thorow fault of the lunges and brest as sometime it doth in whom notwithstanding the vitall force may be sufficiently strong The contraries to these declare firme strength of the vitall vertue These thinges declare the animall po wers to be enfebled tumblings and tossings of the bodie the senses offended watchinges rauings and other principal actions hindered The contraries hereunto shew the contrarie that is firmnes strength of the animal vertue By these functions then you see how it may be coniectured what power in nature is hurt or offended Againe these powers are offended or seem enfebled two waies either because they are outwardly oppressed or because they languish inwardly of themselues in the euacuation it helpeth greatly to know the one from the other for the forces oppressed require large euacuatioÌ„ the other none at al. And the distinction of these is to bee sought out of their euident causes If causes haue gone before which haue already altered or wasted the substance of the forces naturall then wee may iudge them that they are faint and languished If these causes haue not been precedent but that the Patient is only troubled with an vnaccustomed ponderosity then these are but wronged and oppressed The euident and outwarde causes which alter the temperament of the setled vertues are burning Agues which melt the bodily moystures or whatsoeuer els that excessiuely heateth cooleth moysteneth or dryeth the sounde massiue strong and solide parts of the bodie The substance of these parts is wasted by very long sicknes which bringeth the Patient into an Atrophia that is a kind of consumption wherein the body consumeth away with leannesse and is not nourished albeit the sicke continually eate his meate Or into Tabes which is an other kinde of consumption wasting the body by long sickenes and lacke of nourishment consuming and putrifieng the Lites drying away the Patient for want of naturall moysture hauing matter and bloud mixt together The threefold spirit of the flowing humor is altered ether through some distemperature or some poisoned qualitie of the aire which compasseth vs about or through the il quallity of other thinges which violently breake in vppon vs or through some wâ—cked disposition of the bowels or other humours The heate of the aire not onely of that which outwardly compasseth vs about but also that which wee draw into our bodies by breathing inflameth first the lunges then the hart all the spirits so far till often times a feuer is kindled and caused thorow the same Thorow which distemperature of the spirits needs must the strength of the body languish becom enfeebled yea by this excessiue heat of the air the spirits are not only subiect to alteration of temperament but besides they are also thereby greatly wasted diminished Euen so in like maner immoderat cold outwardly the same receiued inwardly into the body by breathing weakneth the spirits inward heat yea soÌ„time altogether put out and extinguish the saá¹e The aire venemous pestilent drawen into the bodie with an infection quite ouerturneth the spirits of life and ofnature wherof â—nsuâ—th grieuous sicknesses to the body no litle decay of bodily strength yea life it selfe is taken away by the so daine disease commonly called the plague Now much more apparantly are the spirites infected with biâ—ings of Scorpions mad dogs and venemous beasts than by the contagion of the Aire Moreouer they are inwarde and hidden causes which doo greatly alter the spirits and whensoeuer any principall part of the bodie is troubled with any distemperature vpon any occasion If the same proceed far it must of necessity goe to the spirites there bred and ingendred And so by offending of them will lessen the strength and vertue of nature Also if any corruption of humor rule in the body the spirits are disperced and offended by the corruption or distemperature of the same humors Therefore when abundance of rawe humors passeth either the whole body or the stomacke and chiefly the mouth of the stomacke the substance both of inward heate and of the spirits waxe cold the Patient languisheth yea sometime hee giueth ouer the Ghost and soundeth Herevppon also when hot choler burneth as it were the inwarde spirits with immoderate heate or nippeth and pricketh the mouth of the stomacke it is the cause of no small euils in the body of man Sometime also it falleth out that some one or other humor in the body is mixed besprinckled or bedewed as it were with some kinde of venemous filth as when the seedy moysture is kept in and putrifieth Or menstruall termes in weomen longer retained than is their due course or when any clodded bloud remaineth behind and is not expelled the vapour of these and such like infecting and decaying the spirits bringeth sometime Sincope sometime suffocation of the wombe sometime the falling sickenes and such other mischiefes which greatly annoy the forces of nature And thus diuersly are the spiriets offended through distemperature Againe the substance of the spirits and naturall forces is diminished sometime euen of it self and as a man may speak voluntarily of his owne accord for the substance being of it selfe thin and wastable and included in an hot thin and open body Therefore of it selfe it dissolueth vaniâ—heth away Sometime the same is decayed by occasion of outwarde and euident causes as are namely these The aire which compasseth vs round hot and dry immoderate euacuations vehement motion affects of the minde paines