haue them vsed vntill the infants be at least a yeare old Mercurialis iudgeth it more safe to stick to the opinion of Auicen not to vse them till the children be a yeare old and that with these three conditions first that the child be full of bloud and of good strength secondly that they be rather applyed to the legs then to the vpper parts because bloud drawne from the lower parts doth not so much impaire the strength nor wast the spirits as that which is drawne in the vpper parts and thirdly that there neuer be taken aboue one ounce or two at the most In the Chapter following he addeth an other caution to wit that if we seeke to draw bloud out of places farre off we apply such cupping instruments as haue wide and large mouthes but if we purpose to draw from neere places then to vse such as haue narrow mouthes and therefore if we apply them to the legs they must haue wider mouthes and if to the places about the loynes the narrower Galen for old age telleth a pretty history of a mad Phisition which raâ—hly did let himselfe bloud Acertavne Phisition of fifty yeares of age being now a seauennight sick and not very strong hauing a great paine in his head not able to stay vntill some of his fellowes could come to him did in the night time let himselfe bloud and his paine quickly ceased But a long time after he was discoloured in his body weake in strength thinne and without nourishment so that hardly he could recouer that habit of health which before he had For women being with child Montanus sayth that wee must greatly suspect as well letting of bloud as any other euacuation in them both in respect of the nourishment of the woman and child and also for feare of an abortement or vntimely birth Especially he will haue them to be auoyded at those times when there is most danger of vntimely birth that is before the fourth moneth and after the seauenth moneth For whereas Hippocrates doth permit to purge women with child being foure moneths gone vntill they come to seauen moneths but them which are yonger conceaued or which haue gone longer we must beware of dealing with them Galen commenting vpon that place doth compare the child in the mothers wombe to the fruit of a tree which when it is very yong is soone fetched off with any wind or blasâ—ing and when it is very ripe it is ready to fall off it selfe but in the middle time it will remayne strong on the tree against all stormes and tempests So the infant in the wombe is most in danger of vntimely birth when the woman is either in the beginning or towards the end of her accompt But Montanus sayth purging bringeth more danger then phlebotomy Phlebotomy is then the mere dangerous if the child be great as is noted by Hippocrates A woman being with child is deliuered before her time if that be great wherewithall she is conceaued Galen expounding that aphorisme doth giue the reason of it because the bigger the infant is the larger nourishment it requireth Yet Montanus addeth that sometimes women with child do receiue much good by opening a vayne especially if they be full of bloud he sayth I haue seene some such women that if they had bin let bloud euery moneth it would haue bin without danger and againe if they had not had sometimes a vayne opened they would haue bin so grieuously sick that there would haue bin danger of an vntimely birth When superfluous bloud is taken away the foode remayneth more holesome for the child Fernelius doth more plainely oppose himselfe against the axiome of Hippocrates and yet not in his owne words but alleaging against him this censure of Cornelius Celsus Ould Phisitions did thinke that childhood and old age could not endure such a help as is Phlebotomy and they were perswaded that the woman which should vndergo such a kind of curing should procure an vntimely birth But afterward experience hath shewed that none of these cautions are perpetuall but that better obseruations are to be marked vnto which the Phisitions counsaile is to be directed for it skilleth not what are the yeares of age nor what the party doth cary in the body but what the strength is a stout boy a strong old man and a woman with child hauing an able body may safely this way be cured As Montanus doth limit and restrayne this liberty appoynting it not to be vsed vnlesse the woman be very full of bloud so Massaria doth likewise require that the Phisition should not only respect the present estate of a woman being with child but to forecast how she shal haue sufficient nourishment and strength to hold out vnto the appointed time of her deliuery Concerning women hauing their termes whether they may securely be let bloud it is thus resolued by Montanus writing vpon the seauenth canon of Auicenna concerning bloud-letting that if they haue them immoderately then may they open the vayne basilica for diuersion But if moderately and naturally then is Phlebotomy not requisite Yet he sayth if such a woman haue a pleâ—risie or a sharp feuer and be in danger that vnlesse the flux of bloud be eased by spitting there should come an inflammation of the lungs and vnlesse the force of the humour flowing to the breft be stayed there would be danger of a suffocation then must the saphena be opened though the woman haue her flowers For costiuenesse I referre the reader to the third Chapter of this second booke how it must be corrected before Phlebotomy As for the flux of the body Platerus doth giue a câ—aueat generally that such persoÌ„s as are apt to swouâ—nings should not be let bloud wheÌ„ they haue a dia rrhaea or loosenesse of the body because the flux doth make them more apt to swoune But otherwayes letting of bloud is of it selfe good for such flâ—xts as Auicen sheweth in his fourth canon and vpon it Montanus because there can be no vacuuin no voyd emptinesse therefore there is made an attraction out of the whole body by succession of parts one vayne draweth from an other vntill at the last it draw from the stomack as the like doth happen in hunger Now when the vaynes haue drawne first one from an other then they from the liuer then the liuer from the mesaraick vaynes and the mesaraick vaines from the stomack thereby the moysture being plucked away the body is made more bounden And besides that stimulating and tickling choler which did before passe downe and cause the flux to be more violent is by Phlebotomy drawne back from the bowels But how is it then that so many vpon letting of bloud do become straightway loose bodyed Montanus doth answere out of Auicen that it is non per se sed per accidens not of it selfe but by meanes of some other accident as of some timorousnesse and feare
