possible for the sick to recover without any means yet are means to be used the omission thereof is imprudent and criminal but the use thereof if the Physician be knowing and discreet safe and as secure as the condition of our mortality permits any thing to be A few dayes or hours of the encreasing distemper will more impair the strength of the sick than the loss of a little blood which in the condition it is adds not to the vigour or nutriment of the diseased the dammage will be easily repaired and perhaps all this nicety will be to no purpose for after a multitude of vexatioâ—s sometimes dangerous symptomes Nature may produce in the almost exhausted patient a violent eruption of bloud and thereby terminate that malady which might have been alleviated or allayed before Fluxus sanguinis largi ex naribus solvunt multa ut Heragorae Non agnoscebant medici The Bloud for which they are so sollicitous Nature her self is not so careful to preserve it but that frequently in the beginning and progress of diseases she alleviates her self by discharging it out of the nose and that in greater quantities of more florid blood than the Lancet would take away This evacuation is of all the most facile the most easie to be regulated by the Physician since he can stop it when he will and the most innocent in the beginning and increment of diseases Sanguinis eruptiones haemorrhagiae hanc habent praerogativam prae aliis evacuationibus quod ipsae etiam in principio in aliis temporibus etiamsi non adsint signa bonae coctionis possunt esse magis utiles quam aliae evacuationes quae fere semper sunt malae ex eo quod sanguis semper per apertas partes fluunt semper libere commodum exire possit nec eget praeparatione concoctione sicut alii humores qui per alias evacuationes excerni debent In evacuatione quae per venas apertas fit nullam merito expectamus concoctionem hinc Medici secta vena in morbis acutis in principio mittunt sanguinem hinc spontinae sanguinis vacuationes bonae erunt Addatis sanguinis eruptiones copiosas nedum utiles fieri propterea quod sanguis malus una excernatur sed etiam quoniam ejusdem sanguinis evacuatio universum corpus refrigerat caloremque transpirabilem corpus difflabile facit Quare hac ratione excretiones sanguinis optimae erunt quae in statu apparent plene cocto existente morbo sed neque ea quae cum cruditatis signis fiunt erunt plane abhorrendae timidae In fine that prudence which obligeth us to self-preservation obligeth us to the most probable courses in order thereunto and What can seem more rational than that which NATVRE directs us unto that whereby she so happily mitigates and concludes diseases that which so many Ages have recommended unto us and in the use whereof not only Greece and Rome but all Nations universally as well barbarous as Civil are agreed on And thus much shall suffice for an answer to his first Argument I now proceed to the second The Blood is the support of Life and we are taught by Divine Writ that in the Bloud that Spiritus rubens is Life I answer That the Scripture in the places aimed at cannot be understood literally and properly for then the words infer that the Beasts have no other soul than the bloud Deut. 22.23 onely be sure that thou eat not the bloud for the bloud is the soul and thou mayest not eat the soul with the flesh Thus it runs in the Original though our Translation renders it Life And so Levit. 17 10 14. in which last place 't is said that the bloud is the soul of all flesh Nay in Genesis c. 9. v. 5. Concerning man 't is said The bloud of your souls will I require It remains then that deserting the literal sense we fly to some that is Analogical And hence it is that most Divines take the word 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 for Life Thus Exod. 21.23 Thou shalt give life for life is not incongruously rendred instead of Thou shalt give soul for soul. Thus the Civil Lawyers frequently stile Loss of Life by the phrase of Animae amissio But however these passages may be popularly current yet in Phylosophy and Physick when we would speak distinctly and argue firmly 't is not to be allowed of for Truth that the Blood or Spiritus rubens as our Helmontian most non-sensically terms for as great a Pyrotechnist as he would seem 't is past his Art to demonstrate that it is a Spirit or Chimically to educe a Spiritus rubens out of it is Life for Life is nothing else but the union of the soul with and its presence in the body or to declare it by its effects 't is the conservation of all those faculties and actions which are proper to the animated creature as Death is the extinction of them Out of which 't is evident that Blood is no more properly called Life than 't is possible for the Definition of Life to be acmodated to Blood that is not at all But since common discourse doth allow us often to fix the principal denomination upon the chief instruments and that the Scripture explains it self Levit. 17.11 and what my Adversary in one place calls the LIFE in another he terms it the principal support of Life let us consider how far that is true That the Bloud is not so much as a part of the body but the Aliment thereof is the assertion of most Authors it is not continuous to the rest of the body but floateth as Liquor in a vessel and in vulgar speech no man takes the loss of bloud for a mutilation or dismembring and there are sundry distempers and phaenomena which conclude in favour of the spirits or what is Analagous to them and the Nerves to assert their pre-eminence above the Blood and its Vessels and whatever may be said concerning Generation which is very disputable 't is a certain mistake in our Helmontian to make the Bloud the principal matter for sensation whereas sanguine persons are not the greatest wits and the senses are most quick in women during their lyings in after a great effusion of bloud as also in dying persons or motion which is not in paralytick members though the Bloud flow unto them continually as it was wont before I add that there is not any convincing Argument to prove that the Bloud is animated I confess the conjunction of the soul and Body and operations consequent thereunto are most mysterious unto me and I think it no less true that our Life is a constant miracle then that we are at first wonderfully framed nor can I determine what particular use the soul makes of all the parts and ingredients of our humane bodies But this appears unto us daily that the conjunction betwixt the Soul and Blood and the
dependance of our Life thereon is not so great or intimate as that upon the effusion of a little no nor of a great deal of the bloud Death or any debility extraordinary and durable should ensue unavoidably and if it happen but sometimes 't is apparent thereby that 't is but accidental and not a proper consequence of that effect 'T is manifest that the operations of the Soul are not restrained to one determinate proportion of bloud in every body nor to the same in any albeit that there seem requisite in all Animals that there be some bloud or what is equipollent thereunto 'T is also manifest that this Bloud for which some are so sollicitous doth continually expend and waste it self in nutrition and that even the nourished parts are in a continual exhaustion so that without supply it would degenerate â—nto choler except in those miraculous fasts and diminish to little or nothing as appears upon great fastings and several diseases 'T is no less manifest that upon great evacutions of bloud by wounds or otherwise when the Bloud hath been so exhausted that very little can be imagined to remain yet in a few dayes the veins and arteries do fill again and nature is so replenished and vigorated that this lost bloud seems not only as good in order to the functions of life but better in order to health and strength since the production of this last in the end of diseases is accompanied with convalescence whereas the precedent did not hinder the indisposition Out of what hath been said the Answer to this Objection is facile viz. The Blood is not so the seat and residence of the Soul nor so absolutely necessary to Life granting all that can be desired of us as that some of it may not be let out without present danger or irreparable detriment so that if the motives for Phlebotomy be cogent or so probable as to render the Action prudential no difficulty can arise from this scruple It is written in Deut. 24.6 No man shall take the upper or nether milstone to pledge for he taketh a man's life or soul to pledge Here the milstone is called the life or soul of a man as much and as properly as ever the Blood is any where else But though there be a prohibition for a man to deprive his poor neighbour thereof as of the support of his Life yet undoubtedly none was ever interdicted by virtue of this precept to help the distressed Miller to pick and dress his Milstones His third Argument is this Moreover one would think it should put a stop to their prodigal profuse bleeding if they did but consider with what difficulty Nature brings this Solar Liquor to perfection how many hazards of becoming spurious and abortive it passes through how easily it is stained by an extraneous tincture how often intermixed with something allogeneous and hostile to it how many elaborate circulations digestions and refinings it undergoes before it be throughly animated and made fit for the right use of the immortal Soul One would imagine by this Objection that the Generation of the Bloud were as difficult a work and required as much of sollicitude as the Philosophers stone and that the least errour would disappoint the process and eject the poor soul out of its tenement and mansion But there is not any such thing he that considers the perpetual supply of Chyle by the Ductus Thoracicus and with how much ease it is transformed a great part into Blood by the similar action of that which pre-existed in the veins together with the concurring aid of the Heart and sanguiferous emunctory vessels and the previous alterations in the stomach and intestines will imagine neither the production of Bloud nor the reparation of it to be so tedious and hard a matter Nor is it true that the Bloud is so easily stained with hostile tinctures since it is a liquor that is in perpetual depuration and hath the convenience of so many out-lets to discharge it self by Neither will every crudity in the immature Chyle or bloud render the blood unfit for the use of the immortal soul there is extraordinary and unimaginable difference betwixt the bloud of one person and another as appears upon distillation burning and mixing it with other liquors yet are all these within the latitude of Health and with equal perfection exercise the operations of Life Nor doth every allogeneous mixture vitiate or deprave the bloud for the Chyle Bloud and Flesh retain some particles of the original food taken into the stomach hence it is that sheep fed with pease-straw though as fat as others yield a flesh differently tasted from other mutton the like is to be observed in the feeding of other Animals generally Nor is this more evident in other Animals than 't is in Men for not to mention those Medicaments which by the alteration they make in the Vrine do demonstrate they have passed along and been once mixed with the bloud as Cassia Rhubarb Annise-seeds c. In fonticulis observavi quod si praecedente die aliquis allium aut cepam comederit pus quod in fonticulo est odorem allii aut cepae obtinebat sanguis autem qui per fonticulum expurgatur non nifi per venaâ— expurgari potest unde possumus dicere quod sanguis acutum odorem detinere possit The like phaenomenon is to be observed in wounds and ulcers which feel detriment according to the various food and drink of the patient Nay in pleurisies and other wounds it hath been taken notice of that the purulent matter hath discharged it self by the veins re-mixing with the bloud into the intestines and by urine The Bloud of some persons in perfect health hath been observed to stink worse than rotten eggs even as it was issuing from the arm upon Phlebotomy yet when it was cold it did not stink nor seemed to differ from the best bloud except that it was of a more beautiful red than is usual I conclude therefore that in this Argument many falsities are contained and there is nothing of such force as to deterr a prudent Physician who understands the rules of his Art and those cautions which are suggested to us in Phlebotomy to let his Patient bloud and emit some of this solar Liquor His fourth Argument They should never attempt yea rather abhorr to enervate in the least by the Lancet the strength with its correlative bloud and spirits without which there is no hopes of attaining a desired Cure For it is a most established verity taught by Hippocrates that Naturae sunt morborum medicatrices the most assured means of sanation is to keep up the vital pillars without which all falls to ruine So that Van Helmont is without controversie in the right when he sayes utcunque rem verteris ignorantiae plenum est procurata debilitatu sanare velle i. e. make the best you can thereof It savours of gross ignorance
I have a great reverence for the name of Experience and the bare mention thereof commands an attention from me But it hath been the peculiar misfortune of my education that I have been taught not rashly to assent nor to believe every thing that is told me since there is nothing but may be spoken by some body I can be so civil and so curious as to give the Relator an hearing how mean soever he be but before I credit him I must consider whether the thing be possible and withall because my knowledge is not the adequate Measure of possibilities in nature Whether it were done If the thing did succeed I inquire Whether it will constantly or most commonly follow upon the like causes and circumstances Or whether it is a rare accident In the two first cases the knowledge thereof makes a Physician the better Artist the latter adds to his gâ—â—eral Science of natural Phaenomena but not at all to his Art except in cases as rare as the Phaenomenon related In Artibus inquit Galenus duo sunt praeceptorum genera unum eorum quae perpetuam habent veritatem alterum quae utplurimum ita se habent tolerantur quae raro fiunt ibi locum non habent At hodie multi sibi placent in scribendis obtrudendis observationibus raris tanquam novis Artium mysteriis sed rara non sunt Artis Ido also consider the quality of the Relator the vain-glorious and ambitious are easily deceived because they passionately desire the thing should be so and 't is for the credit of such Observators if it be so the young are easily imposed upon by the little experience they have of things the credulity that is in them naturally and the good opinion or hopes they have of the integrity of others and because they are conceited of their own knowledge though the prospect of things be narrow they are prone to opiniatrity and vehement in their assertions though too unsetled and impatient as well as ignorant to weigh any thing maturely and with all its requisites I do not weigh the greatness and opulency of Relators but value them as they are Artists for such only can judge in their own Faculties And when controversies arise the Stagirite deluded me into an opinion that the most probable tenet was that which the most or the most intelligent did profess This Pyrotechnist upon many reasons deserves not any credit he writes Books as Mountebanks paste up Bills to invite custom the Medicines he recommends are such as by the sale thereof he would advantage himself all he publisheth is in a subserviency to this end and 't is not his skill but his ignorance that is concealed in his Arcana all that ever sweet William or Andrew related upon a Quack-salvers stage deserves as much of heed and esteem as what G. Thompson talks I do not ask thy pardon Oh! most illiterate and dull disciple of my Lord Verulam for dissenting from Thee But I with submission and deference beg leave for not adhering to Doctor Willis No man of understanding can condemn his practise he hath not altered the Authentick methods but given new and plausible reasons for an Ancient procedure This Character is due unto him that scarce any man surpassed him in his thoughts when awake and 't is his peculiar happiness that his Dreams are pleasant and coherent Amongst all that have written about Phlebotomy and its abuses I never met with one that recounted this for one evil consequence thereof that it inclines men to Feavers I find P. Castellus to reckon up twenty five evil accidents which sometimes ensue thereupon but this is none of them Nor do I see that it is reconcileable to that effect of Phlebotomy whereby it refrigerates the habit of the body and the common distempers which follow the Abuse of it are cold If it be true that it inclineth people to be fat and fat people are neither so hot nor incident to Feavers as the lean and bilious though otherwise more weak there is reason why my doubts should increase upon me It might with some colour have been said that excessive Phlebotomy did dispose to the Rheumatisme and Gout but not to Feavers except by accident that some persons having contracted a grosser and more sanguine habit of body upon Phlebotomy and such complexions being most capable of any malignant or pestilential and contagious infection not by reason of their phlebotomy but from the habit of body which whether natural or adventitious is lyable to those casualties falling upon any excess or other occasional cause into the Small-pox or Sanguine feavers the observation hath been raised into repute It is a thing I have not seen to happen vulgarly nor doth any Author that I know take much notice of that other effect how Phlebotomy inclines to fat I have read in Ioannes Fuchsâ—us a Bavarian that such a thing hath fallen once or so under his observation in a Lady and Doctor Primrose denies the matter of fact that Phlebotomy will make those that are inclined to be fat fatter though persons that are extenuated and eâ—aciated with sickness may by bleeding acquire a greater corpulency And certain it is that in those Countreys where Phlebotomy is most used there are fewest fat men and women as Spain France and Italy or Egypt in this last region it is their particular study and a distinct profession to make people fat but 't is by other courses then Phlebotomy In short I my self have been let blood above fourscore times and yet am lean and so far from being feavourishly inclined that I never had any except the Measils once and Small-pox twice and twice a tertian Ague and I find no imbecillity or prejudice in the least that should induce me to repent what I have done or resolve against it for the future But we must distinguish upon what is produced by any thing as its cause and what is only a concomitant thereof If it ten thousand times proves otherwise we must not impute the growing fat of one Patient to Phlebotomy indefinitely but rather to some alteration the disease in which it was applyed hath wrought in his body to his Analeptic diet and course of life subsequent thereunto or to his individual temper And perhaps it may be not impertinent to add here that as Distillation and the burning of the blood of a Multitude of persons hath convinced me that there is no such deflagration of blood as that learned Physician imagines nor any vital fermentation in the blood depending upon the Chymical ingredients of Salt Sulphur and Spirit c. so neither is the Blood of corpulent persons I never tryed the Obese because they do not bear Phlebotomy except once in a Youth lately that was extream fat and in danger of an Apoplexy and it did not burn with so vigorous and lasting a flame as that of many lean men but by its crackling gave testimonies of much Salt
heterogeneous mixture which advanceth the Native red as Spirit of Vitriol doth that of Conserved Roses It hath been observed that the blood in the progress of Feavers hath seemed from time to time upon Phlebotomy to grow worse and worse even on the day before a natural Crisis Quoties enim contigit videre in continentibus seu Synochis continuis sanguinem multoties die ante Crisin emissum priore misso deteriorem tamen perfectam factam ad salutem aegrotantis jâ—dicationem ac sine recidiva Ballonius observes that many people in the most fatal Sicknesses have bled pure and to appearance good blood whose Bowels and Lungs have been found upon dissection vitiated and râ—tten Others have had their blood extreamly depraved in whose vitals no default could be found Plurimis impurissimus sanguis detractus est imo nunquam fere purus quibus tamen mortuis sectis partes omnes satis integrae sunt deprehensae Aliis fere semper purus quibus tamen viscera pulmones maxime putres sunt inventi In a Pleuritic that dyed I observed once besides that his Lungs grew naturally to his sides that all the left lobe of his Lungs were corrupted and all reduced to a most faeâ—id purulency that the which he avoided in great quantities at his mouth and upon Phlebotomy was very well coloured and seemingly laudable My Author goes on Scitu valde dignumest qui fiat ut multis quibus putrefacta poene viscera sunt reperta laudabilis sanguis detractus fuerit item viris mulieribus multis 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 pallidis ac fere virentibus cum alioqui judicasses sanguinem non ahsimi lem colori cum quale alimentum id est succus in venis talis color efflorescat tamen florentissimus sanguis detractus fuerit non serosus nimium non subviridis virore pallidus Mulâ—os videmus scabie infectos aut simili vitio quibus certo affirmamus nos impurum sectione venae sanguinem detracturos tamen in ista defaedatione cutis illibatus incorruptusque sanguis est opinionem spemque fallit eventus Nos Elephanticis saepe landabilem sanguinem detraximus Quanquam fieri potest ut specie laudabilis sanguis appareat cum intestinum aliquod vitium in eo delitescat quod quidam in habitu corporis praesertim in partibus delicatioribus ut in facie cum ultimo elaboratur in rorem convertitur tum demum se profert exhibet Praeterea siquis splenicus est aut Empyicus manente in venis sanguine puro non deâ—init esse pallidus emaciatus subviridis aut nigricans quia non in massa sanguinis vitium causa labis est sed in alia parte In like manner Blondelus observed that after a Dysentery of two moneths standing accompanied with a Singultus and continued Feaver the Marquess De Ceuvres did upon Phlebotomy avoid at the Arm very laudable blood whilest that of his stools seemed to be extreamly corrupted His superaddo sanguinem detractum omnimodas puritatis notas retinuisse a sero bene repurgatum Doctor Willis after he hath made excellent use of those two old Galenical Comparisons betwixt the Blood Wine and Milk adds this accurate and true relation concerning the morbid discrepancy of Blood Thus the Blood like Milk in its perfection as it cools separates into the several substances of a florid red on the surface a thicker filamentous subsidence and a serous liquor But if it be much depraved when it separates in the Porringer it discovers it self in a different aspect and each part assumes another shape for that cremor which coagulates on the top sometimes is white sometimes green sometimes of a Citrine and livid colour and is not tender but viscid and tenacious so that it becomes as tough as any Membrane is not without difficulty pulled in pieces When the Blood hath been for some time seised with a Feaver upon Phlebotomy there appeareth instead of the beautiful crimson on the surface a certain white or other-coloured Pellicle oftentimes the reason whereof is that the blood being as it were terrified by its effervescence the upper part thereof commuteth its redness and tenderness into a white and more tenacious substance And if the Mass of blood be not well cleared of its saline and sulphureous recrements that superficiary Skin is stained with a Citrine or livid tincture and for the same reason the supernatant Serum acquireth the same Colours Moreover the purple crassament of the Blood undergoeth several variations sometimes it is blackish when the Blood hath been too much terrified with a long effervescence Sometimes the fibres thereof are quite vitiated so that it will not coagulate but remains â—luid like thick Milk which is a bad sign and occurs often in putrid Feavers and Cachexies The Serum is sometimes deficient as in Hicticks and after too much sweat Sometimes it superabounds as in Hydropicks and being set upon the fire will not entirely coagulate into a white mass In some cachectical persons the blood is so watrish that it resembles that sanious blood which stains the water in which flesh is washed I knew a man of an evil habit of body whose blood upon Phlebotomy used to seem white and like to Milk which after a course of steel would be again indifferently red I shall add hereunto that I have frequently seen the Blood in Hectical persons and such as have had a latent Feaver to be very serous and that of a livid and citrine colour and in Hydropics that have bled at the nose there was not any serum in the blood at all In the Febris alba virginea which I here contradistinguish from the Chlorosis I extracted four hours after dinner out of the Saphena of such blood as that the Crassament was laudable for colour and conâ—istence but the serum was so white as not to be distinguished from milk the lacteous serum did coagulate but retained no smell whereas it usually resembles a roasted egg it was saltish to taste At the same time I blooded two more in the foot neither of which had any such lacteous serum but a citrine serum Hers which was a young Lady and in health burned very well and crackled the other being aged sixty years was excellently and equally coloured from top to the bottom and the serum inclining to citrine but would not burn at all only crackled much and puffed with wind She had no indisposition on her only was troubled with a flushing in her face swelling of the nose and an inward heat such as is commonly attributed to an hot liver I do not attribute that lactescense in the first Ladies blood to the mixture of new Chyle which Doctor Lower saith he hath observed in Men and other Animals being phlebotomised a while after meat to create a lacteous ferum for I never in all my life was so happy as to see that though
into one similar body the rest whereof were to be excrements but a more confused Mass of several distinct Alimentary Humours which Nature never intends to unite into one similar body but to continue in a certain more loose mixture each thereof retaining its proper congruity for the continuance of life and health They do confess that there is a pure crimson part sweet and balsomical which they call in rigour Blood but they say Nature never intended this for the sole vital liquor because she never produceth it alone or if it be ever seen so 't is in a morbid condition as in malignant Feavers where the 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 or Blood free from the proportionate mixture of other Humours is reckoned amongst evil signs Qualis sanguis in malignis adurentibusque febribus solet excerni aut e vena tunsa educi And therefore as none of the Humours are ever seen alone any more than Blood is for they hold them all to be excrementitious when separate so they conceive they all together in a certain proportion make up that aggregate called Nutritive Blood and are all actually there because they do observe that all of them at sometimes have their distinct corruptions though they continue still in one mass which they conceive they could not have except they were actually there They do conceive them to be so there that the resemblance betwixt Gall or extravasated Phlegm is but Analogical so that they do not pretend to shew in the Blood a bitter Gall or a pontic arminonious Melancholy They will not allow these to be other than depravations of the Alimentarious Humours and the sincere alimental juyces are no more pretended to be evinced by them then the pure Elements except it be a posteriori by a diversity of effects arguing different causes They saw there was a great latitude in the blood of healthful men yet so as that the blood appeared with different colours and consonant to the colours there seemed a variety in their dispositions and other corporeal qualities they saw the Mass of blood upon perfrigeration to go into several substances and they intellectually disjoyned them more for doctrine-sake obliging themselves to produce each Humour in its imaginary purity when the Chymical fire should exhibite any body not decompounded or the Corpuscularians make more manifest their configurations of Atomes or Texture of Particles Having thus stated the Question with as much perspicuâ—ty as I could I pursue to enquire which is most conformable to the effects in Physick for I will not undertake to determine what God and Nature do in the production or mixture of bodies It is easie for a man to loose himself in those inquiries He that made us can tell how we were made our Argumentations are as vain as if one should assert that a Loaf of bread consisted of Cubes Lozenges or Trapeziums because we can cut it into parts of such a configuration Let us but imagine a subtle Chymist to analyse Chymically our Ale if ever he thereby discover that it is the product of a Barley-corn growing into a stem and grain then turned into Malt grinded boyled with water and fermented I will assent unto the Chymical resolutions of blood Physicians have been alwayes allowed hitherto to be a sort of gross Artisans and I remember Massarias some where calls it an Hippocratical demonstration Indicium autem Curatio To know bodies exquisitely mixed and to mix them intimately is a divine attribute this last is avowed by Galen Miscere corpora tota per tota non Hominis sed Dei Naturae est opus Perhaps it may be replyed that the most ignorant persons may say thus much It is true and if he speak it knowingly I confess I can say no more than he Sed quod dicemus objectioni illi Ignarus aeque ac Philosophus deum causam omnium assignabit Hoc ignarus inscienter Philosophus scienter assignabiâ— quemadmodum Aristoteles ait de Parmenide Melissâ— quemadmodum caecus alicujus tunicam albam esse afâ—erit Nil scimus Dicamus ergo Primarum rerâ—m principiorum aut elementorum cansas reddere nostri non est captus secundarum vero utcunque Id in singulis quaestionibus experiri possumus I say then that notwithstanding any allegations to the contrary it is manifest that a certain proportion of salt sulphur and spirit besides earth and water is neither requisite to perfect sanity nor its defect as to any particular the cause of diseases and this is manifest out of the constitution as well as colour of the blood in morbid and healthy bodies as appears by the burning and distillation of blood There is much of truth that T. T. sayes or may be so Now I am ready to discover in reference to miserable man that the pretended sanguine sulphur or Cacochymy of any in an high Feaver doth afford more salt water and earth each of them than sulphur I have taken that diseased blood termed corrupt which might seem to some to abound with sulphur being clearly conveyed into a Retort with a Receiver joyned thereto I have by a graduated fire regulated very strictly brought over what possibly I could In the upshot upon the separation of the several parts I have found very little sulphur in comparison of each of the rest At another time I procured the purest blood I could get from an healthful person putting it to the same igneous tryal as the former degenerate of equal proportion to it then after sequestration of the parts I could not perceive any considerable difference in the quantity or quality of the several parts of that sound and the seemingly corrupt blood I do say that in the Blood of all persons that are in health there is upon Phlebotomy somewhat that justifieth the supposition of the Galenists but not which confirms the Hypothesis of the Chymists The coagulable serum doth commonly represent their choler in part the florid fluid red their blood which if lightly washed away their is another more darkly-coloured which is proportionate to their Melancholy and if you wash the fibrous mass well it will be white and answerable to their Alimentary Pituita or Phlegm In this last part I have the concurrence of Malpighius who upon washing all the blood from the concrete Mass of blood found the remainder to be a fibrous conâ—texture of a whitish colour which he pitcheth upon as the materials for a Polypus in the Heart And had he taken more particular notice of that fluid blood in the cells of those interwoven fibres he might have discovered two sorts of blood one that readily ascends and is florid the other more black and faeculent which moveth not and both these stain the water they are washed into with different reds the one much brighter than the other That some fibrous concretion in some diseases as Rheumatismes and Plurisieâ— covereth like a pituitous mass the surface of the blood whilest that remains
