex terrena He that can English this passage will find in it the ebullition separation expulsion and despumation of our Doctor In truth those terms nor that which he imports by them are no novelty amongst Physicians and Rhases as Sennertus saith doth not make any mention of those uterine impurities as the cause of the Small Pox but compares the Blood to Must in in which some impurities are to be separated by Ebullition Wherein the whole Hypothesis of this semi-Virtuoso is contained However I cannot allow any more to his Observations than if a man should go without his doublet and pretend to a new Mode of wearing Breeches But that which is most intollerable in Doctor Sydenham is that He seems to attribute all the evil consequences of the Small Pox to the indiscretion of those that attend them be they Nurses or Physicians Thus p. 150. Edit 2. he makes as if Nature did discharge it self in that disease into the fleshy parts only so that if the Eyes Lungs Stomach Guts Pancreas or Membranous parts be affected 't is not the violence of the Disease but the ignorance of the Attendants which occasioned that which is intolerable for any man to say and refuted by Experience I might proceed to demonstrate that there is not any thing new in the whole Cure which Doctor Sydenham useth that in the beginning of the Small Pox before the eruption being as ancient as Bayrus if not derived from the Arabians And the rest hath been inculcated by an hundred
mention those considerations which arise from the general season of the year or the particular malignity of the Disease at that time or the idiosyncrasy or peculiar temperament of the sick or what is singular to some families In the Small Pox there happen frequently three sorts of Feavers one in the beginning which usually terminates on the fourth day or when they come forth Another which begins when the Small Pox begin to come to Suppurate according to that old saying Febris fecit variolas variola febrem And a third which either ariseth afresh upon their coming forth or is the continuance of the primary Feaver which if it abate not upon their eruption creates new cares and troubles in the Physician As to the Feaver which is antecedent to the Small Pox though sometimes there be none at all and sometimes it be so gentle as not to create any mis-apprehensions in the Doctor or Sick yet frequently it happens to be joyned with putridity or malignity or to have something of the Pest it self From all these circumstances the cure must be varied nor is it any disparagement for a Physician to act one thing at one time which he doth not at another and to recede from vulgar Methods in extraordinary cases In some cases he need not phlebotomise if he see no violent Feaver no pernicious or dangerous symptomes if it be either a Tertian or double Tertian or Synochos simplex the danger seems less yet is it a certain observation that oftentimes in the Small Pox the most hopeful beginnings are defeated by sudden and subsequent acdidents so that very many of those whose recovery hath been undoubted at first have in the progress and conclusion of the Disease died Hoc primum sciat consideret prae oculis semper habeat prudens diligens Medicus nimium fidendum non esse plurimum in variolis morbillis quantumvis salutaria signa primo accessu appareant nam in recessu inclinatione facillime in mortem commutantur talis est horum morborum fraudulentia conditio Besides this it often happens that a salubrious and simple synochus turns to one that is putrid and then the danger is least what is intended by Nature for a depuration of the Blood become corruptive and ends in the death of the Patient Also it is frequently seen that the exorbitant matter is so much or Nature so weak as not to discharge it into the habit of the body or there is some particular imbecillity in the principal parts that the Disease seizeth on the Lungs so violently as to exulcerate them in the progress of the Disease or so debilitates them that the Patient languisheth in a Consumption or else it settles in the Glandules of the Throat and the Patient dyes of a kind of Squinancy according to Avicenna Nam qui ex variolis moriuntur inquit Avicenna plerumque ex angina suffocati pereunt orta minimum inflammatione in gutture Sometimes the matter taketh a wrong course so as that a Flux ensues which sometimes becometh bloody and this befals the Patient either before they come out or a little after they have appeared or in the declination in all which cases 't is a bad sign but in the last commonly mortal Si debet hujusmodires experientiae judicio terminari haec fidem saciet fluore in declinatione adveniente etiamsi non sit exulceratious majorem aegrotorum partem mor. Sometimes the matter is so acrimonious that it corrodes the bones as Paraeus testifies upon his knowledge Quineliam animadvertere licet in plerisque hujus morbi malignitate mortuis dissectis eum in principibus partibus invehi corruptionis impressionem quae hydropis phthiseos rauvicitatis