THE ENGLISH Phlebotomy: Or, Method and way of healing by letting of blood.  
Very profitable in this spring time for the preservative intention and most needful all the whole year beside, for the curative intention of Physic.  
Collected out of good & approved authors at times of leisure from his other studies, and compiled in that order that it is: By N. G.  prover. 30. verse. 15. 
The horseleech hath two Daughters which cry, give, give.  prover. 27. verse. 9 
Balm and sweet incense make the heart merry: so sweet is that friend that giveth counsel from the heart.  
¶ Imprinted at London for Andrew Mansell, and are to be sold at his shop in the Royal Exchange.  
1592.   

To the right Worshipful, Master Reginald Scot, Esqure; daily increase of wealth, Worship and wisdom, in the true fear of God.  
THIS pleasant and profitable practice of blood letting (Right Worshipful Sir) hath always, and that worthily been accounted and called of the ancient and latter Physicians, unum è maioribus remedijs, one of the greater remedies in the Art of healing; (not as I take it) for that the same is of greatest charge to the patiented his purse, a vein being commonly opened for twelve pence: but because if the same be done with skill according to Art, it bringeth great profit to health, without any great diminishing of wealth. How this so great a remedy in both the intentions, of Physic, preservative and Curative, is greatly abused by vagabund Horseleeches, & travailing Tinkers, who find work almost in every village, through whose wickedness (having in truth neither learning, knowledge, witre, nor honesty) the sober practitioner and cunning Chirurgeon liveth basely, is despised, and accounted a very abject among the vulgar sort. The whole world with woeful weep too too plentifully can witness, and many godly and faithful Christians here and else where with pinching pains and griping griefs even to the last gasp, have pitifully felt. For these kind of men are so far off from repairers of men's bodies, as they would seem to be that they are, rather marrers and manglers of men, women and children, without all care to men whom they ought to tender, foster and cherish, without all conscience to God, to whom they must one day render a reckoning of this their desperate and devilish dealing.  
No man brought up among Christian men of any practice or calling, but hath long sithence learned this lesson; how frail, infirm, and weak soever our mortal bodies are, yet it hath pleased God to call them his own temples, his own instruments, and his own dwelling places: an unspeakable dignity, far above that for which Alexander Magnus so contended, when he would needs be called the son of jupiter.  
Paul to the Thessalonians willing us to keep our vessels, viz. our bodies in holiness and honour, suggesteth unto us these two points: first the fragility and mortality of our earthly bodies, comparing them to vessels of earth, and pots of clay, which break with a blow, & perish with a knock: secondly, that yet they are not our own bodies, to use as we list to sensuality like bruit beasts; but to keep them carefully, as vessels which the Lord hath cleansed and washed with his own blood, to his own glory in all holiness and honour.  
The Priests of Baal cutting and launsing their own bodies with a vain and wicked supposal, that in so doing they pleased God, grievously sinned (as divers affirm) both against nature and godliness; against nature, because no man ever yet hated his own flesh, but nourisheth and cherisheth it as the Lord doth the Church: against godliness, because works of piety and religion in ourselves or in others, they either quite surcease, or are greatly hindered when the bodies of men are decayed in strength, weakened in vigour, languished with sickness, or finally destroyed by death.  
To let pass these things which divers deliver out of their pulpits, of the excellency and dignity of man's body: have not the Philosophers in the schools called the same Microcosmos, Orbiculus, a little world most beautiful in form, & fairest in shape, excelling far all other living creatures whom the creator hath made. In whose brain, as in primo mobili, is fixed that inesteemable jewel called Reason, no monster or Idol, but the mother of all Arts & Sciences, by whom (God guiding the same) are wrought & invented marvelous matters by Sea and by land, in every matter of speculation or practice. This I have hitherto discoursed to this drift, that those blind bussards, & runagate Artists, might at length see and consider that they are no way willed or waranted like butchers to cut, rend and tear, the bodies of men without skill, either in letting blood or any other practice of Chirurgi, but like brethren to cure, repair and amend that which is amiss, refusing no pain taking for their own parts, nor rejecting due consultation with men experienced, that so the noble Science of healing may be generally honoured, the diseased recovered, & the skilful workman worthily in fine rewarded.  
To met with this mischief according to my Mediocrity, and that such as are desirous of this practice either for pleasure or profit, might be somewhat fraughted with a few pithy instructions and necessary rules in the same, and so at length attain to the most exquisite cunning & deep knowledge thereof: I have thought it good not only to publish this my rude collection, containing (if I be not deceived) the whole handiwork of Phlebotomy, but also to countervail my default as rudely, (yet most humbly) to request your worship's favour for the protection thereof.  
But for as much as Seneca that christian Ethnic (for so doth Erasmus term him, for his profound wisdom & deep judgement) willeth us in bestowing of any gift to be careful that it be fit for the estate of the giver, and also meet for the condition of the receiver, lest in stead of expected thanks disgrace may grow, and what the giver meaneth of good will, may perhaps by the receiver either limping in judgement, or freezing in delight, be little regarded, & less countenanced: I am in a word or two to show that for my part I have not (as I think) much swerved from the sound advise of the Philosopher, in making your worship patron of my poor silly pains.  
First for that even yourself have already in print in your book called The discovery of Witchcraft, openly & biterly enueighed against one sort of blood thirsty men, as I do now against another sort: namely witchmongers, who are daily and hourly without just cause conventing before Magistrates, and haling to the halter (if the Magistrate's dexterity in the administration of justice did not moderate their malice in murdering) poor, plain, silly and simple innocents, and old women: whom by frivolous evidences, incredible proofs, vain guesses, prejudicate presumptions, mere impossibilityes they would have condemned and executed for witches. These men, in mine opinion, should far better please God, and much better deserve, of the Christian common wealth, if they would speedily turn from this their heathenish Infidelity, extreme folly, & barbarous cruelty, & seek rather by due execution of law & justice the blood of these bloodsuckers indeed, who for want of skill in this profitable practice of blood letting, in every corner of the country without controlment, either presently kyl, or at leastwise accelerate the immature deaths of divers faithful Christians to God, and good subjects to their Sovereign. A poor man that robbeth or killeth but one man, is straight way trussed up at Tyburn, and these desperate dicks which range the country with a budget of gross stuff, a box of salve, and a case of tools, living in the Sanctuary of Idleness, skilful in palmistry, tellers of fortunes, counterfeiting themselves to be jews or Egyptians: imitating doctor Tocrub, with strange looks, diricks, pricks, crosses, figures, and such foolish fantasies, may safely kill thousands: no more than come under their hands, which is as many as they can get; for who is so bold as blind Bayard? and withal men must give them money for murdering, whereas if they had had their just hire, they should have had hanging.  
Secondly, I have thought your worship a meet person to dedicate this book unto, not so much for that it was penned at vacant times during mine abode at Scots Hall, under which roof I came by your good means; but rather for that, thorough you when the same was first penned it passed the view and apportation of that right worshipful and wise man M. Doctor Coldwel, a pillar in this our age of that noble profession. I assure you I thought myself happy to have my little Latin examined by the direction of his judgement to whose worthy and famous faculty, the matters therein mentioned were most properly appertaining.  
Thirdly for that being thoroughly acquainted with your gentlemanly conditions, I am not ignorant of that ardent affection which you have always carried unto your friends, Gentlemen I mean of like quality with yourself: for, Amicitia inter●ares, Love is among like, as saith the Philosopher, whom as you love earnestly in time of their felicity, and health, so you never loath in their calamity or sickness, putting in ure that work of compassion & Christianity commended, and commanded us in the Gospel of visiting the sick: which work as you now execute friendly without fear, so in fine you shall not find without reward. In visiting your sick friends, for iner peritura perituri vivimus: this book (if you will vouchsafe to bestow some vacant time in reading of it) may stand you and them in some stead, though not by cunning in the practice, yet by counsel in advise: for verily it containeth the right Method and way of healing, practised by the ancient fathers in Physic, Hypocrates, Galen and Avicen. And as you like a good Christian defy all magical cures which are but cousonages, & would have other men do the like: so here you may spy a very ready way rightly to cure all human diseases, compendious & not costly, both for yourself and for your frined. To let pass Lysimachus a worthy Captain to Alexander, Artemisia a noble Queen, Gentian King of Illyrica, King Solomon, & Queen Saba taught by Solomon in the secrets of Physic and Nature, to the encouragement of all learned and wise gentlemen whatsoever they do otherwise profess) to take now and then some Physical discourse in hand. I produce the example of Dioscorides, no mean gentleman, but a noble Knight of Egypt who served Antonius and Cleopatra like a worthy Soldier in the field, & was so delighted even on the midst of his martial affairs with the study of Physic and Surgery: that one way uz. in the noble knowledge of Oils, he excelled all men before his time, or since.  
For myself that am the giver, if it be objected that this labour is frivolous, for that other men of far greater gifts than myself, even of the self same profession, have written of this argument in the english tongue long ago, as namely Sir Thomas Eliot, & Doctor Bullein, with divers others, men of famous memory▪ the one writing a Castle, the other a Bulwark of health: My answer is, that hardly discuss we that argument, whereof something before to that or the like effect hath not been extant; & this I add beside, that these men entreating of many things in one book, were constrained even purposely to pretermit some, yea divers needful instructions which here may be had largely discussed.  
If it be said that a matter of Physic is no fit argument for a Divine to handle, albeit I might easily wash away this with the apparent examples of divers Divines to the contrary, as of old Doctor Turner, Doctor Penny, & Doctor Coldwel: Now with divers others yet will I say somewhat more, namely, that both these the Divine and the Physician work upon one subject, they assemble themselves in one place, uz. the chamber of the sick, they both visit and busy themselves about the sick to do him good, he is no longer Homo but Cadaver if there be once a separation of the soul from the body. Vbi desinit-Philosophus, ibi incipit medicus, where the Philosopher endeth, there beginneth the Physician: so may it be said likewise in some sense, Vbi desinit medicus, ibi incipit Theologus: where the Phisirion faileth for the body's recovery, there the Divine is required for the soul's health. For mine own part I am fully persuaded in mine own conscience (think or say others what they list) that I have done more good to the Church of God and common wealth of this land, in this simple translation or collection, call it whether you will (for I have but borrowed it of others & brought it into the english) then divers dogged Divines of this age, Penry, Browne, Barrow, and the sectaries I mean, who in stead of the true bread of life that came down from heaven, even jesus Christ with his whole & wholesome doctrine, fed most dangerously the souls of men with devilish devices, & their own fantasies accounted themselves terrene Gods, & desirous of nothing more than among their auditors, to have their own positions horrible & heretical to be admired & embraced as oracles from heaven. If the end of this more than Pharisaical hypocrisy be not the disturbance of God's peace & the Queens, the wisest men in this land have utterly lost their wits, which these men with all their learning, if they have it in such plenty as they would seem to have, shall never make me believe for a truth. Experience of these days prove, that by the means of these men, we are all so generally infected with Clergy factions and Lay factions, that as we are full of fancies, so we follow nothing but factions, which I pray God speedily redress for his great mercy's sake. Finally as Atheism is most iniuriou y objected to him that holdeth these positions. God to be the creator of all things: That God only seethe & searcheth the hearts and reins of men: That he only worketh miracles: That he only maketh thunder, lightning, and tempest, and restraineth them at his pleasure: That he only sendeth life & death, sickness & health, wealth & woe, etc. And as he is most wrongfully & wickedly adjudged a Papist, who detecteth the abomination of their Idolatries, their pestilent practices of knavery & cozenage, their absurdities in opinion and impurities of life, (all which & much more than I here now speak of or can call to memory) are extant in print, & so in the sight of the whole world if men would not be wilfully blinded: so by this little labour beside the exercises of my peculiar profession, it may evidently appear what love & liking I have always borne to good, godly and profitable studies, and how I loath loitering; and so consequently lust which is an unseparable companion of Idleness & sloth, how I have rather passed (as I hope) with commendation from Paul his Epistles to Galen de Sanitate tuenda for public profit, than to Ovid his de Arte Amandi with condemnation for my private pleasure.  
Good Sir as you have been hitherto even (as I may say) zealous for my preferment, and likewise jealous over my credit, an assured testimony of your true love toward me, so I beseech you take in good worth at my hands this poor gift which I offer of pure good will, which if I once perceive that you do, I shall think my travail sufficiently recompensed: and myself enforced during life to the accomplishment of your good pleasure, so far forth as my tenuity shall be able any way to extend.  
Your Worship's unfeigned well-willer & to command in what I may, Nicholas Gyer, minister of the word.   

The English PHLEBOTOMY OR Method and way of healing, by letting of blood.  

Of fullness, emptiness, and their divisions. Chap. 1.  
THat this treatise of blood-letting may have an orderly proceeding; we must begin with Fullness & Emptiness, which have between themselves a mutual relation. Abundance or fullness therefore is called of the Grecians Pleonexia: and after Galen in his book De plenitudine it is two fold. One fullness is in quality, as namely, when the bare quality exceedeth without Humour. The other is of quantity, as abundance of meat or of Humours.  
Abundance of meat is called of the Grecians Plesmone; of the Latins Sacietas: where we are to note, that some interpreters translate very ill, for Plesmone, repletio: as in the second of the Aphorisms. Aphoris. 22. Quicunque morbi ex repletione fiunt curat evacuatio; when it should be thus converted: Quicunque morbi ex satiaetate fiunt, etc. All those diseases that come of fullness, evacuation doth cure.  
Abundance of meat, called of the Latins Satietas, is also twofold, according to Galen in his 2. book of Aphorisines, Comen. 17. One according to the great largeness or capacity of the veins or vessels called of the Latins quo ad vasa: as when such abundance of meat is received, as thereby the stomach is overstretched: the other abundance is according to nature's strength, called quo ad vires: as when more meat is eaten, then nature's force can well overcome.  
Abundance of humours is also of two sorts. One of all the humours called in Greek Plethos or plethora: in Latin plenitudo, or multitudo: whereof Galen writeth in his 13. book. Metho. cap. 6. Vbiautem aequaliter inter sesucci ad aucti sunt, idem plethos & plethoram Graecivocant, nos succerum plenitudinem seu redundantiam dicimus. When as the humours are equally increased between themselves, that the Grecians call plethos or plethora; we call it, abundance of humours. Now whereas Galen saith in his 2. book de Composi. Medic. secundum locos, cap. 1. That to be abundance of humours, when only blood is increased: we are to understand that blood there signifieth impure blood, & such as is mixed with other humours, called blood, of that which principally there aboundeth. For it can not be, that only pure & good blood should be contained in the veins, without sommixture of choler, phlegm or Melancholy: which must be so likewise understood, where it is said that any other humour aboundeth, the same is not pure alone without mixture of others, but that humour joined with others aboundeth in the vessels.  
The second abundance of humours, is called in Greek Cacochymia, in Latin Vitium succi, or vitiosus succus▪ and it is when one humour alone aboundeth. Hereof also Galen speaketh 13. Meth. cap. 6. Vbi flava bile, nigra, vel pituita, vel serosis humoribus repletum corpus fuerit: Cacochymia. i. succorum vitium dicimus. When the body is replete with yellow or black choler, with phlegm or waterish humours, we call it Cacochymia. i. corruption of humours. And in the end of his book de Plenitudine he saith: Plenitudo est copia humorum in universo animalis corpore. Fullness is abundance of humours in the whole body: & a little after, he plainly showeth the difference between Cacochymia & Plethora.  
Plenitude or fullness of humours, is also twofold: one in regard of nature's strength, called Quo ad vires or virtutem: which is, when the humours so abound, that they oppress and much grieve the natural forces of the body. And although there be not such abundance of blood in this fullness quae ad vires, as is in the other quo ad vasa: yet those humours which are in the body, oppress the powers of nature, whereupon nature being oppressed and not able to govern those humours: they being as it were forsaken of nature, lose their goodness, and offorce putrefy. And of this fullness these are the signs: heaviness, stretchings, a sensible weariness, having a feeling like an ulcer: of which Galen sayeth 2. Aphoris. Aphoris. 5. Spontaneae lassitudines morbos praenunciant: Voluntary weariness forsheweth diseases.  
The second fullness of humours called Quae ad vasa is, when there is such abundance of humours or of blood; that the veins and vessels are greatly extended or stretched: so that it is to be feared, lest the veins themselves break. And therefore Hippo in the first book of Aphorisines: Aphoris. 3. would have in wrestlers this dangerous fullness speedily evacuated, that the body might begin again to be nourished. And this plenitude quae ad vasa is either of pure blood only, or of all humours with the blood. And this fullness hath these marks: redness of colour, swelling, veins full & stretched. Of these two Plenitudes and their signs speaketh Galen in his book De Plenitudine, reckoning up these marks: swelling and stretching of the veins, redness, lumpishness of the body, a slothfulness in motion of the bodily members. Also Method. 9 Cap. 5. He reckoneth these signs of repletion quo ad vasa: obstructions, stretchings, swelling & redness: Of this twofold, read Avicen, Secunda primi doct. tertia. cap. 3. Also Galen in his book De Plenitu. & Metho. 9 Cap. 5. & 10. lib. eiusdem Cap. ultimo.  
Because these points taken out of the books of ancient learned Physicians, may seem as yet hard to the unskilfuller sort, that yet rashly and without skill or regard of these things use the practice of letting blood: It will not be lost labour in my poor judgement, with more plain words to illustrate their sayings, if it may be, to the understanding of all men that are this way studious, and yet want the help of the Latin tongue & Latin writers.  
It appeareth by the premises what Repletion is, vz, a superfluous abundance of humours in man's body, which happeneth two ways, either in quantity or in quality.  
We may also learn, that repletion in quantity, is when the four humours are more in abundance than is proportionable to the body that containeth them, or when one humour much exceedeth the rest in quantity: For the blood contained in the veins is not simple, or of one kind, as hath been said; but consisteth of phlegm, black & yellow choler, and pure blood mingled together, which humours notwithstanding so mingled, by common agreement and continual use of speaking: we commonly call blood.  
The just and agreeable proportion of humours is this: That in a man thoroughly healthful & of good temperature: there is less yellow choler than Melancholy: less Melancholy than phlegm: less phlegm than pure blood: so that that blood is accounted best, not that hath like proportion of all humours, but such an equality of the four, as hath been now specified.  
Blood therefore faulteth in quantity when the humours being settled in a just proportion, do pass and exceed the agreeable measure of Nature: for then the whole frame of the body swelleth; the veins above measure are stretched, and all the members, specially after any exercise, are wonderfully wretched. This constitution of humours, though they be good, yet it faulteth, beclause it is come to an immoderate abundance, which accustomably is wont to bring great peril. Whether therefore there be in the body abundance of other humours above the blood, so that the equability of the proportion be not observed that way: or that there be too much abundance of pure blood. Yet because the pure blood in the permixtion greatly exceedeth the other humours; it is a ●ault not in the quality but only in the quantity: and therefore both of these are contained under this kind of repletion in quantity: and this is simply, absolutely, most properly, & commonly judged repletion, & is called Plenitudo ad vasa, as is aforesaid, because it doth thoroughly fill the large capacity of the veins, which are termed the vessels or receptacles of the body, though it enforce not the powers thereof. First therefore, where all the humours superfluously increase, filling & extending the receptories of the body, as the stomach, the veins, and the bowels: It is most properly called in English fullness or repletion in Latin plenitudo, in Greek Plethora as before.  
Repletion in quality; is when the blood or other humour is hotter or colder, thicker or thinner than is convenient to the body. This is the second kind of repletion, mentioned by the foresaid awcient writers in Physic, and which is referred to the force, strength and ability of the body.  
In this repletion, although the vessels of the body be not so much puffed up, neither swell, as in the other: yet they contain more good blood and nourishment than the nature of the patient can well rule or overcome: For a little nourishment to a weak nature, is often troublesome and grievous: and although at the first it be right good; yet it doth not long so continue: but being forsaken of the bodily heat, as not able to concoct the same: in protract of time and number of days, it corrupteth and becometh the causes of diseases.  
This constitution of the Greeks, properly called Cacochymia, is when the body is infarced either with choler yellow or black, or with phlegm, or with watery humours, and of late writers is thus defined: Cacochymia est vitiosa humoris qualitas, qua is a justa mediocritase desciscit: Cacochymia is a corrupted quality of the humours, by reason whereof the humour departeth from his just mediocrity. Under which Cacochymia is contained all corruption of humours in quality: whereby the powers of the body are hindered from their proper functions, whereby also the whole body waxethfilthie & daily decayeth.  
Of this corruption of humours in quality, one kind is somewhat better and more tolerable: as namely, when either superfluous humours are excessively heaped up together; or when the humours mixed with the blood, do not keep their just and natural concord or proportion: the other kind is worse and intolerable: when the superfluous humours or juices in the body, both primi & secundarii, both the principal humours, and these next the principal are fallen into corruption, from their natural and convenient temperature, which is the destruction and corruption either of the substance or of the temperament. Again both these happen sometime with rottenness and putrefaction, sometime without. Where note, moreover that the name Cachochymia largely taken, comprehendeth also the corruption of the excrements. Hypocrates Aphoris. 15. saith, where meat is received much above nature, it causeth sickness. Galon in his Commentaries declaring that place saith, more meat than accordeth with nature's measure, is named Repletion. And afterward he expoundeth that word above nature, to signify too much and superfluously: As who would say, where the meat is superfluously taken, it causeth sickness. Meat but a little exceeding doth not forthwith cause diseases, but may yet keep the body within the bounds of health, for meat engendering sickness must not a little, but much exceed the exquisite measure.  
It appeareth by Galen that in his time certain denied this foresaid division of fullness, set down by the ancient writers, and approved of the late practisioners, saying that the same was to be considered only by the strength of nature, granting plenitudo secundum vires, but not quo advasae. These he confuteth in his book de plenitud. about the beginning in these words. Qui ex ipsis tantum viribus plenitudinem metiuntur hi videnter nunquam utres praeter modum repletosvidisse, nec se etiamplus quapar est unquam impleu●sse ●ibo ita ut ventriculus inde distenderetur. 1. Those that measure Repletion only according to the forces of nature; they seem never to have seen men's bodies puffed up like bladders or bottles, neither at any time to have stuffed themselves with meat, more than moderation required, and whereby the stomach was overstretched.  
Again, others in Galens' time granted only that plenitude which is quo ad vasa. and denied the other quo ad vires. These he confuteth in the same place in these words. Itaque subiecimus duas esse tum notiones, tum relationes multitudinis: alteram ad robur virefque illi us qui defert, alteram ad eius qui suscipit capacitatem. Idest, Therefore we have added that there are two notions and reports of fullness, one according to the strength of the patiented, the other after his capablenes.  
The discommodities which happen by Repletion are manifold, moistness thereby is too much increased, and natural heat quenched, again natural heat resolveth somewhat of the superfluous meat and drink, and of that which is resolved of meat undigested, proceed gross and undigested fumes, which ascending up to the head, and touching the rim wherein the brain is wrapped, causeth headache, trembling of the members, dimness of sight, and many other diseases.  
Moreover the sharpness of the said fumes, prick and annoy the sensible sinews, whose roots are in the brain, and from thence passeth through all the whole body. The said fumes engendered of Repletion, and piercing the innermost part of the said sinews called sensible, greatly annoy the animal powers, there being: by occasion whereof Understanding and Reason both, as touching the use of them, are wonderfully let and troubled, and likewise the tongue which is Reason's Expositor, is greatly deprived and hindered of his Office: As it appearethin them which are miserably drunk, and in those which have most extreme and grievous pains in their head, proceeding of Repletion.  
Thus much harm cometh to the body by too much nourishment, and although the stomach do his Office in concoction, yet the veins too abondantly filled, are spread out, divided, stopped and stuffed with wind, and greatly grieved. It is apparent that of repletion and fullness of the veins (than the which in diseases a more hurtful thing cannot chance) divers infirmities do come, and the repletion of the belly, though the excess may be expelled by vomit or sedge, and so is more tolerable than fullness of the veins: yet it is likewise to be disallowed. If a man have at any time too much ingorged himself by and by he may assay to vomit: for though he do well digest it, yet there is some danger, lest the veins be oppressed with fullness: especially when the party continually liveth intemperately, never regarding or minding evacuation. It is good therefore to vomit first, before the meats be corrupted in the stomach, if any impediment hinder vomiting, a sedge by stool is a present help. If neither serve, sleep long, and oft in drink use warm water. When the surfeit is sufficiently digested chief by sedge, it is expedient to wash and use fomentations. i plasters mitigating pain, and a little to taste of salt meats, and to drink wine or bear alaid or tempered with water. These things by the way touching remedies for surfeiting, which in our days is too usual, to the great dishonour of God, and the certain destruction of our bodies, yea, and of our souls also, if GOD grantus not grace speedily to repent and amend. But if neither siege, nor timely digestion of the meat recemed, do not ensue our surfeitings; then the signs of repletion are to be looked for, which are set down by Oribasius Euporist. lib. 1. which are these that follow: as Loss of appetite, delight in nothing, sloughthfulnes, dullness of wit and senses, more sleep than was accustomed, cramps in the body, starting of the members, fullness of the veins, thickenes of the pulsies, horror and shroveling of the body mixed with heat.  
But the general signs of abundance of blood are these: bleeding at the nose chief forth of the right nostril, spitting of blood, veins full and great, chief in the face, redness of colour, a ponderous weightiness of the whole body unapt to any motion, an unaccustomed drowsiness, a sluggishness of mind without any evident cause, the skin stretched, pulses very full, debility of sight, grievous dreams, plenty of sweet spittle in the mouth, swellings and blush in the face, heaviness and painful weariness in the shoulders as it were after labour or bearing great burdens, urine thick and red. Repletion known by these notes, except it be ruled by Phlebotomy or otherwise, it choketh the natural heat of the body as Galen saith, 1. Aphoris. Aphoris. 3. Nimia repletio calorem natiwm extinguit. Too much fullness extinguisheth natural heat. Also Metho. 13. cap. 6. Plethora tum sanguinis missione curatur, tum frequenti balneo, exercitatione, fiction & digerentibus medicamentis. Repletion is cured by blood-letting, often bathing, exercise, rubbing, and digestive medicines. Look more in Galen 3. & 6. de tuenda sanita. These men therefore in whom blood so aboundeth, are to be helped by Phlebotomy, by opening Mediana or Cephalica, or applying of Boxing-glasses with scarrifieng the place first, or otherwise as after shall be declared. Remembering by the way, that if either purging seem too long, or the opening of a vein cannot be done accordingly: that in these cases Electuarii succi Rosarum are good to purge blood. But hereof there is no place to speak further at this time.  
Finally it is very behoveful to know in what place the corruption or illness of the contents of the body is placed, or where the Repletion is, before we can address ourselves fitly to evacuate. That fullness therefore which of the Greeks, we have said to be called Plethora, is chief resident in the veins and habit of the body, and this being an abundance of all the Humours in quantity, is evacuated by bloud-setting or opening a vein, and with cupping-glasses. The Repletion called Cachochymia being an abundance in quantity of one Humour, is i● the whole body or in some particular part. If Cachochymia be in the whole: it is evacuated by purgation, by general sweat, by abstinence, and that kind called insensibilis evacuatio.  
Cachochymia particular is thus evacuated: If it be in the belly, by vomit and by siege: If in the entrails, with Clysters, Suppositors, and by siege: If in the Liver, by the Urine: If in the Spleen, by the Hemorroids: If in the Breast, by Coughing: If in the Head, it is purged through the Nostrils and roof of the mouth: If in the Rains or Bladder by Urine: If in the Genitals by Venus: If in the Skin, by Sweeting, Resolving and with Cupping Glasses.  
And thus I conclude this first Chapter containing the chiefest and principal points concerning Fullness, Emptiness, and their divisions. Not intending to write any thing at all of the subtle and abundant definitions and descriptions of Galen in his book De plenitudine, and likewise in his Commentaries upon the Aphorisms of Hypocrates.  
For I hope it hath here sufficed, to show what repletion is, the kinds thereof, the operations of them good or evil: remitting them which be curious, and desire a more ample declaration, to the most excellent works of Galen, where he may be satisfied, if he be not determined to repugn against reason.   

What evacuation is, and of the kinds and differences thereof. Chap. 2.  
FOrasmuch as things contained in the body against nature, while they remain in the body, are the inward causes of infirmities, which by Art especially are to be removed: therefore than evacuation, as a most general remedy is first of all to be attempted. Euacua●●●● therefore is an expulsion of those things which are contained in the body against nature. There are contained in the body these three, spirits, humours and excrements. The excrements are the ordure or refuse of the belly: urine and superfluous humours, sent from the brain and the lungs. Humours some are superfluous, some necessary properly called succi. 1. juices. Humours superfluous separated from the blood by nature's force, and as unprofitable for the nutriment of the body: are sent a far off. As phlegm inhereth in the maw, stomach, and about the entrails. yellow choler in his proper coffer, namely the gall. Melancholy in the Spleen: The juices are converted into the substance of the body, nourishing the same: Of this kind are those juices whereof the blood is compact, & those otherwise called secundarii humores. Now each of these are sometime agreeable to nature, sometime repugnant to nature. They are agreeable to nature, when they retain the right quality and quantity, according to the law of nature for conservation of health. They are repugnant to nature, when they keep measure neither in quality nor quantity. And therefore whatsoever of these manifestly departeth from the just mean and measure which nature hath appointed, (because it is the cause of sickness) if otherwise it cannot be amended, it is altogether to be taken away and expelled, the expulsion whereof is called evacuation.  
The differences of Evacuations are to be taken of the situation of the contents and corruptions, which are either Plethora or Cachochymia as was showed in the Chapter precedent. The meats and drinks received into the body, if the stomach and liver do their natural Office, be altered by concoction, in such wise, that the best part thereof goeth to the nutriment of the body, the worst being separated by the members Official from the residue, are made excrements in sundry forms and substances: which excrements are like in quality to the natural Humour, which then reigneth most in the body. These excrements are none other as was said●, but matter superfluous and unsavoury, which by the powers of nature may not be converted into flesh, but remaining in the body corrupt the members: and therefore nature abhorring them, desireth to have them expelled. These excrements are in number three, Ordure, Urine, Humour superfluous.  
Of Ordure are two sorts, one digested which passeth by siege, the other undigested expelled by vomit. Where I say digested I mean that it is passed the stomach, & turned into another figure. Likewise I call that undigested which s●il retaineth the figure of meat.  
Urine is the watery substance of blood, like as whey is of the m●ke, which out of the meat that is altered, concoct, or boiled in the stomach, is strained in the veins called Mesacaicae, which proceedeth from the hollow part of the liver, and sent by the Rains into the Bladder, passeth by the Instrument which is ordained as well for that purpose as for generation.  
Humour superfluous is of three sorts either mixed with any of the four Humours called natural, or else it is gathered into the brain, or is between the skin and the flesh, or lieth among the Sinews, Muscles, or joints: Of Humours some are more gross and cold, some are subtle and hot, and are called Vapours, Now to expel these excrements there are nine sundry kinds of Evacuations. Letting of blood, pargation by siege, abstinence, vomiting, sc●rrifieng or cupping, sweat, urine, spytting, sternutation, bleeding at the nose, bleeding by the Hemmorroids, exercise: and in women there natural purgations▪ But in this Treatise I will only handle that evacuation which is done by opening of a vain, by Cupping-glasses, and by Leaches, showing the commodities which by the discrete using of these, come unto the body of man.  
And that the way of evacuation may be the more easy: we may divide the body of man into three general Regions, which being enclosed in their proper limits, have not only divers receptories of superfluities, but also divers ways to purge the same.  
One and the first Region is extended from the meat pipe called Gula to the middle part of the Liver, wherein are contained the maw, the stomach, the venies Mesecaicae, as many as come to the entrance, the hollow or inner part of the Liver, the Spleen, and Pancreas, that is, a thing between flesh and kernel lying between the stomach and the Liver.  
The 2. Region runneth from the middle of the Liver, through the thin & small veins, of all and singular parts, comprehending the outward part of the liver, and every hollow vein and the greater artery placed by it, and whatsoever is between the Armehole and the flanks.  
The 3. Region comprehendeth the muscles, the uppermost skins, the bones, and the whole mass of the body, which extendeth from the very entrance and lesser veins through every part and the outmost skin itself. Great is the diversity of these Regions, for so much as they are so enclosed within their own limits, that there is between them no fellowship at all. But the greatest diversity is in their own proper operations, having concoctions, excrements, and ways of purging divers one from the other. By observation and marking whereof we shall the better proceed in evacuation.  
Beside these general and universal Regions of the body: there are some more special and particular, having also excrements, yet not retching so far, nor following through the whole body, of which sort are the brains, lungs, rains, and belly. Hereof are derived two differences of Evacuations: one general, the other particular. That is a general evacuation which draweth matter universally from the whole body. Of this sort are Sweat, Bleeding, Vomits, evacuation, by siege. Each of these (though specially & for the most part they evacuate one Region or part of the body. Yet these also empty other parts, though not so abundantly. As vomit first and chief evacuateth the stomach, if it continue long, it purgeth also the bowels and the greater veins, last of all the state of the whole body. evacuation by siege or purging: chief and most of all purgeth the entrails, stomach, bowels, and the first veins, than the greater veins; Last of all the small veins and the state of the whole body. Opening a vain first exhauseth the veins and arteries joined unto them: then the body and all the bowels even till it proceed to the first veins. evacuation by sweat called in Latin, perspicatio or dissipat io per cutem: First dissolveth from the habit or state of the body. Secondly, from the greater veins and arteries. Lastly, from the bowels and inward Region of the body.  
Particular evacuation doth only alleviate some particular part laden with Excrements: Of which sort are, purging of the brain through the palate and nostrils, spitting of phlegm whereby diseases of the breast and lungs are eased: Pissing forth of sand and matter from the rains: Passage of blood by the belly or Hemmorroids: the one cleansing first the lower part of the body called Podex, the other the belly, and both of them the hollow vain called Vena cava. When the womb therefore is provoked either with a Clyster or a Suppository, or whatsoever eruption be made in any other place through the skin, it is likewise a particular evacuation. Again, of Evacuations, some are of their own accord, some are done by Art. Natural or voluntary evacuation, is when any thing is expelled out of the body without any medicine, this chanceth sometime even naturally: For nature while it is in health, rightly governeth the state of the body, and doth expel thence whatsoever supersluously aboundeth or is corrupted; this evacuation is both natural and convenient. This also chanceth sometime contrary to nature, as when the strength of the body is so enfeebled, that it cannot govern and restrain the Humours of the body, but letteth them quite flow forth: or when the virtue is strong, yet it is sometime so provoked either with abundance or acuity of the Humour, that it permitteth the Humour to pass of his own accord out of the proper vessels and receptories thereof: Both these are accidental, unprofitable, and besides nature; because the good blood cometh forth mingled with the bad without choice or order. Artificial evacuation is when the same cometh by outward help & this is two fold.  
The one right profitable, only Euacuating that which offendeth in just quantity, & quality. The other contrary to this, extraordinary and unprofitable, exhausing the Humour that annoyeth not, which cometh by the unskilfulness of the Physician. Nature by her own force, and by the virtue expulsive, accomplisheth her evacuation. The Physician doth his, by divers necessary helps provided for the same. And in letting blood he openeth the vain either with a fine penkife, sleme, or lancet, or some other appliable medicine. Purgation he attempteth with medicines, expelling evil humours from the body either by vomit, or by siege. Also he expelleth evil humours by breathe, evaporations, exercise rubbings, movings, heat, bathe specially sulphureous, & accidentally by abstinence. Also the Physician useth particular Evacuations in particular parts (as ye have heard) He purgeth the brain through the nostrils by medicaments called in Greek Errhinae. And through the palate of the mouth with medicines called, Apophlegmatismi, which chewed in the mouth bring Humours from the head, the breast, and lungs, with medicines called Berhica. The Rains and Bladder with Diuretica. The womb or belly with Hysterica. Again, the belly is softened with suppositories and clysters: again evacuation or eruption is made in particular parts by medicines called Digerentia. ●. resolving medicines by Suppuratoria. ●. medicines breeding matter by medicines, called Amycticam, Caustica, Idest, burning things, by horseleeches, cupping glasses which draw blood with scarrifieng the skin, by launcinges or cuttings, by iron red hot: All these are used of Physicians.  
The kinds of evacuation reckoned up of Fuchlius. Phlebotomy. Purging.  Vomiting, Scarrifieng.  Boxing. Abstinence.  Long sleep. Carnal copulation.  Flux of blood from the Nose.   Termes.   Hemorroids. Evacuations some are Natural, Phlebotomy.  Artificial, Purgation.  common partaking of both.    

What Phlebotomy is and from whence the opening of a vain doth e vacuate. Chap. 3.  
FOR so much as the blood in general is mixed with the four Humours which are also bedewed as it were with a thin watery substance, and that they all are so mingled together through the heat and concoction of the Liver, that never an humour can be seen, never so little, to be severed from the others therefore, I say, the retentive virtue cannot so strongly hold back the blood in the crooked small veins when a great vain is opened, and that with a sufficient large wound: but the same will issue and come forth. If by chance it happen that the retentive virtue go about greedily to suppress the blood, yet at length it will pour it out plentifully with oft handling & rubbing of the veins. Neither doth this or that humour by itself alone come forth, as in purging: but blood generally; that is to say, mixed with other humours in the veins.  
Touching the definition what it is: Phlebotomia (which is word for word out of the Greek, the cutting of a vein:) is an artificial eduction of blood, either abounding in quantity, or offending in quality, by opening of a vein. I call it an artificial incision, because it must not want art and judgement: For in it, consideration must be had of the inflicted wound: of the quantity of the blood: of choosing the aptest vain: either to pull back blood, or to evacuate it quite: or to make it only less in quantity. Also, for that consideration is to be had, whether the vein must be opened straight down, or overthwart, of the same side of the body, or of the other: with divers considerations besides, whereof we will speak in their proper places. Therefore Phlebotomy which is one of the greatest remedies, the Physician useth, is for good cause defined an artificial kind of educing. Galen in his 2. Aphoris. Coment. 17. defineth it to be an exquisite evacuation of all the humours equally. Avicen defineth it universalem evacuationem, quae multitudinem humorum evacuat: or thus Vena sectio est universalis evacuatio, quae anctionem humorum super aequalitatem in venis exuperantium, evacuat. i. an universal evacuation which taketh away abundance of humours, replenishing the veins above measure.  
Though the blood in the veins be in a moderate mean, or but little in quantity, yet of the proper moving, & vehemency of itself it issueth out: nature little or nothing at all protruding the same. Phlebotomy indifferently evacuateth both good & bad humours contained in the veins with the blood. Neither in diseases proceeding of corrupt constitution of humours, can nature so moderate the matter, as that, that humour alone shall flow forth that aboundeth in quantity or offendeth in quality. I confess, that in the judicials of diseases, called Crises, many time's nature separateth & as it were, excludeth by ways convenient, those ill humours prepared before by concoction: yet notwithstanding, if then at that instant we open a vein, nature cannot thereby in so short time expel the hurtful humour.  
Whereas Avicen saith, Phlebotomy eu●cuateth good blood, the ill remaining behind, & that he feareth, lest opening a vein bring the patiented, either to abundance of hot chollerik humours, or crudity of phlegmatic humours: if he mean it of the humours mixed in the veins, it is most falls: for neither doth the watery humour issue forth before choler, nor choler before phlegm, or Melancholy, nor the bad humour before the good. Which daily experience proveth to be true: for when the blood cometh forth, it appeareth simple & of one form: but in the porringer it loseth his colour, & every part thereof congealeth se●crally in his own region. The watery humour swimmeth above, not far unlike urine. Thin choler & the flowering part of the congealed blood, is also above next the water. melancholy abideth in the bottom: the red blood & the paler phlegm keep in the middle region. So that opening of a vein evacuateth all humours which are in the veins equally.  
We are here to set down, from what place the evacuation is made: for, inasmuch as blood is moist and flowing: that first issueth forth which is next the opened vein, then that which is next the same: thirdly, cometh forth, not only that which is in the veins and arteries, but also that which is in the bowels and whole habit of the body. For there is a wonderful continuation and order of the veins, so that a way being once made, all the blood often times floweth out of the body, and bringeth death to the party. But when the passage is stayed, than the blood is sent forth by the veins & arteries, till there be a certain proportion in the whole body: For the emptied and wanting parts by the long small veins draw blood forth of the full parts, & repleated members; and so ●●●●or them, as it were in their need. Again, the full members grieved with too much abundance, unburden themselves on the veins that are emptied. Again, the humour being liquid and flowing voluntarily followeth the lower evacuated regions, and there continueth: whereupon it followeth, that whensoever bloudletting shall empty the veins; the same also shall evacuat the whole body. In regard whereof Phlebotomy in the definition thereof, is called very well an universal evacuation, and that for two causes. First, because it withdraweth all humours whereof the blood consisteth. Secondly, because it evacuateth from the whole body; but yet not in like sort. Forasmuch as the parts of man's body are placed in their order: therefore first it exhauseth from the near parts, then from those that are further off. And again, forasmuch as some veins are spread into some parts of the body, and other into other parts: therefore bleeding with more celerity and force draweth from those parts which are rightly and directly placed, then from those members, which are opposite or overthwart.   

