His first Argument against Phlebotomy.

This is the principal Argument which he hath against Phlebotomy; yet doth he so handle it, as that the onely evidence it carries with it, is, that the Author is a most illiterate person.

It is very ignorantly done of him, to make as if the Galenists in general did let their Patients bloud, merely for a Cacochymy, or depravation of the bloud, as if it were a Rule amongst them, that Whensoe [...]er the blood is de­praved, vitiated, and corrupted, it ought to be emitted by Phlebotomy. Whereas there is not any tenet amongst them more general, then that Cacochymicat bodies re­quire purging; the Plethorick, or such as are in dan­ger to be surcharged with excess of blood, require Phlebotomy; nor do they recede from this resolution, but in urgent cases, and with deliberation: and many are so cautious herein, that if the bloud appear in the porringer to be of an evil colour, Vallesius me­thod-medend l. 2. c. 4. and very corrupt, they enjoyn us to stop the vein presently, and not continue or repeat the eva­cuation. I shall set down the words of Horatius Angenius. Hic vulgarium Medicorum error detegendus est. Horat. Augen. de miss. sangu. l. 9. c. 24. Putant quo sanguis impurior fuerit, & à sua na­tura magis alienus, eo plus detrahendum, & in hoc mirifice sibi placent, in vulgusque propo­nant admodum utilem factam fuisse vacuationem, quod corruptissimum pessimumque sanguinem va­cuaverint. Tu vero cui in animo est humano ge­neri [Page 12] prodesse, & Medicinam inculpate exercere, contra facies; quanto enim magis sanguinem vi­debis à propria natura discedere, tanto minorem quantitatem vacuabis, & aliquando (nisi co­pia urgeat cacochymiae permista) à venae­sectione prorsus abstineto. Nor is this the judgment of a single writer; hundreds are of the same opinion: the Learned L. Septalius Animadv. Medic. l. 4. sect. 2. is of the same judgment. In sanguine detrahendo cavendum maxime, ne, quanto putriorem, & deterioris conditionis sanguinem è vena profluere viderimus, tanto majorem quantitatem effluere sinamus: quod plurimos facere observa­mus: tali enim existente sanguine, & pauciores subesse spiritus constat, & vires facillime solent collabascere. Even Galen and Avicen are alledged for it: Petrus C [...]stel. de abusu Phle­bot. pag. 73. And it ought with less reason to be objected in England, because our Physi­cians generally (as likewise are the Germans) seem not so prodigal of the bloud of their Patients, as to make a Cacochymie, much less, a [...], or total corrup­tion of the sanguineous mass to be the proper indication for bleeding: nay, most that hold Blood-letting in great dis­eases arising from Cacochymie, to be a necessary remedy, (not indicated by the depravation of the bloud, but violence of the disease;) they are cautious in the quantity which they take away, because in such an habit of body the strength of the patient is seldom great enough to bear much. Alex. Massaria Apolog. l. 11. disp. 11. c. 14. Out of which it is manifest, that what he sayes about the impurity of the bloud in the porringer, that 'tis an ex­cuse or imposture used by the Galenists in defence of Phle­botomy: it is a fiction of his own, not made use of directly by any but the followers of Botallus: the rest will give him other reasons for their practice, than a Cacochymie alone, or total corruption of the mass of bloud.

A farther mistake it is in him, that he represents the Galenists as such pittiful fellows, that should not know but that each corruption of the bloud is incorrigible, and [Page 13] therefore let it out. It is true, that we do hold, that it is pos­sible for the bloud to be so vitiated, as to be incorrigible, and that one may assoon hope to see the regress from a total pri­vation, as it restored. This hath been observed in pesti­lential diseases sometimes, and in sphacelated parts: and perhaps I may be allowed to reckon as such, the bloud of that person in Fernelius, Fernel. Physio­log. l. 6. c. 7. which was universally coagula­ted in the veins; so as to be taken out as 'twere branches of coral: River. obs. communicatae à Pachequo, obs. 46. And that Woman's in the observations of Pache­quus, whose bloud in a continual fever did issue out, upon Phlebotomy, as cold as Ice, or Snow: the like to which, in the spotted fever is taken notice of, as a fatal prognostick by Petrus à Castro. Petr. à Castro, de febre ma­lign. pag. 90. If [...]lempius give me leave, I would reckon in putrid fevers, that bloud to be incorrigibly de­praved, which doth not coagulate, and is destitute of its fibres, Fernel. Thera­pent. Univ. l. 2. c. 17. Sennert. de febr. l. 2. c. 1. since Fernelius and others esteem of such as an evi­dent testimony of the highest putrefaction. It is also true, that we do hold, that where diseases are ordinarily, or frequently curable, yet by accident from the idio-syncrasie of the patient, or some other intervening cause, the bloud may be continued in such a vitiated estate, as to be incor­rigibly corrupted, and yet its essential form not lost; as in case of Cancers, Hypochondriacal and Scorbutical distempers, Scirrhosities of the Liver, Spleen, and Mesentery, Lepro­sies, knotted Gout, calculous indispositions, &c. I might mention other cases, but they relate not to the present con­troversie, and I have already said enough to shew the ignorance of this Baconist. To come nearer to the main matter; It is true, that we do hold, that in many distem­pers, as in the Scurvey, putrid Fever, and some others, the mass of bloud is so putrified and corrupted, that even that which is termed more stricktly Blood, is de­praved sundry wayes: for, if the vessels that generate and convey the Chyle, and the Chyle it self be corrupt­ed, 'tis impossible but that which is produced and sup­plied daily out of the Chyle, should participate of it pravity, and so much the more in that they flow in­timately commixed in the same Arteries and Veins: But [Page 14] that in such cases we hold the Blood to be so de­praved, as to have lost its formal essence totally and irre­coverably, is most notoriously falle: and any man may see hence, that this Ignoramus understands not the Galeni­cal way, but deserted it, before he had acquainted himself therewith. This he might have learned from Galen, in his Comment upon Aphor. 17. [...]. 2. We do hold that the blood and asso­ciated humours may come to a partial putrefaction, and yet be recovered again: and 'tis this recovery and redinte­gration that we design by our practice, and if we cannot effect it totally, yet that we aim at, is, to concoct the several humours, so that what there is of them that is alimentary, and agreeable to nature, may be mitified and retained, and the rest so digested, as that it may be with ease and safety ejected the body, and so the Mass of bloud regain its for­mer lustre and amicableness: This being the grand inten­tion of the received Method of Physick, 'tis one thing to debate Whether blood-letting, practiced according to Art, (for we are not otherwise concerned in the Quarrel) be a suitable proper means to atchieve our purposes? And an­other, to say, that we pierce poor mans skill, and rash­ly throw away the support of life, out of a vain appre­hension, that it is totally corrupt, and depraved of its former being, and no wise capable of being retrograde. This cannot be said without an apparent injury unto us: We know the variety and fallaciousness of colours, and by our rules, can well conjecture how far the Humours are vi­tiated, what may be concocted in order to the nutriment and benefit of nature, and what maturated to a convenient ejectment; And we do utterly deny the consequence of this Argument, though we grant the Assumption: Viz.

If the bloud be of such a nature that it may be recovered to its pristine colour and vigour, without Phlebotomy, then ought not men to use Phlebotomy.

But the Bloud, like Mercury, may be polymorphised and changed into divers shapes, and at length be reduced to the same state and condition, as when it was in its primitive es [...]sence. Ergo.

[Page 15]The Assumption I can grant, but not where such a practitioner as G. T. is made use of. I doubt not but the followers of Erasistratus could effect it by their Fastings, Frictions, Bathes, and other remedies used by such judi­cious men: I grant, that robust nature doth daily produce such rectifications of the bloud, in many that make no use of a Physician: But as willing as I am to gratifie my Ad­versary, I should not yield thus much to Helmont, or such as practice with Arcana, and commanding Medica­ments.

To the sequebe of the Major, I reply, that albeit that Nature may oftentimes do miracles, yet are not miracles to be presumed upon: It is possible for the sick to recover with­out any means, yet are means to be used; the omission there­of is imprudent, and criminal, but the use thereof (if the Physician be knowing and discreet) safe, and as secure as the condition of our mortality permits any thing to be: A few dayes or hours of the encreasing distemper will more impair the strength of the sick, than the loss of a little blood, which, in the condition it is, adds not to the vigour or nu­triment of the diseased; the dammage will be easily repaired, and perhaps all this nicety will be to no purpose, for, after a multitude of vexatious (sometimes dangerous) symptomes, Nature may produce in the almost exhausted patient, a violent eruption of bloud, and thereby terminate that malady which might have been alleviated, or allayed before. Fluxus sanguinis largi ex naribus solvunt multa, Hippocr. Epid. sect. 1. l. 2. ut Heragorae. Non agnoscebant medici. The Bloud for which they are so sollicitous, Nature her self is not so careful to preserve it, but that frequently in the beginning and pro­gress of diseases, she alleviates her self by discharging it out of the nose, and that in greater quantities of more florid blood than the Lancet would take away: This evacuation is of all the most facile, the most easie to be regulated by the Physician (since he can stop it when he will) and the most innocent in the beginning and increment of diseases.

[Page 16] ‘Sanguinis eruptiones & haemorrhagiae hanc habent praerogativam prae aliis evacuationibus, Fienus de signis medicis, par. 2. c. 1. sect. 8. & Francise. Ru­beu [...] Nocturn. exe [...]cit. in Hi­stor. Medic. [...]xc [...]c. 6. p. 98, 99, 100. quod ipsae eti­am in principio & in aliis temporibus, etiamsi non adsint signa bonae coctionis, possunt esse magis utiles, quam aliae evacuationes, quae [...]ere semper sunt malae, ex eo quod sanguis semper per apertas partes fluunt, & semper libere & commodum exire possit, nec eget prae­paratione & concoctione, sicut alii humores, qui per alias evacuationes excerni debent.— In evacuati­one, quae per venas apertas fit, nullam merito expecta­mus concoctionem; Prospe [...] Alpin. de praesag. vita & mo [...]te, l. 7. c. 2. & hinc Medici secta vena in mor­bis acutis in principio mittunt sanguinem; hinc & spon­tinae sanguinis vacuationes bonae erunt: Addatis, san­guinis eruptiones copiosas, nedum utiles fieri, propte­rea quod sanguis malus una excernatur, sed etiam quo­niam ejusdem sanguinis evacuatio universum corpus re­frigerat, caloremque transpirabilem, & corpus diffla­bile facit. Quare hac ratione excretiones sanguinis op­timae erunt, quae in statu apparent, plene cocto existen­te morbo, sed neque ea, quae cum cruditatis signis fiunt, erunt plane abhorrendae & timidae.’ — In fine, that prudence which obligeth us to self-preservation, obli­geth us to the most probable courses in order thereunto: and What can seem more rational, than that which NATVRE directs us unto, that whereby she so happily mitigates and concludes diseases, that which so many Ages have recom­mended unto us, and in the use whereof, not only Greece and Rome, but all Nations universally, as well [...]arbarous as Civil are agreed on?

And thus much shall suffice for an answer to his first Argument: I now proceed to the second.

‘ p [...] 32 The Blood is the support of Life; and we are taught by Divine Writ, that in the Bloud, that Spiritus rubens is Life.’

I answer, That the Scripture, in the places aimed at, cannot be understood literally, and properly: for then the [Page 17] words infer, that the Beasts have no other soul than the bloud, Deut. 22.23. onely be sure that thou eat not the bloud; for the b [...]oud is the soul, and thou mayest not eat the soul with the flesh. Thus it runs in the Original, though our Translation renders it Life. And so Levit. 17, 10, 14. in which last place 'tis said, that the bloud is the soul of all flesh. Nay, in Genesis c. 9. v. 5. Concerning man, 'tis said, The bloud of your souls will I require. It remains then, that deserting the literal sense, we fly to some that is Analogical: And hence it is that most Divines take the word [...] for Life. Thus Exod. 21.23. Thou shalt give life for life, is not incongruously rendred instead of Thou shalt give soul for soul. Thus the Civil Lawyers fre­quently stile Loss of Life by the phrase of Animae amissio. But however these passages may be popularly current, yet in Phylosophy and Physick, when we would speak distinctly, and argue firmly, 'tis not to be allowed of for Truth, that the Blood, or Spiritus rubens, (as our Helmontian most non-sensically terms: for, as great a Pyrotechnist as he would seem, 'tis past his Art to demonstrate, that it is a Spirit, or Chimically to educe a Spiritus rubens out of it) is Life: Scaliger de subtil. exercit. 10 [...]. sect. 5. Fernel. Phisio­log. l. 5. c. 16. for Life is nothing else but the union of the soul with, and its presence in the body: or, to declare it by its effects, 'tis the conservation of all those faculties and acti­ons which are proper to the animated creature; as Death is the extinction of them. Out of which 'tis evident, that Blood is no more properly called Life, than 'tis possible for the Definition of Life to be acmodated to Blood: that is not at all. But since common discourse doth allow us often to fix the principal denomination upon the chief instru­ments; and that the Scripture explains it self, Levit. 17.11. and what my Adversary in one place calls the LIFE, in another, he terms it, the [...]rin [...]ipal sup [...]ort of Life: let us consider how far that is true: That the Bloud is not so much as a part of the body, Valies. [...]. philos. c. 5. p. 102. Fe [...]n [...]l. Physiol [...]g. l. 2. c. 1. (but the Ali­ment thereof) is the assertion of most Authors; it is not continuous to the rest of the body, but floateth as Liquor in a [Page 18] vessel: and in vulgar speech, no man takes the loss of bloud for a mutilation, or dismembring: and there are sundry distempers and phaenomena, which conclude in favour of the spirits, (or what is Analagous to them) and the Nerves, to assert their pre-eminence above the Blood, and its Vessels: and whatever may be said concerning Ge­neration, (which is very disputable) 'tis a certain mistake in our Helmontian, to make the Bloud the princi­pal matter for sensation (whereas sanguine persons are not the greatest wits, and the senses are most quick in women during their lyings in, after a great effusion of bloud, as also in dying persons) or motion, which is not in paralytick members, though the Bloud flow unto them con­tinually, as it was wont before. Plempius fun­dam. medic. l. 2. c. 1. I add, that there is not any convincing Argument to prove that the Bloud is ani­mated: I confess the conjunction of the soul and Body, and operations consequent thereunto, are most mysterious unto me: and I think it no less true that our Life is a constant miracle, then that we are at first wonderfully framed: nor can I determine what particular use the soul makes of all the parts and ingredients of our humane bodies: But this appears unto us daily, that the conjunction betwixt the Soul and Blood, and the dependance of our Life there­on, is not so great, or intimate, as that upon the effusion of a little, no, nor of a great deal of the bloud, Death, or any debility, extraordinary and durable, should ensue un­avoidably: and if it happen but sometimes, 'tis apparent thereby, that 'tis but accidental, and not a proper conse­quence of that effect: 'Tis manifest, that the operations of the Soul are not restrained to one determinate proportion of bloud in every body: nor to the same in any: albeit that there seem requisite in all Animals, that there be some bloud, Botallus de [...]gu. mi [...]. [...]. 34. or what is equipollent thereunto: 'Tis also mani­ [...]est, that this Bloud, (for which some are so sollicitous) doth continually expend and waste it self in nutrition, (and that even the nourished parts are in a continualex­haustion) so that without supply, it would degenerate [Page 19] [...]nto choler, (except in those miraculous fasts) and dimi­nish to little or nothing: as appears upon great fastings, and several diseases. 'Tis no less manifest, that upon great evacu­tions of bloud, by wounds, or otherwise, when the Bloud hath been so exhausted, that very little can be imagined to re­main, yet in a few dayes the veins and arteries do fill again, Id ibid. c. 33. sect. 7, 8. & c. 35. and nature is so replenished and vigorated, that this lost bloud seems not only as good, in order to the functions of life, but better, in order to health and strength, since the pro­duction of this last (in the end of diseases) is accompa­nied with convalescence, whereas the precedent did not hinder the indisposition.

Out of what hath been said, the Answer to this Ob­jection is facile: viz. The Blood is not so the seat and re­sidence of the Soul, nor so absolutely necessary to Life (grant­ing all that can be desired of us) as that some of it may not be let out, without present danger, or irreparable detriment: so that, if the motives for Phlebotomy be cogent, or so pro­bable, as to render the Action prudential, no difficulty can arise from this scruple. It is written in Deut. 24.6. No man shall take the upper or nether milstone to pledge; for he ta­keth a man's life [or soul] to pledge. Here the milstone is called the life or soul of a man, as much, and as proper­ly, as ever the Blood is any where else: But, though there be a prohibition for a man to deprive his poor neigh­bour thereof, as of the support of his Life, yet undoubted­ly none was ever interdicted by virtue of this precept, to help the distressed Miller to pick and dress his Mil­stones.

His third Argument is this.

‘Moreover, one would think, p. 7. it should put a stop to their prodigal, profuse bleeding, if they did but consider, with what difficulty Nature brings this Solar Liquor to perfection, how many hazards of becoming spurious and abortive, it pusses through; how easily it is stained by an extraneous tincture; how often intermixed with some­thing [Page 20] allogeneous and hostile to it; how many elaborate circulations, digestions, and refinings it undergoes, before it be throughly animated, and made fit for the right use of the immortal Soul.’

One would imagine by this Objection, that the Genera­tion of the Bloud, were as difficult a work, and required as much of sollicitude, as the Philosophers stone; and that the least errour would disappoint the process, and eject the poor soul out of its tenement and mansion. But there is not any such thing; he that considers the perpetual supply of Chyle, by the Ductus Thoracicus, and with how much ease it is transformed a great part into Blood, by the simi­lar action of that which pre-existed in the veins, (toge­ther with the concurring aid of the Heart, and sanguife­rous emunctory vessels; and the previous alterations in the stomach and intestines) will imagine neither the produ­ction of Bloud, nor the reparation of it, to be so tedious and hard a matter: Nor is it true, that the Bloud is so easily stained with hostile tinctures, since it is a liquor that is in perpetual depuration, and hath the convenience of so many out-lets to discharge it self by. Neither will every crudity, in the immature Chyle, or bloud, render the blood unfit for the use of the immortal soul: there is extra­ordinary, and unimaginable difference betwixt the bloud of one person and another, (as appears upon distillation, burning, and mixing it with other liquors) yet are all these within the latitude of Health, and with equal perfection, exercise the operations of Life: Nor doth every alloge­neous mixture vitiate or deprave the bloud; for the Chyle, Bloud, and Flesh, retain some particles of the original food taken into the stomach: hence it is, that sheep fed with pease-straw (though as sat as others) yield a flesh diffe­rently tasted from other mutton: the like is to be observed in the feeding of other Animals generally: Nor is this more evident in other Animals, than 'tis in Men; for not to mention those Medicaments, which, by the altera­tion [Page 21] they make in the Vrine, do demonstrate they have passed along, and been once mixed with the bloud; as Cassia, Rhubarb, Annise-seeds, &c. Domin. de Marchettis, Anatom. c. 9. ‘In fonticulis observa­vi, quod si praecedente die aliquis allium aut cepam come­derit, pus quod in fonticulo est odorem allii aut cepae obtine­bat: sanguis autem qui per fonticulum expurgatur, non nisi per venas expurgari potest; unde possumus dicere, quod sanguis acutum odorem detinere possit.’ The like phaenome­non is to be observed in wounds and ulcers, which feel de­triment, according to the various food and drink of the patient. Domin. de Marchettis; Anatom. c. 10. Paraus chi­rurg. l. 16. c. 49. Simon Pauli de febt. ma­lignis sect. 11. Nay, in pleurisies, and other wounds, it hath been taken notice of, that the purulent matter hath dis­charged it self by the veins, (re-mixing with the bloud) into the intestines, and by urine. The Bloud of some per­sons in perfect health, hath been observed to stink worse than rotten eggs, even as it was issuing from the arm, upon Phlebotomy; yet when it was cold, it did not stink, nor seemed to differ from the best bloud, except that it was of a more beautiful red than is usual. I conclude therefore, that in this Argument many falsities are con­tained, and there is nothing of such [...]orce, as to deterr a prudent Physician, who understands the rules of his Art, and those cautions which are suggested to us in Phleboto­my, to let his Patient bloud, and emit some of this solar Liquor.

His fourth Argument.

‘They should never attempt, p. 89, 90. yea rather abhorr, to enervate in the least, by the Lancet, the strength, with its correlative bloud and spirits, without which there is no hopes of attaining a desired Cure. For it is a most established verity, taught by Hippocrates, that Naturae sunt morborum medicatrices, the most assured means of sanation, is to keep up the vital pillars, without which, all falls to ruine. So that Van Helmont is without con­troversie in the right, when he sayes, utcunque rem ver­teris, ignorantiae plenum est procurata debilitatu [anare [Page 22] velle. i.e. make the best you can thereof, It savours of gross ignorance, to assay to heal, by bringing one into a weak condition. And p. 84. de febr. Satis sit, satis sit Medico (saith the same Author) quod aeger alioquin inexcusabili debilitate labascat, per morbum, medias, in­appetentias, inquietudines, dolores, anxietates, vigilias, sudores, &c. neque idcirco fidus auxiliator debet debilita­tem addere debilitatibus; fraudulentum est sublevamen quod venae sectio affert; ejusque tam incertum est remedi­um quod nemo medentum hactenus ausit polliceri sanationem inde futuram. One would think it is enough, and too much, for the poor sick man to be brought low with the disease, fasting, want of appetite, restlesness, pains, an­guish, watchings, sweatings; wherefore, in such a case, whosoever is a trusty supporter, ought in no wise to add weakness to weakness: all the succour the Lan­cet can afford is deceitful, and all the address thereby is of such uncertainty, that no Physician dare venture to make a promise of a perfect cure by this means, and to keep one from a relapse.’

I must except against the authority of Van Helmont, in the case, as of a person whose credit is sufficiently taken off, by what I have alledged elsewhere: I must not be concluded, but by the judgment of [...]. Arist. Ethic. l. 10. c. 9. Io. Franc. Ripa, tract. de peste. c. 7. s [...]ct. 17. Arist. l. 8. Phys. c. 3. t. 22. & 1 de ort. & inter. c. 3. t. 59. under­standing practitioners: and in Physick, I must not allow him to have been an intelligent person; and it is notori­ous, that he was a man of no practi [...]e, and conse­quently no fitting judge of the efficacy and ineffica­cy of Medicaments. It is a saying in the Civil Law [...] plus valet umbra experti senis, quam eloquentia juvenis: And those Philosophers, who would, upon certain preju­dicate opinions, and pretences of reason, determine of Me­dicinal cases, are exploded even by Galen: nothing is firm in Physick, but what is confirmed by an happy experience: and 'tis an imbecillity of judgment (saith the great Stagi­rite) to desert experience, and adhere to reason. If Hel­mont [Page 23] was neither conversant in the Experiments of others, nor did himself experiment the inconveniences of Phlebo­tomy, what doth his Assertion or Negation signifie in the case? Besides, 'tis but a single testimony against the Ex­periments of judicious men in all Ages and Countries. As for his Reason, 'tis most infirm. We must not adde imbecil­lity to imbecillity: even this is notoriously false in Physick: for, by the same reason, we should not reduce them to a slen­der diet, no nor so much as sweat them; for after much sweating, every man feels himself weaker for the present; the same may be said of vomits and Emeto cathurties (so much commended by my Adversary) that, during their operation, they add to the imbecillity and sickness of the Patient: upon this reason, none might scarifie a Gan­grene, cut of the sphacelated part, or make use of seve­ral vexatious operations in chirurgery. Besides, who would not allow us to create him a little trouble or weakness, (easie to be repaired) thereby to recover him from a greater evil? there are some times when the lesser of evils becomes eligible, and puts on the qualification of being Good: Steph. Roderic. Castrens. quae ex quib. l. 4. c. 7, 8. there are some times when we are directed to cure one distemper by introducing another. But to pro­ceed; I do deny that Nature is debilitated by bleeding in diseases, if the rules of our Art be observed: for, we daily see, that after bleeding, Nature doth with more ease and speed discharge her self of the disease; and usually thereupon ensues signs of concoction in the urine, a pronity to sweat, and an inclination to solubility of body, and a more strong pulse: which, as they are our daily observa­tion, so they do demonstrate, that Nature is not weak­ned thereby. Heretofore it was usual, after consideration of all due circumstances, to let the sick bleed, even till he swooned away: and that with very good success, in those Fevers called [...]. Iodoc. Lommi­us de curand. [...]ebr. conti [...]. c. 3. ‘ Sub quo casu Hippocrates atque Galenus veniti non sunt, donec animus deficeret, semel detrahere sanguinem. Quam ipsi rem ratione & experien­tia ducti tentaverunt. Profusa namque hac inanitione pri­mum [Page 24] homo in contrarium agitur statum, celerrime ex de fectu animi refrigeratus: With this opi­nion of J. Lommius, doth Citesius ag [...]e [...], de ufu Phleb [...] ­t [...]m. c. 4. post autem alvus subinde pro­rumpit, vel bilis ubertim evenitur, vel certe copiosis su­doribus corpus perfunditur, atque hinc alios protinus con­tingit convalescere; alios plurimum juvari.’ This they practiced in the beginning of such Fevers, and the pra­ctice did so far ennoble Galen, that 'twas proverbially said of him, that He stabbed Fevers. He relates of him­self, that he took away at once from a Patient six pound of blood, and presently put an end to the Fever, the party not finding any diminution of his natural strength there­upon. Galen. de sang. miss. c. 14. But this kind of excessive Phlebotomy hath been long discontinued by Physicians, not that they could absolute­ly condemn it, but out of cautiousness, lest the ill success afterwards should be imputed unto them: yet some Countrey-surgeons do still continue it. I knew one in Warwickshire, who would, in the beginning of any Fever, bleed the Patient thirty or forty ounces, or more, in case he did not fanit: and, really, with great success in rustick bodies. A Captain in the Parliament-Army assured me, that when the spotted fever was in the Camp, their Chi­rurgeon did, in the beginning of the distemper, bleed them till they fainted; then put them to bed, giving them a good Cordial, so they sweat, and recovered pre­sently. He himself was served so; the Chirurgeon bled him in the open field, the bloud fell on the ground, to the quantity (as he guessed) of a quart, when a Lipo­thimy approached, he put him to bed, and giving him a Cordial, he fell into a sweat, and was recovered per­fectly in very few dayes. There is no doubt but the pra­ctice was justifiable in men of a convenient habit of body to bear it, and where neither the climate, (which Cite [...]us de usu P [...]leb [...]om. c. 5. Rolfinc. meth. medic. spec. c. 4. sect. 2. c. 11. o [...]ten­times is particularly repugnant to large Phlebotomy) nor idiosyncrasie, (which Rolfinc. ubi supra. sometimes happens) or evil diet preceeding, or the particular malignity of the venenate dis­ease, nor the prejudicate opinion of the people do contra­indicate. It hath authority from Hippocrates, Galen, Avi­cenna, [Page 25] and many others: Nature doth seem to direct us thereunto, by her own excessive evacuations in that kind, by which diseases are frequently acted: Dilect. Lusit [...]n [...] de venae se­ctione cap. 14. Artic. [...]. and no eva­cuation is to be accounted immoderate, which is bene­ficial. By this, and expurgation, even to Lipothymy, in the first beginning of several diseases, men were cured presently, nor did the maladies proceed to those times which in the usual method they make their progress through. In my Exercitations against Dr. Sydenham (as yet unfinished) I have entreated largely of the several methods of curing, which I shall not now tran­scribe. As for that way of bleeding which is now ge­nerally in use (though practised with a great latitude in several Countries, and by several Physicians in the same Countrey) it is most manifest that if due circum­stances be regarded, and all other medicaments dexte­rously administred, it is so far from debilitating Na­ture, that it adds to its strength, mitigateth the present symptomes, prevents the violence of the future, and con­cocteth the disease apparently. I will not undertake to justifie the demeanour of each particular Physician, any more than I will answer for their intellectuals and skill in Physick: It is not the reading of Sennertus and Ri­verius, with a little knowledge of the new discoveries in Anatomy, and a few Canting terms about Fermen­tation, texture of bodies, or such like knick-knacks and Conundrums of the novel Philosophers which accomplish a man for practice: These men will never come to be ranked with Vallesius, Mercatus, Fernelius, Dure [...]us, Rondeletius, Massarius, Septalius, Claudinus [...] Crato, or Rulandus. If Experience be our Guide, le [...] us in­form our selves by the Histories of such as they have given us of Epidemical and pestilential diseases, and of particular cases, as also the cures, and follow­ing them let us come to practise, and, not deserting our own reason, let us be cautioned by them: These others for want of judgment to consider each circum­stance [Page 26] cannot make an Experiment, G. Fletcher's History of Russi [...], c. 28. p. 279. or relate it: whilest they extenuate the credit of the ancient and modern Physicians that are not Innovators, (though more ob­serving and experimental than themselves) they do it only to excuse their ignorance in that kind of Learn­ing, and whatever they have of the Lord Bacon [...] they have this of the Russe in them, that they neither believe any thing that another man speaketh, nor speak any thing themselves worthy to be believed. For such as these, or any else that do not practise Phlebotomy according to the rules of Art, I cannot make any Apo­logy: nor do I think that their errours ought to ex­tend so far as to disparage all Physicians who demean themselves prudently and discretely: Notwithstanding all our care, some Patients will dye; no Physician can secure all men from what their frail condition hath subjected them unto: If our Method and Medicaments be such as the general rules of Medicine, and an Expe­rience generally happy do warrant, P. Z [...]cchias Qu. Medico legal: l. 9. consil. 40. 'tis as much as can be expected from us; and the Imperial Laws allow of this defence, though they punish the immethodical and novel Experimentators, and the Ignorant. Sicut Me­dico imputari eventus mortalitatis non debet, Vide. I. Franc. Ripio tract. de pes [...]e, c. 7. §. 64, 65, 78, [...]04 [...] ita quod per imperitiam commisit, imputari ei debet: pretextu enim humanae fragilitatis delictum decipientis in periculo hominis innoxium esse non debet.

To conclude this Argument, I say, that although it often happens that diseases are cured by sole Phlebo­tomy: Evenit ut saepius missio sanguinis sola curatio­nem perficiat—Misso sanguine saepe sponte naturae expurg [...]tur corpus alui profluvio, Valles. Meth. Med. l. 2. c. 3. vomitu, aut sudore suc­cedente—Yet no wise Artist will rely upon that alone, but with the addition of other auxiliary medi­caments: Herein Spain and France are pretty well agreed: Vide Riolon. de circulat. Sanguin. c. xx. Vallis. meth, medend. l. 4. c. [...]. And as no wise man will undertake to cure by bleeding alone; so it is most foolishly done of our Helmontian to demand, or expect it, as he doth here.

I come now to his fifth Argument.

This Argument, though our Helmontian rely so much upon it, is a pure Paralogisme.

First, He supposeth that we use Phlebotomy in all diseases, as a direct method of healing: which is not true, except in some maladies, as Apoplexies, Squinancies, Haemorraghies or great eruptions of blood, some Atro­phies, and sometimes in Feavers: in which 'tis fre­quent with us, to rely solely or principally upon Phle­botomy: yet even here we would think it very impro­per to admit of our Phlebotomy to be stiled our direct Method o [...] curing, because it is but a part of our Method, which will include, if not some other prescrip­tions, yet at least dyet. In many cases we use Phlebo­tomy as one part of our Method, but not as the princi­pal: as when we use it antecedently to other remedies Pharmaceutical and dietetical, to prepare way for, or facilitate their happy operation. I am not now to write Institutions in Physick for the documentising of this Disciple of my Lord Bacon, 'tis enough that he may learn any where almost (as in Vallesius, Mercatus, Claudinus, and Plempius) that we propose more than one scope to our selves in Blood-letting; neither is it ever (except in diseases arising from a partial or total Plethora) our direct method of healing: If it be but a part and necessary or useful part thereof, we are sufficiently justified. Thus his Major is enervated: for if he would have opposed the modern practise, he ought to have urged it thus.

‘The means used to let out bad blood without removing the efficient cause thereof, is no direct Me­thod [Page 29] of healing, nor an useful or necessary part thereof.’

This is manifestly false, as I shall shew anon. As to his Minor, That Phlebotomy lets out bad bloud with­out removing the efficient cause thereof. This would the Ancients deny, who bled their Patients in many cases until they swooned or fainted, with great success [...] and we must say it is not absolutely true, there being no Practitioner (I believe) but hath seen some cases in which sole Phlebotomy hath effected the cure: he may see many Instances of this in Botallus, and that in disea­ses where the body was undoubtedly cacochymical: I have seen Agues tertian and anomalous perfectly cured with once bleeding in women with child: and in chil­dren I have seen some Atrophies so cured, that the prin­cipal cause of their recovery was to be attributed to their Bleeding: the like I have observed in several Chronical diseases, even in inveterate quartanes: as al­so others have done: nor is there any thing more common almost in our Cases, than the relation of se­veral diseases absolutely cured by single Phlebotomy; which I shall not transcribe here, but in my large dis­course of Phlebotomy (in Latine) I intend to repre­sent all such cases at large, with their circumstances, and the History of Phl [...]botomy with all that variety of success, which judicious Practitioners relate of it in se­veral diseases, and persons. I add now, that No man can be an accomplished practitioner who is not ver­sed in the History of Diseases, and particular cures: for the general rules and directions make no more a Physician, than such a knowledge in Law would do a Lawyer; the res judicatae import more with us than they do in Law [...]cases; and as Reports of the Iudges in special cases must be known by a compleat Lawyer, so must our Book-cases be our presidents, and regulate our practise. Brune Se [...]lius de mor [...] incurabit, p [...] 57 [...] Duobus enim tanquam cruribus innititur Medicina, neque solis theoreticis rationibus contenta, in­super [Page 30] etiam practicas experientias particularium requirit, & indefessam ad singulos casus intentionem.

Thus is his Minor false, as was his other Propositi­on: and it should have run thus. But Phlebotomy lets out the bad blood without removing the efficient cause thereof, or conducing thereunto.

But he proceeds to defend the Minor thus. If the Cause of bad blood were removed, then would the effect cease: but oftentimes we see that notwithstanding such a depletion the disease continues, and if it be not mor­tal, yet it becomes more truculent. Here he commits the same errour that before, expecting a greater effect from Phlebotomy than we propose generally to our selves in it: we do it sometimes for revulsion of the matter flowing to any part, as in some Pleurisies, Squinancies, the Colick Bilious, and Rheumatismes, &c. wherein we never rely solely upon bleeding, and though often­times the effect transcend our expectation, yet do we not presume upon it. Sometimes we let blood for pre­vention of future diseases, as in great contusions and wounds: Sometimes we let blood only to prepare way for future Pharmacy, Valle [...]. meth. medend. l. 2. c. 3. ‘Ita plerumque in febribus mit­titur sanguis, qui non superat naturalem mensuram, ne­que simpliciter, neque in hoc homine, sed quia nisi mit­tatur, ob febrilem calorem, qui adest, & succorum putrescentium mistionem, corrumperetur, ac fortasse malignè; & cutis rarefactioni, & ventilationi, & vasorum relaxationi ad futuram expurgationem ne­cessari [...], impedimento esset. Itaque mittitur, non quia multa subest copia, sed quia ea quae subest, tunc est in­utilis, & noxia, ac proinde, facultate ferente deponen­da, etsi causa morbi non inclinet ad ideam sanguinis, modo non ab ea plurimum evariet, i. e.’ Thus in fea­vers we usually let blood, not that the blood abounds above its due proportion, either in general, or in refe­rence to this or that individual; but because the blood which flows in the veins is infected with a feavourish [Page 31] heat, and would be corrupted thereupon, and by reason of the intermixed humours now inclined to putrefacti­on, and that perhaps joyned with malignity, for the prevention thereof, and least that plenitude and depra­vation of the Blood should hinder that transpiration in the habit of the body, ventilation of the blood, and laxity in the vessels, which is requisite for the subse­quent purge, do we use Phlebotomy: not imagining that there is any superfluous abundance of blood, but that there is then in the body some that may well be spared, and which, if the Patient hath strength to bear it, may with prudence be let out to prevent so great dangers as are imminent, and to secure unto us the good effect of the subsequent Physick. And if the disease do sometimes encrease upon Phlebotomy, it behoveth wise persons to distinguish whether those symptomes happen by reason of bleeding, or only succeed it in course, the disease being in its increment: for this makes a great difference in the case: as also whether amidst those symptomes (which are in due course most violent in the progress and state of the disease; where­as we bleed usually in the beginning only) there be not some that yield signs of concoction and melioration, which if they do, as we may justly attribute those hopeful consequences in part to Phlebotomy, so we need not be amazed at the present truculency of the disease; which affrights none but the ignorant: If notwith­standing all our care, and due administration of Medi­caments according to Art, the Patient do dye, yet is nei­ther Phlebotomy nor the other Physick to be blamed, but we ought rather to reflect upon Physick, that 'tis a conjectural skill in the most knowing men, and that we are not as Gods to inspect into the bowels and secret causes of diseases, that besides the special judgment of God upon particular persons, all diseases are not cu­rable in all individuals, either by reason of the variety of dis [...]empers complicated, which interfere with and [Page 32] contra-indicate one to the other, or for some unknown idiosyncrasy, or other intervening cause which defeats our Methods, as well as it disappoints the Arcanum of Pepper-drops. I must here take an occasion to remind this Helmontian, that he doth ill to disparage Phleboto­my, by reason that after it there may follow some tru­culent Symptomes, and yet to reject that imputation where his Dietetical rules are in dispute. P. 168, 169 [...] Volles. in Hip­pocr. de victu in morb. anot. l. 3. ‘When he gives his vinous and spirituous liquors in Feavers’ (a practise not peculiar to the Helmontians, but allow­ed, with regard to due circumstances, by Hippocrates not only in diaries but acute-feavers: so Galen would have told this Ignoramus) ‘if any seemingly frightful Symptomes appear, as extraordinary heat, an inquie­tude, a little raving, a swerving from right reason, the Patient must not be startled in a vulgar manner, but be satisfied that these are but the effects or fruits of an Hormetick motion in the Spirits excited and in­creased by good liquors, easily united with them for the routing and pu [...]ting to flight every way what­soever doth disturb its vital government.’ — Though Hippocrates say it is good in all diseases, that the Patient retain his senses; though he reckon inquietude and restlessness in the sick amongst evil signs, yet our Hel­montian dissents from him whatever time of the disease it be, and whatsoever other circumstances attend thereon: [...]. 169. ‘ For oftentimes madness, deviation from the right understanding, a Lethargical or sleepy dispo­sition suddenly break forth. Nihil est quod tam magnifice prodest quod non aliquo ex modo obest. What matters it, if the heat be magnified (besides the main purpose) to some small trouble, if ten times greater benefit accrue to the sick. It is impossible any Physician should perform his duty as he ought, if he boggle at the foppery of heat and cold, meerly momenta­ny and transient, often deluding our senses.’ Surely he that is thus negligent of the Animal faculty in its [Page 33] principal operations, may bear with a pitiful Galenist for not regarding much the loco-motive strength, whilst he is as sollicitous as any Helmontian to support the vitals: and let any one judge which is most likely to impair the vital faculty, a little blood-letting duly ad­ministred, or such an increase of the feavourish heat, restlessness, deliriums, phrensies, lethargies, as our Author here despiseth.

I must not yet dismiss him: not that I intend to laugh at his six-fold digestion (he might as well make a dosen of digestions) but it is necessary that I tell him that the production of good or evil blood doth al­wayes depend upon one root that feeds the branches: for 'tis possible that the stomack, and pancreatick, or bilious mixtures in the guts may not be faultless, and yet the blood of the Patient either not vitiated, the errors of the first concoction being amended by the primige­nial sanguifying Blood (for 'tis the Blood in the vessels which principally sanguifies) or if it be depraved, Ballonius Epi­dem. & ephe­merid. l. 1. p. 101. yet not so as to generate any disease, or abbreviate the life: for cacochymical persons with a little can live more long, and more free from diseases than those of a purer and more generous blood: Nor is it less true that oftentimes it happens that the blood is infected with recrementitious, heterogeneous and noxious mixtures from obstruction of the pores, or other occasional cau­ses, wherein the stomach and vitals (otherwise sound and vegete) are only oppressed and distempered by accident, some of those impure humours being dischar­ged upon them: and in these cases repeated Phlebotomy alone may cure: Vide Riolan. de circulat. sang. c. xx. If the credit of Botallus will not sa­tisfie him herein, let him believe his beloved Hippocra­tes, a man who did extraordinarily practise blood-letting, so as that the French do impatronise him to their Phle [...]otomy; he tells us this story. ‘ A certain man amongst the Oeniada was sick when he was fasting, Hippocrat. Epidem. l. 5. c. 11 [...] 6. he felt as it were a great suction in his stomach, and a vio­lent [Page 34] pain: and after he had eaten any meat, as it di­gested, his pains returned, He grew very tabid, and wast­ed away in his body; his food yielding him no suste­nance, but what he took came away in ill-concocted and adust stools. But when he had newly taken any su­stenance, at that instant he felt none of that vexatious pain and suction: He took for it all manner of Phy­sick, both emeretics and catharti [...]s; but without any alleviation. But being let blood alternately in each arm (or hand) till he had none left in his body [that was vitious] he amended upon it, [...]. See Ant [...]n. Be­nivenius his medicinal observa [...]. c. 44. and was perfectly cured.’ — Read but that case you that are so timorous, with the Comment of Van der Linden in his Selecta Medica c. xiii. and tell me if upon Phlebotomy as ill blood alwayes suc­ceed as is let out. I could add more parallel stories: But to demonstrate unto this Pyrotechnist that single Phlebotomy will amend and inrich the mass of Blood, I propose this case, An ancient Gentlewoman of a very strong and corpulent habit of body, but frequently troubled with hysterical and hypochondriacal vapours, was taken with a violent catarrh upon her stomach, together with great pains in her right and left hypochondria, as if the liver and spleen had been tumified: sometimes she com­plained of an insupportable acidity in her stomach, and sometimes a saline humour molested her: Sometimes she fell into cold clammy sweats, sometimes her sweats were so hot that she complained as if her skin were burnt: and even when her stomach felt any alleviation, she com­plained of a burning fire as it were in her bowels near and in the region of her liver: a perpetual sputation did follow her. I being sent for, after several Medicaments prescribed methodically, but with little or no alleviation, I proposed earnestly that she should be let blood, notwith­standing she were above sixty years old: I took away eight ounces or more: She found immediate alleviation: there seeming no default in the blood or serum, I burned the blood in an arched fire, it came to ignition, but flamed [Page 35] not at all: but crackled like Bay-salt, and after some while a sudden eruption of ventosity made such a noise as equalled the cracking of a Chesnut in the fire: She took a stomack-powder of Ivory, Pearl, Crabs-eyes, &c. and was pretty well for three or four dayes, but upon a small fright relapsed: I bled her again as before, and in that short time (in which she had taken very little su­stenance; but behold this blood (which looked no better than the other) did burn with a vivid and lasting flame as well as any I ever tryed in my life, and without any sign of flatulency: She recovered presently after with some further Medicaments, but not so as to be perfectly well at stomach of a long time. I doubt not but if others would try that way of burning blood, they would soon be convinced the Phlebotomy makes a great alteration therein.

But I proceed to his other Argument.

This is taken out of Van Helmont, p. 107, 103. whose Latine words I shall not transcribe now, but only the Eng­lish.

‘Let them make it appear if this do not imply a contradiction, that a Feaver hath the property to pol­lute the blood, and that this property can be taken away a posteriori, by a posterous manner, to wit, by with­drawing what is putrified. For if first the fouler blood be let out, they open a vein again: all this while they overthrow and confound the strength, and so there­by wholly disappoint a Crisis. But suppose some­times a fresh ruddy blood run out, they presently cry as cock-sure, that a whole troop of diseases is cut off at the first dash, as if the resting place of the Feaver did only extend from the heart to the bending of the arm, and the good blood did take up its abode about the liver.’

[Page 36]This Argument proceeds upon a most gross falshood in that part of it, where we are supposed to place such a value upon the colour of the blood as by the goodness or ruddiness thereof we should esteem our selves as cock-sure that a whole troop of diseases is cut off at the first dash: whereas no intelligent Physician ever thought so: Ballonius Epi­dem, l. 2. p. 191 for we do say that the blood of all men is not alike, neither as to colour nor consistence naturally: and therefore in diseases we do not expect to see such, nor intend to make any alteration to such a degree as transcends the natural estate of the body: for 'tis our business to preserve each man his natural habit, be it bilious, melancholy, or phlegmatick. We do also say that in diseases the blood may be corrupted in its substance and vitiated, and yet the colour amended, or not altered. Ballonius Epi­dem. l. 2. p. 192 Saepe ad speciem & visum purus est san­guis, qui alioqui [...] malus est: ut contra impurus cernitur specie, qui non ita [...] malus est.— And Iacob. Thevart his Scholiast doth observe, that se­veral times in [...] sanguis laudabilis ipsa sectione apparet, Ballon. Epid. l. 2. p. 167. & qualitatibus alienis praeditus est, est enim acriusculus & biliosus nimis. Nay we are so far inde­finitely from pronouncing a cure upon the ruddy co­lour of the blood, that in malignant Feavers we make a quite contrary prognostick. Petrus a Castro de febre ma­lig. puncticul. p. 90. Pessimum signum est [in febre maligna puncticulari] & timoris plenum, cum sanguis v [...]na scissa extrabitur, si purus, rubicundus, & inculpatus educatur, venenositatem superare indicium est, aut putredinem in penitioribus cordis latitare. In meipso olim observarem; nam ter per hanc febrem misso sanguine, nulla prorsus nota putredinis apparebat, alii [...] signis immani ferocitate saevientibus. The same is as­serted and illustrated by fatal instances in Simon Pauli, Simon Pauli digress. de febr. malign. [...]. 12.14. which it would be too long to transcribe here. Having demonstrated unto him these errors, I say further that we do not hold the blood to be putrified in all Feavers, as in Diaries, nor (many of us) in intermit­tent: [Page 37] not to mention others: and in those Feavers wherein 'tis said the Blood doth putrifie, we do let blood often to prevent putrefaction, and not alwayes to cure it by Phlebotomy: and we do it in order to cure the putrefaction, we do not pretend to emit all the putrified blood thereby, but only to alleviate nature of a part thereof, that so she may better overcome the rest; espe­cially being assisted by other Medicaments. So that the whole assertion is false, if it import that any intel­ligent Physician designs to cure a putrid Feaver solely and directly by letting out the putrid blood by repeated venae-section. I will not deny but some in France and Spain have gone about to do it, but the practise is generally condemned by Physicians of the best repute, and therefore ought no more to be charged on us, espe­cially in England, Valles. meth. medend. l. 4. c. 2. Castell [...] de abusu venae-section. p. 60. then the miscarriages of any bold Ex­perimentor, or Baconical practitioner at London upon the Colledge of Physicians. This insolent Disciple of my Lord Bacon understands not the rudiments of our Phy­sick, nor knows what we aim at in the use of Phleboto­my, there being sundry occasions why we use it, and sundry effects what we expect from it. Neither is he less deceived in saying that Phlebotomy (duly admini­stred) overthrows the strength of the Patient (I mean that strength which is necessary to the concoction of the disease) and so thereby wholly disappoints the Cri­sis. For it is manifest that by those profuse Phleboto­mies of the Ancients the Crises were accelerated: and in ours promoted. This is not only manifest out of Hippocrates and Galen, but confirmed unto us by the certain experience of Forrestus, Forrest. de se­bre l. 12. in Scholio [...] and those learned Flo­rentine Physicians who composed the Academy there for the renewing of the Hippocratical and Galenical Method in opposition to the most prevalent Avicen­nists. Novae Acad. Florentinae opuscula adv. Avice [...]. p. 43, & p. 55. ‘Nos igitur Galeno sisi (quoniam sic con­ducit magis, dum vires ferant) sanguinem misimus plurimum, nam bilibre pondus & trilibre in acutis [Page 38] febribus: aut magnis aliis morbis superavimus; atque id non nodo impune, sed & tanta aegrorum tolerantia, ut nil supra eligi potuerit.—’ ‘Quam rem abun­de nobiscum experientia nosti (ut nos quoque aliquan­tisper experientiam oftentemus) ut qui praeter caetera, Ibid. p. 99. quorum Paulo ante mentio fuit, & venae qu [...]que sectione abunde usi sumus, atque id citra discrimen: quin et exactam illam vivend [...] formulam, veteribus quidem fa­miliorem, neotericis vero ne nomine quidem ipso notam, instituimus. Quo factum est, ut jam crises multae ap­pareant, ac velut novus naturae ordo, aegris faelicissime faveat: Cum antehac vel pharmacis agitata, velintem­pestivo victu impedita, nullas ostenderet, aut admodum raras, easque non nisi in rusticis atque infima plebe, qui nec pharmacorum multitudine, neque ciborum aut potio­num, fa [...]igari, aut impediri quirent.’ I have more willingly cited this passage because the renown of that Academy was such that it gave a check to the grandieur and pr [...]v [...]lence of the Arabian Method, and the truth of what they say cannot be questioned by any that knows the persons, and the revolution they brought about in Europe: and hence we may learn the reason of that difference which seems frequently to occur be­twixt the ancient diseases and their critical motions and terminations, and what we generally find: It ariseth not from any such great change in the nature and types of maladies, as some have ignorantly writ of late: nor as this Bacon-face talks, because we reiterate moderate Phlebotomy: but because we do not follow at all the Method of Hippocrates and Galen in the curing of dis­eases: However we pass for Galenists and Hippocrati­cal Physicians, yet in truth we are not such: our practise is made up most out of the Arabian Method, and Me­dicaments, and is a mixture of the Grecian and Sarra­cenical Physick, together with those accessionals which improved Chymistry hath introduced: P. Castell [...] de abusu Phle­botom. p 6, 7. and since we disturb Nature with our vomits and minoratives in the [Page 39] beginning, and neither bleed, dyet or otherwise Physick our Patients according to the ancient prescriptions, do we wonder to see another face and issue of maladies than was heretofore? Or, doth not he rather deserve to be wonder'd at, that should expect in so different circumstances for resembling effects? I believe our Hel­montian with his Emeto-cathartis, and exquisite Arcana (so far transcending all the shop-medicaments, or re­ceived Chymical preparations) doth see as few Crises as any Phlebotomist: and may not I then retort upon him, that he by his practise wholly disappoints a Crisis? Nay, doth not he tell us, that in his way? there will be no need to stand gaping for a crisis, p. 101. sith that may be anticipated, and all secured before that time, if there be a regular procession: And may not the present Galenists justifie themselves in the same manner, since they can better warrant their pro­cess and Medicaments; by a longer succession of Expe­riments happily made by judicious men, then this ig­norant Helmontian Innovator?

Another Argument of his is this.

In this Argument there are so many defaults (which are obvious to be seen) that I must recommend again to these Baconical Philosophers, a Caution I have more than once given them; which is to omit in all their discourses those vexatious coujunctions, Causals and Illatives: 'Tis meer pedantry for them to be tyed up by such particles, the idle foppery of Grammarians, and Logicians, and men of common sense. The Reason, if reduced to form, runs thus.