watchinges great emptines and all vnprofitable excrements which cannot but carry with them from the body as they passe a great quantity or portion of the vitall spirits seeing their substance is spread ouer the whole body and also flowing with other humidities whereby it commeth to passe that whether the belly be very laxitiue by nature or by medecin or that the vrine bee made immoderately as in the infirmity called Diabete or that matter or water go plentifully forth of the brest stomack belâ—y or any great apostumation thereby of necessity the forces of nature must be mightely decayed Much more manifestly must it so fall out when there is any great euacuation of bloud or good humors whether the same pas forth of a wound the nose hemorroids Piles belly or other place In like maner abstinence which taketh away from the body needefull nourishment enfeebleth nature Labor likewise and heat disperseth the substance of the spirits by vapors sweat And therfore they which liue continually in labor about furnaces hot baths because daily some of their substance decayeth doo not commonly so abound with excrements as those that leade a slouthfull delicate and idle life Moreouer they that liue very incontinently haue also for the most part very enfeebled bodies able almost to abideno Phisick by a continuall decay of seedy moystures they haue their spirits mightely consumed wherof look before in the 8. cap. Fig. 17. Great ach paine worketh the same effect more than
labour doth Also of passions of the mind some suffocate the spirites and inwarde heate as namely feare and sorrowe some wast and spread them abroade as mirth and gladnes These are the causes which being in exceise do wast consume inward heat the spirites of life strength of the bodie which being so apparant as they are may be vnto vs assured markes signes wherby to know whether the forces of nature haue yet lost or do still retaine their powers vertue strength Those causes which onely oppresse the strength of the bodie are inward hidden not so know en vnto vs as the forsaid and they are these obstructions immoderate abundance of humors which stop the veines arteries because they are thick grosse and slow humors by meanes wherof they keepe in the spirits do not suffer them to be cooled as it were by any kinde of winnowing whereby the vse of the spirits is taken away their vertues are oppressed and grieuously with the inward heat offended which matter verie oft faleth out so in the Lungs Liuer celles of the braine in the arteries finally in the verie habite of the bodie Obstruction caused of too much abundāce of humors doth grieue oppresse somtime ouercome the inward heat and spirites of life Fulnes also proceeding from any obstruction if the repletion be simple or somewhat part-taking with that called Cacochymia it choketh bodily strength as for example Abundance of bloud in a wrastler Flewine in Leucophlegmatica i. the third kind of dropsie cruditie of humors in the other dropsie abundance of choler in the yellow Iaundies As often therefore as the powers of nature are descried to be weak by the excrements the spirites of life by the pulse breathing the animall facultie by her proper functions and by any of the foresaide vehement causes preceeding wee may determine the spirites of nature to be empaired VVhen none of these causes haue gone before and that yet the bodily strength appeareth weake then iudge them to be onely wronged or oppressed Specially if there do concurre signes of pure and simple repletion or of great corruption of wicked humors the causes greeuing and oppressing the spirites of nature being remoued presently their strength is recouered and they come againe vnto themselues except they be beaten downe with the continuance of their oppression Here therefore I make three steppes or degrees of naturall strength weakely affected either the same is a little throwen downe or ouercharged or thirdly altogether weakened whose particuler tokēs apeare by that which hath beene said in the premisses There are some which only marke the pulses as an infallible signe to iudge the bodily strength by which in trueth is a great marke but yet not alone sufficiēt being both doutfull and vnconstant and also because it is troubled with diuers outward things is oftētimes changed Againe euacuation too aboundant affecteth not onely the vitall spirites but also in like manner the other faculties of nature whose decay bringeth death as assuredly as if the vitall power were extinguished and therefore in euacuation it is requisite aswell to marke and obserue the other faculties of nature as the vital powers For if the pacient be sicke of a vehement continuall disease as of Lienteria i. a fluxe of the stomacke or Atrophia i. a kind of consumption or Marasmus i. the endes of the feuer Hectike let him not bloud albeit the pulse be mightie full And therefore I conclude this Chapter affirming that we are in euacuation to consider the ablenes and strength not of one only but of all the three aboue-said running or flowing faculties of nature Neither to consider of these alone but also of the setled faculties in which is conteined the action of life To knowe by the greatnes of the disease the strength of the naturall powers the quantitie of bloud that must be withdrawen Chap. 14. THe knowledge of the quantitie in euery remedie is the hardest matter in al Phisicke and most of all troubleth the carefull and wise Phisition And although to knowe the quantitie be but a