The first Chapter.

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, Fernel method. medendi lib 2. cap. 1. & 3. 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, Fuchs. Instit. lib. 2. 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 [...], Montanus in medicin [...] vni­uersalis part. 3. euacuatio: The second is called [...], and of Montanus euentatio: The third [...], revul­sio: The fourth [...], deriuatio. The first, which [Page 2] 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, Fernel. method. medend. lib. 2. cap. 1. 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, Montanus medicinae vniuersalis part. 3. 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. Hippocr. 1. Aph. 1. 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 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, Gal. libr. 3. [...] t [...]nda. as Galen doth at large demonstrate, and therefore euacuation by some purging potion shall in this case be more fit then letting of bloud. [Page 3] 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. Fernel. me­thod. medend. lib. 2. cap. 4. 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: Gal. therap. method. lib. 11. 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, [Page 4] being lightened, and hauing put off that which a [...] 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, This [...] is called of Pla­terus euenti­latio. wherupon he maketh a secōd 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; 10. Bapt. Mont. parte 3. Medi­cinae vniuer­salis. so this [...] hath properly a relation to the boyling and bubbling. So ( [...]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 quàm 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: Gal. method. therapeut. libr. 8. 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 [Page 5] when the humours do thus boyle and haue neede of venting, it sha [...]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: Hippocr. libr. de [...]ium na­tura. pag. 245. 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, Gal. lib. 5. de c [...] and. morb. cap. 3. 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: Gal. lib. 4. method. thera­peut. cap. 6. If the flowing be still caryed in his violent course, we must vse revulsion [Page 6] 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, Gal. libr. 2. ad Glaucon. cap. 7. 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.

BEing now to declare particularly, how Phlebotomy is to be vsed in most of the vsuall diseases which cōmonly 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 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 [Page 7] 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, Fernel. method. med. lib. 2. cap. 6. 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:

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, Platerus de febribus pag. 113. 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 [Page 8] 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: Gal. method. therap. libr. 9. 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 s [...]oun­ings wholy to ouerthrow them: Montanus writing vpon the thirtenth Canon of A [...]icenna concer­ning bloud-letting, Montan. me­dicinae vni­uersalis part. 3. 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 [Page 9] 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 plētifully to swouning or fainting. Gal. therap. meth. libr. 9. ad [...] vide li. z. ca. 8. 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: Montan. medi­cinae vniuersa­lis part. 3. and further, it was a feuer alwayes de­clining. But he cōcludeth 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, Trincau. in explanatione lib. [...]. Galeni de d [...]fferenti [...] [...]ebrium. 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 [Page 10] 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 helpeth much transpiration, by meanes whereof it must needes be good to help putrefaction. Mont. medic. vniuers. part. 3. 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. Platerus de febribus pag. 113. And Platerus sheweth an other cause why it ought [Page 11] 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. Fernel. in me­thodo general [...] de curand [...] febribus. Of the same iudgemēt 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. Gal. method. therap. lib. 11. 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, Hippocr. de ratione victus in acutis, sect. 4. 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, Auicennae prima quarti. that bloud is not to be let in it, vnlesse there doe appeare rednesse and thicknesse of vrine, but that is not Causo, Montanus in canonem. 11. Auicennae in medicinae vni­uersalis part. 3. 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 Hippocr. de ratione victus in acutis, sect. 4 pag. 382. [Page 12] 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, Platerus de febribus pag. 115. & pag. 55. 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 dāgerous 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. Trinc. de ra­tione curandi part. corp. affect. lib. 2. cap. 11. But still in the quantity Hippocrates his rule must be obserued, to haue a due regard of the age and strength.

CHAP. 3.

GAlen sheweth, Gal. meth. med. lib. 8. cap. 4. 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 imp [...]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, Gal. method. therapeut. libr. 8. 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. Bapt. Montan. medicinae vni­uersalis parte tertia. 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 [Page 14] 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, whē 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, Gal. de sanit. tuenda libr. 4. 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: Ibid. 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 [Page 15] 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, Platerus de febribus pag. 286. Fuchsius de morbis me­dendis. lib. 4. cap. 1. Brigthus in therapeutica. 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; Gal. lib. 10. method. me­dendi. 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. Gal. method. therap. lib. 10. 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 [Page 16] of the humour, the vse of the extenuating things is best.

CHAP. 4.

MOntanus affirmeth, Mont. medi­cinae vniuersa­lis parte. 3. 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. Vide finem tertiae partis medicinae vni­uersalis Mon­t [...]ni. 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 [Page 17] 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, Platerus' de febribus pag. 151. & 154. 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; Plat. ibid. 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 [Page 18] 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: Plater. Ibid. 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, Fuchsi. de me­dendis morbis lib. 4. cap. 6. 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. Brigthus in therapeutica. Doctor Bright doth thinke requisite that in the first day of intermission (to ventilate the body) 6. or 8. ounces of bloud be taken. Fernelius in methodo gene­rali de curan­dis febribus. 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 [Page 19] 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 tertian, where choler is for the most part mingled with fleame, or where cho­ler doth not make it selfe the matter of the ague, but doth kindle other humours (which may be knowen in that the pulse is much lesse, Fuchs. de morbis me­dendis lib. 4. cap. 7. Brigthus in therapeut. thinner and slower then the other, and the heate also lesse) then is no bloud to be taken at the beginning of the Ague; but afterward the matter being prepared, when the vrine doth appeare red and thick, a vayne may be opened the day going before the fit, and foure ounces of bloud may be taken. But if the bloud prooue thin and somewhat yellowish, then must you straightway suppresse it. In the melancholick quartaine if it come vpon the stay­ing of any vsuall or naturall purging of bloud, then stirre vp that if you can: if you can not, then within the 14. or the 20. day let a little bloud out of the saluatella, if the strēgth be weake; or other­wise out of the basilica of the left arme, hauing be­fore giuen a clyster. But if the quartain do come ex atrabile of black choler, which hath fits begin­ning with lesse shaking, and those also shorter then the melancholick (for the melancholick continu­eth 24. houres) and is also accompanyed with a sharp heat and vehement thirst, and with much more vnquietnes then the melancholick, then you may let bloud in the beginning foure or fiue [Page 20] ounces out of the basilica of the right arme, and the next day after if strength will permit two or three ounces out of the saluatella of the left hand. If that the black choler do proceed of burnt bloud you may let out more then if it proceed of any o­ther humour. Heurnius lib. 2. method. ad pra [...]n. That learned Heurnius sayth, Black choler is ougly, and doth spring of some burnt humour; but melancholy is the very melancholick iuice or the dregs of bloud. These are of a nature farre differing. For to black choler are due those things which may pacify the fiercenes of it, as Violets, Endiue, and such like: but to melancholy are due such things as are moderately warme and opening, as the rootes of Capers, the aperitiue rootes, and such like, alwayes adioyning to them such things as haue vim humectandi a moystening force. And as in potions and medicins these two require a far differing methode, so also (as you haue alreadie heard) in the manner and time of letting of bloud.

In the intermitting agues we must not haue a bare and naked respect only to the feuer it selfe, but we must heedily regard all the symptoms and dangers which may ensue by the meanes of other accidents, Trincau. in [...] ad Glauconem. as Trincauel in his Commentary vpon Galen ad Glauconem doth at large declare by the example of an exquisit tertian. An exquisit ter­tian (sayth he) was neuer in respect of it selfe coun­ted amongst great diseases, and therefore Phlebo­tomy doth not properly appertayne vnto it. But in other respects it is not only profitable, but also necessary, when regarding the state of the body, our scope and purpose is to preuent and auoyd future mischiefes. Trincau. Ibid. For often may an exquisite tertian passe either into a continuall ague, or into a burning [Page 21] ague, when the body is full either of bloud or of choler. His reason is because bloud may by reason of the multitude putrifie: and also choler if it be much, and the strength do grow so weake that it neither can gouerne it nor expell it, it must needs more and more putrifie. Hippocr. libr. de morbis. And also according to Hippo­crates easily may a tertian be conuerted into a plu­risy. For these causes (saith Trincauel) the opening of a vayne may haue place in an exquisite tertian, Trinc. in expl. libr. 1. ad Glau­conem de arte curatiua. but that according to Auicenna must be vntill the third fit. Thus in all intermitting agues, though not in all after the same manner, nor in the same time, nor in the same quantity, nor for the same end and purpose, that axiome of Galen holdeth firmely, Gal. therap. method. lib. 11. that not onely in continuall agues but also in all other agues whatsoeuer where any hu­mour doth putrify, it is good to open a vayne. You haue his words and his reason in the first Chapter of this booke set downe at large in the first vse of Phlebotomy. One generall note to know in tertians and quartaines whether any bloud may be spared, is y ^• thinnesse and y ^• yellow­ishnesse of the bloud. For the same which D. Bright doth write in bastard tertians, Brigt in the­rapeut. that if the bloud do proue thin or yellowish, we must straight stop. The same doth Fuchsius require in quartaines, Fuchs. de re­dend [...] morbis lib. 1. cap. 8. that if the bloud do appeare black and thick, such as is commonly in splenetick men, then we shall let the party bleede more largely; but if the bloud doe prooue thin and yellow, then must it be presently stayed: for such a humour is not vnprofitable, but as well by his substance as also by his quality it doth amend the thick and cold humours.