body from streightness to laxiiy the most powerful were Phlebotomy and Purging and that their principal effects were not meerly to evacuate such or such peccant Humours but in doing so to create a new Texture and configuration of Corpuscles in the whole Body and therefore they held them to be General Medicaments and of use in most great diseases since such distempers were rather occasioned by a streightness than laxity of the pores and even such as were laxe one way as Dysenteries and Diarrhaeas might be accompanied with a streightness in the habit of the body This Hypothesis for the further explication whereof I remit you unto Prosper Alpinus having been of great renoxa and more accommodated to the course of life by which the Romans and since the Turks and others that follow not our Physick did preserve their Health and recover their Maladies did merit my regards and I observed the truth of that part of their Opinion which avows that purging and bleeding have further effects than meerly the evacuation of Blood and other Humours that they had such an influence upon the whole body as to restore and promote all the natural evacuations of the body by its several emunctories and pores and that Phlebotomy did particularly incline to sweat promote urine and sometimes instantly allay its sharpness and make the body soluble so that upon Phlebotomy there needs no antecedent Glyster Neither is it convenient in a great Cacochymy to purge before bleeding not so much for fear of irritating the Humours but that the purge operating so as to attenuate and alter the whole mass of blood and promote secondarily all natural evacuations without preceding Phlebotomy it is scarce safe not secure to purge except in bodies the laxity of whose texture is easily restored or with gentle Medicaments for the Humours being powerfully wrought upon by the strong purges and inclined to be expurged by their several emunctories and those being either defective or the veins and arteries too full to admit a greater rarefaction in the mass of blood which is requisite to their separation and transpiration hereunpon there happens a dangerour Orgasmus or turgency of humours in the sick which Phlebotomy doth prevent And 't is I conceive in reference to this alteration of texture that Hippocrates saith 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 I observed a great congruity betwixt the Static observations and those of the Methodists and that Sanctorius hath a multitude of Aphorismes which agree with them viz. That such bodies as transpire well in the hottest weather they are lighter and not troubled with any vexatious heat That nothing prevents putrefaction like to a large transpiration In fine I did observe that it was the general sense of Physicians that Phlebotomy did draw the Humours from the Centre to the Circumference and I had taken notice of it alwayes in my self even in the Colick bilious when I was tired out with pains vomiting and want to sleep when I took no Laudanum and reduced to extream debility and emaciation I determined in that forlorn case having used all other means for several weeks to bleed so long yet partitely as that I might be freed from a most troublesome pulsation of the descending Artery below the reins I bled eight ounces at first and found a vextious heat in the whole habit of my body I repeated the Phlebotomy in the afternoon and was very hot all night thus I continued to bleed twice each day for three dayes loosing above sixty ounces and then fell into sweats was eased totally in my back and afterwards recovered with a more facile Paresis in my Armes and no contracture then that disease commonly terminates in there These considerations made me think that there was some more important effect in Phlebotomy than the evacuation derivation and revulsion of the Blood and other Humours and that it must consist in promoting that Statical transpiration and I conceived that the Blood was in perpetual motion and though Motion doth hinder Fermentation yet I had observed that in Pipes at Owburne Abby where the drink runs from the Brâ—w-house to the Cellar to be tunned up the Fermentation continues so especially in the stronger drink that the Pipes frequently break therewith as rapid as the motion is I did not imagine that the nature of the Blood was such as to be exalted into one Vniform liquor resembling Wine for such a liquor would not be liable to such sudden changes and alterations from one extream to another but that it was a miscellary of heterogeneous liquors in a perpetual digestive fermentation and depuration by halituous particles arising from it as in more gross by the emunctories which if the conformation of the pores and passages be such as to give it due vent all continues well if they be obstructed or vitiated then several maladies ensue except timely prevention be used I conceived that in Phlebotomy as the Blood issueth from the vein so as in the pouring out of other liquors the Air comes in by the orifice and mingling with the Blood produceth as great or greater effects than in the Lungs when it mixeth there with the Blood invigorating it in an unexpressible way whence we commonly see that the pulse grows stronger and stronger during the bleeding and upon this account I think it may happen that bleeding with Leeches though equal quantity be taken away oftentimes does harm never alleviates so much as Phlebotomy and such persons as by reason of their tender habit of body cannot bear a violent transpiration swoon not by bleeding in water though otherwise they do by reason that the great effects of the Air upon the Blood are impeded by the ambient water the like happens in Scarification with Cupping-glasses and in bleeding with Leeches I did suppose that oftentimes in a Plethora quoad vires transpiration being hindered by the change of the texture of the Body the not-exhaling particles remix with the Blood and there also happens a subsidence of the vessels and change of the porosities so that the Fermentation is is not only clogged with morbose particles of several sorts but so hindered by the subsidence or compression of the vessels and alteration of the pores as not to be able to ferment for freedom of room is necessary to Fermentation nor transpire nor continue its due course nor by reason of the charge of porosities confer aliment aright so that a Plethora ariseth hereupon But as soon as the vein is breathed and the Blood as in your common water-pipes when a Pipe is cut acquires a more free passage that way it presently becomes more rapid and its motion also is accelerated by the fuliginous exhalations hastening to the vent together with the natural Fermentation resuscitated and so the whole boâ—y by a natural coherence and dependance is not only evacuated but altered in its minute texture and conformation It is most evident that the Blood in the Veins and Arteries
repaired to me for directions the whole Hand was extreamly tumified and black and the swelling began hastily to dilate it self towards the Elbow He was seised with a Vertigo vomiting swooning and a cold sweat the violence whereof was such that the drops trickled from his Head as if his Hair had been wet with a great Rain or water where each Tooth had fastened there appeared a blackish Pustule or Blister I appointed his Wife to make a strong Ligature above the tumour at his Elbow and having clipped the Blisters to hold a red-hot Fire-shovel as near to the part affected as he could endure it and to give him a good draught of Viper-wine presently At her return she found her Husband not in a condition to speak intelligibly his Tongue was swelled and he faultered in his speech as those do who have an Hemiplegia or dead Palsie in their Tongues Upon the drinking of the first draught of the said Wine he vomited up abundance of bitter Choler mixed with Phlegme coloured yellow green and blew then she gave him another draught at both times half a pint at least whereupon his vomiting and swooning ceased and his speech returned to him The Ligature had put an happy stop to the progress of the tumour but the heated Fire-shovel produced no effect at all the tumour and pains still increasing betwixt the wounded place and the Ligature By this time I had got on my clothes and hastened thither with a Chirurgeon I found the man as cold as any dead Coarse and all over turned as black as a Tawny-moor though otherwise his skin was very white and amidst the blackness of his hue there was a visible mixture of greenish-yellow I could not feel any Pulse in either Arm and he complained of a palpitation of the Heart I caused two Scarifications to be made on each side of the Finger above the joynt as deep as the tumour permitted and four more to be made on the back of the hand in the like manner and upon incision the stesh did cut as if it had been of a dead body there issuing neither blood nor any serous liquor though he had his feeling there as entire as ever I layed to the places a Plaister of Venice-treacle and gave him inwardly above half an ounce thereof in some viper-Viper-wine the operation whereof was not such as to beget any warmth in his body or any pulse or the least alteration in his Arm whereupon I sent for some Angelica-water being unwilling to give him more of the Viper-wine and put into a draught thereof at least two drachms of Mixtura simplex upon the taking whereof his Pulse returned immediately and a warmth diffused it self all over his body excepting the affected Arm his cold sweats ceased and a red colour came into his face the palpitation of his Heart left him and he became chearful I repeated the dose and caused Fire-shovels to be heated five or six times and held near the scarified places hereupon he fell into a great sweat all over except that hand the affected part became hot and the scarified places bled abundance of florid blood which I suffered to flow without any impediment where the Teeth had fastened there came forth as I took up the Plaister of Treacle two little pieces of black flesh of the bigness of a great pins head and finding him in this hopeful condition I went to Church directing that he should not sleep to which he was much inclined and that there should be given him for food only some Mace-beer with a little Sage and Wormwood boyled in it and that he should take every half hour two or three spoonfuls of Angelica-water with some ten drops of Mixtura simplex and continue his sweat After Sermon I found him very chearful and well no pain in his Arm but what seemed to proceed from the Ligature whereupon I caused the Arm to be unbound and washed with Aqua vitae and a new but gentle Ligature to be made higher towards the Shoulder and that he should continue the Cordial and the Sores were dressed with a mixture of Venice treacle and Basilicon and pieces of Lint dipped therein were put into the holes whence the mortified flesh had come forth After Dinner I found the man in the same condition wherein I had left him only the tumour had diffused it self to the Shoulder and Arm-pit and sent pains as far as his right Breast He had of himself two Stools in which there was nothing observable I directed the taking of his Cordial and at night half an ounce of Venice-treacle But in a few hours after there being no considerable evacuation of matter there was applyed to the Scarifications a Plaister of Burgundy-pitch and simple Melilote equally mixed whereupon there issued forth in good quantities a yellow ichorous matter the efflux whereof was continued by the application of Basilicon and Venice-treacle where the Bite was the Sore grew foul and thereupon that was dressed with Basilicon and Aegyptiacum mixed And thus the Cure was prosecuted to the end according to the discretion of the Chirurgion only during the first and second day the violent tumour of the Finger Hand and Arm continuing notwithstanding the evacuation by Scarification and diffusing it self I did give way to the applying of a Pultice to the Arm from the Wrist to the Elbow made up of Oatmeal green Betony shred and Milk to which was added in the end a little Oyl of Roses Oyl of Mallows Sheeps Suet and Oyle of Spike the which Pultice had been tryed in Warwick upon the like case when all the discretion of a knowing Chirurgeon could not secure the like tumour from an imminent Gangrene the pain also dilating it self as in this case and to the tumour on the back of his hand was applyed green Wormwood shred and heated as hot as could be indured Being called out of Town at my return the next day I found the tumour and pain much abated the Man so well as to sit up without any ill symptome only he had made no water since the Bite whereupon I appointed him to take once in two hours a drachm of Sal Prunellae in his Mace-ale and at the first dose he made much water but it was of so deep a red that his Wife imagined it to be blood the next was high-coloured but on the next morning I found its colour to be natural The tumour on Tuesday being almost gone and the pains every where vanishing I appointed the Chirurgeon to keep the Scarifications open and to order them as common Sores but to continue to the bitten place both holes being run into one the Basilicon and Treacle and being willing to preserve my Venice-treacle I appointed he should take a Clove or two of Garlick every morning which howsoever it be commended in this case did produce such a pain in the Sore that I was forced to alter it for some Mithridate to be taken every night and morning
AN EPISTOLARY DISCOURSE CONCERNING Phlebotomy In Opposition to G. Thomson Pseudo-Chymist a pretended Disciple of the Lord VERVLAM Wherein the Nature of the Blood and the effects of Blood-letting are enquired into and the practice thereof EXPERIMENTALLY justified according as it is used by Iudicious Physicians In the Pest and Pestilential diseases In the Small Pox In the Scurvey In Pleurisies And in several other diseases By HENRY STVBBE Physician in Warwick Hippocrat l. 1. Aph. 2. VASORVM inanitio si talis fiat qualis fieri debet confert bene tolerant sin minus contra Inspicere itaque oportet regionem tempus aetatem morbos in quibus conveniat aut non Printed in the Year MDCLXXI SIR IN obedience to your Commands I have read over the Treatise of Thomson concerning Blood-letting I never underwent a more difficult task in my life And had the Virtuosi imagined with what reluctancy and constraint I should undertake such a work they would have abandoned all their other stratagems and imposed on me this pennance as the most severe I profess I am not so understanding in the Greek Latine or English Tongues as to comprehend his Language yet I think I am not so much in default therein as He who according to the peculiar fate of the modern Baconists hath either out-lived his Learning or never was endued with any That He should pretend to read or understand Hippocrates is a vanity equal to that with which Ecebolius professeth himself to be versed in the writings of Aristotle and when he blames the Method which the Galenists have used above this sixteen hundred years would not one imagine that the birth and flourishing renown of Galen had preceded those Centuries whereas you must place him in the second Century during the Reign of Marcus Aurelius Commodus Pertinax and Severus or you will contradict the account which Galen gives of himself and the relations of other Historians and at such time as he arose the world was prepossessed with Methodists and Empiricks But I wish his greatest errours lay in his ignorance of these things Alas he understands not any thing of the Rudiments of Physick and to inform him one must write an entire Body of Physick Were it not for a few hard words borrowed from Van Helmont such as Enormon Archaeus Daumvirate c. and his extravagancies about fortifying the vitâ—l spirits ejecting the venome or spina in diseases and that by a diaephoresis generally by the means of certain Arcana more famous for the death than recovery of his patients the man would have nothing to say And do we wonder at the unfortunate cures for which he is blamed or that more than one at White-chappel should suffer by his ill-advised Pepper-drops 'T were strange should one that neither understands humane nature nor the types times motions and terminations of diseases should ever except by accident do any good not that He should frequently do harm But a fool may commit more faults than a wiser man than I and of more leisure can discover I shall confine my present address to the point of Phlebotomy wherein he so traduceth the Hippocratical Physicians as so many murtherers and particularly declaimeth against the most judicious Assembly of our Faculty that Europe ever beheld and who if they be culpable are mis-led by the practice and precepts of that Author Hippocrates whom he himself often cites and to less purpose than I might in this controversie alledge him Some years since I designed to write an enquiry into the original and nature of the Blood and the usefulness of Phlebotomy in several diseases in which abstracting from the single opinions of Writers I purposed to illustrate each point by practical principles and ample Histories out of intelligent and creditable Physicians concerning the bad or good success with which Blood hath been let in diseases according to the several Ages of the disâ—ased and the nature of their maladies whether Epidemical Sporadical or of a less general constitution But the Controversies I have been involved in have so incumbred me that I have not been able to pursue thâ—se intentions nor have I any preparations almost in order thereunto as yet digested into writing But this Antagonist requires not all my strength a less powerful Assault will suffice to overthrow Him 'T is not any kindness to him but indulgence to my self that I do not pursue all his errours even in the generation of blood or go about to convince him of the several mistakes which he is fallen into for want of reading more modern Writers and their discoveries Beyond Helmont or in contradiction to him the man neither does nor will understand any thing And even in that Author he seems so little conversant that he sometimes mistakes him and generally represents things with more obscurity and intricacy then they are expressed in the originals of Van Helmont or Grembs Of those that have opposed Phlebotomy these are not the first which this Century hath produced long ago Galen complained of Erasistratus the sisters son of Aristotle that he was 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 fearful to let his Patients blood before him Chrysippus Cnidius Medius and Aristogenes did reject the usage Also Apaemantes together with Strato are recorded to have contradicted the practice of Phlebotomy by Arguments The strength of that faction in Physick was such at Rome in those times that Galen spent several books against the followers of Erasistratus upon this subject But above all that ever intermedled I will give this character to Thomson that never did any presume more upon so weak grounds Nor ever was Confidence so poorly mounted and so pittifully be-jaded After much trouble and enquiry the sum of all he sayes in this case amounts to this The promiscuous mass of Bloud which flows in the Veins and Arteries he divides into three parts the one is called by him the Latex the second Cruor the third Sanguis or most properly Blood The Latex so called by Helmont by some Lympha by the Greeks 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 is a diaphanous clear liquor 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 fabricated in the second digestioâ— by virtue of a ferment there residing It is the inseperable companion of the Bloud and closely perambulates with it through all the wandring Maeandrous pipes in this Microcosme It is the matter of Vrine and Sweat Spittle c. and renders several other considerable services to the body The goodness or pravity of the Latex depends much upon the bloud as it is constituted for albeit it is no essential part thereof yet is it altered for better or worse according to the channels it passeth through the lodging it taketh up and the condition of its associate notwithstanding that it may be sometimes impaired in its due excellency and the bloud withall remain very pure and sincere The second part is called Cruor from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 i. e. Crudus
concretus It is the more crude impure part of the bloud the purer part of the chyle being digested into a saline juyce is carried into the milky vessels and veins and mingling at last with that ruddy liquor is called Cruor and at last becomes perfect bloud It undergoes manifold guises and is often the subject matter of a multitude of diseases being sometimes changed into an Ichor Tabum or Sanies The third part is properly called Sanguis or Bloud 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 it is a most pure sweet Homogeneous Balsamie Vital juyce for the most part of a bright Red or Reddish colour made by the Archaeus by virtue of ferments implanted in the ventricles of the heart lungs veins and arteries causing a formal transmutation of the Ckyme or milky substance into this sanguineous liquor ordained to be the seat of Life and and the principal matter for sense motion nutrition accretion and generation It is for good reason called Balsamum seu Condimentum totius corporis forasmuch as it hath a sanative power sweetly uniting all the parts of the body for the conspiration of the good of the whole It is a great preservative against putrefaction as long as it remains in its integrity for consisting of many saline particles it seasoneth whatsoever it toucheth with a pleasing sapour It is the proper habitation of the vital spirit the immediate instrument of the soul in which it shines displaying its radiant beams every way that sensation motion nutrition and all other functions may be exquisitely performed God and Nature never intended other then that the bloud should be Homogeneous pure plain symbolical with that single principle of the Vniverse Now these Peripatetick Philosophers deliver to the world that the contexture of this vital juyce is made up of Choler Phlegm Melancholy and Blood which united produce this compounded body which we call Sanguis How grosly erroneous and dangerous this Tenet is most Learned Helmont hath made evident Wherefore we conclude with that noble Philosopher that Bloud is an Vnivocal substance divisible only by some external accidental means as the Air or Fire which cause a various texture and different position of its Atomes whereby it seems to consist of parts which are not really inherent in it as is manifest in its degeneration from its native colour sapour consistence and goodness which it had before it became corrupt in the pottinger or underwent the torture of fire Both of which do strangely larvate and disguise the puniceous Balsome giving occasion to the Galenists to frame their four fictitious humours no where really existent This being the foundation of all his declamations against Phlebotomy before I proceed any farther it may seem requisite that I should make some Animadversions thereon I might take much notice of and display his errours as to what he sayes that the Latex is by the Greeks called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 this is the first time I ever read it called so the usual terms being 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 The notion whatever Helmont say is not new at all an hundred Galenists have mentioned and treated of it as the vehicle of the bloud and nourishment But that cruor should come from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 crudus concretus is an opinion singular to the Baconical Philosopher That 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 doth signifie cold I know well and that cruor properly signifies the the bloud of dead people or the mortified bloud issuing from putrefied wounds I no less understand though Authors frequently confound it with Sanguis But that his Latex and the Lympha so called by moderns are the same is news for it is not held that the Lympha in its peculiar form was pre-existent in the Arteries and as such did accompany the Blood through the Maeandrous pipes but is generated as it is discharged into the Lymphaeducts and from them is re-mixed with the bloud And if it were yet would not the definition of this Latex agree with it for the Lympha is no inseparable companâ—on of the bloud as appears by its peculiar vessels it is seldome a diaphanous clear liquor being commonly tinged with several colours oftentimes whitish sometimes yellow or as it were stained with bloud And whereas this Latex is devoid of all sensible qualities those who have experimented the Lympha do not find any such thing but a variety of tasts Nor is it true that the Serum which accompanies the Bloud is such a Latex as our Helmontian describes it being never to my taste free from a salsuginous sapour though it retain that with a great Latitude nor devoid of colour so as to be clear and diaphanous and 't is very seldome seen that the said Serum will not coagulate unless preternaturally upon a gentle fire so that it is no more to be termed a Latex than the whites of eggs beaten to the like fluidity In like manner that in the Lymphaeducts will coagulate as Bartholin observes and others As for the Cruor that there are graduations of the Bloud as to its crudity and impurity is no doubt amongst the Galenists and that it may oftentimes transcend the state of due maturation and so become degenerate is as easily granted as that it should come short of its desired perfection and when this Blood degenerates any way into a Tabum or sanious matter I must tell him that Aristâ—â—le and his followers acquainted us therewith before that Helmont was ever heard of whose Cruor bred in the Liver and distinct from the Bloud impregnated with vitality is such a piece of non-sense as ought not to be mentioned in this Age but to Baconical Philosophers who not only connive at but applaud any Hypothesis Concerning the Blood when I read the Elogies he bestowes upon it as the Seat of the Soul by which sensation motion nutrition generation are performed I thought â—pon the opinion of Aristotle and his zealous sectators â—mongst the Physicians who have denied all Animal spiâ—its fixed the principality of the Members in the Heart and from thence derived even the nerves If G. T. will defend the generality of his Assertion I assure him that Hofman Van der Linden and Harvey will be more serviceable to him than Van Helmont But this consideration hath little influence upon the present Controversie that which follows hath nothing of Truth in it that the Bloud is an Homogeneous pure body for nothing homogeneous can ferment But it is most evident that the bloud is in a perpetual fermentation and that it is such a liquor as is constantly generating constantly depurating and constantly expending it self so that nought but Imagination can represent unto us such a thing as pure bloud and I hope the specious pretences of a Real Philosophy will not terminate in Speculation and Phansie When the bloud either naturally issues forth or upon incision of a vein it representeth unto
us different Phoenomena oftentimes in several porringers and in the same porringer different substances sometimes a supernatant gelatine and mucus a coagulated mass consisting of thinner and a less fibrous crimson and a grosser and more blackish-red body enterwoven with fibres both which may be washed away from the fibrous part and a serous fluid liquor sometimes limpid sometimes of a bilious or other colour in which the concreted mass of bloud doth float All these with other Phoenomena in a great variety are to be seen in the aforesaid cases and even the Bloud of the same body as it issues from several veins furnisheth us with matter for different observations Now in a liquor so pure and Homogeneous as our Disciple of the Lord Bacon imagineth the Bloud to be though we should suppose the Air to corrupt it as it issues into and settles in the pottinger yet would the corruption thereof be uniform which seeing it is not I take it for demonstrated that it is Heterogeneous And that being granted it matters not whether the four humours so frequently mentioned by Physicians be actually or potentially in the blood Whether they be the constitutive parts thereof or whether it be one entire Liquor made up of Heterogeneous parts which in the bodies of sundry individuals produceth such Phaenomena as if it did consist of such Alimentary Humours and degenerates occâ—â—â—onally into those others that are Excrementitious In order to our practice 't is all one for it to be so and to appear so and our documents are nevertheless useful though they seem not rigorously true The Galenical Physicians are not herein agreed nor is any man confined in his sentiments about this subject 'T is malapertness in this Bacon-faced generation to dispute these points since the phaenomena of diseases and the operation of Medicaments doth correspond with this Hypothesis and are as adequate thereunto as humane nature which is not capable of an exact knowledge and ought to acquiesce in what is useful can adjust them Nor is it any more of disparagement to Physick that should be built upon so tottering a foundation then that the Temple of Diana one of the wonders of the world should be situated upon a bogg Hitherto I have examined his preliminary discourse of the Bloud and its concomitant Latex and have made it evident that this person understands not what he asserts nor what he rejects and indeed such is his ignorance that after so much study having rolled every stone and searched out everâ— scruple to be informed concerning the truth of the Galenick and Helmontian way he understands neither Nature nor the Galenists nor Van Helmont I now come to examine his Arguments against Phlebotomy which if they be so weak and inconsiderable as not to justifie so extraordinary an impudence let him blame himself not me who do not intend if possible in such a confused obscure Treatise to injure him in the recital His first Argument against Phlebotomy Had they but considered how this vital moysture the Blood ebbs and flows in goodness and pravity upon slight accidental occasions of any exorbitant passions as fear sorrow anger c. the manifold impressions of the ambient Air ill Diet immoderate exercise divers excessive evacuatioâ— and long retention of any excrement did they rightly understand how bloud like Mercury may be polymorphised and changed into different shapes and at length be retroduced to the same state and condition as when it was in its primitive essence certainly then these Dogmatists would never be so forward to pierce poor man's skin rashly let out and throw away that substantial support of life foolishly and falsely apprehending that to be totally corrupt and deprived of what it was in its former being and in no wise capable to be retrograde and return to it self again because it seems to their eyes when it appears abroad discoloured invested with a contemptible apparel as yellow green white blue c. supposing it to be corrupt and so unfitting to be retained within the verge of life It is no such matter I can maintain for this superficial alteration proceeds from the Air spoiling it of its pristine goodness not that it was really corrupted in the vein For the demonstration of this I will undertake upon forfeiture of a great penalty to open the vein of a Cacochymic body emitting about two or three ounces of the visible aforesaid degenerate matter then stopping the Orifice make use of proper remedies to this Individual whose habit I doubt not so to alter in the space of about a fortnight that no such putrid matter as they improperly call it shall be found in any vein whatsoever opened which may fully satisfie any sober enquirer after truth that the corruption was never really existent in that whilst it was in the vein which in so short a time is thus redintegrated for Corruption being an absolute privation of that formal essence of the thing and sith there is no retrogradation in this kind that an Ens losing its form by dissolution should assume it again Nam à privatione ad habitum non datur regressus it infallibly follows that this juyce thus restored Technicâ—s by Art was never truly corrupted as they would have it Hence it follows that the fair pretence of the Galenists that the juyce drawn out of the Patient forasmuch as it is corrupt in the porringer is happily discharged appears a mere imposture contrived on purpose to stop the mouth of those who scruple and question Phlebotomy This is the principal Argument which he hath against Phlebotomy yet doth he so handle it as that the onely evidence it carries with it is that the Author is a most illiterate person It is very ignorantly done of him to make as if the Galenists in general did let their Patients bloud merely for a Cacochymy or depravation of the bloud as if it were a Rule amongst them that Whensoever the blood is depraved vitiated and corrupted it ought to be emitted by Phlebotomy Whereas there is not any tenet amongst them more general then that Cacochymical bodies require purging the Plethorick or such as are in danger to be surcharged with excels of blood require Phlebotomy nor do they recede from this resolution but in urgent cases and with deliberation and many are so cautious herein that if the bloud appear in the porringer to be of an evil colour and very corrupt they enjoyn us to stop the vein presently and not continue or repeat the evacuation I shall set down the words of Horatius Augenius Hic vulgarium Medicorum error detegendus est Putant quo sanguis impurior fuerit à sua natura magis alienus eo plus detrahendum in hoc mirifice sibi placent in vulgusque proponant admodum utilem factam fuisse vacuationem quod corruptissimum pessimumque sanguinem vacuaverint Tu vero cui in animo est humano generi prodesse
Medicinam inculpate exercere contra facies quanto enim magis sanguinem videbis à propria natura discedere tanto minorem quantitatem vacuabis aliquando nisi copia urgeat cacochymiae permista à venaesectione prorsus abstineto Nor is this the judgment of a single writer hundreds are of the same opinion the Learned L. Septalius Animadv Medic. l. 4. sect 2. is of the same judgment In sanguine detrahendo cavendum maxime ne quanto putriorem deterioris conditionis sanguinem è vena profluere viderimus tanto majorem quantitatem effluere sinamus quod plurimos facere observamus tali enim existente sanguine pauciores subesse spiritus constat vires facillime solent collabascere Even Galen and Avicen are alledged for it And it ought with less reason to be objected in England because our Physicians generally as likewise are the Germans seem not so prodigal of the bloud of their Patients as to make a Cacochymie much less a 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 or total corruption of the sanguineous mass to be the proper indication for bleeding nay most that hold Blood-letting in great diseases arising from Cacochymie to be a necessary remedy not indicated by the depravation of the bloud but violence of the disease they are cautious in the quantity which they take away because in such an habit of body the strength of the patient is seldom great enough to bear much Out of which it is manifest that what he sayes about the impurity of the bloud in the porringer that 't is an excuse or imposture used by the Galenists in defence of Phlebotomy it is a fiction of his own not made use of directly by any but the followers of Botallus the rest will give him other reasons for their practice than a Cacochymie alone or total corruption of the mass of bloud A farther mistake it is in him that he represents the Galenists as such pittiful fellows that should not know but that each corruption of the bloud is incorrigible and therefore let it out It is true that we do hold that it is possible for the bloud to be so vitiated as to be incorrigible and that one may assoon hope to see the regress from a total privation as it restored This hath been observed in pestilential diseases sometimes and in sphacelated parts and perhaps I may be allowed to reckon as such the bloud of that person in Fernelius which was universally coagulated in the veins so as to be taken out as 't were branches of coral And that Woman 's in the observations of Pachequus whose bloud in a continual fever did issue out upon Phlebotomy as cold as Ice or Snow the like to which in the spotted fever is taken notice of as a fatal prognostick by Petrus à Castro If Plempius give me leave I would reckon in putrid fevers that bloud to be incorrigibly depraved which doth not coagulate and is destitute of its fibres since Fernelius and others esteem of such as an evident testimony of the highest putrefaction It is also true that we do hold that where diseases are ordinarily or frequently curable yet by accident from the idio-syncrasie of the patient or some other intervening cause the bloud may be continued in such a vitiated estate as to be incorrigibly corrupted and yet its essential form not lost as in case of Cancers Hypochondriacal and Scorbutical distempers Scirrhosities of the Liver Spleen and Mesentery Leprosies knotted Gout calculous indispositions c. I might mention other cases but they relate not to the present controversie and I have already said enough to shew the ignorance of this Baconist To come nearer to the main matter It is true that we do hold that in many distempers as in the Scurvey putrid Fever and some others the mass of bloud is so putrified and corrupted that even that which is termed more stricktly Blood is depraved sundry wayes for if the vessels that generate and convey the Chyle and the Chyle it self be corrupted 't is impossible but that which is produced and supplied daily out of the Chyle should participate of it pravity and so much the more in that they flow intimately commixed in the same Arteries and Veins But that in such cases we hold the Blood to be so depraved as to have lost its formal essence totally and irrecoverably is most notoriously false and any man may see hence that this Ignoramus understands not the Galenical way but deserted it before he had acquainted himself therewith We do hold that the blood and associated humours may come to a partial putrefaction and yet be recovered again and 't is this recovery and redintegration that we design by our practice and if we cannot effect it totally yet that we aim at is to concoct the several humours so that what there is of them that is alimentary and agreeable to nature may be mitified and retained and the rest so digested as that it may be with ease and safety ejected the body and so the Mass of bloud regain its former lustre and amicableness This being the grand intention of the received Method of Physick 't is one thing to debate whether blood-letting practiced according to Art for we are not otherwise concerned in the Quarrel be a suitable proper means to atchieve our purposes And another to say that we pierce poor mans skin and rashly throw away the support of life out of a vain apprehension that it is totally corrupt and depraved of its former being and no wise capable of being retrograde This cannot be said without an apparent injury unto us We know the variety and fallaciousness of colours and by our rules can well conjecture how far the Humours are vitiated what may be concocted in order to the nutriment and benefit of nature and what maturated to a convenient ejectment And we do utterly deny the consequence of this Argument though we grant the Assumption Viz. If the bloud be of such a nature that it may be recovered to its pristine colour and vigour without Phlebotomy then ought not men to use Phlebotomy But the Bloud like Mercury may be polymorphised and changed into divers shapes and at length be reduced to the same state and condition as when it was in its primitive essence Ergo. The Assumption I can grant but not where such a practitioner as G. T. is made use of I doubt not but the followers of Erasistratus could effect it by their Fastings Frictions Bathes and other remedies used by such judicious men I grant that robust nature doth daily produce such rectifications of the bloud in many that make no use of a Physician But as willing as I am to gratifie my Adversary I should not yield thus much to Helmont or such as practice with Arcana and commanding Medicaments To the sequele of the Major I reply that albeit that Nature may oftentimes do miracles yet are not miracles to be presumed upon It is