coniecturall knowledge yet the same is ioyned with lesse danger and is more secure here than the knowledge of the quantitie in a purgatiue receit The reason is because wee may stoppe the bloud when wee will as Galen witnesseth 2. de ration virt in acutis Commen 11. lib. de curandi rat◠per sangninis missio Chap. 12. But when areceit is in wardly taken the same cannot be againe vntaken Neither is it in our power when it is once in the bellie to take away any part thereof or if neede be to adde vnto it VVhich in bleeding wee may do and therefore lesse danger is in this than in the other The quantitie of the bloud that must be extracted is knowen by the strength of the patient and chiefely by his pulse Therefore while he bleedeth let the Phiebotomer or Phisition seele the Pulseis with his hand and suffer the bloud to passe according to the alteration of the same especially when any great euacuation as euen vnto Syncope is to be made Lest it fall out vnwares that death it selfe doe come in the place of sowning or fainting And except necessitie doe greatlye vrge it is best and safest to abstaine from such plentifull euacuation after Galens councell lib. de Cura rat per sang missionem Chap. 12. If at any time the powers of nature being weake the disease require some plentifull bleeding it is good to deuide the same to open a veine twise or thrise and at eache time to detract a little bloud as ye haue partly heard before and as it shall be shewed more at large hereafter All sicknesse decayeth the strength of nature and so doth in like manner that euacuation which is vsed to helpe nature Lest therefore it might seeme a verie hard dealing in this case more grieuously to afflict one alreadie afflicted and presently grieued the matter is so to be ordered as the substance of the disease may be remoued the forces of nature as little damnified as may be Yea it is a principall poynt in a skilfull practisioner so to worke that the euill may be remedied and the patient brought in hope of a more profitable recouerie for his health than his former Phisick hath been painful vnto him Those hurts which the naturall vertues sustaine by a moderate euacuation are but small and these are againe quieted when the euaacuation is accomplished for nature now freede of those hurtfull humors wherewith shee was before pressed down recouereth her former strēgth Shee renueth that which was drawen from the inward heat and spirites and become almost the conquerour of the disease Shee ouercometh wholly at length yea that which remained behind partly by inward concoction and partly by outward dissipation It wise Hippo councelled to giue a small dyet to the sick patient not fearing thereby more and more to weaken the strength of nature which
reiterating bleeding which they call Epaphaeresis this is the order First in inflamations great paine hot feuers caused of aboundance of hot bloud a veine must be opened as is alreadie shewed euen presently at the very beginning before the matter be gone to som principal member not only that the aboundance and excessiue quantity of bloud but that much more a great deale euen plentifully and generally may be euacuated yea euen till the patient giue ouer if the strenght of the body so permitte And in diseases caused of fulnes the bodily powers are firme for the mostpart neither doo they shrinke or relent much by this plentifull bleeding And when Hippo. permitted bleeding so long till the patient should giue ouer hee ment it so when the strength therevnto sufficient was able to beare it and not otherwise For if fainting doo happen wheÌ„ the powers of nature are firme and constant it doth only wast the spirits in the arteries those forces remaine still vnhurt and vndamnified which narure hath bred in the hart Liuer or braine And albeit these decay in Lypothimia yet of the setled forces other like presently come in place whereby againe the Patient is reuiued But when the strengh of the bodie is weake and greatly enfeebled because the forces of nature setled and seated in the principall members are also impaired If Lypothimia then chaunce reâ—â—itution wil hardly be made Therefore I say the vertues of nature beeing greatly debilitated beware of ouer comming or fainting And this is the order in great and vrgent sicknesses In small generall diseases as in repletions fulnes feuers and such like whose cause and principall matter is conteined in the veines if bodily strength permit we must presently euacuat wholly at the beginning at one time not till the patient ouercome but so much as is needefull and as the infirmitie or malady requireth And this euacuation without any hurt to the naturall forces withdraweth the matter abounding either before the same do wholly putrify or that it posâ—esâ—e some notable member or before any horrible accidents happen He that for feare or any other cause parteth or diuideth in these the euacuation he continueth the disease long time doth no good but great hurt to the sicke patient But if for imbecillity of strength the whole euacuation can not be accomplished or done seeing it is better in this case to marke the strength of the party then the vehemencie of the disease we are inforced to vse partition in the bleeding and yet with a great circumspection and care and let the partition be within a litle distance of time either by vndooing or vnloosiug of the bound or stay the blod with applying the finger on the wound so long as by the foresaid meanes the forces of the body may