nor themselves their own according to vulgar apprehension for what can silence prove more then a plain acknowledgment of such an error as will not indure the light of reason nor reduce any contrary disputant to an incommodum but leave a censure upon the art it self and all other that professe it as if art were onely a conjecture and healing or curing of Diseases were but an accident as if causes had no relation to their effects nor the sublation of them artificially to any substantial predicament which otherwise hath had an equall reputation of excellency in all Ages and the professors thereof amongst all Nations Witness very many Kings which have esteemed the contemplation and practise of medecine as the one chief Jewel in their Crown as hath been more largely expressed in my former writings But to return from this digression I shall resume my discourse of Phlebotomy and shew how unresolved and unsetled a remedy it is in this Disease All the chief professors of medicine establish it upon the indications either of plenitude of humours or magnitude of Diseases these being most proper and universal indications of phlebotomy and although it be a generall precept according to the Doctrine of Galen yet it is not without exception and more especially excepted in this case of the small Pox. Because in this operation a retraction of the peccant humour from the circumference to the Centre cannot be avoided which remedy must be as dangerous as unreasonable because no person of reason will allow a revulsion from an ignoble part to the most vitall and noble parts and although plenitude of humours be an indication for evacuation yet it doth not solely indicate phlebotomy except it be a fulness and redundance of bloud in predominance for impure plenitude is a contra-indicant of phlebotomy the bloud offending more in quantity then in quality being the most proper indication of bloud-letting and though there be some predominancy of bloud yet bloud-letting in such a case hath never proved a curative remedy nor did I ever see a sanguineous apoplexie cured by bloud-letting and yet the indication of phlebotomy is proper yet not curative because it is not per se the cause of the Disease for where the cause is external as a confusion in such case though there be a predominancy of bloud yet bloud-letting doth prove a remedy of no moment There is also an exception against phlebotomy though there be an apparent magnitude of disease As for example there is magnitudo morbi in a lucuphlegmatia or dropsie so also in a Cacexia and yet in these and such like cases phlebotomy can be no remedy nor is it indicated from the magnitude of these Diseases in the Small Pox also there is magnitude of disease and though it be complicated with plethory of bloud yet the 〈◊〉 of a â—ein is not a proper or safe remedy especially from the beginning to their eruption because the motion of nature is critical therefore those that practise phlebotomy upon the precept of Galen without distinction of cases must consequently incur the censure of inconsiderate and rash practisers or such as will abound in their own sense which is non-sense and such Phanaticks there are in medicine equall to those in Theology as doth appear by voluminous indigestions belched out in this Age some of them meer ebullitions of bitterness and others of heresie fomenting faction and mutiny in the Schools of learning as much as in the Common-weal Some such Sectaries there are in Physick that deny phlebotomy to be a remedy in any case or disease such as are the off-spring of Vanhelmont others that make it the sole-remedy in all cases and their instructions are from the mode of France which mode is of no Antiquity in that Nation nor ever so commonly used by any of their Antient professors which do ordain it as it is in it self a great remedy if properly adhibited viz. where there is magnitude and violence of disease conjunct with plethory of bloud and consisting age yet not without distinction of causes and diseases with other circumstances of time and clime And those that do read the most learned of that Nation can find them no otherwise principled yet I have heard Fernelius which I take to be a glory to that Nation to have had a most sad censure by some of Parisian practisers and that it had been better for their Nation that he had been unborn I have heard this language in discourse but could never conceive from what part of his learning they extracted their bitternesse But to return to my Theme of phlebotomy in the Small Pox in which case the agent standeth onely like Archimedes in expectation of a place to fix his foot to dislodge the earthen Globe for untill such an assurance of certainty to depend upon doth manifest it self there will be no well-grounded assurance of curing this Disease by phlebotomy not denying the practise upon just indications from the cause and disease rightly apprehended to be a most effectual remedy but in this case although conjunct with plenitude of bloud which doth most properly indicate evacuation yet this evacuation by bloud-letting is insufficient because according to Galen in his Books de Multitudine de