Whether Phlebotomy must go before purging▪ or contrary. Chap. 4.  
IN this place it is a necessary question to be moved, and answered; whether bleeding or purging must go first, in this case (which is very frequent) where they are both requisite. Some will always have, that when purging is necessary; bleeding must go before● and they bring out the authorities of Hypocrates and Galen. Others contrarily affirm that always some extenuating or lessening receipt called barbarously Medicamentum minoratiwm must be first received, and them Phlebotomy succeed. But of these opinions neither is simply true, and yet both true, as the case may be limited. And for the cases wherein a gentle purgative is to proceed● Phlebotomy: they are in number these six.  
First, when the stomach, the Mesecaicae veins, the great veins, & the ways & passages of the body, or any of these be stuffed with filth, or encumbered with crudities: or that the excrements are hardened in the bowels, although the whole body abound with blood beside, yet a gentle & easy receipt is to be taken; as Manna, Cassia or a clyster (but no violent receipt) which may evacuate from the foresaid veins, & open the obstructed passages. If the blood should first be drawn forth without some gentle purgation or evacuation in the greater veins: then the veins outwardly exhausted by bleeding, through their attractive virtue, would draw unto them ill iuces; specially, if the disease require any plentiful bleeding. This is affirmed by Avicen & Galen. 9 Metho. cap. 5. who did use to refrain from Phlebotomy, if there were crudity of meat in the stomach, or rawness in the veins called Mesecaicae, till their concoction were ended, & the excrements descended.  
Secondly, when the blood is very viscous, clammy & gross, we do not only take medicines attenuating, but also lessening things & a diet convenient to prepare blood: and to make the member bleed the better, use a bath: for oft it cometh to pass, that a vein being opened, no blood issueth forth, because of the thickness & clamminess thereof.  
Thirdly, it fale out in many choleric bodies, that choler contained in the upper part of the stomach is easily moved, & so boileth causing Lipothymia. i. overcoming: in which case it behoveth to use before some Minorative receipt, & also in bleeding to use somewhat to keep back the boiling of choler.  
Fourthly, in diseases wherein appeareth a difficulty by reason of Cacochymia or abundance of other humours mixed with the blood. When a practitioner perceiveth that he must use Phlebotomy, & yet with some difficulty; in this case he may use some easy purgation, or one of some force: whereby it may fall out that nature shall thereby so be eased (which the siege & ease of nature will show thee) that thou shalt not need bleeding at all, but only preparation of the matter, & then to renew the educing thereof as before.  
Fiftly, remember Au●cens saying: Sanguis fraenum cholerae existit: blood is the restrainer of choler: therefore in diseases mere cholerik, it were a rash part to set bleeding before purging, which perhaps thou mayst be without, after the exhibiting of the medicine. And if thou use the patiented well; let those things suffice, which change or repel the sharpness of choler. Yet this is to be added, that if there should be such abundance of choler as might cause a swelling above nature or inflammation; then bleeding upon that, is a present help.  
Sixthly, the same reason may serve in phlegmatic constitutions. Wherein for many causes (although no small fullness appear) yet we are not to use Phlebotomy before purging.  
The cases wherein Phlebotomy precedeth purging are these. First, when great fullness appeareth, which either hath caused, or is like to cause any vehement disease, as Apoplexia, which is a sickness engendered of gross humours, filling the receptories or vessels of the brain, and thereby depriving the party of feeling, speech, and moving: as Peripleumonia, which is an inflammation or an aposteme of the lungs, with a vehement Fever, coming sometime of itself, but most commonly following upon great and sharp rheums, squinances, pleurisies, or such like diseases: as Suffocation; which is in English, strangling: then & in this case without fail, and chiefly if the womb be laxative, use letting of blood without precedent purgation. And this seemeth to agree with Galen lib. 10. de Composi. medica. secundum locos, ca 2 Where he saith: if the body do equally abound with humours: first let blood & then purge. And hereunto Avicen accordeth in quarta primi Cap. 4. This (saith he) is a truth, and the precepts of Hypocrates in lib. Epidemionium: that if both bleeding and purging be necessary, and that the purgative must be vehement, then begin with Phlebotomy.  
Secondly, in dangerous fluxes of blood out of the nose, or in spitting of blood called Hoemoptoicapassio, or in bloody fluxes: for to turn the matter a way in full bodies, we presently let blood without medicine going before.  
Thirdly, in wrestlers abounding with blood: to whom the same abundance threateneth some great danger, & that it is presupposed that there are no ill humours in the circuit or compass of the body; in this case we use Phlebotomy without purging.  
Fourthly, we may safely let blond (without medicine) those that are whole, & for abundance of blood only, are accustomed to yearly bleeding; and that have in the year taken little or no Physic, as it chanceth to many persons in many countries of the North.  
Fiftly, we may open without purging, the inner vain of the arm, in women with child, if they carry Corpora Phletorica, full bodies, & that in the 5. 6. or 7. month after the conception: yea & also before they be quick. This practice we are to use specially, when they being with child, wax very slow, heavy, & as it were, overladen with abundance of blood, we may take salva tella vein: or if plenitude so require; the inner vein of the arm: for the quantity respecting a discreet moderation.  
Sixtly, we may let those blood without medicine, that have fallen from some high place, & taken hurt in the breast and stomach, in whom is to be feared an inconvenience called of the Greeks Egchymosis.  
seventhly, we speedily let blood such persons, without further Physic, as by reason of their fullness through some accident, as fear, or such like, wax domme; in which case we let blood abundantly, so that both arms are opened together.  
Here I am to note a great error in Avicen; both repugnant to truth itself, and also contrary to Galen: For Avicen affirmeth, that when cold and thick humours are in the body: first we must begin with purging, and then open a vein. divers and many ways hath he erred in this. First, because in phlegmatic humours, gross and cold mixed with blood, he would have Phlebotomy not used before purging. And in this case, by all likelihood of reason, the cure should begin with bleeding. Secondly, in this he dissenteth from Galen, who 11. Method. Chap. 4. though there were obstructions in the body of thick and clammy humours: yet first he would begin the cure with Phlebotomy.  
If Auicens' meaning be, when phlegmatic humours overcome the blood in multitude or abundance, that then we must first use purging; then is he greatly deceived, for as much as he proponeth a case in which Phlebotomy should not avail, except with those many cold humours there be also some excess of blood, which chanceth very seldom or not at all. But it may seem that Avicen hath reason, namely this: that the blood being extracted; those humours would wax more raw: and so by opening a vein, the patiented is brought to a marvelous crudity of cold humours. This is no reason: for by Phlebotomy we detract blood; not because of obstructions, caused of gross and cold humours, but because blood superaboundeth. For the stopping is afterward removed with other helps. Therefore, when obstruction concurreth with abundance of blood; we must not extract very much blood, but keep back some, till the time of the cure, as Galen teacheth 11. Method. Chap. 14.  
And thus much, of the order between Phlebotomy and Purging: whereby we see that a strong purgative must follow bleeding: and that an easy purgation or clyster may go before.   

Of the effects, that is, Of the profits and disprofits of opening a vein. Chap. 5.  
Schola Salerni, in two verses reckoneth up three effects of bleeding:  

Exhilerat tristes, iratos placat, amantes  
Ne sint amentes, Phlebotomia facit.  
It suageth wrath, and cheers the sad:  
Preserves lovesick, from being mad.   
FIrst, it maketh glad those that are pensive. Secondly, it appeaseth such as are angry. Anger is especially caused through mixture of much yellow choler with blood. And sadness, by commixture of much Melancholy with blood. And forasmuch as both these humours, choler & Melancholy are exhausted with the blood, these two effects must consequently follow. Thirdly, it preserveth lovesick persons, from madness, by drawing humours from the head to the lower parts, and so expelling the same.  
Although occasion will hereafter better serve to show the causes why we use Phlebotomy: yet here now speaking of the effects, I will briefly show five causes, for which we use to let blood, and by the which may be gathered the profitable effects of this practice: of the which five causes; one only cause is the direct, the other four are indirect.  
The direct cause of bleeding is evacuation of the blood. But forasmuch as blood is good for nature, therefore Phlebotomy must be used ●duissdly: that the same blood only may be expelled, which is unprofitable & hurtful to nature. Blood, as you have partly heard, is made unprofitable to nature two ways: either when it doth not thoroughly keep the proper quality that it cannot so nourish as it did before when it was good: or when in quantity it so increaseth, that it either presseth down the powers of the body, or stuffeth & stoppeth both the veins & the arteries: In these two cases, bleeding is good, as one of the direct evacuating helps. Yet in these cases bleeding is not to be used indifferently, but with this difference: in abundance of blood, much may be detracted: In little plenty, small evacuation serveth. Hereupon Galen writeth lib. 9 cap. 10. Method. Si sanguis vitiosus in corpore fuerit, paulatim quod vitiosum est, evacuare oportet, & paulatim ad in o icem quod salubre est, pro eo reponere. If corrupt blood be in the body, we must by little & little take away the bad; and by little & little procure in the place thereof, that which is good: which way of curing or amending of corrupt blood, the Physicians call in Greek Epicrasis. And to this Alexander Tralleanus subscribeth lib. 9 ca 2. The reason why this is not to be done at once, is for that the powers of the body would relent & give over. And although that which is evacuated be superfluous: yet by a sudden & thorough mutation, it doth more hurt than good. It is better therefore to empty the body safely, and by little at once, than by making haste, to dispatch both the disease & the party diseased.  
And here it appeareth, how much they abuse Phlebotomy which detract the ill blood so long, till the good also begin to come: whereas it may fall out, that all the blood will flow forth of the body, before that the good will appear. It behoveth therefore the evacuation to be little. And (as Gaelen counseleth in this case) before the opening of a vein, to use Epicrasis. i. to give the patiented such meat, as may cause good blood; that good blood may still come in place of the bad: and then a little after, more blood may be taken. This therefore is called the direct bleeding, because it is done of itself, to evacuate that which by opening a vein ought in deed to be withdrawn: namely, multitude of humours & of blood, of blood principally; & of humours secondarily: in as much as they are mingled with the blood. The other are called indirect causes: and are used only to revoke or call back the violent force of humours to the contrary part, or to turn the flux of them aside another way.  
The first indirect cause is, for the greatness of a disease, or for vehement inflammation of an impostume: for in apostumations of great heat, in hot fevers, & in vehement griefs, there is not found a more excellent remedy than opening of a vein.  
The second indirect cause is, to allure the matter to the place of evacuation. Therefore in stopping of Terms or Hemorroids, the vein Saphena is to be opened. Fullness coming by suppression of Termes is to be evacuated by the legs from the knee to the ankle, whether we cut a vein, or use scarifying, or lancing: for veins opened in the arms of women, revoke & draw upward their natural purging.  
The third indirect cause is, that the humours may be turned to some other place, contrary or opposite to the place, unto the which they flow of their own accord. Therefore in immoderate flux of Terms, we open the Basilica vein, that is the inward vein of the arm, which is also called Hepatitis; that the matter being called to a contrary place, may be turned from his flux.  
The fourth indirect cause is, that some part of the matter being taken away by bleeding; nature may the more easily overcome, the rest: For the virtue of the body being weaker, then that it can rule such abundance of humours, we take away by bleeding some portion of them, lest through impotency and debility of nature, the same humours should flow to the weaker members, and there breed apostumations, and swellings contrary to nature. But of this more shall be spoken at large in the proper place thereof, namely in the Chapter of rewlsion and derivation of plucking back, and turning aside of the blood & of humours.  
Touching the utility of bleeding: great is the profit thereof: For Galen reporteth that therewith he hath oft cured fevers: and that it is boldly to be taken in hand when necessity requireth it. Therefore we may worthily blame those, which in our time, contrary to Galens' judgement, & against reason & all experience, speak evil of this profitable practice.  
First, it sharpeneth the sight, making the same more clear: the reason thereof is, for that it diminisheth those humours which through their fumes, hinder the clearness of the eyes: so that consequently the sight thereby is sharpened.  
Secondly, it purgeth the brain, & sharpeneth the wit, by the foresaid reason.  
Thirdly, it heateth the marrow, wasting those superfluous humours, by whose commixture & flowing the marrow in the bones waxeth cold.  
Fourthly, it purifieth all the senses, taking away those fumes and evaporations, which ascend up to the head, and there trouble the senses.  
Fiftly, it purgeth the bowels and entrails: The reason is, because nature governing the body, being disburdened of that blood which was (as it were) an oppression to nature, and grieved her (as it were) with some heavy burden: doth now with ease concoct and overcome raw and rude humours detained in the bowels.  
Sixtly, it stayeth vomits and lasks: for it draweth the humours from the inward parts, to the outward parts. Whereunto Avicen agreeth writing thus, Phlebotomia propteriae quod ad diversum trahit, naturam secundum plurimum retinet. Phlebotomy, because it draweth to the contrary part, therefore commonly it retaineth nature. In which place it is to be understood that in fluxes of the womb, the vein of the Arm is to be taken, which presently helpeth: But if you do otherwise, that is, take the vein in the foot, or leg, it profiteth nothing. Sometime it chanceth that the belly by opening of a vein is more flowing than before, and that especially chanceth two ways: first because nature being disburdened by bleeding, strength is increased: so that sometime it stirreth up other evacuations, as namely by siege. The second way is when through imbecility of the retentive virtue, which imbecility by opening of a vain is increased, so that the womb is more stirred and provoked.  
seventhly, it profiteth against immoderate watching, for it emptieth abundance of humours, from the which commonly divers sharp fumes ascend up to the head and hinder sleep.  
Eighthly, it taketh away heaviness, sluggishness, & weariness of the body. For, as hath been already said before, bleeding disburdeneth nature, which ruleth our bodies of multitude of humours; which before was pressed down by them & oppressed with them. And again, Melancholy, the chiefest cause of heaviness, is expelled with the blood, as the dregs and grounds thereof.  
ninthly, it cureth difficulty of hearing, abating abundance of humours whose thick & slatuous spirits, carried upward into the head, stop the hearing port and passage of the ears.  
Tenthly, it helpeth the voice, taking away superfluous humidi●ies, which too much moisten the artery, or vain of the voice, and speaking. From which humidities horcenes of speech proceedeth,  
eleventhly, it refresheth and increaseth the powers and strength of the body: For the body being freed from a multitude of humours, must of necessity have the virtue and strength thereof augmented. These commodities of bleeding, are thus set down in verse by Schola Salerni.  

Lumina clarificat, sincerat Phlebotomia  
Mentes & cerebrum, calidas facit esse medullas:  
Viseera purgabit, stomachum, ventremque coercet:  
Puros dat sensus, dat somnum, taedia tollin.  
Auditus, vocem, vires producit & auget.   

It cleareth sight, the wits, and brain.  
It marrow warms: doth clean procure  
The entrails, stomach: this is plain:  
It stayeth lasks, makes senses pure,  
It causeth sleep, expelleth grief:  
To ear, to tongue, it brings relief,   
To be short, these are the commodities of Artificial bleeding: thereby the organs of the senses are cleansed: weak bodies are made strong, if years serve. By it are helped Repletions, Pluresies, hot tertians, frenzies, pestilences and deuers other diseases as shall appear in the Chapter ensuing.  
The only disprofit in bleeding is this, that the vital spirits thereby are ●hawen forth which thing Galen witnesseth in his book the Scarrificatione: saying, to open a vein oft in the year, I judge not profitable: for with much blood the vital spirits are also exhaled: which being done too often, wasteth the whole body, making the same cold, and causing the lively operations thereof, to wax worse and worse. To frequent bleeding therefore bringeth on old age apace, and maketh the same subject to many diseases, as the dropsy, gout, shake, palsies, falling sicknesses, and apoplexies. For natural heat being too much cooled, and the principal moisture diminished: the bowels languish and crudity ruleth with many phlegmatic humours, which are the causes and original of the foresaid evils. This Schola Salerni remembreth: And Avicen in primo testifieth the same.  
The best remedy to recover vital spirits decayed, is drinking of wine: for wine among things nourishing quickly and in short time is the most principal. By meats also vital spirits are recovered in time, but not so soon. Wherein is to be noted, that after bleeding must be taken meat easy of digestion, of good juices, and of much nourishment, as potched-egs, & such like: which meat easy of digestion must be taken moderately the first and second day after bleeding, as Rhases counseleth writing to Almonds. lib. 7. cap. 21. For the virtue digestive, made weak by bleeding cannot overcome as yet much meat. Hereupon also Isaacus in his diets writeth thus: Meat to such as have bled, is to be withdrawn and diminished; but drink to be augmented, for in respect of the meat, drink is to be augmented; not in regard of his former use of diet: that now he may drink more than he was accustomed: for in truth, he must drink less than he did before bleeding: because the virtue concoctive (as ye have heard) is yet too weak to bear much abundance of drink. The words of Schola Salerni touching this matter are these,  

Spiritus uberiorque exit per Phlebotomiam.  
Spiritus ex potu vini mox multiplicatur,  
Humorumque cibo damnum lente reparatur.   

Abundant spirit with blood doth pass,  
yet drink of wine doth it restore:  
By help of meat the same alas,  
will hardly come as 'twas before.    

Of Revulsion that is pulling back, and derivation, that is, turning aside of blood and Humours by opening of a vein. Chap. 6.  
REvulsion is a provided remedy for blood flowing out of the nose or belly, or that floweth to any part like them to cause inflammation. It is called in the Greek Antispasis: That is, a turning to the contrary way: in Latin Rewlsio, that is, a pulling back; and as the word impotteth, so is it defined, a drawing of the running humour into the contrary part. Nothing can more speedily keep back the force of a Flux than this practice. Now for to understand which is the contrary part, we must note that the Mathematics call those contraries, which be the extremities of one and the self same strait line, which stand furthest off in a strait proceeding or going forth of the self same vein; through whose passages the humours have their course. For a vain being opened, first the part next the wound is evacuated; & that evacuated part draweth the blood out of the further part. And forasmuch as opening of a vein doth thus evacuate (through the help of the small strait veins which nature hath ordained to allure and draw, as she hath the overthwart veins to expel:) The same opening of a vain (I say) will provoke more blood and in shorter time from those parts where the straight veins are spread then from the rest. Yea, if the veins draw not at all, yet the humours voluntarily will flow in the strait course of the veins: they that are in the right parts, follow the right members: and they that are in the left parts follow the left members: and that course of humours is commended, which are carried strait wise; and that discommended when they are carried crookedly and overthwart, as declaring nature to be violated and corrupted. The names of Physical contraries in this practice are these: before, behind, the right, the left, upward, downward, within, without. Neither are these contraries in revulsion of humours, except they be so placed in a strait course of veins. For the left side is not contrary to a left Pleurisy, or the left leg, from the knee downward, called in Latin Crus, contrary to the right leg inflamed. For herein this is a common and direct society of veins, whereby the left leg being opened, draweth from the right: But from the right side to the left no vain cometh with strait and right strings: Therefore a vain opened in the same removeth not a Pleurisy on the right side: But either leaveth the hurtful humour in the inflamed part, or mingleth it with the pure blood, or bringeth a Pleurisy in the left side: which often falleth out so.  
For as much therefore as all our endeavours and devices must tend, by opening of a vain, to exhaust blood abundantly and speedily from the inflamed part: take such a vein as is straightly situated to the affected part. So in reason we shall follow nature, and imitate Hypocrates, who in a Pleurisy willed to take the inner vein of the Arm on that side which is grieved. Neither only doth the Physician open the inner vein of the right arm in a pleurisy on the right side, but also in inflammation of the liver: and yet all the veins are joined to the liver in fellowship. If that appear not, we may take Mediana: If that neither appear, we go to Vena humeralis, rather than to the inner vein of the left arm; attributing so much to those veins which are directly and straightly scytuated. Therefore Revulsion in a straight course bringeth evident and speedy help, whereas in a crooked or overthwart locution it bringeth none at all.  
Moreover, a large vain opened, withdraweth blood plentifully and speedily from the next places. Therefore when there is a great and vehement inflammation of some evil Humour, abundantly concurring in some principal member, and part of great sense and feeling: a large vein must be opened in some near place unto it: which may abundantly and speedily evacuate from the place affected. If the infirmity be but small, a lesser vain may be chosen, and in a place further distant, to evacuate a less quantity, and at more leisure. Revulsion in this sort, not only stayeth the Flux, but also exhausteth first from the affected member the rotten and ill blood, before it deal with the good blood of the other parts and members of the body, and then all fear is removed of any new Flux to ensue. For when the part affected shall be disburdened more than the other, through great evacuation lately made, very hardly in reason, can the same be grieved with another Flux of humours, except we go on with a fresh intemperate order of living. And again, the members far distant (covetous as it were) because of their great want: will not suffer the blood in them contained, to flow to the others. Neither will the member affected (except there remain in the same great dolour and heat) allure or suck any thing from them, being now but weak and consequently not requiring great nourishment.  
The opinion therefore of the Arabians concerning opening of a vain must needs be false: Who suppose that in a Pleurisy a vain opened on the same side doth increase the force of the Flux. Affirming also that for the plenitude (if it be much) lest the Flux should increase, the same is to be taken from the lower vain of the foot. After this that the Revulsion must be made from the inner vain of the contrary arm. Last of all, that the relics and remainder is to be evacuated out of the same side. What discretion I pray you is this? so oft to vex the sick Patient, whom we may cure at one time: For blood abundantly taken out of the side affected, draweth plenty as it were at the well head, freeing that part from inflammation without suspicion ● orfeare of any new Flux. evacuation made from the overthwart veins, only abateth superfluity of blood and humours, with small quantity of the corrupt blood, and less ease to the pained part: Or else the corrupted blood removed from the affected member, is mingled in the veins with the good blood, and so the evil that was to be remedied, is made worse. When a vain is opened in a right and strait course (e directo as they call it) it both evacuateth, pulleth the humour back, and turneth it aside. And as a slow and continual running, doth most safely pull back from the furthest parts, and remove a flux that might possibly ensue: So also the blood being turned into a long tract, as it were of a new way, by little and little with Revulsion: it turneth from the old course, without offending the natural powers any thing at all.  
Now that this Rewlsion, or calling back of flowing humours to the contrary part: may be practised with the greater profit; I am to give here advertisement, that four conditions are therein to be respected, as Avicen setteth down in quarta primi cap. 1. First we are to consider the diversity of the member, and still to draw to the contrary part, as from the right part to the left, from the lower member to the higher, from before to behind, etc.  
This consideration to be very needful, Hippocrates proveth by experience: For 5. Aphoris. Apho. 68 he writeth that pain in the binder part of the head, is cured by opening a vain in the forehead: which Hippocrates practised to avert the matter as Galen noteth in the Commentary. This aversion or turning to the contrary is done either according to longitude, that is, above and below: or latitude, that is, from the right to the left, or according to the altitude, that is, before and behind.  
The second condition is to have a care of the fellowship and community of the veins▪ therefore in abundant flux of terms, we pull back, applying the Cupping-glasses to the Paps. Which Hippocrates most learnedly witnesseth 5. Aphoris. Aphor. 50. For there is a kind of affinity between the veins of the womb and the veins of the Paps.  
Thirdly, care must be had of the rightness and straightness of the veins, which care being had great profit ensueth.  
The fourth condition is, to observe the farnes of the distance. But of these, two conditions especially are to be observed. That is to say, the fellowship of the veins, with their rectitude or rightness: And therefore Hippocrates counseleth to open the inner vain of the same side or arm, and not of the contrary arm. Which also Galen affirmeth, li. de cura. ratio. sanguinis missione ca 16. whatsoever Avicen would otherwise, in tertia primi. Therefore they are to be blamed that in a Pleurisy of the right side, open a vain in the left▪ as Galen teacheth, lib. artis medic. cap. 95.  
There are three ways of aversion or turning away and a side of humours called Derivatio. One by repelling things that beat back the matter, another by things reveling, which pull the matter clean away, and draw it forth to the contrary part. And the third way is, by things transmissive, which send the matter from one member to another. So Diversio, or Derivatio is as it were genus to Revulsion. If therefore (as ye have heard) there be great inflammation, or a sudden and hasty Flux of humours; open a great vain of the same side might, e d●recto, as these rermeit. I say, a great or large vain because if the evacuation be in the greater vessels, it is done with the more speed: As Galen saith, libri primi arti● medic. cap. 95. And it is said rightly in the same side, for this is the counsel of Galen, lib. 13. Metho. cap. 11. But if the Flux of humours be slow, & not hasty as in the other, or that a vain must be opened for preservation only: A vain further off may be taken according to the judgement and discretion of the Physician, as ye have partly heard before.  
But forasmuch as the Liver is the Fountain and original of all the veins, and Phlebotomy cuacuateth blood, it seemeth that blood should never be abated, either for evacuation or Revulsion, unless the vain of the right arm be taken, which chief doth evacuate and pull back from the fountain, that is, the Liver. Which also may be proved by that notable man Hippocrates his authority, affirming our whole body to be Conspirabile: That is, of one agreement, and of a common and general accord together, one member with another, and Confluxibile, that is, always running together, and so allied, that each part thereof suffereth with the other.  
This being so, it seemeth that rectitude is not at all to be regarded in Revulsion. For what vain soever we open because of the consent of the whole body with the parts the like profit will ensue.  
For the Solution hereof we make answer: that as it is now said, it would follow in effect. But that nature a provident dame hath so placed the midriff, as it divideth the stomach from the lower bowels, and hath separated the right parts from the left: Lest one part being hurt, the other part should also suddenly perish. And this is the cause that therefore rather the right with right, than with the left; and the left with the left, rather than the right, do accord together, and mutually suffer one with the other. And therefore also Hyppacrates said well. Sanguinis rewlsionem secundum rectitudinem (cat a Ixin) fieri debere. That Revultion of blood must be done according unto rectitude. If therefore a vain be thus opened we shall soon see the apparent utility, if we do otherwise or the contrary, it profiteth nothing.  
This is seen even by natural eruptions of blood: For if in swelling of the Spleen, nature expel blood out of the right Nostril, or in swelling of the Liver from the left Nostril, no help ensueth. But if the bleeding Bee according to rectitude called in Greek Cata Ixin, as speniticke persons, out of the left Nostril: and in diseases of the Liver out of the right evident profit will appear. The contrary profiteth not, but oft hurteth diminishing the strength of the body without help to the disease, as saith Galen de curand. rati. per sang. missio. cap. 15. Wherhfore as it were following nature, in that which she doth well, and those things which come voluntarily, and of themselves, and are yet good and profitable to stop bleeding at the nose from the left Nostril, we apply cupping-glasses to the left Hypocondrium: which is the compass of the side near the breast and Paps, and if from the right Nostril, to the right Hypocondrium. The rectitude therefore as an especial matter is to be observed in Revulsion: yea, and more account is to be made thereof, than of the differences of the members, neither are the parts of the body to be judged contrary each to other, except one be opposite to the other according to rectitude.  

An Objection.  
It seemeth that Galen respected not the location of grieved members, according to this rectitude, lib. 13. Method. cap. 5. Whereas the hand being ill affected, he scarified Crura the thighs, and one of the thighs ill affected he scarified the other thigh that was well.   

The Solution.  
Galen in his practice observed rectitude of members. For there is a common and direct society of the veins, so that the opening of the left thigh: which draweth blood from the right, for both the thighs receive blood from the hollow vain called Vena cava.  
Avicen in 4. primi. 1. delivereth two rules not to be neglected in Revulsions. First that if in the member, from which we will pull back, there be great pain: the pain must be assuaged, before we make Revulsion. Otherwise, the dolour greatly attracting, and we also drawing back with Revulsion, the humours to some other part, there would be too great a contention, and an excessive moving of the matter: whereby the body might receive much hurt.  
His second rule is, that when we pull back, the passage must not be thwart any principal member. If any ambiguity arise concerning this rule, because Hippocrates is said before, in ache of the hinder part of the head, to open a vain in the forepart: we answer, that the same passage was not made upon a principal member, to wit, the brain. We also affirm that the passage may be by a veyn of a principal member, though not by the substance of the said member: for the flux doth not abide, or rest in the brain, as in termino, in his bound or limit. Therefore I counceil again and again, because many are killed through the unskilfulness of practisioners in this point: at some of whose deaths I have myself been present. In a pleurisy of the right side, open a vein in the right arm: otherwise, the heart being situate in the middle, between the right side and the left: the passage should be upon a principal member, namely the heart. And hitherto chiefeiy of Revulsion.  
Parocheteusis in Greek: Derivatio in Latin: in English, Derivation, or pulling aside; is defined, a drawing of the flowing humour to the next part. It is done by opening that vain which is found in the very member affected; and whereby also sometime that member received nourishment. But now the ill juice flowing, and that vein opened, the grieved part is presently disburdened.  
This practice is profitably used after rewlsion: In the beginning of inflammation, when the matter is now in fluxion & moving, blood is to be withdrawn from some far distant place, according to rectitude: after that, evacuation must be made from the affected part, when the matter is come thither▪ and there settleth and abideth: then detract blood, either from the affected part, or very near unto it, and this is called Parocheteusis, derivatio. We make derivation from the member affected, when the same is not any noble or principal member: and this is done two ways: either manifestly and sensibly by scarification or boxing: or immanifestly by evaporation, as Galen showeth, lib. Artis Med. cap. 95. But that deduction which is made to the next parts, is most properly called Derivation. Thus to stay blood at the mouth, we bring it to the near parts, and provoke bleeding at the nose. So in women in fluxes of Hemorroids, we stay them in provoking Menstrua. i. their natural Terms. Thus in inflammations of the mouth, we bring them to the nose. So in angina, opening the veins in the hands, and the veins under the tongue, we make derivation to the next place. So in affects of the guts, we do not provoke to stole, but draw it to the next parts: provoking either urine or sweat. So in diseases of the rains, we provoke not urine, but drawing the matter to the next members, namely the bowels, we provoke to stool.  
But here ariseth a doubt: how the rains can be purged by siege, seeing there is no sensible way or passage known, from the rains thither.  
To answer this, we have but authorities, as namely of Galen and Hippocra. Galen affirming in his seventh book de Method. Chap. 13. that the rains, bladder, and bounch of the Liver called Gibba jerinoris are purged by siege. And experience showeth, that when the belly is solluble and laxative; the urine is the less. Hippo. saying in like manner 4. Aphorism. Aphorismo ultimo: That much urine made by night, showeth little siege.  
You have heard before, that derivasion is used after revulsion, when the force of the flux is stayed, when the heat of the inflammation is laid, when there is no fear or suspicion of any other inflammation likely to ensue: and also when the humour is yet moist and liquid in the member, from whence it may return. But if you suppose the humour to be stuffed in the member, and is not able to return: which often times falleth out in continual old inflammations, in which hard apostumated relics remain. In this case, when ye open the vein, use no derivation but fomentation or bathings, and emplasters to digest and mollesie. Wherewith, if the humour cannot be dissolved, the member not being principal; neither any great pain there felt: the affected place may be lanced, and the humour brought forth: specially, if the same be contagious, that it infect and hurt the members adjacent: which practice, though properly it cannot be called derivation, yet it may stand in steed thereof.    

Whether purgation by siege or inward medicine received, cannot, or may not, evacuate the blood. And thereasons answered that are brought for proof thereof. Chap. 7.  
IT seemeth, that an inward receipt sufficiently evacuating blood by siege, may be both found, and used by Isaacus: who in 1. vi●tici, in the Chapter of Cephalaea passio, affirmeth: Quae prosunt Cholerae, prosunt & sangaini: Those things that are good for choler, are good for blood. But it is known that we have evacuating receipts for choler: therefore by the foresaid authority, the same are also good and profitable to evacuate blood. Secondly, there are receipt to evacuate other humours, as choler, phlegm, and Melancholy: therefore also there are to evacuate blood, which is the principal humour.  
Thirdly, Avicen in 2. affirmeth: Pulpam evacuare sanguinem; that the pulp of Coloquintidae evacuateth the blood. Fourthly, Haly supra tegni, affirmeth, that Galen caused one to be hanged that gave a receipt to evacuate blood: therefore there was such a receipt then, and may be now. The contrary to these objections is set down by Galon, that no receipt evacuateth the blood or humour i● the veins, but Phlebotomy only.  
A second question here may be moved, whether if there be such a receipt found, the same may be administered or not? It seemeth that it may, because when other humours offend, we evacuate them by medicine: therefore it seemeth, we may so do, when blood offendeth. The contrary to this is set down by Haly aforesaid, and warranted by Galens' authority, who caused one to be hanged for so doing.  
For solution hereof, we are to understand, that although a medicine evacuating blood may be found out, yet the same may not be used. The reason is: for that such a medicine specially or rather altogether respecting the blood, would neither evacuate nor attract blood, as the other humours are evacuated with their own proper and peculiar receipts▪ Yea, if it happen that it do evacuate blood, as Pulpa Colocynthidis doth, according to Avicen: without doubt, it evacuateth tha● blood which should be still retained for the good health of man's body. Serapio sayeth, that the impropriate or improper humour of a receipt, is sooner thereby evacuated then the proper humour: whereof he rendereth a reason, namely, that the proper humour to a receipt, is the best beloved to the receipt. Whereby (saith he) it cometh to pass, that the improper humour is sooner forsaken of nature, than the proper. The humour improper is quickly drawn to the receipt, and thereby sooner expelled: whereas the humour called proper (which the medicine most properly respecteth) is, as it were, the most beloved friend, and as it were, the most natural child to the evacuating receipt, and therefore is still rather retained than expelled. By this reason o● Serapio, forasmuch as blood is nature's darling, & more helping than the other humours, which are but superfluities in respect of the blood. If there were a receipt evacuating & respecting blood, & that the same were administered the other humours would be attracted & cuacuated before the blood, and so great hurt ensue to the body. And if it were so that only blood offended (which is not perhaps altogether true) yet neither should the blo● alone be evacuated, as now it hath been declared. Again, according to the Philosopher 4. de Animalibus, we are to make choice of the right way, and not to seek crooked ways. Now opening a vein is the righter & safer way to evacuate blood, than medicine: for Phlebotomy evacuateth all humours at once, & principally the blood which most of all aboundeth in the veins: and this thing, medicine cannot do. Again, evacuation is done for two causes: either for to remove the abundance of the humour, or to take away the corrupted quality of the homor. So evacuation of blood is practised, either because it aboundeth in quantity, or offendeth in quality. If we open a vein because blood aboundeth in quantity: then in like sort there is also abundance of other humours. For abundanceof blood cometh through good nutriment, causing bonum Chymun. i good ●uce proceeding of meat digested: which doth not only bring repletion of blood, but also of other humours as helpers unto blood. Therefore when blood thus aboundeth in quantity with other humours, it is better to evacuat them by Phlebotomy than by receipt. If evacuation of blood be made for that it corrupteth in the veins, then by reason it corrupteth the other humours also▪ seeing blood is more abounding in quantity than are the other humours: whereupon Galen saith, that in the fever Sinocha, there is corruption of all the humours, & in all the veins, & therefore blood is never to be evacuated without the other humours together. Now other humours may superfluously abound & be corrupted in quality, without the blood, and so consequently may be evacuated without blood by inward medicine: so that it is natural for the other humours in this sort to be evacuated, and unnatural so to evacuate blood: which was the cause that Haly upon Galens' authority affirmed, that Galen caused one to be hanged, which evacuated blood by inward receipt.  
To the former objections therefore we answer thus: Isaac his saying; Quod prodest Choleri prodest sanguini, is to be understood not of evacuating medicines, but of altering receipts, as thus: those things that are profitable to alter choler, and to extinguish the amity thereof, they work the same effect in alteration of the blood. Or we may understand it of evacuation, and expound it thus: Those things which are profitable to evacuate choler, are profitable to mundefie the blood; because, by evacuation of choler, blood is mundefied and cleansed.  
To the second we answer, that this argument (Blood is nought and offendeth as do other humours, therefore it is good to evacuate the same by medicine, as other homors offending are evacuated) this is a fallax of the consequent, or rather figurae dictionis: for it followeth not, that if blood offend it must be evacuated by inward medicine; because the same may better and more safely be done otherwise; namely by Phlebotomy: and this may serve for answer to the second doubt before moved in like manner.  
To the third may be said, that Pulpa being forcible, it greatly debilitateth the member: and therefore, when blood is superfluous, it looseth and evacuateth the same, and letteth the blood contained in the member, to pass away; but it doth not attract the blood: and this is very pernicious to the body of man.  
The answer to the fourth, is plain in the premises. Where note, that although it have been declared in this Chapter, that blood is not to be evacuated by siege, as other humours are: which flux of blood that way, we rather account a disease, than a remedy: as in Dysenteria & such like: yet this notwithstanding we do not deny, but medicines may be very profitably given, and received to mundify & to purge the blood.   