bee recouered Sometime an hours space is sufficient sometime more houres â—re required to the restoring of the forces of nature The best way is not to deferre the partition of bleeding past one day yet I say if strength permit that partition must be vsed bleede twise in the selfe same day in general diseases especially except other impedâ—mâ—ts greatly let euacuacuat in one day asmuch as is expedieÌ„t before the matter come to putrffaction or that other euils do grow But in partiall diseases of particular meÌ„bers chiefly in inflammations the parted or diuided euacuation may be put off a longer time either to the day following or to the day after to morrow that in this space the corrupted humours may goe from the member diseased into the veins exhausted and so by the next incision be euacuated The member of the bodie that is afflicted with griefe or corruption by little and little euen in one day or two daies at the most sendeth downe the humours to the place where the incision was And for asmuch as they are corrupted they are not there to remaine albeit the former paines be mittigated and asswaged But if the inflammation bee pestilent and venomous as is a pestilent botch or carbuncle the euacuation of necessitie must be reiterated euen the selfe same day lest the pestilent infection sticke and stay any long time in the veines to the great hurt of the partie But neither must reiterating of bleeding be vsed For thereby the vitall spirites and in ward heate is diminished and vntimely age is hastened on apace and the same when it commeth is made subiect to greeuous diseases as Chachexia the dropsie gout in the iointes trembling palsies and apoplexies Yea when the naturall heat is immoderatly cooled and naturall moysture wasted the bowels languish crudity and vndigestion beginneth to beare rule whereby are caused great and greeuous euils in the body of man And thus much of the reiterating of bleeding and order thereof But let vs come againe to our former matter of prescription moderat motion easy walking as it was conuement before bleeding to vnloose and make the humours thinne so also the same is necessarie after bleeding to disperse abroad the reliques of those vapors and humours which are left behinde And as bondes of linnen were vsed before bleeding to the intent the veines might waxe bigge appeare full and bee the better perceiued and seene and that the humour with the more facilitie might come to the place appointed for incision so afterward they are also needfull to stay the fluxe of bloud and bind vp the wound It was already said that the partie let bloud must not sleepe that is to say not within the space of eight or sixe houres at the least whereof this is alleaged as a reason that the fumes caused by sleepe bee not carried vp to the head and so offend the braine There may hereof bee aleaged other caused more as namely lest the veine opened should take hurt by tossing of the patient vp and downe in his sleepe which cause was lately aboue specifyed Also lest in sleepe the humors should flow to the member where the incision was made and there apostumat For pained places as Galen affiâ—meth Capit. 95. medicinatiâ— artis lib. de Curand ratio per sang missionem Capit. 7. are by nature accustomed to receiue fluxes and chiefly in sleepe Auicen alleageth this reason Because by sleepe after bleeding for the most part there chaunceth in the members a confraction or bâ—using For while the member is tossed hether and thether with inordinat and vnorderly motion the bondes are vnloosed the wound vnhealed and as it were newly opened notwithstanding the late incision it doth afresh sende foorth immoderat fluxe of bloud the partie in his sleepe not witting thereof whereby as all men know the life commeth into great danger Againe another discommodity by sleeping immediatly after bleeding is that fumous excrementes through sleepe are againe inwardly reuoked to the principall members Againe the vitall spirits and natural heat which by opening of a veine are drawen to the outward partes and members by sleepe are reuoked to the center or middes of the bodie
may fall away They are with most safety let downe in a reede or a pipe to the affected member lest they might touch together and so by that meanes of ende those partes that are sounde and whole And first before you apply them so presse them and wring them out that they may vtter and cast forth all their venome so as their backes bee greene and their bellies reddish VVee are to choose such Leaches as are not in fowle troubled blacke waters nor such as haue long rayes or strikes in them like roddes called Hyrudines Virgulatae Nor such as are of the colour of Lapis Lazulus for these are venemous But wee are to choose them that bee redde inclining to the colour of the Lyuer hauing two redde lines or strikes or inclining to a certaine greennesse hauing little heads and beeing very slender and had out of cleare flowing waters Let them not bee blacke nor hauing a certaine white hearinesse vppon them as wee see there is vppon certaine hearbes as Clarie and vppon certaine fruites as vpon the Quince but as yee heard before take such as haue greene backes and red bellies To make them fall off if neede require put to their heads Salt Lyme Dust Ashes or Vinegar strawe any of these vppon them and they will fall away if you will haue them off sooner put a horse haire betweene their mouthes and the place and drawe them away when they are off wash the place with a spunge