Klinike, or The diet of the diseased· Divided into three bookes. VVherein is set downe at length the whole matter and nature of diet for those in health, but especially for the sicke; the aire, and other elements; meat and drinke, with divers other things; various controversies concerning this subject are discussed: besides many pleasant practicall and historicall relations, both of the authours owne and other mens, &c. as by the argument of each booke, the contents of the chapters, and a large table, may easily appeare. Colellected [sic] as well out of the writings of ancient philosophers, Greeke, Latine, and Arabian, and other moderne writers; as out of divers other authours. Newly published by Iames Hart, Doctor in Physicke.

CHAP. IX.

Preparation before phlebotomy, during bleeding what to be done, and how to bee ordered after. Of particular phlebotomy by leaches: of sacrification and cupping. Of searing, setum, vesicatories, &c.

IN the first place then before phlebotomy we are to prepare the body,* 1.1 by cleansing it from the excremēts of the first concoction contei∣ned in the guts, & withal we must have a care to correct the crudities of the stomacke and small veines.* 1.2 Crudities before must be cor∣rected by a spare and wholesome Diet. As for expulsion of the fecall excrements, it is safest to use a gentle, emollient glister, of some gentle, lenitive, Manna, sirup of roses, or the like. A broth made of loosening herbes; as mercury, mallowes, betcs, spinage, groundsell, and the like, will sometimes serve the turne. But if necessity constraines us, or any other acute disease urge us: as a Pleurisie, a Squinancy, or the like, we are then to make no delay, but take hold of the present opportunity, delay in this case threatning no lesse danger than death.* 1.3 If the orifice or mouth of the stomacke be ve∣ry sensible, if some choler proceeding from the liver or veines have ceized upon it, or it hath contracted any imbecillity or weakenesse, then before we set upon this worke, we are first to corroborate the sto∣make, and b••unt the edge of these humors, with the juice of lemmons, pomegranats, barberies, or rather their sirups: and the imbecillity of the heart is to bee remedied with a toste in a little Canary-sacke, hipocras or the like; as also with some cordiall loosings, or the like so∣lid or liquid substance. If fasting be offensive, an houre or two before, they may take a little of some liquid substance, broth cawdell or the like. The party to be phlebotomised, if in health, is to bleed sitting,

unlesse upon a small occasion subject to swound in which case he may bleed upon his bed. In sicke persons, especially when they are weake,* 1.4 this same rule is to be observed, and withall we are to be obserue and di∣ligently to marke, whether in the bleeding strength continue;* 1.5 the decay of which may be discerned by the changing of the colour, by ga∣ping and yawning, by stretching and reaching, dazeling of the eyes, singing of the eares, the hicket, loathing of the stomacke, and especi∣ally by the changing of the pulse: in which case it is good either to give over, or else to pause a little untill the partie be a little refreshed, and then to bleed againe, or deferre it a while as occasion shall re∣quire.* 1.6 If hee swound set him backward sprinkle his face with rose∣water, or other ordinary, and present to his nose refreshing smell. Af∣ter bleeding, especially in sicknesse or weaknesse, the patient is to be laid upon a bed on his backe, not sleeping for two or three houres after; and within an houre or two may take some food in a small quan∣tity, and easie of digestion: as some cawdell, broth or the like. And in case of sudden fainting it may bee sooner used▪ or at least some other comfortable cordiall. After this, the patient must keepe a good and spare Diet.