Element de Morbis vulgaribus saying that bloud is most temperate because it is an equall mixture of all humours ad justitiam and therefore Phlebotomy to be an equal evacuation of all humours conjunct with naturall spirits and by this operation the bloud is left in its predominancy according to proportion only the universall plenitude is equally lessned and the morbificall cause still mixed with the remainder answerable both in quantity and quality to its first impression upon the whole masse so that the disease is not extinguished by this remedy but lessened in the cause And although according to this Doctrine of Galen there is an equall evacuation of humours yet the Spirits do at this orifice unequally transpire for in all bloud-letting there is a passe of fixed and innate spirit with the fluent and these cannot come within the compasse of equality because the fluent spirit is daily repaired but the fixed never otherwise if it came within the compasse of repair man should be eternall upon this earth but every evacuation of this nature doth abreviate humane life and hasten old Age as may be observed in the French Children which by this frequent Phlebotomising are withered in juvenile Age. Therefore Phlebotomy is not a common remedy but in such extremity as the person must lose some part of his subsistance to save the whole Moreover in this universall evacuation there may be an expence of some humours which are necessary to be preserved in the masse because they are not so suddainly repaired again and from this cause nature may want a vehicle of motion and suffer tyranny from the disease as when the Phlegmatick part of humours is drawn from the cholerick the bilious humor is left as fire to
what name the Small Pox or Variola passed amongst the Ancients And Sebastianus de morbis puerorum with many other Writers are of the same opinion from whom Marcus Antonius the Florentine Physician doth differ quaest 22. grounded upon the Authority of Galen 4 de sanitat tuend saying Where there is a complication of lassitude with those pustules which the Grecian nominateth Exanthemata from those we may soon diâ—cover the particular excrement which cannot signifie the Small Pox because other pustules do render the special excrement with the same distinction of pure choller burnt choller or phlegme with their quality of saltness and sharpness therefore my endeavour must be to discourse of that kind of Pox which assaulteth humane bodies but once in the whole course of life except rarely Valeriola whose memory is honourable doth endeavour to prove the Small Pox or Measles which appear critically in inpestilential Fevers not to be by Galen nominated Exanthemata with whose opinion I do consent because the appellation is of general extent to all kind of pustules and of choller 's as is verified in his book De atra bile where he affirmeth in deceased persons where excretion by the lower belly is not sufficient in such persons the whole body is affected with pustules quae nigris exanthematis similes essent circum undique scatuit and in other places he speaketh of white pustules which Pliny nameth papulas and of these Cornelius Celsus maketh more kinds of rough and sharp eruptions upon the skin magis minus being the onely distinction of them and many Moderns conceive these Pox to proceed from maternal menstruosity others conceive them to be intercutaneal ill juices or â—eccant humours fermented by an intense heat in the superficies of the skin which corrupt humours according to Fracastorius are generated by corrupt dyet and therefore in his book De morbis he placeth this disease of the Small Pox amongst diseases Epidemical and as it is an affect cutaneal and epidemical so it doth infect all children and young persons because their temper is properly more moist and hot than old age it being cold and dry in it self but excrementitiously moist onely by the decay of natural heat and altogether indisposed to receive the impression of it old age being properly per se cold and dry in temper if otherwise it is mirandum in morbo and for such wonders in diseases I shall refer the Reader to Skenkius and Peâ—rus Forestus c. There are not wanting â—ome Physicians that are 〈◊〉 of that opinion of the Small Pox that it is hereditary to those that are affected with it and not to be avoided by their natural issue let them be of any age or temper and therefore no more to be admired than the Gout Stone Consumption with Paralytick and Hydropical diseases especially and more generally the Small Pox against whose Opinions Fernelius is evidently opposite especially to all Physitians that affirm the Small Pox to proceed from maternal menstruosity but especially caused by the malignity of the air conjunct with vitious humours whose opinion is most reasonable because the Vehicle of universal infection is the ambient air which apprehendeth suddenly all matters subject and disposed to receive contagion Moreover when the Small Pox are universally spreading they frequently usher in the grand Pest upon a stronger infection of the air and that it is a malignity especially of the air hath been frequently proved by the creatures