Pharmaceutice rationalis: or, The operations of medicines in humane bodies. The second part. With copper plates describing the several parts treated of in this volume. By Tho. Willis, M.D. and Sedley Professor in the University of Oxford.

CHAP. I. Of Phlebotomie.

AMong the universal Documents of Philosophie,* 1.1 or aids of Physick, none either in Theory or Practice hath been more ancient or general than the speculation of the Blood and letting it out by opening a Vein. As to the former we have in other places often explicated the nature and constitutive parts of the Blood, we have unfolded the Virtures and Energy of the same, and have demonstrated that it is in truth enkindled, and that from the burning there of the flame of animal life, as of a Lamp, doth begin and receives continuation: But as to what relates to Phlebotomie, all Authors of every age have made mention thereof: Moreover the same was ever in Medicinal use with all Nations howsoever barbarous or rude. Neither is it a won∣der, for truely Nature it self in the first place hath taught the necessity, and way of that part of Chirurgery; Even the Divine Law commanding the Rite of Circum∣cision, as a Symbol thereof, seems to intimate that the innate impurities of Humane Nature ought to be purged in some manner by letting out the blood.

That we may methodically discourse of this great Remedie,* 1.2 we ought first to con∣sider, by what means, also for what causes and ends, the letting of blood either hap∣pens spontaneously to Nature, or is indicated by the Physitian; then secondly we will annex the chief effects of this Evacuation, as well good as bad, whether advan∣tageous or disadvantageous, and together propound certain Rules and Cautions to be observed, about due administration of Phlebotomie.

As to the former, spontaneous Haemorrhagies (which suggest the use of Phlebo∣tomy) whereas they are manifold and of diverse kinds, they are usually reduced to these two heads or ranks: to wit, they are denominated either critical, Nature en∣deavouring something good and wholsome; or symptomatical, which for the most part happen, she being dejected from her government, and being altogether out of order.* 1.3 The bloody eruptions of the former kind are again distinguished; that they are either raised without a Feaver, and are either perodical, which happen often at set seasons, as the Flowers in Women, and the Hemorrhoids in some, and in others the solemn or otherwise accustomed opening of the Nostrils; which very often succeed according to the great changes of the Year, or alterations of the Air: or they are fleeting and uncertain, as when blood doth advantageously break out of those places, and of many others, one while in this part, another while in that part of the body. Moreover, bloody Crises do sometimes happen in a Feaver, and do often put an end to it, as Hippocrates long ago observed, and is now manifest by very common ob∣servation. The blood breaks out in all these cases, inasmuch as being turgid, and above measure rarified within the vessels, it desires a larger space, wherefore, unless some portion thereof give way, the whole mass rund the hazard of being constipated, and as well the motion thereof to be hindered, as the enkindling to be suffocated, and the temperature to be perverted.

For there are two chief Reasons or Causes,* 1.4 wherefore such turgescencies of the Blood do arise: inasmuch as its liquor is as well inflammable, as fermentative.

1. As to the former of these, that the Blood may be duely enkindled for the sup∣poriting Life,* 1.5 and the due exercise of the functions thereof, it behoves that the innate sulphureous particles of it be proportion'd unto the Nitrous adventitious ones from the Air. Therefore as often as the Blood being very boyling and rarified, is much opened and loosened in its own consistence, so that the Sulphur being dissolved, is kindled in greater plenty, there is a most frequent and painfull breathing instituted for the drawing in of a more plentifull Nitre. Now if the Sulphur abounding in this manner, cannot be wasted by burning, nor the vital flame regulated, the next course immediately to diminish the sulphureous suel, is, that a certain portion of the rari∣fied Blood have vent. From hence, not only in Feavers, but after drinking Wine, Bathings, being in the Sun, and other accidents by which the Blood grows very tur∣gent, either an Haemorrhagia of its own accord succeeds, or there is often need to supply the defect of such a spontaneous evacuation by Phlebotomie. But that such

kind of effusions of Blood, whether made by Nature or Chirurgery, are commonly reported to bridle its heat or raging; really they do this only inasmuch as they diminish the kindling of the blood, by withdrawing part of the sulphureous fuel, as Oyl from a Lamp.

2. But moreover in the second place, the Blood,* 1.6 inasmuch as it is a fermentative liquor, it is apt also to be extravasated. Namely, if at any time any heterogeneous thing, and not miscible, be confounded with its liquor, it grows hot very much, like Wine in a Vessel, and boyls up in the Vessels to exclude that disagreeable thing, which if it can neither subdue, nor turn off by Sweat, Urine, or otherwise, the Blood it self excludes part of it self as a Vehicle for carrying that matter forth, whereso∣ever a vent is to be found. For this reason (viz. that any disagreeable or indomita∣ble thing may be turn'd out of the mass of blood) divers sorts of Hemorrhagies hap∣pen, as well in Feavers as without them; all which are excited by Nature for an intention of good, as also those by which the too much enkindling of the Blood is depressed: But that frequently it happens otherwise, ought to be imputed to divers accidents and circumstances. But for the most part the sailure about the spontane∣ous Hemorrhagies critically instituted,* 1.7 is either in the first place because the blood while it is boyling knows no measure of flowing out, and therefore being stirr'd into violence, it flows out too much; or secondly, because the mouths of the vessels once opened do not presently close again, nor are able to be shut; or Thirdly, because Nature endeavouring an excretion of blood, doth it by places more open,but often inconvenient; as when an Hemorrhage happens through the Lungs, the Kidneys, Guts, or other Bowels, which therefore pass from a Critical into a Symptomical and often into a malignant Haemorrhage.