but hath seen some cases in which sole Phlebotomy hath effected the cure he may see many Instances of this in Botallus and that in diseases where the body was undoubtedly cacochymical I have seen Agues tertian and anomalous perfectly cured with once bleeding in women with child and in children I have seen some Atrophies so cured that the principal cause of their recovery was to be attributed to their Bleeding the like I have observed in several Chronical diseases even in inveterate quartanes as also others have done nor is there any thing more common almost in our Cases than the relation of several diseases absolutely cured by single Phlebotomy which I shall not transcribe here but in my large discourse of Phlebotomy in Latine I intend to represent all such cases at large with their circumstances and the History of Phlebotomy with all that variety of success which judicious Practitioners relate of it in several diseases and persons I add now that No man can be an accomplished practitioner who is not versed in the History of Diseases and particular cures for the general rules and directions make no more a Physician than such a knowledge in Law would do a Lawyer the res judicatae import more with us than they do in Law-cases and as Reports of the Iudges in special cases must be known by a compleat Lawyer so must our Book-cases be our presidents and regulate our practise Duobus enim tanquam cruribus innititur Medicina neque solis theoreticis rationibus contenta insuper etiam practicaes experientias particularium requirit indefessam ad singulos casus intentionem Thus is his Minor false as was his other Proposition and it should have run thus But Phlebotomy lets out the bad blood without removing the efficient cause thereof or conducing thereunto But he proceeds to defend the Minor thus If the Cause of bad blood were removed then would the effect cease but oftentimes we see that notwithstanding such a depletion the disease continues and if it be not mortal yet it becomes more truculent Here he commits the same errour that before expecting a greater effect from Phlebotomy than we propose generally to our selves in it we do it sometimes for revulsion of the matter flowing to any part as in some Pleurisies Squinancies the Colick Bilious and Rheumatismes c. wherein we never rely solely upon bleeding and though oftentimes the effect transcend our expectation yet do we not presume upon it Sometimes we let blood for prevention of future diseases as in great contusions and wounds Sometimes we let blood only to prepare way for future Pharmacy Ita plerumque in febribus mittitur sanguis qui non superat naturalem mensuram neque simpliciter neque in hoc homine sed quia nisi mittatur ob febrilem calorem qui adest succorum putrescentium mistionem corrumperetur ac fortasse malignè cutis rarefactioni ventilationi vasorum relaxationi ad futuram expurgationem necessariae impedimento esset Itaque mittitur non quia multa subest copia sed quia ea quae subest tunc est inutilis noxia ac proinde facultate ferente deponenda etsi causa morbi non inclinet ad ideam sanguinis modo non ab ea plurimum evariet i. e. Thus in feavers we usually let blood not that the blood abounds above its due proportion either in general or in reference to this or that individual but because the blood which flows in the veins is infected with a feavourish heat and would be corrupted thereupon and by reason of the intermixed humours now inclined to putrefaction and that perhaps joyned with malignity for the prevention thereof and least that plenitude and depravation of the Blood should hinder that transpiration in the habit of the body ventilation of the blood and laxity in the vessels which is requisite for the subsequent purge do we use Phlebotomy not imagining that there is any superfluous abundance of blood but that there is then in the body some that may well be spared and which if the Patient hath strength to bear it may with prudence be let out to prevent so great dangers as are imminent and to secure unto us the good effect of the subsequent Physick And if the disease do sometimes encrease upon Phlebotomy it behoveth wise persons to distinguish whether those symptomes happen by reason of bleeding or only succeed it in course the disease being in its increment for this makes a great difference in the case as also whether amidst those symptomes which are in due course most violent in the progress and state of the disease whereas we bleed usually in the beginning only there be not some that yield signs of concoction and melioration which if they do as we may justly attribute those hopeful consequences in part to Phlebotomy so we need not be amazed at the present truculency of the disease which affrights none but the ignorant If notwithstanding all our care and due administration of Medicaments according to Art the Patient do dye yet is neither Phlebotomy nor the other Physick to be blamed but we ought rather to reflect upon Physick that 't is a conjectural skill in the most knowing men and that we are not as Gods to inspect into the bowels and secret causes of diseases that besides the special judgment of God upon particular persons all diseases are not curable in all individuals either by reason of the variety of distempers complicated which interfere with and contra-indicate one to the other or for some unknown idiosyncrasy or other intervening cause which defeats our Methods as well as it disappoints the Arcanum of Pepper-drops I must here take an occasion to remind this Helmontian that he doth ill to disparage Phlebotomy by reason that after it there may follow some truculent Symptomes and yet to reject that imputation where his Dietetical rules are in dispute When he gives his vinous and spirituous liquors in Feavers a practise not peculiar to the Helmontians but allowed with regard to due circumstances by Hippocrates not only in diaries but acute-feavers so Galen would have told this Ignoramus if any seemingly frightful Symptomes appear as extraordinary heat an inquietude a little raving a swerving from right reason the Patient must not be startled in a vulgar manner but be satisfied that these are but the effects or fruits of an Hormetick motion in the Spirits excited and increased by good liquors easily united with them for the routing and putting to flight every way whatsoever doth disturb its vital government Though Hippocrates say it is good in all diseases that the Patient retain his senses though he reckon inquietude and restlessness in the sick amongst evil signs yet our Helmontian dissents from him whatever time of the disease it be and whatsoever other circumstances attend thereon For oftentimes madness deviation from the right understanding a Lethargical or sleepy disposition suddenly break forth Nihil
est quod tam magnifice prodest quod non aliquo ex modo obest What matters it if the heat be magnified besides the main purpose to some small trouble if ten times greater benefit accrue to the sick It is impossible any Physician should perform his duty as he ought if he boggle at the foppery of heat and cold meerly momentany and transient often deluding our senses Surely he that is thus negligent of the Animal faculty in its principal operations may bear with a pitiful Galenist for not regarding much the loco-motive strength whilst he is as sollicitous as any Helmontian to support the vitals and let any one judge which is most likely to impair the vital faculty a little blood-letting duly administred or such an increase of the feavourish heat restlessness deliriums phrensies lethargies as our Author here despiseth I must not yet dismiss him not that I intend to laugh at his six-fold digestion he might as well make a dosen of digestions but it is necessary that I tell him that the production of good or evil blood doth alwayes depend upon one root that feeds the branches for 't is possible that the stomack and pancreatick or bilious mixtures in the guts may not be faultless and yet the blood of the Patient either not vitiated the errors of the first concoction being amended by the primigenial sanguifying Blood for 't is the Blood in the vessels which principally sanguifies or if it be depraved yet not so as to generate any disease or abbreviate the life for cacochymical persons with a little can live more long and more free from diseases than those of a purer and more generous blood Nor is it less true that oftentimes it happens that the blood is infected with recrementitious heterogeneous and noxious mixtures from obstruction of the pores or other occasional causes wherein the stomach and vitals otherwise sound and vegete are only oppressed and distempered by accident some of those impure humours being discharged upon them and in these cases repeated Phlebotomy alone may cure If the credit of Botallus will not satisfie him herein let him believe his beloved Hippocrates a man who did extraordinarily practise blood-letting so as that the French do impatronise him to their Phlebotomy he tells us this story A certain man amongst the Oeniada was sick when he was fasting he felt as it were a great suction in his stomach and a violent pain and after he had eaten any meat as it digested his pains returned He grew very tabid and wasted away in his body his food yielding him no sustenance but what he took came away in ill-concocted and adust stools But when he had newly taken any sustenance at that instant he felt none of that vexatious pain and suction He took for it all manner of Physick both emeretics and cathartics but without any alleviation But being let blood alternately in each arm or hand till he had none left in his body that was vitious he amended upon it and was perfectly cured Read but that case you that are so timorous with the Comment of Van der Linden in his Selecta Medica c. xiii and tell me if upon Phlebotomy as ill blood alwayes succeed as is let out I could add more parallel stories But to demonstrate unto this Pyrotechnist that single Phlebotomy will amend and inrich the mass of Blood I propose this case An ancient Gentlewoman of a very strong and corpulent habit of body but frequently troubled with hysterical and hypochondriacal vapours was taken with a violent catarrh upon her stomach together with great pains in her right and left hypochondria as if the liver and spleen had been tumified sometimes she complained of an insupportable acidity in her stomach and sometimes a saline humour molested her Sometimes she fell into cold clammy sweats sometimes her sweats were so hot that she complained as if her skin were burnt and even when her stomach felt any alleviation she complained of a burning fire as it were in her bowels near and in the region of her liver a perpetual sputation did follow her I being sent for after several Medicaments prescribed methodically but with little or no alleviation I proposed earnestly that she should be let blood notwithstanding she were above sixty years old I took away eight ounces or more She found immediate alleviation there seeming no default in the blood or serum I burned the blood in an arched fire it came to ignition but flamed not at all but crackled like Bay-salt and after some while a sudden eruption of ventosity made such a noise as equalled the cracking of a Chesnut in the fire She took a stomack-powder of Ivory Pearl Crabs-eyes c. and was pretty well for three or four dayes but upon a small fright relapsed I bled her again as before and in that short time in which she had taken very little sustenance but behold this blood which looked no better than the other did burn with a vivid and lasting flame as well as any I ever tryed in my life and without any sign of flatulency She recovered presently after with some further Medicaments but not so as to be perfectly well at stomach of a long time I doubt not but if others would try that way of burning blood they would soon be convinced that Phlebotomy makes a great alteration therein But I proceed to his other Argument This is taken out of Van Helmont whose Latine words I shall not transcribe now but only the English Let them make it appear if this do not imply a contradiction that a Feaver hath the property to pollute the blood and that this property can be taken away a posteriori by a posterous manner to wit by withdrawing what is putrified For if first the fouler blood be let out they open a vein again all this while they overthrow and confound the strength and so thereby wholly disappoint a Crisis But suppose sometimes a fresh ruddy blood run out they presently cry as cock-sure that a whole troop of diseases is cut off at the first dash as if the resting place of the Feaver did only extend from the heart to the bending of the arm and the good blood did take up its abode about the liver This Argument proceeds upon a most gross falshood in that part of it where we are supposed to place such a value upon the colour of the blood as by the goodness or ruddiness thereof we should esteem our selves as cock-sure that a whole troop of diseases is cut off at the first dash whereas no intelligent Physician ever thought so for we do say that the blood of all men is not alike neither as to colour nor consistence naturally and therefore in diseases we do not expect to see such nor intend to make any alteration to such a degree as transcends the natural estate of the body for 't is our business to preserve each man his natural habit be
yet the Serum was insipid it is not properly sanguine but pituitous But to resume the discourse I expected to have seen the Minor proved by our Helmontian but although I find that he saith his observation did jump with that of Doctor Willis that Phlebotomy did incline to Feavers Yet my Reader may see that in the first part of the Argument as I have urged it in his own words he reckons amongst the evil consequences of bleeding none that proceed from an opulent and sulphureous blood transcending the dominion of the spirit that remains after Phlebotomy but such as argue an impoverishing of the blood or a cold indisposition I will repeat it again to shew how justly I censure his Logick and so dismiss the Argument If it be so that striking a vein often in a long and tedious disease is a preparatory for a sharp Feaver as we both herein jump right in our observation when am I certain that Phlebotomy repeated in an acute Sickness is a door set open and an in-let for a long infirmity so that this mode of defalcating the vigour of the spirits doth for the most part as I have strictly heeded many years disarm and plunder Nature in such sort that it cannot resist the assaults of every petty infirmity witness those multitudes of relapses or Agues Scorbute Dropsies Consumptions Atrophy Iaundise Asthmaes c. The proof of the Minor here is not only defective but the mischief is that Doctor Willis who judiciously useth Phlebotomy commends it in Feavers both in the beginning and augment of those that are putrid and also in Diaries as the principal remedy inprimis conducit and speaks in the place cited by our Helmontian only of a customary letting blood in time of health Whereas this Bacon-faced Pyrotechnist saith that their Wits jump in this that often striking a vein in a long and tedious disease is a preparatory for a sharp Feaver Let any man read the place and see how he abuseth that excellent Practitioner whose words are Prae caeteris vero observatione constat quod crebra sanguinis missio homines febri aptiores reddat quare dicitur vulgo quibus sanguis semel detrahitur eos nise quotannis idem faciant in febrem proclives esse I am sorry he should seem to give a reason for a vulgar error for once or twice bleeding doth no more create a Custom or dispose Nature to an anniversary commotion in the blood than one Swallow makes a Summer But certain it is I speak of our cold Climates not of those hotter where sweat and transpiration often prevent those determinate motions of nature that such here as are very much accustomed to bleeding keep certain times for it their bodies will require it at that time and if they refrain it they will feel an oppression and dulness or lassitude and may fall into a Feaver but Aches Rheumatisme Gout are more likely except other accidents concur to produce a Feaver if the ebullition be no greater than to produce a Lassitude 't is possible in some bodies that the Scurvy Cacochymy Cachexy Dropsie Asthmaes Cephalalgyes may ensue for the morbifique ferment like the scum boyled into the broth may mix inseparably with the blood and vitiate for ever that great sanguifier with an unexpressible pravity But he that thinks 't will be so in diseases when the Patient is phlebotomised neither understands the motions of nature nor the effects of a sound recovery Instead of Doctor Willis this illiterate Baconist who professeth to be so well versed in the way called Galenical should have as he argues made his recourse to Avicen and his followers who are in many cases fearful of Phlebotomy least it should produce an ebullition yf choler or crudity which two inconveniencies may produce all that G. T. talks of Thus sometimes Tertians have been doubled nay turned into irrecoverable continual Feavers But all the cases relating thereunto concern not an intelligent Physician who understands what is past present and to come and knows when to presume when to fear But I intend not to teach these fellows it were better for the Nation and them too that they were Coblers or day-labourers than Practitioners in Physick a Doctoral Diploma though purchased will not sufficiently qualifie them for the profession and as little doth the title of Experimental Philosophers and Verulamians avail them The next Argument of his that I come unto and which is more than once inculcated as if he thought it a Demonstration is this as I may form it If it be not fitting nor useful to bleed in the Pest which is a Feaver 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 it is not fitting nor useful to bleed in any ill-conditioned Feaver whatsoever But it is not fitting nor useful to bleed in the Pest. Ergo. The Consequence of the Major is thus proved It is no less criminal to suffer the Blood to spin out in any ill-conditioned Feaver whatsoever then in that which is so 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 And Albeit our Phlebotomists do extenuate the matter setting a fair gloss upon it pretending that in malignant Feavers of the inferiour clast Plethorick or Cacochymical indications do manifestly require their utmost assistance before that inconsiderable venome lying occult I must by their favour be bold to tell them they will never solidly and speedily make a sanation of any great Feaver or any other disease till they handle it in some manner like the Plague for there is quiddam deleterium a certain venenosity in most maladies as I can prove ex facto The Minor is thus proved For whosoever at any time upon what pretence soever of caution attempts Phlebotomy for the cure of the Plague takes a course rashly to jugulate the Patient unless some extraordinary redemption happen Certainly here Doctor Willis who allows to persons accustomed to bleeding and in plethorick bodies the humours being very turgent though seldome and with great caution to bleed speaks by rote for had he Anatomised the Pest investigated the nature of that atrocious stroke as I have feeling the smart of it three several times he would as soon allow of piercing a vein in him who hath taken an intoxicated draught as at any time in this case where the Stomach alone is the place from whence the poyson is to be exulated 'T is no wonder if the Galenists strait injoyn bleeding where they find a seeming soulness in the less malignant Feavers when they dare be tampering with it in the greatest The only noted Sluce through which the poysonous matter of all malignant Feavers passes away is the universal Membrane the Skin on which the Stomach hath no small influence governing this Catholick coat at its pleasure in so much that no successful sweat or eruption can be expected as long as the Duumvirate lies prostrate under any insulting calamity Wherefore the Arch-design of the Physician is to cherish corroborate and remove all impediments of this eminent part that
arbitror patet Sudores statim ab initio febris hujus per vim adeo calidorum medicamentorum evocatos non tam utiles esse quam aliqui putant â—iquidem spiritus evacuantur vires dejiciuntur sanguis agitatur turbatur magisque acuitur febris quod subtile est in sanguine excernitur sicque â—rassior intus relicta materia citius facilius interficit Idcirco magis videtur factum consilium eorum approbandum qui ab his medicinis calidis abstinent sive sudent aegri ab initio sive non sudent Certum namque est Sudorem sponte sub initium morbi prodeuntem diaphoreticum symptomaticum non laudabilem criticum esse Thirdly they argue that since there is such danger least the Patient infected should dye for want of strength before the disease be cured and that above all others the vital indication to preserve the strength ought to be most prevalent with a Physician and regulate him in the administring of his remedies since the regard hereunto makes them to quit their usual course of dyet and even compel their Patients to eat plentifully and drink wine 't is no Helmontian Proposal but transmitted to as from Antiquity they conceive it not fit in the beginning of the Plague to debilitate the sick with a violent and tedious sweat perhaps to be reiterated twice or thrice in twenty four hours whereby the spirits will be extreamly dissipated much more than in Phlebotomy the humours good and bad promiscuously evacuated and the blood and grosser humours which are not exhausted by Sweat and in which commonly the Pest is seated as is manifest from the Botches and Carbuncles continue infected still Sane spiritus per sudores affatim copiose vacuari satis indicant prostratae afflictaeque vires post longum sudorem Crasse inquinati sanguinis nihil aut particulam exiguam educi probant accidentia quae fere omnia fiunt post sudorem deteriora Fourthly Though they do very much commend the intentions of such as would presently and without any delay expel the morbific poyson yet they conceive that where the Plague ariseth from previous evil humours congested in the body by an unseasonable year evil diet or the like that then the case differs much from what it is when it is contracted by a forreign contagion and therefore whatever reasons may be alledged in the last case they cannot admit the Method as universal they do apprehend that in the first case the putridity is incorporated and become as it were innate to the mass of blood and is no more to be eliminated by Sweat then mustiness in drink is exterminated by its working out the yeast Besides they do not perceive that the sick receive such benefit when Nature discharges it self into the Skin by the Spots or Tokens that they should imitate that operation by promoting sweat they are afraid that potent sweats may divert Nature from her usual and intended course or discharging it self into the Glandules and whilest a double evacuation is purposed by the Physician the Patient may find the benefit of neither the sweat being so powerful as to disturb that other motion and the humours in which the venome is incorporated being so gross why else should Nature never take the more facile and expedite way of the Skin but the more difficult of the Glandules as not to be exonerated in that manner Lastly Supposing the Plague to be a venenate disease they do not conceive that all poysons are to be cured one way and that by sweat especially as soon as ever they are taken much more if they be of a Septic nature they do not believe sweating to be the remedy for Arsenic or Lapis infernalis should any take them But if it were yet sometimes there is such a plethoric habit of body and the veins are so distended either naturally or through the febrile agitation of humours that 't is imprudent and dangerous to promote sweat till Phlebotomy be premised for thereby the febrile heat will be mitigated obstructions removed the blood ventilated and capable of a further rarefaction in order to sweat and transpiration promoted and Nature inclined to sweat for bleeding doth not draw in the humours or poyson but carries it out to the circumference as experience doth testifie and consequently is rather subservient unto than opposite to the indication that otâ—eâ—s go upon These are the most solid Objections I have met with upon the subject in which whatever is suggested is not so to be understood as if the Galenists did not know that their Adversaries use or pretend to use Cordial and Alexipharmacal Diaphoretickâ— as on the contrary none but this Baconical G. T. would suppose that when a Galenist speaks of Phlebotomy that he intends to use nothing else Those judicious persons do consider the variety of Pests that some of them are by forreign contagion and seise upon healthy bodies in these they are willing that the venome be eliminated presently by sweat except the Plethoric habit make it necessary to bleed first and then they sweat them afterwards immediately taking all imaginable care for to preserve their strength they also know that in such times as the Patients have been used to an ill diet and debilitated through poverty and misery that in such cases even Galen would not allow bleeding for how requisite soever it may be for the disease such persons cannot bear it They know that some Plagues are attended with little or no Feaver yet attended with symptomes dangerous and mortal in these cases they are for Cordial-Alexipharmacal Diaphoreticks and promote sweat as earnestly as any Helmontian in others the Plague is attended with a Synochus and putrid Feaver in these they divide their cures and regard both the Feaver and the pestilential venome c. according as the strength of the Patient will bear they consider not only his present but future strength they proceed to Phlebotomy sometimes they observe the Plague to be so gentle that the infected can go up and down and feels little or no indisposition in himself in this case they only continue the motion of Nature by mild Alexipharmaca that the Botch or Carbuncle do not strike in again and perform the rest by a sollicitous Chirurgery In fine as there is nothing more rational than all their solicitude in cures so they know that in so desperate a disease there is no course to be left unattempted the way by Alexipharmaca and Sudorifics come from them and is properly theirs but they urge no method generally in any disease almost knowing that the same distemper may be cured several wayes by men proceeding upon contrary indications and yet the Art not violated and in the Plague as they know the great variety thereof in specie individuis so their directions leave us in a great latitude upon emergencies They understand that saying of Celsus Nam quo celerius ejusmodi tempestates corripiunt eo
of such as write what they will and defame as they please and permit not others to vindicate themselves nor undeceive the World 'T is ungenerous to pinnion a mans hands and then beat him In reference to that Controversie I add that the Statutes of the Colledge command the Physicians to send their Bills to an honest Apothecary And our Laws make the Colledge Judges of all Receipts as well as Methods of Physick which Act as it conforms with the general practise of Europe so it is very prudential for hereby provision is made not only against noxious Medicaments and the high prizes of Arcana but illegitimate Methods of practise by which last it is as easie to destroy a man as by poyson and more privately How the designs of the Experimentators will consist with our Laws and be accommodated to them I know not I know a Physician may be tryed upon giving his own Medicaments if the Patient miscarry how he shall defend himself I know not I have not seen any reason alledged that is likely to convert the Magistrates throughout Europe to permit it or to gain a repeal of the two last Edicts in Denmark against it 'T is an evil president to dispute against wise Laws 't is worse to act against them and what consequences it will bring upon the Land to see one Profession retrench upon another let the Lawyers judge The beginner of this Novelty the Lord Bacon stopped not at Natural Philosophy but carried on his humour to attempt or project a change of our Laws I do recommend it to the consideration of our Sages in the Law that if Physick Divinity and other Faculties be overthrown by a company of Wits whether it be probable that they shall long continue free from the attempts of the Omniscient But I shall resume the examination of the remaining Arguments of my Adversary Because I often observe many squaring their Therapeâ—tic intentions according to the Definition of the Feaver indeavouring to cool those that are in a scorching heat by breathing a vein let them know that a Feaver whose essential nature is to be inquired into for the use of man is very erroneously defined an Accident for a febrile heat is certainly the product of a foregoing Cause which is primarily to be searched after then whatsoever depends thereon will quickly vanish Now this cutting an hole in venal vessels for the removing a bare Quality is all one as if one should laâ—e out of the Pot ready to boil over a spiritous or some precious Liquor therein contained to the intent it may thereby be quailed neglecting to withdraw the fire the impulsive occasion of the violent motion made therein Do not they take the like absurd course who do think to cool the body in a Feaver by throwing away whole Porringers of the Nectar of life never looking after the ablation of the Causo-poietick cause and focular matter sited about the Stomach which makes an estuation and effervescence in all the other parts That way of frigidation which pillageth the vitals increasing the malady only obliquely abating a tedious quality is never to be approved by a Legitimate Physitian He that will bring to a moderation the finger excessively heated from a thorn impacted therein must extract the same otherwise he will take a wrong course by the use of meer frigefactives So he that will positively refrigerate in any preternatural heat must eliminate that spinous aculeate acid acrid matter which goads the Archaeus incensing it that it becomes exorbitant fretting raging Heautontimorumenos gauling it self at the presence of that which it abominates never to be pacified till it be excluded or some extraordinary Sedative given I mean not Opium vulgarly prepared which may for a time asswage its fury till it have leisure to thrust out the unwelcome guest I could wish my Adversary instead of consulting the Novum Organum of the Lord Bacon had been conversant in that more ancient one of Aristotle he had not then committed so many errors in point of Ratiocination as he now does which renders his discourse intricate confused and oftentimes impertinent to the great distraction of his Reader and vexation of his Antagonist He perpetually mistakes through an Ignorantio Elenchi he never apprehends what he opposeth That the Galâ—nists do define a Feaver by a preternatural heat diffused through the whole body is true They are contented to call that a Feaver which the vulgar does so and accordingly to define it Not but they distinguish in Feavers the Material and Formal cause thereof as also the several Efficients thereof and in their Method of curing except necessity put them upon another procedure they do alwayes and are obliged to do so by the Rules of their Art to remove the Cause of the Feaver and this is notorious to all that understand the first Elements of Physick They consider the evident occasional procatarctick Causes they consider the Antecedent causes which though they are not the immediate and conjunct Causes of the Feaver yet dispose unto it and are of such importance as that they may often degenerate into immediate and conjunct Causes and which is more in the Cure they do not only regard the Cause which gave birth unto and produced the Disease but that which doth foment and continue it and that which may produce or increase it Censeri debet causa non quae facit aut fecit solum sed quae faciet nisi quis obstet And although the curing of the Disease or Feaver be the object of their designs yet As all wise men consider by what means the ends they propose to themselves may be effected so do they deliberate how they shall effect their designs and that is by removing the Cause of the Malady But as in other designs it frequently happens so here they often meet with impediments which must be removed before they can prosecute their intentions by direct means Upon this account they are forced upon many actions which they confess are not immediately conducive to the cure of a Feaver which yet they pursue because without doing so the indisposition either could not be cured or not with such safety as becomes prudent persons Few of them ever bleed that I know of meerly for refrigeration and the extirpation of the formal heat without regard to the material cause of it which is to be concocted and ejected by Nature Though Phlebotomy be but one operation yet it produceth sundry effects in the body and in order to each of them is both indicated and practised For it evacuateth that redundancy of blood which frequently occasioneth diseases alwayes is apt to degenerate into a vitious morbifick matter during the Feaver and by an indirect and exorbitant motion to afflict some or other principal parts to the great danger if not destruction of the Patient upon this account we do use Phlebotomy in Feavers sometimes to diminish the Plethora and so to prevent the violence of the succeeding