asthmatis dysenteriae ulceratis intestinis ac tandem mortis consecutionem attulerit prout pustulae pari rabie debaccâ—aâ—ae sunt quâ— per corporis superficiem furere ceâ—nuntur non enim externas modo partes deturpant pustularum ulcerum altius sese in carnem desigentium impressionibus cicatricibus relictis sed saepe movendi facultatem adimunt arrosis labefactatis cubiti carpi genu pâ—dum dearticulationibus Quinetiam multi inde videndi sensum amiserunt ut nobilis Do. Guymeneus alii audiendi alii olfaciendi oborta hypersarcosi in meatu tum narium tum aurium There being so great danger in this Malady I wonder that Doctor Whitaker should ever look upon it as contemptible saying This disease of the Small Pox was anciently and generally in the common place of Petit and Puerile diseases and the Cure of no moment It is true that Physicians do usually reckon it amongst the Diseases incident to Children and they do believe that Children pass it over with less danger than more adult persons because in them the Humors are not so accrimonious as in others their habit of body is more lax and gives the humors a freer course through the flesh their skin is more perspirable and their innate beat more vigourous than in others It is also true that they do hold that sometimes the Small Pox are so mild that there is little or nothing to be done by the Physician But 't is no less true that from the dayes of Avicenna and Rhases unto ours none ever thought or writ that the Cure was absolutely of no moment For Avicenna in his Treatise of the Small Pox represents unto us a great deal of danger in the Disease and though he grant it is sometimes facile yet he cautions the Reader sufficiently how malignant perillous and mortal it is at other times Horatius Augenius and others aver that this Ebullition is sometimes such as tends to the depuration and perfecting of the blood and sometimes to its depravation and putrefaction And as they compare the one to the ebullition of Must by which it is improved unto good Wine so they compare the other to those effervescencies in Wine when it frets and degenerates Neither is Doctor Sydenham less mistaken when he forbids the Physician to make use of any generous Medicaments but to leave the whole work to Nature and to proceed according to that Regimen which he suggests he representing the disease as facile in it self and only mortal or dangerous by the errors of the Nurse or Physician Whereas it is evident that the Small Pox are at some times accompanied with greater danger and worse Feavers than at other times and all that difference which is to be seen in the Pox that they are green or livid flat or high horny or more soft few or so numerous as to over-run the whole entrails as well as skin and there to run one into another and flux this doth not arise alwayes from the miscarriage of the Attendants but from the malignity and quantity of the morbifick matter as observation and common reason will inform any man Let us therefore judge better of those sage Practitioners who proposed unto themselves sundry scopes in
the cure of this disease and thought it their prudence to prevent all the dangers imminent or present by a cure like unto this First They examine the habit of the Patients body if it abound with blood or evil humours the redundancy of the former they conceive may be such that upon a violent ebullition Nature may not be able to rule it but either some vessels may break or the Patient be strangled by a decumbiture of the blood upon the Lungs or Brain or a bloody flux ensue if it take its course that way or a bloody urine if it incline to the Kidneys The renundancy of evil humors they do apprehend to carry this hazard in it that it may pervert the whole mass of blood upon the febrile effervessence and add such a malignity to the morbifick matter in its expulsion that the evacuation thereof by pustules may not put a period unto that Feaver but continue or exasperate it to the mortal danger of the Patient such evils they think may easily be prevented by a due method in the beginning but in the progress of the Disease they are either remediless or not to be cured but with much difficulty Therefore their first intention is to lessen that plenitude of Blood and other Humors which they find in the Patient Secondly They examine the Nature of the distemper what the Feaver is whether a simple Synochus or one that is putrid a causos or continued tertian They consider the violent symptomes what faculties they effect or what parts and according as they see occasion they apply themselves to correct its malignity or to moderate its fervour without indeavouring to extinguish the Feaver Thirdly They consider the danger that the Eyes Throat Lungs Stomach and Intestines are in should the Small Pox affect them they know that if they be driven forth into the habit of the body and those other parts kept inviolate there is little of danger but on the contrary if the humors discharge themselves on them now all