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 XVII. Of opening a veine.

BUt the most efficacious remedie for evacuation of blood is the breathing of a veine, which neverthelesse hath o∣ther uses, * 1.1 whereof we will here speake together, for tis a que∣stion of great moment when the breathing of a veine, or eva∣cuation of blood by opening of a veine is to be appointed, where first this is to be noted, that the opening o•• a veine is not some one Indicate, but the matter of remedie which is profitable in many Indicates.

There are two generall benefits in the opening of a veine, * 1.2 to evacuate, blood, and by accident, whilst it draws away the blood, the vehicle of heate, to coole; againe in evacuating it performes two things, for it both takes blood out of the body, and allwayes the cource, and violence of humours in the veines; first the way it both takes away the ill blood, and only diminuisheth it offending in quantity, but the latter way it can revell, and draw back and derive the blood flowne into a part, and the blood which is flowne in whilst it is yet moveable, can draw it to the parts neere thereunto; so that the opening of a veine may wholy per∣forme five things, namely to evacuate corrupt blood, to diminuish blood, to revell, derive, and refrigerate.

For first the vitious and putrifying blood may be eva∣cuated by opening of a veine, * 1.3 as that which is contained in veines, and they being opened it flowes out, and indeed tis most profitably appointed in beginning of diseases, since nature for the most part in feavers use to drive no small portion of the peccant matter to the extreames, and those greater veines under the skin.

Secondly, breathing a veine is an excellent remedie to diminish the blood. * 1.4

Thirdly, the opening of a veine is used for revulsion, for a veine being opened, the violence of the blood is turned and drawne back to the contrary part, and therefore tis a very efficacious remedie to stop flowings of humours, con∣tained in the veines.

Fourthly, the opening of a veine may derive the blood, which newly flowed into the part, * 1.5 and is not yet setled there, but as yet fluid; a veine being opened nigh at hand it may, I say drive the blood to a neighbouring part.

Fifthly, * 1.6 opening of a veine cooles by accident, but if dis∣temper

only be present, which may be corrected by other re∣medies, and no other fault of the blood be joyned with it which requires breathing of a veine also, cooling medicines are ordered to be used; but if the blood be so exceeding hot that it requires sudden refrigeration, which other medicines perchance cannot performe, or some other fault of the blood be joyned, which by the same means, opening of a veine may helpe, for this cause also you may open a veine.

From whence it is manifest, * 1.7 that the breathing fo a veine may be profitable, whilst the blood either putrifyes, and is corrupted, or offends in quantity, or flowes to any part, with violence, or oppresseth a part, or burnes vehemently.

Yet it is not allwayes necessary to open a veine when these ••inconveniences are present, since we can take them away by other meanes, but then only breathing a veine is conveni∣••ent, when there is a great corruption of the blood, and it re∣quires sudden releasing, as being that which is the best and most efficacious remedy amongst the evacuations of blood, then presently blood may be evacuated.

In short, * 1.8 the Indicant to which by mediation of the Indi∣cate, as being the matter of helpe, opening of a veine a∣grees, it is a vehement fault of the flowing blood, which is corrupted either in its substance, or it offends in quantity, or rusheth into some part, or oppresseth some part, or growes exceeding hot; yet besides these principle faults, the blood also sometimes, as a cause without which it cannot, and as adjuvant, it may offend; and then also it requires opening of a veine.

Yet we may not allwayes open a veine when these Indi∣cants are present, * 1.9 for since the opening of a veine evacu∣ates blood together, and also exhausteth somewhat of the spirits, and so debilitates the strength, if the strength be great, it permits opening of a veine, if it be weake it pro∣hibits it, and regard is to be had here not only of the pre∣sent, but of the future strength, for when the strength is weake, either oppressed with store of humours, or loosed, in the latter imbecility only breathing of a veine is prohibi∣ted, but in the former it is profitable.

All other things which are said to permit, or prohibit the breathing of a veine, besides strength, they doe it only in this respect, namely as they are the tokens or signes of strength, or debility of nature, as Age, which flourishing admits of opening a veine, Child-hood and old Age prohibit

the same, * 1.10 the Sex, as to women with child, especially in the last monthes, the opening of a veine is prohibited; unlesse some disease inforce it and there be store of blood, proper∣ty of nature, custome, habit of body, course of life, constitu∣tion of Aire, some Symptomes, as large evacuations, watch∣ings and such like, which dissipate the spirits, and substance of our bodyes, and loosen our strength, unlesse they are ta∣ken away by opening of a veine. * 1.11

The quantity of letting blood is indicated from the great∣nesse of the fault depending on the blood, and according as that hath greater or lesse force, so blood is to be evacuated more largely, or sparingly, yet the strength, as also things permitting are here to be weighed, an•• all those things, which are the signes of strength, and weaknesse; and tis to be considered whether the strength will beare that evacua∣tion, which the magnitude of the disease requires.

But whether the quantity of blood which is indicated be to be taken away at once, or severall times, the great∣nesse of the disease, and the strength doe shew; in a most violent evil••, tis convenient to evacuate the blood at once, in milder at severall times; also strong bodyes will beare one large evacuation of blood, but if they are weake, tis better to doe it at severall times.

The presence of those Indicants which serve for the let∣ting blood, * 1.12 shews the time of letting blood, and the ab∣sence of the prohibiting; therefore the most convenient time of letting blood for the most part is the beginning of a disease, yet it is not to be appointed whilst crude juice, and unconcocted meates are in the first passages, and in diseases wherein there are certaine intermissions, and wherein the fits returne at certaine times, the time when the fit is, is not convenient for letting blood, but the time of intermission is more commodious, or if that be too short, the declination of the fit, or the abating of a disease.

As for the houre, * 1.13 if a disease that is violent, provokes or urgeth, in what houre of the day soever, or even at mid∣night, no preparation being made before, and no delay being made, you may open a veine, at other times, one houre or two after sleep is most convenient.

But where, * 1.14 or the place, and veine to be opened, al∣though what veines soever be opened it may evacuate the whole body, yet the larger performe this best, and regard is to be had, to the fountaine of blood, and the rise of the

evil, which are principally the liver and spleen, the veines therefore in the right or left cubit are to be opened, accor∣ding as the disease requires, the internall, externall, or middle, and especially the internall, but what veines are to be opened for Revulsion and Derivation sake shall be shewne in there proper place.

Notes

• * 1.1

  What indi∣cates a breathing of a veine.
• * 1.2

  The use of opening a veine.
• * 1.3

  Putred blood eva∣cuated by the opening of a veine.
• * 1.4

  The cut∣ting of a vtine de∣vinuisheth blood and revels.
• * 1.5

  It derives.
• * 1.6

  Cooles.
• * 1.7

  For which Indicants cutting of a veine serves.
• * 1.8

  The ade∣quate In∣dicant of cutting a veine.
• * 1.9

  Things per∣mitting opening a veine.
• * 1.10

  Se••.
• * 1.11

  How much blood to be evacuated.
• * 1.12

  Time.
• * 1.13

  Houre.
• * 1.14

  What veines to be opened.