A treatise of the plague contayning the causes, signes, symptomes, prognosticks, and cure thereof. Together with sundry other remarkable passages (for the prevention of, and preservation from the pestilence) never yet published by anie man. Collected out of the workes of the no lesse learned than experimented and renowned chirurgian Ambrose Parey.

CHAP. XVI.

Whether purging and bloud-letting be necessarie in the beginning of pestilent diseases.

SO soone as the heart is strengthened and corroberated with cordials & Antidotes, we must come vnto phlebotomie and pur∣ging. As concerning bloud-letting in this case, there is a great controuersie among Physitions. Those that wish it to be vsed, say or affirme that the pestilent Feauer doth infixe it selfe in the bloud, and therein also the pestilent ma∣lignitie taketh its seate; and therefore it will soone infect the other humors, vnlesse that the bloud be euacuated, and the infection that remaineth in the bloud be thereby ta∣ken

away. Contrariwise those that do allow phleboto∣mie in this case, alledge that it often commeth to passe that the bloud is void of malignitie when the other hu∣mors are infected with the venemous contagion. If a∣ny man require my iudgement in this doubtfull questi∣on, I say, that the Pestilence sometimes doth depend on the default of the ayre: This default being drawn through the passages of the bodie, doth at length pierce vnto the entrals, as wee may vnderstand by the abscesses which breake out one while behinde the eares, sometimes in the arme-holes, and sometimes in the groines, as the braine, heart, or liuer are infected. And hereof also come Car∣buncles, and other collections of matter and eruptions, which are seene in all parts of the bodie, by reason that nature vsing the strength of the expulsiue facultie, doth driue forth whatsoeuer is noisome or hurtfull. Therefore if the Physition will follow this motion of nature, he must neither purge, nor let bloud, lest that by a contrarie mo∣tion, that is, by drawing in from without, the motion of nature which proceeds outwardly from within, should be troubled. So wee often see in those who are purged or let bloud for such Buboes as come through vnlawfull copulation, that the matter is thereby made contumaci∣ous, and by drawing it inwardly it speedily causeth the French Poxes. Wherefore when Buboes, Carbuncles, and other pestilent eruptions appeare, which come through the default of the ayre, wee ought to abstaine from purging and phlebotomie; but it is sufficient to forearme the heart inwardly and outwardly with Anti∣dotes that are endewed with a proper vertue of resisting the poison. For it is not to bee doubted, but that when nature is debilitated with both kindes of euacuation, and when the spirits together with the bloud are exhau∣sted, the venemous ayre will soone pierce, and be recei∣ued into the emptie bodie, where it exerciseth its tyran∣nie to the vtter destruction thereof.

In the yeare of our Lord God 1565. in which yeare

there was great mortalitie through out all France, by rea∣so nof the Pestilence, and pestilent diseases, I earnestly and diligently enquired of all the Physitions, and Chirur∣gians of all the Cities (through whom King Charles the ninth passed in his progresse vnto Bayon) what successe their patients had after they were letten bloud & purged, wherunto they all answerd alike, that they had diligently obserued, that all that were infected with the Pestilence, and were letten bleede some good quantitie of bloud, or had their bodies somewhat strongly purged, thencefor∣wards waxed weaker and weaker, and so at length died; but others which were not let bloud, nor purged, but took cordial Antidotes inwardly and applied them outwardly, for the most part escaped and recouered their health: for that kinde of Pestilence tooke its originall of the pri∣matiue and solitarie default of the ayre, and not of the corruption of the humors. The like euent was noted in the hoarsenesse that wee spake of before: that is to say, that the patients waxed worse and worse by pur∣ging, and phlebotomie; but yet I doe not disallow ei∣ther of those remedies, if there bee great fulnesse in the bodie, especially in the beginning, and if the matter haue a cruell violence, whereof may be feared the breaking in vnto some noble part. For we know that it is confir∣med by Hippocrates, that what disease soeuer is caused by repletion, must bee cured by euacuation: and that in diseases that are verie sharpe, if the matter doe swell, it ought to be remedied the same day, for delay in such dis∣eases is dangerous; but such diseases are not caused or inflicted vpon mans bodie by reason or occasion of the Pestilence, but of the diseased bodies and diseases them∣selues commixed together with the Pestilence; there∣fore then peraduenture it is lawfull to purge strongly, and to let a good quantitie of bloud, lest that the pestilentve∣nome should take hold of the matter that is prepared, and so infect it with a contagion, whereby the pestilence ta∣keth new and farre greater strength; especially as Cel∣sus