of the air which have fallen dead to the earth and killed by the poyson of the air Again if this disease were conveyed in the principles of Nature from maternal bloud which is administred to the production of all animals then there were an universal reception of this disease not onely in humane nature but also in all animals whose production is ex semine sanguine But this disease is apprehended by no subject matter indisposed to receive the impression of such venemosity as is of this nature nor is all mankind capable of such reception although Riverius will not have one of one thousand of humane principles to escape it yet in my conjecture there is not one of one thousand in the Universe that hath any knowledge or sense of it from their first ingress into the world to their last egress out of this world which could not be if it were so inherent a concomitant with maternal bloud and seed but the Small Pox is dedicated to Infants more particularly which are most moist and some more than others abounding with vitious humours drawn from maternal extravagancy and corrupt dyet in the time of their gestation and by this aptitude are well disposed to receive infection of the ayre upon the least infection according to Epiphanius Ferdinandus His cum quicquid recipiâ—ur recipitur in subjectum benè disposit um Moreover the want of motion is a stagmatizing cause in Infants by which their best humours may be altered into put refaction and prepare that particular matter to a form fit for such matter for Infants have no other exercise to digest their nutriment but crying according to Aristotle and common observation will manifest that the most quiet Infants are of least duration and most morbifical the causes of the Small Pox therefore are upon the corrupt disposition of the humorable masse internal and these two causes do produce that one effect which Galen nominateth Obstruction of all distribution internal and Transpiration external the permanency and continuation whereof doth effect an ill habit and consequently all diseases both similary dissimilary and common and thus I proceed to the signs of this particular disease Although the signs by which this disease is signified and distinguished from other affects are many which are rendred from the Greeks Arabians and Latines yet from none of them more exactly than à Ioanne Pascalio medico Valentino in their order the first sign of them being a Pain of the back the second Itching of the nose the third Fearful and troubled sleeps the fourth a compunction of the sensible and nervy parts of the body the fifth a Heaviness or ponderosity of the whole body the sixth a flourishing colour in the face the seventh is the Lacrymation of the eyes the eighth a Burning heat and fervency of the whole body the nineth a Gaping yauning and stretching of the whole body the tenth is a Palpitation intercutaneal the eleventh is a Compression and shortnesse of breath the twelveth a Raucedo or hoarsness the thirteenth is a thick spitting from much heat the fourteenth is the heaviness of the head the fifteenth is the trembling of the heart the sixteenth is a great siccity or drouth and driness of the mouth and tongue the seventeenth is the perturbation of the mind with Convulsive motion the eighteenth is the soreness of the throat the nineteenth the trembling of the hands and feet the twentieth is a perturbed and pale Urine These are the Pathognomical and proper signs of this
tyrannize over the remaining humours and the spirits which are more apt to be inflamed and for this reason an universall evacuation by Phlebotomy in the Small Pox is and must be a doubtful remedy because no man can justly prove that in a Phlebotick operation he shall let out the predominant cause more or lesse or equall to any of the mixture in the masse of bloud Therefore if the principal scope of the agent be to relieve nature offended and oppressed by the predominance and turgency of a single peccant cause the remedy indicated must be a particular correction separation and extinction of that particular predominance which is not to be effected by cutting a vein because the evacuation is universall and equally of the whole mass of humours leaving the predominant humour according to proportion as turbulent as before and consequently it can be no specifical remedy in such a case where the scope of cure is indicated from the quantity of the humour in predomination And thus I pass to the circumstance of clime which doth prohibit Phlebotomy universally to be used in all Regions I am not ignorant of the Doctrine of Galen nor of his precepts in this point of Phlebotomy nor of Augenius his 17. Books upon the same Subject and although Galen in very many places affiâ—meth Phlebotomy to be an universal and equal evacuation of the mixt mass of bloud yet not granted without his own exception to be an universall remedy in all Diseases nor in all Regions Therefore I shall now passe or urge his own exception against himself which consisteth in the distinction of Regions and diversities of climes which as they are distinct in the degrees of aire so also distinct in their dyet which doth maintain