Alexander Massaria chiefe Doctor and profes­sor [Page 22] of the Vniuersity of Padua, a man of excellent iudgement, Massaria de [...]upis mit­ [...]endi sanguinis pag. 132. doth in his late treatise concerning Phlebotomy differ from the opinions of Platerus and Fernelius, as touching letting bloud in tertian agues; and alloweth letting bloud sometimes in exquisite tertians, and sometimes in bastard ter­tians, alleaging the auctority of Galen, Gal. lib. 1. ad Glauconem cap. 10. so that it be done [...], straight in the beginning, and other things duly considered, as the strength and plenitude, and due preparation of the body. And he wondereth what Auicen should meane, when he sayth, Massaria pag. 91. that vpon immoderate bleeding chole­rick humours do more boyle and rage, whereby the patients are more inflamed, whereas experi­ence doth testifie that vnseasonable or excessiue bleeding doth bring rather dropsies and cold and bad habits of body, then any boyling heate or in­flaming. If in tertians the cholerick humours of the body be first drawne away and the bowels e­uacuated by a glister, and a fit time chosen for the opening of the vayne when the stomack is fasting and empty, I see no reason but the stomack and bowels should draw back sufficiently to keepe the mesaraick vaynes from sending any such store of humours into the hollow vayne, as should putrefy the bloud in it or the branches thereof. And the rather do I yeeld more to the iudgement of Mas­saria, then of Fernelius and Platerus in this point, because the most learned and expert Phisition Heurnius doth testifie, Heurnius libr, de morbis cap [...]is cap. 10. that in letting bloud in cho­lerick bodies we do often auoyd more choler then bloud, and by experience I haue found it very oft to do much good & bring present help towards the beginning of tertians, although after the fift or [Page 23] sixt fit I haue not seene much good to come there­of. Massaria pag. 133. Gal. libr. 1. ad Gauconem. cap. 11. But in quartain agues Massaria cleaueth to that of Galen, We must deale softly and gently with quar­taine agues at the beginning, and neither vse any strong purging nor euacuation of bloud, vnlesse it do mightely abound: And if to him that openeth the vayne the bloud do appeare black and thick, such as especially is found in splenetick persons, let him let bloud the more boldly; but if it appeare yellow and thin, let him straight­way suppresse it.

CHAP. 5.

AVicenna in his eeuenth canon concer­ning bloud-letting (as Montanus hath deuided them) doth set it downe for a rule, Mont. medie. vniuers. part. 3. 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, Mont. Ibid. 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, Mont. Ibid. and therefore we must absteine from Phlebotomy [Page 24] 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, Platerus de febribus pag. 225. 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, Plater. Ibid. 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 mē 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 [Page 25] 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 [...]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: Trincauel tractat. de febre pesti­lentiali. 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 [Page 26] before the putrefaction of the pestilent feuer be much increased; and before nature do seeke to expell vnto the skin. Hippocr. de morbis vulgar. lib. 1. sect. 7. 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, Montan. in initio consul­tationum me­dicarum. 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. Fuel. consil. 67. 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 [Page 27] heed (as Montanus giueth warning) that wee choose the vayne as farre as we can from the prin­cipall parts, Montanus medicinae vni­uersalis part. 3. from the heart, liuer, and braine, for if we draw the pestilent humour vnto them he sayth we shall kill the patient.

CHAP. 6.

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 beginning of the disease, Heurnius de morbis caepitis cap. 10. pag. 114. 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 quàm 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 [Page 28] 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. A [...]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, 1. Aph. 13. & 1. Aph. 23. 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, Heurnius de morbis capitis cap. 10. 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 [Page 29] 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, Trincau. de ra­tione curandi partic corp. affect. lib. 5. cap. 7. 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, Hippocr. 2. de ratione victus in morbis a­cutis. Fuchsi. de me­dendis morbis lib. 2. cap. 5. 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 [Page 30] 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, Gal. libro de ratione caran­di per venae sectionem. 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.

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. Trincaeuel Consil. pag. 971. Trincauel in his treatise which he calleth rudimentum, hath vnder­taken to confute them. The first reason of Brisso [...]us is, Ratio prima Brissoti. because in such sharp diseases, vnlesse you help presently the party dyeth. And the first scope in an [Page 31] 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. Gal. libr. 2. ad Glauc. 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, Ratio secunda Brissoti. 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 much as is drawne vpward out of the in­ferior parts of the body: whereupon the humour following, the motion which is made by the force of the vayne cut, setling on that side, doth giue an occasion of a new inflammation. And therefore when there is a plenitude in the whole body, espe­cially about the lower parts of the belly, he doth greatly commend the custome practised for many yeares with good successe by the Phisitions of Venice, to wit in this, to open the vayne about the knee, or about the anckle. And he sheweth, that in his owne experience in the same time that he was writing that treatise, he cured an old man of 60. yeares of age (who hauing a body verè plethoricum, was fallen into a plurisie) by causing the vayne to [Page 32] be opend hard by the anckle. If Hippocrates did sometimes open the vayne in the arme of the same side where the pleurisie did lye (as Trincauel doth make accompt he did in the curing of Anaxion the Abderite) it was because the disease was fully made, Hippocr. lib. 3. epidem. and the matter already flowed. But in the beginning of the flowing of the humour, neither Hippocrates nor Galen do allow the same kinde of euacuation, which afterward-they admit when the flux is al­ready made. Hippocr. 6. epidem. par. 2. aph. 19. Hippocrates sayth, If humours be ca­ryed into that part which they ought not, we must reuell them, but if they flow the same way they ought, then to open the passage to them according as euery one is bent. And what his iudgement is touching this matter, you haue it set downe in the end of my Chapter last going before, Vide finem [...]exti capitis huius libri & finem primi capitis. and also toward the end of my first Chapter, where are cited the words of Galen concerning an vlcer caused of a flux, that if the flowing be vehement we must pluck it back into the contrary parts, but when it doth cease and rest setled in a place, then is it best to deriue it. Vpon which point also Galen doth inferre there a gene­rall conclusion. Galen lib. 4. method. therap. cap. 6. It is a generall thing that when fluxes doe begin, wee must vse reuulsion; but when they are setled in any affected part, then euacuate them either from the same place, or from some other place as neere as can be. He speaketh there of purging by medi­cins, but in the 13. and 14. booke of the same method of healing, he requireth the same order likewise in letting of bloud, and repeateth againe as a generall axiome, Gal. method. therapeut. lib. 13. euer make the reuulsion to the furthest parts off. So commenting vpon Hippocra­tes, he biddeth vs first make reuulsions, and after­ward set vpon the contraries, to make locall eua­cuations [Page 33] as he himselfe doth expound it by the example of griefe in the hinder part of the head, Gal. libr. 2. comment in 6. epidem. prop [...] finem com­mentar [...]. Gal. method. therapeut. lib. 13. [...] Institut. lib. 2. which is taken away by opening the vayne of the forehead. And so in an other place, if the right leg haue an inflammation, he appoynteth a vayne to be opened in the left. Fuchsius hath framed sundry answeres to those testimonies of Galen in the 13. booke of his Methodus therapeutica. First he saith, that his generall axiome, that reuulsion must be made alwayes to places furthest distant, can in no wise be wrested vnto letting of bloud, seeing that Galen doth not speake there of letting of bloud, but of purgings, vomits, cupping-glasses, and such like. I wonder that Fuchsius should make that an­swere, seeing that Galen doth not only often in the leaues last going before make mention of Phlebo­tomy, but also when he hath made this generall precept with [...], semper, alwayes reuell to the fur­most, he sayth in the lines next following, that he hath spoken of this in his bookes of Plenitude and Phlebotomy. Gal. method. therap. lib. 13. These things are written in my bookes of fulnesse and bloud-letting. Secondly, Fuchsius saith further, aliquando venae sectione ad longinqua reuelli­mus, sed hoc fit in futuro morbo, sometimes we make reuulsion by bloud-letting into places farre di­stant, but that is when the disease is to come. If Fuchsius confesse so much, then he agreeth with Auic [...]n, Montanus, Trincauell, and such a [...] hold with them. For they all do teach that reuelling in­to places furthermost distant is not alwayes re­quisite, but only in the beginning, when the hu­mour is yet flowing, before the humour be setled, antequam sit morbus factus, before it be a disease made, and that is indeed in futurso morbo, Thirdly, [Page 34] for that place where Galen doth bid that if the one leg haue an inflammation, we should let bloud in the other: Fuchsius answereth, that Galen doth speake in that place of scarifying, that when one leg hath gotten an inflammation we must scarify the other, because scarifying doth stirre vp a griefe and payne, and dolor attrahit, griefe draweth the flux to the place scarifyed. But I maruaile that Fuchsius would not take the words as Galen hath let them downe. Galen speaketh plainely in that place not only of scarifying, but also of bloud­letting, his words are these: [...]al. method. [...] We must either open a vayne, or scarify the places not affected, as the hand be­ing grieued to take the leg, or the one leg being pained, the other.