disease and dangerous symptomes that may insue and then the veins are too much distended to facilitate and secure the operation of subsequent Medicines that are used to evacuate the Antecedent Cause and to maturate and expedite the continent morbifick cause Besides it promotes transpiration incredibly gives a new motion to those humours which together with the blood oppress and indanger the internal and principal parts it diverts them from the head and draws them from the heart lungs stomach and bowels into the habit of the body whereby Nature being alleviated prosecutes her recovery by maturation and expulsion of the peccant depraved matter deducing to its proper state that which is semi-putrid and not irrecoverably vitiated and separating first then exterminating what is incorrigible So the Patient recovers Nor is there any thing more true than this which every Practitioner may daily observe in his practise that Of all the Medicaments which are vsed by Physitians there is not any may compare for its efficacy and utility with Phlebotomy so expedite so facile and so universal is it The universality of its use appears herein that it evacuates the redundant it alters the exorbitant Fluxes of the peccant or deviating humours and blood It relaxeth the vessels and pores of the body and refrigerates the habit thereof And therefore is so absolutely necessary in putrid Feavers that though I do not say they are incurable without it yet I pity the languishing condition of such as omit it the violence of the symptomes being increased thereby and the cure procrastinated to the great trouble and hazard of the sick and his great detriment afterwards for you shall ordinarily meet with a slow convalescence and the blood be so depraved by so long and violent an effervescence that it becomes remediless and degenerates into an evil habit of body Scorbute Dropsie c. This being premised which is more clearly proved by Experience than Reason I answer to his Argument that we do not go about only to refrigerate the Patient but to concoct and eject the morbifick matter that we take the most befitting course to exterminate that spinous offensive cause and as upon the prick of a Thorn if part stick in the wound and be buried therein we proceed to maturate and bring to a paculency the vitiated blood and humours inherent in the part affected and with the suppurated matter draw out the fragment of the Thorn so we do in Feavers where the depraved humours are not so easily separated and extirpated as in the prick of a Thorn maturate and eject the morbifick cause and thereby atchieve the Cure And I do profess my self to concurre with the Ancients in their Opinion that there is a great Analogy betwixt the generation of the Hypostasis in the Vrine after a Feaver and the production of purulent matter in an Apostimation and that Feavers are but a kind of Abscesse in the mass of blood for the proof whereof I do remit my Reader to Ballonius de Hypostasi Vrinarum Amongst the Ancients I find two wayes commonly practised to extinguish this Febrile Heat by a course corresponding with the usual wayes of extinguishing a fire which are 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 by substracting the fewel from it thus they did Phlebotomise at once till the Patient did swoone the other 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 by quenching it thus they gave them cold Water to drink largely until the sick grew pale and fell into a shivering this last was not practised till there were manifest signs of concoction But 't is observable that upon either of these Medicaments they did expect that happy issue that Nature thereupon should presently discharge it self by sundry evacuations of the morbifick matter so that they did not thereby intend bare resignation but the extermination of the concocted febrile matter And thus much may suffice in answer to this Objection The last Objection he makes is this as I shall form it The great Indications of the Galenists for Phlebotomy are either Evacuation of the â—edundant blood in a Plethora or the Revulsion and direct pulling back of what is in flux or flowed into any part already But neither of these Indications are valid and oblige them to that practice Therefore the practise of Phlebotomy is not to be continued As to Phlebotomy in a Plethorick body he thus explodes that It by plenitude be meant an excess of pure blood I absolutely deny there is any such 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 or indication for Phlebotomy for during the goodness of this juyce there must needs be perfect Sanity arising from integrity of all the actions of the body so that it may justly be reputed madness to go about to broach this Balsome of life weakning Nature thereby as long as there is health with abundance of strength Imprimis not andum saith Van Helmont in cap. de febr p. 8. ut nunquam vires peccare possint abundantia ne quidam in Methusalem ita nec bonis sanguis peccat minuitate eo quod vires vitales sanguis sint correlativa i. e. We are to take special notice that too much strength can never be offensive to any yea not to Methusalem no more can any one have too much blood for as much as vital strength and blood are correlatives Well then it is plain that whatsoever sickness seems to indicate Phlebotomy upon the account of an 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 sanguineous superpletion must needs come from an apostate juyce generated by vitious digestions which being hostile to life irritates the Archaeus to frame the Idaea of a disease not as it is meerly provoked by nimiety or plurality but from the pravity of the matter wherefore the case is altered now and the 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 signification or demonstration of evacuating doth in a strait line respect the Crâ—or or Cacochymy directing the Artist to reform mundifie and rid those impurities contained in the seemingly corrupted marred juyce by proper means sequestring the vile from the precious not to let out indistinctly what comes next at randome to the furtive castration of the Eutony lustiness liveliness and strength of the Patient which is to be preferred before all motives whatsoever 'T is certainly known to those who are throughly versed in the Analysis and Synthesis of the parts of bodies that ebullition aestuation effervescence of febrile liquors arising from a pleonasme of degenerate Sal. and Sul. c. as they would have it may be appeased and allayed by Remedies assisting the vitals to make separation and afterwards an exclusion every way of what is reprobate reserving what is acceptable This being performed there is no fear that a plenitude simply of it self can do any harm for hereby so expedite a course is taken that the overplus is in a short time sent packing away by vomiting stool urine expectoration and sweat For this reason considering what strict abstinence the Patient is put upon in a Feaver
't is very unlikely a plenitude should be of any duration Is it not then greater prudence in a Physician to minorate what is superfluous by safe profitable wayes of secretion and excretion still advancing the principal Agent then for that end to give vent indiscreetly to what comes next without any election incommodating if not hazarding the loss of the vital principles For believe it whosoever hath any great quantity of blood taken from him either rues it for the present or hereafter Let him that is heterodox prate what he will alledging examples of those sturdy lusty bodies which have hereby received immediate succour I can make good by practise and challenge any one to come to that otherwise let him forbear his Garrulity whosoever is cured by a Lancet in this sort is either prone to relapses or to live more crazy in his younger or elder years although for some short time he may not by reason of a robust ingrafted constitution be sensible of these inconveniences As for Phlebotomy in order to Revulsion he thus explodes it Another pretended way for sanguâ—â—â—ission is Revulsion by which they say a violent slâ—â—x of morbifick lâ—quâ—r into any noble parts is intercepted for this end they use the Lancet in a Pleuriâ—ie Peripâ—eumony or any inward inflâ—mmation But how far they erre herein is well known to the best Practitioners for although I confess they do sometimes in the beginning suppress and as it were crush the aforesaid diseases yet is it done accidentally very uncertainly rather by way of distraction of the Nature for the loss of its substantial treasure than from any true Revulsion or direct pulling back of what is in flux or already stowed in 'T is true where the vessels are depleted a repletion is forthwith made ob fugam vacui to avoid a vacuity but the supply is from what comes next for as intro as well as intro for as However there is no streight immediate Revulsion intended from the part affected to the Orifice It seems strange to me that any man should pretend thus long to have diligently attended on the practise of Physick and yet never have seen or have the impudence to deny that there can be any such thing as a surcharge of Blood which is that which Physicians call a Plethora or Plenitude But the continuance of these Baconical Philosophers will in time free us from any admiration of this kind In Greece when the Athletae or Wrastlers were publickly maintained the observation indeed was more facile than now but every Countrey almost yields frequent cases of such an indisposition particularly 't is easily to be remarqued in strong healthy and plethorick Children whose sudden death â—s it often ariseth from no other cause so it astonisheth the vulgar and usually raiseth in them suspicions of Witchcraft Hippocrates and Galen having taken notice of the evil consequences attending this habit of body do advise the owner to attempt the change of it though it be accompanied with the most perfect health and vigour imaginable 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 And this habit of body and fulness of blood which he saith would do Methusalem no harm is observed by those who had daily opportunity to see the sad experience of it to abbreviate the life and occasion many diseases as Apoplexies Cardiacal Syncopes and Ruptures of veins in the Lungs Squinancies Pleurisies c. So that Hippocrates condemns that habit of body again in his book De Alimento and Celsus concurs with him therein Ea corpora quae more corum Athletarum repleta sunt celerrime senescunt aegrâ—tant i. e. Those bodies which are dieted and brought up to an Athletick habit do soonest of all decline into sickness and premature old age I never read of any Physician who in his directions for health recommended unto his Patient that course of life wherein the Athletae were bred up thereby to acquire such a Plethoric habit and whatever the present sanity were which they injoyed as to strength of body their intellectuals were very dull and the most understanding persons would have thought it prudential in such a case to broach some of the Balsome of life and weaken Nature thereby rather than to live in a perpetual danger of such perillous diseases as that Euexy subjecteth men unto But our Helmontian doth think otherwise If such an habit of body be thus perillous during perfect health how ought a Physician to apprehend it upon the first approaches of sickness Doth not then Nature add to the redundance of blood by a defective transpiration whereas the veins are so full as not to be able to contain more Is not the pulse weak slow and oppressed and the Heart so debilitated as not to be able to discharge it self of the Blood which flows into it and in danger to stagnate in the Lungs or coagulate in the Ventricles Can there seem any thing more agreeable to common reason in this case than to practise Phlebotomy whereby Nature is at present alleviated the surcharge of blood abated and the imminent dangers prevented Is it not prudential were a little blood so precious a thing and the loss thereof attended with some small irrepairable debility Is it not I say a part of prudence to submit to lesser though certain inconveniences then to run an almost inevitable hazard of the greatest imaginable I read not that the famous Milo arrived to the years of Methusalem nor yet to those of Hippocrates though I am apt to think he was so solicitous for to preserve his strength in its vigour as not to have been much Phlebotomized At the Olympic Games being Victor and going to receive the Garland from the judges he fell down dead suddenly and was thence carried to his Grave It is to be supposed according to our Helmontian that in that Euexy of body something so virulent or odious put the Archaeus into such a fury that it ran mad and destroyed him whereas had it been sublimate or Arsenic it would not have been half so exasperated or hasty 'T is a most humoursome and sensless Kitchin boy that no man knows how to please Suppose that the Brain might be in him a little oppressed with a Vertigo or some petty disorder must this capricious Duumvirate immediately produce the Idaea of no gentler a disease than an Apoplexy or Epilepsy But to pass from these phantastic causes the allegation whereof least becomes an Experimental Philosopher I shall instance in the effects of Bleeding in a Plethora Anton. Benivenius Medicinal observat c. 69. Men commonly attribute much to the Pulse in the discovery of diseases If that be weak low and small they frequently presage death or mortal dangers if it be full and strong they give hopes or assurance of recovery Yet we meet with one Philip a drunken and corpulent fellow who lying sick in his bed I found his Pulse so weak that it was scarce perceivable and I should have
thereupon to take that Analeptick Physick in order to a perfect convalescence whatever ensues is neither the default of the Doctor nor the evil consequence of Phlebotomy The same I may say in case either the sick party be not tractable or those about him malapert or negligent or some extraordinary casualty do fall out For where many concurrent causes are requisite to the producing of an effect if it succeed not we are not to blame what did operate but what failed As to Revulsion that which he saith is very weak G. T averrs that the best Practitioners take it for an Errour 'T is no great vanity to pretend to know more than a Baconical Philosopher I do say that no experienced Physician ever denied the operation though since the tenet of the Circulation of the Blood the manner how such an effect doth succeed admits of some dispute and is obscure We the silly followers of Galen and the Ancients do think it an imbecillity of judgment for any to desert an experimented practise because he doth not comprehend in what manner it is effected In eruptions of blood and Catarrhs every one sees the thing is done and that the Fuga vacui is not the occasion of the subsequent blood flowing to the orifice of the vein I believe those to whom he dedicated his Book will assure him How perfect our Cures are continual tryals demonstrate How little confidence there is to be placed in the Brags of G. T. after his ten years practise any man may determine by taking a due estimate of his Ignorance Having thus examined all his Arguments against Phlebotomy I come now to give our Reasons for it But before I proceed to them it is necessary that I give my Reader some account of The quantity of Blood in Humane bodies The several Qualities of the aforeâ—aid Blood The manner of its Generation As to the Quantity of Blood that is to be found in Humane bodies Gassendus holds that the utmost thereof exceeds not five pounds but he is justly reproved for that errour and for intermedling with Medicinal debates by Riolanus who avows that in suffocating diseases he had taken away much more than that within the space of twelve hours without indangering the Patients life To relinquish therefore these impertinent Naturalists whose discourses in Physick have done more hurt than good being accommodated generally to some prejudicate Hypothesis they take up or founded upon a narrow experience let us see what Artists teach us Avicenna and several of the Arabians do hold that there are ordinarily in a man twenty five pounds of blood and that a man may bleed at the nose twenty pounds and not dye but if the flux exceed that after the loss of twenty five pounds he dies inevitably Moebius doth allow of twenty four pounds to be the usual quantity Homo staturae decentis ad libras xxiv sanguinis in corpore habet Riolanus imagines there may be in such a person fifteen or sixteen pound at most but twenty in a French-man though in a German he sayes Plempius supposed there might be thirty In an healthy sanguine person being in the prime of his years Marquardus Slegelius doth so calculate the matter that he concludes there cannot be above twenty or eighteen pounds and that the generality of men contain but fifteen Doctor Lower in his excellent Treatise Of the Heart doubts whether any man hath twenty five pounds of blood in his body and sayes that according to Anatomists the quantity seldome exceeds twenty four pounds or is less than fifteen Perhaps the consideration of such fluxes of blood as spontaneously happen may give some light unto the controversie and contribute most to the decision of the grand one concerning the prejudice that may arise from the loss of Blood by Phlebotomy It is recorded by Matth. de Gradi that he had under his cure a lean slender and seemingly Phlegmatic Nun which by the Nose Mouth and Vrine did void at least eighteen pound of blood and yet there remained so much in her that upon the application of Cupping-glasses they were instantly filled with Blood and he recovered her notwithstanding that loss of blood Brassavolus relates how he had in cure one Diana a Lady of the House of Este which bled so much at the Nose that he saved and weighed eighteen pounds besides what was lost in the clothes applied to her so that the whole quantity might amount to twenty two pounds He recovered her by the use of several Remedies one whereof was Phlebotomy Marcellus Donatus doth avow that he weighed eighteen pounds of blood which issued from the Nose of a certain Cook of the Cardinal Gonzaga's who was recovered to as perfect health and as good an habit of body as he ever enjoyed before Amatus Lusitanus gives an account of one in a Quartane which bled at the Nose within five dayes twenty pounds and of another who bled in like manner within the space of six dayes forty pounds whom yet he cured by Phlebotomy Montanus saith he cured one of the Emeroids which bled every day for forty five dayes two pounds of blood and more Arculanus doth tell of one Woman that avoided by the Womb in three dayes twenty five pounds of blood and yet recovered Almericus Blondelus cured in a very short space a Souldier who was wounded under the right Arm-pit unto the Lungs after the man had lain without sense or motion many hours on a sudden there issued an incredible quantity of blood out of his mouth The like incredible fluxes of blood in men and women he professeth to have observed many times Forrestus relates how a Gentleman that was his Patient did bleed at the nose in three dayes time about twelve pounds of blood and was recovered as well as ever And when William Prince of Orange was wounded in the throat by an Assassine he bled at the Iugulars before the flux could be stopped which was not done in several dayes twelve pounds of blood and was perfectly recovered to his strength again He also tells of another Gentleman that having drunk Wine-must fell into such an Haemorrhagy at the nose that he bled without intermission six pounds and was cured by Phlebotomy and other befitting Medicaments Massarias did see a young Lady of twelve year old which avoided at the nose about twelve pounds of blood but fell afterwards into a Cachexy To conclude in the words of Io. Riolanus Imo decem vel duodecim libras per nares vel haemorroidas per uterum in mulieribus effundi intrâ— sex octove horas sine vitae detrimento quotidie observamus As to the Quality of the Blood it is observable that there is a great variety in the colour and consistence thereof even in men of perfect health many upon Phlebotomy convince us that their blood is seemingly bad whereas they are not molested with any distemper at all
but enjoy as entire a sanity and are as free from diseases as those whose blood is to appearance better I have elsewhere given an account of several Phaenomena to be remarked upon the burning of Blood which Observations are the â—ore considerable in that I. I. Becherus hath published a great mistake about it viz. Siccum sangninem in ignent lardum â—â—grare absumi non minori celeritate quam ipsum olium vini spiritus in hoc quidem balsamino spiritu igne totius sanguinis vis bonitas consistit quoque corrupto aut alterato totius ejus crasis alteratur But I say that it is not requisite the blood of every healthy person should burn so and 't is evident by those Experiments of mine that there is a very great diversity betwixt the blood of several persons as to inflammability and I know a most fair Lady whose blood will not burn at all only crackles that enjoyes a constant health beyond most of the Sex excepting a pain at her stomach and I have observed that to be an usual consequent to such blood I shall not illustrate this matter at present by demonstrating the great discrepancies of the blood in several healthy persons by mixing it with sundry liquors wherein the diversity of Phaenomena doth manifest the great variety thereof It is observed by many Practitioners that in healthy persons such blood doth often appear upon Phlebotomy as to the Eye seems bad I have seen many saith Blondelus who being casually hurt in the Eye by a tennis-ball or by some other accident wounded and bruised have been let blood and the blood which issued out seemed corrupt yet have not these persons had any thing of a Feaver on them nor been some of them sick of twenty years before And Ballonius observed in several Ladies that out of humour rather than any indisposition were let blood in May and six or seven poringers taken from them that their blood was very putrid And he avows that in the most fair Ladies there generally is found such blood as looks impure and evil yet that such persons enjoy a greater or at least as perfect an health and live as long as any that have a better-coloured blood It is granted by Slegelius that oftentimes upon Phlebotomy the blood which issueth forth may seem impure and yet the Patient be healthy Nonnunquam satis insignis impuritas inest sanguini ex cava educto nullis gravioribus symptomatis homini molestis ex quo patet non tantum semper periculum imminere si nonnullae sordes sanguini admisceantur I shall repeat here again the strange blood which Simon Pauli observed in an healthy person In the year 1654. a Citizen of Coppenhagen aged almost sixty years being accustomed to be let blood every year in May for prevention of the diseases incident in Summer would needs be Phlebotomized in the presence of Me and his Wife and Children the Chirurgeon having prick'd the Mediane vein the blood as it issued out had a peculiar but most noysome smell transcending any rotten Egg or stinking Vlcer c. which was so offensive to all in the room that we were forced to remedy it by burning some perfumes As soon as the Blood was cold in the porrenger the stench ceased and the blood seemed to be of a very good consistence and of so radiant a Scarlet that it equalled or rather exceeded the best red that is to be seen in the most beautiful Flowers it contained but little serum This passage of his recalls to my mind the serum of the blood of a Maid of a sanguine colour and perfect health excepting a pain in her stomach the blood which I caused to be taken from her seemed laudable and burned very vividly but the serum being set to coagulate seemed in consistence like to tallow and smelt like thereunto In another Child that died of an Hydrops thoracis I observed the serum as it heated to sent extreamly ill and with a penetrancy as if it had been Vitriol burning it would not coagulate though I boyled it but afterwards when it had stood to be cold it did jelly I know a Gentlewoman of extraordinary beauty troubled with nothing but Morphew or Vitiligo alba on her Armes in some places being let blood it appeared to be all serum almost and very little of any crimson mâ—ss was in it and that not so tenacious or fibrous as is usual though it were as well coloured as any is I boyl'd away all the serum which made up about six ounces or more and it would never inspissate or coagulate The variety of Blood is further illustrated by the case of Henry van Bueren a Brewers man who in perfect health had his Blood such that though it came out of the vein with a ruddy colour yet as it cooled all the serum did turn lacteous and resembled Milk though the sanguineous Mass retained its due colour and this was constant to him whether he bled by Phlebotomy or any other way A case like unto this is related by Bartholin from Ioh. Bapt. Caballaria Concerning the variety of blood in healthy persons it is further observable that not only in some small wounds admit of no cure or a difficult one whilest others heal with more facility in the same persons when they are young wounds will be easily cured even by the first intention and conjoyning of the lips thereof And afterwards as they grow more in years every superficial wound gives them much trouble but when they become old every scratch degenerates into a foul Vlcer notwithstanding that the Patient all this while commits not any errour in his diet nor is sensible otherwise or any alteration in his body or blood In fine diligent observation will assure any man that not only the Quantity of blood doth vary in sundry persons but even the Quality according to the age temperament and diet of the parties nay even according unto the seasonableness and season of the years Nor shall I exclude the passionately-angry or melancholick or phlegmatick from a latitude yet doth their blood exceedingly vary in the porrenger and consequently in the veins I have oftentimes seen and so hath Van der-Linden that in some healthy persons the blood hath been of a redness equally florid from the top to the bottome in some there hath appeared only some blackish spots at the bottome which no conversion to the open Air would rectifie into a florid crimson and perhaps some Observations may inform a man that the florid colour in the surface of the blood ariseth from a thinner sort of blood of a peculiar kind which radiates through a subtle pellicle on the top and when the blood is turned topsie-turvey 't is not the impressions of the Air that restores the decayed colour in the more black blood but the assent of this Ichorouâ— blâ—â—d through the more black and fibrous mass
I have some groundâ— for this suggestion but I never could 〈◊〉 any 〈◊〉 or thin concretion upon the turned blood and to 〈…〉 fect thereof I have been willing to attribute the â—â—â—â—nomenon when the turned blood hath not equalled in floridness the first superficies Some have attributed that florid colour to the concretion and shooting of some volatile Salts in the surface of the Blood and think that Kiâ—cher mistook those saline striae for Worms in his Microscope Besides this difference in the Mass of Blood as to several Individuals it may not be amiss to consider the difference that is betwixt the Blood in sundry vessels and parts of the body It is the most common tenet amongst Anatomists that the Blood of the Arteries differs very much from that of the Veins Though Harvey seems to deny it with much confidence and appeals to Experience for the proof of his Opinion yet the Generality as Doctor Ent Walaeus and Lower grant there is a great difference in the colour of them and that the Arterious blood is the most florid the venous is of a darker red Besides this difference in colour there is a greater which ariseth from the quantity of serum which abounds in the Arterious blood more than in the venous Comprobavimus in accepto per nos ex crebris Arteriotomiis cruorum duplem ferme compertam ichoris portionem qua fit fortassis ut crediderit Auctor lib de util respir. Sanguinem Arterialem non concrescere velut venalem quanquam nos eum concrescere non semel observavimus So Aurelius Severinus with whom Bartholin agrees And Doctor Ent sayes it is more dilated than the venovs Besides this there is a discrepancy in the venous blood it self for in the Lungs the Blood acquires by the mixture of the Air a tenuity of parts and florid colour exceeding any other venous Blood this Columbus first observed and gave this reason for the colour and great change which is made in the Blood by passing the Lungs proceeding to an imagination that the vital spirits in the Arterious blood might be the result of this intermixture of Air with the Blood in the Lights Most of whose opinion is taken up by Doctor Willis of late and Doctor Lower Besides this there is a discrepancy betwixt the Blood of the Vena porta commonly and that of the Vena Cava which is not barely supposed by Riolanus but yielded by Bartholin Sanguinem in cava prope cor puriorem esse illa qui in vena portae continetur omnibus in confesso est qui circulum norunt Upon this account it is that by the Emerods there is often discharged a black faeculent blood to the great benefit of the Patient but whensoever it is florid the effusion thereof brings a great debility sometimes very lasting unto many persons May I be allowed here to take notice of the Observation of Spigelius concerning the Saluatella that the Blood which issues thereat is more florid and Arterious than any can be drawn from the greater veins this he attributes to the frequent Anastomoses that are betwixt the Arteries and Veins in the remote parts of the body wherein he was defended by Veslingius and Van der Linden Doctor Harvey observed in the most healthy and robust persons a certain muccaginous humour to jelly upon the surface of their Blood which he esteemed to be the most spiritous part thereof others take it to be not an excrementitious Phlegm but indigested Chyle concerning this Maebius doth profess he never observed any of it in the blood drawn or issuing from the veins in the head but frequently in that let out of the arms and most of all in that which hath been taken by Phlebotomy in the feet It hath been observed that the Blood which hath issued from the head at the nose hath been of a laudable colour and consistence when that which hath been let out at the same time by Phlebotomy hath seemed impure And the like difference hath been taken notice of betwixt the Menstruous evacuations of Women and the blood taken from their armes This variety in the blood of several persons oftentimes is a cause of that discrepancy which is to be in the blood of Men that are sick in so much that when sundry men are afflicted with the same Malady yet may it happen so that there be little or no resemblance found in their blood Oftentimes it is observed that in â—utrid feavers the blood that is let out by Phlebotomy is seemingly good Saepe ad speciem visum purus est qui aliqui 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 malus est Vt contra impurus cernitur â— specie qui non ita 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 malus The blood often seems to be good when it is essentially corrupted and noxious and it seems often to be bad when as yet it is incorrupt and alimental In malignant and pestilential Feavers the blood is sometimes good to see to whilest yet the sick languish under most violent symptomes and commonly such blood is of an evil prognostick Pessimum signum est timoris plenum cum sanguis vena scissa extrahitur â—i purus rubicundus inculpâ—tus educatur veneno siâ—atem superare indicum est aut putredinem in penitioribus cordis latitare In me ipso olim observatum nam ter per hanc febrem misso per venam sanguine nulla prorsus putredinis nota apparebat aliis signis immani ferocitate saevientibus In like manner doth Simon Paulli observe such outward goodness of blood to be a sign of malignity in a Feaver and to be of an ill presage which he illustrates with the case oâ— an ancient man fifty six years old who being sick of a Feaver which the Doctor concludes to have been pestilential was let blood that which issued out was so florid that it transcended what any pencil could paint or pen describe now out of any Artery or the Lungs ever surpassed it after it had stood twenty four hours the mass was all coagulated and no serum to be seen the Patient died suddenly and without any pangs of death a little after With this doth that Observation somewhat correspond Coyttarus doth make though he take it for no ill presage that in Epidemical pestilential Feavers at the beginning if they be phlebotomised the blood of the Patient will seem very good and sound but in the progress it will come out putrilaginous Circa morborum Epidemialium principia sanguis si educatur ruber sano similis apparet quoties iterum tertio mittitur corruptior quam prius elicitur This he illustrates with Instances and makes this Hypothesis most judiciously the foundation of his Method to cure such Feavers by letting the sick blood in the progress not beginning of the Disease And undoubtedly if then the blood do not seem corrupted but florid it must be from some venenate or
