the opening of a vayne be very fit and conuenient for it But there are two kinds of it The one is called synochus mitior or ephemera extensa in which only the thinner part of the bloud is kindled it is dissolued very often before the fift day it hath the vrine somewhat reddish and thick the pulse great and thick but not euidently vnequall And the other is called synochus vehementior wherein the whole substance of bloud is inflamed It carieth manifest notes of crudities to wit vnequalnes in the pulse and the vrine red and thick and the tongue waxeth somewhat rough and blackish In either of these synochi letting of bloud is requisite and that as plentifully as strength will permit If at the first it were omitted it may be done in the fourth day or in the seauenth day or after the seauenth day But the best and safest time is euen in the beginning of the infirmity as Fernelius sayth It is more safe to let bloud when the disease approcheth then when it hath already taken possession of vs according to the old verse Aegriùs eijcitur quà m non admittitur hospes It is a more hard thing to cast out a bad guest then it is at the first not to admit him And therefore Platerus willeth vs in these synochi sine putredine wherein the bloud is not putrefied but inflamed to hasten the letting of bloud not only to vent or euentilate the bloud inflamed but also to pluck back the same least breaking out of the vaines into the principall parts it doth stirre vp there most perilous inflammations For Platerus and Fontanonus be both of this opinion that the inflammations in the noble parts do follow these synochi and not go before them And therefore they do aduise in the first beginning to open a vayne and if in the first day it be omitted when the ague is thought to be but an ephemera an inflaming of the spirits for one day yet the next day following when it appeareth plainely that it is no ephemera because it lasteth longer then a day but that it is a playne synochus then let out bloud boldly a good quantity according to the strength of the partie or else take the lesse bloud at once and open the vayne either the same day or the next day againe which is the safest way for such as be weake In this ague doth the second vse of Phlebotomy to wit euentatio or euentilatio greatly shew forth his power according to that of Galen writing of the hoat ague called synochus In whom soeuer the body in the multitude of humours being made vnapt to vent and breath out hath gathered such a heate that now it is come to a feuer the party must be let bloud as much as strength can endure knowing that if this remedie be not taken they which are so affected shall either be strangled by suffocations or suffer syncopies and very dangerous sâ—ounings wholy to ouerthrow them Montanus writing vpon the thirtenth Canon of Aâ—icenna concerning bloud-letting doth make three seuerall sorts of this hote ague comming of bloud inflamed and sheweth in which of them bloud may best be let The first is called Homotona which from the beginning to the end doth keepe the same tenour The second Epacmastica which increaseth more and more vntill it come to state and vigor The third Paracmastica which alwayes decreaseth In the first and the last he admitteth boldly to let bloud but in the second sparingly least strength and power fayling the disease should ouercome nature So also if it be febris putrida or synochus cum putredine a feuer wherein the humor is putrified he doth require a little before in the same booke that we should not let bloud in any great quantity Because where the humour is already putrified although though we should let bloud euen till the strength fayle yet should we not auoyde the putrefaction for putrified bloud is become earthly and therefore can not be expelled And if we let bloud in a great quantity the putrefaction will still remaine and the vertue and strength will be made so weake that we shall not be able to remoue that putrefaction which remayneth He obiecteth the example of Galen his practise who in a certain seruant hauing this synochus cum putredine did let bloud pleÌ„tifully to swouning or fainting But he answereth to that place that when Galen came to that seruant the humour was not fully putrified but only that there appeared some signes of putrefaction and in the second day he opened a vayne So that when the signes of putrefaction did begin he let bloud and not when the humour was alreadie putrified and further it was a feuer alwayes declining But he coÌ„cludeth there I say playnely that of the feuer should be with a putrefaction and a vaine should be opened the patient should be killed The most certaine signe to know when the ague is faulty only by meanes of the inflammation and when it is faulty by the putrefaction is as Trincauel in his explanation vpon Galen doth shew by the systole and diastole of the pulses For there is a double vse of the pulse the one for cooling of the spirits and to that doth serue the diastole or enlarging of the artery for when the artery is enlarged a more cooling ayre being drawne in doth temper the heate of the spirits The other is that the smoaky vapour which must needes be engendred by the force of heate working vpon moysture may be so let out that the spirits may be purified and to this vse serueth systole the contraction or compression of the artery For while the artery is drawne and prest togither the hote ayre and smoky vapours are expelled and auoyded Now it must needes be that betwixt these two contrary motions a rest must of necessitie goe betweene them When there is neede of cooling there the diastole or enlarging of the artery is swifter and the inward pawse or rest is shorter but where there is more neede of auoyding moyst and putrifyed excrements there the systole or contraction of the artery is swifter and the outward pawse is shorter And this later he maketh to be the most certayne note to know all putrifyed agues in which the humours rotting many smoky vapours must needes be engendred this he calleth so proper familiar inseparable and certaine a signe to know and discerne putrified agues from others that it neither doth nor can deceiue An other signe there is of a putrifyed ague when exspiratio est inspiratione insignior when the breathing out is more euident then the breathing in because there is more neede of exhaling putrified vapours then of cooling Alex. Massaria pag. 134. sheweth sundry causes why letting bloud should be good in putrified agues first it cooleth and dryeth and all cooling and drying things are good for putrefactions Againe it is good in respect of the ague and last of all it
the second maketh the diuersion and the third doth empty the place affected For the diuersion to the contrary part Montanus doth not only alleage the auctority of Auicenna and the Arabians but of Archigenes and of Aretaeus Aretaeus is brought in giuing his reason If there should be multitude of bloud and you should draw it from the side where the pleurisie is either you must draw it plentifully to fainting and swouning and so the patient should either dye or get an impostume in the lungs or else you must draw a little and so choake and stifle the party diseased because the plenitude being so great much more will flow then shall be auoyded Trincauell in the conclusion of that treatise which he made against Brissotus and Curtius doth describe seuerall considerations which are to be had in the pleurisy If there be a great fulnesse of bloud and a vehement force of the humour rushing on and that we feare moreouer least the inflammation should ouermuch increase then we do attempt both a reuulsion and also an euacuation as farre off as we can and by the contrary side but if there be no great fulnesse of bloud nor great force of the flowing of humours nor great inflammation then there is no neede to begin with parts farre off because lesse reuulsion is requisite So he expoundeth the meaning of Galen that if the knee or the feete be taken with an inflammation this must first be considered whether there be such a fulnesse of body as doth also fill all the vpper parts whereby there is feared an increase of the swelling for then we must let bloud out of the vaynes of the vpper parts But if the repletion be not so great and that it be only in the inferior parts then shall it be sufficient to let bloud out of the opposite foote The inflammation may be so little and light that it will be enough to open a vayne in the foote of the same side If the testimonies which Fuchsius doth alleage out of Hippocrates and Galen be considered by these circumstances then shall the two opinions be easily reconciled He citeth Galens auctority when the liuer hath begun to gather an inflammation the bloud is both to be plucked back and euacuated by opening the inward vayne of the right arme because it is direct vnto it and a great way hath a society with the vayne which is called the hollow vaine Galen doth there suppose the case to be first a liuer beginning to be inflamed and therefore yet a light inflammation then consider principally whether the whole body haue â—eede of euacuatiou then consider the strength of the patient whether he be able to endure to euacuate once plentifully and whether he do stand strong in power then by Phlebotomy in the right arme reuell or take away the bloud that is caryed towards the liuer This doth nothing ouerthrow the positions before set downe Fuchsius euery where doth build mightely vpon that place of Galen in his booke of Phlebotomy In pleurisies the Phlebotomy which is vsed right vpon the side that is payned doth often bring a most euident help but that which is vsed vpon the opposite hand doth bring either an obscure help or else it is long ere it come No doubt Galen there doth meane such in whom there is morbus iam factus the disease already setled and of them you may see what Galens iudgement is if you reade the conclusion of the sixt Chapter of this my treatise For euer according to the seuerall scope and drift of the Phisition there must be a seuerall manner of Phlebotomy So in the inflammations of the wombe Galen teacheth that in the beginning of them when the humour is now in flowing thou shalt diuert it if thou open the varne in the cubite But if the humour be setled in the place thou shalt deriue it by opening the vayne in the knees or in the anckles True it is that he doth elsewhere teach that Phlebotomies in the arme do stay womens termes as the letting bloud in the legs doth bring the termes downe but as Galen sheweth in the beginning of the inflammations of the wombe it is not good that the termes should be prouoked because they bring downe a humour to the place affected especially in a body that is full of humours apt to flow When we take vpon vs to cure an inflammation of the wombe if there be no other intent nor drift but to case the inflammation then may we open some vayne in the leg but if we take our scope and purpose from the flowing of the humours to the diseased part and from the fulnesse of the whole body then both to empty the plenitude and to pluck back the humours that are sliding downe we must as Galen iudgeth attempt it by the vaynes of the cubite Fuchsius alleageth also the counsayle of Hippocrates who aduiseth in a pleurisy to open the inward vayne of the arme of the same side right vpon it There is none that doth make any question but that in the pleurisy being a confirmed disease and the humours hauing already flowed euacuation is more fit then reuulsion and both may be done by the neerest place yea such a manner of pleurisy it may be as Hippocrates sheweth that you can not fitly vse any Phlebotomy at all his words are these There be some such as in whome in due time bloud may be let But in others it is not so fit as in them The impediment is vnto them which spit bloud time the pleurisie and choler Fuchsius in his Comment vpon that place sheweth that there be three hinderances that do stay them that spit bloud from being let bloud the first is time being too hoat or too cold The other two he ioyneth together and thinketh that he meaneth that in the pleurisy proceeding of choler Phlebotomy is not conuenient Trincauel being by occasion fallen into the consideration of that place of Hippocrates doth shew that Galen commenting vpon that place doth say that the points concerning the time of the yeare and choler may well be admitted but that the exception about the pleurisy doth seeme somewhat hard because if any disease the strength and age consenting do require letting of bloud the pleurisie doth most of all require it But he sayth the knot is straight by Galen loosed to wit that the words of Hippocrates are thus to be vnderstood that alwayes he which spitteth bloud must haue a vayne opened vnlesse the sayd spitting of bloud do come of a pleurisie for then bloud must not alwayes be let but we must vse such liniments as do particularly respect the pleurisie And afterward he sheweth yâ— reason why it is not necessary that such as haue pleurisies should alwayes be let bloud because by experieÌ„ce he knew one meÌ„ded of a pleurisy without letting of bloud his pleurisy being a light pleurisy and voyd of all feare of
ouermuch humiditie which is knowne by this that though the body be emptie yet there is no perfect right feeling of hunger then you must giue also of the iuice of quinces but if there be a coldnesse with the humiditie then you must adde vnto it some sugar with a little cinnamon or some spice conuement And if choler do slow vnto the stomack by the vnluckinesse of the passages of the gall then giue warme water and sâ—rupus acetosies and prouoke a vomit and when the choler is by vomit cast out strengthen the stomack with a morsell of bread and so let the vayne be opened An other occasion may be of a needefull preparation to wit if the party that is to be let bloud haue his bloud ouer-grosse and thick for then for two or three dayes before letting bloud he must vse extenuating things as a decoction of hysop â—ep wild maricrom and penyriall in which is boyled a little white wine and hony Fuchsius addeth further that bathes may be also sometimes vsed especially when bloud must be let in some part farre from the liuer as in the hands or in the feete But in a full body and in suspicion of an inflammation the vse of bathings must be auoyded as very pernicious Trincauel commenting vpon Galen after that he hath shewed that bloud-letting doth not require so great a concoction of humours as other euacuations do because bloud hath no neede to be prepared for the bringing forth vnlesse when it is too thick we do by bathings or some other meanes make it more thin that it may flow more readily yet sometimes not only concoction but also euacuation by purging must go before Phlebotomy not in respect of the bloud but in respect of some other danger as he giueth an instance of quotidian agues in which there is much fleame gathered in the stomack and many crudities in the first vaynes vnlesse this fleame be first digested and drawne out of the stomack it may be as he proueth out of Galen that wheÌ„ the vaynes are emptyed by Phlebotomy they will draw that raw fleame and dispersing it by other vaynes into all the principall parts will make greater obstructions then before he concludeth therefore let first the fleame be either concocted by abstinence or brought out by avomit or auoyded by purging and then maâ—st thou safely open a varne Galen sayth In a faint body wherein is little good bloud and many raw humours Phlebotomies do auovd the good and as for the euill which is conteyned especially in the vaynes about the liuer and mid-bowels they do pluck them into all the body Montanus writing vpon the eight Canon of Auicenna doth discusse this matter at large Let vs suppose sayth he that there be a raw humour without the mesaraick vaynes yet Auicenna will haue vs then to absteme from bloudletting for the raw humour 〈◊〉 drawne into the inward vaynes and the obstruction is made greater and the feuer increased we therefore giue first things that may concoct and not such things as may distribute into the varnes He alleageth the aduise of Galen who prescribeth that if there be any raw humours in the mesaraick vaynes we should absteyne from diospoliticum diacalaminthum and from bathes because they do distribute into the vaynes and that we let only sleepe suffice and the vse of diatrion pipereon because that doth concoct humours and not distribute them into the vaynes When the crudities being concocted we come to letting bloud then Auicen doth there counsayle vs that if the bloud be little and naught we must take but an ounce or two and refreshing the patient with some meate of the best nourishment then to take the like againe which Montanus doth thinke to be the same 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 or tempering of humours which Galen doth so much require This 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 temperatio humorum is nothing else but by little and little 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to take away bad humours and 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to adde and restore good humours Trincauel giuing his aduise about a woman who had the termes suppressed although he perceiued her to haue a reasonable full body and to be of the fittest age to let bloud in which he accompteth to be about the fortieth yeare yet because there was in her body abundance of raw grosse and tough humours he did appoynt her to absteyne from letting bloud If you take away bloud you take away the bridle of raw matters and make them more raw and more grossâ— He buildeth his counsayle vpon that precept of Auicenna Take heed that thou bring not thy patient to either of these two extremities either to haue cold humours made raw or to haue the hoate to be brought to boyle and bubble Montanus discoursing vpon Auicenna his canons doth require that not only in raw phlegmatick matters but also in aboundance of choler some auoyding of it either by vomit or purging should go before Phlebotomy least the bridle to wit bloud being gone the fiercenesse of choler should more increase In those in whome by reason of the tempering of the humour bloud must be let a little at once and often Galen doth wish as well the reiterating of the purging as of the Phlebotomy As many as shall seeme to haue little bloud when you haue brought them to some probable humour you may let them bloud and then refresh them and againe you may purge them and afterward refresh them and againe you may let them bloud especially them whose whole bloud is like vicious and thick slime But he addeth presently but in them which are strong and full of bloud you may begin in them with Phlebotomy So sayth Fernelius that in the feuer synochus you must let bloud straightway in the beginning without any purging before But in what particular diseases you may begin with Phlebotomy and in which not it is shewed in their seuerall Chapters in my other former booke Concerning such as do thinke that the body is not fit for Phlebotomy vnlesse it be first cuacuated with some purging receit or potion the learned Massaria doth mightely condemne them which do neuer attempt the opening of a vayne vnlesse they haue first once or perhaps twise or more often vsed some purging medicine which without doubt doth trouble the fit occasion of the remedy and is altogether contrary to the doctrine of Galen who doth teach that in the beginning of diseases one of the two remedies may be fit to wit either Phlebotomy or purging but in nouise both of them So that if a man do diligently marke this kind of healing which now is commonly and euery where practized nothing can be deuised more filthy then it nothing more repugnant to the decrees of Hippocrates and Galen As Mercurialis in his treatise concerning the small pocks and measels doth forbid purging medicins to be receiued into the stomack at such time as nature