Fuchsius hauing obiected the practise of some which first do diminish the plenitude by opening the saphena, or else the basilica of the contrary arme, and after do take away the reliques out of the same side where the griefe lyeth, doth cry out against this counsayle of the Arabian Phisitions with the same words that Fernelius also doth, [...]ernel [...]in me­ [...] medendi [...] cap. 5. [...] institist. 2. What an od counsaile is this to torment the patient so often, when you may with one act ease him of his payne? But although these two were both of them famous and learned men, yet as good Phisitions as they doe prescribe the act of letting of bloud to be often re­peated either in one day or in dayes immediatly following, and yet are in very good hope that they doe not thereby torment the patient, but worke much more for his ease. Hieron. Mercurial. consil. 15. Mercurialis giuing counsaile to one which in a cough did spit bloud, sayth, If the casting vp of bloud do remayne, it would like me well that bloud should often be let a little at [Page 35] once out of either arme, and therewithall rubbings and bindings applyed both to the anckles and to the knees. Montanus who doth as much reuerence Auicenna, Montan. medi­cinae vniuersalis parte secunda, pag. 312. as Fuchsius and Fernelius do persecute him. For he sayth of him, Auicen was a most diuine man, a follo­wer of Galen, and to be preferred before all that haue drawne their learning out of Galen: We haue Greeke translators (as he nameth there Aëtius, Paulus Aegi­neta, and Oribasius) but compare them with Auicen and they are nothing. Pag. 393. And a little after he sayth, we must know that Auicen doth neuer speake any thing but what was before approued by antiquity. This Mon­tanus as in other points he commendeth Auicen­na, so in the seuerall states of pleurisy he alloweth his iudgement, Montanus me­dicinae vniuer­salis part. 3. that first bloud be drawne from the saphena, then from the opposite vayne of the arme, and last of all from the same side: The first taketh away the multitude; 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. Trincau. in ru­dimento in cōsil. pag. 1043. 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 [Page 36] 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, Fuchsius Instit. libr. 2. then shall the two opinions be easily re­conciled. Galen method. [...] lib. 13. cap. 11. 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 [...]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 [Page 37] 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. Fuchs. Instit. lib. 2. & de morbis meden­dis lib. 2. cap. 8. & in Apologia aduersus Bra­chelium. 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. Gal. de ratione curandi per venae sectionē. 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, Gal. ad Glau­conem therap. libr. 2. 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. Gal. libr. de ra­tione curandi per venae secti­onem. True it is that he doth elsewhere teach, that Phlebotomies in y ^e 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, Gal. method. therap. lib. 13. 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 [Page 38] 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. Fuchs. Instit. [...]ibr. [...]. 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, Hippocr. 6. [...]pidem. part. 3. [...]ph. 32. 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. Fuchs. cōment. [...] 6. epidem. 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 [...]pist. 22. ad Alexandrum Triuellum &c. 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 [Page 39] 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 y ^• rea­son why it is not necessary that such as haue pleu­risies, should alwayes be let bloud, because by ex­periēce he knew one mēded of a pleurisy without letting of bloud, his pleurisy being a light pleu­risy, and voyd of all feare of 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. Hippoc epide [...] lib. 6. sect. 2. [...] 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, Gal. lib. 2. ad Glauconem cap. 7. so Galen doth expound it [...], it signifieth according to rectitude. And in an other place he doth interpret it by the word [...], directnes. Gal. libr. 3. d. iudicys cap. 3. 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. In Coacis praenotionib [...]. 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, [Page 40] 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, [...]ernel. lib. 2. [...]ethod. me­ [...]end [...]. 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, Andraeas I au­entius in A­ [...]t [...]m. [...]usa [...]rus in [...]. 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, [Page 41] 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, Andraeas Lau­rentius in anatom. 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 quàm 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 euacu­ [...]tion or reuulsion or diuersion, and which of them [...]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 [...]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. Mont. medici. vniuers. part. 3. Mon­tantus will haue in euery inflammation two things [Page 42] 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 [Page 43] 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.

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. Trincauel de ratione cu­radi part. corp. affect. is lib. 3. cap. 3. 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, Gal. libr. 1. ad Glauconem cap. 14. 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 [Page 44] 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. Hippocr. 4. de ratione victus in morbis acu­tis. Trallian. lib. 1. cap. 14. Heurnius de morbis capitis cap. 25. 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, Montanus medicinae vni­uersalis part. 3. 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, Mercurial. consil. 66. 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, Mercurial. consil. 104. 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 [Page 45] iudgement is, Trincauel con­sil. 15. pro me­lancholia hypo­chondriaca. that we must abstayne from bloud­letting, 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, Montan. me­dicinae vniuer­salis part. 3. 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, Trincauel de ratione curadi part. corp. aff. lib. 8. cap. 10. 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, Auicenna prima quarti. 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 [Page 46] 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, Fernelius in method [...] gene­rall de curan­dis sebribu [...]. 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.

MOntanus doth make this to be one of the principall and generall vses of Phleboto­my, Montanus me­dicinae vniuer­salis part. 3. 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 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. Heurnius de morbis capitis pag. 335. 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, Fernel. co [...]sil. 12. as Fernelius sheweth in his answere to [Page 48] the Phisition Bucherius, Aliter Montanus consil. 132. 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 [Page 49] like reason doth Fernelius giue in his curing of mor­bus Gallicus, Fernelius de lue [...]en [...]rca pag. 108. 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, Gal. libro de ratione curan­di per venae scciionem. 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: Gal. method. therap. lib. 13. 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, Fuchsi instit. lib. 2. sect. 5. cap. 5. 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 [Page 50] 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.

MOntanus in his conference had with a Doctor called Sonzinus, Montanus [...] 132. 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 [Page 51] 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. Trincauel consil. 4. 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, Gal. desanita te tuenda lib. [...], 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 bloud­letting: Melinus did refuse to yeeld vnto it, clea­ [...]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. Ibid. But he relyed wholy vp­pon that auctority of Galen, Of these kinds and de­grees of sanguisication, some little differ from bloud, [Page 52] 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; [...]ernel. [...]. 46. laying open the whole case vnto him, and desiring him that he would declare his iudgement cōcerning this mat­ter. Fernelius sub [...]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 [...]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, [...] 30. or when it commeth by the obstruction of the gall according to Fuch­sius. The ca [...]hexia, or bad habit of body is percei­ued as Trincanel sheweth by many outward signes, [Page 53] which are commonly these: Trincau. de ra­tione curandi part. corp. affect. l. b. 11. cap. 8. 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, Iohannes W [...]crus [...]ract. de sco [...]buto. whereby the thinner part of melancholy is caryed vpward, and with a sharp corrosion doth infect the gummes, and the grosse [...] 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. Baldwin Rous. in commenta­rtolo [...] magni [...] lienibus Hipp. 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 [Page 54] doth require a vayne to be opened. For (as first Hippocrates, [...]ippocr. 4. de [...]tione vict. [...]ut. 19. and after him Galen doth declare) there are three especiall points to be marked in the drift & purpose of letting of bloud. [...]alen. de rati­ [...]e curandi [...] venae sect. [...]p. 9. The first is cal­led by them the greatnesse of the disease, whether it be present or to come, whether acute, or of long continuance, [...]. Epid sect. 3. [...]ap. 3. if it be great, dangerous, strong, or grieuous. The second is a flourishing age, neither too yong, [...]. Epid. 1. 29. 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. [...]al. method. [...]tedendi lib. 9. [...]ap, vlt. 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. Galen de rati­ [...]ne curandi [...]er venae secti­ [...]nem cap. 6. 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. 1 the quantity and quality of the plenitude, 2. 2 the strength or weake­nesse of the powers, 3. 3 the naturall habite of the whole body, 4. 4. and the time of the yeare, 5. 5. and the region or place of habitation, 6. 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. 7 cu­stome or discontinuance, 8. 8 what motions and exerci­ses he hath vsed, 9. 9 whether he haue had heretofore any euacuations, which are now withholden against custome, 10. 10 and moreouer besides all these, whether [Page 55] 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. Galen. ibid. 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 first Chapter.

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, Gal. lib. 2. de composit. medi­ca neat. se [...] ­du [...] [...]. or rather with excesse of humours ouer the whole body, as Galen doth define it, Plenitude is an abun­dance, [Page 57] 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, [...]. Gal [...]bidem in initio. 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. Brigthus in therapeut. If there be a fulnesse of bloud in respect of the vaynes and o­ther vessels, Plethora ad vasa. 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, Plethora ad Vires. 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 [Page 58] distented vaynes. Other signes of bloud a­bounding. 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. Signes of cho­ler abounding. 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. Signes of fleame aboun­ding. 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. Signes of melancholy abounding. If melancholy do exceede, the colour of the face and whole body will be browne, dusky, and blackish, sometimes equally, and sometimes [Page 59] 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, Leuinus I em­nius in libris duobus de com­plexionibus. 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, Gal. method. therap. lib. 13. 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 dis­ [...]ented fulnesse, then must also Phlebotomy be [Page 60] vsed, but sparingly only, so much as may ease the plenitude, Fernel. consil. 46. and rather (as Fernelius doth aduise) ex interuallis detrahendo quàm 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.