The Major is false every way, whether it be supposed that Phlebotomy produce such an effect per se and di­rectly; or by accident, and only in some persons, in some circumstances. For were it true that Phlebotomy did directly and wheresoever it is used introduce a Feaver, yet it may so happen that a Feaver may be expedient to some Patients for the prevention of greater evils, and sometiems for the curing of them: and in these cases 'tis as much prudence in a Physician to acquiesce in, or run the fortuitous hazard of a lesser or less dangerous evil, as 'tis for States-men in the Body politick. Nature doth [Page 42] often cure one disease by introducing another: and commuting the more dangerous into another of lesser hazard: as any intelligent Physician knows, who un­derstands the Metaptosis and Metastasis of diseases. I am not obliged to read to these Disciples of my Lord Bacon a course of Medicine. Vide Steph. Roder. Castren: Ou [...]e ex q̄uibus. V [...]lles. in Epidem. l. 4. p: 448. in hi­storia Alcippi. & ibid. p. 401. in hist. femu­lae emptitiae. Hieremias Thriverius Brachelius in lib 4. Aphor. 57. There is an Aphorisme of Hippocrates to this purpose. Quia convulsione ant distentione nervorum tenetur, febre superveniente libe­ratur. Upon which words Hieremias Thriverius doth thus comment. Alio modo febris convulsionem tollit ex plenitudine, alio rursum modo distentionem: convulsio­nem enim curat, quia plenitudinem discutit; distentio­nem vero quia insigniter universum corpus incalefacit: forte etiam distentio convulsionis genus nescit. Quic­quid autem sit, utrique febris confert, ac potissimum dia­ria, imo & putrida minus periculi affert, quam ipsa disten­tio. Frustra ergo conflictantur in ea questione Neoterici, an putridam febrem convenit excitare in convulsione ex plenitudine, V [...]lle [...]. contro­vers. Medic. l. 8 c. x. Hieron. Ru­beus in C. Cel­sum. l. 5. sect. 4 aut flatulento tumo [...]e. Which that it may be lawfully and prudentially done (but not by every fool) is a judged case amongst us: and were it not lawful, the Argument would by a parity of reason ex­tend to several operations in Chirurgery. It is the judgment of Celsus long ago, with which I conclude. Sed est circumspecti quoque hominis, & novare interdum, & augere morbum, C. Celsus de Medicina l. 3. c. 9. & febres accendere; quia curationem, ubi id, quod est, non recipit, potest recipere id quod fu­ [...]urum est.

The Major being thus false in that sense which was most pertinent to his purpose: 'tis most ridiculous in the other: For who will not immediately laugh at him that should thus determine? That which may in some persons, and in some circumstances incline unto a Fe [...]ver, is never the proper remedy of [...] Feaver? And how can this Bacon-face upbraid us herewith, who doth himself prescribe to his Patients in Feavers the most generous liquors of the subtilest smack, p. 169. exhibited [Page 43] largely, without insisting upon the nicety of any danger from heating? and yet his Sack and other generous liquors may ingender Feavers, and other distempers in the healthy. In fine, Whoever rejected the use of a thing for the abuse, or condemned peremptorily any cause for accidental inconveniencies following thereon, but such a Dulman as this Helmontian, and his brethren the disciples of my Lord Verulam.

'To the Minor I reply: that for the observations made by this insipid pretender to Pyrotechny, I regard them not at all: he hath not judgment enough to make one. Novae Acad. Florent. opus­cul. p. 21. Ego vero sicuti experientiam multi facio, dummodo commodum expertorem nacta sit: Ita si uni­cuique qui se expertum dicat temere credidero, ridiculus profecto habear: ut qui & fori circulatores ac loquales vetulas, agrestes quoque sacerdotes in pretio habeam. Nam si quaeras, omnes uno verbo, quae proponunt se ex­pertos dicunt. It is true I have a great reverence for the name of Experience, and the bare mention thereof commands an attention from me: But it hath been the peculiar misfortune of my education, that I have been taught, not rashly to assent: nor to believe every thing that is told me, since there is nothing but may be spoken by some body. I can be so civil, and so curious as to give the Relator an hearing, how mean soever he be, but before I credit him, I must consider whether the thing be possible? and withall (because my know­ledge is not the adequate Measure of possibilities in na­ture) Whether it were done? If the thing did suc­ceed, I inquire, Whether it will constantly, or most commonly follow upon the like causes and cir­cumstances? Or whether it is a rare accident? In the two first cases, the knowledge thereof makes a P [...]ysician the better Artist: the latter adds to his general Science of natural Phaenomena, but not at all to his Art, except in cases as rare as the Phaenomenon related. In Artibus, inquit Galenus, duo sunt prae­ceptorum [Page 44] genera, Io. Riolan. in resp. ad dubia Anato­mica Barthol. p. 75. unum eorum quae perpetuam habent veritatem: alterum, quae utplurimum ita se habent, & tolerantur: quae raro fiunt, ibi locum non habent. At hodie multi sibi placent in scribendis & obtruden­dis observationibus raris, tanquam novis Artium my­steriis: sed rara non sunt Artis. I do also consider the quality of the Relator: Ar. Rhet. l. 2. c. 4 [...]. the vain-glorious and ambiti­ous are easily deceived, because they passionately desire the thing should be so, and 'tis for the credit of such Obser­vators, if it be so: the young are easily imposed upon by the little experience they have of things, the credulity that is in them naturally, and the good opinion or hopes they have of the integrity of others; and because they are conceited of their own knowledge (though the prospect of things be narrow) they are prone to opiniatrity, and vehement in their assertions, though too unsetled, and impatient, (as well as ignorant) to weigh any thing maturely and with all its requisites. I do not weigh the greatness and opulency or Relators, but value them as they are Artists, for such only can judge in their own Faculties: And when controversies arise the Stagirite deluded me into an opinion, that the most probable tenet was that which the most, or the most intelligent did profess. This Pyrotechnist upon many reasons deserves not any credit: he writes Books as Mountebanks paste up Bills, to invite custom: the Medicines he re­commends are such as by the sale thereof he would advantage himself: all he publisheth is in a subserviency to this end; and 'tis not his skill, but this ignorance that is concealed in his Arcana: all that ever sweet William or Andrew related upon a Quack-salvers stage deserves as much of heed and esteem, as what— G. Thompson talks. I do not ask thy pardon Oh! most illiterate and dull disciple of my Lord Ve­rulam, for dissenting from Thee. But I with submis­sion and deference beg leave for not adhering to Do­ctor Willis: No man of understanding can condemn [Page 45] his practise: he hath not altered the Authentick me­thods, but given new and plausible reasons for an Ancient procedure: This Character is due unto him, that scarce any man surpassed him in his thoughts, when awake; and 'tis his peculiar happiness, that his Dreams are pleasant and coherent. Amongst all that have written about Phlebotomy, and its abuses, I never met with one that recounted this for one evil consequence thereof, that it inclines men to Feavers: I find P. Castellus to reckon up twenty five evil accidents which some­times ensue thereupon: Claudinus propo [...]eth frequent Phlebotomy as a remedy for s [...]ness. Venae sectio omnino con­venit; imo sunt, qui nihil magis ad de­trahendam corporis mo­lem valere existimant, quem cre­bram sectio­nem venae. Empiric. ratio­nal. l. 1. §. 1. c. 4. but this is none of them. Nor do I see that it is reconcileable to that effect of Phlebo­tomy, whereby it refrigerates the habit of the body, and the common distempers which follow the Abuse of it, are cold: If it be true that it inclineth people to be fat, and fat people are neither so hot, nor incident to Feavers, as the lean and bilious (though otherwise more weak) there is reason why my doubts should increase upon me. It might, with some colour, have been said, that excessive Phlebotomy did dispose to the Rheumatisme and Gout; but not to Feavers; except by accident, that some persons having contracted a grosser and more sanguine habit of body upon Phlebotomy, and ( such complexions being most capable of any malignant or pestilential and contagious infection, not by reason of their phlebotomy, but from the habit of body, which whether natural or adventitious is lyable to those ca­sualties) falling upon any excess or other occasional cause into the Small-pox, or Sanguine feavers, the ob­servation hath been raised into repute. It is a thing I have not seen to happen vulgarly: nor doth any Au­thor [...] that I know, take much notice of that other effect, how Phlebotomy inclines to fat: I have read in Ioannes Fuchsius a Bavarian that such a thing hath fal­len once, Io. Fuchsius Compend. abus. p. 2. c. [...] or so, under his observation, in a Lady: and Doctor Primrose denies the matter of fact, Primros. de vulgi error. l. 4. c. 50. that Phle­botomy will make those that are inclined to be fat, [Page 46] fatter: though persons that are extenuated and ema­ciated with sickness may by bleeding acquire a greater corpulency: And certain it is that in those Countreys where Phlebotomy is most used, there are fewest fat men, and women: as Spain, France, and Italy, or Egypt, in this last region, it is their particular study, and a di­stinct profession, Prosper Alpi­nus de med. Egyptiorum, l. 3. c. 15, 16. to make people fat, but 'tis by other courses then Phlebotomy. In short, I my self have been let blood above fourscore times, and yet am lean: and so far from being feavourishly inclined, that I never had any except the Measils once, and Small-pox twice: and twice a tertian Ague: and I find no imbecillity or prejudice in the least that should induce me to repent what I have done, or resolve against it for the future: But we must distinguish upon what is produced by any thing as its cause, and what is only a concomitant thereof: If it ten thousand times proves otherwise, we must not impute the growing fat of one Patient to Phlebotomy indefinitely, but rather to some alteration the disease (in which it was applyed) hath wrought in his body, to his Analeptic diet, and course of life, subsequent thereunto; or to his individual tem­per. And perhaps it may be not impertinent to add here, that as Distillation and the burning of the blood of a Multitude of persons hath convinced me that there is no such deflagration of blood, as that learned Physician imagines, nor any vital fermentation in the blood depending upon the Chymical ingredients of Salt, Sulphur, and Spirit, &c. so neither is the Blood of corpulent persons (I never tryed the Obese; be­cause they do not bear Phlebotomy; except once in a Youth lately was extream fat, and in danger of an Apoplexy, and it did not burn with so vigorous and lasting a flame as that of many lean men, but by its crackling gave testimonies of much Salt: yet the Se­rum was insipid) it is not properly sanguine, but pitui­tous.

[Page 47]But to resume the discourse: I expected to have seen the Minor proved by our Helmontian; but al­though I find that he saith his observation did jump with that of Doctor Willis, that Phlebotomy did in­cline to Feavers: Yet my Reader may see that in the first part of the Argument, as I have urged it in his own words, he reckons amongst the evil consequences of bleeding none that proceed from an opulent and sul­phureous blood transcending the dominion of the spirit that remains after Phlebotomy, but such as argue an impoverishing of the blood, or a cold indisposition. I will repeat it again, to shew how justly I censure his Logick, and so dismiss the Argument.

If it be so, that striking a vein often in a long and tedious disease, is a preparatory for a sharp Feaver, as we both herein jump right in our ob­servation: then am I certain that Phlebotomy repeated in an acute Sickness, is a door set open, and an in-let for a long infirmity, so that this mode of defalcating the vigour of the spirits doth for the most part (as I have strictly heeded many years) disarm and plunder Nature in such sort that it cannot resist the assaults of every petty in­firmity, witness those multitudes of relapses, or Agues, Scorbute, Dropsies, Consumptions, Atrophy, Iaundise, Asthmaes, &c.

The proof of the Minor here is not only defective: but the mischief is, Dr. Willis de [...]ebr. p. 197. that Doctor Willis, who judiciously useth Phlebotomy, commends it in Feavers both in the beginning and augment of those that are putrid, (and also in Diaries) as the principal remedy ( inprimis [Page 48] conducit) and speaks in the place cited by our Hel­montian only of a customary letting blood in time of health: Dr. Willis de [...]ebr. p. 1 [...]6. edit. 1662 [...] Whereas this Bacon-faced Pyrotechnist, saith that their Wits jump in this, that often striking a vein in a long and tedious disease is a preparatory for a sharp Feaver: Let any man read the place and see how he abuseth that excellent Practitioner, whose words are, Prae caeteris vero observatione constat quod crebra sanguinis missio homines febri aptiores reddat, quare dicitur vulgo, quibus sanguis semel detrahitur, eos, nisi quotannis idem faciant, in febrem proclives esse. I am sorry he should seem to give a reason for a vulgar error: for once or twice bleeding doth no more create a Cu­stom, or dispose Nature to an anniversary commotion in the blood, than one Swallow makes a Summer: But cer­tain it is, (I speak of our cold Climates, not of those hotter where sweat and transpiration often prevent those determinate motions of nature) that such here as are very much accustomed to bleeding, keep certain times for it, their bodies will require it at that time, and, if they refrain it, they will feel an oppression and dulness, or lassitude, and may fall into a Feaver, but Aches, Rheumatisme, Gout are more likely, except other acci­dents concur to produce a Feaver: if the ebullition be no greater than to produce a Lassitude, 'tis possible (in some bodies) that the Scurvy, Cacochymy, Cachexy, Dropsie, Asthmaes, Cephalalgyes may ensue: for the morbifique ferment, like the scum boyled into the broth; may mix inseparably with the blood, and vitiate for ever that great sanguifier with an unexpressible pravity: But he that thinks 'twill be so in diseases, when the Pa­tient is phlebotomised, neither understands the motions of nature, nor the effects of a sound recovery. Instead of Doctor Willis this illiterate Baconist (who profes­seth to be so well versed in the way called Galenical) should have (as he argues) made his recourse to Avicen and his followers, who are ( in many cases) [Page 49] fearful of Phlebotomy, least it should produce an ebulli­tion yf choler, or crudity: which two inconveniencies may produce all that— G. T. talks of. Thus some­times Tertians have been doubled, Hor. Augen. de miss. sangu. l. 4. c. 19. nay turned into irre­coverable continual Feavers. But all the cases relating thereunto concern not an intelligent Physician, who understands what is past, present and to come, and knows when to presume, when to fear. But I intend not to teach these fellows: it were better for the Na­tion, and them too, that they were Coblers, or day-labou­rers, than Practitioners in Physick: a Doctoral Diplo­ma, though purchased, will not sufficiently qualifie them for the profession; and as little doth the title of Experimental Philosophers, and Verulamians, avail them.

The next Argument of his that I come unto, and which is more than once inculcated, as if he thought it a Demonstration, is this, as I may form it.

Before I come to answer particularly to the Argu­ment, give me leave to animadvert upon some passages in this discourse. As to the Du [...]mvirate, I do not understand whether he be absolutely of Helmont's mind, or no, making the Pylorus of the Stomach to be the place where the Soul is radically seated, and whence it displayes it self principally in the management of the Oeconomy of the body; joyning the Spleen with the Stomach as an Associate in that Soveraignty. There is not any thing more foolish than the dreams of Hel­mont; had our Baconist any understanding of humane nature, any converse with modern Writers, the vanity of the Duumvirate would have been manifest unto him: I advise him to read the Fundamenta Medica of the excellent Maebius, where he treats of the Stomach and Spleen: where he alledgeth nothing for himself, why should I insist on any thing. The general Archaeus of the Stomach and that appropriate to each part seem to me to import no more, nor to be more intelligible than the innate heat of each part, and that other influencing each part and disseminated from the Heart: If the in­nate heat of each part be called a particular ferment, it matters not much: I comprehend it as little still: How the operations of Nature are performed I know not, nor ever shall understand by Canting terms, or Similitudes: That the notion of Fermentation is equivo­cal, or not to be accommodated to the Stomach and its digestion, Maebius fun­dam. med. de usu ventriculi, p. 178. but by a certain Animal heat, I think Maebius hath evinced: and I cannot be satisfied with the reply of Kergerus: Kerger. de fermet. §. 3. c. 2. and if the notion of an implanted fer­ment and fermentation be suspicious there, where there [Page 52] is the most to be alledged for it, I may be pardoned for scrupling to fix it elsewhere; but to be content thus to manage the Question, as if it were branched into these Interrogatories.

Whether the Pest be a Feaver [...]?

Whether in the Pest it be lawful and beneficial to let blood?

Whether all ill-conditioned great Feavers, and most maladies have in them a particular venome, dele­terium quiddam, and are to be cured by Corroboratives, and Diaphoreticks, without Phlebotomy?

The distinct solution of these Questions will make the answer to his Argument very facile: and I will not retrench upon the not-to-be-perceived Empire of the Duumvirate, nor inquire by what means the stomach hath such an influence upon the Skin as to govern it as it pleaseth.

The first Question if I were to determine it out of — G. T. in his Treatise of the Pest, I would resolve in the Negative upon this reason. If the Pest be a Fea­ver [...], then is a Feaver inseparable from it, and that term ought to be put into its definition. But— G. T. doth not define the Pest by a Feaver, and grants that the Pest in some produceth no Feaver at all. Ergo—

His definition of the Pest is this. The Pest is a conta­gious disease, G. T. of the Pest: c. 1. p. 8. for the most part very acute, rising from a certain peculiar venemous Gas, or subtile poyson, gene­rated within, or entering into u [...] [...]rom without: at the access or bare apprehension of which, the Archaeus is put into a terrour, and forthwith submitting to the aforesaid poyson, invests it with its own substance, delineating therein the perfect Idaea or image of this special kind of sickness distinct from any other. He that can accommo­date this Definition to a Feaver, or find anything of a [Page 53] Feaver in it more than of the Colick, or Dysentery, Diarrhaea, understands more than I; for even these have been Contagious, as well as Epidemical: Perhaps he will reply, that the Pest is alwayes so: But in this, notwithstanding his boasting here he understands the Pest, and (whereas Rondeletius and other Galenists dissected many that died of the Plague) he did ana­tomise one that deceased of it, yet doth he not know the Nature of it: For the Pest is not alwayes conta­gious, there being recorded many cases in which the Pest hath seised one person, Isbrand. a Di­emerbrook de pest. l. 1. c. 7. [...]. 1. p [...] 1 [...]. edit. 1665. Amsterdami. & Zacchias Qu­medico legal. l. [...]. tit. 3. Qu 1. § [...] 13.14. G [...] T. of the Pest. c. 3. p. 42. and extended no further. However if the words Contagious disease do not include a Feaver [...], there is not any mention­ed in the definition: and if they do, then is also the Scabbado, and Leprosie, &c. a Feaver [...], since each of these is a Contagious disease. In sum, He grants that the Pest may invade without a Feaver, in these words.— It produces a manifest Feaver in this man, and in that none at all, or hardly any sensi­ble.—These words do not become a man that Holds the P [...]st to be a Feaver [...], and carries on the Hy­pothesis so far as to make all malignant, putrid, Feavers to participate thereof, and bear some resemblance there­of: and (which is pretty) that almost all maladies (either Feavers, Isbr. a Diemer [...] de Peste l. 1. c. xii. So Van der Mye during the siege of Breda, relates causes of such as had the Plague, and yet during the whole time of their Sickness had no Feaver. Van der My [...] de mor [...]s Bred p. [...]1 [...] 1 [...] or not) fall under the same predica­ment.

But I pass from— G. T. inquire into the true nature of the Pest according to the most learned and judicious Practitioners that ever attended in it. The most accurate Isbrandus a Diemerbrook relates how many in the Pest at Mymmegen (where he was Visitant) had the Pest without any signs of a Feaver: nor was this to be seen only in such as dyed suddenly, but in those that had Botches and Carbuncles, yet went up and down and pursued their business, without being any way feaverish: of which number himself was one. And he with the allegations of many Authors and Histories [Page 54] of Plagues justifies his Definition, in which he forbears to make the Pest to be a Feaver. In like manner Casper Hofman living in Norimberg, C. Hofmann. Antifer [...]elius Le [...]m, 64. when the Town was be­sieged and the Plague raging, had the Pest himself with a Carbuncle on his shoulder, sed sine alio symptomate, and taking due care of himself, without consining him­self to his bed or chamber, he recovered: He instances in others that escaped, I. N [...]rdiu [...] in Lu [...]ret. l. 6. p. 527. in the same condition. With these agreeth Nardius, who was chief Director in the Plague at Florence in 1630. Alex. M [...]ss [...]r. de pest. l. 1. [...]inter opera) p. 498. & Forrest. de [...]ebr. l. 6. obs. x. Sennert. de [...]ebr. l. 4. c. 1. Dudith. inter apist [...] Schoet. [...] 52. And the most learned Massarias who was Physician at Vicenza when the Plague reigned there in 1577. Out of all which it is manifest that the Pest is not a Feaver [...], since there may be a Pest in which the sick party hath not any Symptome of a Feaver: 'Tis true that many learn­ed men do desine the Pest by a Feaver, and do hold that there is no Plague without one; but since they confess that sometimes neither Pulse, nor Vrine, or any Symp­tome discover the least characterisme of a Feaver, 'tis against common sense to assert what they do in such cases. F [...]teor [...]ebrem hanc pro pu­tredinis [...]ut d [...]ffl [...]tionis condi­tione, copia aut incremento, modo majorem, modo mino­rem exis [...]ere, quam in non­nullis Synochum, Tertianam continuam, & Febrem quem. cunque ardentem incendio & calore aequasse, non ego tantum, sed & Collegae mei, Doctores hujus urbis Medici clarissini, aegri [...] in publico No­ [...]c [...]mio decumbentibus ope­ram praes [...]antes observarunt. M [...]nderer. de pestilentia. c. 6. It is granted that u­sually the Pest is accompanied with a pu­trid malignant Feaver of a very uncer­tain T [...]pe; which sometimes appears not before the Botch and its suppuration, sometimes it begins with the first at­tacque of the venome. If what I have said be true, and that the Pest may be without any sign of a Feaver, or any sen­sible indisposition, I much doubt the rea­lity of his opinion who talks so much of the affrighted Archaeus, and the troubles which essentially and inseparably befal the Duumvirate of the Stomach and Spleen upon this invasion or insur­rection of the pestilent venome: and I am more con­firmed in my jealousie, because I have read that some of them that have had the Plague, have not felt any [Page 55] symptome about their Stomach, not so much as a de­bility of appetite, but sometimes they have complained first of their heads being discomposed, Sennert. de [...]ebr. l. 4 c 1. de pestilent. P [...]us de Pest. l [...] 1. c. xii. and most com­monly of anxieties about their Heart. But 'tis not my intention to write a Treatise of the Plague: 'tis a disease I never saw, though at Fulham-pest [...]house and at Windsor I gave such Prescripts and Medicines in the beginning of the Plague as did equal in effect any of the Arcana of this Helmontian. As for the knowledge this talkative person should acquire by dissecting one body, it is but little; it argues want of reason in him to conclude generally from one case: the Glory of the Act is much abated in this, that Bontius, and Rondeletius in the presence of many Students dissected several; Rondeletius de febr. de febre pesti­lentiali. and (which is more) this last denies the Carcasses of such as dye of the Plague are not infectious; so doth Fracastorius, Iordanus, Gregorius Horstius: I allow that this last is not a constant truth, and that there are some Observations recorded by which it appears that the Carcasses of such as dyed of the Pest (before putre­faction) have been infectious. But to shew with how much injustice he triumphs over the Galenists for his having dis [...]ected one single body, I shall let the World see that the Galenists (without proclaiming the fact, Volcherus C [...]i­ster dissected many in the Hungarian Pestilential feaver: so did [...]ssenius, and Rul [...]ndus. or causing a Picture of it to be cut) have done as much, and that the variety of Pests, and the different effects they produce in bodies is demonstrable. At Pa­lermo in Sicily in 1647. there was a Plague, in which upon the dissection of many bodies by a sort of fel­lows, all whose knowledge did not enable them to cure a cut-finger, whose skill is but words, and advances nothing: these Galenists did Anato­mise them. Haec visa: vasa omnia venae cavae sanguine ita nigro, Ioseph. Man­cusus pro se [...] cub. vena def. p. 153, 154. adusto, atrabilari, turgida ac repleta, ut fusi atramenti similitudinem prae se ferret. Idem sanguis tum in corde, tum in faucibus repertus fuit, pulmones atque hepar tumefacti, inflammati, ventriculus bile turgi­dus, [Page 56] nulla in venis Meseraicis, nulla in intestinis laesio. Eadem haec uniformiter in singulis [...]uerunt observata. If it be said, that 'twas no great attempt; because it was no very mortal Pest; yet this is certain, that it lay in the mass of blood, and that the Duumvirate was not so much concerned, as G. T. could have wished; nor the blood in the vena porta altered according to Circulation: Well: that last at Naples I am sure was as pernicious as ours at London; and there the Colledge of Physicians caused many to be dissected: I have not met with the Programme published by them, but the Duumvirate gains nothing by what I do read. Nam dissecta cadavera, C [...]rol. V [...]lesius de Bourgdieu de pest. p. 239. hepar, pulmonem, intestina, ni­gris maculis interstincta, cor vero atro sanguine con­creto luridum praebuere, ut Medici Senatus Neapolitani programmata die secunda Iunii edita promulgarunt. Neither doth it appear that what this Pyrotechnist saw in the body, after the man was deceased, was either the cause or seat of his distemper when he first fell sick: the last strugglings for life might express many liquors into the stomach, and vitals, and they upon their com­mixture, setling, and refrigescence create, other Phaeno­mena than were meerly the effects of the Pest. 'Tis averred by C. Celsus, C. Celsus me­dicina l. 1. pref. Neque quicquam est stultius, quam quale quid vivo homine est, tale existimare esse moriente, imo mort [...]o.

That I may the better decide the subsequent contro­versies, it will be requisite I represent a more exact De­finition of the Plague; and to do that well, I must di­stinguish upon the word Pest, which is either taken in a general sense, Coyttarus de purpura c. 7. p. 54. Massari [...]s de p [...]st. l. 1. (inter [...]per [...]) p. 497. and so comprehends any Epidemi­cal contagious disease of which many in the same Country do dye, be it attended with a Feaver, or destitute of one, be it occasioned by any speci [...]ick ma­lignity, or anomaly of the Air, or arise from evil diet, or imported by contagion. Thus the Epidemical contagi­ous and pernicious Colick recorded in Aegineta, was a [Page 57] Pest: thus Squinancies, Catarrhs, Pleurisies, Peripneu­monies, Diarrhaeas, Bapt. Codron­chius de morb vulga­ribus. c. [...] Io. Cr [...]to assert. de febr. pest. p. 13. Dysenteries, the Measils, Small­pox, have been pestilential: nay the Garrotillo or Strangulatory disease in Spain, Sicily and Naples, though it seized upon and infected scarcely any but Children, was a Pest, and esteemed so by Aetius Cletus and others Thus it was deem [...]d at Venice to be a Pest of which so many once died, Aetius Cletus de [...] orb [...] Strangulator. c 2. Mer [...]atus, Consult. med. 14. Dudithius in­ter Epist. Scholtzhii. Ep. 51. though there were not any other Symptomes perceivable in it, but a tumor of the testicles accompanied with sudden death. Legi superioribus menstibus libellum Veneti [...]ujusdam, qui ex [...]erientiam te stem citat, multos ex peste mori [...]os esse, quibus testiculi intumescebant solum, nullo [...]aeterea symptomate aegrotos illos invadente. I [...] ma [...]ters n [...]t what is the [...] of the disease, which way t [...]e venenate matter inclines, or what part it principally [...]ffects; a C [...]rbuncle in the throat (as in the Garrotillo) is as pestilential as a Car­buncle on the hand, or toe, if it be as epidemical, con­tagious, and mortal. Ballonius Ephemer. l. 2. p. 237. So the Chin-cough may be pesti­lential upon the like qualifications: and I believe that to be the disease whereof Ballonius speaks, that it was Epidemical amongst the Children in France in 1579. He calls it Tussis Quinta, and admires how it came by that name, and so doth his Scholiast Mr. Th [...]v [...]rt: un­doubtedly it was transmitted from England, and thence came that name, which the French mistook for Tussis Quinta, and Quintana: that is the disease I am sure he describes: he saith none ever writ of it: and I believe it to be true as to forreign Physicians. Such mistakes will hereafter make work for Criticks; who will make strange glosses hereupon, as on the Milor­dus of H. ab Heere, and the Cerevisia Trihopenina in Mercatus; the first imports no more by unus ex iis quos Angli Milordus vocant, Mer [...]at. de recto med. pr [...]s [...]d. usu. l. 1 c. 2. then one whom the English call My Lord: and the other intends nothing by Cer [...]visia Trihopenina than Three-half-penny Ale, and contra di­stinguisheth from Cerevisia dupla, or double Beer. But [Page 58] to resume my discourse; I add that in such times as there are diseases of sundry types, and several symp­tomes, so as that they may seem to be different and sporadical diseases only, yet in case they be malignant, vulgar, pernicious, they are to be accounted either as so many Pests, or as one, under several disguises: for it is not alwayes true that in the time of the Pest all other diseases cease, Hippocrates Epidem. l. 3. cum notis Vallesii. p. 279, 280, 281. as is evident out of Hippocrates: Thus Pestilential Peripneumonies, Squinancies, and Pleurisies did at the same time rage in Germany, (as Wierus relates) near the Rhine in 1564. Wierus Obs. l. 1. de epidem. pleurit. &c. And during the Siege of Breda amongst the Garrison at the same time, besides the vulgar Plague many pestilential disea­ses, as Tenesmes, Vander Mye de morbis Bredanis, p. 4, 5. Dysenteries, Cephalalgies, and Ca­tarrhs, which retaining their distinct types, were with­all pestilential: nor is it strange that I should reckon upon all these as radically one disease; for in the vul­gar pest, Ale [...]. Massar. de pest. l. 1. inter opera. p. 510, 511. such was that at Athens, there are reckoned up as one Pestilence a multitude of diseases that, were it not for that common mixture of a pestilential venome, must have been reduced to several heads. Thus in the spotted Feaver at Lubec did Neucrantzius observe that almost all manner of diseases were the effects of that Pest: Neueranztius de purpura, p. 65. ‘ Purpurae venenata qualitas intro con­cepta, ut tota specie nobis adversa, ita ad morbos totius substantiae merito refertur. Quamvis enim ultro con­cedam nullum fere morborum aut symptomatum genus dari, quod non in purpura sese offerat: isti tamen morbi consuetis non cedent remediis: & in singulis morbis ac symptomatibus peculiare atque abditum quid apparebit, quod experto & prudenti Medico supra sor­tem istorum, sed simplicium, morborum esse, imo a cae­teris similibus totius substantiae morbis se vindicare, totoque genere inimicam illam qualitatem, in qua essen­tialis morbi hujus proprietas posita est, manifesto decla­rare videatur. Sic lues venerea nulli non morborum conjungitur, qui tamen non illis consuetis remediis, sed [Page 54] alexiteriis junctis se curari postulant, adeo ut plerum­que fallant non solum aegrotantes, sed ipsos etiam me­dicos, docente Fabio Paulino lib. 1. comment in pestem Atticam Thucydidis, p. m. 37. Idem in Scorbuto Arctois locis medicinam facientes experimur, qui cui­libet morborum & symptomatum conjungi solet, ut nullis in reliquo corpore sceletyrbes indiciis morbi qua­litas uni membro impressa aliquando haereat, medicos non raro ludat, curationemque moretur.’

Under the aforesaid Definition of Pests I include all those that are called Pestilential feavers, such as the Sweating sickness, Hungarian and Spotted feaver, the Hectick and Semitertian pest, of which you may read in Schenckius: Schenckiu [...] Obs. Medic. l. 6. for by the doctrine de Conjugatis, a Pestilent Feaver is a Feaver that hath the Pest. This is not meerly a Logical Quirk; several Practitioners averre it: and particularly Mindererus: R [...]ymond. Minderer. de pest. c. 6. whose words in opposition to such as distinguish be­twixt a pestilential Feaver and the Pest, are these. ‘Febris pestilens (ut illorum distinctione utar) aut vera est, aut non vera; si vera est, nil aliud est nise Pestis ipsissima, & ut doctissimus Hieron: Mercurialis loquitur a vera peste inseperabilis: si non vera, jam nihil vel parum commercii cum peste habebit, & sic pe­stilens non erit, nisi ob similitudinem aliquam sympto­matum (quod forsan Galenus voluit) ita eam appel­lare placeat, & sic inter malignas annumerabitur: quod si gradum intenderit & vere pestilens effecta fue­rit, nil nisi pestis erit: alioquin simile esset dicere hic Saxo est aut Suevus, ergo non Germanus: aut hic He­truscusest ergo non Italus. Vnde febres malignas [...] & aequivoce pestilentes quando (que) dici observandum.’ i.e. A pestilent Feaver (to use their distinction) is either re­ally such, or it is not so: if it be really such, then it can be nothing but the Pest it self, and as the learned Mer­ [...]urialis observes, no more distinct therefrom than it is from it self: If it be not such really, then it is not to be ac­counted [Page 60] pestilential, except you please to nick-name it so by reason of some resembling symptomes (which it may be was the sense of Galen) whereas it ought to be reputed only malignant, above which degree if it rise and become truly pestilential, 'tis nothing else than the Pest: And to say otherwise is as absurd as to argue, this is a York-shire or a Devon-shire man, there­fore no English-man. Id. ibid. Neucr [...]n [...]zius de purpura c. x. p. [...]50. From whence it is evident that Feavers purely malignant are but equivocally stiled pestilential: and all that are pestilential are sorts of Pests. Thus when Pestilential Pleurisies, Squinan­cies, Cholerick passions, Lethargyes, Erysipelas's do rage, they loose their usual denomination, and become so many Pests (or the same) attended with a Pleuri­sie, Squinancy, Cholerick passion, Lethargy, or Erysi­pelas &c. And then those otherwise formal diseases be­come but symptomes, and accidental consequences of the Pest which vary not the essence thereof. Nor is it ne­cessary to the truth of the Definition, that all these Pests should be actually Epidemical, or afflict all sorts of men; or be alwayes equally mortal: for the spotted Feaver is as much included here, though it extend no further than one single person, Neucrantz. de purpur [...], c. 3. p. 35 Isbr. a Diem­brook de Pest. l 1. c. 1. §. 3. &c. 2. sect 3. Minderer. de pest. c. 6. and so is a pestilential Catarrh, or Cough, as our Physicians include the Plague (commonly so called) under Epidemical diseases, though sometimes it extends not its contagion beyond one family, or destroy but one person. It hath happen­ed that a Pestilential Peripneumony accompanied with spitting of blood was more fatal than any vulgar Plague ever heard of: Schenckius Obs. med. l. 6. such was that in 1348. written of by Guido de Cauliaco (who lived then) it posted from the East to the West, Coyttarus de febr. purp. c. 5. and scarcely left surviving then the tenth part of mankind, if so much. And the Spotted Feaver hath sometimes been more pernicious than the Plague in France: Again, I must say that sometimes even these Pests may not be pernicious or mortal: Such was that Pestilent Epidemical Cough in [Page 61] 1580. which over-ran all Europe, [...] Ob. [...]. 6. obs. 3. I [...] Sporischius de febr. Epid. c. 4. p. 128. V [...]ll [...]ola in append ad loc. commun. c. 2. yet, as sick as [...] were, there dyed not one of a thousand: yet doth not this derogate from my opinion, since not only those that write of it do allow it to have been pestil [...]ntial; but even in the vulgar Plague, where it is expected most should dye, at Millaine in 1576. and 1577. Septal. de Pest. l. 1. c. 14. p. 23. Septalius, who was Physician in it, records it, that many more survived than died at that Uisitation: yet, says he, would I have no body to deny it the title of a Plague, for it had all other signs of the Plague.

There is a great discrepancy betwixt the violence and symptomes of the same pestilential disease in its begin­ning, progress and end; betwixt such a disease (to appearance the same) when it rages at one time and at another, in one season of the year and in another; up­on some sorts of men above others, and some Nations above others (though living together, and using the same dyet and course of life) whereupon circumspect Physicians maturely considering that this variety can­not be alwayes imputed to the discrepancy of dyet, or difference of seasonableness in years, or such like circum­stances, they have allowed of a great variety of ve­nomes, or gradations of putrefaction, and esteem these Pests, though they do agree in one generical nature, and some resemblance of symptomes and effects, yet to arise from different poysons, or graduations of putrefaction; and hence it is that no two Plagues are ever almost cured alike; nor is it possible for to find out one universal Antidote against them all: As in poysons some are Septic, and Arsenical; some of another nature, as the poy­son of Scorpions, Vipers, the Serpent Dipsas, &c. of Napellus, Aconite, &c. so in Pests, by the effects, it is no vain fancy in the Paracelsians, Quercetan. redivivus. Art. medic. pract. p. 39, 40, &c. and Quercetan, or Min­dererus to guess that there is a variety of venomes in qualities corresponding much with those known poy­sons, and analogous unto them.

Concerning the Spotted Feaver was observed by that solid and circumspect Practitioner Paulus Neucran­tzius. P. Neucran­ [...]zius de pur­pura, c. 6. p. 69, 70. ‘An etiam purpurati veneni essentiae diversitas variare purpurae symptomata poterit? Ita censeo. Namque ea late admodum patet, & universo ambitu venenorum fere circumscribitur, variatque ut illa varia & prope innumera sunt. Hinc plerumqu [...] continua­rum febrium indolem ementita; interdum anginae ma­lignae epidemiae, pleuritidis, colicae, alteriusve morbi specie, singulari quasi partium delectu, affligere, atque hujus aut alterius veneni deleteriam vim aemulari vide­tur, ut morbum hunc novis plerum (que) symptomatibus emer­gere medici observarint. Vt enim in peste varietatem veneni memorant Authores, qua eadem interdum Anti­monii, interdum Arsenici, Napelli, aut alterius venenatae materiae virus exprimit, symptomatum similitudine, & [Page 63] alexipharmacorum diversitate: ut quae uni pestil [...]ntiae saluti fuere, succedentibus annis in altera peste consue­tos effectus negent; ita & in purpura ac malignis se­bribus eandem affectuum diversitatem, nec eadem re­media semper prodesse advertere licet. Sed nec diver­sis solum temporibus purpuram diversos characteres ex­primere, sed in una & eadem Epidemiae constitutione, modo hos, modo alios referre, credendum, eadem essen­tiali sed specialissima veneni diversitate; qua ut specie ab altera variat, ita pro indolis suae conditione diversa symptomata procreat, aemula & hic [...] pestis con­stitutione, in qua in eadem tempestate diversos specie morbos, qui ex illa maligna aeris impressione pernicio­sam vim acceperint, grassatos fuisse notum, ex epidem. l. 3. sect. 3.’ I might illustrate this further by the difference betwixt the Sweating Sickness, and other Pests at one time, and another: But I have said enough to shew that notwithstanding my Definition, I do allow that Pests may not alwayes be equal or equal­ly pernicious, or equally contagious, and yet retain their name: there may be such different degrees of venoms, or that superlative putrefaction, and yet the species not be varied. I speak dubiously about the terms of venome and superlative peculiar putrefaction, because the case is intricate, what to call it. I know the Philosophy of this Age, which consists most in Similitudes, will more approve of venome; but if it be hard to defend Pu­trefaction in order to the production of Pests, 'tis no less difficult to illustrate Contagion by Poysons; and in re­ference to the practise of Physick in Pests, I think I can demonstrate that the Galenical notion of putrefaction is the most utile. Some men think they make a great improvement in a Science, if they illustrate it by a new Metaphor, or introduce a novel term, the import where­of is no more emphatical or perspicuous than the for­mer; yet this must be deemed a new discovery, and by the imputation of ignorance, Students are deterred from reading the best Authors.

[Page 64] Thus we climb downward, and advance as much as he that turn' [...] Donne 's Poems into Dutch.

It remains now that I proceed to define the Plague in that sense to which it is in vulgar speech [...]: and amongst the several definitions that are giv [...]n of i [...] by judicious and experienced Practitioners, I sh [...]ll six upon that of Mindererus, as the most [...]x [...]ct and con­formable to the reality of the Phaenomena.

Filindererus de pest. c. 6. The Pest is a venenate malady, very deadly, and contagious, primarily affecting the H [...]art, and commonly attended with a Feaver, BOTCH, CArbuncie, and Spots or To­kens.

This Definition whosoever would see well illustra­ted, let him [...]ead the Author, and also Isbrandus a Di­embrook, Palmarius and Quercetan: not to mention others. It appears evidently hereby that this Pest is but a species of that other more general no [...]ion: It ariseth from a peculiar sort of putrefaction, or venome, and though it have symptomes different from its con­tradistinct species, though it be peculiarly called the Pest, Isbr. a Diemb. l. 1. c. 1. the Sickness, the Plague, [...], il morho, la malady; and such as make it a superlative putrefaction, to shew that it is but of a different de­gree from the others, may alledge that sometimes ma­lignant pestilential Feavers have turned into this Pest n [...]turally, Schenckius obs. l. 6. & Hieron R [...]e­ra in C. Cels. l. 3. c 7. p. 143. Riverius prox. l. 17. sect. 3. c. 1. or upon an evil method of curing. Exact Defi [...]itions are no more to be insisted on in Physick, than in Law; 'tis enough that they are commonly [...]rue, and that a iudicious Practitioner knows when they hold, and when they fail. I have demonstrated that th [...] Plague (so called vulgarly) is not so pernicious alwayes as the Spotted feaver, or pestilential peripneu­mony: it is not alwayes contagious. [...]br. a Diemb. l. 1 c 12. §. 4. ‘ Tales sunt illae s [...]bres, quas Galenus, 3. epid. comm. 57. & alibi, [Page 65] pestilentes sine peste vocat, quales se non raro observasse testatur Amatus Lusitanus cent. 7. curat. 27. Imo Quercetanus in Alexic. & Riverius s [...]ct.. 3. de febr. cap. 1. dicunt hujusmodi febres non semel visas fuisse cum verae pestis indiciis ( puta Anthracibus & Exan­thematibus) & tamen a vera peste longe diversas su­isse, P. Zacchias though he do hold that the Pest is most commonly contagious, yet he proves it is not neces­sary it should be alwayes s [...]. Quest. Me­dico. legal. l [...]. tit. Qu. 2 s [...]ct 21, 22. quia non erant contagiosae. Has febres Saxionia & Riverius appellant Pestilentes sporadicas; Crato & Liddelius, pestilentes privatas: alii pestilentes spurias.’ — I shall add a passage of Crato, which is not that to which this Author refers, but which He, who lived so long, and was so competent a Iudge by the Ex­perience of many pestilential diseases, as his dying words doth import to the World: ‘ Initio vero hoc tenen­dum, quod supra etiam monui; Io Crato assert. lib de [...]ebr, pestilent. p. 18 pestilentes morbos hoc quidem habere proprium, ut sint plurimis perniciosi, graves & lethales. Vt autem per contagium com­municentur, nisi putredo ad istam malignitatem in iis divenerit, ut morbidam expirationem transmittant in alia corpora, non necesse est. Plurimos enim interire nullis prorsus contagionis indiciis extantibus, apparet. Pestilentes igitur privatos, nisi putredo in iis orta mor­bidum expiret, Id. ibid. p. 20. astantibus innoxios esse affirmamus— Accedit ad hoc quod nostra quoque aetate in multis regio­nibus orientalibus & Meridionalibus, Pestilentias plu­rimis exitiosas fuisse constat: in quibus neminem con­tagione contaminatum, nec ullos a consuetudine aegro­tantium refugisse legimus.’ i. e. In the first place it is to be held for a certain truth, that pestilential diseases have their properties, that they are deadly to most, being very afflicting, and mortal. But that they should be contagious, it is not necessary, except the putrefaction be come to that height as to produce such a morbid exhalation as may infect other bodies. For it is most apparent that many dye, and yet there is not any sign of contagion to be demonstrated by its proper effect, of having introduced the like sickness in others. [Page 66] We do therefore avow, that those we call private Pests do not prejudice or infect those that attend the sick party.—Besides, even in our Age several deadly Plagues have destroyed multitudes in the Eastern and Southern Climates of the World, which yet have not diffused themselves by contagion unto others, so that none have declined to converse with the sick.

Whereas it is said in the Definition that it primarily affects the Heart, it is not to be understood so constant­ly, though generally a great debility and disorder of the pulse, and prostration of the strength ensue: for some­times an indisposition in the Stomach is the first sensi­ble symptome the Patient feels: and sometimes the Head is first and primarily affected, as in those that are Lethargical and Soporous, or Vertiginous. I read that A. Paraeus going to visit one sick of the Plague, A P [...]raeus Chirurg. l. 21. c. 12. and ha­stily taking up the bed-clothes, that he might see and dress a Bubo which he had in his groin, and two Car­buncles upon his belly: presently a sudden thick, noi­some vapour issuing from the Carbuncles that were apostimated, and broak, pierced his nostrils and discom­posed his brain, so that he swooned away, and fell as it were dead and senseless upon the floor: afterwards coming a little to himself, he was giddy, and every thing seemed unto him to turn round, so that he had fallen to the ground again had he not laid hold of something whereby to support himself: All the com­fort he had was, that he found no indisposition about his heart, no pain, no palpitation, nor any sign of any powerful and fixed debility of his strength. Which confirmed him in an opinion that only the animal spi­rits were tainted with that pestilent exhalation; in which he was more satisfied, by reason that he sneesed presently ten times with so great a violence, that his nose fell to bleeding, and that evacuation (as he thought) freed him from the vene [...]at [...] impression: for he felt no other ill effect afterwards.

[Page 67]In that I say it is commonly attended with a Feaver; it is upon the grounds already alledged: I add that P. Paaw the great Physician at Leiden (in those Provin­ces the Plague is frequent) denies that the vulgar Pest is to be defined by a Feaver. P. P [...]w tract. de Pest. c. 2. For it is not an usual Feaver, neither sanguine, or putrid: there happens oftentimes no signs of either of those in the Plague. It is not a malignant Feaver; for neither is the type and characterisme thereof to be discovered here, no nor the least sign of heat frequently. You will say that some­times 'tis a common Feaver, sometimes malignant: but neither is that true, for albeit frequently, nay, for the most part it be accompanied with a Feaver, sooner or later, yet is that but a symptome thereof and separable from it: they have different originals; the Pest a ve­nome; the Feaver a putrid heat. All poysons do not ingender a Feaver in him that takes them: why should we think otherwise of Plagues? In short, Experience shews that sometimes there is no sense of any great or unusual heat in the infected, no thirst, no alteration in the Pulse, Vrine, or Respiration: where that which is essentially consequent to a Feaver is not to be found, 'tis but reasonable to deny the antecedent to be there. I refer the unsatisfied for to be further convinced by Sennertus. Sennertus de febr. l. 4. c. 1.

As to the Botches about the Ears, Arm-pits, and Groin, and the Spots (or Tokens) and Carbuncles, those are so no necessary to this Pest (though many die before any appear) that the populace is rather suspici­ous, than convinced, till they be seen.

Having premised this long discourse, which I hope will seem neither useless, nor tedious to any Reader, the solution of the ensuing Questions will be brief.

Concerning Phlebotomy in the Pest, whether it be useful or legitimate, it is a question not to be resolved otherwise than by distinguishing upon the Pest: If it [Page 68] be taken in a general sense, I answer that it hath been frequently practised with great and visible success in se­veral Epidemical, cont [...]gi [...]us and frequently mortal diseases, as the Coy [...]tarus de pur­purat. febr. c. 12, 13. P [...]t [...]u [...] a Castro de [...]ebr. puncticular. sect. 6. & in dedicatori [...] epist. Dilect. Lisnan de venae sect c. 9. art. 4. p 1 [...]9 Septal. de Pest. l. 5. c. 17. p. 217. Spotted Feaver, the Bartholin. de An­gina puer. exercit. 5. [...]everin de abscess p. 449. Men [...]t [...]s consult. [...]4. Paedanchone or strangulatory dis­ease of the Children in Spain, Sicily and Naples: In the Cobelcho [...]er. cent. 5. cut. x. in Scholio. R [...]land de [...]ebr. Vngo­ric. p 270. & alibi. Hungarian Feaver al­so: and in Epidemical catarrh (when it was in Holland) Forrestus did with great success bleed, in 1580. Obs. Medicin. l. 6. obs. 3. But I must also say, that our Expe­rimental Physicians in these cases do some­times interfere one with another; and at least it is manifest that most of those disea­ses have been cured without bleeding: that it is to be administred with great caution; yet is it never more true that Medicaments are as it were the hands of the Almighty, then when in such diseases Phlebotomy is prudently used: all circum­stances must be duly weighed to the administration thereof; and there are so many fatal instances of the [...]vil success, that though they are ballanced by contrary Exp [...]riments made in all Countries, yet ought the wisest to be timorous; and the ignorant ought to consider, that since in such diseases most dye by the violence thereof (and this is their nature) it ought not to seem strange, if Phlebotomy prove as ineffectual, as other Re­medies do. In such diseases, 'tis not rashly to be at­tempted in the beginning of the disease (as Coyttarus in his excellent discourse observes) but when it is in his progress, and that the nature and tendency of the poyson is manifest, and the strength of the Patient bet­ter judged of, if indications require it, nothing is more beneficial; not that it is then administred to evacuate the poyson (as our ignorant Helmontian doth suppose) but to allay the putrid Feaver, and concoct it; for re­vulsion in pestilential Pleurisies, and Squinancies, [Page 69] (wherein each wise man divides his cares betwixt the malignity and the disease it self) to prevent further putrefaction or those inconveniences which some dire­ful symptomes men [...]ce the Patient with. [...]

In the more limited sort of Pest, commonly termed the Plague, as the disease is usually more pernicious than in those others, so do Physicians multiply their fears, and Patients their suspicions. They are much divided upon the point; and though the generality of modern Writers oppose Phlebotomy, (or suspect the good issue) nor can the happy instances for the contrary (though they may be alledged in all Countries) suf­fice to imbolden the present Age. The happy pra­ctise of Botallus is not regarded: Botallus de ven [...] sectio­ne, c 7. Massarias de Pest. l. 1. Roderic [...] a Fonseca in ap­pend ad Iacchin. de febr. p. 354: Septal. de pest [...] l. 5. c. 14. Forrestus Obs. l. 6. obs. 17. C. Hofmann. Anti Fernel. lemm. 64. Prosper Alpin. de medic. Aegyptior. l. 2. c. 7. p. 54. Prosper. Alpin. medic. meth. l. 5. c. 9. Massarias (as learn­ed and as well versed as he was in the Plague) is not able to convince men: Not Rodericus Fonseca at Lis­bone, not Septalius at Millain, not the cautelous Forre­stus, who let them blood in the Pest at Delph within eight hours after infection, though it were occasion'd from f [...]mine and misery, and that with good success: not the president of Hosman in the Plague at Norimberg: Not the constant practise of the Egyptians, who in all pestilential diseases, and plagues do bleed largely the sick parties, as Prosper Alpinus relates; and whose example and experience did so convince him, that in that excel­lent Book of his de Medicina Methodica he thus ex­presseth himself for the cure of pestilent Feavers, and the Plague. ‘Itaque laxata a [...]vo lenitorio Pharmaco, ad vacuationem sanguinis declinandum. Primo secta interna vena cubiti dextri in ea copia mittatur, quam vires permittent: & in altero die, si corpus sanguine abundaverit, & vires permiserint, ex altero brachio evacuatio sanguinis erit repetenda: in pueris, & in viris, & mulieribus albidioribus sanguis mittendus itidem erit copiosus cruribus scarificatis, ex qua sca­rificatione, facta sanguinis evacuatio in febribus pe­stilentibus est utilissima, quia cum ipsa quantum san­guinis [Page 70] volumus, evacuamus, sine virium magna jactura (quod e longinquis partibus educatur) sine violentia, & quod maxime in hisce febribus videtur desiderandum, quoniam ex ea evacuatione a supernis partibus adinfer­nas [...]iat revulsio: Vnde mirum non est, si nos saepius in hisce aegrotis vigilias, vel dolorem capitis, vel deli­rium, vel surditatem, vel aliud symptoma simile con­tinuo sublatum viderimus, praesertimque si copiosa [...]a­cta fuerit evacuatio. De hac Oribasius ita scripsit: Et sane dum pestilentia vehemens Asiam deprehendis­set, In lib. 7. c. 20. multosque perdidisset, meque etiam morbus attigis­set, secunda morbi die remissione febris facta, crus scarificavi, duasque libras sanguinis detraxi, hacque de causa periculum vitavi. In pueris & infantibus in quibus una cum pestilenti febre vel exanthemata vel variolae apparuerint, perpetuo summam utilitatem ab hac evacuatione subsecutam vidimus; qua Aegyptii Arabesque nullum utilius praesidium in hisce febribus esse long a experientia cognoverunt.’ Not all this can either justifie or excuse a Galenist unto these Helmon­tians: I add the opinion of Erastus who lived in Ger­many, which Climate and Nation may seem to corre­spond better with the English; after he had given his reasons for Phlebotomy administred in the beginning, in plethorick bodies, and where nothing doth contra-judicate, especially in such as were used to bleed, or had any sanguinary evacuation at the nose or other parts, stopped on a sudden: and after he had refuted the Arguments of such as would cure the Pest in his time with Alexipharma [...]s and sweating only; he adds, ‘Equidem una consuetudo fere praestare videtur, Th. Brastus epist. 25. ut nostris hominibus venae sectio in hoc morbo minus no­cere videatur. In hac peste prorsus multi ex rusticis vicinorum pagorum nullo alio remedio affugerunt.’ I might cite the judgment of many more in this case, as Rondeletius, Mercatus, Trincavellus, Io. Costaeus, Altomanus, Pereda, Andernacus, Sarracenus, Massa, [Page 71] Mongius, Citantur ab Isbrando a Diemerbrook de pest l. 3. c. 3. §. 1. Paschalius, Mercurialis, Zacuius Lusitanus, Bayrus, Carolus Valesius du Bourgdieu, Ioel, Thevartius (upon Ballonius's Epidemia p. 50, 51.) Hieronymus Rubeus upon Celsus: Of the Ancients Aetius, Avi­cenna, Avenzoar, and that Latine Hippocrates. C. Celsus who particularly sayes, C. Cels. Medi­cin l. 3, c 7. Si vires sinunt, sanguinem mittere optimum est; praecipueque si cum ardore febris est. But I conclude with this assertion, that in the Controversie about Phlebotomy in the Plague, Caeterum in contrariam sententiam abeunt complu­res alii, iidemque doctissimi Medici, docentes omnino secand [...]m esse venam, nec minores paucioresve ad­ducunt felices successus. Hieron. Rubeu [...] in C. Celsum. l. 3. c 7. p. 140. Massarias de Pest. l. 2. (inter opera) p. 531. F. Platerus de [...]ebr. (inter opera) p. 161. the number of them that defend it exceeds that of those which oppose it, and their learning, judgment, practise, the rea­sons, the Experiments they alledge at least, equals what their Adversaries can pretend unto: Some Arabians have advised in the beginning of the Plague (before the disease hath impaired their strength) that the in­fected should bleed even until they swoon­ed: And Platerus informs me, that some having pursued that counsel avow that they have cured many, and therefore dislike all minute Phlebotomy in comparison of that which is so copious: thus Bayrus in his Treatise of the Pest commands, that if the Patient be robust, plethorick, and the pestilential Feaver be accompanied with a violent putrid Feaver, he bleed largely. But to deal candidly in this affair, I do think that of the Germans the most are averse from Blood-letting in the Plague, and depend upon Sudorifics.