or by deriuing meanes as in agues by sieges vrines and sweates in a ripened pleurisie by spitting in inflammations of the liuer if they be in cauo hepatis by soluble medicins if in gibbo hepatis by things diuretick or causing vrine And the more to condemne Auicen Fernelius doth plainely auouch that letting bloud is most fit then when signes of crudittes do appeare At what time so euer yea if it were the twentith day of the sicknesse if signes of cruditie do appeare we may open a vayne for we measure Phlebotomy not by the number of dayes but by the concocting of the matter and the dissoluing of strength If neither of those do happen Phlebotomy may be vsed Montanus interpreteth the meaning of Auicenna that when he will not haue bloud to be let before concoction he doth ayme especially at such diseases in which a thick grosse humour doth abound as in quotidians and melancholick feuers whose humour being tough and raw would be made more rebellious if bloud were taken away First therefore he wil haue that humour to be concocted and euacuated and then if it be thought conuenient to open a vayne if the bloud be corrupt and in great plenty Trincauel maketh this to be the chiefest concoction that is required before letting bloud in respect of the bloud it selfe to wit when it is too thick to make it more fluxible as is before in the third Chapter of this booke There are two kinds of concoctions the first called properly 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 wheÌ„ naturall heate doth turne the food into due nourishment conteyning vnder it those three sorts or degrees of concoction mentioned by Galen whereof the first is called by him the concoction in the stomack and bowels wherein the purer part is sent towards the liuer to be made bloud and the impure is cast out by siege The second the concoction in the vaines wherein the moyst whitish iuice being by the mesaraick vaynes caryed to the liuer and by the liuer turned into bloud is by the vaynes and arteryes perfected and distributed into all the body in respect of the purer part thereof to wit bloud as it conteyneth the principall iuices and seede and the impure is by the vaynes 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 conueyed into the bladder and from thence cast out by vrine The third the concoction in the flesh wherein the purer part of the bloud being by the vaynes and arteryes caryed into all the body is by an other separation in respect of the purer part thereof turned into substance and spirits and the impure is cast out by sweate as Weckerus nameth three kinds of excrements appertayning to the three degrees of concoction excrementa primae concoctionis stercora secundae vrinae tertiae sudores exhalationes These three concoctions being finished the best part of the nourishment is assumilated and made one to the flesh body bloud and spirits of him that is to be nourished Galen sayth When the third concoction is ended there is an assimilation made to the part that is to be nourished These concoctions and the seuerall degrees thereof do all deale with that matter quae est benigna familiaris which is good and familiar vnto the party that hath receiued it There is an other kind of concoction called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 or 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 wherein naturall heate doth deale with a matter not that is good and familiar but such as doth cause disease and doth seeke either to assimilate some part of it if she can or else to make it either lesse hurtfull to the body or more fit to be expelled These two distinct kinds of concoctions when naturall heate can not or doth not performe what it would or should then they leaue distinct kinds of crudities as Galen sheweth speaking of cholerick crudities as those whome the Grecians call 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 whatsoeuer sayth he is of pature ouercome is called by Hippocrates concocted and what soeuer nature can not yet ouercome is called crude and raw as he giueth in the same place an instance of purulent matters in inflammations of spittle of rheumes and of watrish humidities such as do passe out in those vrines which are called vrinae crudae and in choler which being raw he saith it is yellow sharp ill sauoring but being concocted it is more pale and not so ill smelling As for spittings and snot such they may be that they may be the excrements of this later kinde of concoction and such they may be that they may be excrements of the last degree of the former kinde of concoction How these seuerall kinds of concoctions are to be respected in purging and whether in acute or sharp diseases we may giue minoratiue or purging receipts before there appeare signes of concoctioÌ„ of the matter of the disease I do handle at large in my second part of the great Phisick remedies called Cathartice As for Phlebotomy seeing that the chiefest intents thereof are to ease the ouer-much fulnesse of the body or to pluck back or diuert a humour from or to some place we are not so much to wait for the concoction of the matter of yâ— disease vnlesse it be the ouer-much grossenesse of thick bloud as to marke the concoction of nourishment that the first degree thereof be done and the second well forward For if we let bloud when the stomack or first vaynes are full of indigested crudities they will passe into the vaines which are emptyed and make greater obstructions As violent exercises vpon full stomacks do disperse and distribute raw humours into the body to the much hurt of the body so doth also Phlebotomy and therfore that may partly be applyed vnto it which Galen hath written of exercises Then is the best time when the meate before taken is perfectly concocted and digested in respect of the two first concoctions The way to know this time is by the colour of the vrine A waterish vrine doth shew that the iuice which is sent out of the stomack and bowels into the vaynes is yet raw and vndigested The fâ—ry red and cholerick vrine sheweth that the iuices are long ago concoâ—led already That which is moderately pale is a signe of the second concoction euen now finished I haue shewed already in the end of the eight Chapter of my former booke that in many diseases the colour of the vrine may deceiue and in what cases it may most deceiue I neede not therfore heere to speake any more thereof but only to poynt out those other circumstances signes which together with it are ioyntly to be weighed and considered To know perfectly the state of the body Galen doth in one place ioyne with the colour of the vrine fiue other things to be heedily regarded First we must ponder what diet the diseased body hath lately vsed for sundry sorts of meates and wines may cause many alterations in the
outward vayne called externa or humeralis or cephalica The middle vayne called communis or cardiaca or nigra or funâ— brachiâ— or mediana is then vsually opened when either one of the other doth not appeare or else when the infirmitie is as well beneath as aboue the neck for this vayne taketh part of both the other For the lower parts about the hips bladder or wombe take the vayne by the knee or by the anckle The raines as they are placed in the nuddest so as Fuchsius sheweth they do partake with both For if the inflammation in the raynes be new and that there be abudance of bloud then may you take the vayne in the arme but when it is a confirmed disease such as is called nephritis then open the vayne either in the knee or in the anckle If any ill humour be setled in those parts which are betweene the raynes and the flanck Fernelius doth appoynt that if the party haue corpus plethoricum then first we should open the basilica of the same side and afterward the saphena But if the body be not plethorâ—cum then he sayth the only saphena shall sustice that is the inward vayne of the foote for as the outward is called sciatica so the inward saphena If you will not haue the bloud to come fast and speedily then for the cephalica you may take his branch betwixt the thumbe and the fore-finger And for the basilica you may take the vayne by the little finger called saluatella or titillaris which is a branch of the basilica For deriuation to deriue the matter of a griefe if it be in the fore-part of the head take the vayne of the fore-head if in the eyes the broad vaynes at either corner if in the eares the vayne vnder the eare if in the lawes that which is vnder the tongue if in the lungs or spleane or breast or heart the inward vayne of the left arme if in the liuer the right basilica Often the same vaynes will serue both for reuulsion and euacuation as Galen sheweth speaking of an inflammation of the liuer We must both pluck back and also auoyd the bloud which is caryed to the liuer by Phlebotomy opening the inward vayne of the right cubite because directly and with a broad way it doth communicate with the hollow vayne if that do not appeare open the middle vayne if that also 〈◊〉 be perceiued then take the other third which remarneth This speech of Galen maketh me more willing to subscribe to the opinion of Platerus who defendeth that in letting bloud wee must rather choose that vayne which doth most swell with fulnesse of matter then to make any difference betwixt the vaynes of the armes seeing in one place about the throat they come all from the hollow vayne and which vayne hath best relation to the parts most ouercharged the fulnesse thereof will sufficiently make manifest CHAP. 8. What manner of incision must be made how large how small how deepe what quantity of bloud may be taken and therein of the meâ—ning of Galens word to let bloud vnto 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 deliquium animâ— IT is a notable aduertisement of Hippocrates We must open passages as the nostrils and others but it must be what we must and how we must and of what sort and what way and when and how much we must as sweats and all other things This precept of circumstances as it appertayneth generally to all euacuations so doth it greatly take place in the matter of Phlebotomy I haue shewed already the greater part of these circumstances it ramayneth heere that I describe only the manner how and the quantity how much Fernelius aduiseth the Chirurgian to take diligent heed that he strike not either a place swelling with some windinesse or an artery or a tendon in stead of a vaine The tendones be instruments of moouing in the top of the muscles made of sinewes and ligatures and knitting them to the bones they be harder then sinewes and vet not so hard as ligatures The artery being pressed downe will shew it selfe for a vayne which if it be cut it will neither come together againe nor heale but that part will be taken with a mortification and become as dead and senselesse He counsaâ—leth also the Chirurgian that when he hath setled the launcer in one hand leauing out no more of the end or poynt then what is sufficient to pearce and hath with the other hand so taken hold of that part of the body that is to be let bloud that he may strengthen and hold stedfast the vayne with his thumbe then let him put forward hâ— launcer faire and softly without any hastinesse gently and no further in then is sufficient Fuchsius willeth that if the vayne be trembling and not constant for the percing the next place must be bound as well aboue as also beneath And although the vayne be well opened and the bloud flow freshly yet in the middle of the flowing set your finger awhile vpon the wound both that the strength may be more refreshed and lesse scattered and also that the corrupt bloud may the better be brought out of the inward parts vnto the place where the vayne is opened Fernelius giueth one generall rule to know what vaynes must be opened a little ouerthwart and somewhat sidelong and which must be opened right along the vayne If the vayne be in a ioynt then let the pearcing of it go a little sidelong because in the moouing of the ioynt the sides of the incision if they go right with the vayne would gape and so would the wound be the longer in growing together But in the head hands and feete if the incisions go right with the vayne he sayth they heale the sooner because there yâ— sides do still close together Of what bignesse the orifice of the wound must be it is discussed by Montanus writing vpon the ninth Canon of Anicen A little hole sayth he is best to conserue the strength of the party both because the most that then commeth out is but thinne and waterish and also because the bloud goeth not so speedily out whereby the heate and spirits are not so sodainely exhausted But a little orifice hath on the other side a great discommoditie in that it maketh no euacuation of the thick and grosse parts So likewise a great orifice hath one good benefit in auoyding grosse humours but it hath an other great danger that by a too sodaine and ouer-liberall effusion the vertues and powers may be cleane ouerthrowne If the bloud be subtile and power weake let the hole be little but if the bloud be thick and the vertue strong then let the hole be great Auicen teacheth that when we let bloud to preserue from sicknesse then must the orifice be great because the powers are yet constant and likewise when we let bloud in the winter or cold weather because then the coldnes
repletion termed quoad vires is rather to be holpen by medicins then by letting of bloud For if raw and vndigested humours do abound in the body the opening of a vayne will draw out much good bloud but as for the bad bloud which is gathered in the first vaynes about the liuer and the middle entrals it will draw it into the whole body as Galen doth at large demonstrate and therefore euacuation by some purging potion shall in this case be more fit then letting of bloud Yet when by the nature of the disease there is euident danger of a corruption and putrefaction of humours to ensue then a little quantitie of bloud drawen shall be much auaylable to anticipate and preuent it if alwayes regard be had how farre the strength will permit and what humour is especially mixt together with the bloud in the vaynes For as Fernelius sheweth there is another way two kinds of repletion or plethora the one is called pure the other impure Montanus maketh also two the one simple and the other compound The pure doth consist of in a manner an equall portion of all the best iuices The impure is an abounding of vicious humours in the vaines If the plenitude come by choler the vayne may the more plentifully make euacuation But if the fulnesse come by fleame or by melancholie then must the euacuation be made by little and little at seuerall times when necessitie requireth and when the vaynes being ouer-full doe threaten danger How all these seuerall kindes of plenitude shall be knowne I shall haue occasion to declare more at large in the first Chapter of the second booke The first vse of Phlebotomy to wit euacuation hath place not onely in pure repletions but also in all dangers of putrefaction according to that of Galen It is good to open a vayne not onely in feuers called synochi which haue one continuall fit and doe proceede of inflamed bloud but also in all other humours that stand in danger of putrefaction when the regard which is had of age and strength doth nothing prohibite For nature which doth dispose and gouerne our bodies being lightened and hauing put off that which aâ— a burthen did ouercharge her will easily ouercome the rest in such sort that it will concoct what is to be concocted and expell what is to be expelled The second vse of letting-bloud is called of Montanus euentatio wherupon he maketh a secoÌ„d kind called Phlebotomia euentatiua which is the venting of any humour that doth boyle and bubble within the vaines For as the former to wit euacuation hath respect vnto the plenitude so this 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 hath properly a relation to the boyling and bubbling So â—ayth he in quotidians and quartans we do often let bloud not because there is any fulnesse or great multitude of ill humours but because we would by venting take away the boyling and bubbling thereof This venting hath place both whether there be any putrefaction in the humour or no. But if our scope and purpose be only simply to vent then is it best to do it by letting a little bloud and often according to the rule of Auicenna Melior est multiplicatio numeri quà m quantitatis Otherwise if the case be compound that both there be a fulnesse and a boyling that we must both euacuate and vent then shall it be most fit to do it at once and plentifully and as long as the strength will permit as is taught at large by Galen in the eight booke of his Methodus medendi And in the same booke speaking of some agues that are like to Diarian feuers and do come of obstructions he doth vse these words That the humour may be vented wee haue neede of the great remedy wee must let bloud the party being of sufficient strength although there be no signes of plenitude How it shal be knowen when the humours do thus boyle and haue neede of venting it shaâ—l be layd open at large in the two Chapters next following The third vse of letting bloud is called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Revulsion Montanus calleth it Phlebotomia diuersina which is a plucking back of humours when they are caried from any one part of the body into an other with force and violent course Euacuation doth respect the fulnesse Venting the bubbling vp and Revulsion the violent course of the humour How this revulsion must be made is discussed in the seauenth Chapter of this first booke The fourth vse of bloud-letting is called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 deriuatio of Montanus Phlebotomia deriuatiua which is a deriuing of a humour from any place where it is settled and impacted into some other neere place by which it may best be ouercome or auoyded It differeth from revulsion two especiall wayes First revulsion is into places farre distant as Hippocrates sheweth We must endeuour to open a vayne distant as farre as may be from the place where the griefe is made or the bloud gathered for so there shall be no danger of a sodaine change and besides the custome being translated an other way thou shalt make that there shall be no more flowing to the former wonted place But deriuation of humours is into the neerest places as by which they may most fitly be auoyded according to that of Galen Deriuation is made into places nigh ioyning but revulsion is made into places plaine opposite Againe an other difference there is that revulsion is of humours now flowing but deriuation is of them that are already settled as is witnessed by the same Author If the flowing be still caryed in his violent course we must vse revulsion to draw it to the contraries but when the humor is setled and impacted in the place then it is better to deriue it He giueth the reason of it for the change is neerer and both the accesse and the drawing force of the purging medicine is more readie when the place is nigh And what there he speaketh of medicins the same he writeth of Phlebotomy Reuulsion is the remedy of fluxes or rheumes still flowing but deriuation is their help when they haue taken hold of any part but both these kindes of euacuation doth Hippocrates commaund to be done by the common vaynes Thus much briefely concerning the first question what Phlebotomy is and of the foure seuerall kinds or rather vses thereof CHAP. 2. How letting of bloud may be vsed in continuall agues called synochi in hote agues and how also in burning feuers BEing now to declare particularly how Phlebotomy is to be vsed in most of the vsuall diseases which coÌ„monly do raigne amongst men seeing there is no kind of infirmitie that hath more sorts of it selfe subiect to letting of bloud then hath the Ague I haue thought it not amisse to begin first with it In the ague synochus which hath one continuall fit seeing that it proceedeth of the inflammation of bloud needs must
helpeth much transpiration by meanes whereof it must needes be good to help putrefaction When Montanus affirmeth that to let bloud in putrified agues is to kill the patient he meaneth a liberall euacuating of bloud but otherwise his words before do shew plainely that it may be done moderately to vent the vapours And Platerus sheweth an other cause why it ought to be done because the occasion of putrified agues doth lie hid in the bloud and in the branches of the hollow vayne together with the bloud is auoided some portion of the putrified humour Of the same iudgemeÌ„t is Fernelius The opening of a vaine which may take away both the multitude and also a great portion of the putrified humour doth greatly auayle to the curing of the feuer And an other reason sheweth Galen why this must be done because nature being disburthened of a part shall the more easily ouercome the whole as I haue declared in the Chapter going before in the first vse of Phlebotomy If the ague be that which is called Causo the burning feuer whose matter is not the heate of bloud but the burning of choler and whose signes are tossing of the body an vnsatiable thirst the toong dry and rough either yellow or black a nipping about the stomack and liuer yellow excrements the vrine very thinne and something wanne the pulse swift thick and hard doating a little sweate about the forehead and neck but euery where else the skin very dry and therewithall a little rough letting bloud may also well be vsed at the beginning but in no great quantity only foure or fiue ounces for venting or euentilation are sufficient Auicenna in his curing of the Causo doth affirme that bloud is not to be let in it vnlesse there doe appeare rednesse and thicknesse of vrine but that is not Causo but rather synochus Montanus sheweth that the true continuall burning feuer seeing that the matter which doth putrifie in it to wit choler is most hote and most dry it becommeth in a manner altogether firy Hppocrates teacheth the way of curing a burning feuer by quenching the burning heate by giuing water and mulsa aquosa but he maketh no mention of letting of bloud thereupon Montanus doth conclude that letting of bloud is not to be permitted in a burning feuer But I thinke Montanus his argument in that disputation vpon the eleuenth Canon of Auicenna is of small force For although Hippocrates do not precisely commaund in that place bloud to be let in a burning feuer yet he maketh it in the same place to be a signe of the dissolution of the disease if the patient do bleede at the nose and presently vpon it he vttereth these words At in morbis acutis sanguinem detrahes si vehemens fuerit morbus qui aegrotant aetate florenti fuerint virium robore valuerint Platerus doth require in the Causo or burning feuer that there should be a liberall letting of bloud if strength do permit because he thinketh it not to proceede of pure choler as many other Phisitions haue taught but of bloud putrified and inflamed in the great artery and causing so much the more daÌ„gerous feuer as it is kindled in the trunck of the great artery neerest vnto the heart If Hippocrates do require Phlebotomy in morbis acutis then must it needes be good in the burning feuer which as Trincauell declareth is maximus acutissimus morbus But still in the quantity Hippocrates his rule must be obserued to haue a due regard of the age and strength CHAP. 3. How bloud-letting may be admitted in agues caused by obstructions as Diaries c. GAlen sheweth that by obstructions sometimes the transpiration and vapouring out may be intercepted and by the obstructions they which haue bad humours fall into agues as Diaries and such like and in them he requireth as very expedient the opening of a vayne first for venting or euentilation for as he saith vnlesse the bad humour be vented it must needs become putrified and secondly because those things which you shall minister afterward to deliuer from obstructions will worke more effectually For it is best to come to deterge and loose obstructions hauing first by bloud-letting for he speaketh there of Phlebotomy auoyded part of the euill humours For we seeking to deliuer the obstructions before we haue made euacuation it is in danger that we shall impâ—â—t the obstructions more firmely then before How the greatnesse of the obstruction shall be knowne Galen sheweth a little after in the same booke The declaration of the quantity of the obstruction is made manifest by the ague for vpon greater obstructions the ague is greater and vpon lesse obstructions it falleth out to be lesse Montanus being fallen into the consideration of this place of Galen doth make three seuerall kindes of obstructions and sheweth in which of them bloud-letting is requisite and in which not The fyrst obstruction is when in the pores of the skinne in the outward parts the transpiration and vapouring out is stayed and prohibited The second kind of obstruction he calleth coarctatoria when such a multitude of humours is conteyned within the vaynes that the passage of the spirits being stopped they cannot passe thorough the vaynes whereby there commeth a perill of suffocation The third obstruction is called oppilatio wheÌ„ some tough matter doth so stop the conduits and chanels of the vaynes that neither matter nor spirits can passe thorough them In the first kind of obstructions Phlebotomy is good because by it the body is made more thin and humors being without the vaines in the compasse of the skinne are by bloudletting drawne into the vaines and so do passe away as Montanus doth demonstrate out of Galen In the second kind of obstruction letting bloud is also conuenient that the thronging together of humours may cease and that bloud may be vented But in the third kind of obstruction it were ill done to let bloud because the thick humour which is impacted in the first vaynes is not thereby euacuated but rather increased as the same author doth proue out of the same fourth booke of Galen de sanitate tuenda I thinke he hath respect to that position of Galen In a werisome and faint body there is little good bloud and many raw humours Phlebotomies do auoyd the good bloud but as for the ill bloud which is gathered together in the first vaynes especially that which is about the liuer and mid bowels they disperse and spread it throughout all the body How in the two last kinds of obstructions the humour must be prepared and made fluxible before we attempt any letting of bloud it is to be declared hereafter in the third Chapter of the second booke But the question is here only of the first kind of obstructions when in an ague called diaria or ephemera which lasteth not aboue 24. howres by reason either