IT is not without good cause that Fuchsius loth require in Phlebotomy, Fuchsius instit. sect. 5. cap. 4. 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 surfe [...]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: Gal. libr. de [...]. ratio­ne per venae sectionem. To intemperate men, wine­bibbers, 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 [Page 61] 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 y ^• lesse store of superflu [...]e [...], and therefore may the lesse endure any plentifull Phlebotomy, Fuchs. Instit. libr. 2. sect. 5. cap. 4. 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 cōgeased, 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. ad Glauconem [...]herapeutic. lib. 1. cap. 13. Galen sayth, As many as are by [Page 62] 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 whielt [...]euer were acquainted with it. Hippocr. 2. Aph. 50. 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 [...]. Auice [...]a: in his sixteenth. Canon of bloud letting (as Montanus hath deuided them) doth declare three sundrie dispositions of, Montanus me­dicinae vntuer­salis part. 3. mans stomack, which cannot permit the opening of a vayne: Gal. therap. meth. lib. 9. 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 si­no [...]y, it hath great affinity and consent with the brayne and the heart, whereby if there be a fl [...]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 thedo [...]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 [Page 63] 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, Galen. lib. 12. method. the [...]a­peutices. 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 [...]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. Montan. in Canonem 17. Auicenae. 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 [Page 64] any vayne be opened. The manner how it must be done shall appeare in the Chapter follo­wing.

CHAP. 3.

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, Montan. me­dicinae v [...]tuer­salis part. 3. 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 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 s [...]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 [Page 65] letting bloud, [...]uch. [...] lib. 2. sect. 5. Fernel. lib. 2. met [...]d. me­dend [...]. cap. 14. he must vse extenuating things, as a decoction of hysop, [...]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. in explaratione lib. 1. Ga [...]ca [...] ad Gla [...]em de arte cu [...]a­tiua. cap. 12. Trincauel commenting vpon Galen, after that he hath shewed that bloud­letting 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 whē the vaynes are emptyed by Phlebotomy, Galen de sanit. tu [...]nda. lib. 1. 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 ma [...]st thou safely open a varne. Galen sayth, Galen. lib. 4. desan [...]tate tuenda. 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 [Page 66] vaynes about the liuer, and mid-bowels, they do pluck them into all the body. Mont. med [...]cin. [...]uers part. 3. 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. Gal. libr. 4. [...]e [...]anitate tuenda. 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, Aui [...]m. Ca [...]. 8. 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 y ^e same [...], or tempering of humours, which Galen doth so much require. Gal. lib. 9. [...]. me­d [...]. This [...] tempera­tio humorum, is nothing else but by little and little [...], to take away bad humours, and [...], to adde and restore good humours. [...] 77. 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 [Page 67] 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 gross [...]. 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, Montanus in canonem. 8. 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, Galen. lib. 5. method. me­dendi. cap. 14 [...] 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. Fernelius me­thodo gene­ [...]al [...] de [...]ran­dis schribus. 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 [Page 68] with some purging receit or potion, the learned Massaria doth mightely condemne them which do neuer attempt the opening of a vayne, Alex. Massa­rta [...]d sputa­tionibus dua­bus pag. 202. 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. Mercurialis de mor [...]s puero­ [...]u. lib 1. cap. 2. pag. 50. 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 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: [...]tercur. ibid. for (sayth he) it is a fond thing to thinke that the motion of nature i [...] hindered by clysters, seeing that they do worke only in the bowels, and the motion of nature is both neere the skinne, and in the vaynes, nei­ther do clysters so ouerthrow the po [...]ers that we neede to conceiue any feare. Euen so, for as much as in let­ting bloud, our drift is especially either to case na­ture, being ouerburdened, or to expell some dan­gerous [Page 69] 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, Mercur. ibid. pag. 49. 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, Massaria lib. descop. m [...]tten­disang [...]nem pag. 76. 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 [Page 70] of a shilling, of the rootes of asarabacca and beto­ny, each the waight of sixe pence, boyle these in water so much as being well boyled will make a good draught, and being strayned dissolue into it two ounces of ox [...]mel simplex and drinke it off. In hoater diseases the former will be more conue­nient. Fit vomits and clysters they make a prepa­ration speedily, and do nothing trouble the work of nature in expelling to and by the outward parts. P [...]rgations if they be strong they weaken nature: if gentle, then are they long in working, and hauing some hoate qualities in them, must needes as well by their heate as by their drawing a contrary way, trouble that worke whereunto Phlebotomy is directed. Dionysius Fon­tanonus de morborum internorum curatione lib. 4. cap. 2. Fontanonus a learned Doctor of Mountpelier, writing of that synochus or hoat cōtinuall ague, which proceedeth of bloud inflamed in the vaynes neere vnto the heart, after that he hath appointed to begin the cure with pre­sent letting of bloud, What houre of the day soeuer it be, for feare least the bloud do creepe vnto the lungs, and thereupon should come an inflammation of the lungs, or least it should slip into the bulk, and thereof should arise a pleurisie, or finally least it should putrifie, and so there should be made a putred ague of a not pu­tred, he sheweth after how the body must be made fit for this Phlebotomy, not with a purging po­tion, least while the purgation is long in working, the patient should receiue harme by the aboundance of boy­ling bloud, but by a clyster made after this sort. Take of the foure emollitiues each one handfull, (the foure emollitiues are, Heurnius me­thod. ad p [...]a [...]i. [...]. 1. pag. 6. as skilful Heurnius doth lot them out, 1. mallowes, 2. marsh mallowes, 3. violets, or in stead thereof pellitory of the wall, [Page 71] 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.

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 [...] 77. 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, Galen de sani­t [...]te tue [...]da lib. 5. in fine. 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.’ Whē washt he hath, & food for sustenāce receau'd, His li [...]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, Trincauel in rud [...]mento c [...]tra Brisso­ [...]um. 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 [Page 73] ankle, and had a due regard of the strength of the party. Galen lib. 5. de tuenda sanitate. 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. Fernel. lib. 2. methodi me­dendi. cap. 11. 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,

As for children how old they must be before they can admit Phlebotomy, Platerus de [...]ebribus pag. 105. 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, Fernelius me­thodi medendi libr. 2. cap. 11. 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. Montanus me­dicinae [...]uer­salis part. 3. 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 [Page 74] 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. Galen thera [...]. method. lib. 12. 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, Galen. method. therap. libr. 9. 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. Galen. libr. de [...]atione curan­di per Phlebo­tomiam. 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. Gal. method. medendi. lib. 11. 14. 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 [Page 75] or sweateth out very much of the substance of the body. Hippocrates also doth not allow Phlebotomy in yong children, H [...]ppocr. 1. de [...] victu [...] [...] b. 45. 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, Alex. Massa­ria descopi [...] mitt [...]ndi sang. pag. 55. Auer. [...]. 7. Col. c. 3. 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, [...] metho [...] [...]. 2 cap. 11. 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, Massaria. pag. 56. 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 [Page 76] 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, [...] lib. 2. [...]. 1. & lib. 2. ap. 2. 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 was [...]ng any vitall spirits. As for cuppings, where­as Rafes doth defend that they may be vsed vnto children at fiue moneths old, Cases libr. de es [...]e. cap. 4. tuicenna 4. doct. 5. ap. 21. 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: Mercurial. de [...] 2. Cap. 2. 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 [Page 77] 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. lib. 12. method. me­dendi. cap. 1. Galen for old age telleth a pretty history of a mad Phisition which ra [...]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, Mont [...]. medi­ci [...]ae vniuersal. part. 3. 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, Hippocr. 4. aph. 1. 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 blas [...]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 [Page 78] 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. Montanus in Canon. 7. Au [...]ceanae. 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, Hippocr. 5. Aph. 30. 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. Montan. medi­cinae vniuersal. part. 3. 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, Fernelius me­thod. medin [...]. lib. 2. cap. 12. 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, Cornel. C [...]ls. lib. 2. cap. 10. 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, [Page 79] 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, Ale [...]. Massa­ria. pag. 105. 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, Montanus medi [...]nae vni­uersalis part. 3 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 ple [...] ­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. Platerus de fe­bribus pag. 113. As for the flux of the body, Platerus doth giue a c [...]aueat generally, that such persōs as are apt to swou [...]nings should not be let bloud whē 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 fl [...]xts as Auicen sheweth in his fourth canon, and vpon it Montanus, Vt diuidit Montanus Canores med. [...] part. 3. because there can be no vacuuin, no [Page 80] 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, or else by ouermuch cooling of the body, when by bleeding, much of the strength is resolued. Ferne­lius sayth, The raw and vndigested flux which hapneth in a burning feuer, [...] lib. 2. [...] cap. 11. the stomack being dissolued by the drinking of cold water, doth not forbid the opening of a vayne, but a regard must alwayes be had of the power. Alexander Massaria doth aduise, that if the flux do come of venome, or any poysoned humour, we should not let bloud, Alex. Massa­ [...]ria lib. d [...] cap [...]s [...] sangu. because the greatest violence is then offered to the powers, and the spirits are in dan­ger of sainting.

CHAP. 5.