diasena Nicholai somewhat more then halfe an ounce or confectio Hamec maior about halfe an ounce or syrupus de pomis Rondeletâ— about an ounce and a halfe If mixt humours do afflict the body then either to mitigate them compound your aforesayd syrupes and decoctions taking one moity of one and an other of an other or otherwise proportionably mingle them as the humours do more or lesse abound or else to purge them do the like by the forenamed purging receipts or take of Diacatholicum somewhat more then halfe an ounce or hiera Ruffi the quantity of a chesnut dissolued in broth or in pills take pillulae aggregatiuae or pillulae de tribus of either one of them about a dramme At what times these and such other like purgings shall be accompted most fit and what seuerall circumstances are to be obserued therein as well at the very instant of the ministring thereof as also in the preparing of the body before and the guiding of it after These are poynts which I do handle at large in the Cathartice or second part of the great Phisick remedies mentioned in my Preface wherein as I haue already gathered most of the chiefest â—xiomes and aphorismes out of many famous Phisitions of all ages concerning these and such like questions appertayning to the purging of humours and in some sort also disposed them so do I purpose also godwilling to deliuer them hereafter to the view of the world as soone as leasure shall permit to transcribe and friends aduise to publish Soli vni trinoque deo sit tota tributa Laus cuius coeptum dextra secundet opus FINIS The Index The questions and matters concerning letting of bloud haue no neede of any Index seeing they are in the Preface to the Reader gathered into a briefe summe and the Chapters poynted out where euery particular is handled But for as much as many diseases and griefes are touched here by occasion and obiter in sundry seuerall places that one place may the better explane an other and sometimes also supply confirme and second one an other and moreouer that the Booke may be more readye for the vse of the reader I haue thought good to adde alphabetically the names of the infirmities and impediments for which in these two bookes are found many counsayles and remedies A. Agues diaries Pag. 13. 4. Agues continuall of bloud inflamed p. 6. 70. 108. Agues burning p. 11. 12. 113. Agues epialae p. 16. Agues quotidians p. 65. 17. 4. Agues tertians exquisite p. 16. 17. 21. 22. Agues tertians bastard p. 19. 22. Agues quartaines p. 18. 16. 21. 23. 4. 107. S. Anthonies fire p. 112. Apoplexies p. 44. Arteries wounded p. 103. lib. 2. cap. 9. B. Bladder insiaâ—ed Pag. 100. 101. Blâ—ck choler and melancholy hâ—w differ p. 20. 19. 1â—â— Bloud abounding how knowne p. 57. 58. Bloud ouergrosse and thick p. 64. 113. Bloud corrupt p. 107. 108. 110. 114. See humours corrupt and raw â—urning feuer p. 11. 12. 113. C. Cacochymia p. 59. See humours corrupt Cachexia p. 52. See habite bad Choler abounding how knowne pag. 58. lib. 2. cap. 10. Choler abounding how auoyded and purged booke 2. Chapt. 10. Choler auoyded by bloud-letting p. 22. 27. 112. 113. Children what to take in steed of letting bloud p. 73. 74. 75. 76. 78. Costiuenesse how holpen by clysters p. 69. 70. 71. Coâ—ick p. 45. Concoction wanting how knowne booke 2. chap. 5. Conuâ—lsions p. 43. Continuall hoate feuer p. 6. 70. 108. Crudities p. 111. See raw humours Crudities how knowne booke 2. chapt 5. D. Diary feuers Pag. 13. 4. Dropsey p. 45. 52. E. Eares payned p. 101. Epiala feuer p. 16. Epilepsies p. 44. Eyes payned p. 10. 1 F. Falling sicknesse p. 44. Feuers of sundry kinds See Agues Fleame abounding how knowne pag. 58. and booke 2. chapt 10. Fleame abounding how auoyded and purged p. 67. 69. and booke 2. chapt 10. Fulnesse or full habit of body p. 2. 57. 98. Fluxes of body p. 79. 80. G. Gall of ill constitution p. 63. Gout p. 47. 48. 49. H. Habite bad p. 52. Heart payned p. 100. 101. Heart fainting See swounings Head-ach p. 101. Head inflamed Pag. 42. 110. Hips payned p. 100. Humours corrupt and raw whether admit Phlebotomy p. 51. 52. 60. 65. 66. 67. 71. 107. 108. 110. 111. I. Iaundise p. 52. Inflammations and impostumes how cured booke 2. chapt 9. Intemperancy p. 60. and booke 2. chapt 9. Itches p. 51. K. Kidneys inflamed causing stone p. 39. 47. and booke 2. chapt 9. Kidneys inflamed p. 100. 101. L. Legs payned p. 28. Liuer hoate and stomack cold p. 50. Liuer inflamed p. 100. 101. Liuer inflamed in cano booke 2. chapt 9. Liuer inflamed in gibbo booke 2. chapt 9. Liuer full of bloud and choler causing pleurisie p. 42. 100. Loosenesse of body p. 79. 80. Lungs inflamed p. 35. 100. 101. and booke 2. chapt 9. M. Melancholy and black choler how differ p. 20. 19. Melancholy abounding how knowne p. 58. and booke 2. chap. 10. Melancholy abounding how purged and auoided p. 107. and booke 2. chap. 10. Melancholy windes p. 44. Mixt humours how purged booke 2. chapt 10. N. Nostrils bleeding sometimes ill p. 75. sometimes good p. 39. 40. 114. O. Old and lingering diseases p. 105. 