I have blooded my self on purpose two hours after dinner to make the tryal and have an hundred times examined the blood of others who have been blooded at such times as we might expect to see that Phaenomenon of his Yet hath the reality of his observation been confirmed unto me by other credible witnesses so that I question not but he may have seen it though I could not in these Ladies who all dined together about one of the clock and had done bleeding by four Neither may I pass by this Observation that of all the Serum which I have tasted I never found any to be bitter though I extracted some once that seemed so bilious that being put into aâ— Vrinal none could know it from urine highly tinged as soon as I set it on the fire it coagulated with a less heat than I imagine it to have had in the veins and it exchanged its hue for the usual white smelling like a roasted Egg. Yet doth Van der Linden say that some have tasted the blood of Icterical persons and found it bitter Actu nihil naturaliter in sanguine amarum est Sed nec esse potest redderet enim sanguinem ineptum suo muneri ceu observare est in Ictericis In his enim sanguinem amaricare accepimus ab iis qui ipsum vena emissum urinam ejus gustarunt Asclepiadio more And Vesalius gives us an account of one Prosper Martellus a Florentine Gentleman much inclined to and troubled with the Iaundise whose Liver was scirrhous but Spleen sound and his Stomach turgid with choler and wheresoever he opened any of his veins they were full of thick choler and the fluid liquor which was in the Arteries did tinge his hands as if it were choler I find the like Oservation in Th. Kerckringius that an Icterical Woman brought forth a dead Child in the eighth moneth which was so yellow all over that it rather seemed a Statue of such wax than an humane Abortion being dissected By him instead of blood in the veins there was nothing but choler and all the bones were tinged with such a yellow that one would have thought them painted The Scholiast upon Ballonius observed that however the blood is naturally sweet even such as upon obstructions from the Menstrua hath regurgitated and discharged it self at the Gums of women as they have told me yet in one that was troubled with the Green-sickness the blood though florid was salt Potest esse floridus color in se esse acrior biliosior unde quaedam mulier 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 ejusmodi praedita temperamento mihi affirmavit siquando vel ex dentibus sanguis affluit vel e capite eum sibi gustum sentiri salsum molestum When I was at Barbadoes we carried off several poor English thence to Iamaica where many of them falling sick and some being well were let blood I observed that in those poor people which live upon nothing almost but Roots and drink Mobby a liquor made of Potatoes boyl'd and steep'd in water and so fermented that their blood did stream out yellow and in the Porringer did scarce retain any shew of red in the coagulated mass yet are they well and strong but look pale and freckled such persons which are frequent in Barbadoes are called Mobby-faces It were infinite at least beyond my present leisure to relate all that variety of morbid blood which hath been observed in sundry diseases and in several persons languishing under the same distemper as in Pleurisies the Scurvey French-pox Hypochondriacal Melancholy and the like wherein if it be true as it is that oftentimes diseases vary in individuals 't is no less certain that the blood doth also vary in them so that oftentimes ignorant Physicians do imagine a greater corruption in the blood and a greater recess from what is natural to the person and a greater danger in the disease or in the practise of Phlebotomy than they need yet in Epidemical or some Sporadical diseases if the Phaenomena be as general as the disease 't is certain then that the resemblance of the blood argues a resembling cause which prevails over the idiosyncrasy of particulars I know it will be expected that I should say something about the Controversie whether the Blood be one Homogeneous liquor the recrements whereof make up the four Galenical Humours which are no otherwise parts thereof than the Lees and Mothers of Wine are constitutive parts thereof Or whether the four Galenical Humours viz. that which is properly Blood Melancholy Choler and Phlegm are the constitutive parts of the Blood in its natural consistence and Crasis I shall say therefore about this point as much as may be requisite to my present purpose First I observe that the Galenists are at a difference whether the Mass of blood contain those Humours actually or only potentially so that one may hold according to them that the blood is as homogeneous a liquor as any Neoteric doth hold it to be though it arise by the mixture of their five principles Amongst others Erastus hath a disputation in which he amply asserts that all those Humours when they are actually in the blood they become excremenâ—itious and are no longer parts thereof but such as the ejectment thereof depurates and perfects the other remaining blood which he confesâ—eth to consist of several parts constituting one body to which they are as essential as the serous caseous and butyrous part are to Milk which if they be deficient 't is no longer Milk Nam ut non potest lac bubulum intelligi sanum perfectum sine tribus suis partibus sero caseo butyro ita non potest sanguis probus animo concipi definiri absque partium illa varietate Fernelius doth compare the generation of Blood to that of Wine wherein the Chyle is supposed to resemble Must which by fermentation separates and throws out such parts as are not actually in that liquor but arise upon fermentation and are ejected several wayes the more crude parts are by time digested and then the noble wine brought to perfection so he supposeth it to be in the blood and thus though all the humours be at once as it were produced in the Chyle yet are they no more parts of the blood than the Tartar and Mothers are parts of Wine Both these Similitudes of Milk and Wine to Blood were first I think introduced by Galen I am sure he made mention of them and so did his Successours to Mercatus Fernelius Platerus Palleriaca then Carolus Piso began to carry the comparison further in his discourse of Feavers and after him Quercetan and since that our learned and judicious Countrey-man Doctor Willis Others held that the blood as it flows in the veins and is designed by Nature for the Aliment and other uses in man is not to be understood as one liquor consisting of some variety of parts yet united
this descent of that miscellanes the lacteous vessels do imbibe and convey the Chyle in the shape of Milk to the Receptacle where mixing with the recurring Lympha which is sometimes yellowish it passeth through the Ductus Thoracicus unto the Heart and in the Subclavian vein associating with the Blood it passeth along with it supplying the continual decay of the Blood and yielding Nutriment to the parts and new matter for excrementitious humours yet so as that it is not all transmuted into blood or perfected at one passage through the Heart but by repeated Circulations whereby it comes to loose its lacteous colour and contract a more saline taste as well as a serous limpidity or some more degenerate colour yet it is still coagulable except in a morbid state like to the white of an Egg as the depurated Chyle is It were easie to pursue this discourse so as to demonstrate that neither the separation of the Vrine in the Kidneys nor of the Gall in the Liver nor of the Spittle in the Glandules are other than vital Actions wherein the same form which at first shaped the Body is principal Efficient and that in these Operations there is somewhat more than percolation of corpuscles differently seised But I shall conclude this discourse by accommodating of it to the defence of the Galenical Alimentary Humours supposed to constitute the Blood It is manifest in this History of Sanguification that the Pituitous liquor which is derived into the Mouth by the salival vessels is most agreeable to that which is by the Galenists called Phlegme it is not like the serum in the blood for it is not coagulable as the other 't is insipid and as it makes so considerable â— part of the chyle in the stomach so it may well be presumed to continue its intermixture unto perfect Sanguification As for the Gall as its intermixture in great quantities with the Chyle is undeniable so 't is not improbable that it gives a fluidity to the Chyle beyond what it acquires in the stomach thus Painters to make their colours and oyls more fusile and accommodated to their use do mix Gall therewith That upon the mixture it should loose its bitterness and become sweet and alimentary is most agreeable to the Galenists and no wonder for the sapors as well as colours of liquors are easily altered and 't is manifest that this happens in the descent of the Excrements through the tract of the Intestines and why not in the venae lacteae there are signs of it in the flavidity usually observed in the Arterious blood and 't is remarqued by Judicious Maebius concerning the blood that it is not Homogeneous Habet enim sua stamina nigricantes fibras habet serum salino principio imbutum ad putredinem eludendam habet partem subtiliorem splendente rubore excellentem superâ—iciem in extravasato cruore ambientem Et haec in recessu videtur custodire BILEM ALIMENTAREM flavidine sub insigni rubore abscondita Quae ex rubro nigricant flavedini si misceantur talem splendentem ruborem exhibere cuivis clarum est The bitterness which it hath is produced by the Liver upon its separation there which is not done by meer percolation but an accessional of transmutation there As for Melancholy how much the Pancreatick juyce resembles that when it proves not to be bilious as Veslingius and Virsungus alwayes observed it to be let any man judge by what Regnerus de Graeff hath most ingeniously written thereof besides that the more black part of the blood seems as essential thereunto as the more bright Red. But the Degeneration of the Blood into those Excrementitious Humours seems to evince as muck as the Galenists pretend unto Since every thing is not produced out of every thing but out of determinate matter 't is not incongruous to imagine that in the due constitution of the Blood there is an Analogical difference of Alimentary juyces to make up good Blood since there is such a discrepancy in those depurated from it upon which the Soul by the innate temperament of the parts separating doth so operate that its effects are modified by the nature of the subject matter Hence that variety in the tastes of Vrine which is sometimes so bitter that Gall doth not exceed it sometimes sweet so that Fonseca relates of a Portuguess Peasant who by the sweetness of the Vrine would tell who were infected with the Plague The Gall appeared in great variety to Vesalius Longum sane esset ea que in quibusdam tertiana quartana laborantibus dein suspendio aut capite plexis in furiis mania oppressit obsessis in melancholia morbo effectis ex variis febrium quae continuae fuerunt rigorum sudorâ—m inordinatos circuitus faciebant generibus extinctis faedo ictero eoque vario vexatis malo habitu diu pressis dysenteria cruciatis subinde reperi modo commemorare Sive scilicet hic insignem bilis nunc flammae nunc atramenti quo scribimus in modum atrae sive albicantis propemoâ—um colorem qui fere conterminas partes inficeat sive sluidam aut luti modo aut unguenti cujusdam ex farinis melle terebinthina apparati ritu consistentis substantiam sive varias calculorum effigies sive biliâ— vesiculae molem instar duorum pugnorum ob contenta tumidam sive omnis bilis defectum recenserem Quae omnia me de hujus vesiculae natura adhuc magis quam antea habent solicitum As to the Pancreatick juyce its variety is no less observable So for the Phlegm and Blood it self Having said thus much in behalf of the Ancients against some Dullmen of this Age who laugh at any one that mentions but those Humours I might proceed to demonstrate practically their several motions in diseases and justifie the Medicinal Documents created thereon by such instances as countenance thereunto But the digression would be excessive I return therefore to the principal Discourse and shall from what hath been said erect an Hypothesis concerning Plebotomy which will authenticate the received practise which is so judiciously and happiâ—y followed by all prudent men 1. If it be true that there is so great a Quantity of Blood in the body as I have evinced then may we very well suppose that the loss of a few ounces is no great dammage to the Patient 2. If it be true that so great effusions of Blood have happened to several persons without any subsequent prejudice If it be true that large Phlebotomy even usque ad Lipothymiam hath been succesfully practised then is it evident that our partite and diminute Phlebotomy may be safely continued and that whatsoever ill effects follow thereupon the default is not to be ascribed to Blood-letting but to the indiscretion of him that ignorantly made use of it or the unknown idiosyncracy of the Patient or the over-ruling Providence of God which disappoints
his Patient to alleviate the disease in its course by preventing all troublesome and mitigating all dangerous symptomes and to facilitate as well as hasten his recovery It is not questioned but Patients have been and may be recovered of Feavers with little or no blood-letting yet when I consider the great hazard they run in that course the vexatious and perillous symptomes which they languish under longer and with more violence than others I cannot approve of the practise nor think the Physician dischargeth his duty and a good conscience in so doing Extrema necessitas in moralibus ut certum est vocatur quando est probabile periculum and the Patient doth offend against himself if he refuse to take a befitting course against dangers that probably are impending and the Physician doth trespass against his neighbour if he do not propose and practise such a course I cannot to use the words of the incomparable Riolanus I cannot without pity to the sick and some resentment against the Physician read in Platerus's Observations how sundry of his Patients were broyled and torrefied with burning Feavers whom he never let blood He doth relate of himself how he was sick of a most burning Feaver yet did he never so much as let himself blood therein albeit that it were requisite in those cases Such are not obliged to their Doctors but peculiarly to the Divine Providence for their recovery It was the mature consideration of that tenderness w ch is requisite in Physicians towards their Patients which advanc'd the present course of Physick to its glory above all other Methods it being endeared to our esteem by all those regards that represent it as prudential It was not introduced by chance or the subtlety of some persons but the choice of all and so established by the Magistracy that to transgress against the traditions of this Art was criminal in a Physician even by our Laws It may in some cases seem to be troublesome and unpleasant yet SAFETY requires it It may seem tedious sometimes by multiplication of Medicines yet Prudence obligeth by all those means to preserve and secure life and if the omission thereof be criminal in a Physician in case of any sinister accident why is not the practise laudable Would Men but seriously consider How much danger they run and How much more they suffer upon the negligence or indulgence of a Physician who leaves all to Nature and adviseth them to wear out a distemper they would rather hate than love such a Man and the apprehension they should have for the unnecessary jeopardy he put them on would extenuate his credit very much The most rash and brutish counsels may succeed well but yet the most prudent are to be preferred Amonst Physitians I do not reckon the Helmontian as any there is no doubt but a Plethorick indisposition requires Phlebotomy Nature being surcharged with blood forceth us thereunto least some vein should break in the Lungs or the Patient be strangled with that excess this is called Plethora quoad vasa when the vessels are so full of blood that there is danger of their breaking or that the blood should stagnate in the Heart Lungs or Head there wanting room for its motion or take some inordinate course and so strangle the Patient There is another redundancy of Blood which is called Plethora quoad vires or such a plenitude of blood as brings along with it no apparent hazard of breaking the vessels yet doth it oppress Nature so as thereby to become redundant It is more than she can bear in the present juncture 't is more than she can rule and it will suddenly fall into an exorbitant motion to the detriment of some principal part in case timely prevention be not used In both these cases in which the blood is not supposed to be much depraved from its natural estate all do allow of Phlebotomy and if it be timely put in execution it may hinder the progress however it expedites the cure of the disease In these cases we consider not only the present plenitude but also the future what may be in a few dayes to the great exasperation of the disease and peril of the Patient For it is possible that in the first beginnings of a disease there may be neither of these plenitudes but they may ensue a little after For when the insensible transpiration shall have been a while abated as inquietude pain and watching will abate it the Blood degenerates and no longer continuing its usual depuration those excrementitious particles which were lodged in the habit of the body and pores do remix with the sanguine mass and become like so many fermentative corpuscles agitating and attenuating the blood so that whereas before there was no plenitude now there is that the excrementitious particles do contract a fermenting heterogeneous quality different from what they had in the Blood appears hence that those which sweat much as the new-comers in the Indies their sweat is less noysome and bilious by far than it is in those that sweat more seldome Thus Soot is a different body from any thing that is burned Hence it is that those particles being reimbibed into the blood are so offensive to the nervous parts and introduce a lassitude as if the body were surcharged with a plenitude Besides these two cases in which Phlebotomy seems to be directly indicated by a Plethora or surcharge of blood It is practised in other cases by way of revulsion when the Blood and intermixed Humours flow into any determinate part or are fixed there as in Apoplexies Squinancies and Pleurisies for as upon dissection it is manifest that in such diseases there is a greater efflux of Blood than upon other occasions so it is evident by long experience that Phlebotomy doth alter its course and draw back the blood so as that sometimes after that the first blood hath run more pure and defaecated the subsequent hath been purulent as if the conjunct cause of the Pleurisie or Squinancy had been evacuated thereby In reference to such fluxes of the blood to determinate parts we usually consider what in all probability may happen as well as what is at present urging and therefore for prevention thereof we let blood upon great contusions and wounds It is also practised by way of derivation when we let blood near to the affected part thereby to evacuate part of the imparted matter Thus Van der Heyden did frequently let his Patients blood in the same foot for the Gont Thus in a Squinancy to open the Iugulars it is a derivative Phlebotomy In all these cases all Physicians agree to the received practise but in case that the disease be not meerly sanguine but seem to arise rather from a Cachochymy or redundance of evil humours than any plenitude or exorbitant motion of the Blood here many Physicians cry up that Rule That Plethorick Diseases require Phlebotomy but those that arise from a Cachochymy
require expurgation Here they accumulate a multitude of Arguments and undoubtedly since so great men are of that side it must needs be that they have cured those diseases without Phlebotomy But the contrary practise hath so many abettors whose credit equalleth or exceeds that of the others and Experience in a multitude of cases hath shewed the great efficacy of Blood-letting in a Cachochymy or meer impurity of the Mass of Blood and so prodigious is the efficacy thereof in promoting transpiration and opening all the emunctory passages of the body in preventing of putrefaction and expediting of the concoction and in refrigerating the whole habit that Hippocrates and Galen did resolve it in general That whensoever any great Disease did seise upon any Person if he were of Strength and Age to bear it he ought to be let blood The Arabians dissented from this practise but Massarias after Iacchinus and the Florentine Academy did prudently revive it and solidly defend the Tenâ—t and the happy Cures did so convince the World of the truth of their Assertions that all Italy in a manner was presently reduced under them and France and Spain so that though they did and do still in Spain and Italy retain Avicen to be read in their Vniversities as well as Hippocrates yet herein they have abandoned the Arabians` and they which do adhear to that old Maxime of purging out the evil humours when they abound do also comply with the Hippocratical practise and by new excuses accommodate it to their principles So that as to most diseases 't is agreed though upon different grounds what may or must be done Few now are so timorous in bleeding as heretofore and where that apprehension is still continued the Physicians rather comply with the prejudicate conceits of the people then act out of Reason He that can doubt the strange effects of bleeding notwithstanding the concurrent judgment of Physicians let him either read over Prosper Alpinus concerning the Physick practised in Aegypt amongst the Turks where Phlebotomy is the principal and frequently the sole remedy or advise with any Farrier and he will be satisfied that in a Cachochymy nothing is more beneficial though it be particularly said of Beasts that the Life or Soul is in their Blood For my part I am sufficiently convinced of the solidity of their judgment who do much use Phlebotomy and I have frequently observed that the best Medicaments have been ineffectual till after Phlebotomy and then they have operated to the recovery of those Patients who found no benefit by them before so that to begin the cure of most diseases therewith is the most ready and certain way of curing them and to make that previous to purging is the direct course to purge with utility 'T was most Oracularly spoke by Vallesius Facile concesserim venae-sectionem esse optimum omnium auxiliorum quibus Medici utuntur Est enim valentissimum maxime presentaneum multiplex Dico autem multiplex quia vacuans revellens refrigerans venas relaxans omnem transpiratum augens quam ob causam est a Galeno valde celebratum in nullo magno morbo non est opportunum si vires ferunt puerilis aetas non obstat When I considered the strange efficacy of blood-letting in several diseases and that the discovery of the Circulation of Blood had rendered most of the Reasons which were formerly used to be more insignificant or false I was not a little surprised I observed that the effects were such as did exactly correspond with their Hypothesis and that the practise was not faulty or vain though the principles were neither ought any man to quarrel with or laugh at such Arguments as 't is certain will guide a man rightly to his utmost ends 'T is a kind of impertinency that swayes this Age for 't is not so much a Physicians business to talk but to heal It was most judiciously said long ago Ac nihil istas cogitationes ad Medicinam pertinere co quoque sensudisci quod qui diversa de his senserint ad eundem tamen sanitatem homines perduxerint It a que ingenium facundiam vincere morbos autem non eloquentia sed remediis curari Quae siquis elinguis usu discreta bene norit hunc aliquanto majorem Medium futurum quam si sine usu linguam suam excoluerit Neither did Hippocrates place any great value upon Philosophical curiosities and Natural discourses but â—steemed it very well in Physicians if they could demonstrate by their success the solidity of their judgment 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 I resolved with my self that if the Circulation of blood and other modern discoveries taught us but the same practise we already followed it was useless If it contradicted it it must be false I observed that it was the great work of the wiser Novellists to accommodate the new Theories to an old and true way of practise and perceiving that the effects of Phlebotomy were such as the Ancients insisted on I perplexed my self in considering what there might be therein to produce so different effects I abstracted from all common Principles and called to mind the Opinion of the Methodists who were a judicious sort of Physicians and the most prevalent at Rome in Galen's dayes They held that Diseases did not arise from peccant humours since many lived and lived long with Cachochymical bodies and in diseases if in the beginning a multitude of humours and such as Physicians ascribe the disease unto be evacuated by vomit sweat or stool yet the distemper continues and becomes worse and more dangerous by reason of such evacuatians As little did they regard the first qualities of heat and cold siccity humidity concluding them to have no immediate effect in producing diseases but as they varied the symmetry of all or any parts of the body the grounds they went upon were such as were deduced from that Philosophy which makes Rarity and Density the principles of all bodies and they placed Health in such a conformation of the body and such a configuration of particles as did best suit with its nature they held that the interlexture of the minute particles of our bodies were such as admitted of an easie alteration the fabrick being so exquisitely interwoven not only in the solid vessels and parts but a commensuration of prorosities every where the alteration of which texture of the body into a great laxity or streightness and this change of the pores did they make the great causes of all Maladies and the restoration of them to be the way to sanity and this they called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 or the variation of the texture and combination of Corpuscles in the symmetry whereof they placed Health and in the asymmetry or improportionate and incongruous state whereof they placed all Sickness It was their Tenet that amongst those Remedies which did most alter the texture of the
is conveyed as it were in conduit-pipes the Heart being the great Elastic Engine which drives it being fed by the vena Cava and disburthening it self by the Aorta though even the motion of the Heart depend upon a Superiour influence by its Nerves which wherein it consists and how derived from the Brain and Soul is a thing to us incomprehensible I do suppose that the Circulation is continued and carried on principally by Anastomoses betwixt the Capillary veins and Arteries many whereof having been discovered by Spigelius Veslingius and others the rest may well be supposed and perhaps in the coats of the Veins and Arteries there may be a certain texture requisite whereby the transpiration is managed in order to the safe continuance of the digestive fermentation in the Blood and the nutrition of the body The impulse of the Heart together with the pulsation is sufficient to convey the blood to the lesser capillary Arteries and there though the pulse be lost which yet a little inflammation in the extremities of the body will make sensible and in some Ladies as also in Children the least preternatural heat yet it is impelled by the subsequent blood still into the veins and having acquired by the common miscele in the Heart and the digestive fermentation which naturally ariseth in such heterogenious liquors an inclination to expand it self the compression in the Capillary vessels adds to its celerity of motion when the larger veins give liberty for it the Aiery corpuscles of several kinds which are easie to be discovered upon burning by their expansion and contraction adding much thereunto Thus in Water-engines the narrowness of the â—ipes do add to the impetus with which the Water issues forth And I do conceive by the Phaenomena which daily appears in practise that the Animal heat in the Blood actuating that heterogeneous miscele and according to the diversity of its parts producing therein with the help of its fermentation a rarefaction of what is aiery and according to the room there is a liberty or inclination to expand and evaporate themselves this is the principal cause of the continuance of the motion of the blood in the veins and of its saliency upon Phlebotomy Thus upon Scarification there is no salience or spurting out of the blood there being no room for such an expansion or for the Aiery halituous parts in which there is as great a difference as in those exhaling from the terraqueous Globe to rush forward out of the continued Arteries and together with themselves to protrude the blood Upon this account the Methodists and old Physicians as also the Aegyptians where the tender bodies and constitutions of Children and Women or Men admit not of or requireth that great relaxation of the pores and texture of the body which a more robust and firm habit wherein as the natural resistance in health is greater so the recess from it in a bad estate is much greater would be cured by they use these Scarifications and prefer them most judiciously to Phlebotomy This constitution of the Body doth evince the great utility of Phlebotomy and best as I suppose explicates the effects thereof which we daily experiment From hence not only is manifest how the Body is evacuated in a Plethora but in case of Revulsion and Derivation It is manifest in Aqueducts and Siphons that the liquors though much differing in nature from the Blood nor so inclined to evaporate does accelerate their motion and issue out so rapidly upon an incision or fracture in one of the Pipes that a lesser in such a case will deplete the greater notwithstanding its free passage in its own entire Canale Thus the most learned and considerate Physician Sir George Ent having observed first thus much Videmus aquam per siphones delatam si vel minima rimula hiscat foras cum impetu prorumpere And Sanguis per aortam ingressus fluit porro quocunque permittitur peraeque sursum ac deorsum quia motus continuus est quemadmodum in canalibus aquam deferentibus contingit in quibus quocunque feruntur aqua continuo pergit moveri Quare nugantur strenue qui protrusionem hujusmodinon nisi in recta linea fieri posse arbitrâ—ntur After this He explains the doctrine of Revulsion in this manner Quae postea de revulsionibus dicuntur nullum nobis facessunt negotium â—antundem enim sanguinis a pedibus ascendit per venas quantum ad eosdam delabitur per Arterias Facto itaque vulnere in pectore aut capite revulsio instituitur si modo tam longinqua instituenda sit in â—rure Quia sanguis alias quoquoversum ruens facto nunc in pede egressu copiosius per descendentem ramum procul a vulnere delabitur Non enim arbitramur sanguinem aeque celeriter sua sponte per arteriam aut venam fluere atque is secta earum aliquo effluit Nec sanguis ad laesum pectus aut caput per venam cavam impetu affluit quia fluxus ille aperta inferius vena intercipitur I do acknowledge that the reading of these passages did first create in me the thoughts I now impart unto you And hereby it is evident how the Ancients with their large Phlebotomies might derive even the morbifick matter or revell it though impacted Our minute Phlebotomies do seldom produce such an effect for since it is not otherwise done but by a successive depletion out of the Arteries it would seem necessary to extract three or four pounds of Blood to effect such a matter Neither indeed is it necessary albeit that I believe the most speedy cures but great judgment is requisite in such operations were atchieved thereby for though we do not retract the Humour or Blood unto the place where we Phlebotomise we do revell it from the place whither it was flowing and the course of the Blood and Humours being diverted the Arteries leading to the part affected or depleted and the Flux of Humors which was by them is abated their tenseness there which appears by their pulsation there where they did not beat before is relaxed and so becomes less opportune to extravasate either the Blood or other Humours whereupon Nature it self alone or with a little help of the Physician doth digest and dissipate the impacted matter Whereupon if we add the motion of restitution in the parts affected which is hereby facilitated the great change in the digestive fermentation of the Blood which is manifest by the melioration of the Blood which is seen in repeated Phlebotomies and the relaxation of the whole body in order to the transpiration and other depuration of the Blood by its several Glandules the Kidneys Liver Guts the reason of those prodigious benefits which Patients have had of old and now under our practise is manifest nor do we want a justification for reiterating Phlebotomy or exercising it in different veins and divers manners I designed long ago to set aside some spare
hours to a further study of this Hypothesis and in order thereunto to acquaint my self with the Hydraulic Arts as also to examine the truth and solidity of the Static Experiments out of which this texture of the Body the digestive motion of the Blood its change and restitution is demonstrable and to enlarge my prospect by a comparison of the several Methods and Medicaments used by sundry Physicians both Methodists and others in order to the cure of diseases and preservation of health But I must tell you that the malice of my enemies renders my LIFE and Condition so ill-assured And the apprehensions I have least the Projects of Campanella are powerfully and subtly driven on in this Age I am the more confirm'd in my suspicions in that my Adversaries are most intent to ruine me but not to remove those Vmbrages together with the imminent subversion of the Faculty of Physick by the toleration of Divines to practise which is contrary to the Ecclesiastical Canons and makes them irregular the great incouragement of Quacksalvers and Baconical Physicians These reflexions have so discouraged me that I have no mind to pursue those studies or to be much concerned for the present on succeeding generation But could I see Physick regain its lustre the Faculty encouraged by such Acts of Parliament as our Predecessors and Forreign Potentates have made and your Colledge advanced as the Proper and Supreme judicature in reference to Medicine I would willingly imploy all my leiseure in the improving of the present state of Medicine without subverting Learning or disparaging the Ancients without the knowledge of whose writings 't is impossible for any man to be excellent in Physick Poets and Comical Wits owe more to their Birth and need less of industry study and judgment than Physicians The knotty Staffe the Serpent the Pine-apple the Dog the Dragon the Cock with which the pourtraicture of Aesculapius was beautified were not Symbols and Hieroglyphics of a facile study The first Principle that we are taught is 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 But now the reading of two or three Books a Comical Wit a Bacon-face a contempt of Antiquity and a pretence to novel Experiments which are meer excuses for Ignorance and Indiscretion are sufficient Qualifications Notwithstanding the Melancholy and pensiveness into which the present posture of Learning here in England alwayes puts me into when I reflect thereon I will constrain my self to proceed further and examine the cases of Phlebotomy in a Pleuriâ—e the Small-pox and Scurvey concerning all which diseases as I shall debate what an Intelligent Practitioner may do nay is oftentimes obliged to do in conscience and out of discharge of duty to his Patient so I will not justifie any Action of those persons who understand nothing nor can distinguish circumstances in particular cases A thousand things are to be considered by him that would practise Physick exactly the present disease the past condition of the Patient in reference to himself his parenrs his dyet preceding distempers the latter the more remote the conjunct causes what hinders what promotes what effects the cure What will what may happen in the disease what will or may ensue upon recovery In all these cases since he hath not a sensible and easie knowledge thereof but must proceed upon Conjecture you understand well How great a comprehension of affairs and how much in each case he must inquire into who will discharge well the duty of a Physician It was prudently said of the incomparable Aristotle the meanest of whose Works deserves to be read above all that the Novel Experimentators have published if it were but for the wise Apothegmes therein for Civil Society is the grand work of this Life and that is more useful which qualifieth us thereunto then what makes us admirable Mouse-trap-makers Physicians saith he do not cure man in general except it be by accident but Cullias or Socrates or some other individual person Hence even a man that is a speculative Artist how much more those that are neither speculative nor Empirics may be deceived in the application of general rules to singular cases and so may mistake He tells us that it is not for the most dexterous railers or witty Sophisters to judge of State matters nor yet for any man to direct therein who hath not served an Apprenticeship in the Ministry of State for neither in Physick doth the knowledge of a common Praxis accomplish a man thereunto 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 What is it to the purpose if they learn a multitude of Knick-knacks and have an infinite of Conundrums in their Heads if they know not what appertains to Practise These narrow-sighted Verulamians may recommend themselves by success in a few the Grave may conceal or a strong Nature amend their defaults but they are nevertheless ignorant In a calm many can steer a Ship whose imbecillity of judgment sinks it in a storm 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 I have already spoken concerning Phlebotomy in the Plague In a Pleurisie 't is no less evident that Physicians are divided in their judgments To begin with the true state of the Question This is more than this Baconical Philosopher did ever think upon for he without any distinction derives the usefulness of Phlebotomy in a Pleurisie If thou beest unsatisfied whether opening a vein as it is indicated from Evacuation or Revulsion be a competent sufficient Remedy for the cure of a Pleurisie or any high Feaver thou shalt find in this short Tract a Resolution in a Negative sense grounded on Reason Authority but especially that which is the sum of all Matter of Fact delivered according to what Experiments are past offered to be made good for the future Thus he bespeaks his Reader in the Preface and a little after he assures him that He is able to resolve any one that is capable that the most Plethorick body taken with a Feaver or any one Cachochymic afflicted with a Pleurisie may be cured without the Lancet more speedily and safely than by using the same Though I cannot imagine G. T. to be good at resolving Controversies in Physick yet such is his impudence that I will not refuse him the Title of Doctor Resolutus I have read over his Book with some attention but I could not find any Pretensions in it to Authority nor any Experimental Histories related All amounts to this G. Thomson saith It is not good to bleed in a Pleurisie And G. Thomson avows that 'T is verified by observation they who recover by this Apospastick means do for the most part find a great debility succeeding are incident to Empyemas Consumptions and prove to relapse into the like condition again On the other side those who rise from their sick Beds restored by vertue of adaequate Remedies are secured from the forementioned discommodities Assuredly of all those Pleuriticks I have handled above these half-score years I have not known one after their evasion