WHereas euery disease hath foure seue­rall times, the first is called [...], princi­ [...]ium, the beginning, which indureth vntill there appeare some signes of concoction, the second [...], [...] vel [...], incrementum, augmentum vel ascensus, the time of the increase so long as the fits or griefes doe waxe more painefull: the third [...], vigor & status, the vigour of the disease, when it standeth in one stay, and neither increaseth nor decreaseth: the fourth [...], declinatio, so long as the disease doth decline or decrease. It remayneth now to be discussed in how many of these Phlebotomy may take place, and to which of these it is most fit and conuenient. Montanus deliuereth this for Galens doctrine, Montan. me­dicin [...] v [...]tue. la [...] part. 3. In letting of bloud there is no time to be at­tended, but at what time soeuer, by reason of the fulnesse an euacuation is shewed to be the best drift, let the eua­cuation be made, whether the disease be in the begin­ning, or in the increase, or in the state, so that there be not vndigested meates in the stomack and bowels: but he addeth a prouiso, dummodo virtus non sit debilis, so that the vertue and powers b [...] not weake. But for the most part Phlebotomy is most fit in the be­ginning of the disease. That rule of Hippocrates, Hippocr. 2. Aph. 29. In the beginning of diseases if any thing do seeme sit to be [Page 82] mooued, mooue it: but when the diseases are at the high­est state and vigor, it is best then to rest. Galen com­menting vpon it, doth apply it to the two great re­medies, and especially to Phlebotomy. The first canon of Auicenna expounded by Montanus is, A vayne is not to be opened in the day of the diseases motion, that is, when the matter of the disease doth boyle and swell, and nature doth striue to concoct or expell it. Montanus [...]. Montanus sayth, there is duplex motus morbi, two manner of motions of a disease, the one particular, which consisteth in the fits and pa­roxysines, and the other generall or vniuersall in respect of the whole disease from the beginning to the end, and this conteyneth the criticall dayes, the fourth, the seauenth, the eleuenth, the foure­teenth, the seauenteenth, the twentieth, &c. Now we must marke how the matter of the disease is mooued, whether in a criticall day or not criticall, and whether it be moued because nature goeth about to concoct it, or because it is furious: If the motion of it be furious, we must needs vse euacuation. But when the motion of the disease is such that na­ture doth concoct the matter, then is it a day of rest, and no euacuation is then to be attempted. And that doth he make to be the meaning of Hip­pocrates, that we must rest when the disease is in state and vigour, hoc est in die motus morbi seupugnae tempore, that is, in the day of the diseases motion, or the time of the strife betwixt nature and it. Some affirme that in the criticall day bloud is not to be letten, although it prooue a day of rest. But Montanus doth confute them, and doth iustifie that rule of Auicenna, When nature doth mooue, mooue thou nothing, but when she mooueth not, mooue [Page 83] thou in the time of her motion. The time of natures motion it the criticall day, and therefore in the criticall day we must stirre the body. But therein the Phisition must be very wary and circumspect, for if nature haue moued in the fourth day (which is the decla­rer of the seauenth) then may we not euacuate in the seauenth day. And if in the seauenth there ap­peare any motion, we must not mooue in the ele­uenth. But if in the criticall day nature do neither mooue, nor shew some good token and proofe that she will mooue, then may wee indeuour to mooue by Phisick. Afterward vpon the twelfth canon Montanus reprooueth them which affirme that bloud is not to be let after the fourth day of the sicknesse, Montanus in canonem Auicennae 12. Gal. method. therap. lib. 3. and prooueth out of Galen, that in some infirmities a vaine may be opened a hundred dayes after the beginning thereof. But in sharp fe­uers we let bloud only in the beginning, because after the fourth day the powers do faile, and for that cause he sayth Hippocrates doth appoynt, In sharp diseases vse euacuations in the beginnings. Hippocr. 1. Aph. 24. Trincauel likewise doth apply vnto Phlebotomy that other axiome of Hippocrates, Hippoc. 1. Aph. 22. non esse vacuandum in prin­cipio nisi turge [...] morbus, that we must not purge in the beginning vnlesse the disease be furious and vehement. Trincauel epist. 22. ad Aloisiam Cri­uellum Massaria. Gal. in fine lib. 3. com [...]ret. in 6. de morbi [...] vulg. Turgere dicuntur qui adeo concitato motu agitantur vt prae illorum molestia agrotus non possit quiescere, quod magni morbi est indicium, those disea­ses are sayd to rage or swell, which are caryed with such violent motions as that the patient can take no rest, and qui ad excretionem festinant, which would faine breake out. He bringeth in the ex­ample of Galens owne practise, which (as he recor­deth of himselfe) when he was sent for vnto a man [Page 84] sick of the pleurisie, [...] 3. [...] 44. when he saw first that he a­uoyded bloud by spitting, and secondly, that (as the patient being asked did confesse) he felt but little griefe on his side, he vsed some applications to him, but would not let him bloud, because it was a most gentle kind of pleurisie. But how may the former part of that aphorisme of Hippocrates be applyed to Phlebotomy, [...] 22. Purge things concocted and ripe, but not while they are raw? Is concoction first to be expected before we can vse Phleboto­my? Fernelius and Fuchsius do in this poynt bitter­ly inue [...]gh against Auicen, [...] libr. 2. [...] cap. 13. for that he forbiddeth a vayne to be opened vnlesse the humours be first concocted. [...] 2. Their reasons are especially these, first, because in sharp and violent diseases, and where there is aboundance of bloud, it must needs be dangerous to deferre: secondly, though the dis­ease be not sharp, yet may the multitude of bloud of it selfe do har [...]ne, if it be not presently eased: thirdly, because when signes of manifest concocti­on do appeare, then (as Fernelius holdeth) we must deale no more by letting bloud, but the rest of the cure must be finished either by purging, 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: He meaneth of c [...]ud▪ tates morbo [...]ae, which remain so long vntill the disease be ouercome. 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 [Page 85] of the matter, and the dissoluing of strength: If neither of those do happen, Phlebotomy may be vsed. Montanus interpreteth the meaning of Aui­cenna, Montanus [...] Canon. 11. Au [...]ennae. 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. Trincau. in ex­planatione lib. 1. ad Glau. cap. 12. 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 [...], whē naturall heate doth turne the food into due nourishment, conteyning vnder it those three sorts or degrees of concoction mentioned by Galen, Galen libr. 4. desanitate [...] 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 [Page 86] 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, Weckerus [...]: dotar. [...]pecial. [...]ag. 416. 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, Galen. lib. 4. desanitate [...]uenda. 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 [...], 1. Epid. sect. 2. com. 44. 4 [...]. 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, 2. De rat. v [...]ct. morb. acut. 44. 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 [Page 87] 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, Hippocr. 2. Aph 23. acuti morbi diebu [...] 14. [...]. 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 concoctiō 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 y ^• 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, Galen desani­tate [...] lib. 2. Then is the best time when the meate before taken is perfectly concocted and digested in respect of the two first con­coctions. [Page 88] 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 f [...]ry, red, and cholerick vrine sheweth, that the iuices are long ago conco [...]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. Galen desani­ [...] [...] 4. 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 vrine. Secondly, whe­ther he haue bin wont naturally to abound with many ill and vicious humours, and whether any outward signs therof haue appeared by itches, pustles, ring-wormes, swellings, inflammations, and such like. Thirdly, whether any accustomed or naturall euacua­tions haue lately ceased, as vomits, hemorrhoides, fi­stulaes, fluxes, bleedings at y ^• nose, termes, sweats, and such like. Fourthly, whether they hauing bin ac­customed heretofore to auoyd superfluities by Phisick, and haue of late neglected it, and not vsed such pur­gings, vomits, and bathes as heretofore they haue done. Fiftly, to examine not only the vrine, but other excrements, as egestions, spittings, sweates, for as he sayth a little after, The sweate declareth [Page 89] what humour aboundeth in all the body, for it is whi­ter, paler, or yellower, according as the humours be more or lesse phlegmatick, or cholerick, and if the humours be pu [...]rified the sauour of the sweate will greatly bewray it. But in matters that do con­cerne the vaynes (as doth especially Phlebotomy) Galen will haue vs especially to respect the vrine. We haue no effectuall and euident signe to discerne the superfluities that are in the vaynes, Gal. ib [...]dem pa [...]lo [...]. but only that which is by vrine. If the humour be altogether crude and raw, the vrine will be thinne and watery, and neither haue any hypostasis or sediment, nor haue any cloudy matter hanging in the [...] but when it is concoc­ted, these things do appeare, and besides, some thinne clowdes do swimme vpon the top. Sic Hippoc [...]. libr. [...] If the thinne and thicker parts do quickly deuide, and that the sediment be white and smooth, and in euery part equall, that sheweth that straightway care one can speake the word nature will euercome all. If it be longer care the sepa­ration be made, longer it will be care the humours be ouercome. But if in the vrine there be no separa­tion at all, but that it remayne still as it was made, or else if it do breake it be with a bad sediment, then is nature weake, and hath neede of some other help to digest the humours. Many other signes there are of crudities, as the small quantity of vrines, signifying that by their rawnesse they are hardly sent out. Likewise the thicknes of vrine, shewing abundance of raw humours, and thereupon depriuation of concoc­tion. Further, Inequal [...]ie and distempe­rature of the pulles, are signes of mor­b [...]s [...]e crud [...]a­tes. the ill contents in vrine, and the in­equalitie of the palses, but these and many other signes of diseasy crudities must not stay vs from letting of bloud if the greatnesse of the disease do require it, and the party haue a full body, and suf­ficient [Page 90] strength: Fernel met [...]od. lib. [...]. method. medend [...]. cap. 13. cap. 14. but rather as Fernelius sheweth when signes of crudities are, we must vse Phlebo­tomy as the remedy. Only touching our food last taken, let the stomack, bowels, and (if it may be also) the mesaraick vaynes be cleared from raw and corrupt humours, and let such a time be cho­sen wherein also the disease hath most quietnesse from the motions of the paroxysmes. The greatest rest is in the middle time of the intermission or remis­sion, for so shall we be in no danger of drawing the inflammation into the greater vaynes (whereby of an intermitting feuer may be made a cōtinuall) and the powers also of the patient shall least be indangered. But seeing so often Galen and all Phi­sitions in the matter of Phlebotomy do still make their prouiso [...]s that the powers be not dissolued, Galen. libr. de ratione per venae secto­nem. a question may here be mooued of what powers they do especially speake, and how the strength of those powers shall be knowne. Galen describeth three powers in man, Galen. method. [...] lib 9. cap. 10. [...] 5. ca. 7. the first he calleth the natu­rall or nutritiue power, that hath his fountaine in the liuer, and conteyneth vnder it the attractiue power, the retentiue, the expulsiue, and the fourth the altera­tiue power, which is generally to turne the nourishment into substance and particularly to make bloud. The se­cond vertue or power is called the vitall power, ha­uing the seate in the heart, giuing life to the whole body, and conseruing the essence of the vitall spi­rits. The third he calleth the animall or rationall po­wer, hauing the seate in the brayne, and bringing forth sense, motion, and vnderstanding. Each of these three powers haue their particular instru­ments to worke by. To the naturall power do serue the vaynes, to the vitall the arteryes, and to the [Page 91] animal the sinewes. Now which of these powers in letting bloud must most be respected? No doubt there must a care be had of all, Galen. method. medendi. lib. 9. cap. 10. Gal. lib. de curatione [...] sectionem cap. 6. for as Galen sayth there, If any one of them do perish, it must needs be that all the rest shall perish also. And giuing precepts of letting bloud, when he hath taught how we shal try the animall power by the voluntary motions, and the vitall by the pulses, and the naturall by good or bad nourishment, or by good and bad colour, he concludeth generally, when these powers are strong, let bloud. So whereas Hippocrates doth bid vs when diseases are in the vigor to rest, Hippocr. 2. Aph. 29. and not to vse phlebotomy or purging (for so Galen doth expound it) Galen doth giue the reason there of it, because the animall power is then weake and in danger, although the vitall and naturall be strong. Yet certaine it is that the vitall power is that which chiefely we are to obserue in Phlebo­tomy, as he doth elsewhere at large declare, The greatest dignity of all is that which concerneth the acti­ons of the heart, Galen method. [...] lib. 7. cap. vitimo. and of all most needefull to be conside­red in them that are sick. He doth in that place compare the operations of the liuer and of the brayne with the vitall powers of the heart, but he will haue the heart to be principally respected. In extreame apoplexies the animal powers are de­cayed, yet because the vitall powers are not extin­guished Phlebotomy is allowed, and doth often worke good effect. That is the cause that Galen doth giue out that precept in his booke of Phlebo­tomy: Galen de [...]a­ratione per venae secti­onem cap. 11. In all these former rules thou must still haue an eye to the strength of the party touching his pulses. By that word (touching his pulses) he sheweth both that the vitall power is most to be regarded, and [Page 92] also doth point out the meanes how we shall take triall of it, Other signes of strength sayling, by the pulses, are shewed after Chapt. 8. to wit, by the distemperature and the inequalitie of the pulses.