Because our Helmontian doth so opiniater it about the Plague, and would reduce all Feavers (almost all diseases to be cured like it) and insults over the Ga­lenists for their ignorance in the cure, and upbraids them with their ill success in that malady, I shall briefly represent some of the reasons of their evil success; and the arguments they urge against sweating in all [Page 72] Pests, in the beginning, and process of the cure; as also sum up their practise about Phlebotomy.

When I consider the general desolation which the Plague hath made in all parts of Europe, notwithstand­ing the various wayes used for the cure thereof, and that Ge [...]many and the Netherlands can no more boast of an infallible cure, no nor [...]f a better success than Florence, Veni [...]e, Rome, Naples, Paris, or Sevill, me­thinks it is apparent that the recommendation of Medi­caments or M [...]thods of curing in the Plague ariseth from the observation that some by the happy use of such a course, or such a Medicament, have (perhaps amidst d [...]ngerous and seemingly deadly symptomes) been reco­vered: And herein Septalius, and Massarias, and others, say as much for themselves, as Minder [...]rus, or Sennertus: And what Celsus saith of Hippo [...]rates, Herophilus and Asclepiad [...]s; I cannot but call to mind when I reflect on the several Methods of Physick endeared unto us by judicious Practitioners: C. Celsus in pre [...]. Medi­cinae. Si rationes sequi veli­nius, omnium posse videri non improbabiles: si curationes, ab omnibus his aegros perductos esse ad sanitatem. So just I am to those excellent Practitioners: It is certain that in Physick we do of­tentimes commit the Fallacy of non causa pro causa, and attribute those effects to one Medicament, or Method, which either did but accidentally ensue th [...]reon, it contributes nothing to the effect (but only happening to be insisted on at or before the time that the Phoenome­non discovered it self) or only removing something that hindered the natural production of the effect, or only acting as a partial cause therein, or meerly strengthening or making room for nature that the effect might more easily result. Thus we dir [...]ctly yield the glory of one or more successful cures to a wrong ori­ginal, and delude our selves and others not only with vain hopes in the remedy or method, but with new Hy­poth [...]sis raised upon these frail foundations, and with [Page 73] the same levity reject the Medicaments and Methods of others, with which we celebrate our own; nay often­times with more; for those foundations are most sure which are laid by the most men, if they be judicious and observing, and have endured the test of more ages and tryals. If presumption and arrogance could have entombed the Pest, the most insolent but worst of Physi­cians, that is Van Helmont had secured man-kind against its ill effects: and what man could have dyed, or lan­guished under the Gout, or other Chronical distempers, if the Rhodomontades of Paracelsus, Penaltus, Severi­nus Danus, had contained any solidity? But experi­ence hath shewed us that we have only exchanged, not amended our practise, the Tinctures, the Essences, the Elixirs, however graduated, or how gloriously soever denominated, do not exempt us from that condition humane nature is subjected unto; the general in­tentions of curing cito, tuto, jucunde are old: the performance now answers not the pretenses: the Atha­nasia, Iucunda, Mysterium, Ambrosia (of which you may read in Galen) If I were to chuse my Medica­ments by the sound they make, would seem as good as the Anima Auri, Tinctura polyaceia, or Pulvis pestifu­gus; and better than the Alexistomachon, for that like [...], would affrighten me, as if it were a Medicine to drive away a mans stomach. And if I were to word my discourse I would more willingly use a known tongue, than an unknown, and write Secretary rather than the Vniversal Chara­cter: If I cannot acquire knowledge above others, there is more of vanity than glory in the ostentation of a new-fashioned ignorance. I write this because I am convinced, because I do not believe that there is any thing more intelligible in the modish word veno [...], then in the profound, sordid or superlative, [...]trefaction wherein the Galenists placed the [...] If such a putridity be unimaginable (which ye [...] [...] [Page 74] graduated above what we see, and unto which 'tis evi­dent that diseases sometimes gradatim do arrive) it is certain th [...]t there is no such thing as the Arsenical or Napelline poyson in the Pest; but somewhat forsooth Analogous thereunto, Mindererus de pest c. 3. as Mindererus and Sennertus as­sure us: and here we are put upon Gradations again by which Cerusse and Lithargyre, Napellus and Thithymal, Cantharides and Dipsas are to be transmuted into, or graduated up to Arsenic. Most assuredly in this Age the Chimaeras have exchanged their pasture, and being clo [...]ed or starved with feeding upon the Second in­tentions, they are now luxuriously dieted with Meta­phors and Similitudes. I would not therefore have this following discourse to be construed as an Apo­logy for the failures of the Galenists, but of all judicious Practitioners, even of different principles, who inter­meddle with the Plague.

The first reason of their miscarriage, is the difficulty or rather impossibility of discovering of the Plague of­tentimes in its first approach, and sometimes the disease continues and makes a progress hopeful and promising for several dayes: Sennert. de febr l. 4. c. 1. and then manifests it self in the sudden death of the Patient: Anton Beni­venius obs. Medicin. c. 54. H. Florentius in notis ad [...]. P [...]re de pest. p. 154, 155. of the truth hereof I need no Instances: the only care a Practitioner can shew is (after that frequent Funerals have informed him of an approaching or raging Pest) to tend his Patients whatever the distemper be ( little or great) as if it were the Plague: and yet that this supposition is fallacious, I can demonstrate out of the Histories of several Plagues, particularly that of Vicenza, and Breda. Here then our Physician is no more to be blamed, than he is for not being an Angel, or a Deity.

Another reason is, that the sick parties do not come to our Practitioner upon the first and smallest sense of the disease; for after the Pest hath seised upon them a [Page 75] few hours ( eight or twelve hours) Sennertus himself could not cure one in an hundred: Sennertus de febr. l. 4. c. 6. and of this Era­stus complains (who was for bleeding) that most that died came not unto him till that the Plague had too far seised their spirits, and debilitated them so as to render all means ineffectual, Erastus ep. 25. p. 90. though he tryed Sudorifics, and complyed with all Hypothesis in his practise. I must here note that the diversity of Plagues, as to their na­ture, and continuance, makes a greater latitude in the opportunity or timing of Medicines, than to restrain it to eight or ten hours; but this cannot be known till the Plague hath lasted some while.

A third reason is the great difference betwixt the Nature of one Plague and another, so that neither one Method nor the same Medicaments will serve in all Pests, no nor in any two hardly: besides the particular diver­sification which the Pest receives according to idiosyn­crasy and constitution of each infected person. And for this reason Nicolaus Ellain in his Treatise of the Plague (commented upon by the renowned Guido Patin) refused to write down a special cure of the Pest in that book. N. Ellain de pest. apud Guibert. Med. Offic. p. 533. ‘ Quantum ad curationem spectat, eam attingere nolui, quia periculosissimum est ex solis universalibus regulis curationem instituere, idemque calopodium singulis quibusque adaptare. Iuris perito­rum effatum est, Theorias generales non informare animum practicum, qui consistit in singularibus. Si haec propositio in jure vera existit, potiorem locum in Medicina habere debet, in affectu presertim adeo anomalo atque insolenti, cujus ut Protei, nunquam fa [...]ies eadem est. Nulla enim pestis alteri similis est, nisi in uno, quod scilicet ea correpti maximam partem i [...]ereant. Constans opinio est, tot fere species morborum pestilenti­um esse, quot annorum, quibus in vulgus grassantur. Va­rianda proinde curatio ex affectus, causarum, symptoma, tumque varietate: ratioque habenda temporis, regionis, [Page 76] sexus, aetatis, temperamenti, peculiarisque cujusque na­turae (quam Graeci idiofyncrasiam vocant) plurium­que aliarum conditionum a Medico expendendarum. Insignis igitur abusus foret in peste curanda eadem uti Methodo.’ i. e. As for the cure of the Plague, I would not intermeddle with it; because it is a most danger­ous th [...]ng to form a particular practise out of general rules alone, and as it were to work all peoples shooes up­on the same last. It is a Maxime amongst the Law­yers, that General Theories do not accomplish a Practitio­ [...]nr, whose business lies in particular and promiscuous Ca­ses. If this [...]e true in Law, I am sure it ought to hold good in Physick, especially in a disease so anomalous and so seldom happening, as this is, and whose Type is as changeable as that of Proteus, never exactly the same. For no Pest ever was like unto the other perfectly, ex­cept it were in this one qualification, that most that are infected dye thereof. With him a­grees Gerar­dus Columbs de [...]ebr. pestil. c. 24. p. 253 [...] It is a constant opinion in many, that there hath been, and alwayes will be almost as many sorts of Pests, as there have been, or can be Pests: And therefore the cure thereof must be varied according as the disease, its causes, and symptomes vary: and parti­cular regard must be had to the season and course of the year, the countrey, the sex, the age, the temperament, and the individual constitutions of persons, and many other circumstances which a judicious Physician must consider. Wherefore it would seem an abuse and im­posture to prescribe or follow in every Pest the same Method. The truth of which Assertion is so univer­sally assented unto, Mindererus de pest. c. 3. that Mindererus doth caution us diligently to attend unto the course and symptomes of the Plague, and to vary our Method and Medicaments accordingly, and tells us that in individual persons (and not only in the Plague it self) we shall find rea­son to guess that the pestilential poyson admits of an unexpressible discrepancy and variety; And partly from its native variety, partly from concurrent circumstances [Page 77] in the Patient, and Ambient, &c. and combination with sundry humours and i [...]tire commixing with them, it grows up and is improved into new sorts of venome. And from hence, he saith, ariseth a grand difference in the cure as well as [...]ffects of each Pest, so that a multitude of tryals must be circumspectly made, the motion of Nature in the recovery of the Patient ob­served, and many die, or involuntarily, yet unavoidably, be dispatch'd, before the right Method can be known. Hoc enim in incognitis, usu persaepe eveni [...], ut non nisi aliorum damno sapiamus, & ex complurium strage quos morbus perdidit caeteros servare discamus; nihil interim l [...]udis Medica facultate ab hoc amittente, utpote quae plus studii in incertis observandis, quam in lucidis jam & p [...]rspectis malis, commodo consilio amovendis removendis­que sollicita impendit; etenim & Magistratus ad oc­cultum [...]urem deprehendendum debita adhibens media, non minus suo officio fungitur, quam si hunc ipsum comprehensum, capite plecti aut morte multari praece­perit. Since then it is manifest that there is so great a variety in general amongst Plagues, and so great a dis­crepancy in particular Plagues, arising from individual constitutions and other circumstances, since the different motions of Nature are such, that sometimes it is ter­minated happily by sweat, sometimes by stool, some­times by urine, or an haemorhagy. Since it is a disease that so seldome happens (especially here amongst us) that 'tis impossible for any man to acquire a practical dexterity in knowing, or curing it: there is not any in­telligent person will condemn the Galenists, or other prudent Physitians for ignoran [...]e; but rather deplore the misfortune of Man-kind w [...]ic [...] is subjected to so monstrous and pernicious a malady as this is; and by a pious and penitent life rather study to divert the Divine judgment, than to depend upon what is Hu­mane.

[Page 78]These discourses will satisfie any man of the vanity of those pretences of an Vniversal Medicine for all Plagues; or of acquiring any superlative skill by the dissecting of one infected Body, or feeling one sort of Plague twice or thrice; whereas not only each Pest differs in specie, but often in individuo: and un­doubtedly, according as the venome, and venenate symptomes differ, so would the several bodies if dis­sected.

As to the reasons why the Galenists do not suspend the cure of the Pest intirely upon Diaphoreticks, and repeated Sudorifics, I find that they do urge these.

They do conceive that a Physician is obliged to be the Assistant of Nature in all diseases, except it manifestly appear that she acteth irregularly, or by way of such an irritation, as to comply therewith were to destroy the Patient: they know what their Method obligeth them unto; and what necessity doth often put them upon: that some diseases are cured with more facility than others; that 'tis the nature of some diseases not to be cured at the same time, nor in the same manner: that as men are oftentimes forced to make the best of a bad market, so in some indispositions they know what they desire, but know not how to effect it, but by means extra­ordinary, and by a greater difference to the distemper than it is their inclination to submit unto: Scire enim quid fi [...]ri O­port [...]at, magna res non est, sed quibus rationibus illud efficias, id vero ardu­um. Galen 6. m. m c. 2. 'tis not ig­norance and folly, nor the want of generous Medica­ments, which makes them comply, but a tendern [...]ss of the lives of the sick, and the discharge of a good consci­ence; which last obligeth him alwayes to the safest way, and not to follow either doubtful and questionable opinions in Physick (which may pass for probable, P. Zacchias Qu. Medico­legal. l. 6. [...]it. 1. qu. 7. §. 2. id ibid. §. 7, 8 if that be such against which it is one thousand to one that it is false) or to prescribe Medicaments which the [Page 79] rules of Art and Experience do not [...]ustifie. Where­fore they do imagine that a Physician ought to imi [...]ate Nature when she does well (and well she does, when she cures the disease) and since Nature doth in seve­ral Plagues acquit her self sundry wayes, that therefore they ought not to confine themselves to one: Particularly, since some Plagues have been cured by spontaneous Erastu [...]. epist 25 p 97. c. 2. & Th [...] ­v [...]r [...]. in Schol. ad Ball [...]n. Epid [...]m [...] l. 50, 51. [...]ch [...]kiu [...] (ex Paraeo) l. 6. p. 770. Haemorrhagyes at the nose, others by Stools, 'tis most irrationable to expect that any should do otherwise in so dangerous a malady, than to consider the ul [...]roneous emotions thereof, and accord­ingly to demean himself.

Secondly: Seeing that Hippocr. sect. 4. Aphor. 36, 37, & 42. E [...]ast [...]p. 25. p. 99. all Sweats in the begin­ning of a disease are rather bad, than good: since in the Plague few or none are ever freed Erast. epist. 25. p. 9 [...] c. 2. by sponta­neous Sweats: since Nature takes [...]d. ibid. p. 98. Erast. ubi su­pra. p. [...]9. another course by discharging it self into the glandules of the Ears, Arm-pits, and Groin: They do not think that they ought to pursue that M [...]thod. ‘Ex his arbitror, pa­tet, Sudores statim ab initio febris hujus per vim adeo calidorum medicamen [...]orum evocatos, non tam utiles esse quam aliqui putant. Siquidem spiritus evacuan­tur, vires dejiciuntur, sanguis agitatur, turbatur, ma­gisque acuitur febris, quod subtile est in sanguine ex­cernitur, sicque crassior intus relicta materia citius & facilius interficit. Ideirco magis videtur factum & consilium eorum approbandum, qui ab his medicinis ca­lidis abstinent, sive sudent aegri ab initio, sive non sudent. Certum namque est, Sudorem sponte sub ini­tium morbi prodeuntem, diaphoreticum & symptomati­cum, non laudabilem & criticum esse.’

Thirdly they argue; that since there is such dan­ger least the Patient infected should dye for want of strength before the disease be cured, and that above all others the vital indication to preserve the strength [Page 80] ought to be most prevalent with a Physician, and regu­late him in the administring of his remedies: since the regard hereunto makes them to quit their usual course of dyet, and even compel their Patients to eat plentiful­ly, and drink wine ('tis no Helmontian Proposal, Isbr. a Diem. brook de pest. l. 3 c. 2. §. 1.6 & l. 2. c. 6. §. 14. C. Celsu [...] l. 3. c. 7. but transmitted to as from Antiquity) they conceive it not fit in the beginning of the Plague to debilitate the sick with a violent and tedious Sweat (perhaps to be reiterated twice or thrice in twenty four hours) whereby the spirits will be extreamly dissipated (much more than in Phlebotomy) the humours good and bad promiscuously evacuated, and the blood and grosser humours (which are not exhausted by Sweat, and in which commonly the Pest is seated, as is manifest from the Botches and Carbuncles) continue infected still. Sane spiritus per sudores affatim & copiose va­cuari satis indicant prostratae afflictaeque vires post lon­gum sudorem: Erast. ep. 25. p. 97. Crasse & inquinati sanguinis nihil aut particulam exiguam educi, probant accidentia, quae fere omnia fiunt post sudorem deteriora.

Fourthly, Though they do very much commend the intentions of such as would presently and without any delay expel the morbific poyson; yet they conceive that where the Plague ariseth from previous evil hu­mours congested in the body by an unseasonable year, evil diet, or the like, that then the case differs much from what it is when it is contracted by a forreign con­tagion; and therefore whatever reasons may be al­ledged in the last case, they cannot admit the Method as universal: they do apprehend that in the first case the putridity is incorporated and become as it were innate to the mass of blood, and is no more to be elimi­nated by Sweat, then mustiness in drink is exterminated by its working out the yeast: Besides, they do not per­ceive that the sick receive such benefit when Nature discharges it self into the Skin by the Spots, or Tokens, [Page 81] that they should imitate that operation by promoting sweat: they are afraid that potent sweats may divert Nature from her usual and intended course of dischar­ging it self into the Glandules, and whilest a double eva­cuation is purposed by the Physician, the Patient may find the benefit of neither, the sweat being so power­ful as to disturb that other motion; and the humours in which the venome is incorporated being so gross (why else should Nature never take the more facile and expe­dite way of the Skin, but the more difficult of the Glandules?) as not to be exonerated in that man­ner.

Lastly, Supposing the Plague to be a venenate disease they do not conceive that all poysons are to be cured one way, and that by sweat, especially as soon as ever they are taken: much more if they be of a Septic nature: they do not believe sweating to be the remedy for Arse­nic, or Lapis infernalis, should any take them. But if it were, yet sometimes there is such a plethoric habit of body, and the veins are so distended either naturally or through the febrile agitation of humours, that 'tis im­prudent and dangerous to promote sweat, till Phlebotomy be premised: for thereby the febrile heat will be mi­tigated, obstructions removed, the blood ventilated and capable of a further rarefaction in order to sweat, and transpiration promoted, and Nature inclined to sweat; for bleeding doth not draw in the humours, or poyson, but carries it out to the circumference, as experience doth testifie, and consequently is rather subser­vient unto, than opposite to the indication that others go upon.

These are the most solid Objections I have met with upon the subject: in which whatever is suggested is not so to be understood, as if the Galenists did not know that their Adversaries use or pretend to use Cor­dial [Page 82] and Alexipharmacal Diaphoretick [...]: as on the con­trary none but this Baconical — G. T. would sup­pose, that when a Galenist speaks of Phlebotomy, that he intends to use nothing else. Those judicious persons do consider the variety of Pests, that some of them are by forreign contagion, and seise upon healthy bodies: in these they are willing that the venome be eliminated presently by sweat, except the Plethoric habit make it necessary to bleed first, and then they sweat them after­wards immediately: taking all imaginable care for to preserve their strength: they also know that in such times as the Patients have been used to an ill diet, and debilitated through poverty and misery, that in such cases even Galen would not allow bleeding: for how requisite soever it may be for the disease, such persons cannot bear it: They know that some Plagues are at­tended with little or no Feaver, yet attended with symptomes dangerous and mortal; in these cases they are for Cordial-Alexipharmacal Diaphoreticks, and pro­mote sweat as earnestly as any Helmontian: in others the Plague is attended with a Synochus and putrid Fea­ver, in these they divide their cures, and regard both the Feaver and the pestilential venome, &c. according as the strength of the Patient will bear (they consider not only his present but future strength) they pro­ceed to Phlebotomy: sometimes they observe the Plague to be so gentle, that the infected can go up and down and feels little or no indisposition in himself: in this case they only continue the motion of Nature by mild Alexipharmac [...], that the Botch or Carbuncle do not strike in again, and perform the rest by a sollicitous Chi­rurgery. In fine, as there is nothing more rational than all their solicitude in cures: so they know that in so desperate a disease, there is no course to be left unat­tempted: the way by Alexipharmaca and Sudorifies come from them, and is properly theirs: but they urge no method generally in any disease almost; knowing [Page 83] that the same distemper may be cured several wayes by men proceeding upon contrary indications, and yet the Art not violated: Hippocrat. Epidem. l. 6. sect. 7. cum notis Vallesi [...], p. 7 [...]8, 739. and in the Plague, as they know the great variety thereof in specie & indivi­duis, so their directions leave us in a great latitude upon emergencies: They understand that saying of Celsus: Nam quo celerius ejusmodi tempestates corri­piunt, C. Celsus me­dicin. l. 3. c. 7. de febr. pest. eo maturius auxilia, etiam cum qua­dam temeritate, rapienda sunt. As also that, Cum eadem omnibus convenire non possint, Id, ibid. c. [...]. fe­re quos ratio non restituit, temeritas adjuvat. To conclude, if there be any thing that requires a dex­terous Physician, 'tis this disease: And if any thing can make him such, 'tis the diligent reading and under­standing of the Galenists; who have in this case trans­cended themselves, and replenished their discourses with so prudent cautions, such excellent observations, and experiments, that may raise admiration in all that are conversant therein, and satisfie the World, that those notional men, following the ancient Methods of Science, have out-done all that ever the ignorant rash Experi­mentators of this Age could imagine. I have a long time designed a Collection of all the choice Experimental Writers upon Epidemical diseases, whether pestilential, or not; together with the Histories of diseases that are otherwise of a facile cure, and are changed by the mixture of a pestilential venome: for as there is no­thing more dangerous and intricate then such diseases, so there is nothing wherein the generality of Physici­ans are less aquainted: 'tis ar [...] effe [...] of the novelty and curiosity after knick-knacks which infatu [...]tes this Generation, and will ruine the next: there is so much of pedantry in reading, 'tis so much more pleasant, and divertive to talk of, to make Observations about free­zing, then to read over Galen de typis, that I do not wonder to find D. M. not to understand what the Type of a disease is: but I do wonder how he durst [Page 84] say I was intollerably ignorant in the Rudiments of Physick, for speaking as Galen, and the best Phy­sicians do: I may accommodate to these impudent Scholiasts that saying of Hippocrates. They that are sick, and do not know themselves to be so, have an imbecillity in their Intellectuals. Such men are p [...]ss [...]ssed with a desire to prepare their own Medica­ments, contrary to Law: and neglect the study of necessary and useful Books in their Profession, which is contrary to all Reason: 'Tis easie to foresee that the nex Age will scarce be furnished with a wise States­man, Physician, or Civilian; and perhaps scarce yield an accomplished Divine, or an intelligent Sheriffe, or Iustice of Peace. And this evil is become remediless, by reason that the contempt of Vniversity-learning, and neglect of studying, hath so decayed the Trade of Book-selling, that no man that is desirous can furnish up a Library; which I find too true, being not able to re­pair the loss of a choice Collection of Physick-books, which were consumed by the fire at London.

Having thus explained the nature of the Pest, I re­turn to the Argument of— G. T. which gave occasi­on thereunto. That the Pest is neither a Feaver [...], nor indeed a Feaver at all, I have demon­strated: That there are some Pests in which Phleboto­my may be used, I have also made evident: As also that it was not without Singular prudence that the excellent and learned Physician Doctor Willis did pronounce that Phlebotomy was seldome, and not with­out great caution, De febr. p. 235 to be practised in the Pest: because the blood being too much exhausted, and the vessels subsideing, the necessary inclination to transpire and sweat, is not so easie to be promoted, or continued. I have likewise evinced that the Pest doth not consist properly in a Poyson, but in somewhat Analogous there­unto: and consequently since similitudes are not iden­tified, [Page 85] 'tis foolishly argued by— G. T. that because upon the taking of Po [...]son Phlebotomy is useless: there­fore it is so in the Pest. But neither is the antecedent true alwayes; as any man acquainted with t [...]e Medi­cinal History of Poysons doth know: for although up­on the first taking, they are to be attempted with pe­culiar Antidotes, yet if afterwards they produce a Feaver in the Patient, or if there be danger of it, Phle­botomy is both used and allowed, by the Authority of Paulus, Avicenna, and Haly-Abbas and other eminent Physicians: Ioseph. M [...]ne [...] ­sus de sec. ve­nae cubiti in febr. putr. ma­lig. p. 141, 142 [...] particularly by I. Caesar Claudinus in his Emperica rationalis l. 6. sect. 1. c. 1. It is also perspi­cuous out of what I have said, that 'tis false to say that All Feavers, be they ill conditioned, or others, have any resemblance with, or are to be cured like the Pest: much less is it true of most Maladies whatever. Where­as this Impertinent goes about to prove it thus: Be­cause there is quiddam deleterium in them, or a certain venenosity. If he take Quiddam deleterium and a cer­tain venenosity for one and the same thing: it is most false: shew me the effects thereof such as are visible in the Pest, and I may grant there is somewhat Analo­gous: but I cannot see any such thing, nor that they need any such such cure: It is possible— G. T. may with his Pepper-drops, or Essence of Ginger, and such like hot Medicaments drive out some Pustules in the Skin, in most Maladies (and even where were none) but I shall not conclude thence that either the indispo­sition was venenate, or that he did impoyson him, though that be a facile thing to do where the same person acts the Doctor and Apothecary; C. Tacit. An­nal. l. 4. & l. xii. W. C. may learn what Medicus cir­cum [...]oraneus is out of Menagius's Am [...]fu [...]at. jur. civil. c. 3 [...]. and usually done heretofore as any School-boy may know out of Tacitus: or Tully, pro Cluentio, where two are men­tioned, the one the City- Physician, who was called Medicus; such were retained by Salary, the other is termed Pharmacopola circumforaneus, that is a Doctor who kept several Markets, making and vending his [Page 86] own Medicaments, which gave him the opportunity of grati [...]ying Oppianicus his Mother in law: a courtesie the other had oftentimes done for him before: I be­lieve there were no Apothecaries at that time in that place, Lindenbrogius Codex legum Antiq. inter constitut. Sicula [...]. but in 1220, or 1221. when Physick was first made an Vniversity-Faculty, and Doctors thereof crea­ted in imitation of those in Theology, then were the Profession of Physick, and that of the Apothecary made distinct, and that with so mnch caution, that it is a que­stion amongst the Imperial Lawyers, Whether a Phy­sician may have any manner of Contract with An Apothecary, though to drive on other Traf­fick than that of Pharmacy? In the Lombard-Chronicles there are many cases of Princes (and no doubt than others) by Physicians: there was one Sede­chias in the dayes of Charles sirnamed the Bald, in France: and in the reign of Queen Elizabeth one Do­ctor Lopez, and Giulio. If some mens reading extends not to this knowledge, I would have taught D. M. and W. C. this and much more, had not the Artifice and inte­rest of some men debarred me from publishing it. If any man can shew me any Dispensatory made by any European Physicians (since there was so much as a Graduated Doctor) that was previous to the distinct Profession of Apothecaries, I will own then (though it be a certain untruth) that the practise (I do not say practising) of the Apothecary in the Quartane, was contrary to the rules of Physick, and the case well proposed by D. M. All men are at the mercy of such as write what they will, and defame as they please, and permit not others to vindicate themselves, nor unde­ceive the World. 'Tis ungenerous to pinnion a mans hands, and then beat him. In reference to that Con­troversie, I add that the Statutes of the Colledge com­mand the Physicians to send their Bills to an honest Apothecary: St [...]t. Colleg. L [...]din. Miss. in biblioth. [...]. And our Laws make the Colledge Judges of all Receipts, as well as Methods of Physick: which [Page 87] Act as it conforms with the general practise of Europe, so it is very prudential; for hereby provision is ma [...]e not only against noxious Medicaments (and the high prizes of Arcana) but illegitimate Methods of practise, by which last it is as easie to destroy a man, as by poy­son, and more privately: How the designs of the Expe­rimentators will consist with our Laws, and be accommo­dated to them, I know not: I know a Physician may be tryed upon giving his own Medicaments if the Patient miscarry; how he shall defend himself, I know not: I have not seen any reason alledged, that is likely to convert the Magistrates throughout Europe to permit it: or to gain a repeal of the two last Edicts in Den­mark against it: 'Tis an evil president to dispute a­gainst wise Laws: 'tis worse to act against them: and what consequences it will bring upon the Land, to see one Profession retrench upon another, let the Lawyers judge: The beginner of this Novelty, the Lord Ba­con, stopped not at Natural Philosophy, but carried on his humour to attempt or project a change of our Laws. I do recommend it to the consideration of our Sages in the Law, that if Physick, Divinity and other Facul­ties be overthrown by a company of Wits, whether it be probable that they shall long continue free from the attempts of the Omniscient—

But I shall resume the examination of the remaining Arguments of my Adversary.

I could wish my Adversary, instead of consulting the Novum Organum of the Lord Bacon, had been con­versant in that more ancient one of Aristotle: he h [...] [Page 89] not then committed so many errors in point of Ratio­cination, as he now does, which renders his discourse intricate, confused, and oftentimes impertinent, to the great distraction of his Reader, and vexation of his Antagonist. He perpetually mistakes through an Ignorantio Elenchi: he never apprehends what he oppo­seth. That the Galenists do define a Feaver by a pre­ternatural heat diffused through the whole body, is true: They are contented to call that a Feaver, which the vulgar does so, and accordingly to define it: Not but they distinguish in Feavers the Material and Formal cause thereof; as also the several Efficients thereof: and in their Method of curing, except necessity put them upon another procedure, they do alwayes, and are obliged to do so by the Rules of their Art, to remove the Cause of the Feaver: and this is notorious to all that understand the first Elements of Physick. They consider the evident, occasional procatarctick Causes: they consider the Antecedent causes, which though they are not the immediate and conjunct Causes of the Fea­ver, yet dispose unto it; and are of such importance as that they may often degenerate into immediate and conjunct Causes: and, which is more, in the Cure they do not only regard the Cause which gave birth unto, and produced the Disease, but that which doth foment and continue it, and that which may produce or increase it. Valles. meth. med. l. 3 [...] Censeri debet causa non quae facit, aut fecit solum, sed & quae faciet nisi quis obstet. And although the curing of the Disease, or Feaver, be the object of their designs: yet As all wise men consider by what means the ends they propose to themselves may be effected, so do they deliberate how they shall effect their designs: and that is by removing the Cause of the Mal [...]dy: But as in other designs it frequently happens, so here they often meet with impediments, which must be removed, before they can prosecute their intentions by direct means. Upon this account they are forced upon ma­ [...] [Page 90] [...] which they confess are not immediately [...] of a Feaver, which yet they pur­ [...], because without doing so, the indisposition either could not be cured, or not with such safety as becomes prudent persons. Few of them ever bleed that I know of meerly for refrigeration, and the extir­pation of the formal he [...]t, without regard to the ma­terial cause of it, which is to be concocted and ejected by Nature. Though Phlebotomy be but one opera­tion, yet it produceth sundry effects in the body, and in order to each of them is both indicated, and pra­ctised: For it evacuateth that redundancy of blood, which frequently occasioneth diseases, alwayes is apt to degenerate into a vitious morbifick matter during the Feaver, and by an indirect and exorbitant motion to af­flict some or other principal parts to the great danger, if not destruction of the Patient: upon this account we do use Phlebotomy in Feavers sometimes to dimi­nish the Plethora, and so to prevent the violence of the succeeding disease, and dangerous symptomes that may insue; and then the veins are too much distended, to facilitate and secure the operation of subsequent Medicines that are used to evacuate the Antecedent Cause, and to maturate and expedite the continent mor­bifick cause: Besides, it promotes transpiration incre­dibly, gives a new motion to those humours which toge­ther with the blood oppress and indanger the internal and principal parts, it diverts them from the head, and draws them from the heart, lungs, stomach and bowels into the habit of the body, whereby Nature being alle­viated prosecutes her recovery by maturation and ex­pulsion of the peccant depraved matter, deducing to its proper state that which is semi-putrid, and not irrecove­rably vitiated, and separating first, then exterminating what is incorrigible: So the Patient recovers. Nor is there any thing more true than this, which every Pra­ctitioner may daily observe in his practise, that Of all [Page 91] the Medicaments which are vsed by Physitians, there is not any may compare for its efficacy and utility with Phlebotomy: Valles, M [...]th. med. l. 4. c. 2. so expedite, so facile, and so universal is it. The universality of its use appears herein, that it evacuates the redun­dant, it alters the exorbitant Fluxes of the pec­cant or deviating humours and blood: It retax­eth the vessels and pores of the body, and refri­gerates the habit thereof: And therefore is so ab­solutely necessary in putrid Feavers, that though I do not say they are incurable without it, yet I pity the languish­ing condition of such as omit it, the violence of the symp­tomes being increased thereby, and the cure procrasti­nated, to the great trouble and hazard of the sick, and his great detriment afterwards; for you shall ordina­rily meet with a slow convalescence, and the blood be so depraved by so long and violent an effervescence, that it becomes remediless, and degenerates into an evil ha­bit of body, Scorbute, Dropsie, &c.

This being premised, (which is more clearly pro­ved by Experience than Reason) I answer to his Argu­ment, that we do not go about only to refrigerate the Patient, but to concoct and eject the morbifick matter: that we take the most befitting course to ex­terminate that spinous offensive cause: and as upon the prick of a Thorn, if part stick in the wound, and be bu­ried therein, we proceed to maturate and bring to a paculency the vitiated blood and humours inherent in the part affected, and with the supp [...]d m [...]tter dr [...] out the fragment of the Thorn; so we do in Feav [...]s, (where the depraved humours are not so easily sep [...] ­ted and extirpated, as in the prick of a Thorn) matu­rate the eject the morbifick c [...]se, and thereby at­chieve the Cure: And I do profess my self to concurre with the Ancients in their Opinion, that there is a [Page 92] great Analogy betwixt the generation of the Hypostasis in the Vrine after a Feaver, Id autem ita esse aperte intelliges, considerans, quae partibus, in quibus suppu­rationem molimur, con­tingunt. Ea enim altera­tio similli [...]ae est concoctio­ni, quam in materia putri­darum febrium expecta­mus, nisi omnino est eadem. Valles. Method. med. l. 4. c. 2. and the production of purulent matter in an Apostimation; and that Feavers are but a kind of Abscesse in the mass of blood: for the proof whereof I do remit my Reader to Ballonius, de Hypostasi Vrinarum. Amongst the Ancients I find two wayes commonly practised to extinguish this Febrile Heat, by a course corresponding with the usual wayes of extinguishing a fire; which are [...], by substracting the fewel from it: thus they did Phle­botomise at once till the Patient did swoone: the other [...], Galen. [...]eth. medend. l. 9. by quenching it: thus they gave them cold Water to drink largely, until the sick grew pale and fell into a shivering: this last was not practised till there were manifest signs of concoction: But 'tis ob­servable that upon either of these Medicaments, they did expect that happy issue, that Nature thereupon should presently discharge it self by sundry evacuati­ons of the morbifick matter: so that they did not thereby intend bare resignation, but the extermination of the concocted febrile matter.

And thus much may suffice in answer to this Obje­ction.

The last Objection he makes is this, as I shall form it.

As to Phlebotomy in a Plethorick body, he thus ex­plodes that:

[Page 95]As for Phlebotomy in order to Revulsion, p. 126. he thus ex­plodes it. ‘Another pretended wa [...] for sanguimissi­on is Revulsion, by which they say a violent flux of morbifick liquor into any noble parts, is intercept­ed: for this end they use the Lancet in a Pleurisie, Peripneumony, or any inward inflammation: But how far they erre herein, is well known to the best Practi­tioners: for although I confess they do sometimes in the beginning suppress, and as it were crush the aforesaid diseases, yet is it done accidentally, very un­certainly, rather by way of distraction of the Nature for the loss of its substantial treasure, than from any true Revulsion or direct pulling back of what is in flux, or already flowed in. 'Tis true, where the vessels are depleted, a repletion is forthwith made ob fugam vacui, to avoid a vacuity, but the supply is from what comes next: for as intro as well as intro foras. However there is no streight immediate Revul­sion intended from the part affected to the Ori­fice.’

It seems strange to me that any man should pretend thus long to have diligently attended on the practise of Physick, and yet never have seen, or have the impu­dence to deny that there can be any such thing as a surcharge of Blood, which is that which Physicians call a Plethora or Plenitude. But the continuance of these Baconical Philosophers will in time free us from any admiration of this kind. In Greece, when the Athletae or Wrastlers were publickly maintained, the observati­on indeed was more facile than now, but every Coun­trey almost yields frequent cases of such an indisposi­tion: particularly 'tis easily to be remarq [...]ed in strong, healthy and plethorick Children, whose sudden death, [...]s it often ariseth from no other cause, so it astonisheth the vulgar, and usually raiseth in them suspicions of Wit [...]h­craft. Hippocrates, and Galen having taken notice of [Page 96] the evil consequences attending this habit of body, do ad­vise the owner to attempt the change of it, though it be accompanied with the most perfect health and vi­gour imaginable. Hippocr. sect. 1. eph. 3. [...]. And this habit of body, and fulness of blood, which he saith would do Methusalem no harm, is observed by those who had daily opportunity to see the sad expe­rience of it, [...]lato de re­pub. l. 3. to abbreviate the life, and occasion many diseases, as Apoplexies, Cardiacal Syncopes, and Ruptures of veins in the Lungs, Galen in ex­hortat. ad bo­na [...] artes discend. Squinancies, Pleurisies, &c. So that Hippocrates condemns that habit of body again in his book De Alimento: and Celsus concurs with him therein. C. Celsus Me­dicin. l. 1. c. 1. Ea corpora, quae more eorum [Athletarum] repleta sunt, celerrime & senescunt & aegrotant. i. e. Those bodies which are dieted and brought up to an Athletick habit, do soonest of all decline into sickness and premature old age. I never read of any Physician, who in his directions for health recommended unto his Patient that course of life wherein the Athletae were bred up, thereby to acquire such a Plethoric habit: and whatever the present sanity were which they in­joyed as to strength of body, their intellectuals were very dull; and the most understanding persons would have thought it prudential in such a case to broach some of the Balsome of life, and weaken Nature thereby, rather than to live in a perpetual danger of such peril­lous diseases as that Euexy subjecteth men unto: But our Helmontian doth think otherwise.

If such an habit of body be thus perillous during per­fect health, how ought a Physician to apprehend it upon the first approaches of sickness? Doth not then Nature add to the redundance of blood by a defective transpira­tion; whereas the veins are so full as not to be able to contain more? Is not the pulse weak, slow, and [Page 97] oppr [...]ssed, and the Heart so debilitated as not to be able to discharge it self of the Blood which flows into it, and in danger to stagnate in the Lungs, or coagulate in the Ventricles? Can there seem any thing more agree­able to common reason in this case, than to practise Phlebotomy, whereby Nature is at present alleviated, the surcharge of blood abated, and the imminent dangers prevented? Is it not prudential, were a little blood so precious a thing, and the loss thereof attended with some small irrepairable debility? Is it not, I say, a part of prudence, to submit to lesser (though certain) in­conveniences, then to run an almost inevitable hazard of the greatest imaginable? I read not that the famous Milo arrived to the years of Methusalem, nor yet to those of Hippocrates: though I am apt to think he was so solicitous for to preserve his strength in its vi­gour, as not to have been much Phlebotomized: Ae [...]im. var. Histor. l. 9. c. 31. At the Olympic Games being Victor, and going to receive the Garland from the judges, he fell down dead suddenly, and was thence carried to his Grave. It is to be sup­posed, according to our Helmontian, that in that Euexy of body, something so virulent or odious put the Ar­chaeus into such a fury that it ran mad and destroyed him: whereas had it been sublimate or Arsenic, it would not have been half so exasperated, or hasty. 'Tis a most humoursome amd sensless Kitchin boy, that no man knows how to please: Suppose that the Brain might be in him a little oppressed with a Vertigo, or some petty disorder, must this capricious Duumvirate immediately produce the Idae [...] of no gen­tler a disease than an Apoplexy, or Epilepsy? But to pass from these phantastic causes, the allegation whereof least becomes an Experimental Philosopher, I shall in­stance in the effects of Bleeding in a Plethora.

This observation of Boniv [...]nius is confirmed by the like accidents and resembling cures, which had fallen under the observation of Dodonaeus, as he relates there in his Annotations; particularly he sayes, ‘Adfui & ego olim homini ebrioso, qui cum ad tantam plenitudinem venisset, ut quodam modo strangulari videretur, etiam mutus factus suit. Huic vero & sanguis largiter de­tractus e communi dextri brachii vena, mox loquelam & sanitatem restituit.’

[Page 85]It were endless to transcribe cases of this nature: nor do I believe that there is any understanding Practi­tioner who will deny that 'tis possible for an excess of blood to become prejudicial to a man. I proceed a­gainst our Helmontian: He sayes, ‘that nimiety or plurality doth not offend in such cases, but the pra­vity: and that the pravity is to be cured by proper means sequestring the vile from the precious, and afterwards excluding it by vomit, stool, urine, sweat, and expectoration.’ —I answer, that the case here being put concerning persons that are Plethori­cal, and that Quoad vasa, when the vessels are so full that Nature languisheth under the burthen, and is not able to discharge even the vital operations, by reason of its excess: though the Blood may have some mixture of depraved humours, and though they may have occasioned that ebullition or irregular motion of the blood, yet is not the disease ordinarily to be cured without Phlebotomy: I will not deny but that such ca­ses may be alledged, as the Patients may have recover­ed out of those kinds of distempers, not only without Phlebotomy, but without any help at all.

I am willing to grant that the Diatritarii, or Aegyp­tians (who were prohibited by Law to administer any manner of Medicament till after three dayes were pas­sed) that many did recover under their hands: Aristot. polit. l. 3. c. 2. though I believe that in Apoplexyes and Squinancies multitudes must have miscarried: G [...]len. adv. [...]rasis [...]ratum [...] 4. Had not Erasistratus done great Cures, his fame had never equalled that of Hip­pocrates: So Petron was a man of renown, yet perhaps what Celsus avoweth of the last, C. Celsus Me­dicin. l. 3 c. 9. may be fixed upon them all. Plures, si protinus a principiis excepit, in­teremit. Thus much I am willing to grant, when ju­dicious men are the Physicians, [...] was [...] fi [...]st pr [...]ess [...]d to [...] j [...]c [...]nd [...]. C. Cels. l. 3. c. 4. and instead of one Medicament do substitute another. But what Ascle­piades or Erasistratus might do in their dayes (wh [...]n fastings, bathings, oylings, and the like were the so [Page 100] much the vulgar practice in health, that Patients wil­lingly submitted thereunto in sickness) I cannot be­lieve that an ignorant Helmontian, or other cheating Chymist, or illiterate Experimentator of this Age can do. Physick is a PROFESSION where­in we commonly ice Miracles, the events of diseases being such, that Nature oftentimes transcends our Art, [...]. quos [...] non resti­ [...]ui [...], temeri­tas adjuvat. C. Celsus Me­d c. l 3. c. 9. and Imagination: And sundry unexpected Medicaments (undoubtedly rash) do effe [...]t Cures that the most rational and Methodical procedures have failed in. Noth­with [...]tanding all this, I do [...]ot see that we ought to presume upon monstrosities; or regulate our practise by such contingent Cures: And I scarce believe that any discreet person would either put his life upon such an adventure, or take it well from us should we either relinquish or perswade him thereunto. I say then, that in a Plethorick body, suppose we that it is an Ephemera, or Synochus imputris, 'tis well done of the Physician to bleed the Patient, least those Feavers (which we confess, even without Phlebotomy, to be safe) least the Diary feaver should degenerate through some secret indisposition of the Patients body, or some errour committed by him, into an Hectick or putrid Fea­ver: Non est tam [...]n negligenda haec febris Ephemera quamvis velocis & bonae terminationis sit, Forre [...]t. obs. l. 1. obs 3. in Scholio. cum soleat propagines malas gignere, & in alias febres transmutari [...] & licet cito termin [...]tur, non tamen inter morbos acu [...]os reponenda: quia [...] car [...]t malis accidentibus. Si error con­tingat in curatiene vel per medicum imperitum, vel aegro­ [...]um periculum est ne in H [...]cticam transeat, si biliosae [...]ue­rit temperaturae, qui egrotat: In aliis vero in putrid [...]m. This is confirmed by many observations, and allowed of as true by Physicians: No less true is it that a Synochus simplex changes into a putrid Feaver, and Squinancies: as Forrestus, [...] and Experience demonstrates. As for dis­eases accompanie [...] by, or occasion [...]d from a particular [Page 101] conflux of blood (though some humours also be depra­ved) unto any part, as Apoplexies, Squinancies, &c. for any man to think that such distempers can be cured without Phlebotomy, is direct madness: for all other evacuations (by emeto-cath [...]rti [...]s; which every body cannot endure, Si [...] omnia membra vehe­menter resoluta sunt ( [...] apoplexia) sanguinis de­tractio veloccidit, vel li­berat. Aliud curationis genus vix unquam sanita­tem restituit; sepe mor­tem tantum differt. C. Cel­sus Medicin. l 3. c. 27. nor is the Apo­plectick in a condition to swallow) or stool, urine [...] or sweat, and expectoration, are either useless, or too tedious to depend upon in such indispositions. Neither is that to any purpose which this Baconical Impostor saith, that after such a strict abstinence as the Pa­tient is put upon in a Feaver, it is very unlike­ly a plenitude should be of any duration. Itaque mittitur, non quia multa subest copia, sed quia ea quae subest, tunc est inutilis & noxia. Valle [...]. Method, med [...] l. 2 c 3. For if the Feaver be such as is accompanied with a particular defluxion upon ony princi­pal part, the effects of that abstinence will signifie nothing: for the party will dye ( in all probability) before he can reap any benefit by such abstinence: no benefit accrues by abstinence, but after some time: whereas the malady permits no delay. It is notorious that suppuration is not the effect of a few hours: and that pain doth attract (explain the notion how you will, the Phaenomenon is manifest) so that 'tis not to be conceived how so acute a disease should admit of a ling [...]ing cure. The residue doth not need any an­swer: for to say that whosoever loose [...]h any blood doth rue it first or last, is a matter as easily denied by an in­telligent Physician, as it is avowed by one that it is not so: If a prudent man advise it, there is not any danger (abstracting from casualties) if the Patient and those about him do their duty. These last circumstances are such that Hippocrates placed them in the first of his Aphorismes. [...]. It is not impossi [...]le but that a Patient may be so debilitated with his mala­dy, and the means used for his recovery, that he conti­nue [Page 102] afterwards infirm: if he refuse thereupon to take that Analeptick Physick in order to a perfect conva­lescence, whatever ensues is neither the default of the Doctor, nor the evil consequence of Phlebotomy: The same I may say in case either the sick party be not tractable, or those about him malapert or negligent, or some extraordinary casualty do fall out. Potestautem id, dum solum est, non mo­vere, qued junctum alii [...] maxime mo­vet. C. Celsus l. 1. in praef. For where many concurrent causes are requisite to the pro­ducing of an effect, if it succeed not, we are not to blame what did operate, but what failed.

As to Revulsion that which he saith is very weak: —G. T, averrs that the best Practitioners take it for an Errour: 'Tis no great vanity to pretend to know more than a Baconical Philosopher: I do say, that no experienced Physician ever denied the operation though since the tenet of the Circulation of the Blood the manner how such an effect doth succeed admits of some dispute, and is obscure. We the silly followers of Galen and the Ancients do think it an imbecillity of judgment, for any to desert an expe­rimented practise, because he doth not comprehend in what manner it is effected. In eruptions of blood and Catarrhs every one sees the thing is done: and that the Fuga vacui is not the occasion of the subsequent blood flowing to the orifice of the vein, I believe those to whom he dedicated his Book will assure him. How perfect our Cures are continual tryals demonstrate: How little confidence there is to be placed in the Brags of— G. T. after his ten years practise, any man may determine by taking a due estimate of his Igno­rance.

Having thus examined all his Arguments against Phlebotomy, I come now to give our Reasons for it: But before I proceed to them, it is necessary that I give my Reader some account of,

• [Page 103] The quantity of Blood in Humane bodies.
• The several Qualities of the aforesaid Blood.
• The manner of its Generation.

As to the Quantity of Blood that is to be found in Humane bodies, Gassendus holds that the utmost thereof exceeds not five pounds: but he is justly reproved for that errour (and for intermedling with Medicinal de­bates) by Riolanus; I. Riola. opus [...]. Anat. nova, i [...] rot. adv. G [...]s­send. p. 174. who avows, that in suffocating diseases he had taken away much more than that with­in the space of twelve hours, without indangering the Patients life. To relinquish therefore these impertinent Naturalists (whose discourses in Physick have done more hurt than good; being accommodated generally to some prejudicate Hypothesis they take up, or founded upon a narrow experience) let us see what Artists teach us, Alex. Massario [...] de febr. c. [...]9. Io. Riol [...]h En­chirid. Ana­tom. l. 2. c. 27. Avicenna and several of the Arabians do hold, that there are ordinarily in a man twenty five pounds of blood, and that a man may bleed at the nose twenty pounds, and not dye: but if the flux exceed that, after the loss of twenty five pounds he dies inevitably. M [...]bius fund [...] med. c. 12. sect. 18. Moe­bius doth allow or twenty four pounds to be the usual quantity: Homo staturae decentis ad libras xxiv. san­guinis in corpore habet. Riol [...]nus imagines there may be in such a person fifteen or sixteen pound, Riolan. de circulat sang [...] (in Antropo­graph.) c. 15. p. 585. at most but twenty in a French m [...]n, though in a German, he sayes, Plempius supposed there might be thirty. In an heal­thy sanguine person, being in the prime of his years, Marquardus Slegelius doth so calculate the matter, M. [...]legelius de sangu. mo­tu. c. 13. p. [...]04. that he concludes there cannot be above twenty or eighteen pounds; and that the generality of men contain but fifteen. Dr. Lower de Corde. c. 3. p. 115, 116. Doctor Lower in his excellent Treatise Of the Heart, doubts whether any man hath twenty five pounds of blood in his body: and sayes, that according to Anatomists, the quantity seldome exceeds twenty four pounds, or is less than fifteen.