107. Old age whether to be let bloud or no p. 72. 77. P. Palsies Pag. 43. Phrenzies p. 27. Plague or pestilence p. 23. 25. 26. Pleurisie vpon what seuerall causes it commeth p. 42. and booke 2. chapt 9. Pleurisie when and how let bloud in it p. 31. 35. 37. 72. 98. 99. 106. Pleurisie when not let bloud in it p. 38. 39. Pleurisie how outwardly holpen booke 2. chap. 9. Pulses distempered what signifie p. 9. 10. 11. 106. 7. Q. Quartaine feuers p. 16. 18. 21. 23. 4. 107. Quinsies p. 29. 98. Quotidian feuers p. 65. 17. 4. R. Raynes inflamed p. 100. 101. Raynes inflamed causing stone p. 39. 47. Raw humours whether admit letting-bloud p. 51. 52. 60. 65. 66. 67. 71. 107. 108. 110. 111. S. Scabs p. 51. Scuruy p. 53. Spleane obstruâ—ted p. 44. 53. 100. 101. Spleane inflamed p. 39. 40. booke 2. chap. 9. Splenetick bloud p. 23. 113. 114. Spitting bloud p. 34. 38. Spirits inflamed p. 7. 9. Stone in the raynes p. 39. 101. 100. Squinancies p. 29. 98. Stomack weake and loose Pag. 62. Stomack impure p. 64. 69. Strength fayling p. 109. Sweating sicknesse p. 26. Swounings p. 62. 63. 79. 109. 110. Suffocation p. 2. 35. T. Tertian feuer exquisite p. 16. 17. 21. 22. Tertian feuer bastard p. 19. 22. V. Vomits how to be made when the stomack is impure or molested with corrupt humours p. 64. 69. Vrines betokening crudities booke 2. chapt 5. Vrines deceiuing p. 45. W. Women hauing their flowers or with child whether fit for letting bloud p. 77. 79. Women with flowers suppressed p. 99. Wombe inflamed p. 37. 100. Y Yellow and thinne bloud p. 21. 114. Yellow iaundise p. 52. Faults escaped Page 2.
the order and contents of these two bookes of Phlebotomy BEing purposed and resolued for the more generall benefit of my countrymen to publish in two english treatises the first whereof I do heere in title Phlebotomy and the other godwilling hereafter as soone as leysure shall serue Cathartice as compandiously and as orderly as doth or shall lye in my power all the chiefest aphorismes and conclusions which haue bin handled and written by the most famous Phisitions of all ages as concerning such cautions and circumstances as are to be obserued in letting of bloud or purging the body of man Although in practise it doth in many cases fall out that purging ought to take place before the opening of any vayne as shall hâ—ereafter more at large appeere in this booke yet for as much as bloud is the most excellent and principall humour that is dispersed in the whole body according to that of Galen 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 the best and most familiar iuice in man is bloud I haue therefore thought good in my methode of declaring how we must deale with these seuerall humours to follow the example of diuers learned men of our time to wit in respect of the disposing of them to giue vnto bloud the first place and preheminence These two remedyes are not onely accompted the chiefest amongst the kinds of euacuations but also amongst all other corporall helps prescribed or inuented for the curing of mans infirmities As well affirmeth Mercurialis Duo magnorum auxiliorum genera reperiuntur purgatio nempe sanguinis missio There are two kinds of great remedyes found out to wit purging and letting of bloud These 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 are called great helps because they are applyed vnto great diseases and also because howsoeuer they beeing abused do bring the greatest harmes yet beeing well and rightlie administred they do bring the greatest and most present cases and remedyes that euer either inwardlie or outwardlie were deuised for mans health This my first part of the Remedia magna in Phisick I haue comprehended in two bookes the summe and contents whereof as also of euery part thereof I haue thought it not amisse first briefely to prefix and lay open to the view of the well willing reader The first booke shewing what Phlebotomy is and to what vse it serueth in seuerall diseases conteyneth tenne Chapters The first what Phlebotomy is and of the foure distinct kinds and vses thereof The second how letting of bloud ought to be vsed in continuall agues as also in burning feuers The third how bloud-letting may be admitted in some kinds of diary agues made by obstructions The fourth how farre letting of bloud may be allowed in intermitting agues quotidians tertians and quartaines The fift whether letting of bloud be to be admitted in the Plague and pestilent feuer as also in the Poxe measels and such other contagious infirmities and when and how The sixt how letting of bloud is to be vsed in phrensies quinsies pleurisies inflammations of the raynes or wombe and other inward inflammations as they are considered in themselues without agues The seauenth in these dangerous inflammations aforesayd whether euacuation or reuulsion be more necessary on whether side the vayne is to be taken for reuulsion and what is the meaning of Hippocrates his rule 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to flow rightly or with a right course The eight whether letting of bloud be to be practised in cold diseases as palsies cramps apoplexies and whether it may fitly be vsed in melancholick windes colicks and dropsies The ninth whether in rheumes and distillations as also in the gout and in Morbus Gallicus any benefit may ensue by letting of bloud The tenth whether letting of bloud be expedient for such as haue hoat liuers and cold stomacks as also for such as haue itches and scabbes and such other faults of the skinne Further whether it be fit for the disease called of sea-faring men the skuruy and for the cachexia or bad habit of body and finally what and how many are the drifts and scopes in letting of bloud The second booke concerning the rules and circumstances which are to be obserued when for the preuenting or curing of a disease any vayne is to be