But many times is commeth so to passe,* 1.7 that this noble and gene∣rous remedy by opening of a veine cannot so wel be effected, or at least is not so fit, in regard blood is oftentimes impacted into some parti∣cular part, so that it cannot by ordinary phlebotomy bee evacuated, and then doe we betake our selves to a particular kind of phlebotomie by leaches, scarification and cupping glasses.* 1.8 The leaches must be chosen, such as live not in stinking puddle-water, not very greene, nor having great blacke heads: and being caught, they are to bee kept in faire water, which is often to be shifted.* 1.9 Some counsell to put a little sugar in the water, and some a little blood. They are best that live in waters where mosse and frogges abound: not rough on the backe, of the colour of antimony, or having blew lines; but round little tailes like unto mice, and small heads. In defect of phlebotomy, when for some good consideration it cannot conveniently be admini∣stred, we may apply them to the great veines: but most properly they are to be applied to the small veines.* 1.10 They are much used in the he∣morrhoidall veines, and doe best of all draw unto them melancholicke blood: & for this cause, they are of singular good use in Itches, Scabs, and the like. They are to be put through a quill,* 1.11 and so applied to the place wee please; howbeit some use a spunge, fomenting the place first with warme water, and then anointing it with a little blood to make them sucke the sooner. Some, when they are a sucking, cut off their tailes that they may draw more freely. If they fall not off in due time, sprinckle some salt on them: and if they fall off too soone,* 1.12 bath the place with warme water, and if it may be with conveniency, bleed over warme water; and after they are falne off, this will still further the bleeding. If the veine bleed too long, use the same meanes we use in stopping the bleeding of a veine in ordinary phlebotomy, adding,* 1.13 if thou wilt, a little powder of bole armenicke, some powder of galls, &c.

* 1.14Besides these, there is yet another particular evacuation of blood performed by meanes of scarification or racing of the skinne, and dif∣ferreth according to the manner it is used. If deeper, it draweth more copiously and from the remote parts, and withall evacuateth the thick∣er blood. It may often supply the place of Phlebotomy. And thus in the armes deepe scarifications evacuat from the whole, as likewise sometimes in the legges, especially cupping glasses being therewith applied. And thus Oribasius in that great and memorable Asiaticke plague scarified both himselfe and many others, and drew out very neare two pounds of blood, and by this meanes escaped the present danger.* 1.15 Scarification in this same place is also good in a plethory, proceeding from the suppression of the piles or menstruous fluxe. It may sometimes be used, by way of revulsion, to the remote parts, observing still the rectitude or communion of the parts, as in the inflammation of the right legge, scarification of the right hand or left legge. As likewise scarification of the legge attracteth from the inward to the outward parts, and draweth downe-wards, &c. And in the menstru∣ous fluxe scarification of the thighes or hands serveth in stead of deri∣vation in furthering this fluxe. But scarification hath alwaies a most forcible effect in attracting from the remote parts when it is deepe, and a cupping glasse presently applied. But the most proper use of scarification is to evacuat from the part affected, other remedies not prevailing. And for this cause is effectuall in all Scabs, and other brea∣kings forth upon the skinne, as also for an inveterate Scirrhus, Inflam∣mations, Gangrenes, Pestilentiall tumors, bittings of venemous beasts, &c. But with scarification for the most part we use also cupping with or without fire;* 1.16 and these cups are made of divers matters, of horne, glasse and copper; and of severall formes, long, round, some of a wi∣der and some of a narrower orifice. They are for the most part used of glasse called therefore cupping glasses.* 1.17 And of these the round with a narrow mouth or orifice are the best, and draw most effectually; and of these some are bigger, some lesser, according as the evacuation is to be more or lesse In regard of the bodies they are to be applied to,* 1.18 they have a farre more successefull operation in thinne bodies, than in thicker constitutions. Againe, we are to consider the nobility, con∣sent, and the vicinity of the parts in the application and use of this re∣medy; and therefore not to bee applied to any principall part, lest there follow an attraction of bad humors thereunto. But in the mutu∣all consent of two parts, they may to good purpose be applied to the one; as in the immoderate menstruous fluxe, to the breast. They are not to be used of sound and healthfull bodies, to young and growing people,* 1.19 nor to old decrepit persons: nor yet of custome, but with good advice of the learned Physitian, as need shall require, especially in the Spring and in Winter; not in a hot house, but neere a good fire, onely some frictions going before. We use them either with or with∣out fire,* 1.20 also with or without scarification. The time elective is after perfect concoction, the stomacke now being empty, and the guts cleane from cōmon excrements. The time of coaction or necessity is that which requireth this remedy, although the time bee not so seasonable, and