[Page 104]Perhaps the consideration of such fluxes of blood as spontaneously happen may give some light unto the controversie, and contribute most to the decision of the grand one, concerning the prejudice that may arise from the loss of Blood by Phl [...]botomy. It is recorded by Matth. de Gradi, that he had under his cure a lean, slender and seemingly Phlegmatic Nun, [...]nck. Obs. med. l. 1 p. 172 which by the Nose, Mouth and Vrine did void at least eighteen pound of blood; and yet there remained so much in her, that upon the application of Cupping-glasses, they were in­stantly filled with Blood: and he recovered her not­withstanding that l [...]ss of blood. Brassavolus relates how he had in cure one Diana a Lady of the House of [...]ste, Art. Mus [...] Brassavolu [...] c [...]mment. ad Aphor. 23. l. 5. which bled so much at the Nose, that he saved and weighed eighteen pounds, besides what was lost in the clothes applied to her: so that the whole quantity might amount to twenty two pounds. He recovered her by the use of several Remedies, one whereof was Phlebotomy. Marcellus Donatus doth avow, that he weighed eighteen pounds of blood which issued from the Nose of a certain Cook of the Cardinal Gonz [...]ga's; Marcell. Dona­tus de vario. li [...] c 23. who was recovered to as perfect health and as good an habit of body, Amat. Lusit. cur [...]t. 100. c [...]nt. 2. & cur. 60. cent. 7. as he ever enjoyed befored. Amatus Lu­sitanus gives an account of one in a Quartane, which bled at the Nose within five dayes twenty pounds: and of another who bled in like manner, within the space of six dayes forty pounds: whom yet he cured by Phlebotomy. Montanus saith he cured one of the Eme­roids, which bled every day for forty five dayes, Sch [...]n [...]k. obs. med. l 3. p. 312 two pounds of blood, and more. Arculanus doth tell of one Woman that avoided by the Womb in three dayes twenty five pounds of blood, Sh [...]ck. Obs. Medic l. 4. p. 614. and yet recovered. Alme­ricus Blondelus cured in a very short space a Souldier who was wounded under the right Arm-pit unto the Lungs: Alm [...]r. Blonde­lus de venae [...]ectione, c. 2. p. 30. after the man had lain without sense or moti­on many hours, on a sudden there issued an incredible quantity of blood out of his mouth. The like incre­dible [Page 105] fluxes of blood, in men and women, he professeth to have observed many times. Forrest. Obs. Medic. l 1 [...]. Obs. 14. cum Scholio. Forrestus relates how a Gentleman that was his Patient did bleed at the nose in three dayes time, about twelve pounds of blood: and was recovered as well as ever. And when William Prince of Orange was wounded in the throat by an Assassine, he bled at the Iugulars before the flux could be stopped (which was not done in several dayes) twelve pounds of blood: and was perfectly recovered to his strength again. Id. ibid. Obs. 12. He also tells of another Gentle­man, that having drunk Wine-must, fell into such an Haemorrhagy at the nose, that he bled without inter­mission six pounds; and was cured by Phlebotomy, and other befitting Medicaments. Alex. Massari­as de febr. c. 29. Massarias did see a young Lady of twelve year old, which avoided at the nose about twelve pounds of blood: but fell afterwards into a Cachexy. To conclude, in the words of Io. Rio­lanus: I. Riolan. inter opusc. nova Anat. adv. Gassendum. p. 108. Imo decem vel duodecim libras per nares, vel hae­morroidas, per uterum in mulieribus effundi intra sex octove horas sine vitae detrimento quotidie obser­vamus.

As to the Quality of the Blood, it is observa­ble, that there is a great variety in the colour and con­sistence thereof, even in men of perfect health: many upon Phlebotomy convince us that their blood is seem­ingly bad, whereas they are not molested with any di­stemper at all, but enjoy as entire a sanity, and are as free from diseases as those whose blood is to appear­ance better. I have elsewhere given an account of se­veral Phaenomena to be remarked upon the burning of Blood: which Observations are the more considerable, in that I. I. Becherus hath published a great mistake about it: I. I. Becherus Physic. [...]ub­terr [...]n. l. 1. sect 5 c. 1. p. 5 [...]. viz. Siccum sanguinem in igne ut lardum fl [...] ­grare, & absumi, non minori celeritate quam ipsum olium & vini spiritus; & in hoc quidem balsamino spiritu & igne, totius sanguinis vis & bonitas consistit, quoque [Page 106] corrupto aut alterato, totius ejus crasis alteratur. But I say that it is not requisite the blood of every healthy person should burn so: and 'tis evident by those Expe­riments of mine, that there is a very great diversity be­twixt the blood of several persons, as to inflammability; and I know a most fair Lady, whose blood will not burn at all, only crackles, that enjoyes a constant health be­yond most of the Sex, excepting a pain at her stomach: and I have observed that to be an usual consequent to such blood. I shall not illustrate this matter at present by demonstrating the great discrepancies of the blood in several healthy persons, by mixing it with sundry li­quors, wherein the diversity of Phaenomena doth mani­fest the great variety thereof. It is observed by many Practitioners, that in healthy persons such blood doth of­ten appear upon Phlebotomy, as to the Eye seems bad.

‘ Almericus Blondelus de venae se­ctio [...]e. c. 1. p. 8. I have seen many (saith Blondelus) who being ca­sually hurt in the Eye by a tennis-ball, or by some other accident wounded and bruised, have been let blood; and the blood which issued out seemed corrupt: yet have not these persons had any thing of a Feaver on them, nor been some of them sick of twenty years before. And Ballonius observed in several Ladies that out of hu­mour rather than any indisposition were let blood in May, Ballonius Epi­dem l. 1. p. 101 [...] 102. and six or seven poringers taken from them, that their blood was very putrid.’ And he avows that in the most fair Ladies there generally is found such blood as looks impure and evil: Id. ibid. l. 2. p. 192. yet that such persons enjoy a greater, or at least as perfect an health, and live as long as any that have a better-coloured blood. It is granted by Slegelius, that oftentimes upon Phlebotomy the blood which issueth forth may seem impure, and yet the Pa­tient be healthy. M. Sl [...]gel. de sanguinis motu. c 9. p. 75. Nonnunquam satis insignis impuri­tas inest sanguini, ex cava educto, nullis gravioribus symptomatis homini molestis, ex quo patet non tantum semper periculum imminere, si nonnullae sordes sanguini admisceantur. I shall repeat here again the strange [Page 107] blood which Simon Pauli observed in an healthy person.

‘ In the year 1654. a Citizen of Coppenhagen, Simon Paull [...] de febr. ma­lign. sect. 11. aged almost sixty years, being accustomed to be let blood every year in May, for prevention of the diseases incident in Summer, would needs be Phlebotomized in the presence of Me, and his Wife and Children: the Chirurgeon having prick'd the Mediane vein, the blood as it issued o [...]t had a peculiar but most noysome smell, transcending any rotten Egg, or stinking Vlcer, &c. which was so offensive to all in the room, that we were forced to re­medy it by burning some perfumes. As soon as the Blood was cold in the porrenger, the stench ceased, and the blood seemed to be of a very good consistence, and of so radiant a Scarlet, that it equalled or rather exceeded the best red that is to be seen in the most beautiful Flowers: it contained but little serum.’ This passage of his recalls to my mind the serum of the blood of a Maid, of a sanguine colour, and perfect health, except­ing a pain in her stomach: the blood which I caused to be taken from her seemed laudable, and burned very vividly; but the serum being set to coagulate, seemed in consistence like to tallow, and smelt like thereunto. In another Child that died of an Hydrops thoracis, I observed the serum (as it heated) to sent extreamly ill, and with a penetrancy, as if it had been Vitriol burn­ing: it would not coagulate though I boyled it; but afterwards when it had stood to be cold, it did jelly. I know a Gentlewoman of extraordinary beauty, trou­bled with nothing but Morphew or Vitiligo alba on her Armes in some places: being let blood, it appeared to be all serum almost, and very little of any crimson m [...]ss was in it, and that not so tenacious or fibrous as is usual; though it were as well coloured as any is: I boyl'd a­way all the serum (which made up about six ounces, or more) and it would never inspissate or coagulate. The variety of Blood is further illustrated by the case of Henry van Bueren a Brewers man, Regnerus de Graes de ge [...]nitol. p 84, 85. who in perfect [Page 108] health had his Blood such, that though it came out of the vein with a ruddy colour, yet as it cooled all the se­rum did turn lacteous, and resembled Milk: though the sanguineous Mass retained its due colour: and this was constant to him whether he bled by Phlebotomy or any other way. A case like unto this is related by Bar­tholin from Ioh. Bapt. Caballaria. Th B [...]rth [...]li [...]. Spiceleg. de vas. Lym [...]. c 6. Concerning the variety of blood in healthy persons, it is further obser­vable: that not only in some small wounds admit of no cure, or a diffi [...]ult one: whilest others heal with more facility; in the same persons, when they are young, wounds will be easily cured even by the first in­tention, and conjoyning of the lips thereof: And af­terwards as they grow more in years, every superficial wound gives them much trouble; Van der Lin­den Disp. Phy­siol. 39. §. 22. but when they be­come old every scratch degenerates into a foul Vlcer: notwithstanding that the Patient all this while com­mits not any errour in his diet, nor is sensible otherwise or any alteration in his body, or blood. In fine, diligent observation will assure any man, th [...]t not only the Quantity of blood doth vary in sundry persons, but even the Quality, according to the age, temperament, and diet of the parties; nay even according unto the seasonablen [...]ss and season of the years. Nor shall I ex­clude the pass [...]onately angry, or melancholick, or phleg­matick from a latitude, yet doth their blood exceed­ing [...]y vary in the porrenger [...] and consequently in the veins. Van d [...]r Lin­den Disp. Phy­ [...]iol. 41. §. 22. I have oftentimes seen (and so hath Van der­Linden) that in some healthy persons the blood hath been of a redness equally florid from the top to the bottome: in some there hath appeared only some blackish spots at the bottome, which no conversion to the open Air would rectifie into a florid crimson: and perhaps some Observations may inform a man that the florid colour in the surface of the blood ariseth from a thinner sort of blood, of a peculiar kind, which radiates through a subtle pellicle on the top, and when the blood [Page 109] is turned topsie-turvey, 'tis not the impressions of the Air that restores the decayed colour in the more black blood [...] but the assent of this Ichorous blood through the more black and fibrous mass. I have some grounds for this suggestion; but I never could see any pellicle or thin concretion upon the turned blood, and to the de­fect thereof I have been willing to attribute the Phae­nomenon, when the turned blood hath not equalled in floridness the first superficies. Some have attributed that florid colour to the concretion and shooting of some volatile Salts in the surface of the Blood: Simon Paulli de febr. ma­lign. and think that Ki [...]cher mistook those saline striae for Worms in his Microscope.

Besides this difference in the Mass of Blood as to se­veral Individuals, it may not be amiss to consider the difference that is betwixt the Blood in sundry vessels and parts of the body. It is the most common tenet a­mongst Anatomists, that the Blood of the Arteries differs very much from that of the Veins, Harvey Exer­cit. Anat. 2. ad Riolan. Though Harvey seems to deny it with much confidence, and appeals to Experience for the proof of his Opinion: yet the Ge­nerality, as Doctor Ent, Walaeus, and Lower, grant there is a great difference in the colour of them, and that the Arterious blood is the most florid, the venous is of a darker red: Besides this difference in colour, there is a greater which ariseth from the quantity of serum which abounds in the Arterious blood more than in the ve­nous. Aurel. Severi­nu [...] Epidoch. de aq. peric. sect. 8. ‘Comprobavimus in accepto per nos ex crebris Arteriotomiis cruorum duplem ferme compertam icho­ris portionem: qua fit fortassis ut crediderit Auctor lib de util. respir. Sanguinem Arterialem non concre­scere velut venalem; quanquam & nos eum concrescere non semel observavimus. B [...]rthol Spic. 1 de vasis Lym­phat. c. 7.’ So Aurelius Severinus: with whom Bartholin agrees. And Doctor Ent sayes it is more dilated than the venovs. Ent de circul. sang. p. 106. & 267 [...] Besides this, there is a discrepancy in the venous blood it self: for in the [Page 110] Lungs the Blood acquires by the mixture of the Air a tenuity of parts and florid colour exceeding any other venous Blood: Reald. Colum­bus Anatom. l xi. c. 2. this Columbus first observed, and gave this reason for the colour and great change which is made in the Blood by passing the Lungs; proceeding to an imagination that the vital spirits in the Arterious blood might be the result of this intermixture of Air with the Blood in the Lights: Willi [...] in Exer­citat. de sang. accensione, Lower de corde. c. 3. Most of whose opinion is taken up by Doctor Willis of late, and Doctor Lower. Besides this there is a discrepancy betwixt the Blood of the Vena porta commonly and that of the Vena Cava: which is not barely supposed by Riolanus; but yield­ed by B [...]rtholin: Sanguinem in cava prope cor puriorem esse illa qui in vena portae continetur, Bar [...]holin. Spi­celeg. de vas. Lymphat. c. 7. omnibus in confesso est qui circulum norunt. Upon this account it is, that by the Emerods there is often discharged a black faecu­lent blood, to the great benefit of the Patient: but whensoever it is florid, the effusion thereof brings a great debility (sometimes very lasting) unto many persons. May I be allowed here to take notice of the Observation of Spigelius concerning the Saluatella: Spigel. de fab. corp. hum. l. 5. c. 7. that the Blood which issues thereat is more florid and Arterious than any can be drawn from the greater veins: this he attributes to the frequent Anastomoses that are betwixt the Arteries and Veins in the remote parts of the body: Vesling ep. 30. & Van der Linden Select. [...]ed. c. 13. se &. 423. wherein he was defended by Ve­slingius, and Van der Linden. Doctor Harvey observed in the most healthy and robust persons a certain mucca­ginous humour to jelly upon the surface of their Blood, which he esteemed to be the most spiritous part thereof, others take it to be not an excrementitious Phlegm, but indigested Chyle: Maebius fun­d [...]m med. c. 12 p. 258, 259. concerning this Maebius doth pro­fess, he never observed any of it in the blood drawn, or issuing from the veins in the head: but frequently in that let out of the arms, and most of all in that which hath been taken by Phlebotomy in the feet. It hath been observed, that the Blood which hath issued from [Page 111] the head at the nose hath been of a laudable colour and consistence, B [...]lloni [...]a Epi­dem. l. 1. p. [...]8 [...] when that which hath been let out at the same time by Phlebotomy hath seemed impure: And the like difference hath been taken notice of betwixt the Menstruous evacuations of Women, and the blood taken from their armes.

This variety in the blood of several persons often­times is a cause of that discrepancy which is to be in the blood of Men that are sick, in so much that when sundry men are afflicted with the same Malady, yet may it happen so, that there be little or no resemblance found in their blood. Oftentimes it is observed that in [...]utrid feavers the blood that is let out by Phleboto­my is seemingly good. B [...]llon. Epid. l. 2. p 192. Saepe ad speciem & visum purus est, qui aliqui [...] malus est. Vt contra impurus cernitur [...] specie, qui non ita [...] malus. The blood often seems to be good, when it is essentially cor­rupted and noxious: and it seems often to be bad, when as yet it is incorrupt, and alimental. In malignant and pestilential Feavers the blood is sometimes good to see to, whilest yet the sick languish under most violent symptomes, and commonly such blood is of an evil prog­nostick. Pessimum signum est, & timoris plenum, cum sanguis vena scissa extrahitur, Petrus a C [...]stro de febr. pun­cticulari. p. 90. si purus, rubicundus, & inculpatus educatur, venenositatem superare indicum est, aut putredinem in penitioribus cordis latitare. In me ipso olim observatum; nam ter per hanc febrem misso per venam sanguine, nulla prorsus putredinis nota appar [...] ­bat, aliis signis immani ferocitate saevientibus. In like manner doth Simon Paulli observe such outward good­ness of blood to be a sign of malignity in a Feaver, Simon Paulli de febr. ma­lign. §. 11, 14. and to be of an ill presage: which he illustrates with the case of an ancient man, fifty six years old, who being sick of a Feaver (which the Doctor concludes to have been pestilential) was let blood: that which issued out was so florid, that it transcended what any pencil could paint, or pen describe now out of any Artery, or the [Page 112] Lungs ever surpassed it: after it had stood twenty four hours, the mass was all coagulated, and no serum to be seen: the Patient died suddenly and without any pangs of death a little after. With this doth that Ob­servation somewhat correspond Coyttarus doth make (though he take it for no ill presage) that in Epide­mical pestilential Feavers, at the beginning if they be phlebotomised, the blood of the Patient will seem very good and sound, but in the progress it will come out putrilaginous. Coyttarus de febr. pu pur. p. 247. Circa morborum Epidemialium princi­pia— sanguis si educatur, ruber & sano similis ap­paret— quoties iterum & tertio mit [...]itur, corruptior, quam prius elicitur—This he illustrates with Instan­ces, and makes this Hypothesis (most judiciously) the foundation of his Method to cure such Feavers by let­ting the sick blood in the progress not beginning of the Disease: And undoubtedly if then the blood do not seem corrupted but florid, it must be from some vene­nate or heterogeneous mixture which advanceth the Native red, as Spirit of Vitriol doth that of Conserv [...]d Roses.

It hath been observed, that the blood in the progress of Feavers hath seemed from time to time upon Phle­botomy to grow worse and worse, even on the day be­fore a natural Crisis. Almar. Blon­d [...]lu [...] de ven [...]t sectione. p 8. Quoties enim contigit videre in continentibus seu Synochis, & continuis, sanguinem multoties & die ante Crisin emissum priore misso dete­riorem, & tamen perfectam factam, & ad salutem aegro­tantis jndicationem, ac sine recidiva?

Ballonius observes that many people in the most fa­tal Sicknesses have bled pure and to appearance good blood, whose Bowels and Lungs have been found (up­on dissection) vitiated and rotten: Others have had their blood extreamly depraved, in whose vitals no de­fault could be found. ‘Plurimis impurissimus san­guis detractus est, B [...]llon. Epid. l. 2. p. 191. imo nunquam fere purus, quibus ta­men mortuis & sectis partes omnes satis integrae sunt [Page 113] deprehensae. Aliis fere semper purus, quibus tamen viscera & pulmones maxime putres sunt inventi.’ In a Pleuritic that dyed I observed once (besides that his Lungs grew naturally to his sides) that all the lest lobe of his Lungs were corrupted and all reduced to a most fae [...]id purulency, that the which he avoided in great quantities at his mouth, and upon Phlebotomy was very well coloured and seemingly laudable. My Author goes on: ‘Scitu valde dignum est, qui fiat ut multis quibus putrefacta poene viscera sunt reperta, Id. ibid. l. 1. p. [...]00. laudabilis sanguis detractus fuerit, item & viris, & mulieribus multis [...], pallidis ac fere virentibus, cum alioqui judicasses sanguinem non ahsimi lem colori (cum quale alimentum, id est su [...]cus in venis, talis color efflorescat) tamen storentissimus sanguis detractus fuerit non serosus nimium, non subviridis & virore pallidus, — Multos videmus scabie infectos, p. 101. aut simili vi­tio, quibus certo affirmamus nos impurum sectione venoe sanguinem detracturos, & tamen in ista defaedatione cutis, illibatus incorruptusque sanguis est, & opinionem spemque fallit eventus. Nos Elephanticis saepe l [...]ud [...] ­bilem sanguinem detraximus. Quanquam fieri potest, ut specie laudabilis sanguis appareat, cum intestinum aliquod vitium in eo delitescat, quod quidam in habitu corporis, & praesertim in partibus delicatioribus, ut in facie cum ultimo elaboratur, & in rorem convertitur, tum demum se profert & exhibet. Praeterea siquis splenicus est, aut Empyicus, manente in venis sanguine puro, non desinit esse pallidus, emaciatus, subviridis, aut nigricans, quia non in massa sanguinis vitium & causa labis est, sed in alia parte.’

In like manner Blondelus observed that after a Dy­sentery of two moneths standing, accompanied with a Singultus, and continued Feaver, the Marquess De Ceuvres did upon Phlebotomy avoid at the Arm very lau­dable blood, whilest that of his stools seemed to be ex­treamly [Page 114] corrupted. Almaric. Blon­delus de venae sectione. p. 68, 69. His superaddo sanguinem detra­ctum omnimodas puritatis notas retinuisse, a sero bene repurgatum.

Dr. Willis de [...]ebr. c. 1.Doctor Willis after he hath made excellent use of those two old Galenical Comparisons betwixt the Blood, Wine and Milk; adds this accurate and true relation concerning the morbid discrepancy of Blood: ‘ Thus the Blood, like Milk, in its perfe­ction, as it cools separates into the several substan­ces of a florid red on the surface, a thicker filamen­tous subsidence, and a serous liquor: But if it be much depraved, when it separates in the Porringer it discovers it self in a different aspect, and each part assumes another shape: for that cremor which coa­gulates on the top, sometimes is white, sometimes green, En [...]mvero superficies can­dicans gelatinae similis in emisso sangui [...]e, plerum [...]que in morbosis condensa­ta conspicitur, & vi [...] cori ins [...]ar crassam len­tamque; saepe in sebribus acutis hoc anno observa­tur. Th. Bartholin. de la­ [...]teis dubia, c. 3. sometimes of a Citrine and livid colour: and is not tender, but viscid and tenacious, so that it be­comes as tough as any Membrane, & is not without difficulty pulled in pieces. When the Blood hath been for some time seised with a Feaver, upon Phlebotomy there appeareth instead of the beautiful crimson on the surface a certain white or other-coloured Pellicle oftentimes: the reason whereof is that the blood being as it were terrified by its effervescence, the upper part thereof commuteth its redness and tenderness into a white and more tenacious substance: And if the Mass of blood be not well cleared of its saline and sulphureous recrements, that superficiary Skin is stained with a Citrine or livid tincture: and for the same reason the supernatant Serum acquireth the same Colours: Moreover the purple crassa­ment of the Blood undergoeth several variations: [Page 115] sometimes it is It was black, in co­lour and consistence like to liquid Pitch, in the Woman whose menstrua stopp'd eight moneths, and was cured by Galen with rei­terated and large Phle­botomies. Galen 6. Epidem. 3. 29. cum notis Van der Linden. select. med. c. 14. blackish, when the Blood hath been too much terrified with a long effervescence. Sometimes the fibres thereof are quite vitiated, so that it will not Aliquando putrescen­tia non tam se insinuat co­lore, quam substantiae mo­do, ut quum crit ruber sed non concrescens. Valles. de victu in [...]cut. p. 45. coagulate, but remains fluid, like thick Milk; which is a bad sign, and occurs often in putrid Feavers, and Ca­chexis. The Serum is sometimes defi­cient, as in Hicticks, and after too much sweat. Sometimes it superabounds, as in Hydropicks; and being set upon the fire will not entirely coagulate into a white mass: In some cachectical persons the blood is so watrish, that it resembles that sanious blood which stains the water in which flesh is washed. I knew a man of an evil habit of body, whose blood (upon Phlebotomy) used to seem white and like to Milk; which, after a course of Steel would be again indifferently red.’

I shall add hereunto, that I have frequently seen the Blood in Hectical persons, and such as have had a latent Feaver to be very serous, and that of a livid, and citrine colour: and in Hydropics that have bled at the nose there was not any serum in the blood at all. In the Febris alba virginea (which I here contradistinguish from the Chlorosis) I extracted four hours after dinner out of the Saphena of such blood, Both the white serum and blood burned vi­vidly with [...]out any crackling. as that the Crassament was laudable for colour and consistence, but the serum was so white, as not to be distinguished from milk: the lacteous serum did coagulate, but retained no smell, whereas it usually resembles a roasted egg: it was saltish to taste: At the same time I blooded two more in the foot, neither of which had any such lacteous serum, but a citrine serum: Hers, which was a young Lady, and in health, burned very well, and crackled: the other being aged sixty years, was excellently and [Page 116] equally coloured from top to the bottom, and the serum inclining to citrine: but would not burn at all, only crackled much, and puffed with wind. She had no in­disposition on her, only was troubled with a flushing in her face, swelling of the nose, and an inward hear, such as is commonly attributed to an hot liver. I do not attribute that lactescense in the first Ladies blood to the mixture of new Chyle, Dr. Lower de corde, c. 4. p. 21 [...]. which Doctor Lower saith he hath observed in Men, and other Animals, being phle­botomised a while after meat, to create a lacteous fe­rum: for I never in all my life was so happy as to see that, though I have blooded my self on purpose two hours after dinner to make the tryal: and have an hundred times examined the blood of others who have been blooded at such times as we might expect to see that Phaenomenon of his. Yet hath the reality of his observation been confirmed unto me by other credible witnesses: so that I question not but he may have seen it; though I could not in these Ladies, who all dined together about one of the clock, and had done bleeding by four.

Neither may I pass by this Observation, that of all the S [...]rum which I have tasted, I never found any to be bitter, though I extracted some once that seemed so bi­lious, that being put into an Vrinal none could know it from urine highly tinged: as soon as I set it on the fire it coagulated with a less heat than I imagine it to have had in the veins [...] and it exchanged its hue for the usual white, smelling like a roasted Egg. Yet doth Van der Linden say, that some have tasted the blood of Icterical persons, and found it bitter. ‘Actu nihil naturaliter in sanguine amarum est: Van der Lin­den disp. Phy­siolog. 51. sect. 19. Sed nec esse potest; redde­ret enim sanguinem ineptum suo muneri; ceu observare est in Ictericis. In his enim sanguinem amaricare ac­cepimus ab iis, qui & ipsum vena emissum, & urinam ejus gustarunt, Andr. Vesalius de rad. Chinae. p. [...]52, Asclepiadio more.’ And Vesalius gives us an account of one Prosper Martellus, a Florentine [Page 117] Gentleman, much inclined to and troubled with the Iaundise, whose Liver was scirrhous (but Spleen sound) and his Stomach turgid with choler; and wheresoever he opened any of his veins they were full of thick choler, and the fluid liquor which was in the Arteries did tinge his hands as if it were choler. I find the like Observation in Th. Kerckringius: that an Icterical Woman brought forth a dead Child in the eighth moneth, Th. Kerckrie­gius Obs. Anatomic. 57. which was so yellow all over, that it rather seemed a Statue of such wax, than an humane Abortion: being diffected By him, instead of blood in the veins there was nothing but choler, and all the bones were tinged with such a yellow, that one would have thought them painted.

The Scholiast upon Ballonius observed, that however the blood is naturally sweet, even such as upon ob­structions from the Menstrua hath regurgitated and discharged it self at the Gums of women: (as they have told me) yet in one that was troubled with the Green-sickness the blood, though florid, was salt.

‘Potest esse storidus color, & in se esse acrior & bilio­sior: unde quaedam mulier [...], B [...]llon. Epi­dem. l. 1. p. 111. sect. 17. & ejusmodi prae­dita temperamento mihi affirmavit, siquando vel ex dentibus sanguis affluit, vel e capite, eum sibi gustum sentiri salsum & molestum.’

When I was at Barbadoes we carried off several poor English thence to Iamaica, where many of them falling sick, and some being well, were let blood: I observed that in those poor people, which live upon nothing al­most but Roo [...]s, and drink Mobby (a liquor made of Potatoes boyl'd and steep'd in water, and so fermented) that their blood did stream out yellow, and in the Por­ringer did scarce retain any shew of red in the coagu­lated mass: yet are they well and strong, but look pa [...] and freckled: such persons (which are frequent in Barbadoes) are called Mobby-faces.

[Page 118]It were infinite, at least beyond my present leisure, to relate all that variety of morbid blood, which hath been observed in sundry diseases, and in several persons lan­guishing under the same distemper: as in Pleurisies, the Scurvey, French-pox, Hypochondriacal Melancholy, and the like: wherein if it be true, as it is, that often­times diseases vary in individuals, 'tis no less certain that the blood doth also vary in them: so that often­times ignorant Physicians do imagine a greater cor­ruption in the blood, and a greater recess from what is natural to the person, and a greater danger in the disease, or in the practise of Phlebotomy, than they need; yet in Epidemical, or some Sporadical diseases, if the Phae­nomena be as general as the disease, 'tis certain then that the resemblance of the blood argues a resembling cause, which prevails over the idiosyncrasy of particulars.

I know it will be expected that I should say some­thing about the Controversie whether the Blood be one Homogeneous liquor, the recrements whereof make up the four Galenical Humours, which are no otherwise parts thereof, than the Lees and Mothers of Wine are constitutive parts thereof? Or whether the four Gale­nical Humours, viz. that which is properly Blood, Me­lancholy, Choler and Phlegm are the constitutive parts of the Blood, in its natural consistence and Crasis? I shall say therefore about this point as much as may be re­quisite to my present purpose.

First I observe that the Galenists are at a difference whether the Mass of blood contain those Humours actually, or only potentially? so that one may hold ac­cording to them, that the blood is as homogeneous a li­quor, as any Neoteric doth hold it to be, though it arise by the mixture of their five principles. Amongst others Erastus hath a disputation, in which he amply [Page 119] asserts, that all those Humours when they are actually in the blood they become excrementitious, and are no lon­ger parts thereof, but such as the ejectment thereof depurates and perfects the other remaining blood, which he confes [...]eth to consist of several parts constituting one body, to which they are as essential as the serous, ca­seous and butyrous part are to Milk, which if they be deficient 'tis no longer Milk. [...]ro [...]tus disput [...] 19. §. 62.54, Nam ut non potest lac bubulum intelligi sanum & perfectum sine tribus suis partibus, sero, caseo & butyro, ita non potest sanguis probus animo concipi & definiri absque partium illa va­rietate. Fernelius doth compare the generation of Blood to that of Wine, Fernel. Physi. oleg. l. 6. c. 3. wherein the Chyle is supposed to resemble Must, which by fermentation separates and throws out such parts as are not actually in that liquor, but arise upon fermentation and are ejected several wayes: the more crude parts are by time digested, and then the noble wine brought to perfection: so he sup­poseth it to be in the blood: and thus though all the humours be at once as it were produced in the Chyle, yet are they no more parts of the blood, than the Tartar and Mothers are parts of Wine. [...]alen. l. 2. de elem. Both these Simili­tudes of Milk and Wine to Blood were first I think in­troduced by Galen, Galen. 4. de usu part. c. 4. & de nat. fac. l. 3. c. 13. Vallerioia loc. commun. l. 1. c. xi. Mercar. Qu. 65. I am sure he made mention of them, and so did his Successours; to Mercatus, Fer­nelius, Platerus, Palleriaca: then Carolus Piso began to carry the comparison further in his discourse of Feavers: and after him Quercetan: and since that our learned and judicious Countrey-man Doctor Willis. Others held that the blood as it flows in the veins, and is designed by Nature for the Aliment and other uses in man, is not to be understood as one liquor consisting of some variety of parts, yet united into one similar body (the rest whereof were to be excrements) but a more confused Mass of several distinct Alimentary Humours, which Nature never intends to unite into one similar body, but to continue in a certain more loose mixture, [Page 120] each thereof retaining its proper congruity for the con­tinuance of life and health. They do confess that there is a pure crimson part, sweet and balsomical, which they call in rigour Blood: but they say Nature never intended this for the sole vitalliquor; because she ne­ver produceth it alone; or if it be ever seen so, 'tis in a morbid condition; as in malignant Feavers, where the [...], or Blood free from the proportionate mixture of other Humours, is reckoned amongst evil signs, B [...]llon. definit. Medic. p. 7. Qualis sanguis in malignis adurentibusque fe­bribus solet excerni, aut e vena tunsa educi. And there­fore as none of the Humours are ever seen alone, any more than Blood is (for they hold them all to be excre­mentitious, when separate) so they conceive they all together in a certain proportion make up that aggregate called Nutritive Blood: and are all actually there, be­cause they do observe that all of them at sometimes have their distinct corruptions, though they continue still in one mass; which they conceive they could not have, except they were actually there: They do con­ceive them to be so there, that the resemblance betwixt Gall, or extravasated Phlegm is but Analogical: so that they do not pretend to shew in the Blood a bitter Gall, or a pontic arminonious Melancholy: They will not allow these to be other than depravations of the Ali­mentarious Humours: and the sincere alimental juyces are no more pretended to be evinced by them; then the pure Elements, except it be a posteriori, by a diversity of effects arguing different causes. They saw there was a great latitude in the blood of healthful men, yet so as that the blood appeared with different colours, and consonant to the colours there seemed a variety in their dispositions, and other corporeal qualities: they saw the Mass of blood upon perfrigeration to go into several substances, and they intellectually disjoyned them more, for doctrine-sake; ob [...]iging themselves to produce each Humour in its imaginary purity, when [Page 121] the Chymical fire should exhibite any body not de­compounded, or the Corpuscularians make more ma­nifest their configurations of Atomes, or Texture of Particles.

Having thus stated the Question with as much per­spicuity as I could: I pursue to enquire which is most conformable to the effects in Physick; for I will not un­dertake to determine what God and Nature do in the production or mixture of bodies: It is easie for a man to loose himself in those inquiries: He that made us can tell how we were made; our Argumentations are as vain as if one should assert that a Loaf of bread consisted of Cubes, Lozenges, or Trapeziums, because we can cut it into parts of such a configuration. Let us but imagine a subtle Chymist to analyse Chymically our Ale, if ever he thereby discover that it is the pro­duct of a Barley-corn growing into a stem and grain, then turned into Malt, grinded, boyled with water, and fermented; I will assent unto the Chymical re­solutions of blood: Physicians have been alwayes allowed hitherto to be a sort of gross Artisans; and I remember Massarias somewhere calls it an Hippocratical demonstration: De re ipsa ut neque dubites, morbi morborum qi­curationes docent. N [...]mirum hoc est m [...]ximum argumentum Hippocratis, ait Mass [...]ri [...]s. Van der Lin­den disp. Phys. c 2. Indicium autem Curatio. To know bodies exqui­sitely mixed, and to mix them intimately, is a divine attribute: this last is avowed by Galen. Miscere corpora tota per tota, non Hominis, sed Dei & Naturae est opus. Per­haps it may be replyed that the most igno­rant persons may say thus much: Lacuna Epit. Galeni de temper. l. 1. It is true, and if he speak it knowingly, I confess I can say no more than he. Francisc. Sanchez de longit. & brevit. vitae. c. x. ‘Sed quod di­cemus objectioni illi? Ignarus aeque ac Phi­losophus deum causam omnium assignabit: Hoc ignarus inscienter, Philosophus scienter assignabi [...]: quemadmodum Aristoteles ait de Parmenide & Meliss: [Page 122] quemadmodum caecus alicujus tunicam albam esse asse­rit.— Nil seimus. Dicamus ergo. Primarum rerum, principiorum, aut elementorum causas reddere, nostri non est captus: secundarum vero, utcunque. Id in singulis quaestionibus experiri possumus.’

I say then that notwithstanding any allegations to the contrary, it is manifest that a certain proportion of salt, sulphur, and spirit, besides earth and water, is neither re­quisite to perfect sanity, nor its defect as to any particu­lar, the cause of diseases: and this is manifest out of the constitution, as well as colour of the blood, in morbid and healthy bodies, as appears by the burning and di­stillation of blood: There is much of truth that— T. T. sayes, or may be so. Now I am ready to discover in reference to miserable man: I have lately blooded a Woman which after a Quartone was troubled with obstructions of the Spleen and Liver, effervescences in the Intestines, Asthmatic p [...] ­roxysmes, acute pains in her head, obtuse pains in her limbs, visible beginnings of a Dropsie; the blood at its issuing out seemed very black, but was pretty lau­dable in the porringer: it burned well, without any crackling or intumescence al­most: so did the Serum: Here the salt seems rather defective, than to abound, as it ought by those princi­ [...]les. that the pretended sanguine sulphur or Cacochymy of any in an high Feaver doth afford more salt, water and earth, each of them, than sulphur. I have taken that diseased blood termed corrupt, which might seem to some to abound with sul­phur, being clearly conveyed into a Retort with a Receiver joyned thereto, I have by a graduated fire regulated very strictly, brought over what possibly I could. In the upshot upon the separation of the several parts, I have found very little sulphur in comparison of each of the rest.

At another time I procured the purest blood I could get from an healthful person, putting it to the same igneous tryal, as the former dege­nerate of equal proportion to it: then after sequestra­tion of the parts, I could not perceive any considerable difference in the quantity or quality of the several parts of that sound and the seemingly corrupt blood.

[Page 123]I do say that in the Blood of all persons that are in health, there is upon Phlebotomy somewhat that justifi­eth the supposition of the Galenists; but not which confirms the Hypothesis of the Chymists. The coagu­lable serum doth commonly represent their choler in part: the florid fluid red their blood: which if lightly washed away, their is another more darkly-coloured which is proportionate to their Melancholy: and if you wash the fibrous mass well, it will be white, and answerable to their Alimentary Pituita, or Phlegm. In this last part I have the concurrence of Malpighius, M. Malpighi [...] de viscer. structura. p. 163. edit. Londinens. who upon washing all the blood from the concrete Mass of blood, found the remainder to be a fibrous con­texture of a whitish colour, which he pitcheth upon as the materials for a Polypus in the Heart: And had he taken more particular notice of that fluid blood in the cells of those interwoven fibres, he might have disco­vered two sorts of blood, one that readily ascends, and is florid: the other more black and faeculent which moveth not: and both these stain the water they are washed into with different reds, the one much brighter than the other. That some fibrous con­cretion in some diseases, In quibus superficies san­guinis durior est & candi­cans, subjectus sanguis in pelui sine fibris plane est putridus; imo vidi in hu­jusmodi, ne gu [...]t [...]lam colo­ris rubri. Bartbolin. de la­cteis dubia. c. 3. as Rheumatismes and Plurisie [...] covereth like a pituitous mass the surface of the blood, whilest that re­mains fluid and blockish underneath: nay I have out of healthful blood in the Spring (I am almost convinced that the blood va­rieth with each quarter of the year) cast it up to the surface in just such a mass as covers the top of the blood in those distempers, by putting some spirit of Har [...]shorn into the Porringer before the party bled into it. I place the choler in the serum, not but that I know that it hath not the taste or consistence of the excrementitious Bile, but because it hath frequently the colour of it, and the Vrine, and Pancreatick juyce (not to mention the Lymphaeducts) are tinged with it, and [Page 124] oftentimes have the Sapor of it: I am sure that herein I have the suffrage of Pecquetus thus far, that the choler which is separated in the Liver (and which [...]ingeth the Vrine) is extracted out of the serum of the blood, where it circulates first along with it, and is percolated out of it in the place aforesaid. ‘Et vero nullibi per universas animalium species absque bilis mixtura sanguinem reperias: Vide Pecque [...]i Dissertat. Anatomic. de circulat. san­guin. c. xii. Videtur humor felleus san­guini firmiter adhaerescere; q [...]od in seri illius parte fundatus sit, nec facile ab illo, intra ulteriorem prae parationem separari possit. Charleton. oeconom. Ani­mal. c. 7. sect 16. slavescens id serum salsumque testatur; nisi forsitan aliquot in suppositis quibus dul­cem mitior natura sanguinem concoxit, se­cu [...] & in aliis, quibus acciditatis expertem infudit, aut nullo prorsus liene instruxit, aut sane perexiguo.’ I cite him the more willingly, because that If the Galenists seem in [...]atuated for saying the Gall is a constitutive part of the mass of blood, (whereas they cannot demonstrate signs thereof by its bitterness) a great part of the scorn may fall upon Pecquet, Backius, and Sylvius, de le boe, and other Neoterics, who hold it is incorporated in the Mass of blood.

But these Controversies can be no better decided than by an Enquiry into the Generation of Blood, how that it is at first begun, and afterwards continued: the knowledge whereof will conduce much not only to the decis [...]on of that Question, Whether there be in Nature any foundation for those Galenical Humours, that they are constitutive parts of the Mass of Ali­mental Blood? But also to the main debate in hand Concerning Phlebotomy:

There is not any thing more mysterious and wonder­ful in the Vniverse I think then the production of Crea­tures: In so much that Longinus a Paynim doth here­upon take occasion to celebrate the judgment of Mo­ses, in that He represented the Creation by a Divine FIAT, and God said let there be—and it was so. The Mechanical production of Animals from so small [Page 125] and tender rudiments, out of a resembling substance, in all that variety which we see, by a necessary result of determinate Matter and Motion, is so incomprehensi­ble and impossible, that were not this Age full of mon­strous Opinions (the consequent of Ignorance and In­considerateness) one would have thought no rational Men, much less Christians would have indulged them­selves in the promoting and propagating such Tenets. 'Tis an effect of that Soveraign command that every thing hath its being and faculties; ‘Quin nil aliud est Natura, E [...]stus dispu [...]. de propriet. Medic. c 15. quam jussus ille Dei, per quem res omnes hoc sunt quod sunt; & hoc agunt quod agere jussae sunt. Hic, inquam, non aliud quicquam, cuique rei suam dedit speciem & formam. Per hunc non agunt modo pro sua natura, hoc est, prout preceptum est ipsis, res creatae omnes, sed per eundem reguntur, conservantur, propa­gantur: Et nunc etiam quasi creantur.’ This is that which gives a beginning to the Faetus particularly, and by unknown wayes contrives the seminal vertue, its receptacle or Egg, and that colliquament out of which the Body is formed. Because the first rudiments of con­ception are tender and minute, such a provision is made in order thereunto, that the albuginous substance of ordinary Eggs is no other than what is derived into the female womb: This is the opinion of Dr. Highmoro, Velthusius, Courvee, and Ev [...]ra [...]us. And if we may continue the compari­son, it will seem most rational to imagine, that the parts of the whole are contrived at one time, though they neither appear all at the same, nor in a proportionate bulk; for in some their minuteness, in others their whiteness and pellucidity conceals them from the Ob­server: But that even then there are exerted the pro­ludes of those vital operations which are so visible after in Nutrition, I doubt not: and that as in the Coates of our eyes the minute veins and arteries convey their en­closed liquors (though undisernable except in Eyes that are blood-shotten) and as in the brain there hath been discovered veins by some drops of blood issuing [Page 126] in dissection, [...]o. Iac. Wepfe­rus de apopl. p. 92. &c. Bustachius de dentil. c. 20. Th. Kerkring. Obs. Anatom. c. 2 [...]. though no Eye can see most of the capil­lary vessels; and as even the veins and arteries them­selves are thought to be nourished by other arteries and veins, rendring them that service which they do to the more visible parts: even so it is in the first for­mation, wherein after some progress the vessels begin to appear, and blood first discovers it self in the Chorion, and thence continues its progress to the punctum sa­liens, or heat, and undoubtedly proceeds in its Circle, though the smalness of the vessels (as in other cases) conceal the discovery. So that we may imagine that the Plastick form (or whatever else men please to call it) doth produce the blood out of that albuginous li­quor (which seems as dissimilar as the blood out of which it is derived, D Highmore's Hist. of Gen. c. 5. though the parts be providentially more subtilised, and refined) by its own power (as it doth the rest) through the assistance of warmth, and concurrence of the contemporary fabrick: for the first blood can neither give a beginning to its self; nor is it comprehensible, how the weak impulse thereof should shape out all the veins and Arteries in the body, according as they are scituated. Out of which it is [...]vident that the Soul or Plastick form doth at first reside and principally animate in the Spermatic parts (so called not that they are delineated out of the Sperme, but out of the Colliquament, which is Analogous to it) and that they are her first work; the blood is but the secundary, and generated out of the Colliquament (for other Materials there are none) by the Plastic form which is the proper efficient thereof, and besides the Auxilary Heat there are no other instrumental aids but the spermatick vessels wherein the Colliquament at first flows to the punctum album, which when blood is generated do become the Heart and sanguiferous Channels. This is avowed by Doctor Glissen himself: ‘Liquor hic vitalis, Gl [...]ston Anat. Hepatis c. 35. antequam sanguinis ruborem induit, sese a reliquis ovi partibus (quibus promiscue commisce­tur) [Page 127] segregare incipit, & in rivulos seu ramificationes quasdum excurrere, quae postea venas evadunt. Rivuli isti in unum punctum col [...]untes, in eum locum conveni­unt, qui postea punctum saliens & cor appel [...]tur. Idque fieri videtur, diu antequam sanguinis aliquod vestigium compareat.’ Herewith agree the most exquisite Ob­servations of Doctor Highmore. Dr. Hig [...]more hist of Gen. c. 8. p 69, 70. Most certain it is by the History of Generation, that no Parenchymatous part hath any operation in the first production of the blood; all their [...]arenchymas being post-nate thereunto. And if the blood be thus generated at first, it is but rational for us to imagine that it is alwayes so generated du­ring life: For as it is true that the same cause acting in the same manner will alwayes produce the same effect: So in this case to argue from the identity of the eff [...]ct to the identity of the cause, Glissen. Anat. Hepatis. c. 35. is allowable. Est enim causa­rum identitas quae fa [...]it ut effectus sit idem: quippe effectus supponitur non esse, donec a causis existentiam suam indeptus [...]uerit; & dum existentiam illam largi­untur, oportet ipsius quoque identitatem impertiant, qua sine effectus ipsemet nequaquam fuerit, That the Sper­matic vessels in which the blood moves do contribute to [...]anguification much, seems apparent from hence: that the blood is seen in them before it is in the heart: Greg: Horstius Instit. Medi [...]. disp. 3. Co­ron. 1. Ap­pend. con­clus. 4. And because it is observed that the fluidity of the blood seems to depend much on them; and therefore in the dead it doth not coagulate (except praeternaturally) in the veins, though it do commonly in the Heart, or wheresoever it is extravasated. Berigardus Circul. Pi [...]an. 1. part. 6. circ. 7.—Aperta nam (que) in ca­davera vena, sanguis pro­fluit. Ent. de circul. sang [...] sect. 137. "Manat praeterea aliquid a venis nobis incognitum, quod dum earum ambitu sanguis concipitur, prohibet [...]jus concretionem, etiam post mortem in cadaveribus jam perfrigidis, nequis hoc colori acceptum ferat: quod vero coralliorum instar aliquando repertus est concretus in venis ipsis, hoc merito Fernelius ascribit morbo occulto. And not only the [...]uidity but motion of the blood seems to depend much thereon: for if by a l [...]gature the impulse and succession of blood be [Page 128] prevented, yet will the blood in the veins continue its course, and not stagnate. Exempto e corpore corde, mo­tus tamen sanguinis, isque satis c [...]ler in sanis videntur. Et si vena ulla, W [...]l [...]us de motu sang. epist. 2. etiam lactea, duobus locis ligetur, laxata ea sola ligatura quae cordi propinquior est, dum partes ad­huc calent, semper Chylus ad hepar, sanguis ad cor cum movebitur: qui nec a corde per Arterias, nec ab intestinis per lacteas, objecto potuit obice propelli: nec stuiditate sua potius sursum quam deorsum movetur. The truth hereof seeming undeniable to Pecquet, P [...]cquet dis sertat. Anat. de circulat. sang. c. x. he makes use of a new Hypothesis to solve this motion of the blood, as if it arose from compression of other parts, or contraction in the vein it self: But the Phaenomenon will appear in such cases as admit not this pretence. From these rea­sons it is that the blood doth not need so much as any pulse in the veins and arteries (as appears in the first faetus) but as soon as it comes to the Heart it does (to prevent coagulation) the punctum saliens (being en­dowed with no such quality) practiseth its systole and diastole, when yet no such motion is observable in the Arteries at that time. Whence the colour of the blood ariseth, is a secret unto me: I know that digestion re­duceth some Juyces to a redness: in some Fruits the [...]ire doth the like: in some the mixture of acid Li­quors begets a Vermilion: But here I conceive none of these causes produce the effect [...] the generation of the blood is manifestly an Animal Action, and, as such, un­searchable. Whatever I attribute to the veins, it is not to be expected that supposing they should instru­mentally sanguifie, the blood should turn blew from them, any more than that water put into new vessels of Oak should turn white, whereas it becomes reddish. Thus the Plastic form produceth blood at first, and whilest th [...]re is no first concoction in the stomack, sup­plieth that defect by that albuiginous Colliquament which is of the same nature with the Chyle we digest our meat into, and convey by the Lacteous Thoraciducts [Page 129] into the Heart. That it is of the same nature appears hence, that it resembles it, and that it is extracted from the Blood of the Mother; and produceth in the Em­bryo the like excrements of Choler, and Vrine, and Mu­cosities; nay it hath been observed by Riolanus to have been tinged yellow: Riolanus An­thopogr. l. 6. c. ult. p. 411. How much more may be concluded hence in favour of the Galenical aliment [...]ry humours supposed to consti [...]ute the Blood, I leave those to judge who consider the variety of female constituti­ons, and their condition during their being with child: perhaps the Hypothesis of a proportionate mixture of the five Chymical Principles will not seem more colourable?