Neither only by these means, but by many other failings of Nature, or impedi∣ments,* 1.8 do Symptomatical Haemorrhagies happen, in all which either the Blood it self, or the Vessels containing it, or both of them together, are wont to be chiefly in fault.

1. In the first place, the Blood, besides the reasons above mentioned,* 1.9 (to wit, for∣asmuch as it becomes inflammable or fermentable above measure) is apt also to be ex∣travasated, because either its liquor being empoisoned, or otherwise corrupted, can∣not retain its due mixture, but being apt to coagulate or putrifie, divides it self into parts; and whilst some of them being here and there planted, sending forth spots, wheals, and other brands of Malignity, do discolour the Flesh and the Skin, and ob∣struct the proper passages; others otherwise running out an breaking forth where∣soever there is a vent found, do produce bloody Excretions in divers places, as is commonly discerned in the Plague, Small-pox, Measles, and malignant Feavers; yea perhaps this in some measure is the reason why in scorbutick Distempers, as spots and marks, so also Haemorrhagies are so familiar.

2. Secondly, The vessels bringing Blood being faulty many and divers ways,* 1.10 but chiefly in these three, do appear the cause of a symptomatical Haemorrhage, viz. In the first place, if perhaps any where some of them are obstructed, as often as the blood assumes a more rapid motion, either in the same place, or in the contiguous parts, and also sometimes in remote parts it is constrained to burst out. Frequently from such a cause an Haemoptoe proceeds; moreover Spitting of blood, and the Hae∣morrhage of the Nostrils do often follow the suppression of the Terms and Hemor∣rhoids. Secondly, the little mouths of the vessels (by reason of the fleshy Fibres be∣ing loosened or resolved by which they are clos'd) sometimes are ill formed, so that when the ends of the Arteries do gape too much, the little mouths of the veips do close. By reason of this affection, Scorbutical and Cachectical persons, are found ob∣noxious to Haemorrhagies, as we have remarkt in another place. But Thirdly,* 1.11 it fre∣quently comes to pass that the Vessels, being so evilly formed, are also convulsively affected, and so the morbific cause being as it were doubled, this evil is much encreased, insomuch that the muscular fibres of the Vessels being inordinately contracted, cause sudden and violent fluxes of the blood, one while towards the upper parts, anotehr while to wards the lower; and so their little mouths being open in the mean time, they provoke prodigious Haemorrhagies. For I have observed in some persons, when the current of blood was small enough, with a small and weak pulse, the Convul∣sions of the Vessels generated in some place, and propagated under the likeness of wind running to and fro in the body, to drive more impetuously the blood, how∣ever slow of it self, and to constrain it into violent eruptions; and in cases of this

sort, when Phlebotomies and Medicines refrigerating and tempering the blood have not at all profited, the greatest relief hath been found from Narcoticks, Antispasmodicks and Ligatures.

3.* 1.12 Thirdly, If perhaps it shall happen that these faults of the Blood and Vessels are complicated, and put forth their mischiefs joyntly at once, from thence it will be of necessity that this evil will be more intense, and more frequent and prodigious Hae∣morrhagies will be raised; the reasons of which as they appear plain enough by what goes before, it will be neither necessary nor seasonable here longer to dwell upon ex∣plicating of them; but rather, whereas we have designed hitherto the acts of Nature about spontaneous effusion of Blood, and its courses both rightly instituted, and also wrongfully and evilly constrained; now it behoves us next to declare, how far Art (for the most part the Ape of Nature, and sometimes Mistris or Moderatrix thereof,) can act likewise well, or better about letting of blood, and how sometimes it is wont to succeed worse.

We advertise of these things in general,* 1.13 that a Physitian imitates Nature in some cases of letting blood, exceeds her in other cases, and frequently regulates and reduces her when acting amiss. Moreover, ther are some cases wherein Nature excells far the efficacy or Art concerning bloody excretions; briefly of each of these.

Therefore in the first place,* 1.14 in whatever affects, spontaneous Haemorrhagies are wont to bring help, when these are wanting, Physick the Handmaid of Nature rightly substitutes Phlebotomie. Therefore, if perchance the Blood be immoderately kindled by reason of its Sulphur being too much loosened and advanc'd, by breathing a vein, what is superfluous of that inflammable fuel will flow out, as also the immoderate turgescency of Blood, by reason of somewhat untamable being mixed with it, will be allay'd by this course. Wherefore letting of blood is advantageously administred, as well against continual Feavers, which proceed from the former cause, as inter∣mittent Feavers, whose fits proceed from the latter cause. Also in like manner, as often as an accustomed evacuation being suppressed, or a humour driven back from the ourward parts, or a sudden stoppage of the pores, or if a Surfeit, drinking of Wine, or other accidents of this nature, cause a turgescency of blood (inasmuch as they dash heterogeneous particles against it) Phlebotomie is usually the most ready Re∣medy.