eam dimissimus atque ad id faelicissimum purgatorium Medicamentum rursus devenimus a quo post xiv diem salvata fuit It is further to be taken notice of that sometimes Pleurisies have been cured without Phlebotomy purging or vomiting or bleeding by Liniments and expectorating Medicoments as in Gabelchoverus Cent. 1. cur 3. Cent. 2. cur 93 98 99. But to oppose G. T. directly sometimes Pleurisies have been cured by Phlebotomy alone and pectoral Medicaments as in Rulandus Cent. 7 cur 13 14. Cent. 10. cur 49. Gabelchoverus Cent. 3. cur 7. Sometimes by Phlebotomy and sweating as in Rulandus Cent. 6. cur 60. I have hitherto made use of these Authors because they were most eminent Practitioners and particularly famed for their Cures in that disease and it is manifest hereby that Physicians are not bound up to one method therein Neither indeed can they be in any disease for in some years and in some ages and persons and in some circumstances they are forced to recede from their usual courses and sometimes the mildness of a distemper is such that it requires not all their address those Methods which are set down in our praxes I now come to give an account of the most common and received Method of curing Pleurisies amongst Physicians and to shew with how much reason they practise Phlebotomy therein There is not any disease whereof Hippocrates did take so particular care in relating its Diagnostics Prognostics and Cure as a Pleurisie as is evident by what he hath written in his Books De victu in morbis acutis and De morbis besides what he hath set down occasionally in his other Works It is an Acute Feaver finishing its course in seven nine eleven or fourteen dayes though it hath happened as in the case of Anaxion that it extends its period to thirty four dayes It is attended alwayes with troublesome oftentimes with dangerous symptomes A violent Cough difficulty of breathing pricking pains and Stitches in the sides these are the Pathognomonical signs of this Feaver Though the part affected seem principally to be the Pleura or costall membrane yet are the Lungs attacqued by this disease and frequently it hath been found that the seat of the Pleurisie is rather in them than in the Pleura as the followers of Petronius do demonstrate and their fabrick is so tender that it is in great danger to be putrified or corroded in this distemper by the sharpness or other evil qualities of the sputaminous matter Besides it is a very faellatious disease and frequently after hopes of a recovery by a benign Anacatharsis after that the stitches have abared oftentimes the disease becomes crude and exasperated again to the detriment or death of the Patient as appears by the case of Anaxion in Hippocrates and that other related by Franciscus Rubeus as also by Mercatus If it be not happily cured the danger is no less than that it should change into a Phrenitis or Peripneumony or terminate in an Apostemation of the Lungs or an Empyema in the Thorax Where the disease is so full of dangerous as well as vexatious symptomes it is not to be wondered that Physicians have diligently looked into the disease and recommended unto our practise a great many things which they who either perfunctorily look upon matters or superciliously despise dangers or out of ignorance cannot apprehend them may contemn That the Blood in that disease should acquire a congealing or coagulating quality seems unimaginable both because that oftentimes the procatarctic cause is sudden in its operation as when a plethoric person any way doth over-heat himself or drink cold drink c. and also that the congelation in the Pleura when it is there is no other than what is seen in the spots of the spotted Feaver or Plague which seem not to be congelations of the Blood Besides How comes it to pass that this aptitude to congeal if it be in the whole mass of blood doth not discover it self any where else but in the Pleura And if such a Diathesis ad acescendum in the blood produce a Pleurisie How is it true that Hippocrates saith Acidum qui eructant non sunt pleuritidi obnoxii Why also are splenetic persons in whom we may best suppose such a Diathesis not inclined to Pleurisies except the spurious and flatulent ones Is it not moreover known that Vinegar dissolves congealed Blood and is therefore given in bruises As also Oxymel and syrup of Vinegar in Pleurisies But 't is evident that it is a Feaver accompanied with a Catarrh upon the Thorax and Lungs and that it admits of a great diversification according as the Galenical humours do operate in it and in the Cure a different regard is to be had to a bilious or pituitous Pleurisie from what there is in one that is sanguine as any man knows that understands Physick or hath so much as read Salius Diversus upon Hippocrates de Morbis lib. 2. Or Forrestus's Observations lib. 16. It was the advice of Hippocrates at first to try to discuss it by fomentations if they succeeded not then in case the stitches seemed to diffuse themselves upwards towards the shoulders to phlebotomise the Patient and let him to bleed largely until the colour changed from corrupt to red or from pure and red to blackish But in case the pains descended below the Diaphragme then to purge with black Hellebore or Peplium The reason upon which he seemed principally to go was that a Physician was to imitate the progress of Nature and to carry off the peccant humours by such wayes as he inclined them to go which in one case appeared to have a tendency to the Arm in the other to the Bowels But Galen considering the uncertainty that is in the operation of purging Medicaments as also the hazard of irritating inflammations thereby and the diverting that sputation which is so requisite in that disease and that since a Looseness was perillous therein purging could not be safe and I suppose that the sad case of Scomphus may have discouraged him from it who being purged in a Pleurisie became frantick and died on the seventh day the discourses upon which lamentable History in Vallesius and Van der Linden do deserve to be pondered The purge did not work much yet killed him Some other cases as sad as this are recorded upon the account whereof the generality of Physicians have prudently been swayed from purging in a Pleurisie until the latter end Because it is very convenient in a Pleurisie that the body be moderately soluble they do give their Patients Glysters and because the disease is a Catarrh accompanied with a Feaver they conceive their main work to be this to prevent the increase of the fluxion by diverting the course of the Blood another way and to evacuate by a concoction and expectoration the matter inflamed and impacted To do this they place the beginning and foundation
in visceribus aut sanguinis exundantia in vasis quare primo statim morbi insultu deinda erit opera ut evacuatio per vomitum aut sedem si opus fuerit tempestive procuretur pharmacis tantum mitioribus blandis utendum est quae nimirum non irritent aut humores perturbent quare hoc tempore interdum emetica purgantia aut enemata modo haec modo ista locum habent etiam sanguinis missio si plethora adsit bono cum successu celebratur Circa missionem sanguinis instante variolarum eruptione valde ambigitur olim inter nostrates haec res sacra audiebat neque sub ullo necessitatis praetextu Phlebotomia admitti solebat nuper autem experientia duce in quibusdam casibus sanguinem mitti omnino utile necessarium esse comprobatur quae tamen evacuatio si in quavis constitutione indiscriminatur adhibeatur aut quando isthac opus fuerit in quantitate nimis larga peragatur magna saepe incommoda exinde sequuntur These are the words of that intelligent person whereas G. T. seems in the English Text to affix upon him such a sentiment as if he allowed commonly and indiscriminately of Phlebotomy in the very nick of the coming out of the small Pox But it may be replied that he hath done the Doctor justice in the Latine citation but I think not amongst English Readers nor in his vulgar discourses However I shall endeavour to justifie the aforesaid Method of Doctor Willis as Artificial and agreeable to the opinion and happy practise of the best Physicians and that it may be more manifest I will inlarge my work by examining the contrary opinions of some others for G. T. gives my Pen here no employment except it be to tell him that the three noble Personages which he speaks of were not the Doctors Patients as I believe except he be accountable for all that act agreeably to that Method which He and our best Physicians layes down I add that many Actions are warrantable by Art and Prudence which are not successful and to requite his Catalogue I would have him know that when this young King of Spain had the Small Pox he was let blood several times and so was the present Queen of France upon a feaverish indisposition let blood twice in 1663. and two dayes after the Measil◠appeared And this Lewis xiv being sick of the malignant and pestilential Small Pox was thrice blooded by Doctor Vautier and for it received this Elogy from the learned Iacobus Thevart Vt boni omnes Galli palam profiteantur ac praedicent suum se tibi debere Regem charissimum quem nempe malignis ac pestilentibus variolis periculosissime laborantem non cordiacis tantum praesidiis ut Medicastrorum 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 vulgus solet sed ipsa quam in ejusmodi affectibus aversantur ac damnant sanguinis missione ter pro symptomatum urgentium necessitate repetita salvum incolumen restituiste innumeris interim in hac urbe populo sissima pueris hac Epidemica lue e medio sublatis Quod ob facinus tam egregium quae non tibi laudes vir praestantissime quae non soteria debentur Si qui civem Romanum in praelio servaverat quercea corona dignus habitus est Tu certe qui Regem Christianissimum ab hoste tam infenso liberasti auream qualis est ab Atheniensibus Hippocrati concessa meruisti Nec dubito quin si vixisses priscis illis temporibus quibus inter Heroas referebantur quicunque insigni aliquo facinore Rempublicam conservassent adjuvissentve quin inquam ipse Heroum auxisses numerum honoresque prope divinos accepisses I repeat this passage with the more satisfaction because it may serve as example to the English and instruct them with what gratitude and acknowledgments they ought to treat the learned and renowned Physician Sir Alexander Frasier principal Physician to his Majesty for recovering our most gracious Soveraign of the like distemper by the judicious administration of Phlebotomy I could name many other Persons of Honour who do confess that they owe their recovery out of dangerous and malignant Small Pox unto Phlebotomy Of those that have written concerning the Small Pox and are therein professed enemies to Bleeding I shall take only two particularly to task the one is Doctor Tobias Whitaker the other Doctor Thomas Sydenham which I do the more willingly because the one writing in English the other practising at London and endeavouring to insinuate his principles every where with a derogation from the authorised practise of Physicians it must needs seem that all who do not take his course have neither regard to the Patients nor considered seriously the rise and progress of the disease I did at first doubt Whether I ought to reckon them as Distinct Authors because they so for agree in the Regimen and Cure of the disease that the one doth seem to have stollen it from the other As will appear by this Parallel Doctor T. Whitaker of the Cure of the Small Pox p. 22. In the Regimen of this Disease the whole work consists in moderation of Air and Diet without any other mixtures of violence or bland impediments which may altogether pervert or in or by a less force retard Nature in its motion the motion of Nature in this case being from the beginning of the disease to the eruption of the pustules Critical and in Critical motions the least application of any Medicament is so dangerous that no expert Physician will admit of it The Diet is to be Alimentum medicamento sum such as is Milk with Saffron and Marigold flowers Doctor Sydenham doth suppose that it is natural for the Blood of all persons at least once in their lives to undergo a great change and as it were a new form and that there is no peculiar venome or malignity infecting the Blood but all is the result of this inclination in it to exchange its state and in order thereunto some parts are to be expelled and in order thereunto must first be separated This is done by a Feaverish Ebullition in the mass of blood whereby those parts are separated from the residue and discharged into fleshy parts of the Body which Nature looks as requisite in order to the change she is going to make All this is usually done in four dayes and the Blood is recomposed and becomes as calm in its motion as it was before The expelled matter is to be elevated into pustulary abscesses and there maturated and dryed up For the carrying on of all this work it is his judgment that the Physician ought to do nothing But the Patient is to be kept in a moderate heat and temperate diet taking nothing that is cold and not so much as being confined to his bed beyond his ordinary use except necessity require it and then he is to use no more clothes nor warmth than he accustomed himself unto in
antecedent to a Feaver nay the contrary seems evident to all Physicians nor ever was there any whereunto they did not attribute some procatarctick cause Besides he doth not alledge any Reasons or Experiments to shew that there is any alteration in the blood before and after the Small Pox or a Feaver or any difference betwixt the Blood of such as have had those diseases and of those which have not had them So great a supposition ought not to be made without ground And since it is natural and Nature is constant why is not the Disease more ancient and universal than it appears to be For if there be any grounds to think the Small Pox to be of long continuance 't is certain 't is but seldom spoken of by any old Writer perhaps once by Hippocrates yet so as never to be understood by any that hath not seen the indisposition and never by Galen It may be imagined to have come from Aegypt by contagion and might have been called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Quia urbi Bubasti Aegyptiae familiaris hic morbus It infesteth some places more than others In Graecia non adeo frequens Ideo antiquiores Medici vix ejus meminerunt In the West-Indies it was not heard of till the Spaniards came thither and they as also the English there seldome have it I believe the Disease to be novel and of no longer date than the Sarracenical revolution I could instance in the nature of such great alterations that they have ever been preceeded and accompanied with many petty changes in other things and if ever I have so much vacant time as to make political reflexions upon the rise of Mahomet I may declare much to this purpose This is that invidious subject about which Ecebolius Glanvill makes so much noise as if to avow that Mahomet were a Gentleman of noble extraction married to one who for birth riches and beauty might have been a Princess and accomplished with that sober Vertue Wit Eloquence and Education by much travel for he travelled all over Aegypt Africk and Spain as to render himself one of the most considerable of his Age or to say that the Christians were so ignorant and debauched and perfidious and addicted to Legends more than to the sound Doctrine of the Gospel at that time that most of the Fables in the Alcoran were accommodated to the honour of the times more than to truth and so Mahamet told them or to say He pretended to revive Ancient Christianity were to be an Apologist for the Mahometans and an abettor of the Alcoran Whereas none but the Illiterate can deny these things and the Age our Virtuoso speaketh of is the Age of Apostacy according to the Doctrine of our Church Oh Heavens to what an height is Impudence and Ignorance arrived Or what can be safe if so prudential and generous a design as I had must be calumniated by such a R in this manner Bâ—t to resume my discourse in the behalf of my opinion concerning the novelty of this disease besides what the learned Mercurialis hath said I shall conclude with the words of Rodericus a Fonseca which are these Si ex nativitate esset ab initio mundi fuisset aut saltem ita frequenter tunc ut nunc solet esse et licet antiqui aliquam de his pustulis mentionem fecissevisi sint ea certe exigua est dubia ut certum sit vix illis temporibus fuisse talem morbum negligentissimi certe habendi essent si tam ingens commune frequens malum illotis manibus silentio involuissent cum morbus sit puerilis Hippocrates eas numerasset inter aetates 3. Aphor. ubi diligentissime puerorum morbos connumerat tamen nullam hujus mali fecitmentionem sed illud satis demonstrat hunc morbum novum esse quod in multis mundi partibus nunquam visus fuit ubi nunquam apparavit nisi postquam Hispani eo pervenere siquidem per contagium Aethiopis cujusdam illuc delati magnam Indorum partem sustulit I might here insist upon the Hypothesis of Doctor Sydenham concerning the Inclination of the Blood to change its state I cannot believe but that the Physicians understood themselves as well before he writ when it was said that there was in every one that was born something of impurity in the body which was naturally to be purged out by an ebullition in the blood and such an effervescence as terminated in those Abscessus called the Small Pox. Quandoque accidit in sanguine ebullitio secundum semitam putredinis cujusdam de genere ebullitionum quae accidunt succis talia quidem accidentia fiunt per eam ita ut partes eorum ab invicem discernantur Et de hoc est cujus causa est res quasi naturalis faciens ebullitionem sanguines ut expellatur ab eo illud quod ad miscetur ei de reliquis nutrimenti sui menstrualis quod erat in hora impraegnationis aut generatur in eo post illud ex cibis faeculentis malis de illis quae rarificant substantiam ejus faciant eam ebullire donec fiat substantia recta fortior prima magis apparens sicut illud quod natura efficit in succo uvae ita quod rectificat ipsum faciendo vinum similis substantiae jam expulsa est ab eo spuma aerea faex terrena He that can English this passage will find in it the ebullition separation expulsion and despumation of our Doctor In truth those terms nor that which he imports by them are no novelty amongst Physicians and Rhases as Sennertus saith doth not make any mention of those uterine impurities as the cause of the Small Pox but compares the Blood to Must in in which some impurities are to be separated by Ebullition Wherein the whole Hypothesis of this semi-Virtuoso is contained However I cannot allow any more to his Observations than if a man should go without his doublet and pretend to a new Mode of wearing Breeches But that which is most intollerable in Doctor Sydenham is that He seems to attribute all the evil consequences of the Small Pox to the indiscretion of those that attend them be they Nurses or Physicians Thus p. 150. Edit 2. he makes as if Nature did discharge it self in that disease into the fleshy parts only so that if the Eyes Lungs Stomach Guts Pancreas or Membranous parts be affected 't is not the violence of the Disease but the ignorance of the Attendants which occasioned that which is intolerable for any man to say and refuted by Experience I might proceed to demonstrate that there is not any thing new in the whole Cure which Doctor Sydenham useth that in the beginning of the Small Pox before the eruption being as ancient as Bayrus if not derived from the Arabians And the rest hath been inculcated by an hundred
been through Sudorifics or other Medicaments Doth not it often happen that Nature not being able to command the turgent humours they have so fixed themselves in several principal parts occasioning Swoonings or Syncopes Dysenteries as to destroy the Patient in the beginning or so to imbecillitate him that he hath afterwards languished in a Consumption been deprived of his eyes or limbs and subjected to incurable Vlcers It was observed in Germany in 1644. that the Small Pox reduced some to an Atrophy Asthma and Consumptive coughs some have had not only the habit of their body strangely vitiated and altered but even their bones corrupted and corrâ—ded into a Paedorthrocace or Spina ventositatis some have had the Articulation of their Joynts so depraved that they have become immoveable or crooked Oftentimes we see that after the first Feaver is abated and the Small Pox come out in great plenty a looseness follows or a new Feaver prevents their maturation and destroyes the Patient From these Considerations I dare confidently deduce this Conclusion That it becomes a Physician in the Small Pox to examine well in the beginning the constitution of the Patients body if it redound with peccant Humours or no it being easie to apprehend that what is a Cacochymy before this Disease will degenerate into a virulency and malignity in the course of the Disease If it redound with too much Blood as having more than is requisite for the commodious discharge of that Disease for if the body be either way Plethoric there is apparent danger least the Patient be strangled or that the turgent Humours being either streightned for want of room or too luxuriant to be guided will fall upon some important part and so create inseparable evils in the progress of the distemper He ought also to inquire diligently into the preceding season of the year since that adds much to the mildness or perilousness of distempers As also into the present sickness whether it be in others attended with any thing of unusual malignity or pestilence for in such a case he must increase his care as dangers multiply He ought also to weigh well the first Symptomes whether they be so violent as that the Patient is not likely to have strength to support the continuance of the Disease If the Feaver be great and accompanied with swoonings if the Patient being thirsty restless molested with a vomiting difficulty of breathing a dangerous Cough violent and ill-coloured Diarrhaea or Dysentery bloody or black Vrines It is not to be doubted in these cases but the Physician is to make such provision that so ominous a beginning may conclude well if it be possible And since so great a distemper requires great and generous remedies two things will at first if he come timely enough fall under his debate viz. Thlebotomy and Purging Concerning Purging many are very timorous because that a Looseness is dangerous in the Small Pox as also because that they fear least it should divert the Humours from their natural tendency and draw them into the Bowels But neither of these Reasons are of any great validity For neither is a momentany Looseness and 't is that which is equipollent to a Minorative purge dangerous in the first beginning of the Small Pox before they come forth Nor is there any danger that a gentle Purge should create a Flux but rather prevent any such subsequent evil by carrying off the peccant Humours which by continuing in the stomach and intestines would contract a malignity And indeed this consideration is of such importance that it ought to sway a Physician to give some Lenitive in the beginning when he sees occasion Neither will he thereby divert Nature from the expulsion but rather facilitate it and by diminishing part of the redundant Humours enable her to overcome the rest with more ease whereupon Augenius Ranchinous Franciscus Rubeus Riverius Gregorious Horstius and other excellent Practitioners do take this course And Ballonius observes An commode praescribi possunt medicamenta antiquam morbilli se produnt An illa impediunt motum naturae Imo inopinato venaâ—â— fecuimâ—s medicamentum purgans dedimus quibus die sequenti aut postridie apparerent variolae melius multo habuerunt quam quibus non aâ—si fuerimus idem exhibere sic parum probabile quod dicitur minus affatim erumpere populas si corpus ante purgaveris As for Phlebotomy were it not for capricious humours or indiscreet fears of some persons there could be no question about the legitimate use thereof in this Disease For there is not any Indication for Blood letting which may not occurre in the Small Pox And 't is as vain a surmise to think that an intelligent Practitioner will do any thing rashly as 't is an irrational course though too common to censure Men for the ill success when they act according to the best of their judgment and the most folid Rules of their Art The present Controversie includes two Debates The one Concerning Phlebotomy in the beginning of the Small Pox before their eruption The other Concerning Phlebotomy after their eruption In both which cases I do avow that Phlebotomy may be oftentimes prudently and sometimes is necessarily administred I use this manner of speech because that Physicians do make a twofold use of Blood-letting One when the nature of the Disease and its greatness do absolutely require Phlebotomy as the most proper Medicine and without which in all probability the Patient will run an apparent hazard of his life A second when it doth not seem so absolutely necessary to Phlebotomise the Patient but he may recover by other means without it yet because this is the most rational and safe way Physicians do insist thereon that so Nature being disburthened and allâ—viated in part thereby may with more ease overcome the rest Thus in some Diseases Galen professeth he omitted to bleed some Patients because they would not indure it whereas had he esteemed it extreamly necessary he would not have declined that Remedy and used a Purge instead thereof But he looked on it then only as a most convenient Remedy From whence I deduce that whensoever any man reads any Author that doth not practise Phlebotomy in the Small Pox as I. Michael Fehr and one Langius now Professor of Physick at Leipsich or Angelus Sala the uselessness or danger of the Remedy is not to be concluded thereupon since it is evident that Physicianâ— are inforced often to comply with the Humours and prejudicate Opinions of their Patients and the Countries where they live and do not alwayes act according to their best judgment Nor doth it follow that because the imprudence of some hath been or is successful that therefore we ought to relinquish the more wise courses or condemn as needless those cares which Discretion it self doth put us upon Neither ought we to be swayed by the Negative testimonies of Writers or Practitioners For it doth
not follow that what one or more hath not tryed or seen is impossible or impracticable The happy Experience of the Affirming party is the most convincing as our common Logick informs us They who condemn Phlebotomy in the Small Pox either condemn it because they have experienced its evil effects therein or because they have only a sinister opinion of it and some specious reasons against it If the last they say nothing of moment it being the dictate of Hippocrates 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 And Aristotle long ago censured those who out of a preconceived opinion of the event of a thing did form their judgment and imagine it must happen so or so because they think it will do so If they have so often tryed the evil success thereof 't is necessary that they confess they have killed a great many thereby or at least that they profess they have seen the sad Experiments thereof made by others and to make this any way convincing they must first assure us that such Experimentators were Artists and understood their Faculty so well as to weigh all circumstances requisite to the due administring of Phlebotomy otherwise the Actions of the most judicious shall be condemned through the ignorance and folly of others and it must be demonstrated that the death or other evils which befell the sick were the direct consequences of the Phlebotomy and not by accident and from some particular juncture or 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 least we commit the Fallacy of A dicto secundum quid ad dictum simpliciter Doctor Wâ—itaker is pleased to call the practise of Phlebotomy in the Small Pox the Mode of France and makes as if that were the principal Argument produced for it viz. The greatest Argument to confirm this practise is the Mode of France by the same argument they would prove stinking and putrid flesh both of fish and fowl to be most comfortable to the sense and corroborative to the Animal spirits and if their Rhetorick be no better than their Logick to perswade persons of reason and sense to accept their Mode it is most probable it will prove the Numismata of Galen which is a quaere that will pass no further than their own Countrey He afterwards call it the rash practise of Modish persons adding I call it a rash and inconsiderate practise in this Disease because it is a doubt indetermined amongst the most learned Professors of all Nations both Greeks Arabians and Latines and all others principled from them being all of them unresolved of Phlebotomy in the Small Pox upon any Indication to be a safe Remedy And if the disease be conjunct with an undeniable plethory of blood which is the proper Indication of Phlebotomy yet such bleeding ought to be by Scarification and Cupping-glasses without the cutting any Major vessel Assertions so general and peremptory as these are ought to be very well grounded or else they subject the Author to the imputation of Opiniatrity and Ignorance I will not deny but some may have justified their practise by the customary presidents of the French Physicians who neither want sufficient knowledge in their Faculty nor prosperous success to urge against all Cavillers And this they may have done not that ever they could judge it a Mode peculiar to the French but because that Nation is our next Neighbour and so well known unto us that they needed not extend their discourse further nor do there want reasons to shew that If it be requisite for the French and they can bear it It is more requisite for us and we can better tolerate it For our diet is more plentiful our habit of body more firm our innate heat by the coldness of our Climate more concentrated and vigorous our redundance of blood is greater and our pores more dense and apt to be obstipated than theirs and if we may aggravate the malady from the dismal effects and impressions it produceth in the faces of the sick I think I may say it I never was in France that the Small Pox are worse in England which indicates greater Remedies for the most part than in France since the disasters which befall good faces are more frequent and notorious here than amongst them But I do affirm that this practise is not only the Mode of France but of Spain and Italy as well as Aegypt and Africk and that 't is authentick in high and low Germany and Denmark And whereas he sayes that the usefulness of this Remedy is a doubt indetermined amongst the most learned Professors of all Nations both Greeks Arabians and Latines and all others principled from them It is a gross mistake and there is more of truth in that opposite saying of Augenius Omnes qui de variolis scripserunt unanimi consensu principium curationis illarum fieri debere a vacuatione sanguinis contendunt ideâ—que venam incidendam esse aut scarificationes administrandâ—s aut hirudinibus applicitis sanguinis vacuatione procurandam Concerning the Greeks I have considered the passage in Hippocrates concerning the Son of Tmionax and whatever else is alledged out of him or Aetius yet cannot be satisfied that ever they knew any thing of this disease They that do believe it as a strong imagination may transport a man far may reply that since the Malady was rare then and different much from ours 't is not to be wondered that they speak so little of the Cure and never determine a doubt which they never thought of As for the Arabians nothing is more certain than that they considered the disease and all circumstances and did determine in the behalf of Phlebotomy and whosoever is principled from them as all in a manner of the subsequent Physicians have been must allow thereof I do not remember to have read that any of them did ever prohibit Phlebotomy in this case except it be Avenzoar who is said to have given the like directions that Doctor Sydenham doth viz. To do nothing in a manner but relinquish the work to Nature entirely How Avicenna determines the doubt his words will best shew Oportet in variolis ut incipiatur extrahatur sanguis sufficienter cum conditiones fuerint Et similiter si morbillus fuerit cum repletione sanguinis Et spatium illius est usque ad quartum Sed quando egrediuntur variolae non oportet iunc ut administretur phlebotomia nisi inveniatur vehementia repletionis dominium materiei tunc enim phlebotometur quantitate quae alleviet seu minoret Et convenientius quidem quod in hac administratur aegritudine est phlebotomia Et si phlebotometur vena nasi confert juvamentum fluxus sanguinis narium tuetur partes superiores a malitia variolarum Et est magis facilis super infantes Et quando necessaria est phlebotomia non phlebotomatur iterum complete timetur super ipsum corruptio extremitatis Whence it is apparent that amidst such circumstances as amongst