admonisheth vs, where he saith; that, By how much the sooner those sodaine inuasions do happen, by so much the sooner remedies must bee vsed, yea or rather rashly applied; therefore if the veines swell, the face waxe fie∣rie red, if the arteries of the temples beate strongly, if the patient can verie hardly breath by reason of a weight in his stomacke, if his spittle be bloudie, then ought hee to be let bloud without delay, for the causes before men∣tioned. It seemes best to open the liuer veine on the left arme, whereby the heart and the spleene may be better discharged of their abundant matter; yet bloud letting is not good at all times, for it is not expedient when the bodie beginneth to waxe stiffe by reason of the comming of the Feuer; for then by drawing backe the heate and spirits inwardly, the outward parts beeing destitute of bloud waxe stiffe and cold; therefore bloud cannot bee letten then without great losse of the strength, and per∣turbation of the humors. And it is to bee noted, that when those plethoricke causes are present, there is one Indication of bloud-letting in a simple pestilent Feauer, and another in that which hath a Bubo, id est, a Botch or a Carbuncle ioined therewith. For in one or both of these being ioined with a vehement and strong burning Feuer, bloud must bee letten by opening the veine that is neerest vnto the tumor or swelling against nature, kee∣ping the straightnesse of the fibres, that this being open the bloud might be drawne more directly from the part affected; for all and euerie retraction of putrified bloud vnto the noble parts is to bee auoided, because it is noi∣some and hurtfull to nature, and to the patient. There∣fore for examples sake, admit the patient bee plethoricke by repletion which is called Ad vasa, id est, vnto the ves∣sells, and Ad vires, id est, vnto the strength: and there∣withall he hath a tumor that is pestilent in the parts be∣longing vnto his head or necke, the bloud must be let out of the cephalicke or median veine, or out of one of their branches dispersed in the arme on the greened side. But

if through occasion of fatt, or any other such like cause those veines doe not appeare in the arme, there bee some that giue counsell in such a case to open the veine that is betweene the forefinger and the thombe, 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 tumor bee vnder the arme-hole or a∣bout those places, the liuer veine, or the median must be opened which runneth alongst the hand: if it bee in the groine, the veine of the hamme, or Saphena, or any other veine aboue the foote that apreareth well, but alwaies on the greeued fide. And phlebotomie must bee performed before the third day: for this disease is of the kinde or nature of sharpe diseases; because that within foure and twentie houres it runneth past helpe. In letting of bloud you must haue consideration of the strength. You may perceiue that the patient is readie to swound when that his forehead waxeth moist, with a small sweate sodainely arising, by the aking or paine at the stomacke, with an ap∣petite to vomite, and desire to go to stoole, gaping, black∣nesse of the lippes, and sodaine alteration of the face vnto palenesse: and lastly most certainely by a small and slow pulse: and then you must lay your finger on the veine, and stop it vntill the patient come to himselfe againe, either by nature; or else restored by Arte, that is to say, by giuing vnto him bread dipped in wine, or anie other such like thing: then if you haue not taken bloud enough, you must let it goe againe and bleede so much as the great∣nesse of the disease, or the strength of the patient will permit or require: which being done, some one of the An∣tidotes that are prescribed before will be verie profitable to be drunk, which may repaire the strength and infrigne the force of the malignitie.