opened conteyneth likewise ten Chapters The first whether the party that is to be let bloud haue truly that distented plenitude which is called of Phisitions corpus plethoricum and how the seuerall kinds of plenitude may be knowne The second of the consideration of the temperature of the party what it is by manner of diet or by exercises or by place of aboad or by custome or by habit or by constitution of body The third whether the body haue neede to be prepared before letting of bloud The fourth of the age sexe 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 costiue or too soluble may be let bloud The fift of the state and time of the disease what consideration is to be bad thereof in bloud-letting and which we must regard most of the powers the animal the naturall or the vitall The sixt of the time of the yeare the time of the constellations of the planets and the time of the day most fit for letting of bloud The seauenth on whether side the vayne is to be taken when we let bloud to preuent diseases or to auoyd or deriue their matter as also what vayne must chiefely be chosen for sundry infirmities The eight what manner of incision must be made how large how small how deepe what quantity of bloud may be taken and therein of the meaning of Galens word to let bloud ad animi deliquium The ninth what order must be taken with them that are let bloud as well in the act it selfe to preuent swounings as also afterward for their gouernment and diet The tenth how defects and errors are to be supplyed and mended and how the Phisition and in his absence the Chirurgian may know by the bloud being a little while reserued what course is further to be taken with the patient Before I enter into the discourse vpon these seuerall arguments I must pray the reader first to giue me leaue briefely to answere certaine doubts and occasions of offences which perhaps might arise vpon the publishing of this treatise First therefore if any because I baning heretofore committed to the pressse certaine Sermons and matters of Diuinity do now begin to set forth a Phisick worke do therefore gather or suspect that I haue conuerted my studies from the scriptures vnto Galen let him know that in this point I am vtterly mistaken by him for most of my phisick obseruations were then collected when first I gaue my mind that way which was long before I published any matter of Diuinity so that if there haue bin any alteration or conuersion of studies it hath
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 iâ— 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 poâ—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 oxâ—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 Pâ—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 coÌ„tinuall 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 cosâ—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
beginning of the disease but not if it be a hectick phrensy of any continuance Celsus doth affirme that the face being red and the vaynes swelling a vayne may be opened after the fourth day if strength be sufficient But if it come of a cholerick cause then it should seeme to be ill done to let bloud because as Heurnius obiecteth fraenum bilis est sanguis bloud is the bridle of choler To this he answereth Male sanguinem sine bile educeremus imo plus bilis educimus quà m sanguinis Hardly can we auoyd bloud without choler yea rather by Phlebotomy we do bring out more choler then bloud And if it were done but only for deriuation sake yet were it well done But at what time must this Phlebotomy be vsed Caelius Aurelianus sayth that it must be done within three dayes of the beginning and not beyond because in such diseases the strength of the body is in perill Aretaeus also sayth that it ought to be done either the first or the second day If the phrensy begin after the fourth day then open the vayne after the seauenth day but if it do come in the sixth or seauenth day then let no bloud for that is a criticall phrensey Aâ—tius sayth that if the phrensy do come with an ague any day before the fourth day and signes of plenitude appeare wee may well open the middle vayne When the phrensy is old letting bloud is not safe Caelius sayth that to let bloud after the eight day est iugulare homines is nothing but to murder men The quantity must be according to the cause If it proceede of inflamed bloud you may let bloud vsque ad animi deliquium till the heart begin to fayle For there is a vehement inflammation a very sharp feuer and exceeding great griefe in which three cases Galen alloweth large Phlebotomy But if the bloud be much mixed with choler then sixe ounces shall suffice or if the party be strong tenne ounces Aretaeus his opinion is that if it haue the first beginning from the parts about the midriffe then the party may bleed more largely because thereabouts lyeth the fountayne of bloud What you do you must do at once for the disease doth giue no long truce Trallianus commaundeth the vayne of the forehead to be opened But that Heurnius doth condemne as ministring a further increase to the discase especially if the phrensy come of bloud for both the bloud should turne his course into the head and also the euacuation should be made by the very place affected which should be as he thinketh very inconuenient The course which Heurnius doth best like of is this first to open the midle vayne of the arme and after to open either the vayne of the forehead or the vayne vnder the tongue For the Quinsie or squinancie the swelling of the throate causing difficultie of breathing and hardnesse of swallowing Trincauel doth aduise a speedie letting of bloud yet a glister being vsed before if the disease will giue leaue but if the disease as it is a very sharp disease will giue no space then may we do as Hippocrates sometime did