other fears vanished yet upon the suppuration which brings a new Feaver horrible symytomes must ensue in the Stomach Bowels and Lungs And therefore they think it ought to be their care to mitifie the humors and fortifie those parts Fourthly They consider the manner of their eruption and if they come out kindly they intermeddle not If they either come out slowly and in the mean time create Epileptick and convulsive fits or other dangerous symptomes they promote their coming out and according as they perceive by their colour and other signs that they are malignant they apply themselves to amend those defaults If they find Nature to exorbitate in their expulsion and that they come out so thick that there is not sufficient room for them but that they run one into another If the Feaver continue or increase because that destroyes the due suppuration of the pustules they apply themselves to moderate the excessiveness of that evacuation and to correct that Feaver which is not to be terminated by any new excretion of that kind but to be cured in a manner as other putrid Feavers are and in this case all judicious men must allow no greater regard to the Small Pox than a symptomatical evacuatiion deserves Fifthly They imploy their care in securing such parts as are particularly indangered by their eruption expedite the maturation of them if it be to slow and difficult hinder their regress and suffer not any recrementition particles again to reincorporate with the blood and beget a new Feaver or other dangerous symptome and in case any new distemper happen as sometimes a Pleurisie or the like may do they provide for the due cure thereof These are the common intendments of all rational Physicians these things Doctor Willis whose short discourse of this disease contains in a manner all that our best Writers do suggest doth propose to himself and whosoever doth ponder well the course of the disease must assent thereunto Let the Motion be critical all intelligent men know that before the Crisis if we perceive any threatning danger that Nature cannot command the exorbitating humors but that the present symptomes are perillous and the future issue uncertain If the Crisis be immoderate and not agreeable to our desires If it bring no alleviation to the Patient our hands are not bound up nor are we prohibited to intermeddle even by generous Remedies As little are we confined by the Hypothesis of Doctor Sydenham for if Nature be inclined to change the state of the blood yet are we obliged to assist her if she be too weak and deficient or exorbitant and our providence hath the same liberty to exert it self that any other principles indulge it in I come now to those Means by which Physicians principally are said to act and those are the great Remedies of vomiting gentle purges and bleeding and to declare the usefulness thereof 't is necessary that we consider the Small Pox under a twofold notion As the Feaver precedes and as those Pustules do accompany it I think those Physicians to have written most discreetly who divide Feavers into two sorts viz Febres solitariae and Febres comitatae these last they distinguish from symptomatical Feavers in that those do succeed others and depend upon them as their Causes but these others do precede some other distemper or arise with it and are either a cause or occasion thereof and upon the appearance of their companion-disease they cease or abate such are Squinancies Peripnenmonies Pleurisies the Small Pox c. Comitatae febres continuae sunt quae aliquem morbum qui ipsas vel exitavit vel qui ab illis prodiit comitem habent aliaque praeter ea quae febris solitaria affert symptomata a morbo comite prodeuntia cum febrium accidentibus complicata febriumque naturam aliquando permutantia In this distinction we are freed from those impertinencies which others molest us with as if the concomitant disease were a crisis of the other whereas indeed this concomitancy makes us look on them rather as a complication of maladies than any such succession as is feigned and we are thence obliged to consider what indications arise from this conjunction for it is confessed that in these cases the primary disease is not terminated nor altogether to be cured in the usual manner but with a regard to its associate but our care ought to spend it self so as that the primary Feaver may innocently and without prejudice to the sick introduce its Associate and that conclude with an happy recovery To do this we consider the nature of the primary Feaver which is in the Small Pox a simple Synochus or a Synochus putride and sometimes a Tertian or double Tertian or some malignant Feaver These we are so to manage that they neither become exorbitant so as to destroy the Patient before the Associate discovers it self nor then become so depraved violent or malignant as to disturb the
