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A02791 Harvvards phlebotomy: or, A treatise of letting of bloud fitly seruing, as well for an aduertisement and remembrance to well minded chirurgians, as also to giue a caueat generally to all men to beware of the manifold dangers, which may ensue vpon rash and vnaduised letting of bloud. Comprehended in two bookes: written by Simon Harvvard. Harward, Simon, fl. 1572-1614. 1601 (1601) STC 12922; ESTC S103856 94,484 154

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should expell the disease by the skinne because such purgations do trouble the motion of nature and yet at the same time doth allow a clyster of barley water one pound and a halfe of oyle of violets foure ounces of butter three ounces of red sugar candy one ounce or of each of them proportionably a lesse quantity if it be for a child and doth there condemne Nicholaus Florentinus for that he forbiddeth the ministring of a clyster at such time as the sayd diseases do begin to breake out for sayth he it is a fond thing to thinke that the motion of nature i● hindered by clysters seeing that they do worke only in the bowels and the motion of nature is both neere the skinne and in the vaynes neither do clysters so ouerthrow the po●ers that we neede to conceiue any feare Euen so for as much as in letting bloud our drift is especially either to case nature being ouerburdened or to expell some dangerous causes of putred matter by transpirations sweatings euaporatings and such like very expedient it is that we auoyd such purgings as whereby the worke of nature may be either troubled or weakened and content our selues with a more fit preparing brought to passe by glysters It is a great fault amongst very many in England that they are so nice and scrupulous in receiuing of a glyster as seeming to suspect some danger in that which indeede is the most easie and harmelesse remedy of all others And as great a fault it is in many of our countrey Surgeons which so boldly do commonly practise the opening of vaines neither hauing before any direction of learned counsaile neither being themselues stored with those things which should orderly prepare their patient therevnto They which do minister purging potions at that time when nature doth begin to moue say they do it because nature doth moue vnperfectly but to them Mercurialis doth answere intelligere an perfecte moueat in initio non possumus we can not know in the beginning whether nature wil worke perfectly or no. The safest and surest way is by a clyster so to ease the fulnesse and costiuenesse of the body that we do not disease the emptinesse and loosenesse of natures powers If the impurities and crudities be aboue in the stomack then shall it be requisite before Phlebotomy to vse some vomit as to take of the decoction of barley two or three ounces of oyle of sweete almonds and oximel simplex each one ounce of oyle of dill two drams mingle them and giue them for a potion Or if the matter be grosser and colder take of the seeds of rocket leekes radish broome each the waight of a shilling of the rootes of asarabacca and betony each the waight of sixe pence boyle these in water so much as being well boyled will make a good draught and being strayned dissolue into it two ounces of ox●mel simplex and drinke it off In hoater diseases the former will be more conuenient Fit vomits and clysters they make a preparation speedily and do nothing trouble the work of nature in expelling to and by the outward parts P●rgations if they be strong they weaken nature if gentle then are they long in working and hauing some hoate qualities in them must needes as well by their heate as by their drawing a contrary way trouble that worke whereunto Phlebotomy is directed Fontanonus a learned Doctor of Mountpelier writing of that synochus or hoat cōtinuall ague which proceedeth of bloud inflamed in the vaynes neere vnto the heart after that he hath appointed to begin the cure with present letting of bloud What houre of the day soeuer it be for feare least the bloud do creepe vnto the lungs and thereupon should come an inflammation of the lungs or least it should slip into the bulk and thereof should arise a pleurisie or finally least it should putrifie and so there should be made a putred ague of a not putred he sheweth after how the body must be made fit for this Phlebotomy not with a purging potion least while the purgation is long in working the patient should receiue harme by the aboundance of boyling bloud but by a clyster made after this sort Take of the foure emollitiues each one handfull the foure emollitiues are as skilful Heurnius doth lot them out 1. mallowes 2. marsh mallowes 3. violets or in stead thereof pellitory of the wall or mercury 4. branck vrsine or in steede thereof beets of endiue and lettise each halfe a handfull tenne prunes boyle all in a reasonable quantity of water vntill the third part be consumed then strayne it and take thereof one pound and a halfe dissolue into it of cassia newly extracted and red sugar-candy each one ounce of salt a little and you haue your clyster In stead of the pulpe or flowers of cassia may be vsed diacassia Mesuae or diacatholicum Nicholai or electuarium lenitiuum Rhasis any quantity betwixt halfe an ounce and an ounce and a halfe according to the strength of the party the most conuenient oyle to be added to them is the oyle of violets In stead of the aforesayde things the clyster may be made of a little soluble chicken-broth goats-milke and the yolke of an egge stirred and mingled and putting into it of manna and fresh butter each an ounce first melted together these be the ingredients most fit for the clysters of such as are to be let bloud And if any Surgeon by reason of his seate and place of abode be so situated that he shall be enforced sometimes to open a vayne before the counsayle of a learned Phisition may conueniently be obteyned let him be carefull to haue some prouision of these things in store as he tendereth either the testimonie of a good conscience in respect of himselfe or sound and perfect health in regard of his patient For as before is shewed many are the harmes and dangers which ensue if at the time of letting bloud there be crude and corrupt humours in the stomack and bowels prest and ready to be suckt and drawne into the vaynes now newly emptyed by the administring of Phlebotomy CHAP. 4. Of the age sexe strength and solubilitie of the party whether old men or children or women being either with child or hauing their termes may be let bloud Also whether any hauing bodies either too soluble or too cos●iue may be let bloud FOr the beginning of old age there is no question but that bloud may be let very safely in it if other things be corespondent Trincauel saith that about the fortieth yeare of age that is about the beginning of old age we may most fitly be let bloud But Galen doth make three degrees of old age the first he calleth 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 signifying such as haue a greene and lusty old age such as are able yet to deale in the astayres of the world The second he calleth 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 the middest