CHAP. 6.

THe best time of the yeare for Phlebotomy is knowne of all men to be the Spring, ac­cording to that aphorisme of Hippocrates, Hippocrat. 6. [...] 47. The Spring must be the time of letting bloud and pur­ging. The Autumne is in fitnesse the neerest vnto the Spring. The extremitie of the heate of sommer is most dangerous as Galen sayth, hauing named a little before the canicular dayes. Gal. ad Glau­conem therap. lib. 1. They which are sinisterly euacuated in very hoate times of the yeare, do perish either with s [...]ounings, or with resolutions. The extreame cold also of the winter will not per­mit Phlebotomy; or if it do, it must be little: Mon­tanus giueth the reason, because the body is ouermuch cooled, Montanus in [...] and is also made so thinne, that the cold doth strike into the inward parts, whereby are brought disea­ses of very long continuance. Galen will haue them which are vsually sick in the spring time to be let bloud in the beginning of the spring, but such as most commonly haue their sicknes in the sommer time he would haue them to open a vayne in the end of the spring a little before sommer begin. The fittest time for letting bloud is when the signe (as we call it) or the moone is in Aries, Sagittarius, Cancer, Li­bra, Scorpio, Aquarius, or Pisces, vnlesse in any of [Page 93] these signes the moone do predominate in that place that is to be let bloud, as in Aries the head, Taurus the neck, Gemini the shoulders and armes, Cancer the breast, stomack, and ribs, Leo the heart and back, Virgo the belly and bowels, Libra the raynes and loynes, Scorpio the secrets & bladder, Sagittarius the thigh, Capricornus the knees, Aqua­rius the legs, Pisces the feete. There must also a re­gard be had of the age of the party that is to be let bloud, for to them which be growing or yong, the first quarter of y ^• moone is most meete. To middle aged people, the second quarter. To the declining age, the third quarter; and to old age the last quar­ter. The complexion also must be respected. If the party be cholerick let him bloud when the moone is in Cancer, Scorpio, or Pisces. If phlegmatick, let the moone be in Aries, Sagittarius, or Pisces. If me­lancholick, then let the moone be in Libra, Aqua­rius, or Pisces. It is ill to let bloud when the moone is in the full or in the change, or within three dayes either before or after. It is ill also when the moone is in coniunction or opposition with Saturne or Mars. Further, it is ill when the moone is in con­iunction or opposition with Venus or Mercury combust, or in a quadrate aspect with Saturne, Sol, or Mars, vnlesse the aspect be passed at the least eight degrees. But it is good to let bloud when the moone is in a trine or sextile aspect with Iupiter, Sol, Venus, and Mercury, but especially with Iupiter and Venus, with whome all aspects are good, pro­uided that they be not combust. In cases of extre­mitie there is no staying for signes or aspects, for (the necessitie of the disease compelling) I haue my selfe opened a vayne the signe being in the same [Page 94] place, and yet with good successe. But if a man haue liberty to make his choyce of the time, I hold him vnwise that will not take it as neere as he can agreeable to the auncient grounds and principles of Astronomy. It appeareth very many wayes that God hath giuen a power to the heauens, and an influence to the Starres and Planets, which doe mightily worke in the things here below, not to induce any necessities, but to dispose the inclina­tions, so farre as God hath appoynted and deter­mined. 1 Consider how all the times and tempera­tures of the yeare do alter and change according to the course of the sunne, and what difference there is betwixt the operation of Phisick, and the dangers of diseases assaulting vs in the spring, and such other as do befall vnto vs in the canicular dayes. 2 Marke the operation of the Moone in such plants as are set, and such seeds as are sowne in the seuerall times of her age. 3 Waigh the force also of the moone in those which in the scripture are cal­led lunatick. Math. 4 2 [...]. Ma [...]h. 17. 15. Origen doth report the iudgement of Phisitions, Humida moueri in capite secundum ali­quam compassionem ad lumen lunare quod humidam habet naturam, That moyst things are mooued in the head according to the sympathie of the moone which hath a moyst nature, but he thinketh rather that some vncleane spirit doth obserue the diui­sions of the situations of the moone and worke by them. Sermus lib. 1. de medic [...]na. Merc [...]r. lib. 2. de morbis pue­rorum cap. 3. But Serenus, and after him Mercurialis do giue this the reason, because they which are con­ceiued or borne in the wane of the moone are much subiect to the falling sicknesse. Howsoeuer it is, it is sure not without some cause that they are called lunatick, that is moonish, or mooned. And [Page 95] behold also the power of the Moone in the ordi­narie flowers of women, who are otherwise also sometimes too much subiect to that variable and tempestuous planet. 4 See what force it hath like­wise in the sea concerning the ebbings & flowings thereof, as also in respect of cockles and diuers o­ther shell-fishes waxing fuller or lesser according to the age and proportion of the moone. 5 Let also the experiences of mariners somewhat preuaile, which finde the whole leas to be caryed by the course of the firmament from the East vnto the West, whereupon they which trauaile to the west Indies do better passe thither in one moneth, then they can returne againe in three, besides the trials which they haue of their loadstone poynting to­wards the North, and their needles and compasses answering thereunto. 6 In Phisick the criticall dayes falling out either in hard or benigne constitutions of the planets, do dayly giue vnto vs abundant testimonies. 7 In histories what auctor can you al­most reade, but you shal finde therein the trouble­some alterations which haue followed vpon great eclipses? 8 In diuinitie see how Iob doth attribute vnto the Pleiades a sweete influence to cause the kindly spring, Iob. 38. 31. and to Orion a power to cause raines and showers, but so, that God doth loose or hold back the bridle at his only will and pleasure. And waigh those words spoken in the creation of the Sunne & Moone, Gen. 1. 14. let them be (said God) for signes and for appointed times, and for dayes, and for yeares. I do vtterly condemne the abuses of Astro­nomy, as first when men will make them signes of southsaying, to foretell things to come, and so to take that vnto them which is proper to God only, [Page 96] as it is in the Prophet: [...] 41. 23. Shew vs the things that are to come that we may know that ye are gods. God sayth, I w [...]ll destroy the tokens of the s [...]othsayers, and make the wise coniecturers fooles. The will of God is free and soueraigne ouer all his creatures in euery moment to order, alter, rule, and dispose them as seemeth best to his heauenly wisedome. Fata mouere deus, tollere fata potest. We see in one battayle, P [...]ucerus. or in one time of pestilēce (God being angry with sinne, or permitting the Diuell to rage) many thousands do dye at one time, which no doubt most of them were borne in diuers manners of constellations of planets: Wea­ker natures are subiect to the stronger, and particular causes are subiect to the generall. [...] lib. 12. [...] Saint Augustine sayth, In the liues of them which are borne twinnes, in their actions, casualties, professions preferments, and in their very death there is so great a diuersitie, [...] that many meere strangers are more like one to another, then those which in birth were separated with a very small distance of time, and sowen as it should seeme by coniunction in one and the selfe same 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 Chal­d [...]eans were such, that they would not build a house, nor attempt any iourney, nor so much as [Page 97] 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, Ver [...]el. lib. [...] cap. 11. only the south wind doth best admit it in the cold time of winter. The time of the day is [Page 98] made by Galen, Gal. de venae [...] ca. 14. [...] 2. sect. 5. 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. [...] us me­ [...] medena [...] [...]. 2. cap. 13. 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, Montanus in [...] de [...] de stu­ [...]o [...]orum sant­tate [...] lib. 1. cap. 22. 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 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 [Page 99] on the arme of the same side. Trineauel de ratione curan­di part. corp. ass. lib. 6. cap. 4 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 [Page 100] 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 ar [...] neerest to the affected parts, and most right vpon it. And in an other place, [...] The euacuation out of the neerest va [...]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 in [...]erna, or basilica, or axili [...]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 outward vayne called externa, or humeralis, or cephalica.

