THE ENGLISH Phlebotomy: Or, Method and way of healing by letting of blood.

Very profitable in this spring time for the pre­seruatiue intention and most needful al the whole yeare beside, for the curatiue intention of Phisick.

Collected out of good & approued authors at times of leasure from his other studies, and compiled in that order that it is: By N. G.

Prouer. 30. vers. 15.
The horse-leach hath two Daughters which crye, giue, giue.
Prouer. 27. vers. 9.
Balme and sweete incense make the heart mery: so sweete is that friend that giueth counsell from the heart.

¶ Imprinted at London for Andrew Mansell, and are to be solde at his shop in the Royall Exchange.

1592.

To the right Worshipfull, Master Reginald Scot, Esqure; dayly increase of wealth, Wor­ship and wisedom, in the true feare of GOD.

THIS pleasaunt and profitable practise of blood letting (Right Worshipful Sir) hath always, and that wor­thely been accompted and called of the aun­cient and latter Phisi­tions, Vnum è maioribus remedijs, one of the greater remedies in the Arte of healing; (not as I take it) for that the same is of gre­test charge to the patient his purse, a veine being commonly opened for twelue pence: but because if the same be done with skill according to Arte, it bringeth great profit to health, without any great diminishing of wealth. How this so great a remedy in both the intētions, of Phisick, Preseruatiue and Curatiue, is greatly abused by vagabūd Horse-leaches, & trauailing Tinkers, who find work almost in euery village, through [Page] whose wickednes (hauing in truth neither learning, knowledge, witre, nor honesty) the sober practisioner and cunning Chirur­gian liueth basely, is despised, and accoun­ted a very abiect among the vulgar sorte. The whole world with wofull weepings too too plentifully can witnesse, and many godly and faythful Christians here and else where with pinching paines and griping griefs euen to the last gaspe, haue pitifully felt. For these kinde of men are so farre off from repayrers of mennes bodies, as they would seeme to bee that they are, rather marrers and manglers of men, women and children, without all care to men whome they ought to tender, foster and cherish, without all conscience to God, to whom they must one day render a reckoning of this their desperate and diuelish dealing.

No man brought vp among Christian mē of any practise or calling, but hath long sithence learned this lesson; how frayle, in­firme, and weake soeuer our mortal bodies are, yet it hath pleased God to call them his owne temples, his owne instruments, and his owne dwelling places: an vnspeak­able [Page] dignitie, farre aboue that for which Alexander Magnus so contended, when hee would needs bee called the sonne of Iupiter.

Paul to the Thessalonians willing vs to keepe our vessels, viz. our bodies in holy­nesse and honour, suggesteth vnto vs these two poynts: first the fragilitie and mortali­ty of our earthly bodyes, comparing them to vessels of earth, and pots of clay, which break with a blow, & perish with a knock: secondly, that yet they are not our owne bodyes, to vse as wee list to sensuality like bruite beasts; but to keepe them carefully, as vessels which the Lord hath clensed and washed with his owne blood, to his owne glory in all holynes and honour.

The Priests of Baal cutting and launsing their owne bodies with a vayne and w [...]c­ked supposal, that in so doing they pleased God, grieuously sinned (as diuers affirme) both agaynst nature and godlines; against nature, because no man euer yet hated his owne flesh, but nourisheth and cherisheth it as the Lord doth the Church: against god­lines, because works of pietie and religion [Page] in our selues or in others, they either quite surcease, or are greatly hindered when the bodies of men are decaied in strēgth, weak­ned in vigor, languished with sicknes, or fi­nally destroyed by death.

To let passe these things which diuers deliuer out of their pulpits, of the excellen­cie and dignitie of mans body: haue not the Philosophers in the schooles called the same Microcosmos, Orbiculus, a little world most beautiful in forme, & fayrest in shape, excelling farre all other liuing creatures whome the creator hath made. In whose braine, as in primo mobili, is fixed that ine­steemable Iewel called Reason, no monster or Idole, but the mother of all Artes & Sci­ences, by whome (God guiding the same) are wrought & inuented marueilous mat­ters by Sea and by land, in euery matter of speculation or practise. This I haue hi­therto discoursed to this drift, that those blinde bussards, & runagate Artists, might at length see and consider that they are no way willed or warāted like butchers to cut, rend and teare, the bodies of men without skil, either in letting blod or any other pra­ctise [Page] of Chirurgi, but like brethren to cure, repayr and amend that which is amisse, re­fusing no paine taking for their own parts, nor reiecting due consultation with men experienced, that so the noble Science of healing may be generally honored, the dis­eased recouered, & the skilful workman worthily in fine rewarded.

To met with this mischief acording to my Mediocritie, and that such as are desi­rous of this practise either for pleasure or profite, might be somwhat fraughted with a few pithy instructions and necessary rules in the same, and so at length attaine to the most exquisite cunning & deep knowledge therof: I haue thought it good not onely to publish this my rude collection, contei­ning (if I be not deceiued) the whole han­diwork of Phlebotomy, but also to coun­teruaile my default as rudely, (yet most hū ­bly) to request your worships fauour for the protection thereof.

But for as much as Seneca that christian Ethnicke (for so dooth Erasmus terme him, for his profound wisedome & deepe indgement) willeth vs in bestowing of any [Page] gift to be careful that it be fit for the estate of the giuer, and also meete for the conditi­on of the receiuer, least in stead of expected thanks disgrace may growe, and what the giuer meaneth of good will, may perhaps by the receiuer either limping in iudgmēt, or freezing in delight, be little regarded, & lesse countenaunced: I am in a worde or two to shew that for my part I haue not (as I thinke) much swarued from the sound aduise of the Philosopher, in making your worship patron of my poore seely paines.

First for that euen your selfe haue already in print in your booke called The discouery of VVitchcraft, openly & biterly enueighed against one sort of blood thirsty men, as I doo nowe against another sorte: namely witchmongers, who are daily and hourely without iust cause conuenting before Ma­gistrates, and haling to the halter (if the Ma­gistrates dexterity in the administration of iustice did not moderate their malice in murthering) poore, plaine, seely and simple innocents, and olde women: whom by fri­uolous euidences, incredible proofes, vayn ghesses, preiudicate presumptions, meere [Page] impossibilityes they would haue condem­ned and executed for witches. These men, in mine opinion, should farre better please God, and much better deserue, of the Chri­stian cōmon wealth, if they would speedily turne from this their heathenish Infidelity, extream folly, & barbarous cruelty, & seek rather by due execution of lawe & iustice the blood of these bloodsuckers indeede, who for want of skil in this profitable pra­ctise of blood letting, in euery corner of the countrey without controlment, either pre­sently kyl, or at leastwise accelerate the im­mature deaths of dyuers faythful Christiās to God, and good subiects to their Soue­raigne. A poore man that robbeth or killeth but one man, is strayght way trussed vp at Tyborne, and these desperate dicks which range the countrey with a budget of grosse stuffe, a boxe of salue, and a case of tooles, liuing in the Sanctuary of Idlenes, skilful in palmestry, tellers of fortunes, coū ­terfeyting themselues to be Iewes or Egip­tians: imitatyng doctor Tocrub, with strāge lookes, diricks, pricks, crosses, figures, and such foolish fantasies, may safely kill thou­sands: [Page] no moe thē come vnder theyr hands, which is as many as they can get; for who is so bolde as blind Bayard? and withal mē must giue them money for murthering, whereas if they had had their iust hire, they should haue had hanging.

Secondly, I haue thought your wor­ship a meet person to dedicate this booke vnto, not so much for that it was penned at vacant times during mine abode at Scots Hall, vnder which roofe I came by your good meanes; but rather for that, thorow you whē the same was first penned it passed the view and apportatiō of that right wor­shipfull and wise man M. Doctor Coldwel, a piller in this our age of that noble profes­sion. I assure you I thought my selfe happy to haue my little Latine examined by the direction of his iudgement to whose wor­thy and famous faculty, the matters therein mētioned were most properly appertaining.

Thirdly for that being thorowly acquain­ted with your gentlemāly conditions, I am not ignorant of that ardent affection which you haue alwaies caried vnto your friends, Gentlemen I meane of like qualitie with [Page] your selfe: for, Amicitia inter [...]ares, Loue is among like, as sayth the Philosopher, whome as you loue earnestly in time of their felicity, and health, so you neuer loathe in their calamity or sicknes, putting in vre that work of compassion & Christi­anity commended, and commanded vs in the Gospel of visiting the sick: which work as you now execute frendly without feare, so in fine you shall not finde without re­ward. In visiting your sick friends, for in­er peritura perituri viuimus: this booke (if you will vouchsafe to bestow some va­cant time in reading of it) may stand you and them in some stead, though not by cū ­ning in the practise, yet by counsell in ad­uise: for verily it contayneth the right Me­thode and way of healing, practised by the auncient fathers in Phisick, Hippocrates, Galen and Auicen. And as you like a good Christian defie al magical cures which ar but cousonages, & would haue other men doo the like: so here you may spie a very ready way rightly to cure all humane dis­eases, compendious & not costly, both for your selfe and for your frined. To let passe [Page] Lysimachus a worthy Captayne to Alexan­der, Artemisia a noble Queene, Gentian King of Illyrica, King Salomō, & Queen Saba taught by Salomon in the secrets of Phisick and Nature, to the encouragement of all learned and wise gentlemen whatso­euer they doo otherwise professe) to take now and then some Phisicall discourse in hād. I produce the example of Dioscorides, no meane gentleman, but a noble Knight of Egipt who serued Anthonius and Cleo­patra like a worthy Souldier in the field, & was so delighted euen on the midst of his martial affayres with the study of Phisicke and Surgery: that one way vz. in the noble knowledge of Oiles, he excelled all men before his time, or since.

For my selfe that am the giuer, if it bee obiected that this labour is friuolous, for that other men of far greater gifts than my selfe, euen of the self same profession, haue writtē of this argumēt in the english toung long agoe, as namelie Sir Thomas Eliot, & Doctor Bullein, with diuers others, men of famous memorie▪ the one writing a Castle, the other a Bulwark of health: My answere [Page] is, that hardlie discusse we that argument, whereof something before to that or the like effect hath not bin extant; & this I add beside, that these men intreating of manie things in one booke, were constrained euen purposelie to pretermitte some, yea diuers needful instructions which here may bee had largely discussed.

If it be said that a matter of Phisick is no fit argument for a Diuine to handle, albeit I might easily wash away this with the appa­rant examples of diuers Diuines to the con­trarie, as of old Doctor Turner, Doctor Pe­nie, & Doctor Coldwel: Now with diuers others yet will I say somwhat more, name­ly, that both these the Diuine and the Phi­sition work vpō one subiect, they assemble themselues in one place, vz. the chamber of the sick, they both visite and busie them­selues about the sick to doe him good, he is no longer Homo but Cadauer if there bee once a separation of the soule from the bo­die. Vbi desinit-Philosophus, ibi incipit medi­cus, where the Philosopher endeth, there beginneth the Phisition: so may it be saide likewise in some sense, Vbi desinit medicus, [Page] ibi incipit Theologus: where the Phisirion fayleth for the bodies recouery, there the Diuine is required for the soules health. For mine owne parte I am fully perswaded in mine owne conscience (think or say others what they list) that I haue done more good to the Church of God and common welth of this land, in this simple translatiō or col­lection, call it whether you wil (for I haue but borrowed it of others & brought it in­to the english) then diuers dogged Diuines of this age, Penry, Browne, Barrow, and the sectaries I meane, who in stead of the true bread of life that came down from heauen, euen Iesus Christ with his whole & whol­some doctrine, fed most daungerously the soules of men with diuilish deuises, & their owne fantasies accounted thēselues terrene Gods, & desirous of nothing more then a­mong their auditors, to haue their own po­sitions horrible & hereticall tobe admired & embraced as oracles from heauen. If the end of this more then Pharisaical hipocrisie be not the disturbance of Gods peace & the Queenes, the wisest men in this land haue vtterly lost their wittes, which these men [Page] with al their learning, if they haue it in such plenty as they would seeme to haue, shall neuer make me beleeue for a trueth. Expe­rience of these daies prooue, that by the meanes of these men, we are al so generally infected with Cleargie factions and Laie factions, that as we are full of fansies, so we follow nothing but factions, which I pray God speedilie redresse for his great mercies sake. Finally as Atheisme is most iniuri­ou y obiected to him that holdeth these positions. God to be the creator of al things: That God only seeth & searcheth the harts and reines of men: That he onely worketh miracles: That he onelie maketh thunder, lightning, and tempest, and restraineth thē at his pleasure: That he onely sendeth life & death, sicknes & health, wealth & woe, &c. And as he is most wrongfullie & wic­kedly adiudged a Papist, who detecteth the abomination of their Idolatries, their pestilēt practises of knauerie & cousonage, their absurdities in opinion and impurities of life, (al which & much more then I here now speake of or can call to memorie) are extāt in print, & so in the sight of the whole [Page] world if men would not be wilfully blin­ded: so by this little labour beside the exer­cises of my peculiar profession, it may eui­dently appeare what loue & liking I haue alwaies borne to good, godlie and profita­ble studies, and how I loath loytering; and so consequentlie lust which is an vnsepara­ble companion of Idlenes & slouth, how I haue rather passed (as I hope) with com­mendation from Paul his Epistles to Galen de Sanitate tuenda for publike profit, than to Ouid his de Arte Amandi with condem­nation for my priuate pleasure.

Good Sir as you haue been hitherto euē (as I may saie) zealous for my preferment, and likewise iealous ouer my credit, an as­sured testimony of your true loue toward me, so I beseech you take in good worth at my hands this poore gift which I offer of pure good will, which if I once perceiue that you do, I shal think my trauail suffici­entlie recompensed: and my selfe enforced during life to the accomplishment of your good pleasure, so far forth as my tenuitie shall be able anie waie to extend.

Your Worships vnfayned welwiller & to command in what I may, Nicholas Gyer, minister of the word.

The English PHLEBOTOMY OR Methode and way of healing, by letting of bloud.

Of fulnesse, emptinesse, and their diuisions. Chap. 1.

THat this treatise of bloud-let­ting may haue an orderly pro­ceeding; we must begin with Fulnesse & Emptinesse, which haue betweene them selues a mutuall relation. Abundance or fulnes ther­fore is called of the Grecians Pleonexia: and after Galen in his booke De plenitudine it is two fold. One fulnesse is in qualitie, as name­ly, when the bare qualitie exceedeth with­out Humor. The other is of quantitie, as a­boundance of meat or of Humors.

Aboundance of meat is called of the Gre­cians Plesmone; of the Latines Sacietas: wher we are to note, that some interpreters tran­slate verie ill, for Plesmone, repletio: as in the second ofthe Aphorismes. Aphoris. 22. Qui­cunque morbi ex repletione fiunt curat euacua­tio; when it should be thus conuerted: Qui­cunque morbi ex satiaetate fiunt, &c. All those [Page 2] diseases that come of fulnes, euacuation doth cure.

Abundance of meat, called of the Latines Satietas, is also two-fold, according to Galen in his 2. booke of Aphorisines, Comen. 17. One according to the great largenes or ca­pacitie of the veines or vessels called of the Latines quo ad vasa: as when such abundance of meat is receiued, as thereby the stomacke is ouerstretched: the other abundance is ac­cording to natures strength, called quo ad vi­res: as when more meate is eaten, then na­tures force can well ouercome.

Abundance of humors is also of two sorts. One of all the humors called in Greeke Ple­thos or plethora: in Latine plenitudo, or multi­tudo: whereof Galen writeth in his 13. booke. Metho. cap. 6. Ʋbiautem aequaliter inter se­succi ad aucti sunt, idem plethos & plethoram Graecivocant, nos succerum plenitudinem seu redundantiam dicimus. VVhen as the hu­mors are equally increased betweene them­selues, that the Grecians cal plethos or pletho­ra; we call it, abundance of humors. Now whereas Galen saith in his 2. booke de Com­posi. Medic. secundum locos, cap. 1. That to be abundance of humors, when onely bloud is increased: wee are to vnderstand that bloud there signifieth impure bloud, & such as is mixt with other humors, called bloud, of that [Page 3] which principaly there aboundeth. For it can not be, that only pure & good bloud should be conteined in the veines, without som­mixture of choller, flewme or Melancholie: which must be so likewise vnderstood, where it is saide that any other humor aboundeth, the same is not pure alone without mixture of othets, but that humor ioyned with others aboundeth in the vessels.

The second abundance of humors, is cal­led in Greeke Cacochymia, in Latine Vitium succi, or vitiosus succus▪ and it is when one humor alone aboundeth. Hereof also Galen speaketh 13. Meth. cap. 6. Vbi flaua bile, ni­gra, vel pituita, vel serosis humoribus repletū corpus fuerit: Cacochymia. i. succorum vitiū dicimus. VVhen the bodie is replete with yellow or black choler, with flewme or wa­trish humors, we cal it Cacochymia. i. corrup­tion of humors. And in the end of his booke de Plenitudine he saith: Plenitudo est copia hu­morū in vniuerso animalis corpore. Fulnes is a­bundance of humors in the whole bodie: & a little after, he plainly sheweth the differēce between Cacochymia & Plethora.

Plenitude or fulnesse of humors, is also two-fold: one in regard of natures strength, called Quo ad vires or virtutem: which is, when the humors so abounde, that they op­presse and much grieue the naturall forces [Page 4] of the body. And although there be not such aboundance of bloud in this fulnes quae ad vires, as is in the other quo ad vasa: yet those humors which are in the body, oppresse the powers of nature, whereupon nature being oppressed and not able to gouerne those hu­mors: they being as it were forsaken of na­ture, lose their goodnes, and offorce putrifie. And of this fulnesse these are the signes: heauines, stretchings, a sensible werines, ha­uing a feeling like an vlcer: of which Galen sayeth 2. Aphoris. Aphoris. 5. Spontaneae lassitudines morbos praenunciant: Voluntarie wearines forsheweth diseases.

The second fulnes of humors called Quae ad vasa is, when there is such aboundance of humors or of bloud; that the veines and ves­sels are greatly extended or stretched: so that it is to be feared, least the veines themselues breake. And therefore Hippo in the firste booke of Aphorisines: Aphoris. 3. woulde haue in wrestlers this dangerous fulnes spee­dily euacuated, that the bodie might begin againe to be nourished. And this plenitude quae ad vasa is either of pure bloud only, or of all humors with the bloud. And this fulnesse hath these markes: rednesse of color, swel­ling, veines full & stretched. Of these two Plenitudes and their signes speaketh Galen in his booke De Plenitudine, reckoning vp [Page 5] these markes: swelling and stretching of the veines, rednesse, lumpishnes of the bodie, a slouthfulnesse in motion of the bodily mem­bers. Also Method. 9. Cap. 5. He reckoneth these signes of repletion quo ad vasa: obstru­ctions, stretchings, swelling & rednesse: Of this twofold, read Auicen, Secunda primi doct. tertia. cap. 3. Also Galen in his booke De Plenitu. & Metho. 9. Cap. 5. & 10. lib. eius­dem Cap. vltimo.

Because these pointes taken out of the bookes of auncient learned Phisicions, may seeme as yet hard to the vnskilfuller sort, that yet rashly and without skill or regarde of these things vse the practise of letting bloud: It will not be lost labour in my poore iudgement, with more plaine wordes to illu­strate their sayings, if it may be, to the vn­derstanding of all men that are this way stu­dious, and yet want the helpe of the Latine tongue & Latine writers.

It appeareth by the premisses what Re­pletion is, vz, a superfluous aboundance of humors in mans body, which happeneth two waies, either in quantitie or in qualitie.

VVe may also learne, that repletion in quantitie, is when the foure humors are more in aboundance than is proportionable to the bodie that conteineth them, or when one hu­mor much exceedeth the rest in quantitie: [Page 6] For the bloud contained in the veines is not simple, or of one kind, as hath beene said; but consisteth of flewme, blacke & yellow cho­ler, and pure bloud mingled together, which humors notwithstanding so mingled, by co­mon agreement and continuall vse of spea­king: we commonly call bloud.

The iust and agreable proportion of hu­mors is this: That in a man throughly health­full & of good temperature: there is lesse ye­low choler than Melancoly: lesse Melan­coly than flewme: lesse flewme than pure bloud: so that that bloud is accounted best, not that hath like proportion of all humors, but such an equalitie of the foure, as hath beene now specified.

Bloud therfore faulteth in quantitie when the humors being setled in a iust proportion, do passe and exceede the agreable measure of Nature: for then the whole frame of the bodie swelleth; the veines aboue measure are stretched, and all the members, specially af­ter any exercise, are wonderfully retched. This constitution of humors, though they be good, yet it faulteth, beclause it is come to an immoderate abundance, which accustom­ably is wont to bring great perill. VVhether therefore there be in the bodie abundance of other humors aboue the bloud, so that the equabilitie of the proportion be not obser­ued [Page 7] that waie: or that there be too much a­bundance of pure bloud. Yet because the pure bloud in the permixtion greatly excee­deth the other humors; it is a [...]ault not in the qualitie but only in the quantitie: and therfore both of these are conteined vnder this kinde of repletion in quantitie: and this is simply, absolutely, most properly, & commonly iud­ged repletion, & is called Plenitudo ad vasa, as is aforesaid, because it doth throughly fill the large capacitie of the veines, which are termed the vessels or receptacles of the body, though it enforce not the powers therof. First therefore, where al the humors superfluously increase, filling & extending the receptories of the bodie, as the stomacke, the veines, and the bowels: It is most properly called in English fulnesse or repletion in Latine ple­nitudo, in Greeke Plethora as before.

Repletion in qualitie; is when the bloud or other humor is hotter or colder, thicker or thinner than is conuenient to the bodie. This is the seconde kinde of repletion, men­tioned by the foresaide auucient writers in Phisicke, and which is referred to the force, strength and abilitie of the bodie.

In this repletion, although the vessels of the bodie be not so much puffed vp, n [...]i­ther swell, as in the other: yet they con­teine more good bloud and nourishment [Page 8] than the nature of the patient can wel rule or ouercome: For a litle nourishment to a weak nature, is often troublesome and grieuous: and although at the first it be right good; yet it doth not long so continue: but being for­saken of the bodily heat, as not able to con­coct the same: in protract of time and num­ber of daies, it corrupteth and becommeth the causes of diseases.

This constitution of the Greekes, proper­ly called Cacochymia, is when the bodie is in­farced either with choler yelow or black, or with flewme, or with watrie humors, and of late writers is thus defined: Cacochymia est vitiosa humoris qualitas, qua is a iusta medio­critase desciscit: Cacochymia is a corrupted qualitie of the humors, by reason whereof the humor departeth from his iust mediocri­tie. Vnder which Cacochymia is contained all corruption of humors in qualitie: wherby the powers of the bodie are hindred from their proper functiōs, wherby also the whole bodie waxethfilthie & daily decayeth.

Of this corruption of humors in qualitie, one kind is somewhat better and more tolle­rable: as namely, when either superfluous humors are excessiuely heaped vp together; or when the humors mixt with the bloud, do not keepe their iust and naturall concord or proportion: the other kind is worse and in­tollerable: [Page 9] when the superfluous humors or iuces in the bodie, both primi & secundarii, both the principal humors, and these next the principall are fallen into corruption, from their naturall and conuenient temperature, which is the destruction and corruption ei­ther of the substance or of the temperament. Againe both these happen sometime with rottennes and putrifaction, sometime with­out. VVhere note, moreouer that the name Cachochymia largely taken, comprehendeth also the corruption of the excrements. Hippo­crates Aphoris. 15. saith, where meate is re­ceiued much aboue nature, it causeth sicknes. Galon in his Commentaries declaring that place saith, more meate then accordeth with natures measure, is named Replecion. And af­terward hee expoundeth that worde aboue nature, to signifie too much and superfluous­ly: As who would say, where the meate is su­perfluously taken, it causeth sickenes. Meate but a little exceeding doth not forthwith cause diseases, but may yet keepe the bodie within the bounds of health, for meat ingen­dring sickenes must not a little, but much ex­ceede the exquisite measure.

It appeareth by Galen that in his time cer­taine denied this foresaide diuision of fulnes, set downe by the auncient writers, and ap­proued of the late practisioners, saying that [Page 10] the same was to bee considered onely by the strength of nature, granting plenitudo secun­dum vires, but not quo advasae. These he con­futeth in his booke de plenitud. about the be­ginning in these wordes. Qui ex ipsis tantum viribus plenitudinem metiuntur hi videnter nunquam vtres praeter modum repletosvidisse, nec se etiamplus quapar est vnquam impleu [...]sse [...]ibo ita vt ventriculus inde distenderetur. 1. Those that measure Replecion onely accor­ding to the forces of nature; they seeme neuer to haue seene mens bodies puffed vp like bladders or bottels, neither at any time to haue stuffed themselues with meate, more than moderation required, and whereby the stomacke was ouerstretched.

Againe, others in Galens time graunted onely that plenitude which is quo ad vasa. and denied the other quo ad vires. These hee confuteth in the same place in these vvordes. Itaque subiecimus duas esse tum notiones, tum relationes multitudinis: alteram ad robur vi­refque illi us qui defert, alteram ad eius qui sus­cipit capacitatem. Idest, Therefore vve haue added that there are two notions and re­portes of fulnesse, one according to the strength of the patient, the other after his ca­pablenes.

The discommodities vvhich happen by Replecion are manifold, moistnes thereby is [Page 11] too much increased, and naturall heate quen­ched, againe naturall heate resolueth some­what of the superfluous meate and drinke, and of that which is resolued of meate vndi­gested, proceede grosse and vndigested fumes, which ascending vp to the heade, and touching the rim wherein the braine is wrapped, causeth headach, trembling of the members, dimnes of sight, and many o­ther diseases.

Moreouer the sharpenes of the said fumes, pricke and annoy the sensible sinewes, whose roots are in the braine, and from thence pas­seth through all the vvhole body. The said fumes ingendred of Replecion, and pier­cing the innermost part of the saide sinewes called sensible, greatly annoy the animall powers, there beeing: by occasion whereof Vnderstanding and Reason both, as tou­ching the vse of them, are vvonderfully let and troubled, and likevvise the tongue vvhich is Reasons Expositor, is greatly de­priued and hindred of his Office: As it ap­pearethin them vvhich are miserably drunk, and in those vvhich haue most extreame and grieuous paines in their heade, proceeding of Replecion.

Thus much harme commeth to the body by too much nourishment, and although the stomacke doo his Office in concoction, yet [Page 12] the veins too abondantly filled, are spred out, diuided, stopped and stuffed with winde, and greatly grieued. It is apparant that of repleci­on and fulnes of the veines (then the which in diseases a more hurtfull thing cannot chance) diuers infirmities doo come, and the replecion of the belly, though the excesse may be expelled by vomit or sedge, and so is more tollerable than fulnesse of the veines: yet it is likewise to bee disallowed. If a man haue at any time too much ingorged himselfe by and by he may assay to vomit: for though hee doo well digest it, yet there is some dan­ger, lest the veines be oppressed with fulnes: especially when the party continually liueth intemperately, neuer regarding or minding euacuation. It is good therefore to vomit first, before the meates bee corrupted in the sto­macke, if any impediment hinder vomiting, a sedge by stoole is a present helpe. If neither serue, sleepe long, and oft in drinke vse warme water. VVhen the surfet is sufficiently dige­sted chiefly by sedge, it is expedient to wash and vse fomentations. i. plaisters mittigating paine, and a little to tast of salt meates, and to drinke wine or beare alaid or tempered with water. These things by the way touching re­medies for surfetting, which in our daies is too vsuall, to the great dishonour of God, and the certaine destruction of our bodies, yea, [Page 13] and of our soules also, if GOD grantvs not grace speedily to repent and amend. But if neither siege, nor timely digestion of the meate recemed, doo not insue our surfettings; then the signes of replecion are to be looked for, which are set downe by Oribasius Eupo­rist. lib. 1. which are these that followe: as Losse of appetite, delight in nothing, sloughthfulnes, dulnes of wit and senses, more sleepe than was accustomed, crampes in the bodie, starting of the members, fulnesse of the veines, thickenes of the pulsies, horror and shroueling of the bodie mixt with heate.

But the generall signes of abundance of bloud are these: bleeding at the nose chiefly forth of the right nosthrill, spitting of bloud, veines full and great, chiefly in the face, red­nes of colour, a ponderous waightines of the whole body vnapt to any motion, an vna­customed drowsines, a sluggishnes of minde without any euident cause, the skinne stret­ched, pulses very full, debilitie of sight, grie­uous dreames, plenty of sweete spittle in the mouth, swellings and blushings in the face, heauines and painefull wearines in the shoul­ders as it were after labour or bearing great burthens, vrine thicke and red. Replecion knowne by these notes, except it be ruled by Phlebotomy or otherwise, it choketh the na­turall heate of the body as Galen saith, 1. A­phoris. [Page 14] Aphoris. 3. Nimia repletio calorem nati­uum extinguit. Too much fulnes extingui­sheth naturall heate. Also Metho. 13. cap. 6. Plethora tum sanguinis missione curatur, tum frequenti balneo, exercitatione, fictione & dige­rentibus medicamentis. Repletion is cured by bloud-letting, often bathing, exercise, rub­bing, and digestiue medicines. Looke more in Galen 3. & 6. de tuenda sanita. These men therefore in vvhome bloude so aboun­deth, are to bee holpen by Phlebotomy, by opening Mediana or Cephalica, or applying of Boxing-glasses with scarrifieng the place first, or othervvise as after shall bee declared. Remembring by the way, that if either pur­ging seeme too long, or the opening of a veine cannot bee done accordingly: that in these cases Electuarii succi Rosarum are good to purge bloud. But hereof there is no place to speake further at this time.

Finally it is very behouefull to knowe in vvhat place the corruption or ilnes of the contents of the body is placed, or where the Repletion is, before vvee can addresse our selues fitly to euacuate. That fulnes there­fore vvhich of the Greekes, vve haue said to bee called Plethora, is chiefly resident in the veines and habite of the body, and this be­ing an abundance of all the Humors in quan­titie, is euacuated by bloud-setting or ope­ning [Page 15] a veine, and with cupping-glasses. The Repletion called Cachochymia beeing an a­bundance in quantity of one Humor, is i [...] the whole body or in some particuler part. If Cachochymia bee in the vvhole: it is euacua­ted by purgation, by generall sweate, by ab­stinence, and that kind called insensibilis eua­cuatio.

Cachochymia particuler is thus euacua­ted: If it bee in the belly, by vomit and by siege: If in the entrailes, vvith Clisters, Suppositors, and by siege: If in the Liuer, by the Vrine: If in the Spleene, by the Hemorroids: If in the Breast, by Cough­ing: If in the Heade, it is purged through the Nosthrils and roofe of the mouth: If in the Raines or Bladder by Vrine: If in the Genitals by Venus: If in the Skinne, by Svveating, Resoluing and vvith Cupping Glasses.

And thus I conclude this first Chapter containing the chiefest and principall points concerning Fulnesse, Emptinesse, and their diuisions. Not intending to vvrite any thing at all of the subtile and abundant defi­nitions and descriptions of Galen in his book De plenitudine, and likewise in his Com­mentaries vppon the Aphorismes of Hippo­crates.

[Page 16] For I hope it hath here sufficed, to shew what replecion is, the kinds thereof, the operations of them good or euill: remitting them which be curious, and desire a more ample declara­tion, to the most excellent workes of Galen, where he may be satisfied, if he be not deter­mined to repugne against reason.

What Euacuation is, and of the kinds and diffe­rences thereof. Chap. 2.

FOrasmuch as things contained in the bo­dy against nature, while they remaine in the body, are the inward causes of infirmities, which by Art especially are to bee remoued: therefore then Euacuation, as a most generall remedy is first of al to be attempted. Euacua­ [...] therefore is an expulsion of those things which are contained in the body against na­ture. There are contained in the body these three, spirits, humors and excrements. The excrements are the ordure or reffuse of the belly: vrine and superfluous humors, sent from the braine and the lungs. Humors some are superfluous, some necessary properly cal­led succi. 1. iuces. Humors superfluous se­parated from the bloud by natures force, and as vnprofitable for the nutriment of the bo­dy: are sent a farre off. As flegme inhereth in the maw, stomacke, and about the entrailes. [Page 17] yeallow choler in his proper coffer, namely the gall. Melancholy in the Spleene: The iuces are conuerted into the substance of the body, nourishing the same: Of this kind are those iuces whereof the bloud is compact, & those otherwise called secundarii humores. Nowe each of these are sometime agreea­ble to nature, sometime repugnant to nature. They are agreeable to nature, when they re­taine the right quality and quantity, accor­ding to the law of nature for conseruation of health. They are repugnant to nature, when they keepe measure neither in quality nor quantity. And therefore whatsoeuer of these manifestly departeth from the iust meane and measure which nature hath appointed, (because it is the cause of sickenes) if other­wise it cannot be amended, it is altogether to be taken away and expelled, the expulsion whereof is called Euacuation.

The differences of Euacuations are to bee taken of the scituation of the contents and corruptions, which are either Plethora or Ca­chochymia as was shewed in the Chapter pre­cedent. The meats and drinkes receiued into the body, if the stomacke and liuer doo their naturall Office, bee altered by concoction, in such wise, that the best part thereof goeth to the nutriment of the bodie, the worst be­ing separated by the members Officiall from [Page 18] the residue, are made excrementes in sundry formes and substances: which excrementes are like in quality to the naturall Humor, which then raigneth most in the body. These excrements are none other as was said [...], but matter superfluous and vnsauory, which by the powers of nature may not be conuerted into flesh, but remaining in the body corrupt the members: and therefore nature abhor­ring them, desireth to haue them expelled. These excrements are in number three, Or­dure, Vrine, Humor superfluous.

Of Ordure are two sortes, one digested which passeth by siege, the other vndigested expelled by vomit. VVhere I say digested I meane that it is passed the stomack, & turned into another figure. Likewise I call that vndi­gested which s [...]il retaineth the figure of meat.

Vrine is the watry substance of bloud, like as whey is of the m [...]ke, which out of the meate that is altred, concoct, or boyled in the stomacke, is streyned in the veynes called Mesacaicae, which proceedeth from the hol­low part of the Lyuer, and sent by the Raines into the Bladder, passeth by the Instrument which is ordained as well for that purpose as for generation.

Humor superfluous is of three sorts either mixt with any of the foure Humors called naturall, or else it is gathered into the braine, [Page 19] or is betweene the skinne and the flesh, or ly­eth among the Synewes, Muscles, or Ioynts: Of Humors some are more grosse and cold, some are subtle and hot, and are called Va­pors, Now to expell these excrements there are nine sundry kindes of Euacuations. Let­ting of bloud, pargation by siege, abstinence, vomiting, sc [...]rrifieng or cupping, sweat, vrine, spytting, sternutation, bleeding at the nose, bleeding by the Hemmorroids, exercise: and in women there naturall purgations▪ But in this Treatise I will onely handle that Euacua­tion which is done by opening of a veyne, by Cupping-glasses, and by Leaches, shewing the commodities which by the discrete vsing of these, come vnto the body of man.

And that the way of Euacuation may bee the more easie: wee may deuide the body of man into three general Regions, which be­ing inclosed in their proper limits, haue not onely diuers receptories of superfluities, but also diuers waies to purge the same.

One and the first Region is extended from the meat pipe called Gula to the middle part of the Liuer, wherein are contained the maw, the stomacke, the venies Mesecaicae, as many as come to the entrance, the hollow or inner part of the Liuer, the Spleene, and Pancreas, that is, a thing betweene flesh and kernel ly­ing betweene the stomacke and the Liuer.

[Page 20] The 2. Region runneth from the middle of the Liuer, through the thin & small veines, of all and singuler partes, comprehending the outward part of the liuer, and euery hollowe veine and the greater artery placed by it, and vvhatsoeuer is betweene the Armehole and the flanks.

The 3. Region comprehendeth the mus­cles, the vppermost skinnes, the bones, and the whole masse of the body, which exten­deth from the very entrance and lesser veines through euery part and the outmost skinne it selfe. Great is the diuersity of these Regions, for so much as they are so inclosed within their owne limits, that there is betvveene them no fellowship at all. But the greatest di­uersity is in their owne proper operations, hauing concoctions, excrements, and waies of purging diuers one from the other. By ob­seruation and marking whereof vve shall the better proceede in Euacuation.

Beside these generall and vniuersall Regi­ons of the body: there are some more speci­all and particular, hauing also excrements, yet not retching so far, nor following through the whole body, of which sort are the braines, lungs, raines, and belly. Hereof are deriued tvvo differences of Euacuations: one gene­rall, the other particular. That is a generall Euacuation which draweth matter vniuersal­ly [Page 21] from the vvhole body. Of this sort are Svveate, Bleeding, Vomits, Euacuation, by siege. Each of these (thogh specially & for the most part they euacuate one Regiō or part of the body. Yet these also empty other partes, though not so abundantly. As vomit first and chiefly euacuateth the stomacke, if it conti­nue long, it purgeth also the bovvels and the greater veines, last of all the state of the whole body. Euacuation by siege or purging: chief­ly and most of all purgeth the entrailes, sto­macke, bowels, and the first veines, then the greater veines; Last of all the small veines and the state of the vvhole body. Opening a vaine first exhauseth the veines and arteries ioyned vnto them: then the body and all the bovvels euen til it proceede to the first veins. Euacuation by svveat called in Latine, per­spicatio or dissipat io per cutem: First dissolueth from the habite or state of the body. Second­ly, from the greater veines and arteries. Last­ly, from the bowels and inwarde Region of the body.

Particuler Euacuation doth onely alleui­ate some particuler part loden vvith Excre­ments: Of vvhich sort are, purging of the braine through the palate and nosthrils, spit­ting of fleame vvhereby diseases of the brest and lungs are eased: Pissing forth of sand and matter from the raines: Passage of bloud by [Page 22] the belly or Hemmorroids: the one clean­sing first the lower part of the body called Podex, the other the belly, and both of them the hollow veyne called Ʋena caua. VVhen the wombe therefore is prouoked either with a Clister or a Suppository, or whatsoeuer e­ruption bee made in any other place through the skinne, it is likewise a particuler Euacua­tion. Again, of Euacuations, some are of their owne accord, some are done by Art. Naturall or voluntary Euacuation, is when any thing is expelled out of the body without any mede­cine, this chanceth sometime euen naturally: For nature while it is in health, rightly gouer­neth the state of the body, and doth expell thence whatsoeuer supersluously aboundeth or is corrupted; this Euacuation is both na­turall and conuenient. This also chaunceth sometime contrary to nature, as when the strength of the body is so infeebled, that it cannot gouerne and restraine the Humors of the body, but letteth them quite flow forth: or when the vertue is strong, yet it is somtime so prouoked either with abundance or acuity of the Humor, that it permitteth the Humor to passe of his owne accord out of the proper vessels and receptories thereof: Both these are accidentall, vnprofitable, and besides na­ture; because the good bloud commeth forth mingled with the bad without choise or or­der. [Page 23] Artificiall Euacuation is when the same commeth by outward help & this is two fold.

The one right profitable, onely Euacuating that which offendeth in iust quantity, & qua­lity. The other contrary to this, extraordinary and vnprofitable, exhausing the Humor that annoieth not, which commeth by the vnskil­fulnes of the Phisition. Nature by her owne force, and by the vertue expulsiue, accompli­sheth her Euacuation. The Phisition doth his, by diuers necessary helps prouided for the same. And in letting bloud he openeth the veyne either with a fine penkife, sleme, or lan­cet, or some other applyable medicin. Purga­tion hee attempteth with medicins, expelling euil humors from the body either by vomit, or by siege. Also he expelleth euill humors by breathings, euaporations, exercise rubbings, mouings, heat, bathings specially sulphurious, & accidentally by abstinence. Also the Phy­sition vseth particular Euacuations in particu­lar parts (as ye haue heard) Hee purgeth the braine through the nosthrils by medicaments called in Greeke Errhinae. And through the palate of the mouth with medecines called, Apophlegmatismi, which chewed in the mouth bring Humors from the head, the brest, and lungs, with medecines called Berhica. The Raines and Bladder with Diuretica. The wombe or belly with Hysterica. Againe, [Page 24] the belly is softned with suppositories and clisters: againe euacuation or eruption is made in particular parts by medicines called Dige­rentia. [...]. resoluing medicins by Suppuratoria. [...]. medicines breeding matter by medicines, called Amycticam, Caustica, Idest, burning things, by horseleches, cupping glasses which drawe bloude with scarrifieng the skinne, by launcinges or cuttings, by iron red hot: All these are vsed of Phisitions.

The kinds of Euacua­tion recko­ned vp of Fuchlius.Phlebotomy.Purging.
 Ʋomiting,Scarrifieng.
 Boxing.Abstinence.
 Long sleepe.Carnal copulation.
 Fluxe of bloud from theNose.
  Termes.
  Hemorroids.
Euacuations some areNaturall,Phlebotomy.
 Artificiall,Purgation.
 common partaking of both. 

What Phlebotomy is and from whence the ope­ning of a vaine doth e uacuate. Chap. 3.

FOR so much as the bloud in generall is mixed with the foure Humors which are also bedewed as it were with a thin watry substance, and that they all are so mingled to­gether [Page 25] through the heat and concoction of the Liuer, that neuer an humor can be seene, neuer so little, to be seuered from the others therefore, I saie, the retentiue vertue cannot so strongly hold back the bloud in the croo­ked small veines when a great vaine is ope­ned, and that with a sufficient large wound: but the same will issue and come foorth. If by chaunce it happen that the retentiue ver­tue go about gredily to suppresse the bloud, yet at length it will poure it out plentifully with oft handling & rubbing of the veines. Neither doth this or that humor by it selfe a­lone come foorth, as in purging: but bloud generally; that is to saie, mixt with other hu­mors in the veines.

Touching the definition what it is: Phlebo­tomia (which is worde for worde out of the Greeke, the cutting of a veine:) is an artifi­ciall eduction of bloud, either abounding iu quantitie, or offending in qualitie, by ope­ning of a veine. I call it an artificiall incision, because it must not want art and iudgement: For in it, consideration must be had of the inflicted wound: of the quantitie of the bloud: of choosing the aptest vaine: either to pull backe bloud, or to euacuate it quite: or to make it onely lesse in quantitie. Also, for that consideration is to be had, whether the veine must be opened streight downe, or [Page 26] ouerthwart, of the same side of the bodie, or of the other: with diuers considerations be­sides, whereof we will speake in their proper places. Therefore Phlebotomie which is one of the greatest remedies, the Phisition vseth, is for good cause defined an artificiall kind of educing. Galen in his 2. Aphoris. Coment. 17. defineth it to be an exquisite euacuation of al the humors equally. Auicen defineth it vni­uersalem euacuationem, quae multitudinem hu­morum euacuat: or thus Vena sectio est vniuer­salis euacuatio, quae anctionem humorum super aequalitatem in venis exuperantium, euacuat. i. an vniuersal euacuation which taketh away abundance of humors, replenishing the veines aboue measure.

Though the bloud in the veines be in a moderate meane, or but little in quantitie, yet of the proper mouing, & vehemencie of it self it issueth out: nature litle or nothing at al pro­truding the same. Phlebotomie indifferently euacuateth both good & bad humors contei­ned in the veines with the bloud. Neither in diseases proceeding of corrupt constitution of humors, can nature so moderat the matter, as that, that humor alone shal flow forth that aboundeth in quantitie or offendeth in quali­tie. I confesse, that in the iudicials of diseases, called Crises, many times nature separateth & as it were, excludeth by wayes conuenient, [Page 27] those ill humors prepared before by conco­ction: yet notwi [...]hstanding, if then at that in­stant we open a veine, nature cannot therby in so short time expel the hurtfull humor.

Whereas Auicen saith, Phlebotomie eu [...]cu­ateth good bloud, the ill remaining behind, & that he feareth, lest opening a veine bring the patient, either to abundance of hot chollerik humors, or cruditie of flegmatike humors: if he mean it of the humors mixt in the veines, it is most fals: for neither doth the watrie hu­mor issue forth before choler, nor choler be­fore flewme, or Melancoly, nor the bad hu­mor before the good. VVhich daily experi­ence proueth to be true: for when the bloud commeth forth, it appeareth simple & of one forme: but in the porrenger it loseth his co­lour, & euery part therof congeleth se [...]crally in his own region. The watrie humor swim­meth aboue, not farre vnlike v [...]ine. Thinne choler & the flowring part of the congealed bloud, is also aboue next the water. Melan­coly abideth in the bottom: the red bloud & the paler flewme keepe in the middle region. So that opening of a veine euacuateth all hu­mors which are in the veines equally.