Secondly,* 1.15 Physick in Blood-letting, not only imitates Nature, but often excells it; and also succours her being weakened, and reduces her often erring. For if at any time the blood struck with violence, rushes in a heap against any part, and either presently breaks out in the same place, or abundantly gathered together engenders an Inflammation, a vein being pierced in a remote place, stops that preternatural ten∣dency of the blood, and frequently carryes away the bleeding, or inflammation. Wherefore, in a Pleurise, a Squinancy, a Peripneumonia, in spitting or vomiting of blood, when Nature is vanquished, or being outragious, seems to cast violent hands upon her self, Chirurgery recalling the blood to another part, and sending it out, re∣stores the matter that was almost desperate.

Moreover Physick frequently restrains or reduces Nature, when too prodigal or prevaricating in pouring out of the blood: for in truth all immoderate Haemorrhagies do want Bridles, not Spurs. But in the Plague, Small-pox and Measles broke out, and in malignant Feavers, sometimes the blood spontaneously flowing out, portends for the most part evil; therefore in those affects styptic Remedies, or things stopping the eruption of blood, are more convenient than breathing of a Vein.

Thirdly,* 1.16 Notwithstanding on the contrary there are cases of shedding blood by Na∣ture, which Physick can no way imitate, neither if they chance to fail, can be sup∣plyed by Phlebotomy. In Feavers about the Crisis of the Disease, to wit, after the digestion of the matter, that is to say, the preparation for Excretion, spontaneous Haemorrhagies if coming in time, do far excell any Phlebotomie which none knows the best season of; Moreover, the Fluxes of the Terms and Haemorrhoids happening by Natures instinct, are more advantageous than the mission of blood provok'd by Art in any of those places.

Between Phlebotomie and spontaneous Haemorrhagies,* 1.17 there is yet a notable diffe∣rence. (although not of great moment in Physical practice) viz. both as to the Subject and Matter of either of them; for in this the blood being florid, and throughly Scarlet, doth for the most part only flow out of the Arteries, but in the other Evacuation the Blood being of a black purple with a Scarlet Cream, is only drawn out of the

vein. Whence the stream of Blood, which is one within all the vessels and throughout continuous, acquires such a diverse kind of appearance, seeing we have shewed in ano∣ther place, it is not our present purpose to make any surther search into this Aetiolo∣gie; because it concerns not much to the curing any distemper, out of what vessel the blood be let, provided it flow out largely: But that the ancients do in some cases commend Arteriotomie, and prefer it to an incision of a vein, the Circulation of Blood not being then known, we have elsewhere discoursed how well it may be done.

Hitherto of Phlebotomie compared with a spontaneous Haemorrhage;* 1.18 now our next business is, to describe the use and effects thereof, as well good as bad, in Phy∣sical practice. Wherefore we will first shew in general what alteration of the mass of Blood this Evacuation bring; then what diseases it more immediately respects, either of the whole body, or its particular parts.

About the former,* 1.19 it is obvious enough that the blood is altered by breathing a vein, both as to its quantity and temperament, and as to its disposition and mo∣tion.

The first and most common Indication of Phlebotomie, is,* 1.20 that the plenty of blood be diminished by this Administration. And truly this is a vulgar Remedy, to re∣move or provide against a Plethora. Any one, though of the vulgar sort, growing to a full habit of body, lets blood without the advice of a Physitian; Moreover Rusticks and Countrey-men for healths sake,* 1.21 once or twice in a year cause blood to be drawn from themselves and their Beasts But although this custom is grown so much in use with some prodigal of their blood, that they breathe a Vein on the smallest occasion, and sometimes without any manifest cause; notwithstanding we may find many others no less obstinate against this custome, insomuch that for no cause will they lose any blood, unless the greatest necessities be urgent.

Upon this matter (whereas Arguments are alleadged on either part,)* 1.22 that I may in few words determine what seems fit to be ordained, in the first place it is requisite we grant, that letting blood is convenient against a Plethora either made, or begin∣ning: for by no other Remedy are the evils of that Affection wont to be better re∣moved or provided against. Notwithstanding, the necessity of this evacuation ought to be declined as much as may be; because from thence (as we have intimated else∣where) the blood becomes more sulphureous, and less salt, and for that reason it most commonly disposes all men to be feaverish and to be fat. Moreover the Great Remedy Blood-letting, if it be prostituted to every little occasion, becomes less efficacious to any grand affections when need requires: To which we may adde, that according to the vulgar observation, by how much the more familiarly any one uses Phlebotomy, he will the more frequently stand in need of it: for blood being emitted to avoid a Plethora, the rest of the mass will the sooner rise to a Plethora: far other∣wise than is the opinion of some, who dread lest the store of blood be consumed by frequent Phlebotomie; for that on the contrary by this means the quantity is more encreased, although the Crasis be the worser: for so the blood having lost much of its balsamick Salt, and preservative against putrefaction, instead thereof, is filled with a pinguifying and more fiery Sulphur.