that is first let bloud afterward minister the Clyster Fuchsius willeth vs to open the basilica of the arme of the same side where the swelling is But he will haue it to be done at seuerall times by little and little and not all at once least there should happen a swouning and so a perill of suffocation and besides By two sodaine coolings and by fainting of the heart the matter may be caryed from the iawes vnto the lungs and so bring ineuitable danger Yet must not the incision be made too little least by meanes of the narrownesse of the hole the good bloud should be as it were strained out and the thick part remaine within which is the cause of the griefe If the patient be a woman whose termes are stayed open first the saphena and then the vaine vnder the tongue For the pleurisy how conuenient bloud-letting is for it it is a thing so well knowen to all men that there needeth no proofe thereof But on what side the vayne must be taken whether on the same side that hath the inflammation or on the contrary side seeing that there is amongst learned Phisitions a great controuersie about that matter I haue appoynted one Chapter to wit the Chapter next following wholy for the discussing of that question And for as much as also all the arguments layd open in that disputation do as well concerne the inflamation of the raynes and of the wombe and all other inward inflammations as the plurisy I haue thought it good to speake no more of the particulars heere but rather to conclude with that generall speech of Galen To speake briefly when inflammations do begin we must euacuate them by reuulsion that is pluck it back into the parts furthest distant but when they are of long continuance we must empty them out of the places affected or as neere vnto those parts as we can For at the beginning of inflammations it is good to turne back that which floweth but when they haue remayned a long time we must auoyd and expell that which is impacted and fastened in the part affected CHAP. 7. In these dangerous inflammations aforenamed whether euacuation or reuulsion be more necessary and what is the meaning of Hippocrates his rule 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to worke directly and with a right course of flowing PEtrus Brissotus and Matthaeus Curtius two learned Phisitions the one a Frenchman and the other an Italian haue by many arguments prooued that in a pleurisy the vayne ought still to be opened in the arme of the same side where the griefe lyeth Trincauel in his treatise which he calleth rudimentum hath vndertaken to confute them The first reason of Brissoâ—us is because in such sharp diseases vnlesse you help presently the party dyeth And the first scope in an inflammation is to auoyd bloud out of the place inflamed for the performance whereof the same side is most conuenient Trincauel answereth that when the party hath no full body then that position may well stand But if there be a full body then he holdeth with Galen that the scope and purpose of the Phisition must be to forbid that the bloud shall not flow to the place of griefe For the flux of the bloud doth Galen make to be the cause of the vehement inflammation And this staying of the flowing of bloud he thinketh may best be done by euacuating so that we may also reuell the same by drawing it back to the contrary side Brissotus againe obiecteth that by reuulsion there is often stirred vp a pleurisy on the other side vnto which the reuulsion is made Trincauell doth answere that doth happen by meanes of the fulnesse of the whole body especially of the lower parts when the opening of the vpper vaynes can not auoyd so
the second maketh the diuersion and the third doth empty the place affected For the diuersion to the contrary part Montanus doth not only alleage the auctority of Auicenna and the Arabians but of Archigenes and of Aretaeus Aretaeus is brought in giuing his reason If there should be multitude of bloud and you should draw it from the side where the pleurisie is either you must draw it plentifully to fainting and swouning and so the patient should either dye or get an impostume in the lungs or else you must draw a little and so choake and stifle the party diseased because the plenitude being so great much more will flow then shall be auoyded Trincauell in the conclusion of that treatise which he made against Brissotus and Curtius doth describe seuerall considerations which are to be had in the pleurisy If there be a great fulnesse of bloud and a vehement force of the humour rushing on and that we feare moreouer least the inflammation should ouermuch increase then we do attempt both a reuulsion and also an euacuation as farre off as we can and by the contrary side but if there be no great fulnesse of bloud nor great force of the flowing of humours nor great inflammation then there is no neede to begin with parts farre off because lesse reuulsion is requisite So he expoundeth the meaning of Galen that if the knee or the feete be taken with an inflammation this must first be considered whether there be such a fulnesse of body as doth also fill all the vpper parts whereby there is feared an increase of the swelling for then we must let bloud out of the vaynes of the vpper parts But if the repletion be not so great and that it be only in the inferior parts then shall it be sufficient to let bloud out of the opposite foote The inflammation may be so little and light that it will be enough to open a vayne in the foote of the same side If the testimonies which Fuchsius doth alleage out of Hippocrates and Galen be considered by these circumstances then shall the two opinions be easily reconciled He citeth Galens auctority when the liuer hath begun to gather an inflammation the bloud is both to be plucked back and euacuated by opening the inward vayne of the right arme