An epistolary discourse concerning phlebotomy in opposition to G. Thomson pseudo-chymist, a pretended disciple of the Lord Verulam : wherein the nature of the blood, and the effects of blood-letting, are enquired into, and the practice thereof experimentally justified (according as it is used by judicious physicians) : [bracket] in the pest, and pestilential diseases, in the small pox, in the scurvey, in pleurisies, and in several other diseases / by Henry Stubbe ...

SIR ,

IN obedience to your Commands , I have read over the Treatise of — Thomson , concerning Blood-letting : I never underwent a more difficult task in my life : And had the Virtuosi imagined with what reluctancy and constraint I should undertake such a work , they would have abandoned all their other stratagems , and imposed on me this pennance , as the most severe . I profess , I am not so understanding in the Greek , Latine , or English Tongues , as to comprehend his Language : yet I think I am not so much in default therein as He , who , according to the peculiar fate of the modern Baconists , hath either out-lived his Learning , or never was endued with any . That He should pretend to read , or understand Hippocrates , is a vanity equal to that with which Ecebolius professeth himself to be versed in the writings of Aristotle : G. T. Vindis . of the Lord Bacon . p. 35. and when he blames the Method which the Galenists have used above this sixteen hundred years , would not one imagine that the birth and flourishing renown of Galen had preceded those Centuries : whereas you must place him in the second Century , during the Reign of Marcus Aurelius , Lacuna in vita Galeni . Commodus , Pertinax , and Severus , or you will contradict the account which Galen gives of himself , Is. Vossius de Philos. c. 12. sect. 19 Suidas in 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 . and the relations of other Historians : and at such time as he arose , the world was prepossessed with Methodists and Empiricks . But I wish his greatest errours lay in his ignorance of these things . Alas ! he understands not any thing of the Rudiments of Physick ; and to inform him , one must write an entire Body of Physick . Were it not for a few hard words borrowed from Van Helmont , such as Enormon , Archaeus , Daumvirate , &c. and his extravagancies about fortifying the vit●l spirits , ejecting the venome , or spina in diseases , and that by a diaephoresis generally , by the means of certain Arcana , ( more famous for the death than recovery of his patients ) the man would have nothing to say : Let D. M. take notice here , that there private Arcana , such as the Quacks pretend unto , concealing the Medicaments : and others by that name published in Print , in Crollius , Schroder , and others . And do we wonder at the unfortunate cures for which he is blamed ? or that more than one at White-chappel , should suffer by his ill-advised Pepper-drops ? 'T were strange , should one that neither understands humane nature , nor the types , times , motions , and terminations of diseases , should ever ( except by accident ) do any good ; not that He should frequently do harm . But a fool may commit more faults than a wiser man than I , and of more leisure , can discover . I shall confine my present address to the point of Phlebotomy ; wherein he so traduceth the Hippocratical Physicians , In his Preface to the Reader , he sayes , He doubts not , the time will come , yea , is not far off , that a Phlebotomist ( as he hath characterized him ) will be looked upon as little better than a Broachotomist , a Cut-throat . as so many murtherers , and particularly declaimeth against the most judicious Assembly of our Faculty , that Europe ever beheld ; and who , if they be culpable , are mis-led by the practice and precepts of that Author Hippocrates , whom he himself often cites , and to less purpose than I might in this controversie alledge him .

Some years since , I designed to write an enquiry into the original , and nature of the Blood , and the usefulness of Phlebotomy in several diseases : in which , abstracting from the single opinions of Writers , I purposed to illustrate each point by practical principles , and ample Histories , out of intelligent and creditable Physicians , concerning the bad or good success with which Blood hath been let in diseases , according to the several Ages of the dis●ased , and the nature of their maladies , whether Epidemical , Sporadical , or of a less general constitution . But the Controversies I have been involved in , have so incumbred me , that I have not been able to pursue th●se intentions , nor have I any preparations almost in order thereunto , as yet digested into writing . But this Antagonist requires not all my strength ; a less powerful Assault will suffice to overthrow Him .

'T is not any kindness to him , but indulgence to my self , that I do not pursue all his errours , even in the generation of blood ; or go about to convince him of the several mistakes which he is fallen into , for want of reading more modern Writers , and their discoveries . Beyond Helmont , or in contradiction to him , the man neither does , nor will understand any thing : And even in that Author he seems so little conversant , that he sometimes mistakes him , and generally represents things with more obscurity and intricacy , then they are expressed in the originals of Van Helmont or Grembs .

Of those that have opposed Phlebotomy , these are not the first , which this Century hath produced : long ago Galen complained of Erasistratus , Galen . de Sangu . miss . c. 2. ( the sisters son of Aristotle ) that he was 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 , fearful to let his Patients blood ; before him , Chrysippus Cnidius , Medius and Aristogenes , did reject the usage : Also Apaemantes , together with Strato , are recorded to have contradicted the practice of Phlebotomy , by Arguments : The strength of that faction in Physick , was such at Rome , in those times , that Galen spent several books against the followers of Erasistratus upon this subject . But above all that ever intermedled , I will give this character to — Thomson , that never did any presume more upon so weak grounds : Nor ever was Confidence so poorly mounted , and so pittifully be-jaded .

After much trouble and enquiry , the sum of all , he sayes , in this case , amounts to this .

The promiscuous mass of Bloud which flows in the Veins and Arteries , he divides into three parts : the one is called by him the Latex ; the second Cruor ; the third Sanguis , or most properly Blood .

G. Th. of the Blood , p. 19 , 20. The Latex , so called by Helmont , by some Lympha , by the Greeks 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 , is a diaphanous clear liquor , 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 , fabricated in the second digestio● , by virtue of a ferment there residing . It is the inseperable companion of the Bloud , and closely perambulates with it through all the wandring Maeandrous pipes in this Microcosme . It is the matter of Vrine , and Sweat , Spittle , &c. and renders several other considerable services to the body .

Ibid. p. 22. The goodness or pravity of the Latex , depends much upon the bloud , as it is constituted ; for , albeit it is no essential part thereof , yet is it altered for better or worse , according to the channels it passeth through , the lodging it taketh up , and the condition of its associate : notwithstanding that it may be sometimes impaired in its due excellency , and the bloud withall remain very pure and sincere .

Ibid. p. 1 , 2 ▪ and 34. The second part is called Cruor , from 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 , i. e. Crudus concretus : It is the more crude impure part of the bloud ; the purer part of the chyle being digested into a saline juyce , is carried into the milky vessels , and veins , and mingling at last with that ruddy liquor , is called Cruor , and at last becomes perfect bloud . It undergoes manifold guises , and is often the subject matter of a multitude of diseases , being sometimes changed into an Ichor , Tabum , or Sanies .

Ibid. p. 2. The third part is properly called Sanguis , or Bloud , 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 , it is a most pure sweet Homogeneous , Balsamie , Vital juyce ( for the most part of a bright Red , or Reddish colour ) made by the Archaeus , by virtue of ferments implanted in the ventricles of the heart , lungs , veins and arteries , causing a formal transmutation of the Ckyme , or milky substance into this sanguineous liquor , ordained to be the seat of Life , and and the principal matter for sense , motion , nutrition , accretion , and generation .

It is for good reason called Balsamum , seu Condimentum totius corporis , Some peoples flesh will not heal upon the least cut , notwithstanding this Sanative quality in the Blood . forasmuch as it hath a sanative power , sweetly uniting all the parts of the body , for the conspiration of the good of the whole .