Physicians usually seem to require Phlebotomy he doth allow the practise thereof in the Small Pox before they come out be it on the fourth day or later that they discover themselves After they do appear he alloweth not except there be a manifest plenitude and â—urcharge of morbific humours then he alloweth only a minute letting of blood and not what is too copious and adds that in this disease 't is most convenient to let blood and if the Patient be not blooded in a Plethoric constitution and that by a repeated phlebotomy according to the exigency of the case that is compleatly there is danger least the party suffer the corruption or loss of some of his limbs by a Gangrene or other evil accident for when the redundance of the expelled matter is such that it cannot duly maturate and transpire in the pustules it frequently corrodes the ligaments and tendons and otherwise vitiates the remoter parts of the body even Worms have been bred in a pestilential Small Pox all under the pustules as at Stralesund in 1574. sometimes the matter not finding room to disburthen it self in the circumference turns its course into the bowels and begets mortal Diarrhaeas and Dysenteries Of the same opinion is Rhases as appears by what is extant amongst the Scriptores de febribus viz. Si antequam apparere incipiant medicus aegrum inveniat minuere eum faciat aut cum ventosis sanguis extrahatur Minuatur equidem sanguinis multitudo It is true that there he prohibites Phlebotomy after the Pox come forth but I find him cited by others 〈◊〉 concurring with Avicenna as to bleeding even at the nose as extreamly beneficial and to approve of phlebotomy after they come forth in case the Patient find no alleviation thereupon but there continue signs of a plenitude or redundancy of ill humours a great Feaver and difficulty of breathing But there is another piece entitled unto Rhases wherein how indulgent he is to Phlebotomy you may learn from Augenius Rhases libro suo de peste capite sexto mittendum esse sanguinâ—m vult pro quantitate plenitudinis si enim maxima fuerit non veritur vacuare usque ad animi deliquium si mediocris mediocriter educit si parva fuerit paulum sanguinem educit verba ejus sic habent Tu venam incidito quam multum sanguinis effundito scil ad sanguinis defectionem usque Supra vero syndromen attulit maximae plenitudinis paucis interpositis inquit Cum vero haec signa admodum evidentia non erunt veruntamen vehementia quidem parum sanguinis fundito Sin minime minimum haec ille How successful so large bleeding may be though Augenius and Ranâ—hinus and others condemn it we may judge by the practise of Botallus To these I add the authority of Serapion which runs thus Si haec febris fuerit propter causam variolarum virtus aetas consentit tunc non aliquid magis juvativum quam phlebotomia venae Et si aliquid prohibet phlebotomiam tunc oportet ut administrentur ventosae Out of which it is evident that the generality of the Arabians were of a different sentiment from what Doctor Whitaker ascribes unto them and Claudinus is less mistaken when he as do many others avoweth that The Arabians universally agree to let Blood in the Small Pox upon occasion Nor is there more of truth in that which follows in our Doctor viz. that Their followers have not determined this doubt For though two or three may seem refractory still in the World yet it is not amongst Physicians but amongst them that are not Physicians that the doubt is indetermined I shall take some pains to undeceive this Age as to the present point Gordonius's words are these Inprimis si corpus est Plethoricum aut si sanguis dominatur aut virtus est sortis fiat Phlebotomia de mediana postea de summitate nasi i. e. In the first place if the body be plethoric or if the Disease be such as is attended with abundance of blood or if the Patient be strong let him bleed first in the middle vein and afterwards at the Nose Petrus Bayrus having repeated the signs of the Small Pox when they are violent adds His apparentibus statim fac Phlebotomiam copiosam prius scilicet quam variolae ad extra appareant licet possit fieri etiam ipsis incipientibus apparere stante multa repletione non tamen tunc fiat ita copiosa sicut ipsis non apparentibus dicente Avicenna in casu Extrahatur sanguis quantitate quae exiret hoc est minoret i. e. when the Small Pox begin with such a vehemence of symptomes presently take from the Patient a large quantity of Blood before the Small Pox begin to come forth yet may he also be let blood after they begin to appear if there be a great repletion but yet not in so large a manner as otherwise for so Avicenna directs in the case and let the Patient bleed in such a quantity as may dry the habit of his body that is you may lessen the quantity of the morbisick matter so to bring them forth to a kind maturation but not so as to divert Nature from her work I shall not trouble my self to repeat the words of others at large but refer my Reader to the places cited Horatius Augenius one of our best Writers upon the Small Pox and who protests he writes nâ—thing in order to its Cure but what six and forty 〈◊〉 Experience had convinced him of to be good doth allow in difficult cases and when the Disease is somewhat pestilential that the Patient bleed first at the Arm and then at the Nose by irritating it with Yarrow or Horse tayl With him agrees the cautilous and learned Practitioner Iuleus Caesar Claudinus who doth debate and determine this doubt as also doth Dilectus Lusitanus in his Treatise of Venae-sectione and Epiphanius Ferdinandus and Aemilius Campolongus Neither is it to be questioned but that this is the common practise of all Italy so that I shall cite no more of that Nation In Spain 't is approved of by Christophorus a Vega whose words are these Si vero lactae fuerint variolae ab humore fiant crassiore ab initio sanguinem mittere si febris adfuerit sine ipsa vero minime And the best of Writers Ludovicus Mercatus is thus peremptory in his Resolution De sanguinis detractione nullus usquam dubitavit aut id sine ratione fecit nisi aut vires sint adeo dejectae quod neque minimam citra majus damnum ferre possint aut affectus adeo levis aut benignus existat quod satius sit naturae committere quam ipsam infirmare sanguine misso vel sanguinis copia adeo parva quod exquisitiori victus institutione securius rem possis agere quam aliis praesidiis
mention those considerations which arise from the general season of the year or the particular malignity of the Disease at that time or the idiosyncrasy or peculiar temperament of the sick or what is singular to some families In the Small Pox there happen frequently three sorts of Feavers one in the beginning which usually terminates on the fourth day or when they come forth Another which begins when the Small Pox begin to come to Suppurate according to that old saying Febris fecit variolas variola febrem And a third which either ariseth afresh upon their coming forth or is the continuance of the primary Feaver which if it abate not upon their eruption creates new cares and troubles in the Physician As to the Feaver which is antecedent to the Small Pox though sometimes there be none at all and sometimes it be so gentle as not to create any mis-apprehensions in the Doctor or Sick yet frequently it happens to be joyned with putridity or malignity or to have something of the Pest it self From all these circumstances the cure must be varied nor is it any disparagement for a Physician to act one thing at one time which he doth not at another and to recede from vulgar Methods in extraordinary cases In some cases he need not phlebotomise if he see no violent Feaver no pernicious or dangerous symptomes if it be either a Tertian or double Tertian or Synochos simplex the danger seems less yet is it a certain observation that oftentimes in the Small Pox the most hopeful beginnings are defeated by sudden and subsequent acdidents so that very many of those whose recovery hath been undoubted at first have in the progress and conclusion of the Disease died Hoc primum sciat consideret prae oculis semper habeat prudens diligens Medicus nimium fidendum non esse plurimum in variolis morbillis quantumvis salutaria signa primo accessu appareant nam in recessu inclinatione facillime in mortem commutantur talis est horum morborum fraudulentia conditio Besides this it often happens that a salubrious and simple synochus turns to one that is putrid and then the danger is least what is intended by Nature for a depuration of the Blood become corruptive and ends in the death of the Patient Also it is frequently seen that the exorbitant matter is so much or Nature so weak as not to discharge it into the habit of the body or there is some particular imbecillity in the principal parts that the Disease seizeth on the Lungs so violently as to exulcerate them in the progress of the Disease or so debilitates them that the Patient languisheth in a Consumption or else it settles in the Glandules of the Throat and the Patient dyes of a kind of Squinancy according to Avicenna Nam qui ex variolis moriuntur inquit Avicenna plerumque ex angina suffocati pereunt orta minimum inflammatione in gutture Sometimes the matter taketh a wrong course so as that a Flux ensues which sometimes becometh bloody and this befals the Patient either before they come out or a little after they have appeared or in the declination in all which cases 't is a bad sign but in the last commonly mortal Si debet hujusmodires experientiae judicio terminari haec fidem saciet fluore in declinatione adveniente etiamsi non sit exulceratious majorem aegrotorum partem mor. Sometimes the matter is so acrimonious that it corrodes the bones as Paraeus testifies upon his knowledge Quineliam animadvertere licet in plerisque hujus morbi malignitate mortuis dissectis eum in principibus partibus invehi corruptionis impressionem quae hydropis phthiseos rauvicitatis asthmatis dysenteriae ulceratis intestinis ac tandem mortis consecutionem attulerit prout pustulae pari rabie debaccâ—aâ—ae sunt quâ— per corporis superficiem furere ceâ—nuntur non enim externas modo partes deturpant pustularum ulcerum altius sese in carnem desigentium impressionibus cicatricibus relictis sed saepe movendi facultatem adimunt arrosis labefactatis cubiti carpi genu pâ—dum dearticulationibus Quinetiam multi inde videndi sensum amiserunt ut nobilis Do. Guymeneus alii audiendi alii olfaciendi oborta hypersarcosi in meatu tum narium tum aurium There being so great danger in this Malady I wonder that Doctor Whitaker should ever look upon it as contemptible saying This disease of the Small Pox was anciently and generally in the common place of Petit and Puerile diseases and the Cure of no moment It is true that Physicians do usually reckon it amongst the Diseases incident to Children and they do believe that Children pass it over with less danger than more adult persons because in them the Humors are not so accrimonious as in others their habit of body is more lax and gives the humors a freer course through the flesh their skin is more perspirable and their innate beat more vigourous than in others It is also true that they do hold that sometimes the Small Pox are so mild that there is little or nothing to be done by the Physician But 't is no less true that from the dayes of Avicenna and Rhases unto ours none ever thought or writ that the Cure was absolutely of no moment For Avicenna in his Treatise of the Small Pox represents unto us a great deal of danger in the Disease and though he grant it is sometimes facile yet he cautions the Reader sufficiently how malignant perillous and mortal it is at other times Horatius Augenius and others aver that this Ebullition is sometimes such as tends to the depuration and perfecting of the blood and sometimes to its depravation and putrefaction And as they compare the one to the ebullition of Must by which it is improved unto good Wine so they compare the other to those effervescencies in Wine when it frets and degenerates Neither is Doctor Sydenham less mistaken when he forbids the Physician to make use of any generous Medicaments but to leave the whole work to Nature and to proceed according to that Regimen which he suggests he representing the disease as facile in it self and only mortal or dangerous by the errors of the Nurse or Physician Whereas it is evident that the Small Pox are at some times accompanied with greater danger and worse Feavers than at other times and all that difference which is to be seen in the Pox that they are green or livid flat or high horny or more soft few or so numerous as to over-run the whole entrails as well as skin and there to run one into another and flux this doth not arise alwayes from the miscarriage of the Attendants but from the malignity and quantity of the morbifick matter as observation and common reason will inform any man Let us therefore judge better of those sage Practitioners who proposed unto themselves sundry scopes in
the cure of this disease and thought it their prudence to prevent all the dangers imminent or present by a cure like unto this First They examine the habit of the Patients body if it abound with blood or evil humours the redundancy of the former they conceive may be such that upon a violent ebullition Nature may not be able to rule it but either some vessels may break or the Patient be strangled by a decumbiture of the blood upon the Lungs or Brain or a bloody flux ensue if it take its course that way or a bloody urine if it incline to the Kidneys The renundancy of evil humors they do apprehend to carry this hazard in it that it may pervert the whole mass of blood upon the febrile effervessence and add such a malignity to the morbifick matter in its expulsion that the evacuation thereof by pustules may not put a period unto that Feaver but continue or exasperate it to the mortal danger of the Patient such evils they think may easily be prevented by a due method in the beginning but in the progress of the Disease they are either remediless or not to be cured but with much difficulty Therefore their first intention is to lessen that plenitude of Blood and other Humors which they find in the Patient Secondly They examine the Nature of the distemper what the Feaver is whether a simple Synochus or one that is putrid a causos or continued tertian They consider the violent symptomes what faculties they effect or what parts and according as they see occasion they apply themselves to correct its malignity or to moderate its fervour without indeavouring to extinguish the Feaver Thirdly They consider the danger that the Eyes Throat Lungs Stomach and Intestines are in should the Small Pox affect them they know that if they be driven forth into the habit of the body and those other parts kept inviolate there is little of danger but on the contrary if the humors discharge themselves on them now all other fears vanished yet upon the suppuration which brings a new Feaver horrible symytomes must ensue in the Stomach Bowels and Lungs And therefore they think it ought to be their care to mitifie the humors and fortifie those parts Fourthly They consider the manner of their eruption and if they come out kindly they intermeddle not If they either come out slowly and in the mean time create Epileptick and convulsive fits or other dangerous symptomes they promote their coming out and according as they perceive by their colour and other signs that they are malignant they apply themselves to amend those defaults If they find Nature to exorbitate in their expulsion and that they come out so thick that there is not sufficient room for them but that they run one into another If the Feaver continue or increase because that destroyes the due suppuration of the pustules they apply themselves to moderate the excessiveness of that evacuation and to correct that Feaver which is not to be terminated by any new excretion of that kind but to be cured in a manner as other putrid Feavers are and in this case all judicious men must allow no greater regard to the Small Pox than a symptomatical evacuatiion deserves Fifthly They imploy their care in securing such parts as are particularly indangered by their eruption expedite the maturation of them if it be to slow and difficult hinder their regress and suffer not any recrementition particles again to reincorporate with the blood and beget a new Feaver or other dangerous symptome and in case any new distemper happen as sometimes a Pleurisie or the like may do they provide for the due cure thereof These are the common intendments of all rational Physicians these things Doctor Willis whose short discourse of this disease contains in a manner all that our best Writers do suggest doth propose to himself and whosoever doth ponder well the course of the disease must assent thereunto Let the Motion be critical all intelligent men know that before the Crisis if we perceive any threatning danger that Nature cannot command the exorbitating humors but that the present symptomes are perillous and the future issue uncertain If the Crisis be immoderate and not agreeable to our desires If it bring no alleviation to the Patient our hands are not bound up nor are we prohibited to intermeddle even by generous Remedies As little are we confined by the Hypothesis of Doctor Sydenham for if Nature be inclined to change the state of the blood yet are we obliged to assist her if she be too weak and deficient or exorbitant and our providence hath the same liberty to exert it self that any other principles indulge it in I come now to those Means by which Physicians principally are said to act and those are the great Remedies of vomiting gentle purges and bleeding and to declare the usefulness thereof 't is necessary that we consider the Small Pox under a twofold notion As the Feaver precedes and as those Pustules do accompany it I think those Physicians to have written most discreetly who divide Feavers into two sorts viz Febres solitariae and Febres comitatae these last they distinguish from symptomatical Feavers in that those do succeed others and depend upon them as their Causes but these others do precede some other distemper or arise with it and are either a cause or occasion thereof and upon the appearance of their companion-disease they cease or abate such are Squinancies Peripnenmonies Pleurisies the Small Pox c. Comitatae febres continuae sunt quae aliquem morbum qui ipsas vel exitavit vel qui ab illis prodiit comitem habent aliaque praeter ea quae febris solitaria affert symptomata a morbo comite prodeuntia cum febrium accidentibus complicata febriumque naturam aliquando permutantia In this distinction we are freed from those impertinencies which others molest us with as if the concomitant disease were a crisis of the other whereas indeed this concomitancy makes us look on them rather as a complication of maladies than any such succession as is feigned and we are thence obliged to consider what indications arise from this conjunction for it is confessed that in these cases the primary disease is not terminated nor altogether to be cured in the usual manner but with a regard to its associate but our care ought to spend it self so as that the primary Feaver may innocently and without prejudice to the sick introduce its Associate and that conclude with an happy recovery To do this we consider the nature of the primary Feaver which is in the Small Pox a simple Synochus or a Synochus putride and sometimes a Tertian or double Tertian or some malignant Feaver These we are so to manage that they neither become exorbitant so as to destroy the Patient before the Associate discovers it self nor then become so depraved violent or malignant as to disturb the
subsequent cure No man can in reason doubt but the best and most direct means to moderate the primary Feaver is to begin betimes for then the distemper is less violent and Nature least debilitated What we are to do then the course of the Disease best teacheth us in which the most enormous vomitings are so far from doing hurt that they are beneficial to the sick It is therefore manifest that a Physician who is to imitate Nature may in the beginning as he sees occasion and upon due pondering of all circumstances◠administer a vomit for it is neither repugnant but congruous to any of those primary Feavers nor contraindicated by the Associate For hereby those excrementitious humours are evacuated which would otherwise in the progress of the disease add to the distemper producing Phrensies Sopors or other malignant symptomes also part of the super-abundant turgent matter is exhausted and the Lungs who are frequently endangered by a Catarrh in the beginning are disburthened as also the eruption of the Small Pox is facilitated Vomits being alwayes held by the Methodists amongst those Medicaments which principally relax the habit of the body In case that there appear urgent Reasons against a Vomit the next thing under consideration is a Minorative purge whereby the Stomach and Intestines being cleansed and part of the Morbifick matter discharged from the Head Lungs and mass of Blood Nature will be better able to overcome and regulate what remains And herein the Physician is guided by Nature which oftentimes alleviates the Patient by a slight Diarrhaea before the Small Pox do come forth Nor is there any danger in such fluxes as our Practitioners observe Si Diarrhaea fuerit in principio non nocebit And most of them allow a gentle befitting purge in the beginning of this Disease not doubting thereby but to make the subsequent course of it to be more benign and safe for the most turgent urgent bilious and accrimonious humors being carried off together with the promiscuous faeculencies of the Intestines 't is not easie to be imagined that any dangerous malignity can reside in the pustules or any dysentery or flux ensue in the state or declination of the Disease at what time it is extreamly perillous I shall not inlarge upon this subject further it not being my present intention but refer my Reader for his more particular instruction to Horatius Augenius Ranchinus Gregorius Horstius Sennertus and Riverius and if he desire Experiments for the happy use of Vomits and Purges and evidence that they do not retract the humors from the circumference to the center Alas 't is not the time of their separation or motion that way or impede their eruption let him consult Angelus Sala and Forrestus I come now to the practise of Phlebotomy about which sundry Questions arise As Whether it may be `administred in the beginng of the Disease and After the Pox come forth In the State and Declination In all which times I do assert that there may happen such circumstances as may make it necessary But in the beginning I think it may frequently be done with great convenience 1. In the beginning of this Disease that which urgeth is the Feaver and its symptomes which if it be so violent that the Patient may be indangered before the Small Pox do come forth or so debilitated that Nature may not be able to command them and concoct them by reason of their multitude or virulency which the extremity of the Feaver as well as habitual cacochymy or the adventitious malignity may create 't is prudence in the beginning to prevent those perils which in a stort space will become remediless If the body be Plethorical with either sort of plenitude 't is indubitably requisite to bleed and our case here is like to those cases which possess the Brewers or Vintners who whilest they attend diligently to the depuration and fermentation of their liquors employ a part of their thoughts upon the preservation of the Cask least it break Nor is the present plenitude only to be considered but the future which will happen upon the increase of the ebullition and attenuation of the blood together with the defective transpiration which alwayes abates proportionably to the greatness of the Feaver and in case any peril threaten from the violence of the Feaver there doth not appear any more ready course in such as are 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 or in the beginning are at their height perhaps there is no other then to let blood whereby the redundancy is diminished the course of the blood diverted from circulating or stagnating in the inward vessels the habit and texture of the body changed in order to the more facile expulsion of the Small Pox and transpiration promoted then which nothing contributes more to the alleviation of the first and precaution of any subsequent Feaver and malignant putrefaction of the Humors in the Pustules Quoties cunque enim corpus ventilaturi nullo modo transpiratio prohibetur facile putridae fuligines per poros exhalantur nec cordi communicantur neque proin sequitur ulla febris unica enim causa legitima immediata febris est prohibita transpiratio uti etiam illis qui a limine salutarunt Medicinam notum est i. e. Whensoever the blood is well ventilated and insensible transpiration free whatever noxious and venenate vapours are contained in the body which might otherwise fly up to the head and cause incurable Phrensies deadly Sopors and Epileptick fits or create Lipothymies in the Heart or difficulty of breathing which is a mortal sign in this Disease in the Lungs or a Diarrhaea and Dysentery in the Intestines or a virulency in the suppurating Pustules and corrode even the bones and ligaments these vapours exhale by the opened dores and the Feaver abates for any one that knows never so little in Physick understands that the sole legitimate and immediate cause of Feavers is prohibited transpiration From what hath been said it is evident that of all Remedies Phlebotomy is the most important in the Small Pox in the first beginning whether the Feaver be a simple Synochus or one that is putrid and malignant and 't is more a wonder that any man should oppose the due administration of it then that all Europe in a manner should agree to the practise thereof Neither is it only to be administred to allay the plenitude which generall occurs in this Malady or to prevent the evils forementioned but frequently for revulsion when the malignant matter begins to affect the Brain Stomach Lungs Intestines For if during the Feaver the Humors seise upon those parts with any violence the Patient is in apparent danger of death there being no way to prevent the suppuration there and little hopes that the Patient will survive the distemper or if he do escape a Consumption or Dropsie afterwards Sunt aliae ita malignae ut non solum carnosum genus adoriantur
sed ossa quoque dilanient corrumpant quandoque interna membra principalia ut hydropem generent nuper observavimus puellulum quendam D. Donati Profili nepotem mortuum ex hydrope ob variolas morbillos quandoque vidimus alios consumptos ex asthmate ob easdem variolas quandoque vidimus alios diarrhaea dysenteria confectos ex morbillis variolis alios gangrenatos esthiomenatos It is true that Physicians do not alwayes regard the distempers of the brain in this disease because albeit they may be very violent in the beginning yet they afterwards cease of themselves nor do they appear so highly concerned for the animal as vital functions and in such cases great judgment is required in a Practitioner rightly to distinguish betwixt what may affright others and what ought to terrifie him But in case the first approach be accompanied with a violent Cough hoarseness difficulty of breathing the beginnings of Squinancy from a pustulary defluxion into the Glandules of the Throat or with swoonings and perfrigerations of the hand and feet He that thinks Phlebotomy ought not to be administred if other conditions permit understands not himself or complies too much with the prejudicate opinions of the Patient and Relations The Authority of all Physicians almost justifies him the Rules of Art direct him to it the prosperous success which frequently follows thereon imbolden him to it and Nature her self authenticates the practise by her sovereign example for it is usual for Patients in the beginning of the Small Pox to bleed at the nose I have known five or six in one family adult persons that bled of themselves eighteen or twenty ounces with greater benefit whilest I durst not be allowed to take away eight Novimus plures infantes in principio quibus sanguis in copia exnaribus exivit bene habuerunt neque tot tantisque variolis morbillis fuerunt afflicti unde multi autumarunt si puero multa sanguinis copia sponte vel arte exiâ—ret usque ad animi deliquium qoad vel non variolabitur vel non in tanta copia nam variolae morbilli vere sunt morbi a sanguine With this Author agrees the most experient Augenius Saluberrimum esse provocare sanguinem exnaribus docuit experientia nam quibus sponte effluxit variolae pauciores salubriores evenerunt Vidi hactenus pueros duos qui ex fluore sanguinis e nare dextra tertio die immunes a febre evaserunt quarto die supervenerunt variolae paucae benignissimae I add the words of Diomedes Amicus who having recommended the applying of Leeches Yarrow or Horse-tail to the Nose thereby to cause a flux of blood prooceeds Haec enim sanguinis evacuatio a naribus vel sponte vel arte facta adeo confert maxime cum adsint signa fluxum sanguinis portendentia cum tamen non fluat ut solo fluxu isto aegrotantes istos sanatos vidisse Rhases dicat eum solum praeservare a nocumento oculos alias faciei partes dixerit Avicenna quae sanguinis evacuatio ex naribus semper medicum excusat ab omni alia evacuatione sicuti facit etiam qui per uterum vel haemorrhoidas fit modo fiat cum alleviatione The consideration of this so beneficial an effort of Nature made Augenius and others to direct that after Phlebotomy in the Arm the Patient should be forced to bleed at the right Nostril in relation to the Liver or at both and in the cure of Antonio Borghese a Nephew of Pope Paulus V. a Colledge of Physicians at Rome did prescribe Leeches to be applyed to his Nostrils and his recovery was principally ascribed thereunto I shall not undertake to prescribe how much blood may be taken away at once nor how often Phlebotomy is to be repeated in the beginning of the disease I should expatiate too much by such a discourse the general Rules are to be found in Augenius Mercatus Horstius Ranchinus Epiphanius Ferdinandus c. and the accommodation thereof to particular cases doth depend wholly upon the judgment of the Physician employed How Children in whom the Disease if they can be ordered is less dangerous commonly and how Men according to their different habits of body and other circumstances it being more perillous in them their flesh being more solid and tenacious their bodies less perspirable and their blood and humors more acrimonious are to be ordered When the Lancet when Leeches when Cupping glasses and Scarifications are to be made use of the wise do know and the ignorant may learn if they will study to improve by study that time which they mis-spend in censuring the prudent actions of their betters Before I proceed to the second Question it will be convenient to decide that Controversie about Phlebotomy Whether it draw from the Circumference to the Center and may hinder the eruption or cause the Pustules to return in or subside That there are some eminent Physicians who do hold that Phlebotomy doth draw the Humors from the Circumference to the Center I do grant and in the case of the Small Pox that it may chance to do so is the suspicion and fear of Avicenna and Hollerius as well as Doctor Whitaker But why the Doctor should be scrupulous here who hath so great a regard for the Ancients though he cite no good Authors is to me a Miracle For besides the Methodists who are more ancient than his Citations the repute of Galen and Aetius whom Septalius entitles to the Opinion ought not to have been supinely contemned and the Authority of many of the Moderns which a man that cites Fernelius ought not to slight doth prove unto us that Phlebotomy doth promote transpiration eject the peccant humors to the Circumference and not revel them back and this is the Opinion of the learned Septalius Greg. Horstius Instit. Medic. disp 18. coron de venae sect qu. 7. Gregorius Horstius Ioseph de Medicis Collado Botallus and several others I have said enough to decide this point in the preceding discourse about the natue and effects of Phlebotomy Yet since it seems in this place peculiarly necessary to be again spoken unto I thus argue thereunto If it be true that Blood-letting doth draw the humors from the Circumference to the Center how is it that Hippocrates Galen and all the Dogmatists do prescribe Phlebotomy in Pleurisis and Inflammations of the Liver and Lungs Is this the effect of that Revulsion that the Humors should slow more inward and from the surface to the center Is it upon this sentiment that Physicians reiterate their Phlebotomies or practise them at all in the Itch Leprosie or Erysipelas Doth not Hippocrates caution us against the returning in of an Erysipelas Yet is there no man that can rationally condemn bleeding in that Disease How often do we read the happy effects of this usage in pestilential Diseases
Bartholinus and many other Physicians in high and low Germany and the happy practise thereof frequently in this Nation hath given some credit thereunto I mention not the French Physicians because their Authority is excepted against in this disease though no Nation excepting Spain hath ever produced better Practitioners or more judicious men than they are It being manifest then that the number of Physicians which approve the due administration of Phlebotomy in the Augment of the Disease and after that they begin to appear is such as may justifie any prudent Man in the doing thereof Let us now examine with what success it hath been done The Countess of Egmonds cafe I have already recited Bartholinus avows the beneficialness thereof Sunt tamen qui erumpentibus variolis venam secent quando febris intenditur anxietas spirandi difficultas angina pleuritis lotium crassum rubrum aliaque symptomata apparent ut detract a humorum portione reliqua facilius superentur Certe si imperfecte prodeant exanthemata naturae laboranti succurrendum partim parca venae apertione si copia sanguinis oneret qâ—od multorum felix eventus comprobavit partim sudoriferis quae ubi malignitatis suspicio tutius ad extrema corporis clinimant icâ—ores And Dilectus Lusitanus professeth the neglect of it to be an errour Qua in parte aliquorum Italorum Doctorum error timor calumniandus venit qui dum apparere vident variolus inviolabile servant praeceptum nullo modo sanguinem evacuare in praesenti casu exceptio facienda erit cum multa experientia viderimus in his quibus taliâ— evacuatio fuit repugnata ante suppurationem pueros suffocari in multa illarum quantitate etiam suppurata Non enim potest natura tanta regere vincere ulcuscula ideo suffocatur indeque multotier pulmonia alia superveniunt accidentia 'T is needless to recite other cases I proceed to the Reasons of the practise which though they are easily deduced out of the foregoing Treatise concerning the general effects and utility of Phlebotomy yet may it not seem amiss to debate the controversie particularly in this place It is an Aphorisme of Hippocrates that in the beginning of Diseases a Physician is to administer his principal Remedies but in the state to supersede Cum morbi incipiunt siquid videbitur movendum move cum vero vigent quietem agere melius est And the reason of that injunction is because that in the beginning Nature is rather oppressed by the turgent and crude humours then as yet debilitated the temperament of the body is not much vitiated nor the mass of blood much depraved nor the Disease highly prevalent It being most certain Circa initia fines omnia sunt levissima circa vigores autem vehementissima In which Aphorismes the word beginning is so used as to include the Augment of the Disease for he passeth immediately from the Beginning to the State of Diseases Id nunc manifeste ex verbis Hippocratis constat qui principio nominato ad statum transilivit tanquam Augmentum sub principio continuerit Clarius id cognosces quia morbum in tria duntaxat tempora partitur And from hence we learn that the most seasonable time for Phlebotomy is within the time of the Beginning of the Small Pox yet so as it includes the Augment and may then judiciously be practised in case it have been omitted before or that new emergencies urge us thereunto for if we delay then to use it 't will be too late to administer it when Nature is more spent the Blood and Humors more corrupted and perhaps degenerated into a malignity the disease with all its symptomes more violent If then after the eruption of the Pustules the Feaver continue or increase with evil symptomes 't is most evident that we ought to proceed to Phlebotomy not only to diminish the present plenitude of blood and surcharge of peccant humors to allay the vehemence of the present Feaver by ventilating the blood open obstructions relax the texture of the body but also to prevent future evils which will after prove remediless For in case the Feaver continually increase 't is indisputable that no proper maturation of the Pox can ensue the violence thereof interturbing that work and depraving the expulsed humors so as to destroy the habit of the body instead of suppurating in the skin and their eruption is in this case perfectly symptomatical because they bring no alleviation with them but add to the danger so much as their maturation interferes with the proper cure of the putrid or malignant Feaver If ever it be true that the expulsion of the Small Pox is a Critical motion 't is manifest that now they are to be looked on as judicatoria non judicantia as efforts of Nature intending but not being able to effect her easement and consequently they portend either a tedious and perillous sickness or death Omnes excretiones male sunt quae non sedant dolorem quae non judicant difficile judicium reddunt atque quae laedunt in acutis morbis exitium praenunciant And were there any danger of retracting the expulsed matter as there is not because neither doth Phlebotomy draw from the Circumference to the Center nor is it an easie thing to draw back extravasated matter yet would not the regard thereunto deterre us from this practise because in reference to the maturation of the Pustules the Feaver here assumes the nature of a Causa prohibens or an obstacle and impediment thereunto which must first be removed The case is hazardous but 't is now we must act with that prudence which obligeth us to attend unto what is most urgent though we neglect not other considerations Nor can any man in his wits doubt but that we ought to recurre unto Phlebotomy even more than once Cupping-glasses and Scarifications except by declining an uncertain peril we will subject the Patient to one that is certain Other remedy there is none and what imports it if the attempt be hazardous since the omission is likely to be more fatal we know not nay scarce fear that we shall indammage the sick by the remedy we are assured to do it if we forbear seeing that each moment adds to his jeopardy and so far incapacitates us to serve him as it accelerates the state of the Disease in which when the distemper is most violent we are generally obliged to supersede or if we were not yet would our care spend it self to no purpose for in such Small Pox there is not any declination nor doth the Patient survive the State thereof Status autem variolarum lethalium cum omnia in deteriorem labuniur dispositionem exulcerantur subdita partes pus educitur maxime faetidum nigricans viride subjectum corpus plurimum contraxit ingredinis ita ut totum videatur igne ustulatum virtus imbecilla febris interdum magna atque tunc