of the constipation or thicknes of the skinne the spirits and vapours haue lost their accustomable flowing out whereby the spirits are inflamed whether in this ague bloud is to be let or no I answere that according to the iudgement of many excellent Phisitions of our time this ague is best ouercome by causing kindly sweates by medicins loosing obstructions and by vsing fit bathes without letting of bloud But if it do continue more then a day that it be now diaria plurium dierum or as some call it ephemera extensa then all do agree that letting of bloud is very expedient for feare least of an ague not putrified it do become a synochus putrida and so bring greater danger For as diaries or agues of one day do passe into diaries of many dayes vnlesse the obstruction be loosed as Galen sayth Vnlesse the obstruction be cured they fall into agues of many dayes so also the diaries of many dayes do fall into putrified agues and hectick feuers vnlesse they be in time holpen and eased as the same Galen sheweth in the first page of his ninth booke de methodo medendi But concerning letting of bloud Galen doth in the tenth booke generally set downe his iudgement very briefely concerning all diaries caused by obstructions One obstruction commeth by multitude and an other by the quality of the humours being too tough or too thick In that which commeth by multitude letting of bloud is the chiefest manner of curing but in that which commeth by the quality of the humour the vse of the extenuating things is best CHAP. 4. How farre letting of bloud may be allowed in intermitting agues quotidians tertians quartaines MOntanus affirmeth that in a phlegmatick ague if the fleame be thick and of a glassy greene colour as it falleth out in the agues called epialae then in no wise may any vayne be opened because although there be a great boyling yet we haue neede of a great heate that the matter may be concocted and the passages opened and therefore he thinketh that we haue neede rather of frictions But if it be pituita dulcis such a fleame as may easily be conuerted into bloud then he alloweth letting of bloud as a fit help to remoue the obstruction He sheweth in the same place a little before that the chiefest cause why we sometimes vse phlebotomy in quotidians quartaines is to vent the vapours It respecteth not the multitude but the quality because it is done only to help the bubbling of the humour In the tertian he sayth that Phlebotomy is not necessary neither euacuatiue because there is no fulnesse of bloud but only euill humours mixed with the bloud nor yet Euentatiue because the paroxysmes of the tertians continue not aboue twelue howres and haue a great distance of intermission and therefore can not haue so great a boiling as should neede to be vented with so great a remedie as is Phlebotomy And as touching the quartaine he sayth that bloud-letting doth not agree vnto it of it selfe as it dependeth of melancholick humour but per accidens as when it commeth vpon the suppressing of the menstrua or haemorrhodes or when it commeth ratione sanguinis adusti by meanes of burnt bloud then he alloweth the letting of bloud Platerus doth thinke that all intermitting agues do proceede of a putrified cause lying hid in the mesaraick vaynes and therefore if any of them could be opened he supposeth some help might come but seeing those mesaraick vaynes do no where appeare at the skinne it were best not only in quartaines but also in tertians if possibly it may be to cause a flux of y◠haemorrhoids because the haemorrhodiall vaynes are branches of y◠mesaraik vaines He will haue no vayne to be opened there vnlesse it appeare exceeding well because a small wound made there doth bring oftentimes great torments but he will haue either the flux to be procured by some medicine or else leaches to be applied He alloweth not phlebotomy in exquisite tertians and such as are afflicted with most vehement heate by reason of choler inflamed neither doth he thinke it fit in phlegmatick agues in which cases he which shall rashly and vnskilfully let bloud shall not only auoid nothing of the cause lying hid in the mesaraik vaynes but also as he sayth the matter being plucked out of the mesaraick vaynes into the hollow vayne he shall of an intermitting ague make a continuall ague or else the purer bloud by reason of emptying the branches of the hollow vayne being drawne out of the mesaraick vaynes that cholerick and putrified humour which remayneth and whereunto bloud was before a bridle and a meanes to asswage it will now become more fierce Therefore he concludeth that in these kindes of agues more harme is done by admitting Phlebotomy then by omitting it vnlesse some grieuous symotome do happen that by the inflaming of bloud an inflammation also of some of the inward parts be feared or vnlesse there be a plethora or plenitude in the body which may be obserued by the rednes and thicknes of the vrine and by the long continuing of the heate after the fit and when there is no fit then not in the beginning of the ague but about the third or fourth fit in the day of intermission out of that vayne of the arme that appeareth most filled it will do very well to let bloud 5. 6. 7. or 8. oūces In quartains it must be done in y◠left arme somewhat later then in tertians For quartaines are at the beginning gently to be handled least a double quartain or a triple quartain be made and least also the strength should decay which heere we must preserue by reason of the long continuance of the disease Fuchsius in an exquisite tertian which proceedeth of meere choler not mixt with any other humour doth proue out of Galen ad Glauconem that neither letting of bloud nor vehement purging medicine can be conueniēt for it Doctor Bright doth thinke requisite that in the first day of intermission to ventilate the body 6. or 8. ounces of bloud be taken These iudgements do seeme to be contrary but yet the seuerall circumstances being considered they may both be very well reconciled For as Fernelius sheweth the opening of a vayne in respect of it selfe is hurtfull to an exquisite tertian it taketh away the profitable and necessary humour and leaueth behinde the impure and hurtfull Againe in this kind of ague the body is wont to be very thin and of little bloud But the sharp choler which is the matter of the ague and doth abound and boyle vnder the hollow part of the liuer when bloud is taken away doth waxe more fierce Yet he alloweth there letting of bloud in respect of other symptomes such as are headach beating of the temples and heauinesse of the body in corpore plethorico In tertiana notha or the bastard
if it appeare yellow and thin let him straightway suppresse it CHAP. 5. Whether letting of bloud be to be admitted in the plague or pestilent feuer as also in the Pox and such other contagious infirmities and when and how AVicenna in his eeuenth canon concerning bloud-letting as Montanus hath deuided them doth set it downe for a rule that in what agues soeuer there is a most vehement inflammation there must be no letting of bloud Montanus discoursing vpon that place sayth that we must regard not so much what the disease requireth as what the strength can beare In respect of the disease Phlebotomy doth agree but not in respect of the powers He bringeth in an instance of a pestilent feuer and sheweth that bloud is not to be let in it because although of it selfe in regard of the pestilent feuer there is no greater remedie then letting of bloud seeing that by it the body is made apt to vent and vapour out the spirits the inward heate is extinguished and putrified bloud is euacuated yet if bloud be let all do dye and therefore we must absteine from Phlebotomy in the pestilent feuer because in a moment of time the strength vtterly decayeth Platerus sheweth sundry great dangers which letting of bloud doth bring vnto them that are infected with the plague and that little good helpe can be expected thereby I can not see how Phlebotomy can auayle to pluck that venemous quality from the heart or to bring it out of the body together with the bloud seeing that it is rather procured thereby that the infection which from outwardly commeth into the body and doth presently infect the spirits should be drawne more deepely inward And moreouer the motion of nature whereby straightwayes in the first inuasion it goeth about to shake out the poyson by sweates by outward pustles and by botches may be hindred by letting of bloud and the powers thereby weakened which we ought to keepe strong to expell that poyson It neither doth auoyd the cause of the disease neither is there any neede heere of any euentilation of heate seeing it is not heere so vehement Hereupon he concludeth that vpon rash and vnaduised letting of bloud in plague times many meÌ„ are killed Yet he acknowledgeth that when the plague hath taken hold vpon bodies which are summè plethorica vel cachectica full of bloud or of corrupt humours whereby a feuer is kindled then if by opening of a vayne the plenty and putrefaction of the bloud be taken away all the other symptomes will become more tolerable but that must be done sparingly and with a due regard of the strength And if in the beginning strength be decayed then is Phlebotomy not to be admitted though the fulnesse of the vaynes doe require it for of lusty youthes we haue found by experience more to escape in the plague time without letting of bloud then by letting of bloud If Phlebotomy be vsed it must be done rather in respect of the feuer then of the pestilent qualitie seeing that this venome doth not consist in the bloud but comming from outwardly doth sodainely possesse the heart and we do not thinke that it can be expelled or drawne out from it by Phlebotomy And if the case do so stand that by the meanes of the plenitude and feuer a vayne must needs be opened then he sheweth in what order it must be done First it must be done in the beginning for vnlesse the vayne be opened within 24. howres of the beginning it will rather hinder nature then do any good Also it must be considered whether the party be in a sweate or no for in no wise must the sweate be hindered by Phlebotomy But after the party hath sweat and hath bin refreshed with a little meate or some cordiall receipt then may a vayne be opened howsoeuer there hath gone no clyster nor purging before because the time hath not giuen leaue Choose the vayne in that side which is most grieued If any eruption appeare about the flanck open the saphena If in the vpper parts then some vayne in the arme or hand of the same side If vnder the arme-hole take the basilica If about the â—ares the cephalica If in the face open the vayne vnder the tongue And euer to the botches appearing let cupping glasses be fastned that the poyson may abide in the same place and not by Phlebotomy be drawne into the inward parts Trincauel doth accompt it very dangerous to let bloud when pimples do outwardly appeare but when as well by the pulse as by the former manner of diet which the party hath vsed it is found to be expedient then let it be done straight in the beginning before the putrefaction of the pestilent feuer be much increased and before nature do seeke to expell vnto the skin Thus he prooueth out of Galen who commenting vpon one of Hippocrates his patients called Crito who dyed vpon a kind of pestilent feuer he doth excuse Hippocrates and sayth that he did not let him bloud because he was not sent for at the beginning of the disease Which signifieth that if he had bin sent for at the beginning a vaine no doubt should presently haue bin opened Montanus in his epistle to Crato doth allow letting of bloud in the small pocks and such other contagious diseases so that it be in the beginning before signes of putrefaction appeare but when it hath once preuayled then to let bloud he doth call it a pernitious and a deadly thing For nature is then checked when it should wholy be intentiue to expell the venom and infection of the disease Fernelius Hollerius and Syluius three famous and worthie Physitions consulting about the sweating plague called sudor Anglicus did deliuer to the English Embassadour the vse of bloud-letting amongst the meanes to preuent the disease in full bodies the bodies being first orderly purged but the disease hauing once taken hold they aduised no bloud-letting but prescribed good cordials to expell from the heart the venemous infection But in that which is commonly called by the name of Plague although the body be already infected yet if it be corpus pletharicum the notes whereof are in the first Chapter of the booke next ensuing wee may be bold to begin the cure with bloud-letting obseruing as neere as may be the cautions before expressed and especially taking heed as Montanus giueth warning that wee choose the vayne as farre as we can from the principall parts from the heart liuer and braine for if we draw the pestilent humour vnto them he sayth we shall kill the patient CHAP. 6. How letting of bloud is to be vsed in phrensies quinsies plurisies inflammations of the raynes or wombe and other inward inflammations happening often without agues IN the phrensy which is a deprauing of all the principall faculties of the braine caused by the inflammation of the filmes thereof Rhazes doth allow Phlebotomy in the
plenitude for the griefe was but small and the bloud was cast out by spitting now those pleurisies are most gentle in which bloud is spit out 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 in Hippocrates signifieth directly and as it were in a right line a benumming of the thigh right on the same side is a signe of the stone in that kidney so Galen doth expound it 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 it signifieth according to rectitude And in an other place he doth interpret it by the word 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 directnes For a good signe bloud must flowe directly as out of the right nostrill if the liuer or right side be affected and out of the left nostrill if the spleane or the parts thereabouts be greeued The contrary to 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 is 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 as Hippocrates sayth bloud to flow out of the contrary side is an euill signe Good it was for Bion being a splenetick man to bleede out of the left nostrill and good for Herophon after the swelling of his spleene to haue a kernell to rise 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 of the same side So the auctor of the booke de renum affectibus By the benumming of the thigh directly on the same side you shall know which rayne is affected for if there be a benumming in the right thigh then is the stone in the right kidney if in the left thigh then in the left kidney This 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 hath place in the crisis of diseases but Hippocrates doth neuer appoynt Phlebotomies to be made of necessity alwayes 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 directly vpon the same side Fernelius expoundeth this word 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to signifie the rightnes of the fibrae or vills as it were little thready or hairy strings stretched out and running by the longitude of the vaynes But Andraeas Laurentius and Reusnerus vpon Willichius do at large confute that opinion For if Fernelius do make those rectae fibrae helps for euacuation or expulsion then doth he not well for the transuerse fibres and not the right do serue for expulsion and if he make them as they are helps of attraction then must they draw equally as well on the one side as the other because they runne out equally by the length of the vaynes on both sides And the like answere they make to them which would haue the word to signifie the continuing and ioyning together of parts as though all the vaynes of the right side were ioyned one to and in an other amongst themselues and the vaynes of the left side ioyned among themselues and did not rather participate and communicate one with an other But seeing the trunke of the hollow vayne is one the branches thereof on both sides are equally ioyned to the liuer The breaking out of bloud out of the left nostrill doth empty as well the right side as the left and as Reusnerus sayth he saw often by experience that the diseases of the spleane were holpen sometimes by opening the liuer vayne and sometimes by bloud gushing out of the right nostrill And moreouer as Andraeas Laurentius sheweth there is no meeting together betwixt the vaynes of the nostrils and the spleane and yet the spleane being inflamed as you haue heard the bloud that floweth out of the left nostrill doth flow 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 directly And therefore that word of Hippocrates is not to be referred to the ioyning together of the vaynes one in an other but to the rectitude of the whole parts of the body quia dextra dextris sinistra sinistris sunt 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 because the right lims to the right and the left to the left are as it were of one tribe or kinred and therefore like good neighbours do one labour to help an other Maior est vis in forti contentione obsessae partis quà m in venarum situ There is a greater force in the strong contention and striuing of the side that is besieged or set vpon then is in the situation of the vaines And a good criticall signe it is when that side that is impugned can expell part of that wherewith it is ouercharged and oppressed But when for any inflammation a vayne is to be opened we haue many other things to be regarded besides the consideration of the side We must marke well whether the whole body haue a fulnesse of the vaynes whether the humour be flowing or now already flowed and setled whether it doth require euacuâ—tion or reuulsion or diuersion and which of them â—ore then other and how these vses of Phlebotomy and the order thereof shall best be perfourmed of all which points you haue seene already â—hat the best Phisitions of our age haue gathered out of the best Phisitions in times past Only I will adde one obseruation more out of Montanus and so an end of this ouertedious controuersie Montantus will haue in euery inflammation two things principally to be regarded the first membrum mandans the member that doth send the humour and the second membrum recipiens the member or part that doth receiue the humour As he giueth his instance thus of the pleurisy Let there be saith he one of a hoate liuer who hath laboured in the sunne hath dronken strong wine hath inflamed his head hath rested sodainely in a cold place and then as it commeth commonly to passe by the cold the matter is expressed by the vaynes and descending by the vaynes it doth flow downe either to the higher or lower ribs and there followeth a paine Here the member sending is the head and the member receiuing the ribs Let the place of the inflammation be in the right side where must we then let bloud He answereth that seeing the humour is caryed downeward if we should open the basilica of the same side we should draw the humour more downeward and so increase the impostume and indanger the patient The fulnesse is in the head but aboue the head there is nothing if there were we would euacuate from it Therefore either a deriuation must be made to deriue the humour from the head by opening the vaynes which are behinde the eares or by bleeding at the nose which were excellent or by striking the vayne vnder the tongue or else we must follow the expert Arabian Phisitions to let bloud on the contrary side that so by reuulsion the humour may be drawne according to the directnesse of the situation from the right side to the left But if the pleurisy do come of another cause that the flux be not from the head but it be the liuer full of bloud and choler sending humours vnto the ribs by the ascending vayne because there is a plucking of the humours from the lower parts vnto the higher in what vayne then must we let bloud He answereth not from the basilica of the same right side for then we shall draw the humour to the place but as Auicenna doth