Of the impediments or lets of Phlebotomy, and of the causes requiring and furthering the same. Chap. 8.  
THere are certain things which put off bleeding for a while, and other things which altogether hinder & forbid this practice: whereof, the first is indigestion of the meat received: as when a man hath eaten much overnight, and in the morning feeleth himself pained thereby: feeling still, as it were the sent & savour of the meat which he hath eaten remaining still in his stomach, whereby the crudity plainly appeareth. In this case, (except urgent necessity otherwise require) we must forbear bleeding till the digestion be accomplished; that is, till the raw humours be concoct, & also the excrements descended. The reason why crudity and rawness of humours through too much ingorging of meat stayeth bleeding for the time; may be gathered out of Avicen. 1. Doctri. 6. cap. 3. for that there are three things which attract matter unto them: that is emptiness of the place, heat of the members, the habit and state of the whole body. If therefore (the body thus affected) we chance to open a vein, the blood untimely would be drawn by the veins: first, part of this crudity of humours: and the veins being destitute of their proper and convenient nourishment, would draw unto them that which is not as yet concocted in the stomach & Liver: which unconcocted matter sent abroad to the other members of the body, would not easily be amended. For (as Galen saith) the third dgestion doth not remedy the faults of the second: nor the second▪ the curls of the first: Si magnum sit peccatum (as he saith) if the evil be great. So that now, if by this means the matter be turned into the members; there must, in the mean season, of necessity be abundance of excrements remaining in the body, as the occasion of sicknesses: and so at length sicknesses may ensue. Yea, it is far better (as it seemeth to Galen, lib. de Curand. ratio per sanguinis missionem cap. 6. altogether to abstain from bleeding in untemperate drinkers & gluttonous persons: as from such as cannot be cured either by purging or bleeding. For by their untemperate life, they gather in short time again, great abundance of raw & unconcocted humours. With such it is not best to deal: for to what purpose is it, to have the excellent use of this practice, by these men's intemperancy defaced among the common people, which hath been so present a help to divers? See Galen. lib. 11: cap. 9 Method. Meden.  
The second matter, putting off this practice for a time, are the excrements of the belly. Therefore, first exonerate the womb before bleeding, if it be not soluble of itself, with a Clyster of decoction of Mallows, putting thereto Oil and Salt, or with a Suppository, or with eating a little Cassia fistula.  
The third impediment, is some other voluntary evacuation, that may be at that present time: as in flux of Terms in women, and in flux of the Hemorroids: whereunto Gaelen likewise consenteth, lib. 9 Cap. 5. Method. Meden. in these words: If (saith he) in time of bleeding, it happen, that the Terms do flow; or that the vein called Haemorrhois be open, if the force of the same flux seem sufficient, so that it alone may evacuate that which thou requirest: thou shalt leave the matter wholly to nature: if not, than thou mayst detract so much blood, till by both ways, that be brought to pass, which thou wouldst have done. But this is not always to be followed: for in evacuation to turn away the matter, as in immoderate flux of Terms, or in the flux of the Hemorroides we practise bleeding, as was afore showed in the Chapter of Rewlsion.  
Again, concerning these voluntary eruptions of blood, when we intent to open a vein, if the eruption have been much, then stay from further evacuation. But if it little or nothing have withdrawn the matter of the disease, it debarreth us not of further bleeding. Therefore, if the disease and present necessity require it, & that the powers of nature have not been damnified by that voluntary eruption, we may speedily open a vein, as in a strong pleurisy. If there have been much sweeting, vomiting or great sieges, we are not to let blood: but if these slake, and that the natural powers are a little in time recreated, than we may very safely bleed. For those being but accidents, & not removing the cause of the disease, can not serve in steed of bleeding. So in a hot ague, if the womb be laxative, and that there happpen Lienteria (which is a flux of the stomach, when the meat and drink runneth from a man, as he took it, utterly without concoction or alteration, rising of great weakness of the stomach, specially in the power retentive, which is not able to keep the meat till nature in full time may concoct it, through immoderate drinking of cold water: from which, some cannot refrain in hot fevers: This (I say) doth not hinder bleeding, but because thereby nature's strength is enfeebled, the same considered, the bleeding must be the less, if voluntary eruption of blood remove the matter of the disease, or in some reason bring ease to the patiented; according to discretion, commit the matter to nature alone. If not, take away some blood, that through nature's work and the Physicians practise together, the cure may be accomplished. Those things which nature of herself can finish, meddle not withal; but help her with Art, in that which she beginneth, and cannot of herself make an end: therefore I said, in a Pleurisy, in a continual fever, if blood abundantly flow from the belly, hemorroids, or nose: so that the quantity of the evacuation be just, and the patiented thereby eased, let no further blood. If blood come but smally from the foresaid, and that the sickness still continue vehement: that which wanteth is to be done by opening a vein: yea, although the patiented be a woman in childbed: yea, & therefore sometime in a bloody flux, a purgation is given, that the same which cometh forth but softly and slowly, by reason of the unprepared passages; may flow more abundantly by a more convenient course.  
The fourth impediment, is the age of the party that is to bleed, either being too old or too young. Old folk are not to be let blood, because there is in them little good blood, and much ill blood: bleeding from them taketh away the good, and leaveth the bad behind. Old men after 70 years are not to be let blood, except they be of a strong constitution of body, & that the vehemency of the disease require the same. But if in these years, the powers of the body be weak, & that blood aboundeth not: bleeding is not to be in them practised: for as Galen saith, in men of these years, there is little good blood; but of raw humours great plenty: so that opening of a vein, sendeth forth the good; but the ill blood gathered together in the chief veins, in the Liver, & that part called Mesenterion, which is the double skin that fasteneth the bowels to the back: or rather, the branches of the vein called Porta, which convey the juice of the meat concocted from the stomach to the Liver, it draweth forth into the whole body. Consider therefore, the strength of the body, the vehemency of the disease: for not only the number of years, but the constitution also of the body is to be marked. There are of 60 years that are not to bleed, being weak old men. The age fit for bleeding is at as florins, that is: after some, the 17 year of age: after some 9 after some 10. after others 14. or 13.  
Before the 13 year, after the most approved writers of our time, we are not to let blood, except those youths have broad veins: be of sanguine complexion, and that the disease be dangerous & require this practice necessarily. In these cases we may open a vein, if the veins well appear: or we may diminish blood, by scarifying the legs or arms. Schola Salerni sayeth: Denus septenus vix Phlebotomon petit annus.  
The seventeenth year of age scarce good:  
To put in proof letting of blood.  
Children then before they come to 13. or 14. years, are not to bleed, except some great dangerous disease of necessity require it at nine or ten years: the reason is, because their flesh and skin is yet but tender, and easy to breathe thorough, as Galen witnesseth lib. 9 cap. 17. Method. Medendi, in these words: Puerorun substantia omniunfacile digeritur ac dissipatur, propterea quod est omnium humidissima, est omnium minime frigida. The substance or flesh of children, is most easy of all resolved or separated, because it is most moist, and less cold than other fleshy substances. It needeth therefore no evacuation, having naturally of itself, how to be purged, calore extraneo by a foreign, outward and strange kind of heat. And again Galen sayeth, lib, 11. of the same work Cap. 14 speaking of Synochus a kind of fever: Si in puerum incidat, qui 14. annum non hactenus attigit, mitti illi sanguis non debet, propterea quod tantillis, cum praesertim calidi ac humidi sint, plurimum corporis substantiae quotidie defluat ac digeratur: it a quod ex incidenda vena, moliendum nobis fuerat, id ultro nobis ex curati corporis natura praestatur. i. If this fever happen to a child yet not 14 years of age; he is not to be let blood, because such young ones, being of a hot and moist constitution, have much of their bodily substance daily dissolved. So that the same which we go about to bring to pass by opening a vain, is done already to our hands by the constitution of the Patient. Of this imp e diment, namely, the age, beside old men and boys, are also meant decrepits, and very Infants. Avicen remembreth in quarta primi, cap. 20. this matter writing almost in this manner: Thou oughtest to beware of opening a vain in a complexion too cold, in a Country too cold, in time of extreme pain in a member, after resolutive bathings, after carnal copulation, in young age under fourteen, and in old age, except thou have great confidence in the solidity of the Muscles, in the largeness and fullness of the veins, and redness of the colour: such either young or old, boldly may be let blood. Yet those that are young of fourteen year old, must bleed orderly by little and little at once, and at each time more than before: and all this did Avicen take out of Galen. So that although in Phlebotomy we are chief to consider these three things, that is to say, the danger of the disease, the age and natural strength of the party: yet the age is sometime not weighed when the strength of nature serveth, either in old or young. Wherefore Galen lib. de curand. ratione per sanguinis missionem cap. 13. willeth to let blood young sanguine children, and old sanguine men, without consideration of age, if the disease be vehement and dangerous, if the body be sufficiently strong, and that there also be vehemency of the Pulsies. In these cases Necessitas non habet legem; Necessity hath no Law. So in Spain they let children blood of three years old and less, and avenzoar writeth, that he let his son blood at three years of age, and so preserved him from death, lib. septi. cap. tertio Collecta. These limits of years in this point Hippocrates did not set down. Galen appointed them from fourteen, to seventy.  
Moved by the foresaid reasons; Rhases, in old decrepit age, nothing at all fearing the danger of exhausting the natural heat, that remaineth in the body with the blood, (whereof notwithstanding often proceedeth the hazard of life by undiscrete bleeding) by opening a vain in decrepit persons, did then help, and did great good in grievous Pluresies and Perypleumonias. And concerning young folk, this we find true by experience, that in the fifth or sixth years of their age, by opening a vain, Pluresies, inward inflammations, and other grievous diseases are cured.  
Yea, we see by the very course of Nature, that Children and sucking Infants, oft plentifully bleed at the nose without any hurt of body, or any diminishing of their natural strength.  
The age of Childhood hath naturally her strength and bodily forces, why therefore may we not evacuate blood: according to the proportion of the same? Especially, when the child is plentifully fed, having also large veins, and is filled with good concocted blood. Again, if it be granted that the forces of nature are impaired by bleeding: whether is it better for the child to peri●h through plenitude and abundance of humours? or to free him of his disease by abating that abundance, though the strength of nature be thereby a little hindered: Therefore sometime the necessity of bleeding is great, even in childred; as in Pluresies, inward inflammations, and continual fevers. There is therefore no age in my poor judgement, but may abide some measure of evacuation by bleeding if the child be past fourteen years of age: Yet consideration is to be had of what constitution he is, whether his bodily substance be fat or lean, thick or thin, gross or slender, hard or soft, of much blood or of little: In the first we may proceed to open a vain▪ in the other not: and here we most carefully remember, that in children because of their hot & moist temperature, less blood must be taken, than the plenitude seemeth to require.  
The fift impediment is an ill disposition of the stomach incident to some men, more than other some, in whom choleric humours flow to the mouth of their stomachs, and maketh them apt to choleric vomits, although before they have neither accustomed, nor had any desire to vomit. In thesemen, bleeding is to be forborn, because thereby the troubled humours flow to the mouth of the stomach as to the accustomed place, and because the stomach cannot resist so great a Flux of humours, being partly weak of itself, and more weakened through their coming. Hereof divers great discommodities grow to the body, yea this is the very cause, that some fall down and faint in bleeding. For the choleric humours flowing to the stomach, bite and nip the same, and so per Simpathia through a certain kind of compassion that is between the stomach, the heart, and the brain: it causeth Syncope, that is, swooning. Wherhfore Galen lib. 12. Method. cap. 3. Dared neither purge, nor let those blood, which have the mouth of their stomach very sensible, tender, weak and abounding with bitter choler: and which persons also abounding with the same when they bleed, in the very beginning, long afore full evacuation be made, oft fall down and faint: by reason of the foresaid choler, and crudity of humours. And this is also the counsel of Galen lib. de curand. ratio. per sanguine. missio. cap. 1. and of Avicen in quarta primi cap. 20. Ye may perceive the mouth of the stomach to be very sensible, (saith Avicen) when ye cannot swallow down sharp and bitter things without hurt. Weakness of the stomach is known, by loss of Appetite to meat and drink. Abundance of bitter choler is showed, by bitterness of the mouth, by subversion of the stomach long time connnuing, and by oft vomiting up of choler. These signs and tokens descried in any patitient, do dehort from opening a vain: Yea, this ill disposition of the stomach: bringeth not only Sincope, but also sometime present death. As Galen witnesseth lib. 9 cap. 5. Meden. And Avicen in the former cited place.  
The sixth, is weakness of the natural forces▪ Of which there is a threefold condition, for they are either firm, or weak, or between both. The forces of nature being but weak they cannot endure Phlebotomy, so forcible an evacuation. As Galen 2. Aphorismo. Aphorism. encipienti. In quo morbo, etc. & 4. Simplicis medecinae witnesseth. This is one of the principal considerations that are to be regarded in opening a vain, for either we must dehort from it, if nature's forces serve not, or encourage to proceed it, if they will serve unto it. For it standeth with great reason, that bleeding must greatly enfeeble, and put them in danger, that are already weak of nature. Yea it oft falleth out, that divers being let blood, carrying very weak bodies; can never again recover their former and pristinate strength, as Galen lib. de curand. ratio per sang. missio. ca 6. & li. 11. Method. meden. cap. 14. witnesseth. If the body be strong, and that urgent necessiity so require, we may boldly let blood. If necessity do not urge, bleed not at all, or very little. If upon great necessity in this case much blood must be taken, the body being feeble and not able to abide it, we are to evacuate now a little and then a little. Yea, I give here again advise, especially to regard this consideration. For many times when the age, disease, and time require this kind of evacuation, and the natural strength cannot brook it, there ensueth Sincope, that is, swooning: In the which case we must reiterate bleeding, as hath been said, or else stay it, putting the finger on the wound; which stay the Grecians used, and called Apphasis.  
The seventh stay or let is, the habit and constitution of the body, wherein we are to regard the whiteness or blackness, leanness or fatness, thickness or thinness, of the bodies that are to bleed. Thin, white, lean and soft bodies are not to bleed; because many superfluities are resolved from such bodies, which being to them sufficient, they need not any other evacuation. This doth Galen affirm lib. 9 Metho. Medend. fleshy bodies, firm, and thick, are subject nothing so much to dissipation of superfluities, & therefore may better abide bleeding: as for fat and gross bodies, though they be also less subject to wasting & dissipation of humours than other are; yet they hardly tollerat Phlebotomy, because they have but small veins, and they being emptied by bleeding, the fat of the body wringeth, and as it were presseth them down. So that it is greatly to be feared, lest by such oppression, the heat of nature be quite extinguished. In this point of the habit of the body, we are also to consider, the capablenes of the veins, which being great & swollen, may better be opened than the narrow and small little veins. Again, we are also here to regard, the natural disposition of the humours. For hot and thin humours are flowing and quickly dispersed. Thick and cold humours are not so: and because gross & thick fat bodies, have lesser veins, & lesser blood than lean men, & that in such persons, the very fat of their bodies oft presseth down the veins: so suffocating and choking natural heat: therefore we see by experience, that oftentimes these corpulent fat men die a sudden death.  
Whereupon also Hippocrates, 2. Aphoris. Aphoris. 44. supposed that gross men die sooner, and more suddenly than lean persons. This I myself observed, certain years past, by the death of a Gentleman of good credit, in this shire of Kent, one Master Weldon Esquiere, and of the Greencloth: Who died very suddenly being a very fat Gentleman at a parish called great Pecham.  
The eighth impediment is, the cold temperature of the Patient, or the coldness of the complexion. For the bodily constitution being already cold, by bleeding, of force must be made more cold, Whereby frigidity of the body daily increaseth. And as Isaac saith in Vrinis. Sanguis est fundamentum caloris naturalis, in quo calor naturalis confortatur. Blood is the foundation of natural heat, whereby natural heat is strengthened. Therefore Phlebotomy (evacuating blood) diminisheth the natural heat, and consequently bringeth a dangerous coldness to the whole body. The foundation of inward warmth (namely blood) being diminished, inward heat decayeth, and the body still by little and little waxeth more cold. And this is testified by Galen, lib. de curanda ratio per sanguine▪ missio. cap. 6. Yet when the sick is of a melancholy constitution, and is grieved with much Repletion, or that Melancholy hath much blood mixed with it: in this case he may bleed. And again, a hot and a moist constitution of body, having also the bodily substance consisting of found, whole, and massy members: which by reason of inward heat is daily much dissolved; tolerateth not so plentiful evacuation, as other complexions. Where by the way ye are to note that in Physic, that body which aboundeth with much humours in the veins, is most properly called Corpus humidum, and may best of all away with evacuation by bleeding.  
The ninth is rawness, slowness, and clammines of the humours: In which case we are to forbear bleeding. For otherwise crudity of humours will be increased. After Galen 12. Method. Medend. cap. 2. And this is the cause, why in long continuing maladies bleeding is not used according to Avicen: for if it were, there would follow Crudity of Humours; Debility of Natural virtue; Prolongation of the disease, with fear never to be cured.  
And therefore again, as the same Avicen saith further, in diseases daily and continual, called Morte Chronici; Purgation must go before bleeding, and not bleeding first: although we are to use them both. Whereof look before. Chap. 4.  
Of crudity of humours there are two special causes, the first is the excessive multitude of humours in the body, choking the inward natural hear, by reason of whose weakness, and suffocation, nature not being able to overcome those humours, crudities must needs i●●ue in the body. Bu● in th● case Phlebotomy may be used▪ And Galen lib. 2. cap. the Hydroposi ●aith, that bleeding he petrain the 〈◊〉 of a dropsy which is caused through abundance of menstruous blood or of abundance of hemorroids. The reason is, for that although these humours abound in the body: yet bleeding stayeth the flux of them both: of that that is of the menstruous blood, and also of the Hemorroids. This also Trallianus; affirmeth, lib. 9 cap. 2. In the cure of Anasarca: which is a ●inde of dropsy, in these words. Omnium curatio a vacuatione incipiendaest, sed Ascitis quidem dicti, aut Timpaniae a solapurgatione, cousin autem Arasarca nome●i est, ea vena sertionem int●rdum ordum requirit, ut qui ●x sanguine frigidonascitut. The cure of all dropsies must begin at eu cuation. But that kind of dropsy called Ascitis or a Timpany, must begin at purging only. That dropsy (called Anasarca) sometime equireth opening of a vain, as proceeding of cold blood.  
This he faith not that this Anasarca requireth any further coldness to be added, but because the withdrawing of abundance of humours in this case, disburdeneth nature, and maketh her the more able to overcome the same Repletion, being somewhat lessened in quantity by bleeding. It is not therefore repugnant, but very agreeable to reason, in this case, to use Phlebotomy. For we see by daily experience, that a small fire is put out by laying on too much wood at once, or such wood as is green, and that then it burneth when the wood is removed which hindered the burning thereof. Even so is inward heat of the body choked with multitude of humours, and the same is again refreshed, when some portion of them is withdrawn.  
The second cause of crudity of humours, is the debility of the inward natural heat, which happeneth in men of cold Complexions, in men that have been long sick and in old folk: in these bleeding is not used, because blood being taken away from them, which is the restorer and maintainer of the inward natural heat (as ye heard before out of Isaacus) consequently the body must wax cold, and crudity of humours increase. Blood therefore must remain in these persons, to concoct and overcome the humours in the body.  
And therefore very well saith Avicen, Non quotiescunque videris signa Repletionis, est faciōd● Phlebotomia: That is, Phlebotomy is not always presently to be practised, whensoever we see signs of Repletion, as namely, when there is fullness of raw humours in the body, and this doth Galen also affirm, lib. 12. Method. Medend.  
The tenth impediment is the unfit disposition of the Air, when the same is too hot, too cold, too dry, or too moist. Also when the same is not clear, but troubled. And therefore under the star called Canis, in the canicular or dog dries, when thereiss excessive heat and drith, it is good to refrain bleeding: Except great necessity do urge it. So likewise in seasons too moist and too cold, as in the winter in a state of the Air temperately hot, as when the wind is south, or southeast, we may bleed temperarately and sparingly.  
In a more cold state of the Air, as when the north-wind bloweth, or Northwest wind; we must bleed more sparingly than before. In a right temperate and mild state of the heavens, we may bleed plentifully; especially the Air not being greatly disquieted, with great force of tempestuous weather.  
And here may be made a profitable collation in this practice: by folding up together as it were in one: three impediments here specified. The state of the Country being co●de, the time of the year being cold, the present constitution of the Air being cold. All which three are outward causes, and ●oyne in this third point: which is common to them all three: that is, the Country, the Air, and season of the year, compass about every Patient. Therefore in a cold Country and in winter, and when the north-wind bloweth; open no vain. If in a cold Country and in winter the wind blow South, and that so necessity require, we may proceed with this practice; so in a hot Country, and in summer, the wind blowing at the South: bleed not, If necessity in summer require bleeding, open a vain when the North-wind tempereth the immoderate heat of the season. For surely these outward causes, though obscurely, and without any great perceiving▪ yet they do either keep in, or disperse abroad and extenuate, the substance both of inward heat and also of the inward humours. And as in a temperature or complexion hot and moist, Phlebotomy is used best: and not to be used in complexions hot & dry, or complexions cold and dry. So when the season is hot and moist, as in the spring we may bleed safely. But not so, in a season hot and dry, as is the summer, or very cold, as is the winter.  
The eleventh let is some great inflammation, or extreme ache and pain, as appeareth by Galen and Avicen, who both forbidden bleeding in hot inflamed fevers, and in apostumations of great pain. In these cases the opening of a vain doth cause much business, and agitation of humours in the body. Bleeding on the one side, drawing and emptying humours: the inflammation and ache on the other side, striving there against, and attracting humours thither. For all pain, if it be much and all heat, which concurreth with pain, attracteth and hindereth the flux of humours. Whereby it cometh to pass, that by bleeding in this case, the inflammation is thereby increased, and nature more enfeebled, and the same most chief when the bleeding hath been temperate, and done according to Art. But in the foresaid cases: if the blood be withdrawn in great quantity, even till the Patient give over and faint: it profiteth very much for, thereby the abundance of boiling blood in great inflammations is expelled, and the inflamed member is cooled: so that in vehement pains, opening a vain is a present help: keeping back the flux of blood, which otherwise would have recourse to the pained place. And here it is not to be forgotten, that sometime the expulsive virtue, making haste to expel the cause of the grief, causeth thereby sometime an inflamma ●on.  
The reason is, for that the expulsive virtue, having done no good at the first, ●nd 〈◊〉 more venemently than before, to expe●● that matter which causeth annoyance, and doth therewithal wring out forcibly some blood out of the upper parts or members, into the lower afflicted part: as Galen ●heweth at large lib. 23. cap. 3. Method. Medend. And therefore to keep back the said inflammation, bleeding greatly profiteth as ye have heard before Cap. 6. And this is the intent and meaning of Galen, where he saith: In ardentissimis febribus, si usque ad animi defectionem, sanguis mittatur, statim totius corporis habitus refrigeratur, & febris extinguitur. In extreme hot fevers, if we bleed even to giving over and swooning: presently the state o● the whole body is cooled, and so the fever is extinguished.  
In vehement pains and griefs therefore, there is no better remedy fou●de, than ●o ●et blout, even ti●l the Pa●●ent overcome▪ Read more hereof in Galen, lib. 9 Method▪ Med. cap. 4. l●b. de cura●d R●t●▪ sa●g. M●ssionem, capit. undecim. Fuchlium, libr. second▪ sectione. quint. cap. quart. & sext. institutionum Medic.  
The twelfth impediment is the extreme coldness of the Region, a Country which being cold cannot tolerate so large an Euacuatioṅ, as is this kind that we now presently handle. The reason is, for that the body being before sufficiently cooled through the cold temperament of the place, must needs wax more cold, when the natural heat is drawn forth with the blood. Moreover a country too hot, cannot admit this practice, because in such a place extremity ofheate draweth from the body much inward heat of nature, dissolving of itself, and dispersing the natural forces and humours of the body, and therefore in hot Countries, the natural powers are lessened: & there is less blood in the veins, which is the reason that also in extreme hot countries, the bleeding must be none at all, or very little▪ A country somewhat colder and moister than this now specified, keepeth in the humours and inward heat: dissolving very little thereof Therefore men in such countries, may bleed more abundantly. The contrary to this happeneth in extreme cold countries, situated far Northward. For the blood congealed through extreme cold, will not give place to evacuation. And again, if the inward members should be deprived of their natural & inward heat; they were greatly in danger to perish with extremity of outward cold. Look more of this before in the tenth impediment.  
The thirteenth hindrance, is the time or season of the year, which is a matter also in letting blood to be considered: as namely, whether it be too hot a season, as in Summer: or too cold a season, as in Winter: specially when it is frost and snow. For to what purpose is it, when the body is already sufficiently cooled, through the cold season of the year, to make it more cold by bleeding. And for hot seasons, if the heat be extreme: those that bleed in them, oftentimes die by swooning or fainting called Sincope, or resolutio: for extreme heat environing the patiented, doth overcome the vital spirits, which come forth with the blood; drying & weakening the state of the whole body. Therefore in seasons extremely note, it is a point of wisdom to forbear bleeding: which thing Galen teacheth, lib. 11, c●p. 4▪ Method. Medend. in these words: Et omnino quidem non mittes in tempore aestai is, & regione aestuosa, & caeli statn calido & sicco. Thou shalt not at all let blood in Summer time, in an hot country, and in an hot and dry state of the air: as under the dog-star, and from mid july to mid September; or rather to mid August. By Galens' words we may perceive, that there is the like reason of the country, and of the time of the year concerning the heat and coldness of them both. But to put practisioners in ●i●de, that these rules are not always precisely to be observed: I give advertisement still, as I have done in other the like cases before; that in this circumstance of the extreme cold, or the extreme heat: either of the time, or of the country: that it doth not quite exclude bleeding at all time, even in cases of mere necessity: but only thus far; that these cannot admit so large evacuation by bleeding, as their contraries may. The Spring therefore (being the most temperate time of the year, when the forces natural, & humours themselves most abound) is the best time to open a vein, to avoid future maladies. The next convenient season is Autumn or Harvest. And of the Spring, the beginning thereof to be best, Hippo setteth down 7. Aphorism. Aphoris. 54. But hereof look more hereafter in his proper p●●ce, and before in the tenth impediment.  
The fourteenth let of Phlebotomy is former bathe or hot washings: especially resolutive baths: Which as Galen witnesseth in his book of the Utility of respiration Cap. 7. do so forcibly evacuate the spirits from the whole body, that it stayeth opening a vein. And again Hippocra. writeth in his second book Aphoris. 51. That it is very perilous, much and upon the sudden presently one after another, by divers evacuations, to empty the body.  
The fifteenth, is a disposition to vomit: of what cause so ever the same proceedeth. For in this cause of loathsomeness of stomach, if we let blood, the veins by bleeding exhausted do soon draw unto them that wicked and loathsome matter, which lieth in & about the stomach: whereof look more in the fifth impediment.  
The sixteenth impediment, may be custom, or a former order oflife: wherein we are to consider, to what meats we have been most accustomed: what excrements are still retained in the body, contrary to former wont. For too much former repletion of the body with meat and 〈…〉 bleeding, as appeareth in the first impediment. But if there have been before a moderate mean observed in eating and drinking, wherewith the body hath been safely nourished: then we may boldly b●eed. If it be otherwise; then forbear. Ye●, f●om this point also is taken a sure note of the quantity ofblod that must be extracted. For those that have been accustomed to be let b●od, may bleed more in quantity than they that have not been accustomed to bleed. In this impediment, moreover, consideration must be had, whether Hemorroids or Terms, are restrained, contrary to former custom. Or whether we still use our accustomed exercises or no. But although divers matters herein are to be regarded: yet in custom princicipally, these three are to be marked: The precedent order of diet: the kind of life, that we have spent before: and former evacuations. Those that have lived sparingly, either by their own ordinary prescription, or by occasion of sickness; are to bleed less. Those that have lived more frankly, may bleed more plentifully. He that hath been already let blood, so that the natural powers be not thereby too much enfeebled, may, as I now said, better abide to bleed, than they that never were let blood. For this is a general rule: Things accustomed, yea, if they be evil things, are the less grievous; whereby is confuted the opinion of the vulgar sort: who greatly commend the first opening of a vein, as a matter greatly healthful: and discommend all the other bleedings, making their reckoning of this in their most extremities: that though they were never let blood before: yet now they will send for the Phlebotomer, as their last refuge.  
The seventeenth impediment is, carnal copulation: presently after which, the opening of a vein is also forbidden, because Venus so lately embraced, hath thrown down and weakened the powers of the body, and warmed the same more than was convenient. How the powers of man's body are loosened & enfeebled through venereous acts: Galen most excellently declareth, lib. 1. de Semine. cap. 25. saying: In the time of carnal copulation, the stones or genitors, draw forth of the veins all such seedy humour as is contained in them; which is not much in quantities and that which is the same, is admixed with the blood in the likeness of dew: and this to do, is the office of the Testicles. So that first by the genitors having more strength than the veins; the seedy moisture is violently drawn from them. And again, the veins draw the same from the members next unto them: These parts again exhausted from those next unto them in like sort: so that this extraction ceaseth not, till it have gone thorough every part or member of man's body: by reason whereof, all the bodily parts are deprived of their proper nourishment: and always that part which is perfectly & thoroughly evacuated, violently taketh from that which is next adjacent, and hath more plenty of seedy moisture to be extracted. This (I say) being done always, and all parts mutually participating among themselves: necessarily all the receptories, and parts of the whole body must be evacuated, till the strongest of all the parts be filled. And further, it cometh to pass, not only that the seedy moisture is drawn from the parts of the body through carnal copulation; but also the vital spirits pass out of the arteries with the same. And therefore it is no ●●arucile, if such as use lechery immoderately, become weak, both these being taken from the body, that is to say, the seedy moisture, and the vital spirit. Whereunto may be added the pleasure of Venus, which of itself, is able to unloose the vital fir●itie of the body. Yea, it is known that some have died of too much pleasure in the act. Marsilius Ficinus in his book de Sanitate tuenda. Cap. 7. confirmeth in these words, a●l that hath been hitherto said. Venus (saith he) if it do but little exceed the powers natural of the body, presently it exhausteth the spirits, and specially those that are most subtle. Also, it enfeebleth the brain, weakeneth the stomach and heartstrings: yea, there cannot be a more hurtful thing to the wit and memory. Why did Hippo. judge Coitum to be like the falling sickness: but b●cause it woundeth the mind, which is diui●e and heavenly. The immoderate use of ust is so hurtful, that as Avicen sayeth in his boode de Animalibus: If but a little seed issue forth more than nature can afford; it offendeth more, than if fou●tietimes so much blood had proceed●d. And therefore, not without some good ground, d●d the ancient w●iters imagine the nine Muses, and Minerva herself to be vi gi●s▪ Re●d mo●e hereof in Galen, Chap. 86. Artis Medicinae. Pauli Aegnieta, lib. 1. Chap. 35. In Aetius, lib. 3. Chap. 8.  
The seuen●eenth impediment, is long continuance of a disease, wherewith the strength of the body being wearied, a long tract of time, the same cannot now tolerate b●eeding. And forasmuch as now the body is more than inongh enfeebled & brought low, through a long continuing and languishing sickness: by bleeding we may more easily quite extinguish the patiented, than remedy the disease. Galen de Curand. ratio per sanguia. missio. Chap. 20: And Avicen confirm the same, giving adui●e to forbear opening of a vein in bodies which have endured long griefs, except corruption of blood move unto it. In which case sometime blood may be detracted from persons that have continued sick of long time. And Fuchsius counseleth saying: People in consumption: o●de folk: women with child: & young children, are not lightly to bleed.  
The nineteenth impediment, is small quantity of humours being in the body: for a good consideration is to be had, how the humours offend in the body in quantity or in quality: Whether there be many or few humours in the patient. And therefore sometime upon this ground, we open a vein in women with child, if there be abundance of blood, sufficient both for the mother and the infant in the womb, if the bodily strength be firm, and that the greatness of the disease in them so require it. But hereof more at large I mean to write in another place. And ag●ine, beside the quantity: the diversity of nature in humours is also a profitable consideration in this practice. For even according to the variety of humours, the patiented is oft either to be let blood, or not let blood: which Galen seemeth to witness, li. 4. de Sanita tuend. saying: Some humours come to perfect nutriment before the blood: some are as it were, half concocted: some altogether raw and undigested: Some are but little different from the form of blood: some are wholly changed into blood: some very little, some more, some very much. When humours are a very little, as it were, from the nature of blood, as not yet turned into the same: or when they have a very little exceeded further than the nature of blood: we may confidently open a vein. When the same is more than a very little, either the one way or the other, on this side or beyond▪ we are to deal herein more considerately. If the humours want much of, or exceed much beyond the nature of blond; we are altogether to forbear bleeding.  
The twentieth let: after the small quantity of the other humours, may be the quantity of the blood: which the wise Physician in this practice will most wisely regard. As for example: if there be little good blood in the body, and abundance of other humours: we are to make stay from opening a vein. If any of the other three humours be but little in quantity, and the blood abundant; we may boldly let blood. Yea, by diligent observation the Phlebotomer shall easily perceive, what hurtful humour may be withdrawn with the blood: and therefore, if there be many choleric humours in the body of man, and yet not mixed with the blood: or that there be many phlegmatic and raw humours, and but little blood; by no means is a vein to be opened. This doth Anicen forbid in quarta primi. Cap. 20. If the blood be good and little, and that there be in the same body many ill humours also: bleeding taketh away the good, and leaveth the bad behind. And a little after he addeth: that the Physician is diligently to beware, lest by unskilful bleeding in these cases, he bring the patiented (after he hath extracted the blood, (the ill humours still remaining) to an excessive heat of choleric humours, or too much crudity of cold and undigested humours. And although (as ye have heard before) Phlebotomy doth equally evacuate all humours. Yet because now so little blood is in the veins, whereof a little portion is withdrawn by bleeding: it followeth that but a little blood, and less than before, remaineth now in the veins with the other humours: and that there is great plenty of the other humours: forasmuch as they come not out so readily, when a vein is opened, as the blood doth: and therefore, by a necessary consequent, blood being gone: which was, as it were, a bridle to other humours: choler must excessively boil, and phlegm become more cold and undigested. Whereupon also I gather, that those have done ill, and very unskilfully, which have reproved Avicen of error in this place, seeing he is rather very highly to be commended: then upon every small and light occasion to be reprehended.  
Finally, we are to forbear letting of blood after continual vomitings, hunger, great watchings, extreme labours, and after all such things, as immoderately 〈…〉 body, drying and dissolving the 〈…〉 thereof: as Rhases noteth, lib. 7. 〈…〉 Almonsorem. Touching the causes▪ 〈…〉 ring Phlebotomy, they may soon be gathered of their contraries, by those impediments here specified. And in the fifth Chapter before, ye have heard both the direct & indirect causes, which may move to let blood: Unto the which place I refer the studious reader, at this time, concluding this Chapter with the verses of Schola Salerni: wherein are set down most of the impediments here spoken of:  

Frigida natura, & frigens regio, dolour ingens,  
Balnea, post co●tum▪ minor aetas atque senilis,  
Morbus prolixus, repletio potus & escae.  
Si fragilis vel subtilis, sensus stomachi sit,  
& fastiditi tibi non sunt Phlebotomandi.   

Complexion cold, the country so,  
Great grief, bathe, and veneric▪  
Too young, too old, long sickness to:  
Stomach sick, and fastiditie:  
Cannot abide Phlebotomy.    

diligent 〈…〉 ding 〈◊〉 persons as are me●te or unmeet to be ●●r he loud. Chap. 9  
IN this Chapter I will be but brief, because I was prolix in the other before, from whence many things concerning this point, may be very well, and with great profit taken. Neither determined ● at the first, to have made hereof a distinct Chapter: but that in certain Latin writers I found the like done before: whom I thought good to imitate. First, therefore this practice is best for delicate, idle, and corpulent persons, which use to feed plentifully on the best nourishing meats, without taking any great pain, as Avicen witnesseth in prim.  
Secondly, for such as have abundance of blood; which is known by many unfallible signs, and specially by thickness of urine: For abundance of blood maketh the urine thick, as abundance of yellow choler maketh the same thin.  
Thirdly, for such as abound with Melancholy, having in their bodies, much natural Melancholy running with the blood, because blood is not thoroughly purified from it in the Liver. And therefore in this case Phlebotomy must go before purging, and not contrane, as hath been aforesaid.  
And here is to be noted, that Melancholy is twofold. One kind is natural: another kind is not natural. Natural Melancholy is the refuse of blood: And when the same aboundeth, it runneth about in the body with the blood: and to evacuate it, a vein must be opened: and so this kind of Melancholy passeth with the blood, because blood and the refuse thereof, that is natural Melancholy, cometh of one and the self same temperate heat. And when evacuation is thus done, a purgative may be used. But let purgation succeed Phlebotomy after some space, namely, when the concoction is finished.  
Fourthly, bleeding is much profitable to those in whom is to be feared some extraordinary heat, shortly to follow: or some extraordinary boiling, either of blood or of humours, or some other perturbation of body, through too much abundance of these. Such persons as fear or feel any of these things, are presently to have a vein opened. Where note, that this rule yet oft deceiveth divers practisioners: For when their patients do feel any heat or calefaction, presently they judge it some ebullition of humours, and so let them blood: whereas the same may come through heat and inflammation of yellow choler: in which case it is so far off by bleeding, that the heat & ebullition should be allayed, that they are the rather thereby increased and stirred up. For bleeding (as hath been told you before) provoketh the humours to run thorough out the whole body, with the greater violence. In such a case, therefore opening of a vein should not be used; except the same heat and ebullition came altogether of abundance of humours: which is known through abundance of sweat; chiefly that sweat which is in the morning. For some do not sweat, but when they have need of evacuation.  
Fiftly, it is to be practised on them also especially, whose bodily powers are firm and strong: and that are of a sanguine complexion, that is hot and moist: and not cold and dry. Rhazes, lib. 7. ad Almonso. Chap. 21. sayeth: Corpora quae venas habent amplas, & conspicuas, quaeque hirsuta sunt, & colore inter rubrum fuscunqne medio, adolescentum nimirum, iwenum, & senum non decrepitorum, Phlebotomiae presidia magis tollerare possunt: pueris vero & infirmis vena secanda non est, nisi maxima incumbente necessitate. i. Such bodies as have large and manifest veins, that are hairy, and of colour between red and brown: specially of striplings, young men and old men, not decrepites: may most safely away with the help of bleeding. But we are not to open a veinein children, and weak folk, except great necessity so require.  
Sixtly, this practice is with great heed to be used: or rather not at all to be used after the pain of the colic, or rather immoderate perturbation of the bowels: either above or beneath: whether it be Cholica passio, or Illiaca: For the Humours, as ye have heard in the Chapter before, being moved by bleeding, the choleric humour would flow unto the stomach, and inflame the same: nor yet after strong vomits. For the like event would follow: nor after a lask.  
These and such like extremities vehemently heating the body, and greatly dissolving the same: if they should concur●e with Phlebotomy: they would too much inflame the body, excessively move the humours, and mightily weaken the forces of Nature, as appeareth in the Chapter before. Fig. 20.  
seventhly, women with child, or having their terms, are not to be let blood. In women with child, this is the reason: because natural heat serving for digestion, would thereby be diminished, and so nutriment would be withholden from the child, which were very dangerous, if the mother were far gone with child. The fruit in the womb is nourished by the Terms: and not having whereby to be nourished, it must of force in the womb (having life, and wanting nourishment) die for hunger. And again being losened from the natural stays in the womb, it falleth out of the natural bounds, and so causeth aborsion. This (I say) sooner happeneth when the young fruit in the womb is grown much, and the mother far gone therewith: for than it needeth the more nourishment, which it can neither find nor have, the blood being diminished. Fulchsius writeth more hereof 31. Coment. lib. 5. Aphoris▪ Hippon. But here I am to add: that albeit in ancient time it was accounted perilous to let blood women with child, as appeareth by that which hath been now said: yet out of the Chapter precedent Fig. 19 it partly appeareth, that this practice may be done discreetly and safely, in women with child, if necessity so urge: chiefly, if blood be abundant in them: if the body be firm and strong. I affirm that they may bleed: But because it hath been reputed dangerous; we must carefully see that we take not from them much blood. To take a little after the fourth or fifth month of conception hurteth not. Yea, experience proveth, that women thereby are made merry and light, whereas before they were very melancholy, feeling always about them an unaccustomed heaviness: yea, through a little bleeding they are enabled with the more facility, to bear their burden to the due and just time of their deliverance. Again, some women being with child require twice to bleed: that is to say, when they are half gone, and in the beginning of the eighth month; but hereof take great heed, except the woman greatly abound with blood. I have seen saith Guinterus a woman with child, that hath been let blood three times, in the second, the fifth and eighth month: because she was very sanguine, and had experience once or twice before, of aborsion the third month, if she had not bled the second month. In the other months the fifth and eighth she was in danger of suffocation, except she had bled again. When women are brought a bed, they must not bleed, except their second birth be suppressed, or a Fever molest them: In the which cases also, carefully consider in the Patient, her natural strength. Those that have their terms naturally, according to the due course of nature, and the course of the month: are not to be let blood, except in immoderate Fluxes, to draw back the matter. When they break forth naturally, the whole matter is to be let alone to nature.  
Eighthly, bleeding is not good for such persons as are bound, and have the excrements retained. For as ye heard in the eighth Chapter, Fig. 2. The veins being emptied, they attract matter from the next members, and they attract from the stomach the moistness of the excrements, whereby they become more dried and baked, bring divers ways annoyance to the body. In which case the womb by Art is to be made solluble, as appeareth in the place now cited.  
Finally a vain may and is to be opened, without hurt or danger, whensoever we feel ourselves to be heavy, lumpish, and stopped or stuffed in our bodies; first considering the quantity and quality of the fullness: which we may know and discern, by certain tokens, whether it be Plenitudo quo ad vasa, or quo ad vires, as was showed in the first Chapter, the more heavy and drowsy a man feeleth himself to be; so much the more it appeareth to be that fullness, which is quo ad vires: But if he feel the former stuffing in his body increased, than is it that plenitude Quo ad vasa. And thus much to know the quantity of the Repletion.  
The quality of the fullness is known, partly by the colours, partly by those things which are very nearly joined to the nature of the humours: But of these signs sufficient hath been spoken before in the first Chapter.  
In these cases of Repletion, if the strength of the body shall be answerable, we are to open a vain: for as much as bleeding is the chiefest remedy to abate fullness. But if the stuffing and fullness of the body be greatly grievous, and the state of the body not answerable: it is not always necessary to let blood, As Galen noteth, lib. de Curand. ratio. per sanguinis missio. And again, Phlebotomy is not only profitable when any of the foresaid fullness grieve and oppress us: But also (as hath been said) in cases without any fullness: As in the beginning of an inflammation, which cometh either of a blow, ache, pain, or weakness of the member. For pain (as was said) draweth the blood unto it, and of the weakness of the bodily parts, cause an inflammation without fullness.  
Also when the disease is great and vehement, we let blood, although no fullness appear in the Patient: yet always having a regard to the age and strength of the party, as Hippocrates setteth down in these words, 4. Vict. acutorum, 17. In acutis morbis sanguinem de●rahes, ●ivehemens morbus videatur, florueritque aegrotanti aet as, & virium affuerit robur. That is, in sharp disease thou shalt let blood if the sickness seem great, if the age of the Patient permit, and that there be sufficiency of natural strength. And thus much of the persons that are to bleed, concerning the which point, more may be easily conjectured and collected of the studious Practitioner, from the Chapters precedent.   