It is a great preservative against putrefaction , as long as it remains in its integrity , for consisting of many saline particles , Yet are several glandules sweeter to taste , than the sanguineous , fleshy parts of Animals . it seasoneth whatsoever it toucheth with a pleasing sapour .

It is the proper habitation of the vital spirit , the immediate instrument of the soul , What becomes of the duumvirate then ? And may I not ask , if the Spirits be n●t the immediate Instruments of the Soul ? in which it shines , displaying its radiant beams every way , that sensation , motion , nutrition , and all other functions may be exquisitely performed .

God and Nature never intended other , Ibid. p. 5. then that the bloud should be Homogeneous , If God and Nature intended the blood for so pure and homogeneous a liquor ; why did they produce man with such a fabrick , that the chyle ( several ways tinged ) should mix with it in the sub-clavian veins ? pure , plain , symbolical with that single principle of the Vniverse . Now these Peripatetick Philosophers deliver to the world , that the contexture of this vital juyce is made up of Choler , Phlegm , Melancholy , and Blood , which united , produce this compounded body , which we call Sanguis : How grosly erroneous and dangerous this Tenet is , most Learned Helmont hath made evident .

Wherefore we conclude with that noble Philosopher , Ibid. p. 6. that Bloud is an Vnivocal substance , divisible only by some external accidental means , as the Air , or Fire , which cause a various texture , and different position of its Atomes , whereby it seems to consist of parts which are not really inherent in it , as is manifest in its degeneration from its native colour , sapour , consistence , and goodness , which it had before it became corrupt in the pottinger , or underwent the torture of fire . Both of which do strangely larvate and disguise the puniceous Balsome , giving occasion to the Galenists to frame their four fictitious humours , no where really existent .

This being the foundation of all his declamations against Phlebotomy , before I proceed any farther , it may seem requisite that I should make some Animadversions thereon ;

I might take much notice of , and display his errours , as to what he sayes , that the Latex is by the Greeks called 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 : this is the first time I ever read it called so : the usual terms being 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 , C. Hofmann . de Ichor , sect. 12 , 13.9 . Th. Scheuck . de sero sangu . c. 1. , and 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 . The notion ( whatever Helmont say ) is not new at all : an hundred Galenists have mentioned and treated of it , as the vehicle of the bloud and nourishment . But that cruor should come from 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 , crudus concretus , is an opinion singular to the Baconical Philosopher . That 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 doth signifie cold , I know well : and that cruor properly signifies the the bloud of dead people , or the mortified bloud issuing from putrefied wounds , I no less understand ; though Authors frequently confound it with Sanguis ; But that his Latex , and the Lympha , so called by moderns , are the same , is news : for , it is not held that the Lympha , in its peculiar form , was pre-existent in the Arteries , and , as such , G●isson . de hepate , c. 45. Charleton . Occo● . Anim. exercit . 9. sect. 7. did accompany the Blood through the Maeandrous pipes , but is generated as it is discharged into the Lymphaeducts , and from them is re-mixed with the bloud : And , if it were , yet would not the definition of this Latex agree with it : for the Lympha is no inseparable compan●on of the bloud ; as appears by its peculiar vessels : it is seldome a diaphanous clear liquor , being commonly tinged with a a Glisson . Anat . hepat . c. 45. several colours , Quippe tota haec Lympha , uti experientium , compertum est , densior , minusque pellucens , & interdum lactis instar albescens , aliquan●s sufflava . & non nunquam loturae car●is similis . Vide Charlton , ubi supra . oftentimes whitish , sometimes yellow , or , as it were stained with bloud . And whereas this Latex is devoid of all sensible qualities , those who have experimented the Lympha , do not find any such thing , but a variety of tasts : Nor is it true that the Serum which accompanies the Bloud is such a Latex as our Helmontian describes ; it being never ( to my taste ) free from a salsuginous sapour , ( though it retain that with a great Latitude ) nor devoid of colour , so as to be clear and diaphanous : and 't is very seldome seen , that the said Serum will not b b Centies facto experimento , vadi semper serum ipsum non modo leviter incrassari , sed agglutinari fieriqne membraneum . H. Barbat . diss . de sangu . & sero . pag. 16. coagulate , unless preternaturally ) upon a gentle fire : so that it is no more to be termed a Latex , than the whites of eggs beaten to the like fluidity : In like manner that in the Lymphaeducts will c c Th. Bartholin . Spicileg . p. 71. M. Bogdan . apolog. adv. O. Rudbek . sect. 116. coagulate , as Bartholin observes , and others .

As for the Cruor , that there are graduations of the Bloud , as to its crudity and impurity , is no doubt amongst the Galenists : and that it may oftentimes transcend the state of due maturation , and so become degenerate , is as easily granted , as that it should come short of its desired perfection ; and when this Blood degenerates any way into a Tabum , or sanious matter , I must tell him , that Arist●●le and his followers acquainted us therewith , Vide Hofman . de Ichoribus , sect. 71 , &c. before that Helmont was ever heard of , whose Cruor bred in the Liver , and distinct from the Bloud , impregnated with vitality , is such a piece of non-sense , as ought not to be mentioned in this Age , but to Baconical Philosophers , who , not only connive at , but applaud any Hypothesis .

Concerning the Blood , when I read the Elogies he bestowes upon it , as the Seat of the Soul , by which sensation , motion , nutrition , generation , are performed ; I thought ●pon the opinion of Aristotle , and his zealous sectators ●mongst the Physicians , who have denied all Animal spi●its , fixed the principality of the Members in the Heart , and from thence derived even the nerves . If G. T. will defend the generality of his Assertion , I assure him that Hofman , Van der Linden , and Harvey , will be more serviceable to him than Van Helmont : But this consideration hath little influence upon the present Controversie : that which follows hath nothing of Truth in it : that the Bloud is an Homogeneous , Dr. Willis de ●erment . c. 6. Kerger . de fermentat . sect. 1. c. 11. pure body : for nothing homogeneous can ferment : But it is most evident , that the bloud is in a perpetual fermentation , and that it is such a liquor , as is constantly generating , constantly depurating , and constantly expending it self : so that nought but Imagination can represent unto us such a thing as pure bloud : and I hope the specious pretences of a Real Philosophy , will not terminate in Speculation and Phansie . When the bloud either naturally issues forth , or upon incision of a vein , it representeth unto us different Phoenomena oftentimes in several porringers , and in the same porringer different substances ; sometimes a supernatant gelatine , and mucus , a coagulated mass , consisting of thinner , and a less fibrous crimson , and a grosser , and more blackish-red body , enterwoven with fibres ( both which may be washed away from the fibrous part ) and a serous , fluid liquor , sometimes limpid , sometimes of a bilious , or other colour , in which the concreted mass of bloud doth float : All these , with other Phoenomena , ( in a great variety ) are to be seen in the aforesaid cases : and even the Bloud of the same body , E venis capitis nunquam talem muccaginem affluentem vidimus , crebrius è venis brachii , è pedum autem venis creberrimè , & in majori copia . as it issues from several veins , furnisheth us with matter for different observations . Now in a liquor so pure and Homogeneous , as our Disciple of the Lord Bacon imagineth the Bloud to be , though we should suppose the Air to corrupt it , as it issues into , and settles in the pottinger , yet would the corruption thereof be uniform : which , seeing it is not , I take it for demonstrated , that it is Heterogeneous : And that being granted , it matters not whether the four humours ( so frequently mentioned by Physicians ) be actually or potentially in the blood : Moebius fundam . medic . de usu Cord●● . p 259 Whether they be the constitutive parts thereof , or whether it be one entire Liquor , made up of Heterogeneous parts , which , in the bodies of sundry individuals , produceth such Phaenomena , as if it did consist of such Alimentary Humours , and degenerates occ●●●onally into those others that are Excrementitious : In order to our practice , 't is all one for it to be so , and to appear so : and our documents are nevertheless useful , though they seem not rigorously true . The Galenical Physicians are not herein agreed ; nor is any man confined in his sentiments , about this subject : 'T is malapertness in this Bacon-faced generation , to dispute these points , since the phaenomena of diseases , and the operation of Medicaments doth correspond with this Hypothesis , and are as adequate thereunto , as humane nature ( which is not capable of an exact knowledge , and ought to acquiesce in what is useful ) can adjust them . Nor is it any more of disparagement to Physick , that should be built upon so tottering a foundation , then that the Temple of Diana , one of the wonders of the world , should be situated upon a bogg .

