The workes of that famous chirurgion Ambrose Parey translated out of Latine and compared with the French. by Th: Johnson

CHAP. XXIIII. Whether purging and bloud-letting bee necessary in the beginning of pestilent diseases.

SO soon as the heart is strengthened & corroberated with cordials & an∣tidotes, * 1.1 we must come to phlebotomy & purging. As concerning bloud-letting in this case, there is a great controversie among Physicians. Those that wish it to be used, say or affirme that the pestilent Feaver doth infixe it selfe in the bloud, and therein also the pestilent malignity taketh its seate; and therefore it will soone infect the other humours; unlesse that the bloud be evacuated, & the infection that remaineth in the bloud be thereby taken away. Con∣trariwise, those that do not allow phlebotomy in this case, alledge, that it often com∣meth to passe that the bloud is voyd of malignity when the other humours are infe∣cted with the venemous contagion. If any man require my judgement in this doubt∣full question, I say, that the pestilence sometimes doth depend on the default of the aire: This default being drawne through the passages of the body, doth at length * 1.2 pierce unto the entrals, as we may understand by the abscesses which breake out one while behind the eares, sometimes in the arme-holes, and sometimes in the groines, as the braine, heart or liver are infected. And hereof also come Carbuncles, and o∣ther collections of matter, and eruptions, which are seene in all parts of the body, by reason that nature using the strength of the expulsive faculty, doth drive forth whatsoever is noysome or hurtfull. Therefore if the Physician will follow this mo∣tion of nature, he must neither purge nor let bloud, lest that by a contrary motion, that is, by drawing in from without, the motion of nature which proceeds outward∣ly

from within, should be troubled. So wee often see in those who are purged or let bloud for such Buboes as come through unlawfull copulation, that the matter is thereby made contumacious, and by drawing it inwardly, it speedily causeth the French Pocks.

Wherefore, when Buboes, Carbuncles and other pestilent eruptions appeare, which come through the default of the Aire, we ought to abstain from purging and phlebotomie; but it is sufficient to fore-arme the heart inwardly and outwardly with Antidotes that are endued with a proper vertue of resisting the poyson. For it is not to bee doubted, but that when nature is debilitated with both kindes of eva∣cuation, and when the spirits together with the bloud are exhausted, the venemous Aire will soone pierce, and be received into the empty body, where it exerciseth its tyranny to the utter destruction thereof.

In the yeare of our Lord God 1565. in which yeare there was great mortality * 1.3 throughout all France, by reason of the pestilence and pestilent diseases, I earnestly & diligently enquired of all the Physicians & Chirurgians of all the Cities (through which King Charles the ninth passed in his progresse unto Bayon) what successe their patients had after they were letten bloud and purged, whereunto they all answered alike, that they had diligently observed, that all that were infected with the Pesti∣lence, and were letten bleed some good quantity of bloud, or had their bodies some-what strongly purged, thence forwards waxed weaker and weaker, and so at length dyed; but others which were not let bloud nor purged, but took cordiall Antidotes inwardly, and applyed them outwardly, for the most part escaped and recovered their health: for that kind of Pestilence tooke its originall of the primitive and soli∣tary default of the Aire, and not of the corruption of the humours.