The middle vayne called communis, [...] or cardiaca, or nigra, or fun [...]: brachi [...], 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 [Page 101] 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, [...] 9. 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 plethor [...]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 [...] [Page 102] be perceiued, then take the other third which re­marneth. Platerus de s­ [...]bus pag. 114. 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.

IT is a notable aduertisement of Hippocra­tes, Hippocr. [...]. 2. 33. 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, [...]. lib. 2. [...] cap. 15. 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 [Page 103] 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, He meaneth it can very hardly be hea led: see the beginning of the [...] Chapter. it will neither come together againe, nor heale, but that part will be taken with a mortifica­tion, and become as dead and senselesse. He counsa [...] ­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 h [...] launcer faire and softly without any hastinesse gently, and no further in then is sufficient. Fuchsius In [...]itut. lib. 2 sect. 5. 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. Fernel lib. 2. methodi me­dendi. cap. 15 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 [Page 104] the head, hands, and feete if the incisions go right with the vayne he sayth they heale the sooner, be­cause there y ^• 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. Montanus [...]edicinae vni­ [...]ersal [...] part. 3 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 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,

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 cub [...]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 y ^• 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. [...] Insti­ [...] 2. sect. 5. 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 [Page 106] 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. H [...]ppoc [...]. lib. 2. [...] 10. 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, [...] Iustit. lib. 2. sect. 5. 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 [Page 107] arise, when either for the toughnesse of the ha­mour, or for the weakenes of the party, the bloud is let not at onc [...], but at seuerall times, how neere those times ought one to succeede an other. Fern [...] ­lius sayth, [...] lib. 2. met [...]d. me­d [...]ndt. 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, [...] sanitate [...] lib. 1. cap. 22. to be let bloud if they feele a plenitude, and he appoynteth it to be done twi [...]e in one day in the morning and in the co [...]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. Mont. medicin. [...] part. 3. The like speech hath Auicen in his third ca­non, where he adui [...]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. Galen. lib. 1. ad Glant. cap. 11. In that quartaine ague which comm [...]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 adu [...]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, Feruel. libr. 2. method. me­dend. cap. 17. or is estranged and departed from [Page 108] 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 s [...]ow: and when it shall be found to be very farre from the forme and shape of bloud, then must you altoge­ther ab [...]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, Gal. method. [...] lib. 9. 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, Ibid. lib. 9. [...] M. 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? Hippocrat. [...] 23. [...] lib. 9. [...]. 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, [Page 109] 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, [...] 239. 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: [...]. Gala. ad [...] cap. 14. 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, Gal. method. medendi lib. 12. cap. [...]. they cause syncopas or swounings. But if those grosse humours do neither obstruct nor oppresse, then they bring no syncopas or swounings, [Page 110] but they bring a certaine faint [...]es, [...] the Grecians call Leipoply [...]hia, or [...]. The [...]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: Galen. method. medendt. lib. 9. 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, wea [...]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 [Page 111] 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. Gal. de ratione curandi per venae sectio­nem cap. 6. 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: Gal. ibid. cap. 12. 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, In the fift Chapter of this second booke. 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, Galen lib. 4. de sanitate tuenda cap. 4. & 1. de ali­ment. facul. cap. 2. 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, [Page 112] that there is no place at all left for Phl [...]bo­tomy. Massaria. pag. 77. Galen. [...] 6. If in any place Galen doth deny and forbid letting of bloud in abundāce of corrupt humours, (as he doth sometimes, Aph 47. & Comme [...]t. [...] 2. [...] 8. & lib [...]. de sanitate tuenda. cap. 4. Gal. method. medend. lib. 9. cap. 11. allotting vnto them rather purgings then phlebotomie) we must accompt it to be done not in respect of the vicious humours, for Phlebotomy is cōmon 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, Auicen. [...]. 1. fen. 4. cap. 1 [...]. Gal. [...] per venae se [...] [...] ­nem. cap. 9. 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 Phlebotom [...]: for when such a multitude of raw hu­mours [...]gathered that it forbiddeth Phlebotomy, yet th [...] my former conclusion is not reprooued, for in such there is no strength sit for it. Gal. ibid. cap. 13. But (as he sayth after­ward) If these two scopes, to wit, the greatnes of the disease, and th [...] 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 [...]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. Auicen. lib. 4. f [...]n. 3. tr. 1. cap. 9. & 10. Anthonies fier comming of burning citrine choler mixed with melācholy, sayth, Necessaria est Phlebotomia vt vacu [...]tur sanguis cholericus, Phlebo­tomy is necessary that the cholerick bloud may be au [...]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 [Page 113] Massaria doth prooue out of the second booke de crisibus, Massaria. pag. 82. Gal. com. in 1. aph. 23. and out of his words vpō 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: Philotheus in Comment. in 1. Aph. 23. 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, Vide Brigthi therapeuticam in tractatu de causone. Vide bic supr [...] pag. 11. 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 [Page 114] 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. [...]. 29. Galen (when all other Phi­sitions withstood him) did let a woman bloud plē ­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 cōtinue the more bold­ly the bleeding of his patient. Cold constitutions may not endure much diminishing of bloud, Hipp. 1. [...]p [...]. 23. and those lipothymies, which Galen and Hippocrates [Page 115] 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.

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 [...]it for a perfect case and rest, so that no one limme or part may be put to any labour. Mont. medici vniuers. part. Montanus vpon the tenth Canon of Auctco [...]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 Institut. li [...] sect. 5. ca [...] Fuchsius is of the same iudgement, Let [Page 116] the patient so lye with his face vpward, that all the parts of the body may leane vpon the basis or ground­worke, to wit, the back-bone. ernelius me­ [...]od. medendi br. 2. cap. 16. 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.

The appointing of sixe houres watching is thought by many good Phisitions to be somewhat more then needeth. uchsius instit. b. 2. sect. 5. [...]ap. 12. 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. ernel metho­i medendi. b. 2. cap. 16. Fernelius his opinion is, that in one houre after bleeding the party may take foode, and within two houres af­ter he may safely sleepe.