greenish burnt choler if of a leaden colour pernicious melancholy if it be of diuers colours then it is shewed that diuers humours doe abound There is sometimes a certayne fatnesse lyke a spiders webbe swimming vpon the bloud If it be in a full bodie it signifyth a bloud prone vnto fatnesse but if it be in a leane bodie it commeth of the consuming and wasting thereof If the bloud doe smell ill as it falleth out but seldome it is a signe of a very great putrefaction Fernelius sheweth how in the bloud you may behold all the foure humours Cum sanguis concrenit serum per summa innatat vrinae haud absimile bilis est tenuis florida concreti sanguini● pars suprema melancholia subsidet sanguis rubentior petuita pallidior media tenent When the bloud is congealed there are fiue things offered vnto our view The tenue serum or whayish part swimmeth vpon the top much like vnto vrine The choler is the thinne and flourishing highest part of the congealed bloud The melancholy falleth downe to the bottom The bloud is the redder part and the fleame is the whiter part of that which doth possesse the middest betwixt the choler and the melancholy Galen sayth what soeuer is most vnctuous light in the bloud is choler but what is most grosse and as it were dregges which by ouer-much heating is dryed vp that is melancholy Fernelius doth aduise vs not only to marke the colour and contents but also when the bloud hath settled awhile to compare the little basins one with an other If all be like it is likely that all the rest in the body is like vnto it and that only the multitude did offend For although the bloud be neuer so good yet if it be in ouer-much plenty it may greeue the body offend the senses and bring very many dangers If all the bloud be ill or if the first be good and the last ill it sheweth that many humours do yet remayne to be rooted out by good diet and by fit euacuations or else if the bloud-letting be in a great inflammation then the last bloud being worse then the first doth often declare that the very matter of the disease is auoyded and the euacuation made fully complete So likewise if the last bloud be better then the first it is a good signe of a perfect euacuation If the bloud be powred afterward into warme water that the substances of it may be seuered one from an other it will declare much vnto vs. The whayish thinne part will be so confounded with the water that you can not discerne the one from the other The thinner part of bloud will also be mingled with the water but yet so that by the colour thereof you may haue a good iudgement of the nature of the humour The thicker and fibrous part of the bloud will shrinke to the bottome which shall be iudged to be pure and agreeable vnto nature if it be bright thinne somewhat whitish and cleauing well together but if it be thick it declareth that the bloud in the body is thick If it be black or infected with any bad colour it sheweth with what humour the bloud is oppressed If it cleaue not together but do easily fall asunder it is an argument of very great putrefaction When thus the humour abounding is knowne and therewithall a consideration had of the state quality and nature of the disease if it be found that there is still a continuance of the payne or griefe then must we either vse those things which do gently correct the humour appearing to abound or else if time and occasion require it harken to that practise which Hippocrates doth commend in many of his writings as Galen doth collect out of him When humours are increased with a iust proportion amongst themselues he indeuoureth to bring help by Phlebotomy but when some one humour amongst the rest is superfluous then doth he giue a fit medicine for the purging of it If Choler abounding do yet annoy the body then either delay it with syrupus acetosus syrupe of limons and syrupe of citrons or with some brothes or drinks wherein are boyled lettice purslaine endiue the white flowers of water-lilly sorell stubwoort and dandelion ioyning with them some sperage and germander or else purge it either with some simple as Rewbarbe a dramme or cassia an ounce or manna an ounce and a halfe taken either in some of the aforesaid broth or in a decoction of tamarinds and prunes or else by a compound as syrupe of roses two ounces or syrupus de cithoreo cum Rhababaro one ounce a halfe or diaprunum compositum or diaprunis laxatiue or by electuarium de succo rosarum any of them a little vnder halfe an ounce If superfluous fleame do seeme still to bring danger then either diminish it without purging by syrupe of hysop syrupe of hore hound syrupe of mayden haire oxymel simplex oxymel squillaticum and by ptisanes of barley water wherein are boyled some elicampane foelefoote licorice and annise seede or else purge it either with simples as with infused and strayned agarick about three drams or with colocynthis about twentie graines or with elaterium as much being well gathered light white and bitter or with tithymall leaues dried and prepared one dramme or else with some compound as with the powder of hiera picra made into pils with the iuice of baulme or sage about two drams and a halfe or by pils de turbith or pillulae stomachicae of either one of them about one dramme or diacarthami halfe an ounce Or if the disease haue bin so lingering and the humours be become so tough and clammy that scammoniate things may be vsed you may giue of Diaphoenicum or of electuarium Indum maius of either one of them about halfe an ounce Where I vse the word about my meaning is still that in the young or in the very weake and feeble you must take a little lesse and in the stronger sort a little more then the quantity here specifyed but otherwise vsually and commonly to ayme as neere as may be to the waight and dosis here mentioned prescribed If melancholy abounding do seeme to aggrauate the impediment then either auoyd it without purging by syrupes of borage and buglosse syrupe of agrimony or syrupe of fumiterre or by some broths or drincks wherein are boyled baulme rosemary and the flowers thereof tamariske dodder hartstoong the foure cordiall flowers to wit of roses violets borage and buglosse also capers and ceterach called of some fingerferne or else purge it either by a simple as by Sene in powder one dramme or by Sene in decocton halfe an ounce or by polypody or epithyme of either of them about halfe an ounce steeped boyled and wrong out or by black Hellebore about halfe a dramme or by lapis Armenius washed a dramme or else by some compound as by