VVe are here to set downe, from what place the evacuation is made: for, inasmuch as bloud is moyst and flowing: that first issueth forth which is next the opened veine, [Page 28] then that which is next the same: thirdly, commeth foorth, not onely that which is in the veines and arteries, but also that which is in the bowels and whole habite of the body. For there is a wonderfull continuation and order of the veines, so that a way being once made, all the bloud often times floweth out of the bodie, and bringeth death to the par­tie. But when the passage is stayed, then the bloud is sent foorth by the veines & arteries, till there be a certain proportion in the whole bodie: For the emptied and wanting partes by the long small veines draw bloud forth of the full partes, & repleated members; and so [...]or them, as it were in their need. Againe, the full members grieued with too much a­boundance, vnburthen them-selues on the veines that are emptied. Againe, the humor being liquide and flowing voluntarily follo­weth the lower euacuated regions, and there continueth: whereupon it followeth, that whensoeuer bloudletting shall emptie the veines; the same also shall euacuat the whole bodie. In regard whereof Phlebotomy in the definition thereof, is called verie well an vni­uersall euacuation, and that for two causes. First, because it withdraweth all humors whereof the bloud consisteth. Secondly, be­cause it euacuateth from the whole bodie; but yet not in like sort. Forasmuch as the [Page 29] partes of mans bodie are placed in their or­der: therefore first it exhauseth from the neere partes, then from those that are further off. And againe, forasmuch as some veines are spred into some partes of the bodie, and other into other partes: therefore bleeding with more celeritie and force draweth from those partes which are rightly and directly placed, then from those members, which are opposite or ouerthwart.

Whether Phlebotomie must go before purging▪ or contrarie. Chap. 4.

IN this place it is a necessarie question to be moued, and aunswered; whether bleeding or purging must go first, in this case (which is verie frequent) where they are both requi­site. Some will alwaies haue, that when pur­ging is necessarie; bleeding must go before [...] and they bring out the authorities of Hippo­crates and Galen. Others contrarily affirme that alwaies some extenuating or lessening receit called barbarously Medicamentum minoratiuum must be first receiued, and them Phlebotomie succeede. But of these opinions neither is simply true, and yet both true, as the case may be limitted. And for the cases wherein a gentle purgatiue is to proceed [...] Phlebotomie: they are in number these sixe.

[Page 30] First, when the stomacke, the Mesecaicae veines, the great veines, & the waies & passa­ges of the bodie, or any of these be stuffed with filth, or incombred with crudities: or that the excrements are hardened in the bo­wels, although the whole bodie abound with bloud beside, yet a gentle & easie receit is to be taken; as Manna, Cassia or a clister (but no violent receit) which may euacuate from the foresaid veines, & open the obstructed passages. If the bloud should first be drawen forth without some gentle purgation or eua­cuation in the greater veines: then the veines outwardly exhausted by bleeding, through their attractiue vertue, would drawe vnto them ill iuces; specially, if the disease require any plentiful bleeding. This is affirmed by Auicen & Galen. 9. Metho. cap. 5. who did vse to refraine from Phlebotomie, if there were cruditie of meat in the stomake, or rawnes in the veines called Mesecaicae, til their conco­ctiō wer ended, & the excremēts descended.

Secondly, when the bloud is verie viscous, clammie & grosse, we do not only take medi­cines attenuating, but also lessening things & a dyet conuenient to prepare bloud: and to make the mēber bleed the better, vse a bath: for oft it commeth to passe, that a veine be­ing opened, no bloud issueth forth, because of the thicknes & clamminesse thereof.

[Page 31] Thirdly, it faleth out in many cholerike bo­dies, that choller contained in the vpper parte of the stomacke is easily moued, & so boileth causing Lipothymia. i. ouercoming: in which case it behoueth to vse before some Mino­ratiue receit, & also in bleeding to vse some­what to keepe backe the boiling of choller.

Fourthly, in diseases wherein appeareth a difficultie by reason of Cacochymia or abun­dance of other humors mixt with the bloud. When a practisioner perceiueth that he must vse Phlebotomie, & yet with some difficultie; in this case he may vse some easie purgation, or one of some force: whereby it may fall out that nature shal thereby so be eased (which the siege & ease of nature wil shew thee) that thou shalt not need bleeding at all, but onely preparation of the matter, & then to renue the educing thereof as before.

Fiftly, remember Au [...]cens saying: Sanguis fraenum cholerae existit: bloud is the restrainer of choler: therfore in diseases mere cholerik, it were a rash part to set bleeding before pur­ging, which perhaps thou maist be without, after the exhibiting of the medicine. And if thou vse the patient wel; let those things suf­fice, which change or repell the sharpnes of choller. Yet this is to be added, that if there shuld be such abundance of choller as might cause a swelling aboue nature or inflamation; then bleding vpon that, is a present help.

[Page 32] Sixthly, the same reason may serue in fleg­matike constitutions. Wherein for many cau­ses (although no small fulnesse appeare) yet we are not to vse Phlebotomie before pur­ging.

The cases wherein Phlebotomie precee­deth purging are these. First, when great ful­nes appeareth, which either hath caused, or is like to cause any vehement disease, as A­poplexia, which is a sicknes engendred of grosse humors, filling the receptories or ves­sels of the braine, and thereby depriuing the partie of feeling, speach, and mouing: as Pe­ripleumonia, which is an inflamation or an a­postume of the lungs, with a vehement Fe­uer, comming sometime of it selfe, but most commonly following vpon great and sharpe rewmes, squinances, pleurisies, or such like diseases: as Suffocation; which is in English, strangling: then & in this case without faile, and chiefely if the wombe be laxatiue, vse letting of bloud without precedent purgati­on. And this seemeth to agree with Galen lib. 10. de Composi. medica. secundum locos, ca. 2 VVhere he saith: if the bodie doe equally abound with humors: first let bloud & then purge. And hereunto Auicen accordeth in quarta primi Cap. 4. This (saith he) is a truth, and the precepts of Hippocrates in lib. Epide­mionium: that if both bleeding and purging [Page 33] be necessarie, and that the purgatiue must be vehement, then begin with Phlebotomie.

Secondly, in dangerous fluxes of bloud out of the nose, or in spitting of bloud called Hoemoptoicapassio, or in bluddie fluxes: for to turne the matter a way in full bodies, wee presently let bloud without medicine going before.

Thirdly, in wrastlers abounding with bloud: to whom the same abundance threat­neth some great danger, & that it is presup­posed that there are no ill humors in the cir­cuite or compas of the bodie; in this case wee vse Phlebotomie without purging.

Fourthly, we may safely let blond (without medicine) those that are whole, & for abun­dance of bloud only, are accustomed to yere­ly bleeding; and that haue in the yere taken little or no Phisicke, as it chanceth to many persons in many countries of the North.

Fiftly, we may open without purging, the inner vaine of the arme, in women with child, if they carrie Corpora Phletorica, full bodies, & that in the 5. 6. or 7. moneth after the con­ception: yea & also before they be quicke. This practise wee are to vse specially, when they being with child, waxe verie slowe, hea­uie, & as it were, ouerladen with abundance of bloud, we may take Salua tella veine: or if plenitude so require; the inner veine of the [Page 34] arme: for the quantitie respecting a discreete moderation.

Sixtly, we may let those bloud without me­dicine, that haue fallen from some high place, & taken hurt in the brest and stomacke, in whome is to be feared an inconuenience cal­led of the Greekes Egchymosis.

Seuenthly, we speedily let bloud such per­sons, without further Phisick, as by reason of their fulnes through some accident, as feare, or such like, waxe domme; in which case wee let bloud abundantly, so that both armes are opened together.

Here I am to note a great error in Auicen; both repugnant to trueth it selfe, and also contrarie to Galen: For Auicen affirmeth, that when colde and thicke humors are in the bodie: first wee must begin with pur­ging, and then open a veine. Diuers and ma­ny waies hath he erred in this. First, because in flegmatick humors, grosse and colde mixt with bloud, hee woulde haue Phlebotomie not vsed before purging. And in this case, by all likelyhood of reason, the cure should begin with bleeding. Secondly, in this hee dissenteth from Galen, who 11. Method. Chap. 4. though there were obstructions in the bodie of thicke and clammie humors: yet first hee would begin the cure with Phle­botomie.

[Page 35] If Auicens meaning be, when flegma­tike humors ouercome the bloud in multi­tude or abundance, that then wee must first vse purging; then is hee greatly de­ceiued, for as much as hee proponeth a case in which Phlebotomie should not auaile, ex­cept with those many colde humors there be also some excesse of bloud, which chaun­ceth verie sildome or not at all. But it may seeme that Auicen hath reason, namely this: that the bloud being extracted; those humors would waxe more rawe: and so by opening a veine, the patient is brought to a marueilous cruditie of colde humors. This is no reason: for by Phlebotomy wee detract bloud; not because of obstructions, caused of grosse and colde humors, but because bloud superaboundeth. For the stopping is afterward remoued with other helpes. Therefore, when obstruction concurreth with abundance of bloud; wee must not extract verie much bloud, but keepe backe some, till the time of the cure, as Galen tea­cheth 11. Method. Chap. 14.

And thus much, of the order betweene Phlebotomie and Purging: whereby wee see that a strong purgatiue must followe blee­ding: and that an easie purgation or clister may go before.

Of the effectes, that is, Of the profits and dis­profits of opening a veine. Chap. 5.

Schola Salerni, in two verses reckoneth vp three effects of bleeding:

Exhilerat tristes, iratos placat, amantes
Ne sint amentes, Phlebotomia facit.
It swageth wrath, and cheeres the sad:
Preserues loue-sick, from being mad.

FIrst, it maketh glad those that are pen­siue. Secondly, it appeaseth such as are angrie. Anger is especially caused through mixture of much yellow choler with bloud. And sadnesse, by commixture of much Me­lancoly with bloud. And forasmuch as both these humors, choler & Melancoly are ex­hausted with the bloud, these two effectes must consequently follow. Thirdly, it pre­serueth loue-sicke persons, from madnesse, by drawing humors from the head to the lo­wer partes, and so expelling the same.

Although occasion will hereafter better serue to shewe the causes why wee vse Phle­botomy: yet here nowe speaking of the ef­fectes, I will briefely shewe fiue causes, for which wee vse to let bloud, and by the which may be gathered the profitable effectes of this practise: of the which fiue causes; one [Page 37] onely cause is the direct, the other foure are indirect.

The direct cause of bleeding is euacuation of the bloud. But forasmuch as bloud is good for nature, therfore Phlebotomy must be vsed [...]duissdly: that the same bloud only may be expelled, which is vnprofitable & hurtfull to nature. Bloud, as you haue partly heard, is made vnprofitable to nature two waies: ei­ther when it doth not throughly keepe the proper qualitie that it cannot so nourish as it did before when it was good: or when in quantitie it so increaseth, that it either pres­seth downe the powers of the bodie, or stuf­feth & stoppeth both the veines & the arte­ries: In these two cases, bleeding is good, as one of the direct euacuating helpes. Yet in these cases bleeding is not to be vsed indiffe­rently, but with this difference: in abundāce of bloud, much may be detracted: In little plentie, small euacuation serueth. Hereupon Galen writeth lib. 9. cap. 10. Method. Si san­guis vitiosus in corpore fuerit, paulatim quod vitiosum est, euacuare oportet, & paulatim ad in o icem quod salubre est, pro eo reponere. If corrupt bloud be in the bodie, wee must by little & little take away the bad; and by litle & litle procure in the place therof, that which is good: which way of curing or amending of corrupt bloud, the Phisicions call in Greeke [Page 38] Epicrasis. And to this Alexander Tralleanus subscribeth lib. 9. ca. 2. The reason why this is not to be done at once, is for that the po­wers of the bodie would relent & giue ouer. And although that which is euacuated be su­perfluous: yet by a sudden & thorough mu­tation, it doth more hurt than good. It is bet­ter therefore to emptie the bodie safely, and by little at once, than by making hast, to dis­patch both the disease & the partie diseased.

And here it appeareth, how much they a­buse Phlebotomy which detract the ill bloud so long, til the good also begin to come: wher­as it may fall out, that all the bloud will flowe forth of the bodie, before that the good will appeare. It behoueth therefore the euacuatiō to be little. And (as Gaelen councelleth in this case) before the opening of a veine, to vse E­picrasis. i. to giue the patient such meat, as may cause good bloud; that good bloud may still come in place of the bad: and then a little af­ter, more bloud may be taken. This therfore is called the direct bleeding, because it is don of it self, to euacuate that which by opening a veine ought in deede to be withdrawen: namely, multitude of humors & of bloud, of bloud principally; & of humors secondarily: in asmuch as they are mingled with the blod. The other are called indirect causes: and are vsed only to reuoke or call backe the violent [Page 39] force of humors to the contrary part, or to turne the fluxe of them aside another way.

The first indirect cause is, for the greatnes of a disease, or for vehement inflamation of an impostume: for in apostumatiōs of great heat, in hote feuers, & in vehement griefes, there is not found a more excellent remedie than o­pening of a veine.

The second indirect cause is, to allure the matter to the place of euacuation. Therefore in stopping of Termes or Hemorroids, the veine Saphena is to be opened. Fulnes cōming by suppression of Termes is to be euacuated by the legges from the knee to the anckle, whether we cut a veine, or vse scarifying, or launcing: for veines opened in the armes of weomen, reuoke & draw vpward their natu­rall purging.

The third indirect cause is, that the humors may be turned to some other place, contrary or opposite to the place, vnto the which they flow of their own accord. Therfore in immo­derat fluxe of Termes, we open the Basilica veine, that is the inward veine of the arme, which is also called Hepatitis; that the matter being called to a contrarie place, may be tur­ned from his fluxe.

The fourth indirect cause is, that some part of the matter being takē away by bleeding; nature may the more easily ouercom, the rest: [Page 40] For the vertue of the bodie being weaker, then that it can rule such aboundance of hu­mors, wee take away by bleeding some por­tion of them, least thorough impotencie and debilitie of nature, the same humors should flowe to the weaker members, and there breede apostumations, and swellings con­trarie to nature. But of this more shal be spo­ken at large in the proper place therof, name­ly in the Chapter of reuulsion and deriuation of plucking backe, and turning aside of the bloud & of humors.

Touching the vtilitie of bleeding: great is the profit therof: For Galen reporteth that therewith he hath oft cured feuers: and that it is boldly to be taken in hand when neces­sitie requireth it. Therfore we may worthily blame those, which in our time, contrarie to Galens iudgement, & against reason & al ex­perience, speak euil of this profitable practise.

First, it sharpeneth the sight, making the same more cleare: the reason thereof is, for that it diminisheth those humors which tho­rough their fumes, hinder the clearnes of the eies: so that consequently the sight thereby is sharpened.

Secondly, it purgeth the braine, & sharpe­neth the wit, by the foresaid reason.

Thirdly, it heateth the marrow, wasting those superfluous humors, by whose com­mixture [Page 41] & flowing the marrow in the bones waxeth cold.

Fourthly, it purifieth all the senses, taking away those fumes and euaporations, which ascend vp to the head, and there trouble the senses.

Fiftly, it purgeth the bowels and entrailes: The reason is, because nature gouerning the body, being disburdened of that bloud which was (as it were) an oppression to nature, and greued her (as it were) with some heauy bur­den: doth now with ease concoct and ouer­come rawe and rude humors deteined in the bowels.

Sixtly, it stayeth vomits and laskes: for it draweth the humors from the inwarde parts, to the outward parts. VVherevnto Auicen agreeth writing thus, Phlebotomia propteriae quod ad diuersum trahit, naturam secundum plurimum retinet. Phlebotomy, because it draweth to the contrary part, therefore com­monly it reteineth nature. In which place it is to be vnderstood that in fluxes of the womb, the veine of the Arme is to be taken, which presently helpeth: But if you doo otherwise, that is, take the veine in the foote, or legge, it profiteth nothing. Sometime it chanceth that the belly by opening of a veine is more flow­ing than before, and that especially chanceth two waies: first because nature being disbur­dened [Page 42] by bleeding, strength is increased: so that sometime it stirreth vp other euacua­tions, as namely by siege. The second way is when through imbecility of the retentiue vertue, which imbecility by opening of a veyne is increased, so that the wombe is more stirred and prouoked.

Seauenthly, it profiteth against immode­rate watching, for it emptieth abundance of humors, from the which commonly diuers sharpe fumes ascend vp to the head and hin­der sleepe.

Eighthly, it taketh away heauines, sluggish­nes, & wearines of the body. For, as hath bin already said before, bleeding disburdeneth nature, which ruleth our bodies of multitude of humors; which before was pressed downe by them & oppressed with them. And again, Melancholly, the chiefest cause of heauines, is expelled with the bloud, as the dregs and grounds thereof.

Ninethly, it cureth difficulty of hearing, a­bating abundance of humors whose thicke & slatuous spirits, carried vpward into the head, stop the hearing port and passege of the eares.

Tenthly, it helpeth the voice, taking away superfluous humidi [...]ies, which too much moi­sten the arterie, or veyne of the voyce, and speaking. From which humidities horcenes of speech proceedeth,

[Page 43] Eleuenthly, it refresheth and increaseth the powers and strength of the body: For the body beeing freed from a multitude of hu­mors, must of necessity haue the vertue and strength thereof augmented. These commo­dities of bleeding, are thus set downe in verse by Schola Salerni.

Lumina clarificat, sincerat Phlebotomia
Mentes & cerebrum, calidas facit esse medullas:
Viseera purgabit, stomachū, ventrem (que) coercet:
Puros dat sensus, dat somnum, taedia tolli [...].
Auditus, vocem, vires producit & auget.
It cleareth sight, the wits, and braine.
It marrow warmes: doth cleane procure
The entrailes, stomacke: this is plaine:
It stayeth lasks, makes senses pure,
It causeth sleepe, expelleth griefe:
To eare, to tongue, it brings reliefe,

To be short, these are the commodities of Artificiall bleeding: therby the organs of the senses are cleansed: weake bodies are made strong, if yeares serue. By it are helped Re­pletions, Pluresies, hot tertians, frensies, pesti­lences and d [...]uers other diseases as shall ap­peare in the Chapter ensuing.

The onely disprofit in bleeding is this, that the vitall spirits thereby are [...]havven [Page 44] foorth which thing Galen witnesseth in his booke de Scarrificatione: saying, to open a veine oft in the yeare, I iudge not profitable: for with much bloud the vitall spirits are also exhaled: which beeing done too often, wa­steth the whole body, making the same cold, and causing the liuely operations thereof, to waxe worse and worse. To frequent blee­ding therefore bringeth on old age apace, and maketh the same subiect to many diseases, as the dropsie, gowt, shakings, palsies, falling sickenesses, and apoplexies. For naturall heate being too much cooled, and the princi­pall moysture diminished: the bowels lan­guish and crudity ruleth with many flegma­ticke humors, which are the causes and origi­nall of the foresaid cuils. This Schola Salerni remembreth: And Auicen in primo testefi­eth the same.

The best remedy to recouer vitall spirites decaied, is drinking of wine: for wine among things nourishing quickly and in short time is the most principall. By meats also vitall spirits are recouered in time, but not so soone. Wher­in is to be noted, that after bleeding must be taken meate easie of digestion, of good iuces, and of much nourishment, as potched-egs, & such like: which meate easie of digestion must be taken moderately the first and second day after bleeding, as Rhases counselleth writing [Page 45] to Almons. lib. 7. cap. 21. For the vertue di­gestiue, made weake by bleeding cannot o­uercome as yet much meate. Herevpon also Isaacus in his dyets writeth thus: Meate to such as haue bled, is to be withdrawen and di­minished; but drinke to be augmented, for in respect of the meat, drink is to be augmented; not in regard of his former vse of diet: that now he may drinke more than hee was accu­stomed: for in truth, he must drinke lesse than hee did before bleeding: because the vertue concoctiue (as ye haue heard) is yet too weak to beare much abundance of drinke. The words of Schola Salerni touching this matter are these,

Spiritus vberiorque exit per Phlebotomiam.
Spiritus ex potu vini mox multiplicatur,
Humorumque cibo damnum lente reparatur.
Abundant spirite with bloud doth passe,
yet drinke of wine doth it restore:
By helpe of meate the same alasse,
will hardly come as twas before.

Of Revulsion that is pulling backe, and deriua­tion, that is, turning aside of bloud and Hu­mors by opening of a veine. Chap. 6.

REvulsion is a prouided remedy for bloud flowing out of the nose or belly, [Page 46] or that floweth to any part like them to cause inflammation. It is called in the Greek Antispasis: That is, a turning to the con­trary way: in Latine Reuulsio, that is, a pulling backe; and as the word impotteth, so is it de­sined, a drawing of the running humor into the contrary part. Nothing can more spee­dely keepe backe the force of a Fluxe than this practise. Now for to vnderstand which is the contrary part, we must note that the Ma­thematicks call those contraries, which be the extremities of one and the selfe same straight line, which stand furthest off in a straight pro­ceeding or going forth of the selfe same vein; through whose passages the humors haue their course. For a veyne beeing opened, first the part next the wound is euacuated; & that euacuated part draweth the bloud out of the further part. And forasmuch as opening of a veine doth thus euacuate (through the helpe of the small straight veynes which nature hath ordained to allure and draw, as shee hath the ouerthwart veynes to expell:) The same opening of a veyne (I say) will prouoke more bloud and in shorter time from those parts where the streight veynes are spread then from the rest. Yea, if the veynes drawe not at all, yet the humors voluntarily will flowe in the straight course of the veynes: they that are in the right parts, followe the right mem­bers: [Page 47] and they that are in the left partes fol­low the left members: and that course of hu­mors is commended, which are carryed straight wise; and that discommended when they are carried crookedly and ouerthwart, as declaring nature to bee violated and cor­rupted. The names of Phisicall contraries in this practise are these: before, behinde, the right, the left, vpward, downewarde, within, without. Neither are these contraries in re­vulsion of humors, except they bee so placed in a straight course of veines. For the left side is not contrary to a left Pluresie, or the left leg, from the knee downewarde, called in La­tine Crus, contrary to the right leg inflamed. For herein this is a common and direct socie­ty of veines, whereby the left leg beeing o­pened, draweth from the right: But from the right side to the left no veyne commeth with straight and right strings: Therefore a veyne opened in the same remoueth not a Pluresie on the right side: But either leaueth the hurtfull humor in the inflamed part, or min­gleth it with the pure bloud, or bringeth a Pluresie in the left side: which often falleth out so.

For as much therefore as all our inde­uours and deuises must tende, by ope­ning of a veyne, to exhaust bloud abun­dantly and speedely from the inflamed part: [Page 48] take such a veine as is straitly scituated to the affected part. So in reason we shall followe nature, and imitate Hippocrates, who in a Pluresie willed to take the inner veine of the Arme on that side which is grieued. Nei­ther onely doth the Phisition open the inner veine of the right arme in a pluresie on the right side, but also in inflammation of the li­uer: and yet all the veins are ioyned to the li­uer in felowship. If that appeare not, we may take Mediana: If that neither appeare, we goe to Ʋena humeralis, rather than to the in­ner veine of the left arme; attributing so much to those veynes which are directly and straightly scytuated. Therefore Revulsion in a streight course bringeth euident and speedy helpe, whereas in a crooked or ouer­thwart locution it bringeth none at all.

Moreouer, a large veyne opened, with­draweth bloud plentifully and speedely from the next places. Therefore when there is a great and vehement inflammation of some e­uill Humor, abundantly concurring in some principall member, and part of great sense and feeling: a large veine must be opened in some neere place vnto it: which may abun­dantly and speedely euacuate from the place affected. If the infirmity be but small, a les­ser veyne may be chosen, and in a place fur­ther distant, to euacuate a lesse quantity, and [Page 49] at more leysure. Revulsion in this sort, not onely stayeth the Fluxe, but also exhausteth first from the affected member the rotten and ill bloud, before it deale with the good bloud of the other parts and members of the body, and then all feare is remooued of any newe Fluxe to insue. For when the part affe­ct ed shall bee disburdened more than the o­ther, through great euacuation lately made, very hardly in reason, can the same be grieued with another Fluxe of humors, except we go on with a fresh intemperate order of liuing. And againe, the members far distant (coue­tous as it were) because of their great want: wil not suffer the bloud in them contained, to flow to the others. Neither will the member affected (except there remaine in the same great dolor and heate) allure or sucke any thing from them, being now but weake and consequently not requiring great nourish­ment.

The opinion therefore of the Arabians concerning opening of a veyne must needes be false: VVho suppose that in a Pluresie a veyne opened on the same side doth increase the force of the Fluxe. Affirming also that for the plenitude (if it be much) lest the Flux should increase, the same is to bee taken from the lower veyne of the foote. After this that the Revulsion must bee made from the [Page 50] inner veyne of the contrary arme. Last of all, that the reliques and remainder is to bee euacuated out of the same side. VVhat dis­cretion I pray you is this? so oft to vexe the sicke Patient, whom wee may cure at one time: For bloud abundantly taken out of the side affected, draweth plenty as it were at the well head, freeing that part from inflammati­on without suspition [...] orfeare of any newe Fluxe. Euacuation made from the ouerthwart veynes, onely abateth superfluity of bloud and humors, with small quantity of the cor­rupt bloud, and lesse ease to the pained part: Or els the corrupted bloud remooued from the affected member, is mingled in the veyns with the good bloud, and so the euill that was to be remedied, is made worse. VVhen a veyne is opened in a right and straight course (e directo as they call it) it both euacu­ateth, pulleth the humor backe, and turneth it aside. And as a slowe and continuall run­ning, doth most safely pull backe from the furthest partes, and remooue a fluxe that might possibly insue: So also the bloud be­ing turned into a long tract, as it were of a new way, by litle and litle with Revulsion: it turneth from the old course, without offen­ding the naturall powers any thing at all.

Now that this Reuulsion, or calling backe of flowing humors to the contrary part: may [Page 51] be practised with the greater profit; I am to giue here aduertisement, that foure conditi­ons are therein to bee respected, as Auicen setteth downe in quarta primi cap. 1. First we are to consider the diuersity of the member, and still to draw to the contrary part, as from the right part to the left, from the lower member to the hyer, from before to behinde, &c.

This consideration to bee very needfull, Hyppocrates prooueth by experience: For 5. Aphoris. Apho. 68. hee writeth that paine in the binder part of the head, is cured by o­pening a veyne in the forehead: which Hyp­pocrates practised to auert the matter as Ga­len noteth in the Commentary. This auer­sion or turning to the contrary is done either according to longitude, that is, aboue and be­lowe: or latitude, that is, from the right to the left, or according to the altitude, that is, before and behind.

The second condition is to haue a care of the fellowship and community of the veyns▪ therefore in abundant fluxe of termes, wee pull backe, applying the Cupping-glasses to the Paps. VVhich Hyppocrates most learnedly witnesseth 5. Aphoris. Aphor. 50. For there is a kind of Affinite betweene the veynes of the wombe and the veynes of the Paps.

[Page 52] Thirdly, care must be had of the rightnes and straightnes of the veynes, which care be­ing had great profit insueth.

The fourth condition is, to obserue the farnes of the distance. But of these, two con­ditions especially are to be obserued. That is to say, the fellowship of the veynes, with their rectitude or rightnes: And therefore Hyppocrates counselleth to open the inner veyne of the same side or arme, and not of the contrary arme. VVhich also Galen affirmeth, li. de cura. ratio. sanguinis missione ca. 16. what­soeuer Auicen would otherwise, in tertia primi. Therefore they are to be blamed that in a Pluresie of the right side, open a veyne in the left▪ as Galen teacheth, lib. artis medic. cap. 95.

There are three waies of auersiō or turning away and a side of humors called Deriuatio. One by repelling things that beat backe the matter, another by thinges reuelling, which pull the matter cleane away, and draw it forth to the contrary part. And the third way is, by thinges transmissiue, which sende the matter from one member to another. So Diuersio, or Deriuatio is as it were genus to Revulsion. If therefore (as yee haue heard) there be great inflammation, or a sodaine and hasty Fluxe of humors; open a great veyne of the same side might, e d [...]recto, as these rermeit. I say, a [Page 53] great or large veyne because if the euacuati­on be in the greater vessels, it is done with the more speede: As Galen saith, libri primi arti [...] medic. cap. 95. And it is saide rightly in the same side, for this is the counsaile of Galen, lib. 13. Metho. cap. 11. But if the Fluxe of humors be slowe, & not hasty as in the other, or that a veyne must be opened for preserua­tion onely: A veyne further off may bee ta­ken according to the iudgement and discre­tion of the Phisition, as ye haue partly heard before.

But forasmuch as the Liuer is the Foun­taine and originall of all the veynes, and Phlebotomy cuacuateth bloud, it seemeth that bloud should neuer be abated, either for Euacuation or Revulsion, vnlesse the veyne of the right arme bee taken, which chiefly doth euacuate and pull backe from the foun­taine, that is, the Liuer. VVhich also may be prooued by that notable man Hyppocrates his authority, affirming our whole body to be Conspirabile: That is, of one agreement, and of a common and generall accorde together, one member with another, and Confluxibile, that is, alwaies running together, and so al­lied, that each part thereof suffereth with the other.

This beeing so, it seemeth that rectitude is not at all to be regarded in Revulsion. For [Page 54] what veyne soeuer wee open because of the consent of the whole body with the parts the like profit will insue.

For the Solution hereof we make answere: that as it is now said, it would follow in effect. But that nature a prouident dame hath so placed the midriffe, as it diuideth the sto­macke from the lower bowels, and hath se­parated the right parts from the left: Lest one part being hurt, the other part should al­so sodainely perish. And this is the cause that therefore rather the right with right, than with the left; and the left with the left, ra­ther than the right, doo accord together, and mutually suffer one with the other. And therefore also Hyppacrates said well. Sangui­nis reuulsionem secundum rectitudinem (cat a Ixin) fieri debere. That Revultion of bloud must bee done according vnto rectitude. If therefore a veyne be thus opened wee shall soone see the apparant vtility, if wee doo o­therwise or the contrary, it profiteth no­thing.

This is seene euen by naturall eruptions of bloud: For if in swelling of the Spleene, na­ture expell bloud out of the right Nosthrill, or in swelling of the Liuer from the left No­sthrill, no helpe insueth. But if the bleeding bee according to rectitude called in Greeke Cata Ixin, as speniticke persons, out of the [Page 55] left Nosthrill: and in diseases of the Liuer out of the right euident profit will appeare. The contrary profiteth not, but oft hurteth diminishing the strength of the body without helpe to the disease, as saith Galen de curand. rati. per sang. missio. cap. 15. VVherefore as it were following nature, in that which shee doth well, and those thinges which come vo­luntarily, and of themselues, and are yet good and profitable to stoppe bleeding at the nose from the left Nosthrill, wee apply cupping­glasses to the left Hypocondrium: which is the compasse of the side neere the breast and Paps, and if from the right Nosthril, to the right Hypocondrium. The rectitude there­fore as an especiall matter is to bee obserued in Revulsion: yea, and more account is to bee made thereof, than of the differences of the members, neither are the parts of the body to bee iudged contrary each to other, except one bee opposite to the other according to rectitude.

An Obiection.

It seemeth that Galen respected not the lo­cation of grieued members, according to this rectitude, lib. 13. Method. cap. 5. VVhereas the hand being ill affected, he scarrified Cru­ra the thighs, and one of the thighs ill affected he scarrified the other thigh that was well.

The Solution.

Galen in his practise obserued rectitude of members. For there is a common and direct societie of the veines, so that the opening of the left thigh: which draweth bloud from the right, for both the thighes receiue bloud from the hollowe veyne called Ʋena caua.

Auicen in 4. primi. 1. deliuereth two rules not to be neglected in Revulsions. First that if in the member, from which wee will pull backe, there bee great paine: the paine must be asswaged, before we make Revulsi­on. Otherwise, the dolour greatly attra­cting, and wee also drawing backe with Re­vulsion, the humors to some other part, there would bee too great a contention, and an ex­cessiue moouing of the matter: whereby the body might receiue much hurt.

His second rule is, that when wee pull backe, the passage must not bee thwart a­ny principall member. If any ambiguity arise concerning this rule, because Hyppocra­tes is saide before, in ach of the hinder part of the head, to open a veyne in the forepart: we answere, that the same passage was not made vpon a principall member, to wit, the braine. VVe also affirme that the passage may be by a veyn of a principall member, though not by [Page 57] the substance of the said member: for the fluxe doth not abide, or rest in the braine, as in termino, in his bound or limit. Therefore I coun [...]eil ag ine and againe, because manie are killed through the vnskilfulnes of practi­sioners in this point: at some of whose deaths I haue my seife beene present. In a pleurisie of the right side, open a veine in the right arme: otherwise, the hart being situate in the mid­dle, betweene the right side and the left: the passage should be vpon a principall member, namely the heart. And hitherto chiefeiy of Revulsion.

Parocheteusis in Greeke: Deriuatio in La­tine: in English, Deriuation, or pulling aside; is defined, a drawing of the flowing humor to the next part. It is done by opening that vaine which is found in the verie member af­fected; and whereby also sometime that member receiued nourishment. But now the ill iuce flowing, and that veine opened, the grieued part is presently disburthened.

This practise is profitably vsed after reuul­sion: In the beginning of inflammation, when the matter is now in fluxiō & mouing, bloud is to be withdrawen from some farre distant place, according to rectitude: after that, euacuation must be made from the af­fected part, when the matter is come thither▪ and there settleth and abideth: then detract [Page 58] bloud, either from the affected part, or verie neere vnto it, and this is called Parocheteusis, deriuatio. VVee make deriuation from the member affected, when the same is not any noble or principall member: and this is done two wayes: either manifestly and sensibly by scarification or boxing: or immanifestly by euaporation, as Galen sheweth, lib. Artis Med. cap. 95. But that deduction which is made to the next partes, is most properly cal­led Deriuation. Thus to staye bloud at the mouth, wee bring it to the neere partes, and prouoke bleeding at the nose. So in weo­men in fluxes of Hemorroids, wee stay them in prouoking Menstrua. i. their naturall Termes. Thus in inflammations of the mouth, wee bring them to the nose. So in angina, opening the veines in the handes, and the veines vnder the toung, wee make deri­uation to the next place. So in affectes of the guttes, we do not prouoke to stole, but draw it to the next partes: prouoking either vrine or swet. So in diseases of the raines, wee prouoke not vrine, but drawing the matter to the next members, namely the bowels, wee prouoke to stoole.

But heere a [...]yseth a doubt: howe the raines can be purged by siege, seeing there is no sensible waye or passage knowen, from [Page 59] the raines thither.

To aunswere this, wee haue but autho­rities, as namely of Galen and Hippocra. Galen affirming in his seuenth booke de Me­thod. Chap. 13. that the raines, bladder, and bounch of the Liuer called Gibba Ierinoris are purged by siege. And experience sheweth, that when the bellie is solluble and laxatiue; the vrine is the lesse. Hippo. saying in like manner 4. Aphorism. Apho­rismo vltimo: That much v [...]ine made by night, sheweth little siege.

You haue heard before, that deriuasion is vsed after revulsion, when the force of the fluxe is stayed, when the heat of the inflammation is layde, when there is no feare or suspicion of any other inflammation likely to ensue: and also when the humor is yet moyst and liquide in the member, from whence it may returne. But if you suppose the humor to be stuffed in the mem­ber, and is not able to returne: which of­ten times falleth out in continuall olde in­flammations, in which harde apostumated reliques remaine. In this case, when yee o­pen the veine, vse no deriuation but fomen­tation or bathinges, and emplasters to di­gest and mollesie. Wherewith, if the humor cannot be dissolued, the member not [Page 60] being principall; neither any great pain there felt: the affected place may be launced, and the humor brought foorth: specially, if the same be contagious, that it infect and hurt the members adiacent: which practise, thogh properly it cannot be called deriuation, yet it may stand in steede thereof.

Whether purgation by siege or inward medi­cine receiued, cannot, or may not, euacuate the bloud. And thereasons answered that are brought for proofe thereof. Chap. 7.

IT seemeth, that an inward receit suffici­ently euacuating bloud by siege, may be both found, and vsed by Isaacus: who in 1. vi­ [...]tici, in the Chapter of Cephalaea passio, affir­meth: Quae prosunt Cholerae, prosunt & san­gaini: Those things that are good for choler, are good for bloud. But it is knowen that we haue euacuating receits for choler: therefore by the foresaid authoritie, the same are also good and profitable to euacuate bloud. Se­condly, there are receites to euacuate other humors, as choler, flewme, and Melancoly: therefore also there are to euacuate bloud, which is the principall humor.

Thirdly, Auicen in 2. affirmeth: Pulpam evacuare sanguinem; that the pulpe of Colo­quintidae euacuateth the bloud. Fourthly, [Page 61] Haly supra tegni, affirmeth, that Galen caused one to be hanged that gaue a receit to euacu­ate bloud: therefore there was such a receit then, and may be now. The contrarie to these obiections is set downe by Galon, that no receit euacuateth the bloud or humor i [...] the veines, but Phlebotomy onely.

A second question here may be moued, whether if there be such a receit found, the same may be administred or not? It seemeth that it may, because when other humors of­fend, we euacuate them by medicine: there­fore it seemeth, wee may so do, when bloud offendeth. The contrarie to this is set downe by Haly aforesaid, and warranted by Galens authoritie, who caused one to be hanged for so doing.

For solution hereof, we are to vnderstand, that although a medicine euacuating bloud may be found out, yet the same may not be vsed. The reason is: for that such a medicine specially or rather altogether respecting the bloud, would neither euacuate nor attract bloud, as the other humors are euacuated with their owne proper and peculiar receits▪ Yea, if it happen that it do euacuate bloud, as Pulpa Colocynthidis doth, according to A­uicen: without doubt, it euacuateth tha [...] bloud which should be still retained for the good health of mans bodie. Serapio sayeth, [Page 62] that the impropriate or improper humor of a receit, is sooner thereby euacuated then the proper humor: whereof he rendreth a rea­son, namely, that the proper humor to a re­c [...]it, is the best beloued to the receit. Wher­by (saith he) it commeth to passe, that the improper humor is sooner for saken of nature, than the proper. The humor improper is quickly drawen to the receit, and therby soo­ner expelled: whereas the humor called pro­per (which the medicine most properly re­specteth) is, as it were, the most beloued friend, and as it were, the most natural childe to the euacuating receit, and therefore is stil rather reteined than expelled. By this reason o [...] Serapio, forasmuch as bloud is natures dar­ling, & more helping than the other humors, which are but superfluities in respect of the bloud. If there were a receit euacuating & re­specting bloud, & that the same were admi­nistred the other humors would be attracted & cuacuated before the bloud, and so great hurt ensue to the bodie. And if it were so that onely bloud offended (which is not perhaps altogether true) yet neither should the blo [...] alone be euacuated, as now it hath bin decla­red. Againe, according to the Philosopher 4. de Animalibus, we are to make choice of the right way, and not to seeke crooked wayes. Now opening a veine is the righter & safer [Page 63] way to euacuate bloud, than medicine: for Phlebotomy euacuateth all humors at once, & principally the bloud which most of all a­boundeth in the veines: and this thing, medi­cine cannot do. Againe, euacuation is done for two causes: either for to remooue the a­boundance of the humor, or to take away the corrupted qualitie of the homor. So euacua­tion of bloud is practised, either because it a­boundeth in quantitie, or offendeth in quali­tie. If we open a veine because bloud aboun­deth in quantitie: then in like sort there is also abundance of other humors. For abundāceof bloud cometh through good nutriment, cau­sing bonū Chymū. i. good [...]uce proceeding of meat digested: which doth not only bring re­pletion of bloud, but also of other humors as helpers vnto bloud. Therefore when bloud thus aboundeth in quantitie with other hu­mors, it is better to euacuat them by Phlebo­tomie than by receit. If euacuatiō of bloud be made for that it corrupteth in the veines, then by reasō it corrupteth the other humors also▪ seeing bloud is more abounding in quantitie than are the other humors: wherupon Galen saith, that in the feuer Sinocha, there is corrup­tion of all the humors, & in all the veines, & therefore bloud is neuer to be euacuated without the other humors together. Now o­ther humors may superfluously abound & be [Page 64] corrupted in qualitie, without the bloud, and so consequently may be euacuated without bloud by inward medicine: so that it is natu­rall for the other humors in this sort to be euacuated, and vnnaturall so to euacuate bloud: which was the cause that Haly vpon Galens authoritie affirmed, that Galen caused one to be hanged, which euacuated bloud by inward receit.

To the former obiections therefore wee answere thus: Isaac his saying; Quod prodest Choleri prodest sanguini, is to bee vnderstood not of euacuating medicines, but of altering receits, as thus: those things that are profi­table to alter choler, and to extinguish the amitie thereof, they worke the same effect in alteration of the bloud. Or wee may vnder­stand it of euacuation, and expound it thus: Those things which are profitable to eua­cuate choler, are profitable to mundefie the bloud; because, by euacuation of choler, bloud is mundefied and cleansed.

To the second we answere, that this ar­gument (Bloud is naught and offendeth as do other humors, therefore it is good to eua­cuate the same by medicine, as other homors offending are euacuated) this is a fallax of the consequent, or rather figurae dictionis: for it followeth not, that if bloud offend it must be euacuated by inward medicine; because [Page 65] the same may better and more safely be done otherwise; namely by Phlebotomie: and this may serue for aunswere to the second doubt before moued in like manner.

To the third may be said, that Pulpa be­ing forcible, it greatly debilitateth the mem­ber: and therefore, when bloud is superflu­ous, it looseth and euacuateth the same, and letteth the bloud conteined in the member, to passe away; but it doth not attract the bloud: and this is verie pernitious to the bo­die of man.

The answere to the fourth, is plaine in the premisses. VVhere note, that although it haue bin declared in this Chapter, that bloud is not to be euacuated by siege, as other hu­mors are: which fluxe of bloud that way, we rather account a disease, than a remedie: as in Dysenteria & such like: yet this notwithstan­ding we do not denie, but medicines may be verie profitably giuen, and receiued to mun­difie & to purge the bloud.

Of the impediments or lets of Phlebotomy, and of the causes requiring and furthering the same. Chap. 8.

THere are certeine things which put off bleeding for a while, and other things which altogether hinder & forbid this pra­ctise: whereof, the first is indigestion of the [Page 66] meat receiued: as when a man hath eaten much ouer-night, and in the morning feeleth himselfe pained therby: feeling still, as it were the sent & sauour of the meat which he hath eaten remaining still in his stomack, whereby the cruditie plainly appeareth. In this case, (except vrgent necessitie otherwise require) wee must forbeare bleeding til the digestion be accomplished; that is, til the rawe humors be concoct, & also the excrements descen­ded. The reason why cruditie and rawnes of humors through too much ingorging of meat stayeth bleeding for the time; may be gathe­red out of Auicen. 1. Doctri. 6. cap. 3. for that there are three things which attract matter vnto them: that is emptines of the place, heat of the members, the habit and state of the whole bodie. If therefore (the bodie thus affected) wee chaunce to open a veine, the bloud vntimely woulde be drawen by the veines: first, part of this cruditie of humors: and the veines being destitute of their proper and conuenient nourishment, would drawe vnto them that which is not as yet concocted in the stomack & Liuer: which vnconcocted matter sent abroad to the oth [...]r members of the bodie, would not easely be amended. For (as Galen saith) the third d­gestion doth not remedie the faults of the se­cond: nor the second▪ the curls of the first: Si [Page 67] magnum sit peccatum (as he saith) if the euill be great. So that now, if by this meanes the matter be turned into the members; there must, in the meane season, of necessitie be a­bundance of excrementes remaining in the bodie, as the occasion of sicknesses: and so at length sicknesses may ensue. Yea, it is far bet­ter (as it seemeth to Galen, lib. de Curand. ratio per sanguinis missionem cap. 6. altogether to absteine from bleeding in vntemperat drin­kers & gluttonous persons: as from such as cannot be cured either by purging or blee­ding. For by their vntemperat life, they ga­ther in short time againe, great abundance of rawe & vnconcocted humors. VVith such it is not best to deale: for to what purpose is it, to haue the excellent vse of this practise, by these mens intemperancie defaced among the common people, which hath been so pre­sent a helpe to diuers? See Galen. lib. 11: cap. 9. Method. Meden.

The seconde matter, putting off this pra­ctise for a time, are the excrementes of the bellie. Therefore, first exonerate the wombe before bleeding, if it bee not solu­ble of it selfe, with a Clister of decoction of Mallowes, putting thereto Oyle and Salte, or with a Suppositorie, or with eating a little Cassia fistula.