percepissem quamvis neque etiam morbi â—emissionem sequenti die tantundem ex altero brachio exhanriri imperitaâ—i quae solo praesidio dei non â—â—nouento â—ot â—nâ— virulentiam e corpore emisi breviâ—â—r me a tetrica pâ—sie expediri atque hostem jugulum petentem plumbeo ut dicunt gladio jugulavi quod salutare Medicamentum plurimi postea adhibentes atque mea vestigia sequentes scilicet sanguinis missionem celebrantes vere e mortis faucibus erepti vindicati sunt In the account of the Small Pox I omitted the opinion of Franciscus Oswaldus Grembs a German Physician of good note and great admirer of Van Helmont who yet allows of bleeding in some cases in the Small Pox. His words are these Fr. Oswaldus Grembs Arbor hominis integra ruinosa l. 2. c. 3. de febr malign The danger of the Small Pox doth consist in two cases First if Nature move the hot and vitious humors and is not able through debility or their tenaciousness or the dense habit of the body to expel them and then the Disease becomes deadly the humours recurring upon the Heart and Vitals Secondly if Nature do protrude them forth and is not afterwards able to regulate them by reason of their multitude or malignity but that the Feaver becomes more malignant then at first and either dispatcheth the sick or destroyes some particular parts with a most faetid corruption therof There are four Indications for the cure of the Small Pox The first is to evacuate what is redundant The second is to prosecute the emotions of Nature The third is to restrain the venenateness of the Disease The fourth is to secure some particular parts And because the Feaver which goes along with the Small Pox is a Synochus it requires Phlebotomy here is no room for purging In Children Scarification in the Armes calf of the Leg and Nostrils or Horse leeches applyed to the Back Breech or Thighs may be used instead of venaesection when the Small Pox do not come forth If the Pox do come forth kindly in the beginning none of these things are to be practised In grown people a minute Phlebotomy is to be practised after the first or second day only when the Humors are protruded 't is dangerous for it draws in the Humours except some new accident as a Pleurisie does render it necessary When they are coming forth Nature is to be aided with Frictions and Alexipharmacal Cordials as Bezoar Vnicorns-horn Electuarium de Gemmis c. A noble Lady of the age of fourteen years fell sick and bled at the Nose she had a nauseousness at Stomach and great pains in her back the Physicians being sent for a Clyster was proposed of Broth with Cassia it came away without any operation her pains and Feaver increased and certain spots appeared behind her Ears which portended the Small Pox one of the Physicians commended Blood letting as the most suitable remedy for a great disease and not inconsistent with her years and strength especially since she was plethorical hereby he said the blood being diminished the vessels would be less distended the malignity repressed and pains mitigated But so it happens frequently that we cannot embrace the most obvious counsils whether it be an imbecillity in our minds which being distracted betwixt hope and fear and sollicitous about the future forgets the present urgency or whether it be the method of Providence which to effect its designs transports us besides our selves The rest of the Physicians seemed astonished at the proposal and neither assenting nor dissenting proceeded only to insinuate the peril of that operation But that they might seem to do something they proposed an anodyne Fomentation to mitigate her pains which having continued ten hours produced no benefit The ensuing night she was very restless and on the morning her strength began to be sensibly impaired thereat the Physicians were much troubled and considering the present exigency they gave her a Cordial of Bezoar and the species de Hyacintho it was not given sooner because there was amongst the number one who was extreamly averse from giving any Cordials in the Small Pox to bring them forth as if thereby the humours were exasperated the ebullition rendered too violent and the Pustules protruded in so great an excess as to strangle the Patient he said that Nature understood her own work and could do it best that she was to be left to her self and needed no incentives And by these suggestions he intrigrued the determinations of the Physicians so as that no Cordial or Alexipharmacon was given sooner The Patient having taken some of the aforesaid Cordial and afterwards avoided a great deal of blood by Urine which yet some suspected to be a Menstruous excretion a little after she vomited up a great deal of blood this same took to be a Critical effort of Nature which had alleviated the violent ebullition of the blood in the greater vessels by discharging a part thereof at the Mouth and ordinary passages in the mean space the malignity of the Disease prevailed above the strength of Nature the whole mass of blood being vitiated and 't was a miserable sight to behold the poor Lady as it were drowned in her own blood and thus destroyed all her back was full of large livid setlings of blood as if she had been bruised or whipped with cords and being dead her body was opened on the same day all her Bowels were sound the Liver in no default only the Lungs were blackish through the adustion of the blood in the Disease And now the Physicians quarrelled one with another one blamed the Clyster which impeded the course of Nature and retracted the humours inwards whose tendency was to the habit of the body Others censured the Fomentation which though anodyne might close the Pores and give occasion to the bloody urine by repercussion of the pustulary matter Thus one Physician inveighed against the errors of the rest whilest indeed all of them ought privately to confess that their great failour was in omitting Phlebotomy and that this was the cause of her death Thus Physicians oftentimes occasion the death of their Patients by not doing what they should and not only by over-acting this last is the default of those who attend on the sick and first try their own pretended Experiments then have recourse to the receipts of the populace or prescriptions of some practising Ladies and thus by doing what they ought not they most officiously kill the sick and prevent the seasonable advise of wise Physicians who ought to have been consulted at first These kind of persons are in as much default as those timorous and cautelous Doctors who dare not administer those Remedies which are necessary in acute diseases but by neglecting their Patients suffer the Disease to prevail over the vital faculties and kill the infirm Thus far the Helmontian but to give him his due judicious Practitioner and I recommend this
therefore in raillery demanded by one If he used to walk upon his hands Moreover though that which is called by Anatomists the Cutis be thinner in the hands and feet than in other parts of the body yet is the Cuticula thicker there and 't is possible that even it may admit of a latitude in its native density and porosity in individuals since 't is acknowledged and hath been observed that some persons have had a double Cuticula It is also certain that the texture of the Cuticle may be so changed that those humors which issued thereout by way of insensible transpiration may be at some times intercepted and lodged in the skin and under the Epidermis and if â—o Why may not that happen in a determinate part which does happen universally In fine 't is frequently observed in Scorbutiâ—s and such as are said to have an hot Liver that they feel a troublesome heat in the palms of their hands and soles of their feet notwithstanding that otherwise they have delicate and tender skins or bodies which introduceth a dryness in the Cuticle there and can there be dryness without a condensation of the Pores or can there be such an heat without an obstipation thereof And doth not such a condensation dryness and heat indicate a befitting relaxation and humectation How then cometh it that any man should deny the possibility of the Phaenomenon in the Small Pox especially since daily events make it sensibly manifest or refuse to practise what is indicated I confess the old procedure of England is to anoint with unsalted Butter or to bathe with Butter and Beer which is conformable to the documents of Rhases But you see the practise of France Italy high and low Germany doth warrant the use of warm water He further urgeth that upon the opening of the Pores by bathing thus 't is possible for the ambient Air to gain such an advantage upon the sick as to repel the morbifick matter from these ignoble and extream parts to the more noble in the course of the sanguineous circulation But since continual practise doth manifest as appears by the Authors cited that this doth not inevitably nor commonly happen What is an effect of negligence in the Attendants or unknown idiosyncrasy of Patients doth neither disparage the Physician nor contra-indicate to the Remedy And so much for Doctor Whitaker to whom the English are obliged for his good intentions towards them in that Treatise but not for his performances 't is his latest Legacy to his Countrey but in Legacies it often falls out that the Legatee receives no other benefit by the gifts of a Testator than that he is assured he remembred him and had some resenturents for him where I say that letting of blood doth not except by Accident in some persons produce fatness I do confirm my Assertion further by the Authority of Epiphanius Ferdinandus who in his advice to an Italian Prince how to prevent excessive Corpulency doth direct a Phlebotomy and that to be repeated in both Armes Neither do I remember any Commentator upon the Aphorismes of Hippocrates who hath not directed that course for the extenuating of Athletick bodies This is a case in which the Germans are reconciled with the French and Italians and wherein Prosper Alpinus accords with Franciscus Silvius de le boe the former sayes that since frequent and large eruptions of blood do continue the Patients lean or reduce them that are otherwise fat to such an habit that even Nature seems to instruct an Artist so as to promote such like evacuations And the latter avows that immoderate growth of the musculous parts is to be prevented amongst other accessional courses by often bleeding I think there needeth not any more to be said about the point neither can it be justly doubted but that if Phlebotomy had so usually produced this effect of fatness it would have been reduced into observation by Physicians before 1650. Where I treat concerning Phlebotomy in the Small Pox that it may be safely administred even after that they begin to appear It is justified by a multitude of Examples one whereof lately was Sr. W. Roberts aged above forty years as I am most credibly informed they did not come forth kindly but most perillous symtoms did multiply upon him so that his condition seemed desperate yet upon the administration of this generous Remedy their eruption was expedited and all danger ceased so that he recovered with ease And at New Colledge in Oxford in the year 1660. or 1661. I remember not well the year the Small Pox raged with much malignity and proved mortal to many but it was aparent that few if any dyed who were let blood whereas on the contrary those that were not Phlebotomised died all or generally decease This I was assured of by more then one who were then present though not being Physicians they could not inform me of other particular Circumstances Concerning Phlebotomy in general there is one Objection against it that I think I ought to take notice of since it proceeds Originally from some Virtuosi And though one that hath urged it be most grosly mistaken in his assertion that the Turks use no Phlebotomy the contrary whereunto is not only evident out of Prosper Alpinus but is confirmed unto me by the observation of my intelligent friend Mr. Denton of Q. Colledge in Oxford nothing being more frequent at Constantinople then to bleed upon every small occasion and every Barber there being a Phlebotomist yet I believe that in China and Iapan the Natives do not practise Phlebotomy though the Europeans there do Notwithstanding this I do not apprehend the force of the Objection as 't is managed against Plebotomy nor can I commend their judgement who from those Presidents which indeed are but one Authority the Iaponese being no other then a Chinase-Collony would put us upon an Essay of practising without Vene section Eor the difference of particlar Countries and Nations arising either from their Temperament Diet and Efficacious Medicaments and Method of Curing as to render Phlebotomy useless or dangerous there whereas in other places there may be nay 't is certain is a necessity for a different procedure I have already remarqued that at Montpelier there is a greater repugnancy unto and danger of Phebotomy then at Paris And the Presidents of the one Province doth not oblige the others And though it be true that as in China so in Languidock Physick is in a good condition yet doth it not follow that therefore it is in a bad condition in the other parts of France Spain or Italy c. 'T is no less certain that in hot Countries as well as here in Summer and Winter the method of carrying varies from what is to be practised in colder Climates And as wounds in the Head and Leggs are in some places cured with much more easie Medicaments then else where So 't is no less manifest that 't is
be granted But the nâ—tion is incomprehenâ—ible and this Scurvy Idea is more ridiculous than thaâ— Scurvy Qualities The Analysis Synthesis of inanimate bodies doth not teach the Operatour convincingly what may be done in those that are Animate p. 124. How much blood doth he account to be a great Quantity I do not know of any Physician that takes away such great Quantities as to create these dangers Can you make good by practise that Phlebotomy is the cause of these subsequent evils p. â—26 Hippocr sect 1. aph 3. Plato de repub l. 3. Galen in exhortat ad bonas artes discend G. Celsus Medicin l. 1. c. 1. Aeâ—iâ—n vâ—r Histor. l. 9. c. 31. Aristot. polit l. 3. c. 2. Galen adv Erasistratum c. 4. C. Celsus Medicin l. 3 c. 9. Asclepiades was he that first professed to cure cito tuâ—o jucinde C. Cels. l. 3. c. 4. Fere quos ratio non restituit temeritas adjuvat C. Celsus Med c. l 3. c. 9. Forrest obs l. 1. obs 3. in Scholio Forrest obs l. 1. obs 12 13. Si omnia membra vehementer resoluta sunt in apoplexia sanguinis detractio vel occidit vel liberat Aliud curationis genus vix unquam sanitatem resiituit saepe mortem tantum differt C. Celsuâ— Medicin l. 3. c. 27. Itaque mittitur non quia multa â—ubest copia sed quia ea quae subest tunc est inutilis noxia Valler Method med l. 2 c 3. Potestautem id dum solum est non movere quod junctum aliis maxime movet C. Celsuâ— l. 1. in praef I. Riola opusâ— Anat. nova in rot adv Gassend p. 174. Alex. Massaria de febr c. 29. Io. Riolah Enchirid Anatom l. 2 c. 27. Maebius fund med c. 12. sect 18. Riolan de circulat sang in Antropograph c. 15. p. 585. M. Slegelius de sangu motu c. 13. p. 104 Dr. Lower de Corde c. 3. p. 115 116. Schenck Obs. med l. 1. p. 172 Art Muso Brassavolus comment ad Aphor. â—3 l. 5. Marcell Donatus de variolis c 23. Amat Lusit curat 100. cent 2. cur 60. cent 7. Schenck obs med l 3. p. 312 Schenck Obs. Medic. l. 4. p. 614. Almar Blondelus de venae fectione c. 2. p. 30. Forrest Obs. Medic. l 1â— Obs. 14. cum Schâ—lio Id. ibid. Obs. 12. Alex. Massarias de â—ebr c. 29. I. Riolan inter opusc novâ— Anat. adv Gâ—ssendum p. 108. I. I. Beâ—herus Physic. subâ—erran l. 1. sect 5. c. 1. p. 30â— Almericus Blondelus de venae sectioue c. 1. p. 8. Ballonius Epidem l. 1. p. 101 102. Id. ibid. l. 2. p. 192. M. Siegel de sanguinis motu c 9. p. 75. Simon Paullâ— de febr malign sect 11. Regnerus de Graef de ge nitol p 84 85. Th Bartholiâ— Spiceleg de 〈◊〉 Lympe c 6. Van der Linden Disp. Physiol 39. §. 22. Van der Linden Disp. Physiol 41. §. 22. Simon 〈◊〉 de febr malign Harvey Exercit Anat. 2. ad Riolan â—urel Severinâ—s Epidoch de aq peric sect 8. Barthol Spic 1. de vaâ—is Lymphat c. 7 Ent de circul sâ—ng p 106. 267. Reald. Columbus Anatom l xi c. 2. Willis in Exercitat de sang accensione Lower de corde c. 3. Bartholin Spiceleg de vas Lymphat c. 7. Spigel de â—ab corp hum l. 5. c. 7. Vesling ep 30. Van der Liâ—den Select 11 ed. c. 13. se 423. Maebius fundam med c. 12 p. 258 259. Ballonius Epidem l. 1. p. 68. Ballon Epid. l. 2 p 192. Petrus a Castro de febr puncticulari p. 90. Simon Paulli de febr malign §. 11 14. Coyâ—tarus de febr pu pur p. 247. Almar Bloâ—dâ—lus de venâ—e sectione p 8. Bâ—llon Epid. 〈…〉 Id. Ibid. l. 1 p. 100. p. 101. Almaric Blondelus de venae sectione p. 68 69. Dr. Willis de sebr c. 1. En'mvero superficies candicans gelantinae similis in emisso sanguiâ—e plerumque in morbosis condensata conspicitur vidi cori instar crassam lentamque saepe in febribus acutis hoc anno observatur Th. Bartholin de lacteis dubia c. 3. (a) It was black in colour and consistence like to liquid Pitch in the Woman whose menstruâ— stopp'd eight moneths and was cured by Galen with reiterated and large Phlâ—botomies Galen 6. Epidem 3.29 cum notis Van der Linden select med c. 14. (b) Aliquando putrescentia non tam se insinuat colore quam substantiae modo ut quum erit raber sed non concrescens Vâ—lles de victu in â—cut p. 45. Both the white serum and blood burned vividly without any crackling Dr. Lower de corde c. 4. p. 217. Van der Linden disp Physiolog 51. sect 19. Andr. Vesalius de rad Câ—inâ— p. 253. Th. Kerckriegius Obs. Anatomic 57. Ballon Epidem l. 1. p. 111. sect 17. Eâ—aâ—â—us disput 19. §. 62.54 Fernel Physioleg l. 6. c. 3. â—â—len l. 2. de elem Galen 4. de usu part c. 4. de nat fac l. 3. c. 13. Vâ—llerioia loc commun l. 1. c. xi Mercat Qu. 65. Bâ—llon definit Medic. p. 7. De re ipsa â—t neque dubi tes morbi morborumq icurationes docent Nimirum hoc est maximum argumentum Hippocratis aâ—t Massarias Van der Linden disp Phys. c 2. Lacuna Epit. Caleni de temper l. 1. Francisc. Sanchez de longit brevit vitae c. x. I have lately blooded a Woman which after a Quartane was troubled with obstructions of the Spleen and Liver effervescences in the Intestines Astheâ—atic pâ—voxysmes acute pains in her head obtuse pains in her limbs visible beginnings of a Dropsie the blood at its issuinâ— out seemed very black but was pretty laudable in the porringer it burned well without any crackling or iâ—umescence almost sâ— did the Serum Here the salt seems rather defective than to abound as it ought by those principles M. Malpighi de viscer structura p 163. edit Londinens In quibus superficies fanquinâ—s durior est candicans subjectus sanguis in pelui sine fibris plane est putridus iâ—o vidi in hujusmodi ne guttulam coloris rubri Bartâ—olin de lacteis dubia c. 3. Vide Pecqueâ—i Dissertat Anatomic de circulat sanguin c. xii Videtur humor felleus sanguini firmiter adhaerescere quod in seri illius parte fundatus sit nec facile ab illo intra ulteriorem praeparationem separari possit Charleton oeconom Aniâ—al c. 7. sect 16. Erostus disput de propriet Medic. c. 15. This is the opinion of Dr. Highmore Velthusius Courvee and Everatius Io. Ioc. Wepfoâ—us de apopl p. 92. c. Bustachius de dentil c. 20. Th. Kerkring Obs. Anatom c. 26. D Highmore's Hist. of Gen. c. 5. Glisâ—â—n Anat. Hepatis c. 35. Dr. Higemore hist of Gen. c. 8. p 69 70. Glissen Anat. Hepatis c. 35. Greg Horstiuâ— Instit. Medic. disp 3. Coron 1. Append concluâ— 4. Berigardus Circul Pifan 1. part 6. circ 7. â—peâ—ta namque in cadavera vena sanguis prostuit Ent.
it bilious melancholy or phlegmatick We do also say that in diseases the blood may be corrupted in its substance and vitiated and yet the colour amended or not altered Saepe ad speciem visum purus est sanguis qui alioqui 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 malus est ut contra impurus cernitur specie qui non ita 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 malus est And Iacob Thevart his Scholiast doth observe that several times in 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 sanguis laudabilis ipsa sectione apparet qualitatibus alienis praeditus est est enim acriusculus biliosus nimis Nay we are so far indefinitely from pronouncing a cure upon the ruddy colour of the blood that in malignant Feavers we make a quite contrary prognostick Pessimum signum est in febre maligna puncticulari timoris plenum cum sanguis vena scissa extrahitur si purus rubicundus inculpatus educatur venenositatem superare indicium est aut putredinem in penitioribus cordis latitare In meipso olim observarem nam ter per hanc febrem misso sanguine nulla prorsus nota putredinis apparebat aliis signis immani ferocitate saevientibus The same is asserted and illustrated by fatal instances in Simon Pauli which it would be too long to transcribe here Having demonstrated unto him these errors I say further that we do not hold the blood to be putrified in all Feavers as in Diaries nor many of us in intermittent not to mention others and in those Feavers wherein 't is said the Blood doth putrifie we do let blood often to prevent putrefaction and not alwayes to cure it by Phlebotomy and we do it in order to cure the putrefaction we do not pretend to emit all the putrified blood thereby but only to alleviate nature of a part thereof that so she may better overcome the rest especially being assisted by other Medicaments So that the whole assertion is false if it import that any intelligent Physician designs to cure a putrid Feaver solely and directly by letting out the putrid blood by repeated venae section I will not deny but some in France and Spain have gone about to do it but the practise is generally condemned by Physicians of the best repute and therefore ought no more to be charged on us especially in England then the miscarriages of any bold Experimentor or Baconical practitioner at London upon the Colledge of Physicians This insolent Disciple of my Lord Bacon understands not the iudiments of our Physick nor knows what we aim at in the use of Phlebotomy there being sundry occasions why we use it and sundry effects that we expect from it Neither is he less deceived in saying that Phlebotomy duly administred overthrows the strength of the Patient I mean that strength which is necessary to the concoction of the disease and so thereby wholly disappoints the Crisis For it is manifest that by those profuse Phlebotomies of the Ancients the Crises were accelerated and in ours promoted This is not only manifest out of Hippocrates and Galen but confirmed unto us by the certain experience of Forrestus and those learned Florentine Physicians who composed the Academy there for the renewing of the Hippocratical and Galenical Method in opposition to the most prevalent Avicennists Nos igitur Galeno fisi quoniam sic conducit magis dum vires ferant sanguinem misimus plurimum nam bilibre pondus trilibre in acutis febribus aut magnis aliis morbis superavimus atque id non modo impune sâ—d tanta aegrorum tolerantia ut nil supra eligi potucrit Quam rem abunde nobiscum experientia nosti ut nos quoque aliquantisper experientiam ostentemus ut qui praeter caetera quorum Paulo ante mentio fuit venae quoque sectione abunde usi sumus atque id citra discrimen quin et exactam illam vivendi formulam veteribus quidem familiorem neotericis vero ne nomine quidem ipso notam instituimus Quo factum est ut jam crises multae appareant ac velut novus naturae ordo aegris faelicissime faveat Cum antehac vel pharmacis agitata velintem-pestivo victu impedita nullas ostenderet aut admodum raras easque non nisi in rusticis atque infima plebe qui nec pharmacorum multitudine neque ciborum aut potionum fatigari aut impediri quirent I have more willingly cited this passage because the renown of that Academy was such that it gave a check to the grandieur and prevalence of the Arabian Method and the truth of what they say cannot be questioned by any that knows the persons and the revolution they brought about in Europe and hence we may learn the reason of that difference which seems frequently to occur betwixt the ancient diseases and their critical motions and terminations and what we generally find It ariseth not from any such great change in the nature and types of maladies as some have ignorantly writ of late nor as this Bacon-face talks because we reiterate moderate Phlebotomy but because we do not follow at all the Method of Hippocrates and Galen in the curing of diseases However we pass for Galenists and Hippocratical Physicians yet in truth we are not such our practise is made up most out of the Arabian Method and Medicaments and is a mixture of the Grecian and Sarracenical Physick together with those accessionals which improved Chymistry hath introduced and since we disturb Nature with our vomits and minoratives in the beginning and neither bleed dyet or otherwise Physick our Patients according to the ancient prescriptions do we wonder to see another face and issue of maladies than was heretofore Or doth not he rather deserve to be wonder'd at that should expect in so different circumstances for resembling effects I believe our Helmontian with his Emeto-cathartis and exquisite Arcana so far transcending all the shop-medicaments or received Chymical preparations doth see as few Crises as any Phlebotomist and may not I then retort upon him that he by his practise wholly disappoints a Crisis Nay doth not he tell us that in his way there will be no need to stand gaping for a crisis sith that may be anticipated and all secnred before that time if there be a regular procession And may not the present Galenists justifie themselves in the same manner since they can better warrant their process and Medicaments by a longer succession of Experiments happily made by judicious men then this ignorant Helmontian Innovator Another Argument of his is this If it be so that striking a vein often in a long tedious disease is a preparatory for a sharp Feaver as Doctor Willis and I both herein jump right in our observation then am I certain that Phlebotomy repeated in an acute sickness is a door set open and an in-let for a long infirmity so that this mode of defalcating the vigour of the
health not so much as being obliged to keep his armes in Bed On the fourth day he gives them one very gentle Cordial to promote their eruption and abandons them to Saffron and Milk to be given twice a day and ordains that he be kept in a constant moderate warmth such as is natural and usual to the Patient This is the sum of his Method except I add that when they are upon maturation he gives a mild Cordial twice each day morning and evening And in case that during the time of the decumbiture of the Patient by any accident a new Feaver arise then is the Patient to be kept still in such a proportionate heat as is usual to him in health if the season be temperate he is not to have a fire to be dieted with small Beer and Water-gruel stewed Apples or the like but to have no Cordial not so much as Harts-horn posset-drink By this Method Doctor Sydenham doth not doubt but this disease which so afrighteth people and is so frequently mortal will pass off with much gentleness ease and safety Betwixt these two there is a little discrepancy in their Method of curing the disease though there be some in their expressions and Doctor Sydenham doth seem the Comment the other the Text. Both of them oppose Phlebotomy Vomits Purges and Glysters as well as Sudorifics Though they differ in the râ—ason for their rejecting Phlebotomy For Doctor Whitaker doth avow that it draws from the Circumference to the Center But Doctor Sydenham yields that it produceth a quite contrary motion and causeth the Small Pox to come out Doctor Whitaker doth avow that this course of his is the old English Method and the ancient national and successful government of our Nation But Doctor Sydenham would seem to erect his practise upon his own Observations though all he propose in a manner be no more than the common actings of Countrey-people except when by any accident the Feaver be exasperated in the beginning or progress that he prohibits Cordials and what I belive was derived from Avenzoâ—r and Fracastorius Of these Writers it is remarkable that Doctor Whitaker doth never allow that there can be any malignity in the Small Pox so great and urgent as to induce a Physician to intermeddle beyond a moderate Diet and temperate Air because the Motion being Critical admits of no violence But this is a great Errour in the fundamentals of Physick For first in Diseases complicated with malignity not only the prognosticks but the issues are very uncertain as to life or death and the Critical evacuations deceitful so as that oftentimes they bring a momentany alleviation oftentimes notwithstanding those evacuations the distemper increases and the Patients dye This every man understands who is conversant in our accounts of Malignant Feavers so that to grant at any time that there is a malignity or venenate indisposition in the sick and to abandon him to a temperate Air and Diet relying upon Saffron and Milk is a practise never to be justified in Physick But alas we are not to be afrighted with the bug-wâ—rd Critical motion nor half an Aphorisme out of Hippocrates viz. Quae judicuntur sinere oportet These general sentences neither qualifie a Doctor in Law nor a Physician It becomes us to consider in a Critical motion several things First Supposing it to happen in its due time we must consider whether it be only a Motion or whether it be proportionate to the Disease for no evacuation that is diminute is properly Critical If therefore the pathognomonies of the Disease be such as argue a multitude of the Small Fox to be requisite for the recovery of the sick and only a few come out the Physician is obliged to assist Nature Secondly Supposing that they do come out plentifully yet if they be not such as should come out but black livid green or interspersed with purple spots not to mention other circumstances which every Nurse can tell 't is certain that the evacuation how critical soever doth not oblige the Physician to stand an idle Spectator No more ought he to be in case that all symptomes increase upon the critical motion and his Feaver and dangers multiply thereupon 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Thirdly It is requisite that the Critical evacuation be per loca conferentia by such wayes as are necessary to the disease But if the Small Pox during their eruption be attended with a dysentery bloody urine or other pernicious excretion that scrap of Hippocrates will not excuse the Physicians negligence for it supposeth that all the conditions requisite to a good evacuation be found in that which the Physician is not to intermeddle with I need say no more to intelligent persons 't is not my present work to turn Institutionist Whether Doctor Sydenham intend to ascribe sense appetite and judgment unto the Blood I cannot well tell but either He canteth in Metaphors or explaineth himself in his general Hypothesis about Feavers as if his meaning were such Quinimo nec mea sententia minis liquet febrilem sanguinis commotionem saepe ne dicam saepius non alio collineare quin ut ipse sese in novum quendant statum diathesin immutet hominemque etiam cui sanguis purus intaminatus perflat febre corripi posse sicuti in corporibus sanis evenire frequenti observatione compertum est in quibus nullus apparatus morbificus vel quoad plethoram vel quoad cacochymiam fuerit nulla insalubris aeris anomalia quae febri occasionem submiâ—nistraret Nihilominus etiam hujusmodi homines praecedente insigni aliqua aeris vel victus caeterarumque rerum non-naturalium ut vocant mutatione identidem febre corripiuntur propterea quod eorum sanguis novum statum conditionem adipiscigestit qualem ejusmodi aer aut victus postulaverint minime vero quod particularum vitiosarum in sanguine stabulantium irritatio febrim procreet 'T is true he did not pen it in Latine but another Mr. G. H. for him and perhaps his skill in that tongue may not be such as to know when his thoughts are rightly worded But it seems strange and irrational to attribute such an understanding to the Blood and to transmute a natural Agent into one that is spontaneous and which is more having represented it as such to make it so capricious as not to know when it is well but to run phantastically upon such dangerous changes as occur in putrid Feavers and the Small Pox for even in this last ariseth from a desire the Blood hath to change its state Since natural Agents demean themselves uniformly and of them 't is most true Idem quatenus idem semper facit idem I was surprised to see these new principles and to see effects of this nature arise without any cause It doth not seem possible for him ever to demonstrate that there is no Plethora or Cacochymy or obstipation of the pores of the body