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
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
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
by the History of Generation that no Parenchymatous part hath any operation in the first production of the blood all their Parenchymas being post-nate thereunto And if the blood be thus generated at first it is but rational for us to imagine that it is alwayes so generated during life For as it is true that the same cause acting in the same manner will alwayes produce the same effect So in this case to argue from the identity of the effect to the identity of the cause is allowable Est enim causarum identitas quae facit ut effectus sit idem quippe effectus supponitur non esse donec a causis existentiam suam indeptus fuerit dum existentiam illam largiuntur oportet ipsius quoque identitatem impertiant qua sine effectus ipsemet nequaquam fuerit That the Spermatic vessels in which the blood moves do contribute to sanguification much seems apparent from hence that the blood is seen in them before it is in the heart And because it is observed that the fluidity of the blood seems to depend much on them and therefore in the dead it doth not coagulate except praeternaturally in the veins though it do commonly in the Heart or wheresoever it is extravasated Manat praeterea aliquid a venis nobis incognitum quod dumearum ambitu sanguis concipitur prohibet ejus concretionem etiam post mortem in cadaveribus jam perfrigidis nequis hoc colori acceptum ferat quod vero coralliorum instar aliquando repertus est concretus in venis ipsis hoc merito Fernelius ascribit morbo occulto And not only the fluidity but motion of the blood seems to depend much thereon for if by a ligature the impulse and succession of blood be prevented yet will the blood in the veins continue its course and not stagnate Exempto e corpore corde motus tamen sanguinis isque satis celer in sanis videntur Et si vena ulla etiam lactea duobus locis ligetur laxata ea sola ligatura quae cordi propinquior est dum partes adhuc calent semper Chylus ad hepar sanguis ad cor cum movebitur qui nec a corde per Arterias nec ab intestinis per lacteas objecto potuit obice propelli nec stuiditate sua potius sursum quam deorsum movetur The truth hereof seeming undeniable to Pecquet he makes use of a new Hypothesis to solve this motion of the blood as if it arose from compression of other parts or contraction in the vein it self But the Phaenomenon will appear in such cases as admit not this pretence From these reasons it is that the blood doth not need so much as any pulse in the veins and arteries as appears in the first faetus but as soon as it comes to the Heart it does to prevent coagulation the punctum saliens being endowed with no such quality practiseth its systole and diastole when yet no such motion is observable in the Arteries at that time Whence the colour of the blood ariseth is a secret unto me I know that digestion reduceth some Juyces to a redness in some Fruits the fire doth the like in some the mixture of acid Liquors begets a Vermilion But here I conceive none of these causes produce the effect the generation of the blood is manifestly an Animal Action and as such unsearchable Whatever I attribute to the veins it is not to be expected that supposing they should instrumentally sanguifie the blood should turn blew from them any more than that water put into new vessels of Oak should turn white whereas it becomes reddish Thus the Plastic form produceth blood at first and whilest there is no first concoction in the stomack supplieth that defect by that albuiginous Colliquament which is of the same nature with the Chyle we digest our meat into and convey by the Lacteous Thoraciducts into the Heart That it is of the same nature appears hence that it resembles it and that it is extracted from the Blood of the Mother and produceth in the Embryo the like excrements of Choler and Vrine and Macosities nay it hath been observed by Riolanus to have been tinged yellow How much more may be concluded hence in favour of the Galenical alimentary humours supposed to constitute the Blood I leave those to judge who consider the variety of female constitutions and their condition during their being with child perhaps the Hypothesis of a proportionate mixture of the five Chymical Principles will not seem more colourable Having thus related how Sanguification is performed in the Faetus at first I come to give an account how it is performed afterwards and even here it seems an Action perfectly Animal for even Concoction in the Stomach is not the bare effect of Heat elixating the meat nor of acid or saline Ferments dissolving it nor of any other kind of imaginary Fermentation But 't is the effect of an Animal power operating upon the Meat in the stomachs of sundry Men and Animals by several wayes This appears most evidently herein that the same meat eaten by several Persons or different Animals produceth different Blood and different Excrements therefore Chylification is an Animal operation and is modulated by the specifick and individual constitutions Having thus determined of things that the Soul in all these actions is the Efficient we may consider that the meat being masticated in the mouth and commixed with the salival juyce or spittle is prepared in order to Chylification then it descends into the stomach and is there sometimes in a longer sometimes in a shorter space reduced into a cremor which is so far from being acid as Helmont saith that it is generally rather saline as are also the recrements of it that remain in the empty stomach It is true that according to the stomachs of Individuals and the meat they eat it happeneth so that this Cremor hath no certain taste nor colour Undoubtedly it must have been bitter in that Marriner and such as he of whom Vesalius writes that the Gall did naturally discharge it self into his stomach yet did he digest very well and never was apt to vomit or to be so much as sea-sick From the stomach the Cremor descends into the Intestines not all at once but as it is digested and there undergoes a second digestion receiving into its mixture the Gall and Pancreatick juyce I shall not speak of the variety that hath been observed in those two liquors nor trouble my self about the manner how they operate on the Chyle It is manifest that upon that mixture the Chyle suffers a great alteration if not some effervescence and some parts are coagulated and as it were precipitated and by a succession of changes the several particles are so blended and refracted in their qualities that the excrements at last are neither acid nor bitter but in dogs both sapors are extinguished In the mean time during