teach either wee must draw it downe by opening the saphena of the same side or else we must deale with the opposite side aboue The rest of Montanus his opinion you haue seene before in this Chapter where I haue compared his iudgement with the iudgement of others the most excellent Phisitions of our age CHAP. 8. Whether letting of bloud may be practised in cold diseases as palsies cramps apoplexies and whether it may fitly be vsed in melancholick windes colicks and dropsies FOr the diseases mentioned in this and the two Chapters following I purpose not to shew the censures of many Phisitions but only for euery infirmitie to content my selfe with the auctority of one or two of whom I make best reckoning and so to hasten to those other points which more generally and vniuersally are to be considered in the whole practise of Phlebotomy Although cramps and palsies conuulsions and resolutions be cold diseases yet Aetius Paulus Aretaeus and diuers do appoint to begin the cure with letting of bloud Galen doth allow it but not generally alwayes He only doth admit it in these cases and with these conditions First when these cold diseases haue their beginning by the suppression of the termes or hemorrhodes Secondly if they be with a feuer but then it must be done moderatly sparingly Thirdly if there be great plenty of bloud either in the whole or in the head For as Galen sheweth and also Hippocrates by the ouermuch fulnesse of the vaynes there are made oftentimes epilepsies and apoplexies Trallianus beginneth his cure of a lethargie by letting of bloud if other circumstances do not prohibite Heurnius in his Chapter of conuulsions doth like well of the iudgement of Aretaeus to wit that whether the cramp or conuulsion do come of coldnesse or by a wound or by vntimely birth the vayne in the arme is to be opened especially if bloud be the cause or if it be such a crick that the neck or body can bend no way or if it be an inflammation or a wound Montanus alloweth Phlebotomy in epilepsies and apoplexies when they depend of bloud but he addeth this clause hoc autem faciendum debitis temporibus praecipue vere this must be done in due time especially in the spring time For melancholick winds caused by obstructions of the liuer or spleane Mercurialis giuing aduise in that case to a Noble man of Germany sayth first you must thinke of letting bloud not that the abundance of it doth plainely shew any such matter but because other noble helps can hardly be safely administred vnlesse letting of bloud do go before And in an other place writing counsayle for a woman which had fiue yeares suffered the obstruction of the spleene and was now come to a schirrus or hard swelling he sayth I thinke it were excellent well that she should be let bloud first out of the common vayne then out of the lienaris and last of all out of the vayne of the left foote so that at thrice there be in all taken a pound of bloud Trincauel his iudgement is that we must abstayne from bloud-letting when the melancholick humour is dispersed into the vaynes of the hypochondria and the whole body and that then we must rather purge or procure the hemorrhodes if the party haue had them vsually before For the Colick Auicen doth forbid bloud-letting to be vsed in it Montanus writing vpon the sixth Canon of Auicen giueth the reason of it because the colick commeth of some cold and thick matter and phlebotomy both doth make more cold and also hath no power to auoid the thick and grosse causes of the griefe Yet he addeth this But if the colick do come by the inflammation of the colum one of the lowest guts by meanes of bloud or choler flowing to the place in this case if you let not bloud the patient will dye For the Dropsie Trincauel teacheth that if it come by the suppression of some vsuall flux as the termes the hemorrhodes and bleedings at nose whereby by the superfluous abundance of bloud the naturall heate of the liuer beginneth to be quenched then the first thing in the cure must be phlebotomy But if it come of fleame then omitting bloud-letting we must only seeke to purge the fleame He maketh there an obiection what we must do if the termes be not suppressed and yet the vrine do appeare high coloured whether may we then let bloud or no seeing that Auicen sayth that if the vrine do appeare red and thick a vayne must presently be opened Trincauel answereth that yet we must not let bloud because in this disease that rule of Auicen doth not take place For the red tincture of the vrine doth not come by abundance of bloud but first because little vrine is made in these diseases therefore it is the higher coloured for the thinne iuices of choler and bloud from the which doth come the colour of the vrine being mingled with a little moysture do giue the greater tincture and make it higher coloured And a second cause of the high colour in the vrine he sayth may be the debility of the raynes which by reason of their weakenesse being not able perfectly to separate the bloud from the excrement do let some little portion of bloud passe with the vrine whereby the vrine is dyed red A third reason doth Fernelius giue why the colour of the vrine may often deceiue because when the choler is cast out by the liuer it doth not only colour the thinne part of bloud but maketh the vrine also to looke as though the bloud were inflamed as he giueth an instance by Iaundises and Dropsies and concludeth They do therefore offend which by the vrine being of citrine colour and thicke do iudge straight that bloud is to be let For such an vrine doth not come by the abundance or by the kindling of bloud but by the powring out of choler out of the liuer I will not speake heere of the razing of the stone in the raynes and some other occasions that may be that a little bloud issuing may alter mightely the colour of vrine This which hath already bin spoken may put vs sufficiētly in mind in the matter of bloud-letting not so much to be led by the colour of the vrine as by other euident tokens which shall be hereafter more at large declared But when the vrine doth concurre with other signes then vis vnita munita Et quae non prosunt singula multa iuuant CHAP. 9. Whether in rheumes and distillations and also whether in the Goute and the disease called Morbus Gallicus any benefit may ensue by letting of bloud MOntanus doth make this to be one of the principall and generall vses of Phlebotomy then to take place When any hath some notable heate of some member by means of which heate it doth easily receiue excrements and so fall into a disease as if
HARWARDS Phlebotomy Or A Treatise of letting of Bloud Fitly seruing as well for an aduertisement and remembrance to well minded Chirurgians As also to giue a caueat generally to all men to beware of the manifold dangers which may ensue vpon rash and vnaduised letting of Bloud Comprehended in two Bookes Written by SIMON HARVVARD Imprinted at London by F. Kingston for Simon Waterson 1601. ⧠To the Right Honourable his singular good Lord Gilbert Earle of Shrewsbury Baron Talbot Lord Comin of Badenho Valence and Montchency Lord Strange of Blanch-minster of Brimsfeld Corfham Furniuall Verdon and Louctoft Knight and companion of the most noble order of the Garter and one of her Maiesties most honorable priuie Counsell many ioyful and happy yeeres with all increase of Honour IT is a propertie Right Honourable my singular good Lord naturally giuen to euery workman and artificer that be his worke neuer so rude and homely yet would he be loth that his labour should vanish and perish but seeing that it is the best that his abilitie can performe he desireth the same as long as may be to remayne and continue vpon the earth This cause maketh also many to be so forward in publishing their writings in print that when they themselues are taken away by death yet by their works there may still remaine some lasting record and remembrance of the workemen But the especiall cause which hath mooued me at this time to set foorth these my two bookes of Phlebotomy is the sincere affection and desire that I haue to bring some supply and helpe if I can vnto two very great wants and abuses which I dayly perceiue to be now too common and grassant in sundrie corners of this realme For first although in Cities as principallie in the famous Citie of London the people enioy a great blessing of God in hauing so many worthie and expert Phisitions and Chirurgians so neerely dwelling together that at all times the one may be able and readie to aduise and the other also as willing and sufficient to lend a helping hand yet in Countrie townes there are many nowadayes which doe practize the opening of vaynes almost in euery other Village one and most of them neither haue any learned counsaile to direct them neither are of themselues sufficiently instructed in the matter which they take in hand whereby though many of them do meane well and intend all for the best yet in the euent both to the harme of their patients and also to their owne griefe there often insueth more hurt and danger then ease and succour And another as great an occasion there is of many detriments and hinderances to mans health to wit the wilfull temeritie and rashnesse of some ignorant people which for euery small impediment haue recourse presently to letting of bloud and by their vnaduised importunitie do vrge forward the Chirurgian and euen greedily draw vpō themselues those manifold inconueniences from which afterward they can not againe so easily be deliuered and made free For although on the one side the benefits be most excellent which redound by Phlebotomy being rightly duly administred for thereby the fulnesse of the body doth come to a mediocrity griefes which come by extension are pacified the spirits are refreshed naturall heate euented the lims being as it were eased of a great burthen are made more quick ready to execute euery office nature is inabled to concoct what is requisite and to expell the vnprofitable flowing humours are either drawne back or turned aside from the place where they annoy or else are they dispatched and vtterly auoyded narrow and obstructed passages are opened and finally very present help is brought thereby to many dangerous infirmities Yet on the other side great also are the harmes which may ensue by letting of bloud if the same be rashly and vnconsiderately attempted the spirits and bloud are spent and wasted the naturall heate is pluckt away and dispersed the principall parts are made ouercold and vtterly lose their strength old age is hastened on and made subiect to palsies apoplexies dropsies and cachexies or bad habits many the bridle of choler being taken away do in a moment fall into most faint Iaundises many haue the one halfe of their hearing and sight diminished and the one arme and the one side vtterly weakened and many also are brought to an vnrecouerable destruction of their health and life To redresse in some part these most perillous incidents I haue collected out of the most famous Phisitions both auncient and moderne this discourse of Phlebotomy which although it be penned as commonly Phisick treatises are in plaine and familiar words most fit for them to whome it is principally directed yet because it comprehendeth the handling of one of the greatest remedies of corporall griefes as a learned Phisition commenting vpon Galen ad Glauconem doth write Venae sectio in magnis remedijs ab omnibus medicis semper habita est And Messaria the chiefe Doctor and professor of Padua in a treatise of Phlebotomy dedicated to Contarenus a worthy Senatour of Venice sayth Inter medica remedia nullum sanguinis missione nobilius nullum praestantius nullum tutius and doth call it further generosum praesentaneum vitae hominis praesidium And seeing also that amongst the high cares and charges which chiefe peeres and gouernours do beare in common wealths this seemeth not to be the least which concerneth so neerely the health the strength and euen the life it selfe of so large a part of the inferiour commons I haue therefore aduentured most humbly here to present and offer this my first part of the great Phisick remedies vnto your Honours patronage and fauourable protection not doubting but that according to your Lordships accustomed clemencie you will vouchsafe the same thereof not so much respecting the poore gift as the good heart of the giuer and according to your prone inclinatiion vnto the truth and to the generall good of the commons your Honor will haue greater regard vnto the graue auctorities of the auctors out of whome these obseruations are collected then vnto the homely phrase and plaine method of the obseruer and collector thereof The eternall God who hath heaped vpon your Lordship all those degrees of honour vnto which your noble Progenitours haue often heretofore bin most worthily aduanced graunt vnto your Lordship with the like good successe as they in former times haue done many prosperous yeares happily to inioy them to your dayly increase of honour and to the good and glory of our English nation euer continuing you in the high fauour of our most gratious Soueraigne and blessing you perpetually both in this world with the loue and hartie affection of the whole Commons and also for euer with the happie societie of the Saints in the life to come From Tanridge in Surrey this 29. of August Anno. 1601. Your Honours most humble in all duties to be commaunded Simon Harward The Preface declaring
the order and contents of these two bookes of Phlebotomy BEing purposed and resolued for the more generall benefit of my countrymen to publish in two english treatises the first whereof I do heere in title Phlebotomy and the other godwilling hereafter as soone as leysure shall serue Cathartice as compandiously and as orderly as doth or shall lye in my power all the chiefest aphorismes and conclusions which haue bin handled and written by the most famous Phisitions of all ages as concerning such cautions and circumstances as are to be obserued in letting of bloud or purging the body of man Although in practise it doth in many cases fall out that purging ought to take place before the opening of any vayne as shall hâ—ereafter more at large appeere in this booke yet for as much as bloud is the most excellent and principall humour that is dispersed in the whole body according to that of Galen 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 the best and most familiar iuice in man is bloud I haue therefore thought good in my methode of declaring how we must deale with these seuerall humours to follow the example of diuers learned men of our time to wit in respect of the disposing of them to giue vnto bloud the first place and preheminence These two remedyes are not onely accompted the chiefest amongst the kinds of euacuations but also amongst all other corporall helps prescribed or inuented for the curing of mans infirmities As well affirmeth Mercurialis Duo magnorum auxiliorum genera reperiuntur purgatio nempe sanguinis missio There are two kinds of great remedyes found out to wit purging and letting of bloud These 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 are called great helps because they are applyed vnto great diseases and also because howsoeuer they beeing abused do bring the greatest harmes yet beeing well and rightlie administred they do bring the greatest and most present cases and remedyes that euer either inwardlie or outwardlie were deuised for mans health This my first part of the Remedia magna in Phisick I haue comprehended in two bookes the summe and contents whereof as also of euery part thereof I haue thought it not amisse first briefely to prefix and lay open to the view of the well willing reader The first booke shewing what Phlebotomy is and to what vse it serueth in seuerall diseases conteyneth tenne Chapters The first what Phlebotomy is and of the foure distinct kinds and vses thereof The second how letting of bloud ought to be vsed in continuall agues as also in burning feuers The third how bloud-letting may be admitted in some kinds of diary agues made by obstructions The fourth how farre letting of bloud may be allowed in intermitting agues quotidians tertians and quartaines The fift whether letting of bloud be to be admitted in the Plague and pestilent feuer as also in the Poxe measels and such other contagious infirmities and when and how The sixt how letting of bloud is to be vsed in phrensies quinsies pleurisies inflammations of the raynes or wombe and other inward inflammations as they are considered in themselues without agues The seauenth in these dangerous inflammations aforesayd whether euacuation or reuulsion be more necessary on whether side the vayne is to be taken for reuulsion and what is the meaning of Hippocrates his rule 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to flow rightly or with a right course The eight whether letting of bloud be to be practised in cold diseases as palsies cramps apoplexies and whether it may fitly be vsed in melancholick windes colicks and dropsies The ninth whether in rheumes and distillations as also in the gout and in Morbus Gallicus any benefit may ensue by letting of bloud The tenth whether letting of bloud be expedient for such as haue hoat liuers and cold stomacks as also for such as haue itches and scabbes and such other faults of the skinne Further whether it be fit for the disease called of sea-faring men the skuruy and for the cachexia or bad habit of body and finally what and how many are the drifts and scopes in letting of bloud The second booke concerning the rules and circumstances which are to be obserued when for the preuenting or curing of a disease any vayne is to be opened conteyneth likewise ten Chapters The first whether the party that is to be let bloud haue truly that distented plenitude which is called of Phisitions corpus plethoricum and how the seuerall kinds of plenitude may be knowne The second of the consideration of the temperature of the party what it is by manner of diet or by exercises or by place of aboad or by custome or by habit or by constitution of body The third whether the body haue neede to be prepared before letting of bloud The fourth of the age sexe and solubilitie of the party whether old men or children or women being either with child or hauing their termes may be let bloud Also whether any hauing bodies either too costiue or too soluble may be let bloud The fift of the state and time of the disease what consideration is to be bad thereof in bloud-letting and which we must regard most of the powers the animal the naturall or the vitall The sixt of the time of the yeare the time of the constellations of the planets and the time of the day most fit for letting of bloud The seauenth on whether side the vayne is to be taken when we let bloud to preuent diseases or to auoyd or deriue their matter as also what vayne must chiefely be chosen for sundry infirmities The eight what manner of incision must be made how large how small how deepe what quantity of bloud may be taken and therein of the meaning of Galens word to let bloud ad animi deliquium The ninth what order must be taken with them that are let bloud as well in the act it selfe to preuent swounings as also afterward for their gouernment and diet The tenth how defects and errors are to be supplyed and mended and how the Phisition and in his absence the Chirurgian may know by the bloud being a little while reserued what course is further to be taken with the patient Before I enter into the discourse vpon these seuerall arguments I must pray the reader first to giue me leaue briefely to answere certaine doubts and occasions of offences which perhaps might arise vpon the publishing of this treatise First therefore if any because I baning heretofore committed to the pressse certaine Sermons and matters of Diuinity do now begin to set forth a Phisick worke do therefore gather or suspect that I haue conuerted my studies from the scriptures vnto Galen let him know that in this point I am vtterly mistaken by him for most of my phisick obseruations were then collected when first I gaue my mind that way which was long before I published any matter of Diuinity so that if there haue bin any alteration or conuersion of studies it hath
bin from the perusing of Phisick auctors to the reading of writers wholy theologicall And yet still the coniunction betwixt the body and soule being so neâ—re and the sympathy so great I see no cause but that he which studieth Diuinity may lawfully now and then so bestow a spare houre in viewing of the remedyes ordeyned by God for mans infirmities that he may be able in corporall extremities to yeeld reliefe as well particularly to himselfe as in common to his good friends If any do thinke otherwise if he be a Deuine I pray him that he will graunt me licence to compare small enterprises to those which were so farre more noble and excellent and to offer to his consideration that example of Moses which was learned in all the wisedome of the Aegyptians that is as Augustine doth expound it in Astronomy Geometry Arithmetick and such like which knowledges though they came sometimes from heathen men yet were they the gifts of God Qui operatur per malos non in malis Or to call to his remembrance Salomon whome the holy Ghost doth entitle with the name of Preacher and yet God gaue him wisdome also to discourse vpon philosophicall matters concerning beasts birds fishes and euery sort of simples euen from the greatest to the least from the Cedar tree to the mosse that groweth vpon the wall If he be a Phisition which supposeth that the study of Phisick can not be tolerated in them whose vocation is spirituall then doo I onely oppose against him the auctoritie of the most worthie Phisition and graue interpretour of Plato Marsilius Ficinus who because some did obiect agaynst him Nonne est Marsilius sacerdos Quid sacerdotibus cum medecina Quid cum astrologia commercij Ficinus maketh an apologie for himselfe proouing euidently Antiquissimos quondam sacerdotes fuisse medicos pariter astronomos He addeth for proofe quod sanè Chaldaeorum Persarum Aegyptiorum testantur historiae Ad nullum praetereà magis quà m ad pium sacerdotem pertinere singularis charitatis officia He concludeth officium verè praestantissimum est procul dubio maximè necessarium inprimis ab hominibus exoptatum efficere videlicet vt sit mens sana in corpore sano id autem tum demum praestare possumus si conâ—ungimus sacerdotio medicinam Now if there be any that shall thinke it strange that I do so often alleage the testimonies of Fernelius Fuchsius Montanus and others as relying much vpon them and yet do in some poynts a little dissent from them I wish them to be certified that I haue a reuerend opinion of those writers and am very willing that in those positions which are best determined by them they should in no wise be frustrated of their due prayse and glory But if others in some doubts haue found out more then they then do I chalenge liberty as neere as I can to make choyce of the soundest and in these humaine matters to be as the Poet speaketh of himselfe Nullius addictus iurare in verba magistri Where Galen doth well I must needs giue him his due commendations and euen admire those singular gifts of nature which God bestowed vpon him but where he skoffeth as he doth sometimes at Christianitie there I detest and abhorre his blasphemies and leaue him to the iudgement of that God to whome only it is knowne whether euer before his death his heart were better lightened with some beames of sparkles of his grace The words of those excellent Greeke and Latin Phisitions vpon whose auctorities and the reasons deliuered by them these my assertions are grounded I haue not set them downe in the proper languages of the first auctors because my purpose was as neere as I could to reduce the whole matter into a briefe and compendious treatise but I haue both faithfully Verbatim translated them and also in most places caused the chiefest parts of their arguments and conclusions by a seuerall print to be apparantly distinguished very plainely to be discerned By which distinct forme of character as also by the bookes and discourses cited in the margent it may euidently appeere that howsoeuer to put some difference betwixt this my labour and an other english Phlebotomy heretofore published I haue prefixed my name to the title of the whole worke yet I do not presume to cary away the matter as of my selfe but am very desirous that the louing reader should be satisfied with the iudgements of those worthie and famous writers whose counsailes and aduises can not I hope but be welcome vnto them which with modest and well affected mindes shall desire to imbrace the truth The first booke of Harwards Phlebotomy The first Chapter What Phlebotomy is and of the foure distinct kinds and vses thereof PHlebotomy is the letting out of bloud by the opening of a vayne for the preuenting or curing of some griefe or infirmitie I take in this place bloud not as it is simple and pure of it self but as it is mingled with other humours to wit fleame choler melancholy and the tenue serum which all as Fernelius sheweth as they are conteined together in the vaynes are by one word vsually called by the name of bloud And although it still fall out that other humours are also by Phlebotomy euacuated out of the whole body yet as Fuchsius doth proue out of Galen it is properly the remedy of those diseases which of the ranknes of bloud haue taken their originall There are foure seuerall sorts and vses of letting of bloud The first is called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 euacuatio The second is called 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and of Montanus euentatio The third 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 revulsio The fourth 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 deriuatio The first which is called Euacuation is the auoyding of that repletion and fulnesse whereby the body is ouercharged Repletion or fulnesse called of the Grecians Plethora is an vniuersall redounding of bloud It is of two sorts the one is called quoad vasa when the vaynes and vessels conteyning bloud haue their whole capacity fully and thoroughly filled and the second repletion is called quoad vires in which the vaynes do not swell and yet they conteyne more bloud and nourishment then by nature can be ordered and gouerned In the repletion quoad vasa as Montanus sheweth are two dangers first least by the immoderate quantity there should happen either suffocation or the rupture of some vayne and secondly least the abundance of bloud should corrupt and putrefie For the auoyding of both these perils it is very expedient that in a full body a vaine should be opened although no griefe do draw vs thereunto but only the meere fulnesse For as Hippocrates sayth The full habit of the bodies of champions if it come to the highest degree of fulnesse it is fraile and slippery for it can not contiune long in the same estate The second kinde of