The thirde impediment, is some other [Page 68] voluntarie euacuation, that may be at that present time: as in fluxe of Termes in weo­men, and in fluxe of the Hemorroids: where­unto Gaelen likewise consenteth, lib. 9. Cap. 5. Method. Meden. in these words: If (saith he) in time of bleeding, it happen, that the Termes do flowe; or that the veine called Haemorrhois be open, if the force of the same fluxe seeme sufficient, so that it alone may euacuate that which thou requirest: thou shalt leaue the matter wholly to nature: if not, then thou maist detract so much bloud, till by both wayes, that be brought to passe, which thou wouldest haue done. But this is not alwayes to be followed: for in euacuati­on to turne away the matter, as in immode­rate fluxe of Termes, or in the fluxe of the Hemorroides wee practise bleeding, as was afore shewed in the Chapter of Reuulsion.

Againe, concerning these voluntarie eruptions of bloud, when wee intend to o­pen a veine, if the eruption haue been much, then stay from further euacuation. But if it little or nothing haue withdrawen the mat­ter of the disease, it debarreth vs not of fur­ther bleeding. Therefore, if the disease and present necessitie require it, & that the po­wers of nature haue not beene damnified by that voluntarie eruption, wee may speedily open a veine, as in a strong plurisie. If there [Page 69] haue been much sweating, vomiting or great sieges, we are not to let bloud: but if these slake, and that the naturall powers are a little in time recreated, then wee may verie safely bleede. For those being but accidents, & not remouing the cause of the disease, can not serue in steed of bleeding. So in a hote agew, if the wombe be laxatiue, and that there happpen Lienteria (which is a fluxe of the stomacke, when the meate and drinke run­neth from a man, as he tooke it, vtterly with­out concoction or alteration, rising of great weakenes of the stomacke, specially in the power retentiue, which is not able to keepe the meate till nature in ful time may concoct it, through immoderate drinking of colde water: from which, some cannot refraine in hote feuers: This (I say) doth not hinder bleeding, but because thereby natures strength is enfeebled, the same considered, the bleeding must be the lesse, if voluntarie eruption of bloud remoue the matter of the disease, or in some reason bring ease to the patient; according to discretion, commit the matter to nature alone. If not, take away some bloud, that through natures worke and the Phisitions practise togither, the cure may be accomplished. Those things which nature of her selfe can finish, meddle not withall; but helpe her with Art, in that which shee be­ginneth, [Page 70] and cannot of her selfe make an end: therfore I said, in a Plurisie, in a continual fe­uer, if bloud abundantly flow frō the bellie, hemorroids, or nose: so that the quantie of the euacuation be iust, and the patient there­by eased, let no further bloud. If bloud come but smally from the foresaide, and that the sicknesse still continue vehement: that which wanteth is to be done by opening a veine: yea, although the patient be a woman in child-bed: yea, & therefore sometime in a bloudie fluxe, a purgation is giuen, that the same which commeth foorth but softly and slowly, by reson of the vnprepared passages; may flowe more abundantly by a more con­uenient course.

The fourth impediment, is the age of the partie that is to bleed, either being too old or too yong. Old folk are not to be let bloud, because there is in them little good bloud, and much ill bloud: bleeding from them taketh a­way the good, and leaueth the bad behinde. Olde men after 70 yeares are not to be let bloud, except they be of a strong constitutiō of body, & that the vehemency of the disease require the same. But if in these yeres, the po­wers of the bodie be weake, & that bloud a­boundeth not: bleeding is not to be in them practised: for as Galen saith, in men of these yeres, there is little good bloud; but of rawe [Page 71] humors great plentie: so that opening of a veine, sendeth forth the good; but the ill blod gathered together in the chiefe veines, in the Liuer, & that part called Mesenterion, which is the double skin that fasteneth the bowels to the backe: or rather, the branches of the veine called Porta, which conuey the iuce of the meat concocted from the stomake to the Liuer, it draweth forth into the whole bodie. Consider therfore, the strength of the body, the vehemencie of the disease: for not onely the number of yeres, but the constitutiō also of the body is to be marked. There are of 60 yeres that are not to bleed, being weake old men. The age fit for bleeding is at as florens, that is: after some, the 17 yeare of age: after some 9. after some 10. after others 14. or 13.

Before the 13 yeare, after the most appro­ued writers of our time, wee are not to let bloud, except those youthes haue broad veines: be of sanguine complexion, and that the disease be dangerous & require this pra­ctise necessarily. In these cases wee may o­pen a veine, if the veines well appeare: or we may diminish bloud, by scarifying the legges or armes. Schola Salerni sayeth: Denus septenus vix Phlebotomon petit annus.

The seuenteenth yere of age scarce good:
To put in proofe letting of blood.

[Page 72] Children then before they come to 13. or 14. yeares, are not to bleede, except some great dangerous disease of necessitie require it at nine or tenne yeares: the reason is, because their flesh and skinne is yet but tender, and easie to breath thorow, as Galen witnesseth lib. 9. cap. 17. Method. Medendi, in these words: Puerorū substantia omniūfaci­le digeritur ac dissipatur, propterea quod est om­nium humidissima, est omnium minime frigida. The substance or flesh of children, is most easie of all resolued or separated, because it is most moyst, and lesse cold than other fleshie substances. It needeth therefore no euacua­tion, hauing naturally of itselfe, how to be purged, calore extraneo by a forrein, outward and strange kinde of heate. And againe Ga­len sayeth, lib, 11. of the same worke Cap. 14 speaking of Synochus a kinde of feuer: Si in puerum incidat, qui 14. annum non hactenus attigit, mitti illi sanguis non debet, propterea quod tantillis, cum praesertim calidi ac humidi sint, plurimum corporis substantiae quotidie de­fluat ac digeratur: it a quod ex incidenda vena, moliendum nobis fuerat, id vltro nobis ex cura­ti corporis natura praestatur. i. If this feuer hap­pen to a childe yet not 14 yeares of age; he is not to be let bloud, because such yong ones, being of a hote and moyst constitution, haue much of their bodily substance daily dissol­ued. [Page 73] So that the same which we goe about to bring to passe by opening a veyne, is done al­ready to our hands by the constitution of the Patient. Of this imp e diment, namely, the age, beside old men and boyes, are also meant decrepits, and very Infants. Auicen remem­breth in quarta primi, cap. 20. this matter writing almost in this manner: Thou ough­test to beware of opening a veyne in a com­plexion too colde, in a Country too colde, in time of extreme paine in a member, after re­solutiue bathinges, after carnall copulation, in young age vnder fourteene, and in olde age, except thou haue great confidence in the so­lidity of the Muscles, in the largenes and ful­nes of the veynes, and rednes of the colour: such either young or olde, boldly may be let bloud. Yet those that are young of fourteene yeare olde, must bleede orderly by little and little at once, and at each time more than be­fore: and all this did Auicen take out of Galen. So that although in Phlebotomy wee are chiefly to consider these three thinges, that is to say, the danger of the disease, the age and naturall strength of the party: yet the age is sometime not wayed when the strength of nature serueth, either in old or yong. Wher­fore Galen lib. de curand. ratione per sanguinis missionem cap. 13. willeth to let bloud young sanguine children, and olde sanguine men, [Page 74] without consideration of age, if the dis­ease be vehement and dangerous, if the bo­dy bee sufficiently strong, and that there also bee vehemency of the Pulsies. In these cases Necessitas non habet legem; Necessity hath no Lawe. So in Spaine they let children bloud of three yeares olde and lesse, and Auenzo­ar writeth, that hee let his sonne bloud at three yeares of age, and so preserued him from death, lib. septi. cap. tertio Collecta. These limits of yeares in this point Hyppocrates did not set downe. Galen appointed them from fourteene, to seauentie.

Mooued by the foresaide reasons; Rhases, in olde decrepite age, nothing at all fearing the danger of exhausting the naturall heate, that remaineth in the body with the bloud, (whereof notwithstanding often proceedeth the hazarde of life by vndiscrete bleeding) by opening a veyne in decrepite persons, did then helpe, and did great good in grieuous Pluresies and Perypleumonias. And con­cerning young folke, this wee find true by ex­perience, that in the fifth or sixth yeares of their age, by opening a veyne, Pluresies, in­ward inflammations, and other grieuous dis­eases are cured.

Yea, wee see by the very course of Na­ture, that Children and sucking Infantes, oft plentifully bleede at the nose without any [Page 75] hurt of body, or any diminishing of their na­turall strength.

The age of Childhood hath naturally her strength and bodely forces, why therefore may we not euacuate bloud: according to the proportion of the same? Especially, when the childe is plentifully fedde, hauing also large veynes, and is filled with good concocted bloud. Againe, if it bee graunted that the forces of nature are impaired by bleeding: whether is it better for the childe to peri [...]h through plenitude and abundance of humors? or to free him of his disease by abating that a­bundance, though the strength of nature be thereby a litle hindered: Therefore somtime the necessity of bleeding is great, euen in chil­dred; as in Pluresies, inward inflammations, and continuall feuers. There is therefore no age in my poore iudgement, but may a­bide some measure of Euacuation by blee­ding if the child bee past fourteene yeares of age: Yet consideration is to be had of what constitution hee is, whether his bodely sub­stance be fat or leane, thicke or thin, grosse or slender, hard or soft, of much bloud or of litle: In the first we may proceed to open a veyne▪ in the other not: and here we most carefully remember, that in children because of their hot & moist temperature, lesse bloud must be taken, than the plenitude seemeth to require.

[Page 76] The fift impediment is an ill disposition of the stomack incident to some men, more than other some, in whom chollerick humors flow to the mouth of their stomacks, and maketh them apt to chollericke vomits, although be­fore they haue neither accustomed, nor had any desire to vomit. In thesemen, bleeding is to bee forborne, because thereby the trou­bled humors flowe to the mouth of the sto­macke as to the accustomed place, and be­cause the stomacke cannot resist so great a Flux of humors, being partly weake of it self, and more weakened through their comming. Hereof diuers great discommodities growe to the body, yea this is the very cause, that some fall downe and faint in bleeding. For the chollericke humors flowing to the sto­macke, bite and nip the same, and so per Sim­pathia through a certaine kind of compassion that is betweene the stomacke, the heart, and the braine: it causeth Syncope, that is, sowning. VVherefore Galen lib. 12. Method. cap. 3. Durst neither purge, nor let those bloud, which haue the mouth of their stomacke ve­ry sensible, tender, weake and abounding with bitter choler: and which persons also a­bounding with the same when they bleede, in the very beginning, long afore full euacua­tion bee made, oft fall downe and faint: by reason of the foresaide choler, and crudity of [Page 77] humors. And this is also the counsaile of Ga­len lib. de curand. ratio. per sanguin. missio. cap. 1. and of Auicen in quarta primi cap. 20. Ye may perceiue the mouth of the stomacke to bee very sensible, (saith Auicen) when yee cannot swallowe downe sharpe and bitter thinges without hurt. VVeakenes of the stomacke is knowen, by losse of Apetite to meate and drinke. Abundance of bitter cho­ler is shewed, by bitternes of the mouth, by subuersion of the stomacke long time conn­nuing, and by oft vomiting vp of choler. These signes and tokens discried in any pati­tient, doo dehort from opening a veyne: Yea, this ill disposition of the stomacke: bringeth not onely Sincope, but also sometime present death. As Galen witnesseth lib. 9. cap. 5. Me­den. And Auicen in the former cited place.

The sixt, is weakenes of the natural forces▪ Of which there is a threefold condition, for they are either firme, or weake, or betwene both. The forces of nature being but weake they cannot indure Phlebotomy, so forcible an euacuation. As Galen 2. Aphorismo. Aphorism. encipienti. In quo morbo, &c. & 4. Simplicis medecinae witnesseth. This is one of the prin­cipall considerations that are to bee regarded in opening a veyne, for either wee must de­hort from it, if natures forces serue not, or in­courage to proceede it, if they will serue vnto [Page 78] it. For it standeth with great reason, that blee­ding must greatly infeeble, and put them in danger, that are already weake of nature. Yea it oft falleth out, that diuers being let bloud, carrying very weake bodies; can neuer again recouer their former and pristinate strength, as Galen lib. de curand. ratio per sang. missio. ca. 6. & li. 11. Method. meden. cap. 14. witnesseth. If the body bee strong, and that vrgent ne­cessiity so require, wee may boldly let bloud. If necessity doo not vrge, bleede not at all, or very litle. If vpon great necessity in this case much bloud must bee taken, the body being feeble and not able to abide it, we are to eua­cuate now a litle and then a little. Yea, I giue heere againe aduise, especially to regarde this consideration. For many times when the age, disease, and time require this kind of euacua­tion, and the naturall strength cannot brooke it, there insueth Sincope, that is, sowning: In the which case we must reiterate bleeding, as hath beene said, or else stay it, putting the fin­ger on the wound; which stay the Grecians vsed, and called Apphasis.

The seauenth stay or let is, the habite and constitution of the body, wherein wee are to regard the whitenes or blackenes, leannes or fatnes, thicknes or thinnes, of the bodies that are to bleede. Thinne, white, leane and soft bodies are not to bleede; because many [Page 79] superfluities are resolued from such bodies, which being to them sufficient, they need not any other euacuation. This doth Galen affirm lib. 9. Metho. Medend. fleshy bodies, firme, and thicke, are subiect nothing so much to dissipa­tion of superfluities, & therefore may better abide bleeding: as for fatte and grosse bodies, though they be also lesse subiect to wasting & dissipation of humors than other are; yet they hardly tollerat Phlebotomy, because they haue but small veynes, and they being emptied by bleeding, the fat of the body wringeth, and as it were presseth them down. So that it is gret­ly to bee feared, lest by such oppression, the heat of nature be quite extinguished. In this point of the habit of the body, we are also to consider, the capablenes of the veyns, which being great & swollen, may better be opened than the narrow and small litle veyns. Again, we are also here to regard, the naturall dispo­sition of the humors. For hot and thin humors are flowing and quickly dispersed. Thicke and cold humors are not so: and because grosse & thicke fat bodies, haue lesser veynes, & lesser bloud than leane men, & that in such persons, the very fat of their bodies oft presseth down the veyns: so suffocating and choking naturall heate: therfore wee see by experience, that oftentimes these corpulent fat men die a so­daine death.

[Page 80] VVherevpon also Hyppocrates, 2. Apho­ris. Aphoris. 44. supposed that grosse men die sooner, and more sodainly than leane per­sons. This I my selfe obserued, certaine yeares past, by the death of a Gentleman of good credite, in this shiere of Kent, one Mai­ster Weldon Esquiere, and ofthe Greencloth: VVho died very sodainely beeing a very fat Gentleman at a parish called great Pecham.

The eighth impediment is, the colde tem­perature of the Patient, or the coldnes of the complexion. For the bodily constitution beeing already colde, by bleeding, of force must be made more cold, VVhereby frigi­ditie ofthe body dayly increaseth. And as I­saac saith in Ʋrinis. Sanguis est fundamen­tum caloris naturalis, in quo calor naturalis confortatur. Bloud is the foundation of na­turall heate, whereby naturall heate is streng­thened. Therefore Phlebotomy (euacuating bloud) diminisheth the naturall heate, and consequently bringeth a dangerous coldne [...] to the whole body. The foundation of in­ward warmth (namely bloud) being dimini­shed, inwarde heate decayeth, and the body still by little and little waxeth more colde. And this is testefied by Galen, lib. de curanda ratio per sanguin▪ missio. cap. 6. Yet when the sicke is of a melancholy constitution, and is grieued with much Repletion, or that Me­lancholy [Page 81] hath much bloud mixt with it: in this case hee may bleede. And againe, a hot and a moist constitution of body, hauing also the bodily substance consisting of found, whole, and massie members: which by rea­son of inwarde heate is daily much dissolued; tollerateth not so plentifull euacuation, as o­ther complexions. VVhere by the way yee are to note that in Phisicke, that body which aboundeth with much humors in the veynes, is most properly called Corpus humidum, and may best of all away with euacuatiō by blee­ding.

The ninth is rawnes, slownes, and clammi­nes of the humors: In which case wee are to forbeare bleeding. For otherwise crudity of humors will bee increased. After Galen 12. Method. Medend. cap. 2. And this is the cause, why in long continuing maladies bleeding is not vsed according to Auicen: for if it were, there woulde followe Crudity of Humors; Debility of Naturall vertue; Prolongati­on of the disease, with feare neuer to bee cu­red.

And therefore againe, as the same Auicen saith further, in diseases daily and continuall, called Morte Chronici; Purgation must goe before bleeding, and not bleeding first: al­though we are to vse them both. VVhereof looke before. Chap. 4.

[Page 82] Of crudity of humors there are two speci­all causes, the first is the excessiue multitude of humors in the body, choking the inwarde naturall heare, by reason of whose weakenes, and suffocation, nature not beeing able to o­uercome those humors, crudi [...]es must needes i [...]ue in the body. Bu [...] in th [...] case Phleboto­my may be vsed▪ And Galen lib. 2. cap. de Hy­droposi [...]aith, that bleeding he pet [...]in the [...] of a dropsie which is caused thro [...]gh abundance of menstruous bloud or of abun­dance of hemorroids. The reason is, for that although these humors abounde in the body: yet bleeding stayeth the fluxe of them both: of that that is of the menstruous bloude, and also of the Hemorroids. This also Trallianus; affi [...]meth, lib. 9. cap. 2. In the cure of Ana­sarca: which is a [...]inde of dropsie, in these words. Omnium curatio a vacuatione incipi­endaest,sed Ascitis quidem dicti, aut Timpaniae a solapurgatione, cus autem Arasarca nome [...]i est, ea vena sertionem int [...]rdum ordum requirit, vt qui [...]x sanguine frigidonascitut. The cure of all dropsies must begin at eu cuation. But that kind of dropsie called Ascitis or a Timpany, must beginne at purging onely. That dropsie (called Anasarca) sometime equireth ope­ning of a veyne, as proceeding of colde bloud.

This he faith not that this Anasarca requi­reth [Page 83] any further coldnes to be added, but be­cause the withdrawing of abundance of hu­mors in this case, disburdeneth nature, and maketh her the more able to ouercome the same Repletion, being somewhat lessened in quantity by bleeding. It is not therefore re­pugnant, but very agreeable to reason, in this case, to vse Phlebotomy. For we see by daily experience, that a small fire is put out by lay­ing on too much wood at once, or such wood as is greene, and that then it burneth when the woode is remooued which hindered the burning thereof. Euen so is inward heate of the bodie choaked with multitude of hu­mors, and the same is againe refreshed, when some portion of them is withdraw­en.

The second cause of crudity of humors, is the debility of the inward naturall heate, which happeneth in men of colde Complexi­ons, in men that haue beene long sicke and in olde folke: in these bleeding is not v­sed, because bloud being taken away from them, which is the restorer and maintai­ner of the inwarde naturall heate (as yee heard before out of Isaacus) consequent­ly the body must waxe colde, and crudity of humors increase. Bloud therfore must remain in these persons, to concoct and ouercome the humors in the body.

[Page 84] And therfore very well saith Auicen, Non quotiescun (que) videris signa Repletionis, est faciō ­d [...] Phlebotomia: That is, Phlebotomy is not alw [...]ies presently to bee practised, whensoe­uer wee see signes of Repletion, as namely, when there is fulnes of raw humors in the bo­dy, and this doth Galen also affirme, lib. 12. Method. Medend.

The tenth impediment is the vnfit dispo­sition of the Aire, when the same is too hot, too cold, too dry, or too moist. Also when the same is not cleare, but troubled. And therefore vnder the starre called Canis, in the canicular or dogge d [...]ies, when thereis exces­siue heate and drith, it is good to refraine bleeding: Except great necessity doo vrge it. So likewise in seasons too moist and too colde, as in the winter in a state of the Aire temperately hot, as when the wind is south, or southeast, wee may bleede temperarately and sparingly.

In a more cold state of the Aire, as when the North-winde bloweth, or North-west winde; wee must bleede more sparingly than before. In a right temperate and mild state of the heauens, we may bleed plentifully; espe­cially the Aire not beeing greatly disquieted, with great force of tempestious weather.

And here may be made a profitable colla­tion in this practise: by folding vp together [Page 85] as it were in one: three impediments here spe­cified. The state of the Country being co [...]de, the time of the yere beeing cold, the present constitution of the Aire beeing colde. All which three are outward causes, and [...]oyne in this third point: which is common to them all three: that is, the Country, the Aire, and season of the yeare, compasse about euery Patient. Therefore in a cold Country and in winter, and when the Northwind blow­eth; open no veyne. If in a colde Country and in winter the wind blow South, and that so necessity require, wee may proceede with this practise; so in a hot Country, and in sum­mer, the winde blowing at the South: bleede not, If necessity in summer require bleeding, open a veyne when the North-wind tempe­reth the immoderate heate of the season. For surely these outward causes, though obscure­ly, and without any great perceiuing▪ yet they doo either keepe in, or disperse abroade and extenuate, the substance both of inward heat and also of the inwarde humors. And as in a temperature or complexion hot and moist, Phlebotomy is vsed best: and not to be vsed in complexions hot & dry, or complexions cold and dry. So when the season is hot and moist, as in the spring we may bleed safely. But not so, in a season hot and dry, as is the summer, or very cold, as is the winter.

[Page 86] The eleuenth let is some great inflammati­on, or extreme ach and paine, as appeareth by Galen and Auicen, who both forbid bleeding in hot inflamed feuers, and in apostumations of great paine. In these cases the opening of a veyne doth cause much busines, and agitation of humors in the body. Bleeding on the one side, drawing and emptying humors: the in­flammation and ach on the other side, striuing there against, and attracting humors thither. For all paine, if it be much and all heat, which concurreth with paine, attracteth and hinde­reth the fluxe of humors. VVhereby it commeth to passe, that by bleeding in this case, the inflammation is thereby increased, and nature more infeebled, and the same most chiefly when the bleeding hath beene tem­perate, and done according to Art. But in the foresaid cases: if the bloud be withdrawen in great quantity, euen till the Patient giue o­uer and faint: it profiteth very much for, thereby the abundance of boyling bloud in g [...]eat inflammations is expelled, and the in­flamed member is cooled: so that in vehe­ment paines, opening a veyne is a present helpe: keeping backe the fluxe of bloud, which otherwise would haue recourse to the pained place. And here it is not to be forgot­ten, that sometime the expulsiue vertue, ma­king hast to expell the cause of the griefe, [Page 87] causeth thereby sometime an inflamma [...] ­on.

The reason is, for that the expulsiue vertue, haui [...]g done no good at the first, [...]nd [...] more venemently than before, to expe [...] that matter which causeth annoyance, and doth therewithall wring out for [...]ibly some bloud out of the vpper partes or members, into the lower afflicted part: as Galen [...]heweth at large lib. 23. cap. 3. Method. Medend. And there­fore to keepe backe the saide inflammation, bleeding greatly profiteth as yee haue heard before Cap. 6. And this is the intent and mea­ning of Galen, where he saith: In ardentissimis febribus, si vsque ad animi defectionem, san­guis mittatur, statim totius corporis habitus re­frigeratur, & febris extinguitur. In extreame hot feue [...]s, if we bleede euen to giuing ouer and sowning: presently the state o [...] the whole body is cooled, and so the feuer is extingui­shed.

In vehement p [...]ines and grieses therefore, there is no better remedy fou [...]de, than [...]o [...]et blou [...], euen ti [...]l the Pa [...]ent ouercome▪ Reade more hereof in Galen, lib. 9. Method▪ Med. cap. 4. l [...]b. de cura [...]d R [...]t [...] ▪ sa [...]g. M [...]ssi­onem, capit. vndecim. Fuchlium, libr. secund▪ sectione. quint. cap. quart. & sext. institutionum Medic.

The twelfth impediment is the extreame [Page 88] coldnes of the Region, a Country which be­ing cold cannot tollerate so large an Euacua­tioṅ, as is this kind that wee nowe presently handle. The reason is, for that the body being before sufficiently cooled through the colde temperament of the place, must needes waxe more cold, when the naturall heate is drawen forth with the bloud. Moreouer a country too hot, cannot admit this practise, because in such a place extremity ofheate draw eth from the body much inward heat of nature, dissol­uing of it selfe, and dispersing the naturall for­ces and humors of the body, and therefore in hot Countries, the naturall powers are lesse­ned: & there is lesse bloud in the veyns, which is the reason that also in extreame hot coun­tries, the bleeding must be none at all, or very litle▪ A country somwhat colder and moister than this nowe specified, keepeth in the hu­mors and inward heate: dissoluing very little thereof Therfore men in such countries, may bleede more abundantly. The contrary to this hapneth in extreme cold countries, scitu­ated far Northward. For the bloud congeled through extreme colde, will not giue place to euacua [...]iō. And again, if the inward members should be depriued of their natural & inward heate; they were greatly in danger to perish with extremity of outward cold. Look more of this before in the tenth impediment.

[Page 89] The thirteenth hinderance, is the time or season of the yeare, which is a matter also in letting bloud to be considered: as namely, whether it be too hote a season, as in Som­mer: or too colde a season, as in VVinter: specially when it is frost and snowe. For to what purpose is it, when the bodie is alreadie sufficiently cooled, through the colde season of the yeare, to make it more colde by blee­ding. And for hote seasons, if the heat be ex­treme: those that bleede in them, often­times die by sowning or fainting called Sin­cope, or resolutio: for extreme heat enuironing the patient, doth ouercome the vital spirites, which come foorth with the bloud; drying & weakening the state of the whole bodie. Therefore in seasons extremely note, it is a point of wisedome to forbeare bleeding: which thing Galen teacheth, lib. 11, c [...]p. 4▪ Method. Medend. in these wordes: Et om­nino quidem non mittes in tempore aestai is, & regione aestuosa, & caeli statn calido & sicco. Thou shalt not at all let bloud in Sommer time, in an hote countrey, and in an hote and drie state of the aire: as vnder the dog-starre, and from mid Iuly to mid September; or ra­ther to mid August. By Galens wordes wee may perceiue, that there is the like reason of the countrey, and of the time of the yere con­cerning the heat and coldnes of them both. [Page 90] But to put practisioners in [...]i [...]de, that these rules are not alwayes p [...]eci [...]ely to be obser­ued: I giue aduertisement still, as I haue done in other the like cases before; that in this circumstance of the extreme colde, or the extreme heat: either of the time, or of the countrey: that it doeth not quite ex­clude bleeding at all time, euen in cases of meere necessiti [...]: but onely thus farre; that these cannot admit so large euacuation by bleeding, as their contraries may. The Spring therefore (beeing the most tempe­rate time of the yeare, when the forces na­turall, & humors them-selues most abound) is the best time to open a veine, to auoide fu­ture maladies. The next conuenient sea­son is Autumne or Haruest. And of the Spring, the beginning thereof to be best, Hippo setteth downe 7. Aphorism. Aphoris. 54. But hereof looke more hereafter in his p [...]oper p [...]ce, and before in the tenth impe­diment.

The fourteenth let of Phlebotomy is for­mer bathings or hote washings: especially resolutiue bathes: VVhich as Galen wit­nesseth in his booke of the Vtilitie of respi­ra [...]ion Cap. 7. do so forciblie euacuate the spi­rites from the whole bodie, that it stayeth opening a veine. And againe Hippocra. wri­teth in his second booke Aphoris. 51. That it [Page 91] is verie perillous, much and vpon the sudden presently one after another, by diuers eu [...]cu­ations, to emptie the bodie.

The fifteenth, is a disposition to vomit: of what cause so euer the same proceedeth. For in this cause of lothsomnes of stomack, if we let bloud, the veines by bleeding exhausted do soone drawe vnto them that wicked and lothsome matter, which lyeth in & about the stomacke: whereof looke more in the fifth impediment.

The sixteenth impediment, may be cu­stome, or a former order oflife: wherein wee are to consider, to what meates wee haue beene most accustomed: what excrementes are still reteined in the bodye, contr [...]rie to former wont. For too much former rep [...]e­tion of the bodie with meate and [...] bleeding, as appeareth in the first im­pediment. But if there haue beene before a moderate meane obserued in eating and drinking, wherewith the bodie hath beene safely nourished: then we may boldly b [...]eed. If it be otherwise; then forbeare. Ye [...], f [...]om this point also is takē a sure note of the quan­tity ofblod that must be extracted. For those that haue bin acustomed to be let b [...]od, may bleede more in quantitie than they that haue not bin accustomed to bleede. In this impe­diment, moreouer, consideratiō must be had, [Page 92] whether Hemorroids or Termes, are restrei­ned, contrarie to former custome. Or whe­ther wee still vse our accustomed exercises or no. But although diuers matters herein are to be regarded: yet in custome princi­cipally, these three are to be marked: The precedent order of dyet: the kinde of life, that we haue spent before: and former eua­cuations. Those that haue liued sparingly, ei­ther by their owne ordinarie prescription, or by occasion of sicknes; are to bleede lesse. Those that haue liued more frankly, may bleede more plentifully. He that hath been alreadie let bloud, so that the natural powers be not thereby too much enfeebled, may, as I now said, better abide to bleed, than they that neuer were let bloud. For this is a ge­nerall rule: Things accustomed, yea, if they be euill things, are the lesse grieuous; where­by is confuted the opinion of the vulgar sort: who greatly commend the first opening of a veine, as a matter greatly healthfull: and dis­commend all the other bleedings, making their reconing of this in their most extremi­ties: that though they were neuer let bloud before: yet now they will send for the Phle­botomer, as their last refuge.

The seuenteenth impediment is, carnall copulation: presently after which, the ope­ning of a veine is also forbidden, because [Page 93] Venus so lately embraced, hath thrown down and weakened the powers of the bodie, and warmed the same more than was conuenient. How the powers of mans bodie are loosened & enfeebled through venerious actes: Galen most excellently declareth, lib. 1. de Semine. cap. 25. saying: In the time of carnall copu­lation, the stones or genitors, drawe forth of the veines all such seedie humor as is contei­ned in them; which is not much in quantities and that which is the same, is admixed with the bloud in the likenes of dewe: and this to do, is the office of the Testicles. So that first by the genitors hauing more strength than the veines; the seedie moysture is violently drawen from them. And againe, the veines drawe the same from the members next vn­to them: These partes againe exhaust from those next vnto them in like sort: so that this extraction ceaseth not, till it haue gone tho­row euery part or member of mans body: by reason whereof, all the bodily partes are de­priued of their proper nourishment: and al­ways that part which is perfectly & through­ly euacuated, violently taketh from that which is next adiacent, and hath more plentie of seedie moysture to be extracted. This (I say) being done alwayes, and all partes mu­tually participating among themselues: ne­cessarily all the receptories, and partes of the [Page 94] whole bodie must be euacuated, till the strongest of all the partes be filled. And fur­ther, it commeth to passe, not onely that the seedie moysture is drawen from the partes of the bodie through carnall copulation; but also the vitall spirites passe out of the arte­ries with the same. And therefore it is no [...]arucile, if such as vse lecherie immoderat­ly, become weake, both these being taken from the bodie, that is to saye, the seedie moysture, and the vitall spirite. VVhere­unto may be added the pleasure of Venus, which of it selfe, is able to vnloose the vitall fir [...]itie of the bodie. Yea, it is knowen that some haue dyed of too much pleasure in the act. Marsilius Ficinus in his booke de Sani­tate tuenda. Cap. 7. confirmeth in these words, a [...]l that hath been hitherto said. Ʋenus (saith he) if it do but little exceede the powers na­turall of the bodie, presently it exhausteth the spirites, and specially those that are most sub [...]ile. Also, it enfeebleth the braine, weak­neth the stomack and hart-strings: yea, there cannot be a more hurtfull thing to the witt and memorie. VVhy did Hippo. iudge Coitum to be like the falling sicknesse: but b [...]cause it woundeth the minde, which is diui [...]e and heauenly. The immoderate vse of ust is so hurtfull, that as Auicen sayeth in his boode de Animalibus: If but a little [Page 95] seede issue foorth more than nature can a­foorde; it offendeth more, than if fou [...]tie­times so much bloud had proceed [...]d. And therefore, not without some good grounde, d [...]d the auncient w [...]iters immagine the nine Muses, and Minerua her selfe to be vi gi [...]s▪ Re [...]d mo [...]e hereof in Galen, Chap. 86. Ar­tis Medicinae. Pauli Aegnieta, lib. 1. Chap. 35. In Aetius, lib. 3. Chap. 8.

The seuen [...]eenth impediment, is long con­tinuance of a disease, wherewith the strength of the bodie being wearied, a long tract of time, the same cannot nowe tollera [...]e b [...]eeding. And forasmuch as now the bodie is more than inongh enfeebled & brought lowe, thorough a long continuing and lan­guishing sicknesse: by bleeding wee maye more easily quite extinguish the patient, than remedie the disease. Galen de Curand. ratio per sanguia. missio. Chap. 20: And A­uicen confirme the same, giuing adui [...]e to forbeare opening of a veine in bodies which haue endured long griefes, except corrup­tion of bloud moue vnto it. In which case sometime bloud may be detracted from persons that haue continued sicke of long time. And Fuchsius councelleth saying: People in consumption: o [...]de folke: weo­men with chi [...]de: & yong chi [...]d [...]en, are not lightly to bleede.

[Page 96] The nineteenth impediment, is small quantitie of humors being in the bodie: for a good consideration is to be had, how the hu­mors offend in the bodie in quantitie or in qualitie: VVhether there be many or fewe humors in the pacient. And therefore some­time vpon this ground, wee open a veine in weomen with child, if there be abundance of bloud, sufficient both for the mother and the infant in the wombe, if the bodily strength be firme, and that the greatnes of the disease in them so require it. But hereof more at large I meane to write in another place. And ag [...]ine, beside the quantitie: the diuersitie of nature in humors is also a profitable con­sideration in this practise. For euen accor­ding to the varietie of humors, the patient is oft either to be let bloud, or not lettē bloud: which Galen seemeth to witnesse, li. 4. de Sa­nita tuend. saying: Some humors come to perfect nutriment before the bloud: some are as it were, halfe concocted: some altogether rawe and vndigested: Some are but little dif­ferent from the forme of bloud: some are wholly changed into bloud: some verie litle, some more, some verie much. VVhen hu­mors are a verie little, as it were, from the na­ture of bloud, as not yet turned into the same: or when they haue a verie little excee­ded further than the nature of bloud: wee [Page 94] may confidently open a veine. VVhen the same is more than a verie little, either the one way or the other, on this side or beyond▪ wee are to deale herein more considerately. If the humors want much of, or exceed much beyond the nature of blond; we are altoge­ther to forbeare bleeding.

The twentieth let: after the small quan­titie of the other humors, may be the quan­titie of the bloud: which the wise Phisition in this practise will most wisely regard. As for example: if there be little good bloud in the body, and abundance of other humors: wee are to make staie from opening a veine. If any of the other three humors be but litle in quantitie, and the bloud abundant; we may boldly let bloud. Yea, by diligent obseruati­on the Phlebotomer shall easily perceiue, what hurtfull humor may be withdrawen with the bloud: and therfore, if there be ma­ny cholerike humors in the body of man, and yet not mixt with the bloud: or that there be many flegmatike and rawe humors, and but little bloud; by no meanes is a veine to be opened. This doth Anicen forbid in quar­ta primi. Cap. 20. If the bloud be good and little, and that there be in the same bodie many ill humors also: bleeding taketh away the good, and leaueth the bad behind. And a little after he addeth: that the Phisition is [Page 98] diligently to beware, lest by vnskilful blee­ding in these cases, hee bring the patient (af­ter he hath extracted the bloud, (the ill hu­mors still remaining) to an excessiue heat of cholericke humors, or too much crudi­tie of colde and vndigested humors. And although (as ye haue heard before) Phlebo­tomy doth equally euacuate all humors. Yet because now so little bloud is in the veines, whereof a little portion is withdrawen by bleeding: it followeth that but a little bloud, and lesse than before, remaineth now in the veines with the other humors: and that there is great plentie of the other humors: forasmuch as they come not out so redily, when a veine is opened, as the bloud doth: and therefore, by a necessarie consequent, bloud being gone: which was, as it were, a bridle to other humors: choler must exces­siuely boile, and flegme become more colde and vndigested. VVhereupon also I gather, that those haue done ill, and verie vnskil­fully, which haue reproued Auicen of error in this place, seeing he is rather verie highly to be commended: then vpon euery small and light occasion to be reprehended.

Finally, wee are to forbeare letting of bloud after continuall vomitings, hunger, great watchings, extreme labours, and after [Page 101] all such things, as immoderately [...] body, drying and dissoluing the [...] thereof: as Rhases noteth, lib. 7. [...] Almonsorem. Touching the causes▪ [...] ring Phlebotomie, they may soone be gathe­red of their contraries, by those impedi­ments here specified. And in the fifth Chap­ter before, yee haue heard both the direct & indirect causes, which may moue to let bloud: Vnto the which place I referre the studious reader, at this time, concluding this Chapter with the verses of Schola Sa­lerni: wherin are set downe most of the im­pediments here spoken of:

Frigida natura, & frigens regio, dolor ingens,
Balnea, post co [...]tum▪ minor aetas at (que) senilis,
Morbus prolixus, repletio potus & escae.
Si fragilis vel subtilis, sensus stomachi sit,
& fastiditi tibi non sunt Phlebotomandi.
Complexion cold, the countrie so,
Great griefe, bathings, and veneric▪
Too yong, too old, long sicknes to:
Stomacke sicke, and fastiditie:
Cannot abide Phlebotomy.
[...]
[...]

diligen [...] [...] ding [...] persons as are me [...]te or vnmeete to be [...]r he loud. Chap. 9.

IN this Chapter I wil be but briefe, because I was prolixe in the other before, from whence many things concerning this point, may be verie well, and with great profit ta­ken. Neither determined [...] at the first, to haue made hereof a distinct Chapter: but that in certaine Latine writers I found the like done before: whom I thought good to imi­tate. First, therefore this practise is best for delicate, idle, and corpulent persons, which vse to feed plentifully on the best nourishing meates, without taking any great paine, as Auicen witnesseth in prim.

Secondly, for such as haue abundance of bloud; which is knowen by many vnfallible signes, and specially by thicknesse of vrine: For abundance of bloud maketh the vrine thicke, as aboundance of yellow choler ma­keth the same thinne.

Thirdly, for such as abounde with Me­lancholy, hauing in their bodies, much natu­rall Melancoly running with the bloud, be­cause bloud is not throughly purified from it in the Liuer. And therefore in this case Phlebotomy must go before purging, and not contrane, as hath beene aforesaide.

[Page 101] And here is to be noted, that Melanco­lie is two-folde. One kinde is naturall: an­other kinde is not naturall. Naturall Me­lancoly is the refuse of bloud: And when the same aboundeth, it runneth about in the bodie with the bloud: and to euacuate it, a veine must be opened: and so this kinde of Melancolie passeth with the bloud, be­cause bloud and the refuse thereof, that is naturall Melancolie, commeth of one and the selfe same temperate heate. And when euacuation is thus done, a purgatiue may be vsed. But let purgation succeede Phle­botomie after some space, namely, when the concoction is finished.

Fourthly, bleeding is much profitable to those in whome is to be feared some ex­traordinarie heat, shortly to followe: or some extraordinarie boyling, either of bloud or of humors, or some other perturbation of bodie, through too much aboundance of these. Such persons as feare or feele any of these things, are presently to haue a veine opened. VVhere note, that this rule yet oft deceiueth diuers practisioners: For when their pacients doe feele any heate or calefa­ction, presently they iudge it some ebullition of humors, and so let them bloud: whereas the same may come through heate and in­flammation of yellow choler: in which case [Page 102] it is so farre off by bleeding, that the heat & ebullition should be allayed, that they are the rather thereby encreased and stirred vp. For bleeding (as hath beene tolde you be­fore) prouoketh the humors to runne tho­row out the whole bodie, with the greater violence. In such a case, therefore opening of a veine should not be vsed; except the same heat and ebullition came altogether of aboundance of humors: which is knowen through abundance of sweat; chiefely that sweat which is in the morning. For some do not sweate, but when they haue neede of euacuation.

Fiftly, it is to be practised on them also especially, whose bodily powers are firme and strong: and that are of a sanguine com­plexion, that is hote and moyst: and not colde and drye. Rhazes, lib. 7. ad Almonso. Chap. 21. sayeth: Corpora quae venas habent amplas, & conspicuas, quaeque hirsuta sunt, & colore inter rubrum fuscunqne medio, adoles­centum nimirum, iuuenum, & senum non de­crepitorum, Phlebotomiae presidia magis tolle­rare possunt: pueris vero & infirmis vena se­canda non est, nisi maxima incumbente neces­sitate. i. Such bodies as haue large and ma­nifest veines, that are hairie, and of colour betweene red and browne: specially of strip­plings, [Page 103] yong men and olde men, not decre­pites: may most safely awaye with the helpe of bleeding. But wee are not to open a veinein children, and weake folke, except great necessitie so require.

Sixtly, this practise is with great heede to be vsed: or rather not at all to be vsed af­ter the paine of the cholicke, or rather im­moderat perturbation of the bowels: either aboue or beneath: whether it be Cholica passio, or Illiaca: For the Humors, as ye haue heard in the Chapter before, being mooued by bleeding, the chollericke humor would flowe vnto the stomacke, and inflame the same: nor yet after strong vomits. For the like euent woulde followe: nor after a laske.

These and such like extremities vehe­mently heating rhe bodie, and greatly dis­soluing the same: if they should concur [...]e with Phlebotomy: they would too much inflame the bodie, excessiuely moue the hu­mors, and mightily weaken the forces of Nature, as appeareth in the Chapter be­fore. Fig. 20.

Seuenthly, weomen with child, or hauing their termes, are not to be let bloud. In weo­men with childe, this is the reason: because naturall heat seruing for digestion, woulde [Page 104] thereby be diminished, and so nutriment would be with-holden from the child, which were verie dangerous, if the mother were farre gone with child. The fruit in the womb is nourished by the Termes: and not hauing whereby to be nourished, it must of force in the wombe (hauing life, and wanting nou­rishment) die for hunger. And againe being losened from the naturall staies in the womb, it falleth out of the naturall boundes, and so causeth aborsion. This (I say) sooner happe­neth when the yong frute in the wombe is growen much, and the mother farre gone therewith: for then it needeth the more nou­rishment, which it can neither finde nor haue, the bloud being diminished. Fulchsius wri­teth more hereof 31. Coment. lib. 5. Aphoris▪Hippon. But here I am to adde: that albeit in auncient time it was accounted perilous to let bloud weomen with childe, as appeareth by that which hath beene now said: yet out of the Chapter precedent Fig. 19. it partly appeareth, that this practise may be done di­screetely and safely, in weomen with childe, if necessitie so vrge: chiefely, if bloud be a­bundant in them: if the bodie be firme and strong. I affirme that they may bleede: But because it hath beene reputed dangerous; wee must carefully see that we take not from them much bloud. To take a little after the [Page 105] fourth or fifth moneth of conception hurteth not. Yea, experience prooueth, that women thereby are made merry and light, whereas before they were very melancholly, feeling alwaies about them an vnaccustomed heaui­nes: yea, through a little bleeding they are inabled with the more facility, to beare their burden to the due and iust time of their deli­uerance. Againe, some women being with child require twise to bleede: that is to say, when they are halfe gone, and in the begin­ning of the eighth moneth; but hereof take great heede, except the woman greatly a­bound with bloud. I haue seene saith Guin­terus a woman with child, that hath beene let bloud three times, in the second, the fifth and eighth moneth: because shee was very san­guine, and had experience once or twise be­fore, of aborsion the third moneth, if shee had not bled the seconde moneth. In the other moneths the fifth and eighth shee was in dan­ger of suffocation, except shee had bled a­gaine. VVhen women are brought a bed, they must not bleede, except their seconde birth be suppressed, or a Feuer molest them: In the which cases also, carefully consider in the Patient, her naturall strength. Those that haue their termes naturally, according to the due course of nature, and the course of the moneth: are not to bee let bloud, except in [Page 106] immoderate Fluxes, to drawe backe the matter. VVhen they breake forth natural­ly, the whole matter is to bee let alone to na­ture.

Eighthly, bleeding is not good for such persons as are bounde, and haue the excre­ments retained. For as yee heard in the eighth Chapter, Fig. 2. The veynes beeing emptied, they attract matter from the next members, and they attract from the sto­macke the moystnes of the excrements, whereby they become more dried and ba­ked, bring diuers waies annoyance to the body. In which case the wombe by Art is to be made solluble, as appeareth in the place now cited.