Hitherto I have examined his preliminary discourse of the Bloud , and its concomitant Latex , and have made it evident , that this person understands not what he asserts , nor what he rejects : and indeed such is his ignorance , that after so much study , " having rolled every stone , and searched out ever● scruple , to be informed concerning the truth of the Galenick , p. 87. and Helmontian way , " he understands neither Nature nor the Galenists , nor Van Helmont . I now come to examine his Arguments against Phlebotomy , which , if they be so weak and inconsiderable , as not to justifie so extraordinary an impudence , let him blame himself not me , who do not intend ( if possible , in such a confused , obscure Treatise ) to injure him in the recital .

His first Argument against Phlebotomy .

" Had they but considered how this vital moysture [ the Blood ] ebbs and flows in goodness and pravity , p. 6 , 7. upon slight accidental occasions of any exorbitant passions , as fear , sorrow , anger , &c. the manifold impressions of the ambient Air , ill Diet , immoderate exercise , divers excessive evacuatio● and long retention of any excrement : did they rightly understand how bloud , like Mercury , may be polymorphised , and changed into different shapes , and at length be retroduced to the same state and condition , as when it was in its primitive essence : certainly then these Dogmatists would never be so forward to pierce poor man's skin , rashly let out and throw away that substantial support of life , foolishly and falsely apprehending that to be totally corrupt , and deprived of what it was in its former being , and in no wise capable to be retrograde , and return to it self again ; because it seems to their eyes when it appears abroad discoloured , invested with a contemptible apparel , as yellow , p. 18. green white , blue , &c. — supposing it to be corrupt , and so unfitting to be retained within the verge of life . It is no such matter , I can maintain : for this superficial alteration proceeds from the Air , spoiling it of its pristine goodness , not that it was really corrupted in the vein . For the demonstration of this , I will undertake , upon forfeiture of a great penalty , to open the vein of a Cacochymic body , emitting about two or three ounces of the visible aforesaid degenerate matter , then stopping the Orifice , make use of proper remedies to this Individual , whose habit I doubt not so to alter in the space of about a fortnight , that no such putrid matter as they improperly call it , shall be found in any vein whatsoever opened ; which may fully satisfie any sober enquirer after truth , that the corruption was never really existent in that , whilst it was in the vein , which , in so short a time is thus redintegrated : for Corruption being an absolute privation of that formal essence of the thing : and sith there is no retrogradation in this kind , that an Ens losing its form by dissolution , should assume it again , Nam à privatione ad habitum non datur regressus : it infallibly follows , that this juyce thus restored , Technic●s , by Art , was never truly corrupted , as they would have it . Hence it follows , that the fair pretence of the Galenists ▪ that the juyce drawn out of the Patient , forasmuch as it is corrupt in the porringer , is happily discharged : appears a mere imposture , contrived on purpose to stop the mouth of those who scruple and question 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 Whensoever 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 Cacochymical bodies require purging ; the Plethorick , or such as are in danger to be surcharged with excels 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 Augenius . 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 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 Castel . 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 't is 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 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 't were 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 Plempius 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 , 't is 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 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 false : and any man may see hence , that this Ignoramus understands not the Galenical way , but deserted it , before he had acquainted himself therewith . This be might have learned from Galen , in his Comment upon Aphor. 17. l. 2. We do hold that the blood and associated humours may come to a partial putrefaction , and yet be recovered again : and 't is 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 , 't is 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 skin , 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 essence . Ergo.

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 sequele 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 vexatio●s ( 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 . Hippocr . Epid. sect. 1. l. 2. Fluxus sanguinis largi ex naribus solvunt multa , 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 .

Fienus de signis medicis , par. 2. c. 1. sect. 8. & Francisc. Rubeus Nocturn . exercit . in Histor. Medic. exerc. 6. p. 98 , 99 , 100. " Sanguinis eruptiones & haemorrhagiae hanc habent praerogativam prae aliis evacuationibus , quod ipsae etiam in principio & in aliis temporibus , etiamsi non adsint signa bonae coctionis , possunt esse magis utiles , quam aliae evacuationes , quae fere 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 ; Prosper Alpin . de praesag . vita & morte , 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 barbarous as Civil are agreed on ?

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

p. 52. " 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 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 bloud 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 't is said , that the bloud is the soul of all flesh . Nay , in Genesis c. 9. v. 5. Concerning man , 't is 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 , 't is 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 , 't is 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 . 102. 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 , 't is 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 't is evident , that Blood is no more properly called Life , than 't is 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 principal support of Life : let us consider how far that is true : That the Bloud is not so much as a part of the body , Valles . sacr. philos. c. 5. p. 102. Fernel . Physiolog . 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 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 ) 't is 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 sundam . medic . l. ● . 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 , 't is apparent thereby , that 't is but accidental , and not a proper consequence of that effect : 'T is 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 sangu . 〈◊〉 . c. 34. or what is equipollent thereunto : 'T is also manifest , 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 continual exhaustion ) so that without supply , it would degenerate ●nto choler , ( except in those miraculous fasts ) and diminish to little or nothing : as appears upon great fastings , and several diseases . 'T is 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 , p. 7. one would think , 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 passes through ; how easily it is stained by an extraneous tincture ; how often intermixed with something 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 fat 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 't is in Men ; for , not to mention those Medicaments , which , by the alteration they make in the Vrine , do demonstrate they have passed along , and been once mixed with the bloud ; as Cassia , Domin . de Marchettis , Anatom . c. 9. Rhubarb , Annise-seeds , &c. " 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 nifi per vena● 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. 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 , Simon Pauli de febr . malignis sect. 11. 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 force , 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 sanare 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 (a) (a) 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 . 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 practise , 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 , Arist. Ethic. l. 10. c. 9. quam eloquentia juvenis : And those Philosophers , who would , upon certain prejudicate opinions , Io. Franc. Ripa , tract . de peste . c. 7. sect. 17. and pretences of reason , determine of Medicinal cases , are exploded even by Galen : nothing is firm in Physick , Arist. l. 8. Phys. c. 3. t. 22. & 1 de ort. & inter . c. 3. t. 59. but what is confirmed by an happy experience : and 't is an imbecillity of judgment ( saith the great Stagirite ) to desert experience , and adhere to reason . If Helmont 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 , 't is but a single testimony against the Experiments of judicious men in all Ages and Countries . As for his Reason , 't is 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 ; a●d 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 . febr . contin . 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 homo in contrarium agitur statum , celerrime ex de fectu animi refrigeratus : With this opinion of J. Lommius , doth Citesius agree , de usu Phlebotom . 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 't was 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 , left 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 a a Citesius de usu Phlebotom . c. 5. Rolfinc . meth. medic . spec . c. 4. sect. 2. c. 11. oftentimes is particularly repugnant to large Phlebotomy ) nor idiosyncrasie , ( which b b 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 contra-indicate . It hath authority from Hippocrates , Galen , Avicenna , 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 . Lusitan de venae sectione cap. 14. Artic. 1. 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 , Duretus , Rondeletius , Massarius , Septalius , Claudinus , Crato , or Rulandus . If Experience be our Guide , let 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 cannot make an Experiment , G. Fletcher's History of Russ●● , 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. Zacchias Qu. Medico legal : l. 9. consil. 40. 't is 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. Ripia tract . de peste , c. 7. §. 64 , 65 , 78 , 104. 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 expurgatur corpus alui profluvio , ●●lles . 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 Riolan . de circulat . Sanguin . c. xx Vallis . meth. medend . l. 4. c. 2. 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 .