beginning of the disease but not if it be a hectick phrensy of any continuance Celsus doth affirme that the face being red and the vaynes swelling a vayne may be opened after the fourth day if strength be sufficient But if it come of a cholerick cause then it should seeme to be ill done to let bloud because as Heurnius obiecteth fraenum bilis est sanguis bloud is the bridle of choler To this he answereth Male sanguinem sine bile educeremus imo plus bilis educimus quà m sanguinis Hardly can we auoyd bloud without choler yea rather by Phlebotomy we do bring out more choler then bloud And if it were done but only for deriuation sake yet were it well done But at what time must this Phlebotomy be vsed Caelius Aurelianus sayth that it must be done within three dayes of the beginning and not beyond because in such diseases the strength of the body is in perill Aretaeus also sayth that it ought to be done either the first or the second day If the phrensy begin after the fourth day then open the vayne after the seauenth day but if it do come in the sixth or seauenth day then let no bloud for that is a criticall phrensey Aâ—tius sayth that if the phrensy do come with an ague any day before the fourth day and signes of plenitude appeare wee may well open the middle vayne When the phrensy is old letting bloud is not safe Caelius sayth that to let bloud after the eight day est iugulare homines is nothing but to murder men The quantity must be according to the cause If it proceede of inflamed bloud you may let bloud vsque ad animi deliquium till the heart begin to fayle For there is a vehement inflammation a very sharp feuer and exceeding great griefe in which three cases Galen alloweth large Phlebotomy But if the bloud be much mixed with choler then sixe ounces shall suffice or if the party be strong tenne ounces Aretaeus his opinion is that if it haue the first beginning from the parts about the midriffe then the party may bleed more largely because thereabouts lyeth the fountayne of bloud What you do you must do at once for the disease doth giue no long truce Trallianus commaundeth the vayne of the forehead to be opened But that Heurnius doth condemne as ministring a further increase to the discase especially if the phrensy come of bloud for both the bloud should turne his course into the head and also the euacuation should be made by the very place affected which should be as he thinketh very inconuenient The course which Heurnius doth best like of is this first to open the midle vayne of the arme and after to open either the vayne of the forehead or the vayne vnder the tongue For the Quinsie or squinancie the swelling of the throate causing difficultie of breathing and hardnesse of swallowing Trincauel doth aduise a speedie letting of bloud yet a glister being vsed before if the disease will giue leaue but if the disease as it is a very sharp disease will giue no space then may we do as Hippocrates sometime did that is first let bloud afterward minister the Clyster Fuchsius willeth vs to open the basilica of the arme of the same side where the swelling is But he will haue it to be done at seuerall times by little and little and not all at once least there should happen a swouning and so a perill of suffocation and besides By two sodaine coolings and by fainting of the heart the matter may be caryed from the iawes vnto the lungs and so bring ineuitable danger Yet must not the incision be made too little least by meanes of the narrownesse of the hole the good bloud should be as it were strained out and the thick part remaine within which is the cause of the griefe If the patient be a woman whose termes are stayed open first the saphena and then the vaine vnder the tongue For the pleurisy how conuenient bloud-letting is for it it is a thing so well knowen to all men that there needeth no proofe thereof But on what side the vayne must be taken whether on the same side that hath the inflammation or on the contrary side seeing that there is amongst learned Phisitions a great controuersie about that matter I haue appoynted one Chapter to wit the Chapter next following wholy for the discussing of that question And for as much as also all the arguments layd open in that disputation do as well concerne the inflamation of the raynes and of the wombe and all other inward inflammations as the plurisy I haue thought it good to speake no more of the particulars heere but rather to conclude with that generall speech of Galen To speake briefly when inflammations do begin we must euacuate them by reuulsion that is pluck it back into the parts furthest distant but when they are of long continuance we must empty them out of the places affected or as neere vnto those parts as we can For at the beginning of inflammations it is good to turne back that which floweth but when they haue remayned a long time we must auoyd and expell that which is impacted and fastened in the part affected CHAP. 7. In these dangerous inflammations aforenamed whether euacuation or reuulsion be more necessary and what is the meaning of Hippocrates his rule 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to worke directly and with a right course of flowing PEtrus Brissotus and Matthaeus Curtius two learned Phisitions the one a Frenchman and the other an Italian haue by many arguments prooued that in a pleurisy the vayne ought still to be opened in the arme of the same side where the griefe lyeth Trincauel in his treatise which he calleth rudimentum hath vndertaken to confute them The first reason of Brissoâ—us is because in such sharp diseases vnlesse you help presently the party dyeth And the first scope in an inflammation is to auoyd bloud out of the place inflamed for the performance whereof the same side is most conuenient Trincauel answereth that when the party hath no full body then that position may well stand But if there be a full body then he holdeth with Galen that the scope and purpose of the Phisition must be to forbid that the bloud shall not flow to the place of griefe For the flux of the bloud doth Galen make to be the cause of the vehement inflammation And this staying of the flowing of bloud he thinketh may best be done by euacuating so that we may also reuell the same by drawing it back to the contrary side Brissotus againe obiecteth that by reuulsion there is often stirred vp a pleurisy on the other side vnto which the reuulsion is made Trincauell doth answere that doth happen by meanes of the fulnesse of the whole body especially of the lower parts when the opening of the vpper vaynes can not auoyd so
there be a heate of the raynes there is made the stone if of the liuer the iaundise and if of the brest the salt rheume Razes doth commend in a rheume letting of bloud But Heurnius doth restrayne it with certaine limits He will not haue it to be vsed vnlesse there do appeare the signes of fulnesse of bloud as the rednesse of the face and eyes and extending of the vaynes and vnlesse the body head appeare to be hote and the rheume salt with a matter not very farre differing from bloud and further vnlesse there be some danger of the instruments of breathing the lungs and the sides then he admitteth bloud-letting but as he saith sparingly and not too much but in a cold rheume the sweet mitigation of bloud is not to be taken away In the Goute Phlebotomy is not to be vsed vnlesse great fulnesse do of necessitie vrge thereunto There may this reason be giuen of it because that thinne distillation which floweth from the braine into the ioynts and being there thickned and setled doth cause the gout doth not fall downe by any vayne as Fernelius sheweth in his answere to the Phisition Bucherius but doth distill from the brayne to the neck shoulders and from thence to the feet partes consecuta subcutaneas hauing gotten for passage the parts vnder the skinne and because it is thinne doth flow vnsensibly Bucherius thought that because in the bloud that he saw drawne out of vaynes there appeared sometimes phlegmatick matter to flow out with the bloud therefore that fleame slipping out of the vaynes might be a cause of the goute But Fernelius doth confute him and sheweth that that which swimmeth so whitish in the basen is a kind of phlegmatick bloud such as doth abound in the disease called Leucophlegmatia and that it is so farre from sliding out of the vaynes into the ioynts that it can not be drawne out of the vaynes by strong medicines For that fleame which is fetched out of the body by purgings and vomits doth not come from the vaynes but it is wholy either from the brayne or from the stomack or from the bowels He addeth I thinke this to be one of the greatest errours of the common sort of people that in all diseases they place the faults of the humours no where else but in the vaynes and when the question is of humours they vnderstand nothing of those which do abound in other places but only of those which are mingled with the bloud in the vaynes Although the cause and nourishmēt of the gout doth not flow from the vaynes yet if the party haue a full body it will be very dangerous for him to omit letting of bloud for that attenuating and resoluing diet which by meanes of his disease he must vse will make his plenitude the more perilous vnlesse hauing first purged his body he do also cause some vayne to be opened The like reason doth Fernelius giue in his curing of morbus Gallicus after that he hath aduised the body to be twise or thrice purged he sayth that also he must be let bloud as his fulnesse shall require and sterngth permit for so not only the inward parts and whole body shall be cooled but also the dangers of plenitude which may be stirred vp by the vse of attenuating and resoluing things shall be thereby auoyded What vayne must be chosen in the gout when bloud-letting is thus found requisite Galen doth declare towards the end of his booke of Phlebotomy In the gout we must open the vain◠in the cubite but in the falling sicknesse and in that swimming in the head which maketh all things seeme to go round we must do it rather in the legs But how doth this agree with that place which I haue alleaged before out of Galen in my seuenth Chapter If one leg haue an inflammation scarify and let bloud in the other Humours do seeme with greater difficulty to ascend then descend and the hollow vayne in the lower part of the body deuiding his branches equally to both the legges it should seeme that the legge is not only the fittest place according to some 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to diuert or reuell but also the meetest place to make euacuation Fuchsius sayth that Galen doth commaund in the gout to let bloud in the arme for two causes first because both the legs in that disease are afflicted though not both at once but per vices one after an other and secondly because in the goute the bloud doth only offend in plenty and is not so putrified and vicious as it is in a hoat and red inflammation But seeing the chiefest intent of Phlebotomy in the gout is to euacuate the fulnesse of the whole body it may therefore seeme especially for that cause most fit to open a vayne in the cubite As for the matter of the disease it is rather auoyded by a good fit diet dry and moderately warme and the vse sometimes of things that do extenuate and resolue then by seeking to draw out either the cause or the nourishment thereof by the vse of Phlebotomy CHAP. 10. Whether letting of bloud be fit for such as haue hoa◠liuers and cold stomacks as also for such as haue itches and scabs and such other faults of the skinne Further whether it be good for the disease called of the seafaring men the scuruy and for the cachexia or bad habit of body and finally what and how many are the drifts and scopes of letting of bloud MOntanus in his conference had with a Doctor called Sonzinus about a man which had bin lately a souldier who was iudged by his busy fierce practises by the rednesse of his face and by the fulnesse of the vaynes about the eyes and other places to haue a hoat brayne a hoat heart and a hoat liuer and by the red sand and heate of vrine appeared also to haue hoat raines and yet hauing so many parts hoa◠had y◠stomack cold by meanes of the heate of the liuer wasting and consuming the fatnesse of the cawle or sew which should conscrue and keepe in the due naturall heate of the bowels and who also by these occasions for want of good concoction had many rheumes distillations making his body very soluble by meanes of their slippery descending which otherwise in regard of so many hoat parts must needs haue bin very costiue he saith Here I would commend principally bloud-letting to take away the heate of the liuer and of the inferiour parts the body being first gently purged by cassia Yet if the infirmitie haue continued long and brought the body to a great weakenesse Trincauel will then in no case admit Phlebocomy For giuing his aduise to one which had a boat and a dry liuer but a moist stomack and who was troubled with plentifull thinne spitting with paines in the ioynts and lassitude of the whole body he sayth In this body so spent with
leanesse and lingring sicknesse and moreouer so full of crudities I dare not so much as once make mention of letting of bloud As for the itch which is thought by Melinus a learned Phisition to be the same which Galen calleth after Hippocrates 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 spontaneae lassitudines The same Phisition Melinus being himselfe fallen into it when the other Phisitions about him and a Chirurgian who was procured to come by the French kings Embassadour did all earnestly perswade him to be let bloud and shewed what good they had done in the like cases by bloud-letting Melinus did refuse to yeeld vnto it cleaâ—ing stedfastly to the iudgement of Galen who in this impediment of the itch and scabs will haue either no bloud to be taken at all or else very little and that rather to pluck back then to euacuate The common opinion of Chirurgians was that the more corrupt the bloud was the greater quantitie he might spare of it But he relyed wholy vppon that auctority of Galen Of these kinds and degrees of sanguisication some little differ from bloud some more and some most of all In those which on either side differ but a little from bloud you may boldly vse Phlebotomy In them which differmore do it more warily but in them which are most departed from bloud vse it not at all If the good bloud be little and the other humour much then abstayne from letting bloud but if the humour be little and the bloud plentifull then boldly vse Phlebotomy Melinus though he knew these conclusions of Galen yet because the case was his owne and did so neerely concerne himselfe he sent a letter to Fernelius laying open the whole case vnto him and desiring him that he would declare his iudgement coÌ„cerning this matter Fernelius subâ—â—ribeth to the opinion of Melinus and sheweth that in a pure plenitude of bloud the fulnesse may safely be deminished by Phlebotomy but in an impure plenitude that hath a cacochymia or vicious humour mingled with it the fulnesse must be a little eased by opening a vayne sparingly and by distances of time and the rest of the impurity must be taken away by purging But then doth bloud â—etting most harme when the ill humour is bred as it is most commonly by the fault of the liuer and stomack For the bloud though impure being taken away a much more impure doth succeede He giueth instance of the iaundise the cachexia and that kind of dropsie which maketh the flesh spungie and the whole body to swell For the iaundise in a full body it may sometimes be vsed either when it commeth by the ouermuch heate of the liuer according to Montanus or when it commeth by the obstruction of the gall according to Fuchsius The caâ—hexia or bad habit of body is perceiued as Trincanel sheweth by many outward signes which are commonly these the swelling of the face especially vnder the eyes the countenance and whole body discoloured a swelling in the belly such moyst and waterish pussings vp of the legges and feete that if you presse in your finger it will leaue a dent or hole the mouth alwayes full of spittle vomitings vp of some watery matter and nippings about the heart The scuruy seeing as Wierus declareth it commeth of the obstruction of the spleene whereby the thinner part of melancholy is caryed vpward and with a sharp corrosion doth infect the gummes and the grosseâ— part thereof falling downe doth infect and spot the legs I shall neede to say no more of it then I haue set downe already in the eight Chapter concerning the obstructions of the spleene and experience hath taught vs sufficiently that much ease may come vnto it by the right and aduised vse of Phlebotomy Baldwinus Roussaeus declareth what vayne in his iudgement is most fit to be opened in the scuruy If the humour be not fallen downe he counsayleth bloud to be let out of the middle vayne of the left arme but if the melancholick iuice hath already flowed downe to the hips then open the vayne of the knee or of the anckle I leaue it to the reader to examine and measure this aduise of his as well by those principles and grounds which I haue discussed at large in the seauenth Chapter of this present booke as also by those circumstances and other obscruations which I shal haue occasion to intreate of hereafter in the former fiue Chapters of the booke next following Thus you haue in this first booke the first scope and intention of bloud-letting briefely laid open to wit in what infirmities the greatnesse of the discase doth require a vayne to be opened For as first Hippocrates and after him Galen doth declare there are three especiall points to be marked in the drift purpose of letting of bloud The first is called by them the greatnesse of the disease whether it be present or to come whether acute or of long continuance if it be great dangerous strong or grieuous The second is a flourishing age neither too yong nor too old for the vndergoing of that remedy The third is the strength of the powers of the patient True it is that Galen doth sometimes name diuers other scopes and intents in the matter of Phlebotomy In his method of healing he reckoneth eight There are in this opening of a vayne many scopes and obseruations 1. The first nature and temperature of the party 2. his manner and custome 3. his age 4. the place of abode 5. the time of the yeare 6. the constitution or the state of the heauens 7. the affection of the disease which we haue in cure 8. the strength of the patient Sometimes he nameth tenne besides the age as in his treatise of Phlebotomy If in respect of age they be neither children nor old folks then consider of Phlebotomy hauing a regard especially to these first scopes and drifts 1. the quantity and quality of the plenitude 2. the strength or weakenesse of the powers 3. the naturall habite of the whole body 4. and the time of the yeare 5. and the region or place of habitation 6. the former life whether the party so affected haue vsed a fulnesse of meates and drinks and especially such as are of great nourishment 7. custome or discontinuance 8. what motions and exercises he hath vsed 9. whether he haue had heretofore any euacuations which are now withholden against custome 10. and moreouer besides all these whether the party be leane or grosse All these varieties doth Galen bring into a briefer diuision and reduce them into two seuerall heads first such scopes as declare whether bloud be to be let or no and secondly such as shew what quantity of bloud is to be taken To the first do appertayne the three generall scopes of Hippocrates and to the second sort do belong also all the rest For so be