because it is direct vnto it and a great way hath a society with the vayne which is called the hollow vaine Galen doth there suppose the case to be first a liuer beginning to be inflamed and therefore yet a light inflammation then consider principally whether the whole body haue â—eede of euacuatiou then consider the strength of the patient whether he be able to endure to euacuate once plentifully and whether he do stand strong in power then by Phlebotomy in the right arme reuell or take away the bloud that is caryed towards the liuer This doth nothing ouerthrow the positions before set downe Fuchsius euery where doth build mightely vpon that place of Galen in his booke of Phlebotomy In pleurisies the Phlebotomy which is vsed right vpon the side that is payned doth often bring a most euident help but that which is vsed vpon the opposite hand doth bring either an obscure help or else it is long ere it come No doubt Galen there doth meane such in whom there is morbus iam factus the disease already setled and of them you may see what Galens iudgement is if you reade the conclusion of the sixt Chapter of this my treatise For euer according to the seuerall scope and drift of the Phisition there must be a seuerall manner of Phlebotomy So in the inflammations of the wombe Galen teacheth that in the beginning of them when the humour is now in flowing thou shalt diuert it if thou open the varne in the cubite But if the humour be setled in the place thou shalt deriue it by opening the vayne in the knees or in the anckles True it is that he doth elsewhere teach that Phlebotomies in the arme do stay womens termes as the letting bloud in the legs doth bring the termes downe but as Galen sheweth in the beginning of the inflammations of the wombe it is not good that the termes should be prouoked because they bring downe a humour to the place affected especially in a body that is full of humours apt to flow When we take vpon vs to cure an inflammation of the wombe if there be no other intent nor drift but to case the inflammation then may we open some vayne in the leg but if we take our scope and purpose from the flowing of the humours to the diseased part and from the fulnesse of the whole body then both to empty the plenitude and to pluck back the humours that are sliding downe we must as Galen iudgeth attempt it by the vaynes of the cubite Fuchsius alleageth also the counsayle of Hippocrates who aduiseth in a pleurisy to open the inward vayne of the arme of the same side right vpon it There is none that doth make any question but that in the pleurisy being a confirmed disease and the humours hauing already flowed euacuation is more fit then reuulsion and both may be done by the neerest place yea such a manner of pleurisy it may be as Hippocrates sheweth that you can not fitly vse any Phlebotomy at all his words are these There be some such as in whome in due time bloud may be let But in others it is not so fit as in them The impediment is vnto them which spit bloud time the pleurisie and choler Fuchsius in his Comment vpon that place sheweth that there be three hinderances that do stay them that spit bloud from being let bloud the first is time being too hoat or too cold The other two he ioyneth together and thinketh that he meaneth that in the pleurisy proceeding of choler Phlebotomy is not conuenient Trincauel being by occasion fallen into the consideration of that place of Hippocrates doth shew that Galen commenting vpon that place doth say that the points concerning the time of the yeare and choler may well be admitted but that the exception about the pleurisy doth seeme somewhat hard because if any disease the strength and age consenting do require letting of bloud the pleurisie doth most of all require it But he sayth the knot is straight by Galen loosed to wit that the words of Hippocrates are thus to be vnderstood that alwayes he which spitteth bloud must haue a vayne opened vnlesse the sayd spitting of bloud do come of a pleurisie for then bloud must not alwayes be let but we must vse such liniments as do particularly respect the pleurisie And afterward he sheweth yâ— reason why it is not necessary that such as haue pleurisies should alwayes be let bloud because by experieÌ„ce he knew one meÌ„ded of a pleurisy without letting of bloud his pleurisy being a light pleurisy and voyd of all feare of
teach either wee must draw it downe by opening the saphena of the same side or else we must deale with the opposite side aboue The rest of Montanus his opinion you haue seene before in this Chapter where I haue compared his iudgement with the iudgement of others the most excellent Phisitions of our age CHAP. 8. Whether letting of bloud may be practised in cold diseases as palsies cramps apoplexies and whether it may fitly be vsed in melancholick windes colicks and dropsies FOr the diseases mentioned in this and the two Chapters following I purpose not to shew the censures of many Phisitions but only for euery infirmitie to content my selfe with the auctority of one or two of whom I make best reckoning and so to hasten to those other points which more generally and vniuersally are to be considered in the whole practise of Phlebotomy Although cramps and palsies conuulsions and resolutions be cold diseases yet Aetius Paulus Aretaeus and diuers do appoint to begin the cure with letting of bloud Galen doth allow it but not generally alwayes He only doth admit it in these cases and with these conditions First when these cold diseases haue their beginning by the suppression of the termes or hemorrhodes Secondly if they be with a feuer but then it must be done moderatly sparingly Thirdly if there be great plenty of bloud either in the whole or in the head For as Galen sheweth and also Hippocrates by the ouermuch fulnesse of the vaynes there are made