Finally a veyne may and is to bee opened, without hurt or daunger, whensoeuer wee feele our selues to bee heauy, lumpish, and stopped or stuffed in our bodies; first consi­dering the quantity and quality of the ful­nesse: which wee may knowe and discerne, by certaine tokens, whether it bee Plenitu­do quo ad vasa, or quo ad vires, as was shewed in the first Chapter, the more hea­uy and drowsie a man feeleth him selfe to be; so much the more it appeareth to bee that fulnesse, which is quo ad vires: But if hee feele the former stuffing in his body in­creased, [Page 107] than is it that plenitude Quo ad vasa. And thus much to know the quan­tity of the Repletion.

The quality of the fulnesse is knowen, partly by the colours, partly by those things which are very neerely ioyned to the na­ture of the humors: But of these signes sufficient hath been spoken before in the first Chapter.

In these cases of Repletion, if the strength of the body shall bee answerable, wee are to open a veyne: for as much as bleeding is the chiefest remedy to abate fulnesse. But if the stuffing and fulnesse of the body bee greatly grieuous, and the state of the body not answerable: it is not alwaies necessary to let bloud, As Galen noteth, lib. de Curand. ratio. per sanguinis missio. And againe, Phlebotomy is not one­ly profitable when any of the foresaid ful­nesses grieue and oppresse vs: But also (as hath beene saide) in cases without any ful­nesse: As in the beginning of an inflam­mation, which commeth either of a blow, ache, paine, or weakenesse of the mem­ber. For paine (as was saide) draweth the bloud vnto it, and of the weakenesse of the bodily parts, cause an inflammation without fulnesse.

[Page 108] Also when the disease is great and vehe­ment, we let bloud, although no fulnes appear in the Patient: yet alwaies hauing a regard to the age and strength of the party, as Hyppo­crates setteth downe in these wordes, 4. Vict. acutorum, 17. In acutis morbis sanguinem de­ [...]rahes, [...]ivehemens morbus videatur, florue­ritque aegrotanti aet as, & virium affuerit robur. That is, in sharpe disease thou shalt let bloud if the sickenes seeme great, if the age of the Patient permit, and that there be sufficiencie of naturall strength. And thus much of the persons that are to bleede, concerning the which point, more may be easily coniectured and collected of the studious Practitioner, from the Chapters precedent.

What corruption of Humors bleeding remoueth from the veines. Chap. 10.

IT hath beene said, that bleeding generally, is the present and proper helpe, when Hu­mors offend in the veyns either in quantity or in quality. It hath been already declared, that some humors it euacuateth, other some it re­uoketh and pulleth backe, which is called re­vulsion, whereof hath beene spoken in a di­stinct Chapter by it selfe. Now order re­quireth in some briefe sort to shew what cor­ruption of humors generally, bleeding eua­cuateth [Page 109] from the veynes. The defect of hu­mors in the veynes is either Plethora, or Ca­cochymia, as was shewed in the first Chapter. The onely and peculiar remedy of Plethora, or abundance of bloud, is the opening of a veyne. And forasmuch as fulnes of bloud is of two sorts: One of fulnes simple and pure, consisting of a like proportion of the best humors: and the other vnpure and com­pounded, taking part with Cacochymia: that is, abundance of humors corrupted in the veynes. Therefore it is to bee marked, that in both these Repletions, the opening of a veyn greatly profiteth. VVhen so euer therefore the muscles are sounde, whole, and full, the veynes large, great, and swelling, menacing thereby imminent danger to the members: presently bloud must bee detracted. After which eu cuation these effects will insue: mi­tigation of paines caused by ouermuch ret­ching of the veynes: ease vnto the body, which seemeth as it were nowe disburdened of a grieuous and waighty ponderousnes: a more nimblenes to all exercise and labour than was before: an increase and refreshing of the naturall heate: an opening of the straight passages and pores of the members. Finally, there will follow a happy repulse of diuers imminent dangers and diseases, where­vnto by all probability in short time the body [Page 110] would haue beene brought.

For it is greatly tobee feared, lest the veynes ouerreatched with fulnesse of bloud, should open and breake, and through that meanes cause inflammation, or lest some generall obstruction should arise, which might keepe backe the inwarde heate, and so vtterly choke vp the bodily forces wherby might bee caused some vehement hot feuer, or as it oft hapneth a sodaine death of the party.

Now from these daungers, can no man bee safely and speedely freed, either by pur­ging, exercise or abstinence, but by bleeding, and with the bloud is this Repletion most safely abated.

That fulnes which is vnpure and com­pounded, is not so safely cured by bleeding, and yet the more nigh that it commeth in likenes to that Repletion which is simple, and pure: the more confidently, and the more plentifully we may let bloud. And the more vnpure that it is, the more carefully and spa­ringly ought a veyne to bee opened. There­fore those persons that haue an il constitution of body, and yet haue their veyns abundant­ly filled, or that beeing of a constitution, are yet repleat with corrupted meates: These I say, are to bleede no longer, but to auoid the [Page 111] danger of fulnes, and the impurities remai­ning behinde, are to bee expelled by Purga­tion.

Hot chollericke Repletions, of all vn­pure constitutions, are most safely abated by bleeding, because bleeding in this case, not onely diminisheth choler, but also coo­leth the same mightily.

Melancholly Repletions, can nothing so well away, with this practise, because it doth not so exceede in heate, that it neede at all any refrigeration or cooling, and the flegmaticke constitution can in no case brooke it, for being a very cold complexion it quite reiecteth bleeding. For Phlebotomy by great cooling, so greatly increaseth cru­dity and rawnes in the body, that it can ne­uer or very hardly bee recouered or amen­ded.

VVeakenesse of bodilie strength, re­sembleth this foresaide Repletion, and therefore also by the selfe same reason, reie­cteth any large euacuation. And in truth, is not in this respect to bee dealt withall, except the veynes abundantly repleate, threaten some great hurt, or that necessity so require it, and then it must not bee done all at once, but by little and little, as it hath beene be­fore declared.

[Page 112] Therefore in each and euery fulnes that is vnpure, we are to begin with opening a veyn, for without it wee cannot safely afterwardes purge. For a vehement purgation especially (if bleeding haue not gone before) troubling and molesting the full body both with much heate, and by force of the attractiue vertue: bringeth the Patient into greater hazarde than he was before, and therfore to conclude this point, the veynes being swollen, and fil­led, if moderate bleeding doo no good, it can doo no harme at all.

The otherfulnes quae ad vires, which can­not very easily be knowen by signes, althogh it cannot ouerstretch or breake the veynes, nor ouercome the inward heate: yet because it oppresseth the weake forces of nature, lest there should insue putrifaction or corruption of humors, it may be diminished by opening of a veyne: Leauing yet behinde so much as nature may easily rule: yea, and the same also, (because it bringeth no doubt of present danger) may be profitably taken away, with spare dyet or abstinence. Of corruption and putrifaction of bloud and humors in the veynes without plenitude, called Cacochymia: that is, fulnes quae ad vires: There riseth a great doubt, whether the same may aptly bee remooued by bleeding. VVee answer, that to remoue by bleeding a simple corrup­tion [Page 113] of humors in the veynes is profitable and easie (regard beeing had) both to the abun­dance thereof, and to the forces of nature in the Patient. For albeit when a veyne is ope­ned, all humors issue forth equally, and that there remaine behind still as there did before one and the selfe same proportion of humors: yet because now by bleeding part is abated of that burden, wherewithall nature was be­fore oppressed, the forces and powers natural waxe not the more feeble, but they become more strong and chearefull, so that they can beare with the greater ease, those humors, which as yet remaine still behind, and nature hir self gouerneth them with farre lesse trou­ble than before. And herevpon in continuall feuers, when there is great crudity and cor­ruption in the veyns, bloud being often times detracted, the vrine also beeing red, troubled, and thicke before: It appeareth nowe more cleare, and sheweth forth euident signes of concoction. And note (here by the way) that the Phlebotomer must be very well exercised in those signes, which prognosticate fulnes, & repletion. Yea & ye must also know perfectly the place of each particular humor: lest after the manner of the vnskilfuller sort, when the nose a little bleedeth, and the vrine appeare somewhat red, by and by yee doo let bloud▪ Whereas bloud often times easily commeth [Page 114] forth, not onely by reason of fulnes, but vp­pon diuers other occasions, nature her selfe often attempting voluntary eruptions of bloud. Hereof it commeth that such persons as haue (as it were) the small litle mouths of the veines called Oscula, eaten or gnawen: or that haue a weake and apostumated Liuer: and that Hydropicall persons bleede oft at the nose.

Also vrine waxeth re [...] and bloudy, by the fretting of the stone in the Raines. Vrine waxeth yeallow in that kinde of yeallow ian­dies which is simple in Scirrho hepalis, That is in the hard part of the liuer: and in that kind of dropsie which is called Ascites: Yet in these effects we are not to let bloud, for Ca­cochymia proceeding of corruption of the bowels, is not that way cured. Therefore the certaine knowledge when a veyne is to be o­pened necessarily, is onely gathered of those markes and tokens which manifestly declare abundance of each humor: And hereby yee may gather, that bleeding alone speedily hel­peth that corruption of humors, which lyeth in the great veynes, and only freeth the Pa­tient from this kind of corruption, except the same take beginning from the bowels ill affe­cted: and in this kind of corruption, purgation is more meete than bleeding. And thus it ap­p [...]areth in a generall sort, what corruption of [Page 115] humors the opening of a veyne doth remedy.

A particular rehersall of those diseases pre­sent, or future, which are cured by bleding. Chap. 11.

FIrst as yee haue heard, a veyne is profita­bly opened in the two plenitudes, nature being strong and the age conuenient. In the fulnes quaead vires, haue speciall regard that the naturall forces be firme. But if in this ple­nitude, raw, cold, and vndigested humors bee greatly gathered together in the body, for­beare; taking this as a rule, that with great a­bundance of raw humors, the strength of the body cannot stand as yee haue already partly heard, and as Galen witnesseth, lib. de curand. ratio. per sangui. missio. cap. 9.

Secondly, it helpeth diseases present, and future, and serueth both in the curatiue and preseruatiue intention. VVe read that Galen in the spring time did let bloud those persons that were subiect to these diseases following: to wite, Spitting of bloud: A polexies: Falling sicknes: Peripneumonia: Pluresies: Angi­naes: Stoppinges of Hemorroids or Termes: Swimmings in the head: The Gowt in the feete and in the ioynts. All which Auicen also setteth downe in quarta primi cap. de Phlebotomia.

[Page 116] Thirdly, we doo not onely open a veyne in repletion, as Menodorus falsly supposeth; but also as hath beene said without fulnes: when wee feare some inflammation through some fall or other accidentall griefe. And moreo­uer as wee haue already specified, wee open a veyne for two purposes, sometime to euacu­ate, sometime to pull backe immoderate flux of humors to the contrary part, as Galen no­teth lib. de Curand. ratio per sang. missio. cap. 11 & 9. Metho. Medend. cap. 11. As to stay bloud at the nose we open a veyne in the arme. For this cause Galen lib. 13. Metho. Medend▪ ca. 21. in Letargus which is a drowsie and forgetfull sicknes, rising of impostumation, of cold pu­trified fleame, especially, in the hinder part of the braine: whereby memory and reason almost perisheth, and the sensitiue pow­er is greatly hindred, causing men commonly to forget their owne names, also to shut their mouthes after they haue gaped and by no meanes to stay from sleeping. In this disease (I say) at the first beginning thereof, Galen willed to open a veyne, albeit the disease bee colde, rather as it seemeth to reuoke, than to euacuate the matter: or Galen so appointed it, because fulnes is alwaies concurring with this forgetfull and drowsie disease.

Herevpon Galen 11. Meth. Meden. cap. 15. affirmeth it to bee very healthfull to open a [Page 117] veyne not onely in continuall feuers called Continentes: but in all feuers caused and kind­led of a putrifieng humor, which should not seeme to bee true, especially in intermittant f [...]uers which leaue off for a time, as are tertian and quartan agues. Forasmuch as in these, bloud offendeth not in the veynes: but some other humor beside bloud, putrifieth without the veyns, which by bleeding in reason can­not be euacuated. This place of Galen cannot sound to reason or experience, except we vn­derstand Galen to giue vs aduise to euacuate by bleeding the matter of such intermittant feuers, as haue also with the bloud, ful­nesse, and abundance of other humors con­curring: So that this may bee his mea­ning. Bleeding may bee vsed in intermittant feuers, if they fortune to haue abundance of humors ioyned with the bloud. For obstru­ction as Galen sheweth li. 11. Meth. Meden. cap. 4. happeneth in rotten and putrified fe­uers, sometime through abundance of hu­mors, sometime through the clammines, gros­nes and thickenes of them. Galen there­fore counselleth to let bloud in staying and intermittant feuers: rather because of the abundance, than the rottennes or putrifacti­on of the humor without the veynes. And that this is his meaning, appeareth by the words which Galen afterwards vseth, saying: [Page 118] Forasmuch as nature ruling the body, by bleeding is lightned and disburthened of that wherwith she was before oppressed, therfore shee will with ease ouercome that which re­steth and remaineth behinde, which is a [...] signe that Plethora or fulnes is also annox [...]d to such feuers.

Fourthly, in bleeding, we are not onely to consider the disease it self, which wee deter­mine to remedie, but also oft times the cause therof: so that whatsoeuer the sicknes be, if Phlebotomy may remoue the cause, then also it taketh away the griefe it selfe in the ende. Hereupō somtime, albeit the disease be cold, yet when the cause moueth vs to open a vein, we may safely bleede without hurt. Hippo. (saith Galen) sheweth a cure of his done on a woman by letting her bloud in the Ankle. This woman after child-birth, was not freed ofher seconds: then a shaking came vpō her. This woman I cured (saith Hippo.) by letting her bloud in the Ankle, for all her shaking. Shaking is a cold affect, & bloud is hote: and they that must be heated, must not haue bloud taken from them. He for al that, bold­ly did it: & he sheweth the reason. I conside­red (said he) the cause, & the occasion of the cause. He knew the cause of shaking, was a­bundance of bloud kept backe, which was a burthen to nature. The occasion of the cause [Page 119] was the griefe of the matrix. This abundāce requiring euacuatiō, & the affected part she­wing the place most fit for eu [...]cuation: consi­dering both these things together, he let her bloud in the ankle, because the wombe or matrix was affected. In griefes of the womb or bellie, we take the vaine of the ankle, kno­wing by the Anotomie the communion be­tweene the veines: for some veines commu­nicate to some part of the body, & others to other partes. And euacuation is to be made from such veines as haue fellowship with the member affected. For, as yee heard in the Chapter of Revulsion: if we take that veine which communicateth not with the part af­fected, wee hurt the whole bodye, & do the griefe no easement. The profitable vse of this fellowship of veines apeareth especially in re­vulsion or pulling backe of humors, which is both wel & speedily done, when this cōmu­nitie of veins is obserued, as was there decla­red. But let vs return to our former purpose.

Fiftly, by opening of a veine, is cured the fe­uer called Synochus: both that which cōmeth of ebullition of blod without putrifaction, & that which is caused with putrifaction of the bloud. So are also hereby cured continuing feuers, coming of putrifaction in the greater veines. And to these diseases reckoned vp of Galen Fig. 2. we may adde these that follow: [Page 120] Frensies, Opthalmia parotis i. an apostumatiō about or behind the eares: diseases of the Li­uer & splene: Nephritis. i. paines of the raines and backe: inflammations of the wombe or matrix: of the priuie partes: arme-holes: armes, thighes, & ioynts. Finally, all inflam­matiōs inward or outward, which the Greeks call Phlegmonae. These inflamations are cau­sed by flowing of bloud to a member when a veine is open & broken: which bloud there abundantly heaped togither, bringeth forth a tumor or swelling. To these also are to be added: a consumption in the beginning: vo­miting of bloud: bleedings at the nose, bely, or hemorroids: at the beginning of which diseases, the opening of a veine greatly profi­teth, staying the force of the fluxe, & by re­vulsion, if the veine be opened at the contra­ry part, calling back much of the matter frō the member affected: so that bleeding is a present helpe for those diseases whatsoeuer, which take the beginning from too much a­bundance of good bloud. Those sicknesses which come of an vnpure & mixt plenitude, because they are somewhat neere linked vn­to these; they may also be cured by bleeding. And although the matter of these diseases be vnpure: yet either it lyeth in the veines, or procedeth from the veines. A gaine, by blee­ding are cured Carbuncles, felons, moyst [Page 121] scabs, outward rednes in the skinne & such like: all these are cured by this practise.

Thus also is cured the burning ague called Causus, & all continuall feuers, whose putri­faction is conteined in the greater venies. Yet sometime a continuall feuer commeth of an humor heaped togither & inflamed about the stomack, chiefely about the mouth of the stomack, & the flat parts of the Liuer, which feuer cannot be takē away by bleeding. Nei­ther can the cause therof by this practise be remoued. Pure intermittant feuers, whether they be Tertians, Quartans, or Quotidians, because the next matter & proper cause of them is not in rhe greater vessels, neither flo­weth from the veines, are not con [...]eniently cured hereby. And yet sometime in these al­so we bleede, either when the veines swell with immoderat fulnes, so that therby some danger at hand may be feared: or when any accident of hote inflamed & boyling bloud perswadeth vs therto: as are namely beating paines of the head: tossings & mouing of the body this way & that way: excessiue heat al­most stragnling the pacient. Howbeit, these many times come also of boyling choler a­bout the inward partes called praecordia, in the which cases, bleeding remoueth neither the feuer, nor the cause therof: but onely as­swageth the vehemencie of those accidents, [Page 122] which are present, or shortly like to ensue.

Further, concerning perticuler affects cu­red hereby, we may adioyne, beating paines of the head: Letargus spoken of before fig. 3 and trembling of the heart. These with the foresaid, are not onely cured hereby, when they presently affect and afflict the patient, but happening yerely vnto vs: so that it is verie likely we shalbe grieued with them in time to come. VVe may verie well preuent them by bleeding, whē we haue once espied plenitude to haue beene in vs, the causes of these infirmities. For there is one & the self­same way of healing common, both to mala­dies present and future. And those thinges which are to be done when diseases are pre­sent, may likewise be attempted when the same are but a beginning, or nigh at hand. And here is to be repeated that which hath bin alreadie said, & cannot be too often spo­ken: that some time we open a veine, not on­ly without fulnesse, but euen in emptinesse: namely, when some euident cause: as a bruze, ache, or heat, causeth flux ofhumors, & brin­geth inflammation to the members: and this is done, not for any greatnes, or feare of any present griefe; but for some doubt of that which is a beginning, & as it were, at hand.

Here ariseth a doubt, whether it be more vsuall to open a veine, the disease being now [Page 123] present, or future & nie at hand. The answere is, that when the fulnes is very great & dan­gerous, though the disease be not yet cau­sed, notwithstanding, without hurt the paci­ent may bleed plentifullie, because the bloud offendeth nature in the aboundance there­of. And hereby the Pacient is oft made safe, and escapeth the daunger of sicknesses ap­proching. But when a disease is bred, and the forces of nature impaired or lessened, either by the presence or long continuance there­of: iust euacuation of bloud, without hurt, can by no possible meanes be made. Where­upon Hippo councelleth to preuent by blee­ding accustomable impediments rather then to stay their approch and comming. Hereup­pon also in that kind of feuer called Epheme­ra, which dureth commonly but one day, & is caused of obstruction. In the feuer called Synocris simplex, bloud is aboundantly with­drawen, before the matter do putrifie. Ther­fore this is the cōclusion of this matter, that bloud is let more safely before the sicknes be present & already come, thē when in truth it is presēt: & with greater profit are we to see his comming a far off, and so beware of him, thē to stay til he come, & thē labour to repel him: wherin we are to remember a prety and common verse seruing fitly to this purpose.

Aegrius eiicitur quam non admttitur hospes.
[Page 124] If once a guest be enterteind,
with greater shame we him repell:
Then if at all we had not him
receiued with vs in house to dwell.
And also this verse of Ouid.
Principiis obsta, sero medicina paratur
Dum mala per long as conualaere moras. ▪i.
Beginnings stop, too late comes cure,
When once the mischiefs grow in vre.

Reason imputeth thus much: that when sicknes presently possesseth any pacient, the same requireth a speedie remedie, with a greater necessitie, than when as, it hath not yet inuaded. Wherupon this also followeth, that opening of a veine is more necessarie, when a griefe is present, then when the sam e is but onely approching. The crueltie of a present aduersarie vrgeth vs with a greater necessitie, than the daunger of an enimie that may come, but is not yet present. And so I conclude, that in a present disease there is a necessitie. In a disease onely imminent, there is but onely, in a manner, a securitie. For a further instruction, to know what dis­eases in particular are cured by this practise: I referre thee to a Chapter hereafter fol­lowing, which declareth in particular, what veine is to be opened in ech particu­lar disease.

What voluntary eruption of bloud profiteth [...] sicknes. Chap. 12.

BLoud voluntarily and of it selfe issueth foorth from the nose, the veines called Haemorroidae, and the belly: and sometime also out of the mouth by coughing and vo­mitting. From other partes of the bodie it commeth not except very seldome, and that against nature. But from what part soeuer it come, if it bleede slowly and sparingly, and albeit the same bee according to nature, yet we are to account it vnprofitable: for it ne­ther remoueth the disease, neitheir disswa­deth vs from that conuenient euacuation by art, which the vehemencie of the disease re­quireth. That voluntarie flux of bloud which is aboundant either in plenitude, oppressing natnre, or in that feuer called Sinocha is pro­fitale, and oft cureth the same in the iudge­ment day called dies Criticus. For in asmuch as then a generall euill equally (as it were) occupyeth all the veines, from whence so­euer abatement of bloud happen, it cea­ceth these accidents of heuines & fulnes.

But in the feuer Causon, and in all other cō ­tinual feuers, in the which other humors pu­trifie in the greater veines: bloud issuing forth neuer so plentifully, bringeth not such profit; and bleeding at the nose, though it [Page 126] watchinges, rauinges, headach and other such like accidents, yet very hardly it remo­ueth the proper cause, and roote (as it were) of the disease: except there fall out some im­moderat bleeding, euen (as it were) to the dissolution of the natural forces: which in ve­ry deed is neuer to be wished or desired. For corrupt bloud last of all floweth out of the nose, yea and not before there hath passed great store of the good & profitable bloud. And therefore in these feuers, albeit the pa­cient bleed much & oftentimes, yet a veine in the arm must be opened. Experiēce (I say) proueth, that oft out of the nose commeth good bloud, both in colour and substance, when vnpure and filthy bloud is drawen out of the arme.

A boundant flux of bloud in these diseases, out of the Hemorroidae veines, are out of the belly: because it floweth next of all from the holow veine of the loines: the same is to be accounted much more profitable thā the abouesaid. Yet neither doth this many times take away the verie root of the feuer, which lieth lurking in the veines next the hart. Wherupon it cōmeth to passe, that oftētimes we let bloud in the arme, notwithstanding: yet but sparingly in flux of termes, in womē brought a bed, & freed of their seconds: lest we inflame & kindle in them the heat of an [Page 127] ague. A like reason and more apparant there is also sometime to let bloud in the arme, when the hemeroids flow. For inflammation and other diseases of those partes which are aboue the liuer and midriffe: are litle or no­thing at all eased by fluxe of bloud from the hemoroids or belly: Neither those that oc­cupy the lower partes by flux of bloud from the nose. Also flux of bloud out of the right nosthril helpeth not affectes on the left side: nor contrary. And therefore voluntary erup­tiō of bloud without reason forbiddeth not that bleeding which is to bee done accor­ding to art, reason and experience. Againe Phlebotomy helpeth diseases either of it self, or accidentally. Of it selfe it euacuateth or pulleth backe. Accidentally, sometime it cooleth, drawing forth the hotter bloud: sometime it openeth obstructions, yet only those which proceede of fulnes, and it is al­waies to bee vsed in those affectes, which it helpeth of it selfe: but not alwaies in those which it cureth by accident. To helpe hot distemperature of the Liuer by bleeding, when there is in the Pacient little bloud, is not the best way, but rather vse for that pur­pose such things as are of their owne nature cooling, and take proper remedies for hot distemperature: and thus much for this matter.

How to know by certain [...] signes the greatnes of the disease, and the firmenes of the naturall forces: wherby coniecture may be made, whe­ther the Pacient bee to be let bloud or no. Chap. 13.

IN euerie affect, wherin bleeding auaileth: the same is out of hand to bee done, if the disease be vehement, and the strength of na­ture agreeable. Touching the disease it is sometime so small, that it is cured alone of it s [...]lfe without the helpe of art. And although at other times the same be very vehement & great, yet the forces of nature not onely sceme, but also are indeede so weake, that they can not tollerat any euacuation. Yea vndoubtedly this practise would vndoo, di­s [...]roy, & dissolue the whole substance of the naturall forces, for whose preseruation sake (in truth) we take the cure in hand. Therfore to know thorowly and perfectly, how much bloud is to be takē in euery disease, we must first consider how great and greeuous the sicknes is, and how firme and strong the po­wers of nature are. Now a disease is either al­ready caused, and in state, or is now a begin­ning or proceeding to state. Againe a disease is called great & greeuons, ether in regard of it selfe, or of the cause thereof, which con­sisteth in the humors, or in regard of the gre­uousnes of some accident. But first, it is great [Page 129] of his owne kinde and nature. Thus an in­flammation in any mēber is more greeuous, then a simple distemperature in the same member. And again the greatnes of a disease is iudged by the great vse and excellency of the mēber which it possesseth: as if it be any principall member, namely the hart, braine, or Liuer, and it is contraty when the griefe is in a base, vnnoble or no principall member. Againe, iudgement touching the greatnes of a disease, is to be giuen according to the lo­call placing of the members, as they stand next to the principall partes. Therefore next the diseates of the hart, braine, and liuer, are to be accompted those of the lunges, sides, stomacke, and splen: and wee are otherwise to iudge of those that are in parts further off: as namely the bowels, raines, bladder and the outward limmes consisting of bones, flesh, and sinewes, called in Latine Artus, and in all the other members, placed in the extremities of the body. Againe in this point iudgement may be giuen by the sensiblenes or feeling of the member wherein the griefe is, if the diseased member haue a quick sense, and a liuely feeling, the greater ferre is the danger, than if the member were but of a blunt and dull sence.

The greatnes of the cause in any disease is iudged by the condition and nature of the [Page 130] humour that is gathered to the part affected, & is there the continual matter of the griefe: wherein we are to consider whether the hu­mour be good or bad, putrified or not putri­fied, or of what ill quallity it is any māner of way. And also whether the same humour be too much or too litle: & if the humor which is the cause of the sicknes be wicked & cor­rupt, thē we may soon iudge the griefe to be great. The greatnes of the antecedent cause is perceiued by the fulnes or emptines of the veins, bowels, & of the whole body, & by the purity or impurity of humours, cōteined in the same. We iudge the greatnes of the acci­dents, by the intention & remission of those things which do chaunce: as the increasing or diminishing of paine, thirst, appetit, wat­chings, and such like: all which bring down the forces of nature, and make the Pacient to languish.

As for example: If any yll disease, as namely an inflammation, possesse the Liuer, braine, or parts next the hart, and that there be a venomed and putrified humour, wh [...]e­with the veines of the body appeare to bee stuffed and filled; so that there insueth in the patient, agitation of the bodie, ill appetite, thirst, paine, & watchinges: this sicknes wo may esteeme vehement, in the which eua­cuation may do great good. And againe a [Page 131] disease in which these do not concurre, but rather their contraries, we may iudge a small infirmitie, and not requiring any euacuation. Betweene these are their interiected sick­nesses, of a middle sorte, which are to bee euacuated more or lesse according to the remission or intention of the disease, and the accidents thereof.

Now let vs come to the estimation of the forces of nature, of the natural powers some are setled, and bred in particular members: and are common, and flowing to all partes of the bodie. The forces of nature bred and setled in a member, haue one and the selfe same essence (as it were) of the inward heat: and they are called one nature, and are in­gendred (as a man might say) of the in­ternall spirits, and the first begotten moi­sture: whereunto is added (as a matter thereunto requisite) a sound and whole sub­stance of bodilie members. The essence of the common forces of nature, haue (as it were) a threefold originall or beginning, or is [...]threefold spirit diffused and spred into the whole body.

The force called virtus animalis, the ani­mall vertue, is diffused from the braine, by the sinewes: The vitall force from the hart, by the arteries: The naturall strength from the Liuer by the veines: The bodily powers [Page 132] that are bred in ech of these parts: the brain, the hart, and the Liuer, are susteined by those common and flowing powers of nature: so that the whole liuing creature, name ly man is ruled and gouerned of both these vertues: Insitae & communes, setled and common (to vse as good english wordes as wee may) to make manifest this great point of phisicks skill. Therefore if this liuing creature and most excellent creature man, bee in perfect health: of necessitie these powers of nature must be sound and vncorrupted, which they will bee, if their substance consist in a iust moderation, that is to say, in a iust or right quantity, and in a good temperament. And contrary wise, if the quantitie or tempera­ment of their substance, be inuerted, chaun­ged, turned, or altered, they must needes suffer hurt and offence, and so become weake and enfeebled: Whereby their fun­ctions are presently hindered, the rule of all the bodie is disordered, and at length there will follow euen extinction of life it selfe. And therefore whether the natures forces are weake or strong: may be knowen by their seuerall operations & duties. Thus raw and vndigested excrementes, either by siege or by vriyne, when either the one or the other is thinne, watrish, or like vnto wa­ter, wherein flesh is washed, do shew imbe­ [...]illity [Page 133] of naturall force: so doth holding backe of these excremntes, or any other fun­ction naturall, that is staied or hindered.

Wee discerne the vitall strength to be enfe­bled by obscure languishing, and smal pulse▪ by breathing hardly and with paine, and oftner, & more quickly thā was accustomed: by smalnes and faintnes of speach: so as the same onely come thereby, and not thorow fault of the lunges and brest; as sometime it doth, in whom notwithstanding the vitall force may be sufficiently strong. The contra­ries to these, declare firme strength of the vi­tall vertue.

These thinges declare the animall po wers to be enfebled: tumblings and tossings of the bodie, the senses offended, watchinges, ra­uings, and other principal actions hindered. The contraries hereunto shew the contrarie, that is, firmnes & strength of the animal ver­tue. By these functions then you see, how it may be coniectured what power in nature is hurt or offended.

Againe these powers are offended, or seem enfebled two waies: either because they are outwardly oppressed, or because they lan­guish inwardly of themselues, & in the eua­cuation it helpeth greatly to know the one from the other: for the forces oppressed re­quire large euacuatiō, & the other none at al. [Page 134] And the distinction of these is to bee sought out of their euident causes. If causes haue gone before, which haue already altered or wasted the substance of the forces naturall: then wee may iudge them that they are faint and languished. If these causes haue not been precedent, but that the Patient is only troubled with an vnaccustomed ponderosi­ty: then these are but wronged and oppres­sed. The euident and outwarde causes which alter the temperament of the setled vertues: are burning Agues, which melt the bodily moystures, or whatsoeuer els, that excessiuely heateth, cooleth, moysteneth, or dryeth, the sounde, massiue, strong, and solide parts of the bodie. The substance of these parts is wasted by very long sicknes, which bringeth the Pa­tient into an Atrophia that is, a kind of con­sumption, wherein the body consumeth a­way with leannesse, and is not nourished al­beit the sicke continually eate his meate: Or into Tabes, which is an other kinde of con­sumption, wasting the body by long sickenes and lacke of nourishment, consuming and pu­trifieng the Lites: drying away the Patient, for want of naturall moysture, hauing matter and bloud mixt together.

The threefold spirit of the flowing hu­mor is altered, ether through some distempe­rature, or some poisoned qualitie, of the aire [Page 135] which compasseth vs about, or through the il quallity of other thinges, which violently breake in vppon vs: or through some w [...]c­ked disposition of the bowels or other hu­mours. The heate of the aire, not onely of that which outwardly compasseth vs about, but also that which wee draw into our bo­dies by breathing, inflameth first the lunges, then the hart, & all the spirits, so far till often times a feuer is kindled, and caused thorow the same. Thorow which distemperature of the spirits, needs must the strength of the bo­dy languish & becom enfeebled: yea by this excessiue heat of the air, the spirits are not on­ly subiect to alteration of temperament, but besides they are also thereby greatly wasted & diminished. Euen so in like maner, immo­derat cold outwardly, & the same receiued inwardly into the body by breathing, weak­neth the spirits, & inward heat: yea & sōtime altogether put out, and extinguish the saṁe. The aire venemous & pestilent, drawen into the bodie with an infection quite ouertur­neth the spirits of life and ofnature: wherof [...]nsu [...]th grieuous sicknesses to the body, no litle decay of bodily strength, yea life it selfe is taken away by the so daine disease, com­monly called the plague.

Now much more apparantly are the spi­rites infected with bi [...]ings of Scorpions, mad [Page 136] dogs, and venemous beasts, than by the con­tagion of the Aire.

Moreouer they are inwarde and hidden causes, which doo greatly alter the spirits, and whensoeuer any principall part of the bo­die, is troubled with any distemperature, vpon any occasion: If the same proceed far, it must of necessity goe to the spirites there bred and ingendred: And so by offending of them will lessen the strength and vertue of nature. Also if any corruption of humor rule in the body, the spirits are disperced, and of­fended by the corruption or distemperature of the same humors. Therefore when abun­dance of rawe humors, passeth either the whole body or the stomacke: and chiefly the mouth of the stomacke, the substance both of inward heate, and of the spirits waxe cold, the Patient languisheth, yea, sometime hee giueth ouer the Ghost and soundeth. Here­vppon also when hot choler burneth, as it were, the inwarde spirits with immoderate heate, or nippeth and pricketh the mouth of the stomacke: it is the cause of no small e­uils in the body of man. Sometime also it fal­leth out, that some one or other humor in the body is mixed, besprinckled or bedewed, as it were, with some kinde of venemous filth, as when the seedy moysture is kept in and pu­trifieth: Or menstruall termes in weomen [Page 137] longer retained than is their due course: or when any clodded bloud remaineth behind, and is not expelled: the vapour of these and such like, infecting and decaying the spirits; bringeth sometime Sincope: sometime suffo­cation of the wombe: sometime the falling sickenes, and such other mischiefes, which greatly annoy the forces of nature. And thus diuersly are the spiriets offended through di­stemperature.

Againe, the substance of the spirits, and na­turall forces is diminished, sometime euen of it self (and as a man may speak) voluntarily of his owne accord: for the substance being of it selfe thin and wastable, and included in an hot thin and open body: Therefore of it selfe it dissolueth & vani [...]heth away. Sometime the same is decayed by occasion of outwarde and euident causes, as are namely these: The aire which compasseth vs round: hot and dry, im­moderate euacuations: vehement motion: af­fects of the minde: paines, watchinges, great emptines, and all vnprofitable excrements: which cannot but carry with them from the body as they passe, a great quantity or porti­on of the vitall spirits: seeing their substance is spread ouer the whole body, and also flow­ing with other humidities: whereby it com­meth to passe, that whether the belly be very laxitiue by nature, or by medecin: or that the [Page 438] vrine bee made immoderately as in the infir­mity called Diabete: or that matter or water go plentifully forth of the brest, stomack, bel­ [...]y, or any great apostumation: thereby of ne­cessity the forces of nature must be mightely decayed. Much more manifestly must it so fall out, when there is any great euacuation of bloud, or good humors, whether the same pas forth of a wound, the nose, hemorroids, Piles, belly, or other place. In like maner abstinence which taketh away from the body needefull nourishment, enfeebleth nature. Labor like­wise and heat disperseth the substance of the spirits by vapors & sweat: And therfore they which liue continually in labor about furna­ces, & hot baths, because daily some of their substance decayeth: doo not commonly so abound with excrements, as those that leade a slouthfull delicate and idle life.

Moreouer they that liue very incontinent­ly, haue also for the most part very enfeebled bodies, able almost to abideno Phisick; & by a continuall decay of seedy moystures, they haue their spirits mightely consumed: wherof look before in the 8. cap. Fig. 17. Great ach & paine worketh the same effect, more than la­bour doth. Also of passions of the mind, some suffocate the spirites and inwarde heate, as namely feare and sorrowe: some wast and spread them abroade, as mirth and gladnes. [Page 139] These are the causes, which being in exceise, do wast & consume inward heat, the spirites of life & strength of the bodie: which being so apparant as they are, may be vnto vs assu­red markes & signes, wherby to know, whe­ther the forces of nature haue yet lost, or do still retaine their powers, vertue & strength.

Those causes which onely oppresse the strength of the bodie are inward & hidden, & not so know en vnto vs, as the forsaid: and they are these: obstructions, & immoderate abundance of humors which stop the veines & arteries, because they are thick, grosse, and slow humors: by meanes wherof they keepe in the spirits, & do not suffer them to be coo­led, as it were, by any kinde of winnowing: whereby the vse of the spirits is taken away: their vertues are oppressed, and grieuously with the inward heat offended: which mat­ter verie oft faleth out so in the Lungs, Liuer, celles of the braine, in the arteries: finally, in the verie habite of the bodie.

Obstruction caused of too much abundāce of humors, doth grieue, oppresse, & somtime ouercome the inward heat and spirites of life. Fulnes also proceeding from any obstructi­on: if the repletion be simple, or somewhat part-taking with that called Cacochymia: it choketh bodily strength, as for example: A­bundance of bloud in a wrastler: Flewine [Page 141] in Leucophlegmatica. i. the third kind of drop­sie: cruditie of humors in the other dropsie: abundance of choler in the yellow Iaundies. As often therefore, as the powers of nature are descried to be weak by the excrements: the spirites of life by the pulse, & breathing: the animall facultie by her proper functions; and by any of the foresaide vehement causes preceeding: wee may determine the spirites of nature to be empaired. VVhen none of these causes haue gone before, and that yet the bodily strength appeareth weake: then iudge them to be onely wronged or oppres­sed: Specially, if there do concurre signes of pure and simple repletion, or of great corrup­tion of wicked humors: the causes greeuing and oppressing the spirites of nature being remoued: presently their strength is recoue­red, and they come againe vnto themselues, except they be beaten downe with the con­tinuance of their oppression. Here there­fore I make three steppes or degrees of naturall strength weakely affected: either the same is a little throwen downe, or ouer­charged, or thirdly, altogether weakened: whose particuler tokēs apeare by that which hath beene said in the premisses.

There are some which only marke the pul­ses as an infallible signe, to iudge the bodily strength by, which in trueth, is a great marke: [Page 141] but yet not alone sufficiēt, being both dout­full and vnconstant: and also because it is troubled with diuers outward things, is oftē ­times changed. Againe, euacuation too a­boundant, affecteth not onely the vitall spi­rites, but also in like manner, the other fa­culties of nature: whose decay bringeth death as assuredly, as if the vitall power were extinguished: and therefore in euacuation it is requisite, aswell to marke and obserue the other faculties of nature, as the vital powers. For if the pacient be sicke of a vehement & continuall disease, as of Lienteria. i. a fluxe of the stomacke, or Atrophia. i. a kind of con­sumption, or Marasmus. i. the endes of the feuer Hectike: let him not bloud; albeit the pulse be mightie & full. And therefore I conclude this Chapter: affirming that we are in euacuation to consider the ablenes and strength, not of one only, but of all the three aboue-said, running or flowing faculties of nature. Neither to consider of these alone, but also of the setled faculties, in which is conteined the action of life.

To knowe by the greatnes of the disease, & the strength of the naturall powers: the quantitie of bloud that must be withdrawen. Chap. 14.

THe knowledge of the quantitie in euery remedie▪ is the hardest matter in al Phi­sicke, [Page 142] and most of all troubleth the carefull and wise Phisition. And although to knowe the quantitie be but a coniecturall know­ledge: yet the same is ioyned with lesse dan­ger, and is more secure here than the know­ledge of the quantitie in a purgatiue receit. The reason is, because wee may stoppe the bloud when wee will, as Galen witnesseth 2. de ration. virt. in acutis Commen. 11. & lib. de curandi rat [...]. per sangninis missio. Chap. 12. But when areceit is in wardly taken, the same cannot be againe vntaken. Neither is it in our power, when it is once in the bellie, to take away any part thereof: or, if neede be, to adde vnto it: VVhich in bleeding wee may do: and therefore lesse danger is in this, than in the other.

The quantitie of the bloud that must be extracted, is knowen by the strength of the patient: and chiefely by his pulse. Therefore while he bleedeth, let the Phiebotomer or Phisition seele the Pulseis with his hand: and suffer the bloud to passe, according to the al­teration of the same: especially, when any great euacuation (as euen vnto Syncope) is to be made: Lest it fall out vnwares, that death it selfe doe come in the place of sowning or fainting.

And except necessitie doe greatlye vrge, it is best and safest to abstaine from [Page 143] such plentifull euacuation after Galens coun­cell, lib. de Cura rat. per sang. missionem. Chap. 12.

If at any time, the powers of nature being weake, the disease require some plentifull bleeding: it is good to deuide the same, to open a veine twise or thrise, and at eache time to detract a little bloud, as ye haue part­ly heard before: and as it shall be shewed more at large hereafter. All sicknesse de­cayeth the strength of nature, and so doth in like manner that euacuation, which is vsed to helpe nature. Lest therefore it might seeme a verie hard dealing in this case, more grieuously to afflict one alreadie afflicted, and presently grieued: the matter is so to be ordered, as the substance of the disease may be remoued, the forces of nature as little damnified as may be. Yea, it is a principall poynt in a skilfull practisioner, so to worke, that the euill may be remedied, and the pa­tient brought in hope of a more profitable recouerie for his health, than his former Phi­sick hath been painful vnto him. Those hurts which the naturall vertues sustaine, by a mo­derate euacuation are but small: and these are againe quieted, when the euaacuation is ac­complished: for nature now freede of those hurtfull humors, wherewith shee was before pressed down, recouereth her former strēgth, [Page 144] Shee renueth that which was drawen from the inward heat and spirites, and become al­most the conquerour of the disease. Shee o­uercometh wholly at length, yea, that which remained behind: partly by inward con­coction, and partly by outward dissipation. It wise Hippo councelled to giue a small dyet to the sick patient, not fearing thereby more and more to weaken the strength of nature, which was otherwise but weake: let vs so esteeme of euacuation. But as in dyet, so in euacuation we must beware, lest the vertues of nature extremely enfeebled, do quite giue ouer, and be altogether extinguished: in re­gard whereof, we are circumspectly to fore­see, how farre the patient can or may endure the same. For (in truth) a iust quantitie with­drawen without any great hurt, taketh away and cureth the disease. And this point of the iust quantitie is knowen, by a comparison of the disease, and of the strength of nature: for persons firme and strong may bleed as much as the sicknes requireth: They that are not so strong, may bleede lesse: they that are quite cast downe, are not to bleede at all.

And here a profitable question may be moued: whether naturall strength may so greatly be enfeebled, that it cannot or may not away with any euacuation be it neuer so little. VVee see many times, that in great [Page 145] of decayd strength, there fall out voluntarie euacuations, which do much good, and pro­cure health. And againe, it seemeth, that to ech diminution of strength (be the same great or smal) the quantitie of the euacuation may be proportionated accordingly. Neither is it credible, that an vnce or half an vnce [...]blod taken, can doe no great hurt to the naturall vertues, albeit they bee alreadie much de­cayed. These matters seeme somewhat ob­scure: but that the question may be expla­ned, and all ambiguities of auncient writers taken out of the way: we answere by distin­ction: affirming, that there are three degrees of quantitie in euacuation. The first degree is, when the same euacuation is thorow per­fect and absolute, taking away either all, or the greatest part of the matter that causeth or continueth the disease. The second degree is a profitable euacuation, but not so perfect and absolute as the other: which taketh away onely some part of the sicknes, making that which remaineth more easie and tollerable than it was before. The third step is so small & little an euacuation, that the pacient ther­by is not one whit eased or relieued. Now to come to aunswere the former question: the naturall strength is seldome so greatly deie­cted, except the same be altogether ouercom & past all hope of recouerie, but that it may [Page 146] abyde some little euacuation.

But hereof the auncient writers haue made no mention at all, being, as it were, a matter altogether vnprofitable, seeing it is so little: not procuring reilefe to the [...]cke patient, but rather bringing more daunger to t [...] naturall forces aire die decayed. And in fi [...]e, they haue decreede and set downe, that in this case no euacuation should be v­sed. Therefore, the naturall powers being firme and strong, require an absolute and perfect euacuation: The same but meane and somewhat enfeebled; an euacuation more vnperfect and yet profitable: altoge­ther decayed; they require none at all.

If the disease be verievehement, so that it cannot, either at all, or well be cured with­out bleeding: it requireth necessarily abun­dant euacuation: The same but meane, and not sowehement; it requireth a more mode­rate bleeding: but yet the same greatly pro­fitable, because the cure may afterwardes be accomplished with the more celeritie and safetie. If the disease be small, it requireth small euacuation or none at all.