the words of Galen Therefore by the disease and the age and the powers we know that bloud is to be let but the quantity of the euacuation is to be gathered not only by these but by all the other intentions The second booke of Harwards Phlebotomy concerning the rules and circumstances which are to be obserued when for the prenenting or curing of a disease any vayne is to be opened The first Chapter Whether the party that is to be let bloud haue that dâ—â—bented plenitude which is called of Phisitions corpus plethoricum and how the feuerall kindes of plenitudes may be knowen THe principall thing whereof consideration is most to be had in letting of bloud is named of most writers to be magnitudo morbi the greatnesse of the disease of which I haue no purpose now to write seeing it is in a manner the whole matter subiect of the booke already ended When it is found by the nature of the disease that a vayne is to be opened then we are next to examine the constitution of the party from whom the bloud is to be taken and especially by all signes and tokens exactly to waigh whether he haue corpus vere plethoricum a body ouercharged with the fulnesse of the vaynes or rather with excesse of humours ouer the whole body as Galen doth define it Plenitude is an abundance or an excesse of humours thoroughout all the body There are two sorts of plenitude the one is called ad vasa in respect of the vessels conteyning and the other ad vires in respect of the power not to be able to beare those humours that are The plenitude quoad vasa is made by Galen to be of two sorts the first he calleth simply a plenitude which he defineth to be the foure humours being proportionably increased The second kinde he calleth a plenitude with an addition or a plenitude compound when some other humour besides bloud doth abound more then it ought These I will not stand vpon because I haue already deciphered them in the first Chapter of the first booke There remayneth only heere to set downe the marks and euident signes whereby they may best be knowne when the patient commeth in presence If there be a fulnesse of bloud in respect of the vaynes and other vessels then the colour both of the face and the whole body will be much enclined to red after any strong motion the vaynes will swell and the arteryes beate a sweate will easily breake out a wearinesse doth oppresse the body and lims which are loth to moue by reason of their owne waight the hand can hardly be clutched together the drawing breath will be very thick after exercises In the fulnesse in respect of ouercharging the powers and strength these things do happen the motions of the body lims are somewhat slower the sleepe is heauie but troublesome the partie doth often dreame that he is ouer-charged with some burthen and that he can not stirre himselfe and he feeleth likewise a wearinesse and heauines as is in the former but it is without those full and distented vaynes If the bloud do particularly exceede in these plenitudes then some do adde moreouer these signes the pulse thick full and soft the laughters great the head enclined to aches the body somewhat costiue the spittle sweete the vrine red and thick the dreames either of colours red or of things amorous and in women their termes vsually in the first quarter of the moone When any other humour doth abound it is called a cacochymy A cacochymy is an abounding of any other humour but bloud If choler do abound the colour of the face and eyes and whole body will be pale or yellow or of a citrine or tawny colour the party will be watchfull and of little sleepe griefes will be most on the right side vomitings will be often the thirst much and the appetite to meate faint the pulse will be slender hard and swift in the mouth sometimes a bitternesse the vrine of a firy colour and with little ground or sediment the dreames will be much of matters of fire and the termes vnto women happen most in the second quarter of the moone If fleame do abound the colour of the face and body will be white the body it selfe waighty fat soft and cold the tast weake the griefes most about the ribs stomack or the hinder part of the head the pulse slow soft and weake the vrine pale or white sometimes thinne and sometimes thick with much grounds or sediment the sleepe sound and much the dreames either of drowning or watery matters and the termes vnto women vsually in the old of the moone If melancholy do exceede the colour of the face and whole body will be browne dusky and blackish sometimes equally and sometimes somewhat bespotted feares will come needelesly and sorowes without cause the pulse will be hard the vrine will be thinne and white and sometimes when melancholy doth auoyd it will be thick and black or black and blew or somewhat greenish the sleepe troublesome and full of fearefull dreames and the termes to women commonly after the full I could here rehearse many other signes whereof Leuinus Lemnius doth make mention drawne from the fashions studyes and manner of life of the party to make tryall of euery one by the manner of his gate by the deuises of his braine and by the performance of his actions but then I should perhaps make some to thinke too well and some too ill of themselues although in deede hardly will any thinke too ill and I should increase this latter booke into a greater quantity then is now my purpose to performe Briefely I conclude this first poynt concerning the plenitudes with the censure and iudgement of Galen who when he hath brought them all to two generall heads When the humours are equally increased they call it in Greeke plethos or plethora but when the body is full of yellow or black choler or of sleame or of thinne whayish moystures then they call it not plethora but eacochymia He doth presently after shew how they must be holpen and amongst the remedyes of plethora he maketh letting bloud the principall Plethora is cured by letting of bloud but for cacochymia he maketh the chiefest remedy to be purging But cacochymia is cured by that purging which is proper and peculiar to euery seuerall abounding humour If this cacochymia be also with a disâ—ented fulnesse then must also Phlebotomy be vsed but sparingly only so much as may ease the plenitude and rather as Fernelius doth aduise ex interuallis detrahendo quà m vniuersim affatim vacuando sublata plenitudine praecipiti periculosa reliqua impuritas cacochymia purgatione eximenda est But of this already in the last Chapter of the former booke CHAP. 2. Of the consideration of the temperature of the party what it is by manner
of dyet or by exercises or by place of abode or by custome and habit or by constitution of body IT is not without good cause that Fuchsius loth require in Phlebotomy that an especiall regard be had in it of the dyet which the party hath vsed whose vayne is to be opened for if he haue vsed much surfeâ—â—ing and so gotten an aboundance of raw humours he is then not to be let bloud as he secketh to prooue out of those words of Galen To intemperate men wine-bibbers and gluttonous surfetters thou shalt bring small profit either by purging or letting bloud Although the purpose of Galen indeede is not in that place to deny purging and letting of bloud to them which by surfetting are already filled with raw humours as Fuchsius doth seeme to apply it but to shew that it is a needlesse enterprise and a very lost labour to apply vnto intemperate men these soueraigne remedyes seeing that they haue gotten such a custome and habite of riotousnesse that they will presently fill themselues againe with all noysome humours for so doth Galen there giue his reason For they which do vse an intemperate dyet do quickly gather an aboundance of raw humours and therefore we must not so much as endeuour to heale them Besides excesse and surfeiting a due regard must be had whether the party that is to be let bloud haue vsed though temperatly such drinke and especially wines as are apt to ingender much bloud for in houses of great personages and in cities where wine is much in vse there is farre greater necessity of letting bloud then in those countrey villages where their accustomed drinks are of lesser and weaker nourishment And especially seeing the former liuing in ease and without any great exercises do soone gather store of superfluous humours they may therefore admit a more liberall bleeding but the later continually labouring toiling do leaue in their bodies yâ— lesse store of superfluâ—â—eâ— and therefore may the lesse endure any plentifull Phlebotomy And yet as well in cities as in countries the temperature of the place of abode may also make some difference They which haue hoat and dry habitations in sandy places haue much of their naturall heate and humours spene discussed and scattered and therefore must bleede lesse then they which dwell in more cold and moyst places where the strength of the naturall heate is not so apt to be disperseth prouided alwayes that the place be not by reason of hard weather so extreame cold that the bloud should be as it were coÌ„geased for then to let bloud would be very perillous as likewise it would be inconuenient when the constitution of the party is ouer-hoat and dry to vse any great euacuation by Phlebotomy Galen sayth As many as are by nature boat and dry they all do easily receiue harme by liber all euacuations And in that place Galen in the words immediatly following doth shew that custome also is of great force as to all other things so likewise to shew what persons may best admit Phlebotomy For they which haue bin often accustomed to it do incurre more danger in omitting of it then they whieltâ—euer were acquainted with it Hippocrates doth giue it out as a general axiome Things accustomed though they be bad yet do they 〈…〉 lesse then those wherewithall we were neuer 〈◊〉 Auiceâ—â—a in his sixteenth Canon of bloud letting as Montanus hath deuided them doth declare three sundrie dispositions of mans stomack which cannot permit the opening of a vayne first if there be a great and quick sensibilatie of the mouth of the stomack secondly if it haue a faint debilitie and thirdly if there be a flux of choler flowing vnto it For the first Montanus sayth of all the lims the mouth of the stomack is made of quickest fecling and sharpest sensibilitie that thereby there might be an apprehension of hunger and being for that cause very sinoâ—y it hath great affinity and consent with the brayne and the heart whereby if there be a flâ—x of 〈◊〉 sharpe humour vnto it the brayne and the heart doe straight suffer with it and thereupon doth come a fainting and swouning By the debilitie of the stomack he meaneth not that weakenesse which doth come by distemperature but that which commeth by thedoâ—senesse of the stomack when the stomack can not bind in it selfe and gather it selfe together vpon the meate That loosenesse commeth of the moysture of it and they which haue this imbecillitie vpon euery light occasion they swoune and faint away and are therefore vnfit to be let bloud By the flowing of the choler to the mouth of the stomack he sheweth what indeed doth most offend the sensibilitie of that place and bring not only swouning but also other great dangers For as Galen writeth The mouth of the stomack by the quicknsse of the sense thereof doth bring both many other symptomes and also swounings From the liuer and the gall there are two passages one greater the other lesse The greater goeth downe to the gut which is called â—eiunum and the lesse goeth to the bottome of the stomack Some haue but one of these passages by meanes whereof many times cholerick men because they haue only that passage which goeth to intestinum ieiunum and want that passage that should go to the bottome of the stomack do neuer vomit choler And on the other side other that are phlegmatick do vomit often choler because they haue that passage which goeth to the bottome of the stomack but want the other which should go to the gut called ieiunum Montanus sayth of these that infaelicitatem habent à generatione they are vnhappy by the manner of their procreation and birth Those which haue the passage wholy to the stomack whereby choler is caryed to the mouth of it are knowne as Auicen sayth by this that they haue the mouth often bitter and do vomit choler vpon euery small cause such haue porum felleum infaeliciter compositum the passage of the gall vnluckily made Auicen sheweth that if there be a necessity of letting bloud in any that hath any of these impediments the party hath neede to be prepared and strengthened before any vayne be opened The manner how it must be done shall appeare in the Chapter following CHAP. 3. Whether the body haue neede to be prepared before letting of bloud IF the party from whome bloud must needes be taken be found to haue a great sensibilitie of the mouth of the stomack which is knowne by this that if you offer any sharp sower or biting thing such as is the iuice of limons or pepper he is straight offended then before he be let bloud that there may be no flux of choler to the mouth of the stomack you must giue him a few morsels of bread steeped in some astringent thing as in the iuice of quinces and of ripe peares If there be a relaxation of the stomack by
should expell the disease by the skinne because such purgations do trouble the motion of nature and yet at the same time doth allow a clyster of barley water one pound and a halfe of oyle of violets foure ounces of butter three ounces of red sugar candy one ounce or of each of them proportionably a lesse quantity if it be for a child and doth there condemne Nicholaus Florentinus for that he forbiddeth the ministring of a clyster at such time as the sayd diseases do begin to breake out for sayth he it is a fond thing to thinke that the motion of nature iâ— hindered by clysters seeing that they do worke only in the bowels and the motion of nature is both neere the skinne and in the vaynes neither do clysters so ouerthrow the poâ—ers that we neede to conceiue any feare Euen so for as much as in letting bloud our drift is especially either to case nature being ouerburdened or to expell some dangerous causes of putred matter by transpirations sweatings euaporatings and such like very expedient it is that we auoyd such purgings as whereby the worke of nature may be either troubled or weakened and content our selues with a more fit preparing brought to passe by glysters It is a great fault amongst very many in England that they are so nice and scrupulous in receiuing of a glyster as seeming to suspect some danger in that which indeede is the most easie and harmelesse remedy of all others And as great a fault it is in many of our countrey Surgeons which so boldly do commonly practise the opening of vaines neither hauing before any direction of learned counsaile neither being themselues stored with those things which should orderly prepare their patient therevnto They which do minister purging potions at that time when nature doth begin to moue say they do it because nature doth moue vnperfectly but to them Mercurialis doth answere intelligere an perfecte moueat in initio non possumus we can not know in the beginning whether nature wil worke perfectly or no. The safest and surest way is by a clyster so to ease the fulnesse and costiuenesse of the body that we do not disease the emptinesse and loosenesse of natures powers If the impurities and crudities be aboue in the stomack then shall it be requisite before Phlebotomy to vse some vomit as to take of the decoction of barley two or three ounces of oyle of sweete almonds and oximel simplex each one ounce of oyle of dill two drams mingle them and giue them for a potion Or if the matter be grosser and colder take of the seeds of rocket leekes radish broome each the waight of a shilling of the rootes of asarabacca and betony each the waight of sixe pence boyle these in water so much as being well boyled will make a good draught and being strayned dissolue into it two ounces of oxâ—mel simplex and drinke it off In hoater diseases the former will be more conuenient Fit vomits and clysters they make a preparation speedily and do nothing trouble the work of nature in expelling to and by the outward parts Pâ—rgations if they be strong they weaken nature if gentle then are they long in working and hauing some hoate qualities in them must needes as well by their heate as by their drawing a contrary way trouble that worke whereunto Phlebotomy is directed Fontanonus a learned Doctor of Mountpelier writing of that synochus or hoat coÌ„tinuall ague which proceedeth of bloud inflamed in the vaynes neere vnto the heart after that he hath appointed to begin the cure with present letting of bloud What houre of the day soeuer it be for feare least the bloud do creepe vnto the lungs and thereupon should come an inflammation of the lungs or least it should slip into the bulk and thereof should arise a pleurisie or finally least it should putrifie and so there should be made a putred ague of a not putred he sheweth after how the body must be made fit for this Phlebotomy not with a purging potion least while the purgation is long in working the patient should receiue harme by the aboundance of boyling bloud but by a clyster made after this sort Take of the foure emollitiues each one handfull the foure emollitiues are as skilful Heurnius doth lot them out 1. mallowes 2. marsh mallowes 3. violets or in stead thereof pellitory of the wall or mercury 4. branck vrsine or in steede thereof beets of endiue and lettise each halfe a handfull tenne prunes boyle all in a reasonable quantity of water vntill the third part be consumed then strayne it and take thereof one pound and a halfe dissolue into it of cassia newly extracted and red sugar-candy each one ounce of salt a little and you haue your clyster In stead of the pulpe or flowers of cassia may be vsed diacassia Mesuae or diacatholicum Nicholai or electuarium lenitiuum Rhasis any quantity betwixt halfe an ounce and an ounce and a halfe according to the strength of the party the most conuenient oyle to be added to them is the oyle of violets In stead of the aforesayde things the clyster may be made of a little soluble chicken-broth goats-milke and the yolke of an egge stirred and mingled and putting into it of manna and fresh butter each an ounce first melted together these be the ingredients most fit for the clysters of such as are to be let bloud And if any Surgeon by reason of his seate and place of abode be so situated that he shall be enforced sometimes to open a vayne before the counsayle of a learned Phisition may conueniently be obteyned let him be carefull to haue some prouision of these things in store as he tendereth either the testimonie of a good conscience in respect of himselfe or sound and perfect health in regard of his patient For as before is shewed many are the harmes and dangers which ensue if at the time of letting bloud there be crude and corrupt humours in the stomack and bowels prest and ready to be suckt and drawne into the vaynes now newly emptyed by the administring of Phlebotomy CHAP. 4. Of the age sexe strength and solubilitie of the party whether old men or children or women being either with child or hauing their termes may be let bloud Also whether any hauing bodies either too soluble or too cosâ—iue may be let bloud FOr the beginning of old age there is no question but that bloud may be let very safely in it if other things be corespondent Trincauel saith that about the fortieth yeare of age that is about the beginning of old age we may most fitly be let bloud But Galen doth make three degrees of old age the first he calleth 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 signifying such as haue a greene and lusty old age such as are able yet to deale in the astayres of the world The second he calleth 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 the middest
of old age more fit for sleepe and rest then for toyle and labour to whome agreeth that of the Poet Vt lauit sumpsitque cibum det membra sopori WheÌ„ washt he hath food for sustenaÌ„ce receau'd His liâ—s of rest and sleepe let seldome be bereau'd The third sort he nameth 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 such as are ready to be sent away and haue one foote in the graue Although many be very much stricken in yeares yet if they fall into those diseases which require bloud-letting as sometimes they do then may a vayne be opened as Trincauel sheweth that in a pleurisie he did let an old man bloud being threescore yeares of age and he did happily speedily recouer but he made choyce of the vayne of the ankle and had a due regard of the strength of the party For as Galen sayth of diet so it may be sayd of Phlebotomy if old men do neuer so little exceede a due measure they take great harme whereas yong men though they transgresse very much yet their harmes are of short continuance Fernelius recordeth of Razes that by an occasion of a vehement pleurisie he did open a vayne euen in crooked old age but the old verse must be remembred Aetatis mediae multum de sanguine tolle sed puer atque senex tollet vterque parum Middle age mickle Old and yong little As for children how old they must be before they can admit Phlebotomy Platerus sayth If they passe once tenne yeares old if danger of an inflammation do hang ouer them I would be bold to open a vayne Fernelius doth aduenture further for when he hath set downe the example of Auenzoar who with good successe did open a vayne in his owne sonne being three yeares old he after maketh mention of his owne practise This we do commonly proue that in the sixt or fift yeare of age three or foure ounces of bloud doth end the pleurisie and such grieuous diseases He addeth his reason because they do often bleede at the nose and finde helpe and why should not arte imitate nature He concludeth There is no age which cannot indure some measure of euacuation Montanus doth giue two reasons why children should not be let bloud First because bloud is as it were the foode of children seeing that thereby they are not only nourished but also do grow and increase Secondly because when bloud is taken away one part doth succeede in the place of an other vt non fiat vacuum because there can be nothing cleane voyd and empty and thereby the body is made either windy or thinne and spungious and all the powers resolued as there he prooueth by the auctority of Galen But no doubt although Galen doe rehearle children amongst the number of them which are not fit to be let bloud as when he forbiddeth Phlebotomy to those which are apt by nature to haue the pores open as children and likewise when the constitution is very hoate and dry also to all which are of a thinne habit of body and moreouer to them which haue the mouth of the stomack either troubled with a sharp flux of choler or weake or of more sensibilitie then it ought to be his purpose is not vtterly to condemne letting of bloud in all these sorts of people when vpon vrgent necessity they are driuen to it but to shew that it must be done as seldome as may be as sparingly as may be and alwayes carefully endeuouring to remedy and meete with that impediment and danger for which the prohibition was made and whereunto that nature is found most subiect For in an other place Galen alloweth Phlebotomy in children Some Phisitions thinke that children haue no strength but they thinke amisse we may let them bloud if the disease be great But Galen doth in the same place except 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 yong children and he calleth them 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 yong children vntill they come to be fourteene yeares old and vntil that age he doth not permit their vaynes to be opened But if the hoat ague which he hath spoken of in the line before shall be in a yong child not yet fourteene yeares old it is not good to vse Phlebotomy for in such warme and moist bodies euery day there floweth out and vapoureth or sweateth out very much of the substance of the body Hippocrates also doth not allow Phlebotomy in yong children because their strength is soone ouerthrowne Quickly doth the power decay in children by meanes of the store which they haue of stowing out but it will continue sufficient in flourishing age Many doe exclayme vpon Galen as though his practise of Plusick were too strong and violent for the present estate of mans nature But we see in this point that Hippocrates and he are a great deale more wary and circumspect and more loath to ouercharge the strength of man then many of our late practicioners I thinke it farre more safe to follow them then to be so rash as to imitate those Spanish Phisitions of whome Massaria doth report that they vse to let bloud in infantibus vix annum secundum aut tertium natis in infants scarce two or three yeares old or that bold Auenzoar of whome Auerroes writeth that he let his sonne bloud being but three yeares old or yet to thinke that the experiments of Fernelius Fuchsius and Valeriola who aduentured to let bloud at fiue or sixe yeares old though perhaps sometimes they wrought good effect are therefore to be commonly tried againe by vs. For the reason which Fernelius doth alleage that seeing that by eruptions of bloud out of the nose they finde often case and therefore the Phisition must imitate nature Massaria answereth that he hath often obserued that those eruptions of bloud in children haue not bin healthfull to them but haue bin occasions of dropsies and of bad habits of body And for the experiments which as they say haue often done good he accompteth that either they were rather of fortune then of any good reason or else that the help was such as whereby they were better vncured then cured For many may haue for a time a mitigation of paine for which afterward they may be sory for many yeares following But if yong infants who vndoubtedly may sometimes fall into hoate agues called synochi and that also with aboundance of bloud may not haue their vaynes opened what course is then to be taken with them in those feuers which can hardly be taken away without diminishing of bloud Mercurialis doth appoynt two helps for them the one by cuppings and the other by leaches The leaches being applyed aut natibus aut cruribus they do draw out bloud by so small holes that there is no danger of wasâ—â—ng any vitall spirits As for cuppings whereas Rafes doth defend that they may be vsed vnto children at fiue moneths old and Auicenna will not
