Nine books of physick and chirurgery written by that great and learned physitian, Dr Sennertus. The first five being his Institutions of the whole body of physick: the other four of fevers and agues: with their differences, signs, and cures.

CHAP. V. Of breathing of a vein.

NOw for the cure to be performed by these intentions, * 1.1 and first concerning Phlebotomy. Galen 11. meth. medendi. cap. 15. gives this rule. It is most wholesome he sayes in all Fevers to open a vein, not only in continued, but also in all others which the putrifying humour stirreth up, * 1.2 especially when neither age nor want of strength prohibites it. And he addeth this reason; For nature which rules our bodies being enlighthed, and unburthened of that by which as with a pack it was oppressed, what remains, it will overcome without difficulty, and therefore not being forgetful of its proper office, will both concoct what can be concocted, and cast out what may be emitted. Yet this precept of Galen is to be rightly understood and explained. For although there are many occasions for opening a vein, and Au∣thors cannot agree about the reason why Galen commands Phle∣botomy in putred Fevers: Yet 'tis clear he did it, that by evacu∣ation of the blood, nature might be enlightened and freed from the greatest part of her burthen, for when blood abounds, the opening of a vein, and purging of Cacochymy are the best reme∣dies; furthermore when it is a plethorick body, without doubt we should open a vein. In some measure the breathing of a vein, doth take away the cacochymy contained in the veins, and mixed with the blood, since the vein being opened, the vitious humours go out with the blood, especially because purgation which can take away foul humours out of the veins, is not so safe as the breathing of a vein to be appointed at the beginning of a Fever. For although Phlebotomy cannot take away all the ill humours out of the veins, yet nature is lessned some part of her burthen, and therefore can concoct and master the remain∣der the more easily, for it may be that the plenty of blood, which before the sickness was no trouble to the party, now being sick and weakened with a Fever, may become burthensom unto him. And although some good blood be emitted therewith, yet that hurts not the sick, but rather helps, as is said: As we also see by critical Hemorrhodes, that nature sends out no small quantity of good blood together. Yet nature for the most part useth to

drive no small part of peccant humours to the extream and sub∣cutaneous parts; thence and in the first place most commonly the worst blood comes first out. Whence it is manifest especially in continual Fevers, in those who abound with blood, or have peccant humours mixt with their blood, that bleeding is pro∣per, and that at the beginning, that nature may be unladed of part of her burthen, but if vitious humours are not intermingled with the blood in the greater veins, the breathing of a vein for e∣vacuation thereof is not to be used.

Cooling and fanning the blood is performed by lerting blood: but they are only to be done when bleeding will not cool it alone. * 1.3

We are not only to observe whether bleeding be needful, but also whether the party be strong enough to suffer it, when the strength of the vital faculty is principally to be required, so that the strength do not languish by too great store of blood suf∣focating the Spirits, Age, Habit of body, and condition of the ambient air shew the strength.

But how much blood is to be taken away, * 1.4 first by the plenty of blood, then by comparing the strength of the Patient with the greatness of the disease, will be manifest; for greater quantity requires larger emission, lesser, less; robustious bodies require larger breathings of veins, weaker require less. The strength varies according to temperament, habit of body, age, sex, sea∣son of the year, the condition of the Heavens, and the Region, as also in regard of certain Symptomes, which use to be accom∣panied with Fevers, as of watchings, pain, and such like.

As for the time for letting blood, * 1.5 'tis to be done when 'tis indicated, and no way prohibited; which is in the beginning, and by how much the more the disease hastens to increase, so much the sooner blood is to be taken away, * 1.6 but if the concocti∣ons are more dull and slow, Pulebotomy may be deferr'd longer.

Veins that are opened for evacuation are best in the middle of the arm; yet if the sick be weak, and that also revulsion is to be made from the head, the veins in the foot are to be opened to the greatest benefit of the sick.

Notes

• * 1.1

  Letting blood.
• * 1.2

  Whether, when, and why to be done in a putred Fe∣ver.
• * 1.3

  Rules al∣lowing Phleboto∣my.
• * 1.4

  The quan∣tity that may be ta∣ken.
• * 1.5

  The time.
• * 1.6

  The place.