Now let vs make comparison of the great­nes of the disease, and firmenesse of the strength together. VVhen the strength is verie firme, and the disease meane, and not [Page 147] verie vehement: bleeding is not altogether necessarie, but onely profitable, in which case, bloud may be safely taken, and as much as the disease needeth. There is no feare to diminish a little the bodily forces; so as the roote of the disease may be pulled vp. For they are againe verie speedily and redily re­couered.

VVhen the strength is firme and the dis­ease daungerous, replenishing the veines with an immoderate fuldesse, as it falleth out in the bodily constitution of wrestlers, and in feuers called Synochi: a plentifull eua­cuation is to be appointed, answerable to the greatnes of the disease. Yea, it profi­teth (sayeth Hippo to bleede euen vnto Syn­cope, If the patient maye abide it: in which place Hippocrates meaneth not that sowning which commeth of feare or of co­wardlinesse, or of sharpnesse of humors, pricking and prouoking the mouth of the stomacke: but onely that which commeth of abundant euacuation. For so in an ex­treame disease Hippo. appointed as a rule and iust order of euacuation. And this de­fect of minde and strength is called Lipothy­miae, or Liposychia: in which the partie spea­keth, heareth, seeth, and knoweth them that are present.

[Page 148] Nowe, Syncope, is (as it were) a suddeine decay of all naturall strength, as in the falling sicknes: in the which the patient neither see­eth, heareth, or doth any outwarde action. Lipothymia is more easie than Syncope, and accustomably goeth before the same. In the foresaide affectes therefore, wee let bloud euen vntil Lipothymia come vpon vs: and yet rashly or without iudgement.

Now when the powers of nature begin to quaile and giue ouer through euacuation, we must stay the bloud. Neither are wee to pro­ceede so farre as vnto Sincope: for then the partie escapeth but daungerously: albeit the strength of the body be reasonably firme. In consideration whereof, wee are to with­drawe the abounding humor, as the bodily forces will permit. And whensoeuer they are wasted, albeit some of the offending hu­mor remaine still behinde: yet wee are pre­sently to desist: and this shalt thou most cer­tainly vnderstand, if thou diligently marke and obserue the Pulsies, how they alter from great to little: from equall to vnequall: from strong to weake: from apparant to ob­scure: and by marking how the force of the fluxe of bloud beginneth to relent, and the patient to waxe weake.

That practisioner which setteth by his credite, and will auoide ill speaches, must [Page 149] neuer through bleeding, bring his Patient to Syncope: because the same being, as it were, an image of death, terrifieth the standers by, and putteth the Patient in a great hazarde of his lyfe. Yea, and it is bet­ter to let the patient still remaine in griefe, than to take away with the disease, life it selfe.

And hetherto we haue shewed, what is to bee done, touching the quantitie that must be withdrawen, when the powers of nature are firme and constant.

If the disease be but meane, and the bo­dily powers but indifferent, the euacuation must be moderated, which may remoue the whole cause of the sicknesse with little or small hurt to the strength of nature.

VVhich albeit, it be but a small and mode­rate bleeding: yet the same is verie profita­ble, as ye haue heard before. If a great sick­nesse concurre with strength alreadie de­cayed, and that the same also require some large euacuation: yet because the powers of nature cannot tollerate it, the same must not be done wholy at one time: but by ite­ration, as yee haue beene tolde: lest wee take away both the disease and the partie diseased: Natures forces being quite ouer­throwen, albeit the disease so require: yet the bodie can permit little or no euacuation: [Page 150] for it is vnprofitable and superfluous, not bringing any commodity, but discommodi­tie and perturbation to the sicke. Therfore in this case this must be the practise: mode­rately and often to giue the patient meates of good iuice and nourishment, to confirm, strengthen, and recouer nature: and such as haue some vertue in them a proprietate a­gainst the present infirmitie, & may redresse the inward corruption of humors. And whē thus the naturall forces shall be recouered, Phlebotomy may succeed. And this practise is much vsed in continual and long sicknesses, in sharp diseases, called morbi acuti: this long stay were doubtfull and dangerous.

An obseruation of things present & past, and al­so a foresight of things future: needful & ne­cessarie to the further knowledge of the quā ­titie of bloud that must be taken. Chap. 15.

OBseruations of euident causes, touching the greatnes of the disease & constancy of naturall forces, doth greatly further our knowledge in this behalfe. Of which euident causes, three of them are in ward and bred in our selues, as namely, the temperament, the complexion, & the age: & three of them are outward and accidentall: namely, the cō ­stitution of the aire, according to the seueral seasons of the year, the situation of the coun­trie & state of the heauēs. All which are in­cluded [Page 151] in one cause, as groūded al vpon one reason: secōdly, former euacuatiōs, ether slaid or immoderatly flowing▪ thirdly custome & order in diet & life, or kind of euacuations proceding. By knowledge of these forepassed causes, we may atteine to the vnderstanding of the strength both of nature & of the dis­ease: & so consequently of the quantity that wee must bleed: & albeit that the causes pre­sent & future haue not yet altered, either the disease, or strēgth of nature: yet for asmuch as they begin to dissolue some humours frō the body, & to wast the strength of nature, they haue some moment in this practise. For what these causes present or past can doo, ye haue heard in the 8. &. 14. chap. to the which I re­fer you cōcerning the perticulars: here onely being contented to rekon thē vp by name [...] the tēperamēt: the state of the body: the age: the countrietthe time of the year: the dispo­sition of the aire & sky: voluntary euacuatiōs, custom, & the rest, as appeareth ca. 8, It is the part & property of a wife & skilful phisition, to consider not only the state present of the natural vertues: but also to foresee what will be their state in time to come after bleeding. The natural powers after euacuation, are so to be conserued, as that the same may be a­ble afterwardes to take other helps & con­tinue out the prolixity of a cōtinuing di [...]e [...]s. [Page 152] Yea, we must reteine alwaies some bloud for future fits, and courses of the disease which are yet to come. Lest afterwards vrged ther­vnto, wee begin vnfitly, and out of due time againe to nourish the same. And this chiefly is to be done in bleeding, for corrupted and putrifying feuers, whose putrifaction & ob­struction is not taken away by bleeding: but the putrifaction is afterwardes the better ouercome, by the strong force of nature, when by opening of a veine, shee is some­what relieued. Therefore to this purpose alwaies some bloud must be left for natures preseruation, as Galen councelleth. lib 11. method. cap. 14.

We may coniecture the future strength of the patiēt, partly by the presēt causes, which are also afterwards like to continue, & part­ly by accidents, which may happen contra­ry to our opiniō. Among present causes these are the chiefe: the state of the heauens, & the order of mans life. If the constitution of the aire hath bene hot & dry, & is like so to cōti­nue, the bleeding must be lesse, than if wee suppose a cold aire to ensue. Again if we per­ceaue, that the patient will liue sparingly, & [...]ēperatly, either for want of appetite, or be­cause the disease will not suffer him to feed: as in Augina the Quincie: which shutteth vp the Iawes: we are to take lesse bloud, than [Page 153] whē we see he wil liue more frankly and li­berallie. In these cases we must still reserue some bloud, as natures treasure, to helpe at a pinch in time of neede.

Suddaine accidentes and vnlooked for which greatly enfeeble natural strength, are these, great paine and ach, watchinge vo­luntarie euacuations: and chiefly Sinc [...]pe. into the which many do fall, beeing not accustomed to bleede at the first opening of a veine, either because they are we [...]ke of nature, or strucken with some great feare, or because the mouth of the stomake fi [...]ed with bitter choler, is becom very vnsensible and weake. When we suppose that some of these matters wil fall out: albeit the strength be firme, yet no blood at all, or very litle is to be withdrawen: except by art wee naue preuented the former accidents. It is (I say) great wisedome to foresee a farre off, [...] beware of such suddaine and vnlooked for accidents.

This we will manifest by an example. Let the pacient be of a sanguine complexion, of body, thicke and well set, of a florishing age, that hath long time led a leacherous life, feeding plentifully of good meats, and that hath omitted his accustomed exercises▪ and liued at home idely: in whom also accusto­med eruptions of bloud, out of the nose, [Page 154] belly, or Hemo [...]roids are sta [...]ed: so that by concourse of these causes, the body hath greatly encreased or waxed, & that the large veines through repletion, are greatly filled. Whē soeuer a strong ague, or great in­flammation, shall possesse such a patient, presently he must be let bloud, and that plé­tifully: Both the greatnes of the disease, and of the cause requiring the same. Moreouer this is confirmed by obseruation of thinges past, if present causes agree to these, name­ly, that there bee a sit temperature of aire, by occasion of the countrie, season of the yeare, and the present state of the weather, mode­ratly cold and moist: and that the patient bee apt to euacuation: also that the sick­nesse bee not like to continue long after, neither apparant signification of an exces­siuely hot temperature of aire to come, no thveatning of future paine, or of abstinence, watchinges, voluntarie euacuations: If all these thus agree together, who may doubt but that a large euacuation may in this case bee made: And none at all, when the con [...]raryes doo appeare. Sometime these obseruations, are mingled among themselues, and contrary to themselues: In which confusion a wise iudgement is need­full, by comparison of them to prescribe the iust quantitie of euacuation.

[Page 155] The consideration of passed matters many times perswade a plentifull bleeding, which the obseruation of things present by and by taketh away: As for example, if the Patient laying aside his accustomed exercise, giue himselfe to pleasure and idlenes, stuffing him­selfe withmeats, and hauing some notable e­uacuation staied in him: but his body is wax­ed fat, white of colour, loose, open, soft, full of thiniuce, and that it be Summer, a hot & dry country, a hot & dry constitution of weather without stormes: In this case, let not bloud at all, for sufficient is already euacuated from such a body of it selfe, and that not obscurely, but apparantly. In this foresaid constitution, thou maist detract a little bloud, if it bee winter, in a cold country, and the wind▪ stan­ding at North: and in this mixture of things, thou must marke not onely the multitude of the obseruations, but the force of them: Be­cause one many times exceedeth all the rest in power and sway, and he that can neither by art, experience, nor sound iudgement de­fine the quantity of euacuation, according to the aduise of Hyppocrates, let him rather eua­cuate lesse, than more than needeth.

In this place albeit somewhat hath beene spoken before to the same purpose, cap. 9. Fig. 7. It may be profitably demaunded, whether being with child, be to be accounted among [Page 156] these obseruations heere handled, shewe of truth, and some probability may be alleaged, that when women with childe are grieuously sicke, we are not to let them bloud, because of the young that is in the wombe. This is also defended by Hyppocrates saying, Mulier in vtero gestans abortit, incisa vena: idque magis, si faetus auctior fuerit, that is, A woman with child is deliuered before her time if shee bee let bloud, specially if the young be much in­creased, and growen in the wombe. But this of Hyppocrates is not alwaies true, as neither that which hee setteth downe a little before, Mulierem in vtero gerentem acuto morbo corripi: Lethale est. That is, it is deadly for a woman with child to be taken with a sharpe disease. For seeing a purgation made of wic­ked and venemous simples, standeth with greater danger of the childe than opening of a veyne, and that Hyppocrates graunteth that women with child wexed with a disease cau­sed of corruption of ill humors, may bee pur­ged in the moneths betweene the third and the eighth moneth; truely with much more safety may we let those bloud, being grieued with any sicknes caused of Repletion. And if in the middle time of the going with childe, the same may bee done: Much rather in the beginning when the bloud more aboundeth, and the yong needeth lesse nourishment.

[Page 157] Againe, if women being with child, nature of her selfe oftentimes attempteth euacuati­on of that which is supersluous (with great profit) out of the nose, by the hemorroids & belly, and that sometime the Termes flowe healthfully at times appointed: why vpon great necessity may we not imitate nature in our Art? Yea, many women bring vntimely fruit except about the fourth moneth a veyne be opened, the young fruit beeing ouercome with plenitude of the Patient, neither onely in fulnes, but without the same a veyn is ope­ned in the arme of a woman with child, when need constraineth, as in a Pluresie, or other vehement inflammation. It is dangerous in deede to open any of the lower veynes in women with child, because the fluxe turned downewarde, the termes would flowe, and so the fruit in the wombe bee deiected and cast downe. A veyne is opened very seldome in the eighth or nine moneth without causing of vntimely birth, forasmuch as then a woman of euery light cause receiueth hurt, and is de­liuered before her time, through the weake­nes and slipperines of the wombe. In this case Cornelius Celsu [...] only considered the greatnes of the disease, and ablenes of the strength. Olde Phisitions▪ (saith hee) were of opinion that the first and latter age could not brooke bleeding, and that a woman with child cured [Page 158] by Phlebotomy should bring foorth vntimely fruit: yet experience prooued afterward that none of these were perpetuall, but that bet­ter obseruations wer to be considered, which the Phisition is to remember: For the matter is not great what the age bee, or what a wo­man beareth in hir wombe, but what her strength is: a fierce childe: a strong olde man: a lusty sanguine woman with child, may safely bleede. And thus you see howe a great belly in a woman may be an obseruation con­cerning the quantity of bloud that must bee withdrawen.

Another obseruation to finde out the iust quantite, is to marke the alteration of colour in the bloud. So iudged Hyppocrates in Pleu­ritide secundo de ratione virtus in acutis Com­men. 10. where hee counselleth to let bloud if the paine in a Pluresie ascend to the arme, or the Paps so long till the bloud came forth in colour more red or more yeallow: or for pure and red bloud, blacke and blewe, which both doo happen. For bloud in an inflammation▪ differeth in colour from the naturall bloud, as more heated and inflamed. If the naturall bloud before in the body were crude and vn­digested bloud, that which is in the inflamed place, is a great deale redder and yeallower, if it were before redde through adustion, it be­commeth now more swart and blacke: But if [Page 159] the Patient f [...]i [...]t or faile, before the bloud alter in colour, stay not then for the mu [...]ation or change thereof. Finally the plenitude in the body admonisheth vs of the quantity more or lesse and thus we conclude, touching the knowledge of the quantity: how muoh must [...] taken.

Of the time and seasons of the sickenesse, of this yea [...]e, of the daie, and houre of the daie, when a man is to bleede, or not to bleede. Chap. 16.

ALthough it hath beene declared, that we are not to let bloud in a season of the yeare too hot or too colde. Yet in this Chap­ter, wee purpose more exactly to discusse, what time of the sickenesse, and what day, the same is to bee done, Auicen, in quarti [...] primi cap. 20. saith that for preseruation, a veyne is most safely opened, when the dis­ease is not come or yet present, disallowing altogether of this practise in the beginning of sickenesse: and his reasons to prooue it are these.

In the beginning of a sickenesse (saith he) it attenuateth the humors and causeth them to slow throughout all the bodie: mingling the bad Humors with the good bloud.

[Page 160] These wordes of Auicen are neither true nor agreeable to Hyppocrates, & Galen, Hyp­poc. 2. Aphoris. Aphoris. 29. writeth, that at the beginning of sickenes. If any matter be to be remoued▪ the same ought then to be done ac­cordingly: and when the euils are in their state, then to giue them rest▪ Galen in the Com­men▪ saith, that bleeding and purging may be v [...]ed at the beginning, but neither of them, Morb [...] Consistenti, that is, in the state of t [...] disease: whereofin the Aphoris. following [...]yppocrates rendreth a reason: at the first and las [...] ( [...]aith he) t [...]ings are more weake, than in the middle estate: for then all things are most firme and strong. Againe, why he should stay for concoction in bleeding, I see no reason, for as much as bloud of his owne nature is al­waies concocted, and a veyne beeing opened it floweth out easily of his owne accorde. A­gaine, where Auicen in his reasons saith, that by bleeding in the beginning, that corrupted bloud is not euacuated that should be, which afterward puts still the Patient to more pain, so that wee are forced oftentimes, after wee haue let bloud in the beginning of a sicknes, to take medicines purposely to asswage do­lors and paine: I perceiue not how bleeding can take the good and leaue the bad, seeing nature alwaies reserueth to it selfe as a friend good humors, & good bloud, reiecting those [Page 161] that are naught and vnprofitable. Also when he saith it attenuateth the humors, hee is contrary to himselfe, for in quarta primi, cap. 4. he iudgeth rather bleeding to make humors thicke, than thin: The bloud and spirits themselues which attenuate the humors by bleeding being with­drawen. Againe, this is wonderfull, that when the state of the disease is past, and the Patient past danger, that he would haue then the mise­rable Patient with a new wound and cutting of a veyne againe tormented.

If any thinke Auicen to be blameles, as be­ing of this iudgement, that a veyne is to be ope­ned when nature hath attempted Crisin, that is, the iudgement of the disease: which fall [...]th out to bee vnperfect and litle, not able to doo the feat and accomplish the whole force, neither doth this defende him: For by what reason would yee haue bleeding to euacuate the mat­ter left behind of an vnperfect Crisis: The na­turall vertue being made so weake by that time with continuall contending and striuing with the disease: that it can doo no good or very lit­tle in the cure, and especially when the rest of that matter is daily vsed to be easily euacuated by purgations. In sharp & dangerous sicknesses therfore, euery one seeth here Auicens error: for in these sharp, vehement, & continuall diseases, we must bleede or be purged the first day: ye [...], stay in these, is very dangerous, as Hyppo. saith, [Page 162] 4. Aphoris. Aphoris. 10. If Auicen meant it of Morbi salubres. i. recouerable diseases: in these truely neither first nor last, nor at any time are we to bleed: for then most vsually we let bloud when a disease is vehement and dangerous.

The opinion of other some in this place is to be [...]aughed at, who thinketh that Auicen admoni­sheth not to bleede at the beginning in sicknes­ses not dangerous, as in a tertian, because nature is terrefied by the newnes and sodainnes of the disease: and these make, or imagine nature to be a thing indued with knowledge, or an vnder­standing and knowing faculty: which is not so. But if nature be made afraide in sickenesses not perillous, how much more will she be afraide in daungerous diseases, in which not withstanding, wee hasten to let bloud euen at the very first. These matters therefore are full of error.

Let this therefore bee the conclusion, that wee must bleede in the beginning of sicke­nesses. VVherevpon Galen counselleth (the disease being come) to open a veyne, lib. de Cu­rand. ratio per sang. missio. cap. 9. & cap. 12. If (faith hee) there bee repletion of hot boyling bloud, whereby a strong ague is inflamed: pre­sently euacuat, yea, euen vnto sowning: yet still regarding the strength of nature. And this is his aduise prim. Aphoris. Aphoris. 23. VVhat diseases so euer are caused of plenitude, or o­ther corruption of humors in the veynes; they [Page 163] are at the beginning to bee cured by bleeding: for by this meanes, the disease likely to grow is kept backe, and so much as is already bred, na­ture will easily subdue: Thus hot Agues before they are yet inflamed with heate of boyling bloud, or by vehement putrifaction, are & may bee cured. Also inward inflammations at the first, as long as the flowing humor cleaueth not to the member, but followeth the bloud may be cured. The said humor issuing forth with the bloud, when a veyne is once opened, strength at the beginning is firme and constant in the Patient, almost like vnto vs that are well in health: If therefore at any time bleeding bee needefull, the same may best be done at the be­ginning: he that in fulnes of bloud, or fluxe of matter, will stay from bleeding, and vse other helps, in a peruerse order of healing, he doubleth the griefe, and troubleth the forces of nature more than is conuenient: Yea, let the veyne so timely bee opened, as the stomacke and first veynes be not first stuffed, with either corrup­tion or cruditie of humors or meats vndigested.

Thus you haue heard the former words of A­uicen to be erronious, howsoeuer certain labor to salue them vp: yea, & Auicen seemeth to vn­derstand his owne saying, not only of particuler diseases in the members: but also of all other diseases. For afterwards speaking of all Feuers, and especially of Febris fanguinea, Feuers cau­sed [Page 164] of bloud, hee counselleth in them not to let bloud abundantly: except there haue gone before concoction, and concerning this reason, that humors are lessened by bleeding, it cannot be so, for yee haue already heard, that both be­fore bleeding and after, there is retained in the body one and the selfe same proportion of hu­mors. If any difference or mutation happen, seeing the thin humor issueth foorth with the greatest speed, and the thick humor but slow: it is more likely, and probable, that opening of a veyne should rather make the bloud and hu­mors thicke than thin. A gaine, whereas he saith in his reason that the humors thereby are agita­ted, moued, and driuen through the whole bo­dy: how should there bee this agitation of hu­mors, seeing rather this practise abateth the multitude of them which was before the cause of perturbation & sickenes. In reason all things now should become farre more quiet than be­fore. VVhereas he saith the ill bloud is mixt in the veynes with the good, what inconuenience commeth thereof if a veyne bee opened? then no doubt the bad must passe foorth with the good. Put the case there bee a strong or vehe­ment sickenes caused of abundance of bloud onely, as are both the Synochi Feuers, as is the putrified feuer, caused through plenitude, as are Angina, Pleurisis, Peripneumonia, also inflam­mations of the Liuer and other partes. In these [Page 165] if they bee great and dangerous through much abundance of bloud, who will not presently o­pen a veyne? who will not while strength ser­ueth, take away that fulnes which bringeth a disease and danger of death? Hereupon in Syno­ [...]ha presently at the first, we hasten to let bloud euen till the Patient faint, and before the mat­ter putrifie. But Auicen in a sanguine feuer at the first letteth bloud sparingly, & more plen­tifully afterwardes, when signes of concoction appeare. But what concoction doth hee looke for of good bloud, and already well concocted, and offending onely in quantity? In these san­guine feuers therefore, euen as in very sharpe sickenesses, either to put off, or to stay bleeding it is very ill, as Hyppocrates saith, if the disease be not so sharpe or vehement, yet let bloud at the beginning, according to the proportion of the fulnes. If wee should in these stay with Auicen, till concoction (the beginning and state of the disease) be past: wee should suffer the disease to grow & increase, and cause for want of skill the Patient to bee cruelly hand'ed and intreated without helpe of Phisicke, which wee may ad­minister, if the disease be deadly, it will neuer be brought to concoction: If it be doubtfull, or re­couerable called Morbus salutaris (as ye haue heard) after the state in the declination, & when the Patient is past daunger, what profit doth Phlebotomy then bring? as ye haue heard before.

[Page 166] Nature by concoction, separateth the ill hu­mors frō the good: these to conseruation: those to expulsion. This she doth either by her self, or by the help of Phisick. But opening of a veine, indifferently without choice, euacuateth al hu­mors. VVherefore then in bleeding, shall wee tarrie for this concoctiō & diuision of humors? as for example: In apostumations, if the corup­ted bloud be made matter or filth, it is not then taken away by bleeding, but by some other meanes. So in feuers, whose matter is conteined in the veines: when the humor is concoct & di­uided, we vse not to withdraw the same by bleeding; but by some other practise in Phisick: in which case, by that time that concoction is ac­complished, wee shall haue nature to helpe vs, who ofher selfe, indeuoureth to expell humors concocted & diuided, the bad from the good. And if nowe after concoction & separation of humors we open a veine, we do not onely eua­cuat the bad, but also the good: and that which is worse; those humors which are separated by nature, we shal mingle with the pure bloud, de filing the same, & so both confound all, & di­sturb the good worke of nature herself. Ther­fore, when the apparant signes of concoction shall appeare, the cure must be done, not any more by opening of a veine, but either by pur­gation, or some other help, to turne the matter aside some other way, except (which sometime [Page 167] chanceth) there appeare signes of cruditie.

In feuers: when the plen [...]tude is abated, and things which putrified are concocted, we must assay to euacuat them by siege, v [...]ine or sweat. Those things which are rotten and turned to filth, in a P [...]uris [...]e or P [...]ripneumonia, we euacu [...]t by spitting. Matter putrified in the Liuer, pas­seth through the hollowe veine by the belly. Corruption in the [...]ines & in Gibba, passeth by v [...]ine: and so e [...]he pu [...]rified matter▪ accordingly out of ech member, is to be purged by the next places & fi [...]test passages.

If by feare, slouth, or any other occasion, o­pening of a veine haue not bin put in vre in the beginning of a sicknes: the same may be d [...]n at any time: yea, the twentieth day after, if the signes of fulnes & c [...]uditie still continue, and that the bodily strength be answerable & not decayed through prolixitie of sicknes. But here is the doubt, that oft the matter of the disease is digested or the strength of nature wasted.

But Auicens opinion, that in the beginning of a disease, a veine is not to be opened: see­meth to haue grounde out of Galen. Chap. [...]7. Artis Medicinalis & Comment. 22. lib. 4. A­phoris norum: saying, The Phisition is t [...]e minister of Nature: But Nature her s [...]lfe, ne­uer in the beginning of a disease, when the hu­mors are yet altogether r [...]we and vnconco­cted, appointeth any euacuation.

[Page 168] therefore, neither must the Phisition, at the first: when all things are yet vnconcocted, at­tempt any euacuation, and so much the lesse, because crude and vndigested matter not yel­ding to euacuation: stirreth vp grieuous acci­dēts in the bodie. Galen. li. 1. Aphoris. Cōmen. 22

Again, say some (in Auicens) defence, it may be that in the beginning of a sicknes: opening of a veine maketh the superfluities of the body thinne: so that they may flowe & runne tho­rough out the whole body, and so be mingled with the good bloud, wherby it fortuneth that the same is not extracted, which necessitie re­quireth to be expelled. VVhereby also it hap­peneth further, that the patient must be let bloud againe, sometime euen the same day, and sometime the day after, which too much enfee­bleth the powers of the bodie. And thus it is contended, partly by reason, partly by authori­tie in the behalfe of Auicen. And surely, if the words of Auicen might be restringed, that ve­rie seldome, and onely in the case limitted, a veine is not to be opened at the beginning of sicknes: it may wel stand to sense & reason: but Fernelius & others gather, that Auicens words were spoken more generally, than that he can by this speciall case only, be defended. And be­cause the matter is controuerted, as ye see, I haue set downe the reasons brought both a­gainst Auicen, and for him. Leauing the depth [Page 169] of the controuersie, to be examined & discided by others, rather as yet inclining for my part: (for ought that I can see) to the aduersarie [...]p [...] ­niō to Auicens, stil affirming it to be more viual a great deale, to open a veine in the beginning of sicknes, than to stay a longer time.

And that this assertion may the rather ap­peare to be true: I will set downe certeine ru [...]es whereby it may truely be manifested & appro­ued so by science and experience. First, when wicked humors greatly swel, being (as it were) excited & stirred vp through repletion of their owne accord: they perswade to euacuation at the beginning of the disease, when the humors are not yet concoct. For otherwise, the vncon­stant humor, mouing from place to place, and frō member to member without order, might make stay at some principall member, to the great hurt of the patient. It happeneth in deede but seldome, that the humors are moueable, & flowing from one part to another: for cōmonly they remaine firme & stable in one place.

Secondly, a veine is to be opened in the be­ginning of a disease: when quantitie of matter aboundeth in the veines, as Galen saith, Com. 29. li. 2. Aphoris. Yea, in this case also somtime a purgation is taken, that nature may easily [...]ō ­coct & ouercome the residue of the matter of the disease, when the same is lessened by art.

Thirdly, when the disease is great & vehe­ment, [Page 170] as in verie dolorous apostumations: albeit there be not in the bodie much matter antece­dent: yet the humor that is, is to be repelled, lest the apostumation open and breake sooner than is conuenient. To auoid therefore these gr [...]at & euil accidents: by & by, at the begin­ning incision is to be made: which Galen tea­cheth li. 13. Cap. 20. Method. Medend. in these words. In such affects (saith he) a veine must be opened at the beginning; so that none of those things hinder, which we haue spoken of. i. either the abundance of raw e humors: childish yeares: the time of the yeare: the temperature of the countrey, too hote or too cold. For not only in sharp diseases & inflamations, but also in wounds & bruses of particular parts; specialy being principall: bloud is to be taken from the contrarie part, to repell the inflamation: albeit the bloud be but little in quantitie.

In the beginning of sharpe diseases called morbiacuti, or peracuti: opening of a veine is passing good. For the better vnderstanding whereof, you must remember, that a sharp dis­ease is two-fold: either exquisite & throughly vehement, passing not the fourth daye, which is called of Phisitions Malus peracutus. i. tho­roughly sharp: and of some perperacutus, imi­tating barbarous authors in Phisick. The other not exquisite or throughly sharpe & vehemēt, whose greatest force wilbe in the seuenth day. [Page 171] These diseases being but short, & at their ex­treame fits in few daies, without any truce, presently at the beginning, these are to be cu­red. And because they proceed chiefly of hot humours, namely, of bloud and yellow cho­ler, therefore specially they require bleeding. Whereupon Hippo. lib. 4. writeth. De vict. rati­one in morbis acutis. Aphoris. 19. In acutis morbis sanguinem detrahes: si vehemens morbus videa­tur, florueritque aegrotanti aet [...]s viriū & aff [...]er it robur. In sharpe diseases withdraw bloud, if the disease seeme vehement, if the age of the patient be florishing, and that the naturall forces be firme and strong. Schola salerni hath these verses of this very matter.

Principio minnas in acutis perperacutis.
Aetatis mediae multum de sanguine tolle,
Sit puer at que senex, tollet vterque parum.
Ʋer tollat duplum, reliquum tempus tibi simplum.
In sicknes sharpe let blood with speed.
take much from men of middle age.
Not so when child or old men bleede:
the spring requires the aduantage.

As there is regard to bee had of gene­rall times, so there is also of perticular daies and times, in the which diseases come, spe­ciallie in those diseases, which haue by [Page 172] course an appointed and set time of intermis­sion and remission. For euacuation is not to be made when the disease is now fierce, but when the same is asswaged. Feuer, sand espe­cially those that are called intermittents, dis­continuing agues, euē naturally at the begin­ning and their first inuasion, cause vomits: and at the declining, sweats. At which times wee may by art prouoke these, but in no case vse purging or bleeding. In the time of the fit like­wise wee must refraine from these, as thinges which nature then can not brooke. If such ac­cidents of bleeding, or of siege come, they are but accidental, and are caused only of the heat and force of the disease. No euacuation can be done safely in such fits, seeing they do too ex­ceedingly hurt the powers of nature. Also when the humours do so boile with heat, that they are perturbed & mingled together, there can not be made by practise of art any iust di­uision of the said humours. And if it chaunce that the hurtful matter of the disease, be infla­med without the greater veines, & that in a fit, a veine be opened: it is to be feared, least pre­sētly the same corrupted matter passe into the empty veines, & so of an intermitting feuer, wil come a continuall. Wheras a veine opened in the most quiet time of a disease, troubleth not nature, but without any feare of an inflamma­tion, taketh the plenitude out of the greater [Page 173] veines. The greatest time of quietnes, is the time in the middle, betweene the remission & intermissiō of the disease. If the time between the fits bee much, it is an easy matter to per­ceiue the said middle time. If the time bee but little, then is it far more hard to discerne the same. Because many times no leasure can bee graunted either before or after bleeding, by reason of the swift courses of fits, to nourish the party. Thus you see Phlebotomy is not to be practised in the day of the fit of any sicknes, which in Latine is called Crisis, or dies Criticus, in the which day, neither bleeding, nor any o­ther euacuation is to be attēpted, lest the mat­ter should be drawen from that place, where­vnto nature hath driuen it, to be rid or dispat­ched thereof: and therfore like wise neither in the fit it selfe ought the same to bee done. Ex­cellently therefore did Galen giue in charge, Comment. 29. lib. 2. Aphoris. that in time of the fit, neither bleeding nor purging ought to bee vsed, because then the concoctiō of the disease is chiefly wrought. Which is farre better accō ­plished in quietnes and rest, then in motion or disturbance. For what respect the state hath to the whole disease: that comparison hath the [...]itt to the daies of intermission. As therefore in the state of a disease no euacuation is to bee vsed: so neither in time of the fit.

Againe, it may profitablie here bee admo­nished [Page 174] notwithstāding the premisses: that ble­ding is not presently to be vsed at the very be­ginning of a diseas, whē we iudge the Crisis or iudgement ofthe sicknes to bee yet far of [...]. For bloud beeing the foundation of inward heat, wherwith, the same is vpholden: (natural heat beeing ingendred of bloud, as of a materiall cause,) If bloud should bee detracted at the beginning of a disease, the natural heat would bee diminished, which should concoct the materiall cause of the sicknes. Whereby fur­ther it commeth to passe, that the disease is longer time protracted, and the forces of na­ture enfeebled, through which two, namely the continuance of the disease, and imbecilli­tie of nature: great feare of death commeth in the end: and this is the case, wherein Auicens former opinion may stand true.

There is therfore no prescribed day for cer­taine, appointed to let bloud in. Whereupon Galen tooke occasion to deride those: lib. de curand. ratio. per sang. missio. cap. 12. which from the 2. houre of the day to the 5. or 6. houre onely did let bloud, and at none other time. And Galen witnesseth ofhimselfe, that he did let bloud at all times without any daunger, yea euen in the night. And 9. me­thod. Cap. 5. hee affirmeth it best, which hee also him selfe obscrued, to mark not the num­ber of the daies, but onely the strength of the [Page 175] Patient, because by experience wee haue prooued that not onely the sixt or seuenth daies, but also in the daies following the sixt or seuenth, a veine may bee opened. But be­cause as Galen witnesseth, Libro de Curand. ratio. per sanguin. missionem. Capit. 20. in di­uers diseases through continuance of time, the strength of nature is greathe abated: Therefore the occasion of letting of bloud is not omitted for the number of the daies, but for that the naturall strength is wasted: So that if the vertues of the bodie seem to be con­sumed the second day from the beginning of a disease: euen then wee forbeare opening of a veine. And he thertoo the wordes of Galen.

Now in diseases which are cured by bleeding when they are present, or propelled being but future: if they grant leisure so that a choice of an houre to bleede in May bee made: in this case (I say) the fore noone houre is better then the after noone. For from the rysing of the Sunne the bloud is quickened, reuiued, and beareth rule in the body: yea in that time of the day it becommeth thin, cleere, & apt to flow. Let not the patient sleepe nor slumber in that houre, wherin he is to bleed, but at lest let him be awake a whole hour before: see also that he haue wel digested the meat he did eate the day before: so that the excrements be descended, & that the body haue done his accustomed dutie [Page 176] both by siege & by vrine. And these must most principally be done, when a great veine is to be opened. And they are not so greatly to bee obserued, when we withdraw bloud, from the sm [...]ller veines: from whence the bloud flow­eth but slowly. If the patient be in health, let [...]im do some work, or goe first an houre about his businesse in his shop, warehouse, market, s [...]hole, or other place: as his vocation is: and then bleed; choosing out for the purpose the [...] hou [...]e that may be: vide Auicen 4. pri­n [...]cap. 20. And thus much of the time of the sicknes, and of the day.

Of the time of the yeare best to bleed in, it is agreed generally, the same to bee the begin­ [...]g of the spring, which is a temperat time, [...] too hot, nor too cold. Therefore Hippo. [...]. Aphoris. 54. writeth: Quibus a venis sangui­ [...] [...]ttere confert: iis vere secare venā oportet. Those that must haue a veine opened, must [...]aue the same done in the spring. And Ga­len lib. de Cura. ratio. persang. missio. saith: that [...]ee by letting bloud in the beginning of the spring, cured many of the gout, and o­ther diseases.

There are 3. moneths belonging specially to the Mone (as some say. viz. May, April, Septe­ber: in which there are also certaine daies which are not good to bleed in, as some au­thors (not contemptible in mine opinion) do [Page 177] affirme: namely, the first of May, and the thir­tieth of the two other moneths. This for all these sayinges of wise Clarkes, is not alwaies so found: for euen in these daies, if other thinges agree, a veyne may be opened, which I my selfe haue done without hurt insuing. In like case that is false, which is set downe by some, that: the eating of Goose on any the foresaid e three daies, is perillous: which seemeth to bee taken from the custome and superstition of the Iews. Men in their flourishing yeares of a sanguine complexion, may bleede euery moneth of the yeare: if necessity vrge by occasion of great dan­gerous sickenes, and that bloud abound in the veynes. For in these, substance of humors is not easily wasted or dispersed abroad. But for con­seruation of health: bleeding is best vsed, in one of these three moneths, Aprill, May, Septem­ber. And yetnot all alike, for in Aprill, and May, the Lyuer veyne is to bee opened for a­bundance of bloud in the spring: and in Sep­tember the veyne of the Milt, because in har­uest Melancholly aboundeth more than any o­ther humor, and I would wish persons greatly subiect to diseases, caused of fulnes of bloud, and that are cured by bleeding, to bleed these two times in the yeare: that is to say, from the Lyuer veyne on the right arme in the spring, and from the veyne of the Milt on the left arme in September. Those that thinke that if they bee [Page 178] let bloud one yeare they must be so euery yere: Shall herafter in the twenty foure Chapter bee shewed to the contrary: for as one swallowe makes not the spring: So Phlebotomy practised once or twise, doth not import an annuall blee­ding, and so we must iudge of boxing. The ver­ses of Schola Salerni, concerning these matters insue.

Tres insunt istis Maius, September, Aprilis.
Et sunt Lunares, sunt velut hydrae, dies.
Prima dies primi postremaque posteriorum,
Ne [...] sanguis minui, nec carnibus anseris vti.
Sit senium aet (que) iuuent a licet, si sanguis abundat,
Omni mense probe, confert incisio venae.
Hi sunt tres menses: Maius, September, Aprilis:
In quibus eminuas, vt longo tempore viuas.
In May, September, and Aprill,
There be three daies are very ill:
The first in May, of rest the last,
In which ne bleede, nor of Goose tast.
Though old or young, if bloud abound:
In each moneth bleede, this rule is sound.
But three be best, and farre excell,
September, May, and eke Aprill.
A Table of the things speci­fied in this Chapter following.
  • [Page 179]An accidēt apper tai­ning to the considera­tion of bloudlet­ting in ge­nerall: is the time: which is of the
    • yeare, whereof looke Cap. 8. Fig. 13. and in this present Chapter.
    • Of the day or houre, for in
      • Persons not sicke, for the Preser­uatiue intention, the morning is best, an houre or two after sleepe, when the body is dis­burthened by siege, by vrine.
      • Sicke and hauing
        • their fit vpon them, who are to bleede when the fit of the feuer is off.
        • or not hauing fits by intermission, as in continuall feuers and inflammations, who may bleede present­ly at any houre of the day or night, if the disease be vehe­ment and daunge­rous, and the bode­lie strength firme: but if the disease vrge not, choose (as for persons not sick) the morning houre.

Of Astrologicall obseruation in bleeding, and of an other obseruation neerely aanexed vnto the same: shewing what members, and parts of the bodie are to bee opened according to the seuerall seasons of the years.

AStrologicall obseruation of the newe and full of the Moone, and other considerati­ons heere set downe as follow, are to bee regar­ded in light and small sickenesses: but not so, if the same bee vehement and dangerous. For the heauenly causes are very farre off, neither did Hyppocrates make reckoning of them 4. Apho­ris. Aphoris. 10. The first day wee must helpe (saith he) in sharpe diseases. And Galen de Cura. ratio per sanguin. missio. cap. 12. saith: that those persons are presently to be euacuated, in whom appeareth abundance of hot bloud, before the same begot to some principall part (as ye heard before) so that these things are not to be obser­ued in a vehemēt pluresie: In Angina the quin­cie: Inimmoderat flux of bloud: In great pleni­tude of the vessels: neither in discōtinuing agues or feuers that come by fits. In which the time of rest, remission, & stay, is farre better than the morning time: In which wee let bloud at what houre so euer it be, of the night or the day: if the fit be off, and other things answerable. There­fore I say in these, we are not strictly to obserue [Page 181] these rules Astrologicall: obserue them, as mat­ters of some force, in healthfull Patients, which bleede onely for preseruation, and in light▪ and small infirmities: if then it happen that thou do bleede.

To come to these Astrologicall obseruati­ons we are not to let bloud in the new or full of the moone: nor else except the moone bee in these signes ♈. ♋. and the first halfe of ♎. the last halfe of Scorpio, or in ♐. ♒. ♓. Also not in the day of the change, the day next before, or day next after: Nor when the signe is in the place where the incision should be made.

Another obseruation is this, to open a veyne in flegmaticke persons: when the ☽ is in ♈. sa­uing in the heade. In a melancholly man, the moone beeing in the first halfe, or first fifteene degrees of ♎. except in the hips: or when the moone is in ♒. sauing in the legs. In a chollerick body when the ☽ is in ♋. sauing in the breast. The last halfe of Scorpio: except in the priuy members, or in ♓. sauing in the feete. Sanguine men may bleed in any of the signes, so the sign be not in that member.

Againe, after the Mathematicke, this is the constellation or election of time. In fiery signes it is good for flegmaticke persons to bleede, as in ♈. ♐. Leo is excepted being the house of the Sunne, in the which there must be no bleeding. In Airie Signes good for Melancholly men: [Page 182] as ♎. ♒. ♊. is excepted, and the last seauenteene degrees of Libra, because ♊. respecteth the hands and the armes, in which commonly wee let bloud.

In watry signes, good for chollericke men, as in ♋. ♏. ♓. In earthly signes it is ill to bleed, as in ♉. ♍. ♑.

The generall rules of Ptolome for Phlebotomy in 30. of Centiloquium is this: Tangere ferro membrum cum Luna in signo illius membriest pe­riculosum. It is daungerous to open a member with a chirurginal instrument, when the moone is in the signe belonging to that member. Good aspectes in bleeding are these ♂. ☽. and ♃. also ☽. & ♀. so as ♀. be not cōbust ■. ☽. & ♃. ⚹. ☽. & ♃. ⚹. ☽. & ♀. △. ☽. & ♃. △. ☽. & ♀. △. & ⚹. ☉. & ♃. or ☽. also △. ☽. & ♂. or ⚹. ☽. & ♂.

Againe this is an other obseruation, from the new of the moone to the first quarter, for pueri, i. those that are in their childhoode from the first quarter to the full: for Iuuenes: that is, young men from the full to the last quarter: for Ʋiri: that is, those that are of mans state, and begin to grow in yeares, and from that time to the new againe: for old growen folke: Looke more hereof in a Table hereafter following. 28. Chapter.

Another obseruation, how particuler mem­bers are to be taken, according to the particu­ler times and seasons of the yeare, is this: In [Page 183] the spring and summer time, the veynes of the right side of the body are to be opened: name­ly of the right hand, right arme, and right, foot. But in haruest and in winter, the veynes of the left hande, arme, or foote. In the spring time, bloud increaseth: In the Summer yeallow cho­ler: therefore in the spring time, and in Sum­mer, those veynes are to be opened which most abound with bloud and yeallow choler: that is, specially the right raines: for in the right part of the body is scituated the member causing bloud: that is, the Lyuer: and Choledochos the Cofer of yeallowecholer: that is, the gall. In haruest is ingendred melancholly, which is not dissolued, but increased in the winter: therfore in haruest and winter, those veynes must haue incision, in which melancholly chiefly raigneth: that is, the left veynes for the Spleene, there­ceptacle of melācholly is placed on the left side. Moreouer, these foure members, the head, hart, feete, and Lyuer: are to be euacuated according to the foure seasons. The heart in the spring: the Lyuer in Summer: the head in winter: the feete in haruest: Of which matter you shall heare speake, Schola Salerni,

Ʋer aestas dextras, autumnus (que), hyems (que) sinistras.
quatuor haec mēbra: hepar pes, Cephae, cor, vacuad [...]
Aest as habet hepar, ver, cor sicque ordo sequetur.
The right, the spring and summer haue:
The left, autum, and winter craue.
[Page 184] The Summer hath the Lyuer his,
The Spring also claimeth the heart:
The head the winter doth dismis,
O fayling foote thou Autums Art.

Preparation before bleeding. Chap. 18.

AS occasion of the time is to bee taken, so there must be vsed before, some prepara­tion of the body. The neglecting whereof, would bring great hurt to the party; and surely, the chiefest preparation is this. To purge and cleanse the members, that are in the first Regi­on of the body: touching this preparation ma­ny things are to be regarded, whereof mention is made in the eighth Chapter, from whence I purpose to take foure principall considerations in this behalfe, being vrged thereto, for perspi­cuity sake: leauing the rest to thine owne dis­cretion to be scanned.