Secondly,* 1.23 Phlebotomie doth frequently correct the mixture and temperament of the blood in a manifold respect. For in the first place, if any thing heterogeneous be confounded with its mass, which cannot be rightly digested, nor easily excerned and sent away: a Vein being opened, the blood flowing out conveyes frequently much of the portion of that matter forth with it, insomuch that the rest may be either subdued or expell'd. For the orifice of a vessel being opened, presently the blood fermenting gathers together the extraneous particles as much as possible, and excludes that portion of it self wherein many of them are heaped up: From hence we may observe the blood flowing out first and last to be well enough,* 1.24 when that emitted between appears corrupt. Also secondly, the blood declining from its tem∣perament, is frequently restored by Phlebotomie. For when the mass thereof by the Sulphur or fixt Salt, or both together being exalted, shall degenerate into sharp, salt, or saline-sulphureousness, a portion of the blood being withdrawn, immediately a new fermentation thereof arises, and very often there is a transposition made of all the particles of that sort, that afterwards the Spirits may a little emerge with the volatile Salt, and recover their dominion, the Sulphur, and fixt Salt (as is fitting) being subdued. For this reason it is that letting Blood doth not only confer great

help in Feavers, but also in the Scurvy, Jaundies, and beginning Consumption; for the blood after the vessels are emptyed, like the Stomach disburden'd, doth better digest and assimilate any humoursingested, and the more easily throws off and separates what∣ever is heterogeneous.

But if the mixture of Blood begins to be much loosned and become very bad,* 1.25 as in the Plague and malignat Feavers, we must altogether abstain from Phlebotomie; for the blood being withdrawn, the store of Spirits (whose only part it is to vindicate the mass of blood from putrefaction and corruption) is diminished, so that immedi∣ately all things tend to a deadly dissolution. Moreover, if the Dyscrasie of the blood shall be of that manner, that the more noble Principles, to wit, the Spirit, the vola∣tile Salt and Sulphur, being depressed or cnsumed, the watery and earthy particles predominate, the blood ought not to be sent out, but preserved even as the treasure of life; for when the abundance of Spirits are so small, any loss of them doth cause all the functions to stagger, and gives way to the disease; wherefore in a Dropsie, Cachexia, Consumption, and other Distempers, where the active Principles are greatly depressed, the opening a vein is almost the same thing as cutting the mans throat.

In the before mentioned cases,* 1.26 where the temperament of blood is respected, it is easie to determine, whether Phlebotomie be convenient or not; but in some others, as in a putrid continual feaver, when upon this hinge Life and Death are turned, there is need of the greatest deliberation: and so much the rather because the event of the Disease, and the success of all the accidents in its whole course, whether good or bad, is usually imputed to Blood-letting, or its omission: and from hence it is, that Physitians being solicitous to preserve their own repute, do chiesly raise doubts in their consultations of this matter.* 1.27 But truly in this difficult knot that we may not be led by the rumour of the vulgar (as it chances to happen) one while approving, another whise condemning Phlebotomie, but with more certain advice: we must consider the state of the Blood, the tendency of the morbific matter, and the strength of Nature. First as to the former, if in a putrid Feaver, the blood very much growing hot shall raise a great heat, with thirst, watchings, and burning of the Jaws, and no eruption of abundant sweat, nor pushes appear, or is suddenly expected, opening of a vein is so clearly demonstrated,* 1.28 that it is a wickedness to omit it; but on the contrary if in a languid body, a slow and remiss Feaver, but continual, arises, with a weak Pulse, let Blood-letting be spared, and the cleansing thereof be procured by breath∣ing Sweats, Urine, and blistering. Notwithstanding, in a middle state of Blood, and of a Feaver, Phlebotomy almost indifferent in it self, is determined by other things. Therefore secondly we must weigh the tendency or flux of the morbific matter, which if it remain dull in the mass of blood, and unfit to be separated, and so (as it is fre∣quently wont to be) instead of a Crisis, a translation towards the head be made, and threaten the brain and nervous stock, the cutting of a vein ought seasonably to be administred, whereby these evils may be provided against. Notwithstanding, if that this matter being soon raised into a rage, and either rushing inwardly to the bowels of the nether Belly, provokes a huge Vomiting, or Dysenterical affections, or being driven outwardly, seems to be about to bring the Small-pox, Measles, and other pushes, every such force of Nature, if good, ought not to be disturbed, if evil, not to be made worse by Phlebotomie; for in these cases it is not only dangerous to let blood, but also very scandalous, Thirdly, about Phlebotomy to be administred in a doubtful case, we are to take heed to the strength of the Patient; for in a health∣ful Constitution, a vigorous Age, the commencing of a Disease, and the functions both vital and animal being yet in a florid or indifferent estate, we may confidently prescribe letting of blood, unless something indicates the contrary. Notwithstanding, when it is otherwise, as to those conditions, we may not rashly proceed to that Eva∣cuation.