Further, [...]uchs. Instit. [...]b. 2. sect. 5. [...]p. 12. he that is let bloud must haue a great care, that (as Fuchsius sayth) he auoyd all strong [Page 117] labours and contentions both of body and of mind for certaine dayes following, and that he vse for a while an exact diet, not beginning rashly or greedily with too much at the first, but increasing by little and little, least if he fall too hastily to a full diet, either the naturall heate being diminished be not able to concoct it, or else the vaynes being made more emptie should draw into themselues those vndigested crudities. Montan [...] in Can. 17. Auicennae medicinae vni­uersalis part. 3. Montanus interpreting the seuenteenth Canon of Auicen, graunteth, that they which are of strong powers, and of a hoate stomack must be fed, because their hoat body doth consume much nourishment euery day, but he sayth, they must be fed with an abiding and substan­tiall nourishment, not with that meate which is of quick nourishment, because such foode would quickly be con­nerted into fumes, and dry away. Giue vnto a countrey labourer the flesh of chickens, and it will straightway be resolued and turned into fumes and choler. Auicen in that canon doth appoynt the meate either to be broyled vpon coales, or to be rosted speedily with a quick fire, whereby the inward moysture may not be so much consumed, for in his iudgement, Nulla caro est dete­rior quam quae paulatim assatur, quia interius & exte­rius exsiccatur, There is no flesh worse then that which is rosted ouer-softly, because it hath the moysture dryed vp as wel inwardly as outwardly, yet must it be sufficiently either rosted or boyled: for as Galen sayth, Gal. lib. 4. de sauitate tuen­da cap. vlt. It is not possible that either bread too little baked, or flesh vnperfectly boyled, should be well and profitably concocted in the stomack. His purpose is in that place to shew what diet a man must keepe when for some inflammation he hath bin let bloud. First he will haue him for two or three [Page 118] dayes to abstaine from wine, and to vse in the meane time sometimes ptisane, and sometimes other drinks moderately cooling, or if in the third day he take wine, it must be small and white, vsing for a while a diet that shall nourish good iuices, but in no wise procure ouer-much heate: But chiefely of all we must take heed of nourishing againe too plentifully at the first, for they which vpon such e­uacuations do returne straightway to their former diet, haue their habit of body filled with raw humours, which the whole waight of the body doth draw into it selfe be­fore they can be well digested in the stomack and in the vaynes, and therefore we must not fill the body hastely after Phlebotomy, nor ouer-charge any part with more then it may be able well to con­coct, euen as if the body be wasted and consumed with long abstinence, it is not good presently to fill it againe too plentifully, for (as Galen sayth there) Many when they haue their habite of body ex­tenuated, vnlesse they do afterward feede moderately, they gather many superfluities into the whole habit, and get thereby no small diseases. [...]uchs▪ Instit. [...]br. 2. sect. 5. [...]ap. 12. Fuchsius doth sharply condemne the grosse abuse amongst Dutch men, which would God it were not too common a­mongst vs, together with other the dutch carow­sings and excesses: Detestable is the custome of the Germaines, which for the most part do neuer feede more sumptuously, nor drinke more libe­rally, then immediately after bloud-letting. And not only must the party that is let bloud be care­full inwardly for his diet, but also outwardly he must apply such fomentations, cataplasmes, and oyntments, as are most fit for the griefe, for the which his vayne was opened. For it is a foolish [Page 119] and fond conceipt of many, who thinke that if in pleurisies, or other inflammations of the lungs, liuer, raines, or other parts they once haue a vayne opened, they neede not then to take any further care. If there be any such inflammation or impo­stume, there must with Phlebotomy many out­ward applications be also annexed. M [...]thodus ge­neralis curandi in flammatio­nes [...] aposte­mata. 1. [...] [...] dolorent se­dantia. As first anoyn­tings and plasters made of things, called [...], anodyna, which do cease payne and griefe, as oyle of camomill, oyle of dill, meale of barley, meale of beanes, fengreek, ducks grease, capons grease, oyle of sweete almonds, wormewood, mingling with them some cooling things, as oyle of quinces, oyle roset, or oleum omphacinum, vnguentum rosaceum, or vnguentum santalinum. If these preuaile not, then if the impostumation haue neede of suppu­rating to be brought vnto matter (as it hath if the paine being not able to be asswaged do increase more and more, for the augmenting of the paine sheweth how long you must vse suppurating things) to help suppuratiō, make your cataplasmes or oyntments of such things as they call [...], 2. per [...] suppu [...]an­tia. as oyle of lillyes, fresh butter, hogs grease, goose grease, mallowes, marsh mallowes, brookelime, wheate meale, oyle of camomill, oyle of sweete al­monds, mirth, frankincense, and safron, or in stead of these diachylon cum gummi Vigonis. But with these, if the payne be very great, you must alwayes ioyne some astringent things, as roses, plantaine, the meate of quinces, and the oyle of mastick. Whē the matter is fully ripened, which is knowne by the decreasing of the payne (for as Hippocrates sayth, 2. Aph. 47. While the matter is in ripening, the paynes and the feuers are greater, then when it is [Page 120] already ripened,) 3. per [...] e­uelle [...]tia & extra [...]entia. then breake it by applying out­wardly such things as are [...], as doues doung, mustard seed, nettle seed, leauen, rootes of briony, hermodactyls, and old oyle, with a little turpentine. And at the time of the breaking, take inwardly some of a decoction made of furmiterre, and the roots of germander, eating some salt thing vpon it, and lying downe vpon the sounder side. Also at the same time hold in your mouth a pill made of three parts, hiera picrae, and one part colo­cynthis, to cause a forcible spitting, not [...]wallowing the pill, but holding it awhile in the mouth. When it is broken (which will appeare by manifest signes in the vrine, siege, or spittle) then vse those things which be called [...], [...] per [...] antem ter­entia. which do mundify & haue a clensing force, as inwardly hydromel or honyed water, with the decoction of barley, hysop, hore­hound, chichpease, licorice, and some red sugar­candy dissolued into it: And if there be an ague, then you must mingle also with these things the foure great cold seeds, the seeds of cucumbers, gourds, citruls, and pompions. You may apply also outwardly a plaster made of some of your a­foresayd decoction, adding to it the meales of beanes, lupins, and barley. The inflammations of the lungs (which are knowne by a difficultie of breathing without payne, and by a grauitie and distension of the bulk with a cough, but without any feeling of griefe, vnlesse the membranes of the lungs, being along the brest knit to the brest, be inflamed) are clensed by spittle, and also by vrine, and by siege. The inflammations of the hollow part of the liuer (which are knowne by a great payne somewhat lower, and by an aptnes to vomi­ting [Page 121] 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 y ^e 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 [Page 122] 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, Gal. libr. de constitutione artis medicae. Fuchs. & Trall. capitibus de pleuritide. Trine. in ex­planatione lib. 2. Galeni de differentijs febr. lect. 44. Trine. de ratio­ne curandi part. corp. aff. lib. 6. cap. 3. Gal. 4. de pul­sibus cap. 8. & 12. 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 [...], [...]. per [...] conglutinantia & cicatricem inducentia. 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.

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, Galen▪ method. medendi. lib. 5. 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. Fernel. me­thod. meden d [...] lib. 2. cap. 16. 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 [Page 124] doth charge especially, Gal. therap. meth. lib. 5. 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, [...]uchs. Instit. lib. 2 sect. 5. cap. 9. 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, Fernel. lib. 2. method. me­deudi. cap. 15. 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. Ibid. cap. 17. Fernelius immediatly after doth shew, Fuchs. instit. lib. 2. sect. 5. cap. 11. 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 [Page 125] 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, Fernelius methodi me­dendi lib. 2. cap. 3. how in the bloud you may behold all the foure humours, Cum san­guis concrenit serum per summa innatat vrinae haud absimile, bilis est tenuis & florida concreti sanguini [...] pars suprema, melancholia subsidet, sanguis ruben­tior & petuita pallidior media tenent: When the bloud is congealed, there are fiue things offered vnto our view. The tenue serum or whayish part swimmeth vpon the top, much like vnto vrine. The choler is the thinne and flourishing highest part of the congealed bloud. The melancholy fal­leth downe to the bottom. The bloud is the redder part, and the fleame is the whiter part of that which doth possesse the middest betwixt the cho­ler and the melancholy. Gal. lib. 2. de crisibu [...]. cap. 12. Galen sayth, what soe­uer is most vnctuous & light in the bloud is choler [Page 126] but what is most grosse, and as it were dregges, which by ouer-much heating is dryed vp, that is melancholy. Fernel. lib. 2. method. me­dend [...]. [...]. 17. 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, Fernelius ibidem. 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 [Page 127] body is thick. If it be black or infected with any bad colour, it sheweth with what humour y ^e 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, Gal. in com­ment. 2. Aph. 8. 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, How to auoyd Choler. 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 [Page 128] seeme still to bring danger, How to anoyd fleame. 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. How to auoyd melancholy. 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; [Page 129] 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 diasena Nicholai, somewhat more then halfe an ounce, or confectio Hamec ma­ior about halfe an ounce, or syrupus de pomis Ronde­let [...] about an ounce and a halfe. How to auoyd mixt humours. If mixt humours do afflict the body, then either to mitigate them compound your aforesayd syrupes and decocti­ons, taking one moity of one, and an other of an other, or otherwise proportionably mingle them, as the humours do more or lesse abound, or else to purge them, do the like by the forenamed purging receipts, or take of Diacatholicum somewhat more then halfe an ounce, or hiera Ruffi, the quantity of a chesnut dissolued in broth, or in pills take pillulae aggregatiuae, or pillulae de tribus, of either one of them about a dramme. At what times these and such other like purgings shall be accompted most fit, and what seuerall circumstances are to be obser­ued therein, as well at the very instant of the mi­nistring thereof, as also in the preparing of the body before, and the guiding of it after. These are poynts which I do handle at large in the Cathar­tice, or second part of the great Phisick remedies mentioned in my Preface: wherein as I haue al­ready gathered most of the chiefest [...]xiomes and [Page 130] aphorismes out of many famous Phisitions of all ages, concerning these and such like questions ap­pertayning to the purging of humours, and in some sort also disposed them; so do I purpose also (godwilling) to deliuer them here­after to the view of the world, as soone as leasure shall per­mit to transcribe, and friends aduise to publish.