Having thus related how Sanguification is perform­ed in the Faetus at first; I come to give an account how it is performed afterwards; and even here it seems an Action perfectly Animal: Concerning Concoction in the stomach see the excel­lent discourse of Maebius de usu ventriculi su [...]dam [...] Medi [...]. c. x where he resolves it is done by an Animal heat, or Spiritus vitalis veget [...] c [...]lote praedi­tus. for even Concoction in the Stomach is not the bare [...]ffect of Heat elixating the meat; nor of acid or saline Ferments dissolving it; nor of any other kind of imaginary Fermentation: But 'tis the effect of an Animal power operating upon the Meat in the stomachs of sundry Men and Animals by several wayes: This appears most evidently herein, that the same meat eaten by several Persons, or different Animals produceth different Blood and different Excre­ments: therefore Chylification is an Animal operation, and is modulated by the speci [...]ick and individual con­stitutions. Having thus determined of things, that the Soul in all these actions is the Efficient, we may consider that the meat being masticated in the mouth, and commixed with the salival juyce or spittle, is pre­pared in order to Chylification: then it descends into the stomach, and is there (sometimes in a longer, some­times in a shorter space) reduced into a cremor which is so far from being acid (as H [...]lmont saith) that it is generally rather saline, Vide Maebi [...]m ubi supra [...] & Kerger. de ferment sect. 3. c. 2. p. 20 [...], 201. as are also the recrements of it that remain in the empty stomach: It is true that ac­cording [Page 130] to the stomachs of Individuals, and the meat they eat, it happeneth so that this Cremor hath no cer­tain taste, nor colour: Undoubtedly it must have been bitter in that Marriner (and such as he) of whom Vesalius writes, V [...]salius de fabric. hum. corp l. 5 c. 8. that the Gall did naturally discharge it self into his stomach, yet did he digest very well, and never was apt to vomit, or to be so much as sea­sick. From the stomach the Cremor descends into the Intestines (not all at once, Re [...]sueru [...] de urinis. c. 3. p. 42. but as it is digested) and there undergoes a second digestion receiving into its mixture the Gall and Pancreatick juyce: I shall not speak of the variety that hath been observed in those two liquors, nor trouble my self about the manner how they operate on the Chyle: It is manifest that upon that mixture the Chyle suffers a great alteration (if not some effervescence) and some parts are coagulated and as it were precipitated, and by a succession of changes the several particles are so blended, Dr. Needham deformat. faet. p. 101, 102. and r [...]fracted in their qualities, that the excrements at last are neither acid, nor bitter, but (in dogs) both sapors are extin­guished. In the mean time, during this descent of that miscellanes the lacteous vessels do imb [...]be and con­vey the Chyle in the shape of Milk to the Receptacle, where mixing with the recurring Lympha (which is sometimes yellowish) it passeth through the Ductus Thoracicus unto the Heart; and in the Subclavian vein associating with the Blood, it passeth along with it, supplying the continual decay of the Blood, and yield­ing Nutriment to the parts, and new matter for excre­mentitious humours: yet so as that it is not all transmu­ted into blood, or perfected, at one passage through the Heart, but by repeated Circulations, whereby it comes to loose its lacteous colour, and contract a more saline taste, as well as a serous limpidity, or some more dege­nerate colour: yet it is still coagulable (except in a mor­bid state) like to the white of an Egg, Dr. Lower de corde. c. 5. as the depurated Chyle is. It were easie to pursue this discourse so as to [Page 131] demonstrate that neither the separation of the Vrine in the Kidneys, nor of the Gall in the Liver, nor of the Spittle in the Glandules are other than vital Actions, wherein the same form which at first shaped the Body is principal Efficient, and that in these Operations there is somewhat more than percolation of corpuscles diffe­rently seised: But I shall conclude this discourse by accommodating of it to the defence of the Galenical Alimentary Humours supposed to constitute the Blood: It is manifest in this History of Sanguification that the Pituitous liquor which is derived into the Mouth by the salival vessels is most agreeable to that which is by the Galenists called Phlegme: it is not like the serum in the blood, for it is not coagulable, as the other: 'tis insi­pid; and as it makes so considerable a p [...]rt of the chyle in the stomach, so it may well be presumed to con­tinue its intermixture unto perfect Sanguification: As for the Gall, as its intermixture in great qu [...]ntities with the Chyle is undeniable, so 'tis not improbable that it gives a fluidity to the Chyle beyond what it acquires in the stomach: Platerus Quaest. Phy­siolog. 17. thus Painters to make their colours and oyls more fusile, and accommodated to their use, do mix Gall therewith. That upon the mixture it should loose its bitterness and become sweet and alimentary is most agreeable to the Galenists, and no wonder: for the sapors as well as colours of liquors are easily alter­ed: and 'tis manifest that this happens in the descent of the Excrements through the tract of the Intestines: and why not in the venae l [...]cteae? there are signs of it in the flavidity usually observed in the Arterious blood: and 'tis remarqued by Judicious Maebius con­cerning the blood, that it is not Homogeneous.

‘Habet enim sua stamina, Maebius fun­dam Medic [...] c. 14. p 3 [...]9 [...] & nigricantes fibras: ha­bet serum salino principio imbu [...]um ad putrodinem elu­dendam: habet partem sub [...]liorem splendente rubore excellentem, supersiciem in extravasato cruore ambien­tem: Et haec in recessu videtur custodire BILEM ALI­MENTAREM, [Page 132] flavidine sub insig [...]i rubore abscon­dita. Quae ex rubro nigricant, s [...]avedini si miscean­tur, talem spl [...]ndentem ruborem exhibere, cuivis cla­rum est.’ The bitterness which it hath is produced by the Liver upon its separation there, Mabius ubi supra. p. 338. which is not done by meer percolation, but an accessional of trans­mutation there. As for Melancholy, how much the Pancreati [...]k juyce resembles that (when it proves not to be bilious, as Veslingius and Virsungus alwayes ob­served it to be) let any man judge by what Regneru [...] de Gr [...]eff hath most ingeniously written thereof: be­sides tha [...] the more black part of the blood seems as essen [...]ial thereunto, as the more bright Red. But the Degeneration of the Blood into those Excrem [...]ntitious Humours, seems to evince as much as the Galenists pre­tend unto; Since every thing is not produced out of eve­ry thing, but out of d [...]terminate matter: 'tis not incon­gruous to imagine that in the due constitution of the Blood there is an Analogical difference of Alimentary juyces to make up good Blood, since there is such a discrepancy in those depurated from it; upon which the Soul, by the innate temperament of the parts separating, doth so operate that its effects are modified by the na­ture of the subject matter: Hence that variety in the tastes of Vrine, which is sometimes so bitter that Gall doth not exceed it: sometimes sweet; so that Fonse­ca relates of a Por [...]uguess Peasant, Fonseca de Excrement. c. de Vrinis [...] who by the sweet­ness of the Vrine would tell who were infected with the Plague.

The Gall appeared in great variety to Vesalius: ‘Longum sane esset, ea que in quibusdam tertiana & quar [...]ana laborantibus, Vesalius. Exa­min. obs. [...]ullop. p. 191. & dein suspendio aut capite plexis, in furiis & mania oppressit obsessis, in melancho­lia morbo effectis, ex variis f [...]brium (quae continuae fuerunt, & rigorum & sudorum inordinatos circuitus faciebant) generibus extinctis, faedo ictero, eoque va­ri [...] vexatis, malo habitu diu pressis, & dysenteria cru­ciatis, [Page 133] subinde reperi, modo commemorare: Sive sci­licet hic insignem bilis nunc flammae, nunc atramenti quo scribimus in modum atrae, sive albicantis prope­modum colorem (qui fere conterminas partes inficeat) sive [...]luidam, aut luti modo, aut unguent [...] cujusdam ex farinis & melle & terebinthina apparati ritu consi­stentis substantiam, sive varias calculorum effigies, si­ve bilis vesiculae molem instar duorum pugnorum ob con­tenta tumidam, [...]egner. d [...] Gr [...]eff de succo pan [...] creatit. §. 65. sive omnis bilis defectum, recenserem. Quae omnia me de hujus vesiculae natura adhuc magis quam antea habent solicitum,’ As to the Pancreatick juyce its variety is no less observable: So for the Phlegm, and [...]lood it self.

Having said thus much in behalf of the Ancients against some Dullmen of this Age, who laugh at any one that mentions but those Humours, I might proceed to demonstrate practically their several motions in disea­ses, and justifie the Medicinal Documents created there­on by such instances as countenance thereunto: But the digression would be excessive; I return therefore to the principal Discourse, and sh [...]ll from what hath been said er [...]ct an Hypothesis concerning Plebotomy which will authenticate the received practise, which is so judi­ciously and happily followed by all prudent men.

• 1. If it be true, that there is so great a Quantity of Blood in the body, as I have evinced, then may we very well suppose, that the loss of a few ounces is no great dammage to the Patient.
• 2. If it be true, that so great effusions of Blood have happened to several per­sons [Page 134] without any subsequent prejudice: If it be true, that large Phlebotomy even usque ad Lipothymiam hath been succes­fully practised; then is it evident that our partite and diminute Phlebotomy may be safely continued: and that whatsoever ill effects follow thereupon, the default is not to be ascribed to Blood-letting, but to the indiscretion of him that ignorantly made use of it, or the unknown idiosyn­cracy of the Patient, or the over-ruling Providence of God which disappoints frequently the most rational and best Me­thods of curing.
  S [...]n [...]ca de be­ni [...]. l. [...].
  Quaedam ejus sunt con­ditionis, ut effectum praestare debeant: qui­busdam pro effectu est, omnia attentasse, ut proficerent. Si omnia fecit ut sanaret, pe­regit Medicus partes suas: etiam damnato reo, Oratori constat eloquentia officium, si omni arte usus sit.
• 3. If it be true, that there is so great a variety and discrepancy in the Blood, then is there no secure judgment to be made of [Page 135] the Blood issuing out of the vein, either to the continuing or stopping its Flux: But the Physician is to proceed accord­ing to the Rules of Art; and according­ly as they direct him, may he promote, stop, or repeat the evacuation: A seeming Ca­cochymy in the Blood doth not impede ve­nae-section, nor call for purging, and recti­fying: Nothing is evil that is natural to a man; but real Cachochymy or redundance of Humours offending Nature, this doth call for our assistance, and requires some­times Phlebotomy, and sometimes other Medicaments.
• 4. If it be true, that Sanguisication is an Animal Action, if it be true that the Plastick form is in being before the Blood, and produceth it, and the whole Fabrick, and subsequent operations; and that the motion of the Heart is proved by Doctor Lower to depend upon the Nerves during life: then in there no such strict connexion betwixt the Soul, [Page 136] Life, and Blood, as— G. T. doth fancy.
• 5. If it be true that the Blood doth continually waste and spend it self, in Nutriment and Excrements; then is it manifest not only that the loss of a little Blood partitely taken away is not the loss of life, or prejudicial thereunto. Neither doth it follow that the loss of Blood in a moderate quantity is any imminution of the vital Nectar: it is neither the chief residence or seat of the Soul, nor in a deter­minate quantity requisite to the continu­ance of Life, but comes under a great lati­tude: It abounds more in some seasons of the year, and times, than at others: and why may not Artists imitate Nature in di­minishing its redundance upon occasion, as she does? As long as he proceeds not to exhaust all, or too much: The loss is easily repaired upon convalescence, and the quantity is more than can be governed by Nature in sickness; 'tis but the observation [Page 133] of a Geometrical proportion in such a Phle­botomist. The same Agent will produce the same effects: if Nature be corrobora­ted, and the vitiated tonus of the concoct­ing and distributing vessels be amended, there is no fear of wanting a new supply proportionate to the exigence of the Pa­tient. The Blood we take away is no other than what would be expended or exhau­sted naturally within a few hours, or dayes, as the Staticks shew: and it must needs be considering the quantity of Chyle which flows into the veins upon eating and drinking.

• 6. If it be true, not only that Nature doth thus expend in transpiration and Ex­crements as well as Nourishment, much of the Blood, and repairs her defests by a new supply (whereby Life is continued, not impaired) so as that the melioration of the following Blood is rather evident in his first years by his growth, Botallus de venae sect. c. 15. vigour, strength and intellectuals: But also that She doth of [Page 134] her self make men and women apt to bleed at some times, Hippocrat. se [...]t. [...]. Aphor. [...]7.20. ages, and seasons (which is known to all) then is not the effusion of this solar liquor so unnatural a thing, nor so homicidial an Act, as 'tis re­presented. 'Twould seem a strange Law that should punish every Boy that breaks the Head or Nose of another as a Bron­chotomist, or Cut-throat.

  If it be true, that Nature doth often­times alleviate even in the beginning, and in the end cure Diseases by spontaneous evacuations of Blood, at the Nose, and Vte­rus, by vomiting and stool, then a Physici­an, whose business it is to imitate Na­ture in her beneficial Operations, is suffi­ciently authorised and impowered to pra­ctise due Phlebotomy, by the best of Presi­dents.

Having premised these Conclusions, which are all ei­ther proved in the foregoing discourse, or evident in themselves to all understanding men: I shall proceed to give an account of the Reasons why Physicians do so frequently and in so many Diseases practise Blood-let­ting; [Page 135] and those deduced from its variety of effects in Humane bodies: For it is not a single Remedy subser­vient unto one Indication, or End, but conducing to many, and therefore made use of upon several occasions to different intentions. Vtile est id remedium ad quamplurima, Valles. Meth. med. l. 4. c. 2. & vix potest in ullo magno morbo non esse aliquid, cujus gratia utile sit.

Before I come to particulars, it is necessary I tell you that in the cure of all diseases Physicians propose unto themselves sundry considerations: they regard the disease, the antecedent causes, and the symptomes which attend or will ensue thereupon either generally, or in such an individual constitution: they employ their cares to prevent some inconveniences, as well as to re­dress others. Some remedies they make use of be­cause they are necessary; of some, because they are be­neficial, yet may the disease ('tis granted) be cured o [...]herwise, in case the Patient have a reluctancy thereto, or for some private reasons the Physicians esteem it fit­ting to alter their course. Upon this account 'tis as­sented unto, that many distempers may be cured with­out Phlebotomy, which yet are ordinarily cured with it, or may be so: And herein the disagreement of Physi­cians, or different procedures are all according to their Art, nor is it denied but that All of them may atchieve their ends by their several Methods. So that it is a gross paralogisme for any one to conclude this or that Physi­cian is mistaken, or takes a wrong course, because ano­ther takes or prescribes a different one. All the Physi­cians in Spain, France and Italy do not bleed with equal profuseness: In Germany and England some do practise more frequent Phlebotomies, than others do: and nei­ther of the parties do erre, in case the other remaining Method be inviolately observed. It is in humane bo­dies as it is in the body Politick, where there is a Me­thod of ruling, though it be carried on by several wayes [Page 136] and means; and whilst each States-man doth prudenti­ally sway the Government, procuring peace and plenty to the subject, his conduct, though it vary from that of his Predecessour, is not to be blamed. It is not to be doubted but that many grievous distempers are cured by Nature, without the use of any remedies at all: Yet will no wise man adventure his life on such incertain­ties: 'tis not to be denied but some are cured with fewer Remedies than others are: But yet 'tis not pru­dence to put Nature upon too great a stress, or to ac­count all means unnecessary which are not absolutely requisite, or without which the effect may (though with more difficulty, and hazard) be brought to pass. It lyeth upon the Physician therefore to pursue all those means which may secure the life of his Patient, to alleviate the disease in its course by preventing all troublesome and mitigating all dangerous symptomes, and to facilitate as well as hasten his recovery. It is not questioned but Patients have been and may be recovered of Feavers with little or no blood-letting; yet when I consider the great hazard they run in that course, the vexatious and perillous symptomes which they languish under longer and with more violence than others, I can­not approve of the practise, nor think the Physician dis­chargeth his duty and a good conscience in so doing: Extrema necessitas in moralibus, ut certumest, vocatur, quando est probabile periculum: and the Patient doth offend against himself, if he refuse to take a befitting course against dangers that probably are impending: and the Physician doth trespass against his neighbour, if he do not propose and practise such a course. Riol [...]nus de circulat [...]ang. c. xx. Antho­pograph. p. 585. ‘I cannot (to use the words of the incomparable Rio­lanus) I cannot without pity to the sick, and some resentment against the Physician, read in Platerus's Ob­servations, how sundry of his Patients were broyled and torrefied with burning Feavers, whom he never let blood. Platerus Ob­servat. l. 2. He doth relate of himself, how he was sick of [Page 137] a most burning Feaver, yet did he never so much as let himself blood therein, albeit that it were requisite in those cases. Such are not obliged to their Doctors, but peculiarly to the Divine Providence for their re­covery.’

It was the mature consideration of that tenderness w ^ch is requisite in Physicians towards their Patients which advanc'd the present course of Physick to its glory above all other Methods: it being endeared to our esteem by all those regards that represent it as prudential. It was not introduced by chance, or the subtlety of some per­sons. but the choice of all, and so established by the Ma­gistracy, that to transgress against the traditions of this Art, was criminal in a Physician, even by our Laws. It may in some cases seem to be troublesome and unplea­sant: yet SAFETY requires it: It may seem te­dious sometimes by multiplication of Medicines; yet Prudence obligeth by all those means to preserve and secure life; and if the omission thereof be cri­minal in a Physician (in case of any sinister accident, why is not the practise laudable? Would Men but seriously consider How much danger they run, and How much more they suffer upon the negligence or indulgence of a Physician, who leaves all to Nature, and adviseth them to wear out a distemper, they would rather hate, than love such a Man; and the apprehension they should have for the unnecessary jeopardy he put them on would extenuate his credit very much: The most rash and brutish counsels may succeed well; but yet the most prudent are to be preferred.

Amonst Physitians (I do not reckon the Helmonti­ans as any) there is no doubt but a Plethorick in­disposition requires Phlebotomy; Nature being sur­charged with blood forceth us thereunto, least some vein should break in the Lungs, or the Patient be strangled with that excess: this is called Plethora quoad vasa: when the vessels are so full of blood, that there [Page 138] is danger of their breaking, or that the blood should stagnate in the Heart, Lungs or Head, there wanting room for its motion: or take some inordinate course, and so strangle the Patient.

There is another redundancy of Blood which is cal­led Plethora quoad vires, or such a plenitude of blood as brings along with it no apparent hazard of breaking the vessels, yet doth it oppress Nature so as thereby to become redundant: It is more than she can bear in the present juncture; 'tis more than she can rule, and it will suddenly fall into an exorbitant motion, to the de­triment of some principal part, in case timely preventi­on be not used. In both these cases (in which the blood is not supposed to be much depraved from its na­tural estate) all do allow of Phlebotomy, and if it be timely put in execution, it may hinder the progress; however it expedites the cure of the disease. In these cases we consider not only the present plenitude, but al­so the future, what may be in a few dayes, to the great exasperation of the disease, and peril of the Patient: For it is possible that in the first beginnings of a disease there may be neither of these plenitudes, but they may ensue a little after: For when the insensible tran­spiration shall have been a while abated (as inquietude, Sanctor. Med. Static. sect. 1. aphor. 41, 49. sect. 4. aphor. 7, 8. pain, and watching will abate it) the Blood degene­rates, and no longer continuing its usual depuration, those excrementitious particles which were lodged in the habit of the body and pores do remix with the san­guine mass, and become like so many fermentative cor­puscles agitating and attenuating the blood, so that whereas before there was no plenitude, now there is: that the excrementitious particles do contract a fer­menting heterogeneous quality different from what they had in the Blood appears hence, that those which sweat much (as the new-comers in the Indies) their sweat is less noysome and bilious by far, than it is in those that sweat more seldome: Thus Soot is a different body [Page 139] from any thing that is burned. Hence it is that those particles being reimbibed into the blood are so offensive to the nervous parts, and introduce a lassitude, as if the body were surcharged with a plenitude. Besides these two cases in which Phlebotomy seems to be directly in­dicated by a Plethora or surcharge of blood: Sanctor. Med. Static. sect [...] 4. aphor. 10, 11. It is pra­ctised in other cases by way of revulsion when the [...]lood and intermixed Humours flow into any determi­nate part, or are fixed there as in Apoplexies, Squinan­cies, and Pleurisies: for as upon dissection it is manifest, that in such diseases there is a greater efflux of Blood than upon other occasions, so it is evident by long ex­perience, that Phlebotomy doth alter its course, and draw back the blood so as that sometimes after that the first blood hath run more pure and defaecated [...] the subsequent hath been purulent, as if the conjunct cause of the Pleu­risie or Squinancy had been evacuated thereby. In re­ference to such fluxes of the blood to determinate parts, we usually consider what in all probability may hap­pen, as well as what is at present urging: and there­fore for prevention thereof we let blood upon great contusions and wounds. It is also practised by way of derivation, when we let blood near to the affected part, thereby to evacuate part of the imparted matter: Thus Van der Heyden did frequently let his Patients blood in the same foot for the Gout: Van der Hey­den Synopsis discurs. disc. 2 de potu fri [...]gida. Thus in a Squi­nancy to open the Iugulars, it is a derivative Phleboto­my. In all these cases all Physicians agree to the re­ceived practise: but in case that the disease be not meerly sanguine, but seem to arise rather from a Cacho­chymy, or redundance of evil humours, than any pleni­tude, or exorbitant motion of the Blood: here many Physicians cry up that Rule: That Plethorick Dis­eases require Phlebotomy, but those that arise from a Cachochymy require expurgation. Here they accumulate a multitude of Arguments; and un­doubtedly, since so great men are of that side, it must [Page 140] needs be that they have cured those diseases without Phle­botomy. But the contrary practise hath so many abet­tors whose credit equalleth or exceeds that of the others; and Experience in a multitude of cases hath shewed the great efficacy of Blood-letting in a Cacho­chymy or meer impurity of the Mass of Blood: and so prodigious is the efficacy thereof in promoting transpi­ration, and opening all the emunctory passages of the body, in preventing of putrefaction, and expediting of the concoction, and in refrigerating the whole habit, that Hippocrates and Galen did resolve it in general, That whensoever any great Disease did seise upon any Person, if he were of Strength and Age to bear it, he ought to be let blood. The Arabians dissented from this practise, but Massarias (after Iac­chinus and the Florentine Academy) did prudently re­vive it, and solidly defend the Ten [...]t: and the happy Cures did so convince the World of the truth of their Assertions, that all Italy in a manner was presently re­duced under them, and France and Spain; so that though they did, and do still in Spain and Italy retain Avicen to be read in their Vniversities as well as Hippo­crates, yet herein they have abandoned the Arabians` and they which do adhear to that old Maxime of pur­ging out the evil humours, when they abound, do also comply with the Hippocratical practise, and by new excuses accommodate it to their principles: So that as to most diseases 'tis agreed (though upon different grounds) what may or must be done. Few now are so timorous in bleeding as heretofore; and where that apprehension is still continued, the Physicians rather comply with the prejudicate conceits of the people, then act out of Reason. He that can doubt the strange effects of bleeding, notwithstanding the concurrent judgment of Physicians, let him either read over Prosper Alpinus concerning the Physick practised in Aegypt a­mongst the Turks (where Phlebotomy is the principal [Page 141] and frequently the sole remedy) or advise with any F [...]rrier, and he will be satisfied that in a Cachochymy nothing is more beneficial, though it be particularly said of Beasts, that the Life or Soul is in their Blood. For my part I am sufficiently convinced of the solidity of their judgment who do much use Phle­botomy, So Blondelus could not with all his Skill cure the Marquess of Caeuvere till he did bleed him) in a chronical ter­rible d [...]sente­ry: which he confesseth, though he writes against Phlebotomy in Epidemical dysenteries. Valles. meth. med. l. 4. c [...]. and I have frequently observed that the best Medicaments have been ineffectual till after Phlebotomy, and then they have operated to the recovery of those Patients who found no benefit by them before: so that to begin the cure of most diseases therewith is the most ready and certain way of curing them: and to make that previous to purging, is the direct course to purge with utility. 'Twas most Oracularly spoke by Vallesius. ‘Facile concesserim venae-sectionem esse optimum omni­um auxiliorum quibus Medici utuntur. Est enim va­lentissimum, & maxime presentaneum, & multiplex. Dico autem multiplex, quia & vacuans, & revellens, & refrigerans, & venas relaxans, & omnem transpiratum augens, quam ob causam (& est a Galeno valde cele­bratum) in nullo magno morbo non est opportunum, si vires ferunt, & puerilis aetas non obstat.’

When I considered the strange efficacy of blood-letting in several diseases, and that the discovery of the Circulation of Blood had rendered most of the Reasons which were formerly used to be more insignificant, or false: I was not a little surprised. I observed that the effects were such as did exactly correspond with their Hypothesis, and that the practise was not faulty or vain, though the principles were: neither ought any man to quarrel with or laugh at such Arguments as ('tis cer­tain) will guide a man rightly to his utmost ends. 'Tis a kind of impertinency that swayes this Age; for 'tis not so much a Physicians business to talk; but to heal. It was most judiciously said long ago, C. Celsus Me­dicin. in pres. ‘Ac nihil istas cogitationes ad Medicinam pertinere, eo quoque sensu­disci, quod, qui diversa de his senserint, ad eundem ta­men [Page 142] sanitatem homines perduxerint.—Itaque inge­nium & facundiam vincere: morbos autem non elo­quentia sed remediis curari. Quae siquis elinguis usu discreta benenorit, hunc aliquanto majorem Medium futurum, quam si sine usu linguam suam excoluerit.’ Neither did Hippocrates place any great value upon Philosophical curiosities, and Natural discourses, but esteemed it very well in Physicians if they could de­monstrate by their success the solidity of their judg­ment, [...]- Hippocrat. de Arte. c. 23. I resolved with my self, that if the Circulation of blood and other modern discoveries taught us but the same pra­ctise we already followed. it was useless; If it contra­dicted it, it must be false: I observed that it was the great work of the wiser Novellists to accommodate the new Theories to an old and true way of practise; and perceiving that the effects of Phlebotomy were such as the Ancients insisted on, I perplexed my self in consi­dering what there might be therein to produce so dif­ferent effects: I abstracted from all common Principles, and called to mind the Opinion of the Methodists, who were a judicious sort of Physicians, and the most prevalent at Rome in Galen's dayes. They held that Diseases did not arise from peccant humours, since many lived, and lived long with Cachochymical bodies: and in diseases if in the beginning a multitude of humours (and such as Physicians ascribe the disease unto) be eva­cuated by vomit, sweat, or stool, yet the distemper con­tinues, and becomes worse and more dangerous by reason of such evacuatians: As little did they regard the first qualities of heat and cold, siccity humidity, concluding them to have no immediate effect in producing diseases, but as they varied the symmetry of all or any parts of the body: the grounds they went upou were such as were de­duced from that Philosophy which makes Rarity and [Page 143] Density the principles of all bodies; and they placed Health in such a conformation of the body, and such a configuration of particles as did best suit with its na­ture: they held that the intertexture of the minute par­ticles of our bodies were such as admitted of an easie al­teration, the fabrick being so exquisitely interwoven, not only in the solid vessels, and parts, but a commensura­tion of prorosities every where, the alteration of which texture of the body into a great laxity, or streightness, and this change of the pores did they make the great causes of all Maladies, and the restoration of them to be the way to sanity, [...]. Cassius in problem .71. and this they called [...] & [...], or the variation of the texture and combination of Corpuscles, in the symmetry whereof they placed Health, and in the asymmetry or improportionate and incongruous state whereof they placed all Sickness. It was their Tenet, that amongst those Remedies which did most alter the tex­ture of the body from streightness to laxiiy, They seldome used purging, imagining it not fit till the body was prepar'd, and hu­mours concocted [...] but they made much use of vo­mits. the most powerful were Phlebotomy, and Purging, and that their principal ef­fects were not meerly to evacuate such or such peccant Humours, but in doing so to create a new Texture and configuration of Corpuscles in the whole Body, and therefore they held them to be Gene­ral Medicaments, and of use in most great diseases, since such distempers were rather occasioned by a streightness than laxity of the pores, and even such as were laxe one way (as Dysenteries and Diarrhaeas) might be accom­panied with a streightn [...]ss in the habit of the body. This Hypothesis (for the furthe [...] explication whereof I remit you unto Prosper [...]lpinus) having been of great renown, and most accommodated to the course of life by which the Romans (and since the Turks and others that follow not our Physick) did preserve their Health, and recover the [...] Mal [...]dies, did merit my re­gards: [Page 144] and I observed the truth of that part of their Opinion, which avows that purging and bleeding have further effects than meerly the evacuation of Blood and other Humours: that they had such an influence upon the whole body as to restore and promote all the na­tural evacuations of the body by its several emunctories and pores; and that Phlebotomy did particularly incline to sweat, promote urine, (and sometimes instantly al­lay its sharpness) and make the body soluble, so that upon Phlebotomy there needs no antecedent Glyster: Nei [...]her is it convenient in a great Cacoch [...] ­my to purge before bleeding; Valles. method. medend. l. 4. c. 2. Gregor. Horstius Instit. Med. disp. 18. Coron. d [...] venae sect. qu. xi. not so much for fear of irritating the Humours, but that the purge operating so as to attenuate and alter the whole mass of blood, and promote se­condarily all natural evacuations; without preceding Phlebotomy it is scarce safe (not secure) to purge, Any man that is conver­sant in Physick knows that such purges as operate on the blood, promote urine, and sweat, and transpiration, even during the working [...] for those very qu [...]lmes the Patient [...] feel are an effect of Di [...]phoresis. Lipothymia juvet: quia sudorem & validam perspirationem [...]a­cit. Sanctor. Med. Stat. sect. 1. Aph. 98. except in bodies the laxi­ty of whose texture is easily restored, or with gentle Medicaments: for the Humours being powerfully wrought upon by the strong purges, and inclined to be expurged by their sev [...]ral emunctories, and those being either defective, or the veins and arteries too full to admit a greater rarefaction in the mass of blood (which is requisite to their separation and transpiration) hereupon there happens a dangerour Orgasmus or turgency of humours in the sick: which Phlebotomy doth prevent. And 'tis I conceive in reference to this alteration of texture that Hippocrates saith, Hippocrat. § 2. aphor. x. [...]. I observed a great congruity betwixt the Static observations and those of the Methodists; and that Sanctorius hath a multitude of Aphorismes which agree with them: Sanctor sect. 1. aphor. 104. Id ibid. sect. 2. aphor. 28. §. 1. aph. 120. viz. That such bodies as transpire well in the hottest weather, they are lighter, and not troubled with any vexatious heat. That nothing pre­vents [Page 145] putrefaction like to a large transpiration, In fine, I did observe that it was the general sense of Physicians, that Phlebotomy did draw the Humours from the Centre to the Circumference, and I had taken notice of it al­wayes in my self; even in the Colick bilious, when I was tired out with pains, vomiting and want of sleep (when I took no Laudanum) and reduced to extream debility and emaciation, I determined in that forlorn case (having used all other means for several weeks) to bleed so long (yet partitely) as that I might be freed from a most troublesome pulsation of the descend­ing Artery, I did herein follow Galen, and those that represent Phlebotomy as a great Ano­dyne: and particu­larly Citesius concerning the Colick in Poictiers. below the reins: I bled eight ounces at first, and found a vextious heat in the whole habit of my bo­dy: I repeated the Phlebotomy in the afternoon, and was very hot all night: thus I continued to bleed twice each day for three dayes, loosing above sixty ounces, and then fell into sweats, was eased totally in my back, and afterwards recovered with a more fa­cile Paresis in my Armes (and no contracture) then that disease commonly terminates in there. These considerations made me think that there was some more important effect in Phlebotomy than the evacua­tion, derivation and revulsion of the Blood and other Humours; and that it must consist in promoting that Statical transpiration: and I conceived that the Blood was in perpetual motion, and though Motion doth hinder Fermentation, yet I had observed that in Pipes at Owburne Abby, where the drink runs from the Brew-house to the Cellar (to be tunned up) the Fer­mentation continues so (especially in the stronger drink) that the Pipes frequently break therewith, as rapid as the motion is: I did not imagine that the na­ture of the Blood was such as to be exalted into one Vniform liquor resembling Wine, (for such a liquor would not be liable to such sudden changes and altera­tions from one extream to another) but that it was a miscellary of heterogeneous liquors in a perpetual dige­stive [Page] fermentation and depuration by halituous parti­cles arising from it (as in more gross by the emuncto­ries) which if the conformation of the pores and pas­sages be such as to give it due vent, all continues well: if they be obstructed or vitiated then several maladies ensue, except timely prevention be used: I conceived that in Phlebotomy as the Blood issueth from the vein, so (as in the pouring out of other liquors) the Air comes in by the orifice, and mingling with the Blood produceth as great, or greater effects than in the Lungs when it mixeth there with the Blood, invigorating it in an unexpressible way, whence we commonly see that the pulse grows stronger and stronger during the bleeding: and upon this account I think it may happen that bleeding with Leeches though equal quantity be taken away, oftentimes does harm, never alleviates so much as Phlebotomy: and such persons as by reason of their tender habit of body cannot bear a violent transpirati­on, swoon not by bleeding in water, (though otherwise they do) by reason that the great effects of the Air upon the Blood are impeded by the ambient water: the like happens in Scarification with Cupping-glasses; and in bleeding with Leeches. I did suppose that often­times in a Plethora quoad vires, transpiration being hin­dered by the change of the texture of the Body, the not-exhaling particles remix with the Blood, and there also happens a subsidence of the vessels, and change of the porosities, so that the Fermentation is is not only clogged with morbose particles of several sorts, but so hindered by the subsidence or compression of the ves­sels and alteration of the pores, Kergerus de [...]erment sect. 1 c. 9. & sect. 2. c 8. Williss. de fer­ment. c. 6 [...] as not to be able to fer­ment (for freedom of room is necessary to Fermenta­tion) nor transpire, nor continue its due course, nor by reason of the charge of porosities confer aliment aright, so that a Plethora ariseth hereupon. But as soon as the vein is breathed, and the Blood (as in your com­mon water-pipes when a Pipe is cut) acquires a more [Page 147] free passage that way, it presently becomes more rapid, and its motion also is accelerated by the fuliginous ex­halations hastening to the vent, together with the na­tural Fermentation resuscitated, and so the whol [...] [...] by a natural coherence and dependance, is not only e [...] ­cuated, but altered in its minute texture, and conforma­tion.

It is most evident that the Blood in the Veins and Arteries is conveyed as it were in conduit-pipes, the Heart being the great Elastic Engine which drives it, being fed by the vena Cava, and disburthening it self by the Aorta: though even the motion of the Heart depend upon a Superiour influence by its Nerves, which wherein it consists and how derived from the Brain and Soul, is a thing to us incomprehensible. I do suppose that the Circulation is continued and carried on prin­cipally by Anastomoses betwixt the Capillary veins and Arteries, many whereof having been discovered by Spigelius, Veslingius and others, the rest may well be sup­posed: and perhaps in the coats of the Veins and Ar­ [...]eries there may be a certain texture requisite whereby the transpiration is managed in order to the safe con­tinuance of the digestive fermentation in the Blood, This is agree­able to the Hypothesis of the Metho­dists, and the nutrition of the body. The impulse of the Heart, together with the pulsation, is sufficient to con­vey the blood to the lesser capillary Arteries, and there though the pulse be lost (which yet a little inflamma­tion in the extremities of the body will make sensi­ble, and in some Ladies, as also in Children, the least pre­ternatural heat) yet it is impelled by the subsequent blood still into the veins, and having acquired by the common miscele in the Heart and the digestive fer­mentation (which naturally ariseth in such heteroge­nious liquors) an inclination to expand it self, the com­pression in the Capillary vessels adds to its celerity of motion when the larger veins give liberty for it: the Aiery corpuscles of several kinds (which are easie to [Page 148] be discovered upon burning) by their expansion, and contraction adding much thereunto: Thus in Water-engines the narrowness of the Pipes do add to the im­petus with which the Water issues forth: And I do conceive (by the Phaenomena which daily appears in practise) that the Animal heat in the Blood actuating that heterogeneous miscele, and according to the diver­sity of its parts producing therein (with the help of its fermentation) a rarefaction of what is aiery, and, according to the room there is, a liberty or inclination to expand and evaporate themselves, this is the princi­pal cause of the continuance of the motion of the blood in the veins, and of its saliency upon Phl [...]botomy. Thus upon Scari [...]ication there is no salience or spurting out of the blood, there being no room for such an expansion, or for the Aiery halituous parts (in which there is as great a difference as in those exhaling from the terra­queous Globe) to rush forward out of the continued Arteries and together with themselves to protrude the blood: Upon this account the Methodists and old Physicians (as also the Aegyptians) where the tender bodies and constitutions of Children and Women or Men admit not of, or requireth that great relaxation of the pores and texture of the body, which a more robust and firm habit (wherein as the natural resi­stance in health is greater, so the recess from it in a bad estate is much greater) would be cured by, they use these Scarifications, and prefer them (most judi­ciously) to Phlebotomy.

This constitution of the Body doth evince the great utility of Phlebotomy, and best (as I suppose) expli­cates the effects thereof which we daily experiment. From hence not only is manifest how the Body is eva­cuated in a Plethora, but in case of Revulsion, and Derivation. It is manifest in Aqueducts and Siphons, that the liquors (though much differing in nature from the Blood, nor so inclined to evaporate) does [Page 149] accelerate their motion, and issue out so rapidly upon an incision or fracture in one of the Pipes, that a lesser in such a case will deplete the greater, notwithstanding its free passage in its own entire Canale. Thus the most learned and considerate Physician, Sir George Ent, having observed first thus much. Apolog. pro circul. sangu. sect. 23. p 62. ‘Videmus aquam per si­phones delatam, si vel minima rimula hiscat, foras cum impetu prorumpere.’ And, ‘Sanguis per aortam in­gressus, fluit porro quocunque permittitur, Id. ibid. p. 107 [...] 108. peraeque sursum ac deorsum, quia motus continuus est: quemad­modum in canalibus aquam deferentibus contingit, in quibus, quocunque feruntur, aqua continuo pergit move­ri. Quare nugantur strenue, qui protrusionem hujus­modinon nisi in recta linea, fieri posse arbitrantur.’ After this He explains the doctrine of Revulsion in this manner. Id. ibid. p. 179, 180. ‘Quae postea de revulsionibus dicuntur, nullum nobis facessunt negotium. Tantundem enim sanguinis a pedibus ascendit per venas, quantum ad eos­dam delabitur per Arterias. Facto itaque vulnere in pectore, aut capite, revulsio instituitur (si modo tam longinqua instituenda sit) in crure. Quia sanguis alias quoquoversum ruens, facto nunc in pede egressu, copiosius per descendentem ramum, procul a vulnere, de­labitur. Non enim arbitramur, sanguinem aeque cele­riter sua sponte per arteriam aut venam fluere, atque is secta earum aliquo effluit. Nec sanguis ad laesum pe­ctus aut caput, per venam cavam impetu affluit, quia fluxus ille aperta inferius vena intercipitur.’ I do ac­knowledge that the reading of these passages did first create in me the thoughts I now impart unto you: And hereby it is evident how the Ancients (with their large Phlebotomies) might derive even the morbi [...]ick matter, or revell it, though impacted. Our minute Phle­botomies do seldom produce such an effect; for since it is not otherwise done, but by a successive depletion out of the Arteries, it would seem necessary to extract three or four pounds of Blood to effect such a matter: [Page 150] Neither indeed is it necessary: albeit that I believe the most speedy cures (but great judgment is requisite in such operations) were atchieved thereby: for though we do not retract the Humour, or Blood unto the place where we Phl [...]botomise, we do revell it from the place whither it was flowing: and the course of the Blood and Humours being diverted, the Arteries leading to the part affected or depleted, and the Flux of Hu­mors (which was by them) is abated, their tenseness there (which appears by their puls [...]tion there where they did not beat before) is relaxed, and so becomes less opportune to extravasate either the Blood or other Humours: whereupon Nature it self alone, or with a little help of the Physician, doth digest and dissipate the impacted matter. Whereupon if we add the mo­tion of restitution in the parts affected, which is hereby facilitated, the great change in the digestive fermenta­tion of the Blood (which is manifest by the melioration of the Blood which is seen in repeated Phlebotomies) and the relaxation of the whole body in order to the transpiration and other depuration of the Blood by its several Glandules, the Kidneys, Liver, Guts, the reason of those prodigious benefits which Patients have had of old, and now under our practise, is manifest; nor do we want a justification for reiterating Phlebotomy, or exercising it in different veins, and divers man­ners.

I designed long ago to set aside some spare hours to a further study of this Hypoth [...]sis, and in order thereunto to acquaint my self with the Hydraulic Arts; The alteration of the te [...] ­ture of the body is no less evident, out of Dietetical observations: of which I have made many, and did intend once to prosecute far these inquiries; as also the discovery thereof in dead bodies. as also to examine the truth and solidity of the Static Experi­ments: (out of which this texture of the Body, the digestive motion of the Blood, its change, and restitution, is demonstrable) and to enlarge my prospect by a comparison of the several Methods and Medicaments [Page 151] used by sundry Physicians (both Methodists and others) in order to the cure of diseases, and preserva­tion of health: But I must tell you that the malice of my enemies renders my LIFE and Condition so ill-assured; And the apprehensions I have least the Pro­jects of Campanella are powerfully and subtly dri­ven on in this Age (I am the more confirm'd in my suspicions; in that my Adversaries are most intent to ruine me, but not to remove those Vmbrages) together with the imminent subversion of the Faculty of Phy­sick by the toleration of Divines to practise (which is contrary to the Ecclesiastical Canons, I intend some time this Summer to write a di­scourse con­cerning the Vnlawfulness of Divines to pr [...]ctise Phy­sick. and makes them irregular) the great incouragement of Quack-salvers, and Baconical Physicians: These reflexi­ons have so discouraged me, that I have no mind to pur­sue those studies, or to be much concerned for the pre­sent on succeeding generation: But could I see Physick regain its lustre, the Faculty encouraged by such Acts of Parliament, as our Predecessors, and Forreign Potentates have made, and your Colledge advanced as the Pro­per and Supreme judicature in reference to Medi­cine, I would willingly imploy all my leiseure in the im­proving of the present state of Medicine, without sub­verting Learning, or disparaging the Ancients, without the knowledge of whose writings 'tis impossible for any man to be excellent in Physick. Vide Meibo­mium in sur. Hippocrat. c. 5. Io: Laurent. dissert. de Aesculapio [...] Poets and Comical Wits owe more to their Birth, and need less of in­dustry, study and judgment, than Physicians: The knotty Staffe, the Serpent, the Pine-apple, the Dog, [...]. Hippocr. lege. c. 2. the Dragon, the Cock, with which the pourtraicture of Aesculapius was beau­tified, were not Symbols and Hieroglyphi [...]s of a facile study: The first Principle that we are taught is, [...]. But now the reading of two or three Books, a Comical Wit, a Bacon-face, a con­tempt [Page 152] of Antiquity, and a pretence to novel Experiments (which are meer excuses for Ignorance, and Indiscreti­on) are sufficient Qualifications,

Notwithstanding the Melancholy and pensiveness into which the present posture of Learning here in England alwayes puts me into, when I reflect thereon: I will constrain my self to proceed further, and examine the cases of Phlebotomy in a Pleurisie, the Small-pox, and Scurvey: concerning all which diseases as I shall debate what an Intelligent Practitioner may do, nay is oftentimes obliged to do in conscience, and out of discharge of duty to his Patient, so I will not ju­stifie any Action of those persons who understand no­thing, nor can distinguish circumstances in particular cases: A thousand things are to be considered by him that would practise Physick exactly, the present disease, the past condition of the Patient in reference to him­self, his paren [...]s, his dyet, preceding distempers, the latter, the more remote, the conjunct causes; what hinders, what promotes, what effects the cure: What will, what may happen in the disease, what will or may ensue upon recovery: In all these cases, since he hath not a sensi­ble and easie knowledge thereof, but must proceed upon Conjecture, you understand well How great a compre­hension of affairs, and how much in each case, he must in­quire into, who will discharge well the duty of a Physi­cian. It was prudently said of the incomparable Ari­stotle (the meanest of whose Works deserves to be read above all that the Novel Experimentators have published; if it were but for the wise Apothegmes therein: for Civil Society is the grand work of this Life; and that is more useful, which qualifieth us thereunto, then what makes us admirable Mouse-trap-makers!) ‘ Physicians, saith he, do not cure man in general, Aristot. Metap, lib. 1. c. 1. except it be by accident, but Cullias, or Socrates, or some other individual person. Hence even [Page 153] a man that is a speculative Artist (how much more those that are neither speculative, nor Empiri [...]s?) may be deceived in the application of general rules to singular cases, and so may mistake: He tells us that it is not for the most dexterous railers, Ethicor. l. x. c. 9. or witty Sophi­sters, to judge of State matters, nor yet for any man to direct therein, who hath not served an Apprentice­ship in the Ministry of State: for neither in Phy­sick, doth the knowledge of a common Praxis accom­plish a man thereunto: [...]. [...].’ What is it to the purpose, if they learn a multitude of Knick-knacks, and have an infinite of Conundrums in their Heads, if they know not what appertains to Practise? These narrow-sighted Verulamians may recommend them­selves by success in a few; the Grave may conceal, or a strong Nature amend their defaults; but they are nevertheless ignorant. In a calm many can steer a Ship, whose imbecillity of judgment sinks it in a storm. [...]. Hipp [...]cr. de veter medi­cin. c. 17.

I have already spoken concerning Phlebotomy in the Plague: In a Pleurisie 'tis no less evident that Phy­sicians are divided in their judgments. To begin [Page 154] with the true state of the Question: This is more than this Baconical Philosopher did ever think upon; for he without any distinction derives the usefulness of Phlebotomy in a Pleurisie. ‘ If thou beest unsa­tisfied whether opening a vein as it is indicated from Evacuation, or Revulsion, be a competent sufficient Remedy for the cure of a Pleurisie, or any high Feaver; thou shalt find in this short Tract a Resolution in a Ne­gative sense, grounded on Reason, Authority, but espe­cially that which is the sum of all, Matter of Fact de­livered according to what Experiments are past, offered to be made good for the future.’ —Thus he bespeaks his Reader in the Preface: and a little after he assures him, that ‘ He is able to resolve any one that is capa­ble, that the most Plethorick body taken with a Feaver, or any one Cachochymic afflicted with a Pleurisie may be cured without the Lancet more speedily and safely than by using the same.’ —Though I cannot ima­gine— G. T. to be good at resolving Controver­sies in Physick, yet such is his impudence, that I will not refuse him the Title of Doctor Resolutus: I have read over his Book with some attention, but I could not find any Pretensions in it to Authority, nor any Experimental Histories related: All amounts to this— G. Thomson saith, ‘ It is not good to bleed in a Pleurisie. p. 126. And— G. Thomson avows that 'Tis verified by observation, they who recover by this Apospastick means do for the most part find a great debility succeeding, are incident to Empyemas, Con­sumptions, and prove to relapse into the like condition again. On the other side, those who rise from their sick Beds, restored by vertue of adaequate Remedies, are secured from the forementioned discommodities. Assuredly of all those Pleuriticks, I have handled above these half-score years, I have not known one after their evasion procured by a legitimate form of Physick, ei­ther live crasie, fall into secondary calamities, or reci­divate [Page 155] into a Languour of the like Idaea.’ —This is that irrefragable Argument drawn from past Experi­ments, which is the Sum of all Proofs, and must satisfie all that are capable: which it is possible it may do, if there be persons in the World that are capa­ble of being resolved hereby: But impossible Suppositions are equipollent to Negations: Assuredly either this Age affords no such Men, or they are a Company of Fools: Who else will give credit to the bare assertions of— G. T? He should have done like his Brother Odowde, printed an account of Cures, though they had been all false and fictitious: but as the case is, he neither cites so much as Van Hel­mont, and the Peasant that cured Pleurisies with stoned-horse-dung; but is himself Author and Witness: Thus he bristles most Porcupine like.

This is all I reply to his Authority, and Experi­ments: His pretences to Reason are no less gain. He sayes, p. 126. That when we bleed any Pleuritick, there is no streight immediate Revulsion intended from the part affected to the orifice —which is a most TRUE, and Bacon-like Aphorisme! for we never thought that the Revulsion could be streight, whereas the line in which 'tis made is crooked. If we Phlebo­tomise in the Arm, (whether it be on the same side, or on the contrary) or in the foot, none was ever so besotted as to avow the Revulsion to be streight, though he held not the Circulation of the Blood: But such as hold that the Revulsion is made thus, in that the Veins draw from the Arteries, and so as in Siphons, divert the stream, they cannot hold any thing like it: nor that the Blood impacted or flowing was immedi­ately revelled, and drawn back: But I am apt [...]o think that some upon large and repeated Phlebotomies may [Page 156] have drawn some of the purulent and degenerate blood out of the veins of the Arm; in which there is no more of impossibility, than that it should be carried by the emulgent Arteries into the Kidneys, and discharged by urine: which last is avowed to have been done. I do not know that such large Phlebotomies in a Pleurisie are practised by the English Physicians; See Schencki­us obs. l. 2. de pleurit. Prosper Alpin. Medic. meth. l. 7. c. xi. though I think there is not so much of Reason, as vulgar preju­dice to oppose the thing, when the Doctor is an under­standing Man. For why may not we in England bear that which they do in Holland? I. Heurnius apud Schenc­kius lib. 2. de pleurit. there Heurnius took away above four pounds of blood from one Plethorical Pleuritic at one time, in a dangerous Pleurisie, and reco­vered him when all others gave him up for dead. I believe there may be some amongst us that repeat Phlebotomy too often; but I am confident the genera­lity erre in taking away too little at one time, in the be­ginning of Pleurisies and Feavers.

His next Argument is, that the Cure by Phlebotomy is accidental only and uncer­tain: p. 126. I would willingly know of this Holmontion, whether it be a Rhizotomous cure, when Nature doth put a period to a disease, by an eruption of blood at the nose? Here is no dulcification of the acid Latex; no rectifi­cation of the stomach; and no other mortification of the malignity. sometimes in the beginning they do thereby suppress the disease, and as it were crush it, but it is a contingent, not at all Rhi­zotomous Cure, which ought to be performed by those things which are [...], dulcifying the acid Latex, carrying it off through all its emunctories, rectifying the stomach, and mor­tifying the malignity.—That all Pleuri­ties shall be cured by Phlebotomy, is a thing no wise man will undertake for: As little will any man promise to cure a Pleurisie by sole Phlebotomy, without giving the Patient any Expectorating, or Sudo­rifick Medicaments, or other Potions; besides the Powders of Pikes-jaws, Boares-teeth, Crabs-eyes, &c. which correct the acidity of the Latex; if there be any such thing.

[Page 157]But to shew the folly and impertinence of this— G. T. There are several sorts of Pleurisies, in many whereof no Galenical Practitioner is obliged to Phlebo­tomy at all; though in some such cases it be left to their discretion either to use it, or omit it; as in Bastard Pleurisies. Of those which have the Character of true Pleurisies, Quercetan. Redivivus t 3. p 102. Baptist. Co [...]dronch. de morb. vulga [...] c. xii. and Bartoletus de diffic. respir. l. 5. c. 4. Bartoletus de difficil. respir. l. 5. c. 4. Wierus obser. l. 1. de Epid. pleuritide. some are occasioned by the Wormes: in which— G. T. cannot imagine that any man would rely on Phlebotomy. There are also Pestilential Pleurisies, wherein the effects of Phlebotomy are as un­certain as in the Pest it self: Gesner (in his Epistles somewhere) speaks of such a one, in which all died that were blooded: So doth Bartoletus, and Wierus. There was also an Epidemical Disease in Friuli, which Vincentius Baronius first named a Pleuripneumony, in which the Pleura and Lungs were both affected (where the seat of a Pleurisie is, is doubtful amongst Physici­ans) but yet so, that though they had all the signs of a common Pleurisie at the beginning, Vincent. Baro­nius de pleu­ripneumon. l. 1. c. 1. yet did they ne­ver come to suppuration, but were cured by Phleboto­my, immediately upon the administration whereof they were relieved, and with the help of accessional Medi­caments expectorated bilious and pituitous spittle, and so recovered. As to those which are confessed to be Pleurisies, Cost [...]llus de abusa Phle­botom. p. 87. it is to be observed, that neither can all persons, nor all places bear Phlebotomy therein, and in such cases no wise Physician will administer it: the qualities of the Climate, and individual constitutions or debilities, are circumstances he will alwayes regard. It is granted that some Pleurisies are so mild, Gabelchoveru [...] centur. 2. cur 92 in Scholio Hollerius apud la [...]o [...]ium in Coac. l. 7. sect. 2. sect. 18. vide etiam I [...]ot. in Coac. l. 5. sect. 2. §. 26. and at­tended with such favourable symptomes, of so good a prognostick, that they do not need Phlebotomy: ‘In moderata pleuritide, in qua videlicet parum urgent re­spiratio, tussis, dolor, febris, Phlebotomia inu [...]ilis est, aut certe non necessaria. Aliis enim levioribus auxi­liis curari potest, quomodo is a Galeno p [...]rcuratus, qui [Page 158] in levi pleuritide sanguinem expuebat; Galenus com­ment. 3 in l. 6. Epidem. But Riolanus doth blame Galen as vio­lating his own Rules hereby, De circulat. sang. c. xx. & plurimi visi sunt a nobis & aliis medicis citra ejusmodi auxilium convaluisse.’ But although I am ready to grant that in such cases Phlebotomy may be omitted, and yet the Patient escape: yet I can hardly commend the prudence of such Physicians as do omit it: For, since a Pleurisie is alwayes an acute Disease, (in such our Prognosticks are not certain) and the parts affect­ed such as are of greatest importance, Hippocrat. l. 2. Aphor. 19. and equal tender­ness; since the disease is frequently so fallacious, that amidst the most hopeful signes, and when we may justly expect its happy termination, even then most direful symptomes break out, and render the case de­plorable. [ Nam aliquando ubi antea signa omnia sa­lutem praenuntiaverint, Holler. de morb. intern. l. 1. c. 26. De pleuritide. crisis tempore, quae fere fit ad septimum, aut alium diem criticum, vehementer Pleuritis exacerbatur, symptomata omnia increscunt, tum nihil movendum est: sed omnia naturae committenda sunt.] Since the Patients condition is such, I do not see how any Physician can answer it well to his Conscience, or the Rules of Art (I am sure 'tis criminal in Italy) if he forbear to take some Blood (albeit not so much as otherwise he would) away from him: Zacchias Qu. Medico-legal. l. 9. consil. 40. sect. 4. the damage is inconsiderable, but the hazard otherwise so great, that no prudence can well contemn it.