that to prevent a further danger. They are not ordinarily to be used before generall or universall evacuations have been used, but in some cases; as in the wind-colicke: or when as by reason of the thinne stru∣cture of the body it is not so safe to open a veine; or when we would attract any tumor from the internall to the externall and superficiall parts of the body. Wee are then to apply this remedy either to the part affected, or the next to it, when there is now no more affluxe of matter. Dry cups without scarification draw and evacuat the body insensibly, especially of wind.* 1.21 They are sometimes for staying of vo∣mits and yexing applied to the stomacke. They are in divers cases ap∣plied to severall parts of the body: as the hinder part of the head, and the crowne for divers infirmities of the eyes and head: to the fore∣part for the Phrensie, Lethargy, &c: as also to the shoulders, chinne, thighes, legges, &c; for divers infirmities, whereon I must not now insist, but proceed.

Besides the premisses, there are yet some other particular evacua∣tions performed by the hand of the Surgeon, the which for affinitie with the former, although no bloody evacuations,* 1.22 we will handle in this place. Of these, the chiefe is burning or searing of some parti¦cular place of the skin both for preservation and recovering of health; whereunto we referre also the two other, setum and vesicatory.* 1.23 This sea∣ring, in Latine called cauterium, is nothing else but a little ulcer made in the superficiall part of the body of man, with some actually or po∣tentially hot thing, by this meanes to make a free passage for a lei∣surely ensuing out of peccant, noxious matter causing diseases: and that both for inhibiting corruption, corroboration of the members of the body, and the restriction of the influxe of humors.* 1.24 This remedy is of greater utility and profit than many are aware of; and may indif∣ferently be used in all ages, not excepting infancy it selfe, where it is most soveraigne, even when they are yet in the cradle, and that for curing and preventing many diseases: as Convulsions, Epilepsies and rheumes; and besides, is not denied to any sex. The severall sorts or kindes of it are distinguished by three severall & distinct names:* 1.25 the one sonticulus, the next setaceum or setum; from a thred of silke or haire drawne thorow; and the last vesicans or vesicatorium, and of the vulgar, a blister, from the effect: and as for others dropax, sinapismus, psilothrum, as not being so frequent and usefull in sicknesse and health, as the for∣mer, I passe by. Now as concerning the part or place of the body where this issue is to be made, we must be very circumspect,* 1.26 and well consider where this noxious matter to be evacuated is ingendred. If the matter be by the issue to be derived, diverted or drawne aside, then is the issue to be made neare to the part affected. If it be for revulsion or pulling backe, then we are to beware of molesting any noble part, and therefore the place of the issue must be made a little further off; with that caveat notwithstanding, that the rectitude and consent with the part affected be observed. Neither are wee ever to make any issue in the part affected, unlesse the matter be already there impacted,* 1.27 and universall evacuations have already proceeded. This issue is made most commonly with an instrument made of iron actually hot, and of

divers formes according to the nature of the part affected: and some are also made of gold.* 1.28 Some againe use no materiall instrument of iron or other metall; but some hot burning medicine, composed of some ingredients of a hot, burning operation, although no heat to the outward senses of seeing or touching be therein discerneable; called therefore potentiall cauteries:* 1.29 and these being applied to the part, doe in a short time make an issue. Some againe use to open the part by incision, and so make the issue; but is farre inferior to the former. The best way is that which is seared with gold or iron; and next to that, such as are made of causticke matter; especially, if care be had that is performe its operation with speed, and with as little paine as is possible.* 1.30 The particular place where this is to be made, is indica∣ted by the place affected, where the matter hath its residence; which if ingendred in the liver ascendeth up into the head, then is it to bee made in the legge; and if it descend into the legge, then is the arme of the same side to have an issue opened. Againe, if noxious humours abound in the nether belly, it must be opened in the legge; if in the middle region, in the arme, if there be no impediment: but if there be any such matter in the head, it must be made in the the hinder part of the head: if it take the way downe towards the breast and the lungs, then both in the coronall future in the forehead, and in the hinder part. If it be ingendred in the head, and descend upon the backe-bone, the loines and nether parts, then must it bee made in the beginning of the backe-bone to intercept the matter. In many other particular places of the body we use this remedy, which would be here too long to relate.