" The means to let out bad blood without removing the efficient cause thereof , Pag. 105.106 . is no direct method of healing .

Now Phlebotomy lets out bad blood without removing the efficient cause thereof . Ergo , Phlebotomy is no direct Method of healing .

The Major is proved thus : Whatsoever suffers the cause to remain , can never remove the effect : For manente causa manet effectus .

Now Phlebotomy suffers the cause to remain , Ergo , it can never remove the effect .

The Minor is made good by frequent experience : If the cause of bad blood were cut off , the Feaver or Scorbute depending ( according to Dr. Willis ) upon the degeneration , Sal and Sulph . therein , would quickly cease : but we plainly see the contrary ; for after the veins are much depleted , the disease becomes more truculent , and oftentimes mortal ; which could never be if this depraved blood were any other than a product or an effect of an essential morbifick cause . The same agent which in sanity sanguifies regularly without any considerable defection , in sickness becomes exorbitant , sending out a vitious juyce into all parts : be it good or bad , it still springs from a root , which continually feeds the branches : so that it cannot be other than great folly and wrong to the Patient , to let out that juyce , though it seem never so corrupt , when another of the like condition must needs enter into its place , derived from the shop the duumvirate , where it first receives a previous rudiment , which ought in all reason rather to be reformed , than to give vent to those easily evanid particles inseparably joyned with this ruddy liquor , how ill soever represented . If all contained in the reins ( supposed to be corrupt ) were discharged , yet as long as the ferments principally of the first and sixth digestion deviate from their right scope , He should rather have regarded the ●econd then sixth digestion . there would in a short space be a succedaneous repletion of a matter equally contemptible , yea worse , in respect of an enervation of strength , than before . "

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 't is 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 of 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 , 't is 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 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 Phlebotomy 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 Seidelius de morb . incurabit . p. 57. Duobus enim tanquam cruribus innititur Medicina , neque solis theoreticis rationibus contenta , insuper etiam practicaes 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 , Valles . 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 necessariae , 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 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 't is 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 distempers complicated , which interfere with and 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 : Valles . 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 putting 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 : p. 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 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 't is 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 't is 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 Riol●n . 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 Phlebotomy ; 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 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 cathartics ; 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 , 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 . 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 , See Ant●n . B●nivenius his medicinal observat. c. 44. 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 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 that Phlebotomy makes a great alteration therein .

But I proceed to his other Argument .

This is taken out of Van Helmont , p. 107 , 108. 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 . "

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 't is 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 . Fallonius 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 vena scissa extrahitur , 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 , aliis 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 : not to mention others : and in those Feavers wherein 't is 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 , Valles . meth. medend . l. 4. c. 2 especially in England , then the miscarriages of any bold Experimentor , or Baconical practitioner at London upon the Colledge of Physicians . Castellus de abusu venaesection . p. 60. This insolent Disciple of my Lord Bacon understands not the iudiments 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 that 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 febre 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●n . p 43 , & p. ●3 . " Nos igitur Galeno fisi ( quoniam sic conducit magis , dum vires ferant ) sanguinem misimus plurimum , nam bilibre pondus & trilibre in acutis febribus : aut magnis aliis morbis superavimus : atque id non modo impune , s●d & tanta aegrorum tolerantia , ut nil supra eligi potucrit . — " " Quam rem abunde nobiscum experientia nosti ( ut nos quoque aliquantisper experientiam ostentemus ) ut qui praeter caetera , Ibid. p. 99. quorum Paulo ante mentio fuit , & venae quoque sectione abunde usi sumus , atque id citra discrimen : quin et exactam illam vivendi 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 , velintem-pestivo victu impedita , nullas ostenderet , aut admodum raras , easque non nisi in rusticis atque infima plebe , qui nec pharmacorum multitudine , neque ciborum aut potionum , fatigari , 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 prevalence 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. Castellus de abusu Phlebotom . p 6 , 7. and since we disturb Nature with our vomits and minoratives in the 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 secnred 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 .

" If it be so that striking a vein often in a long tedious disease , p. 110. is a preparatory for a sharp Feaver , as Doctor Willis and I 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 who after sharp conflicts fall either into relapses , or Agues , Scorbute , Dropsies , Consumptions , Atrophy , Jaundise , Asthmaes &c. which might be easily prevented , if a mature regular course were taken to give convenient Emeto-cathartics , Analeptics , Diaphoretics , which safely and speedily cleanse the Stomach , keep up the strength and breath , that we need not fear any mischief from this late invention , Redundance of Sulphur , or Salt in the blood , no more than choler , phlegm , and melancholy in the Ancients . "

" The observation of Doctor Willis is this : de febr . p. 75. p. 108. Prae caeteris vero observatione constat , quod crebra sanguinis missio Homines febri aptiores reddat . i. e. Now above all , it is certainly known according to observation , that often bleeding makes men more apt to fall into a Feaver : Again he follows it close . Hinc sit ut qui crebro mittunt sanguinem , non tantum in febres proclives sint , verum etiam pinguescere soleant propter cruorem succo Sulphurco plus impregnatum : i. e. Hence it comes to pass , that they who often breath a vein , are not only prone to fall into Feavers , but also are wont to grow fat by reason the blood is full of Sulphur . In another place to this purpose he drives it home . Qui sanguinem habent sole volatilisato bene saturatum ij sunt minus febribus obnoxii : hinc etiam qui saepius sanguinem emittunt ad febres aptiores sunt . They whose blood abounds with volatile Salt , are not subject unto Feavers : for this cause , they that use Phlebotomy often are more liable to Feavers . "

" From hence — G. T. forms this Epilogisme . Well then the Doctor and I agree thus far in the main , p. 109. G. T. understands not what a procatarctick cause is : it is here a causa 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 that frequent bleeding procures Feavours ; which is sufficient to back my Assertion , that Phlebotomy is no good method of healing , sith it is plainly a procatarctick cause of Feavers . For whatsoever means exhausting the strength ( as I can demonstrate this course doth , more or less , sensibly or insensibly ) inviting or making way for Feavers , instead of preventing of them , is not to be approved of or allowed in curing the Scurvey or other diseases : unless we do act like Tinkers , some whereof are reported to amend one hole and make another : for how can it possibly consist with the honour and credit of a Physician , quem creavit Altissimus , to go about to correct the blood by often letting it out in a Chronick disease , and likewise withall to usher in , or as it were to be a Pander to the introduction of an Acute feaver , which in a short space dissipates that strength which this Phlebotomical harbinger hath in part worsted ? "

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 conjunctions , Causals and Illatives : 'T is 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 .