What corruption of Humours bleeding removeth from the veins. Chap. 10.  
IT hath been said, that bleeding generally, is the present and proper help, when Humours offend in the veins either in quantity or in quality. It hath been already declared, that some humours it evacuateth, other some it revoketh and pulleth back, which is called revulsion, whereof hath been spoken in a distinct Chapter by itself. Now order requireth in some brief sort to show what corruption of humours generally, bleeding evacuateth from the veins. The defect of humours in the veins is either Plethora, or Cacochymia, as was showed in the first Chapter. The only and peculiar remedy of Plethora, or abundance of blood, is the opening of a vain. And forasmuch as fullness of blood is of two sorts: One of fullness simple and pure, consisting of a like proportion of the best humours: and the other unpure and compounded, taking part with Cacochymia: that is, abundance of humours corrupted in the veins. Therefore it is to be marked, that in both these Repletions, the opening of a veyn greatly profiteth. When so ever therefore the muscles are sound, whole, and full, the veins large, great, and swelling, menacing thereby imminent danger to the members: presently blood must be detracted. After which eu cuation these effects will ensue: mitigation of pains caused by overmuch retching of the veins: ease unto the body, which seemeth as it were now disburdened of a grievous and weighty ponderousness: a more nimbleness to all exercise and labour than was before: an increase and refreshing of the natural heat: an opening of the strait passages and pores of the members. Finally, there will follow a happy repulse of divers imminent dangers and diseases, whereunto by all probability in short time the body would have been brought.  
For it is greatly tobee feared, lest the veins overreatched with fullness of blood, should open and break, and through that means cause inflammation, or lest some general obstruction should arise, which might keep back the inward heat, and so utterly choke up the bodily forces whereby might be caused some vehement hot fever, or as it oft happeneth a sudden death of the party.  
Now from these dangers, can no man be safely and speedily freed, either by purging, exercise or abstinence, but by bleeding, and with the blood is this Repletion most safely abated.  
That fullness which is unpure and compounded, is not so safely cured by bleeding, and yet the more nigh that it cometh in likeness to that Repletion which is simple, and pure: the more confidently, and the more plentifully we may let blood. And the more unpure that it is, the more carefully and sparingly ought a vain to be opened. Therefore those persons that have an ill constitution of body, and yet have their veins abundantly filled, or that being of a constitution, are yet replete with corrupted meats: These I say, are to bleed no longer, but to avoid the danger of fullness, and the impurities remaining behind, are to be expelled by Purgation.  
Hot choleric Repletions, of all unpure constitutions, are most safely abated by bleeding, because bleeding in this case, not only diminisheth choler, but also cooleth the same mightily.  
Melancholy Repletions, can nothing so well away, with this practice, because it doth not so exceed in heat, that it need at all any refrigeration or cooling, and the phlegmatic constitution can in no case brook it, for being a very cold complexion it quite rejecteth bleeding. For Phlebotomy by great cooling, so greatly increaseth crudity and rawness in the body, that it can never or very hardly be recovered or amended.  
Weakness of bodily strength, resembleth this foresaid Repletion, and therefore also by the self same reason, rejecteth any large evacuation. And in truth, is not in this respect to be dealt withal, except the veins abundantly replete, threaten some great hurt, or that necessity so require it, and then it must not be done all at once, but by little and little, as it hath been before declared.  
Therefore in each and every fullness that is unpure, we are to begin with opening a veyn, for without it we cannot safely afterwards purge. For a vehement purgation especially (if bleeding have not gone before) troubling and molesting the full body both with much heat, and by force of the attractive virtue: bringeth the Patient into greater hazard than he was before, and therefore to conclude this point, the veins being swollen, and filled, if moderate bleeding do no good, it can do no harm at all.  
The otherfulnes quae ad vires, which cannot very easily be known by signs, although it cannot overstretch or break the veins, nor overcome the inward heat: yet because it oppresseth the weak forces of nature, lest there should ensue putrefaction or corruption of humours, it may be diminished by opening of a vain: Leaving yet behind so much as nature may easily rule: yea, and the same also, (because it bringeth no doubt of present danger) may be profitably taken away, with spare diet or abstinence. Of corruption and putrefaction of blood and humours in the veins without plenitude, called Cacochymia: that is, fullness quae ad vires: There riseth a great doubt, whether the same may aptly be removed by bleeding. We answer, that to remove by bleeding a simple corruption of humours in the veins is profitable and easy (regard being had) both to the abundance thereof, and to the forces of nature in the Patient. For albeit when a vain is opened, all humours issue forth equally, and that there remain behind still as there did before one and the self same proportion of humours: yet because now by bleeding part is abated of that burden, wherewithal nature was before oppressed, the forces and powers natural wax not the more feeble, but they become more strong and cheerful, so that they can bear with the greater ease, those humours, which as yet remain still behind, and nature herself governeth them with far less trouble than before. And hereupon in continual fevers, when there is great crudity and corruption in the veins, blood being often times detracted, the urine also being red, troubled, and thick before: It appeareth now more clear, and showeth forth evident signs of concoction. And note (here by the way) that the Phlebotomer must be very well exercised in those signs, which prognosticate fullness, & repletion. Yea & ye must also know perfectly the place of each particular humour: lest after the manner of the unskilfuller sort, when the nose a little bleedeth, and the urine appear somewhat red, by and by ye do let blood▪ Whereas blood often times easily cometh forth, not only by reason of fullness, but upon divers other occasions, nature herself often attempting voluntary eruptions of blood. Hereof it cometh that such persons as have (as it were) the small little mouths of the veins called Oscula, eaten or gnawn: or that have a weak and apostumated Liver: and that Hydropical persons bleed oft at the nose.  
Also urine waxeth re● and bloody, by the fretting of the stone in the Rains. Urine waxeth yellow in that kind of yellow iandies which is simple in Scirrho hepalis, That is in the hard part of the liver: and in that kind of dropsy which is called Ascites: Yet in these effects we are not to let blood, for Cacochymia proceeding of corruption of the bowels, is not that way cured. Therefore the certain knowledge when a vain is to be opened necessarily, is only gathered of those marks and tokens which manifestly declare abundance of each humour: And hereby ye may gather, that bleeding alone speedily helpeth that corruption of humours, which lieth in the great veins, and only freeth the Patient from this kind of corruption, except the same take beginning from the bowels ill affected: and in this kind of corruption, purgation is more meet than bleeding. And thus it appears in a general sort, what corruption of humours the opening of a vain doth remedy.   

A particular rehearsal of those diseases present, or future, which are cured by bleeding. Chap. 11.  
FIrst as ye have heard, a vain is profitably opened in the two plenitudes, nature being strong and the age convenient. In the fullness quaead vires, have special regard that the natural forces be firm. But if in this plenitude, raw, cold, and undigested humours be greatly gathered together in the body, forbear; taking this as a rule, that with great abundance of raw humours, the strength of the body cannot stand as ye have already partly heard, and as Galen witnesseth, lib. de curand. ratio. per sangui. missio. cap. 9  
Secondly, it helpeth diseases present, and future, and serveth both in the curative and preservative intention. We read that Galen in the spring time did let blood those persons that were subject to these diseases following: to wit, Spitting of blood: A polexies: Falling sickness: Peripneumonia: Pluresies: Anginaes': Stoppinges of Hemorroids or Terms: Swimmings in the head: The Gout in the feet and in the joints. All which Avicen also setteth down in quarta primi cap. de Phlebotomia.  
Thirdly, we do not only open a vain in repletion, as Menodorus falsely supposeth; but also as hath been said without fullness: when we fear some inflammation through some fall or other accidental grief. And moreover as we have already specified, we open a vain for two purposes, sometime to evacuate, sometime to pull back immoderate flux of humours to the contrary part, as Galen noteth lib. de Curand. ratio per sang. missio. cap. 11 & 9 Metho. Medend. cap. 11. As to stay blood at the nose we open a vain in the arm. For this cause Galen lib. 13. Metho. Medend▪ ca 21. in Letargus which is a drowsy and forgetful sickness, rising of impostumation, of cold putrefied phlegm, especially, in the hinder part of the brain: whereby memory and reason almost perisheth, and the sensitive power is greatly hindered, causing men commonly to forget their own names, also to shut their mouths after they have gaped and by no means to stay from sleeping. In this disease (I say) at the first beginning thereof, Galen willed to open a vain, albeit the disease be cold, rather as it seemeth to revoke, than to evacuate the matter: or Galen so appointed it, because fullness is always concurring with this forgetful and drowsy disease.  
Hereupon Galen 11. Meth. Meden. cap. 15. affirmeth it to be very healthful to open a vain not only in continual fevers called Continentes: but in all fevers caused and kindled of a putrifieng humour, which should not seem to be true, especially in intermittant f●uers which leave off for a time, as are tertian and quartan agues. Forasmuch as in these, blood offendeth not in the veins: but some other humour beside blood, putrefieth without the veins, which by bleeding in reason cannot be evacuated. This place of Galen cannot sound to reason or experience, except we understand Galen to give us advise to evacuate by bleeding the matter of such intermittant fevers, as have also with the blood, fullness, and abundance of other humours concurring: So that this may be his meaning. Bleeding may be used in intermittant fevers, if they fortune to have abundance of humours joined with the blood. For obstruction as Galen showeth li. 11. Meth. Meden. cap. 4. happeneth in rotten and putrefied fevers, sometime through abundance of humours, sometime through the clammines, grossness and thickness of them. Galen therefore counseleth to let blood in staying and intermittant fevers: rather because of the abundance, than the rottenness or putrefaction of the humour without the veins. And that this is his meaning, appeareth by the words which Galen afterwards useth, saying: Forasmuch as nature ruling the body, by bleeding is lightened and disburdened of that wherewith she was before oppressed, therefore she will with ease overcome that which resteth and remaineth behind, which is a 〈◊〉 sign that Plethora or fullness is also annox●d to such fevers.  
Fourthly, in bleeding, we are not only to consider the disease itself, which we determine to remedy, but also oft times the cause thereof: so that whatsoever the sickness be, if Phlebotomy may remove the cause, than also it taketh away the grief itself in the end. Hereupon sometime, albeit the disease be cold, yet when the cause moveth us to open a vein, we may safely bleed without hurt. Hippo. (saith Galen) showeth a cure of his done on a woman by letting her blood in the Ankle. This woman after childbirth, was not freed ofher seconds: then a shaking came upon her. This woman I cured (saith Hippo.) by letting her blood in the Ankle, for all her shaking. Shaking is a cold affect, & blood is hot: and they that must be heated, must not have blood taken from them. He for all that, boldly did it: & he showeth the reason. I considered (said he) the cause, & the occasion of the cause. He knew the cause of shaking, was abundance of blood kept back, which was a burden to nature. The occasion of the cause was the grief of the matrix. This abundance requiring evacuation, & the affected part showing the place most fit for evacuation: considering both these things together, he let her blood in the ankle, because the womb or matrix was affected. In griefs of the womb or belly, we take the vain of the ankle, knowing by the Anatomy the communion between the veins: for some veins communicate to some part of the body, & others to other parts. And evacuation is to be made from such veins as have fellowship with the member affected. For, as ye heard in the Chapter of Revulsion: if we take that vein which communicateth not with the part affected, we hurt the whole body, & do the grief no easement. The profitable use of this fellowship of veins appeareth especially in revulsion or pulling back of humours, which is both well & speedily done, when this community of veins is observed, as was there declared. But let us return to our former purpose.  
Fiftly, by opening of a vein, is cured the fever called Synochus: both that which cometh of ebullition of blood without putrefaction, & that which is caused with putrefaction of the blood. So are also hereby cured continuing fevers, coming of putrefaction in the greater veins. And to these diseases reckoned up of Galen Fig. 2. we may add these that follow: Frenzies, Opthalmia parotis i. an apostumation about or behind the ears: diseases of the Liver & spleen: Nephritis. i pains of the rains and back: inflammations of the womb or matrix: of the privy parts: armholes: arms, thighs, & joints. Finally, all inflammations inward or outward, which the Greeks call Phlegmonae. These inflammations are caused by flowing of blood to a member when a vein is open & broken: which blood there abundantly heaped together, bringeth forth a tumour or swelling. To these also are to be added: a consumption in the beginning: vomiting of blood: bleedings at the nose, belly, or hemorroids: at the beginning of which diseases, the opening of a vein greatly profiteth, staying the force of the flux, & by revulsion, if the vein be opened at the contrary part, calling back much of the matter from the member affected: so that bleeding is a present help for those diseases whatsoever, which take the beginning from too much abundance of good blood. Those sicknesses which come of an unpure & mixed plenitude, because they are somewhat near linked unto these; they may also be cured by bleeding. And although the matter of these diseases be unpure: yet either it lieth in the veins, or proceedeth from the veins. A gain, by bleeding are cured Carbuncles, felons, moist scabs, outward redness in the skin & such like: all these are cured by this practice.  
Thus also is cured the burning ague called Causus, & all continual fevers, whose putrefaction is contained in the greater venies. Yet sometime a continual fever cometh of an humour heaped together & inflamed about the stomach, chiefly about the mouth of the stomach, & the flat parts of the Liver, which fever cannot be taken away by bleeding. Neither can the cause thereof by this practice be removed. Pure intermittant fevers, whether they be Tertians, Quartans, or Quotidians, because the next matter & proper cause of them is not in the greater vessels, neither floweth from the veins, are not conveniently cured hereby. And yet sometime in these also we bleed, either when the veins swell with immoderate fullness, so that thereby some danger at hand may be feared: or when any accident of hot inflamed & boiling blood persuadeth us thereto: as are namely beating pains of the head: toss & moving of the body this way & that way: excessive heat almost stragnling the patient. Howbeit, these many times come also of boiling choler about the inward parts called praecordia, in the which cases, bleeding removeth neither the fever, nor the cause thereof: but only assuageth the vehemency of those accidents, which are present, or shortly like to ensue.  
Further, concerning particular affects cured hereby, we may adjoin, beating pains of the head: Letargus spoken of before fig. 3 and trembling of the heart. These with the foresaid, are not only cured hereby, when they presently affect and afflict the patiented, but happening yearly unto us: so that it is very likely we shallbe grieved with them in time to come. We may very well prevent them by bleeding, when we have once espied plenitude to have been in us, the causes of these infirmities. For there is one & the self-same way of healing common, both to maladies present and future. And those things which are to be done when diseases are present, may likewise be attempted when the same are but a beginning, or nigh at hand. And here is to be repeated that which hath been already said, & cannot be too often spoken: that some time we open a vein, not only without fullness, but even in emptiness: namely, when some evident cause: as a bruise, ache, or heat, causeth flux ofhumors, & bringeth inflammation to the members: and this is done, not for any greatness, or fear of any present grief; but for some doubt of that which is a beginning, & as it were, at hand.  
Here ariseth a doubt, whether it be more usual to open a vein, the disease being now present, or future & nigh at hand. The answer is, that when the fullness is very great & dangerous, though the disease be not yet caused, notwithstanding, without hurt the patient may bleed plentifully, because the blood offendeth nature in the abundance thereof. And hereby the Patient is oft made safe, and escapeth the danger of sicknesses approaching. But when a disease is bred, and the forces of nature impaired or lessened, either by the presence or long continuance thereof: just evacuation of blood, without hurt, can by no possible means be made. Whereupon Hippo counseleth to prevent by bleeding accustomable impediments rather than to stay their approach and coming. hereupon also in that kind of fever called Ephemera, which dureth commonly but one day, & is caused of obstruction. In the fever called Synocris simplex, blood is abundantly withdrawn, before the matter do putrefy. Therefore this is the conclusion of this matter, that blood is let more safely before the sickness be present & already come, them when in truth it is present: & with greater profit are we to see his coming a far off, and so beware of him, them to stay till he come, & then labour to repel him: wherein we are to remember a pretty and common verse serving fitly to this purpose.  

Aegrius eiicitur quam non admttitur hospes.  
If once a guest be enterteind,  
with greater shame we him repel:  
Then if at all we had not him  
received with us in house to dwell.  
And also this verse of ovid.  
Principiis obsta, sero medicina paratur  
Dum mala per long as convalaere moras. ▪ i.  
Beginnings stop, too late comes cure,  
When once the mischiefs grow in ure.   
Reason imputeth thus much: that when sickness presently possesseth any patient, the same requireth a speedy remedy, with a greater necessity, than when as, it hath not yet invaded. Whereupon this also followeth, that opening of a vein is more necessary, when a grief is present, then when the same e is but only approaching. The cruelty of a present adversary urgeth us with a greater necessity, than the danger of an enemy that may come, but is not yet present. And so I conclude, that in a present disease there is a necessity. In a disease only imminent, there is but only, in a manner, a security. For a further instruction, to know what diseases in particular are cured by this practice: I refer thee to a Chapter hereafter following, which declareth in particular, what vein is to be opened in each particular disease.   

What voluntary eruption of blood profiteth 〈◊〉 sickness. Chap. 12.  
Blood voluntarily and of itself issueth forth from the nose, the veins called Haemorroidae, and the belly: and sometime also out of the mouth by coughing and vomiting. From other parts of the body it cometh not except very seldom, and that against nature. But from what part soever it come, if it bleed slowly and sparingly, and albeit the same be according to nature, yet we are to account it unprofitable: for it nether removeth the disease, neither dissuadeth us from that convenient evacuation by art, which the vehemency of the disease requireth. That voluntary flux of blood which is abundant either in plenitude, oppressing natnre, or in that fever called Sinocha is profitale, and oft cureth the same in the judgement day called dies Criticus. For in as much as then a general evil equally (as it were) occupieth all the veins, from whence soever abatement of blood happen, it ceaceth these accidents of heaviness & fullness.  
But in the fever Causon, and in all other continual fevers, in the which other humours putrefy in the greater veins: blood issuing forth never so plentifully, bringeth not such profit; and bleeding at the nose, though it watchings, ravinge, headache and other such like accidents, yet very hardly it removeth the proper cause, and root (as it were) of the disease: except there fall out some immoderate bleeding, even (as it were) to the dissolution of the natural forces: which in very deed is never to be wished or desired. For corrupt blood last of all floweth out of the nose, yea and not before there hath passed great store of the good & profitable blood. And therefore in these fevers, albeit the patient bleed much & oftentimes, yet a vein in the arm must be opened. Experience (I say) proveth, that oft out of the nose cometh good blood, both in colour and substance, when unpure and filthy blood is drawn out of the arm.  
A boundant flux of blood in these diseases, out of the Hemorroidae veins, are out of the belly: because it floweth next of all from the hollow vein of the loins: the same is to be accounted much more profitable than the abovesaid. Yet neither doth this many times take away the very root of the fever, which lieth lurking in the veins next the heart. Whereupon it cometh to pass, that oftentimes we let blood in the arm, notwithstanding: yet but sparingly in flux of terms, in women brought a bed, & freed of their seconds: lest we inflame & kindle in them the heat of an ague. A like reason and more apparent there is also sometime to let blood in the arm, when the hemeroids flow. For inflammation and other diseases of those parts which are above the liver and midriff: are little or nothing at all eased by flux of blood from the hemoroids or belly: Neither those that occupy the lower parts by flux of blood from the nose. Also flux of blood out of the right nostril helpeth not affects on the left side: nor contrary. And therefore voluntary eruption of blood without reason forbiddeth not that bleeding which is to be done according to art, reason and experience. Again Phlebotomy helpeth diseases either of itself, or accidentally. Of itself it evacuateth or pulleth back. Accidentally, sometime it cooleth, drawing forth the hotter blood: sometime it openeth obstructions, yet only those which proceed of fullness, and it is always to be used in those affects, which it helpeth of itself: but not always in those which it cureth by accident. To help hot distemperature of the Liver by bleeding, when there is in the Patient little blood, is not the best way, but rather use for that purpose such things as are of their own nature cooling, and take proper remedies for hot distemperature: and thus much for this matter.   

How to know by certain signs the greatness of the disease, and the firmness of the natural forces: whereby conjecture may be made, whether the Patient be to be let blood or no. Chap. 13.  
IN every affect, wherein bleeding availeth: the same is out of hand to be done, if the disease be vehement, and the strength of nature agreeable. Touching the disease it is sometime so small, that it is cured alone of it s●lfe without the help of art. And although at other times the same be very vehement & great, yet the forces of nature not only sceme, but also are indeed so weak, that they can not tollerat any evacuation. Yea undoubtedly this practice would undo, destroy, & dissolve the whole substance of the natural forces, for whose preservation sake (in truth) we take the cure in hand. Therefore to know thoroughly and perfectly, how much blood is to be taken in every disease, we must first consider how great and grievous the sickness is, and how firm and strong the powers of nature are. Now a disease is either already caused, and in state, or is now a beginning or proceeding to state. Again a disease is called great & greevons, either in regard of itself, or of the cause thereof, which consisteth in the humours, or in regard of the grievousness of some accident. But first, it is great of his own kind and nature. Thus an inflammation in any member is more grievous, than a simple distemperature in the same member. And again the greatness of a disease is judged by the great use and excellency of the member which it possesseth: as if it be any principal member, namely the heart, brain, or Liver, and it is contraty when the grief is in a base, unnoble or no principal member. Again, judgement touching the greatness of a disease, is to be given according to the local placing of the members, as they stand next to the principal parts. Therefore next the diseates of the heart, brain, and liver, are to be accounted those of the lungs, sides, stomach, and splen: and we are otherwise to judge of those that are in parts further off: as namely the bowels, rains, bladder and the outward limbs consisting of bones, flesh, and sinews, called in Latin Artus, and in all the other members, placed in the extremities of the body. Again in this point judgement may be given by the sensibleness or feeling of the member wherein the grief is, if the diseased member have a quick sense, and a lively feeling, the greater far is the danger, than if the member were but of a blunt and dull sense.  
The greatness of the cause in any disease is judged by the condition and nature of the humour that is gathered to the part affected, & is there the continual matter of the grief: wherein we are to consider whether the humour be good or bad, putrefied or not putrefied, or of what ill quality it is any manner of way. And also whether the same humour be too much or too little: & if the humour which is the cause of the sickness be wicked & corrupt, them we may soon judge the grief to be great. The greatness of the antecedent cause is perceived by the fullness or emptiness of the veins, bowels, & of the whole body, & by the purity or impurity of humours, contained in the same. We judge the greatness of the accidents, by the intention & remission of those things which do chance: as the increasing or diminishing of pain, thirst, appetit, watchings, and such like: all which bring down the forces of nature, and make the Patient to languish.  
As for example: If any ill disease, as namely an inflammation, possess the Liver, brain, or parts next the heart, and that there be a venomed and putrefied humour, wherewith the veins of the body appear to be stuffed and filled; so that there ensueth in the patiented, agitation of the body, ill appetite, thirst, pain, & watchings: this sickness woe may esteem vehement, in the which evacuation may do great good. And again a disease in which these do not concur, but rather their contraries, we may judge a small infirmity, and not requiring any evacuation. Between these are their interjected sicknesses, of a middle sort, which are to be evacuated more or less according to the remission or intention of the disease, and the accidents thereof.  
Now let us come to the estimation of the forces of nature, of the natural powers some are settled, and bred in particular members: and are common, and flowing to all parts of the body. The forces of nature bred and settled in a member, have one and the self same essence (as it were) of the inward heat: and they are called one nature, and are engendered (as a man might say) of the internal spirits, and the first begotten moisture: whereunto is added (as a matter thereunto requisite) a sound and whole substance of bodily members. The essence of the common forces of nature, have (as it were) a threefold original or beginning, or is ●●threefold spirit diffused and spread into the whole body.  
The force called virtus animalis, the animal virtue, is diffused from the brain, by the sinews: The vital force from the heart, by the arteries: The natural strength from the Liver by the veins: The bodily powers that are bred in each of these parts: the brain, the heart, and the Liver, are sustained by those common and flowing powers of nature: so that the whole living creature, name lie man is ruled and governed of both these virtues: Insitae & communes, settled and common (to use as good english words as we may) to make manifest this great point of physics skill. Therefore if this living creature and most excellent creature man, be in perfect health: of necessity these powers of nature must be sound and uncorrupted, which they will be, if their substance consist in a just moderation, that is to say, in a just or right quantity, and in a good temperament. And contrary wise, if the quantity or temperament of their substance, be inverted, changed, turned, or altered, they must needs suffer hurt and offence, and so become weak and enfeebled: Whereby their functions are presently hindered, the rule of all the body is disordered, and at length there will follow even extinction of life itself. And therefore whether the nature's forces are weak or strong: may be known by their several operations & duties. Thus raw and undigested excrements, either by siege or by uriyne, when either the one or the other is thin, waterish, or like unto water, wherein flesh is washed, do show imbecility of natural force: so doth holding back of these excremntes, or any other function natural, that is stayed or hindered.  
We discern the vital strength to be enfeebled by obscure languishing, and small pulse▪ by breathing hardly and with pain, and oftener, & more quickly than was accustomed: by smallness and faintness of speech: so as the same only come thereby, and not thorough fault of the lungs and breast; as sometime it doth, in whom notwithstanding the vital force may be sufficiently strong. The contraries to these, declare firm strength of the vital virtue.  
These things declare the animal powers to be enfeebled: tumblings and toss of the body, the senses offended, watchings, rave, and other principal actions hindered. The contraries hereunto show the contrary, that is, firmness & strength of the animal virtue. By these functions than you see, how it may be conjectured what power in nature is hurt or offended.  
Again these powers are offended, or seem enfeebled two ways: either because they are outwardly oppressed, or because they languish inwardly of themselves, & in the evacuation it helpeth greatly to know the one from the other: for the forces oppressed require large evacuation, & the other none at al. And the distinction of these is to be sought out of their evident causes. If causes have gone before, which have already altered or wasted the substance of the forces natural: then we may judge them that they are faint and languished. If these causes have not been precedent, but that the Patient is only troubled with an unaccustomed ponderosity: then these are but wronged and oppressed. The evident and outward causes which altar the temperament of the settled virtues: are burning Agues, which melt the bodily moistures, or whatsoever else, that excessively heateth, cooleth, moisteneth, or drieth, the sound, massive, strong, and solid parts of the body. The substance of these parts is wasted by very long sickness, which bringeth the Patient into an Atrophia that is, a kind of consumption, wherein the body consumeth away with leanness, and is not nourished albeit the sick continually eat his meat: Or into Tabes, which is an other kind of consumption, wasting the body by long sickness and lack of nourishment, consuming and putrifieng the Lites: drying away the Patient, for want of natural moisture, having matter and blood mixed together.  
The threefold spirit of the flowing humour is altered, either through some distemperature, or some poisoned quality, of the air which compasseth us about, or through the ill quality of other things, which violently break in upon us: or through some wicked disposition of the bowels or other humours. The heat of the air, not only of that which outwardly compasseth us about, but also that which we draw into our bodies by breathing, inflameth first the lungs, than the heart, & all the spirits, so far till often times a fever is kindled, and caused thorough the same. Thorough which distemperature of the spirits, needs must the strength of the body languish & become enfeebled: yea by this excessive heat of the air, the spirits are not only subject to alteration of temperament, but besides they are also thereby greatly wasted & diminished. Even so in like manner, immoderate cold outwardly, & the same received inwardly into the body by breathing, weakeneth the spirits, & inward heat: yea & sometime altogether put out, and extinguish the saṁe. The air venomous & pestilent, drawn into the body with an infection quite overturneth the spirits of life and ofnature: whereof ensueth grievous sicknesses to the body, no little decay of bodily strength, yea life itself is taken away by the so deign disease, commonly called the plague.  
Now much more apparently are the spirits infected with bivings of Scorpions, mad dogs, and venomous beasts, than by the contagion of the Air.  
Moreover they are inward and hidden causes, which do greatly alter the spirits, and whensoever any principal part of the body, is troubled with any distemperature, upon any occasion: If the same proceed far, it must of necessity go to the spirits there bred and engendered: And so by offending of them will lessen the strength and virtue of nature. Also if any corruption of humour rule in the body, the spirits are disperse, and offended by the corruption or distemperature of the same humours. Therefore when abundance of raw humours, passeth either the whole body or the stomach: and chief the mouth of the stomach, the substance both of inward heat, and of the spirits wax cold, the Patient languisheth, yea, sometime he giveth over the Ghost and soundeth. hereupon also when hot choler burneth, as it were, the inward spirits with immoderate heat, or nippeth and pricketh the mouth of the stomach: it is the cause of no small evils in the body of man. Sometime also it falleth out, that some one or other humour in the body is mixed, besprinkled or bedewed, as it were, with some kind of venomous filth, as when the seedy moisture is kept in and putrefieth: Or menstrual terms in women longer retained than is their due course: or when any clodded blood remaineth behind, and is not expelled: the vapour of these and such like, infecting and decaying the spirits; bringeth sometime Sincope: sometime suffocation of the womb: sometime the falling sickness, and such other mischiefs, which greatly annoy the forces of nature. And thus diversly are the spiriets offended through distemperature.  
Again, the substance of the spirits, and natural forces is diminished, sometime even of itself (and as a man may speak) voluntarily of his own accord: for the substance being of itself thin and wastable, and included in an hot thin and open body: Therefore of itself it dissolveth & vanisheth away. Sometime the same is decayed by occasion of outward and evident causes, as are namely these: The air which compasseth us round: hot and dry, immoderate evacuations: vehement motion: affects of the mind: pains, watchings, great emptiness, and all unprofitable excrements: which cannot but carry with them from the body as they pass, a great quantity or portion of the vital spirits: seeing their substance is spread over the whole body, and also flowing with other humidities: whereby it cometh to pass, that whether the belly be very laxitive by nature, or by medicine: or that the urine be made immoderately as in the infirmity called Diabete: or that matter or water go plentifully forth of the breast, stomach, bel●y, or any great apostumation: thereby of necessity the forces of nature must be mightily decayed. Much more manifestly must it so fall out, when there is any great evacuation of blood, or good humours, whether the same pas forth of a wound, the nose, hemorroids, Piles, belly, or other place. In like manner abstinence which taketh away from the body needful nourishment, enfeebleth nature. Labour likewise and heat disperseth the substance of the spirits by vapours & sweat: And therefore they which live continually in labour about furnaces, & hot baths, because daily some of their substance decayeth: do not commonly so abound with excrements, as those that lead a slothful delicate and idle life.  
Moreover they that live very incontinently, have also for the most part very enfeebled bodies, able almost to abideno Physic; & by a continual decay of seedy moistures, they have their spirits mightily consumed: whereof look before in the 8. cap. Fig. 17. Great ache & pain worketh the same effect, more than labour doth. Also of passions of the mind, some suffocate the spirits and inward heat, as namely fear and sorrow: some waist and spread them abroad, as mirth and gladness. These are the causes, which being in exceise, do waist & consume inward heat, the spirits of life & strength of the body: which being so apparent as they are, may be unto us assured marks & signs, whereby to know, whether the forces of nature have yet lost, or do still retain their powers, virtue & strength.  
Those causes which only oppress the strength of the body are inward & hidden, & not so know en unto us, as the foresaid: and they are these: obstructions, & immoderate abundance of humours which stop the veins & arteries, because they are thick, gross, and slow humours: by means whereof they keep in the spirits, & do not suffer them to be cooled, as it were, by any kind of winnowing: whereby the use of the spirits is taken away: their virtues are oppressed, and grievously with the inward heat offended: which matter very oft fale out so in the Lungs, Liver, celles of the brain, in the arteries: finally, in the very habit of the body.  
Obstruction caused of too much abundance of humours, doth grieve, oppress, & sometime overcome the inward heat and spirits of life. Fullness also proceeding from any obstruction: if the repletion be simple, or somewhat partaking with that called Cacochymia: it choketh bodily strength, as for example: Abundance of blood in a wrestler: Flewine in Leucophlegmatica. i. the third kind of dropsy: crudity of humours in the other dropsy: abundance of choler in the yellow jaundice. As often therefore, as the powers of nature are descried to be weak by the excrements: the spirits of life by the pulse, & breathing: the animal faculty by her proper functions; and by any of the foresaid vehement causes preceding: we may determine the spirits of nature to be impaired. When none of these causes have gone before, and that yet the bodily strength appeareth weak: then judge them to be only wronged or oppressed: Specially, if there do concur signs of pure and simple repletion, or of great corruption of wicked humours: the causes grieving and oppressing the spirits of nature being removed: presently their strength is recovered, and they come again unto themselves, except they be beaten down with the continuance of their oppression. Here therefore I make three steps or degrees of natural strength weakly affected: either the same is a little thrown down, or overcharged, or thirdly, altogether weakened: whose particular tokens appear by that which hath been said in the premises.  
There are some which only mark the pulses as an infallible sign, to judge the bodily strength by, which in truth, is a great mark: but yet not alone sufficient, being both doubtful and unconstant: and also because it is troubled with divers outward things, is oftentimes changed. Again, evacuation too abundant, affecteth not only the vital spirits, but also in like manner, the other faculties of nature: whose decay bringeth death as assuredly, as if the vital power were extinguished: and therefore in evacuation it is requisite, aswell to mark and observe the other faculties of nature, as the vital powers. For if the patient be sick of a vehement & continual disease, as of Lienteria. i. a flux of the stomach, or Atrophia. i. a kind of consumption, or Marasmus. i. the ends of the fever Hectike: let him not blood; albeit the pulse be mighty & full. And therefore I conclude this Chapter: affirming that we are in evacuation to consider the ableness and strength, not of one only, but of all the three abovesaid, running or flowing faculties of nature. Neither to consider of these alone, but also of the settled faculties, in which is contained the action of life.   

To know by the greatness of the disease, & the strength of the natural powers: the quantity of blood that must be withdrawn. Chap. 14.  
THe knowledge of the quantity in every remedy▪ is the hardest matter in all Physic, and most of all troubleth the careful and wise Physician. And although to know the quantity be but a conjectural knowledge: yet the same is joined with less danger, and is more secure here than the knowledge of the quantity in a purgative receipt. The reason is, because we may stop the blood when we will, as Galen witnesseth 2. de ration. virt. in acutis comen. 11. & lib. de curandi rat●. per sangninis missio. Chap. 12. But when areceit is in wardly taken, the same cannot be again untaken. Neither is it in our power, when it is once in the belly, to take away any part thereof: or, if need be, to add unto it: Which in bleeding we may do: and therefore less danger is in this, than in the other.  
The quantity of the blood that must be extracted, is known by the strength of the patiented: and chiefly by his pulse. Therefore while he bleedeth, let the Phiebotomer or Physician seel the Pulseis with his hand: and suffer the blood to pass, according to the alteration of the same: especially, when any great evacuation (as even unto Syncope) is to be made: Lest it fall out unwares, that death itself do come in the place of swooning or fainting.  
And except necessity do greatly urge, it is best and safest to abstain from such plentiful evacuation after Galens' council, lib. de Cura rat. per sang. missionem. Chap. 12.  
If at any time, the powers of nature being weak, the disease require some plentiful bleeding: it is good to divide the same, to open a vein twice or thrice, and at each time to detract a little blood, as ye have partly heard before: and as it shall be showed more at large hereafter. All sickness decayeth the strength of nature, and so doth in like manner that evacuation, which is used to help nature. Lest therefore it might seem a very hard dealing in this case, more grievously to afflict one already afflicted, and presently grieved: the matter is so to be ordered, as the substance of the disease may be removed, the forces of nature as little damnified as may be. Yea, it is a principal point in a skilful practitioner, so to work, that the evil may be remedied, and the patiented brought in hope of a more profitable recovery for his health, than his former Physic hath been painful unto him. Those hurts which the natural virtues sustain, by a moderate evacuation are but small: and these are again quieted, when the evaacuation is accomplished: for nature now freed of those hurtful humours, wherewith she was before pressed down, recovereth her former strength, She reneweth that which was drawn from the inward heat and spirits, and become almost the conqueror of the disease. She overcometh wholly at length, yea, that which remained behind: partly by inward concoction, and partly by outward dissipation. It wise Hippo counseled to give a small diet to the sick patient, not fearing thereby more and more to weaken the strength of nature, which was otherwise but weak: let us so esteem of evacuation. But as in diet, so in evacuation we must beware, lest the virtues of nature extremely enfeebled, do quite give over, and be altogether extinguished: in regard whereof, we are circumspectly to foresee, how far the patient can or may endure the same. For (in truth) a just quantity withdrawn without any great hurt, taketh away and cureth the disease. And this point of the just quantity is known, by a comparison of the disease, and of the strength of nature: for persons firm and strong may bleed as much as the sickness requireth: They that are not so strong, may bleed less: they that are quite cast down, are not to bleed at all.  
And here a profitable question may be moved: whether natural strength may so greatly be enfeebled, that it cannot or may not away with any evacuation be it never so little. We see many times, that in great of decayed strength, there fall out voluntary evacuations, which do much good, and procure health. And again, it seemeth, that to each diminution of strength (be the same great or small) the quantity of the evacuation may be proportionated accordingly. Neither is it credible, that an ounce or half an ounce ●●blod taken, can do no great hurt to the natural virtues, albeit they be already much decayed. These matters seem somewhat obscure: but that the question may be explained, and all ambiguities of ancient writers taken out of the way: we answer by distinction: affirming, that there are three degrees of quantity in evacuation. The first degree is, when the same evacuation is thorough perfect and absolute, taking away either all, or the greatest part of the matter that causeth or continueth the disease. The second degree is a profitable evacuation, but not so perfect and absolute as the other: which taketh away only some part of the sickness, making that which remaineth more easy and tolerable than it was before. The third step is so small & little an evacuation, that the patient thereby is not one whit eased or relieved. Now to come to answer the former question: the natural strength is seldom so greatly dejected, except the same be altogether overcome & passed all hope of recovery, but that it may abide some little evacuation.  
But hereof the ancient writers have made no mention at all, being, as it were, a matter altogether unprofitable, seeing it is so little: not procuring reilefe to the ●●cke patiented, but rather bringing more danger to t●● natural forces air die decayed. And in fi●e, they have decreed and set down, that in this case no evacuation should be used. Therefore, the natural powers being firm and strong, require an absolute and perfect evacuation: The same but mean and somewhat enfeebled; an evacuation more unperfect and yet profitable: altogether decayed; they require none at all.  
If the disease be verievehement, so that it cannot, either at all, or well be cured without bleeding: it requireth necessarily abundant evacuation: The same but mean, and not sowehement; it requireth a more moderate bleeding: but yet the same greatly profitable, because the cure may afterwards be accomplished with the more celerity and safety. If the disease be small, it requireth small evacuation or none at all.  
Now let us make comparison of the greatness of the disease, and firmness of the strength together. When the strength is very firm, and the disease mean, and not very vehement: bleeding is not altogether necessary, but only profitable, in which case, blood may be safely taken, and as much as the disease needeth. There is no fear to diminish a little the bodily forces; so as the root of the disease may be pulled up. For they are again very speedily and readily recovered.  
When the strength is firm and the disease dangerous, replenishing the veins with an immoderate fuldesse, as it falleth out in the bodily constitution of wrestlers, and in fevers called Synochi: a plentiful evacuation is to be appointed, answerable to the greatness of the disease. Yea, it profiteth (sayeth Hippo to bleed even unto Syncope, If the patient may abide it: in which place Hypocrates meaneth not that swooning which cometh of fear or of cowardliness, or of sharpness of humours, pricking and provoking the mouth of the stomach: but only that which cometh of abundant evacuation. For so in an extreme disease Hippo. appointed as a rule and just order of evacuation. And this defect of mind and strength is called Lipothymiae, or Liposychia: in which the party speaketh, heareth, seethe, and knoweth them that are present.  
Now, Syncope, is (as it were) a sudden decay of all natural strength, as in the falling sickness: in the which the patiented neither seeth, heareth, or doth any outward action. Lipothymia is more easy than Syncope, and accustomably goeth before the same. In the foresaid affects therefore, we let blood even until Lipothymia come upon us: and yet rashly or without judgement.  
Now when the powers of nature begin to quail and give over through evacuation, we must stay the blood. Neither are we to proceed so far as unto Sincope: for then the party escapeth but dangerously: albeit the strength of the body be reasonably firm. In consideration whereof, we are to withdraw the abounding humour, as the bodily forces will permit. And whensoever they are wasted, albeit some of the offending humour remain still behind: yet we are presently to desist: and this shalt thou most certainly understand, if thou diligently mark and observe the Pulsies, how they altar from great to little: from equal to unequal: from strong to weak: from apparent to obscure: and by marking how the force of the flux of blood beginneth to relent, and the patiented to wax weak.  
That practitioner which setteth by his credit, and will avoid ill speeches, must never through bleeding, bring his Patient to Syncope: because the same being, as it were, an image of death, terrifieth the standers by, and putteth the Patient in a great hazard of his life. Yea, and it is better to let the patiented still remain in grief, than to take away with the disease, life itself.  
And hitherto we have showed, what is to be done, touching the quantity that must be withdrawn, when the powers of nature are firm and constant.  
If the disease be but mean, and the bodily powers but indifferent, the evacuation must be moderated, which may remove the whole cause of the sickness with little or small hurt to the strength of nature.  
Which albeit, it be but a small and moderate bleeding: yet the same is very profitable, as ye have heard before. If a great sickness concur with strength already decayed, and that the same also require some large evacuation: yet because the powers of nature cannot tolerate it, the same must not be done wholly at one time: but by iteration, as ye have been told: lest we take away both the disease and the party diseased: Natures forces being quite overthrown, albeit the disease so require: yet the body can permit little or no evacuation: for it is unprofitable and superfluous, not bringing any commodity, but discommodity and perturbation to the sick. Therefore in this case this must be the practice: moderately and often to give the patiented meats of good juice and nourishment, to confirm, strengthen, and recover nature: and such as have some virtue in them a proprietate against the present infirmity, & may redress the inward corruption of humours. And when thus the natural forces shall be recovered, Phlebotomy may succeed. And this practice is much used in continual and long sicknesses, in sharp diseases, called morbi acuti: this long stay were doubtful and dangerous.   