I do further confess that many have been recovered out of very dangerous Pleurisies without Phlebotomy: as he in Alexius Pedemontius with the pectoral drink, Alexius Pede­mont. de secr. l. 1. p. 51, 49. River. cent. 4. obs. 88. Quercetan. Redivivus l. 3. p. 103. and perhaps that other by the eating of an Apple roast­ed with Olibanum in it: whereof Quercetan makes mention; who also speaks of another Powder given in the water of Corn-poppies, with which he cured many Pleuritics, administring nothing else inwardly, or out­wardly. There is a Case in Valleriola (which yet he rather accounts miraculous, than to be presumed upon again) of a young Woman eight months gone with [Page 159] child, that fell into a Pleurisie on the left side, with a violent Feaver, a troublesome Cough, and difficulty of breathing. ‘Vno die miraculo curata, non misso san­guine, Fr. Valleriol [...] obs. Medic. l. 4. obs. 1. non cucurbitulis adhibitis, ullave purgatione, duo­bus tantum illi praescriptis Clysteribus emollientibus, sputo eodem dio cruento plurimo & cum facilitate ema­nante: sudore interim copioso sub noctem secuto, po­stride sana evasit, absque dolore, absque febre (quae tamen vehementissima in ea erat) & absque ullis symptomatis relictis, a morbo integre curata reman­sit.’

Neither will I deny that grievous Pleurisies have been cured by Sudorifics: this Method was practised by Lazarus Meyssonnierius, and that for this reason: He sayes the common People about Lyons in France call a Pleurisie Lou-san-prei, Lazarus Mes­sonnierius doctr. nov. febr. Exerc. 3. p. 41, 42. [...]. Hippocrot. de victu in acut. l. 1. sect. 8. or congealed Blood: and that Platerus (and others) upon dissection have found no other default in the Pleura, than that there hath been a livid spot thereon, which he looks upon as a concretion of salino-serous Blood; considering this, and that the Critical termination of Pleurisies is by Sweat, he per­fected his Cures by discussing the coagulated blood by Sweat, and that sometimes so as not to use the other subsidiary Remedies of Phlebotomy, or Lenitives.

‘ Imo non adhibitis Medicorum ignorantia, vel adstan­tium negligentia convenientibus remediis aliis, in vera Pleuritide sudorem excitavimus diebus decretoriis 7. & 14. quod nobis feliciter cessit, praesertim in adole­scento praedivite, qui tempesti [...]a phlebotomia omissa ad mortem properabat, ille siquidem septima morbi propi­nato a nobis vocatis potu hedrotico intra biduum sa­nus in publicum prodiit: vocatur ille Serre, & Bur­gundii apud Delphinates taurice vivit-’ I must take notice here that our Author dislikes not, but complains of the omission of mature Phlebotomy; notwithstanding that he compleated his Cures by sweating: Neither is [Page 160] this way of his condemned by Vallesius, whose words are these. Valles. in Hip­pocrat. de vi­ct [...] in morb. acut. l. 4. p. 197 ‘ Haec [apud Hippocratem ibi] ratio curandi pl [...]uriticos, potionibus vehementer discutienti­bus, non admodum in usu est nostris Medicis, quippe qui post missionem sanguinis, & inunctiones & moventia sputa, & quae ad has intentiones pertinent, nisi excreent aegroti, d [...]sperant servari posse, ad nullam aliam transe­untes curationem. Scio tamen quendam, cui homo qui­dam vulgaris nescio quid hujusmodi in potu dedit, co­piosissimo sudore excitato, servatum esse brevi, & tho­racem laxatum, & sputum redditum facile, cum septi­ma jam dies esset, & nihil caepisset excreare, & pene jam strangulari prae respirandi difficultate periclitare­tur. Idiotae etiam qui Emperice curationem quorun­dam aggrediuntur, exudatoriis curant pleuritides, saepe cum optimo successu: atqui profecto ratione hoc non caret.’ Of the like Cures, without Phlebotomy, or other Medicaments besides what expectonate, (and perhaps a pectoral liniment, or fomentation) you may see in the excellent Rulandus cent. 1. cur. 59, 75. cent. 6. cur. 76. And Gabelchoverus cent. 3. cur. 49.

Neither is it to be denied, but that Rulandus fre­quently cured Pleurisies (even the most desperate) by vomits of Aqua Benedicta, or the Emetic infusion, and pectoral drinks, without ever proceeding to Pectoral liniments, or Phlebotomy, except there did appear fur­ther occasion thereof after the vomit. So Cent. 1. cur. 41, 81. Cent. 4. cur. 26. Cent. 6. cur. 13. Cent. 7. cur. 42. But when there seemed occasion for Phlebotomy, after the aforesaid vomit, then he useth it. Cent. 1. cur. 35, 36, 57, 62, 65, 68. Hartman. praxis chym. de pleurit. p [...] 1 33. edit. Genevens. Cent. 4. cur. 16. Cent-5. cur. 53, 56, 57. The like course was practised by Hartman, who begins with the same vomit; and if occasion require de­scends to Phlebotomy, and Diaphoretics, Liniments, and expectorating Medicaments. In Plethorick bodies, [Page 161] doth Hartman bleed before he vomit his Patients. Sometimes Rulandas doth vomit them with his Aqua benedicta, bleed, and sweat them for several dayes till they be well; using other pectoral Medicaments: as Cent. 6. cur. 18. Sometimes he sweats and vomits them at once with the powder of Asarabacca-roots, and a Decoction or Water of Carduus benedictus, and doth not Phlebotomise: as Cent. 5. cur. 6. Concerning the use of his Aqua benedicta, or the Emetick infusion in Pleurisies he avows it to be Experimentum opti­mum contra hunc morbum, et omnium alio­rum Medicamentorum certissimum. Cent. 1. cur, 66. I must profess I have generally guided my pra­ctise in the Countrey by the Presidents of Rulandus, proceeding to Phlebotomy after vomiting, if the pain were not mitigated and expectoration facile; but if it were, I acquiesced in topicks, and expectoration, and sweating. Where the Patient could, or would not vo­mit [...] I followed the Presidents of the said Rulandus, for to purge with the decoction of Senna, Agaric and some pectoral additions; and then to expectorate, and sweat the sick, not bleeding except occasion required it, and then I either premised, or used it subsequently, as I saw cause: thus Rulandus Cent. 5. cur. 36, 64. for which procedure you may see his Reasons added Cent. 7. cur. 20. And the practise of Gabelchoverus Cent. 1. cur. 11 Cent. 2. cur. 23. But Gabelchoverus in his Scholium here doth not allow of so strong purges as Rulandus sometimes makes use of, and defends by the Authority of Hippocrates, who did use Peplium and Hellebore in such Pleurisies, as the pain descended to the Hypochon­dria, and did not ascend to the Omoplate: But Rulandus doth not regard that distinction, nor Gabelchover, nor many others. The case of the Wife of Ludovicus Pa­niza doth deserve to be set down here.

It is further to be taken notice of, that sometimes Pleurisies have been cured without Phlebotomy, purging, or vomiting, or bleeding; by Liniments and expectora­ting Medicoments: as in Gabelchoverus Cent. 1. cur. 3. Cent. 2. cur. 93, 98, 99.

But to oppose— G. T. directly: sometimes Pleu­risies have been cured by Phlebotomy alone and pecto­ral Medicaments: as in Rulandus Cent. 7. cur. 13, 14. Cent. 10. cur. 49. Gabelchoverus Cent. 3. cur. 7. Sometimes by Phlebotomy, and sweating: as in Ru­landus Cent. 6. cur. 60.

[Page 163]I have hitherto made use of these Authors, because they were most eminent Practitioners, and particularly famed for their Cures in that disease: and it is manifest hereby, that Physicians are not bound up to one method therein. Neither indeed can they be in any disease: for in some years, and in some ages, and persons, and in some circumstances, they are forced to recede from their usual courses; and sometimes the mildness of a distemper is such, that it requires not all their address, those Methods which are set down in our praxes.

I now come to give an account of the most common and received Method of curing Pleurisies amongst Phy­sicians; and to shew with how much reason they pra­ctise Phlebotomy therein. There is not any disease whereof Hippocrates did take so particular care in re­lating its Diagnostics, Prognostics, and Cure, as a Pleu­risie, as is evident by what he hath written in his Books De victu in morbis acutis; Hippocrat. aphor. 8. § 4. cum notis Vollesii. and De morbis, besides what he hath set down occasionally in his other Works: It is an Acute Feaver, finishing its course in seven, Hippocrat. Epidem. § 3 [...] l. 3. p. 309, 310, 311, 312 [...] cum notis Vollesii. nine, eleven, or fourteen dayes; though it hath happened (as in the case of Anaxion) that it extends its period to thirty four dayes. It is attended alwayes with troublesome, oftentimes with dangerous symp­tomes. A violent Cough, difficulty of breath­ing, pricking pains and Stitches in the sides: these are the Pathognomonical signs of this Feaver. Though the part affected seem principally to be the Pleura or costall membrane, yet are the Lungs attacqued by this disease (and frequently it hath been found that the seat of the Pleurisie is rather in them than in the Pleura; as the followers of Petronius do demonstrate) and their fabrick is so tender, that it is in great danger to be putrified or corroded in this distemper, by the sharpness or other evil qualities of the sputaminous [Page 164] matter. Hippocr. Coac. praenot. l. 5. sect. 2. sect. 27. cum notis Iacotii. B [...]llonius Epidem. l. 1. p. 20. Besides, it is a very fallacious disease, and frequently after hopes of a recovery by a benign Ana­catharsis, after that the stitches have abated, often­times the disease becomes crude and exasperated again, to the detriment or death of the Patient: as appears by the case of Anaxion in Hippocrates, and that other re­lated by Franciscus Rubeus: Franc. Rubeus nocturn. ex­ercitat. xii. Lud. Mercatus consult. xi. Hippocr. Coat. Praenot. lib. 5. sect. 2. sect. 72 cum notis Iacotii. as also by Mercatus. If it be not happily cured, the danger is no less than that it should change into a Phrenitis, or Peripneumony, or terminate in an Apostemation of the Lungs, or an Empye­ma in the Thorax. Where the disease is so full of dan­gerous as well as vexatious symptomes, it is not to be wondered that Physicians have diligently looked into the disease, and recommended unto our practise a great many things, which they who either perfunctorily look upon matters, or superciliously despise dangers, or out of ignorance cannot apprehend them, may contemn. That the Blood in that disease should acquire a congeal­ing or coagulating quality seems unimaginable: both because that oftentimes the procatarctic cause is sudden in its operation: [...]. Hippocr. de victu acut. l. 1. sect. 35. Isbrand. a Die­merbrook de pest. c. 14. sect. 7. as when a plethoric person any way doth over-heat himself, or drink cold drink, &c. and also that the congelation in the Pleura (when it is there) is no other than what is seen in the spots of the spotted Feaver, or Plague; which seem not to be congelations of the Blood: Besides, How comes it to pass that this aptitude to congeal, if it be in the whole mass of blood, doth not discover it self any where else but in the Pleura? And if such a Diathesis ad acescendum in the blood produce a Pleurisie, How is it true that Hip­pocrates saith, Hippoc. aphor. 33. sect. 6. Acidum qui eructant, non sunt pleuritidi obnoxii? Why also are splenetic persons (in whom we may best suppose such a Diathesis) not inclined to Pleurisies; except the spurious and statulent ones? Is it not moreover known, that Vinegar dissolves con­gealed Blood, and is therefore given in bruises: As al­so [Page 165] Oxymel and syrup of Vinegar in Pleurisies? But 'tis evident that it is a Feaver accompanied with a Catarrh upon the Thorax and Lungs; and that it admits of a great diversification according as the Galenical hu­mours do operate in it; and in the Cure a different re­gard is to be had to a bilious or pituitous Pleurisie, from what there is in one that is sanguine: as any man knows that understands Physick, or hath so much as read Salius Diversus upon Hippocrates de Morbis lib. 2. Or Forrestus's Observations, lib. 16. It was the advice of Hippocrates at first to try to discuss it by fomentati­ons: if they succeeded not, then in case the stitches seemed to diffuse themselves upwards towards the shoulders, to phlebotomise the Patient, and let him to bleed largely until the colour changed, Hippocrat. de victu in morb. alcuct. l. 2. cum notis Vallesu. p. 42. from corrupt to red, or from pure and red to blackish: But in case the pains descended below the Diaphragme, then to purge with black Hellebore, or Peplium. The reason upon which he seemed principally to go was, that a Physician was to imitate the progress of Nature, and to carry off the peccant humours by such wayes as he inclined them to go: which in one case appeared to have a tendency to the Arm, [...]. Hippoc. aphor. 16. l. 6. in the other to the Bowels. But Galen considering the uncertainty that is in the opera­tion of purging Medicaments; as also the hazard of irritating inflammations thereby, and the diverting that sputation which is so requisite in that disease: and that since a Looseness was perillous therein, purging could not be safe: and I suppose that the sad case of Scomphus may have discouraged him from it: who be­ing purged in a Pleurisie, became frantick, and died on the seventh day: Valles. in Hip­pocrat. Epid. l. 6. p. 456. & Van der Linden select. Medic. c.xii. the discourses upon which lamenta­ble History, in Vallesius and Van der Linden do deserve to be pondered: The purge did not work much, yet kil­led him. Some other cases as sad as this are record­ed: upon the account whereof the generality of Phy­sicians have prudently been swayed from purging in [Page 166] a Pleurisie until the latter end: Hippocr. Coac. praenot. l. 5. sect. 2. sect 25. Because it is very con­venient in a Pleurisie that the body be moderately solu­ble: they do give their Patients Glysters: and because the disease is a Catarrh accompanied with a Feaver, they conceive their main work to be this, to prevent the increase of the fluxion, by diverting the course of the Blood another way: and to evacuate by a concoction and expectoration the matter inflamed and impacted. To do this, they place the beginning and foundation of the Cure in Phlebotomy; yet do not we now insist up­on their bleeding to a Lipothymy, or till the colour of the blood change, but rather chuse to proportion our Phlebotomies by other considerations; especially since it is visible in the case of great fluxes of Blood, that re­vulsion is best performed by par [...]ite, and, after some inter­mission, repeated phlebotomies: and in order to the Anacatharsis or expurgation by spittle, we do give them all besitting means to expectorate concocted mat­ter: and use anodyne unguents and fomentations in or­der thereunto. There was heretofore a great quarrel about bleeding in a Pleurisie, which arm it should be administred in, and in what vein: But those are not the contests of this Age, Vesalius saith, that all the quarrels about the different Phlebotomies in a Pleurisie, w [...]re Rixa de lana caprina. Vesal. exam. obs. Fallopii. p. 129. yet this is evident, that Nature delights to eva­cu [...]t [...] diseases of the liver by an Haemorragy of the right nostril; of the spleen, by the right. And that there is as it were a seam in the body, is apparent in the Palsie. So that 'tis wisdome for us to imagine, that 'tis not indif­ferent what side w [...] bleed [...]n. wherein it is agreed to bleed on the same side that is affected, and to repeat the phlebotomy on the contrary foot or arm. Neither ought there to be any dispute about repeating phlebo­tomy, since the first occasion thereof conti­nuing, or upon a recrudescence urging us again thereunto, if the Patients strength can bear it, we ought to repeat it. In this case the Methodists and Galen are reconci­led; and I suppose it most evident upon those Principles I have laid down. For if the Habit of the Body in a Pleurisie be become too adstrict, then is it necessary to relax it and if the disease be great, by as great remedies; now [Page 167] their grand relaxatory is Phlebotomy: and after a vomit, Valles Meth. med. l. 4. c. 2. Riolanus de circular. sangu. c.xx. Forrest: Obs. l.xvi. Obs. [...]3. in Scholio. they used it: yet had they this care, not to bleed too much, least the body being too much relaxed, should not be able to concoct the impacted matter: and the Galenists do give the like caution, that we have a care of hindering the suppuration by importune Phleboto­mies. I find Hippocrates to have blooded Anaxion upon the eighth day: Forrestus gives us Instances of the like nature. That frequent Phlebotomies in the same Pleurisies have been practised very beneficially, is evident upon record: and in Holland I find Tulpius to accord with the French and Spaniards, Tulpius Obs. l. 2. c. 1, 2, 3. and to allow, if the disease be violent, that the Pleuritic bleed three, nay five or eight times: and gives such Presidents for it at Amsterdam, as may justifie us at London. I will re­cite one case of his.

There is a great variety in the practise of Physicians as to Phlebotomy, some using it more frequently than others do: whether these be rash, or the others in­discreetly timerous, I will not determine now: Both may do well as to the recovery of the Patients; because a judicious person supplies one Medicine by the use of another: But these Bocanical Ignoramus's cannot do that. I find that Forrestus seldome, if ever bled his [Page 168] Pleuritics above once: and Blondelus assures me, that the Peasants of France bleed but once in a Pleurisie at the beginning, Almaricus Blondelus de venae sectio­ne, p. 50. and recover. ‘Plebeii fere omnes una vice contenti adire Medicum, una sola adhibita v [...]nae sectione curantur, & ex decem unus vel duo emo­riun [...]ur, & aliquando omnes sanantur’ Without all controversie Phlebotomy is one of the most generous re­medies in the World, if a man understand the Art of using it: But 'tis our old Books, and not the No­vum Organum of my Lord Bacon, or the insipid Wri­tings of the modern Experimentators will qualifie a man thereunto. I do believe that B [...]tallus did the wonders he speaks of, but as there were left-handed Catoes heretofore, so there is many a left-handed Bo­tallus, that would imitate his practise, yet wants his judgment and learning. I would advise such to be tender how they deal much in this noble remedy, or ra­ther that they would totally desist from practising Phy­sick.

I know that in Germany most are scrupulous about reiterated Phlebotomies, Platerus prax. t. 2. c. x. yet Platerus commends it in Pleurisies, and adviseth to bleed frequently, even twice in a day in the beginning of the Disease. 'Tis not that the people there cannot bear it so well as in France, or Spain, I. Riolan. de circulat. sang. c. 20. but that they will not: There was a time when Galen thought that such as the French, could not bear will the loss of blood: and Valleriola did imagine that the Moors and Spaniards could not endure it so well as the Dutch, or French: there was a time when to let a Woman with child blood in England, was esteemed impracticable: and the Lady Drury was a bold Lady, that in the dayes of Queen Elizabeth, Botallus de venae sect. c. 3. durst obey Bo­tallus therein, against the opinion of the greatest Eng­lish Doctors: But a greater maturity of iudgment, and the good success hath undeceived us, and convinced us, that our fears were but panick and vain: and in oppo­sition to Galen and Hippocrates we accord with Celsus.

[Page 169] ‘Siquidem antiqui, primam ultimamque aetatem susti­nere non posse hoc auxilii genus judicabant; C. Celsus Me­dic. l, 2. c. 10. persua­serantque sibi, mulierem gravidam quae it a curata esset, abortum esse facturam, Postea vero usus ostendit, nihil ex his esse perpetuum, aliasque potius observationes ad­hibendas esse, ad quas curantis consilium dirigi debeat. Interest enim, non quae oetas sit, neque quid in corpore intus geratur, sed quae vires sint. Ergo si juvenis imbecillus est; aut si mulier, quae gravid [...] non est, parum valet, male sanguis mittitur, emoritur enim vis, siqua supererat, hoc modo erepta. At firmus puer, & robu­stus senex, & gravida mulier val [...]ns, tuto si [...] curantur.’ I have seen some of all Ages phlebotomised, and have preserved the lives of some small Children by that means; I have seen L [...]dies with child to be let bl [...]d, when they were continually sw [...]ning, and f [...]inti [...]g, and extream weak: and that judicio [...]sly: for they havi [...]g large veins, and otherwise a firm and imperspirable h [...]bit of body, we did not regard the Animal imbecillity, n [...] the irregularity of a puls [...] altered by vapours, but pro­ceeded to cure them by Phlebotomy and it pro­spered. even Pleurisies. But the effects of Phlebotomy in a pleuritic woman, which was within a fortnight of her time, are remarkably described by that cautious Practitioner, Baldassar [...]imaeus: He did not scruple to let a gravid wom [...]n blood, but she was so far gone, as that he trembled: ‘ Tandem non tantum adstan­tibus mulierculis, sed & ipsa aegra venae­sectionem vehementer u [...]gente, exemplo Pe­tri Salii Diversi, qui ultimo mense, & in­stante partus tempore feliciter venum ape­ruit, Baldass. Timaeus respons. Medic. 58. Petrus Salius Diversus de affect. particular. c.xxii. j [...]ci aleam, & secta mediana sangui­nem ad uncias circiter sex detraxi, & sic optato successu & maetrem & faetum a prae­sentissimo vitae periculo, Dei gratia, liberavi.’ There are a multitude of things to be considered by him that would judiciously practise Phlebotomy in Pleurisies; besides what I have intimated: as Whether it succeed another disease, as the Measils, or be primary: Whether it be complicated with other distempers, or solitary: Whe­ther it be crude, or upon concoction: Whether it be likely to be long, or short: Whether the Patient do expectorate, [Page 170] or not, If he do; what colour, and what consistence, or taste the evacuated matter hath: Whether the disease be upon a recrudescence, or not: These are circumstances which he ought well to understand, for as to the time of phlebotomy, 'tis one in a long disease, when the be­ginning is protracted to seven, ten or seventeen dayes; and another in that which will terminate in seven dayes: the urgency is one in an incoct Pleurisie, when nothing is (in due time) expectorated; and another, when blood, or purulent but benign matter is avoided: and another when the matter is black, livid, very yel­low, or stinking, or sweet to the taste: the case alters when Nature doth ease her self by a propitious loose­n [...]ss, and when it is an importune Diarrhaea: when it turns to an Empyema, and when it proceeds to an ami­cable Crisis. These things are to be pondered by the Physician, and his repute is not to be questioned, for his actings, by such as understand not the case, or ap­prehend not by what exigences and presidents the in­telligent Practitioner is guided. Men ought not to judge of Diseases by their names only; and condemn a knowing man for doing that in one disease at one time, which neither they nor he would adventure in ano­ther: and since it is not allowed us to abandon our Patients in some cases, according to the advice of Hip­pocrates: give us leave to make use of that Apology which Celsus doth suggest unto us: C. Celsus Me­dic. l. 2. c. 10. ‘Fieri tamen potest, ut morbus quidem id desiderat, corpus tamen vix pati posse videatur: Sed, si nullum tamen appareat aliud auxilium, periturusque sit, qui laborat, nisi temeraria quoque via fuerit adjutus, in hoc statu boni Medici est ostendere, quam nulla spes sine sanguinis detractione sit; faterique quantus in hac ipsa remetus sit, & tum demum, si exigatur, sanguinem mittere. De quo dubitare in ejusmodi re non oportet Satius est enim anceps auxilium experiri, quam nullum.’ Let the World rest assured, that an understanding Ga­lenist [Page 171] doth nothing rashly: that he considers of all cir­cumstances, and knows their case better than them­selves; that he hath as great a regard to the preserva­tion of their vital strength, as they can wish: and ap­prehends when to desist, and when to operate, and in what manner: but these are mysteries to the Baconists: and I can give no better directions to the sick, than that they would apply themselves to a prudent Physician, rather than Quacksalvers, and refer themselves to his judgment, without imposing their own, or that of igno­rant Experimentators, and Arcanists. And so much concerning Phlebotomy in Pleurisies: the more exact handling whereof, and the accommodating of the Me­thod of Rulandus to that of the Galenists, must be the subject of another discourse: I add only, that Nature it self doth teach us the use of Phlebotomy in Pleuri­sies; for they are often accompanied with a bleeding at the nose, in the beginning, which is benefici [...]l to the Pa­tient. Larvi sanguinis fluxus ex naribus multa sol­vunt, ut Heragorae. Hippocr. Epid. l. 2. sect. 3. p. 102. cum notis V [...]ll [...]s [...]i. Prosp. Alpinus de pr [...]s [...]g. vi­ta & morte. l 7. c. 2. Non agnoscebant Medici. Though it happen symptomatically, yet is it frequently advan­tageous, even in Pleurisies: nay 'tis an accident we may commonly expect in them: Quibus febricitantibus rubores in facie, & capitis vehemens dolor, venarumque pulsus, Coac. praenot. l. 4. v. [...]0 [...] Prosp. Alpinus de praesag l. 7. c. 16. iis ut plurimum fluor fit sanguinis: and in a Pleurisie, 'tis alwayes the most mild and safe, if the Patient begin his Anacatharsis by a sub-cruent sputa­tion. In fine, she usually terminates this Feaver by an Haemorraghy at the Nose, P. Saluis com. in lib. 1. de morb [...], p. 170 [...] Holler. apud Iacot. in Co [...]e. l. 5. sect. 2. sect. 59. which if it be small doth por­tend evil; but if it be large, is beneficial. Pleuritis larga haemorrhagia enaribus judicare potest, stillatione non potest. And this good fortune did recover De­mosthenes out of an incurable Pleurisie, as he relates it himself. Demos [...]h. adv. C [...]no [...]. cit [...]nte Beve [...]ovicio de Med. vet [...] part. 3. c. 7, p [...] 312. ‘Febres me continuae sequebantur, & cru­ciatus totius corporis perquam vehementes & atroces: imprimis vero laterum & imi ventris: neque cibum capere poteram; & ut Medicus quidam affirmabat, nisi [Page 172] mihi doloribus afflicto, & jam desperata purgatio san­guinis ultro copiosa supervenisset, me saniosum ( [...]) factum fuisse periturum: nunc is sanguis recessu mihi suo saluti fuit.’ I have not the original by me, to consult the Text: but whether it were at the Nose, or by Stool (I believe the former) it is all one to the present purpose; Hippocr. Epid. l. 6. sect. 3. p. 665. cum notis Vallesii. but it may seem pertinent to observe, that those which bleed much at the Emeroids are not incident to Pleurisies.

The subject of my next discourse must be concern­ing Phlebotomy in the Small Pox: pag. 8 [...]. My Adversary blameth Doctor Willis for allowing of Phlebotomy in the Small Pox, upon the nick of their eruption: but by way or Argument against the judgment of that eminent Practitioner, he alledgeth nothing but this: ‘ Make this good by fact, that 'tis profitable and necessa­ry in any such case to open a vein (for [...], will never carry with me) then I shall forthwith become a Proselyte to your Method. Assuredly this, I am certain of it, was neither profitable nor necessary for the Nation, that we should by this means loose three persons of the noblest extract.’ —I have alwayes looked on the discourse of that Learned man concerning Fea­vers, as one of the most judicious Writings that ever our Faculty produced: 'tis succinct without obscurity, and without the omission of any circumstances that fre­quently or rarely fall under the consideration of a Physici­an, and the practise, as well as Medicaments so safe, so authenticate according to the Rules of Art and practical Observations (which we preserve) that 'tis above all the effects of Envy and Malice.

It is a great abuse to the Doctor which this Bacon-faced Helmontian put upon him, as if he approved generally and indefinitely of bleeding in the Small Pox upon the nick of their eruption. It appears there not to be his practise, but upon urgent cases; and [Page 173] he, on purpose relates an History of its evil effects, there­by to deterr others from using Phlebotomy rashly in that disease. I shall repeat his words, and method of curing it, as far as relates to the beginning of the disease.

‘Quoad primum intentio sit, Williss. de febr. c. 15. ut naturae impedimenta quaevis anferamus, quo sanguis, variolarum fermento in­quinatus, & coagulari aptus, adhuc motum aequabilem in corde & vasis stagnatione retineat, ac effervescens por­tiones cum veneno gelatus foras expellat: interim cau­tio sit, ne fermentationis, seu effervescentiae opus ulla­tenus cohibeatur, aut nimium proritetur: hoc enim cru­oris massa plus debito in portiones congelatus agitur, isto restringitur nimis in motu, nec particulae venenatae cum cruore gelato foras emandantur: natura a secretionis & expulsionis opere impedire solet nimia excremento­rum congerie in visceribus, aut sanguinis exundantia in vasis; quare primo statim morbi insultu deinda erit opera, ut evacuatio per vomitum, aut sedem, si opus fuerit, tempestive procuretur, pharmacis tantum mitioribus & blandis utendum est, quae nimirum non irritent, aut hu­mores perturbent: quare hoc tempore interdum emetica, purgantia, aut enemata, modo haec, modo ista locum ha­bent: etiam sanguinis missio si plethora adsit, bono cum successu celebratur.—Circa missionem sanguinis instante variolarum eruptione valde ambigi­tur: olim inter nostrates haec res sacra audiebat, neque sub ullo necessitatis praetextu Phlebotomia admitti sole­bat: nuper autem experientia duce in quibusdam casibus sanguinem mitti omnino utile & necessarium esse com­probatur: quae tamen evacuatio si in quavis constitu­tione indiscriminatur adhibeatur, aut quando isthac opus fuerit, in quantitate nimis larga peragatur, magna saepe incommoda exinde sequuntur.’

These are the words of that intelligent person; whereas— G. T. seems in the English Text to affix upon him such a sentiment as if he allowed commonly [Page 174] and indiscriminately of Phlebotomy in the very nick of the coming out of the Small Pox: But it may be replied, that he hath done the Doctor justice in the Latine ci­tation: but I think not amongst English Readers, nor in his vulgar discourses. However I shall endeavour to justifie the aforesaid Method of Doctor Willis as Artifi­cial, and agreeable to the opinion and happy practise of the best Physicians: and that it may be more manifest, I will inlarge my work, by examining the contrary opi­nions of some others: for— G. T. gives my Pen here no employment, except it be to tell him, that the three noble Personages which he speaks of were not the Doctors Patients, as I believe: except he be accountable for all that act agreeably to that Method which He (and our best Physicians) layes down: I add, that many Actions are warrantable by Art and Prudence, which are not successful: and to requite his Cata­logue, I would have him know, that when this young King of Spain had the Small Pox, he was let blood several times: and so was the present Queen of France upon a feaverish indisposition let blood twice, in 1663. and two dayes after the M [...]asils appeared: And this Lewis xiv. being sick of the malignant and pestilen­tial Small Pox was thrice blooded by Doctor Vautier: and for it, received this Elogy from the learned Iaco­bus Thevart. Iacob. Thevart in dedicatio­ne tomi tertii Consil. Me­dicin. —Vt boni omnes Galli palam profite­antur ac praedicent suum se tibi debere Regem charissi­mum, quem nempe malignis ac pestilentibus variolis peri­culosissime laborantem non cordiacis tantum praesidiis (ut Medicastrorum [...] vulgus solet) sed & ipsa, Ballonii, ad D [...] D. Francisc. Vautier Archi atrorum Co­mitem. quam in ejusmodi affectibus aversantur ac damnant, sanguinis missione ter, pro symptomatum urgentium necessitate, re­petita, salvum & incolumen restituiste, innumeris inte­rim in hac urbe populo sissima pueris hac Epidemica lue e medio sublatis. Quod ob facinus tam egregium quae non tibi laudes, vir praestantissime, quae non soteria de­bentur? Si qui civem Romanum in praelio servaverat, [Page 175] quercea corona dignus haebitus est, Tu certe qui Regem Christianissimum ab hostè tam infenso liberasti, auream, qualis est ab Atheniensibus Hippocrati concessa, meruisti. Nec dubito quin si vixisses priscis illis temporibus, quibus inter Hero as referebantur quicunque insigni aliquo faci­nore Rempublicam conservassent adjuvissentve; quin, in­quam, ipse Heroum auxisses numerum, honoresque prope di­vinos accepisses. I repeat this passage with the more sa­tisfaction, because it may serve as example to the Eng­lish, and instruct them with what gratitude and ackn [...]w­ledgments they ought to treat the learned and renowned Physician Sir Alexander Frasier, principal Physician to his Majesty, for recovering our most gracious So­veraign of the like distemper, by the judicious admi­nistration of Phlebotomy. I could name many other Persons of Honour, who do confess that they owe their recovery out of dangerous and malignant Small Pox unto Phlebotomy.

Of those that have written concerning the Small Pox, and are therein professed enemies to Bleeding, I shall take only two particularly to task; the one is Doctor Tobias Whitaker, the other Doctor Thomas Sy­denham: which I do the more willingly, because the one writing in English, the other practising at London, and endeavouring to insinuate his principles every where, with a derogation from the authorised practise of Physicians, it must needs seem that all who do not take his course, have neither regard to the Patients, nor considered seriously the rise and progress of the dise [...]se. I did at first doubt, Whether I ought to reckon them as distinct Authors, because they so far agree in the Regimen and Cure of the disease; that the one doth seem to have stollen it from the other: As will appear by this Parallel.

By this Method Doctor Sydenham doth not doubt but this disease which so afrighteth people, and is so frequently mortal, will pass off with much gentleness, ease and safety.

Betwixt these two there is a little discrepancy in their Method of curing the disease: though there be some in their expressions, and Doctor Sydenham doth seem the Comment, the other the Text. Both of them oppose Phlebotomy, Vomits, Purges and Glysters, as well as Sudorifics. Though they differ in the reason for their rejecting Phlebotomy; For Doctor Whitaker doth avow, that it draws from the Circumference to the Cen­ter: But Doctor Sydenham yields, that it produceth a quite contrary motion, and causeth the Small Pox to come cut.

[Page 178] p 65.Doctor Whitaker doth avow, that this course of his is the old English Method, and the ancient, natio­nal and successful government of our Nation. But Doctor Sydenham would seem to erect his practise upon his own Observations; though all he propose (in a manner) be no more than the common actings of Countrey-people; (except when by any accident the Feaver be exasperated in the beginning, or progress, that he prohibits Cordials) and what I belive was derived from Avenzo [...]r, Fowest. obs. l. 6. obs. 44. and Fracastorius.

p. 25.Of these Writers it is remarkable, that Doctor Whi­taker doth never allow that there can be any malignity in the Small Pox so great and urgent, as to induce a Physician to intermeddle beyond a moderate Diet, and temperate Air: because the Motion being Critical, admits of no violence. But this is a great Errour in the fundamentals of Physick. For, first in Diseases com­plicated with malignity, not only the prognosticks, but the issues are very uncertain as to life, or death, and the Critical evacuations deceitful, so as that oftentimes they bring a momentany alleviation; Prosper. Alpin. de praesag. vit. & morte. lib. 6. c.xi. oftentimes, not­withstanding those evacuations, the distemper increases, and the Patients dye: This every man understands who is conversant in our accounts of Malignant Fea­vers; so that to grant at any time that there is a ma­lignity, or venenate indisposition in the sick, and to abandon him to a temperate Air and Diet, relying upon Saffron and Milk, is a practise never to be justified in Physick. But alas! we are not to be afrighted with the bug-word, Critical motion, nor half an Apho­risme out of Hippocrates; viz. Quae judicuntur, sinere oportet. These general sentences neither qualifie a Doctor in Law, nor a Physician: It becomes us to consi­der in a Critical motion several things:

First, (Supposing it to happen in it [...] due time) we must consider whether it be only a Mo [...]n, or whe­ther [Page 178] it be proportionate to the Disease: for no evacuation that is diminute, is properly Critical: If therefore the pathognomonies of the Disease be such as argue a multitude of the Small Pox to be requisite for the recovery of the sick, and only a few come out, the Physician is obliged to assist Nature.

Secondly, Supposing that they do come out plenti­fully, yet if they be not such as should come out, but black, livid, green, or interspersed with purple spots (not to mention other circumstances, which every Nurse can tell) 'tis certain that the evacuation (how critical soever) doth not oblige the Physician to stand an idle Spectator: No more ought he to be in case that all symptomes increase upon the critical motion, and his Feaver and dangers multiply thereupon. Hippocr. Aph. 23 sect. 1. & aph. 25. sect. 1. [...].

Thirdly, It is requisite that the Critical evacuation be per loca conferentia, by such wayes as are necessary to the disease: But if the Small Pox during their eruption be attended with a dysentery, bloody urine, or other pernicious excretion; that scrap of Hippocrates will not excuse the Physicians negligence; for it sup­poseth that all the conditions requisite to a good eva­cuation be found in that which the Physician is not to intermeddle with. I need say no more to intelligent persons: 'tis not my present work to turn Institu­tionist.

Whether Doctor Sydenham intend to ascribe sense, appetite and judgment unto the Blood I cannot well tell; but either He canteth in Metaphors, or explain­eth himself, in his general Hypothesis about Feavers, as if his meaning were such: p. 4, 5 [...] ‘Quinimo nec, mea sententia, minis liquet febrilem sanguinis commotionem saepe (ne dicam saepius) non alio-collineare, quin ut ipse sese in novum quendam statum, & diathe­sin immutet, hominemque etiam cui sanguis purus [Page 180] & intaminatus perflat, febre corripi posse: sicuti in corporibus sanis evenire, frequenti observatione com­pertum est, in quibus nullus apparatus morbificus, vel quoad plethoram, vel quoad cacochymiam fuerit, nulla insalubris aeris anomalia, quae febri occasionem submi [...] nistraret. Nihilominus etiam hujusmodi homines, prae­cedente insigni aliqua aeris vel victus; caeterarumque rerum non-naturalium (ut vocant) mutatione identi­dem febre corripiuntur; propterea quod eorum san­guis novum statum, & conditionem adipisci gestit, qualem ejusmodi aer aut victus postulaverint: minime vero quod particularum vitiosarum in sanguine stabulantium irritatio, febrim procreet.’ — 'Tis true he did not pen it in Latine, but another (Mr. G. H.) for him: and perhaps his skill in that tongue may not be such, as to know when his thoughts are rightly worded: But it seems strange and irratio­nal to attribute such an understanding to the Blood; and to transmute a natural Agent into one that is spontaneous: and, which is more, having represent­ed it as such, to make it so capricious as not to know when it is well; but to run phantastically upon such dangerous changes as occur in putrid Feavers, and the Small Pox; for even in this last ariseth from a desire the Blood hath to change its state. p. 127. Since natural Agents demean themselves uniformly, and of them 'tis most true, Idem, quatenus idem, semper facit idem: I was surpri­sed to see these new principles, and to see effects of this nature arise without any cause. It doth not seem possi­ble for him ever to demonstrate that there is no Ple­thora, or Cacochymy, or obstipation of the pores of the body antecedent to a Feaver: nay the contrary seems evident to all Physicians; nor ever was there any whereunto they did not attribute some procatarctick cause. Besides, he doth not alledge any Reasons, or Experiments, to shew that there is any alteration in the blood before and after the Small Pox, or a Feaver, or [Page 181] any difference betwixt the Blood of such as have had those diseases, and of those which have not had them. So great a supposition ought not to be made without ground. And since it is natural (and Nature is con­stant) why is not the Disease more ancient and uni­versal than it appears to be? For, if there be any grounds to think the Small Pox to be of long con­tinuance, 'tis certain 'tis but seldom spoken of by any old Writer: perhaps once by Hippocrates (yet so as never to be understood by any that hath not seen the indisposition) and never by Galen. Salmas. de an­nis Climacter. p 726, [...]27. 'Tis Epidemi­c [...]l to Aegipt at this day. It may be imagi­ned to have come from Aegypt by contagion, and might have been called [...], Quia urbi Bubasti Aegyp­tiae familiaris hic morbus. It infesteth some places more than others. Prosp. Alpin. de med. Aegipt. l. 1. c. 14. In Graecia non adeo frequens. Ideo antiquiores Medici vix ejus meminerunt. In the West-Indies it was not heard of till the Spaniards came thither: Roderic. a Fonseca Con­sult. Medic. t. 1. consult. 48. and they (as also the English there) seldome have it. I believe the Disease to be novel, and of no longer date than the Sarracenical revoluti­on: I could instance in the nature of such great alt [...] ­rations, that they have ever been preceded and accompa­nied with many pe [...]ty changes in other things: and if ever I have so much vacant time a [...] to make political reflexions upon the rise of Mahom [...], I may declare much to this purpose. This is that invidi [...]us subject about which E [...]bolius Glanvili mak [...] so [...]uch noise: as if, to avow that Mahomet [...]ere a Gentle­man of noble extraction, marrie [...] to one who [...]r birth, riches and be [...]uty might h [...]ve b [...]en a Princ [...]ss; and accomplished with that sober Uertue, Wit [...]l [...] ­quence, and Education, by much trav [...]l ( [...]or he tra­velled all over Aegypt, Africk, and [...]pain) a [...] to [...]n­der himself one of the most considerable of his Age: or to say that the Christians were so ignorant, and debauched, and perfidious, and addicted to Legends more than to the sound Doctrine of the Gospel, at [...]hat [Page 182] time, that most of the Fables in the Alcoran were accommodated to the honour of the times, more than to truth ( [...]nd so Mahamet told them) or to say He pretended to revive Ancient Christianity; were to be an Apologist for the Mahometans, and an abettor of the Alcoran: Whereas none but the Illi­terate can deny these things: and the Age our Virtuoso speaketh of is the Age of Apostacy, according to the Doctrine of our Church. Oh Heavens! to what an height is Impudence and Ignorance arrived! Or what can be safe, if so prudential and generous a de­sign as I had must be calumniated by such a R—in this manner! Bnt to resume my discourse, in the be­half of my opinion concerning the novelty of this dis­ease, (besides what the learned Mercurialis hath said) I shall conclude with the words of Rodericus a Fonseca, Roderic a Fon­seca in ap­pend. ad Iac. chin. de febr. c. 54. vide & Ranehin. de morb. puer. sect. 2. c. 1. p. 258. Hofman. Ani­madu. in Monton. c 7. sect. 15. & Instit. l. 3. [...]. 109. [...]ect 1. & N [...]rdicis noct. genial. 7 p. 456 [...] 457. which are these. ‘ Si ex nativitate esset, ab initio mundi fuisset, aut saltem ita frequenter tunc, ut nunc solet esse: et licet antiqui aliquam de his pustulis men­tionem fecisse visi sint, ea certe exigua est, & dubia, ut c [...]rtum sit, vix illis temporibus fuisse talem morbum: negligentissimi certe habendi essent, si tam ingens, com­mune, & frequens malum; illotis manibus, silentio in­voluissent: & cum morbus sit puerilis, Hippocrates eas numerasset inter aetates, 3. Aphor. ubi diligentissime pue­rorum morbos connumerat; & tamen nullam hujus mali fecitmentionem: sed illud satis demonstrat, hunc mor­bum novum esse; quod in multis mundi partibus nun­quam visus fuit, ubi nunquam apparavit, nisi postquam Hispani eo pervenere: siquidem per contagium Aethio­pis cujusdam illuc delati, magnam Indorum partem su­stulit.’

I might here insist upon the Hypothesis of Doctor Sydenham, concerning the Inclination of the Blood to change its state: I cannot believe but that the Physicians understood themselves as well before he [Page 183] writ; when it was said, that there was in every one that was born, something of impurity in the body, which was naturally to be purged out by an ebullition in the blood, and such an effervescence as terminated in those Absces­sus called the Small Pox. Avicenna de febribus, c. 6. de variolis. ‘ , Quandoque accidit in sanguine ebullitio secundum semitam putredinis cujusdam de genere ebullitionum quae accidunt succis: & talia quidem accidentia fiunt per eam, ita ut partes eorum ab invicem discernantur. Et de hoc est cujus causa est, res quasi naturalis faciens ebullitionem san­guines, ut expellatur ab eo illud, quod ad miscetur ei de reliquis nutrimenti sui menstrualis, quod erat in hora impraegnationis, aut generatur in eo post illud ex cibis faeculentis, & malis, de illis quae rarificant substantiam ejus, & faciant eam ebullire, donec fiat & substantia recta fortior prima & magis apparens: sicut illud, quod natura efficit in succo uvae, ita quod rectificat ip­sum, faciendo vinum similis substantiae: & jam ex­pulsa est ab eo spuma aerea, & faex terrena.’ He that can English this passage will find in it the ebullition, separation, expulsion and despumation of our Doctor. In truth those terms, nor that which he im­ports by them are no novelty amongst Physicians: and Rhases (as Sennertus saith) doth not make any men­tion of those uterine impurities as the cause of the Small Pox, Rhases de pestilent. c. 1. Sennert. de febr. l. 4. c. xii. but compares the Blood to Must, in in which some impurities are to be separated by Ebulli­tion. Wherein the whole Hypothesis of this semi-Virtuoso is contained: However, I cannot allow any more to his Observations, than if a man should go with­out his doublet, and pretend to a new Mode of wearing Breeches. But that which is most intollerable in Do­ctor Sydenham is, that He seems to attribute all the evil consequences of the Small Pox to the indiscretion of those that attend them; be they Nurses, or Physicians. Thus (p. 150. Edit. 2.) he makes as if Nature did discharge it self in that disease into the fleshy parts [Page 184] only: [...]or Augen. de febr. l. 9. [...] xx. Steph. C [...]en. Qu [...] ex qui­ [...]s. l. 3 c. 16 T [...]. B [...]r [...]ho [...]in. Ci [...]a Medica, p. 594. so that if the Eyes, Lungs, Stomach, Guts, Pan­creas, or Membranous parts be affected, 'tis not the vio­lence of the Disease, but the ignorance of the Attendants which occasioned that: which is intolerable for any man to say, and refuted by Experience.

F [...]n [...]l p [...]tho. l. 4 c. 18. & de abdit. rerum [...], lib. 2. c xii. Coll [...]do obs. in [...] c 92. Io. Dan. Horsti­us obs. Ana­tom. 9.I might proceed to demonstrate that there is not any thing n [...]w in the whole Cure which Doctor Sydenham useth: that in the beginning of the Small Pox, before the eruption, being as ancient as Bayrus, if not derived from the Arabians: And the rest hath been inculcated by an hundred Writers: provided the Small Pox were gentle: yet, as much as they have been for the keep­ing of them moderately cool as to Air, or Diet, before the eru [...]tion of them; yet I dare say our Doctor is the first whoever did imagine that the longer they were in coming forth the better it was. Dr. Sydenh [...]m, p. 138 Mihi quidem rationi consent aneum videtur, ut quo diutius Natura separatio­nem moli [...]ur, ac perficit, dum modo ebullitio non omnino torpeat, co certius at que universalius eadem separatio ab­solvitur. In genere melius est va­riolos & mor billos icto [...] quam ta [...]de erumpere. Sennert. de febr. l. 4. c. xii. For our best Writers, as Mercatus, Augenius, Forrestus, Sennertus, Riverius, Ronchinus, and others, do avow, that the sooner they appear, the better is the presage. But all this while his discourse extends no [...]urtherr, than to that sort of Small Pox which is mild and favourable, not accompanied with any peril­lous or mortal Prognostics. but should any such case happen, these two Doctors leave us in obscurity, and we must help our selves, for they give us little of assi­stance.

I shall therefore proceed to enquire what directions the most judicious Writers, and Rules of our Art pre­scribe unto us in this Disease.

It is confessed that the Small Pox are sometimes so mild as not to be accompanied with any Feaver, or evil symptome at all, so that the Patient need not be con­fined [Page 185] (at least is not) to his Chamber, and any strict­ness of Rules: Coyttarus de purpur [...]ebr. p. 245. This is granted by Avicenna, Rhases, Schenckius, Hollerius, Epiphanius Ferdinandus, Coytta­rus; and Franciscus Rubeus, whose words are these: Variolae aliquando sine febre, Rubeus No­cturn exer. 7. in Scholiis. p. 104. & aliquando cum febre mihi & placidissima, nonnunquam cum febre acuta, & quondoque cum febre maligna crumpunt. In this case there is no doubt but the Physician may do nothing, and ought to do little, there being no need of his assi­stance.

It is confessed that sometimes the Small Pox are at­tended with so gentle a Feaver, of the nature of a Sy­nochus simplex, that the Patient may do very well, by the directions of Doctor Whitaker, and Doctor Syden­h [...]m. Yet must I add, that, supposing the truth of these two Cases, I cannot conceive it proper to imagine that the Small Pox are then a Critical motion of Nature: there being in the one juncture no Disease whereof they should be a Crisis; in the other no such Disease as to discharge it self in so copious an eva­cuation. The Notion of a Crisis in the production of the Small Pox will seem more absurd, when we con­sider how frequently it happens, that notwithstanding their coming out plentifully, the Feaver doth still con­tinue, and increaseth the dangers of the Patient. Be­sides, How is it a Crisis, when there seldom proceeds any Coction, and when the preceeding Disease observes no times?

Of those Diseases which terminate by a Crisis there is a great variety in the evacuation insuing thereupon, as an Haemorraghia, looseness, sweat, pro [...]usion of urine: but here, whatsoever the nature of the Disease be, a Synochus simplex, putrid, malignant, or tertian Feaver, the Crisis by the Small Pox is constantly the same: and the expulsion not only towards the skin and habit of the body, but every way, as on the Stomach, Throat, Lungs, Guts, &c. and after this kind of Crisis it fre­quently [Page 186] happens that the Patient dyes, no errour inter­vening: whereupon Ioseph de Medicis exclaims after forty years of practise. Ioseph de Me­dicis apud Greg Horst. t. 2. p. 56. Hei mihi, quoties malitiosae variolae me fefellerunt! And Augenius, though he be inclined to the Opinion of Doctor Whitaker, to ex­plain this Crisis, is forced to desert the vulgar notion of a salubrious Crisis, and include in its definition, even those that are noxious, saying out of Galen: Crisis esi mutatio quaedam subita ad salutem, Hor. Augen [...] de [...]ebr. l. 9. c. 5. aut mortem: and after all concludes thus: ‘Haec si vera sunt, osten­dunt rectissime dixisse Arabes, variolas contingere per modum cujusdam Crisis: siquidem modus quidam est particularis, quo febris magna saneri crisi con­suevit, longe distans ab aliis. Omnes enim aut per vo­mi [...]um, aut per alvum, aut per urinas, aut persudores sanantur; ut hujusmodi febris nullo ex illis sanatur modis, sed persolam superficiem, non extimam solum, ut ardentes febres, quae sudore copioso superveniente libe­rantur, sed ex [...]imam & intimam simul, utque sic per abscessus parvos, quos pustulas nuncupavimus, ubique procreatos. Nunquam alvi fluore, nunquam vomitu sanantur; imo si forte adveniant, pessimum signum est.’ But if we take Crisis and Critical evacuations in this sense, 'tis certain then that a Physician may and ought frequently to intermeddle, notwithstanding that Nature is already engaged critically, and the founda­tions of this Doctor are threby overthrown.

I add, that if the motion of the Small Pox be critical, then is not the Small Pox properly a Disease of it self, Avicenna de febr. c. 6. with whom agrees Fracastorius, and, I think, the generali­ty of Physici­ans, who make it to bear some resem­blance of a Crisis, but not a Crisis. but the termination of one. And therefore the Arabians did prudently say, that the Small Pox do hap­pen, per viam cujusdam criseos, in the way of a Crisis, not that they are properly the Crisis of another disease. They are generated by an effort of Nature, which dischargeth it self of certain humours which are offen­sive unto her by their quantity, or quality; and this is done not by their eruption in the exteriour parts, but [Page 187] even in all the entrails, and other internal parts: and sometimes this evacuation is a discharge of so crude, malignant matter, that it is destructive to the sick: which is not usual in a Crisis: and this is that which the Arabians call Ebullitio secundum semitam putre­dinis; which made Fernelius and others ascribe there­unto a venenate quality. Fernel. de ab­dit. rer. causi [...] lib. 2. c.xii. ‘Hoc & morborum foedi­tas testatur, tam deformis aliquando visa, ut occaecutis oculis, universa cutis in squammas faetidas & in crustas ingentes solveretur: corpus omne non aliter contabes­ceret & macie nigroreque torreretur, quam si menses quatuore furca pependisset.’