oftentimes epilepsies and apoplexies Trallianus beginneth his cure of a lethargie by letting of bloud if other circumstances do not prohibite Heurnius in his Chapter of conuulsions doth like well of the iudgement of Aretaeus to wit that whether the cramp or conuulsion do come of coldnesse or by a wound or by vntimely birth the vayne in the arme is to be opened especially if bloud be the cause or if it be such a crick that the neck or body can bend no way or if it be an inflammation or a wound Montanus alloweth Phlebotomy in epilepsies and apoplexies when they depend of bloud but he addeth this clause hoc autem faciendum debitis temporibus praecipue vere this must be done in due time especially in the spring time For melancholick winds caused by obstructions of the liuer or spleane Mercurialis giuing aduise in that case to a Noble man of Germany sayth first you must thinke of letting bloud not that the abundance of it doth plainely shew any such matter but because other noble helps can hardly be safely administred vnlesse letting of bloud do go before And in an other place writing counsayle for a woman which had fiue yeares suffered the obstruction of the spleene and was now come to a schirrus or hard swelling he sayth I thinke it were excellent well that she should be let bloud first out of the common vayne then out of the lienaris and last of all out of the vayne of the left foote so that at thrice there be in all taken a pound of bloud Trincauel his iudgement is that we must abstayne from bloud-letting when the melancholick humour is dispersed into the vaynes of the hypochondria and the whole body and that then we must rather purge or procure the hemorrhodes if the party haue had them vsually before For the Colick Auicen doth forbid bloud-letting to be vsed in it Montanus writing vpon the sixth Canon of Auicen giueth the reason of it because the colick commeth of some cold and thick matter and phlebotomy both doth make more cold and also hath no power to auoid the thick and grosse causes of the griefe Yet he addeth this But if the colick do come by the inflammation of the colum one of the lowest guts by meanes of bloud or choler flowing to the place in this case if you let not bloud the patient will dye For the Dropsie Trincauel teacheth that if it come by the suppression of some vsuall flux as the termes the hemorrhodes and bleedings at nose whereby by the superfluous abundance of bloud the naturall heate of the liuer beginneth to be quenched then the first thing in the cure must be phlebotomy But if it come of fleame then omitting bloud-letting we must only seeke to purge the fleame He maketh there an obiection what we must do if the termes be not suppressed and yet the vrine do appeare high coloured whether may we then let bloud or no seeing that Auicen sayth that if the vrine do appeare red and thick a vayne must presently be opened Trincauel answereth that yet we must not let bloud because in this disease that rule of Auicen doth not take place For the red tincture of the vrine doth not come by abundance of bloud but first because little vrine is made in these diseases therefore it is the higher coloured for the thinne iuices of choler and bloud from the which doth come the colour of the vrine being mingled with a little moysture do giue the greater tincture and make it higher coloured And a second cause of the high colour in the vrine he sayth may be the debility of the raynes which by reason of their weakenesse being not able perfectly to separate the bloud from the excrement do let some little portion of bloud passe with the vrine whereby the vrine is dyed red A third reason doth Fernelius giue why the colour of the vrine may often deceiue because when the choler is cast out by the liuer it doth not only colour the thinne part of bloud but maketh the vrine also to looke as though the bloud were inflamed as he giueth an instance by Iaundises and Dropsies and concludeth They do therefore offend which by the vrine being of citrine colour and thicke do iudge straight that bloud is to be let For such an vrine doth not come by the abundance or by the kindling of bloud but by the powring out of choler out of the liuer I will not speake heere of the razing of the stone in the raynes and some other occasions that may be that a little bloud issuing may alter mightely the colour of vrine This which hath already bin spoken may put vs sufficiētly in mind in the matter of bloud-letting not so much to be led by the colour of the vrine as by other euident tokens which shall be hereafter more at large declared But when the vrine doth concurre with other signes then vis vnita munita Et quae non prosunt singula multa iuuant CHAP. 9. Whether in rheumes and distillations and also whether in the Goute and the disease called Morbus Gallicus any benefit may ensue by letting of bloud MOntanus doth make this to be one of the principall and generall vses of Phlebotomy then to take place When any hath some notable heate of some member by means of which heate it doth easily receiue excrements and so fall into a disease as if