There are therefore (as there wee did set downe) foure things especially which stay and put backe bleeding: That is to say, first crudi­ty of the stomacke and first veynes. Secondly, a filthy gathering together of hurtfull humors. Thirdly, the belly bound with dry and baked excrements. Fourthly, the mouth of the sto­macke weake, and very sensible. These doo not altogether put off bleeding, but stay the same for a while till by Art they may be withdrawen or remedied. If a veyne be opened, while crudi­tie [Page 185] ruleth in the stomacke, this euill will follow: that many rawe, vnconcocted & vndigested hu­mors wilbe congested, & gathered together in the place of bloud. In hardnes of the wombe this mischiefe ensueth: that the Liuer & exhau­sted veines, suck out of the excrements, silthie iuices, & vncleane substance: in regard whereof it is most conuenient, to stay so long as the rawe matter may be concocted, & till the excremēts descend. And if they cannot vtter of them­selues, as ye heard, cap. 8. They are to be prouo­ked with suppositors or clysters, and the womb is to be made laxatiue with prunes or Cassia. Cruditie & indigestion is knowen by the qua­litie & quantitie of meates receiued. Also by the time in which they were eaten, and also by ponderousnes, & raw belchings of the stomack. Againe, corrupt humors abounding in the sto­mack, or partes neare vnto it: whether the same be bred there, or that they proceede from the head, Liuer, or splene; they perswade the put­ting off of bleeding, til they may be purged; els this corruptiō of humors drawen into the veins would be more daungerous to the bodie than cruditie it self, and infect the veines, farre with much more vncleannes: whereof do come ob­structions or a consumption, proceeding of the ill disposition of the body: or the diseases which we would cure, grow greater, & their accidents [...]rre worse: yea, and because these corrupt hu­mors [Page 186] are stirred, they become more fierce and hurtfull, nipping the stomack, & the parts cal­led praecordia. i. the fleshie skin called the Mid­riffe, which separateth the heart & lungs from the stomack, Liuer, & other bowels: whereby is caused appetite to vomite, convulsions, Ly­pothimia, Syncope, and other fearsull accidents. The signes whereby to know, whether the bo­dily partes are possessed with corruption of hu­mors are these: loathing of meat, aptnes to vo­mit, vomiting vp the noysom & offensiue hu­mor: oft going to the stoole: heauines & paine in the stomack, fulnes & swelling of the sto­mack & precordial parts. If these apeare in the patient, without cruditie of meats: then are we to expell the offensiue humors out of the first region of the body, which hath bin the cause of the foresaid euils. If the humor of himself giue vpwards, assay the expulsion by vomit: drin­king a draught either of warm water, or of Hy­drelaeū warmed, that is water mixt with oyle: wherof take the quantitic of halfe a pound. If the humor gine downward, expell it by siege. Cassia is not strong enough to purge the hu­mor from the stomack, as not being sufficiēt to expel by siege such clammie & cleauing hu­mors. For Cassia hath but a meane vertue, and that onely to asswage and mollifie. Rubarb, or Senna, or some other gentle medicine, accor­ding to the qualitie of the humor: and not so [Page 187] vehement, as to molest the state of the whole bodie. And these we may vse, not once or twise but oftener if neede require. After all this pre­paration, then we are to let bloud.

VVhen the corruption of humors is spread throughout all the bodie & euery particular part, so that the whole body is vnpure: then we must obserue this order: that is, we must purge euerie part orderly: as first, the greater veines: and this called Mesentericae venae which are branches of the great carrying veine called Porta, by which both the guttes are nourished, and the iuice of meat concocted, is conueyed from the stomacke to the Liuer, to be made bloud. Yea, these veines are the second time to be purged, before wee euacuate the whole habite of the bodie, and not contrarie: that is, from the first veines to the greater: and from them to bring the humor into the state of the bodie: which were not to purge the noysome humor, but to infect and hurt the whole bodie therewith. But this is the course: to drawe the humor from the habite of the bodie into the greater veines, from them into the first veins, and then to bring it into the bely. Yea, this great corruption of humors not onely stayeth bleeding for a time, but often times altoge­ther. And therefore wee let not bloud in the dropsie, in Cacheria, in hard apostumations of the Liuer and splene.

[Page 188] The third matter of the preparation before bleeding was aboue said, to be either the sensi­bilitie or imbecillitie of the stomack. For those persons haue notable quick feeling, whose veins sent from the brain, are soft, tender, open & re­die to occur and meete with any matter, so that these persons without hurt cannot eate anye sharpe, sower or salt things, as vinegar, pepper, mustard. Imbecilitie of the [...]tomake procee­deth either of distemperature, or of a verie thinne placing and standing of the small veines in the same place. And this is knowen by losse ofappetite, when meat cannot abide in the sto­mack, but that there will be always paine ofthe stomack, & a promptnes still to vomit. Those persons that are thus affected, are troubled greatly euen with the hasard of life, of euerie small occasion: as fasting, anger, sorrow, feare & also by bleeding. Phlebotomy in these (I say) wasteth greatly the vitall spirits, & greatly mo­ueth the other humors of the bodie beside the bloud, whereupon there befall to them when they haue bled, conuulsions, the falling euill, sownings & other feareful accidents, which are caused hereby. In such therfore, we must haue a foresight, & corroborat the mouth of the sto­macke with things repelling the sharpnes & in­fluence of humors: as with iuice of a Pome­granate, a Quince, Malum medicum, with iuice of Citrons, Lymons, & iuice of Barbaries, sower [Page 189] grages, viniger, or syrops made of these. If there be doubt of a cold distemperature, vse hote a­romatike things, chiefely syrop of Mynts, Dia­cydonion, sower or sharpe wine, or ypocras. Take a little of these wines, or a morsel of good bread dipt in them, and when the patient hath a little rested vpon it: open a veine, and this is the preparation, if the disease permit it. A ve­hement disease [...]asteneth bleeding, and can­not stay for this preparation: as repletion in wrastlers, in whom present suffocation, or brea­king of veines is to be feared: as a great Pluri­sie: a fernent agewe: a great fall or bruse: In the which wee are more to feare the present danger of the disease, than the hurt by defect ofthe preparation. If we thinke the humors in the bodie to be thicke, and that they will not flow (for which cause also we vse to walke be­fore bleeding) wee may enter into a bath, to make the humors subtile: not the same daye, in which we bleede, but a day or two before: Not in the selfe same daye, because it maketh the skin soft & thinne, and so in the stroke, the skinne slippeth & starteth from the Phleboto­mer, which is verie dangerous. For this cause also wee giue a little syrupus acetosus certaine dayes before bleeding, to subtiliate the matter. And again, that the humors may passe with the more facilitie & become subtile: to prepare thē to this purpose, we vse frication of the mēber, [Page 190] to rub the arme or other parts, & the members next vnto the place that is to receiue incision. Also we giue before bleeding to such persons as haue weak & sensible stomacks nipped with sharpnes of choler, flowing to the mouth of the same, some portion of meat: yet not all meates with indifferencie, but meates of good digesti­on: as a morsell of bread dipt in Syrupus aceto­sus, which comforteth the stomacke through the ponticitie, to vse the old barbarous word the sharpnes or [...]owernes thereof: which also letteth the fluxe of humors, & keepeth them back from the stomack, by reason of a certeine frigiditie. For as soone as choler sloweth to the stomack, so soone by the sharpnes hereof, the same is repressed & repelled.

What is to be done in the verie time of the in­cision. Chap. 19.

THe pacient is to bleede lying in the grea­test quiet that he may, both of body & of mind: especially if the strength of the bodie be infirme, & that there be doubt of Sincope, let him sit vp in his bed, & lift vp his head aboue the pillowes: for while we stand or sit, that fa­cultie which beareth vp the bodie, is in a kinde of trauell, and the entrailes & bowels hanging of the precordiall partes, do enforce the vitall & natural powers. By lying therfore (specially some what vpright) the bodily strength is pre­serued, [Page 191] according to Galen. prima particula. prognosticorum. And as dead bodies are layde forth vpon their backs: so the lying of sicke and weake bodies, must be vpon their broadest part, which is the back. Againe, the back bone is the stronger part of the body, being acording to Auicen the foundation of the bodie, as the keele or bottome of a ship is the ground worke of all the shipwrights labor.

If the partie that is to bleede be fearfull, turne his face away to the contrarie side, & let his minde be drawen by other talke of the standers by from the present practise of the Phlebotomer. The member that is to be o­pened, must hang downward, that the course of the bloud may be direct and easie for that part which we desire most to euacuat. Then that part of the member which we meane to take: as of arme, thigh, hande, or foote: must bee rubbed, to drawe the bloud vnto that part, euen vntill it waxe hote. Next wee take a strong bond & binde it next aboue the place, whose veine must be taken, that the bloud comming downe, the veine may swell and ap­peare in sight. It must be bounde harder in some, than in others: as namely in such per­sons that haue their veines couered, as it were, with much flesh or fatt.

By this hard binding, the veine is stretched out, or swelleth: it standeth sure and flyeth not [Page 192] frō the stroke of the Phebotomer. And third­ly, the bloud commeth forth with the more force: we vse also to binde beneath the place, when the quiuering & vnconstant veine, slip­peth aside out of his place from the hand of the Phisicion. They that haue a full & thick skin, narrow veines, and deepe in the flesh: or great veines, & couered with fat, must be bound both waies, and haue the bond tyed faster than those of a contrarie constitution. If the veines be verie small & little, that they do not fully & sufficiently apeare by binding, as it happeneth in the veines of the hands, feet & ankles. VVe soke them in warme water, or pour warme wa­ter vpon them: that the skin & flesh may waxe soft, and the veines beseene: & then we binde them, & so they bleed the better. If the veine yet appeare not, wee search for it, in the place where it should be with our singars vntil partly thereby, & partly by the fluxe of blod we wel perceiue the same. VVe bind the necke, but softly, when wee take the veine of the fore­head, or the veines vnder the tonug. Yea, many times in these wee take a table napkin, & put­ting it about the necke, cause the partie him­selfe to hold both the endes, as he may suffer or indure the same. VVhen wee throughly and well perceiue the veine, we strike the same soft­ly with the instrument, diligently taking heed, that he wound not in steede thereof, an arterie, [Page 193] sinewe, or some g [...]istly ende of a muskle called a Tendon, lying vnder the veine, or some other part neare vnto it. For somtime when we bind hard with the bonde, there appeareth a place puffed vp with wind, & there swelleth a thing like a veine that is no veine. And sometime, an arterie pressed downe, doth not moue, and so seemeth to be a veine: and therefore to be more sure, let him with the forefinger feele the place of the incision, & the veine vnderneath. This done, let the Phisition take his instru­ment at the verie fingers ends, with a good eye, and a good hande: and let him not put foorth more of the point than is sufficient to pearce withall. And that the veine escape not the in­strument, in one hand, let him hold the laun­cet, and with the thombe of the other hande applyed to the veine that is to be opened, let him settle, presse, and keepe downe the same, chat it start not aside: and so softly without haste, put in the instrument sufficiently, and let the Phlebotomer haue good experience to o­pen a veine with both hands: for a veine of the right aṙme, is best opened with the right hand▪ & a veine of the left with the left hand. The veines in the ioynts in the bending of the arme, & in the hammes being cut in rectum that is right, growe together but slowly, because the ioynts with motion do open still the lippes of the wound. Neither are we so to cut them, ex­cept [Page 194] when wee neede to reiterate bleeding▪ Veines without the ioynts, as in the head, in the hands, in the feet, opened in rectum are quickly couered with a skarre, because the sides doe soone grow together againe.

There lyeth vnder the inner vaine (called Basilica) also an arterie: and vnder the middle veine, a sinewe: and vnder both, for the most part, Tendons of the Muskles. Cephalica veine albeit it be heard to take: yet it is most safely taken of all the rest. For in opening therof a mā cannot light vp [...] ̄ any Tendon, arterie or sinew. VVhen a Tendon or sinew is prickt, there fol­loweth great paine, astonishment, resolution & convulsion of the atme, with a swelling. VVhē an arterie is prickt, the bloud is verie hardly stayed: and consequently through effusion of much bloud: the strength of nature is wasted. Neither doth the arterie heale vp or growe a­gaine togither: but part of it is corrupted like Gangraena, which is a putrifying or rotting of the flesh, by mortifying the sensible parts ther­of: if a sinewe or Tendon be prickt, the same is perceiued by great paine, convulsion, & swel­ling following.

If there be doubt that a sinewe is prickt: let not the wound grow together, till it be safe srō inflamation; & that two or three dayes ar ouer passed: it may be kept from growing together, by bathing of it in warme oyle. After three [Page 195] daies: if the paine cease, & that there come no new accidents, we may permit the vnion, & suf­fer it to grow togethers againe: if not, then we are to vse opening, & attracting things, & such as wil help the pricking of sinewes, as namely turpentine, putting therto somtime á litle En­forbium. VVhen an arterie is wounded there cōmeth forth thin bloud, red, fine & spinning out. To help this case, make a plaister of Aloes, Mirrh, Frankencense, Bol-armoniak, the white of an egge, & haires of an Hare: lay ouer these a linnen cloth dipt in Rose-water, & fasten the plaister wel with a bond that it come not off in 3 dayes: then (this being gently remoued) ap­ply another like vnto it. If the arterie will not grow togither with these, cut the whole arteri [...] ouerthwart, that when the extremities are pul­led vp on both sides, the place may growe, and be couered with soft flesh.

Touching the maner of the incision, & quan­titie of the wound: if we iudge the bloud in the pacient to be thick, clammie & Melancoly: & that the constitution of the aire be colde; the wound must be reasonaby large & wide: that the thick bloud, & grosse fumes, may the bet­ter issue foorth: for the wound in this case be­ing little & strait; the most thinne bloud alone floweth out, the grosse thick bloud remaining still behinde. A large wound therefore is best in these three cases.

[Page 196] First, when the bloud is grosse, thick & Me­lancoly, that it may passe foorth with the more facilitie. Secondly, when there is great abun­dance of humors: for they are better expelled with a large than a narrowe or small wound. Thirdly, when the countrey or season of the yere is extreme colde, as in Winter, in srost and snow: for cold maketh the humors thick. Con­trariwise, a narrow or little cut is best, when the strength of the bodie is but weake: lest the wound being too large, the vitall spirites might immoderatly passe foorth with the bloud. Also in a hote countrey or season, or when euacuati­on of subtile and thinne bloud is requifite: Schola Salerni sayeth:

Fac plagam largam, mediocriter, vt cito fumus, exeat vberius, liberius (que) cruor.
The wound make meane, for meanly done:

The fumes may passe, & bloud may [...]unne. Melancoly & slegmatike complexions bleede often times guttatim. i. drop by drop, & there­fore a larger wound must be made in thē than in others. When the veine is opened, we oft also loose the band from the vpper partes, that the bloud may runne the better. If the bloud run sufficiently, let it alone: if but slowly, & that through fault of the incisiō, amend it. If throgh grosnes of the bloud, or of any other cause; let the patient bend his fist hard together, or turne the staffe about in his hand, or by coughing or [Page 197] lowd speaking, let him enforce the sinewes, Muskles & sydes. And if need so require, bath the wound with warme water. If he be feare­full or faint harted when he seeth the bloud, & that it be stayed through feare; leaue off a while til the strength be recouered, by such meanes as we shal declare anon: Yea, albeit the bloud flow reasonably wel; yet it is good in the midst of bleeding, to stop it with the finger, both to recreat the strength, that it be not too much wasted: & also that the filthie & corrupt bloud may with the more speede come from the in­most partes, & so be expelled.

The quantitie of bloud passed forth is to be considered, as wee shewed before 14 & 15 Chapters, that it may be stayed in due time: & in this behalfe therof two regards are to be had especially. First, the necessitie of the disease. Secondly, the constancie & firmenes of natural strength: wherof looke in the foresaid places more at large. After good bloud apeares, bleed no more for feare of the crampe, convulsion, palsie, dropsie, & such like. In a simple pleni­tude, to auoid imminent dangers, it shal be suf­ficient only to abate the abundance: albeit, a mediocritie stil remain. But in an vniuersal dis­ease, as is a feuer; a mediocritie will not serue, but bloud is abated more then so. And in infla­mations we are not only to regard the quantity but in like maner the alteratiō of the colour & [Page 198] substance of bloud, and when great paine, or in­flamation is in places neere the incision: stay not the bloud before the paine begin to asswage, or the colour of the bloud to change. For alterati­on of colour sheweth that the same bloud (vn­like the other that good is) proceeded from the inflamed part. If the humor cleaue fast to the member, or that by euacuation the strength of nature bee wasted, then wee are vrged to stay bleeding, before the bloud doo chaunge in co­lour, and to detract that which remaineth by reiterating Phlebotomy, either the same day, or the day after. Hyppocrates, 2. vict. acuto. 10. In the cure of the Pluresie writeth, that in the cure of that disease, the inner veyne of the arme is speedily to be opened, and bloud plentifully to be withdrawen vntill the same appeare far red­der than it did at the first: or that for pure and red bloud, the same appeare swart and blacke, which both happen in Plurisies. If the bloud were before rawe, crude, & vndigested: and that it come from the inflamed place, neere an incisi­on: it becommeth redder, or yeallower, because this bloud is horter, than that which went be­fore. If it were at the first thus coloured: name­ly, redde or yeallowish, than when it commeth from a member inflamed, it turneth to be black and swart, thorough adustion, and thus you see how to stop the fluxe of bloud, by the quantity, by the substance, and by the colour of the same▪

[Page 199] As wee are to consider the foresaide thinges, in the bloud, so are wee to consider strength in the Pacient. Of defect of strength these are the signes: The fluxe of bloud relenting: pa [...]e co­lour in the face: gapings: stretchings: noise in the eares: webs in the cies: and defect of see­ing: All these shew a decay of the spirits oflife; they shewe faintnes of the heart; and that the bodily parts are forsaken of inward heate. To these may bee added, the hicket: and a desire to vomit, which commeth of fluxe of the humor, to the mouth of the stomacke, as were already shewed. But the most certaine and assured marke, is the alteration of the Pulse, which changing from thicke to slow, from great to lit­tle, from strong to weake, from equall to vne­quall; prognosticate defect of nature, and a per­turbation in the body, not much vnlike Epilep­sia: that is, the falling sickenes. If these come through feare, or of humors nipping the sto­macke; stay bleeding, recreate and strengthen the Pacient a while: that afterward the residue of the euacuation, may be perfected.

The waies to recouer and fetch strength a­gaine, if the same giue ouer before a conueni­ent and commodious quantity of bloud may be taken, are these: to cast colde water on the face of the Pacient: to sprinckle vppon the face white odoriferous wine, to put to the nose of the same party, vineger, strong wine, muske, or [Page 200] other aromatick thinges, if these helpe not, wee must close vp the veyne a while with the fin­ger, and if neede be, the euacuation is to be im­parted or diuided. But to auoide all these acci­dents, the remedy is to let bloud, the party ly­ing in his bed, for so the partes of the body are reduced into one equality of position, whereby the principall parts mutually bestow one on an other inward heat and vitall spirits: if the Pa­tient bee not brought againe by the foresaide thinges, then prouoke vomit by tickling in the throat, or by pouring in a litle oile, for the force of vomiting stirreth vp strength, and draweth away weakenesse of the stomacke and heart, and presently after recouery, renue the strength of nature, with wine, iuce of Pomgranats, broth of flesh, with the receit called Diamo [...]cho, and other cordiall things.

The instrument may bee annointed with oile, or other such liquor, that it may inflict the wound without paine, and for the most part the wounde must bend somewhat aslaunt or croo­kedly. The incision is made two waies, as Hyp­pocrates saith: one straight Secundum rectum, or Edirecto, downeright: the other contrary crookedly, or a swash. In these two waies wee must vse great discretion, to vse them as neede requireth, and not deceiue our selues, vsing the one, when wee should the other, (as many are deceiued in these daies.) To shewe which of [Page 201] these is to bee preferred, would require a long discourse, whereof read at large, Fuchsius in his Apologie against Brachelius.

There is newe kinde of instruments to let bloud withall nowe a daies: as the Rapier, Sword, and long Dagger; which bring the bloud letters sometime to the Gallowes, be­cause they strike too deepe. These instruments are the Ruffians weapons, more malitious than manly. But in this practise the veyne must be opened with a fine Launcet, no fleme with a beard like a bloud-iron wherewith Smiths let horses bloud, for they will sometime cut a veyn thorough on both sides, causing a crampe and deadly convulsion. And here I giue aduise, that no Surgion except he be very skilfull himselfe, open any veyne without the counsaile of the learned Phisition, or the iudgement of some o­thers, that haue auncient and tried experience in the practise. Ignorant Barbers doo great hurt herein, taking that which comes to hand first, or which appeareth greatest (perhaps a sinew for a veyne) so letting out the vitall spirits, and kil­ling many: and when it is done, this is all their defence, to say the signe was there, and he would needs be let bloud.

Vnction or annointing, is oft vsed in this practise: sometime we rub the member, whose veyne is to be taken with oile, that thorough the warmth thereof, bloud may bee made the [Page 202] more flowing: sometime the instrument is an­nointed, as was saide before, to mittigate the paine of the inflicted wound. Sometime the wound it selfe is annointed, that it may bee the longer time, before it bee couered with the Scarre, and that the humors left behinde▪ may with the more liberty breath foorth, and that the ill humors remaining, may bee also the bet­ter dispersed.

Drinke, and especially wine, may bee very well taken both in the bleeding, if Syncope happen, and after bleeding, to cause good bloud, and to recouer againe the vitall spirits.

Bathing two or three daies before, is vsed in some causes (as was declared in the former chap­ter) but not the selfe same day.

The common opinion is, that bleeding must be done fasting, and vppon an empty sto­macke: but this is not approoued of the best writers, for many of them giue aduise to eate be­fore bleeding a soft or poched egge, with a draught of wine about nine or ten of the clocke [...]n the forenoone: and then presently to open a veyne. For nature (the stomacke being empty, and being altogether destitute of nourishment) doth mightily holdfast, and retaine the bloud: whereas when a little nourishment is taken in small quantitie, as is a poched egge, & a draught of wine; shee permitteth the bloud easily to passeforth.

[Page 203] It hath bin declared before Chapter 16. that if necessitie vrge, there is no prescribed time of bleeding, but that if the disease require, the same may be done at all times, yea euen in the night. Yet the forenoone of the day is the most vsuall time. There is an houre of ne­cessitie, which is any houre in the day or night: and beside this, hora necessitatis, there is hora commodi [...]atis, which is the morning or forenoone houre. viz. Galen. de Curan. r [...]tio per sang. missio. cap. 13. & 20. & in praesagio experi­entia Comprobat [...] cap. 4. Aetium lib. 3. cap. 16. Oribasi. lib. 1. cap. 11.

Moreouer, if a veine opened send forth bloud whitish in coloure: stay the same, for it ap­peareth that the humours in the bodie are rawe, colde, and vndigested, through defect of naturall and digesting heate. This is affir­med by Aristotle lib. 1. & 9. de animalibus: and Hippocra. witnesseth, that alwaies womens termes appeare not in their proper colour; & that by reason of frigiditie and coldnes of white bloud, they oftentimesvomit, and haue fluxe of tearmes.

Finally, as in purging, so in bleeding, as wee haue already said, wee are to consider the standing of the wind, & in winter to bleed whē the same is Sowtherly: & in Sommer when the same is Northerly. For the North wind with cold tempereth the heat of the time.

[Page 204] The verses of Schola salerni.

Hac facienda tibi, quando vis Phlebotomari,
Ʋel quando minuas, fueris vel quādo minutus,
Ʋnctio siue lauacrum, & potus fascia, motus,
Debent non fragili tibi singula mente teneri.
Before and after letting bloud,
all these are meete and requisite:
Vnguent, a bath, strong drinke and good,
with motion mean, and bonds most fit.
Remember all doo none forgit.

A prescription, or regiment of the patient, after bleeding. Chap. 20.

WHen a sufficient quantity of bloud is withdrawen, proportionable vnto the greatnes of the disease, vnloose the bond, and drie the wound: lest beeing moistened with clodded bloud, either it growe not together againe, or bring some doubt of impostumation. These thinges not done ac­cordingly, enforceth vs sometime the eight day after, to open the wound againe. If any piece of fat come forth, the same must not be cut off, but softly put againe into the wound. When the wound is wiped cleane, & drie, close vp the veine with linnen dipt in rose water, or sweete water; or with Oile, if wee purpose to bleede againe. Let the same bee tyed on [Page 265] with bondes: not too [...]hard for writhing the skinne, or lippes of the wound.

If a sinew or Tendon be pricked, yee heard in the chapter before what is to be done. If there be doubt of fluxe of bloud, or an inflammation through pricking of a sinew, we may beside the premisses, apply after the practise of others, a plaster of Ceruse: and in compas about that, a Cataplasme of Housleeke, Nightshade, Plan­taine, and other cold things. After bleeding lye a while on the backe, for quietnes sake, and to recreate the strength of nature, and to recouer the vitall spirits. He must not frequent his accustomed affaires, nor moue his bodie haste­ly, nor exercise himselfe immoderatly, nei­ther must he vse Venus delightes, nor yet bath himselfe. For the bloud and spirits naturall, vi­tall and animall which haue of late bin vehe­mently stirred by bleeding, are now by rest a­gaine to be setled: else the same bloud and spi­rites would by these outward vehement exer­cises, bee inflamed, and so wast and consume away. Neither must the party presently sleep, lest either the languishing heat be quite extin­guished, or the lessened spirits, altogether o­uerwhelmed. Let him therefore watch, and rest void of contention, either in mind or in body. When an houre or two is past after bleeding, a litle meate may bee giuen him: Little (I say) in quantity, but of good iuice, to nourish the [Page 206] bodie, and profitable also to withstand the present disease: & when 2. hours are past this short repast, he may then sleepe, so as his kee­pers carefully take heed, that he tumble and turne not himselfe on the arme that hath bled, or that the bond by tumbling and tossing be not remooued, which may cause the bloud to slow againe a fresh, or some other displea­sure to fall out. Afterward the diet must bee increased by little and little, both in respect of the quantity, and of the goodnes of the meat. Neither as yet must we hasten to a full diet, for the heat of nature being abated by bleeding, can not as yet receiue or digest aboundance of meat. And againe, the veines lately emptied, would exhaust out of much aboundance of meat, much raw and vndigested matter, wher­with the whole bodie is stuffed againe. If con­coction bee perfected and accomplished, so that we may eate great quantity of meat, yet vse a moderation: for to what purpose is it, presently againe to stuffe the bodye with iuices and humours: for the abating and ta­king away wherof, we did so lately let bloud. Therefore after bleeding the patient is to liue more finely and exquisitly, and not to goe to his old intemperat diet againe, as the dog to his vomit. Neither are these intemperat per­sons meete men to be let bloud, as we prooued and shewed before in the 8. Cap. Fig. 1.

[Page 267] Of reiterating bleeding, which they call Epa­phaeresis, this is the order. First in inflamations, great paine, hot feuers caused of aboundance of hot bloud: a veine must be opened, as is al­readie shewed, euen presently at the very be­ginning before the matter be gone to som prin­cipal member: not only that the aboundance and excessiue quantity of bloud, but that much more a great deale, euen plentifully, and ge­nerally may be euacuated, yea euen till the pa­tient giue ouer, if the strenght of the body so permitte. And in diseases caused of fulnes, the bodily powers are firme for the mostpart: nei­ther doo they shrinke or relent much, by this plentifull bleeding. And when Hippo. permit­ted bleeding so long, till the patient should giue ouer: hee ment it so, when the strength therevnto sufficient, was able to beare it, and not otherwise. For if fainting doo happen whē the powers of nature are firme and constant, it doth only wast the spirits in the arteries, those forces remaine still vnhurt and vndamnified, which narure hath bred in the hart, Liuer or braine. And albeit these decay in Lypothimia, yet of the setled forces other like presently come in place whereby againe the Patient is reuiued. But when the strengh of the bo­die is weake, and greatly enfeebled, be­cause the forces of nature setled and seated in the principall members, are also impaired.

[Page 208] If Lypothimia then chaunce, re [...]itution wil hardly be made. Therefore (I say) the vertues of nature beeing greatly debilitated: beware of ouer comming or fainting. And this is the or­der in great and vrgent sicknesses.

In small generall diseases, as in repletions, fulnes, feuers, and such like, whose cause and principall matter is conteined in the veines: if bodily strength permit, we must presently eua­cuat, & wholly at the beginning, & at one time: not till the patient ouercome, but so much as is needefull▪ and as the infirmitie or malady requireth. And this euacuation with­out any hurt to the naturall forces, withdraw­eth the matter abounding, either before the same do wholly putrify, or that it pos [...]es [...]e some notable member, or before any horrible acci­dents happen. He that for feare or any other cause parteth or diuideth in these, the euacua­tion: he continueth the disease long time, & doth no good, but great hurt to the sicke pati­ent. But if for imbecillity of strength the whole euacuation can not be accomplished or done: seeing it is better in this case, to marke the strength of the party, then the vehemencie of the disease: we are inforced to vse partition in the bleeding; and yet with a great circumspe­ction and care: and let the partition be within a litle distance of time, either by vndooing or vnloosiug of the bound, or stay the blod with [Page 209] applying the finger on the wound so long, as by the foresaid meanes, the forces of the body may bee recouered. Sometime an hours space is sufficient, sometime more houres [...]re requi­red, to the restoring of the forces of nature. The best way is not to deferre the partition of bleeding past one day: yet (I say) if strength permit, & that partition must be vsed, bleede twise in the selfe same day, in general diseases especially: & except other imped [...]m [...]ts great­ly let, euacuacuat in one day, asmuch as is ex­pediēt, before the matter come to putrffaction or that other euils do grow. But in partiall dis­eases of particular mēbers, chiefly in inflam­mations, the parted or diuided euacuation may be put off a longer time, either to the day following, or to the day after to morrow: that in this space, the corrupted humours, may goe from the member diseased into the veins exhausted: and so by the next incision, be eua­cuated. The member of the bodie that is af­flicted with griefe or corruption, by little and little, euen in one day or two daies at the most, sendeth downe the humours to the place where the incision was. And for asmuch as they are corrupted, they are not there to remaine: albeit the former paines be mittigated and as­swaged. But if the inflammation bee pestilent and venomous, as is a pestilent botch or car­buncle, the euacuation of necessitie must be [Page 210] reiterated euen the selfe same day: lest the pestilent infection sticke and stay any long time, in the veines, to the great hurt of the partie.

But neither must reiterating of bleeding be vsed: For thereby the vitall spirites, and in ward heate is diminished, and vntimely age is hastened on apace, and the same when it commeth is made subiect to greeuous disea­ses, as Chachexia, the dropsie, gout in the iointes, trembling, palsies, and apoplexies. Yea when the naturall heat is immoderatly cooled and naturall moysture wasted, the bo­wels languish, crudity and vndigestion begin­neth to beare rule, whereby are caused great and greeuous euils in the body of man. And thus much of the reiterating of bleeding, and order thereof.

But let vs come againe to our former matter of prescription, moderat motion, & easy wal­king, as it was conuement before bleeding, to vnloose, and make the humours thinne, so also the same is necessarie after bleeding to disperse abroad the reliques of those vapors and humours which are left behinde. And as bondes of linnen were vsed before bleeding, to the intent the veines might waxe bigge, appeare full, and bee the better perceiued and seene: and that the humour with the more facilitie might come to the place appointed [Page 211] for incision: so afterward, they are also need­full, to stay the fluxe of bloud, and bind vp the wound.

It was already said that the partie let bloud must not sleepe, that is to say, not within the space of eight or sixe houres at the least▪ whereof this is alleaged as a reason, that the fumes caused by sleepe, bee not carried vp to the head, and so offend the braine▪ There may hereof bee aleaged other caused more, as namely: lest the veine opened should take hurt by tossing of the patient vp and downe in his sleepe: which cause was lately aboue spe­cifyed. Also lest in sleepe the humors should flow to the member, where the incision was made, and there apostumat. For pained pla­ces as Galen affi [...]meth Capit. 95. medicinati [...] artis & lib. de Curand, ratio. per sang. missio­nem. Capit. 7. are by nature accustomed to re­ceiue fluxes: and chiefly in sleepe. Auicen alleageth this reason: Because by sleepe af­ter bleeding (for the most part) there chaun­ceth in the members, a confraction or b [...]using. For while the member is tossed hether and thether with inordinat and vnorderly moti­on: the bondes are vnloosed, the wound vn­healed, and (as it were) newly opened, not­withstanding the late incision, it doth a­fresh sende foorth immoderat fluxe of bloud, the partie in his sleepe not witting thereof▪ [Page 212] whereby (as all men know) the life commeth into great danger. Againe, another discom­modity by sleeping immediatly after bleeding is: that fumous excrementes through sleepe are againe inwardly reuoked to the principall members.

Againe, the vitall spirits, and natural heat, which by opening of a veine, are drawen to the outward partes and members, by sleepe are reuoked to the center, or middes of the bodie: and so very often, partly through a commotion made by incision, and partly through that retraction made by sleepe: such a boiling happeneth in the humours of the body, that oft therby at length a feuer is cau­sed and kindled. It is therefore apparant, that sleepe presently after bleeding is not good, and chiefly if in the meane season the patient haue receiued no meat. If after taking of meat hee sleepe an houre or two, or more (dispositi­on so seruing) it hurteth not at all, or verie little.

But for as much as the commotion of hu­mours can not fully be setled in short space af­ter bleeding, it is far safer to forbeare sleepe, as we haue proued by sundry reasons. If neces­sity & dispotition v [...]ge sleepe, let the same bee short, and with a d [...]ligent circumspection, that the bonds bee not vnlosed, and so the Patient brought in perill of his life. Some bring in a [Page 213] further reason, yet of the fore said, namely, why we should not presētly sleep after bleeding & that is: because the matter through sleep▪ wax­eth thicke, and so a brusing or a confraction that way happeneth in the members: as is ac­customed in a quartan, through the thicknes & coldnes of the matter. Againe the veines & si­newes after bleeding, being now emptied, are becom cold, & so the fumes which are brought vnto the veines and sinewes in sleepe, do also be come thicke and waxe colde: because by sleepe the whole naturall heat of the bodie is drawen euen into the depth and profunditie of the bodily partes. And when the veines and si­newes are become cold, partly for defect of bloud, partly through cold fumes brought by sleepe vnto them: they doo participate gros­nes, coldnes, & confraction to the other mem­bers: for it is a principle, Simile a simili facile afficit [...]r. Like of the like is easily affected. And thus much of sleepe after bleeding, which is to bee vnderstood of sleepe onely following im­mediatly after, and not otherwise.

The verses of Scola Salerni concerning this point are these.

Sanguine subtracto sex horis est vigilandum,
Ne somni fumus laedat tibi sensile corpus
Ne neruum laedas non sit tibi plaga profunda.
Sanguine purgatus, ne carpas protinus escas.
[Page 214] Sixe houres sleepe not, when bloud is let:
The fume by sleepefull hurtfull is:
It hurtes the veine, if stroke be great,
To feede streightwaies, is farre amisse.

The patient is a while after bleeding, to ab­staine from meat, till the motion of humors be appeased. For in this case, rawe iuices and meat not yet concected, is drawen with the bloud to aid the member afflicted. Looke Galen, lib. 4. Cap. 10. de Sanitate tuenda.

Milke, & meates made of milke, after blee­ding are to be eschewed: for certeine of those humors which were troubled and moued in o­pening the veine, flowe vnto the stomack: and forasmuch as milke is otherwise of it selfe, sub­iect to corruption: being nowe in this case in­wardly receiued, & mingled with the foresaide humors: it is verie soone putrified: and because of the sweetnes thereof, though it be vnconco­cted & rawe, yet it is mightily sucked vp, and drawen in of the emptie veines.

Irem, all cold things, either in wardly taken, or outwardly applyed, are to be auoided: of which sort are chiefely cold meats, cold drinks, cold bathings & washings, cold aire, thinnesse of clothes, bare sitting vpon stones, coldnes of the head & feete: for by these the body would be immoderatly cooled; natural heat being al­readie diminished through bleeding.

[Page 215] Item, mistie & cloudie aire is to be eschewed: for such weather ingendreth Melancholie bloud, & maketh a heauie mind. He must ther­fore walke in cleare, bright & faire weather: for thereby the spirits of life are refreshed.

Item, immoderat motion is to be forborne, & a temperat quietnes to be imbraced, both of body & of mind. For vehement mouings do yet more & more stil disturb the humors of the body, before excited & stirred vp by bleeding▪ & so consequently the same weaken too much the bodily forces: wheras quietnes & rest soon appeaseth this commo [...]on of humors.

Item, eating of salt fish is to be auoided af­ter incision: for these salt meates often times cause itchings & scabs▪ Simeon Sethi, depiscibus.

The verses of Schola Salerni, in these matters.
Omnia de lacte vitabis rite minutus,
& vitet potum, Phlebotomatus home.
Frigida vitabit, quia sunt in mica minutis,
Interdiclus eritq▪ minutis, nubulus aier,
Spiritus exultat (que) minutis, luce per auras,
Omnibus apta quies & motus s [...]pe nociuus.
VVhite meates eschew, d ink not too much
Cold things forbeare as ill for such▪
VValke not abrode in clowdie daies,
cleare aire doth cheare the spirits alwaies,
Be wholly quiet at all assayes.

[Page 216] Item, Beware of much meat, the first or se­cond day. And let the meat be of good digesti­on, and causing good blood: as soft egges: good wine: chickens, and such like. Therefore Isaac in dietis saith of such as are let bloud: that their meat must be lessened, and drinke increased: that is, the drinke must be more in respect of his meat that he eateth daily, not in regard of that custome which he obserued before blee­ding. Yea, he must nowe drinke lesse than he did before.

Some after letting bloud, are verie drye in the mouth: which happeneth through the great motion of the humors, and by abundance and ebullition of choler, whose fumes arise vpward to the mouth & other parts. These are to drink Barlie water, to mitigate the acuitie, sharpnes & heat of choller: & so must they do in like ma­ner that are in doubt of inflammation of the Liuer and stomake, through abundant boiling of chollericke humors: specially, if it be red choller, that aboundeth in them.

If through hard binding of the arme, be­fore or after bleeding, paine doe ensue, and so consequently sluxe of humors to the place cau­sing apostumation in the arme: then according to Auicen, let bloud in the other arme: or ac­cording to Rhazes, aboue the place in the same arme; and apply to the place repercussiues to keepe backe the matter.

[Page 217] The wound in the arme after bleeding som­time healeth but slowly, because the instrumēt was annoynted with oyle, as wee said before, that the same might enter the better & do lest hurt to the pacient, as Galen saith 9. Method. The cause now of this slowe healing is, for that the healing is much hindered, by reason of the oyle which is betweene the sides or the lippes of the wound: For, as the same Galen & other authors affirme, a wound is not cured or healed as long as there is any thing betweene the sides or lippes of the same. Another cause why after bleeding the wound closeth but softly is, that there hath bin too much euacuation of bloud, whereby the force of nature is debilitated, which hindereth the continuatiō or consolida­tion of the wound. A third reason hereof may be, the oft mouing of the arme: for wounds do neuer heale, except the member enioy rest, where they are inflicted. Therfore let this fault be remedied by contraries, as thus: Let not the instrument be oyled: euacuat not too much [...]loud: & lastly, forbeare exercise & motion of the arme.

What veines are to be opened, both in generall, & particular diseases. Chap. 21.

SOmetime are opened veines, & sometime arteries. Of opening of an arterie wee pur­pose to speake afterward in a Chapter by it selfe. And now of opening onely of a veine; [Page 218] which is vsed in many members: Sometime in the arme called Manus magna: somtime in the hand called Manus parua: somtime in the feete: somtime in the nose: somtime in the forehead: lipps: toung: palat, or roofe of the mouth: some­time in the corner of the eye, toward the fore­head: sometime in one place: sometime in ano­ther: as this discourse following doeth plainly teach. It is knowē to those that haue seen Ana­tomies, that there are in the bodie of man, two sortes of veines. Generall, & speciall.

Fiue veines are opened in Manu magna, in the great hande: that is, ab ascellis vsque ad cu­bitum, that is, from the elbowe forwarde, or downward, as Rhazes faith in 7. ad Almonsor. Chap. 21. and Auicen in quarta. i. Chap. 20. VVhere note, that Phisicions by the great hande, do meane the whole arme, together with the hand: as by the foot, the whole legg, from the hippes or huckle bone, to the soale of the foote.

The common or generall veines which ap­peare in the middest of a mans arme, are these: The first is Humeraria, or Humeralis, in Greek called Omiata, because by the shoulder it commeth to the hande. It is also called in La­tine Vena exterior, the outward veine, because it goeth along on the outside of the arme. It is againe called Cephalica, or the veine of the head.

[Page 219] This veyne is most apt and fit, and most safe to bee opened, for diseases of the vpp [...]r parts of mans body; it is lesse dangerous than the rest, because there is no sinew or artery vnder it, to hinder or indanger the opening thereof. If a man chaunce not to touch it at the first stroke, he may be bold to strike it againe: for there is I say, no ieoperdy to cut any muskle. It is ope­ned with a long cut to let out grosse bloud: and albeit there be no feare of any sinew, artery, or Tendon vnderneath it: yet wound it not too deepe, for feare of apostumation. This veyne is taken when the parts aboue the breast or necke (as the face or heade) are discased. Therefore it is opened profitably for passions of the heade, as Hemicrania: the Mygrame, and Mania: Madnesse, which commeth of too much abundance of good bloud, hauing re­course vnto the heade: And such other like hote passions of the head, proceeding of ho [...]e matter.

Also Cephalica is taken in headach: watch­ings: and paines of the eies. If it bee opened for headach, purge a day before with a certaine quantity of Pils of Hiera simplex, according as the learned Phisition shall appoint thee to take. If you cannot finde out this veyne in the arme, take his braunch about the thombes ende. Galen cap. decimo sextode Curand. ra [...]io. per sanguin. missio. Cephalica opened, cuacuateth [Page 220] and pulleth backe from those parts which are a­boue the canell bone of the throat called Cla­uicula, and this it doth with the more celerity and greater speede, if it be opened in the arme: more weakely, and with lesse speede, if it be ta­ken but in the braunch thereof: that is, be­tweene the forefinger and the thombe. Inward and outward affects of the head, whether they be but yet a beginning, or that they are in Statis maximo, in the greatest force; are cured and drawen backe, by opening Humeraria veyne in the right arme, if the affects be on the right part or side of the heade: or in the left arme, if the paine be on the left side. This practise may be done not so speedily but at more leysure, only to preuent the foresaid cuils to come, by opening the braunch of Caephalica, iust betweene the thombe and the forefinger. These affects are oft remoued without opening of a veyne, as are also sometimes frensies, rauinges, apoplexies, e­uen by scarrification of the shoulders, by box­ing and bleeding at the nose. Item eies infla­med, and burned with sharpe droppinges, and cies that water, are remedied: First by opening of Humeraria on that side where the paine is most: and afterward the matter of these affects is pulled backe, by applying cupping-glasses, to the hinder part of the necke and shoulders.

The second generall veyne in the arme, is the inner veyne of the same, called of the Greekes [Page 221] Haepatitis: Of the Latins Fecoria, or Lienaris: late Phisitions call it Basilica or Regia in the right arme it is called Hepatica, the veyne of the Liuer: and in the left arme Pulmatica the veine of the lungs: it is also called vena interior, and it commeth or groweth thorough the armehole. Fuchsius calleth it Axillaris: that is, the veyne comming from the liuer to the arme hole: Of Axilla which is the arme hole, or hollow place vnder a mans arme, where the haire doth grow.

The opening of this veyne is very doubtfull and dangerous, both for the artery, and muskle that lyeth vnder it, and alfo for the manifold and vncertaine course of the sinewes in that place: & specially it maketh a man more doubtfull in the inner bought of the arme, than in other pla­ces, because there the arme is lesse fleshy. Igno­rant Barbers, thinking to open Basilica open of­tentimes a great sinew hard by it, which is like a veyne, and so the vitall spirits, and life it selfe oft runneth out together with the bloud, and this doo ignorant Barbers take in cure for headach, and want of sleepe, when they should take Ce­phalica, of whose dangerous boldnes we spake before, Chap. 19.

This veyne emptieth from those parts which are beneath the necke, as are the breastes, sides, lungs, heart, liuer, spleene and marrow: yea, it emptieth from the middle part of the body, vs­que ad Clauiculam, to the canell bone of the [Page 222] throate, and i [...] opened to helpe passions of the brest, stomacke, spleene, and liuer, and also to helpe Pluresies of the sides. If ye cannot spie it in the arme, seeke the braunch of it betweene the fourth and the little singer: the liuer and heart are the roots of this veyne.

Seuerall fulnes, being no affect of any parti­cul [...]r part, without choice may be withdrawen from any veyne: yet most commonly it is done with greatest profit, from the inner veyn of the right arme; which principally eu [...]cuateth from vena caua: the hollow veyne and the liuer. So also is fulnes of choler, taken fromthe inner veyne of the right arme, as melancholly re­pletion is abated from the inner veyne of the left arme, according to the s [...]ituation of the Milt. In which regard, the Basilica of the left arme is called aboue Lienaris. That repletion which commeth of a filthy gathering together of raw and crude humors, must equally bee ta­ken out of both armes.