It is avowed that there is more than one sort of Fea­ver which is antecedent to the eruption of the Small Pox: and common Reason will tell us, that in such ca­ses the Physician must vary his Method: if the Feaver be a Synochus simplex, without any putrefaction, 'tis not to be doubted but that the Small Pox may be cured by the course prescribed by Doctor Whitaker, and Do­ctor Sydenham: but what if it be a Synochus joyned with putrefaction, or malignity? Must we then abandon Nature to her self, and stand Idle Spectators amidst so great and visible dangers? If the Small Pox be a Cri­sis of the Feaver, what influence hath that considera­tion upon us, before the time of the Crisis? Are we not obliged to facilitate and secure the Crisis by con­venient means before it approach? May it not other­wise happen that there will be too great a redundancy of humours, so that Nature will not be able to guide them orderly, and for the benefit of the Patient? Do not we see this frequently to happen, where no irrita­tion hath been through Sudorifics, or other Medica­ments? Doth not it often happen, that Nature not be­ing able to command the turgent humours, they have so fixed themselves in several principal parts, occasion­ing Swoonings or Syncopes, Dysenteries, as to destroy the [Page 188] Patient in the beginning? or so to imbecillitate him, that he hath afterwards languished in a Consumption, been deprived of his eyes, or limbs, and subjected to incurable Vlcers? Ioh. Michael Febr. de Scor­zonera. p. 81, 82, 83. It was observed in Germany, in 1644. that the Small Pox reduced some to an Atrophy, Asthma, and Consumptive coughs: some have had not only the habit of their body strangely vitiated and al­tered; but even their bones corrupted and corr [...]ded into a Paedorthrocace, or Spina ventositatis: some have had the Articulation of their Joynts so depraved, that they have become immoveable, or crooked. Oftentimes we see that after the first Feaver is abated, and the Small Pox come out in great plenty, a looseness follows, or a new Feaver prevents their maturation and destroyes the Patient.

From these Considerations I dare confidently deduce this Conclusion, That it becomes a Physician in the Small Pox, to examine well in the beginning, the constitution of the Patients body, if it redound with peccant Humours, or no: it being easie to apprehend, that what is a Cacochymy before this Disease, will de­generate into a virulency and malignity in the course of the Disease: If it redound with too much Blood, as h [...]ving more than is requisite for the commodious dis­charge of that Disease: for if the body be either way Plet [...]ori [...], there is apparent danger least the Patient be strangled, or that the [...]urgent Humours, being either streightned for want of room, or too luxuriant to be guided, will fall upon some important part, and so create inseparable evils in the progress of the distemper. He ought also to inquire diligently into the preceding sea­son of the year; Forrest. obs. lib. [...]. cbs. 44. since that adds much to the mildness or perillousness of distempers: As also into the present sickness, whether it be in others attended with any thing of unusual malignity, or pestilence: for in such a case, he must increase his care, as dangers multiply. He [Page 189] ought also to weigh well the first Symptomes, Hor. Augen. de febr. l. x. c. 1. whether they be so violent as that the Patient is not likely to have strength to support the continuance of the Disease: If the Feaver be great, and accompanied with swoon­ings; if the Patient being thirsty, restless, molested with a vomiting, difficulty of breathing, a dangerous Cough, violent and ill-coloured Diarrhaea, or Dysentery, bloody or black Vrines: It is not to be doubted in these cases, but the Physician is to make such provision, that so ominous a beginning may conclude well, if it be possible. And since so great a distemper requires great and generous remedies: two things will at first (if he come timely enough) fall under his debate; viz. Phlebotomy, and Purging.

Concerning Purging many are very timorous, be­cause that a Looseness is dangerous in the Small Pox: as also because that they fear least it should divert the Humours from their natural tendency, and draw them into the Bowels. But neither of these Reasons are of any great validity. For neither is a moment any Loose­ness (and 'tis that which is equipollent to a Minorative purge) dangerous in the first beginning of the Small Pox, before they come forth: Nor is there any danger that a gentle Purge should create a Flux; but rather prevent any such subsequent evil, by carrying off the peccant Humours, which by continuing in the stomach and intestines would contract a malignity. And in­deed this consideration is of such importance, that it ought to sway a Physician to give some Lenitive in the beginning, when he sees occasion. Neither will he there­by divert Nature from the expulsion, but rather facili­tate it, and by diminishing part of the redundant Hu­mours, enable her to overcome the rest with more ease: whereupon Augenius, Ranchinous, Franciscus Rubeus, Riverius, Gregorious Horstius, and other excellent Pra­ctitioners do take this course. And Ballonius observes: ‘ [Page 190] Ballon. Epid. l. 1. p 37. vide Forrest. obs. l. 6. obs. 49.An commode praescribi possunt medicamenta anti­quam morbilli se produnt? An illa impediunt motum naturae? Imo inopinato venam secuimus, & medica­mentum purgans dedimus, quibus die sequenti, aut po­stridie apparerent variolae, & melius multo habuerunt, quam quibus non ausi fuerimus idem exhibere: sic pa­rum probabile, quod dicitur, minus affatim erum­pere populas si corpus ante purgaveris.’

As for Phlebotomy, were it not for capricious humours, or indiscreet fears of some persons, there could be no question about the legitimate use thereof in this Dis­ease. For there is not any Indication for Blood-let­ting which may not occurre in the Small Pox: And 'tis as vain a surmise to think that an intelligent Pra­ctitioner will do any thing rashly; as 'tis an irrational course (though too common) to censure Men for the ill success, when they act according to the best of their judgment, and the most solid Rules of their Art.

The present Controversie includes two Debates: The one Concerning Phlebotomy in the beginning of the Small Pox, before their eruption: The other Con­cerning Phlebotomy after their eruption. In both which cases I do avow, that Phlebotomy may be oftentimes pru­dently, and sometimes is necessarily administred. I use this manner of speech, because that Physicians do make a twofold use of Blood-letting: Ferdinand. Mena com­ment. in lib. de sang. emiss. c. 22. One, when the nature of the Disease and its greatness do absolutely require Phlebotomy, as the most proper Medicine, and without which in all probability the Patient will run an appa­rent hazard of his life: A second, when it doth not seem so absolutely necessary to Phlebotomise the Patient, but he may recover by other means, without it: yet be­cause this is the most rational and safe way, Phy­sicians do insist thereon, that so Nature being disbur­thened [Page 191] and alleviated in part thereby, may with more ease overcome the rest. 4. de saint. tuend. Thus in some Diseases Galen pro­fesseth he omitted to bleed some Patients, because they would not indure it: whereas had he esteemed it extreamly necessary, he would not have declined that Remedy, and used a Purge instead thereof: But he looked on it then only as a most convenient Remedy. From whence I deduce, that whensoever any man reads any Author that doth not practise Phlebotomy in the Small Pox (as I. Michael Fehr, and one Langiu [...], now Professor of Physick at Leipsich, or Angelus Sala) the uselessness or danger of the Remedy is not to be con­cluded thereupon: since it is evident that Physicians are inforced often to comply with the Humours and prejudicate Opinions of their Patients, and the Countries where they live; and do not alwayes act according to their best judgment: Nor doth it follow, that because the imprudence of some hath been, or is successful; that therefore we ought to relinquish the more wise courses, or condemn as needless those cares which Dis­cretion it self doth put us upon. Neither ought we to be swayed by the Negative testimonies of Wri­ters, or Practitioners: For it doth not follow that what one (or more) hath not tryed, or seen, is impossible, or impracticable: The happy Experience of the Af­firming party is the most convincing: as our com­mon Logick informs us. They who condemn Phlebo­tomy in the Small Pox, either condemn it because they have experienced its evil effects therein; or because they have only a sinister opinion of it, and some speci­ous reasons against it: If the last; they say nothing of moment: it being the dictate of Hippocrates, De diaet [...]. l. [...]. c. 5. [...]. And Aristotle long a­go censured those who out of a preconceived opinion of the event of a thing did form their judgment; Frederic. Bo­nav [...]ntura de partu octo­mestri. l. 5. c. 64. and imagine it must happen so, or so, because they think it will do so. If they have so often tryed the evil suc­cess [Page 192] thereof, 'tis necessary that they confess they have killed a great many thereby: or at least that they pro­fess they have seen the sad Experiments thereof made by others: and to make this any way convincing, they must first assure us that such Experimentators were Artists, and understood their Faculty so well as to weigh all circumstances requisite to the due admini­string of Phlebotomy; otherwise the Actions of the most judicious shall be condemned through the igno­rance and folly of others: and it must be demonstrated, that the death or other evils which befell the sick, were the direct consequences of the Phlebotomy; and not by accident, and from some particular juncture, or [...]: least we commit the Fallacy of A dicto secundum quid, ad dictum simpliciter.

Doctor Whitaker is pleased to call the practise of Phlebotomy in the Small Pox, p. 27. the Mode of France; and makes as if that were the principal Argument produced for it. viz. ‘The greatest Argument to confirm this practise, is, the Mode of France: by the same argu­ment they would prove stinking and putrid flesh, both of fish and fowl to be most comfortable to the sense, and corroborative to the Animal spirits: and if their Rhe­torick be no better than their Logick to perswade per­sons of reason and sense to accept their Mode, it is most probable it will prove the Numismata of Ga­len, which is a quaere that will pass no further than their own Countrey.’ —He afterwards call it the rash practise of Modish persons: adding, ‘I call it a rash and inconsiderate practise in this Dis­ease, p 28. because it is a doubt indetermined amongst the most learned Professors of all Nations, both Greeks, Arabians and Latines, and all others principled from them; being all of them unresolved of Phlebo­tomy in the Small Pox, upon any Indication to be a safe Remedy: And if the disease be conjunct with [Page 193] an undeniable plethory of blood (which is the proper Indication of Phlebotomy) yet such bleeding ought to be by Scarification and Cupping-glasses without the cut­ting any Major vessel.’ —Assertions so general and peremptory as these are ought to be very well ground­ed, or else they subject the Author to the imputation of Opiniatrity, and Ignorance. I will not deny but some may have justified their practise by the customary pre­sidents of the French Physicians; who neither want sufficient knowledge in their Faculty, nor prosperous suc­cess to urge against all Cavillers: And this they may have done, not that ever they could judge it a Mode peculiar to the French, but because that Nation is our next Neighbour, and so well known unto us, that they needed not extend their discourse further: nor do there want reasons to shew that If it be requisite for the French, and they can bear it: It is more requi­site for us, and we can better tolerate it. For our diet is more plentiful, our habit of body more firm; our innate heat, by the coldness of our Climate, more concentrated and vigorous; our redundance of blood is greater: and our pores more dense and apt to be obsti­pated, than theirs; and if we m [...]y aggravate the ma­lady from the dismal effects and impressions it produ­ceth in the faces of the sick, I think I may say it (I ne­ver was in France) that the Small Pox are worse in England (which indicates greater Remedies, for the most part than in France, since the disasters which be­fall good faces are more frequent and notorious here than amongst them.

But, I do affirm that this practise is not only the Mode of France, but of Spain and Italy as well as Aegypt and Africk; and that 'tis authentick in high and low Germany, and Denmark: And whereas he sayes that the usefulness of this Remedy, is a doubt in­determined amongst the most learned Professors of all Nations, both Greeks, Arabians, and Latines [...] and all [Page 194] others principled from them: It is a gross mistake: and there is more of truth in that opposite saying of Augenius: Hor. Augen. de febr. lx.c.iv. ‘Omnes, qui de variolis scripserunt, unanimi consensu, principium curationis, illarum fieri debere a vacuatione sanguinis contendunt, ideoque venam incidendam esse, aut scarificationes admini­strandas, aut hirudinibus applicitis sanguinis vacua­tione procurandam.’

Concerning the Greeks, I have considered the pas­sage in Hippocrates concerning the Son of Tmionax, Hippocr. Epid. l 7. p. 894. cum notis Vallesii. and whatever else is alledged out of him, or Aetius, yet can­not be satisfied that ever they knew any thing of this disease. They that do believe it (as a strong imagi­nation may transport a man far) may reply, that since the Malady was rare then, and different much from ours 'tis not to be wondered that they speak so little of the Cure; and never determine a doubt which they never thought of. As for the Arabians nothing is more cer­tain than that they considered the disease, and all cir­cumstances, and did determine in the behalf of Phlebo­tomy; and whosoever is principled from them (as all in a manner of the subsequent Physicians have been) must allow thereof. I do not remember to have read that any of them did ever prohibit Phlebotomy in this case, except it be Avenzoar, who is said to have given the like directions that Doctor Sydenham doth, viz. To do nothing in a manner: but relinquish the work to Nature entirely. How Avicenna determines the doubt, Avicenna de febr. c. 10. his words will best shew. ‘ Oportet in variolis ut incipiatur, & extrahatur sanguis sufficien­ter, cum conditiones fuerint. Et similiter si morbillus fuerit cum repletione sanguinis. Et spatium illius est usque ad quartum. Sed quando egrediuntur variolae, non oportet tunc ut administretur phlebotomia, nisi inve­niatur vehementia repletionis, & dominium materiei: tunc enim phlebotometur quantitate quae alleviet, seu minoret. Et convenientius quidem, quod in hac [Page 195] administratur aegritudine est phlebotomia. Et si phlebotometur vena nasi, confert juvamentum fluxus sanguinis narium, & tuetur partes superiores a malitia variolarum. Et est magis facilis super infantes. Et quando necessaria est phlebotomia, & non phlebotomatur iterum complete, timetur super ipsum corruptio extre­mitatis.’ Whence it is apparent, that amidst such cir­cumstances as amongst Physicians usually seem to re­quire Phlebotomy, he doth allow the practise thereof in the Small Pox, Joseph de Me­dicis apud Greg. Horst, t. 2. p. 46. before they come out, be it on, the fourth day, or later that they discover themselves. After they do appear, he alloweth not, except there be a manifest plenitude, and surcharge of morbi [...]ic humours, then he alloweth only a minute letting of blood, and not what is too copious: and adds, that in this disease 'tis most convenient to let blood; and if the Patient be not blooded in a Plethoric constitution, and that by a repeated phlebotomy, according to the exigency of the case, that is, compleatly, there is danger least the party suffer the corruption or loss of some of his limbs by a Gangrene, or other evil accident: for when the redun­dance of the expelled matter is such, that it cannot du­ly maturate and tr [...]nspire in the pustules, it frequently corrodes the ligaments, and tendons, and otherwise vi­tiates the remoter parts of the body; even Worms have been bred in a pestilential Small Pox, all under the pustules: Fr. Joel. prax. l. 9. sect. 5. sect. 2. as at Stralesund, in 1574. sometimes the matter not finding room to disburthen it self in the circum [...]erence, turns its course into the bowels, and be­gets mortal Diarrhaeas and Dysenteries. Of the same opinion is Rhases, as appears by what is extant amongst the Scriptores de febribus: Rh [...]ses (inter Scriptores de febribus) c. 18. viz. ‘Si antequam appa­rere incipiant, medicus aegrum inveniat, minuere eum faciat, aut cum ventosis sanguis extrahatur. Minua­tur equidem sanguinis multitudo.’ It is true, that there he prohibites Phlebotomy after the Pox come forth: but I find him cited by others as concurring [Page 196] with Avicenna as to bleeding even at the nose, as ex­treamly beneficial; and to approve of phlebotomy after they come forth, in case the Patient find no alleviation thereupon, Rh [...]ses 18. Cont. 8. citan [...]te Diomed. Amico in tract. de va­riolis. c.x. but there continue signs of a plenitude, or redundancy of ill humours, a great Feaver and diffi­culty of breathing. But there is another piece enti­tled unto Rhases, wherein how indulgent he is to Phle­botomy you may learn from Augenius. ‘Rhases libro suo de peste, Horat Augen. de febr. l.x. c. 3. capite sexto: mittendum esse sanguin [...]m vult pro quantitate plenitudinis; si enim maxima sue­rit, non veritur vacuare usque ad animi deliquium: si medi [...]cris, mediocriter educit: si parva fuerit, paulum singuinem educit: verba ejus sic habent. Tu ve­nam incidito, & quam multum sanguinis ef­fundito: scil. ad sanguinis defectionem usque. Supra vero syndromen attulit maximae plenitudinis, & paucis interpositis inquit. Cum vero haec signa ad­modum evidentia non erunt, veruntamen ve­hementia quidem, parum sanguinis fundito: Sin minime, minimum: haec ille.’ How suc­cessful so large bleeding may be (though Augenius, and Ran [...]hinus and others condemn it, [...]otallu de ve­nae sectione, c. 5. we may judge by the practise of Botallus. To these I add the authority of Serapion, which runs thus. ‘Si haec febris fuerit propter causam variolarum, Serapion (in­ter script. de sebr. c. 12. & virtus & aetas consentit, tunc non aliquid magis juvativum quam phle­botomia venae. Et si aliquid prohibet phlebotomiam, tunc oportet ut administrentur ventosae.’ Out of which it is evident, that the generality of the Arabians, were of a different sentiment from what Doctor Whitaker ascribes unto them: and Claudinus is less mistaken when he (as do many others) avoweth, that The Arabians universally agree to let Blood in the Small Pox, I. C. Cl [...]udinus Empir. ratio­nal l. 5. sect 1. c. 1. p. 286. upon occasion. Nor is there more of truth in that which follows in our Doctor, viz. that Their followers have not determined this doubt. For though two or three may seem refractory still in [Page 197] the World, yet it is not amongst Physicians, but amongst them that are not Physicians that the doubt is inde­termined. I shall take some pains to undeceive this Age as to the present point.

Gordonius's words are these; ‘Inprimis si corpus est Plethoricum, Gordoniu [...]; lilium Medi­cinae. part. 1. c. 12. de va­riolis. aut si sanguis dominatur, aut virtus est fortis, fiat Phlebotomia de mediana, & postea de sum­mitate nasi: i. e.’ In the first place, if the body be ple­thoric, or if the Disease be such as is attended with abundance of blood, or if the Patient be strong, let him bleed first in the middle vein, and afterwards at the Nose.

Petrus Bayrus having repeated the signs of the Small Pox, Petrus Bayrus de pest. in ca­pite de vario­lis & morbil­lis. when they are violent, adds: ‘ His apparenti­bus statim fac Phlebotomiam copiosam, prius scilicet quam variolae ad extra appareant: licet possit fieri eti­am ipsis incipientibus apparere, stante multa repletione; non tamen tunc fiat ita copiosa, sicut ipsis non apparen­tibus: dicente Avicenna, in casu, Extrahatur san­guis quantitate quae exiret, hoc est minoret:’ i. e. when the Small Pox begin with such a vehemence of symptomes, presently take from the Patient a large quantity of Blood, before the Small Pox begin to come forth: yet may he also be let blood after they begin to appear, if there be a great repletion, but yet not in so large a manner as otherwise: for so Avicenna directs in the case: and let the Patient bleed in such a quantity as may dry the habit of his body: that is, you may les­sen the quantity of the morbifick matter, so to bring them forth to a kind maturation, but not so as to divert Nature from her work.

I shall not trouble my self to repeat the words of others at large; but refer my Reader to the places ci­ted. Horatius Augenius, Hor. Augen. de febr. l.x, c. 9. one of our best Writers up­on the Small Pox, (and who protests he writes no­thing in order to its Cure, but what six and forty years [Page 198] [...]d. ibid. c. 3.Experience had convinced him of to be good) doth allow, in difficult cases, and when the Disease is some­what pestilential, that the Patient bleed first at the Arm, and then at the Nose, by irritating it with Yarrow, or Horse tayl.

I. C. Claudinus Empir. rati­on. l. 5. sect. 1. c. 1.With him agrees the cautilous and learned Practi­tioner Iuleus Caesar Claudinus: who doth debate, and determine this doubt: as also doth Dilectus Lusitanus, Dilectus Lusi­ [...]anus de ve­nae sectione. c. xi. Artic. 1. p. 145. Epiphanius Ferdinandus cas. Medic. 78. Aemil. Campol. de variolis. c 413. in his Treatise of Venae-sectione: and Epiphanius Fer­dinandus, and Aemilius Campolongus. Neither is it to be questioned, but that this is the common practise of all Italy; so that I shall cite no more of that Na­tion.

In Spain 'tis approved of by Christophorus a Vega, whose words are these. ‘Si vero lactae fuerint va­riolae, & ab humore fiant crassiore, Christo a Vega de arte med. l. 2. sect. 7. c. 1. ab initio sanguinem mittere, si febris adfuerit; sine ipsa vero minime.’ And the best of Writers, Lud. Mercatus de puer. morb l. 2. c. 22 Vide etiam Ludo. Mercat. de [...]ebr. l. 7. c 3 & de recto Medicinal. praesid. usu. l. 1. c. 4. & Anton. Ponce Sanctacruz de impediment [...] magn. auxil. l. 3. c, 18. Ludovicus Mercatus is thus peremptory in his Resolution. ‘De sanguinis deiractione nullus usquam dubitavit, aut id sine ratione fecit, nisi aut vires sint adeo dejectae, quod neque mini­mam, citra majus damnum ferre possint, aut affectus adeo levis, aut benignus existat, quod satius sit naturae committere, quam ipsam infirmare sanguine misso, vel s [...]nguinis copia adeo parva, quod exquisitiori victus in­stitutione securius rem possis agere quam aliis praesidiis, quae licet aliquo modo possint convenire, non subinde sunt ita secura & certa, quod eis prorsus fidendum sit.’ i. e. Concerning Blood-letting no man ever did doubt thereof, or if he did, he did it without any reason, ex­cept the Patient were so weak that he could not en­dure it without greater hazards, or that the disease were so mild and benign, that it seemed better to leave all to the strength of Nature, without debilitating any way the sick person, or the redundance of blood and pec­cant humours so inconsiderable, that the Cure might be [Page 199] wrought by a diligent attendance and well-ordered diet, without employing any of those Remedies which how convenient or safe soever, yet (according to that fate which disposeth of all humane affairs) may some­times have an evil issue, and are not therefore needlesly to be presumed upon.

In Portugal I find Rodericus a Fonseca to approve of Phlebotomy in this disease: Roderic. a Fon­seca in appen. ad J [...]cchin, de febr. c. 54. & Cons. Medic. l. 1. cons. 48. Steph. Roderic. Castrens. Quae ex quibus. l 3. c. 16. As also Stephanus Roderi­cus Castrensis avoweth its utility upon his own Expe­rience.

I might add others, but that this is the general practise of Spain, is so indisputable, that I should but abuse the patience of my Reader.

I now come to Germany, and Denmark, where the most learned, and the most eminent Physicians that we hear of, have admitted of this Remedy. The benefici­alness thereof was experimented by that famed Practi­tioner, Forrestus. Forrestus obs. lib. 6. obs. 47. in Scholio: & ibid. obs. 46, 49. ‘Solet enim mirifice prodesse in hoc affectu hoc auxilii genus, modo tamen fiat in principio, antequam morbilli aut vari­olae egrediantur.’ i. e. It is usually of marvellous benefit to the Patient, if he bleed before the Small Pox or Measils do come forth: Whereupon he did ordina­rily begin his Cures therewith, and saith, that undeni­ably it ought to be so, if all requisite circumstances con­curre. Felix Platerus (a man of principal esteem in Switzerland, and Germany) recommends it to our practise, F [...]lix Platerus l. 2. de cur. variolar. inter opera, p. 200. ‘Sanguinis detractio per venae sectionem in brachio facta ab initio, si Synochi hae sunt febres, [...]u juscunque generis, ad sanguinis accensi, vel simul puiri­di, vel maligni etiam portionem educendam, causamque sic minuendam, in adul [...]is plurimnm competet. Quae & infantibus majoribus, cum in minoribus na [...]u non li­ceat, non inutiliter administraretur. Quae tamen, si jam maculae & pustulae eruperint, ne naturae motus impe­diatur, omittenda erit.’ i. e. Bleeding in the Arm, [Page 200] when it is practised in the beginning, if the Feaver be any kind of Synochus, arising from the inflammation of the mass of blood, or its being putrefied, or vitiated by any malignity, will be of great benefit to those that are of Age, to lessen the morbific matter, and abate the violence of the cause of the distemper. It might also be done to Children of some bigness (not to little ones) may be profitably. But if the Pox be coming forth it is to be forborn, least it cause them to retire in, Neither is it a common Elogy for this practise, that Gregorius Horstius commends, Greg. Horstius oper. medic. t [...] 2. l 6 in ap­pend. de va­riola: & ibid. de sebr. l. 1. Q [...]e ult. 1. Dan Horstius epist. x. Sennert. de febr. l. 4, c. xii. and justi [...]ies it.

And his learned Son, Io. Daniel Horstius asserts the the judgment of his Father. As cautelous as Senner­tus would seem, he only doubts concerning Phlebotomy in Children, not in others. ‘Si tamen in aetate, quae venae sectionem perferre possit, sanguinis abundantia ve­nae sectionem postulet, mox in principio ante quartum diem, aut sane prius quam variolae erumpant; dum vires adhuc constant, & sanguinis tanta copia ad ambitum corporis confluxit, vena aperienda, ut natura oneris parte levata, quod reliquuum est facilius vincere possit. Post quartum autem di [...]m, & ubi meculae erumpere incipiunt, abstinendum a venae sectione; inprimis si jam aeger melius habere incipiat, ne materia ad ambitum corporis tendens ad interiora revocetur.’ i. e. But if the Age of the Patient be such as to be able to endure Phleboto­my, and the redundance of blood be such as to make that Remedy necessary, a Uein must be opened before the fourth day, and whilest yet the Small Pox are not come forth, the strength not being yet impaired, and the blood so immoderately discharging it self upon the ex­teriour parts of the body: that hereby Nature being disburthened of a part of what molested her, may the more easily concoct and subdue the rest. But after the fourth day, and when they begin to come forth, Phlebotomy is not to be used, especially if the Patient seem alleviated, least thereupon the matter be drawn [Page 201] back which was hastening unto and fixed in the habit of the body. To these may be added Baldasser Ti­maeus, Baldassar Ti­maeus cos. medicin. l. 8. c. 29. Physician to the Elector of Brandenburgh, who after thirty six years of practise approved this course: and I. Petrus Lotichus: I. Petr. Loti­chius lib. 1. obs. medic. c. 7 obs. 13. D Sebizius disp. de vari­olis ult. qu. 4. I. Christ. Fram­man. discurs. medic. sect. 97 103. Fr. Ioel pract. l. 9. sect. 5. § 2 Th. Bartholin. Cissa Medica, p. 60. Also Hoeserus Her­cul. medic l. 7. c. 6. and S. He [...]enreffer de morb. cut. l. 2. c. 4. as also the younger Sebizius [...] now Professour at Iena; and I. Christianus Fromma­nus, a Physician in Saxony: and Franciscus Ioel: In Denmark I find Bartholinus to be resolute for it, be­fore the Small Pox do come out: and if they do not come forth kindly, but that symptomes of an evil pre­sage multiply upon the Patient, he allows a minute bleeding then, and sayes many have been happily recovered by these means. And so much for Ger­many.

In England the paucity of our W [...]iters upon this subject gives me no opportunity to defend Doctor Wil­lis by the citation of any Book: 'tis enough, that since the original and first records of the Disease no other Method than what he pursues, hath been commonly proposed: that the generality of the world, the wisest of Physicians, the most able and judicious of our Pro­fessors principled by Avicenna) do approve thereof: 'tis not bare complyance with the Mode of France, but the Dictates of Reason, confirmed by a prosper­ous success in several to my knowledge: I would fain see any man justifie the Rhodomontade of Doctor Whita­ker, by producing ten Physicians that reject Phlebotomy: I remember none but Fracastorius, Langius, Rolfinckius, and Densingius, and one or two more, and a company of old Wives and Nurses. I never yet Phlebotomised any; yet 'twas because I either had no exigency for it, or the Patients were too timorous to admit of it. But were my own life concerned, I would undergo it: and I hope the Baconical Philosophers have not so irrecove­rably infatuated this Nation, but that we may come to [Page 202] be undeceived in this point, as well as we have been in others.

Although it be not my intention to write an intire Tract about the Small Pox, yet that I may demonstrate the Rationableness of their procedure who do let blood in the Small Pox, 'tis necessary that I acquaint my Rea­der with those cases wherein they do apprehend them­selves obliged to act as they do.

In the cure of the Small Pox, whensoever a Physici­an employes his thoughts about Phlebotomy, he consi­ders the Feaver which attends it; and the dangers in­to which the Patient is likely to fall: and the strength he hath to bear them: not to mention those conside­rations which arise from the general season of the year, or the particular malignity of the Disease at that time, or the idiosyncrasy or peculiar temperament of the sick, or what is singular to some families. In the Small Pox there happen frequently three sorts of Fea­vers: one in the beginning, which usually terminates on the fourth day, or when they come forth: Another which begins when the Small Pox begin to come to suppurate: according to that old saying, Febris fecit variolas, & variolae febrem. And a third, which either ariseth afresh upon their coming forth, or is the conti­nuance of the primary Feaver, which if it abate not upon their eruption, creates new cares and troubles in the Physician.

As to the Feaver which is antecedent to the Small Pox: though sometimes there be none at all: and sometimes it be so gentle as not to create any mis-appre­hensions in the Doctor, or Sick; yet frequently it hap­pens to be joyned with putridity, or malignity, or to have something of the Pest it self: From all these cir­cumstances [Page 203] the cure must be varied; nor is it any dis­paragement for a Physician to act one thing at one time which he doth not at another; and to recede from vulgar Methods in extraordinary cases. In some cases he need not phlebotomise, if he see no violent Feaver, no pernicious or dangerous symptomes: if it be either a Tertian, or double Tertian, or Synochos simplex: the danger seems less: yet is it a certain observation, that oftentimes in the Small Pox, the most hopeful beginnings are defeated by sudden and subsequent acdidents: so that very many of those whose recovery hath been un­doubted at first, have in the progress and conclusion of the Disease died. Lud. Mercatu [...] de puer mor­bis, l. 2. c. 22. ‘Hoc primum sciat & consideret, prae oculis semper habeat prudens & diligens Medicus, nimium fidendum non esse plurimum in variolis & morbillis, quantumvis salutaria signa primo accessu ap­pareant: nam in recessu & inclinatione facillime in mortem commutantur: tali [...] est horum morborum frau­dulentia & conditio.’ Besides this, it often happens that a salubrious and simple Synochus turns to one that is putrid: and then the danger is, least what is intend­ed by Nature for a depuration of the Blood, become cor­ruptive, and ends in the death of the Patient. Also it is frequently seen that the exorbitant matter is so much, or Nature so weak as not to discharge it into the habit of the body, or there is some particular imbecillity in the principal parts, that the Disease seizeth on the Lungs so violently as to exulcerate them in the progress of the Disease, or so debilitates them that the Patient lan­guisheth in a Consumption; or else it settles in the Glandules of the Throat, and the Patient dyes of a kind of Squinancy, according to Avicenna. ‘Nam qui ex variolis moriuntur, Diom. Amic [...] tr. de vario­lis, c. 8. inquit Avicenna, plerumque ex an­gina suffocati pereunt, orta minium inflammatione in gutture.’ Sometimes the matter taketh a wrong course, so as that a Flux ensues, which sometimes be­cometh bloody: and this be [...]als the Patient either be­fore [Page 204] they come out, or a little after they have appear­ed: or in the declination: in all which cases, 'tis a bad sign: but in the last, commonly mortal. ‘Si debet hujusmodi res experientiae judicio terminari, [...]or. Augen. de febr l. x. c. [...]. haec fi­dem faciet, fluore in declinatione adveniente, etiam si non sit exulceratio [...]s, majorem aegrotorum partem mori.’ Sometimes the matter is so acrimonious, that it corrodes the bones, as Paraeus testifies upon his knowledge. ‘Quinetiam animadvertere licet in plerisque hujus morbi malignitate mortuis & dissectis, Ambr. Paraeus Chirurg. l. 9. c. 1. eum in principi­bus partibus invehi corruptionis impressionem, quae hy­dropis, ph [...]hiseos, rauvicitatis, asthmatis, dysenteriae ulceratis intestinis, ac tandem mortis consecutionem at­tulerit: prout pustulae pari rabie debacchatae sunt, qua per corporis superficiem furere ce [...]nun [...]ur: non enim externas modo partes deturpant, pustularum & ulcerum altius sese in carnem defigent [...]um impressionibus & ci­catricibus relictis, sed & saepe movendi facultatem adimunt, arrosis & labefactatis cubiti, carpi, genu & pe­dum dearticulationibus. Quinetiam multi inde viden­di sensum amiserunt, ut nobilis Do. Guymeneus; alii audiendi, alii olfaciendi, oborta hypersarcosi in meatu tum narium, tum aurium.’ There being so great dan­ger in this Malady, I wonder that Doctor Whitaker should ever look upon it as contemptible: saying, ‘This disease of the Small Pox was anciently and generally in the common place of Petit and Puerile diseases; and the Cure of no moment.’ It is true that Physicians do usually reckon it amongst the Diseases incident to Children: and they do believe that Chil­dren pass it over with less danger than more adult per­sons: because in them the Humors are not so accrimoni­ous as in others: their habit of body is more lax, and gives the humors a freer course through the flesh, their skin is more perspirable, and their innate heat more [...]i­gourous than in others: It is also true, that they do hold that sometimes the Small Pox are so mild, that [Page 205] there is little or nothing to be done by the Physician: But 'tis no less true, that from the dayes of Avicenna and Rhases unto ours, none ever thought or writ, that the Cure was absolutely of no moment. Avicenna de febr. c. 6. For Avicenna in his Treatise of the Small Pox represents unto us a great deal of danger in the Disease; and though he grant it is sometimes facile; yet he cautions the Rea­der sufficiently how malignant, perillous and mortal it is at other times. Horatius Augenius and others aver, Hor. Augenius de febr. l. 9. c [...] 4, 6, that this Ebullition is sometimes such as tends to the depuration and perfecting of the blood; and sometimes to its depravation and putrefaction: And as they com­pare the one to the ebullition os Must, by which it is im­proved unto good Wine, so they compare the other to those effervescencies in Wine when it frets, and dege­nerates. Neither is Doctor Syden [...]am less mistaken, when he forbids the Physician to make use of any ge­nerous Medicaments, but to leave the whole work to Na­ture, and to proceed according to that Regimen which he suggests; he representing the disease as facile in it self, and only mortal or dangerous by the errors of the Nurse, or Physician: Whereas it is evident that the Small Pox are at some times accompanied with greater danger and worse Feavers than at other times: and all that difference which is to be seen in the Pox, that they are green, or livid; flat, or high; horny, or more soft; [...]ew, or so numerous as to over-run the whole entrails, as well as skin, and there to run one into another, and flux; this doth not arise alwayes from the miscarriage of the Attendants, but from the malig­nity and quantity of the morbifick matter; as observa­tion and common reason will inform any man.

Let us therefore judge better of those sage Practi­tioners, who proposed unto themselves sundry scopes in the cure of this disease: and thought it their pru­dence to prevent all the dangers imminent or present, by a cure like unto this.

• [Page 206]First, They examine the habit of the Patients body, if it abound with blood, or evil humours: the redun­dancy of the former they conceive may be such, that upon a violent ebullition Nature may not be able to rule it, but either some vessels may break, or the Pati­ent be strangled by a decumbiture of the blood upon the Lungs, or Brain, or a bloody flux ensue, if it take its course that way; or a bloody urine, if it incline to the Kidneys. The renundancy of evil humors they do ap­prehend to carry this hazard in it, that it may pervert the whole mass of blood upon the febrile effervessence, and add such a malignity to the morbifick matter in its expulsion, that the evacuation thereof by pustules may not put a period unto that Feaver, but continue or exas [...]perate it, to the mortal danger of the Patient: such evils they think may easily be prevented by a due me­thod in the beginning; but in the progress of the Dis­ease, they are either remediless, or not to be cured but with much difficulty. Therefore their first intention is to lessen that plenitude of Blood, and other Humors, which they find in the Patient.
• Secondly, They examine the Nature of the distem­per, what the Feaver is, whether a simple Synochus, or one that is putrid; a causos, or continued tertian: They consider the violent symptomes what faculties they effect, or what parts: and according as they see occasion they apply themselves to correct its maligni­ty, or to moderate its fervour; without indeavouring to extinguish the Feaver.
• Thirdly, They consider the danger that the Eyes,
  Fuerint ulcera maligna in faucibus, in asperaarteria, in aesophago, in intestinis saepe­n [...]mero, quae hominem non multo negotio de medio to [...]nt. Hor. Augen. de febr. l. x. c. 2.
  Throat, Lungs, Stomach, and Inte­stines are in, should the Small Pox affect them: they know that if they be driven forth into the habit of the body, and those other parts kept inviolate, there is little of [Page 207] danger: but on the contrary, if the humors discharge themselves on them, now all other fears vanished; yet upon the suppuration (which brings a new Feaver) horrible symytomes must ensue in the Stomach, Bowels and Lungs. And therefore they think it ought to be their care to mitifie the humors, and fortifie those parts.
• Fourthly, They consider the manner of their erupti­on; and if they come out kindly, they intermeddle not: If they either come out slowly, and in the mean time create Epileptick and convulsive fits, or other danger­ous symptomes, they promote their coming out: and according as they perceive by their colour, and other signs, that they are malignant, they apply themselves to amend those defaults: If they find Nature to exor­bitate in their expulsion, and that they come out so thick that there is not sufficient room for them, but that they run one into another: If the Feaver conti­nue, or increase, because that destroyes the due suppura­tion of the pustules, they apply themselves to moderate the excessiveness of that evacuation, and to correct that Feaver, which is not to be terminated by any new excre­tion of that kind, but to be cured in a manner as other putrid Feavers are: and in this case all judicious men must allow no greater regard to the Small Pox, than a symptomatical evacuation deserves.
• Fifthly, They imploy their care in securing such parts as are particularly indangered by their eruption; expedite the maturation of them, if it be to slow, and difficult; hinder their regress, and suffer not any recre­mentitious particles again to reincorporate with the blood, and beget a new Feaver, or other dangerous symp­tome: and in case any new distemper happen (as some­times a Pleurisie, or the like may do) they provide for the due cure thereof.

[Page 208]These are the common intendments of all rational Physicians: these things Doctor Willis (whose short discourse of this disease contains in a manner all that our best Writers do suggest) doth propose to him­self: and whosoever doth ponder well the course of the disease must assent thereunto. Let the Motion be critical; all intelligent men know, that before the Crisis, if we perceive any threatning danger, that Na­ture cannot command the exorbitating humors, but that the present symptomes are perillous, and the future issue uncertain: If the Crisis be immoderate, and not agreeable to our desires; If it bring no alleviation to the Patient, our hands are not bound up, nor are we prohibited to intermeddle even by generous Remedies. As little are we confined by the Hypothesis of Doctor Sydenham: for, if Nature be inclined to change the state of the blood, yet are we obliged to assist her, if she be too weak, and deficient, or exorbitant: and our providence hath the same liberty to exert it self, that any other principles indulge it in.

I come now to those Means by which Physicians principally are said to act: and those are the great Re­medies, of vomiting, gentle purges, and bleeding; and to declare the usefulness thereof; 'tis necessary that we consider that Small Pox under a twofold notion. As the Feaver precedes; and as those Pustules do accompany it: I think those Physicians to have written most discreetly, who divide Feavers into two sorts: viz, Febres solitariae, and Febres comitatae: these last they distinguish from symptomatical Feavers, in that those do succeed others and depend upon them as their Causes: but these others do precede some other di­stemper, or arise with it, and are either a cause or occa­sion thereof: and upon the appearance of their com­panion-disease they cease or abate: such are Squinan­cies, [Page 209] Peripnenmonies, Pleurisies, the Small Pox, &c. ‘Comitatae febres continuae sunt, F. Platerus prax. t. 2. p. 13 de febr. gene­rib [...]. quae aliquem mor­bum qui ipsas vel exitavit, vel qui ab illis prodiit, comi­tem habent, aliaque praeter ea quae febris solitaria af­fert symptomata, a morbo comite prodeuntia, & cum febrium accidentibus complicata, febriumque naturam aliquando permutantia.’ In this distinction we are freed from those impertinencies which others molest us with, as if the concomitant disease were a crisis of the other: whereas indeed this concomitancy makes us look on them rather as a complication of maladies, than any such succession as is feigned; and we are thence obliged to consider what indications arise from this conjunction: for it is confessed that in these cases the primary disease is not terminated, nor altogether to be cured in the usual manner, but with a regard to its associate: but our care ought to spend it self so as that the primary Feaver may innocently and without prejudice to the sick introduce its Associate, and that conclude with an happy recovery. To do this we consider the nature of the primary Feaver: which is in the Small Pox a simple Synochus, or a Synochus pu­tride; and sometimes a Tertian, or double Tertian, or some malignant Feaver. These we are so to manage that they neither become exorbitant, so as to destroy the Patient before the Associate discovers it self, nor then become so depraved, violent, or malignant, as to di­sturb the subsequent cure: No man can in reason doubt but the best and most direct means to moderate the primary Feaver is to begin betimes; Hippocr. l. 2. Aphor. 20. for then the di­stemper is less violent, and Nature least debilitated: What we are to do then the course of the Disease best teacheth us; in which the most enormous vomitings are so far from doing hurt, that they are beneficial to the sick: It is therefore manifest that a Physician, who is to imitate Nature, may in the beginning (as he sees oc­casion, [Page 210] and upon due pondering of all circumstances) administer a vomit: for, it is neither repugnant but congruous to any of those primary Feavers; nor contra-indicated by the Associate: For hereby those excre­mentitious humours are evacuated, which would other­wise in the progress of the disease add to the distem­per, producing Phrensies, Sopors, or other malignant symptomes; also part of the super-abundant turgent matter is exhausted, and the Lungs (who are frequent­ly endangered by a Catarrh in the beginning) are dis­burthened: as also the eruption of the Small Pox is facilitated: T. Bartholinus de augin. Epidem. ex­cicit. 4. p. 56. Vomits being alwayes held by the Me­thodists amongst those Medicaments which principally relax the habit of the body. In case that there ap­pear urgent Reasons against a Vomit: the next thing under consideration, is a Minorative purge, whereby the Stomach and Intestines being cleansed, and part of the Morbifick matter discharged from the Head, Lungs, and mass of Blood, Nature will be better able to over­come and regulate what remains. And herein the Physician is guided by Nature, which oftentimes alle­viates the Patient by a slight Diarrhaea before the Small Pox do come forth: Epiphan. Fer­dinandus cas. medic. 7 [...]. Nor is there any danger in such fluxes, as our Practitioners observe: Si Diarrhaea fuerit in principio non nocebit. And most of them allow a gentle befitting purge in the beginning of this Disease, not doubting thereby but to make the subse­quent course of it to be more benign, and safe; for the most turgent urgent bilious and accrimonious humors being carried off together with the promiscu­ous faeculencies of the Intestines; 'tis not easie to be imagined that any dangerous malignity can reside in the pustules, or any dysentery or flux ensue in the state or declination of the Disease; at what time it is ex­treamly perillous. I shall not inlarge upon this subject further (it not being my present intention) but refer [Page 211] my Reader, for his more particular instruction, to Ho­ratius Augenius, Ranchinus, Gregorius Horstius, Sen­nertus and Riverius: and if he desire Experiments for the happy use of Vomits, and Purges, and evidence that they do not retract the humors from the circumference to the center (Alas! Angel. Sala ternar. Be­zoart. c. viii. Forrestus [...]ib. 6 obs. 49. cum Scholio. y'tis not the time of their separa­tion or motion that way!) or impede their eruption, let him consult Angelus Sala, and Forrestus.

I come now to the practise of Phlebotomy, about which sundry Questions arise: As, Whether it may be `administred in the beginng of the Disease? and After the Pox come forth? In the State? and Declination? In all which times I do assert that there may happen such circumstances as may make it necessary: But in the beginning I think it may frequently be done with great convenience.

1. In the beginning of this Disease: that which urgeth is the Feaver and its symptomes, which if it be so violent that the Patient may be indangered before the Small Pox do come forth, or so debilitated that Nature may not be able to command them and concoct them by reason of their multitude or virulency (which the extremity of the Feaver, as well as habitual cacochymy, or the adventitious malignity may create) 'tis prudence in the beginning to prevent those pe­rils, which in a stort space will become remedi­less. If the body be Plethorical with either sort of plenitude, 'tis indubitably requisite to bleed: and our case here is like to those cases which possess the Brew­ers, Greg. Horstisu de variolis & morb. or Vintners, who whilest they attend diligently to the depuration and fermentation of their liquors: em­ploy a part of their thoughts upon the preservation of the Cask, least it break,

Nor is the present plenitude only to be considered, but the future, which will happen upon the increase of [Page 212] the ebullition and attenuation of the blood, together with the defective transpiration, which alwayes abates proportionably to the greatness of the Feaver: and in case any peril threaten from the violence of the Fea­ver, there doth not appear any more ready course (in such as are [...], or in the beginning are at their height, perhaps there is no other) then to let blood; whereby the redundancy is diminished, the course of the blood diverted from circulating or stagnating in the in­ward vessels, the habit and texture of the body changed in order to the more [...]acile expulsion of the Small Pox, and transpiration promoted, then which nothing contributes more to the alleviation of the first, and pre­caution of any subsequent Feaver, and malignant pu­trefaction of the Humors in the Pustules. ‘Quoties cunque enim corpus ventilatur & nullo modo transpira­tio prohibetur, Ioseph de Me­dicu apud Gr. Horst. [...]. 5. p. 50. facile putridae fuligines per poros ex­halantur, nec cordi communicantur, neque proin sequi­tur ulla febris: unica enim causa legitima & immedia­ta febris est, prohibita transpiratio; uti etiam illis qui a limine salutarunt Medicinam, notum est.’ i. e. Whensoever the blood is well ventilated, and insensible transpiration free, whatever noxious and venenate va­pours are contained in the body, which might other­wise fly up to the head, and cause incurable Phrensies, deadly Sopors, and Epileptick fits; or create Lipothy­mies in the Heart, or difficulty of breathing (which is a mortal sign in this Disease) in the Lungs, or a Diar­rhaea and Dysentery in the Intestines, or a virulency in the suppurating Pustules, and corrode even the bones and ligaments; these vapours exhale by the opened dores, and the Feaver abates: for any one that knows never so little in Physick, understands that the sole le­gitimate and immediate cause of Feavers is prohibited transpiration: From what hath been said it is evident, that of all Remedies Phlebotomy is the most important in the Small Pox, in the first begin­ning, [Page 213] whether the Feaver be a simple Synochus, or one that is putrid and malignant: and 'tis more a wonder that any man should oppose the due administration of it, then that all Europe in a manner should agree to the pra­ctise thereof.

Neither is it only to be administred to allay the ple­nitude (which generall occurs in this Malady) or to prevent the evils forementioned; but frequently for revulsion, when the malignant matter begins to af­fect the Brain, Stomach, Lungs, Intestines: For if du­ring the Feaver the Humors seise upon those parts with any violence, the Patient is in apparent danger of death, there being no way to prevent the suppuration there; and little hopes that the Patient will survive the distemper, or (if he do) escape a Consumption or Dropsie afterwards. Epiphan. Fer­dinand. cas. medic. 78. ‘Sunt aliae ita malignae, ut non solum carnosum genus adoriantur, sed ossa quoque dila­nient, & corrumpant, & quandoque interna membra principalia, ut hydropem generent, & nuper observavi­mus puellulum quendam D. Donati Profili nepotem mor­tuum ex hydrope ob variolas, & morbillos: quandoque vidimus alios consumptos ex asthmate, ob easdem vario­las: quandoque vidimus alios diarrhaea & dysenteria confectos ex morbillis & variolis, & alios gangrenatos & esthiomenatos.’ It is true that Physicians do not al­wayes regard the distempers of the brain in this disease, because albeit they may be very violent in the begin­ning, yet they afterwards cease of themselves: nor do they appear so highly concerned for the animal, as vi­tal functions: and in such cases great judgment is re­quired in a Practitioner rightly to distinguish betwixt what may affright others, and what ought to terrifie him: Si est bona vox, & bona respiratio, spes est in tu­to. ex Avi­cenna. Epith. Ferdinand. cas, medic. 78. But in case the first approach be accompanied with a violent Cough, hoarseness, difficulty of breathing, the beginnings of Squinancy from a pustulary defluxion into the Glandules of the Throat, or with swoonings, and perfrigerations of the hand. and feet; He that thinks [Page 214] Phlebotomy ought not to be administred (if other conditions permit) understands not himself, or com­plies too much with the prejudicate opinions of the Patient and Relations. The Authority of all Physicians almost justifies him: the Rules of Art direct him to it: the prosperous success which frequently follows thereon imbolden him to it: and Nature her self authen­ticates the practise by her sovereign example: for it is usual for Patients in the beginning of the Small Pox to bleed at the nose: I have known five or six in one [...]amily (adult persons) that bled of themselves eigh­teen or twenty ounces, with greater benefit: whilest I durst not be allowed to take away eight. Epiph [...]r. Fer­dinand. cas. med. c. 78. ‘Novimus plures infantes in principio quibus sanguis in copia ex­naribus exivit, & bene habuerunt, neque tot tantisque variolis & morbillis fuerunt afflicti unde multi autu­marunt, si puero multa sanguinis copia sponte vel arte exieret, usque ad animi deliquium, qoad vel non variola­bitur, vel non in tanta copia: nam variolae & morbilli vere sunt morbi a sanguine.’ With this Author a­grees the most experient Augenius, Hor. Augenius de febr. l. x. c. 3. ‘Saluberrimum esse provocare sanguinem exnaribus docuit experientia: nam quibus sponte effluxit, variolae pauciores & salu­briores evenerunt. Vidi hactenus pueros duos, qui ex sluore sanguinis e nare dextra tertio die immunes a fe­bre evaserunt, & quarto die supervenerunt variolae paucae & benignissimae.’ I add the words of Diomedes Amicus, who having recommended the applying of Leeches, Yarrow, or Horse-tail to the Nose, thereby to cause a flux of blood, Diom Amicus de variolis, c x. prooceeds: ‘ Haec enim san­guinis evacuatio a naribus, vel sponte, vel arte factae adeo confert, maxime cum adsint signa fluxum sangui­nis portendentia, (cum tamen non fluat) ut solo fluxu isto aegrotantes istos sanatos vidisse Rhases dicat; Rhases 18. [...]nt. 8. & eum solum praeservare a nocumento oculos & alias fa­ciei partes dixerit Avicenna: quae sanguinis evacuatio ex naribus semper medicum excusat ab omni alia eva­cuatione: [Page 215] sicuti facit etiam qui per uterum, vel hae­morrhoidas fit, modo fiat cum alleviatione.’ The con­sideration of this so beneficial an effort of Nature made Augenius and others to direct that after Phlebotomy in the Arm; the Patient should be forced to bleed at the right Nostril (in relation to the Liver) or at both: and in the cure of Antonio Borghese, a Nephew of Pope Paulus V. a Colledge of Physicians at Rome did prescribe Leeches to be applyed to his Nostrils, Philander Co­lutius in de­dic. Marsil. Cagnati super aph. 22. sect. 1. and his recovery was principally ascribed thereunto.