the words of Galen Therefore by the disease and the age and the powers we know that bloud is to be let but the quantity of the euacuation is to be gathered not only by these but by all the other intentions The second booke of Harwards Phlebotomy concerning the rules and circumstances which are to be obserued when for the prenenting or curing of a disease any vayne is to be opened The first Chapter Whether the party that is to be let bloud haue that dâ—â—bented plenitude which is called of Phisitions corpus plethoricum and how the feuerall kindes of plenitudes may be knowen THe principall thing whereof consideration is most to be had in letting of bloud is named of most writers to be magnitudo morbi the greatnesse of the disease of which I haue no purpose now to write seeing it is in a manner the whole matter subiect of the booke already ended When it is found by the nature of the disease that a vayne is to be opened then we are next to examine the constitution of the party from whom the bloud is to be taken and especially by all signes and tokens exactly to waigh whether he haue corpus vere plethoricum a body ouercharged with the fulnesse of the vaynes or rather with excesse of humours ouer the whole body as Galen doth define it Plenitude is an abundance or an excesse of humours thoroughout all the body There are two sorts of plenitude the one is called ad vasa in respect of the vessels conteyning and the other ad vires in respect of the power not to be able to beare those humours that are The plenitude quoad vasa is made by Galen to be of two sorts the first he calleth simply a plenitude which he defineth to be the foure humours being proportionably increased The second kinde he calleth a plenitude with an addition or a plenitude compound when some other humour besides bloud doth abound more then it ought These I will not stand vpon because I haue already deciphered them in the first Chapter of the first booke There remayneth only heere to set downe the marks and euident signes whereby they may best be knowne when the patient commeth in presence If there be a fulnesse of bloud in respect of the vaynes and other vessels then the colour both of the face and the whole body will be much enclined to red after any strong motion the vaynes will swell and the arteryes beate a sweate will easily breake out a wearinesse doth oppresse the body and lims which are loth to moue by reason of their owne waight the hand can hardly be clutched together the drawing breath will be very thick after exercises In the fulnesse in respect of ouercharging the powers and strength these things do happen the motions of the body lims are somewhat slower the sleepe is heauie but troublesome the partie doth often dreame that he is ouer-charged with some burthen and that he can not stirre himselfe and he feeleth likewise a wearinesse and heauines as is in the former but it is without those full and distented vaynes If the bloud do particularly exceede in these plenitudes then some do adde moreouer these signes the pulse thick full and soft the laughters great the head enclined to aches the body somewhat costiue the spittle sweete the vrine red and thick the dreames either of colours red or of things amorous and in women their termes vsually in the first quarter of the moone When any other humour doth abound it is called a cacochymy A cacochymy is an abounding of any other humour but bloud If choler do abound the colour of the face and eyes and whole body will be pale or yellow or of a citrine or tawny colour the party will be watchfull and of little sleepe griefes will be most on the right side vomitings will be often the thirst much and the appetite to meate faint the pulse will be slender hard and swift in the mouth sometimes a bitternesse the vrine of a firy colour and with little ground or sediment the dreames will be much of matters of fire and the termes vnto women happen most in the second quarter of the moone If fleame do abound the colour of the face and body will be white the body it selfe waighty fat soft and cold the tast weake the griefes most about the ribs stomack or the hinder part of the head the pulse slow soft and weake the vrine pale or white sometimes thinne and sometimes thick with much grounds or sediment the sleepe sound and much the dreames either of drowning or watery matters and the termes vnto women vsually in the old of the moone If melancholy do exceede the colour of the face and whole body will be browne dusky and blackish sometimes equally and sometimes somewhat bespotted feares will come needelesly and sorowes without cause the pulse will be hard the vrine will be thinne and white and sometimes when melancholy doth auoyd it will be thick and black or black and blew or somewhat greenish the sleepe troublesome and full of fearefull dreames and the termes to women commonly after the full I could here rehearse many other signes whereof Leuinus Lemnius doth make mention drawne from the fashions studyes and manner of life of the party to make tryall of euery one by the manner of his gate by the deuises of his braine and by the performance of his actions but then I should perhaps make some to thinke too well and some too ill of themselues although in deede hardly will any thinke too ill and I should increase this latter booke into a greater quantity then is now my purpose to performe Briefely I conclude this first poynt concerning the plenitudes with the censure and iudgement of Galen who when he hath brought them all to two generall heads When the humours are equally increased they call it in Greeke plethos or plethora but when the body is full of yellow or black choler or of sleame or of thinne whayish moystures then they call it not plethora but eacochymia He doth presently after shew how they must be holpen and amongst the remedyes of plethora he maketh letting bloud the principall Plethora is cured by letting of bloud but for cacochymia he maketh the chiefest remedy to be purging But cacochymia is cured by that purging which is proper and peculiar to euery seuerall abounding humour If this cacochymia be also with a disâ—ented fulnesse then must also Phlebotomy be vsed but sparingly only so much as may ease the plenitude and rather as Fernelius doth aduise ex interuallis detrahendo quà m vniuersim affatim vacuando sublata plenitudine praecipiti periculosa reliqua impuritas cacochymia purgatione eximenda est But of this already in the last Chapter of the former booke CHAP. 2. Of the consideration of the temperature of the party what it is by manner