Thirdly,* 1.29 the inordinate motions of the Blood, when being very much moved, as it were with fury, it either rushes impetuously one while into these parts, another while into those, or transferres the noxious matter, are best restrained or reduced by Phle∣botomy; wherefore in great Cephalalgies, in all soporiferous or convulsive invasi∣ons, for Catarrhs, Ophthalmia's, and a Cough, Asthma, fits of the Gout, and Stone, or Phlegmons, Erysipelas's, also for many other Distempers, raised by the flowings of the Blood or Serum, an incision of the vein is commonly prescribed, and indeed for the most part as with good success, so also upon right Reason; for the Vessels being

emptyed, the blood having obtained a more free space, is circulated pleasantly and undisturbedly, besides, whatever is extravasated of the Blood or Serum, is wont to be suckt up again and reduced into its course.

The Effects as well good as bad being thus shewn,* 1.30 which happen to the blood in the manifold state thereof, by Phlebotomie, we will next make strict examination what Diseases chiefly, either of the whole body, or of any private Region that kind of Remedy doth more immediately regard. And first as to what relates to general Distempers, it is commonly enough known, that letting blood is indicated bu a hot and dry temperament, and interdicted by a moist and cold. It is usually propound∣ed in every Feaver, but never in a Dropsie, Moreover, if we consider particular Diseases, there is no region or part of the Body, but as they rejoyce in the influence of vital as well as nutritious blood (as long as it is well) so as often as it is disturbed in any place, or reaches out any disagreeable or provocative thing, in place of be∣nign Juice, it requires avocation and a letting out thereof. If I should take notice of every single case of this Indication, we should here rehearse almost the whole Patho∣logie of the humane body. An aking Head, a Brain oppress'd with blood, or over∣flowed with Serum (whence spring a world of evils) burning of the eyes, inflamma∣tion of the face, mouth and throat, all the diseases of the Breast and Praecordia (inas∣much as the disorder of Blood affords a rise or fuel to each of these) likewise ob∣structions or inflammatory affections of the Liver, Spleen, and other Bowels; more∣over, as a Plethora, and Athletick habit of the whole body, so also the tumours of each member, painful and convulsive passions, seem to accuse the blood as Author of all the evil, and require its sending out, as a certain kind of revenge.

In these and very many other distempers, if at any time Bleeding be clearly indi∣cated,* 1.31 before it be performed four things ought to be considered, viz. In what place, by what manner and instrument, at what season, and in what quantity the Blood ought to be taken away.

First, as to the former, although according to the Laws of the Circulation of the Blood, as oft as the mass should be diminished,* 1.32 it differs little from what vessel a part thereof be taken, provided it be large enough; notwithstanding, for that besides a general evacuation of the blood, sometimes a particular one properly called Deri∣vation (as when the blood is to be brought out of a private place where it is accumu∣lated) and moreover a Revulsion, when it is to be called into this or that part, are intended; for that reason, in a humane Body there are appointed as it were various Boundaries, out of which, now by this, now by that, or by another vein, the blood may be emitted as occasion is given, and for the uses chiefly requisite.

If therefore at any time an univeral Evacuation of the blood be indicated, the medi∣an vein of the Arm is best to be opened, for this is easily opened being large enough, and whereas it equally flows from the whole body to the orifice thereof being open enough, by whose more free efflux nt only a Plethora is taken away, but the greater vessels being every where emptyed after this manner, the blood stagnating in any place, is brought into motion, and being extravasated is again swallowed up into the veins; wherefore, in great distempers when the blood being heaped in the Brain,* 1.33 or Praecordia, does threaten sudden destruction, the best way not only of general Eva∣cuation, but of a Revulsion, is to send the blood by a full current out of the vein of the Arm, being largely open'd.

But if without any great Plethora the blood ought to be evacuated from the whole, and pulled back from the upper part of the body towards the inferiour, as in the suppression of the menstrual flux or Hemorrhoids, it will be rather fit to bleed in the Foot or sedentary vessels by Leeches.* 1.34 But if after the blood being evacuated from the whole, it be also to be derived from any private part where it is accumula∣ted, let its drawing off be near the place affected. Hence in Cephalick Diseases, we open the vein of the Forehead, of the Temples, or of the Throat. To cure Tumours, or pains raised in the Joynts, we cut a vessel either beneath or near them, or draw out the blood by Cupping-glasses or Leeches. In like manner in distempers of the Thorax and nether Belly, either Cupping-glasses are applyed to the region suffering,* 1.35 or Leeches to the sedentary vessels.

But that some Vessels are reported to bear a peculiar respect to certain Bowels, and that they ought to be lanced in their distempers; viz. such are the outward brachial vein, which is said to respect the head, and the inward the Liver, also the outer vein of the Hand tending to the Ring-finger, which is said to respect th Spleen, and for

that cause this is called the Salvatella, and the former of them the Cephalick, and the other the Jecorary; all this is meerly a vulgar error, which being propt by no reason or Anatomical observation, I am ignorant whence it took its origine: Therefore as soon as it is agreed on to cut a vein and its place, let a large Vessel be chosen, and very con∣spicuous, that it may the more easily be opened; and being remote from an Arterie, Nerve, and Tendon, may be the more securely lanced; wherefore in the Arm the median vein is commonly chosen, although the Cephalick being less environed with other Vessels, is the more safely opened.