aegrotus moritur Neither is this the only case in which a Physician ought to practise Phlebotomy but it may be done safely and warrantably if that the Small Pox do not come out kindly but appear and then retire in again of come out so slowly or evil coloured as that the Patient may be in danger to perish during the progress of the malady For in the first case is a certain sign that Nature is not able to govern those humors in the first eruption either because of their malignity or surcharge and if it be not to be done by her when the Disease is not arrived to its height nor she as yet much debilitated how can we imagine but she must fail in the vigour of it It is therefore requisite that a Physician duly considering all circumstances do proceed to secure the infirm by a minute and perhaps iterated blood-letting For it is not here as in other putrid or malignant Feavers in which we have a greater latitude of practise and what Nature cannot effect by one way of termination may be accomplished by another The concomitant Pox alter the course of the Feaver and suffer it to admit of no other issue but by a due maturation of the Pustules since therefore that Phlebotomy promotes the eruption and by altering the texture of the whole body and facilitating transpiration doth diminish the morbifick matter hinder putrefaction extinguish the Feaver and so alleviate Nature that she is enabled to prosecute happily her work I see no reason but that it ought to be administred and the same considerations do sway me to approve of it in the latter case for if the Pox appear malignant in their first coming forth their continuance will prove fatal if this Remedy be not applyed for we have none so effectual No Minoratives can be used to disburthen part of the humour no powerful Cordials for those however they seem to yield a present benefit do in the issue debilitate Nature dissipate the spirits retard the maturation and oftentimes increase the Feaver and occasion a Phrenitis or other deadly symptomes Vesicatories are attended with no less jeopardy not only for that they frequently cause bloody Vrines and exulcerate the Bladder and procure a vexatious tenasmus which I have seen to fall out when they were applyed in other distempers but because the ill-conditioned matter being attracted to them may cause a Gangrene or otherwise endanger the Patient upon which account I do not remember any that ever proposed them in this Disease 'T is true I knew a Person of Honour who in France was four times blooded pretty largely before their eruption and then had Pigeons applyed to his face and other places because they came not forth well and so was recovered 'T is true that Prosper Alpinus doth commend Inunctions with Nitre and Oyl of bitter Almonds to be used once or twice in a day but besides what Melichius records the practise being novel in England and seldome used in Europe I believe no discreet man will adventure his credit or the life of the sick thereupon but rather acquiesce in the received warrantable happy practise of the generality of Physicians In case that there be a great redundancy of the mass of blood in the aforesaid cases so that Nature seems oppressed and to be so streightned as not to be able to free her self from the corrupted humours who can doubt but the Physician hath more reason than otherwise to phlebotomise the sick in this time of the Disease It is a Rule in Physick That we ought to attend principally in diseases to that which is most urgent yet so as not to neglect those other considerations which arise from the nature of the Disease In this last case the regard unto plenitude is most urgent For if there be so great a Plethora as that there is danger least the Patient be suffocated and the natural heat extinguished which is the supposition of Avicenna when he sayes Timetur super eum corruptio extremitatis And if Phlebotomy either hath been omitted or not administred as 't was requisite who can imagine that Nature will be able to govern and regulate so great a surcharge to the benefit and recovery of the Patient but that when the humours separate and extravasate some part will mortifie and sphacelate or the party be suffocated It is really to be supposed that the sick person will dye within a short time except Nature alleviate it self by a large esflux of blood at the Nose It is here as it is in a Synochus putrida for commonly 't is a Synochus putrida which accompanies the Small Pox in which if either by reason of the reluctancy of the Patient or ignorance of the Physician blood-letting be omitted the case becomes exceeding perillous except Nature be very strong or a great flux of blood or plentiful sweat succeed as Galen relates in the ninth Book and fourth Chapter 'T is meer folly here to object that albeit that Phlebotomy be omitted yet ought we to presume well of the Patient because the Small Pox do come forth as when sweat appears in a Synochus for there is a great disparity in the cases The sweat is discharged out of the skin the Small Pox are lodged in the surface of the body and must there be maturated besides that the Small Pox infest also all the