In the cure of Feuers, this order of blee­ding is to bee obserued: A simple Sinochus fe­uer, or a simple feuer putrified or caused through putrifaction of humors: requireth to haue the Basilicam of the right side, or arme opened. So doth an hote pestelenciall feuer simple, and not compound. So doth a tertian, and a continuall quotidian. A quar­tan requireth the inner veyne of the left arme▪ [Page 223] This is also the Methode in pure intermit­tant and discontinuing feuers, if either the plenitude or accidents will haue vs to open a veyne.

Revulsion of matter from those partes pla­ced betweene the canell bone of the throate and the raines: is done from the right Basillica or left, as the disease requireth, if the right parts be affected, open for revulsion Basilicam dextri brachii: If the left, the other Basilica: Open this veyne in the arme, if great and spee­dy bleeding be needefull. If a more slacke and remisse bleeding will serue the turne, seeke the braunch of it in the hand, betweene the little finger and the fourth, as some say from the right kidney to the left, and passing ouer the bottome of the stomacke.

Inflammations in the gut called Colon, which is a great gut rising from the left side to the right, or in which is the disease called the Col­lick, albeit the same be vnder the raines, yet they are cured by revulsion; opening Basilicam, or the inner veyne of the arme. For so the begin­nings, and deriuations of the veynes doo shew.

In inflamations of the lungs: take the Basili­ca or inner veyne of the left arme, rather than of the right, because the veynes of the lungs, come from the right side of the hart, which part of the heart is placed toward the left part of vena caua, & so by the left wing, rūneth into the left arme.

[Page 224] This order of incision also helpeth spitting of bloud, thorough extreame coughing: the disease called Tabes: trembling of the heart and such like.

In a Ṗluresie, open the Basilica of the arme, according as the paine shall happen in the right or left side. In a Pluresie of the right side, the right Basilica, and so contrary. Item the interior veyne is taken in inwarde and outward apostu­mations of the brest, or midriffe, and in inwarde Vlcers, which cause vs to spit bloud. Thus also by opening of Basilica, are cured inflamations on the shoulders, and vnder the arme holes: ex­cept they come to the very bought of the arme: for then it were very dangerous to open the very part or member inflamed; but in this case we open a veyne in the hand, e directo: that is, straight.

In paines and inflamations of the Liuer, wee open the right Basilica: and so the left Basilica when the Milt is inflamed, grieued, or ill affe­cted: and in all these wee must take the veyne in the arme if much bleeding be needefull: and if not, then the veyne in the hand. Deriuation from the Spleene, is not made as some do think, into the veynes called Hymorroide, but into the belly. So de [...]iuation from the hollownes of the Liuer▪ is made also into the belly.

A postumations in the Raines, when the veynes also all full of bloud, are repelled by the [Page 225] right Basilica, if the right kidney bee grieued: by the left Basilica, if the left kidney bee ill affe­cted.

If excessiue fulnesse doo not vrge in these a­postumations, the revulsion is better attemp­ted out of the lower veynes, which are straight and right, as out of the right or left anckle.

Affects of the belly, as immoderate fluxe of termes, are stayed by opening Basilica in the arme, which draweth the fluxe vpwardes: So doo also cupping-glasses, applyed either to the paps or nauill.

That revulsion which is made by opening Basilica in the arme (specially the right Basilica) is to be accounted generall: because it draweth from the Liuer (which is the fountaine it selfe) from whence all fluxe of bloud commeth, whe­ther the same bee fluxe of termes, or any other fluxe of bloud.

Revulsion made from the lower veynes, is particuler: not euacuating first from the Liuer, the fountaine of bloud, as the other doth. And forasmuch as things vniuersall, goe before parti­ticuler things: therefore in inflamations vnder the kidneyes, wee must first pull backe with di­rect opening of Basilica in the arme: and after­ward wee are to open the lower veynes, which also haue some force to reueale: but if either the fulnes or the fluxe be great, it is not best first to open these v eynes below.

[Page 226] Finally imminent diseases like to arise tho­rough plenitude of bloud, are kept backe be o­pening the right Basilica: that is, the inner veyn in the bought of the right arme.

The third generall veyne in the arme, is the middle veyne, called of some very properly and fitly venacommunis: of other Cardiaca or Cor­diaca: venanigra: and Mater: and of the bar­barous Phisitions, Mediana. It is called Media or Mediana for three considerations: First, inre­gard of the scituatiō, hauing in the vpper part of the arme aboue it Cephalica vein, & in the lower part of the arme beneath it the Basilica veyne: and so these being as it were extreames, it pos­sesseth the mids betweene them both: Yea, it is indeede a braunch of them both. And for this cause secondly it hath the name Mediana, as if it were made of them two, as the meane is made or consisteth of the two extreames. Thirdly, it hath the name Media or Mediana, for that it is Media: that is, in the middle in respect of eua­cuation: Euaeuating both from aboue and from belowe, aboue the necke, from the necke, and from beneath the necke: For it springeth (I say) from the diuision or parting of both the other veynes, that is, Cephalica and Basilica.

By opening this veyn, there is made a gene­rall euacuation of humors, through the whole body. A generall or vniuersall euacuation I call it, not because it springeth frō the hart as some [Page 227] affirme, but because the fluxe commeth gene­rally from all parts: This veyne being a braunch (as yee haue heard) both of Cephalica and Ba­silica.

This veyne is taken when neither of the o­ther appeareth, and withdraweth bloud from them both, according to the iudgment of some: This veyne is the same which is called also Funi [...] brachii. Cephalica and Basilica, are (as it were) the Parents of Mediana: As often there­fore as thou art determined to open Basilica, and that the same doo not appeare, take rather the Mediana veyne, than the Cephalica. And if thou purpose to detract bloud from Cephalica, and that the same doo not shewe conueniently; open rather Mediana than Basilica: and being compact of Cephalica and Basilica, it with­draweth bloud indifferently from them both: both from place and parts beneath, and also a­boue.

Some giue aduise (vpon what ground I doo not yet see) not to open Cardiaca if the Pati­ent feele any weakenes at the heart: but if ne­cessiity of bleeding bee vrged, the heart beeing enfeebled, wee are rather to open Cephalica or Basilica.

This veyne is opened to cu [...]e [...]assions of the whole body, especially when they pro­ceede of heate of the heart, and of the Lungs▪ In opening whereof wee must bee very warie [Page 228] and circumspect, for vnder it there is a certaine muskle, which being very deepely cut or pear­sed, bringeth the Patient in ieoperdy of life: and it is opened in paines of the brest right side, and in Pluresies; and must be opened somewhat o­uerthwart. The danger in the cut [...]ing for the si­new vnderneath, is especially, if the wound bee deepe: and the same daunger in the Greeke is called Aneurisma. Yet for all this, there is lesse perill in opening of this, than of Basilica: and as being compound of Cephalica, and Basi­lica, it euacuateth from them both: so it reuel­leth and pulleth backe from them also, and is for the most part deepely wrapped in the flesh, and appeareth not but as it were Soboles, an off­spring of Cephalica and Basilica. VVhere note that albeit the opening of a veyne, as Galen, and Auicen do testefie, be an vniuersall euacuation out of the whole body, yet not so of all veynes a like, but chiefly that is to bee called and accounted a common and generall euacua­tion, which is made out of these three com­mon and generall veynes in the arme: And as affects of the vpper parts are cured by inci­sion of the vpper veynes, in the arme; So are griefes of the neither partes, by opening of vey n es in the h [...]ms and anckles, as Galen faith, and as wee gaue instructions before in the eighteene and nineteenth Chapters. If wee doubt whether the [...]atient will bleede effectu­ally [Page 233] or no. First, bath the arme in hotte wa­ter, and when the wound is inflicted, drawe the wounde wide and abroade, that the grosse melancholly bloude, may the more eassy passe forth. Note also that in all sickenesses and times, except in time of pestilent infection: that veyn of the three, must be taken: which appeareth biggest and most full: for by that yee may per­ceiue that the members appertinent to those veins, are most abounding with superfluous hot▪ bloud. And thus you see the profit of opening the common veynes in the arme.

Moreouer a veyne opened in the arme, stay­eth fluxe of hemorroids: If any inflamation be about the priuy parts, Arese, Bladder, or other parts called Obscaenae: so as ther be no venombd matter in the same; the fulnes and flux is to be abated out of the vpper veynes in the arme. After the which if necessity require, particuler revulsion may bee made out of the lower parts▪ And so in fulnes and fluxes of the thighs apo­stumated; first open a veyne in the arme, and af­terwardes in the foote. If the plenitude or in­flamation be but small, omit the vpper veynes, that euacuation from the lower partes shall bee sufficient: And this is the order of opening a veyne either in the beginning, or in the state of diseases.

For detraction of bloud, to withhold disea­ses like to come of present fulnes and repletion▪ [Page 230] to stay the Hemorroids, withdraw the fulnes out of the vpper veines. If a member haue full veines broken, or like to break, & that the mē ­ber readily receaue fluxes comming vnto it, & that there be yet no disease bred: do not eua­cuat the matter at a veine ve [...]ie nigh the af­fected part, but a farre off, and direct as it were: whereby the future fluxe may be stay­ed, and the accustomed force withdrawen another way. And thus much of the gene­rall veines in the arme.

Now to proceed to special veins: we are first of all to call to mind: especially the veine cal­led Saluatella, or Salubris: this veine is cal­led of the Arabians, barbarous phisitions, and of Auicen Sceilen. This veine appea­reth in the hand betweene the ring finger and the middle finger, where wee are to note that oftentimes among the Arabians & barbarous phisitions, that veine which sheweth it selfe, at the wrest, and is compact of a braunch of Cephalica or Humeraria veine, and the veine called Axillaris, is called Sceilen: whereup­on late writers call also the veine Saluatell [...] Axillaris.

This veine is opened in the right hand, for obstructions of the Liuer: and in the left hand for obstructions of the splene: where of as yet there is no apparant reason, but that exper [...]ēce prooueth it to be so. Moreouer when we open [Page 231] this veine, the hand of the patient must be put in warme water till the veine be puffed vp, and swell, and may easily bee seene: and that the humour may bee made subtil. Yea when the veine is opened, it is againe put into the water, that the bloud may the sooner issue foorth: if it com forth but softly as it accustomably hap­peneth to most of those that bleed at this vein. Againe, it is good to let it bleede in the warme water, lest the wound bee too soone coue­red ouer with the skarre. Rhaz. lib. 7. Cap. 21. ad Almons. and Auicen quarta prim, cap. 20. When this veine hath bledd as much as you will, apply on it a little Oile and Salt, and there is no feare in it, because it is far from the hart. This practise (I say) of opening Salua­tella for opilations of the Liuer and splene, hath no manifest reason, but is grounded vppon Galens experience: who hauing a patient trou­bled with those diseases, deemed, that if he did let her bloud of Saluatella veine, shee should recouer: which hee did accordingly, and she was cured presently.

Saluatella in the right hand betweene the little finger and the next adioyning, is opened in opilations of the brest, against gummy mat­ter in the e [...]es, perbreakings, yellow iaund [...]es, paines of the cholicke in the right side of the belly. Saluatella in the left hand is opened a­gainst all diseases of the splene comming of [Page 232] repletion & oppilation: it is good to heale the Hemorroids, frensies, and chollickes in the left side, diseases of the veines, and aboun­dancè of termes. And I am here to aduertise of the variety which I find among writers tou­ching the place where Saluatella is to be ope­ned. For the most part I take it to bee opened betweene the middle fingar & the ring fingar. Yet another place of his incision (as some hold) is betweene the ring fingar and the eare fingar or little fingar.

Of the incision of Satuatella sixe vtilities are found & numbred. First it purgeth the splene: secondly it clenseth the Liuer: thirdly it purifi­eth the brest: fourthly it taketh away impedi­ment in speach: fiftly it conserueth & keepeth from hurts those parts called Praecordia. i. the strings of the hart, the mouth of the stomake, and all the spirituall members neere the hart: sixtly it remoueth vnnaturall paines, euen from the ha [...]t it selfe: Which commodi­ties are conteined in these verses of Schol [...] Salern [...].

Ex Saluatella, tibi plurima dona, minu [...]a,
Splenem, hepar, pectus, vocem, praecordia purgat.
In naturalem tollit de c [...] de dolorem.
Veine Saluatel doth profite all,
The splene, the Liuer, brest, and voice.
It purgeth partes praecordiall,
And makes the hart for to reioice.

[Page 233] And thus you see from how many places the opening of Saluatella withdraweth bloud: that is from the splene, liuer, brest, precor­diall partes, and the hart it selfe: in whose o­pening, no daunger is to bee feared, onely with warme water (as yee heard) we must both subtiliat and make thinne the bloud, & cause the small veine, the better to appeare in sight.

Although (as yee heard in Saluatella) that this name Axillaris, of some writers bee giuen to the veine Saluatella: And that the veine cal­led Sceilen of the Arabians, is also of some cal­led Vena Axillaris: yet in truth, we following the most approued authors, take here Axillaris to be a braunch of Basilica, & that it appeareth in the bending of the arme downwards, & for Phisicke helpes is iudged to remedy those dis­eases, which are cured by opening of Basilica.

Funis brachii is like Cephalica, & is a branch of Cephalica descending, and the iudgement thereof in phisicke helps, is as the iudgement of Cephalica aforesaid.

Arteries, as in whom is the greatest danger, they are placed of nature far more inwardly, & the veines are more outward, to keepe the body from dangerous hurts. Of Arteries wee purpose anone to speake, in a distinct chapter: now here wee are yet to proceed further to more particular veines.

[Page 234] Item there are two veines in the hinder part of the head, good to bee opened against the fren [...]y, swimminges in the head, astonishment, and other passions of the head.

Item, there are 2. veins of the temples of the head, which are opened in the cure of Hemi­crani or the mygrā, in great & contintal head­ach, in distillations of humours to the eies, in impediment of sight, & in diseases of the cars.

Item, in the middes of the forehead be­tweene the two browes is a veine whose in­cision profiteth in heauines of the head, spe­cially the hinder part of the head: for infirmi­ties in [...]he face, as rednes, morphues, itch, scabs and in affectes of the eies, Cephalica first bee­ing opened.

Item, a veine in the higher part of the forehead is opened in all diseas [...]s of the head and braine, speciallie if they bee of long continuance: also it cureth the new begun leprie.

Item in the nose is a veine, in whose incision you must tye the necke with a napkin vntill the partes of the head swell, and the veine ap­peare, & this must also be done, when the veine in the forehead is opened. This veine in the tip of the Nose, is opened against apostumati­ons of the head, rewmes, and fluxes of the Eies: it purgeth the braine, and comfor­teth memory. This veine must bee sought for [Page] very suerly and wisely, for it lyeth deepe▪ and therefore he that will be sure of it, must find it euen in the very mids betweene the 2. sides of the nose end. The 2. veins within the nosthrils are opened against heauines of the head.

Item, there are veines between the l [...]ppes & gums which are opened in apostumatiōs of the mouth & gums, Cephalica being first opened.

Itē, ther are veins vnder the toung opened in diuers affects, chieflie in Angina, the Cephalic [...] being first opened: there are [...]. of them in num­ber, they are also opened in fluxes of the head▪ palsies, squinances or quinsees, scroplules, apo­plexies, coughs, pains of the mouth, [...]eeth▪ and gums, impediments of speech: generally in all diseases of the brest, hart, lunges, and arteries.

Item, there are 2. veines within the mouth, which be opened in diseases of the head, tooth­ach, paines of the iawes, mouth and throat: al­so against freckles of the face.

Itē there are 4. veines in the roofe or pallate of the mouth, which are opened in tothaches, reumes, & catarres of the head flowing to the teeth, & causing the tothach: these veins are manifest enough. Iohā. de Sancto Amardo, an old practisioner, setteth downe a cure that hee d [...]d on a woman grieued with tothach. First [...] vsed percussiues to stay the rewme, and it did no good: thē things mitigatiue, & they did as lit­tle: thē maturatiues, nether did they any good▪ [Page 236] Then I let her bloud in Cephalica first, and o­pened (saith he) these [...]oure veines, when the matter of the fluxe was digested, and so shee was cured: but if the matter be not digested, the opening of these helpeth not.

Item, there are c [...]rt [...]i [...]e veines in the watrie angles of the eies, toward the brow, which are opened in passions of the eyes, paines of the head: Opthalmia that hath long continued, and in wat [...]ie disti [...]lations of the eyes, the Cepha­lica first opened. Item, hereby are cured webs, spots, clouds, mistes, pearle, rednes, cornes, & such other infirmities of the eyes, with weake­nes of sight.

Item, there are two veines in the concauities & hollownes of the eares, which being opened, heale shaking of the head, swimming of the eies, dis [...]ines, pypings & sounding in the eares, vn­cleannes of the mouth, a new begun deafnes.

Item, there are two veines behind the eares, which are opened to preserue memorie, to clense the f [...]ce, to take away the rewme & di­s [...]llations from the head, generally in all desea­ses of the mouth & gummes.

Item, in the temples neare the eares, are veines opened in the diseases called Ʋertigo, & the Migram: and in great & continual paines of the head. This incision maketh a man barren, as Hipp. affirmeth▪ lib. de Genitura, & in lib. de aere, aquis & locis, in these words: Quibusdam [Page 237] iuxta aures venae sectae sunt. Hi [...] cocunt quidem & ge [...]ituram emit [...]unt, verum mancā debilem & infae [...]undam. Some haue certei [...]e veines cut, not far from their eares, w [...]ic [...] do the act of gene­ration, & giue forth seede, but the same is vn­perfect, weake, & barren. Neither is this cōtra­rie to reason: for most of the seedie moysture descendeth from the head into the marrow of the back. Hippo. also af [...]irmeth, that the noble men of Scythia, by incision nigh their eares, be­come vnfrutfull. These veines Auicen called Iuueniles.

Item, there is a veine between the chin & the neithet lip, which is opened in a stinking breth.

Item, there is a veine, lying right vnderneath the chin, which is opened also against a stinking breath, & also in diseases of the head & brest: Polipus in the nose, paines in the cheekes, stin­king of the nosthri [...]s, spots about the face.

Item, there are two veines in the neck, one before, another behinde, that are opened in a plurisie, in a new begun leprosie, shaking of the members, humors, and distillations from the head, too much stifnes oflimmes. The Gre­ [...]ians call these veines Sphagitidas: the Latines Iugulares, they are veines of the throat. The Arabians cal them Guidez: the barbarous Phi­sicions call them Subeticae: wee may call them Ʋenae apoplecticae, or the sleepie veines: because being wrung hard, or pressed down, they bring [Page 238] an heauie sleepe, and a certeine drousines like the disease called Apoplexia. To speake plaine English: these veines of the necke or throat, being hard tyed, bring Iudas disease▪ i. verie hanging. These are opened (I say) in the be­ginning of leprosie, when the breath is verie short, in the beginning of Angina: in the dis­ease called Asthma: in horcenes of voice: in apostumation of the lungs: in Dyspnaea. i. pur­sines or stoppings of the lungs, caused of much hot bloud, in griefs of the Splene & side. Ʋide librum Anatomiae viuorum Galeno adscriptum▪ Cap. 28. Rhazen. & Auicen.

Item, there are two veines vnder the arme­holes, which are opened in streitnes of the brest, paine of the midrife, & the lungs, in dif­ficultie of breathing called Asthma.

Item, there are two veines aboue the el­bowes, which are opened in all diseases of the brest, swimming ofthe head, spalme, the falling sicknes.

Item, there is a veine called Ʋena purpure [...], or the purple veine, lying in the right arm, next Hepatica, or Basilica toward the hand; which is opened against diseases of the spirituall mem­bers, and of the bowels.

Item, there is a veine called Illiaca next vnto the purple veine: which being wel takē, is good to heale paines of all the inward members.

Item, there is a veine called vena pulsatilis, or [Page 239] the beating veine, which is opened in trēblings of the heart, sowning, & Cordiaca passio.

Item, there are two veines in the thombes, which are opened in diseases of the head, blea­red eyes, & in most feuers.

Item, there is a veine between the forefingar and the thombe, which is opened in stopping of the head, to purge superfluitie ofcholer, also in agewes, & diseases of the eyes.

Item, there is a veine between the ringfingar & the little fingar, which is opened in diseases of the head, lungs, & splene.

Item, there is in th right hand betweene the little fingar & the next adioyning, a veine caled Saluatella whereof before. Item, Saluatella in the left hand: looke also before.

Item, there is a v eine in the right side, ope­ned in Lienteria Dysenteria, dropsies, & other infirmities of cold matter.

Item, there is a veine in the left side, which is opened in apostumations, & excori [...]tions of the bladder, paines of the loynes, swellings & stop­pings of the splene.

Item, there is a veine in the belly, which is opened in diseases of the raines, and to purge out the Melancoly bloud.

Item, there are 4 veines about the place cal­led Pecten. i. the place where the haire grow­eth about the priuie members, on either sides which may bee opened in superfluous issues [Page 240] of the Hemorroids: to asswage paine and disea­ses in the bladder & secret places: to stop blee­ding at the nose and other members: to heale Lyenteria, & Stranguria.

Item, there is a veine ouer the fore-skin of the yard, which is opened against the dropsie, and all diseases of the same member.

Item, there is a veine vnderneath the saide fore-skin, which is opened for the crampe, spalme, collick, swelling of the coddes, strangu­rie, Dissuria, the stone in the raines & bladder.

Item, there are two veines in the thighes, which are opened in diseases of the raines and bladder.

Item, there are two veines in the legges, which are opened in dropsies, paines & apostu­mation of the bladder, raines, and priuie parts: in the gowt, & swelling of the knees.

Item, in the feete there are three vaines, Is­chiatica, Saphena, & Vena poplitis: the veine of the hamme behind the knee. These we open to reuoke bloud downward, as in prouoking of menstruous Termes. But among all these, the veine in the ankle is most conuenient, as A­uicen saith: For, vena poplitis, being more nigh vnto the wombe, it draweth bloud better frō thence than either Saphena, or Ischiatica. When the plenitude in the bodie is not great, it is bet­ter to detract the same from the right lower veines of the hammes, & the ankle.

[Page 241] Ʋena poplitis opened, prouoketh Termes: so doth it fluxe of Hemorroids: for the force of the bloud tending downwardes, as it were, openeth the womb, & prouoketh consequent­ly both Termes & Hemorroids.

If there be any inflamation in or about the bely, at the biginning thereof, draw the matter vpward, and that directly: For from aboue, as from the head, the fluxe proceedeth. Neither in this case are we to feare in weomen stopping of Termes, by opening a veine in the arme: if presently therewithall, we open a direct veine in the hamme or ankle, which is the waye to turne them aside, as we hane said alreadie. But if first you should opē a veine below, the force of the inflammation would therhy be incresed.

Affects in any part vnder the raines, are most speedily cured by opening the greater veines of the hamme: the same are cured slowly, and with lesse speede, by opening Saphena in the ankle. The raines are in the middle betweene the vpper parts & the lower: Yet I prescribe & appoint not the position, so much by order of the member, as by the original & productiō of the veines passing into that part. And ther­fore inflamations in the right muskles, of that part called Abdemē aboue the nauile. i. in the outward & vpward part of the bely or panch, are reuoked by opening a veine below: and in­flamations beneath the raines in the gut Colon [Page 242] are pulled back, by opening the inner vaine of the arme, as before.

Saphena is opened to withdrawe bloud from the raines, matrix, womb, stones, & yard, & frō all mēbers placed below. Saphena & Ischiatica are braunches of one veine as Galen saith 6. A­phoris. Saphena, on the inner side of the legge, is opened in stopping of termes, griefe of the ma­trix, raines, hippes and priuie members of men or of women.

Ischiatica corrruptly called Sciatica begin­neth aboue at the huckle bone, or haunch, cal­led Ischias. This veine may be called the out­ward Saphena, descending from thence on the outside of the legges. It draweth frō the raines & lower members that are outwardly placed: & is opened in paines of the huckle bone, caled Sciatica: in griefes of the bladder & bowels: gout of the hands & feete: paines of the ioynts: palseyes: in the disease called Ʋaux .i. when a crooked veine swelleth with Melancoly blod in the temples, bellie, or legges, & in leprosie.

Itē, there are two outward veines in the an­kles, which are opened in stopping of Termes, sicknesses of the Splene, paines in the backe, strangurie and stone.

Item, there are two veines vnder the little toa, which are opened to purge superfluities of the matrix, in scrophules on the face and legges.

[Page 243] Item, there are two veines adioyning to the litle toe, which being opened, cure apoplexies, yellow Iaundies, and choler, palsies, and disea­ses of the raines.

Item, there are two veines in the les [...]er ioynt of the little toe, which are opened in olde coughes, pustles, & Opthalmia.

Item, there are two veines in the middle toe, which are opened inscrophuls, diseases of the face, spots, rednes, pimples, watrie eies, canker, knots, & stopping of the Termes.

Item, there is a veine on the left ioynt in the great toe, which is opened in Opthalmia, spots of the face, & legges, [...]ch, euil vlcers & super­sluitres of the matrix.

Finally, I conclude with Venatalii, the ankle veine, called also Saphena, that of the lower veines, it is of great profit, and to be opened in paines, stoppings, & swelling of the matrix, or yard: & is opened the foote being put in a ves­sel of water. The Sciatica veine, which is one of the middle veines towarde the outside of the foot, is next in vse, for the disease caled Sciatica in the huckle bone: So as first we purge with Hiera, and annoynt the place outwardly with oyle of the same. And when bloud letting i [...] not conuenient, (as afterward you shal heare) as also in this practise for Sciatica, wee may applye boxes, with scarification: as the place, humours, and time requires, and as affectes [Page 244] in the vpper partes are cured, by vpper veines, opened in the arme: so they in the nether partes, are cured by lower veines, opened in the hammes and ankles.

As wee haue hitherto declared the veines in generall & particular, with their profits in bleeding, for manifold diseases: So also, to the intent that the practisioner may be furnished throughly with knowledge in this point which is the most principal: and to know in euery dis­ease what veine to open, & so not to take Hob for Gib (as the prouerb saith:) it shall not be greatly amisse for the more perfectnes herein, to teach this lesson forward and backward, as they learne their Gamma vt, both waies; that intend to be good Musicians: so must those be most perfect in this discourse, that in this pra­ctise of letting bloud will be accounted skil­full and good Phisicions. Nowe, therefore in a most compendious sort, I will first set downe the disease, and then the veine that is to be o­pened for the same.

And first, touching a body that is not yet sick & diseased: but who that is sicke, either in his whole bodie, or in some particular member in the spring & the beginning thereof, he may be let bloud of any veine, of the great & gene­rall veines, & so in the preseruatiue intention, may be kept backe, continuall & vniuersall fe­uers, & a general or vniuersall gowt: if there be [Page 245] doubt of any particular inflamation in any par­ticular member, let bloud some veine in some part far off, whereby the v [...]e and custome of nature, and also the fluxe of bloud may be tur­ned from that member where the daunger is verie likely to rest, into some other part farre distant, and in these two pointes resteth the whole preseruatiue intention of this practise.

Concerning a pacient sicke and diseased, & the curatiue intention of this practise: If he be sicke, he is diseased also, either in the whole bo­die, or in some particular part: If the disease lye in the whole bodie, then the Basilica or inner veine of the arme is to be opened, which di­rectly answereth vnto the Liuer▪ which is the verie fountaine of bloud.

If the pacient be sick in any particular part, the same is either aboue the necke, as in the face, or in the head: or it is beneath the necke. The diseases in the face and head are these 7. a Frensie, an Apoplexie, the Letargus or slee­ping disease, the falling sicknesse, the Quincie, inflamation of the eyes, fluxe of bloud from the nose.

1 In a Frensie, in the beginning thereof▪ bloud must be pulled backe from the head by opening some vaines, as will from farre with­drawe the matter: alwayes obseruing recti­tude with the parte affected: and this may best be done from the Cephaliea veine. In the state [Page 246] of a frens [...]e, or when the force thereof is some­what abated, first take away the repletion of the whole body, and then let bloud, either in the member it selfe that is affected, or member very neere vnto it: as in this case the fittest veine is the veine of the forehead, or that veine which is betweene the nosethrils.

2 In an Apoplexie, first in the beginning therofopen Cephalica: If that appeare not, open Ʋena communis, or Mediana, or that veyne which is betweene the thombe and forefinger [...] afterward if the disease be rooted and continue: open the veyne vnder the tongue.

3 In Letargus or the drowsie disease, first o­pen Cephalica: afterwards if the same continue long▪ open the veyne of the forehead.

4 In the falling sicknes, open the selfe same veynes that are opened for apoplexie.

5 In Angina or quincie, first open Cephalica: then the veyne vnder the tongue.

6 In inflammation of the eies, first open Ce­phalica, then the veyne in the inner angle or corner of the eie.

7 In sluxe of bloud from the nose, open Ce­phalica, or Mediana, the common veyne.

For diseases beneath the necke, they are ei­ther aboue the raines, in the raines, or beneath the raines. Aboue the raines are these foure: A Pluresie, diseases of the lungs, inflammation of the liuer, inflammation of the spleene.

[Page 247] 1 In a pluresie, & the beginning therof, open the Basilica or inner veine of the arme on that side, that is pained abating and putting backe the aboüdance of bloud so long, till the bloud chaunge in colour, if so be the strength of bo­die in the patient, will beare it.

2 In diseases of the Lunges, Vena Axillaris, or the inner veine of the arme is to be opened, or if that appeare not, the common or middle veine: or for the more forcible reuultion, wee may take the veine in the hand, betweene the ring finger and the middle finger: or that veine which is betweene the ring finger and the lit­tle finger: Alwaies respecting rectitude of ope­ning in the right veine.

3 In inflammations & diseases of the Liuer, doo as is said for the lungs Basilica veine: ob­seruing alwais rectitude of members.

4 In inflammations & diseases of the splene do also as before, obseruing the rectitude on the left side. If the diseases be in the rames thē ­selues, that they are inflamed: & that the same inflammation bee but a beginning: open the inner veine, or Basilica of the arme. If the inflā ­mation be in his state, or somewhat relenting, open the inner veine of the ham, or anckle. If the diseases be beneth the rains, they are either diseases of the wombe or belly, or of the blad­der, or priuy parts: or of menstruous termes, or of the Hemorroidae veines, thigh, or haunche.

[Page 214] 1 In diseases of the wombe or belly, if the fluxe be a beginning, and that there is repletion in the body: open a veyne in the arme, to turne the fluxe an other waxe: when the fluxe is don, and the affect bee not remoued, open the inner veyne of the ham or anckle.

2 In diseases of the bladder, do euen so: both in their beginning and in their state.

3 In inflammation and diseases of the priuie parts, doo likewise euen so.

4 In restraint of termes, open the veyne of the ham or anckle, or scarrifie vpon the anckles.

5 In termes immoderately flowing, open the veyne of the arme.

6 In restraint of hemorroids, open a veyne in the hamme or shanke, which is from the knee downe to the ancklee.

7 In immoderate fluxe of hemorroids, open the Basilica in the arme.

8 In paine or ach of the thigh or huckle bone (called Sciatica) first open the inner veyn of the arme, to pull backe the matter: afterward open the outward veyne of the anckle, to eua­cuate the same.

Finally, remember alwaies that when sulnes hath adioined with it in the body, corrupt hu­mors, or that with increase of much bloud, there is also some euill and corrupted iuces: as happeneth in that fulnes which is onely Quo ad vires: and in continuall feuers, ioyned with [Page 249] putrifaction: than wee are both to let bloud, and to purge, as was shewed before in Chap­ter, 4.

Certaine very old english verses, concerning the veines and letting of bloud, taken out of a very auncient paper booke of Phisicke notes.

YE Maisters that vsen bloud-letting,
And therewith getten your liuing:
Here may you learne wisedome good,
In what place ye shall let bloud,
In man, in woman, or in child:
For euils that be wood and wild.
There beene veynes thirty and two:
For wile is many, that must be vndo.
Sixteene in the head full right:
And sixteene beneath I you plight.
In what place they shall be found,
I shall you tell in what stound.
Beside the eares there beene two,
That on a child mote beene vndoo:
To keepe his head from euill turning.
And from the scale withouten letting.
And two at the temples must bleede,
For stopping and aking I reede:
And one is in the mid forehead,
For Lepry, & for sawcesleme that mot bleede.
Aboue the nose forsooth is one.
That for the frensie mote be vndone.
[Page 250] Also when the eien beene sore,
For the red gowt euermore,
And two other be at the eien end,
If they bleeden them to amend.
And the web that comes thorow smoking,
I you tell without [...]n leasing.
And at the hole of the throat, there beene two:
That Lepry and straight breath will vndoo.
In the lips foure there beene,
Able to bleede I tell it be deene,
Two beneath, and aboue also:
I tell thee there beene two▪
For sorenes of the mouth to bleede,
VVhen it is flawne as I thee reede.
And two in the tongue withouten lie:
Mote bleede for the quiuancie.
And when the tongue is ought aking,
For all manuer of swelling.
Now I haue tolde of certaine,
That longer for the head I weene,
And of as many I will say:
That else where there beene in fay.
In euery arme there beene fife,
Full good to bleede for man and wife.
Cephalica is one iwis,
Cephali­ca.
The head veyne he cleaped is,
The body aboue and the head:
He cleanseth f [...]o euill and qued.
[Page 251] In the bought of the arme also,
An order there must be vndoo:
Basilica his name is,
Lowest he sitteth there ywis:
B [...]sili [...].
Forsooth he clenseth the Liuer aright:
And all other members beneath I twight.
The middle is betweene the two,
Cora [...] id [...] vena.
Corall he is cleppid also,
That veine clenseth withouten doubt:
Aboue & beneath, within and without.
For Basilica that I of told,
One braunched veine sty vp ful bold,
To the thomb goeth that one braunch:
The Cardiacle he wil staunch,
That there braunch full right goeth,
To the little finger withouten oth:
Saluatell is his name,
Saluatel
He is a veine of noble fame,
There is no veine that clenseth so clene▪
The stopping of the Liuer and Splene.
Aboue the knuckles of the feet,
With two veines may thou meet,
Within sitteth Domestica:
Dom [...]sti­c [...]. [...].
And without Saluatica.
Domestica clenseth well▪
The bladder euery deal,
Siluatica withouten doubt,
Sil [...]atica [...].
He clenseth well for the gout▪
In the hammes a woman shall bleede,
For stopping of her flours at neede,
[Page 252] A man shall bleede there also,
For the Hemotroids to fordo.
Two veines if thou vse I say,
The quartane thou maist void away▪
All the veines thee haue I told,
That clenseth man both yong and old.
If thou vse them at thy need:
These foresaid euils they dare not dreed.
So that our Lord be them helping,
That all hath in his gouerning.
So mote it be, so say all wee.
Amen, amen, for charitee.

A profitable obseruation of the bloud extra­cted. Chap. 22.

WHen the bloud floweth foorth of the woūd, the same is to be receiued in clean wiped porringers of earth, glasse, tinne, or sil­uer: not of brasse, lest the same cause alterati­on of the substance, colour, or other quallity of the bloud, and so our iudgement by that oc­casion be peruerted & corrupted. Of these lit­tle vessels, there must be many in number, that in each of them, the varietie of the bloud may appeare and be seene: and they are to be set in a faire place, that no dust, smoke, winde, or Sunne, come vnto them. The first obseruation1. Sub­stanti. is the substance of the bloud, which sometime is viscous, & cleaueth to the fingers like glue; [Page 235] this floweth out but softly and slowly, because it is thicke, and it quickly againe congeleth. This kind of bloud is the cause of obstructions in the body, and of such diseases as are caused by obstructions. That bloud which congea­leth not so soon in the porringer, is thin bloud. And that which waxeth not hard, being cold: is watrish and putrified bloud. Thicke & vis­cous bloud, and compacted hard, is hardly cut or diuided, & thin bloud very easily: putri­ed bloud not at all: but as soone as it is tou­ched with ones finger, or a knife, it is torne & rent (as it were) into small pieces.

2. Serum. Whey, which is (as it were) a yellow water swimming on the bloud, wehn it is clodded. sheweth eitherimmoderat drinking, or a weak Liuer, as in hidropicall persons: or weaknes of the raines, and obstruction of the same. For these diseases cause aboundance of watry wheyish matter in the veines, mingled with the bloud. The thicke bloud is verie hardly imparted, or distributed among the small veines: for thereby they would soone be ob­structed.

3. Spu­ma. Froth swimming on the bloud except the force of the fluxe haue caused it, declareth heat, and inflammation of that humour, which the colour expresseth. Red fome sheweth bloud: yellowe fome choller: white fome [...]egme: swart some melancoly.

[Page 254] The colour of the congealed bloud, being very red in the top, sheweth a good profitable qloud. The colour red and cleere, sheweth hot bloud: as that of the arteries. An obscure red colour expresseth a mean or mediocritie, as is the colour of the bloud in the veines. A ci­trine colour. i▪ of the colour of a citron, golde, or or [...]nge, sheweth dominion of choler: white colour, dominion of flegme: green colour, su­periority of adust choler: and a colour swart, or like lead, sheweth aboundance of hurtful melanco [...]e with mortification of the spirites. A mixture of diuers colours, sheweth aboun­dance of diuers humours: whether the colou­red humors be putrified or no, the substance of the bloud declareth. White colour com­meth of good concoction, chiefly in those that haue full strength: whose vrins appeare well concoct, with most white residencies in the bottom. The bloud of such persōs in the veines through concoction waxe white. If the bloud be white in colour, & viscous in substance: it signifieth adust flegme, by reason of burning heat in the same. If it bee not viscous, but thin & wat [...]ish, it sheweth natural flegme. The best colour in bloud is red, inclining to a certaine obscurity or darknes. Purple colour very thin & cleer, sheweth choler as Galen witnesseth inpri. de Chrisi. If it be very dark, it betokeneth grosse bloud. Greene bloud sheweth perfect adustiō.

[Page 255] When the bloud floweth soorthspedely, it is suetile and thin: when it spinneth not foorth, but comes guttatim, slowly drop by drop: it betokeneth that it is grosse bloud: when mean­ly betweene both, then is it a mean bloud, be­tweene grosse and thin. Againe sometime it is quickly congeled, then is it g rosse bloud: som­time slowly compacted, and then is it subtile. Thicke and grosse bloud, sheweth thicke and grosse matter in the bodie: or it sheweth great heat and drith, which hath consumed the hu­midity of bloud. If it be subtile & thin, it shew­eth want of digestion, and abundance of raw, vnconcocted humours, of hot humours, or of cold, as the colour shall discrie.

If the bloud be oily, it betokeneth either a future leprosie, or too much fatnes in the body: for leprosy is caused of extremity of heat in the bloud, burning the same, and conuerting it in­to an oily substance. Againe, take a bat round in the end, and set it to the congeled bloud, if it withstand it not, but giue place vnto it, and bee diuided: it is an argument of drith. If the bloud greatly resist the entrance of the bat, then is it a very thicke and viscous bloud. If be­tween both▪ then is it a meane bloud▪ And thus of the substance of the bloud, which should haue bin inserted before. And touching the co­lour in like sort, this briefe obseruation by the way, which was also omitted, but may come in [Page 256] here yet in good sort a good bloud is of diuers colours, according to the diuersitie of the parts: for in the vpper parte and in the com­passe of the vessell, it is of a red colour: for the good bloud (being light) alwaies ascendeth vp to the higher partes: in the middes it is red, and not cleere: in the bottom it is blacke and melancolious. For melancoly (being heauy) resteth alwaies in the bottome.

[...]. Pin­guedo. Sometime there swimmeth on the toppe of the bloud a certaine fatte, or oily matter, like a copweb. If the body bee very grosse and fat: this is caused of the verie bloud, which is in such bodies inclining to fat. If the body be very leane, it declareth the same now to be­ginne8. Subsi­dentia. to melt, and to languish.

In the bottom of the clodded bloud there is resident an earthly & a filthy substance, which being deuided, or clouen asunder, appeareth in colour, either red, darke, blacke, bright, or greene: whereby we may coniecture the na­ture of the humour mixt with the bloud: yea & by the colour much or little, we may know, how much ech humour aboundeth in the veines.

Some say, if the bloud bee cut or deuided, &7. Grana. that there bee found in the same, certaine grainees like small sande, that it noteth le­prosie, or inclination vnto it: which alwaies hath not been found true by certaine that [Page 257] haue obserued it.

It is sildome, that the bloud comming from the veines, doth sinke: but if it doo, the same sheweth corrupt and stinking humours, and is a token of vncurable putrifaction and cor­ruption.

No man doth willingly tast detracted bloud, but if by chaunce it come into the mouth, and doo tast sweet, it is according to nature, good, and of perfect concoction. If it bee bitter in tast, it sheweth aboundance of choller: if it be sowre, sharpe, and restringent, it denotateth aboundance of melancoly: if vnsauery, aboun­dance of flegme: if salt, the bloud is mixt with salt flegme. After obseruation of the substāce and colour of the bloud, conferre all the smal porringers, or vessels of bloud together. If they shew all equally good bloud, it is to be suppo­sed that the rest in the veines, is like vnto it. Yet the same is to bee withdrawen, if it offend in quantity, and greeue the body, hurting the sences, and causing in the body putrifaction and other euils. If bloud appeare corrupt, then with a greater profit, the same is to be with­drawē, because it hurteth the body two waies: both with the quantity and qualitie thereof. If it be not sufficiently withdrawen at one time, afterward againe, a veine must be opened: and beside bleeding, if Cacochymia concur with plenitud: that is, that bloud offend both in [Page 258] quantitie and qualitie, as wee noted in the 21. Chapter: beside bleeding, the body must more ouer be purged with inward medicine.

If that bloud which came first were good, and the other corrupt: then suppose that yet much such bloud remaineth in the bodie, to be auoided by good order of diet, and order­ly euacuation. But if it fall out so in inflamati­ons, it is a good signe that the euacuation is ab­solute and perfect: quite taking away the mat­ter of the disease from the affected member. The bloud poured into warme water, hath thereby his partes and substances deuided: the wheyish and watrìe substance is confoun­ded with the water, and cannot be knowen from it. Also the thinner and more subtile part of the bloud is mingled with the water likewise: whereby yet notwithstanding after a sort, wee may giue iudgement of the nature of the humor. The thicker parte of the bloud resteth in the bottome▪ which is reputed good and naturall bloud: if so be it be whitish, thinne, bright, and cohering together. If the same be more grosse, it sheweth the grosnesse of the bloud that remaineth in the bodie. If it be obscure, blacke, or otherwise coloured, after the difference of the colour, iudge the bloud to be corrupted, or not corrupted with [...]ilthinesse of wicked humors. If it do not co­here, but be distracted and diuided: it beto­keneth [Page 259] vncurable putrifaction.

Last of all, remember that the more vn­pure and vnconcocted the bloud appeareth, being altered from the nature of good bloud, the same is to be withdrawen in the lesse quan­titie, and not so plentifully, as when the same draweth more nigh the substance of good bloud: which is done otherwise, and quite contrarie by our common barbors and letters of bloud. And looke howe much the hu­mors doe passe and exceede, either lesse or more, the nature of bloud: so much more spa­ringly, are wee to let bloud. And when they exceede too farre from the nature of bloud, either the one waie or the other: then wee are altogether to forbeare bleeding, as wee haue noted in a certeine place alreadie.

A short rehersall of eight auncient errours, touching bleeding, and a sufficient confu­tation of them, by auncient authorities. Chap. 23.

FIrst, that bloud must not be let, but in the morning. This is confuted by Galen, lib. de Curand. ratio. per sanguin. Missio. Capitul. 12. saying: Feare not to let bloud by night: forit is ridiculous that some doe maintaine: onely letting bloud, from the second houre [Page 260] of the daye, to the fifth or sixth, and no other time.

The second errour is, that obstruction and putrifaction, are the causes of letting bloud. Galen also confutes this 2. Metho. Med. cap. 14. in these wordes: Neither obstruction, nor putrifaction is the cause of le [...]ting bloud, but abundance of humors: for neither can stop­ping, or putrifaction be cured by bleding, but require other remedies.

The third error. That opening of a veine is vnn [...]edefull, except the disease be present. This also is confuted by Galen▪ de Opt. sect. ad Thrasis, Cap. 37. For the most part (saith hee) we vse remedies, as purgagion and bleeding, when the diseas is not present but future.