haue them vsed vntill the infants be at least a yeare old Mercurialis iudgeth it more safe to stick to the opinion of Auicen not to vse them till the children be a yeare old and that with these three conditions first that the child be full of bloud and of good strength secondly that they be rather applyed to the legs then to the vpper parts because bloud drawne from the lower parts doth not so much impaire the strength nor wast the spirits as that which is drawne in the vpper parts and thirdly that there neuer be taken aboue one ounce or two at the most In the Chapter following he addeth an other caution to wit that if we seeke to draw bloud out of places farre off we apply such cupping instruments as haue wide and large mouthes but if we purpose to draw from neere places then to vse such as haue narrow mouthes and therefore if we apply them to the legs they must haue wider mouthes and if to the places about the loynes the narrower Galen for old age telleth a pretty history of a mad Phisition which raâ—hly did let himselfe bloud Acertavne Phisition of fifty yeares of age being now a seauennight sick and not very strong hauing a great paine in his head not able to stay vntill some of his fellowes could come to him did in the night time let himselfe bloud and his paine quickly ceased But a long time after he was discoloured in his body weake in strength thinne and without nourishment so that hardly he could recouer that habit of health which before he had For women being with child Montanus sayth that wee must greatly suspect as well letting of bloud as any other euacuation in them both in respect of the nourishment of the woman and child and also for feare of an abortement or vntimely birth Especially he will haue them to be auoyded at those times when there is most danger of vntimely birth that is before the fourth moneth and after the seauenth moneth For whereas Hippocrates doth permit to purge women with child being foure moneths gone vntill they come to seauen moneths but them which are yonger conceaued or which haue gone longer we must beware of dealing with them Galen commenting vpon that place doth compare the child in the mothers wombe to the fruit of a tree which when it is very yong is soone fetched off with any wind or blasâ—ing and when it is very ripe it is ready to fall off it selfe but in the middle time it will remayne strong on the tree against all stormes and tempests So the infant in the wombe is most in danger of vntimely birth when the woman is either in the beginning or towards the end of her accompt But Montanus sayth purging bringeth more danger then phlebotomy Phlebotomy is then the mere dangerous if the child be great as is noted by Hippocrates A woman being with child is deliuered before her time if that be great wherewithall she is conceaued Galen expounding that aphorisme doth giue the reason of it because the bigger the infant is the larger nourishment it requireth Yet Montanus addeth that sometimes women with child do receiue much good by opening a vayne especially if they be full of bloud he sayth I haue seene some such women that if they had bin let bloud euery moneth it would haue bin without danger and againe if they had not had sometimes a vayne opened they would haue bin so grieuously sick that there would haue bin danger of an vntimely birth When superfluous bloud is taken away the foode remayneth more holesome for the child Fernelius doth more plainely oppose himselfe against the axiome of Hippocrates and yet not in his owne words but alleaging against him this censure of Cornelius Celsus Ould Phisitions did thinke that childhood and old age could not endure such a help as is Phlebotomy and they were perswaded that the woman which should vndergo such a kind of curing should procure an vntimely birth But afterward experience hath shewed that none of these cautions are perpetuall but that better obseruations are to be marked vnto which the Phisitions counsaile is to be directed for it skilleth not what are the yeares of age nor what the party doth cary in the body but what the strength is a stout boy a strong old man and a woman with child hauing an able body may safely this way be cured As Montanus doth limit and restrayne this liberty appoynting it not to be vsed vnlesse the woman be very full of bloud so Massaria doth likewise require that the Phisition should not only respect the present estate of a woman being with child but to forecast how she shal haue sufficient nourishment and strength to hold out vnto the appointed time of her deliuery Concerning women hauing their termes whether they may securely be let bloud it is thus resolued by Montanus writing vpon the seauenth canon of Auicenna concerning bloud-letting that if they haue them immoderately then may they open the vayne basilica for diuersion But if moderately and naturally then is Phlebotomy not requisite Yet he sayth if such a woman haue a pleâ—risie or a sharp feuer and be in danger that vnlesse the flux of bloud be eased by spitting there should come an inflammation of the lungs and vnlesse the force of the humour flowing to the breft be stayed there would be danger of a suffocation then must the saphena be opened though the woman haue her flowers For costiuenesse I referre the reader to the third Chapter of this second booke how it must be corrected before Phlebotomy As for the flux of the body Platerus doth giue a câ—aueat generally that such persoÌ„s as are apt to swouâ—nings should not be let bloud wheÌ„ they haue a dia rrhaea or loosenesse of the body because the flux doth make them more apt to swoune But otherwayes letting of bloud is of it selfe good for such flâ—xts as Auicen sheweth in his fourth canon and vpon it Montanus because there can be no vacuuin no voyd emptinesse therefore there is made an attraction out of the whole body by succession of parts one vayne draweth from an other vntill at the last it draw from the stomack as the like doth happen in hunger Now when the vaynes haue drawne first one from an other then they from the liuer then the liuer from the mesaraick vaynes and the mesaraick vaines from the stomack thereby the moysture being plucked away the body is made more bounden And besides that stimulating and tickling choler which did before passe downe and cause the flux to be more violent is by Phlebotomy drawne back from the bowels But how is it then that so many vpon letting of bloud do become straightway loose bodyed Montanus doth answere out of Auicen that it is non per se sed per accidens not of it selfe but by meanes of some other accident as of some timorousnesse and feare
moment It was a damnable opinion amongst the Chaldaeans to make the constellations of the starres to be a table of all fatall lawes as though the whole life of man were written therein As Tarutius Firmianus being skilfull in the Chaldaean sciences tooke vpon him by the manner of Romulus his life and death to calculate what time he was borne that because he wrought such actes and dyed in such a manner therefore he must needes be borne such a yeare and such an howre The superstitions of the Chaldâ—eans were such that they would not build a house nor attempt any iourney nor so much as put a new garment vpon them but they would first haue a regard of the constellations and planets These fond and wicked abuses of astronomy I do wholy reiect and disallow But in the vse of Phisick seeing that a great part thereof doth concerne the flowing and issuing the staying and the passing away of humours and that it is found by the termes of women by the fluxes and refluxes of the seas and many other wayes that the moone hath by the maker thereof certaine influences giuen vnto her much auaylable to the auoyding and correcting of humours I do not thinke but if it be found by the experiences of former ages that at sometimes and in some signes or aspects her forces are more violent then at other we may haue some consideration thereof and make choyce of such as are most meetest for our purpose euen as the husbandmen may also take such times for their grafting sowing planting and such like as by the proofes of all nations haue appeared to be fittest for the fruitfull growing and propagation thereof To returne now to our argument of letting bloud seeing that as I haue shewed the signe may sometimes seeme to be good and yet by other aspects the same may be controuled what course is then to be taken when for want of good helps we can not come to the knowledge of the aspects Surely then our best way will be to obserue the manner of the weather When the weather is setled to be very dry then are not humours apt to flow but in open and moyst weather we find them very fluxible Fernelius sayth The north wind vtterly forbiddeth letting bloud only the south wind doth best admit it in the cold time of winter The time of the day is made by Galen and out of him Fuchsius to be the fittest within an howre or thereabouts after the party is risen after the yesterdayes meate is prety well digested and the body eased as well by stoole as by making water Fernelius sayth in suffocante pleuritide angina quouis tempore fiat If the disease be an intermitting ague I haue shewed in the last Chapter that the fittest time is the middle betwixt two fits at what time of the day soeuer it be and the party must a little before be dicted thereafter Montanus sayth If he looke for the fit in the morning let bloud in the euening before Marsilius Ficinus will have schollers who abounding with bloud do vse Phlebotomy to preuent diseases to vse it both morning euening but at either time a little foure ounces in the morning and as many in the euening because it is dangerous to auoyd too much bloud at once but of this in the eight Chapter CHAP. 7. On whether side the vayne is to be taken when we let bloud to preuent diseases or to auoyd or deriue their matter also what vayne must chiefely be chosen for sundry infirmities ON what side the vayne must be taken in great dangerous inflammations where there is cause of reuulsions I haue shewed alreadie in the seauenth Chapter of the former booke It is not denyed but that in some cases it is requisite that the vayne should be opened in the same side where the inflmmation lyeth But if any do vrge a necessitie that it must needs be euer on the arme of the same side Trincauel doth aske one question Si in muliere supprimantur solitae purgationes ex ea occasione superuenerit pleuritis Item si ex retento sanguine ex hamorrhoidibus fluente vt ait Hippocr 6. epid in libro de humor quod quibus sanguis ex haemorrhoidibius fluere solet illi neque pleuritide neque peripneumonia capiuntur quae vena iam secanda illane quae costis affectis communicat an potius alia impellens particula but of this alreadie I hope sufficiently in the Chapter aboue named The doubt is now on what side the vayne must be opened when we do it to preuent diseases the old verse is commonly knowne Aestas Ver dextras autumnus hyemsque sinistras The spring sommer right side vains would haue But autumne and the winter left do craue But here we must take heed that we vse not too much to let bloud on one side for that thereby we see many to be brought to particular palsies and to lose the vse of one eye or care or the strength of one arme or side partly because the longer that superfluous humours haue found a vent in one place the more apt they are to haue recourse to the same place and if they haue not their former passage they will easily either make obstructions or breede some inconuenience and partly because the letting bloud too much on one side may perhaps coole that side more vehemently then is requisite If therefore thou hast bin heretofore let bloud on the one side thy best way is the next time to take the other side and to labour by all meanes that the humours may flow equally and that they may be caryed with no greater force towards thy one side then thy other When there is neede of euacuation and deriuation and not reuulsion then doth Galen appoynt vs to take the vayne alwayes on the same side If the right side of the wombe be grieued auoid bloud out of the right hand or right leg and if the left side be enflamed then take the side that is right with it for that is the meaning of the 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 of Hippocrates to wit that we open the 〈…〉 hepatica and lienaris directly for they arâ— neerest to the affected parts and most right vpon it And in an other place The euacuation out of the neerest vaâ—nes and which are common to the place affected is both best and easiest As concerning what vayne is to be opened this rule is most generally prescribed that if the parts beneath the neck be grieued we must open the inward vayne of the arme called generally inâ—erna or basilica or axiliâ—ris and more particularly if it be in the right arme called recoraria or hepatica in the left henaris this is opened commonly on the left side if the heart lungs or spleene be affected and on the right side if the liuer or stomack be affected If the parts which be afflicted be aboue the neck then we open the
of the ayre doth keepe the spirits from flying too fast out But in the sommer or hoat weather he will haue the orifice to be narrower because the bloud is commonly then more subtile and heate doth helpe much to dilatation passage If it fall out to be temperate weather then to proceede in the meane betwixt both The verses of the Salerline schoole are to be vnderstood of full strength and powers Fac plagam largam mediocâ—â—â—ter 〈…〉 exeat vberius liberiusque cruor Make well and wide thy blow That bloud and fumes may largely flow Hippocrates sayth In places where 〈◊〉 no danger and where the bloud also is grosse vse a broader launcer for so the bloud will passe otherwise not but take heed of going too deepe Fernelius sheweth some dangers Vnder the inward vayne lyeth an artery vnder the middle a sinew and vnder both do lye the tendones of the muscles If any of these be pearced there may ensue much griefe and sometimes great danger The cephalica may be opened with least perill of all the vaynes which appeare in the cubâ—â—e Now for the quantity of bloud how much may be taken at once I haue had occasion to declare much already concerning that poynt when I intreated in my former booke of Phlebotomy in particular diseases I meane not therefore now to stand much vpon it Montanus vpon the fourteenth Canon of Auicen doth appoynt that in old diseases when by long infirmitie the bloud is become grosse we must take but a little bloud at once and reiterate the bloud-letting often and still in the meane time to nourish yâ— patient with a good moistening diet If the bloud appeare to be whitish then as Auicen will haue it you must let out none at all least a cachexia or bad habit or dropsie do thereupon ensue Fuchsius doth giue vnto a Chirurgian three generall notes whereby he shall gesse when is the fittest time to stay the bleeding first by the change of bloud secondly by the force of flowing waxing more faint and thirdly by the change of the pulses The first that is the change of the bloud both in colour and in consistence must then especially be attended and wayted for when the griefe or inflammation for which we let bloud is neere vnto the place where the vayne is opened For Hippocrates sheweth that in a pleurisie the bloud which is nigh vnto the inflammation doth farre differ from that which is conteyned in other parts of the body being by the vehement heate much altered so that if the bloud of the rest of the body be phlegmatick it will be about the inflammation red and if the rest be red it will be about the inflammation adust and burnt This change of the bloud is not alwayes to be taryed for for it may be that either the strength is not able to indure it or else that the phlegmone is such a maligne and impacted humour that it will hardly giue place In these cases wee must cease before the bloud doe change and the rest is to be withdrawne by a second phlebotomy The other note to know when it is time to stay the bloud is by the violence of the flowing now waxen more slow feeble for that sheweth that the strength and powers are ready to decay especially if palenesse of the face and dazeling of the eyes do begin to draw on But the most certaine signe of all when we must stay the bloud is the changing of the pulse for if of thick it become thinne if of great it become little if of vehemently strong it become weake and obscure if of equall it become vnequall it presageth that the powers are now ready to be dissolued The safest way in letting bloud is to be sure to be within compasse what wanteth may easily be supplyed by reiterating but what is taken too much can not so easily be restored Heere an other doubt may arise when either for the toughnesse of the hamour or for the weakenes of the party the bloud is let not at oncâ— but at seuerall times how neere those times ought one to succeede an other Fernâ—lius sayth In diseases that vniuersally afflict the body the best is to let bloud twise in one day but in the griefes of particular parts the reiterating must be longer deferred to wit to the second or third day Ficinus counsaileth such as by studyes are growne melancholick to be let bloud if they feele a plenitude and he appoynteth it to be done twiâ—e in one day in the morning and in the coâ—ning but at either time sparingly for he sayth bloud is the temperer of melancholy the nourisher of the spirits and the treasure of life The like speech hath Auicen in his third canon where he aduiâ—â—th men that are troubled with a long lingring disease not to be too wastfull of their bloud because a long iourney remayneth to them and therefore they had neede to gather store of good strength he addeth this precept Keepe bloud as a pretious treasure In that quartaine ague which commâ—th ex atra bile and in other infirmities comming of the like cause seeing that the atra bilis may come as well of bloud or fleame as of choler or melancholy the black bloud sheweth that it proceedeth of bloud aduâ—t and therefore a more larger Phlebotomy is permitted vnto it then vnto any other atra bilis which shall proceede of choler fleame or melancholy adust But otherwise the common opinion of Chirurgians who thinke that generally the corrupter the bloud is the more plentifully they may let it flow out is vtterly condemned by Fernelius You must not when the bloud is more impure or raw or is estranged and departed from his owne nature then take so much the more away after the manner of common bad Phisitions but by how much more the humours are departed either on this side or beyond the nature of bloud so much the more sparingly and leasurely you must let that bloud sâ—ow and when it shall be found to be very farre from the forme and shape of bloud then must you altogether abâ—taine from Phlebotomy for where there is little good bloud there must needs the strength be weake The corrupt bloud doth seeme very fit to be expelled as Galen sayth That which is corrupt is against nature and that sheweth that it ought to be taken away The constitution therefore of the bodie doth shew that this ought to be our scope and drift to euacuate the matter either by Phlebotomie or by purging but on the other side the weakenesse of the powers will suffer neither of them How must we doe then in these great contrarie occasions Galen maketh answere We must in these contrarie occasions and drifts by little and little auoyd the bad and by little and little restore the good which healing of euill humours is called of Phisitions Epicrasis or good tempering of humours Why doth Galen then
in the same leafe a little before in continuall agues called synochi aduise to let bloud 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 vntill the heart faint as likewise he doth in many great inflammations in his comment vpon Hippocrates He sheweth himselfe the cause in that place where he intreateth of agues he doth appoynt it to quench the vehement inflammation and doth meane that it shall be as much as possibly the strength can beare Montanus discoursing vpon the fifth Canon of Auicenna sayth that Galen doth commaund sometimes to let bloud vsque ad syncopen but I thinke that in that poynt either he was deceiued or else that they which did commit to writing his speeches for he wrote little himselfe did not well remember his words I reade sometimes in Galen that vpon vnseasonable and excessiue letting of bloud or any other immoderate euacuation a syncope or dangerous swouning may ensue but I can no where finde that he appoynteth to let bloud vsque ad syncopen vnto a cutting off of all the powers by swouning The fainting vnto which in some cases he doth require Phlebotomie to be extended is called by Hippocrates and him not syncope but sometimes 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 sometimes 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and sometimes 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Some doe make 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to be more particular faintings of some affections and powers of the heart and brayne and 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 to signifie a more generall dissipation of the vitall spirits But Galens words do playnely ouerthrow that fond distinction For hauing named the words 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 hee addeth immediatly 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Phisitions are wont to giue both these names to one thing as they signifie indeede one and the same matter And that they both do differ from syncope hee doth shewe playnely when he teacheth that grosse humours when by their toughnesse they doe obstruct or by their multitude oppresse the passages of transpirations they cause syncopas or swounings But if those grosse humours do neither obstruct nor oppresse then they bring no syncopas or swounings but they bring a certaine faintâ—es 〈◊〉 the Grecians call Leipoplyâ—hia or 〈◊〉 The â—etting of bloud euen vnto fainting which Galen doth allow sometimes in great inflammations and certaine hoat feuers as I haue before declared must be done very warily and with great consideration for many are the harmes and dangers which may ensue thereby if it be rashly or vnaduisedly practised as in one place Galen doth plainely and plentifully lay open vnto vs I saw two men dye in the very hands of the Phisitions fainting indeed away but neuer recouering againe Many although they dye not presently yet afterward they come to it by the decaying of their powers and if they had bin euacuated without dissoluing the strength they should not haue perished And some also their powers being by immoderate euacuation dissolued do fall into a long lingering disease Others for all their life time afterward haue then whole temperature of their body ouer-much cooled being neuer able to recouer that harme which he hath gotten by auoyding too much bloud By which coldnes some haue liued afterward ill coloured and with bad habit of body and easily annoyed with euery small thing and others by the same meanes haue bin taken with deadly diseases dropsies streightnes of breath by stopping of the lights weaâ—â—nes of liuer and stomack apoplexies and dotings There are many vnskilfull Surgeons which doe thinke and defend that for the quantity of bloud how much may be spared they neede no other obseruation but to let the bloud to runne vpon their nayle and so long as they see it to be grosse and corrupt so long to let it flow It they take this course with some diseases they may vtterly ouerthrow the strength of their patient They which haue much corrupt bloud haue little good and they which haue little good bloud must needs haue little strength and such as are of weake powers may soone by a great quantity of bleeding receiue vnrecouerable mischiefes Galen sheweth that when it hapneth that crude humours are gathered in the body a great heed must be taken what quantity the strength will indure For the powers being already dissolued in such constitutions of crude humours are wont by Phlebotomy to fall into such extremities as out of which they can neuer againe be recouered And therefore a little after he sheweth what in this case his owne practise was In them which haue a multitude of raw humours I do auoyd a little bloud and do straightway giue a little water and hony well boyled together with some extenuating thing as hysop wild marierom and sometimes calamint and then I take away a little more bloud sometimes the same day and sometimes the day following in which giuing againe some of the aforesaid medicins I take away bloud againe and the third day likewise twise Galen often when he nameth crudities or raw humours speaketh not of the two first kinds of crudities to wit first meates vndigested and secondly when any hurtfull matter doth not obey the lawes of nature of which two I haue spoken already but of a third kinde of crudities when any thick or cold humours do abound in the body for so doth Galen describe all those humours to be crude or raw which are in the body besides bloud of a thick or cold substance The more they depart from bloud the lesse bloud may be spared and sometimes they depart so farre from bloud as in dropsies and in some agues comming of the abundance of raw humours that there is no place at all left for Phlâ—botomy If in any place Galen doth deny and forbid letting of bloud in abundaÌ„ce of corrupt humours as he doth sometimes allotting vnto them rather purgings then phlebotomie we must accompt it to be done not in respect of the vicious humours for Phlebotomy is coÌ„mon both to good humours ouer-much abounding and to ill humours ouermuch annoying it is as Galen and Auicen do make it a remedy both against the superfluitie of bloud and also against the vices of bloud but Galen doth prohibit it only in regard of the weakenes of the strength for so doth he expound himselfe These three scopes to wit the greatnes of the disease the strength of the powers and slourishing age are sufficient for Phlebotomâ— for when such a multitude of raw humours â—â—gathered that it forbiddeth Phlebotomy yet thâ—â— my former conclusion is not reprooued for in such there is no strength sit for it But as he sayth afterward If these two scopes to wit the greatnes of the disease and thâ— strength of the powers be present there 〈◊〉 no such or so great aboundance of raw humours as that it ought to forbid this remedie of Phlebotomy Auicen although â—n some cholerick diseases he deny letting of bloud and willeth it to be kept for a