inward parts so that the danger is greater here than upon the eruption of sweat Moreover the sweat consists of a more subtle and Ichorous substance and finds a more facile and certain exiture but the Small Pox are of a grosser substance and come not forth with equal facility It is also to be considered that as a large evacuation by sweat may happily terminate a Synochus so although the Patient do abound with blood Nature may sometimes so expel and regulate the matter that the party may avoid the imminent perils but he that trusts thereunto must well ponder not only how plentifully the Pox come forth but whether it be proportionate to the exigencies of Nature for whatever is not such is minute and what alleviation insues not to mention other things And as when sweat doth not appear in due time due quantity with due qualifications the Patient doth nevertheless dye So we daily observe it to fall out in the coming forth of the Small Pox. And therefore I do assent unto the directions of Avicenna and Augenius that in case of this urgency Phlebotomy be judiciously made use of and whatsoever danger may seem to be in it 't is prudence to submit thereunto rather than to incurre greater Hitherto I have treated of Phlebotomy as 't is an evacuative and relaxing Remedy but there is oftentimes occasion for it by way of Revulsion when not only the Eyes are in great hazard to be spoiled or the blood stagnates about the Heart Lungs and Therax or that the Small Pox very much affect the Stomach and Entrails or occasion a Diarrhaea
nos aerâ— admodum calido In another place he sayes There is not any time of a disease in which you may not bleed but the sooner it is done the better Another sayes Vbi magnitudo morbi postulet vires permittunt non solum octavo die ut Hippocrates Anaxioni sed decimo ac vigesimo felici successu `venam secammus This point is excellently prosecuted and illustrated by Botallus to whom I referre our Experimentators for to be satisfied And I must avow that in other disease I have never scrupled at this caution as others but practised it with success in the State and sometimes Declination And why we may not do it in this Disease is the present Question It is certain that in the Small Pox at this time there happeneth sometimes a Strangulatory distemper or Squinancy sometimes a Pleurisie sometimes a Diarrhaea or Dysentery sometimes an immoderate Flux of the Menstrua In all these cases 't were great indiscretion if not ignorance to omit Phlebotomy If any of them can be disputed 't is that of a Diarrhaea and Dysentery and yet that is so vindicated by Botallus and Prosper Alpinus not to mention others and attested unto by a successful Experience that 't is no longer a Controversie I have already shewed that Phlebotomy doth not draw back the expelled matter but promoteth transpiration which is impeded by the maturation of the Pox during the State it ventilateth the blood hindereth further putrefaction and diminisheth that plenitude which whatever it be is too much for debilitated Nature to govern it revelleth the impacted humours or such as are flowing to any determinate part so that not only in the aforesaid cases but if an new Feaver arise then or any danger threaten the Patient in the declination both which cases often occurre I do not see why it may not or ought not to be done whatever the peril be that may happen thereupon Few there are but have so much strength as to bear a small evacuation by blood-letting and he is unacquainted with his profession who hath not seen prodigious effects arise from a minute Phlebotomy Our Writers do sufficiently explain the signs by which we are to be assured Whether the Patient can bear Phlebotomy and in what quantity which conjectures if they be not duly pondered 't is the default of the Physician not of the practise when any sinister event doth ensue And therefore I can only recommend to the World this caution that they make use not of such Practitioners as talk most and pretend to new Reasons Methods and Medicaments but of those who best understand the old Diagnestics Prognostics Methods and Medicaments in order to a cure and have from more than one or two Books informed themselves of the history of Physick as it relates to particular cases and by a diligent attendance on their practise observed the truth of what they have read and learned to accommodate their Rules to each individual Could a man ocularly demonstrate all the curiosities of Malpighius by the best Microscopes or manifest the Ductus rorifer of De Bils unto any Spectator nay what if he could make the volatile Salt of Tartar or the Helmontian tincture of Amber or even the Philosopher's stone what is this to practise How much less are they qualified who can alledge nothing for themselves then that they are enrolled in the Society of the Rosicrucians that so many men extol them who are obliged to magnifie justly or undeservedly all of their number and that they are good Wits ingenious Drolls Masters of some