That which inclines unto a Feaver is not a proper remedy in a Feaver .

But frequent blood-letting inclines to Feavers .

Ergo.

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 't is as much prudence in a Physician to acquiesce in , or run the fortuitous hazard of a lesser or less dangerous evil , as 't is for States-men in the Body politick . Nature doth 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 : Ouae ex quibus . Valles . in Epidem . l. 4. p ▪ 448. in historia Alcippi . & ibid. p. 401. in hist. ●omulae emptitiae ▪ Hieremias Thriverius Brachelius in lib. 4. Aphor. 57. There is an Aphorisme of Hippocrates to this purpose . Quia convulsione aut 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 antem 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 , Valles . controvers. Medic. l. 8. c. x. Hieron . Rubeus in C. Celsum . l. 5. sect. 4 ▪ aut flatulento tumore . 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. Celsu● de Medicina l. 3. c. 9. & febres accendere ; quia curationem , ubi id , quod est , non recipit , potest recipere id quod futurum est .

The Major being thus false in that sense which was most pertinent to his purpose : 't is 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 Feaver , is never the proper remedy of a 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 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 . Nov● Acad. Flo●ent . 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 Physician the better Artist : the latter adds to his g●●eral 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 genera , Io. Riolan . in resp. ad . dubia Anatomica Barth●l● 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 . Ido 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 't is 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 of 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 't is not his skill , but his 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 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 't is 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 proposeth frequent Phlebotomy as a remedy for fatness . Venae sectio omnino convenit ; imo f●nt , qui nihil r●agis ad detrahendam corporis molem valere existimant , quem erebram 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 : Io. Fuchsius Compend . abus . p. 2. c. 7. I have read in Ioannes Fuchs●us a Bavarian that such a thing hath fallen once , 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 , fatter : though persons that are extenuated and e●aciated 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 't is 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 that 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 .

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 : when 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 conducit ) and speaks in the place cited by our Helmontian only of a customary letting blood in time of health : Dr. Willis de febr . p. 166. 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 , nise 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 , 't is 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 't will 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 ) 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 .

" If it be not fitting , nor useful to bleed in the Pest , which is a Feaver 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 , it is not fitting , nor useful to bleed in any ill-conditioned Feaver whatsoever . "

" But it is not fitting , nor useful to bleed in the Pest. Ergo. "

" The Consequence of the Major is thus proved . It is no less criminal to suffer the Blood to spin out in any ill-conditioned Feaver whatsoever , p. 82. then in that which is so 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 . p. 99. And , Albeit our Phlebotomists do extenuate the matter , setting a fair gloss upon it , pretending that in malignant Feavers of the inferiour clast , Plethorick or Cacochymical indications do manifestly require their utmost assistance before that inconsiderable venome lying occult : I must , by their favour , be bold to tell them they will never solidly and speedily make a sanation of any great Feaver , or any other disease , till they handle it in some manner like the Plague : for there is quiddam deleterium , a certain venenosity in most maladies ; as I can prove ex facto . "

" The Minor is thus proved . For whosoever at any time , p. 81. upon what pretence soever of caution , attempts Phlebotomy for the cure of the Plague , takes a course rashly to jugulate the Patient , unless some extraordinary redemption happen . Certainly here Doctor Willis ( who allows to persons accustomed to bleeding , and in plethorick bodies , the humours being very turgent , though seldome , and with great caution , to bleed ) speaks by rote , for had he Anatomised the Pest , investigated the nature of that atrocious stroke , as I have , feeling the smart of it three several times , he would as soon allow of piercing a vein in him who hath taken an intoxicated draught , as at any time in this case , where the Stomach alone is the place from whence the poyson is to be exulated . 'T is no wonder if the Galenists strait injoyn bleeding , where they find a seeming soulness in the less malignant Feavers , when they dare be tampering with it in the greatest . — The only noted Sluce through which the poysonous matter of all malignant Feavers passes away , p. 99. is the universal Membrane , the Skin , on which the Stomach hath no small influence , governing this Catholick coat at its pleasure , in so much that no successful sweat or eruption can be expected as long as the Duumvirate lies prostrate under any insulting calamity . Wherefore the Arch-design of the Physician is to cherish , corroborate , and remove all impediments of this eminent part , that it may protrude , explode , or ejaculate from its bosome to the utmost limits , whatsoever is virulent , closely supplanting the fortress of life . Now whether bleeding be any competent Medium to atchieve this , let any one indifferently versed in the knowledge of the Pest be Judge , wherein no honest able Artist dare open a vein , because it will attract the Miasme inwardly , hindring the extrinsecall motion of the Archaeus , for the expulsion of what is mortiferous . "

Before I come to answer particularly to the Argument , give me leave to animadvert upon some passages in this discourse . As to the Duumvirate , 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 fer met . §. 3. c. 2. and if the notion of an implanted ferment and fermentation be suspicious there , where there 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 us from 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 any thing of a 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. 18. edit. 1665. and extended no further . However if the words Contagious disease do not include a Feaver 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 , there is not any mentioned in the definition : Amsterdami . & Zacchias Qu. medico legal . l. 3. tit . 3. Qu 1. §. 13 , 14. 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 , G T. of the Pest. c. 3. p. 42. 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 Pest 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 , or not ) fall under the same predicament . Isbr. a Diemerb . de Peste l. 1. c. xii .

But I pass from — G. T. to inquire into the true nature of the Pest according to the most learned and judicious Practitioners that ever attended in it .

So Van der Mye during the siege of Breda , relate● causes of such as had the Plague , and yet during the whole time of their Sickness had no Feaver .

Van der Mye de morbis Bred p. 11 , 12

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 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 , Antifernelius Lemm . 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 confining himself to his bed or chamber , he recovered : He instances in others that escaped , I. Nardius in Lucret. l. 6. p. 527. in the same condition . With these agreeth Nardius , who was chief Director in the Plague at Florence in 1630. Alex. Mossar . de pest . l. 1. ( inter opera ) p. 498. & Forrest . de ●ebr . l. 6. obs. ● . 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 : Sennert . de ●ebr . l. 4. c. 1. 'T is true that many learned men do define the Pest by a Feaver , Dudith . inter apist . Schoet . ep. 52. 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 , 't is against common sense to assert what they do in such cases . Fateor febrem hanc pro putredinis aut d●ffl●tionis conditione , copia aut incremento , modo majorem , modo minorem existere , quam in nonnullis Synochum , Tertianam continuam , & Febrem quemcunque ardentem incendio & calore aequasse , non ego tantum , sed & Collegae mei , Doctores hujus urbis Medici clarissimi , aegris in publico Nosocomio decumbentibus operam praestantes observarunt . Minderer . de pestilentia . c. 6. It is granted that usually the Pest is accompanied with a putrid malignant Feaver of a very uncertain Type ; 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 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 febr . l. 4 c 1. de pestilent . Pa●a●● de Pest. l. 1. c. xii . and most commonly of anxieties about their Heart . But 't is not my intention to write a Treatise of the Plague : 't is 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 , Rondeletius de febr . de febre pestilentiali . and Rondeletius in the presence of many Students dissected several ; 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 in●ustice he triumphs over the Galenists for his having dissected one single body , I shall let the World see that the Galenists ( without proclaiming the fact , Volcherus C●●ster dissected many in the Hungarion Pestilential feaver : so did Iessenius , 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 , I●seph . M●ncusus pro sec. 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 , nulla in venis Meseraicis , nulla in intestinis laesio . Eadem haec uniformiter in singulis fuerunt observata . If it be said , that 't was 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 , Carol. Valesius 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. 'T is averred by C. Celsus , Neque quicquam est stultius , quam quale quid vivo homine est , C. Celsus medicina l. 1. pref. tale existimare esse moriente , imo mortuo .