The Jugular Vein is almost always opened as often as blood is let in Beasts,* 1.36 it is a wonder it hath not obtained the same Custom in Man, when the large and eminent Pipe hereof may most easily and safely here be cut, because it neither hath an Arterie for its companion, and lies a great way from any Nerve. Moreover, from this vessel as from any other whatsoever opened, an universal evacuation of blood is made from the whole body, and together the best derivation thereof from the head, so that all the stagnations or aggestions of the Blood and Serum are discharged thence.

Concerning Vessels in the soot or the hand there is no great reason of choice,* 1.37 but take the vein which chiefly swells: it matters little concerning the Place, unless that if inci∣sion be made above, or near the Ankle, there is great care to be taken lest a Tendon be hurt, which sometimes by unskilful or rash Chirurgeons happens to the damage of the Patient. Moreover, let care be taken lest a vein be cut near its Anastomosis with an Artery, for if this be committed, the blood being entirely Scarlet, will impetuously skip out, and the flux thereof is not easily stayed, nor the orifice of the vessel soon stopt.

The chief places being thus designed of letting forth the blood,* 1.38 and the choice of the vessels being shewed, we ought next to treat of the Manner or Instruments by which blood is drawn out; which is used to be done either by a Lancet, in cutting the vein, or by suction by Leeches, or by Cupping-glasses after Scarification. But there is no need of discoursing these, because each of these parts of Chirurgerie are every where in familiar use by Quacks, Barbers and Women, and all things relating to them so commonly known, as a man his own house; wherefore we will speak but one word.

Helmont of late, and still certain followers of him,* 1.39 Pseudochymists and Fanaticks, have ejected Bleeding out of all Physick, because they think this evacuation to be a great injury to Nature, (which being aided either by her own strength, or by their Panacea's, they will have to overcome every offensive thing of her self;) Surely, this is no less ridiculous a thing than that long since Chrysippus, Apaemantes, Strato, and some others, (as Galen reports) damn'd this remedy, because a vein is diffi∣cultly known from an Artery. Truly it is manifest enough by sad experience, that in cutting a vein sometimes an Artery hath been pierced; whence either death or loss of the member sometimes ensues: the reason whereof is, not as is commonly alleadged, that the coats of an Artery being more nervous or membranous than the coats of a Vein, can scarcely or not at all be healed; when in truth that Vessel is en∣dowed with more and thicker fleshy fibres;* 1.40 but the cause is, that an Artery like the Heart it self, ought incessantly to shake and beat, the fibres thereof repeating perpetual turns of Systole and Diastole; wherefore, a little hole being made in its Pipe for the most part remains uncurable by reason of the continual motion of the Vessel, and the efflux of blood. It is otherwise in a Vein whose opening is immedi∣ately stopt of its own accord; for but little of contractive work lies in its Coats, yea this only, that its fibres being lightly opened as occasion serves, the blood flowing back of its own accord, is gently moved forwards; and after Phlebotomy, the ves∣sel being empty, they are permitted to be quiet, so that in the mean time the little hole made by incision is easily glewed together. Whenever Physitian or Patient do dread the opening of a vein to be administred, drawing of blood by Leeches or Cupping-glasses, will aptly enough and with like advantage supply the defect hereof. Moreover these administractions to remove the conjunct cause of a disease, where there is need rather of partial than general Evacuation or Derivation, are frequent∣ly preferr'd to Blood-letting it self. There is no need to dwell longer on explicating the manner and reafon of the effects of either of these operations, commonly enough known, but proceeding to other things, we will next throughly weigh the Time and Quantity of letting Blood.

The opportunity of letting blood is often of so great moment,* 1.41 that whereas this Eva∣cuation succeeds well at one time, at another it highly prejudices: But there are diverse respects of time to be considered about the due performance of Blood∣letting, but chiefly these four: The Time of the Disease, the Age, the Year, and Day: The first concerns chiefly the Cure of the Patient, the others the Preservation of him.

First therefore if blood ought to be let in any Disease,* 1.42 it will be chiefly sesonably about the beginning or encrease thereof, but not at all or very cautiously in the state or declination. For at that time whilst Nature is busied, endeavouring a Crisis, so that the Spirits are in great labour, and the blood ferments very much, that great endeavour of it ought not to be disturbed; and in the height of the disease, either Nature being Conqueress doth not want such a relief, or being subdued will not en∣dure such an Evacuation.

Secondly, If at any time for preservation it be deliberated touching letting blood,* 1.43 Infants, Boys, and Old men, by the Custon of all Nations obtain an exemption; also this evacuation was wont to be interdicted to pregnant Women, but now most commonly prescribed. Men of a vigorous Constitution and middle Age, do well enough endure Phlebotomy, and often times want it. Notwithstanding the first and second time it ought not to be done without great occasion, for that being once be∣gun and afterwards repeated, it will soon proceed into an inevitable Custom.

Thirdly, Hence they who used to let blood Spring and Autumn,* 1.44 afterwards cannot omit this evacuation without hazard. But to whom it will be either profltable or necessary to breath a Vein once or twice a year, the chief seasonable times will be in the beginning of Spring and Autumn, viz. when the Blood being prone to ferment anew, is in danger to change its Crasis. Phlebotomy seasonably administred, pro∣vides lest the Sulphur and Salts being exalted, it should contract a feaverish, scorbuti∣cal or other peccant distemper; likewise, lest suffering a flux, it should pour forth the serous Recrements, and other Feculencies upon the Brain, the Lungs or Bowels of the nether belly. About the Solstices, when our bodies are very cold, or hot, the blood, as the juice of all Vegetables, consisting in a more fixt state, and unapt to sweel up, ought not to be let out, unless upon some urgent cause.