frequently the most rational and best Methods of curing Quaedam ejus sunt conditionis ut effectum praestare debeant quibusdam pro effectu est omnia attentasse ut proficerent Si omnia fecit ut sanaret peregit Medicus partes suas etiam damnato reo Oratori constat eloquentia officium si omni arte usus sit 3. If it be true that there is so great a variety and discrepancy in the Blood then is there no secure judgment to be made of the Blood issuing out of the vein either to the continuing or stopping its Flux But the Physician is to proceed according to the Rules of Art and accordingly as they direct him may he promote stop or repeat the evacuation A seeming Cacochymy in the Blood doth not impede venae-section nor call for purging and rectifying Nothing is evil that is natural to a man but real Cachochymy or redundance of Humours offending Nature this doth call for our assistance and requires sometimes Phlebotomy and sometimes other Medicaments 4. If it be true that Sanguification is an Animal Action if it be true that the Plastick form is in being before the Blood and produceth it and the whole Fabrick and subsequent operations and that the motion of the Heart is proved by Doctor Lower to depend upon the Nerves during life then is there no such strict connexion betwixt the Soul Life and Blood as G. T. doth fancy 5. If it be true that the Blood doth continually waste and spend it self in Nutriment and Excrements then is it manifest not only that the loss of a little Blood partitely taken away is not the loss of life or prejudicial thereunto Neither doth it follow that the loss of Blood in a moderate quantity is any imminution of the vital Nectar it is neither the chief residence or seat of the Soul nor in a determinate quantity requisite to the continuance of Life but comes under a great latitude It abounds more in some seasons of the year and times than at others and why may not Artists imitate Nature in diminishing its redundance upon occasion as she does As long as he proceeds not to exhaust all or too much The loss is easily repaired upon convalescence and the qnantity is more than can be governed by Nature in sickness 't is but the observation of a Geometrical proportion in such a Phlebotomist The same Agent will produce the same effects if Nature be corroborated and the vitiated tonus of the concocting and distributing vessels be amended there is no fear of wanting a new supply proportionate to the exigence of the Patient The Blood we take away is no other than what would be expended or exhausted naturally within a few hours or dayes as the Staticks shew and it must needs be considering the quantity of Chyle which flows into the veins upon eating and drinking 6. If it be true not only that Nature doth thus expend in transpiration and Excrements as well as Nourishment much of the Blood and repairs her defests by a new supply whereby Life is continued not impaired so as that the melioration of the following Blood is rather evident in his first years by his growth vigour strength and intellectuals But also that She doth of her self make men and women apt to bleed at some times ages and seasons which is known to all then is not the effusion of this solar liquor so unnatural a thing nor so homicidial an Act as 't is represented 'T would seem a strange Law that should punish every Boy that breaks the Head or Nose of another as a Bronchotomist or Cut-throat If it be true that Nature doth oftentimes alleviate even in the beginning and in the end cure Diseases by spontaneous evacuations of Blood at the Nose and Vterus by vomiting and stool then a Physician whose business it is to imitate Nature in her beneficial Operations is sufficiently authorised and impowered to practise due Phlebotomy by the best of Presidents Hâ—ving premised these Conclusions which are all either proved in the foregoing discourse or evident in themselves to all understanding men I shall proceed to give an account of the Reasons why Physicians do so frequently and in so many Diseases practise Blood-letting and those deduced from its variety of effects in Humane bodies For it is not a single Remedy subservient unto one Indication or End but conducing to many and therefore made use of upon several occasions to different intentions Vtile est id remedium ad quamplurima vix-potest in ullo magno morbo non esse aliquid cujus gratia utile sit Before I come to particulars it is necessary I tell you that in the cure of all diseases Physicians propose unto themselves sundry considerations they regard the disease the antecedent causes and the symptomes which attend or will ensue thereupon either generally or in such an individual constitution they employ their cares to prevent some inconveniences as well as to redress others Some remedies they make use of because they are necessary of some because they are beneficial yet may the disease 't is granted be cured oâ—herwise in case the Patient have a reluctancy thereto or for some private reasons the Physicians esteem it fitting to alter their course Upon this account 't is assented unto that many distempers may be cured without Phlebotomy which yet are ordinarily cured with it or may be so And herein the disagreement of Physicians or different procedures are all according to their Art nor is it denied but that All of them may atchieve their ends by their several Methods So that it is a gross paralogisme for any one to conclude this or that Physician is mistaken or takes a wrong course because another takes or prescribes a different one All the Physicians in Spain France and Italy do not bleed with equal profuseness In Germany and England some do practise more frequent Phlebotomies than others do and neither of the parties do erre in case the other remaining Method be inviolately observed It is in humane bodies as it is in the body Politick where there is a Method of ruling though it be carried on by several wayes and means and whilst each States-man doth prudentially sway the Government procuring peace and plenty to the subject his conduct though it vary from that of his Predecessour is not to be blamed It is not to be doubted but that many grievous distempers are cured by Nature without the use of any remedies at all Yet will no wise man adventure his life on such incertainties 't is not to be denied but some are cured with fewer Remedies than others are But yet 't is not prudence to put Nature upon too great a stress or to account all means unnecessary which are not absolutely requisite or without which the effect may though with more difficulty and hazard be brought to pass It lyeth upon the Physician therefore to pursue all those means which may secure the life of
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
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
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