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. and so comprehends any Epidemical contagious disease of which many in the same Country do dye , Massarias de pest . l. 1. ( inter opera ) p. 497. be it attended with a Feaver , or destitute of one , be it occasioned by any specifick 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 Pest : thus Squinancies , Catarrhs , Pleurisies , Peripneumonies , Diarrhaeas , Bapt. Codronchius de morb . vulgaribus , c. 3. Io. Crato assert . de febr . pest . p. 13. Dysenteries , the Measils , Small-pox , 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 deemed at Venice to be a Pest of which so many once died , Actius Cletus de morb● Strangulator . c 2. though there were not any other Symptomes perceivable in it , but a tumor of the testicles accompanied with sudden death . Mereatus , Consult . med. 14. Legi superioribus menstibus libellum Veneti cujusdam , qui experientiam testem citat , Duditbius inter Epist. Scholt●hii . Ep. 51. multos ex peste mortuos esse , quibus testiculi intumescebant solum , nullo praeterea symptomate aegrotos illos invadente . It matters not what is the 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 of the disease , which way the venenate matter inclines , or what part it principally affects ; a Carbuncle 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. Thevart : 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. praesid . usu . l. 1 c. 2. then one whom the English call My Lord : and the other intends nothing by Cerevisia Trihopenina than Three-half-penny Ale , and contradistinguisheth from Cerevisia dupla , or double Beer . But 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 with-all 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 venom● , must have been reduced to several heads . Thus in the spotted Feaver at L●bec did Neucrantzius observe that almost all manner of diseases were the effects of that Pest : Neueronz●ius de purpur● , p. 65. " Purpurae vene●ata 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 a● 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 alexiteriis junctis se curari postulant , adeo ut plerumque fallant non solum aegrotantes , sed ipsos etiam medicos docente Fabio Paulino lib. 1. comment in pestem Attic●m Thucydidis , p. m. 37. Idem in Scorbuto Arctois lo●is medicinam facientes experimur , qui cuilibet morborum & symptomatum conjungi solet , ut nullis in reliquo corpore sceletyrbes indiciis morbi quaelitas 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 : Schenckius 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 : Reymond . 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 nisi Pestis i●sissima , & 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 : ali●quin simile esset dicere hic Saxo est aut Suevus , ergo non Germanus : aut hic Hetruscus est ergo non Italus . Vnde febres malignas 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 & aequivoce pestilentes quandoque 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 , ●hen it is not to be accounted 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 , 't is 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. Neucran●zius de purpura c. x. p. 150. 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 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 , Neucrantz . de purpura , c. 3. p. 35. though it extend no further than one single person , and so is a pestilential Catarrh , or Cough , as our Physicians include the Plague ( commonly so called ) under Epidemical diseases , Isbr. a Diembrook de Pest. l 1. c. 1. §. 3. &c. 2. sect 3. though sometimes it extends not its contagion beyond one family , Minderer . de pest . c. 6 : 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 : Schenekius 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 ●ebr . 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 1580. which over-ran all Europe , Wierus Obs. l. 2 de pestilenti & Epidemica tussi ▪ & Forestus Obs. l. 6. obs. 3. yet , as sick as men 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 pestilential ; but even in the vulgar Plague , where it is expected most should dye , Io. Sporischius de febr . Epid. c. 4. p. 128. at Millaine in 1576. and 1577. Septalius , Vallenola in append ad loc. commun . c. 2. 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 , Sept●l . de Pest. l. 1. c. 14. p. 23. 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 , and Quercetan , Quercetan recivivus . Art. medic . pract . p. 39 , 40 , &c. or Mindererus to guess that there is a variety of venomes in qualities corresponding much with those known poysons , and analogous unto them . Mindererus de peste . c. 3. " His consideratis , observatoque variarum pestilitatum diversis locis ac temporibus grassandi modo , magistra rerum experientia docebit , venenum pestis adeo esse varium & diversum ut singulae propemodum pesti suae sit peculiaris juncta malitia inferendae neci sufficiens , cujus discrimen a nocendi modo & symptomatum varietate petendum siet . Diligentissime proinde haec venenositatis & pestis animadvertenda , & curationem suscepturis observanda . Etenim si pestis graves somniculositates , ingentes sapores Lethargos & comata invexerit longe aliter tractari sese postulabit , quam si vigilas inquietudines aut ingentes cordis siccitates intulerit . Venenum enim pestilentiale modo Dipsadis , modo Vipera , modo Cicutae , modo Naepelli aut alterius exhibiti toxici naturam aemulatur , cui in curatione singulari diligentia attendendum . "

" Prout igitur his , per peculiaria ac cuique propria antidota succurrimus , ita & pesti , modo per haec , modo per alia alexipharmaca obsistendum admonemus . "

" Et nos quandoque haec ipsa studiosius considerantes , pestem ab exhibitis venenis aut animalium venenatorum citu ; morsu ac percussione immissis vix quicquam differre cognovimus . "

Concerning the Spotted Feaver was observed by that solid and circumspect Practitioner Paulus Neucrantzius . P. Neucrantzius 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 plerumque 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 plerumque 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 , & alexipharmacorum diversitate : ut quae uni pestilentiae 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 ; quant 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 venom● 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 , 't is 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 .

Thus we climb downward , and advance as much as he that turn'd 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 restrained : and amongst the several definitions that are given of it by judicious and experienced Practitioners , I shall fix upon that of Mindererus , as the most exact and conformable to the reality of the Phaenomena .

Mindererus de pest . c. 6. The Pest is a venenate malady , very deadly , and contagious , primarily affecting the Heart , and commonly attended with a Feaver , BOTCH , CArbuncle , and Spots or Tokens .

This Definition whosoever would see well illustrated , let him read 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 notion : 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 morbo , 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 naturally , Schenckius obs. l. 6. & Hieron . Rubeu● 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 Definitions are no more to be insisted on in Physick , than in Law ; 't is enough that they are commonly true , and that a judicious Practitioner knows when they hold , and when they fail . I have demonstrated that the Plague ( so called vulgarly ) is not so pernicious alwayes as the Spotted feaver , or pestilential peripneumony : it is not alwayes contagious . I●br . a Diemb. l. 1 c 12. §. 4. " Tales sunt illae febres , quas Galenus , 3. epid . comm. 57. & alibi , pestilentes sine peste vocat , quales se non raro observasse testatur Amatus Lusitanus cent. 7. curat . 27. P. Zacchias though he do hold that the Pest is most commonly contagious , yet he proves it is not necessary it should be alwayes so . Quest. Medico . legal . l. 3. tit . 3. Qu. 2 sect. 21 , 22. Imo Quercetanus in Alexic . & Riverius sect. 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 fuisse , 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 , Io. Crato assert . lib. de febr , pestilent . p. 18 quod supra etiam monui ; 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 ort a morbidum expiret , Id. ibid. p. ●0 . 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 . 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. Paraeus Chirurg. l. 21. c. ●● . 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 venenate impression : for he felt no other ill effect afterwards .