To â—â—nt the bloud after they bee remooued if neede so require for sometime bloud floweth out two houres after the Leaches bee gone straw vppon the place powder of roses or of buâ—nâ—d gaâ—ls or powder of a new tile or powde◠〈…〉 straw a little Sanguis Draconis or lay on the place powder of a spunge and pitch 〈◊〉 or a linen cloth burned or the hearbe 〈◊〉 Pastoris bruised â—fter the fall of the Leaches apply cupping 〈◊〉 to purge the venome and excrements which they haue left behind and to withdrawe 〈◊〉 bloud which they haue drawne somewhat outwardly but haue not quite euacuated Finally I giue aduise that before you vse them to the purposes aforesaid you apply them being hungry which is done thus by keeping them in water a day so that they eate nothing If you will keepe them longer put in the same water some Lambes bloud or such like that so they may be kept aliue some season For further matter herein I referre thee to Galen who hath written a booke De Hirudinibus That is of Bloudsuckers Of Cupping or boxing scarification the other two particular euacuations of bloud Chap. 27. FOrasmuch as it is not conuenient to be let bloud oft times in the yeare for that much of the vitall spirit passeth forth with the bloud and that the blould being taken away the body waxeth colde and the operations of nature become weake and enfeebled as we haue before in a certeine place declared therefore I counsell saith Galen that the baser partes of the bodie as the legges be boxed or cupped which is the most sure remedie as well to conserue health as to repaire the same being decayed For it cureth the eyes annoyed with long distillations It profiteth also the head vpper partes of the bodie as the brest and backe and against sundrie other diseases For in what member so euer the bloud is gathered the bodie being first purged by cupping the griefe may be cured Also Oribasius affirmeth that it helpeth Quincies in the throat dissolueth stoppings of all places Notwithstanding application of boxes about the stomack in hote feuers where reason is troubled are to be eschewed for feare of suffocation Likewise put vnto the head vndiscreetly they hurt both the head and the eyes Boxing helpeth swellings letteth foorth winde stoppeth immoderate Termes and the bloudie flixe helpeth appetite when a woman sowneth it reuiueth her â—pirites againe It draweth foorth water asswageth hard swelling clenseth Melancolie and that chiefely in weak bodies It will remoue humors from place to place as from the head to the necke from the neck to the shoulders Galen wrote a booke intituled de Cucur bitula tâ—aâ— is of the Cupping Glasse and rehâ—arâ—â— hâ—â—pâ—â—nese effectes thereof that boxing doâ—tâ— Non solum materiam euacuare sed etâ—â—m dolorem soluere Phlegmonon minuere insâ—â—tâ—onem discutere appetitum reuocare ventriculo in firmo roburaddere aâ—imi deliquio liberare ex alâ—o fluxiones transferre sanguinis eruptiones cohibere facultates mensium corruptrices extrahere mensesque supprimere i. not onely euacuate the matter but also asswage paine take away inflammations abate swellings recouer appetite strengthen a weake stomacke reuiue those that sowne drawe downe fluxes and stoppe fluxes withdrawe corruption of Termes and also stoppe the fluxe of them VVhich effectes shall hereafter be reheased with their cures by this practise more particular There are three causes which perswade vs to vse this practise and to refraine letting of bloud First because our purpose is to euacuate from some one member and not from another and therefore particular euacuation is done by boxing or Cucurbitulas which they that follow barbarous authors in Pinsicke doe also call Ventosas Nowe particular euacuation cannot be made by Phlebotomy for the same euacuateth and emptieth from the whole bodie Secondly because the strength is weake or the age vnfit to bleed or that there is some other of those impediments spoken of in the 8 Chapter For as Rhazes sayeth in 7 Ventosas drawe bloud but from the little veines and therefore the heat and spirites are thereby but a little diminiâ—hed whereas opening of a veine greatly debilitateth nature drawing from the greater veines with the bloud much heat vitall spirites Thirdly because our intent is to euacuate onely from the baser members Bleeding euacuateth from the most noble members and greater veines Ventosas from the meane members and little small veines which arein the outward bodily partes and lye without the greater veines Of boxings there are two sortes the one gentle without scarification or launcing the other with scarification which both in steede of bloud-letting are vsed when age debilitie the time of the yeare or other considerations will not permit the op ening of a veine Hereby is produced the thinne bloud next the skinne and being presently vsed after scarification when little incisions and holes are made in the member that bloud and humors may easily come foorth it mightily withdraweth by force and flame of heat not onely the thinne flowing humors and spirites which are about the member after scarifying but also that which is in places further distant If the skinne I say be first exasperated with the Iron it doth this that wee heare speake of more manifestly If the skinne be whole and not scarified it prouoketh bloud and humors from the furthest parts into the skinne and bringeth it to that parte whereunto the cupping boxes are applyed The cupping glasse infixed the skinne being incided or launced purgeth the