I shall not undertake to prescribe how much blood may be taken away at once: nor how often Phlebotomy is to be repeated in the beginning of the disease: I should expatiate too much by such a discourse; the general Rules are to be found in Augenius, Mercatus, Horstius, Ranchinus, Epiphanius Ferdinandus, &c. and the accom­modation thereof to particular cases doth depend wholly upon the judgment of the Physician employ­ed; How Children (in whom the Disease, if they can be ordered) is less dangerous commonly: and how Men according to their different habits of body, and other circumstances (it being more perillous in them, their fl [...]sh being more solid and tenacious, their bodies less perspirable, and their blood and humors more acrimonious) are to be ordered: When the Lan­cet, when Leeches, when Cupping glasses and Scarifica­tions are to be made use of; the wise do know, and the ignorant may learn, if they will study to improve by study that time which they mis-spend in censuring the prudent actions of their betters.

Before I proceed to the second Question, it will be convenient to decide that Controversie about Phlebo­tomy, Whether it draw from the Circumference to the Center, and may hinder the erupti­on, or cause the Pustules to return in, or [Page 216] subside? That there are some eminent Physicians who do hold, that Phlebotomy doth draw the Humors from the Circumference to the Center, I do grant: and in the case of the Small Pox, that it may chance to do so, is the suspicion and fear of Avicenna and Holle­rius, as well as Doctor Whitaker. But why the Doctor should be scrupulous here, who hath so great a regard for the Ancients, (though he cite no good Authors) is to me a Miracle: For besides the Methodists, who are more ancient than his Citations; the repute of Galen and Aetius (whom Septalius entitles to the Opinion) ought not to have been supinely contemned: and the Authority of many of the Moderns (which a man that cites Fernelius ought not to slight) doth prove unto us that Phlebotomy doth promote transpiration, eject the peccant humors to the Circumference, and not re­vel them back: and this is the Opinion of the learned Septalius, Lud. Septal. de pest. l. 5: c. 17. Greg. Horstius Instit. Medic. disp. 18. co [...]ron. de venae sect. qu. 7. Ioseph de Medicis apud Gr. Horst. t. 2. p. 52.53. Collado obs. in Hollerii meth. c 93. Botallus de venae sect. c. 5. sect. 6. Gregorius Horstius, Ioseph de Medicis, Collado, Botallus, and several others. I have said enough to decide this point in the preceding discourse about the natue and effects of Phlebotomy: Yet since it seems in this place peculiarly necessary to be again spoken un­to, I thus argue thereunto. If it be true that Blood-letting doth draw the humors from the Circumference to the Center; how is it that Hippocrates, Galen and all the Dogmatists do prescribe Phlebotomy in Pleuri­sies, and Inflammations of the Liver, and Lungs? Is this the effect of that Revulsion, that the Humors should [...]low more inward? and from the surface to the center? Is it upon this sentiment that Physicians reiterate their Phlebotomies? or practise them at all in the Itch, Leprosie, Hippocr. sect. 6 aphor. 25. or Erysipelas? Doth not Hippocrates caution us against the returning in of an Erysipelas? Yet is there no man that can rationally condemn bleeding in that Disease? How often do we read the happy effects of this usage in pestilential Diseases after the eruption of the Spots (which Septalius tried upon himself; Septal. de pest. l, 5. c 17. [Page 217] and Minadous upon an infinity of Patients) and of the Parotudes (of which Riverius boasteth) of the Carbuncles and Botches (the successfulness whereof con­verted the other Physicians to adhere unto Septalius, Io. Baptist. Minadous de abusu non mittendi sang. c. 14. Riverius prax. medic. l. 17. c. 1. in opposition to the timorous Francastorius) and even of the Small Pox, in which Avicenna alloweth of it before their eruption, and sometimes after it? Consi­der the Authors, and the Cases related concerning the prosperous issue of Phlebotomy in the Small Pox, and how speedily they have come forth thereupon; and see if it be possible to frame a ground for such sentiments, as Doctor Whitaker [...] suggests: I will not here repeat the multitude of cases recorded by the French, Italian and Spanish Physicians; nor alledge the cases out of Forrestus: but content my self with the single instance of Heurnius. Heurnius in lib. 2. aphor. 15. ‘Quin si dyspnaea adfuerit cum ex­anthematibus, interdum ad Phlebotomian venimus. Ita nobilissimae comitissae hymondanae Franciscoe, Admi­ralii filiae, venam pertundi jussi, cum exanthematu non satis prodirent, idque felici successu.’ Can we imagine that if the proper effect of Phlebotomy to draw in the humours, that it should so frequently, nay uni­versally, produce so different an operation? Or, is it not more rational to think that the proper effect thereof is to draw from the Center; and that when­sover it happens otherwise, 'tis by accident only? Doth not Collado argue judiciously against the generality of that Assertion? Collado obs. in Holler. me­thod. c. 93. viz. All Phlebotomy draweth from the Circumference to the Center: when he reasons thus?

• Whatsoever doth draw back the humours from the Circumference towards the Center, is noxi­ous in the Small Pox.
• But some Phlebotomies are not hurtful in the Small Pox.
• [Page 218]Therefore some Phlebotomies do not retract the Humors from the Surface to the Center of the Body.
• Which Conclusion is contradictory to the uni­versality of the Proposition aforesaid.

I hope I need not inculcate to those of the contrary te­n [...]t that old Rule in Logick: ‘Syllogizari non est ex particulari.’

Pag. 14 [...]. edit. 2.As for Doctor Sydenham, he grants that 'tis most false for any to say that Phlebotomy (and other evacuati­ons) hinders the eruption of the Small Pox, by introdu­cing a contrary motion to what Nature intends by the Circumference: Since that 'tis commonly seen to hap­pen quite otherwise, they suddenly coming out thereupon: and therefore he suggests other Reasons, but of little validity. ‘Per hasce evacuationes non tan­tum ebullitio nimis imminuitur, Ibid. p. 141. cujus interim ope par­tes despumandae accurate secerni debuerunt: verum etiam illud ipsum subducitur, quod caeptae secretioni quasi pa­bulum continenter suppeditaret; unde saepenumero con­tingit, ut variolae primum laudabili impetu erumpentes (coque fortasse melius, quod evacuationes jam dictae praecesserant) paulo post ex improviso quasi repercussae detum [...]scunt, idque ob eam potissimum causam, quod materia desit, quae quasi a tergo praeeuntem insequere­tur, atque agmen clauderet.’ These are his most im­portant and perswasive Reasons! so conformable to his Observations, that he makes them the Basis in a manner of his practise! so powerful, that all that the Physicians have observed, said, and writ for above seven hundred years is not worth a straw in compari­son thereof! Ep. dedic. ad cl. R. B. Such is the Treatise of his, Quae etiamsi neque mole ampla, neque spoliis Authorum (quorum cineres per me molliter cubent) sit sufferta, tamen non e [...]it, uti spero, eo nomine tibi minus grata, quippe [Page 219] qui inter magna quid intersit & tumida non ignoras! I have wondered often that his Books should meet with any applauds: and with what confidence he could ob­trude upon the World so irrational and absurd a piece; except it were to shew how judicious in fra­ming of Hypothesis, and exact in their observations these Baconical Philosophers are. I would not be under­stood to say the Doctor is a Con­jurer. But, not to disturb the repose of Fr. Bacon, or Bungey ( quorum ci­neres per me molliter cubent) all that he proceeds on in that Book about Feavers, amounts to this, that Nature affects a new state and disposition of the Blood; and so produceth a Feaver. ‘Febrilem sanguinis commotio­nem saepe (ne dicam saepius) non alio colliceare, De feb. con­tinuis. p. 5. quam ut ipse sese in novum quendam statum, & diathesin immutet.’ Well, for discourse sake, I will now allow him this: but I must remind him that he saith the same of the Small Pox: How then comes it to pass that the Indications are not the same, where the supposi­tion is the same, and the procedure of Nature the same, by Ebullition and Despumation? Before, he ex­pressed himself thus; pag. 6. ‘Ita mecum reputo, Indicatio­nes veras, & gemines quoe in hoc morbo consurgunt, in eo versari, ut sanguinis commotio intra modum naturae proposito congruentem sistatur; ea nimium ratione, ut nec hinc plus aequo gliscat, unde periculosa symptomata insequi solent, nec illinc nimium torpeat, quo pacto vel materae morbificae protrusio impediretur, vel sanguinis novum statum effectantis labefacturentur conatus.’ We were then allowed to intermeddle, as we saw occasion, and to assist Nature by Vomits, Purges, and repeated Phlebotomies, in case the Ebullition were so violent, as that it was incongruous for the affecting that change in the mass of blood; or on the contrary so defective, as not to be able to bring it about: But now, when the same things fall under our debate; the same Ebullition, at­tended with no less violence and danger (rather much more) and the like despumation is to be effected, how [Page 220] come the Indications to vary, and that our hands are tyed up from prescribing those Remedies, which a parity of Reason doth ligitimate? If it were not ne­cessary, we were then obliged by our Observator not to busie our selves: but amidst the aforesaid circum­stances we might interpose our aid: and why not now? No Reply can be made but this extravigant and intolerable Assertion; that, In the Small Pox there never can happen any immoderate, or defective Ebulliti­on naturally; but it must arise from the errour of the Physician, Patient, or Attendants. And all the proof of this that I can find amounts to no more, than that some, or many have been recovered by doing nothing in the Small Pox; when Salubrious that oftentimes upon Phlebotomy, and other evacuations practised in the beginning of the Small Pox, though they have come forth well (nay the better for the use thereof) yet in the progress of the disease, they have subsided, and re­turned in: those antecedent Remedies having either rendered the Ebullition too minute to finish the despu­mation, or having carried off part of that matter which should have brought up the rear, whereby the forlorn-hope, or vant-guard are disappointed behind. Most excellent! But may not I say on the other side, that since we oftentimes see that the Small Pox are preceded by a malignant, pestilential, or putrid Fea­ver (no defaults in any person being to be alledged in the case) and that many (sometimes most) do not recover: that in those difficulties we are exempted from his general Rule, and cannot without betraying our Patients and our own repute, omit those Remedies, and moderate the Ebullition, or correct it? Is it not so apparent that none, but such as prejudice hath rendered blind, and deaf, can deny it, that Nature frequently produceth an effusion of blood at the Nose [Page 221] (or menstrous) in this disease, to the benefit, at least not to the detriment of the infirm? Nuper, cum 1665 vario­lis decumberent filii filiae [...] que, uri prae caeteris san­guine florido rubenti, li­benter nonnihil sanguini [...] subtraxissem prius quam eruptio fieret: sed incerti eventus metu retractus optimum consi­lium intermisi, quod proficuum videbam: In mittendo enim sanguine non tam annos Medicus numerat, quam vires aegro­tantis aestimat, Celso prae­ [...]unte. Negligentiam ta­men meam vel metum sup­plevit Natura optato suc­cessu & felici variolarum eruptione. Quippe quot­quot ex meis decubuerunt, plerisque delirantibus, e­ruptionem variolarum, hae­morrhagia narium praeces­sit, qua sublevata Natura promptius expulit variola [...] numero plures, sed nulla alia malignitate infestas. Bartholin. medic. Dan. dis­sert. 9. p. 428, 429. Is it not most notorious in England, that oftentimes people are vomited, purged, and blooded, in the beginning, they not suspect­ing the malady, and yet none of these in­conveniencies do ensue? Cannot the a­vowed practise of Italy, France, Spain, Africk, Egypt, High and Low Germany, and of many in our Nation, convince a man that these ill consequences do neither gene­rally nor necessarily follow upon the due administration of Phlebotomy? So that neither is the Ebullition rendered too minute (which may sometimes be almost insensible) nor doth the Van run away for want of a Rear-guard. If it be so, as 'tis un­deniable, and our Book-cases make it good, I conceive the Doctors Reasons to be as weak as any were ever alledged, and that whatsoever is the cause of those subsequent evils, the artificial use of Phlebotomy cannot be the proper cause thereof: since nothing is more true, than that old Axiome, Idem, quatenus idem, semper facit idem. But here those effects are frequently visible, where Phleboto­my is not used; and do not ensue, as frequently, where it is judiciously used: therefore those effects are not to be ascribed simply to the bleeding of the Patient. 'Tis an imbecillity of ratiocination to erect universal theorems upon a Saepenumero, or what oftentimes happeneth; especially if that oftentimes be coun­terpoised by almost as many, or more Experi­ments of a contrary event. Besides, who in Physick ever found out such a Rule, Vide Valles. meth. med. l. 4. c. 2. as Vrgency, or a Cura co­acta did not absolve the Practitioner from its obligation at some times? And that is the present case. We do [Page 222] universally grant, and Spain it self will joyn with Doctor Sydenham, Sed maxime notandum est, exire aliquand [...] variolas, aut morbillos, ita placide cum febre, vel sine febre, ut error sit venam secare. Commoda regio est, nullum acciden [...] urget, neque ex pulsu, aut alio signo cog­nosci potest latitans malum. Quorsum sine ulla indica­tione audet Medicus turba­re crisin? Auton. Ponce San­tacruz. de imped. magn. auxil. l. 3. c. 18. that in the Small Pox, when either there is no Feaver, or a mild and salubrious one, and that Nature without any dangerous symptomes doth expeditely and congruously carry on the work; we ought not, or need not to Phlebotomise: But we do say, some exigencies may happen (without any intervening errour) in which that practise is legitimate, because then necessary. I know not how diligent our Observatour was, when he took notice of such as miscarried upon Phlebotomy: were the Physi­cians besitting Artists? did the Patient, and all Atten­dants faithfully discharge their duty? was there no Malignity superiour oftentimes to all Medicines; no individual circumstances, such as commonly frustrate a Cure under the most judicious Methods? I must be in­formed of this, before I can determine, as our Author intends. Oh! what a misery is much study! and how many scruples is this Doctor Sydenham freed from, by suffering our best Writers to remain untouched, unconsulted!

But I need say no more: and therefore proceed to the second Question.

The second Question is; Whether in the AUG­MENT or increase of the Small Pox, it be law­ful to let the Patient bleed? For the better under­standing hereof, I think it requisite I explain what I mean by the Beginning, Augment, State, and Declination of the Small Pox. I intend by the Beginning all that time which intervenes from the first illness, decumbiture, or Feaver, until the Small Pox do begin to appear: this space is uncertain; for commonly it exceeds not three, or four dayes: though I have known it to be much longer before they have [Page 223] appeared. Zacut. Lusi­tan. Medic. princip. hist. l. 2. qu. 2. And Zacutus Lusitanus shall confirm it to any one that doubts the truth of my Observations. ‘Variolae in die septimo, octavo, undecimo, & duodeci­mo; &, quod plus est, vigesimo saepe apparere solent, quando natura prae humorum onere pressa causam mor­bificum citius expellere non potuit.’ Diomedes Amicus de variolis, c. 6. Diomedes Amicus saith he had a Souldier at Millaine under cure, who having had seven fits of an exquisite Tertian, in the end of the last paroxysme, the Small Pox came forth, and he remained perfectly freed from any Feaver, till their suppuration occasioned one, which ended in an happy recovery. 'Tis true the Feaver preceding the Small Pox may have its distinct times (which fall also under the consideration of a Physician) and some­times the Small Pox are so gentle, Horat. Augen. de febr. l. 9. c. 18. that this distinction cannot take place: But 'tis not to my present purpose to entreat hereof: I have sufficiently proved that Phlebotomy may be administred in the beginning: and the number of those that deny that, is very inconside­rable: but in the Augment many are more timorous. By the Augment I mean all the time from their first sensible appearance until they swell up, imbody, and ex­change their red colour for one more white: during which time commonly the Feaver ceaseth, or giveth little of trouble to the Patient: and this extends usu­ally to the seventh, ninth, and sometimes the eleventh day: sometimes it happens that the Pox arise one un­der another, and then the Augment of the for­mer becomes coincident with the state of the lat­ter.

It is not here to be debated, whether we may let blood in the Augment when it is gentle, and our progno­stics happy: but in difficult cases: as if the Feaver be so far from any alleviation upon their appearance, that it increaseth, and the symptomes become more terri­ble: If the difficulty of breathing become greater, or continue violent: If the throat become very sore, and [Page 224] be accompanied with a difficulty of swallowing: If the first deliriums persist, and there be danger of a Frenzy, or Convulsions: If the Cough be vehement: If swoon­ings or vomitings begin, or continue: If a looseness, or bloody flux, or bloody urine ensue: If they come out in­terruptedly, and disappear after they have come forth: If they come forth of a dangerous colour, or be very hard and horny (as they call it) or interspersed with purple spots: If they come out in such multitudes, that Nature seems oppressed, and incapable of disburthening her self, or ruling them in order to due maturation: If appar [...]nt danger threaten the Eyes: In these (and other cases that are perilous) it is controverted, Whether we may let blood? And I am for the Affirmative; sup­posing that either Phlebotomy hath not been admini­stred; or so diminutely, C. Cels. Medic. l. 3. c 18. Vallesius in Hippocr. sect. 2. aph 3, Ludovic. Mer­cat. de morb. pueror. l. 2. c. 22. M. I. Paschal. meth. me [...]. l. 2. c. x. H. Augen. de febr. l x. c. 3. I. C. Claudin. Empir. ratio­nal l. 5. sect. 1. c. 1. p. 286. Epiphan. Fer­dinand. hist. 78. Dilect. Lusi­tan. de venae sect. c. xi. Art 1 p. 145. Iose [...]h de Me­dicis apud Greg. Horst. t. 2 Hoeferus l. 7. p. 366. Bar [...]holin cist. medic. p. 101. that there is still occasion for it. Multa in praecipiti periculo recte fiunt, alias omittenda: I have already alledged the Authority of Avicenna and Rhases, and Bayrus, and the practise of Heurnius up­on the Countess of Egmond: I add here, that 'tis ap­proved of by Vall [...]sius, Mercatus, Paschalius, Fonseca, and the Physicians of Spain: by Horatius H [...]genius, Caesar Claudinus, Epiphanus Ferdinandus, Dilectus Lu­sitanus, and the vulgar practise of Italy: By Ioseph de Medi [...]is, Hoeferus, Bartholinus, and many other Physicians in high and low Germany: and the happy practise thereof frequently in this N [...]tion, hath given some credit thereunto. I mention not the French Physici­ans, because their Authority is excepted against in this disease: though no Nation (excepting Spain) hath ever produced better Practitioners, or more judicious men than they are. It being manifest then that the number of Physicians which approve the due admi­nistration of Phlebotomy in the Augment of the Dis­ease, and after that they begin to appear, is such as may justi [...]ie any prudent Man in the doing thereof; Let us now examine with what success it hath been done. [Page 225] The Countess of Egmonds case I have already reci­ted: Bartholinus avows the beneficialness thereof. ‘ Sunt tamen qui erumpentibus variolis venam secent, Th. Bartholin. cist. med. pag. 601. quando febris intenditur, anxietas, spirandi difficul­tas, angina, pleuritis, lotium crassum, & rubrum, alia­que symptomata apparent, ut detracta humorum portio­ne, reliqua facilius superentur. Certe si imperfecto prodeant exanthemata, naturae laboranti succurrendum, partim parca venae apertione, si copia sanguinis oneret, quod multorum felix eventus comprobavit, partim sudoriferis, quae, ubi malignitatis suspicio, tutius ad extrema corporis clinimant ichores.’ And Dilectus Lu­sitanus professeth the neglect of it to be an errour: ‘Qua in parte aliquorum Italorum Doctorum error & timor calumniandus venit, Dilect. Lusitan. de venae se­ctione cap xi Art. 1. p. 146. qui dum apparere vident va­riolus inviolabile servant praeceptum nullo modo san­guinem evacuare; & in praesenti casu exceptio facien­da erit, cum multa experientia viderimus in his quibus talis evacuatio fuit repugnata, & ante suppurationem pueros suffocari, & in multa illarum quantitate etiam suppurata. Non enim potest natura tanta regere & vincere ulcuscula, & ideo suffocatur, indeque multotie [...] pulmonia & alia superveniunt accidentia.’ 'Tis need­less to recite other cases: I proceed to the Reasons of the practise; which though they are easily deduced out of the foregoing Treatise, concerning the general effects and utility of Phlebotomy, yet may it not seem amiss to debate the controversie particularly in this place.

It is an Aphorisme of Hippocrates, that in the begin­ning of Diseases a Physician is to administer his prin­cipal Remedies: but in the state to supersede: Cum morbi incipiunt, Hi [...]p [...]cr. sect. [...] aph. 29. siquid videbitur movendum, move: cum vero vigent, quietem agere melius est. And the rea­son of that injunction is, because that in the beginning Nature is rather oppressed by the tu [...]gent and crude hu­mours, [Page 226] then as yet debilitated; the temperament of the body is not much vitiated, nor the mass of blood much depraved; nor the Disease highly prevalent. It being most certain, Id. ibid. aphor. 30. Circa initia & fines omnia sunt levissima: circa vigores autem vehementissima. In which Aphorismes the word beginning is so used as to include the Augment of the Disease: for he pas­seth immediately from the Beginning to the State of Diseases. Hier. Thriver. in Hipp. l. 2. aphor. 29. Id nunc manifeste ex verbis Hippocratis constat, qui principio nominato ad statum transilivit, tanquam Augmentum sub principio continuerit. Clarius id cognosces, quia morbum in tria duntaxat tem­pora partitur. And from hence we learn, that the most seasonable time for Phlebotomy is within the time of the Beginning of the Small Pox, yet so as it in­cludes the Augment, and may then judiciously be practised, in case it have been omitted before, or that new emergencies urge us thereunto: for if we delay then to use it, 'twill be too late to administer it, when Nature is more spent, the Blood and Humors more cor­rupted and perhaps degenerated into a malignity; the disease with all its symptomes more violent. If then after the eruption of the Pustules the Feaver continue, or increase, with evil symptomes; 'tis most evident that we ought to proceed to Phlebotomy, not only to dimi­nish the present plenitude of blood, and surcharge of pec­cant humors, to allay the vehemence of the present Feaver (by ventilating the blood) open obstructi­ons, relax the texture of the body; but also to prevent future evils, which will after prove remediless. For in case the Feaver continually increase, 'tis indisputable that no proper maturation of the Pox can ensue: the violence thereof interturbing that work, and depra­ving the expulsed humors so as to destroy the habit of the body, instead of suppurating in the skin: and their eruption is in this case perfectly symptomatical, because they bring no alleviation with them, but add to the [Page 227] danger so much as their maturation interferes with the proper cure of the putrid or malignant Feaver: If ever it be true that the expulsion of the Small Pox is a Critical motion, 'tis manifest that now they are to be looked on as judicatoria non judicantia, as efforts of Nature intending, but not being able to effect her ease­ment; and consequently they portend either a tedious and perillous sickness, Prosper Alpin. de praesag. vita & morte [...] l. 1. c. ult. or death. Omnes excretiones male sunt, quae non sedant dolorem—& quae non judi­cant, difficile judicium reddunt, atque quae laedunt in acutis morbis exitium praenunciant. And were there any danger of retracting the expulsed matter, as there is not (because neither doth Phlebotomy draw from the Circumference to the Center: nor is it an easie thing to draw back extravasated matter) yet would not the regard thereunto deterre us from this practise; be­cause in reference to the maturation of the Pustules, the Feaver here assumes the nature of a Causa prohibens, or an obstacle and impediment thereunto, which must first be removed. The case in hazardous; but 'tis now we must act with that prudence which obligeth us to attend unto what is most urgent; though we neglect not other considerations: Nor can any man in his wits doubt but that we ought to recurre unto Phlebotomy (even more than once) Cupping-glasses, and Scarifications, except by declining an uncertain pe­ril we will subject the Patient to one that is certain. Other remedy there is none: and what imports it, if the attempt be hazardous, since the omission is likely to be more fatal? we know not, nay scarce fear that we shall indammage the sick by the remedy; we are assured to do it, if we forbear: seeing that each mo­ment adds to his jeopardy, and so far incapacitates us to serve him, as it accelerates the state of the Disease; in which when the distemper is most violent, we are generally obliged to supersede: or if we were not, yet would our care spend it self to no purpose; for in [Page 228] such Small Pox there is not any declination, nor doth the Patient survive the State thereof. Hor. Augen. de febr. l. 9. c. 18. ‘ Status au­tem [variolarum lethalium] cum omnia in deterio­rem labuntur dispositionem: exulcerantur subdita partes, pus educitur maxime faetidum, nigricans, vi­ride; subjectum corpus plurimum contraxit ingredinis, ita ut totum videatur igne ustulatum, virtus imbecilla, febris interdum magna: atque tunc aegrotus moritur.’

Neither is this the only case in which a Physician ought to practise Phlebotomy; but it may be done safely and warrantably, if that the Small Pox do not come out kindly; but appear, and then retire in again, or come out so slowly, or evil coloured, as that the Pa­tient may be in danger to perish during the progress of the malady. For in the first case, is a certain sign that Nature is not able to govern those humors in the first eruption, either because of their malignity, or sur­charge: and if it be not to be done by her, when the Disease is not arrived to its height, nor she as yet much debilitated: how can we imagine, but she must fail in the vigour of it? It is there­fore requisite that a Physician (duly considering all circumstances) do proceed to secure the infirm by a minute, and perhaps iterated blood-letting. For it is not here as in other putrid or malignant Feavers, in which we have a greater latitude of practise; and what Nature cannot effect by one way of termination, may be accomplished by another. The concomitant Pox alter the course of the Feaver, and suffer it to admit of no other issue, but by a due maturation of the Pustules: since therefore that Phlebotomy promotes the eruption, and by altering the texture of the whole body and fa­cilitating transpiration doth diminish the morbifick matter, hinder putrefaction, extinguish the Feaver, and so alleviate Nature, that she is enabled to prosecute happily her work; I see no reason, but that it ought to be administred: and the same considerations do sway [Page 229] me to approve of it in the latter case: for if the Pox appear malignant in their first coming forth, their continuance will prove fatal, if this Remedy be not applyed: for we have none so effectual. No Mino­ratives can be used to disburthen part of the hu­mour; no powerful Cordials: for those, however they seem to yield a present benefit, do in the issue debilitate Nature, dissipate the spirits, retard the maturation, and oftentimes increase the Feaver, and occasion a Phreni­tis, or other deadly symptomes. Vesicatories are at­tended with no less jeopardy, not only for that they frequently cause bloody Vrines, and exulcerate the Bladder, and procure a vexatious tenasmus, (which I have seen to fall out, when they were applyed in other distempers) but because the ill-conditioned matter be­ing attracted to them, may cause a Gangrene, or other­wise endanger the Patient: upon which account, I do not remember any that ever proposed them in this Disease. 'Tis true, I knew a Person of Honour, who in France was four times blooded pretty largely before their eruption, and then had Pigeons applyed to his face and other places (because they came not forth well) and so was recovered: Prosper Alpin. de med. meth. l. 5. c. 9. p. 17 [...]. de medic. Aegypt. l. 4. c. 15. Melichius A [...] ­mament. me­dic. dist 9 in Scholio super Pilulis de [...]i­tro. 'Tis true that Prosper Al­pinus doth commend Inunctions with Nitre and Oyl of bitter Almonds to be used once or twice in a day: but besides what Melichius records, the practise being novel in England, and seldome used in Europe, I believe no discreet man will adventure his credit, or the life of the sick thereupon; but rather acquiesce in the received, warrantable, happy practise of the generality of Physicians.

In case that there be a great redundancy of the mass of blood in the aforesaid cases, so that Nature seems oppressed, and to be so streightned, as not to be able to free her self from the corrupted humours, who can doubt but the [...]hysi [...]ian hath more reason than [Page 230] otherwise to phlebotomise the sick in this time of the Disease? It is a Rule in Physick, That we ought to at­tend principally in diseases to that which is most urgent [...] [...]et so as not to neglect those other considerations which arise from the nature of the Disease. In this last case the regard unto plenitude is most urgent. For if there be so great a Plethora, as that there is danger least the Patient be suffocated, and the natural heat extin­guished, which is the supposition of Avicenna, when he sayes, Timetur super eum corruptio extremitatis. And if Phlebotomy either hath been omitted, or not admi­nistred as 'twas requisite, who can imagine that Na­ture will be able to govern and regulate so great a sur­charge to the benefit and recovery of the Patient, but that when the humours separate and extravasate, some part will mortisie and sphacelate, or the party be suffo­cated? It is really to be supposed that the sick per­son will dye within a short time, except Nature alle­viate it self by a large e [...]flux of blood at the Nose. It is here as it is in a Synochus putrida, (for commonly 'tis a Synochus putrida which accompanies the Small Pox) in which if either by reason of the reluctancy of the Patient, or ignorance of the Physician, blood-letting be omitted, the case becomes exceeding perillous, ex­cept Nature be very strong, or a great flux of blood, or plentiful sweat succeed: as Galen relates in the ninth Book, and fourth Chapter. 'Tis meer folly here to object, that albeit that Phlebotomy be omitted, yet ought we to presume w [...]ll of the Patient, because the Small Pox do come [...]orth: as when sweat appears in a Synoc [...]us: [...]or there is a great dispa [...]ity in the cases: The sweat is discharged out of the skin: the Small Pox are lodged in the surface of the body, and must there be maturated; besides that the Small Pox infest also all the inward parts; so that the danger is greater [...]re, than upon the eruption of sweat: Moreover the sweat consists of a more [...]ubtle and Ichorous substance, [Page 231] and finds a more facile and certain exiture; but the Small Pox are of a grosser substance, and come not forth with equal facility. It is also to be considered, that as a large evacuation by sweat may happily terminate a Synochus; so, although the Patient do abound with blood, Nature may sometimes so expel and regulate the matter, that the party may avoid the imminent pe­rils: but he that trusts thereunto must well ponder not only how plentifully the Pox come forth, but whe­ther it be proportionate to the exigencies of Nature (for whatever is not such, is minute) and what alle­viation insues: not to mention other things. And as when sweat doth not appear in due time, due quantity, with due qualifications, the Patient doth nevertheless dye: So we daily observe it to fall out in the coming forth of the Small Pox. And therefore I do assent un­to the directions of Avicenna, and Augenius, that in case of this urgency, Phlebotomy be judiciously made use of: and whatsoever danger may seem to be in it, 'tis prudence to submit thereunto rather than to incurre greater.

Hitherto I have treated of Phlebotomy as 'tis an eva­cuative and relaxing Remedy; but there is oftentimes occasion for it by way of Revulsion, when not only the Eyes are in great hazard to be spoiled, or the blood stagnates about the Heart, Lungs, and Thorax: or that the Small Pox very much affect the Stomach, and En­trails, or occasion a Diarrhaea, or Dysentery: For in these cases, 'tis most probable that the Patient either will not live to the state of the disease, or dye then. 'Tis a received tradition from Avicenna d [...]nwards, [...] that in case the Patient in the Small Pox do br [...]th free­ly, and suffer no defect in his voice, there is lit [...]le, or no danger; unless some accident introduce a Dysentery: Because that is a sign that the Throat and parts relating unto respiration are secure. But in case it appe [...] [Page 232] that the inward parts are infested by the Pox, and that swoonings, vomitings, difficulty of breathing, a soar throat, and great hoarsness trouble the Patient, 'tis most manifest that he ought to be blooded for revul­sion; least in the State of the Disease, the Pustules coming to maturation, may by their purulent stench annoy, or by their growth and inflammation suffocate Nature, or exulcerate and apostemate the Lungs. It is usually seen that people dye of the Small Pox in the State of the Disease (on the sixteenth, seventeenth, nay twentieth day) though they have seemed plenti­fully and kindly to come out: and the reason is (I abstract from all errors) because a due regard hath not been had to those that infested the inward parts: for they have exulcerated the Intestines and created Fluxes, they have occasioned in their maturation a new and perillous Feaver, a Squinancy, a Pleurisi [...], and particularly by affecting the membranes of the Sto­mach, they have created Vomitings and Lipothy­mies, &c. And this will seem credible to any that by considering what happens in the surface of the body, apprehend what must ensue upon their maturation within: and those Ignorants who have admired at these events in the state, and declination, will cease to wonder, when they assume these thoughts of Physici­ans, and weigh attentively the Augment, State and Declination of the Pustules.

To conclude this discourse; who hath not seen in the Augment of the Small Pox large eruptions of blood at the Nose, as also menstruous Fluxes ordinately and inordinately to intervene, without any peril; some­times to the great benefit of the sick? About fourteen years ago I accompanied an eminent Physician to a Patient of his, in whom the Small Pox were come out well coloured, and plentifully, yet did the Feaver conti­nue, together with a deliriousness, want of sleep, and [Page 233] restlessness: to all which a great Hemorrhagy at the Nose (of above fourteen ounces) did put a period: and of the latter case, I had (amongst many others) an happy Instance lately at Warwick.

I come now to the third Question: Whether in the State of the Small Pox Phlebotomy may be administred? I call that the State of the Small Pox, when they are come to their full bigness, and be­come white, and replenished with suppurated matter: or, in case they are malignant or deadly Pox, I call that the State, when the Pustules (being green, blewish, or black) are exulcerated, the subject parts corroded, and a stinking, black or greenish purulency issues. And here I avow that a Physician may sometimes according to the Rules of Art, and with great judgment admi­nister Phlebotomy. 'Tis most true, that I cannot (to my knowledge) defend this practise by the Authori­ty of any one Writer in Physick, I. C. From­mannus de venae sect. in declin. mor­bill. sect. 104. Hippocr. Aph. 29. sect. 2. except it be I. From­mannus, who finds some cases in which he justifieth it in the State of the Measils. 'Tis also true, that the common Precept amongst us is, not to disturbe Nature in the State, when she is busied most about Concoction; but rather to supersede from the great Remedies. But I have learned from our Masters, that there is scarce any Rule in our Art, the Obligation whereof is not suspended by urgency, and that they conclude us in the ordinary, not enforced procedures: ‘Necessity is absolved from all Laws; and Wisdome it self pre­scribes that we should not alwayes take its counsels: 'tis certain she meddles not with the regulation of ex­tremities, nor with the conduct of Despair: She in some encounters dispenseth us from those things, which in others she ordered us. Without offending her, we may cross the fields when there is danger on the right and left, and try whether an excess wil [...] not cure as [...] when other remedies have ill operated [...] [...]cast our selves [Page 235] into the armes of an enemy, when she is no longer able to defend us.’ I am told by Vallesius, that although Diocles, and Celsus, and some others have prohibited Phlebotomy after the fourth day: Valles. meth. med. l: 4. c. 2. and though Avicen­na profess that venae-section being once pretermitted ought not to be resumed: yet both these tenets are er­roneous: for though Phlebotomy be most convenient in the beginning of the Disease, yet ought it not to be excluded in the other times, when occasion requires it. There are few Diseases whose beginning extends not it self beyond the fourth day: and even in the decli­nation oftentimes we may beneficially let blood, for the attemperation of the inward parts, to ventilate the bo­dy, and allay its inward fervour: How much more then in the Augment, and State? Besides, Galen himself laughs at those who confine the use of Phlebotomy within a certain number of dayes. G [...]len. de sang. missione, c. 20. ‘Quocunque etenim die mittendi sanguinis scopos in aegrotante in­veneris, in eo praesidium hoc adhibeto, etiam si vig [...]simus ab initio morbi dies juerit. Quinam vero fuerunt hiscopi. Magnus morbus, virium robur, excepta aetate puerili, & ambiente no [...] aere admodum calido.’ In ano­ther place he s [...]yes. G [...]len. meth. l 9. c. 5. There is not any time of a disease in which you may not bleed; but the sooner it is don [...], the better. Another sayes, Vbi m [...]gnitudo morbi postulet, & vires permittunt, Hier. Rubeus in C. Cels l 2. c 10. p. 94. non solum octavo die, ut Hippocra­tes An [...]xioni, sed & decimo, ac vigesimo, felici successu `venam secamus. This point is excellently prosecuted and illustrated by [...]otallus, B [...]tallus de venae sect c. 22. Concerning bleeding in the Augment, [...] and Declina­tion of a pu [...]r [...]d [...]eaver, see Cas [...]ar Br [...]vo Resolut Me­dic. p 4. disp 1. sect. 7. reso­lut. 8, 9, 10. to whom I referre our Experimentators for to be satisfied. And I must avow that in other diseases I h [...]ve never scrupled at this caution, as others, but practised it with success in the State, and sometimes Declina­tion. And why we may not do it in this Disease? is the present Question. It is certain that in the Small Pox at this time, there happeneth sometimes a Strangulatory [Page 236] distemper or Squinancy, sometimes a Pleurisie; some­times a Diarrhaea or Dysentery: sometimes an immo­derate Flux of the Menstrua: In all these cases 'twere great indiscretion, if not ignorance, to omit Phleboto­my: If any of them can be disputed, 'tis that of a Diarrhaea and Dysentery: and yet that is so vindicated by Botallus, B [...]t [...]l [...]u [...] c. 5. Prosper Al [...]i­ [...]us de med. Aegypt. l. 2. c. [...]. and Prosper Alpinus, (not to mention others) and attested unto by a successful Experi [...]nce, that 'tis no longer a Controversie. I have already shewed that Phlebotomy doth not draw back the expel­led matter: but promoteth transpiration, which is impeded by the maturation of the Pox, during the State: it ventilateth the blood, hindereth further putrefaction, and diminisheth that plenitude, which, whatever it be, is too much for debilitated Nature to govern: it revelleth the impacted humours, or such as are flowing to any determinate part: so that not only in the aforesaid cases; but if a new Feaver arise then, or any danger threaten the Patient in the declination (both which cases often occurre) I do not see why it may not (or ought not) to be done, whatever the pe­ril be that may happen thereupon. Few there are but have so much strength, as to bear a small evacu [...] ­tion by blood-letting: and he is unacquainted with his prof [...]ssion, who hath not seen prodigious eff [...]cts arise from a minute Phlebotomy. Our Writers do sufficient­ly explain the signs by which we are to be assured, Whe­ther the Patient can bear Phlebotomy; and in what quan­tity: which conjectures if they be not duly pondered, ' [...]is the default of the Physician, not of the practise, when any sinister event doth ensue. And therefore I can only recommend to the World this caution, that they make use not of such Practitioners as talk most, and pretend to new Reasons, Methods, and Medica­ments; but of those who best understand the old Di­agnestics, Prognostics, Methods and Medicaments, in order to a cure: and have from more than one or two [Page 237] Books informed themselves of the history of Physick, as it relates to particular cases, and by a diligent at­tendance on their practise observed the tru [...]h of what they have read, and learned to accommodate their Rules to each individual. Could a man ocularly demon­strate all the curiosities of Malpighius by the best Mi­croscopes, or manifest the Ductus rorifer of De Bils unto any Spectator: nay, what if he could make the vola­tile Salt of Tartar, or the Helmontian tincture of Am­ber, or even the Philosopher's stone, what is this to pra­ctise? How much less are they qualified, who can al­ledge nothing for themselves then that they are enrol­led in the Society of the Rosicrucians; that so many men extol them, who are obliged to magnifie ( justly or undeservedly) all of their number; and that they are good Wits, ingenious Drolls, Masters of some Mathema­tical and Mechanical knowledge? As to the point of Concoction, that tis not to be hindered; In the Small Pox, if they be salubrious, this consideration is overswayed by present Vrgency; and if it were not, yet would that repugne only to a profuse evacuati­on; and contra-indicate no more, then doth the re­gard unto the strength of the Patient: a minute and partite Phlebotomy doth not impede any concoction; as our book cases, and daily practise sheweth: And in case the Small Pox be perillous or deadly, 'tis most certain that there is either no concoction at all, or so imperfect a one, that it doth not at all oblige the Physician to su­persede, but rather to proceed hereunto, except he be timorous and unwilling to disparage so generous a Re­medy, or the Patient and Attendants be averse from it. Neither of which regards are so authentick as to dero­gate from the attempts of those who will not abandon their Patients to the uncertain prognostics of acute dis­eases: however they may in some sort excuse those that take a contrary course.

[Page 238]The last Question is, Whether in the declination of the Disease a Physician may practise Phlebo­tomy? I call that the Declination of the Small Pox, when the matter in the pustules is condensed into Scabs, and they dry up, and the Epidemis with them doth pill off, leaving impressions or marks in the Skin. This Question doth not relate unto the mortal Pox, for they have no declination: Hor. A [...]g [...]n. de [...]ebr. l. 9. c. 8. Cas [...]ar Bravo resolut. med. part. 2. disp 3. [...]esol. vii. but to such as are salu­brious, and though they may have been accompanied with dangerous symptomes, yet are now in an hopeful way of recovery. Or if we must allow a Declinati­on in the pernicious malignant Small Pox, it can be only one that is uncertain and fallacious; for when any Patient feels an unexpected alleviation, and such is grounded upon no reason, there is no trust to be placed therein. Hi [...]pocr. aph. 27. sect. 2. ‘Tis quae non secundum rationem sublevant, non oportet fidere: neque terreri multum, ob mala quae praeter rationem fiunt: pleraque enim horum sunt in­firma, neque diu manere atque durare consueverunt:’ In this time, I say, there may happen such cases as require Phlebotomy, and in which it ought to be practised. 'Tis observed that a Flux in the declination of the Small Pox is generally mortal, Hor. Augen. de [...]ebr. l x c. 8. although it be not accompani­ed with a Dysentery or exulceration of the Gutts. It is no critical evacuation, because such happen not at that time: and because it be falleth the Patient in the most unseasonable time of the Disease, when Nature is most debilitated with the precedent Disease, and ought rather to testifie signs of strength, then of further im­becillity: it enforceth us to employ all those cares which a symptomatical evacuation doth call for: and in this case, since purging is dangerous, and astringents full of hazard, there seems no way so safe as Phleboto­my duly administred. It may also happen that the Patient fall into a Pleurisie: Thus in the case of From­mannus, in the declination of the Measils, the Gentlewo­man fell into a Pleurisie, which he indeavered to cure [Page 239] by Phlebotomy, and was defended in the practise by the best Physicians in Germany.

The Reasons which have been urged already in the other times will many of them justifie the Practitioner in this: and nothing is more certain in Physick, than that the use of Phlebotomy is not indicated by the time of the Disease, or contraindicated by any number of dayes, but by other motives: and that whensoever it is necessary upon any urgency, nothing but want of strength doth repugne thereunto.

It may perhaps be demanded, Whether upon the declination of the Small Pox, if there be any danger of an Asthma or Consumption to be contracted, it be safe to let blood, or in order to better conva­lescency?

I profess it may safely and prudently be done for Re­vulsion, before the humours [...]e more radicated and [...] there, and the Disease become incurable: for this is an infallible sign that the Disease is not well ter­minated: and then those Rules which oblige us not to intermeddle with any perfect Crisis, or indication, are infirm, conclude us not. Oftentimes we see Rheuma­tismes, and Botches to ensue, and they shew that all the morbifick matter is not ejected: Besides, in order to a better convalescence, if Phlebotomy have been omitted in the beginning, and that the recovery is likely to be slow, I think (and 'tis said to be the judgment of Avi­cenna) that it may be done: and I have seen it pra­ctised with a much more happy success than ever I saw Purge given in that time: But in this last case I referre it to every mans judgment to act as he please; and request only that they would not condemn others of a different practise from what they follow.

After all this discourse of bleeding in the Small Pox, I must conclude with this intimation, that in sundry cases, and some habits of body, 'tis possible that Phlebo­tomy [Page 240] may be supplied by Cupping-glasses and Scarifica­tion: and I profess, that were the Scarification of the Aegyptians (mentioned by Prosper Alpinus, Prosper Alpi­nus de medic Aegypt. l. 3. and fre­quently used amongst the Ancients) admitted into our practise, I should frequently prefer them before any Phlebotomy: Being in Iamaica I observed that the Spanish Negroes there did much use them: and during my sickness of the Colick bilious, I had the curiosity to have them tryed upon me in the beginning. I obser­ved that they were as indolent as Prosper Alpinus and Mannus do relate them to be: but no blood almost ensu­ed thereupon: whence they presaged to me a long and violent sickness; saying, that all the water of my blood was translated out of the veins into my bowels: yet I have seen them to extract one from another a pound, or more, as they pleased.

But I find my self wearied with the prosecution of this Letter; and the sickliness of the season permits me not leisure to carry on the debate unto the Scur­vey: But whosoever examines attentiv [...]ly that disease, [...]orre [...]tus l. 20. obs. xi.xii, Claudinus Emperic. ration. l. 3. sect. 3. tract. 4. c. 5. Ioel pract. l. 2. sect. 5. §. 4. [...]. Dodon [...]us obs. med c 33. Eugalen. de scorbuto, p 150.151. B. Brunerus (sub finem Eugaleni) & H. Bruc [...]us ibid. Bald [...]ssar Timaeus cas. medic. l. 3. cas. 39. Platerus prax. [...]. 3. p 431. [...]nnertus de scorbuto, c. 7. B. Ronsseus de scorb. c 8. Wierus in curat. scorbuti. [...]. Albert. de scorb. § 240, &c. M. Martinus, sect. 145. &c. Gregor. Horstius de scorbuto [...]xercit. 2. sect xi. Mollenbroccius de varis c. 8. & 1 [...] will be easily satisfied that it may be beneficial, and oftentimes absolutely necessary to the cure thereof. In those Countries where it is most frequent, and where the Climate bears a great corre­spondence with ours, this is the practise: as you may see in Forrestus: I add the Au­thority of Claudinus: Ioel, (who pre­scribes the repeating of Phlebotomy at least three times) Rembertus Dodonaeus: Severi­nus Eugalenus: Balthasar Brunerus: Hen­ricus Brucaeus: Baldassar Timaeus, (who also reiterates bleeding several times) Pla­terus: Sennertus: Baldwinus Ronsseus: Io. Wierus: Salomon Albertus: Matth. Martinus: Gregor Horstius: Valentinus Andreas Mol­lenbroccius: [Page 241] and the Colledge of Physicians at Coppen­hagen (in their advice for the Scurvey, Bartholin. cist. medic. p. 50 [...]. published by Bartholinus) I might add others to this Catalogue, but that 'twere needless. 'Tis true, that in the Scurvey many do not bear well large Phlebotomy; but that is not the Question: 'tis enough that they minute ve­nae-section, and that reiterated, doth agree well with them [...] and is oftentimes so necessary to the cure, that the omission thereof doth frustrate the most efficacious Medicaments. The Disease generally ariseth from an obstipation of the Pores, and such an alteration in the texture of the body as the Methodists would bring un­der Adstriction: and therefore it seldome occurreth in hot Countries, except the wind suddenly change into a cold quarter: and a multitude of Cures are recorded wherein Phlebotomy hath been the leading Remedy. The sick do frequently bleed at the Nose, and Em­rods, &c. and since in distempers of the Spleen I find Phlebotomy commended, 'tis not to be denied in this case, without some special contra-indicant, which I am not yet acquainted with.

I think I have in the precedent discourse enervated all that M. N. hath maliciously and ignorantly suggested against Phlebotomy: neither do I know one passage in him that can raise any scruple in the breast of a judi­cious person: but I must particularly caution him not to give too much credit to the dotages of Thonerus, a man of little note in his own Countrey; nor to go about to delude the World with Fables, as if the North [...]rn Climates did not suit well with Phlebotomy: whereas it is notorious that no Nations do bleed more largely [...] nor more frequently than they: I will not insist on what they do in their natural or artificial Bathes, with Cupping-glasses and Scarifications, Th. Iordan. de [...]lu [...] orav. p. 13. whereby they ex­tract many ounces frequently every year; they apply­ing ten, or fifteen Cupping-glasses, with Scarifications; which sometimes they repeat twice in one hour.

[Page 242]As to Phlebotomy, in Denmark nothing is more com­mon than whensoever the Almanack recommends bleeding, for every man almost to s [...]ep into the Barbers-shop, and having bled, to go about his business: which custom though Bartholinus condemn, yet doth it evince the general use thereof in time of health: and who can doubt but that they who bear it so well, whilest free from any Disease but a tincture of the Scurvey: might endure it in sickness? did not a pueri [...]e fear in the Patient, or ignorance in the Physician, hinder them. ‘Adultiores alii in venarum apertione nimis sunt pro­fu si vel audaces, Th. Bartholin [...] medic. [...]an. dissert. 9. p 4 [...]1, 432. quippe visa fascia rubente ante aed [...]s Chirurgorum appensa, ex Calendariorum signis depen­dentium, statim sine alia corporum praeparatione in sella officinae considentes brachium sine delectu pertun­dendum offerunt; & peract a operatione vel itineri se committant, aliisque negotiis conficiendis, vel vini mo­dium ebibunt: cumulati errores acri censura digni sunt: sed verba perdere nolo, quia Aethiopem me lavare scio. Monendum tamen duxi, scorbutica nostra corpora maxima indigere praeparatione antequam generoso isti remedio subjiciantur.’ If letting of blood were so pernicious in the Scurvey, 'twere impossible in so general a practise but the inconvenience would be dis­covered: and the people reclaimed from that invete­rate vulgar custom of Switzerland; is, he that blameth it, doth thus describe. ‘Solent nostrates, Ruricolae in­primis, ter quaterve in anno venaesectiones usurpare, Wep [...]erus de a poplex a hi­stor. 3. p. 12. & quolibe [...] vice duas, quandoque tres, non raro quatuor ve­nas pertundendas [...]urant; emittunt soepe binas sangni­nis libras: Nulla cura est vel temperamenti, vel sexus, vel aetatis: Videntur quandoque gravidae, quae bis terve gestationis tempore sanguinem vena secta ef­fundunt, nec etiam partui vicinae a venaesectione sibi temperant, persuasae salubrius puerperium agi. Vidi senes octuagenanios hoc remedii genus expertos: nec san­guine fuso admodum solliciti sunt, qua ratione inanitae [Page 243] venae prestantiore sanguine replendae sint, frequenter enim statim ac secta vena est, & cibo & potu nimio corpus inferciunt.’ I have not read of the like pra­ctises in France, Spain, or Italy: Nay, 'tis in Germany, that for healths sake very old men bleed largely twice each year: instance whereof are given by Faber in his Notes upon the Mexican Herbal. Rolfinc. me­thod. medic. special. l 4. sect. 2. cap. 5. ‘ Reverenda ca­nitie, & septuaginta annorum decursu venerabili prae suli Ienensi Iohanni Majori plethorico salutaris erat sanguinis per venam sectam missio. Neque ingraves cente aetate ab ea erat alienus. Attingebat annum 89. senili confectus marasmo.’ Out of which 'tis evident, that whatsoever the German practise be in Diseases, 'tis not their Reason, but superstition and imaginary fear that makes th [...]m to decline to bleed therein [...] Nor do I find the relations of M. N. to be consonant to the usage of the German Physicians, except you will judge of them by the adherents of Helmont and Pa­racelsus. I might except against Thonerus, that in his Appendix he prosesseth that he doth not absolutely reject Phlebotomy even in malignant Feavers: and as good, if not a better Physician than he doth give this account, I [...]. [...] obs. & [...] ep. x p. 5. in opposition to him: ‘Experientia testa­tur quod non solum in Febribus his, sed & in va­riolis & morbil [...]is, venaesectio in initio adhibita cor humoribus non repleat, sed roboret, ut expelle­re possit sufficienter variolas, Morbillos & Pe­techius.’

But I find my self to exceed the bounds of a Let­ter; but I hope you will pardon the length of it, since it was an effect of my compliance with your desires: and if I have not fully answered them, nor polished my Discourses as they might otherwise have been, be plea [...]ed to consider the shortness of the time allotted unto me, the great distractiin with which I [Page 244] write, and the multiplicity of controversities I have in­treated on, and the multitude of books which I found my self obliged to consult, and transcribe passages out of; and then I doubt not but I shall obtain your par­don, whereunto that I may have the more colourable title, I avow my self to be