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. Paaw 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 't is 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 , 't is 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 be taken in a general sense , I answer that it hath been frequently practised with great and visible success in several Epidemical , contagious and frequently mortal diseases , as the (a) (a)

Coyttarus de purpurat . febr . c. 12 , 13.

Petrus a Castro de febr . puncticular . sect. 6. & in dedicatoria epist.

Dilect . Lusitan . de venae sect c. 9. art. 4. p. 129.

Septal. de Pest. l. 5. c. 17. p. 217.

Spotted Feaver , the (b) (b) Bartholin . de Angina puer . exercit . 5. Severin . de abscess . p. 449. Mena●us consult . 14. Paedanchone or strangulatory disease of the Children in Spain , Sicily and Naples : In the (c) (c)

Cabelchover . cent. 5. cur . x. in Scholio .

Buland . de febr . Vnga●ic . 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 evil success , that though they are ballanced by contrary Experiments 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 , 't is 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 , ( 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 menace the Patient with . Hieron . Rubeus in C Celsum . l. 3. c. 7. p. 140 , 141.

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 venae 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. ● . 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 famine 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 alvo 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 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 fiat 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 facta 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 v●riolae apparuerint , perpetuo summam utilitatem ab hac evacuatione subsecutam vidimus ; qua Aegyptii Arabesque nullum utilius praesidium in hisce febribus esse longa experientia cognove unt . " 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 Alexipharmacs and sweating only ; he adds , Th. Brastus epist. 25. " Equidem una consuetudo fere praestare videtur , 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 , Mongius , Citanturab Is●rando a Diemerbrook de pest l. 3. c. 3. §. 1. Paschalius , Mercurialis , Zacutus Lusitanus , Bayrus , Carolus Val●sius du Bourgdien , 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 compluresalii , iidemque doctissimi . Medici , docentes omnino secand●m esse venam , nec minores paucioresve adducunt selices successus . Hieron . Rubeus in C. Celsa● . l. 3. c 7. p. 140. 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 :

Massarias de Pest. l. 2. ( inter opera ) p. 531.

F. Platerus de febr . ( inter opera ) p. 161.

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 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 Germany and the Netherlands can no more boast of an infallible cure , no nor of a better success than Florence , Venice , Rome , Naples , Paris , or Sevill , methinks it is apparent that the recommendation of Medicaments or Methods 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 dangerous and seemingly deadly symptomes ) been recovered : And herein Septalius , and Massarias , and others , say as much for themselves , as Mindererus , or Sennertus : And what Celsus saith of Hippocrates , Herophilus and Asclepiades ; I cannot but call to mind when I reflect on the several Methods of Physick endeared unto us by judicious Practitioners : C. Celsus in pref. Medicin● . Si rationes sequi velimus , 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 eff●cts to one Medicament , or Method , which either did but accidentally ensue thereon , 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 directly 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 Hypothesis raised upon these frail foundations , and with 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 venome , then in the profound , sordid or superlative , putrefaction wherein the Galenists placed the Pest : If such a putridity be unimaginable ( which yet is but graduated above what we see , and unto which 't is evident that diseases sometimes gradatim do arrive ) it is certain that there is no such thing as the Arsenical or Napelline poyson in the Pest ; but somewhat forsooth Analogous thereunto , Mind●rerus 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 Tithymal , Can●harides 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 cloyed 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 : ●ennert . de febr l. 4. c. 1. and then manifests it self in the sudden death of the Patient : Anton Beni●enius obs. Medicin . c. 54. H. Florentius in notis ad P. Paare de pest p. 154 , 155. of the truth hereof ● need no ●nstances : 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 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 no● 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 periculo sissimum 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 ●ffectu presertim adeo an●malo atque insolenti , cujus ut Protei , nunquam facies eadem est . Nulla enim pestis alteri similis est , nisi in uno , quod scilicet ea correpti maximam par●em intereant . Constans opinio est , tot fere species morborum pestilentium esse ▪ quot annorum , quibus in vulgus grassantur . Varianda proinde curatio ex affectus , causarum ▪ symptomatumque varietate : ratioque habenda temporis , regionis , sexus , aetatis , temperamenti , peculiarisque cujusque naturae ( quam Graeci idiosyncrasiam 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 thing 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 Practitionr , whose business lies in particular and promiscuous Cases . If this be 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 Columba de febr . 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 , that Mindererus doth caution us diligently to attend unto the course and symptomes of the Plague , Mindererus de pest . c. 3. 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 in the Patient , and Ambient , &c. and combination with sundry humours and intire 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 effects 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 evenit , ut non nisi aliorum damno sapiamus , & ex complurium strage quos morbus perdidit caeteros servare discamus ; nihil interim laudis Medica facultate ab hoc amittente , utpote quae plus studii in incertis observandis , quam in lucidis jam & perspectis malis , commodo consilio amovendis removendisque sollicita impendit ; etenim & Magistratus ad occultum furem 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 , 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 't is 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 ignorance ; but rather deplore the misfortune of Man-kind which 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 .

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 't is 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 , Scire enim quid fieri oporteat , magna res non est , sed quibus rationibus illud efficias , id vero arduuin . Galen . 6. m. m. c. 2. 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 : 't is not ignorance and folly , nor the want of generous Medicaments , which makes them comply , but a tenderness 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. Medico-legal . l. 6. tit. 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 rules of Art and Experience do not iustifie . Wherefore they do imagine that a Physician ought to imitate 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 confine themselves to one : Particularly , since some Plagues have been cured by spontaneous (a) (a) Erastu● epist 25 p 97. c. 2. & Thevar● . in Schol. ad Ballon . Epidem . p. 50 ▪ 51. Schenkiu● ( ex Par●o ) l. 6. p. 770. Haemorrhagyes at the nose , others by Stools , 't is 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 (b) (b) Hippocr . sect. 4. Aphor. 36 , 37 , & 42. Erast ep. 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 (c) (c) Erast. epist. 25. p. 97 c. 2. by spontaneous Sweats : since Nature takes (d) (d)

id . ibid. p. 98.

Erast. ubi supra . p. 99.

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 Method . " Ex his arbitror , patet , Sudores statim ab initio febris hujus per vim adeo calidorum medicamentorum evocatos , non tam utiles esse quam aliqui putant . ●iquidem spiritus evacuantur , vires dejiciuntur , sanguis agitatur , turbatur , magisque acuitur febris , quod subtile est in sanguine excernitur , sicque ●rassior intus relicta materia citius & facilius interficit . Idcirco 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 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 ( 't is no Helmontian Proposal ,

Isbr. a Diem . brook de pest . l. 3 c. 2. §. 1.6 & l. 2. c. 6. §. 14.