An observation of things present & past, and also a foresight of things future: needful & necessary to the further knowledge of the quantity of blood that must be taken. Chap. 15.  
Observations of evident causes, touching the greatness of the disease & constancy of natural forces, doth greatly further our knowledge in this behalf. Of which evident causes, three of them are in ward and bred in ourselves, as namely, the temperament, the complexion, & the age: & three of them are outward and accidental: namely, the constitution of the air, according to the several seasons of the year, the situation of the country & state of the heavens. All which are included in one cause, as grounded all upon one reason: secondly, former evacuations, either slaid or immoderately flowing▪ thirdly custom & order in diet & life, or kind of evacuations proceeding. By knowledge of these forepast causes, we may attain to the understanding of the strength both of nature & of the disease: & so consequently of the quantity that we must bleed: & albeit that the causes present & future have not yet altered, either the disease, or strength of nature: yet for as much as they begin to dissolve some humours from the body, & to waste the strength of nature, they have some moment in this practice. For what these causes present or past can do, ye have heard in the 8. &. 14. chap. to the which I refer you concerning the particulars: here only being contented to reckon them up by name 〈◊〉 the temperament: the state of the body: the age: the countrietthe time of the year: the disposition of the air & sky: voluntary evacuations, custom, & the rest, as appeareth ca 8, It is the part & property of a wife & skilful physician, to consider not only the state present of the natural virtues: but also to foresee what will be their state in time to come after bleeding. The natural powers after evacuation, are so to be conserved, as that the same may be able afterwards to take other helps & continue out the prolixity of a continuing di●e●s. Yea, we must retain always some blood for future fits, and courses of the disease which are yet to come. Lest afterwards urged thereunto, we begin unfitly, and out of due time again to nourish the same. And this chief is to be done in bleeding, for corrupted and putrefying fevers, whose putrefaction & obstruction is not taken away by bleeding: but the putrefaction is afterwards the better overcome, by the strong force of nature, when by opening of a vein, she is somewhat relieved. Therefore to this purpose always some blood must be left for nature's preservation, as Galen counseleth. lib 11. method. cap. 14.  
We may conjecture the future strength of the patiented, partly by the present causes, which are also afterwards like to continue, & partly by accidents, which may happen contrary to our opinion. Among present causes these are the chief: the state of the heavens, & the order of man's life. If the constitution of the air hath been hot & dry, & is like so to continued, the bleeding must be less, than if we suppose a cold air to ensue. Again if we perceive, that the patient will live sparingly, & temperately, either for want of appetite, or because the disease will not suffer him to feed: as in Augina the Quincie: which shutteth up the jaws: we are to take less blood, than when we see he will live more frankly and liberally. In these cases we must still reserve some blood, as nature's treasure, to help at a pinch in time of need.  
Sudden accidents and unlooked for which greatly enfeeble natural strength, are these, great pain and ache, watching voluntary evacuations: and chief Sinc●pe. into the which many do fall, being not accustomed to bleed at the first opening of a vein, either because they are we●ke of nature, or strucken with some great fear, or because the mouth of the stomach fi●●ed with bitter choler, is become very unsensible and weak. When we suppose that some of these matters will fall out: albeit the strength be firm, yet no blood at all, or very little is to be withdrawn: except by art we nave prevented the former accidents. It is (I say) great wisdom to foresee a far off, 〈◊〉 beware of such sudden and unlooked for accidents.  
This we will manifest by an example. Let the patient be of a sanguine complexion, of body, thick and well set, of a flourishing age, that hath long time led a lecherous life, feeding plentifully of good meats, and that hath omitted his accustomed exercises▪ and lived at home idly: in whom also accustomed eruptions of blood, out of the nose, belly, or Hemo●roids are sta●ed: so that by concourse of these causes, the body hath greatly increased or waxed, & that the large veins through repletion, are greatly filled. When soever a strong ague, or great inflammation, shall possess such a patiented, presently he must be let blood, and that plétifully: Both the greatness of the disease, and of the cause requiring the same. Moreover this is confirmed by observation of things past, if present causes agree to these, namely, that there be a sit temperature of air, by occasion of the country, season of the year, and the present state of the weather, moderately cold and moist: and that the patiented be apt to evacuation: also that the sickness be not like to continue long after, neither apparent signification of an excessively hot temperature of air to come, no thveatning of future pain, or of abstinence, watchings, voluntary evacuations: If all these thus agree together, who may doubt but that a large evacuation may in this case be made: And none at all, when the contraries do appear. Sometime these observations, are mingled among themselves, and contrary to themselves: In which confusion a wise judgement is needful, by comparison of them to prescribe the just quantity of evacuation.  
The consideration of passed matters many times persuade a plentiful bleeding, which the observation of things present by and by taketh away: As for example, if the Patient laying aside his accustomed exercise, give himself to pleasure and idleness, stuffing himself withmeats, and having some notable evacuation stayed in him: but his body is waxed fat, white of colour, lose, open, soft, full of thiniuce, and that it be Summer, a hot & dry country, a hot & dry constitution of weather without storms: In this case, let not blood at all, for sufficient is already evacuated from such a body of itself, and that not obscurely, but apparently. In this foresaid constitution, thou mayst detract a little blood, if it be winter, in a cold country, and the wind▪ standing at North: and in this mixture of things, thou must mark not only the multitude of the observations, but the force of them: Because one many times exceedeth all the rest in power and sway, and he that can neither by art, experience, nor sound judgement define the quantity of evacuation, according to the advise of Hippocrates, let him rather evacuate less, than more than needeth.  
In this place albeit somewhat hath been spoken before to the same purpose, cap. 9 Fig. 7. It may be profitably demanded, whether being with child, be to be accounted among these observations here handled, show of truth, and some probability may be alleged, that when women with child are grievously sick, we are not to let them blood, because of the young that is in the womb. This is also defended by Hippocrates saying, Mulier in utero gestans abortit, incisa vena: idque magis, si faetus auctior fuerit, that is, A woman with child is delivered before her time if she be let blood, specially if the young be much increased, and grown in the womb. But this of Hippocrates is not always true, as neither that which he setteth down a little before, Mulierem in utero gerentem acuto morbo corripi: lethal est. That is, it is deadly for a woman with child to be taken with a sharp disease. For seeing a purgation made of wicked and venomous simples, standeth with greater danger of the child than opening of a vain, and that Hippocrates granteth that women with child waxed with a disease caused of corruption of ill humours, may be purged in the months between the third and the eighth month; truly with much more safety may we let those blood, being grieved with any sickness caused of Repletion. And if in the middle time of the going with child, the same may be done: Much rather in the beginning when the blood more aboundeth, and the young needeth less nourishment.  
Again, if women being with child, nature of herself oftentimes attempteth evacuation of that which is superfluous (with great profit) out of the nose, by the hemorroids & belly, and that sometime the Terms flow healthfully at times appointed: why upon great necessity may we not imitate nature in our Art? Yea, many women bring untimely fruit except about the fourth month a vain be opened, the young fruit being overcome with plenitude of the Patient, neither only in fullness, but without the same a veyn is opened in the arm of a woman with child, when need constraineth, as in a Pleurisy, or other vehement inflammation. It is dangerous in deed to open any of the lower veins in women with child, because the flux turned downward, the terms would flow, and so the fruit in the womb be dejected and cast down. A vain is opened very seldom in the eighth or nine month without causing of untimely birth, forasmuch as then a woman of every light cause receiveth hurt, and is delivered before her time, through the weakness and slipperiness of the womb. In this case Cornelius Celsu● only considered the greatness of the disease, and ableness of the strength. Old Physicians▪ (saith he) were of opinion that the first and latter age could not brook bleeding, and that a woman with child cured by Phlebotomy should bring forth untimely fruit: yet experience proved afterward that none of these were perpetual, but that better observations were to be considered, which the Physician is to remember: For the matter is not great what the age be, or what a woman beareth in her womb, but what her strength is: a fierce child: a strong old man: a lusty sanguine woman with child, may safely bleed. And thus you see how a great belly in a woman may be an observation concerning the quantity of blood that must be withdrawn.  
Another observation to find out the just quantity, is to mark the alteration of colour in the blood. So judged Hippocrates in Pleuritide secundo de ratione virtus in acutis comen. 10. where he counseleth to let blood if the pain in a Pleurisy ascend to the arm, or the Paps so long till the blood came forth in colour more red or more yellow: or for pure and red blood, black and blue, which both do happen. For blood in an inflammation▪ differeth in colour from the natural blood, as more heated and inflamed. If the natural blood before in the body were crude and undigested blood, that which is in the inflamed place, is a great deal redder and yeallower, if it were before red through adustion, it becometh now more swart and black: But if the Patiented f●i●t or fail, before the blood alter in colour, stay not then for the mutation or change thereof. Finally the plenitude in the body admonisheth us of the quantity more or less and thus we conclude, touching the knowledge of the quantity: how muoh must 〈◊〉 taken.   

Of the time and seasons of the sickness, of this yea●e, of the day, and hour of the day, when a man is to bleed, or not to bleed. Chap. 16.  
ALthough it hath been declared, that we are not to let blood in a season of the year too hot or too cold. Yet in this Chapter, we purpose more exactly to discuss, what time of the sickness, and what day, the same is to be done, Avicen, in quartic primi cap. 20. saith that for preservation, a vain is most safely opened, when the disease is not come or yet present, disallowing altogether of this practice in the beginning of sickness: and his reasons to prove it are these.  
In the beginning of a sickness (saith he) it attenuateth the humours and causeth them to slow throughout all the body: mingling the bad Humours with the good blood.  
These words of Avicen are neither true nor agreeable to Hippocrates, & Galen, Hyppoc. 2. Aphoris. Aphoris. 29. writeth, that at the beginning of sickness. If any matter be to be removed▪ the same aught then to be done accordingly: and when the evils are in their state, then to give them rest▪ Galen in the comen▪ saith, that bleeding and purging may be used at the beginning, but neither of them, Morb● Consistenti, that is, in the state of t●● disease: whereofin the Aphoris. following hippocrates rendereth a reason: at the first and las● (●aith he) things are more weak, than in the middle estate: for then all things are most firm and strong. Again, why he should stay for concoction in bleeding, I see no reason, for as much as blood of his own nature is always concocted, and a vain being opened it floweth out easily of his own accord. Again, where Avicen in his reasons saith, that by bleeding in the beginning, that corrupted blood is not evacuated that should be, which afterward puts still the Patient to more pain, so that we are forced oftentimes, after we have let blood in the beginning of a sickness, to take medicines purposely to assuage dolours and pain: I perceive not how bleeding can take the good and leave the bad, seeing nature always reserveth to itself as a friend good humours, & good blood, rejecting those that are nought and unprofitable. Also when he saith it attenuateth the humours, he is contrary to himself, for in quarta primi, cap. 4. he judgeth rather bleeding to make humours thick, than thin: The blood and spirits themselves which attenuate the humours by bleeding being withdrawn. Again, this is wonderful, that when the state of the disease is past, and the Patient past danger, that he would have then the miserable Patient with a new wound and cutting of a vain again tormented.  
If any think Avicen to be blameless, as being of this judgement, that a vain is to be opened when nature hath attempted Crisin, that is, the judgement of the disease: which fall●th out to be unperfect and little, not able to do the feat and accomplish the whole force, neither doth this defend him: For by what reason would ye have bleeding to evacuate the matter left behind of an unperfect Crisis: The natural virtue being made so weak by that time with continual contending and striving with the disease: that it can do no good or very little in the cure, and especially when the rest of that matter is daily used to be easily evacuated by purgations. In sharp & dangerous sicknesses therefore, every one seethe here Auicens' error: for in these sharp, vehement, & continual diseases, we must bleed or be purged the first day: ye●, stay in these, is very dangerous, as Hyppo. saith, 4. Aphoris. Aphoris. 10. If Avicen meant it of Morbi salubres. i recoverable diseases: in these truly neither first nor last, nor at any time are we to bleed: for then most usually we let blood when a disease is vehement and dangerous.  
The opinion of other some in this place is to be laughed at, who thinketh that Avicen admonisheth not to bleed at the beginning in sicknesses not dangerous, as in a tertian, because nature is terrified by the newness and suddenness of the disease: and these make, or imagine nature to be a thing endued with knowledge, or an understanding and knowing faculty: which is not so. But if nature be made afraid in sicknesses not perilous, how much more will she be afraid in dangerous diseases, in which not withstanding, we hasten to let blood even at the very first. These matters therefore are full of error.  
Let this therefore be the conclusion, that we must bleed in the beginning of sicknesses. Whereupon Galen counseleth (the disease being come) to open a vain, lib. de Curand. ratio per sang. missio. cap. 9 & cap. 12. If (faith he) there be repletion of hot boiling blood, whereby a strong ague is inflamed: presently evacuat, yea, even unto swooning: yet still regarding the strength of nature. And this is his advise prim. Aphoris. Aphoris. 23. What diseases so ever are caused of plenitude, or other corruption of humours in the veins; they are at the beginning to be cured by bleeding: for by this means, the disease likely to grow is kept back, and so much as is already bred, nature will easily subdue: Thus hot Agues before they are yet inflamed with heat of boiling blood, or by vehement putrefaction, are & may be cured. Also inward inflammations at the first, as long as the flowing humour cleaveth not to the member, but followeth the blood may be cured. The said humour issuing forth with the blood, when a vain is once opened, strength at the beginning is firm and constant in the Patient, almost like unto us that are well in health: If therefore at any time bleeding be needful, the same may best be done at the beginning: he that in fullness of blood, or flux of matter, will stay from bleeding, and use other helps, in a perverse order of healing, he doubleth the grief, and troubleth the forces of nature more than is convenient: Yea, let the vain so timely be opened, as the stomach and first veins be not first stuffed, with either corruption or crudity of humours or meats undigested.  
Thus you have heard the former words of Avicen to be erroneous, howsoever certain labour to salve them up: yea, & Avicen seemeth to understand his own saying, not only of particular diseases in the members: but also of all other diseases. For afterwards speaking of all Fevers, and especially of Febris fanguinea, Fevers caused of blood, he counseleth in them not to let blood abundantly: except there have gone before concoction, and concerning this reason, that humours are lessened by bleeding, it cannot be so, for ye have already heard, that both before bleeding and after, there is retained in the body one and the self same proportion of humours. If any difference or mutation happen, seeing the thin humour issueth forth with the greatest speed, and the thick humour but slow: it is more likely, and probable, that opening of a vain should rather make the blood and humours thick than thin. A gain, whereas he saith in his reason that the humours thereby are agitated, moved, and driven through the whole body: how should there be this agitation of humours, seeing rather this practice abateth the multitude of them which was before the cause of perturbation & sickness. In reason all things now should become far more quiet than before. Whereas he saith the ill blood is mixed in the veins with the good, what inconvenience cometh thereof if a vain be opened? then no doubt the bad must pass forth with the good. Put the case there be a strong or vehement sickness caused of abundance of blood only, as are both the Synochi Fevers, as is the putrefied fever, caused through plenitude, as are Angina, Pleurisis', Peripneumonia, also inflammations of the Liver and other parts. In these if they be great and dangerous through much abundance of blood, who will not presently open a vain? who will not while strength serveth, take away that fullness which bringeth a disease and danger of death? Hereupon in Syno●ha presently at the first, we hasten to let blood even till the Patiented faint, and before the matter putrefy. But Avicen in a sanguine fever at the first letteth blood sparingly, & more plentifully afterwards, when signs of concoction appear. But what concoction doth he look for of good blood, and already well concocted, and offending only in quantity? In these sanguine fevers therefore, even as in very sharp sicknesses, either to put off, or to stay bleeding it is very ill, as Hippocrates saith, if the disease be not so sharp or vehement, yet let blood at the beginning, according to the proportion of the fullness. If we should in these stay with Avicen, till concoction (the beginning and state of the disease) be passed: we should suffer the disease to grow & increase, and cause for want of skill the Patient to be cruelly hand'ed and entreated without help of Physic, which we may administer, if the disease be deadly, it will never be brought to concoction: If it be doubtful, or recoverable called Morbus salutaris (as ye have heard) after the state in the declination, & when the Patient is past danger, what profit doth Phlebotomy then bring? as ye have heard before.  
Nature by concoction, separateth the ill humours from the good: these to conservation: those to expulsion. This she doth either by herself, or by the help of Physic. But opening of a vein, indifferently without choice, evacuateth all humours. Wherhfore then in bleeding, shall we tarry for this concoction & division of humours? as for example: In apostumations, if the corrupted blood be made matter or filth, it is not then taken away by bleeding, but by some other means. So in fevers, whose matter is contained in the veins: when the humour is concoct & divided, we use not to withdraw the same by bleeding; but by some other practice in Physic: in which case, by that time that concoction is accomplished, we shall have nature to help us, who ofher self, endeavoureth to expel humours concocted & divided, the bad from the good. And if now after concoction & separation of humours we open a vein, we do not only evacuat the bad, but also the good: and that which is worse; those humours which are separated by nature, we shall mingle with the pure blood, defiling the same, & so both confound all, & disturb the good work of nature herself. Therefore, when the apparent signs of concoction shall appear, the cure must be done, not any more by opening of a vein, but either by purgation, or some other help, to turn the matter aside some other way, except (which sometime chanceth) there appear signs of crudity.  
In fevers: when the plenitude is abated, and things which putrefied are concocted, we must assay to evacuat them by siege, urine or sweat. Those things which are rotten and turned to filth, in a Pleurisy or P●ripneumonia, we euacu●t by spitting. Matter putrefied in the Liver, passeth through the hollow vein by the belly. Corruption in the ●ines & in Gibba, passeth by urine: and so e●he putrified matter▪ accordingly out of each member, is to be purged by the next places & fittest passages.  
If by fear, sloth, or any other occasion, opening of a vein have not been put in ure in the beginning of a sickness: the same may be d●n at any time: yea, the twentieth day after, if the signs of fullness & crudity still continue, and that the bodily strength be answerable & not decayed through prolixity of sickness. But here is the doubt, that oft the matter of the disease is digested or the strength of nature wasted.  
But Auicens' opinion, that in the beginning of a disease, a vein is not to be opened: seemeth to have ground out of Galen. Chap. ●7. Artis Medicinalis & Comment. 22. lib. 4. Aphoris norum: saying, The Physician is t●e minister of Nature: But Nature her s●lfe, never in the beginning of a disease, when the humours are yet altogether r●we and unconcocted, appointeth any evacuation.  
therefore, neither must the Physician, at the first: when all things are yet unconcocted, attempt any evacuation, and so much the less, because crude and undigested matter not yielding to evacuation: stirreth up grievous accidents in the body. Galen. li. 1. Aphoris. comen. 22  
Again, say some (in Auicens') defence, it may be that in the beginning of a sickness: opening of a vein maketh the superfluities of the body thin: so that they may flow & run through out the whole body, and so be mingled with the good blood, whereby it fortuneth that the same is not extracted, which necessity requireth to be expelled. Whereby also it happeneth further, that the patient must be let blood again, sometime even the same day, and sometime the day after, which too much enfeebleth the powers of the body. And thus it is contended, partly by reason, partly by authority in the behalf of Avicen. And surely, if the words of Avicen might be restringed, that very seldom, and only in the case limited, a vein is not to be opened at the beginning of sickness: it may well stand to sense & reason: but Fernelius & others gather, that Auicens' words were spoken more generally, than that he can by this special case only, be defended. And because the matter is controverted, as ye see, I have set down the reasons brought both against Avicen, and for him. Leaving the depth of the controversy, to be examined & decided by others, rather as yet inclining for my part: (for aught that I can see) to the adversary opinion to Auicens', still affirming it to be more vival a great deal, to open a vein in the beginning of sickness, than to stay a longer time.  
And that this assertion may the rather appear to be true: I will set down certain ru●es whereby it may truly be manifested & approved so by science and experience. First, when wicked humours greatly swell, being (as it were) excited & stirred up through repletion of their own accord: they persuade to evacuation at the beginning of the disease, when the humours are not yet concoct. For otherwise, the unconstant humour, moving from place to place, and from member to member without order, might make stay at some principal member, to the great hurt of the patiented. It happeneth in deed but seldom, that the humours are movable, & flowing from one part to another: for commonly they remain firm & stable in one place.  
Secondly, a vein is to be opened in the beginning of a disease: when quantity of matter aboundeth in the veins, as Galen saith, Com. 29. li. 2. Aphoris. Yea, in this case also sometime a purgation is taken, that nature may easily concoct & overcome the residue of the matter of the disease, when the same is lessened by art.  
Thirdly, when the disease is great & vehement, as in very dolorous apostumations: albeit there be not in the body much matter antecedent: yet the humour that is, is to be repelled, lest the apostumation open and break sooner than is convenient. To avoid therefore these gr●at & evil accidents: by & by, at the beginning incision is to be made: which Galen teacheth li. 13. Cap. 20. Method. Medend. in these words. In such affects (saith he) a vein must be opened at the beginning; so that none of those things hinder, which we have spoken of. i. either the abundance of raw e humours: childish years: the time of the year: the temperature of the country, too hot or too cold. For not only in sharp diseases & inflammations, but also in wounds & bruises of particular parts; specially being principal: blood is to be taken from the contrary part, to repel the inflammation: albeit the blood be but little in quantity.  
In the beginning of sharp diseases called morbiacuti, or peracuti: opening of a vein is passing good. For the better understanding whereof, you must remember, that a sharp disease is twofold: either exquisite & thoroughly vehement, passing not the fourth day, which is called of Physicians Malus peracutus. i. thoroughly sharp: and of some perperacutus, imitating barbarous authors in Physic. The other not exquisite or thoroughly sharp & vehement, whose greatest force willbe in the seventh day. These diseases being but short, & at their extreme fits in few days, without any truce, presently at the beginning, these are to be cured. And because they proceed chief of hot humours, namely, of blood and yellow choler, therefore specially they require bleeding. Whereupon Hippo. lib. 4. writeth. De vict. ratione in morbis acutis. Aphoris. 19 In acutis morbis sanguinem detrahes: si vehemens morbus videatur, florueritque aegrotanti aet●s virium & aff●er it robur. In sharp diseases withdraw blood, if the disease seem vehement, if the age of the patiented be flourishing, and that the natural forces be firm and strong. Schola salerni hath these verses of this very matter.  

Principio minnas in acutis perperacutis.  
Aetatis mediae multum de sanguine tolle,  
Sit puer at que senex, tollet uterque parum.  
Ver tollat duplum, reliquum tempus tibi simplum.  
In sickness sharp let blood with speed.  
take much from men of middle age.  
Not so when child or old men bleed:  
the spring requires the advantage.   
As there is regard to be had of general times, so there is also of particular days and times, in the which diseases come, specially in those diseases, which have by course an appointed and set time of intermission and remission. For evacuation is not to be made when the disease is now fierce, but when the same is assuaged. Fever, sand especially those that are called intermittents, discontinuing agues, even naturally at the beginning and their first invasion, cause vomits: and at the declining, sweats. At which times we may by art provoke these, but in no case use purging or bleeding. In the time of the fit likewise we must refrain from these, as things which nature then can not brook. If such accidents of bleeding, or of siege come, they are but accidental, and are caused only of the heat and force of the disease. No evacuation can be done safely in such fits, seeing they do too exceedingly hurt the powers of nature. Also when the humours do so boil with heat, that they are perturbed & mingled together, there can not be made by practice of art any just division of the said humours. And if it chance that the hurtful matter of the disease, be inflamed without the greater veins, & that in a fit, a vein be opened: it is to be feared, least presently the same corrupted matter pass into the empty veins, & so of an intermitting fever, will come a continual. Whereas a vein opened in the most quiet time of a disease, troubleth not nature, but without any fear of an inflammation, taketh the plenitude out of the greater veins. The greatest time of quietness, is the time in the middle, between the remission & intermission of the disease. If the time between the fits be much, it is an easy matter to perceive the said middle time. If the time be but little, then is it far more hard to discern the same. Because many times no leisure can be granted either before or after bleeding, by reason of the swift courses of fits, to nourish the party. Thus you see Phlebotomy is not to be practised in the day of the fit of any sickness, which in Latin is called Crisis, or dies Criticus, in the which day, neither bleeding, nor any other evacuation is to be attempted, lest the matter should be drawn from that place, whereunto nature hath driven it, to be rid or dispatched thereof: and therefore like wise neither in the fit itself ought the same to be done. Excellently therefore did Galen give in charge, Comment. 29. lib. 2. Aphoris. that in time of the fit, neither bleeding nor purging aught to be used, because then the concoction of the disease is chief wrought. Which is far better accomplished in quietness and rest, then in motion or disturbance. For what respect the state hath to the whole disease: that comparison hath the ●itt to the days of intermission. As therefore in the state of a disease no evacuation is to be used: so neither in time of the fit.  
Again, it may profitably here be admonished notwithstanding the premises: that bleeding is not presently to be used at the very beginning of a disease, when we judge the Crisis or judgement of the sickness to be yet far of●. For blood being the foundation of inward heat, wherewith, the same is upholden: (natural heat being engendered of blood, as of a material cause,) If blood should be detracted at the beginning of a disease, the natural heat would be diminished, which should concoct the material cause of the sickness. Whereby further it cometh to pass, that the disease is longer time protracted, and the forces of nature enfeebled, through which two, namely the continuance of the disease, and imbecility of nature: great fear of death cometh in the end: and this is the case, wherein Auicens' former opinion may stand true.  
There is therefore no prescribed day for certain, appointed to let blood in. Whereupon Galen took occasion to deride those: lib. de curand. ratio. per sang. missio. cap. 12. which from the 2. hour of the day to the 5. or 6. hour only did let blood, and at none other time. And Galen witnesseth ofhimselfe, that he did let blood at all times without any danger, yea even in the night. And 9 method. Cap. 5. he affirmeth it best, which he also himself observed, to mark not the number of the days, but only the strength of the Patient, because by experience we have proved that not only the sixth or seventh days, but also in the days following the sixth or seventh, a vein may be opened. But because as Galen witnesseth, Libro de Curand. ratio. per sanguine. missionem. Capit. 20. in divers diseases through continuance of time, the strength of nature is greathe abated: Therefore the occasion of letting of blood is not omitted for the number of the days, but for that the natural strength is wasted: So that if the virtues of the body seem to be consumed the second day from the beginning of a disease: even than we forbear opening of a vein. And he thereunto the words of Galen.  
Now in diseases which are cured by bleeding when they are present, or propelled being but future: if they grant leisure so that a choice of an hour to bleed in May be made: in this case (I say) the fore noon hour is better than the after noon. For from the rising of the Sun the blood is quickened, revived, and beareth rule in the body: yea in that time of the day it becometh thin, clear, & apt to flow. Let not the patiented sleep nor slumber in that hour, wherein he is to bleed, but at lest let him be awake a whole hour before: see also that he have well digested the meat he did eat the day before: so that the excrements be descended, & that the body have done his accustomed duty both by siege & by urine. And these must most principally be done, when a great vein is to be opened. And they are not so greatly to be observed, when we withdraw blood, from the sm●ller veins: from whence the blood floweth but slowly. If the patiented be in health, let ●im do some work, or go first an hour about his business in his shop, warehouse, market, s●hole, or other place: as his vocation is: and then bleed; choosing out for the purpose the 〈◊〉 hou●e that may be: vide Avicen 4. prin●●cap. 20. And thus much of the time of the sickness, and of the day.  
Of the time of the year best to bleed in, it is agreed generally, the same to be the beginning of the spring, which is a temperate time, 〈…〉 too hot, nor too cold. Therefore Hippo. 〈◊〉. Aphoris. 54. writeth: Quibus a venis sangui●●●●ttere confert: iis vere secare venam oportet. Those that must have a vein opened, must ●aue the same done in the spring. And Galen lib. de Cura. ratio. persang. missio. saith: that ●ee by letting blood in the beginning of the spring, cured many of the gout, and other diseases.  
There are 3. months belonging specially to the Moon (as some say. viz. May, April, Septeber: in which there are also certain days which are not good to bleed in, as some authors (not contemptible in mine opinion) do affirm: namely, the first of May, and the thirtieth of the two other months. This for all these sayings of wise Clerks, is not always so found: for even in these days, if other things agree, a vain may be opened, which I myself have done without hurt ensuing. In like case that is false, which is set down by some, that: the eating of Goose on any the foresaid e three days, is perilous: which seemeth to be taken from the custom and superstition of the jews. Men in their flourishing years of a sanguine complexion, may bleed every month of the year: if necessity urge by occasion of great dangerous sickness, and that blood abound in the veins. For in these, substance of humours is not easily wasted or dispersed abroad. But for conservation of health: bleeding is best used, in one of these three months, April, May, September. And yetnot all alike, for in April, and May, the liver vain is to be opened for abundance of blood in the spring: and in September the vain of the Milt, because in harvest Melancholy aboundeth more than any other humour, and I would wish persons greatly subject to diseases, caused of fullness of blood, and that are cured by bleeding, to bleed these two times in the year: that is to say, from the liver vain on the right arm in the spring, and from the vain of the Milt on the left arm in September. Those that think that if they be let blood one year they must be so every year: Shall hereafter in the twenty four Chapter be showed to the contrary: for as one swallow makes not the spring: So Phlebotomy practised once or twice, doth not import an annual bleeding, and so we must judge of boxing. The verses of Schola Salerni, concerning these matters ensue.  

Tres insunt istis Maius, September, Aprilis.  
Et sunt Lunares, sunt velut hydrae, dies.  
Prima dies primi postremaque posteriorum,  
Ne● sanguis minui, nec carnibus anseris uti.   

Sit senium aetque iwent a licet, si sanguis abundat,  
Omni mense probe, confert incisio venae.  
Hi sunt tres menses: Maius, September, Aprilis:  
In quibus eminuas, ut longo tempore vivas.   

In May, September, and April,  
There be three days are very ill:  
The first in May, of rest the last,  
In which ne bleed, nor of Goose taste.   

Though old or young, if blood abound:  
In each month bleed, this rule is sound.  
But three be best, and far excel,  
September, May, and eke April.   

A Table of the things specified in this Chapter following.  
An accident appertaining to the consideration of bloudletting in general: is the time: which is of the 

year, whereof look Cap. 8. Fig. 13. and in this present Chapter.  
Of the day or hour, for in 

Persons not sick, for the preservative intention, the morning is best, an hour or two after sleep, when the body is disburdened by siege, by urine.  
Sick and having 

their fit upon them, who are to bleed when the fit of the fever is off.  
or not having fits by intermission, as in continual fevers and inflammations, who may bleed presently at any hour of the day or night, if the disease be vehement and dangerous, and the bodily strength firm: but if the disease urge not, choose (as for persons not sick) the morning hour.          

Of Astrological observation in bleeding, and of an other observation nearly aanexed unto the same: showing what members, and parts of the body are to be opened according to the several seasons of the years.  
Astrological observation of the new and full of the Moon, and other considerations here set down as follow, are to be regarded in light and small sicknesses: but not so, if the same be vehement and dangerous. For the heavenly causes are very far off, neither did Hippocrates make reckoning of them 4. Aphoris. Aphoris. 10. The first day we must help (saith he) in sharp diseases. And Galen de Cura. ratio per sanguine. missio. cap. 12. saith: that those persons are presently to be evacuated, in whom appeareth abundance of hot blood, before the same begot to some principal part (as ye heard before) so that these things are not to be observed in a vehement pleurisy: In Angina the quincie: Inimmoderat flux of blood: In great plenitude of the vessels: neither in discontinuing agues or fevers that come by fits. In which the time of rest, remission, & stay, is far better than the morning time: In which we let blood at what hour so ever it be, of the night or the day: if the fit be off, and other things answerable. Therefore I say in these, we are not strictly to observe these rules Astrological: observe them, as matters of some force, in healthful Patients, which bleed only for preservation, and in light▪ and small infirmities: if then it happen that thou do bleed.  
To come to these Astrological observations we are not to let blood in the new or full of the moon: nor else except the moon be in these signs ♈. ♋. and the first half of ♎. the last half of Scorpio, or in ♐. ♒. ♓. Also not in the day of the change, the day next before, or day next after: Nor when the sign is in the place where the incision should be made.  
Another observation is this, to open a vain in phlegmatic persons: when the ☽ is in ♈. saving in the head. In a melancholy man, the moon being in the first half, or first fifteen degrees of ♎. except in the hips: or when the moon is in ♒. saving in the legs. In a choleric body when the ☽ is in ♋. saving in the breast. The last half of Scorpio: except in the privy members, or in ♓. saving in the feet. Sanguine men may bleed in any of the signs, so the sign be not in that member.  
Again, after the Mathematic, this is the constellation or election of time. In fiery signs it is good for phlegmatic persons to bleed, as in ♈. ♐. Leo is excepted being the house of the Sun, in the which there must be no bleeding. In Airy Signs good for Melancholy men: as ♎. ♒. ♊. is excepted, and the last seventeen degrees of Libra, because ♊. respecteth the hands and the arms, in which commonly we let blood.  
In watery signs, good for choleric men, as in ♋. ♏. ♓. In earthly signs it is ill to bleed, as in ♉. ♍. ♑.  
The general rules of Ptolemy for Phlebotomy in 30. of Centiloquium is this: Tangere ferro membrum cum Luna in signo illius membriest periculosum. It is dangerous to open a member with a chirurginal instrument, when the moon is in the sign belonging to that member. Good aspects in bleeding are these ♂. ☽. and ♃. also ☽. & ♀. so as ♀. be not combust ■. ☽. & ♃. ⚹. ☽. & ♃. ⚹. ☽. & ♀. △. ☽. & ♃. △. ☽. & ♀. △. & ⚹. ☉. & ♃. or ☽. also △. ☽. & ♂. or ⚹. ☽. & ♂.  
Again this is an other observation, from the new of the moon to the first quarter, for pueri, i. those that are in their childhood from the first quarter to the full: for Iwenes: that is, young men from the full to the last quarter: for Viri: that is, those that are of man's state, and begin to grow in years, and from that time to the new again: for old grown folk: Look more hereof in a Table hereafter following. 28. Chapter.  
Another observation, how particular members are to be taken, according to the particular times and seasons of the year, is this: In the spring and summer time, the veins of the right side of the body are to be opened: namely of the right hand, right arm, and right, foot. But in harvest and in winter, the veins of the left hand, arm, or foot. In the spring time, blood increaseth: In the Summer yellow choler: therefore in the spring time, and in Summer, those veins are to be opened which most abound with blood and yellow choler: that is, specially the right rains: for in the right part of the body is situated the member causing blood: that is, the liver: and Choledochos the coffer of yeallowecholer: that is, the gall. In harvest is engendered melancholy, which is not dissolved, but increased in the winter: therefore in harvest and winter, those veins must have incision, in which melancholy chief reigneth: that is, the left veins for the Spleen, thereceptacle of melancholy is placed on the left side. Moreover, these four members, the head, heart, feet, and liver: are to be evacuated according to the four seasons. The heart in the spring: the liver in Summer: the head in winter: the feet in harvest: Of which matter you shall hear speak, Schola Salerni,  

Ver aestas dextras, autumnusque, hyemsque sinistras.  
quatuor haec membra: hepar pes, Cephae, cor, vacuad●  
Aest as habet hepar, ver, cor sicque ordo sequetur.  
The right, the spring and summer have:  
The left, autumn, and winter crave.  
The Summer hath the liver his,  
The Spring also claimeth the heart:  
The head the winter doth dismis,  
O failing foot thou Autums Art.    