* 1.31As for vesicatories, or blistering remedies, they use to bee made of such things as blister the flesh; such as be crowfoot, euphorbium, pelli∣tory of Spaine, mustard, cantharides; being any one or more of these mingled, with sowre leaven and vineger wrought together; the blister so made is to be opened, the place to bee kept open with a little fresh butter, or cere-cloth.

* 1.32That which we call Setum or Sataceum, is an issue most commonly made in the necke with a hot needle drawne thorow the necke with a thred of white or crimson silke, the place kept open by drawing the silke to or fro out of its place, and dressing it afterwards as is fitting. Some used heretofore a haire in stead of silke, from whence this opera∣tion taketh its denomination.

There is yet mention made of another manner of making of this issue with this hot needle, recorded by a a 1.33 famous Surgeon, on which now I will not insist. Now all these issues are to be kept open untill such time as this noxious and evill matter bee quite spent and wasted away, at which time it may safely againe be closed up. But if they be appointed by way of revulsion, or pulling backe any humor, accusto∣med to fall downe upon any place, and have been of a long time con∣tinued, then may they not so safely be dried up, unlesse another bee made to supply the place of the former. This Setum is a singular good meanes to helpe all infirmities of the eye-sight, and many inveterate infirmities of the braine: as Epilepticke fits, bad memory proceeding

of moisture, and many more. And thus have I somewhat at large handled phlebotomy, and all circumstances concerning the same; and so much the rather, for that I see the world so much herein abu∣sed, and so many by the indiscreet use thereof miscary: now I pro∣ceed to the other and second generall evacuation called purgation.

Notes

• * 1.1

  Preparation to be u∣sed before phleboto∣my.
• * 1.2

  Crudities.

  Expulsion of the fe∣call ordure.
• * 1.3

  Imbecillity of the o∣rifice of the stomack.
• * 1.4

  Situation of the pati∣ent to be let blood.
• * 1.5

  What to be observed in the bleeding.
• * 1.6

  Swounding.

  After how to be o••∣dered.
• * 1.7

  Particular phleboto∣my by leaches.
• * 1.8

  Election of leaches.
• * 1.9

  Preparation of lea∣ches.
• * 1.10

  In what cases most usefull.
• * 1.11

  Application.
• * 1.12

  To make them fal off
• * 1.13

  To stop the bleeding
• * 1.14

  O•• scarification.
• * 1.15

  In what cases to be u∣sed.
• * 1.16

  C••pp••r•• commonly used with scarificati∣on
• * 1.17

  The matter & forme of these cups.
• * 1.18

  In what bodies most usefull.
• * 1.19

  Manner of applica∣tion.
• * 1.20

  The time.
• * 1.21

  Dry cups without sca∣rification in that ••••∣ses to be used.
• * 1.22

  Burning or searing of some parts.
• * 1.23

  What it is.
• * 1.24

  Vtility and profit of this remedy.
• * 1.25

  Fonticulu••. Setaceum. V••ficatorium.
• * 1.26

  The place where wee are to make this issue
• * 1.27

  With what cautions.
• * 1.28

  With what instrumēt it is made.
• * 1.29

  Potentiall cauteries.
• * 1.30

  The particular place.
• * 1.31

  Vesicatories or bliste∣ring remedies.
• * 1.32

  Setum what.
• a 1.33

  Guilielm. F••bricius Hild. observat, chirug. observat. 40. & 41.