But whereas some precisely, or rather ridiculously, observe about Phlebotomy,* 1.45 (even as the Countrey-men about Gelding Cattle,) the position of the Heavens, and the Aspects of Moon and Stars, it appears altogether frivolous; and for that chiefly is this Custom condemned, inasmuch as counterfeit Astrologers have a Figure in their Almanacks wherein every sign of the Zodiack, is allotted to every particular member of our bodies; and for that cause, under what sign the Moon is conversant, they for∣bid blood to be drawn from the respective part of man. They who observe without reason the Heavens, do erre (as the saying is) the whole compass of the Heavens. Moreover, this vulgar error is not only absurd, but frequently malevolent, inasmuch as many of the common people will abstain from Phlebotomy whatever indication makes for the same, if (as they say) the Sign be in the place of letting blood.

Fourthly, As to what relates to the time of the Day, in acute Disease,* 1.46 when a Phy∣sitian is sent for, and there be indication for Phlebotomy immediately to be performed, after the body is prepared, he may prescribe that operation any hour in day or night; but otherwise, if any interval may be allowed, then breathing a Vein rather is to be celebrated in a morning when the Stomach is fasting, the vessels emptyed by sweat in the night, the stream of blood being quietest, and appearing free from any ••••ous filth. Yea although necessity urge, it may be deferr'd a little untill the new Juice of things eaten be pass'd into the blood; for the vessels being emptryed-will not only snatch the crude Chyle into themselves, but frequently what is disagreeable or unproportionate unto the blood, whence not only its motion is difordered, but also the vital flame runs the hazard of being extinct. I have known some by Phlebotomy administred presently after plentiful Drinking, or pouring in of vinous liquors, to have fallen into dreadfull swoundings away, which have lasted very long, untill the vi∣tal spirit being almost overwhelmed recovered it self again.

Moreover, in the fifth place, the opening the vein being indicated,* 1.47 and its time appointed, there remains still no little consideration to be had, what Quantity of blood is to be let out, in which point there is most commonly a fault committed, while some being too audacious, and others no less timerous, they affix those bounds on this or that side of which for the most part consists the Right. For that I may

omit those who scarcely or not at all admit of Phlebotomy (as I have before hinted) so I cannot easily assent to their practice who fear not to draw blood to swounings:* 1.48 Be∣sides, an error of no light moment is committed within the moderate bounds, while in some cases blood is drawn by too sparing a hand, and in others with too free. In a burning Feaver,* 1.49 Pleurisie, Peripneumonia, Squinancy, Frenzie, Apoplexie, and other great diseases, that have their origine from a turgescency or phlegmonic incursion of the blood, a sparing Phlebotomy doth always more prejudice than advantage. For besides that it doth not remove the antecedent cause of the disease, to wit, the Plethora, it further causes the conjunct cause, viz. the inflammation and bursting out of the blood to be angmented. For truly it is a constant observation, that upon blood too sparingly drawn, the whole mass doth boyl up more notably, and doth acquire a new flux into the part affected; the reason of which is, that in a great Plethora many portions both of the Blood and Serum being thrust forward into recesses and strait places, are there constrained to abide; which, after the Vessels being a very little emptyed,* 1.50 do impetuously regurgitate into the mass of blood, and do much di∣sturb it, and force it more impetuously to and fro. Wherefore also in this respect the vessels ought to be very much empted, viz. that besides freeing the former Juice from straitness, also space may be given to the Juice reduced from exile, which other∣wise being not congruous, coming upon the blood, troubles it, and provokes it into effervescencies and eruptions. From hence we may observe, that almost all men grow more hot presently after Phlebotomy, and yet the blood being sufficiently evacu∣ated, a little after they enjoy a more temperate condition.

But as a slender withdrawing of blood in some cases is only vain, but is per∣formed with prejudice, so in other cases too much effusion is rarely committed scot∣free, and sometimes brings notable detriment of health. For when either strength languishes, or the body labours under a notorious Cachexia, we must spare Blood∣letting and its taking away is either prohibited, or being indicated by some accident, is allowed but in a small quantity. Wherefore in men endowed with a weak, tender and cold Constitution, and in consumptive persons, those affected with a long or malignant Feaver,* 1.51 also in Hydropicks or Cacochymicks a vein is not rashly to be breathed, at least if it be, much blood is not suffered to be taken away. It will be an impossible thing to prescribe general Rules, according to the particular cases of every individual person, whereby the quentity of letting Blood may be exactly proportion'd according to the strength of the Disease and the ability of the Patient; but let this be left to the judgment of the prudent Physitian present, and let his Commands be ever exacutly observed; And let not (as it every where is) such leave be given to Quacks, Empiricks and Barbers to play with humane life, who every where rashly and wic∣kedly use Phlebotomy; and if the blood spring more sreely and appear discolour'd, therefore bragging of the vessel being well pierc'd, they say it must be let out more plentifully, because it appears bad, when oftentimes on the contrary it ought to be spared.