The like event was noted in the hoarsenesse that we spake of before: that is to say, * 1.4 that the patients waxed worse and worse by purging and phlebotomie; but yet I doe not disallow either of those remedies, if there be great fulnesse in the body, especi∣ally in the beginning, and if the matter have a cruell violence, whereof may bee fea∣red the breaking in unto some noble part. For wee know that it is confirmed by Hy∣pocrates, that what disease soever is caused by repletion, must be cured by evacuation; * 1.5 and that in diseases that are very sharpe, if the matter do swell, it ought to be remedi∣ed the same day, for delay in such diseases is dangerous; but such diseases are not caused orinflicted upon mans body by reason or occasion of the pestilence, but of the diseased bodies, and diseases themselves commixed together with the Pestilence; therefore then peradventure it is lawfull to purge strongly, and to let a good quanti∣ty of bloud, l••st that the pestilent venome should take hold of the matter that is pre∣pared, and so infect it with a contagion, whereby the Pestilence taketh new and farregreater strength; especially as Celsus admonisheth us, where he saith; that, By * 1.6 how much the sooner those sudden invasions doe happen, by so much the sooner re∣medies must be used, yea or rather rashly applyed; therefore if the veines swell, the face waxe fiery red, if the arteries of the temples beat strongly, if the patient can ve∣ry hardly breathe by reason of a weight in his stomacke, if his spittle be bloudy, then ought he to bee let bloud without delay, for the causes before mentioned. It seems best to open the liver veino on the left arme, whereby the heart and the spleene may * 1.7 be better discharged of their abundant matter; yet bloud-letting is not good at all times, for it is not expedient when the body beginneth to waxe stiffe by reason of the comming of a Feaver; for then by drawing backe the heat and spirits inwardly, the outward parts being destitute of bloud, waxe stiffe and cold; therefore bloud can∣not bee letten then without great losse of the strength, and perturbation of the hu∣mours. And it is to be noted, that when those plethoricke causes are present, there is one Indication of bloud-letting in a simple pestilent Feaver, and another in that which hath a Bubo, idest, a Botch or a Carbuncle joined ther with. For in one or both of these, being joyned with a vehement & strong burning Feaver, bloud must be let∣ten by opening the veine that is nearest into the tumour or swelling against nature, keeping the straightness of the fibres, that this being open, the bloud might be drawn more directly from the part affected; for all and every retraction of putrefied bloud unto the noble parts, is to be avoyded, because it is noysome and hurful to nature, and

to the patient. Therefore, for example sake, admit the patient be plethoricke by re∣pletion, which is called Advasa, idest, unto the vessels, and Advires, idest, unto the strength: and there withall he hath a tumour that is pestilent in the parts belonging unto his head or necke, the bloud must bee let out of the cephalick or median veine, or out of one of their branches dispersed in the arme on the grieved side. But if through occasion of fatte, or any other such like cause, those veines doe not appeare in the arme, there bee some that give counsell in such a case to open the veine that is betweene the fore-finger and the thumbe, the hand being put into warme water, whereby that veine may swell and be filled with bloud, gathered thither by meanes of the heate.

If the tumour be under the arme-hole, or about those places, the liver veine, or the median must be opened which runneth alongst the hand: if it be in the groine, the veine of the hamme, or Saphena, or any other veine above the foote that appeareth well, but alwaies on the grieved side. And phlebotomie must bee performed before the third day: for this disease is of the kind or nature of sharpe diseases; because that within foure and twenty houres it runneth past helpe. In letting of bloud you must have consideration of the strength. You may perceive that the patient is ready to swoune, when that his forehead waxeth moyst, with a small sweate suddenly arising, by the aking or paine at the stomacke, with an appetite to vomit, and desire to goe to stoole, gaping, blacknesse of the lippes, and sudden alteration of the face unto pale∣nesse: and lastly most certaincly by a small and slow pulse: and then you must lay your finger on the veine, and stop it untill the patient come to himselfe againe, ei∣ther by nature, or else restored by art; that is to say, by giving unto him bread dip∣ped in wine, or any other such like thing: then, if you have not taken bloud enough, you must let it goe againe, and bleed so much as the greatnesse of the disease, or the strength of the patient will permit or require: which being done, some one of the Antidotes that are prescribed before will be very profitable to be drunk, which may repaire the strength, and infringe the force of the malignity.

Notes

• * 1.1

  Reasons for and against bloud-letting in the Plague.
• * 1.2

  The composing of this contro∣versie.
• * 1.3

  A history.
• * 1.4

  When purging and bleeding may be used.
• * 1.5

  Aph. 22 sect 2. Aph. 10. sect. 4.
• * 1.6

  Cap. 7. lib 3.
• * 1.7

  Why bloud must 〈◊〉〈◊〉 let on th •…•…me in the Plague.