Preparation before bleeding. Chap. 18.  
AS occasion of the time is to be taken, so there must be used before, some preparation of the body. The neglecting whereof, would bring great hurt to the party; and surely, the chiefest preparation is this. To purge and cleanse the members, that are in the first Region of the body: touching this preparation many things are to be regarded, whereof mention is made in the eighth Chapter, from whence I purpose to take four principal considerations in this behalf, being urged thereto, for perspicuity sake: leaving the rest to thine own discretion to be scanned.  
There are therefore (as there we did set down) four things especially which stay and put back bleeding: That is to say, first crudity of the stomach and first veins. Secondly, a filthy gathering together of hurtful humours. Thirdly, the belly bound with dry and baked excrements. Fourthly, the mouth of the stomach weak, and very sensible. These do not altogether put off bleeding, but stay the same for a while till by Art they may be withdrawn or remedied. If a vain be opened, while crudity ruleth in the stomach, this evil will follow: that many raw, unconcocted & undigested humours willbe congested, & gathered together in the place of blood. In hardness of the womb this mischief ensueth: that the Liver & exhausted veins, suck out of the excrements, filthy juices, & unclean substance: in regard whereof it is most convenient, to stay so long as the raw matter may be concocted, & till the excrements descend. And if they cannot utter of themselves, as ye heard, cap. 8. They are to be provoked with suppositors or clysters, and the womb is to be made laxative with prunes or Cassia. Crudity & indigestion is known by the quality & quantity of meats received. Also by the time in which they were eaten, and also by ponderousness, & raw belchings of the stomach. Again, corrupt humours abounding in the stomach, or parts near unto it: whether the same be bred there, or that they proceed from the head, Liver, or spleen; they persuade the putting off of bleeding, till they may be purged; else this corruption of humours drawn into the veins would be more dangerous to the body than crudity itself, and infect the veins, far with much more uncleanness: whereof do come obstructions or a consumption, proceeding of the ill disposition of the body: or the diseases which we would cure, grow greater, & their accidents ●●rre worse: yea, and because these corrupt humours are stirred, they become more fierce and hurtful, nipping the stomach, & the parts called praecordia. i. the fleshy skin called the Midriff, which separateth the heart & lungs from the stomach, Liver, & other bowels: whereby is caused appetite to vomit, convulsions, Lypothimia, Syncope, and other fearsull accidents. The signs whereby to know, whether the bodily parts are possessed with corruption of humours are these: loathing of meat, aptness to vomit, vomiting up the noisome & offensive humour: oft going to the stool: heaviness & pain in the stomach, fullness & swelling of the stomach & precordial parts. If these appear in the patiented, without crudity of meats: then are we to expel the offensive humours out of the first region of the body, which hath been the cause of the foresaid evils. If the humour of himself give upwards, assay the expulsion by vomit: drinking a draft either of warm water, or of Hydrelaeun warmed, that is water mixed with oil: whereof take the quantitic of half a pound. If the humour give downward, expel it by siege. Cassia is not strong enough to purge the humour from the stomach, as not being sufficient to expel by siege such clammy & cleaving humours. For Cassia hath but a mean virtue, and that only to assuage and mollify. Rhubarb, or Senna, or some other gentle medicine, according to the quality of the humour: and not so vehement, as to molest the state of the whole body. And these we may use, not once or twice but oftener if need require. After all this preparation, than we are to let blood.  
When the corruption of humours is spread throughout all the body & every particular part, so that the whole body is unpure: then we must observe this order: that is, we must purge every part orderly: as first, the greater veins: and this called Mesentericae venae which are branches of the great carrying vein called Porta, by which both the guts are nourished, and the juice of meat concocted, is conveyed from the stomach to the Liver, to be made blood. Yea, these veins are the second time to be purged, before we evacuate the whole habit of the body, and not contrary: that is, from the first veins to the greater: and from them to bring the humour into the state of the body: which were not to purge the noisome humour, but to infect and hurt the whole body therewith. But this is the course: to draw the humour from the habit of the body into the greater veins, from them into the first veins, and then to bring it into the belly. Yea, this great corruption of humours not only stayeth bleeding for a time, but often times altogether. And therefore we let not blood in the dropsy, in Cacheria, in hard apostumations of the Liver and spleen.  
The third matter of the preparation before bleeding was above said, to be either the sensibility or imbecility of the stomach. For those persons have notable quick feeling, whose veins sent from the brain, are soft, tender, open & ready to occur and meet with any matter, so that these persons without hurt cannot eat any sharp, sour or salt things, as vinegar, pepper, mustard. Imbecility of the stomach proceedeth either of distemperature, or of a very thin placing and standing of the small veins in the same place. And this is known by loss ofappetite, when meat cannot abide in the stomach, but that there will be always pain of the stomach, & a promptness still to vomit. Those persons that are thus affected, are troubled greatly even with the hazard of life, of every small occasion: as fasting, anger, sorrow, fear & also by bleeding. Phlebotomy in these (I say) wasteth greatly the vital spirits, & greatly moveth the other humours of the body beside the blood, whereupon there befall to them when they have bled, convulsions, the falling evil, sownings & other fearful accidents, which are caused hereby. In such therefore, we must have a foresight, & corroborat the mouth of the stomach with things repelling the sharpness & influence of humours: as with juice of a Pomegranate, a Quince, Malum medicum, with juice of Citrons, Lemons, & juice of Barbaries, sour grages, vinegar, or syrups made of these. If there be doubt of a cold distemperature, use hot aromatic things, chiefly syrup of Mynts, Diacydonion, sour or sharp wine, or hippocras. Take a little of these wines, or a morsel of good bread dipped in them, and when the patiented hath a little rested upon it: open a vein, and this is the preparation, if the disease permit it. A vehement disease ●asteneth bleeding, and cannot stay for this preparation: as repletion in wrestlers, in whom present suffocation, or breaking of veins is to be feared: as a great Pleurisy: a fernent ague: a great fall or bruise: In the which we are more to fear the present danger of the disease, than the hurt by defect of the preparation. If we think the humours in the body to be thick, and that they will not flow (for which cause also we use to walk before bleeding) we may enter into a bath, to make the humours subtle: not the same day, in which we bleed, but a day or two before: Not in the self same day, because it maketh the skin soft & thin, and so in the stroke, the skin slippeth & starteth from the Phlebotomer, which is very dangerous. For this cause also we give a little syrupus acetosus certain days before bleeding, to subtiliate the matter. And again, that the humours may pass with the more facility & become subtle: to prepare them to this purpose, we use frication of the member, to rub the arm or other parts, & the members next unto the place that is to receive incision. Also we give before bleeding to such persons as have weak & sensible stomachs nipped with sharpness of choler, flowing to the mouth of the same, some portion of meat: yet not all meats with indifferency, but meats of good digestion: as a morsel of bread dipped in Syrupus acetosus, which comforteth the stomach through the ponticitie, to use the old barbarous word the sharpness or ●owernes thereof: which also letteth the flux of humours, & keepeth them back from the stomach, by reason of a certain frigidity. For as soon as choler sloweth to the stomach, so soon by the sharpness hereof, the same is repressed & repelled.   

What is to be done in the very time of the incision. Chap. 19  
THe patient is to bleed lying in the greatest quiet that he may, both of body & of mind: especially if the strength of the body be infirm, & that there be doubt of Sincope, let him sit up in his bed, & lift up his head above the pillows: for while we stand or sit, that faculty which beareth up the body, is in a kind of travel, and the entrails & bowels hanging of the precordiall parts, do enforce the vital & natural powers. By lying therefore (specially some what upright) the bodily strength is preserved, according to Galen. prima particula. prognosticorum. And as dead bodies are laid forth upon their backs: so the lying of sick and weak bodies, must be upon their broadest part, which is the back. Again, the back bone is the stronger part of the body, being according to Avicen the foundation of the body, as the keel or bottom of a ship is the ground work of all the shipwrights labour.  
If the party that is to bleed be fearful, turn his face away to the contrary side, & let his mind be drawn by other talk of the standers by from the present practice of the Phlebotomer. The member that is to be opened, must hang downward, that the course of the blood may be direct and easy for that part which we desire most to evacuat. Then that part of the member which we mean to take: as of arm, thigh, hand, or foot: must be rubbed, to draw the blood unto that part, even until it wax hot. Next we take a strong bond & bind it next above the place, whose vein must be taken, that the blood coming down, the vein may swell and appear in sight. It must be bound harder in some, than in others: as namely in such persons that have their veins covered, as it were, with much flesh or fat.  
By this hard binding, the vein is stretched out, or swelleth: it standeth sure and flieth not from the stroke of the Phebotomer. And thirdly, the blood cometh forth with the more force: we use also to bind beneath the place, when the quivering & unconstant vein, slippeth aside out of his place from the hand of the Physician. They that have a full & thick skin, narrow veins, and deep in the flesh: or great veins, & covered with fat, must be bound both ways, and have the bond tied faster than those of a contrary constitution. If the veins be very small & little, that they do not fully & sufficiently appear by binding, as it happeneth in the veins of the hands, feet & ankles. We soak them in warm water, or pour warm water upon them: that the skin & flesh may wax soft, and the veins beseen: & then we bind them, & so they bleed the better. If the vein yet appear not, we search for it, in the place where it should be with our singars until partly thereby, & partly by the flux of blood we well perceive the same. We bind the neck, but softly, when we take the vein of the forehead, or the veins under the tonug. Yea, many times in these we take a table napkin, & putting it about the neck, cause the party himself to hold both the ends, as he may suffer or endure the same. When we thoroughly and well perceive the vein, we strike the same softly with the instrument, diligently taking heed, that he wound not in steed thereof, an artery, sinew, or some gristly end of a muscle called a Tendon, lying under the vein, or some other part near unto it. For sometime when we bind hard with the bond, there appeareth a place puffed up with wind, & there swelleth a thing like a vein that is no vein. And sometime, an artery pressed down, doth not move, and so seemeth to be a vein: and therefore to be more sure, let him with the forefinger feel the place of the incision, & the vein underneath. This done, let the Physician take his instrument at the very fingers ends, with a good eye, and a good hand: and let him not put forth more of the point than is sufficient to pierce withal. And that the vein escape not the instrument, in one hand, let him hold the lancet, and with the thumb of the other hand applied to the vein that is to be opened, let him settle, press, and keep down the same, chat it start not aside: and so softly without haste, put in the instrument sufficiently, and let the Phlebotomer have good experience to open a vein with both hands: for a vein of the right aṙme, is best opened with the right hand▪ & a vein of the left with the left hand. The veins in the joints in the bending of the arm, & in the hams being cut in rectum that is right, grow together but slowly, because the joints with motion do open still the lips of the wound. Neither are we so to cut them, except when we need to reiterate bleeding▪ Veins without the joints, as in the head, in the hands, in the feet, opened in rectum are quickly covered with a scar, because the sides do soon grow together again.  
There lieth under the inner vain (called Basilica) also an artery: and under the middle vein, a sinew: and under both, for the most part, Tendons of the muscles. Cephalica vein albeit it be heard to take: yet it is most safely taken of all the rest. For in opening thereof a man cannot light vp●̄ any Tendon, artery or sinew. When a Tendon or sinew is pricked, there followeth great pain, astonishment, resolution & convulsion of the atme, with a swelling. When an artery is pricked, the blood is very hardly stayed: and consequently through effusion of much blood: the strength of nature is wasted. Neither doth the artery heal up or grow again together: but part of it is corrupted like Gangraena, which is a putrefying or rotting of the flesh, by mortifying the sensible parts thereof: if a sinew or Tendon be pricked, the same is perceived by great pain, convulsion, & swelling following.  
If there be doubt that a sinew is pricked: let not the wound grow together, till it be safe from inflammation; & that two or three days are over passed: it may be kept from growing together, by bathing of it in warm oil. After three days: if the pain cease, & that there come no new accidents, we may permit the union, & suffer it to grow togethers again: if not, than we are to use opening, & attracting things, & such as will help the pricking of sinews, as namely turpentine, putting thereto sometime á little Enforbium. When an artery is wounded there cometh forth thin blood, red, fine & spinning out. To help this case, make a plaster of Aloes, Myrrh, Frankincense, Bol-armoniak, the white of an egg, & hairs of an Hare: lay over these a linen cloth dipped in Rose-water, & fasten the plaster well with a bond that it come not off in 3 days: then (this being gently removed) apply another like unto it. If the artery will not grow together with these, cut the whole artery overthwart, that when the extremities are pulled up on both sides, the place may grow, and be covered with soft flesh.  
Touching the manner of the incision, & quantity of the wound: if we judge the blood in the patient to be thick, clammy & Melancholy: & that the constitution of the air be cold; the wound must be reasonaby large & wide: that the thick blood, & gross fumes, may the better issue forth: for the wound in this case being little & straight; the most thin blood alone floweth out, the gross thick blood remaining still behind. A large wound therefore is best in these three cases.  
First, when the blood is gross, thick & Melancholy, that it may pass forth with the more facility. Secondly, when there is great abundance of humours: for they are better expelled with a large than a narrow or small wound. Thirdly, when the country or season of the year is extreme cold, as in Winter, in srost and snow: for cold maketh the humours thick. Contrariwise, a narrow or little cut is best, when the strength of the body is but weak: lest the wound being too large, the vital spirits might immoderately pass forth with the blood. Also in a hot country or season, or when evacuation of subtle and thin blood is requifite: Schola Salerni sayeth: 
Fac plagam largam, mediocriter, ut cito fumus, exeat uberius, liberiusque cruor.  
The wound make mean, for meanly done:   
The fumes may pass, & blood may ●unne. melancholy & slegmatike complexions bleed often times guttatim. i. drop by drop, & therefore a larger wound must be made in them than in others. When the vein is opened, we oft also lose the band from the upper parts, that the blood may run the better. If the blood run sufficiently, let it alone: if but slowly, & that through fault of the incision, amend it. If through grossness of the blood, or of any other cause; let the patiented bend his fist hard together, or turn the staff about in his hand, or by coughing or loud speaking, let him enforce the sinews, muscles & sides. And if need so require, bathe the wound with warm water. If he be fearful or faint hearted when he seethe the blood, & that it be stayed through fear; leave off a while till the strength be recovered, by such means as we shall declare anon: Yea, albeit the blood flow reasonably well; yet it is good in the midst of bleeding, to stop it with the finger, both to recreate the strength, that it be not too much wasted: & also that the filthy & corrupt blood may with the more speed come from the inmost parts, & so be expelled.  
The quantity of blood passed forth is to be considered, as we showed before 14 & 15 Chapters, that it may be stayed in due time: & in this behalf thereof two regards are to be had especially. First, the necessity of the disease. Secondly, the constancy & firmness of natural strength: whereof look in the foresaid places more at large. After good blood appears, bleed no more for fear of the cramp, convulsion, palsy, dropsy, & such like. In a simple plenitude, to avoid imminent dangers, it shall be sufficient only to abate the abundance: albeit, a mediocrity still remain. But in an universal disease, as is a fever; a mediocrity will not serve, but blood is abated more than so. And in inflammations we are not only to regard the quantity but in like manner the alteration of the colour & substance of blood, and when great pain, or inflammation is in places near the incision: stay not the blood before the pain begin to assuage, or the colour of the blood to change. For alteration of colour showeth that the same blood (unlike the other that good is) proceeded from the inflamed part. If the humour cleave fast to the member, or that by evacuation the strength of nature be wasted, than we are urged to stay bleeding, before the blood do change in colour, and to detract that which remaineth by reiterating Phlebotomy, either the same day, or the day after. Hippocrates, 2. vict. acuto. 10. In the cure of the Pleurisy writeth, that in the cure of that disease, the inner vain of the arm is speedily to be opened, and blood plentifully to be withdrawn until the same appear far redder than it did at the first: or that for pure and red blood, the same appear swart and black, which both happen in Pleurisies. If the blood were before raw, crude, & undigested: and that it come from the inflamed place, near an incision: it becometh redder, or yeallower, because this blood is horter, than that which went before. If it were at the first thus coloured: namely, red or yeallowish, than when it cometh from a member inflamed, it turneth to be black and swart, through adustion, and thus you see how to stop the flux of blood, by the quantity, by the substance, and by the colour of the same▪  
As we are to consider the foresaid things, in the blood, so are we to consider strength in the Patient. Of defect of strength these are the signs: The flux of blood relenting: pa●e colour in the face: gapings: stretchings: noise in the ears: webs in the eyes: and defect of seeing: All these show a decay of the spirits oflife; they show faintness of the heart; and that the bodily parts are forsaken of inward heat. To these may be added, the hicket: and a desire to vomit, which cometh of flux of the humour, to the mouth of the stomach, as were already showed. But the most certain and assured mark, is the alteration of the Pulse, which changing from thick to slow, from great to little, from strong to weak, from equal to unequal; prognosticate defect of nature, and a perturbation in the body, not much unlike Epilepsia: that is, the falling sickness. If these come through fear, or of humours nipping the stomach; stay bleeding, recreate and strengthen the Patient a while: that afterward the residue of the evacuation, may be perfected.  
The ways to recover and fetch strength again, if the same give over before a convenient and commodious quantity of blood may be taken, are these: to cast cold water on the face of the Patient: to sprinkle upon the face white odoriferous wine, to put to the nose of the same party, vinegar, strong wine, musk, or other aromatic things, if these help not, we must close up the vain a while with the finger, and if need be, the evacuation is to be imparted or divided. But to avoid all these accidents, the remedy is to let blood, the party lying in his bed, for so the parts of the body are reduced into one equality of position, whereby the principal parts mutually bestow one on an other inward heat and vital spirits: if the Patient be not brought again by the foresaid things, then provoke vomit by tickling in the throat, or by pouring in a little oil, for the force of vomiting stirreth up strength, and draweth away weakness of the stomach and heart, and presently after recovery, renew the strength of nature, with wine, juice of pomegranates, broth of flesh, with the receipt called Diamo●cho, and other cordial things.  
The instrument may be anointed with oil, or other such liquor, that it may inflict the wound without pain, and for the most part the wound must bend somewhat aslaunt or crookedly. The incision is made two ways, as Hippocrates saith: one strait Secundum rectum, or Edirecto, downright: the other contrary crookedly, or a swash. In these two ways we must use great discretion, to use them as need requireth, and not deceive ourselves, using the one, when we should the other, (as many are deceived in these days.) To show which of these is to be preferred, would require a long discourse, whereof read at large, Fuchsius in his Apology against Brachelius.  
There is new kind of instruments to let blood withal now a days: as the Rapier, Sword, and long Dagger; which bring the blood letters sometime to the Gallows, because they strike too deep. These instruments are the Ruffians weapons, more malicious than manly. But in this practice the vain must be opened with a fine lancet, no phlegm with a beard like a bloud-iron wherewith Smiths let horses blood, for they will sometime cut a veyn through on both sides, causing a cramp and deadly convulsion. And here I give advise, that no Surgeon except he be very skilful himself, open any vain without the counsel of the learned Physician, or the judgement of some others, that have ancient and tried experience in the practice. Ignorant Barbers do great hurt herein, taking that which comes to hand first, or which appeareth greatest (perhaps a sinew for a vain) so letting out the vital spirits, and killing many: and when it is done, this is all their defence, to say the sign was there, and he would needs be let blood.  
Unction or anointing, is oft used in this practice: sometime we rub the member, whose vain is to be taken with oil, that through the warmth thereof, blood may be made the more flowing: sometime the instrument is anointed, as was said before, to mitigate the pain of the inflicted wound. Sometime the wound itself is anointed, that it may be the longer time, before it be covered with the scar, and that the humours left behind▪ may with the more liberty breath forth, and that the ill humours remaining, may be also the better dispersed.  
Drink, and especially wine, may be very well taken both in the bleeding, if Syncope happen, and after bleeding, to cause good blood, and to recover again the vital spirits.  
Bathing two or three days before, is used in some causes (as was declared in the former chapter) but not the self same day.  
The common opinion is, that bleeding must be done fasting, and upon an empty stomach: but this is not approved of the best writers, for many of them give advise to eat before bleeding a soft or poch egg, with a draft of wine about nine or ten of the clock ●n the forenoon: and then presently to open a vain. For nature (the stomach being empty, and being altogether destitute of nourishment) doth mightily holdfast, and retain the blood: whereas when a little nourishment is taken in small quantity, as is a poch egg, & a draft of wine; she permitteth the blood easily to passeforth.  
It hath been declared before Chapter 16. that if necessity urge, there is no prescribed time of bleeding, but that if the disease require, the same may be done at all times, yea even in the night. Yet the forenoon of the day is the most usual time. There is an hour of necessity, which is any hour in the day or night: and beside this, hora necessitatis, there is hora commodi●atis, which is the morning or forenoon hour. viz. Galen. de Curan. r●tio per sang. missio. cap. 13. & 20. & in praesagio experientia Comprobate cap. 4. Aetium lib. 3. cap. 16. Oribasi. lib. 1. cap. 11.  
Moreover, if a vein opened send forth blood whitish in colour: stay the same, for it appeareth that the humours in the body are raw, cold, and undigested, through defect of natural and digesting heat. This is affirmed by Aristotle lib. 1. & 9 de animalibus: and Hippocra. witnesseth, that always women's terms appear not in their proper colour; & that by reason of frigidity and coldness of white blood, they oftentimesvomit, and have flux of terms.  
Finally, as in purging, so in bleeding, as we have already said, we are to consider the standing of the wind, & in winter to bleed when the same is Sowtherly: & in Summer when the same is Northerly. For the North wind with cold tempereth the heat of the time.  
The verses of Schola salerni.  

Hac facienda tibi, quando vis Phlebotomari,  
Vel quando minuas, fueris vel quando minutus,  
unctio sive lavacrum, & potus fascia, motus,  
Debent non fragili tibi singula mente teneri.   

Before and after letting blood,  
all these are meet and requisite:  
Unguent, a bath, strong drink and good,  
with motion mean, and bonds most fit.  
Remember all do none forgit.    

A prescription, or regiment of the patiented, after bleeding. Chap. 20.  
WHen a sufficient quantity of blood is withdrawn, proportionable unto the greatness of the disease, unloose the bond, and dry the wound: lest being moistened with clodded blood, either it grow not together again, or bring some doubt of impostumation. These things not done accordingly, enforceth us sometime the eight day after, to open the wound again. If any piece of fat come forth, the same must not be cut off, but softly put again into the wound. When the wound is wiped clean, & dry, close up the vein with linen dipped in rose water, or sweet water; or with Oil, if we purpose to bleed again. Let the same be tied on with bonds: not too●hard for writhing the skin, or lips of the wound.  
If a sinew or Tendon be pricked, ye heard in the chapter before what is to be done. If there be doubt of flux of blood, or an inflammation through pricking of a sinew, we may beside the premises, apply after the practice of others, a plaster of Ceruse: and in compass about that, a Cataplasm of Houseleek, Nightshade, Plantain, and other cold things. After bleeding lie a while on the back, for quietness sake, and to recreate the strength of nature, and to recover the vital spirits. He must not frequent his accustomed affairs, nor move his body hastily, nor exercise himself immoderately, neither must he use Venus' delights, nor yet bathe himself. For the blood and spirits natural, vital and animal which have of late been vehemently stirred by bleeding, are now by rest again to be settled: else the same blood and spirits would by these outward vehement exercises, be inflamed, and so waste and consume away. Neither must the party presently sleep, lest either the languishing heat be quite extinguished, or the lessened spirits, altogether overwhelmed. Let him therefore watch, and rest void of contention, either in mind or in body. When an hour or two is passed after bleeding, a little meat may be given him: Little (I say) in quantity, but of good juice, to nourish the body, and profitable also to withstand the present disease: & when 2. hours are passed this short repast, he may then sleep, so as his keepers carefully take heed, that he tumble and turn not himself on the arm that hath bled, or that the bond by tumbling and tossing be not removed, which may cause the blood to slow again a fresh, or some other displeasure to fall out. Afterward the diet must be increased by little and little, both in respect of the quantity, and of the goodness of the meat. Neither as yet must we hasten to a full diet, for the heat of nature being abated by bleeding, can not as yet receive or digest abundance of meat. And again, the veins lately emptied, would exhaust out of much abundance of meat, much raw and undigested matter, wherewith the whole body is stuffed again. If concoction be perfected and accomplished, so that we may eat great quantity of meat, yet use a moderation: for to what purpose is it, presently again to stuff the body with juices and humours: for the abating and taking away whereof, we did so lately let blood. Therefore after bleeding the patiented is to live more finely and exquisitely, and not to go to his old intemperate diet again, as the dog to his vomit. Neither are these intemperate persons meet men to be let blood, as we proved and showed before in the 8. Cap. Fig. 1.  
Of reiterating bleeding, which they call Epaphaeresis, this is the order. First in inflammations, great pain, hot fevers caused of abundance of hot blood: a vein must be opened, as is already showed, even presently at the very beginning before the matter be gone to some principal member: not only that the abundance and excessive quantity of blood, but that much more a great deal, even plentifully, and generally may be evacuated, yea even till the patiented give over, if the strength of the body so permit. And in diseases caused of fullness, the bodily powers are firm for the mostpart: neither do they shrink or relent much, by this plentiful bleeding. And when Hippo. permitted bleeding so long, till the patient should give over: he meant it so, when the strength thereunto sufficient, was able to bear it, and not otherwise. For if fainting do happen when the powers of nature are firm and constant, it doth only waste the spirits in the arteries, those forces remain still unhurt and undamnified, which narure hath bred in the heart, Liver or brain. And albeit these decay in Lypothimia, yet of the settled forces other like presently come in place whereby again the Patient is revived. But when the strength of the body is weak, and greatly enfeebled, because the forces of nature settled and seated in the principal members, are also impaired.  
If Lypothimia then chance, restitution will hardly be made. Therefore (I say) the virtues of nature being greatly debilitated: beware of over coming or fainting. And this is the order in great and urgent sicknesses.  
In small general diseases, as in repletions, fullness, fevers, and such like, whose cause and principal matter is contained in the veins: if bodily strength permit, we must presently evacuat, & wholly at the beginning, & at one time: not till the patiented overcome, but so much as is needful▪ and as the infirmity or malady requireth. And this evacuation without any hurt to the natural forces, withdraweth the matter abounding, either before the same do wholly putrefy, or that it pos●es●e some notable member, or before any horrible accidents happen. He that for fear or any other cause parteth or divideth in these, the evacuation: he continueth the disease long time, & doth no good, but great hurt to the sick patiented. But if for imbecility of strength the whole evacuation can not be accomplished or done: seeing it is better in this case, to mark the strength of the party, than the vehemency of the disease: we are enforced to use partition in the bleeding; and yet with a great circumspection and care: and let the partition be within a little distance of time, either by undoing or unloosiug of the bound, or stay the blood with applying the finger on the wound so long, as by the foresaid means, the forces of the body may be recovered. Sometime an hours space is sufficient, sometime more hours ●re required, to the restoring of the forces of nature. The best way is not to defer the partition of bleeding past one day: yet (I say) if strength permit, & that partition must be used, bleed twice in the self same day, in general diseases especially: & except other imped●m●ts greatly let, evacuacuat in one day, as much as is expedient, before the matter come to putrffaction or that other evils do grow. But in partial diseases of particular members, chief in inflammations, the parted or divided evacuation may be put off a longer time, either to the day following, or to the day after to morrow: that in this space, the corrupted humours, may go from the member diseased into the veins exhausted: and so by the next incision, be evacuated. The member of the body that is afflicted with grief or corruption, by little and little, even in one day or two days at the most, sendeth down the humours to the place where the incision was. And for as much as they are corrupted, they are not there to remain: albeit the former pains be mitigated and assuaged. But if the inflammation be pestilent and venomous, as is a pestilent botch or carbuncle, the evacuation of necessity must be reiterated even the self same day: lest the pestilent infection stick and stay any long time, in the veins, to the great hurt of the party.  
But neither must reiterating of bleeding be used: For thereby the vital spirits, and in ward heat is diminished, and untimely age is hastened on apace, and the same when it cometh is made subject to grievous diseases, as Chachexia, the dropsy, gout in the joints, trembling, palsies, and apoplexies. Yea when the natural heat is immoderately cooled and natural moisture wasted, the bowels languish, crudity and undigestion beginneth to bear rule, whereby are caused great and grievous evils in the body of man. And thus much of the reiterating of bleeding, and order thereof.  
But let us come again to our former matter of prescription, moderate motion, & easy walking, as it was convement before bleeding, to unloose, and make the humours thin, so also the same is necessary after bleeding to disperse abroad the relics of those vapours and humours which are left behind. And as bonds of linen were used before bleeding, to the intent the veins might wax big, appear full, and be the better perceived and seen: and that the humour with the more facility might come to the place appointed for incision: so afterward, they are also needful, to stay the flux of blood, and bind up the wound.  
It was already said that the party let blood must not sleep, that is to say, not within the space of eight or six hours at the least▪ whereof this is alleged as a reason, that the fumes caused by sleep, be not carried up to the head, and so offend the brain▪ There may hereof be alleged other caused more, as namely: lest the vein opened should take hurt by tossing of the patiented up and down in his sleep: which cause was lately above specified. Also lest in sleep the humours should flow to the member, where the incision was made, and there apostumat. For pained places as Galen affirmeth Capit. 95. medicinati● artis & lib. de Curand, ratio. per sang. missionem. Capit. 7. are by nature accustomed to receive fluxes: and chief in sleep. Avicen allegeth this reason: Because by sleep after bleeding (for the most part) there chanceth in the members, a confraction or bousing. For while the member is tossed hither and thither with inordinate and unorderly motion: the bonds are unloosed, the wound unhealed, and (as it were) newly opened, notwithstanding the late incision, it doth afresh send forth immoderate flux of blood, the party in his sleep not witting thereof▪ whereby (as all men know) the life cometh into great danger. Again, another discommodity by sleeping immediately after bleeding is: that fumous excrements through sleep are again inwardly revoked to the principal members.  
Again, the vital spirits, and natural heat, which by opening of a vein, are drawn to the outward parts and members, by sleep are revoked to the centre, or mids of the body: and so very often, partly through a commotion made by incision, and partly through that retraction made by sleep: such a boiling happeneth in the humours of the body, that oft thereby at length a fever is caused and kindled. It is therefore apparent, that sleep presently after bleeding is not good, and chief if in the mean season the patient have received no meat. If after taking of meat he sleep an hour or two, or more (disposition so serving) it hurteth not at all, or very little.  
But for as much as the commotion of humours can not fully be settled in short space after bleeding, it is far safer to forbear sleep, as we have proved by sundry reasons. If necessity & dispotition v●ge sleep, let the same be short, and with a d●ligent circumspection, that the bonds be not unlosed, and so the Patient brought in peril of his life. Some bring in a further reason, yet of the foresaid, namely, why we should not presently sleep after bleeding & that is: because the matter through sleep▪ waxeth thick, and so a bruising or a confraction that way happeneth in the members: as is accustomed in a quartan, through the thickness & coldness of the matter. Again the veins & sinews after bleeding, being now emptied, are become cold, & so the fumes which are brought unto the veins and sinews in sleep, do also be come thick and wax cold: because by sleep the whole natural heat of the body is drawn even into the depth and profundity of the bodily parts. And when the veins and sinews are become cold, partly for defect of blood, partly through cold fumes brought by sleep unto them: they do participate grossness, coldness, & confraction to the other members: for it is a principle, Simile a simili facile afficit●r. Like of the like is easily affected. And thus much of sleep after bleeding, which is to be understood of sleep only following immediately after, and not otherwise.  
The verses of Scola Salerni concerning this point are these.  

Sanguine subtracto sex horis est vigilandum,  
Ne somni fumus laedat tibi sensile corpus  
Ne neruum laedas non sit tibi plaga profunda.  
Sanguine purgatus, ne carpas protinus escas.  
Six hours sleep not, when blood is let:  
The fume by sleepefull hurtful is:  
It hurts the vein, if stroke be great,  
To feed streightwaies, is far amiss.   
The patiented is a while after bleeding, to abstain from meat, till the motion of humours be appeased. For in this case, raw juices and meat not yet concected, is drawn with the blood to aid the member afflicted. Look Galen, lib. 4. Cap. 10. de Sanitate tuenda.  
Milk, & meats made of milk, after bleeding are to be eschewed: for certain of those humours which were troubled and moved in opening the vein, flow unto the stomach: and forasmuch as milk is otherwise of itself, subject to corruption: being now in this case inwardly received, & mingled with the foresaid humours: it is very soon putrefied: and because of the sweetness thereof, though it be unconcocted & raw, yet it is mightily sucked up, and drawn in of the empty veins.  
Irem, all cold things, either in wardly taken, or outwardly applied, are to be avoided: of which sort are chiefly cold meats, cold drinks, cold bathe & washings, cold air, thinness of clothes, bare sitting upon stones, coldness of the head & feet: for by these the body would be immoderately cooled; natural heat being already diminished through bleeding.  
Item, misty & cloudy air is to be eschewed: for such weather engendereth Melancholy blood, & maketh a heavy mind. He must therefore walk in clear, bright & fair weather: for thereby the spirits of life are refreshed.  
Item, immoderate motion is to be forborn, & a temperate quietness to be embraced, both of body & of mind. For vehement movings do yet more & more still disturb the humours of the body, before excited & stirred up by bleeding▪ & so consequently the same weaken too much the bodily forces: whereas quietness & rest soon appeaseth this commo●on of humours.  
Item, eating of salt fish is to be avoided after incision: for these salt meats often times cause itchings & scabs▪ Simeon Sethi, depiscibus.  

The verses of Schola Salerni, in these matters.  
Omnia de lact vitabis rite minutus,  
& vitet potum, Phlebotomatus home.  
Frigida vitabit, quia sunt in mica minutis,  
Interdiclus eritq▪ minutis, nubulus air,  
Spiritus exultatque minutis, luce per auras,  
Omnibus apta quies & motus s●pe nociws.  
White meats eschew, d ink not too much  
Cold things forbear as ill for such▪  
Walk not abroad in cloudy days,  
clear air doth cheer the spirits always,  
Be wholly quiet at all assays.   
Item, Beware of much meat, the first or second day. And let the meat be of good digestion, and causing good blood: as soft eggs: good wine: chickens, and such like. Therefore Isaac in dietis saith of such as are let blood: that their meat must be lessened, and drink increased: that is, the drink must be more in respect of his meat that he eateth daily, not in regard of that custom which he observed before bleeding. Yea, he must now drink less than he did before.  
Some after letting blood, are very dry in the mouth: which happeneth through the great motion of the humours, and by abundance and ebullition of choler, whose fumes arise upward to the mouth & other parts. These are to drink Barley water, to mitigate the acuitie, sharpness & heat of choler: & so must they do in like manner that are in doubt of inflammation of the Liver and stomach, through abundant boiling of choleric humours: specially, if it be red choler, that aboundeth in them.  
If through hard binding of the arm, before or after bleeding, pain do ensue, and so consequently sluxe of humours to the place causing apostumation in the arm: then according to Avicen, let blood in the other arm: or according to Rhazes, above the place in the same arm; and apply to the place repercussives to keep back the matter.  
The wound in the arm after bleeding sometime healeth but slowly, because the instrument was anointed with oil, as we said before, that the same might enter the better & do lest hurt to the patient, as Galen saith 9 Method. The cause now of this slow healing is, for that the healing is much hindered, by reason of the oil which is between the sides or the lips of the wound: For, as the same Galen & other authors affirm, a wound is not cured or healed as long as there is any thing between the sides or lips of the same. Another cause why after bleeding the wound closeth but softly is, that there hath been too much evacuation of blood, whereby the force of nature is debilitated, which hindereth the continuation or consolidation of the wound. A third reason hereof may be, the oft moving of the arm: for wounds do never heal, except the member enjoy rest, where they are inflicted. Therefore let this fault be remedied by contraries, as thus: Let not the instrument be oiled: evacuat not too much ●loud: & lastly, forbear exercise & motion of the arm.   