The fourth error. That Phlebotomy must be done in the iudgement day of a disease. A­uicen impugneth this in quart. primi. chap. de Phlebo. saying: Neither must bleeding nor purgation be done, in the day of the mouing of a disease, nor when the same hath Crisim. [...]. iudgement. But if it be possible, let there be rest. This is also proued Aphorism. 21. Qua iudicatur vel iud [...]cata sunt &c.

The fift error. That bleeding dulleth the sight. Gallen remoueth this error, li. de Curand. ratio. per sangui. missio. Chapitul. 7. Some haue a weake sight, hauing aboundauce of bloud: Euacuate such, either with purga­tion, [Page 261] if there bee other humors beside bloud, or by bleeding: and so detracting of bloud doth good, not dulling, but quickening the sight.

6 The sixth error is, that in fulnes alwaies a veyne must bee opened. Gaben confu [...]eth this error, 4. de vict▪ in morb. acut. Commen. 19. Pleni­tude is not alwaies cured by bleeding, but by rubbings, many and oft batlings, and by absti­nence.

7 The seauenth error is, that bloud must be let, the wombe beeing very la [...]atiue, this Hyp­pocrates refelleth, 4. de vict in morb. acut. cap. 118. If it bee needefull to withdrawe bl [...]ud from any: you must stay the wombe, and so let bloud, and Galen in the same place saith: If the belly bee flowing let not bloud: lest the fluxe continuing, the strength of the body bee cast downe.

8 The eighth error is, That there is no dif­ference of the times of the yeare, to let bloud in. Galen contrary to this, writeth ad Glanco. cap. 14. Those Phisitions which consider not of the state of the times, and withdraw bloud, they kill men. Et 4. de vict. in morb acut is Com­mentar. 19. If the Aire be too hote and dry, we refraine from bleeding, though the sickenes bee vehement, and the age of the party youthfull.

A sufficient confutation of the supposed ne­cessitie of annuall bleeding. Cap. 24.

THere commeth here to my minde, a com­mon opinion among the ignorant people, which do certeinly beleeue, that if any person be let bloud one yeare, he must be let bloud euery yere, or else he is (I cannot tell, nor they neither) in how great danger. VVhich fonde opinion of theirs: whereof so euer the same sprong first: it is no more like to be true, than if I should say: when a man hath receiued a great wound by chaunce, in any part of his body, whereby he looseth much bloud: yet after it is healed, he must needs haue the like wounde a­gaine there the next yeare, to auoid as much bloud, or els he is in daunger of great sicknes, yea, & also in hasard to lose his life: which opini­on (if I did affirme to be true) albeit it be most false: yet I might vse the like reason & authori­tie to defend it, that the comon people vse, in the defence of theirs. For they can say nothing, if they be asked, why they thinke so; but that they haue heard many to say so. Therefore I would wish, that no man should credit this fo­lish opinion, being most false, vnlesse he can shew some good reason for it, which I am sure no man can do.

This I think, that like as bloud letting is not [Page 263] good against al diseases: so is it not good in all persons (as we haue set it down in the 9 Chap­ter) but only in those that wil be content to vse afterward a moderat & conuenient diet. Those therefore that do abound with bloud, & wil be let bloud to preserue themselues frō the dan­ger of any disease that is like shortly to ensue, must long time after be content to vse a mo­derat diet: For intemperat persons & gluttons, great drinkers & wine bibbers; they doe not only receiue no commoditie at al by bleeding; but often times greater hurt, than if they had bin without it: For, within 3 or 4 dayes after, they fill & stuffe them selues with more rawe iuices & humors, by vnmeasurable dyet, than they had before: and often times these die through convulsion.

And hereupon we are to note, that there is such force in moderat diet, to eschew sicknes, that without obseruation thereof, Phleboto­my is to no purpose. And therefore if this cō ­mon saying of the comō people be true in any▪ namely, that they must be let bloud oftē, th [...]r are once let bloud: it is only true in such as keep ill diet presently after bleeding. Therefore to conclude this Chapter, I councell al persons to beware of excesse after opening of a veine.

Ofincision of Arteries. Chap. 25.

[Page 260] AS a veine is opened, according to our for­mer discourse hitherto: so somtime also an arterie is opened, that is to say, only such a vein, wherein the vitall spirites mixed with the blod do runne & flowe: but for the hard stinting of the fluxe from an arterie: Phisicions are in doubt to make insicion thereof: and yet some sometime practise it (as in the disease called Ʋertigo.) If in opening of a veine, we chance to stick an arterie, we can very hardly by & by stint the bleeding: and although the matter▪ fall out very well, that the wound or incision be brought to a skarre by diuision: yet there will be a dilation, or spreading abroad of the cut ar­terie stil: as Galen witnesseth, lib. de Curand. ra­tio. per sang. missio. Cap 21. & 22.

The bleeding of an arterie is hardly stayed: partly for the heat of the arterial bloud, which is very quickly moued, & by spreading abroad, openeth the arterie, whereupon incision of an arterie greatly furthereth the bleeding partly, because the motion of the arteries neuer cea­seth, as Galen witnesseth, lib. 2. Cap. 20. de Sani­tate tuend. whereby also it commeth to passe, that the wounds of the arteries, are the more slowly cured. For such things as are to be hea­led, require rest & ease, Gal. lib. 5. Cap. 8. metho▪ medend. & commet. 6. lib. 6. Aphoris. The ope­ning of an arterie is to be vsed, when the body is repleate with thinne, windie, and verie hote [Page 256] bloud. For the seat of subtile, thinne & wind [...] bloud, whereof the naturall heat and vitall spi­rites are ingendred, is in the arteries: and to is the hotest bloud which commeth from the hotest member, that is the heart, and which is carried into the other members of the bodie, conteined likewise in the arteries. The recep­tacles of the thicker bloud, wherwith the [...]ē ­bers are nourished, is in the veines.

Vpon what occasion Galen did cut an arte­rie, he himselfe sheweth, Cap. 22. dv Curand. [...]at. per sanguinis missio. being warned (saith Galer) by certeine dreames, of which, two among the rest, most plainly appeared vnto mee: I we [...]t to cut that arterie of the right hande, which is betweene the forefinger and the thombe, and I let it bleede, till it stayed of it selfe: for [...]o (saith Galen) I was warned by my dreame: and there fl owed out not a whole pound and the continuall paine ceased, that was specially in that part where the Liuer lyeth in the mid­riffe. I knowe one long troubled with con­tinuall paine in the side, freede thereof, by o­pening an arterie in the arme: the same also being attempted through the warning of a dreame.

It is verie dangerous, either willingly or vn willingly, to cut the greater arterie vnder the veine in the arme, or vnder the veine in the hammes: For the bloud being thinne, hote, & [Page 266] forcebly issuing out, will hardly bee stopped, and many haue dyed of Gangraena, rising in the member where the incision hath beene: as did a Gentleman of new Rumney in Kent, a yeare or two past: and so much the sooner, commeth this putrifieng, rotting and mortification to the member, when the Phlebotomer goeth about with a band to stay Haemorrhagiam: That is the dangerous fluxe of the arteriall or vitall bloud. If the bloud bee stayed, the wound cannot bee brought to a skarre, without Aneurisma: by reason of the continuall pulse, and the thicke and hard tunicles in the same place. If necessi­tie so require, it is best to cut the whole grea­ter artery ouerth wartly, for the bloud is soonest staid, when the ends and extremities of the ar­tery cut asunder bee pulled vp, whereon the plaister of Aloe before spoken of Cap. 19. is to be applied.

VVithout these dangers we may cut the les­ser arteries, which are in the outwarde lims or members: as in the head, hands, and feete. For these may bee fastened together, chiefly in soft, moist bodies, as of women and children. These are opened in continuall and great paines, about the vppermost skinne of any member: which paine, is like a pricking, or kinde of shooting, because of sensiblenes, and much feeling of the Membrana or outmost skinne: and it is there­withall a beating paine, by reason of the moo­uing [Page 267] of the arteries. The cause of these pric­king paines, is abundance of much thinne hot bloud, inclosed in the arteries of the pained place, and the same is taken away, when the outward arteries, are found out and cut, which proceede from those inwarde affected mem­bers.

Fewe in our daies cut arteries, because they are not manifest to appeare in sight, nor easie to come by. Arteries cut in the temples doo remedy, hote biting humors, and fluxes of the eies, in which cases▪ these arteries are wholly cut, and burnt with an hote iron, or some bur­ning medicine.

Arteries behinde the eares are cut in swim­mings, and continuall paines of the head, caused of winde and of heate: Also in rednes of the face, and in other long continuing affects of the head.

The artery betweene the thombe and fore­finger is opened with continuall paines of the sides, betweene the bowels, and the Mid­riffe.

An artery about the anckle is opened: in long continuing paines of the huckle bones, alwaies chose that artery, which is direct to the affected member, as wee aduised before in opening of veynes.

Of particuler euacuation of bloud, and first of bloudsuckers or horseleaches. Chap. 26.

TO this discourse of opening a veyne, which is a generall euacuation of bloud, is to bee added, the particuler euacuation thereof, by leaches and ventosas: whereof wee will briefly speake in these two Chapters, and so conclude this our present Pamphlet.

VVhen bloud is so in any member, that it cannot be pulled backe by opening of a veyne or by some other practise: the same is to bee withdrawen from the affected member, by such remedies, as may outwardly abide vpon the griefe, and so free the same of the present e­uill. Of this sort are Leaches. Launsing, cupping or boxing: which apparantly drawe bloud, from the member affected.

Leaches or bloudsuckers, are wormes found in waters, which applied outwardly to the member, draw forth bloud: They make a three square wound, which penetrateth not only the skinne, but also more deepely if the skinne bee tender▪ (as is the skin of children and infants.) These being empty and well applied, sucke out bloud greedily and safely, and that so long, till they swell with fulnesse, and so fall off: And sometime when they are off, the bloud still fol­loweth plentifully, especially if they were fixed [Page 269] vpon so open and manifest veyne: In which case, they stand in steede of Phlebotomy. Thus applied to the hemeroide veynes, sometime they doo so prouoke bloud, that to stoppe the same, we are necessarily forced to vse thinges a­stringent: yea, and applied to the arme of chil­dren, they are equall to bleeding: And that ex­traction which is thus drawen from a hollo we veyne, is to bee accounted for an vniuersall e­uacuation. But when they are fixed to the hard skinne vnder which there is no great veyne, they onely empty that place that these touch: extracting very litle from the neerer parts, and nothing at all from the members far off. And therefore leaches are onely vsuall in corrupti­ons of the vppermost skinne: as in the scab in Ʋitiligo, which is a fowlenes of the body with spots of diuers colours, whereof are three kinds: In Impetigo a disease which wee call the Ring­worme. In the disease called Panus, which after Celsus is a kind of kernell growing in the grind of a man, or behinde his eares: In rednes of the nose and face, and little swellinges in leaprous persons. So oftentimes wee apply them to the Arse-hole called Anus, against melancholly diseases, caused of the stopping of hemorroids. In scabs, itch, and wicked wounds, they are very profitable: the body beeing first euacuated by letting of bloud. Yea, the drawing of horse­leaches is more conuenient in fulnes of bloud, [Page 270] than scarrifieng is: Forasmuch as they fetch bloud more deepely, and also that which is withdrawen by Leaches, is more of the sub­stance of bloud: Albeit the opinion of some is, that they drawe no bloud, but corrupt bloud; and such as is not agreeable, and proportiona­ble vnto our bodies. And therefore in griefes which happen betweene the skin and the flesh, of bloud corrupted, these are more conueni­ent than scarrifieng.

The attracting of bloud by Ventosas and horseleaches, hath this difference: that these drawe more deepely from the body: Ventosas but from the superficiall partes. Therefore let Leaches bee applyed to those places, from whence we would drawe humors more deepe­ly.

Their vse and application is this: First, be­fore they bee put to any part of the body, they must be kept all one day before, and nourished with a little bloud, which wee may giue them in a little piece of fresh flesh: then we must put them, and keepe them in cleane water, some­what warmed: and before we vse them, with a spunge wipe away the skinne that is about them: Rubbe the part of the member affected whereto you will apply them with salt: or scratch the same till it looke red: or annoint the same with a little fresh bloud. Some lay on them a spunge, that when they be full, they may [Page 271] fall away. They are with most safety let downe in a reede or a pipe to the affected mem­ber, lest they might touch together, and so by that meanes of ende those partes that are sounde and whole. And first before you apply them, so presse them and wring them out, that they may vtter and cast forth all their venome, so as their backes bee greene, and their bellies reddish.

VVee are to choose such Leaches as are not in fowle troubled blacke waters: nor such as haue long rayes or strikes in them, like roddes: called Hyrudines Ʋirgulatae. Nor such as are of the colour of Lapis Lazulus: for these are venemous. But wee are to choose them, that bee redde, inclining to the colour of the Lyuer, hauing two redde lines or strikes: or inclining to a certaine greennesse, hauing little heads, and beeing very slender, and had out of cleare flowing waters. Let them not bee blacke, nor hauing a certaine white heari­nesse vppon them, as wee see there is vppon certaine hearbes as Clarie, and vppon cer­taine fruites, as vpon the Quince: but (as yee heard before) take such as haue greene backes, and red bellies.

To make them fall off if neede require, put to their heads Salt, Lyme, Dust, Ashes, or Vinegar: strawe any of these vppon them, and they will fall away, if you will haue them [Page 272] off sooner, put a horse haire betweene their mouthes and the place, and drawe them away: when they are off, wash the place with a spunge. To [...]nt the bloud after they bee remooued, if neede so require: for sometime bloud floweth out two houres after the Leaches bee gone, straw vppon the place, powder of roses, or of bu [...]n [...]d ga [...]ls, or powder of a new tile, or pow­de [...] [...] straw, a little Sanguis Draconis: or lay on the place, powder of a spunge, and pitch [...] or a linen cloth burned: or the hearbe [...] Pastoris bruised.

[...]fter the fall of the Leaches, apply cupping [...] to purge the venome, and excrements which they haue left behind, and to withdrawe [...] bloud, which they haue drawne somewhat outwardly, but haue not quite euacuated.

Finally I giue aduise, that before you vse them to the purposes aforesaid, you apply them being hungry, which is done thus: by keeping them in water a day, so that they eate nothing. If you will keepe them longer, put in the same water some Lambes bloud; or such like, that so they may be kept aliue some season. For further matter herein, I referre thee to Galen, who hath written a booke De Hirudinibus: That is of Bloudsuckers.

Of Cupping, or boxing & scarification, the o­ther two particular euacuations of bloud. Chap. 27.

FOrasmuch as it is not conuenient to be let bloud oft times in the yeare: for that much of the vitall spirit passeth forth with the bloud, and that the blould being taken away, the bo­dy waxeth colde, and the operations of nature become weake and enfeebled (as we haue be­fore in a certeine place declared:) therefore I counsell (saith Galen) that the baser partes of the bodie, as the legges, be boxed or cupped, which is the most sure remedie, as well to con­serue health, as to repaire the same being de­cayed.

For it cureth the eyes annoyed with long di­stillations. It profiteth also the head, & vpper partes of the bodie, as the brest and backe, and against sundrie other diseases. For in what member so euer the bloud is gathered, the bo­die being first purged by cupping, the griefe may be cured. Also Oribasius affirmeth, that it helpeth Quincies in the throat: dissolueth stoppings of all places. Notwithstanding ap­plication of boxes about the stomack, in hote feuers, where reason is troubled, are to be es­chewed, for feare of suffocation. Likewise, put vnto the head vndiscreetly, they hurt both [Page 274] the head and the eyes.

Boxing helpeth swellings, letteth foorth winde, stoppeth immoderate Termes, and the bloudie flixe: helpeth appetite: when a woman sowneth, it reuiueth her [...]pirites againe. It dra­weth foorth water: asswageth hard swelling: clenseth Melancolie, and that chiefely in weak bodies. It will remoue humors from place to place: as from the head to the necke: from the neck to the shoulders.

Galen wrote a booke intituled de Cucur bi­tula, t [...]a [...] is▪ of the Cupping Glasse: and re­h [...]ar [...] h [...]p [...]nese effectes thereof, that box­ing do [...]t [...]: Non solum materiam euacuare, sed et [...]m dolorem soluere, Phlegmonon minuere, in­s [...]t [...]onem discutere, appetitum reuocare, ventri­culo in firmo roburaddere, a [...]imi deliquio libe­rare, ex al [...]o fluxiones transferre, sanguinis erup­tiones cohibere, facultates mensium corruptrices extrahere mensesque supprimere. i. not onely euacuate the matter, but also asswage paine, take away inflammations, abate swellings, re­couer appetite, strengthen a weake stomacke, reuiue those that sowne, drawe downe fluxes, and stoppe fluxes: withdrawe corruption of Termes, and also stoppe the fluxe of them. VVhich effectes shall hereafter be reheased, with their cures by this practise more parti­cular.

There are three causes which perswade vs [Page 275] to vse this practise, and to refraine letting of bloud.

First, because our purpose is to euacuate from some one member, and not from another: and therefore particular euacuation is done by boxing or Cucurbitulas, which they that fol­low barbarous authors in Pinsicke doe also call Ʋentosas. Nowe particular euacuation can­not be made by Phlebotomy: for the same euacuateth and emptieth from the whole bo­die.

Secondly, because the strength is weake, or the age vnfit to bleed: or that there is some o­ther of those impediments spoken of in the 8 Chapter. For as Rhazes sayeth in 7 Ʋentosas drawe bloud but from the little veines: and therefore the heat and spirites are thereby but a little dimini [...]hed: whereas opening of a veine greatly debilitateth nature, drawing from the greater veines with the bloud, much heat & vitall spirites.

Thirdly, because our intent is to euacuate onely from the baser members. Bleeding euacuateth from the most noble members, and greater veines: Ʋentosas from the meane members, and little small veines, which arein the outward bodily partes, and lye without the greater veines.

Of boxings there are two sortes, the one gentle without scarification or launcing: the [Page 276] other with scarification, which both in steede of bloud-letting are vsed, when age, debilitie, the time of the yeare, or other considerations will not permit the op ening of a veine. Hereby is produced the thinne bloud next the skinne: and being presently vsed after scarification, when little incisions and holes are made in the member, that bloud and humors may easily come foorth: it mightily withdraweth by force and flame of heat, not onely the thinne & flo­wing humors and spirites which are about the member after scarifying, but also that which is in places further distant. If the skinne (I say) be first exasperated with the Iron, it doth this that wee heare speake of more manifestly. If the skinne be whole and not scarified, it prouo­keth bloud and humors from the furthest parts into the skinne, and bringeth it to that parte, whereunto the cupping boxes are applyed. The cupping glasse infixed (the skinne being incided or launced) purgeth the outmost parts of the body more mightily, than if to the af­fects wee onely vsed either scarification, or on­ly leches.

Boxings without scarification, which are cal­led easie cuppings, do not apparantly with­drawe bloud, but only the spirites: yet it doth pull backe vnto it humors, and forcible fluxes: and applyed to the contrarie part, it stayeth ef­fusion of bloud in any place wheresoeuer: [Page 277] chiefely, when infirmitie of strength will not permit revulsion, by opening of a veine. More­ouer it stayeth fluxes of the wombe, or of hu­mors: and applyed to the member where the fluxe of humors is, it turneth the same anothet way. Also, it prouoketh outwardly that fluxe of humors which lyeth deep in the bodie: & ther­fore it serueth as a remedie in astonishmentes, palsies, & in veterat paines: it wasteth winde & spirites, included in any member: and therefore quickly stayeth tremblings or pantings of the heart, or else-where within the bodie, the hic­ket, colick, & paines of the raines. And this pre­sent kind of remedie, is without daunger: nei­ther hurting the bodie, nor weakening the strength.

That easie & light boxings are best for re­vulsion, as to pull back Termes, appeareth by Hippo. 5. Aphoris. Aphoris. 50. Simulieri men­strua sistere volueris, Cucurbitulam quam maxi­mam, sub mammis defige. If thou wouldst stay Termes in a woman, apply a good great cup­ping glasse neare or aboue her pappes. And Galen. 5. lib. Ther. Metho. with easie boxing, applyed Hypocondiis. i. the sides & short ribbs, aboue the nauill, where the Liuer lyeth on the right side, and the Splene on the left: affirmeth bleeding at the nose to be stayed, being ap­plyed on the Liuer, or right Hypocondrion, if the fluxe come foorth of the right nosthrill, and on [Page 278] the left Hypocondrion, and on the Splene: if from the left, and vpon them both, if it proceed from both the nosthri's.

Againe, gentle cupping is vsed in such per­sons as are alreadie euacuated, in stuffed bo­dies, wee vse them not, nor in inflamed mem­bers, nor in the beginning of other affectes, but where as nothing else hath beene before, or where the bodie hath beene alreadie eua­cuated.

In this case of revulsion by cupping without scarification, as in fluxe of Termes, as ye heard out of Hippo, and in fluxe of bloud from the nose, as ye heard out of Galen, be verie cir­cumspect to apply the cupping glasses on the member set ouer against the place, from whēce wee purpose to pul-backe, according to recti­tude of position: that the place cupped may haue agreement with the place, from whence wee purpose to reuoke. Otherwise wee doe no good, as we shewed before, speaking of revul­sion in bleeding, Chap. 6.

Againe, gentle cupping is vsed without scari­fication, when wee will drawe humors from deepe and inward partes of the bodie to the outward members. Therefore Galen. 13. Me­thod. Medend. saith: that it is caeteris attractiuis fortius: stronger than any other attractiues: thus in harde apostumations, it draweth the matter outward: yea, and by it, hard apostumations [Page 279] may be remoued, if generall euacuation haue gone before, according as the fulnesse in the pa­tient requireth.

Againe, it is vsed without scarification when we stay any member, or bring a member to his proper place. Thus when the bowels fal down, we applie Ʋentosas aboue the bellie, to reteine them or bring them back.

Also, it is vsed without scarification, to dis­solue windines, as in the collick: so a cer em fat woman troubled with the collick, tooke two narrow mouthed pots, & did put them magret brasen vessel, & she did put the vessel of brasse to the fire, & afterward applyed the two hot pots to her bellie: first couering the same with alynnen cloth, & so shee was healed.

Item, it is vsed without scarification to mit­tigate paines, & that in all apostumations and colliks generally, whether the same be cau [...]ed of cholenke matter, stegme or windines. Galen lib. 13. Metho. Medond. Cap. a [...]firmeth: [...] it wasteth wind, & so careth the cause i [...] it come thereof: or it mittigateth the p [...]ine, a [...]beit it doe not perfectly cure it, of what matter so euer it come. VVith scarifying it is vsed, in inflamed members, stuffed or vexed with paine, in the disease called Scirrhus, which is a ha [...]d [...]s gro­wing in the fle [...]h within the skinne, called com­monly kirnels: in fluxes that are stayed in a certaine place.

[Page 280] Also when the parts are filled with sharp mat­ter, or outwardly infected with venome: or when we will draw the matter from one mem­ber to another. Also, it is vsed with scarifica­tion in sharpe diseases, when the strength is weake, and nature not able to tollerate blee­ding. And thus you haue heard, in what cases boxing is vsed without scarifying, & with sca­rifying, which is a worthie and profitable ob­seruation.

The difference betweene Ʋentosas & Phle­botomy is, that Phlebotomy euacuateth the grosse bloud, and the other subtile and thinne bloud. Againe Ventosas are called attraction per vacuum, and differeth frō attractions made by medicine, or not made per vacuum. Attra­ctiue medicines which do purge, attract & eua­cuat some certeine determined humor. Phle­botomy all the humors indifferently, and Ven­tosas, or attraction per vacuum, that humor that is most subtile and thinne among them all in that part.

The difference betweene the attraction made by Ʋentosas, and that made by leaches is this: that the leaches drawe humors from the profound and deepe places, and Ʋentosas but from the superficiall partes.

Item, fat persons are not to vse cupping: for it is with them, as with water pypes in the ground, which being filled and stopped with [Page 281] earth or other matter, stay the water course that it cannot run: so the veynes in the body, are like those water pipes, and are sometime so filled with fleshy fat, that the bloud cannot haue his course thorow them, and therefore the veynes in fat folke, beeing either so strict, or so stopped, the Ventosas cannot withdrawe from them, but with great violence: and if they at­tract any thing, it is the most subtile bloud, the grosse bloud cannot passe thorow the stopped places.

Concerning the time, they are not to bee v­sed at the new of the moone, because then the humors are quiet, and so hardly drawen, nor in the last quarter: for this season being cold, the humors are not easily attracted: but in the mid­dle season: when the humors are flowing, and are not too colde: and vse them in the third houre of the day, for then by reason of heate, the poores are opened, and the bloud beeing then easily mooueable, is with the more facility attracted to the members, and from the mem­bers,

After bathings we are not to vse them, for there were to bee feared, too great a fluxe of bloud, yet if we can perceiue the bloud to bee too grosse, wee may to subtiliate the same, vse bathing before in such a case, as was saide in the rules of Phlebotomy.

That these pointes thus generally spoken of [Page 282] me hitherto, may in particul [...]r with more profit yet now be set downe, wee will before we con­clude, proceede therein a [...]itle further, to the ap­plication of Ventosas particularly, in eu [...]ry pra­ctise.

Boxing without scarrification are vsed, to re­uoke and pull backe matter, called before re­vulsion: or to turne bloud and humors aside, which was called deriuation, cap. 6.

Thus cupping reuoketh bloud at the nose, as yee heard aboue out of Galen, by applying the Ventosas vnto the sides: that is, vpon the Lyuer and right side, if out of the right nosethrills, & contra, as before.

Thus we stoppe fluxe of termes, applying a great cupping-glasse to the roote of the Paps, as ye heard out of Hyppocrates.

Thus the falling downe of the wombe or matrix, is reuoked by application of the cup­ping-glasse, neere to the nauill.

Thus to reuoke matter from the head,
we apply them, to the inside of the Thigh: where note, that this better prouoketh termes, than the ope­ning of Saphena vein.
Thus against stopping of termes,
we apply them, to the inside of the Thigh: where note, that this better prouoketh termes, than the ope­ning of Saphena vein.
Thus against stopping of hemorroids,
we apply them, to the inside of the Thigh: where note, that this better prouoketh termes, than the ope­ning of Saphena vein.

[Page 283] Cupping-glasses are not vsed for deriuation sake: that is, to turne bloud & humors aside an­other way, except when the body is first euacu­ated, or when the humors are setled in any part, and that the member is swollen, in this case, for deriuation sake, we apply Ventosas to the hinder part of the necke than to the partes called Spa­tulae, which ioine to the necke; sometimes also to the but tocks and haunches.

Boxing with scarrification is vsed, when some euacuation of bloud is required, standing in steede of Phlebotomy (as we said before) when certaine occasions hinder the same. First, in this practise wee apply the Ventosas to the member. Afterward we open that very part, in many pla­ces in the skinne onely, with a small penknife, for the purpose, and so applying the glasses a­gaine, wee euacuate bloud. But wee must not doo this before the body bee first euacuated, chiefly in vncleane and corrupt bodies, lest too great abundance of humors bee drawen into that part. Boxing with Scarrificati­on is vsed, either in the vpper partes, in the middle partes, or the lower partes of the body.

Cupping-Glasses applyed to the forepartes of the heade: offende the Senses and vnder­standing. Applyed on both the middle partes of the necke, or vppon Nucham Puppis: they stande in steede of opening Ʋena Nigra, [Page 284] and they helpe heauinesse of the browes, and lighten the eie-lids: they helpe scabbines of the eies: they cause both the Parent and the childe begotten by him, to bee forgetfull. Ʋuerke­rus.

Ʋentosas applyed to the lower part of the neckwhich is called Acheal standeth in steed of opening Basilica: they helpe pains of the shoul­ders and gullet: that is, the place whereby meate and drinke passeth into the stomacke: they helpe diseases of the breast, caused of bloud: the crampe caused of bloud, and trem­bling of the heart.

Ʋentosas applyed to the vpper part of the necke: that is, the very ioyning together of the head and necke: are in steed of opening Cepha­lica, and helpe in affects of the head, as the sha­king, and particuler palsie of the head: yea, and in affects of the parts of the head, and ther­fore it profiteth for toothach: paines of the eies and eares: but there must goe before purging of the whole body: lest matter bee drawen vp againe to the heade, and fill the same, and so the diseases increase againe: as Galen saith, 13. Me­thod. Medend. cap. 4. we must beware here in this case, not to apply them thus too oft, because they hurt the memory.

VVhere as a litle before we spake of an ap­plicatiō, which serued in steed of Basilica: so we say now that Ventosas applied aboue Spondiles, [Page 285] serueth also in steede of Basilica, and cleanseth the breast: and yet hurteth the mouth of the stomacke, and causeth trembling of the heart: and therefore they are subiect to these diseases, must beware howe they vse them, and yet ac­cording to Rhases. 2. ad Almonson. It helpeth in trembling of the heart, caused of repletion and with heate. But it should seeme, that either Rhases meant of application of Ʋentosas to the lower part of the necke, called Acheal, which indeede (as we said before) helpeth trembling of the heart. So confounding this application with the former. VVhich the rather may so seeme, because it is said: that they both serue in steede of Basilica: or els (that this applica­tion hurteth the heart) is ignorantly added, and put to of some vndiscrete writer.

Ʋentosas applyed to or vnder the chinne, helpeth the teeth, the face and the throat, clen­seth the heade and the Iawes: especially they cleanse the face from scabs and itch.

Ʋentosas applyed in the ioyning together of Spatula with the necke, profiteth in passions of the face, as scab or itch, and in stincke of the mouth. It may be, that this application is euen the selfe same which immediatly went before. And thus much of particuler application of Ventosas, to the vpper parts.

Now of their application to the middle parts of the body, applyed between the two Spatula: [Page 286] his hands, or hath allanderous tongue, & can do they help diseases of the brest caused of bloud, and a crampe comming of the same case, and in these two, this application agreeth with that, to the lower part of the necke, before called Acheal: but this last application, hath two discommodities: for they weaken the stomack, and cause trembling of heart. VVhere note, that this application seemeth one and the selfe same, with that Super spondiles, and so it is true, that was there saide, concerning the offence of the stomacke and heart thereby.

Ʋentosas applyed aboue or vppon the raines, helpe apostumations and pushes of the thighs or haunches, scabs, gowt, and hemorroids, lepro­sie, windines of the bladder, & matrix, itchings of the back, and all diseases of the lower parts.

Ʋentosas, applyed vnder those parts called in Latine Cauillas, otherwise Alchahab, helpeth stopping of termes: the gowt in the feete, and the Sciatica gowt, and thus of application to the middle parts.

Thirdly, concerning their application to the lower parts. Ʋentosas applyed aboue or vppon the thighs, or rather the shanke from the knee to the anckle: which part of the leg in Latin is cal­led Crus, they stande in steede of Phlebotomy: they mundefie the bloud, prouoke termes, and are better than the opening of Saphena, to pro­uoke termes, in white, soft, and weake women.

[Page 287] Ʋentosas applyed to the former part of Coxa: That is, the Thighes or Haunches, helpeth apostumations of the testicles and woundes of the Thighes, Haunches, and Shanks applyed to the hinder part thereof, they helpe apostumations of the Arse, and Buttocks: and goinges out of the fundament, and blames, and pushes in the same part.

Ʋentosas applyed betweene the two An­ches: That is, hypsor buttocks: helpeth the two Anches: and the two inner partes of the thighs or h [...]unches. Also the hemorroids: the gowt in the fecte: and ruptu [...]s about the p [...]iuie parts of men or women.

Ʋentosas applyed vpon the buttockes, attract from the whole body, and the heade, and hel­peth the bowels: also they helpe corruption of menstruous termes, and by meanes thereof lighten the body.

Ventosas applyed vnder the ham behinde the▪ knee, helpe beating & shaking in the hams, cau­sed of an hot humor: also wicked pushes, & cor­rupt vlcers in the shanks, & in the feet: and thus much of the particuler application of cupping or boxing glasses.

There is another kind of boxing that we haue not here to deale withall: necessary and good sometime to bee vsed, as for example sake: If you haue any sawsie Lowt, or loytering Lub­ber in your house, that is either too busie of [Page 288] nothing but play one of the parts of the foure and twenty orders of knaues, there is no pretier medicin for this, nor sooner prepared, than box­ing is, three or foure times wel set on a span long on both the cheeks: & althogh perhaps this wil not alter his lubberly conditions, yet I assure you, it will for a time change his knauish com­plexion, and helpe him of the greene sickenes: and euery man may practise this, as occasion shall serue in his owne house to reforme them.

Because as we haue saide, boxing is often v­sed together with launcing: therefore a word or two of scarrification and so an end.

Launcing is done with a Lancelot or some in­strument called in Greeke Epidermes: and in Latine Scalpellum. The member is cut by lit­tle and litle with this Chyrurginall instrument, ometime it striketh but the very skinne: some­time it goeth in deeper. It euacuateth onely out of the diuided member, except by hap it wound and hurt the veyne. Scarrification causeth the humor vnderneath to passe forth, not forcibly extracting any thing from places distant and further off: and the deeper the Instrument go­eth in, the more aboundant is the effusion of bloud: It serueth to purge the skin, and helpeth those affects which Leaches doo cure: and those which are in the skinne, and sticke stifly vnto the same: As old inflamations of corrupt mat­ter, as the disease called Scirchus mentioned [Page 289] before as Gangraena, a cankerous mortification of a member, or part of a member: as Sphace­lus, which is when any part or member is morti­fied, thorow inflamation and such like, in which diseases, naturall heat beeing (as it were) cho­ked vp, and strangled, desireth (as it were) to bee winnowed. VVhere note, that Launsing doth more plentifully draw bloud, if presently vpon it, boxing bee vsed, as was partly signified before.

A profitable and compendious Table of Phlebo­tomy or bloudletting containing diuers points in this Treatise handled and discussed of, and set­ting downe by diuision the generall and speciall considerations thereunto belonging. Chap. 28.
A principall rule and obseruation.

AS in other thinges, so in bloudletting the cause is first skilfully and circumspectly to be considered, as that it bee to purge the body of some vnnaturall, naughty, and superfluous humor, whose substance is either simple, or mixt: Simple, when it doth of it selfe without the admixture of any other degenerate, as bloud doth when it putrifieth in the veyne, the Pores being stopped: mixt, when it is mingled with some that is already corrupted, as in the dropsie, where the bloud is mixt with water [Page 290] The cause beeing thus allowed, and certainely knowen for needefull and good to the Patient otherwise letting of bloud is very dangerous, and openeth a way to grieuous infirmities, as ye haue heard in this treatise.

There remaineth to be considered, how it standesh with the Patient.
  • Inwardly
    • For his Complexion.
    • For his Age.
  • Outwardly
    • For the time of the yeare, and moneth generally.
    • For the time of the day and diet particularly.
1 Complexion.
  • In the complexion is to be con­sidered, whether he be
    • Sanguine. i. hote and moyst.
    • Colericke. i. hote and dry.
    • Melancolicke. i. cold and drie.
    • Phlegmaticke. i. cold and moyst.
2 The Age.
  • [Page 291]In his age: whether he be
    • In his youth.
    • In his manly middle age.
    • In his elderly age.
    • In his crooked old age.
3 The time of the yeare.
  • Concerning the time of the yeare, he is to be ad­uised what partes ther­of are
    • good, as the spring: from the mid­dest whereof to the beginning of Summer, is simply the best time: howbeit some thinke Autume reasonable good, as no doubt it is in regard of Summer or VVin­ter: being otherwise in it self, ra­ther to be rekoned for bad than good.
    • Bad
      • Verie bad, as Summer & VVinter, for the extre­mitie of heat & colde.
      • More tollerable, as Au­tumne, being somewhat more temperate.
4 The time of the Moneth.
  • [Page 292]Concerning the time of the Moneth these gene­rall cautions are to be obserued, that he be not let bloud in any mēber with chirurgicall instrument:
    • The Moone being in ♉. ♊. ♌. ♍▪ or the last half of ♎. and first of ♍.
    • The Sunne, the Moone, or lorde of the Horroscope being in the s [...]gne that ruleth that member.
    • The Moone being in any parte of via lactea, or in via combusta, or in domo casus sui, or being va­cua or tarda cursu, or in terminis infortuniorum, or in the duodena­rial diuision of the 12. houses, placed either in 1. 6. 8. or 12. place thereof, or applying to the lord of the house.
    • The d [...]y before the day it self: the day after the chāge of the Moon.
    • Halfe a naturall day, that is 12. hours before & as many houres after the quarters of the Moone.
    • A day before & a day after the full of the Moone.
    • A day before & a day after the coniunction, quartile opposition of the ☽ with ♄ or ♂.
    • A day before the coniunction of the ☽ with ☿. ♀. or the head or the taile of the Dragon infortu­nate, and euill.
  • [Page 293]The conue­nienst time of the yere.
    • For the Sanguine: the Moone being in any of the signes.
    • For the cholericke: the Moone being in ♋. or ♓.
    • For the Melancolick: in ♒. and first halfe of ♎.
    • For Flegma [...]ick: the Moone be­ing in ♈. or ♐. Howbe [...]t some commend ♋. ♒. and ♓. for bloud letting.
  • Also the best & most laudible a­spectes for this purpose are these, according to our soundest writers.
    • The coniunction of the Moone with ♃. or ♀. are simply the best: so that ♀. bee not com­bust.
    • The △. or ⚹. of the ☽. with ♃. ☉. ♀. and ☿. are good: but especially with ♃. or ☿.
    • The ♊. or ☍. of the ☽. with ♃. or ♀. doth well.
    • The △. or ⚹. of the ☽. with ♂. are indifferent good.
  • [Page 294]The time of the Moneth for
    • Youth: from the chaunge to the first quarter.
    • Middle age: from the first quar­ter to the full.
    • Elderly age: from the full to the last quarter.
    • Old age: from the last quarter to the chaunge.

A reason of this rule is: Like reioyseth in his like. Howbeit as we haue taught in this Trea­tise no childe would bee let bloud before four­teene yeares of age▪ nor olde man after three­score and ten, vnlesse his strength be the greater and somewhat more than ordinary, at those yeares.

5 The time of the daie.
  • The time of the day must be either
    • Morning: after the rising of the Sun, when a man is yet fasting: which is simply the best, ex­cepting the houres of ♂. and ♄▪ and choosing the houres of ♃▪ and ♀. whose nature is most temperate.
    • Afternoone: after reasonable good, or rather perfect digesti­on and expulsion of of super­fluities.

[Page 295] Herewithall regard must be had of the aire, that it bee neither too hote, nor too colde: or clowdy: but milde, cleare, and temperate: the wind being then either Northerly or westerly. The Southwind is counted no friend to Phle­bot [...]my: whereof this is the reason, heate loose­neth too much: cold bindeth too much.

An Exception.

NOtwithstanding the premisses of bloud­letting before: The Frensie, Squinancie, Pluresie, and Apoplexie, or for a continuall headach proceeding of choler or bloud, for any hote burning Feuer, or other extreme paine and desperate disease: A man in such a case may not tarry a chosen time regularly set downe by the Astronomer or Phisition: for so the Pati­ent might miscarry in the meane season. But in­continently with all conuenient speede, hee is this way to seeke his remedy: except either he bee very weake, or like to sowne, or that the Moone bee in the same signe that ruleth that very part of the body. VVhere also note, that in the foresaid case of extremity, bloud is not to bee let in so great a quantity as otherwise it would, if a chosen time might conueniently be expected.

As before bloudletting these circumstances of complexion, age, and times are to be consi­dered▪ [Page 296] So after the same, consideration is to be had of our meats and exercise.

For meates such must bee taken as are of an easie and light digestion.

For exercise wee are to abstaine from all ex­clusiue, vntill the fourth day, not onely those that be vehement: as riding, running, leaping, vawting, wrastling, fensing, tennise, &c. But also such as are more milde, as walking, bowling, ba­thing, and especially Venerie: whereof wee haue spoken in the twentith Chapteer: and I doubt not but I may effectually conclude, (both antecedent and consequent limitations duely and orderly obserued) this auncient pra­ctise of Phlebotomy to bee very commendable both for the preseruatiue and curatiue intenti­on of Phisicke.

Conclusio Operis.

And thus according to my simple skill, and poore talent, I haue set downe those remedies, which withdraw bloud, either from the whole body generally, as Phlebotomy: or from certain parts particulerly, as Leeches, boxing, and scar­rification: which was my purposed determina­tion at the beginning to doo. If any thing bee here set down repugnant to sound skill, I craue pardon, hauing no skill to iudge, because Phi­sicke is not my profession: onely drawen with [Page 297] a delight in this practise: First, for my pleasure, now (I trust) for orhers profit, I haue further trau [...]iled herein, than I thought to haue done. If any fault or error be in the order, methode, or disposition, I assigne that vn [...]o my selfe▪ [...] pardon for ought that is ami [...]se: protesting in truth, (which a man may easily discrie) t [...]at this booke is rather a collection from others, than an inuention of mine owne. God graunt that this my trauaile herein, (whatsoeuer it bee, may make vnto his glory, and the comfort of his people, which are the two impulsiue causes, moouing euery good Christian, one way or o­ther, to imploy his indeuour.

Deo laus honos & gloria in omne aeuum.

FINIS.

¶ The Contents of the seueral Chap­ters in this Treatise.

  • Cap. 1 OF fulnes, emptines, and their diuisions.
  • 2 What euacuation is, and the kindes and diffe­ces thereof.
  • 3 What Phlebotomie is, and from whence the opening of a veyne doth euacuate.
  • 4 Whether Phlebotomie must goe before purging or con­trary.
  • 5 Of the effects, that is, the profits & disprofits of bleeding.
  • 6 Of reuulsion, that is, pulling back: and deriuation, that is, turning a side of blood and humors by opening of a veine.
  • 7 Whether purgation by siedge or inward medicine recei­ued can not, or may not euacuate the blood, and the reasons an­swered that are brought for proofe thereof.
  • 8 Of the impediments or lets of Phlebotomy, and of the cau­ses requiring and furthering the same.
  • 9 Of such persons as are meete or not meete to be let blood.
  • 10 What corruption of humors, bleeding remoueth from the veynes generally.
  • 11 A particular rehearsal of those diseases present or future, which are cured by bleeding.
  • 12 What volūtary eruption of blood profiteth in sicknes.
  • 13 How to know by certayne signes the greatnes of the dis­ease, & the firmenesse of the natural forces, wherby coniecture may be made whether the patient be to be let blood or no.
  • 14 To know by the greatnes of the disease, and strength of the natural powers, the quātity of blod that must be withdrawē.
  • 15 An obseruation of things present and past, and also a foresight of things future, needfull and necessary to the fur­ther knowledge of the quantity of blood that must be taken.
  • 16 Of the times and seasons of the sicknes of the yeare, of the day, and houre of the day, when a man is to bleede or not to bleede.
  • 17 Of Astrologicall obseruation in bleeding, and of an o­ther [Page] obseruation neerely annexed vnto the same, shewing what members and parts of the body are to bee opened accor­ding to the seueral seasons of the yeare.
  • 18 What preparation must goe before bleeding.
  • 19 What is to be done in the very time of the incision.
  • 20 A prescription or regiment of the patient after blee­ding.
  • 21 What veynes are to bee opened both in generall and particular diseases.
  • 22 A profitable obseruation of the blood extracted.
  • 23 A short rehearsal of 8. auncient errors touching blee­ding, and a sufficient confutation of them by auncient autho­rities.
  • 24 A sufficient confutation of the supposed necessitie of annual bleeding.
  • 25 Of incision of the arteries.
  • 26 Of particuler euacuation of blood, and first of bloodsuc­kers, and Horse-leaches.
  • 27 Of cupping or boxing, and scarrification: the other two particular euacuations of blood.
  • 28 A profitable compēdious table of Phlebotomy or blood letting, conteining diuers poynts in this Treatise handled, & discussed off, and setting downe by deuision the generall and speciall considerations thereunto belonging.

The names of the authors whose help is chiefly vsed in this Collection.

  • Aristotle, Actuarius, Aetius,
  • Auicen, Alexius, Andernacus,
  • Auerroes, Arnoldus de villa noua.
  • Bacchanellus,
  • Bullein Anglus.
  • Cornelius Celsus.
  • Eliota Anglus.
  • Fernelius. Fuchsius.
  • Galenus. Gesnerus.
  • Hippocrates. Rich. Harueius Anglus.
  • Holl [...]rius.
  • Iohannes, de Santo Amando.
  • Iohannes de vigo.
  • Mesue.
  • Oribasius.
  • Paulus Aegineta.
  • Rhasis.
  • Rondoletus.
  • Schola Salerni.
  • Weckerus.

LONDON, Printed by William Hos­kins & Iohn Danter, dwelling in Feter-Lane. 1592.

[...]y [...]sts i [...] [...] [...]*

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