Mathematical and Mechanical knowledge As to the point of Concoction that t is not to be hindered In the Small Pox if they be salubrious this consideration is overswayed by present Vrgency and if it were not yet would that repugne only to a profuse evacuation and contra-indicate no more then doth the regard unto the strength of the Patient a minute and partite Phlebotomy doth not impede any concoction as our book cases and daily practise sheweth And in case the Small Pox be perillous or deadly 't is most certain that there is either no concoction at all or so imperfect a one that it doth not at all oblige the Physician to supersede but rather to proceed hereunto except he be timorous and unwilling to disparage so generous a Remedy or the Patient and Attendants be averse from it Neither of which regards are so authentick as to derogate from the attempts of those who will not abandon their Patients to the uncertain prognostics of acute diseases however they may in some sort excuse those that take a contrary course The last Question is Whether in the declination of the Disease a Physician may practise Phlebotomy I call that the Declination of the Small Pox when the matter in the pustules is condensed into Scabs and they dry up and the Epidemis with them doth pill off leaving impressions or marks in the Skin This Question doth not relate unto the mortal Pox for they have no declination but to such as are salubrious and though they may have been accompanied with dangerous symptomes yet are now in an hopeful way of recovery Or if we must allow a Declination in the pernicious malignant Small Pox it can be only one that is uncertain and fallacious for when any Patient feels an unexpected alleviation and such is grounded upon no reason there is no trust to be placed therein Iis quae non secundum rationem sublevant non oportet fidere neque â—erreri multum ob mala quae praeter rationem fiunt pleraque enim horum sunt infirma neque diu manere atque durare consueverunt In this time I say there may happen such cases as require Phlebotomy and in which it ought to be practised 'T is observed that a Flux in the declination of the Small Pox is generally mortal although it be not accompanied with a Dysentery or exulceration of the Gutts It is no critical evacuation because such happen not at that time and because it befalleth the Patient in the most unseasonable time of the Disease when Nature is most debilitated with the precedent Disease and ought rather to testifie signs of strength then of further imbecillity it enforceth us to employ all those cares which a symptomatical evacuation doth call for and in this case since purging is dangerous and astringents full of hazard there seems no way so safe as Phlebotomy duly administred It may also happen that the Patient fall into a Pleurisie Thus in the case of Frommannus in the declination of the Measils the Gentlewoman fell into a Pleurisie which he indeavered to cure by Phlebotomy and was defended in the practise by the best Physicians in Germany The Reasons which have been urged already in the other times will many of them justifie the Practitioner in this and nothing is more certain in Physick than that the use of Phlebotomy is not indicated by
therefore in raillery demanded by one If he used to walk upon his hands Moreover though that which is called by Anatomists the Cutis be thinner in the hands and feet than in other parts of the body yet is the Cuticula thicker there and 't is possible that even it may admit of a latitude in its native density and porosity in individuals since 't is acknowledged and hath been observed that some persons have had a double Cuticula It is also certain that the texture of the Cuticle may be so changed that those humors which issued thereout by way of insensible transpiration may be at some times intercepted and lodged in the skin and under the Epidermis and if â—o Why may not that happen in a determinate part which does happen universally In fine 't is frequently observed in Scorbutiâ—s and such as are said to have an hot Liver that they feel a troublesome heat in the palms of their hands and soles of their feet notwithstanding that otherwise they have delicate and tender skins or bodies which introduceth a dryness in the Cuticle there and can there be dryness without a condensation of the Pores or can there be such an heat without an obstipation thereof And doth not such a condensation dryness and heat indicate a befitting relaxation and humectation How then cometh it that any man should deny the possibility of the Phaenomenon in the Small Pox especially since daily events make it sensibly manifest or refuse to practise what is indicated I confess the old procedure of England is to anoint with unsalted Butter or to bathe with Butter and Beer which is conformable to the documents of Rhases But you see the practise of France Italy high and low Germany doth warrant the use of warm water He further urgeth that upon the opening of the Pores by bathing