What veins are to be opened, both in general, & particular diseases. Chap. 21.  
SOmetime are opened veins, & sometime arteries. Of opening of an artery we purpose to speak afterward in a Chapter by itself. And now of opening only of a vein; which is used in many members: Sometime in the arm called Manus magna: sometime in the hand called Manus parva: sometime in the feet: sometime in the nose: sometime in the forehead: lips: tongue: palate, or roof of the mouth: sometime in the corner of the eye, toward the forehead: sometime in one place: sometime in another: as this discourse following doth plainly teach. It is known to those that have seen Anatomies, that there are in the body of man, two sorts of veins. General, & special.  
Five veins are opened in Manu magna, in the great hand: that is, ab ascellis usque ad cubitum, that is, from the elbow forward, or downward, as Rhazes faith in 7. ad Almonsor. Chap. 21. and Avicen in quarta. i Chap. 20. Where note, that Physicians by the great hand, do mean the whole arm, together with the hand: as by the foot, the whole leg, from the hips or huckle bone, to the sole of the foot.  
The common or general veins which appear in the midst of a man's arm, are these: The first is Humeraria, or Humeralis, in Greek called Omiata, because by the shoulder it cometh to the hand. It is also called in Latin Vena exterior, the outward vein, because it goeth along on the outside of the arm. It is again called Cephalica, or the vein of the head.  
This vain is most apt and fit, and most safe to be opened, for diseases of the upper parts of man's body; it is less dangerous than the rest, because there is no sinew or artery under it, to hinder or endanger the opening thereof. If a man chance not to touch it at the first stroke, he may be bold to strike it again: for there is I say, no jeopardy to cut any muscle. It is opened with a long cut to let out gross blood: and albeit there be no fear of any sinew, artery, or Tendon underneath it: yet wound it not too deep, for fear of apostumation. This vain is taken when the parts above the breast or neck (as the face or head) are diseased. Therefore it is opened profitably for passions of the head, as Hemicrania: the Mygrame, and Mania: Madness, which cometh of too much abundance of good blood, having recourse unto the head: And such other like hot passions of the head, proceeding of ho●e matter.  
Also Cephalica is taken in headache: watchings: and pains of the eyes. If it be opened for headache, purge a day before with a certain quantity of Pills of Hiera simplex, according as the learned Physician shall appoint thee to take. If you cannot find out this vain in the arm, take his branch about the thumbs end. Galen cap. decimo sextode Curand. ra●io. per sanguine. missio. Cephalica opened, cuacuateth and pulleth back from those parts which are above the canell bone of the throat called Clavicula, and this it doth with the more celerity and greater speed, if it be opened in the arm: more weakly, and with less speed, if it be taken but in the branch thereof: that is, between the forefinger and the thumb. Inward and outward affects of the head, whether they be but yet a beginning, or that they are in Statis maximo, in the greatest force; are cured and drawn back, by opening Humeraria vain in the right arm, if the affects be on the right part or side of the head: or in the left arm, if the pain be on the left side. This practice may be done not so speedily but at more leisure, only to prevent the foresaid evils to come, by opening the branch of Caephalica, just between the thumb and the forefinger. These affects are oft removed without opening of a vain, as are also sometimes frenzies, ravinge, apoplexies, even by scarification of the shoulders, by boxing and bleeding at the nose. Item eyes inflamed, and burned with sharp droppinges, and eyes that water, are remedied: First by opening of Humeraria on that side where the pain is most: and afterward the matter of these affects is pulled back, by applying cupping-glasses, to the hinder part of the neck and shoulders.  
The second general vain in the arm, is the inner vain of the same, called of the Greeks Haepatitis: Of the Latins Fecoria, or Lienaris: late Physicians call it Basilica or Regia in the right arm it is called Hepatica, the vain of the Liver: and in the left arm Pulmatica the vein of the lungs: it is also called vena interior, and it cometh or groweth through the armehole. Fuchsius calleth it Axillaris: that is, the vain coming from the liver to the arm hole: Of Axilla which is the arm hole, or hollow place under a man's arm, where the hair doth grow.  
The opening of this vain is very doubtful and dangerous, both for the artery, and muscle that lieth under it, and alfo for the manifold and uncertain course of the sinews in that place: & specially it maketh a man more doubtful in the inner bought of the arm, than in other places, because there the arm is less fleshy. Ignorant Barbers, thinking to open Basilica open oftentimes a great sinew hard by it, which is like a vain, and so the vital spirits, and life itself oft runneth out together with the blood, and this do ignorant Barbers take in cure for headache, and want of sleep, when they should take Cephalica, of whose dangerous boldness we spoke before, Chap. 19  
This vain emptieth from those parts which are beneath the neck, as are the breasts, sides, lungs, heart, liver, spleen and marrow: yea, it emptieth from the middle part of the body, usque ad Claviculam, to the canell bone of the throat, and i● opened to help passions of the breast, stomach, spleen, and liver, and also to help Pluresies of the sides. If ye cannot spy it in the arm, seek the branch of it between the fourth and the little singer: the liver and heart are the roots of this vain.  
Several fullness, being no affect of any particular part, without choice may be withdrawn from any vain: yet most commonly it is done with greatest profit, from the inner veyn of the right arm; which principally eu●cuateth from vena cava: the hollow vain and the liver. So also is fullness of choler, taken fromthe inner vain of the right arm, as melancholy repletion is abated from the inner vain of the left arm, according to the s●ituation of the Milt. In which regard, the Basilica of the left arm is called above Lienaris. That repletion which cometh of a filthy gathering together of raw and crude humours, must equally be taken out of both arms.  
In the cure of Fevers, this order of bleeding is to be observed: A simple Sinochus fever, or a simple fever putrefied or caused through putrefaction of humours: requireth to have the Basilicam of the right side, or arm opened. So doth an hot pestelenciall fever simple, and not compound. So doth a tertian, and a continual quotidian. A quartan requireth the inner vain of the left arm▪ This is also the Method in pure intermittant and discontinuing fevers, if either the plenitude or accidents will have us to open a vain.  
Revulsion of matter from those parts placed between the canell bone of the throat and the rains: is done from the right Basillica or left, as the disease requireth, if the right parts be affected, open for revulsion Basilicam dextri brachii: If the left, the other Basilica: Open this vain in the arm, if great and speedy bleeding be needful. If a more slack and remiss bleeding will serve the turn, seek the branch of it in the hand, between the little finger and the fourth, as some say from the right kidney to the left, and passing over the bottom of the stomach.  
Inflammations in the gut called Colon, which is a great gut rising from the left side to the right, or in which is the disease called the Colic, albeit the same be under the rains, yet they are cured by revulsion; opening Basilicam, or the inner vain of the arm. For so the beginnings, and derivations of the veins do show.  
In inflammations of the lungs: take the Basilica or inner vain of the left arm, rather than of the right, because the veins of the lungs, come from the right side of the heart, which part of the heart is placed toward the left part of vena cava, & so by the left wing, runneth into the left arm.  
This order of incision also helpeth spitting of blood, through extreme coughing: the disease called Tabes: trembling of the heart and such like.  
In a Ṗluresie, open the Basilica of the arm, according as the pain shall happen in the right or left side. In a Pleurisy of the right side, the right Basilica, and so contrary. Item the interior vain is taken in inward and outward apostumations of the breast, or midriff, and in inward Ulcers, which cause us to spit blood. Thus also by opening of Basilica, are cured inflammations on the shoulders, and under the arm holes: except they come to the very bought of the arm: for than it were very dangerous to open the very part or member inflamed; but in this case we open a vain in the hand, e directo: that is, strait.  
In pains and inflammations of the Liver, we open the right Basilica: and so the left Basilica when the Milt is inflamed, grieved, or ill affected: and in all these we must take the vain in the arm if much bleeding be needful: and if not, than the vain in the hand. Derivation from the Spleen, is not made as some do think, into the veins called Hymorroide, but into the belly. So derivation from the hollowness of the Liver▪ is made also into the belly.  
A postumations in the Rains, when the veins also all full of blood, are repelled by the right Basilica, if the right kidney be grieved: by the left Basilica, if the left kidney be ill affected.  
If excessive fullness do not urge in these apostumations, the revulsion is better attempted out of the lower veins, which are strait and right, as out of the right or left ankle.  
Affects of the belly, as immoderate flux of terms, are stayed by opening Basilica in the arm, which draweth the flux upwards: So do also cupping-glasses, applied either to the paps or navel.  
That revulsion which is made by opening Basilica in the arm (specially the right Basilica) is to be accounted general: because it draweth from the Liver (which is the fountain itself) from whence all flux of blood cometh, whether the same be flux of terms, or any other flux of blood.  
Revulsion made from the lower veins, is particular: not evacuating first from the Liver, the fountain of blood, as the other doth. And forasmuch as things universal, go before partiticuler things: therefore in inflammations under the kidneys, we must first pull back with direct opening of Basilica in the arm: and afterward we are to open the lower veins, which also have some force to reveal: but if either the fullness or the flux be great, it is not best first to open these v eynes below.  
Finally imminent diseases like to arise through plenitude of blood, are kept back be opening the right Basilica: that is, the inner veyn in the bought of the right arm.  
The third general vain in the arm, is the middle vain, called of some very properly and fitly venacommunis: of other Cardiaca or Cordiaca: venanigra: and Mater: and of the barbarous Physicians, Mediana. It is called Media or Mediana for three considerations: First, inregard of the situation, having in the upper part of the arm above it Cephalica vein, & in the lower part of the arm beneath it the Basilica vain: and so these being as it were extremes, it possesseth the mids between them both: Yea, it is indeed a branch of them both. And for this cause secondly it hath the name Mediana, as if it were made of them two, as the mean is made or consisteth of the two extremes. Thirdly, it hath the name Media or Mediana, for that it is Media: that is, in the middle in respect of evacuation: Euaevating both from above and from below, above the neck, from the neck, and from beneath the neck: For it springeth (I say) from the division or parting of both the other veins, that is, Cephalica and Basilica.  
By opening this veyn, there is made a general evacuation of humours, through the whole body. A general or universal evacuation I call it, not because it springeth from the heart as some affirm, but because the flux cometh generally from all parts: This vain being a branch (as ye have heard) both of Cephalica and Basilica.  
This vain is taken when neither of the other appeareth, and withdraweth blood from them both, according to the judgement of some: This vain is the same which is called also Funi● brachii. Cephalica and Basilica, are (as it were) the Parents of Mediana: As often therefore as thou art determined to open Basilica, and that the same do not appear, take rather the Mediana vain, than the Cephalica. And if thou purpose to detract blood from Cephalica, and that the same do not show conveniently; open rather Mediana than Basilica: and being compact of Cephalica and Basilica, it withdraweth blood indifferently from them both: both from place and parts beneath, and also above.  
Some give advise (upon what ground I do not yet see) not to open Cardiaca if the Patient feel any weakness at the heart: but if necessiity of bleeding be urged, the heart being enfeebled, we are rather to open Cephalica or Basilica.  
This vain is opened to cu●e ●assions of the whole body, especially when they proceed of heat of the heart, and of the Lungs▪ In opening whereof we must be very wary and circumspect, for under it there is a certain muscle, which being very deeply cut or pierced, bringeth the Patient in jeopardy of life: and it is opened in pains of the breast right side, and in Pluresies; and must be opened somewhat overthwart. The danger in the cut●ing for the sinew underneath, is especially, if the wound be deep: and the same danger in the Greek is called Aneurisma. Yet for all this, there is less peril in opening of this, than of Basilica: and as being compound of Cephalica, and Basilica, it evacuateth from them both: so it reveleth and pulleth back from them also, and is for the most part deeply wrapped in the flesh, and appeareth not but as it were Soboles, an offspring of Cephalica and Basilica. Where note that albeit the opening of a vain, as Galen, and Avicen do testify, be an universal evacuation out of the whole body, yet not so of all veins a like, but chief that is to be called and accounted a common and general evacuation, which is made out of these three common and general veins in the arm: And as affects of the upper parts are cured by incision of the upper veins, in the arm; So are griefs of the neither parts, by opening of vey n es in the h●ms and ankles, as Galen faith, and as we gave instructions before in the eighteen and nineteenth Chapters. If we doubt whether the ●atient will bleed effectually or no. First, bath the arm in hot water, and when the wound is inflicted, draw the wound wide and abroad, that the gross melancholy blood, may the more eassy pass forth. Note also that in all sicknesses and times, except in time of pestilent infection: that veyn of the three, must be taken: which appeareth biggest and most full: for by that ye may perceive that the members appertinent to those veins, are most abounding with superfluous hot▪ blood. And thus you see the profit of opening the common veins in the arm.  
Moreover a vain opened in the arm, stayeth flux of hemorroids: If any inflammation be about the privy parts, Arese, Bladder, or other parts called Obscaenae: so as there be no venomed matter in the same; the fullness and flux is to be abated out of the upper veins in the arm. After the which if necessity require, particular revulsion may be made out of the lower parts▪ And so in fullness and fluxes of the thighs apostumated; first open a vain in the arm, and afterwards in the foot. If the plenitude or inflammation be but small, omit the upper veins, that evacuation from the lower parts shall be sufficient: And this is the order of opening a vain either in the beginning, or in the state of diseases.  
For detraction of blood, to withhold diseases like to come of present fullness and repletion▪ to stay the Hemorroids, withdraw the fullness out of the upper veins. If a member have full veins broken, or like to break, & that the member readily receive fluxes coming unto it, & that there be yet no disease bred: do not evacuat the matter at a vein ve●ie nigh the affected part, but a far off, and direct as it were: whereby the future flux may be stayed, and the accustomed force withdrawn another way. And thus much of the general veins in the arm.  
Now to proceed to special veins: we are first of all to call to mind: especially the vein called Saluatella, or Salubris: this vein is called of the Arabians, barbarous physicians, and of Avicen Sceilen. This vein appeareth in the hand between the ring finger and the middle finger, where we are to note that oftentimes among the Arabians & barbarous physicians, that vein which showeth itself, at the wrist, and is compact of a branch of Cephalica or Humeraria vein, and the vein called Axillaris, is called Sceilen: whereupon late writers call also the vein Saluatell● Axillaris.  
This vein is opened in the right hand, for obstructions of the Liver: and in the left hand for obstructions of the spleen: where of as yet there is no apparent reason, but that experience proveth it to be so. Moreover when we open this vein, the hand of the patient must be put in warm water till the vein be puffed up, and swell, and may easily be seen: and that the humour may be made subtle. Yea when the vein is opened, it is again put into the water, that the blood may the sooner issue forth: if it come forth but softly as it accustomably happeneth to most of those that bleed at this vein. Again, it is good to let it bleed in the warm water, lest the wound be too soon covered over with the scar. Rhaz. lib. 7. Cap. 21. ad Almonds. and Avicen quarta prim, cap. 20. When this vein hath bled as much as you will, apply on it a little Oil and Salt, and there is no fear in it, because it is far from the heart. This practice (I say) of opening Saluatella for oppilations of the Liver and spleen, hath no manifest reason, but is grounded upon Galens' experience: who having a patiented troubled with those diseases, deemed, that if he did let her blood of Saluatella vein, she should recover: which he did accordingly, and she was cured presently.  
Saluatella in the right hand between the little finger and the next adjoining, is opened in oppilations of the breast, against gummy matter in the e●es, perbreaking, yellow jaundice, pains of the colic in the right side of the belly. Saluatella in the left hand is opened against all diseases of the spleen coming of repletion & oppilation: it is good to heal the Hemorroids, frenzies, and chollickes in the left side, diseases of the veins, and aboundancè of terms. And I am here to advertise of the variety which I find among writers touching the place where Saluatella is to be opened. For the most part I take it to be opened between the middle fingar & the ring fingar. Yet another place of his incision (as some hold) is between the ring fingar and the ear fingar or little fingar.  
Of the incision of Satuatella six utilities are found & numbered. First it purgeth the spleen: secondly it cleanseth the Liver: thirdly it purifieth the breast: four it taketh away impediment in speech: fifthly it conserveth & keepeth from hurts those parts called Praecordia. i. the strings of the heart, the mouth of the stomach, and all the spiritual members near the heart: sixtly it removeth unnatural pains, even from the ha●t itself: Which commodities are contained in these verses of Schol● Salern●.  

Ex Saluatella, tibi plurima dona, minu●a,  
Splenem, hepar, pectus, vocem, praecordia purgat.  
In naturalem tollit de c●● de dolorem.  
Vein Saluatel doth profit all,  
The spleen, the Liver, breast, and voice.  
It purgeth parts praecordiall,  
And makes the heart for to rejoice.   
And thus you see from how many places the opening of Saluatella withdraweth blood: that is from the spleen, liver, breast, precordiall parts, and the heart itself: in whose opening, no danger is to be feared, only with warm water (as ye heard) we must both subtiliat and make thin the blood, & cause the small vein, the better to appear in sight.  
Although (as ye heard in Saluatella) that this name Axillaris, of some writers be given to the vein Saluatella: And that the vein called Sceilen of the Arabians, is also of some called Vena Axillaris: yet in truth, we following the most approved authors, take here Axillaris to be a branch of Basilica, & that it appeareth in the bending of the arm downwards, & for Physic helps is judged to remedy those diseases, which are cured by opening of Basilica.  
Funis brachii is like Cephalica, & is a branch of Cephalica descending, and the judgement thereof in physic helps, is as the judgement of Cephalica aforesaid.  
Arteries, as in whom is the greatest danger, they are placed of nature far more inwardly, & the veins are more outward, to keep the body from dangerous hurts. Of Arteries we purpose anon to speak, in a distinct chapter: now here we are yet to proceed further to more particular veins.  
Item there are two veins in the hinder part of the head, good to be opened against the frenzy, swimminge in the head, astonishment, and other passions of the head.  
Item, there are 2. veins of the temples of the head, which are opened in the cure of Hemicrani or the mygran, in great & contintal headache, in distillations of humours to the eyes, in impediment of sight, & in diseases of the cars.  
Item, in the mids of the forehead between the two brows is a vein whose incision profiteth in heaviness of the head, specially the hinder part of the head: for infirmities in ●he face, as redness, morphues, itch, scabs and in affects of the eyes, Cephalica first being opened.  
Item, a vein in the higher part of the forehead is opened in all disease's of the head and brain, specially if they be of long continuance: also it cureth the new begun lepry.  
Item in the nose is a vein, in whose incision you must tie the neck with a napkin until the parts of the head swell, and the vein appear, & this must also be done, when the vein in the forehead is opened. This vein in the tip of the Nose, is opened against apostumations of the head, rheums, and fluxes of the Eyes: it purgeth the brain, and comforteth memory. This vein must be sought for very surely and wisely, for it lieth deep▪ and therefore he that will be sure of it, must find it even in the very mids between the 2. sides of the nose end. The 2. veins within the nostrils are opened against heaviness of the head.  
Item, there are veins between the l●ppes & gums which are opened in apostumations of the mouth & gums, Cephalica being first opened.  
Item, there are veins under the tongue opened in divers affects, chiefly in Angina, the Cephalic being first opened: there are ●. of them in number, they are also opened in fluxes of the head▪ palsies, squinances or quinsees, scroplules, apoplexies, coughs, pains of the mouth, ●eeth▪ and gums, impediments of speech: generally in all diseases of the breast, heart, lungs, and arteries.  
Item, there are 2. veins within the mouth, which be opened in diseases of the head, toothache, pains of the jaws, mouth and throat: also against freckles of the face.  
Iten there are 4. veins in the roof or palate of the mouth, which are opened in tothaches, rheums, & catarrhs of the head flowing to the teeth, & causing the tothach: these veins are manifest enough. johan. de Sancto Amardo, an old practitioner, setteth down a cure that he d●d on a woman grieved with tothach. First ● used percussives to stay the rheum, and it did no good: them things mitigative, & they did as little: them maturatives, nether did they any good▪ Then I let her blood in Cephalica first, and opened (saith he) these ●oure veins, when the matter of the flux was digested, and so she was cured: but if the matter be not digested, the opening of these helpeth not.  
Item, there are c●rt●i ●e veins in the watery angles of the eyes, toward the brow, which are opened in passions of the eyes, pains of the head: Opthalmia that hath long continued, and in watery disti●lations of the eyes, the Cephalica first opened. Item, hereby are cured webs, spots, clouds, mists, pearl, redness, corns, & such other infirmities of the eyes, with weakness of sight.  
Item, there are two veins in the concavities & hollowness of the ears, which being opened, heal shaking of the head, swimming of the eyes, dis●ines, pypings & sounding in the ears, uncleanness of the mouth, a new begun deafness.  
Item, there are two veins behind the ears, which are opened to preserve memory, to cleanse the f●ce, to take away the rheum & dis●●llations from the head, generally in all diseases of the mouth & gums.  
Item, in the temples near the ears, are veins opened in the diseases called Vertigo, & the Migram: and in great & continual pains of the head. This incision maketh a man barren, as Hipp. affirmeth▪ lib. de Genitura, & in lib. de aere, aquis & locis, in these words: Quibusdam juxta aures venae sectae sunt. Hi● cocunt quidem & ge●ituram emit●unt, verum mancam debilem & infae●undam. Some have certain veins cut, not far from their ears, w●ic● do the act of generation, & give forth seed, but the same is unperfect, weak, & barren. Neither is this contrary to reason: for most of the seedy moisture descendeth from the head into the marrow of the back. Hippo. also affirmeth, that the noble men of Scythia, by incision nigh their ears, become unfruitful. These veins Avicen called Iweniles.  
Item, there is a vein between the chin & the neithet lip, which is opened in a stinking breath.  
Item, there is a vein, lying right underneath the chin, which is opened also against a stinking breath, & also in diseases of the head & breast: Polipus in the nose, pains in the cheeks, stinking of the nostrils, spots about the face.  
Item, there are two veins in the neck, one before, another behind, that are opened in a pleurisy, in a new begun leprosy, shaking of the members, humours, and distillations from the head, too much stiffness oflimmes. The Grecians call these veins Sphagitidas: the Latins jugulares, they are veins of the throat. The Arabians call them Guidez: the barbarous Physicians call them Subeticae: we may call them Venae apoplecticae, or the sleepy veins: because being wrung hard, or pressed down, they bring an heavy sleep, and a certain drowsiness like the disease called Apoplexia. To speak plain English: these veins of the neck or throat, being hard tied, bring judas disease▪ i. very hanging. These are opened (I say) in the beginning of leprosy, when the breath is very short, in the beginning of Angina: in the disease called Asthma: in horcenes of voice: in apostumation of the lungs: in Dyspnaea. i. pursines or stops of the lungs, caused of much hot blood, in griefs of the Spleen & side. Vide librum Anatomiae vivorum Galeno adscriptum▪ Cap. 28. Rhazen. & Avicen.  
Item, there are two veins under the armholes, which are opened in straitness of the breast, pain of the midrife, & the lungs, in difficulty of breathing called Asthma.  
Item, there are two veins above the elbows, which are opened in all diseases of the breast, swimming of the head, spalme, the falling sickness.  
Item, there is a vein called Vena purpured, or the purple vein, lying in the right arm, next Hepatica, or Basilica toward the hand; which is opened against diseases of the spiritual members, and of the bowels.  
Item, there is a vein called Illiaca next unto the purple vein: which being well taken, is good to heal pains of all the inward members.  
Item, there is a vein called vena pulsatilis, or the beating vein, which is opened in tremble of the heart, swooning, & Cordiaca passio.  
Item, there are two veins in the thumbs, which are opened in diseases of the head, bleared eyes, & in most fevers.  
Item, there is a vein between the forefingar and the thumb, which is opened in stopping of the head, to purge superfluity ofcholer, also in agewes, & diseases of the eyes.  
Item, there is a vein between the ringfingar & the little fingar, which is opened in diseases of the head, lungs, & spleen.  
Item, there is in th' right hand between the little fingar & the next adjoining, a vein called Saluatella whereof before. Item, Saluatella in the left hand: look also before.  
Item, there is a v eine in the right side, opened in Lienteria Dysenteria, dropsies, & other infirmities of cold matter.  
Item, there is a vein in the left side, which is opened in apostumations, & excori●tions of the bladder, pains of the loins, swellings & stops of the spleen.  
Item, there is a vein in the belly, which is opened in diseases of the rains, and to purge out the Melancholy blood.  
Item, there are 4 veins about the place called Pecten. i. the place where the hair groweth about the privy members, on either sides which may be opened in superfluous issues of the Hemorroids: to assuage pain and diseases in the bladder & secret places: to stop bleeding at the nose and other members: to heal Lyenteria, & Stranguria.  
Item, there is a vein over the foreskin of the yard, which is opened against the dropsy, and all diseases of the same member.  
Item, there is a vein underneath the said foreskin, which is opened for the cramp, spalme, colic, swelling of the cods, strangury, Dissuria, the stone in the rains & bladder.  
Item, there are two veins in the thighs, which are opened in diseases of the rains and bladder.  
Item, there are two veins in the legs, which are opened in dropsies, pains & apostumation of the bladder, rains, and privy parts: in the gout, & swelling of the knees.  
Item, in the feet there are three veins, Ischiatica, Saphena, & Vena poplitis: the vein of the ham behind the knee. These we open to revoke blood downward, as in provoking of menstruous Terms. But among all these, the vein in the ankle is most convenient, as Avicen saith: For, vena poplitis, being more nigh unto the womb, it draweth blood better from thence than either Saphena, or Ischiatica. When the plenitude in the body is not great, it is better to detract the same from the right lower veins of the hams, & the ankle.  
Vena poplitis opened, provoketh Terms: so doth it flux of Hemorroids: for the force of the blood tending downwardly, as it were, openeth the womb, & provoketh consequently both Terms & Hemorroids.  
If there be any inflammation in or about the belly, at the biginning thereof, draw the matter upward, and that directly: For from above, as from the head, the flux proceedeth. Neither in this case are we to fear in women stopping of Terms, by opening a vein in the arm: if presently therewithal, we open a direct vein in the ham or ankle, which is the way to turn them aside, as we have said already. But if first you should open a vein below, the force of the inflammation would therhy be increased.  
Affects in any part under the rains, are most speedily cured by opening the greater veins of the ham: the same are cured slowly, and with less speed, by opening Saphena in the ankle. The rains are in the middle between the upper parts & the lower: Yet I prescribe & appoint not the position, so much by order of the member, as by the original & production of the veins passing into that part. And therefore inflammations in the right muscles, of that part called Abdemen above the navile. i. in the outward & upward part of the belly or paunch, are revoked by opening a vein below: and inflammations beneath the rains in the gut Colon are pulled back, by opening the inner vain of the arm, as before.  
Saphena is opened to withdraw blood from the rains, matrix, womb, stones, & yard, & from all members placed below. Saphena & Ischiatica are branches of one vein as Galen saith 6. Aphoris. Saphena, on the inner side of the leg, is opened in stopping of terms, grief of the matrix, rains, hips and privy members of men or of women.  
Ischiatica corrruptly called Sciatica beginneth above at the huckle bone, or haunch, called Ischias. This vein may be called the outward Saphena, descending from thence on the outside of the legs. It draweth from the rains & lower members that are outwardly placed: & is opened in pains of the huckle bone, called Sciatica: in griefs of the bladder & bowels: gout of the hands & feet: pains of the joints: palseyes: in the disease called Vaux i when a crooked vein swelleth with Melancholy blood in the temples, belly, or legs, & in leprosy.  
Item, there are two outward veins in the ankles, which are opened in stopping of Terms, sicknesses of the Spleen, pains in the back, strangury and stone.  
Item, there are two veins under the little toa, which are opened to purge superfluities of the matrix, in scrofules on the face and legs.  
Item, there are two veins adjoining to the little toe, which being opened, cure apoplexies, yellow jaundice, and choler, palsies, and diseases of the rains.  
Item, there are two veins in the les●er joint of the little toe, which are opened in old coughs, pustles, & Opthalmia.  
Item, there are two veins in the middle toe, which are opened inscrophuls, diseases of the face, spots, redness, pimples, watery eyes, canker, knots, & stopping of the Terms.  
Item, there is a vein on the left joint in the great toe, which is opened in Opthalmia, spots of the face, & legs, ●●ch, evil ulcers & supersluitres of the matrix.  
Finally, I conclude with Venatalii, the ankle vein, called also Saphena, that of the lower veins, it is of great profit, and to be opened in pains, stops, & swelling of the matrix, or yard: & is opened the foot being put in a vessel of water. The Sciatica vein, which is one of the middle veins toward the outside of the foot, is next in use, for the disease called Sciatica in the huckle bone: So as first we purge with Hiera, and anoint the place outwardly with oil of the same. And when blood letting i● not convenient, (as afterward you shall hear) as also in this practice for Sciatica, we may apply boxes, with scarification: as the place, humours, and time requires, and as affects in the upper parts are cured, by upper veins, opened in the arm: so they in the nether parts, are cured by lower veins, opened in the hams and ankles.  
As we have hitherto declared the veins in general & particular, with their profits in bleeding, for manifold diseases: So also, to the intent that the practitioner may be furnished thoroughly with knowledge in this point which is the most principal: and to know in every disease what vein to open, & so not to take Hob for Gib (as the proverb saith:) it shall not be greatly amiss for the more perfectness herein, to teach this lesson forward and backward, as they learn their Gamma ut, both ways; that intent to be good Musicians: so must those be most perfect in this discourse, that in this practice of letting blood will be accounted skilful and good Physicians. Now, therefore in a most compendious sort, I will first set down the disease, and then the vein that is to be opened for the same.  
And first, touching a body that is not yet sick & diseased: but who that is sick, either in his whole body, or in some particular member in the spring & the beginning thereof, he may be let blood of any vein, of the great & general veins, & so in the preservative intention, may be kept back, continual & universal fevers, & a general or universal gout: if there be doubt of any particular inflammation in any particular member, let blood some vein in some part far off, whereby the v●e and custom of nature, and also the flux of blood may be turned from that member where the danger is very likely to rest, into some other part far distant, and in these two points resteth the whole preservative intention of this practice.  
Concerning a patient sick and diseased, & the curative intention of this practice: If he be sick, he is diseased also, either in the whole body, or in some particular part: If the disease lie in the whole body, than the Basilica or inner vein of the arm is to be opened, which directly answereth unto the Liver▪ which is the very fountain of blood.  
If the patient be sick in any particular part, the same is either above the neck, as in the face, or in the head: or it is beneath the neck. The diseases in the face and head are these 7. a Frenzy, an Apoplexy, the Letargus or sleeping disease, the falling sickness, the Quincie, inflammation of the eyes, flux of blood from the nose.  
1 In a Frenzy, in the beginning thereof▪ blood must be pulled back from the head by opening some veins, as will from far withdraw the matter: always observing rectitude with the part affected: and this may best be done from the Cephaliea vein. In the state of a frenzy, or when the force thereof is somewhat abated, first take away the repletion of the whole body, and then let blood, either in the member itself that is affected, or member very near unto it: as in this case the fittest vein is the vein of the forehead, or that vein which is between the nostrils.  
2 In an Apoplexy, first in the beginning therofopen Cephalica: If that appear not, open Vena communis, or Mediana, or that vain which is between the thumb and forefinger● afterward if the disease be rooted and continue: open the vain under the tongue.  
3 In Letargus or the drowsy disease, first open Cephalica: afterwards if the same continue long▪ open the vain of the forehead.  
4 In the falling sickness, open the self same veins that are opened for apoplexy.  
5 In Angina or quincie, first open Cephalica: then the vain under the tongue.  
6 In inflammation of the eyes, first open Cephalica, than the vain in the inner angle or corner of the eye.  
7 In sluxe of blood from the nose, open Cephalica, or Mediana, the common vain.  
For diseases beneath the neck, they are either above the rains, in the rains, or beneath the rains. Above the rains are these four: A Pleurisy, diseases of the lungs, inflammation of the liver, inflammation of the spleen.  
1 In a pleurisy, & the beginning thereof, open the Basilica or inner vein of the arm on that side, that is pained abating and putting back the aboüdance of blood so long, till the blood change in colour, if so be the strength of body in the patiented, will bear it.  
2 In diseases of the Lungs, Vena Axillaris, or the inner vein of the arm is to be opened, or if that appear not, the common or middle vein: or for the more forcible rewltion, we may take the vein in the hand, between the ring finger and the middle finger: or that vein which is between the ring finger and the little finger: Always respecting rectitude of opening in the right vein.  
3 In inflammations & diseases of the Liver, do as is said for the lungs Basilica vein: observing always rectitude of members.  
4 In inflammations & diseases of the spleen do also as before, observing the rectitude on the left side. If the diseases be in the rames themselves, that they are inflamed: & that the same inflammation be but a beginning: open the inner vein, or Basilica of the arm. If the inflammation be in his state, or somewhat relenting, open the inner vein of the ham, or ankle. If the diseases be beneath the rains, they are either diseases of the womb or belly, or of the bladder, or privy parts: or of menstruous terms, or of the Hemorroidae veins, thigh, or haunch.  
1 In diseases of the womb or belly, if the flux be a beginning, and that there is repletion in the body: open a vain in the arm, to turn the flux an other wax: when the flux is done, and the affect be not removed, open the inner vain of the ham or ankle.  
2 In diseases of the bladder, do even so: both in their beginning and in their state.  
3 In inflammation and diseases of the privy parts, do likewise even so.  
4 In restraint of terms, open the vain of the ham or ankle, or scarify upon the ankles.  
5 In terms immoderately flowing, open the vain of the arm.  
6 In restraint of hemorroids, open a vain in the ham or shank, which is from the knee down to the ancklee.  
7 In immoderate flux of hemorroids, open the Basilica in the arm.  
8 In pain or ache of the thigh or huckle bone (called Sciatica) first open the inner veyn of the arm, to pull back the matter: afterward open the outward vain of the ankle, to evacuate the same.  
Finally, remember always that when sulnes hath adjoined with it in the body, corrupt humours, or that with increase of much blood, there is also some evil and corrupted juices: as happeneth in that fullness which is only Quo ad vires: and in continual fevers, joined with putrefaction: than we are both to let blood, and to purge, as was showed before in Chapter, 4.  

Certain very old english verses, concerning the veins and letting of blood, taken out of a very ancient paper book of Physic notes.  

YE Masters that usen blood-letting,  
And therewith gotten your living:  
Here may you learn wisdom good,  
In what place ye shall let blood,  
In man, in woman, or in child:  
For evils that be wood and wild.  
There been veins thirty and two:  
For wile is many, that must be undo.  
Sixteen in the head full right:  
And sixteen beneath I you plight.  
In what place they shall be found,  
I shall you tell in what stound.  
Beside the ears there been two,  
That on a child mote been undo:  
To keep his head from evil turning.  
And from the scale withouten letting.  
And two at the temples must bleed,  
For stopping and aching I reed:  
And one is in the mid forehead,  
For Lepry, & for sawcesleme that mote bleed.  
Above the nose forsooth is one.  
That for the frenzy moat be undone.  
Also when the eien been sore,  
For the red gout evermore,  
And two other be at the eien end,  
If they bleeden them to amend.  
And the web that comes thorough smoking,  
I you tell withouten leasing.  
And at the hole of the throat, there been two:  
That Lepry and strait breath will undo.  
In the lips four there been,  
Able to bleed I tell it be deene,  
Two beneath, and above also:  
I tell thee there been two▪  
For soreness of the mouth to bleed,  
When it is flawn as I thee reed.  
And two in the tongue withouten lie:  
might bleed for the quivancie.  
And when the tongue is aught aching,  
For all manuer of swelling.  
Now I have told of certain,  
That longer for the head I ween,  
And of as many I will say:  
That else where there been in faith.   

In every arm there been fife,  
Full good to bleed for man and wife.  
Cephalica is one iwis,  

Cephalica.  The head vain he cleped is,  
The body above and the head:  
He cleanseth f●o evil and qued.  
In the bought of the arm also,  
An order there must be undo:  
Basilica his name is,  
Lowest he sitteth there iwis: 
B●sili●●.   
Forsooth he cleanseth the Liver aright:  
And all other members beneath I twight.  
The middle is between the two, 
Cora●● id 〈…〉 vena.   
Coral he is cleppid also,  
That vein cleanseth withouten doubt:  
Above & beneath, within and without.  
For Basilica that I of told,  
One branched vein sty up full bold,  
To the thomb goeth that one branch:  
The Cardiacle he will staunch,  
That there branch full right goeth,  
To the little finger withouten oath:  
Saluatell is his name, 
Saluatel   
He is a vein of noble fame,  
There is no vein that cleanseth so clean▪  
The stopping of the Liver and Spleen.  
Above the knuckles of the feet,  
With two veins may thou meet,  
Within sitteth Domestica: 
Dom●stic●. 〈…〉.   
And without Saluatica.  
Domestica cleanseth well▪  
The bladder every deal,  
Siluatica withouten doubt, 
Sil●atica 〈◊〉.   
He cleanseth well for the gout▪  
In the hams a woman shall bleed,  
For stopping of her flowers at need,  
A man shall bleed there also,  
For the Hemotroids to fordo.  
Two veins if thou use I say,  
The quartan thou mayst void away▪  
All the veins thee have I told,  
That cleanseth man both young and old.  
If thou use them at thy need:  
These foresaid evils they dare not dread.  
So that our Lord be them helping,  
That all hath in his governing.  
So moat it be, so say all we.  
Amen, amen, for charity.     

A profitable observation of the blood extracted. Chap. 22.  
WHen the blood floweth forth of the wound, the same is to be received in clean wiped porringers of earth, glass, tin, or silver: not of brass, lest the same cause alteration of the substance, colour, or other quality of the blood, and so our judgement by that occasion be perverted & corrupted. Of these little vessels, there must be many in number, that in each of them, the variety of the blood may appear and be seen: and they are to be set in a fair place, that no dust, smoke, wind, or Sun, come unto them. The first observation 
1. Substanti.  is the substance of the blood, which sometime is viscous, & cleaveth to the fingers like glue; this floweth out but softly and slowly, because it is thick, and it quickly again congealeth. This kind of blood is the cause of obstructions in the body, and of such diseases as are caused by obstructions. That blood which congealeth not so soon in the porringer, is thin blood. And that which waxeth not hard, being cold: is waterish and putrefied blood. Thick & viscous blood, and compacted hard, is hardly cut or divided, & thin blood very easily: putried blood not at all: but as soon as it is touched with one's finger, or a knife, it is torn & rend (as it were) into small pieces.  

2. Serum.  Whey, which is (as it were) a yellow water swimming on the blood, wehn it is clodded. showeth eitherimmoderat drinking, or a weak Liver, as in hidropicall persons: or weakness of the rains, and obstruction of the same. For these diseases cause abundance of watery wheyish matter in the veins, mingled with the blood. The thick blood is very hardly imparted, or distributed among the small veins: for thereby they would soon be obstructed.  

3. Spuma.  Froth swimming on the blood except the force of the flux have caused it, declareth heat, and inflammation of that humour, which the colour expresseth. Red foam showeth blood: yellow foam choler: white foam phlegm: swart some melancholy.  
The colour of the congealed blood, being very red in the top, showeth a good profitable qloud. The colour red and clear, showeth hot blood: as that of the arteries. An obscure red colour expresseth a mean or mediocrity, as is the colour of the blood in the veins. A citrine colour. i▪ of the colour of a citron, gold, or or●nge, showeth dominion of choler: white colour, dominion of phlegm: green colour, superiority of adust choler: and a colour swart, or like lead, showeth abundance of hurtful melancholy with mortification of the spirits. A mixture of divers colours, showeth abundance of divers humours: whether the coloured humours be putrefied or no, the substance of the blood declareth. White colour cometh of good concoction, chief in those that have full strength: whose urins appear well concoct, with most white residencies in the bottom. The blood of such people in the veins through concoction wax white. If the blood be white in colour, & viscous in substance: it signifieth adust phlegm, by reason of burning heat in the same. If it be not viscous, but thin & waterish, it showeth natural phlegm. The best colour in blood is red, inclining to a certain obscurity or darkness. Purple colour very thin & clear, showeth choler as Galen witnesseth inpri. de Chrisi. If it be very dark, it betokeneth gross blood. Green blood showeth perfect adustion.  
When the blood floweth soorthspedely, it is suetile and thin: when it spinneth not forth, but comes guttatim, slowly drop by drop: it betokeneth that it is gross blood: when meanly between both, then is it a mean blood, between gross and thin. Again sometime it is quickly congealed, then is it g rose blood: sometime slowly compacted, and then is it subtle. Thick and gross blood, showeth thick and gross matter in the body: or it showeth great heat and drith, which hath consumed the humidity of blood. If it be subtle & thin, it showeth want of digestion, and abundance of raw, unconcocted humours, of hot humours, or of cold, as the colour shall descry.  
If the blood be oily, it betokeneth either a future leprosy, or too much fatness in the body: for leprosy is caused of extremity of heat in the blood, burning the same, and converting it into an oily substance. Again, take a bat round in the end, and set it to the congealed blood, if it withstand it not, but give place unto it, and be divided: it is an argument of drith. If the blood greatly resist the entrance of the bat, then is it a very thick and viscous blood. If between both▪ then is it a mean blood▪ And thus of the substance of the blood, which should have been inserted before. And touching the colour in like sort, this brief observation by the way, which was also omitted, but may come in here yet in good sort a good blood is of divers colours, according to the diversity of the parts: for in the upper part and in the compass of the vessel, it is of a red colour: for the good blood (being light) always ascendeth up to the higher parts: in the mids it is red, and not clear: in the bottom it is black and melancolious. For melancholy (being heavy) resteth always in the bottom.  

●. Pinguedo.  Sometime there swimmeth on the top of the blood a certain fat, or oily matter, like a copweb. If the body be very gross and fat: this is caused of the very blood, which is in such bodies inclining to fat. If the body be very lean, it declareth the same now to begin 
8. Subsidentia.  to melt, and to languish.  
In the bottom of the clodded blood there is resident an earthly & a filthy substance, which being divided, or cloven asunder, appeareth in colour, either red, dark, black, bright, or green: whereby we may conjecture the nature of the humour mixed with the blood: yea & by the colour much or little, we may know, how much each humour aboundeth in the veins.  
Some say, if the blood be cut or divided, & 
7. Grana.  that there be found in the same, certain grainees like small sand, that it noteth leprosy, or inclination unto it: which always hath not been found true by certain that have observed it.  
It is seldom, that the blood coming from the veins, doth sink: but if it do, the same showeth corrupt and stinking humours, and is a token of uncurable putrefaction and corruption.  
No man doth willingly taste detracted blood, but if by chance it come into the mouth, and do taste sweet, it is according to nature, good, and of perfect concoction. If it be bitter in taste, it showeth abundance of choler: if it be sour, sharp, and restringent, it denotateth abundance of melancholy: if unsavoury, abundance of phlegm: if salt, the blood is mixed with salt phlegm. After observation of the substance and colour of the blood, confer all the small porringers, or vessels of blood together. If they show all equally good blood, it is to be supposed that the rest in the veins, is like unto it. Yet the same is to be withdrawn, if it offend in quantity, and grieve the body, hurting the senses, and causing in the body putrefaction and other evils. If blood appear corrupt, then with a greater profit, the same is to be withdrawn, because it hurteth the body two ways: both with the quantity and quality thereof. If it be not sufficiently withdrawn at one time, afterward again, a vein must be opened: and beside bleeding, if Cacochymia concur with plenitud: that is, that blood offend both in quantity and quality, as we noted in the 21. Chapter: beside bleeding, the body must more over be purged with inward medicine.  
If that blood which came first were good, and the other corrupt: then suppose that yet much such blood remaineth in the body, to be avoided by good order of diet, and orderly evacuation. But if it fall out so in inflammations, it is a good sign that the evacuation is absolute and perfect: quite taking away the matter of the disease from the affected member. The blood poured into warm water, hath thereby his parts and substances divided: the wheyish and watrìe substance is confounded with the water, and cannot be known from it. Also the thinner and more subtle part of the blood is mingled with the water likewise: whereby yet notwithstanding after a sort, we may give judgement of the nature of the humour. The thicker part of the blood resteth in the bottom▪ which is reputed good and natural blood: if so be it be whitish, thin, bright, and cohering together. If the same be more gross, it showeth the grossness of the blood that remaineth in the body. If it be obscure, black, or otherwise coloured, after the difference of the colour, judge the blood to be corrupted, or not corrupted with filthiness of wicked humours. If it do not cohere, but be distracted and divided: it betokeneth uncurable putrefaction.  
Last of all, remember that the more unpure and unconcocted the blood appeareth, being altered from the nature of good blood, the same is to be withdrawn in the less quantity, and not so plentifully, as when the same draweth more nigh the substance of good blood: which is done otherwise, and quite contrary by our common barbers and letters of blood. And look how much the humours do pass and exceed, either less or more, the nature of blood: so much more sparingly, are we to let blood. And when they exceed too far from the nature of blood, either the one way or the other: then we are altogether to forbear bleeding, as we have noted in a certain place already.   