nature in its perpâ—tuo fluere and as every Region hath a customary dyet so is their customary or common aire most agreeable to the inhabitants as mud is to Eeles and these are principally their subsistance and much disordered upon any alteration of their aire and dyet and if this accident had not hapned to William Parr of our own Nation his principles of nature might have lasted to this day unquenched and it is a large vulgar errour to defend the death of any person to be just according to the power of his principles nor could any person perswade Sir Thomas More upon the Scaffold but if it had been the Kings pleasure he might have lived many more years upon the principles of nature but these changes are accidental But as every distinct Region hath their particular aire and dyet so are the remedies or medicinall ingressions of their own clime most proper for their common and vulgar distempers and those remedies will be more specifically sanative in that Region then any other aliuâ—de or contracted from another clime and out of a general observation Galen hath excepted against his general precept of Phlebotomy in his 9th Book de methodo medendi where he saith in the extraction of bloud there are many scopes observable and to be considered by the Physitian viz. custom strength of spirit consisting Age with the temper of the Region and place of Habitation as also the time of the year with the State of the Heavens and by reason of these circumstances though bloud-letting be necessary yet without a necessity of coaction not to be adhibited and if there be such a necessity it is to be drawn sparingly and with great consideration as by these expressions of Galen the whole universe may take cognizance that as he esteemeth Phlebotomy to be a grand remedy so he adviseth the use of it with as great circumspection and judgement and the non-establishment of this remedy neither by the antient nor modern Professors of healing is the cause of so much difference in consultation every man imbracing his own commentary upon it which maketh the remedy more doubtful otherwise it were according to Gantius the Portugal Physitian the most pleasant and suddain remedy in all diseases for it is quickly done and with as little trouble and pain And now I pass to the circumstances of time to be observed in this operation Riverius I conceive amongst all the Moderns to be the greatest assertor of Phlebotomy in variolis morbillis which are the Small Pox and Measles And yet without the circumstances of time age and plethory of bloud he will not adhibit phlebotomy nor upon redundance of bloud if there appear any sign of their eruption neither doth he admit of any inordinate sleep Si pustulae erumpunt and for this reason quia motus motui contrarius for sleep doth colligate the sense and retract the spirit and humors to the Centre and for the same reason Phlebotomy is prohibited And the same Author saith those that will begin the cure with bloud-letting must be sure that the foresaid indications of Age and redundance of bloud be compleated Moreover it is very rare to meet with such a conjunction of indicants plethory it self according to the proper signification is a fulnesse and redundance of the purest bloud and such a redundance as is ad distentionem vasoruÌ„ and very rarely discovered in Diseases therfore the remedy doubtfull and being uncertain it must be rashnesse or debility of intellect to apply such remedy The same Author saith also that if the Physitian shall not be invited at the first ebullition when this disease is in its first firmentation and before there be any signification of eruption or very few in number and quantity that at such time Phlebotomy may be profitable and in the next lines contradicteth himself diametrically where he saith upon the eruption of the Pustules the fervency and symptoms are abated and the whole operation is left to the motion of nature which is then propelling the cause to the skin from the centrall parts to the circumferential and then Phlebotomy is unnecessary and of no use Again the same Author affirmeth that if this pustulous eruption be intense and conjunct with a difficulty of breathing it is a sign that nature is onerated or over-burthened and therefore bloud-letting is to be ordained for disoneration of nature and enabling it to encounter the remainder which is reasonable if such a part of the onerating humour might solely per se be extracted without the losse of spirit for the support ofspirit is the principal scoâ—e of cure in this disease which is no way effected by bloud-letting Therefore this practise is insignificant otherwise the argument would be acceptable to all Logical persons and as inacceptable to the whole Sect of Galenists which affirm phlebotomy to be an equall evacuation of all humours with fixt and fluent spirits which are the principal prohibition of this practise in this case Otherwise upon an universal oneration it were reasonable disburthening of nature and properly indicated if seasonably administred and upon a critical motion But to conclude with the determination of this Author he in one worâ— saith bloud-lettings in the