thus 't is possible for the ambient Air to gain such an advantage upon the sick as to repel the morbifick matter from these ignoble and extream parts to the more noble in the course of the sanguineous circulation But since continual practise doth manifest as appears by the Authors cited that this doth not inevitably nor commonly happen What is an effect of negligence in the Attendants or unknown idiosyncrasy of Patients doth neither disparage the Physician nor contra-indicate to the Remedy And so much for Doctor Whitaker to whom the English are obliged for his good intentions towards them in that Treatise but not for his performances 't is his latest Legacy to his Countrey but in Legacies it often falls out that the Legatee receives no other benefit by the gifts of a Testator than that he is assured he remembred him and had some resenturents for him where I say that letting of blood doth not except by Accident in some persons produce fatness I do confirm my Assertion further by the Authority of Epiphanius Ferdinandus who in his advice to an Italian Prince how to prevent excessive Corpulency doth direct a Phlebotomy and that to be repeated in both Armes Neither do I remember any Commentator upon the Aphorismes of Hippocrates who hath not directed that course for the extenuating of Athletick bodies This is a case in which the Germans are reconciled with the French and Italians and wherein Prosper Alpinus accords with Franciscus Silvius de le boe the former sayes that since frequent and large eruptions of blood do continue the Patients lean or reduce them that are otherwise fat to such an habit that even Nature seems to instruct an Artist so as to promote such like evacuations And the latter avows that immoderate growth of the musculous parts is to be prevented amongst other accessional courses by often bleeding I think there needeth not any more to be said about the point neither can it be justly doubted but that if Phlebotomy had so usually produced this effect of fatness it would have been reduced into observation by Physicians before 1650. Where I treat concerning Phlebotomy in the Small Pox that it may be safely administred even after that they begin to appear It is justified by a multitude of Examples one whereof lately was Sr. W. Roberts aged above forty years as I am most credibly informed they did not come forth kindly but most perillous symtoms did multiply upon him so that his condition seemed desperate yet upon the administration of this generous Remedy their eruption was expedited and all danger ceased so that he recovered with ease And at New Colledge in Oxford in the year 1660. or 1661. I remember not well the year the Small Pox raged with much malignity and proved mortal to many but it was aparent that few if any dyed who were let blood whereas on the contrary those that were not Phlebotomised died all or generally decease This I was assured of by more then one who were then present though not being Physicians they could not inform me of other particular Circumstances Concerning Phlebotomy in general there is one Objection against it that I think I ought to take notice of since it proceeds Originally from some Virtuosi And though one that hath urged it be most grosly mistaken in his assertion that the Turks use no Phlebotomy the contrary whereunto is not only evident out of Prosper Alpinus but is confirmed unto me by the observation of my intelligent friend Mr. Denton of Q. Colledge in Oxford nothing being more frequent at Constantinople then to bleed upon every small occasion and every Barber there being a Phlebotomist yet I believe that in China and Iapan the Natives do not practise Phlebotomy though the Europeans there do Notwithstanding this I do not apprehend the force of the Objection as 't is managed against Plebotomy nor can I commend their judgement who from those Presidents which indeed are but one Authority the Iaponese being no other then a Chinase-Collony would put us upon an Essay of practising without Vene section Eor the difference of particlar Countries and Nations arising either from their Temperament Diet and Efficacious Medicaments and Method of Curing as to render Phlebotomy useless or dangerous there whereas in other places there may be nay 't is certain is a necessity for a different procedure I have already remarqued that at Montpelier there is a greater repugnancy unto and danger of Phebotomy then at Paris And the Presidents of the one Province doth not oblige the others And though it be true that as in China so in Languidock Physick is in a good condition yet doth it not follow that therefore it is in a bad condition in the other parts of France Spain or Italy c. 'T is no less certain that in hot Countries as well as here in Summer and Winter the method of carrying varies from what is to be practised in colder Climates And as wounds in the Head and Leggs are in some places cured with much more easie Medicaments then else where So 't is no less manifest that 't is