A short rehearsal of eight ancient errors, touching bleeding, and a sufficient confutation of them, by ancient authorities. Chap. 23.  
FIrst, that blood must not be let, but in the morning. This is confuted by Galen, lib. de Curand. ratio. per sanguine. Missio. Capitul. 12. saying: Fear not to let blood by night: forit is ridiculous that some do maintain: only letting blood, from the second hour of the day, to the fifth or sixth, and no other time.  
The second error is, that obstruction and putrefaction, are the causes of letting blood. Galen also confutes this 2. Metho. Med. cap. 14. in these words: Neither obstruction, nor putrefaction is the cause of letting blood, but abundance of humours: for neither can stopping, or putrefaction be cured by bleeding, but require other remedies.  
The third error. That opening of a vein is vnn●edefull, except the disease be present. This also is confuted by Galen▪ de Opt. sect. ad Thrasis, Cap. 37. For the most part (saith he) we use remedies, as purgagion and bleeding, when the disease is not present but future.  
The fourth error. That Phlebotomy must be done in the judgement day of a disease. Avicen impugneth this in quart. primi. chap. de Phlebo. saying: Neither must bleeding nor purgation be done, in the day of the moving of a disease, nor when the same hath Crisim. ●. judgement. But if it be possible, let there be rest. This is also proved Aphorism. 21. Qua judicatur vel iud●cata sunt etc.  
The fift error. That bleeding dulleth the sight. Galen removeth this error, li. de Curand. ratio. per sangui. missio. Chapitul. 7. Some have a weak sight, having aboundauce of blood: Evacuate such, either with purgation, if there be other humours beside blood, or by bleeding: and so detracting of blood doth good, not dulling, but quickening the sight.  
6 The sixth error is, that in fullness always a vain must be opened. Gaben confu●eth this error, 4. de vict▪ in morb. acut. comen. 19 Plenitude is not always cured by bleeding, but by rubbings, many and oft batlings, and by abstinence.  
7 The seventh error is, that blood must be let, the womb being very laxative, this Hippocrates refelleth, 4. de vict in morb. acut. cap. 118. If it be needful to withdraw blaud from any: you must stay the womb, and so let blood, and Galen in the same place saith: If the belly be flowing let not blood: lest the flux continuing, the strength of the body be cast down.  
8 The eighth error is, That there is no difference of the times of the year, to let blood in. Galen contrary to this, writeth ad Glanco. cap. 14. Those Physicians which consider not of the state of the times, and withdraw blood, they kill men. Et 4. de vict. in morb acut is Commentar. 19 If the Air be too hot and dry, we refrain from bleeding, though the sickness be vehement, and the age of the party youthful.   

A sufficient confutation of the supposed necessity of annual bleeding. Cap. 24.  
THere cometh here to my mind, a common opinion among the ignorant people, which do certainly believe, that if any person be let blood one year, he must be let blood every year, or else he is (I cannot tell, nor they neither) in how great danger. Which fond opinion of theirs: whereof so ever the same sprung first: it is no more like to be true, than if I should say: when a man hath received a great wound by chance, in any part of his body, whereby he looseth much blood: yet after it is healed, he must needs have the like wound again there the next year, to avoid as much blood, or else he is in danger of great sickness, yea, & also in hazard to lose his life: which opinion (if I did affirm to be true) albeit it be most false: yet I might use the like reason & authority to defend it, that the common people use, in the defence of theirs. For they can say nothing, if they be asked, why they think so; but that they have heard many to say so. Therefore I would wish, that no man should credit this foolish opinion, being most false, unless he can show some good reason for it, which I am sure no man can do.  
This I think, that like as blood letting is not good against all diseases: so is it not good in all persons (as we have set it down in the 9 Chapter) but only in those that will be content to use afterward a moderate & convenient diet. Those therefore that do abound with blood, & will be let blood to preserve themselves from the danger of any disease that is like shortly to ensue, must long time after be content to use a moderate diet: For intemperate persons & gluttons, great drinkers & wine bibbers; they do not only receive no commodity at all by bleeding; but often times greater hurt, than if they had been without it: For, within 3 or 4 days after, they fill & stuff themselves with more raw juices & humours, by unmeasurable diet, than they had before: and often times these die through convulsion.  
And hereupon we are to note, that there is such force in moderate diet, to eschew sickness, that without observation thereof, Phlebotomy is to no purpose. And therefore if this common saying of the common people be true in any▪ namely, that they must be let blood often, th●r are once let blood: it is only true in such as keep ill diet presently after bleeding. Therefore to conclude this Chapter, I council all persons to beware of excess after opening of a vein.   

Ofincision of Arteries. Chap. 25.  
AS a vein is opened, according to our former discourse hitherto: so sometime also an artery is opened, that is to say, only such a vein, wherein the vital spirits mixed with the blood do run & flow: but for the hard stinting of the flux from an artery: Physicians are in doubt to make insition thereof: and yet some sometime practise it (as in the disease called Vertigo.) If in opening of a vein, we chance to stick an artery, we can very hardly by & by stint the bleeding: and although the matter▪ fall out very well, that the wound or incision be brought to a scar by division: yet there will be a dilation, or spreading abroad of the cut artery still: as Galen witnesseth, lib. de Curand. ratio. per sang. missio. Cap 21. & 22.  
The bleeding of an artery is hardly stayed: partly for the heat of the arterial blood, which is very quickly moved, & by spreading abroad, openeth the artery, whereupon incision of an artery greatly furthereth the bleeding partly, because the motion of the arteries never ceaseth, as Galen witnesseth, lib. 2. Cap. 20. de Sanitate tuend. whereby also it cometh to pass, that the wounds of the arteries, are the more slowly cured. For such things as are to be healed, require rest & ease, Gal. lib. 5. Cap. 8. metho▪ medend. & comet. 6. lib. 6. Aphoris. The opening of an artery is to be used, when the body is replete with thin, windy, and very hot blood. For the seat of subtle, thin & wind●● blood, whereof the natural heat and vital spirits are engendered, is in the arteries: and to is the hottest blood which cometh from the hottest member, that is the heart, and which is carried into the other members of the body, contained likewise in the arteries. The receptacles of the thicker blood, wherewith the ●●embers are nourished, is in the veins.  
Upon what occasion Galen did cut an artery, he himself showeth, Cap. 22. dv Curand. ●at. per sanguinis missio. being warned (saith Galer) by certain dreams, of which, two among the rest, most plainly appeared unto me: I we●t to cut that artery of the right hand, which is between the forefinger and the thumb, and I let it bleed, till it stayed of itself: for ●o (saith Galen) I was warned by my dream: and there flowed out not a whole pound and the continual pain ceased, that was specially in that part where the Liver lieth in the midriff. I know one long troubled with continual pain in the side, freed thereof, by opening an artery in the arm: the same also being attempted through the warning of a dream.  
It is very dangerous, either willingly or unwillingly, to cut the greater artery under the vein in the arm, or under the vein in the hams: For the blood being thin, hot, & forcebly issuing out, will hardly be stopped, and many have died of Gangraena, rising in the member where the incision hath been: as did a Gentleman of new Rumney in Kent, a year or two past: and so much the sooner, cometh this putrifieng, rotting and mortification to the member, when the Phlebotomer goeth about with a band to stay Haemorrhagiam: That is the dangerous flux of the arterial or vital blood. If the blood be stayed, the wound cannot be brought to a scar, without Aneurisma: by reason of the continual pulse, and the thick and hard tunicles in the same place. If necessity so require, it is best to cut the whole greater artery overth wartly, for the blood is soon stayed, when the ends and extremities of the artery cut asunder be pulled up, whereon the plaster of Aloe before spoken of Cap. 19 is to be applied.  
Without these dangers we may cut the lesser arteries, which are in the outward limbs or members: as in the head, hands, and feet. For these may be fastened together, chief in soft, moist bodies, as of women and children. These are opened in continual and great pains, about the uppermost skin of any member: which pain, is like a pricking, or kind of shooting, because of sensibleness, and much feeling of the Membrana or outmost skin: and it is therewithal a beating pain, by reason of the moving of the arteries. The cause of these pricking pains, is abundance of much thin hot blood, enclosed in the arteries of the pained place, and the same is taken away, when the outward arteries, are found out and cut, which proceed from those inward affected members.  
Few in our days cut arteries, because they are not manifest to appear in sight, nor easy to come by. Arteries cut in the temples do remedy, hot biting humours, and fluxes of the eyes, in which cases▪ these arteries are wholly cut, and burnt with an hot iron, or some burning medicine.  
Arteries behind the ears are cut in swimmings, and continual pains of the head, caused of wind and of heat: Also in redness of the face, and in other long continuing affects of the head.  
The artery between the thumb and forefinger is opened with continual pains of the sides, between the bowels, and the Midriff.  
An artery about the ankle is opened: in long continuing pains of the huckle bones, always chose that artery, which is direct to the affected member, as we advised before in opening of veins.   

Of particular evacuation of blood, and first of bloodsuckers or horseleeches. Chap. 26.  
TO this discourse of opening a vain, which is a general evacuation of blood, is to be added, the particular evacuation thereof, by leeches and ventosas: whereof we will briefly speak in these two Chapters, and so conclude this our present Pamphlet.  
When blood is so in any member, that it cannot be pulled back by opening of a vain or by some other practice: the same is to be withdrawn from the affected member, by such remedies, as may outwardly abide upon the grief, and so free the same of the present evil. Of this sort are Leaches. Launsing, cupping or boxing: which apparently draw blood, from the member affected.  
Leeches or bloodsuckers, are worms found in waters, which applied outwardly to the member, draw forth blood: They make a three square wound, which penetrateth not only the skin, but also more deeply if the skin be tender▪ (as is the skin of children and infants.) These being empty and well applied, suck out blood greedily and safely, and that so long, till they swell with fullness, and so fall off: And sometime when they are off, the blood still followeth plentifully, especially if they were fixed upon so open and manifest vain: In which case, they stand in steed of Phlebotomy. Thus applied to the hemeroide veins, sometime they do so provoke blood, that to stop the same, we are necessarily forced to use things astringent: yea, and applied to the arm of children, they are equal to bleeding: And that extraction which is thus drawn from a hollo we vain, is to be accounted for an universal evacuation. But when they are fixed to the hard skin under which there is no great vain, they only empty that place that these touch: extracting very little from the nearer parts, and nothing at all from the members far off. And therefore leeches are only usual in corruptions of the uppermost skin: as in the scab in Vitiligo, which is a foulness of the body with spots of divers colours, whereof are three kinds: In Impetigo a disease which we call the ringworm. In the disease called Panus, which after Celsus is a kind of kernel growing in the grind of a man, or behind his ears: In redness of the nose and face, and little swellings in leprous persons. So oftentimes we apply them to the Arsehole called Anus, against melancholy diseases, caused of the stopping of hemorroids. In scabs, itch, and wicked wounds, they are very profitable: the body being first evacuated by letting of blood. Yea, the drawing of horseleeches is more convenient in fullness of blood, than scarrifieng is: Forasmuch as they fetch blood more deeply, and also that which is withdrawn by Leeches, is more of the substance of blood: Albeit the opinion of some is, that they draw no blood, but corrupt blood; and such as is not agreeable, and proportionable unto our bodies. And therefore in griefs which happen between the skin and the flesh, of blood corrupted, these are more convenient than scarrifieng.  
The attracting of blood by Ventosas and horseleeches, hath this difference: that these draw more deeply from the body: Ventosas but from the superficial parts. Therefore let Leeches be applied to those places, from whence we would draw humours more deeply.  
Their use and application is this: First, before they be put to any part of the body, they must be kept all one day before, and nourished with a little blood, which we may give them in a little piece of fresh flesh: then we must put them, and keep them in clean water, somewhat warmed: and before we use them, with a sponge wipe away the skin that is about them: Rub the part of the member affected whereto you will apply them with salt: or scratch the same till it look red: or anoint the same with a little fresh blood. Some lay on them a sponge, that when they be full, they may fall away. They are with most safety let down in a reed or a pipe to the affected member, lest they might touch together, and so by that means of end those parts that are sound and whole. And first before you apply them, so press them and wring them out, that they may utter and cast forth all their venom, so as their backs be green, and their bellies reddish.  
We are to choose such Leeches as are not in fowl troubled black waters: nor such as have long rays or strikes in them, like rods: called Hyrudines Virgulatae. Nor such as are of the colour of Lapis Lazulus: for these are venomous. But we are to choose them, that be red, inclining to the colour of the liver, having two red lines or strikes: or inclining to a certain greenness, having little heads, and being very slender, and had out of clear flowing waters. Let them not be black, nor having a certain white hearinesse upon them, as we see there is upon certain herbs as clary, and upon certain fruits, as upon the Quince: but (as ye heard before) take such as have green backs, and red bellies.  
To make them fall off if need require, put to their heads Salt, lime, Dust, Ashes, or Vinegar: straw any of these upon them, and they will fall away, if you will have them off sooner, put a horse hair between their mouths and the place, and draw them away: when they are off, wash the place with a sponge. To ●●nt the blood after they be removed, if need so require: for sometime blood floweth out two hours after the Leeches be gone, straw upon the place, powder of roses, or of burned ga●ls, or powder of a new tile, or powder 〈…〉 straw, a little Sanguis Draconis: or lay on the place, powder of a sponge, and pitch 〈◊〉 or a linen cloth burned: or the herb 〈◊〉 Pastoris bruised.  
●fter the fall of the Leeches, apply cupping 〈◊〉 to purge the venom, and excrements which they have left behind, and to withdraw 〈◊〉 blood, which they have drawn somewhat outwardly, but have not quite evacuated.  
Finally I give advise, that before you use them to the purposes aforesaid, you apply them being hungry, which is done thus: by keeping them in water a day, so that they eat nothing. If you will keep them longer, put in the same water some lambs blood; or such like, that so they may be kept alive some season. For further matter herein, I refer thee to Galen, who hath written a book De Hirudinibus: That is of Bloodsuckers.   

Of Cupping, or boxing & scarification, the other two particular evacuations of blood. Chap. 27.  
FOrasmuch as it is not convenient to be let blood oft times in the year: for that much of the vital spirit passeth forth with the blood, and that the blood being taken away, the body waxeth cold, and the operations of nature become weak and enfeebled (as we have before in a certain place declared:) therefore I counsel (saith Galen) that the base parts of the body, as the legs, be boxed or cupped, which is the most sure remedy, as well to conserve health, as to repair the same being decayed.  
For it cureth the eyes annoyed with long distillations. It profiteth also the head, & upper parts of the body, as the breast and back, and against sundry other diseases. For in what member so ever the blood is gathered, the body being first purged by cupping, the grief may be cured. Also Oribasius affirmeth, that it helpeth Quincies in the throat: dissolveth stops of all places. Notwithstanding application of boxes about the stomach, in hot fevers, where reason is troubled, are to be eschewed, for fear of suffocation. Likewise, put unto the head undiscreetly, they hurt both the head and the eyes.  
Boxing helpeth swellings, letteth forth wind, stoppeth immoderate Terms, and the bloody flux: helpeth appetite: when a woman soundeth, it reviveth her spirits again. It draweth forth water: assuageth hard swelling: cleanseth Melancholy, and that chiefly in weak bodies. It will remove humours from place to place: as from the head to the neck: from the neck to the shoulders.  
Galen wrote a book entitled de Cucur bitula, t●a● is▪ of the Cupping Glass: and rehearse h●●p●●nese effects thereof, that boxing do●t●: Non solum materiam evacuare, sed et●●m dolorem solvere, Phlegmonon minuere, ins●●t●onem discutere, appetitum revocare, ventriculo in firmo roburaddere, a●imi deliquio liberare, ex al●o fluxiones transfer, sanguinis eruptiones cohibere, facultates mensium corruptrices extrahere mensesque supprimere. i. not only evacuate the matter, but also assuage pain, take away inflammations, abate swellings, recover appetite, strengthen a weak stomach, revive those that sown, draw down fluxes, and stop fluxes: withdraw corruption of Terms, and also stop the flux of them. Which effects shall hereafter be reheased, with their cures by this practice more particular.  
There are three causes which persuade us to use this practice, and to refrain letting of blood.  
First, because our purpose is to evacuate from some one member, and not from another: and therefore particular evacuation is done by boxing or Cucurbitulas, which they that follow barbarous authors in Pinsicke do also call Ventosas. Now particular evacuation cannot be made by Phlebotomy: for the same evacuateth and emptieth from the whole body.  
Secondly, because the strength is weak, or the age unfit to bleed: or that there is some other of those impediments spoken of in the 8 Chapter. For as Rhazes sayeth in 7 Ventosas draw blood but from the little veins: and therefore the heat and spirits are thereby but a little diminished: whereas opening of a vein greatly debilitateth nature, drawing from the greater veins with the blood, much heat & vital spirits.  
Thirdly, because our intent is to evacuate only from the base members. Bleeding evacuateth from the most noble members, and greater veins: Ventosas from the mean members, and little small veins, which arein the outward bodily parts, and lie without the greater veins.  
Of boxings there are two sorts, the one gentle without scarification or lancing: the other with scarification, which both in steed of blood-letting are used, when age, debility, the time of the year, or other considerations will not permit the open ening of a vein. Hereby is produced the thin blood next the skin: and being presently used after scarification, when little incisions and holes are made in the member, that blood and humours may easily come forth: it mightily withdraweth by force and flame of heat, not only the thin & flowing humours and spirits which are about the member after scarifying, but also that which is in places further distant. If the skin (I say) be first exasperated with the Iron, it doth this that we hear speak of more manifestly. If the skin be whole and not scarified, it provoketh blood and humours from the furthest parts into the skin, and bringeth it to that part, whereunto the cupping boxes are applied. The cupping glass infixed (the skin being incided or lanced) purgeth the outmost parts of the body more mightily, than if to the affects we only used either scarification, or only leeches.  
Boxings without scarification, which are called easy cuppings, do not apparently withdraw blood, but only the spirits: yet it doth pull back unto it humours, and forcible fluxes: and applied to the contrary part, it stayeth effusion of blood in any place wheresoever: chiefly, when infirmity of strength will not permit revulsion, by opening of a vein. Moreover it stayeth fluxes of the womb, or of humours: and applied to the member where the flux of humours is, it turneth the same another way. Also, it provoketh outwardly that flux of humours which lieth deep in the body: & therefore it serveth as a remedy in astonishmentes, palsies, & in veterat pains: it wasteth wind & spirits, included in any member: and therefore quickly stayeth tremble or pant of the heart, or elsewhere within the body, the hicket, colic, & pains of the rains. And this present kind of remedy, is without danger: neither hurting the body, nor weakening the strength.  
That easy & light boxings are best for revulsion, as to pull back Terms, appeareth by Hippo. 5. Aphoris. Aphoris. 50. Simulieri menstrua sistere volveris, Cucurbitulam quam maximam, sub mammis defige. If thou wouldst stay Terms in a woman, apply a good great cupping glass near or above her paps. And Galen. 5. lib. Ther. Metho. with easy boxing, applied Hypocondiis. i. the sides & short ribs, above the navel, where the Liver lieth on the right side, and the Spleen on the left: affirmeth bleeding at the nose to be stayed, being applied on the Liver, or right Hypocondrion, if the flux come forth of the right nostril, and on the left Hypocondrion, and on the Spleen: if from the left, and upon them both, if it proceed from both the nosthris.  
Again, gentle cupping is used in such persons as are already evacuated, in stuffed bodies, we use them not, nor in inflamed members, nor in the beginning of other affects, but where as nothing else hath been before, or where the body hath been already evacuated.  
In this case of revulsion by cupping without scarification, as in flux of Terms, as ye heard out of Hippo, and in flux of blood from the nose, as ye heard out of Galen, be very circumspect to apply the cupping glasses on the member set over against the place, from whence we purpose to pul-backe, according to rectitude of position: that the place cupped may have agreement with the place, from whence we purpose to revoke. Otherwise we do no good, as we showed before, speaking of revulsion in bleeding, Chap. 6.  
Again, gentle cupping is used without scarification, when we will draw humours from deep and inward parts of the body to the outward members. Therefore Galen. 13. Method. Medend. saith: that it is caeteris attractivis fortius: stronger than any other attractives: thus in hard apostumations, it draweth the matter outward: yea, and by it, hard apostumations may be removed, if general evacuation have gone before, according as the fullness in the patient requireth.  
Again, it is used without scarification when we stay any member, or bring a member to his proper place. Thus when the bowels fall down, we apply Ventosas above the belly, to retain them or bring them back.  
Also, it is used without scarification, to dissolve windines, as in the colic: so a certain fat woman troubled with the colic, took two narrow mouthed pots, & did put them magret brazen vessel, & she did put the vessel of brass to the fire, & afterward applied the two hot pots to her belly: first covering the same with alynnen cloth, & so she was healed.  
Item, it is used without scarification to mitigate pains, & that in all apostumations and colliks generally, whether the same be cau●ed of cholenke matter, stegme or windines. Galen lib. 13. Metho. Medond. Cap. affirmeth: 〈◊〉 it wasteth wind, & so careth the cause i● it come thereof: or it mitigateth the p●ine, a●beit it do not perfectly cure it, of what matter so ever it come. With scarifying it is used, in inflamed members, stuffed or vexed with pain, in the disease called Scirrhus, which is a ha●d●●●s growing in the fle●h within the skin, called commonly kernels: in fluxes that are stayed in a certain place.  
Also when the parts are filled with sharp matter, or outwardly infected with venom: or when we will draw the matter from one member to another. Also, it is used with scarification in sharp diseases, when the strength is weak, and nature not able to tolerate bleeding. And thus you have heard, in what cases boxing is used without scarifying, & with scarifying, which is a worthy and profitable observation.  
The difference between Ventosas & Phlebotomy is, that Phlebotomy evacuateth the gross blood, and the other subtle and thin blood. Again Ventosas are called attraction per vacuum, and differeth from attractions made by medicine, or not made per vacuum. Attractive medicines which do purge, attract & evacuat some certain determined humour. Phlebotomy all the humours indifferently, and Ventosas, or attraction per vacuum, that humour that is most subtle and thin among them all in that part.  
The difference between the attraction made by Ventosas, and that made by leeches is this: that the leeches draw humours from the profound and deep places, and Ventosas but from the superficial parts.  
Item, fat persons are not to use cupping: for it is with them, as with water pipes in the ground, which being filled and stopped with earth or other matter, stay the water course that it cannot run: so the veins in the body, are like those water pipes, and are sometime so filled with fleshy fat, that the blood cannot have his course thorough them, and therefore the veins in fat folk, being either so strict, or so stopped, the Ventosas cannot withdraw from them, but with great violence: and if they attract any thing, it is the most subtle blood, the gross blood cannot pass thorough the stopped places.  
Concerning the time, they are not to be used at the new of the moon, because then the humours are quiet, and so hardly drawn, nor in the last quarter: for this season being cold, the humours are not easily attracted: but in the middle season: when the humours are flowing, and are not too cold: and use them in the third hour of the day, for then by reason of heat, the poors are opened, and the blood being then easily movable, is with the more facility attracted to the members, and from the members,  
After bathe we are not to use them, for there were to be feared, too great a flux of blood, yet if we can perceive the blood to be too gross, we may to subtiliate the same, use bathing before in such a case, as was said in the rules of Phlebotomy.  
That these points thus generally spoken of me hitherto, may in particular with more profit yet now be set down, we will before we conclude, proceed therein a ●itle further, to the application of Ventosas particularly, in eu●ry practice.  
Boxing without scarification are used, to revoke and pull back matter, called before revulsion: or to turn blood and humours aside, which was called derivation, cap. 6.  
Thus cupping revoketh blood at the nose, as ye heard above out of Galen, by applying the Ventosas unto the sides: that is, upon the liver and right side, if out of the right nosethrills, & contra, as before.  
Thus we stop flux of terms, applying a great cupping-glass to the root of the Paps, as ye heard out of Hippocrates.  
Thus the falling down of the womb or matrix, is revoked by application of the cupping-glass, near to the navel.  
Thus to revoke matter from the head, 
we apply them, to the inside of the Thigh: where note, that this better provoketh terms, than the opening of Saphena vein.  Thus against stopping of terms, 
we apply them, to the inside of the Thigh: where note, that this better provoketh terms, than the opening of Saphena vein.  Thus against stopping of hemorroids, 
we apply them, to the inside of the Thigh: where note, that this better provoketh terms, than the opening of Saphena vein.   
Cupping-glasses are not used for derivation sake: that is, to turn blood & humours aside another way, except when the body is first evacuated, or when the humours are settled in any part, and that the member is swollen, in this case, for derivation sake, we apply Ventosas to the hinder part of the neck than to the parts called Spatulae, which join to the neck; sometimes also to the but tocks and haunches.  
Boxing with scarification is used, when some evacuation of blood is required, standing in steed of Phlebotomy (as we said before) when certain occasions hinder the same. First, in this practice we apply the Ventosas to the member. Afterward we open that very part, in many places in the skin only, with a small penknife, for the purpose, and so applying the glasses again, we evacuate blood. But we must not do this before the body be first evacuated, chief in unclean and corrupt bodies, lest too great abundance of humours be drawn into that part. Boxing with Scarification is used, either in the upper parts, in the middle parts, or the lower parts of the body.  
Cupping-Glasses applied to the foreparts of the head: offend the Senses and understanding. Applied on both the middle parts of the neck, or upon Nucham Puppis: they stand in steed of opening Vena Nigra, and they help heaviness of the brows, and lighten the eyelids: they help scabbines of the eyes: they cause both the Parent and the child begotten by him, to be forgetful. Vuerkerus.  
Ventosas applied to the lower part of the neckwhich is called Acheal standeth in steed of opening Basilica: they help pains of the shoulders and gullet: that is, the place whereby meat and drink passeth into the stomach: they help diseases of the breast, caused of blood: the cramp caused of blood, and trembling of the heart.  
Ventosas applied to the upper part of the neck: that is, the very joining together of the head and neck: are in steed of opening Cephalica, and help in affects of the head, as the shaking, and particular palsy of the head: yea, and in affects of the parts of the head, and therefore it profiteth for toothache: pains of the eyes and ears: but there must go before purging of the whole body: lest matter be drawn up again to the head, and fill the same, and so the diseases increase again: as Galen saith, 13. Method. Medend. cap. 4. we must beware here in this case, not to apply them thus too oft, because they hurt the memory.  
Where as a little before we spoke of an application, which served in steed of Basilica: so we say now that Ventosas applied above Spondiles, serveth also in steed of Basilica, and cleanseth the breast: and yet hurteth the mouth of the stomach, and causeth trembling of the heart: and therefore they are subject to these diseases, must beware how they use them, and yet according to Rhases. 2. ad Almonson. It helpeth in trembling of the heart, caused of repletion and with heat. But it should seem, that either Rhases meant of application of Ventosas to the lower part of the neck, called Acheal, which indeed (as we said before) helpeth trembling of the heart. So confounding this application with the former. Which the rather may so seem, because it is said: that they both serve in steed of Basilica: or else (that this application hurteth the heart) is ignorantly added, and put to of some undiscrete writer.  
Ventosas applied to or under the chin, helpeth the teeth, the face and the throat, cleanseth the head and the jaws: especially they cleanse the face from scabs and itch.  
Ventosas applied in the joining together of Spatula with the neck, profiteth in passions of the face, as scab or itch, and in stink of the mouth. It may be, that this application is even the self same which immediately went before. And thus much of particular application of Ventosas, to the upper parts.  
Now of their application to the middle parts of the body, applied between the two Spatula: his hands, or hath allanderous tongue, & can do they help diseases of the breast caused of blood, and a cramp coming of the same case, and in these two, this application agreeth with that, to the lower part of the neck, before called Acheal: but this last application, hath two discommodities: for they weaken the stomach, and cause trembling of heart. Where note, that this application seemeth one and the self same, with that Super spondiles, and so it is true, that was there said, concerning the offence of the stomach and heart thereby.  
Ventosas applied above or upon the rains, help apostumations and bushes of the thighs or haunches, scabs, gout, and hemorroids, leprosy, windines of the bladder, & matrix, itchings of the back, and all diseases of the lower parts.  
Ventosas, applied under those parts called in Latin Cavillas, otherwise Alchahab, helpeth stopping of terms: the gout in the feet, and the Sciatica gout, and thus of application to the middle parts.  
Thirdly, concerning their application to the lower parts. Ventosas applied above or upon the thighs, or rather the shank from the knee to the ankle: which part of the leg in Latin is called Crus, they stand in steed of Phlebotomy: they mundefie the blood, provoke terms, and are better than the opening of Saphena, to provoke terms, in white, soft, and weak women.  
Ventosas applied to the former part of Coxa: That is, the Thighs or Haunches, helpeth apostumations of the testicles and wounds of the Thighs, Haunches, and Shanks applied to the hinder part thereof, they help apostumations of the Arse, and Buttocks: and goings out of the fundament, and blames, and bushes in the same part.  
Ventosas applied between the two Anches: That is, hypsor buttocks: helpeth the two Anches: and the two inner parts of the thighs or haunches. Also the hemorroids: the gout in the foot: and ruptu●s about the privy parts of men or women.  
Ventosas applied upon the buttocks, attract from the whole body, and the head, and helpeth the bowels: also they help corruption of menstruous terms, and by means thereof lighten the body.  
Ventosas applied under the ham behind the▪ knee, help beating & shaking in the hams, caused of an hot humour: also wicked bushes, & corrupt ulcers in the shanks, & in the feet: and thus much of the particular application of cupping or boxing glasses.  
There is another kind of boxing that we have not here to deal withal: necessary and good sometime to be used, as for example sake: If you have any saucy Lout, or loitering Lubber in your house, that is either too busy of nothing but play one of the parts of the four and twenty orders of knaves, there is no prettier medicine for this, nor sooner prepared, than boxing is, three or four times well set on a span long on both the cheeks: & although perhaps this will not alter his lubberly conditions, yet I assure you, it will for a time change his knavish complexion, and help him of the green sickness: and every man may practise this, as occasion shall serve in his own house to reform them.  
Because as we have said, boxing is often used together with lancing: therefore a word or two of scarification and so an end.  
Lancing is done with a Lancelot or some instrument called in Greek Epidermes: and in Latin Scalpellum. The member is cut by little and little with this Chyrurginall instrument, ometime it striketh but the very skin: sometime it goeth in deeper. It evacuateth only out of the divided member, except by hap it wound and hurt the vain. Scarification causeth the humour underneath to pass forth, not forcibly extracting any thing from places distant and further off: and the deeper the Instrument goeth in, the more abundant is the effusion of blood: It serveth to purge the skin, and helpeth those affects which Leeches do cure: and those which are in the skin, and stick stiffly unto the same: As old inflammations of corrupt matter, as the disease called Scirchus mentioned before as Gangraena, a cankerous mortification of a member, or part of a member: as Sphacelus, which is when any part or member is mortified, thorough inflammation and such like, in which diseases, natural heat being (as it were) choked up, and strangled, desireth (as it were) to be winnowed. Where note, that Launsing doth more plentifully draw blood, if presently upon it, boxing be used, as was partly signified before.   

A profitable and compendious Table of Phlebotomy or bloudletting containing divers points in this Treatise handled and discussed of, and setting down by division the general and special considerations thereunto belonging. Chap. 28.  
A principal rule and observation.  
AS in other things, so in bloudletting the cause is first skilfully and circumspectly to be considered, as that it be to purge the body of some unnatural, naughty, and superfluous humour, whose substance is either simple, or mixed: Simple, when it doth of itself without the admixture of any other degenerate, as blood doth when it putrefieth in the vain, the Pores being stopped: mixed, when it is mingled with some that is already corrupted, as in the dropsy, where the blood is mixed with water The cause being thus allowed, and certainly known for needful and good to the Patient otherwise letting of blood is very dangerous, and openeth a way to grievous infirmities, as ye have heard in this treatise.  

There remaineth to be considered, how it standesh with the Patient.  
Inwardly 

For his Complexion.  
For his Age.     

Outwardly 

For the time of the year, and month generally.  
For the time of the day and diet particularly.     

1 Complexion.  
In the complexion is to be considered, whether he be 

Sanguine. i hot and moist.  
choleric. i hot and dry.  
Melancolicke. i cold and dry.  
Phlegmatic. i cold and moist.     

2 The Age.  
In his age: whether he be 

In his youth.  
In his manly middle age.  
In his elderly age.  
In his crooked old age.     

3 The time of the year.  
Concerning the time of the year, he is to be advised what parts thereof are 

good, as the spring: from the midst whereof to the beginning of Summer, is simply the best time: howbeit some think Autumn reasonable good, as no doubt it is in regard of Summer or Winter: being otherwise in itself, rather to be reckoned for bad than good.  
Bade 

Very bad, as Summer & Winter, for the extremity of heat & cold.  
More tolerable, as Autumn, being somewhat more temperate.       

4 The time of the month.  
Concerning the time of the month these general cautions are to be observed, that he be not let blood in any member with chirurgical instrument: 

The Moon being in ♉. ♊. ♌. ♍▪ or the last half of ♎. and first of ♍.  
The Sun, the Moon, or lord of the Horoscope being in the s●gne that ruleth that member.  
The Moon being in any part of via lactea, or in via combusta, or in domo casus sui, or being vacua or tarda cursu, or in terminis infortuniorum, or in the duodenarial division of the 12. houses, placed either in 1. 6. 8. or 12. place thereof, or applying to the lord of the house.  
The d●y before the day itself: the day after the change of the Moon.  
Half a natural day, that is 12. hours before & as many hours after the quarters of the Moon.  
A day before & a day after the full of the Moon.  
A day before & a day after the conjunction, quartile opposition of the ☽ with ♄ or ♂.  
A day before the conjunction of the ☽ with ☿. ♀. or the head or the tail of the Dragon infortunate, and evil.     

The convenienst time of the year. 

For the Sanguine: the Moon being in any of the signs.  
For the choleric: the Moon being in ♋. or ♓.  
For the Melancolick: in ♒. and first half of ♎.  
For Phlegmatic: the Moon being in ♈. or ♐. Howbeit some commend ♋. ♒. and ♓. for blood letting.     

Also the best & most laudable aspects for this purpose are these, according to our soundest writers. 

The conjunction of the Moon with ♃. or ♀. are simply the best: so that ♀. be not combust.  
The △. or ⚹. of the ☽. with ♃. ☉. ♀. and ☿. are good: but especially with ♃. or ☿.  
The ♊. or ☍. of the ☽. with ♃. or ♀. doth well.  
The △. or ⚹. of the ☽. with ♂. are indifferent good.     

The time of the month for 

Youth: from the change to the first quarter.  
Middle age: from the first quarter to the full.  
Elderly age: from the full to the last quarter.  
Old age: from the last quarter to the change.     
A reason of this rule is: Like rejoiceth in his like. Howbeit as we have taught in this Treatise no child would be let blood before fourteen years of age▪ nor old man after threescore and ten, unless his strength be the greater and somewhat more than ordinary, at those years.  

5 The time of the day.  
The time of the day must be either 

Morning: after the rising of the Sun, when a man is yet fasting: which is simply the best, excepting the hours of ♂. and ♄▪ and choosing the hours of ♃▪ and ♀. whose nature is most temperate.  
Afternoon: after reasonable good, or rather perfect digestion and expulsion of of superfluities.     
Herewithal regard must be had of the air, that it be neither too hot, nor too cold: or cloudy: but mild, clear, and temperate: the wind being then either Northerly or westerly. The Southwind is counted no friend to Phlebotomy: whereof this is the reason, heat looseneth too much: cold bindeth too much.  

An Exception.  
NOtwithstanding the premises of blood-letting before: The Frenzy, Squinancy, Pleurisy, and Apoplexy, or for a continual headache proceeding of choler or blood, for any hot burning Fever, or other extreme pain and desperate disease: A man in such a case may not tarry a chosen time regularly set down by the Astronomer or Physician: for so the Patient might miscarry in the mean season. But incontinently with all convenient speed, he is this way to seek his remedy: except either he be very weak, or like to sown, or that the Moon be in the same sign that ruleth that very part of the body. Where also note, that in the foresaid case of extremity, blood is not to be let in so great a quantity as otherwise it would, if a chosen time might conveniently be expected.  
As before bloudletting these circumstances of complexion, age, and times are to be considered▪ So after the same, consideration is to be had of our meats and exercise.  
For meats such must be taken as are of an easy and light digestion.  
For exercise we are to abstain from all exclusive, until the fourth day, not only those that be vehement: as riding, running, leaping, vaulting, wrestling, fensing, tennis, etc. But also such as are more mild, as walking, bowling, bathing, and especially Venery: whereof we have spoken in the twentieth Chapteer: and I doubt not but I may effectually conclude, (both antecedent and consequent limitations duly and orderly observed) this ancient practice of Phlebotomy to be very commendable both for the preservative and curative intention of Physic.   

Conclusio Operis.  
And thus according to my simple skill, and poor talon, I have set down those remedies, which withdraw blood, either from the whole body generally, as Phlebotomy: or from certain parts particularly, as Leeches, boxing, and scarification: which was my purposed determination at the beginning to do. If any thing be here set down repugnant to sound skill, I crave pardon, having no skill to judge, because Physic is not my profession: only drawn with a delight in this practice: First, for my pleasure, now (I trust) for orhers' profit, I have further trau●iled herein, than I thought to have done. If any fault or error be in the order, method, or disposition, I assign that vn●o myself▪ 〈…〉 pardon for aught that is amiss: protesting in truth, (which a man may easily descry) t●at this book is rather a collection from others, than an invention of mine own. God grant that this my travail herein, (whatsoever it be, may make unto his glory, and the comfort of his people, which are the two impulsive causes, moving every good Christian, one way or other, to employ his endeavour.    
Deo laus honos & gloria in omne aewm.  
FINIS.   

¶ The Contents of the several Chapters in this Treatise.  

Cap. 1 OF fullness, emptiness, and their divisions.  
2 What evacuation is, and the kinds and diffeces thereof.  
3 What Phlebotomy is, and from whence the opening of a vain doth evacuate.  
4 Whether Phlebotomy must go before purging or contrary.  
5 Of the effects, that is, the profits & disprofits of bleeding.  
6 Of rewlsion, that is, pulling back: and derivation, that is, turning a side of blood and humours by opening of a vein.  
7 Whether purgation by siege or inward medicine received can not, or may not evacuate the blood, and the reasons answered that are brought for proof thereof.  
8 Of the impediments or lets of Phlebotomy, and of the causes requiring and furthering the same.  
9 Of such persons as are meet or not meet to be let blood.  
10 What corruption of humours, bleeding removeth from the veins generally.  
11 A particular rehearsal of those diseases present or future, which are cured by bleeding.  
12 What voluntary eruption of blood profiteth in sickness.  
13 How to know by certain signs the greatness of the disease, & the firmness of the natural forces, whereby conjecture may be made whether the patiented be to be let blood or no.  
14 To know by the greatness of the disease, and strength of the natural powers, the quantity of blood that must be withdrawn.  
15 An observation of things present and past, and also a foresight of things future, needful and necessary to the further knowledge of the quantity of blood that must be taken.  
16 Of the times and seasons of the sickness of the year, of the day, and hour of the day, when a man is to bleed or not to bleed.  
17 Of Astrological observation in bleeding, and of an other observation nearly annexed unto the same, showing what members and parts of the body are to be opened according to the several seasons of the year.  
18 What preparation must go before bleeding.  
19 What is to be done in the very time of the incision.  
20 A prescription or regiment of the patiented after bleeding.  
21 What veins are to be opened both in general and particular diseases.  
22 A profitable observation of the blood extracted.  
23 A short rehearsal of 8. ancient errors touching bleeding, and a sufficient confutation of them by ancient authorities.  
24 A sufficient confutation of the supposed necessity of annual bleeding.  
25 Of incision of the arteries.  
26 Of particular evacuation of blood, and first of bloodsuckers, and Horseleeches.  
27 Of cupping or boxing, and scarification: the other two particular evacuations of blood.  
28 A profitable compendious table of Phlebotomy or blood letting, containing divers points in this Treatise handled, & discussed off, and setting down by division the general and special considerations thereunto belonging.    

The names of the authors whose help is chief used in this Collection.  

Aristotle, Actuarius, Aetius,  
Avicen, Alexius, Andernacus,  
Averroes, Arnoldus de villa nova.  
Bacchanellus,  
Bullein Anglus.  
Cornelius Celsus.  
Eliota Anglus.  
Fernelius. Fuchsius.  
Galenus. Gesnerus.  
Hypocrates. Rich. Harueius Anglus.  
Holl●rius.  
johannes, de Santo Amando.  
johannes de vigo.  
Mesue.  
Oribasius.  
Paulus Aegineta.  
Rhasis.  
Rondoletus.  
Schola Salerni.  
Weckerus.    


LONDON, Printed by William Hoskins & john Danter, dwelling in Feter-Lane. 1592.  
●y●sts i● 〈◊〉 ●*