As soon as the Quantity of Blood to be taken away is determined,* 1.52 our next care ought to be, that a more large orifice being made, the blood equally mixt may flow out as soon as may be; for otherwise, if it go out from a small hole, or drop by drop, or with a little stream, the mass of blood fermenting will separate into parts, and what is more subtile and spirituous will burst out, the thicker and feculent remaining behind. Hence it is to be observed, that the blood being let out of a large orifice with a more full stream, if it be a little stopt with the finger clapt on it, and a little after suffered to flow out, the blood going out the second time becomes much purer and brighter than the former, because in the interval of flowing, the more subtile par∣ticles being unfolded from the thicker, and accumulated together, have prepared themselves to fly away. Wherefore, if Hippocrates's Precept shall be observed, 'viz. to let it run to the change of its Colour, it behoves us to procure that it spring out quickly, with a full a not interrupted stream. Besides all this, as to what apper∣tains to the alteration of the blood let out, and cold, and to the inspection and the judgment thereof, for that we have often discoursed it in other places, we now pass it by, hastening to other things; and now the thread of Method leads us to entreat of Re∣medies opposite to Blood-letting, to wit Ischaemones, that is, those which are convenient to stop immoderate Haemorrhagies, whether engenderd by Nature or by accident.

Notes

• * 1.1

  Phlebotomie a very general and ancient medicine.
• * 1.2

  Nature shews it by Haemorrha∣gies.
• * 1.3

  Critical either with or with∣out a feaver.
• * 1.4

  The causes there∣of proceed ei∣ther,
• * 1.5

  1. From the kindling of the blood.
• * 1.6

  2. From its Fermentation.
• * 1.7

  1. Criticall Hemorrhagies sometimes turn into symptor∣matical.
• * 1.8

  2. Symptoma∣tical Hemor∣rhagies arise either,
• * 1.9

  First by the fault of the blood.
• * 1.10

  Secondly, The fault of the Vessels, for that they are ill formed.
• * 1.11

  Thirdly, Foras∣much as they are convulsive∣ly affected.
• * 1.12

  3. From the blood and ves∣sels being both in sault.
• * 1.13

  Emission of the Blood procured by art.
• * 1.14

  1. It either imi∣tates Nature.
• * 1.15

  2. Or excells and regulates it.
• * 1.16

  3. Or Art out∣done by Nature.
• * 1.17

  Phlebotomy and spontaneous He∣morrhagies dif∣fer as to the subject and matter.
• * 1.18

  The use and effects of Phle∣botomy.
• * 1.19

  How it affects and alters the Blood.
• * 1.20

  1. Diminishes its quantity.
• * 1.21

  Emission of the Blood is not to be either too prodigally, or too slenderly made.
• * 1.22

  The reasons of the former hint∣ed at.
• * 1.23

  2. Phlebotomie amends the mixture of the Blood.
• * 1.24

  It restores its temper.
• * 1.25

  Some distempers of the blood ad∣mit not Phle∣botomy.
• * 1.26

  In some eases about Phleboto∣my it is very doubtfull.
• * 1.27

  And chiefly in a continual pu∣trid Feaver.
• * 1.28

  How the doubt is to be deter∣mined.
• * 1.29

  Thirdly, Phle∣botomy corrects or stays the inordinate mo∣tions of the Blood.
• * 1.30

  What Diseases, and of what parts Blood-letting chiefly respects.
• * 1.31

  After Phleboto∣my being indi∣cated these four things follow∣ing ought to be considered.
• * 1.32

  First the place from whence Blood is to be taken.
• * 1.33

  In some cases from the Arm.
• * 1.34

  In others from the vein of the Forehead, Tem∣ples or Throat.
• * 1.35

  The Cophalic Vein of the Arm, the Liver Vein, or the Salvatella er∣roneoufly so called.
• * 1.36

  The jugular Veln is most safely opened.
• * 1.37

  Of Veins in the band or feet.
• * 1.38

  we ought to con∣sider by what menns or by what instru∣ment the Blood ought to be drawn forth.
• * 1.39

  Some of the Ancients as well as Modern have ridicu∣lously exclaim∣ed against let∣ting of Blood.
• * 1.40

  Wherefore in opening a Vein the pricking of an Artery is so dangerous.
• * 1.41

  Thirdly, The Time of letting Blood comes in∣to considera∣tion.
• * 1.42

  1. In respect of the disease.
• * 1.43

  2. In respect of age.
• * 1.44

  3. In respect of the Tear and its parts.
• * 1.45

  The Aspect of the Moon and Stars are here of no moment.
• * 1.46

  4. The time of the day about letting of Blood.
• * 1.47

  5. The Quanti∣ty of the Blood to be taken a∣way ought to be considered.
• * 1.48

  Too much Phle∣botomy to be avoided.
• * 1.49

  But a more spare Bleeding often hurts, and fixes a feavour.
• * 1.50

  The Reason of which is de∣clared.
• * 1.51

  In some eases the mission of Blood must be altogether avoi∣ded.
• * 1.52

  Phlebotomy ought ever to be done with a large orifice.