treasure yet in firmer strength in the cure of a kind of S. Anthonies fier comming of burning citrine choler mixed with melaÌ„choly sayth Necessaria est Phlebotomia vt vacuâ—tur sanguis cholericus Phlebotomy is necessary that the cholerick bloud may be auâ—yded Galen also alloweth letting of bloud not only in continuall agues comming of bloud inflamed but also in that burning feuer called Causo comming of choler putrifying in the vaynes as Massaria doth prooue out of the second booke de crisibus and out of his words vpoÌ„ the Aphorismes which are these In most burning agues letting of bloud euen vnto fainting doth straightway coole the whole habit of the body and extinguish the feuer and also in very many the belly is wont to be made soluble and sweates are accustomed to flow by which deede some are altogether deliuered from their ague And he doth confirme it also by the testimonie of the most auncient and excellent Phisition Philotheus who commenting vpon the same Aphorisme vseth these words In whome we may let bloud euen vnto fainting it is manifest that it is in them who are sick of burning feuers and yet not them all but those in whom the powers are strong But why dowe let bloud in them euen vnto fainting seeing that burning feuers are kindled by humours putrified The putrefaction conteyneth two things to wit the matter putrified and the badnes of the quality Bloud being let euen vnto fainting doth both diminish the quantity of the matter and moreouer extinguish the sharp and inflaming quality for by the fainting of the courage the body is cooled And finally he doth conuince the same by reason seeing that by bloud breaking out at the nostrils the sayd burning feuers are oftentimes healed Those Phisitions which are of opinion that in this burning feuer bloud must be let only a little for euentilation from foure to sixe ounces longè citra lipothymiam farre lesse then that which doth bring lipothymye or fainting of courage whose aduise is that which I haue mentioned in the second Chapter of my first booke I thinke they do counsayle it chiefely in respect of the weakenes of the powers which oftentimes doth accompany this feuer and then they dissent not much from Philotheus who doth not permit lipothymies in all but only in them whole vertues and powers are firme and strong Whether the humour be more thinne and cholerick as in cholerick agues and in phrenzies or whether it be more cold or thick as in apoplexies epilepsies and lethargies I haue shewed in my first booke that Phlebotomy may haue in them a profitable vse Galen when all other Phisitions withstood him did let a woman bloud pleÌ„tifully when the bloud came out in colour and thicknes like to liquide pitch or tarre In euery opening of a vaine an especiall consideration must be had what humour it is that doth most indanger the disease For in splenetick infirmities it is profitable to auoyd well the thick melanecholick bloud and to stay it if it be thinne because the thinne hath a good necessary vse the better to keepe the thicker from obstructions but still the chiefest respect must be had of the strength of the party If the bloud be not a thick black melancholick bloud causing some melancholick disease but otherways corrupted and greatly degenerating from the nature of bloud Phlebotomy also may take place but warily and sparingly and pervices by little and little diminishing the ill and restoring the good euer assuring our selues that the lesse store there is of bloud the more feeble is the strength and in no wise thinking that the triall of the bloud appearing ill vpon the thumbe may be a sufficient warrant to the Surgeon to coÌ„tinue the more boldly the bleeding of his patient Cold constitutions may not endure much diminishing of bloud and those lipothymies which Galen and Hippocrates do allow sometimes to coole in extreame heates are short faintings for a time and not vtter deiections and ouerthrowings of the strength and powers If the bloud be loth to come Fuchsius declareth chese helps first vnloose a little the band secondly let him clutch some thing hard in his hand drawne together thirdly let him force himselfe to them and cough and last of all bath the incision with warme water Some do accompt it the readiest way both to make the vayne to appeare well and to make the bloud issue well is to lap about the lower part of the arme from the place of incision downeward a boat linnen cloth three or foure times folded CHAP. 9. What order must be taken with them that are let bloud as well in the act it selfe to prouent sâ—ounings as also afterward for their gouernment and diet WHen the patient hath bled what is found to be sufficient if there be any danger of fainting then must his body be placed in such manner as is most â—it for a perfect case and rest so that no one limme or part may be put to any labour Montanus vpon the tenth Canon of Auctcoâ—â—a doth affirme that this shall be best perfourmed if the party be layd downe vpon a bed with the face vpward For all the sinews in the body the instruments of motion haue their beginning from the ioynts of the back-bone and therefore the sinews of him that lyeth vpon the back do rest and do suffer no violence Fuchsius is of the same iudgement Let the patient so lye with his face vpward that all the parts of the body may leane vpon the basis or ground-worke to wit the back-bone Fernelius biddeth that if the patient begin to faint away it will be a good course to sprinkle a little cold water into the face or to put vnto the nose a cloth or peece of bread moystened in wine and vineger or by tickling the iawes within the mouth to prouoke a vomit But he sayth Praestantissimum est aegrum prosternere The best thing is to lay the body downe all along meaning no doubt the same manner which is already described Though in this case of fainting the party must be layd downe yet must he not be suffered immediatly to sleepe The Salernitane schoole commendeth rest Omnibus apta quies est motus saepe nociuus yet doth it on the other side forbid sleeping for sixe houres after bloud-letting Sanguine subtracto sex herij est vigilandum The appointing of sixe houres watching is thought by many good Phisitions to be somewhat more then needeth Fuchsius requireth that within an houre or two after bloud-letting the party be refreshed with a little foode of good nourishment and within two houres after he sayth there is nothing doth hinder but that he may sleepe so that they which stand by do looke vnto it that he do not rowle himselfe vpon that arme in which the vaine was opened that the hands do not loosen from that place which was pearced Fernelius his opinion is that in one houre after bleeding
inflammations of the hollow part of the liuer which are knowne by a great payne somewhat lower and by an aptnes to vomiting and loathing of meate but ioyned with an immoderate thirst of drinke are clensed best by the siege The gibbus hepatis or the vpper part of the liuer bending somewhat compasse downeward ioyning to the midriffe out of which the hollow vayne doth issue if it haue an impostume which being very great will appeare to the handling vnlesse the body be ouer-fat or fleshy or else it is knowne by a payne of the right side reaching vp higher towards the throate and causing much griefe in fetching breath is clensed best by vrine The inflammations of the raines which are knowne by a payne neerer the back bone and an astonishment of the loynes and thighs on the same side that the kidney is inflamed together with some vomitings and with vrines often but painefull when they are fit for clensing are clensed also the same way to wit by a moderate vse of the diuretica or things causing vrine as the rootes of garden parsley Petroselinum Macedonicum kneeholme and Sperage or electuarium Iustini but remembring still that if there be an ague you ioyne with them the aforesayd great cooling seeds or the lesse cooling seeds of lettise endiue scariole and purslayne If the inflammations be of the spleene which may be knowne and felt by the swelling of the left hypochondrium about the short ribs on the left side and do suppurate which hapneth very seldome they may clense the same way that the liuer doth but you may do well to adde to the outward receipts the oyle of capers and the oyle of tamariske If the inflammation be a pleurisie which is knowne by a pricking payne ioyned with the shortnes of breathing and a cough and continuall feuer the pulse being hard and rough like a saw you may intermix in the clensing of it such things as doe best auoyd the cause of it For Galen sheweth Aliam pleuritidem ex sanguine aliam ex bile aliam ex pituita ortum habere That some pleurisies do come by bloud some by choler and some by fleame Fuchsius and Trallianus make some to come of melancholy but Trincauel sheweth that that must needs be either neuer or very seldome because melancholy is of a thick and earthly substance and can hardly passe into that thick solide and skinnie membrane which doth vnderbinde the ribs He further declareth that it commeth most often of choler according to that assertion of Galen Plerumque pleuritis fit à bilioso succo peripneumoniae à pituitoso For the most part a pleurisie commeth of a cholerick humour and the inflammation of the lungs of a phlegmatick What things do best help the auoyding of these humours you shall see in the end of the Chapter next following Last of all when the matter and cause of impostumes is clensed away you must vse 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 things that doe conglutinate consolidate heale and cicatrize as inwardly sugar rosate bole armine prepared and a little of the decoction of cumfrey but outwardly oyle roset oyle of myrtils and the white of an egge adding some hypocistis acatia coriars sumach mastick aloe sarcocolla sanguis draconis and frankencense It shall be good also to drinke some of a decoction of vulnerary herbs as sanicle bugle selfeheale herb two pence virga aurea great valerian and padelion strayned and againe boyled with some sugar CHAP. 10. How defects and errours are to be supplyed and amended and how the Phisition or in his absence the Chirurgian may know by the bloud being a little while reserued what course is further to be taken with the patient GAlen sheweth that a certayne young Phisition for according to the french prouerbe Ieunes medecins cymitieres bossus vieux procureurs proces tortus Young Phisitions and old aduocates the one do make vneeuen churchyards and the other many crooked actions when he had bound the arme of his patient and by the binding an artery did appeare high vp he strake the artery in stead of a vayne a yellowish bloud and thinne and hoate did straightwayes shoote out and that with a certaine leaping and skipping Galen when hee vnderstoode thereby that an artery was cut did first apply a fit plaster to stay the bleeding and afterward an other to heale the incision for he defendeth there and auoucheth by his owne experience that a wounded artery may be healed Fuchsius doth interpret that 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 which commeth out of arteryes to be sanguis rubicundus igneus a firy red bloud Fernelius thinketh that the fittest plaster to lay vpon a wounded artery is to be made of aloe myrrh franckencense bole armine and the white of an egge mingled with the haire of a hare Galen appointeth the plaster to remaine on foure dayes without remoouing And in the same place doth charge especially that whatsoeuer is layd to a wounded artery be of a very drying property So much doth the artery require more drying things then the vaynes as it is by nature of a more dry constitution If a sinew or a muscle be pricked there will follow an astonishment and a conuulsion or crampe or else a great payne and some swelling and in this case Fernelius sheweth our course must be not to suffer the wound to grow together vntill it be first deliuered from the inflammation and swelling and the way not to suffer it to grow together is to bath it with warme oyle After three dayes you may suffer it to heale vp putting vppon it a little turpentine mingled with Euphorbe Fernelius immediatly after doth shew as doth likewise Fuchsius how by the bloud hauing a little while rested wee may much perceiue what humour doth most abound in the patient When the sawcers wherein the bloud is conteyned haue bin set vp some little time in a place where neither wind nor sunne beames may come vnto them if the bloud be thick and viscous such as is the cause of obstructions then it will soone congeale together and being touched it will stick somewhat to the finger If it be long in congealing and waxing hard then is the bloud to be accompted very thinne but if when it is cold it waxe not hard at all then is it all together either waterish or putrifyed Much whayish and yellowish water swimming vpon or by the bloud doth shew either too much vse of drinking or the liuer weake or the raynes feeble and obstructed The spume or froth that swimmeth vppon it vnlesse it come by the violence of the flowing it sheweth the heate and inflammation of that humour whose colour it caryeth as the red froth signifieth the heate of bloud the yellow of choler the white of fleame and the blackish and blewish of melancholy The colour of the bloud continuing red is a signe of good and profitable bloud If it be pale it signifyeth choler if white fleame if
greenish burnt choler if of a leaden colour pernicious melancholy if it be of diuers colours then it is shewed that diuers humours doe abound There is sometimes a certayne fatnesse lyke a spiders webbe swimming vpon the bloud If it be in a full bodie it signifyth a bloud prone vnto fatnesse but if it be in a leane bodie it commeth of the consuming and wasting thereof If the bloud doe smell ill as it falleth out but seldome it is a signe of a very great putrefaction Fernelius sheweth how in the bloud you may behold all the foure humours Cum sanguis concrenit serum per summa innatat vrinae haud absimile bilis est tenuis florida concreti sanguiniâ— pars suprema melancholia subsidet sanguis rubentior petuita pallidior media tenent When the bloud is congealed there are fiue things offered vnto our view The tenue serum or whayish part swimmeth vpon the top much like vnto vrine The choler is the thinne and flourishing highest part of the congealed bloud The melancholy falleth downe to the bottom The bloud is the redder part and the fleame is the whiter part of that which doth possesse the middest betwixt the choler and the melancholy Galen sayth what soeuer is most vnctuous light in the bloud is choler but what is most grosse and as it were dregges which by ouer-much heating is dryed vp that is melancholy Fernelius doth aduise vs not only to marke the colour and contents but also when the bloud hath settled awhile to compare the little basins one with an other If all be like it is likely that all the rest in the body is like vnto it and that only the multitude did offend For although the bloud be neuer so good yet if it be in ouer-much plenty it may greeue the body offend the senses and bring very many dangers If all the bloud be ill or if the first be good and the last ill it sheweth that many humours do yet remayne to be rooted out by good diet and by fit euacuations or else if the bloud-letting be in a great inflammation then the last bloud being worse then the first doth often declare that the very matter of the disease is auoyded and the euacuation made fully complete So likewise if the last bloud be better then the first it is a good signe of a perfect euacuation If the bloud be powred afterward into warme water that the substances of it may be seuered one from an other it will declare much vnto vs. The whayish thinne part will be so confounded with the water that you can not discerne the one from the other The thinner part of bloud will also be mingled with the water but yet so that by the colour thereof you may haue a good iudgement of the nature of the humour The thicker and fibrous part of the bloud will shrinke to the bottome which shall be iudged to be pure and agreeable vnto nature if it be bright thinne somewhat whitish and cleauing well together but if it be thick it declareth that the bloud in the body is thick If it be black or infected with any bad colour it sheweth with what humour the bloud is oppressed If it cleaue not together but do easily fall asunder it is an argument of very great putrefaction When thus the humour abounding is knowne and therewithall a consideration had of the state quality and nature of the disease if it be found that there is still a continuance of the payne or griefe then must we either vse those things which do gently correct the humour appearing to abound or else if time and occasion require it harken to that practise which Hippocrates doth commend in many of his writings as Galen doth collect out of him When humours are increased with a iust proportion amongst themselues he indeuoureth to bring help by Phlebotomy but when some one humour amongst the rest is superfluous then doth he giue a fit medicine for the purging of it If Choler abounding do yet annoy the body then either delay it with syrupus acetosus syrupe of limons and syrupe of citrons or with some brothes or drinks wherein are boyled lettice purslaine endiue the white flowers of water-lilly sorell stubwoort and dandelion ioyning with them some sperage and germander or else purge it either with some simple as Rewbarbe a dramme or cassia an ounce or manna an ounce and a halfe taken either in some of the aforesaid broth or in a decoction of tamarinds and prunes or else by a compound as syrupe of roses two ounces or syrupus de cithoreo cum Rhababaro one ounce a halfe or diaprunum compositum or diaprunis laxatiue or by electuarium de succo rosarum any of them a little vnder halfe an ounce If superfluous fleame do seeme still to bring danger then either diminish it without purging by syrupe of hysop syrupe of hore hound syrupe of mayden haire oxymel simplex oxymel squillaticum and by ptisanes of barley water wherein are boyled some elicampane foelefoote licorice and annise seede or else purge it either with simples as with infused and strayned agarick about three drams or with colocynthis about twentie graines or with elaterium as much being well gathered light white and bitter or with tithymall leaues dried and prepared one dramme or else with some compound as with the powder of hiera picra made into pils with the iuice of baulme or sage about two drams and a halfe or by pils de turbith or pillulae stomachicae of either one of them about one dramme or diacarthami halfe an ounce Or if the disease haue bin so lingering and the humours be become so tough and clammy that scammoniate things may be vsed you may giue of Diaphoenicum or of electuarium Indum maius of either one of them about halfe an ounce Where I vse the word about my meaning is still that in the young or in the very weake and feeble you must take a little lesse and in the stronger sort a little more then the quantity here specifyed but otherwise vsually and commonly to ayme as neere as may be to the waight and dosis here mentioned prescribed If melancholy abounding do seeme to aggrauate the impediment then either auoyd it without purging by syrupes of borage and buglosse syrupe of agrimony or syrupe of fumiterre or by some broths or drincks wherein are boyled baulme rosemary and the flowers thereof tamariske dodder hartstoong the foure cordiall flowers to wit of roses violets borage and buglosse also capers and ceterach called of some fingerferne or else purge it either by a simple as by Sene in powder one dramme or by Sene in decocton halfe an ounce or by polypody or epithyme of either of them about halfe an ounce steeped boyled and wrong out or by black Hellebore about halfe a dramme or by lapis Armenius washed a dramme or else by some compound as by