C. Celsus 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 , that they should imitate that operation by promoting sweat : they are afraid that potent sweats may divert Nature from her usual and intended course or 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 't is 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 ot●e●s 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 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 Alexipharmaca , 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 Sudorifics come from them , and is properly theirs : but they urge no method generally in any disease almost ; knowing 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 , repienda sunt . As also that , Cum eadem omnibus convenire non possint , Id , ibid. c. 9. fere quos ratio non restituit , temeritas adjuvat . To conclude , if there be any thing that requires a dexterous Physician , 't is this disease : And if any thing can make him such , 't is 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 than such diseases , so there is nothing wherein the generality of Physicians are less acquainted : 't is an effect of the novelty and curiosity after knick-knacks which infatuates this Generation , and will ruine the next : there is so much of pedantry in reading , 't is so much more pleasant , and divertive to talk of , to make Observations about freezing , then to read over Galen de typ●s , 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 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 imb●cillity in their Intellectuals . Such men are p●ss●s●ed with a desire to prepare their own Medicaments , contrary to Law : and neglect the study of necessary and use●ul Books in their Profession , which is contrary to all Reason : 'T is easie to foresee that the nex ●ge will scarce be furnished with a wise states-man , 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 mueh 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 identifi●d , 't is foolishly argued by — G. T. that because upon the taking of Poyson Phlebotomy is useless : therefore it is so in the Pest. But neither is the antecedent true alwayes ; as any man acquainted with the 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 Pa●lus , Avicenna , and Haly-Abbas and other eminent Physicians : Ioseph . Mane●●●●si● de sec. venae cubiti in sebr . 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 't is 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 . and usually done heretofore as any School-boy may know out of Tacitus : or Tully , W. C. may learn what Med●●●● circumforaneus is out of Menagius's . Amanitat . ●ur . civil . c. 3● . 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 own Medicaments , which gave him the opportunity of gratifying 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 Co●ex 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 m●ch 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 . 'T is 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 : Stat. Colleg. Londin . Miss. in biblioth . O●on ▪ And our Laws make the Colledge Judges of all Receipts , as well as Methods of Physick : which Act as it conforms with the general practise of Europe , so it is very prudential ; for hereby provision is made 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 : 'T is an evil president to dispute against wise Laws : 't is 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 .

" Because I often observe many squaring their Therape●tic intentions according to the Definition of the Feaver , indeavouring to cool those that are in a scorching heat , by breathing a vein , let them know , Cannot an Accident be the product of a fore going cause ? Besides , whoever defined a Feaver so as to make its Gen●●● to be An Accident ? that a Feaver , whose essential nature is to be inquired into for the use of man , is very erroneously defined an Accident : for a febrile heat is certainly the product of a foregoing Cause which is primarily to be searched after , then whatsoever depends thereon will quickly vanish . "

" Now this cutting an hole in venal vessels for the removing a bare Quality , is all one as if one should la●e out of the Pot ready to boil over a spiritous , or some precious Liquor therein contained , to the intent it may thereby be quailed , neglecting to withdraw the fire , the impulsive occasion of the violent motion made therein . Do not they take the like absurd course , who do think to cool the body in a Feaver by throwing away whole Porringers of the Nectar of life , never looking after the ablation of the Causo-poietick cause and focular matter sited about the Stomach , which makes an estuation and effervescence in all the other parts . That way of frigidation which pillageth the vitals , increasing the malady , only obliquely abating a tedious quality , is never to be approved by a Legitimate Physitian . He that will bring to a moderation the finger excessively heated from a thorn impacted therein , must extract the same , otherwise he will take a wrong course by the use of meer frigefactives . So he that will positively refrigerate in any preternatural heat , must eliminate that spinous , aculeate , acid , acrid matter which goads the Archaeus , incensing it that it becomes exorbitant , fretting , raging , Heautontimorumenos , gauling it self at the presence of that which it abominates , never to be pacified till it be excluded , or some extraordinary Sedative given ( I mean not Opium vulgarly prepared ) which may for a time asswage its fury till it have leisure to thrust out the unwelcome guest . "

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 had 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 Gal●nists 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 c. 1. 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 Malady : 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 many actions which they confess are not immediately conducive to the cure of a Feaver , which yet they pursue , 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 heat , 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 the Medicaments which are vsed by Physitians , Valles , Meth. med. l. 4 , c. 2. there is not any may compare for its efficacy and utility with Phlebotomy : 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 relaxeth 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 suppurated matter draw out the fragment of the Thorn ; so we do in Feavers , ( where the depraved humours are not so easily separated and extirpated , as in the prick of a Thorn ) maturate and eject the morbifick cause , and thereby atchieve the Cure : And I do profess my self to concurre with the Ancients in their Opinion , that there is a great Analogy betwixt the generation of the Hypostasis in the Vrine after a Feaver , Id aut●● ita esse aperte intelliges , considerans , quae partibus , in quibus suppurationem molimur , contingunt . Ea ●enim alteratio simillimae est concoctioni , quam in materia putridarum febrium expectamus , nisi omnino est eadem . V●lles . Method . ●ed . 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 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 , ●olon . ●eth . ● . ●dend . 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 't is 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 .

" The great Indications of the Galenists for Phlebotomy , are either Evacuation of the ●edundant blood in a Plethora : or , the Revulsion and direct pulling back of what is in flux , or flowed into any part already . "

" But neither of these Indications are valid , and oblige them to that practice ▪ "

" Therefore the practise of Phlebotomy is not to be continued . "

As to Phlebotomy in a Plethorick body , he thus explodes that : " It by plenitude be meant an excess of pure blood , p. 1●● ▪ I absolutely deny there is any such 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 , or indication for Phlebotomy : for during the goodness of this juyce there must needs be perfect Sanity arising from integrity of all the actions of the body , so that it may justly be reputed madness to go about to broach this Balsome of life , weakning Nature thereby , as long as there is health with abundance of strength . Imprimis not andum ( saith Van Helmont in cap. de febr . p. 8. ) ut nunquam vires peccare possint abundantia , ne quidam in Methusalem : ita nec bonis sanguis peccat minuitate , eo quod vires vitales & sanguis sint correlativa . i. e. We are to take special notice that too much strength can never be offensive to any , yea , not to Methusalem ; no more can any one have too much blood , for as much as vital strength and blood are correlatives . Well then it is plain , that whatsoever sickness seems to indicate Phlebotomy upon the account of an 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 , p. 123. sanguineous superpletion , must needs come from an apostate juyce generated by vitious digestions , which being hostile to life irritates the Archaeus to frame the Idaea of a disease , I would willingly know how this Arch●us doth frame the Idaea of a disease ? and what this Idaea of a Feaver is ? to return — G. T. his own words : Is it a Substance , or an accident ? Material or Im●●terial ? That it specificateth the disease , must be granted : But the n●tion is incomprehen●ible : and this Scurvy Idea is more ridiculous than tha● Scurvy Qualities . not as it is meerly provoked by nimiety or plurality , but from the pravity of the matter : wherefore the case is altered now , and the 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 , signification or demonstration of evacuating , doth in a strait line respect the Cr●or , or Cacochymy , directing the Artist to reform , mundifie , and rid those impurities contained in the seemingly corrupted marred juyce , by proper means sequestring the vile from the precious , not to let out indistinctly what comes next at randome to the furtive castration of the Eutony , lustiness , liveliness , and strength of the Patient , which is to be preferred before all motives whatsoever . "

The Analysis & Synthesis of inanimate bodies , doth not teach the Operatour convincingly what may be done in those that are Animate . " 'T is certainly known to those who are throughly versed in the Analysis and Synthesis of the parts of bodies , that ebullition , aestuation , effervescence of febrile liquors arising from a pleonasme of degenerate Sal. and Sul. &c. as they would have it , may be appeased and allayed by Remedies assisting the vitals to make separation , and afterwards an exclusion every way of what is reprobate , reserving what is acceptable . This being performed , there is no fear that a plenitude simply of it self can do any harm , for hereby so expedite a course is taken , that the overplus is in a short time sent packing away by vomiting , stool , urine , expectoration and sweat : For this reason , considering what strict abstinence the Patient is put upon in a Feaver , 't is very unlikely a plenitude should be of any duration . Is it not then greater prudence in a Physician to minorate what is superfluous by safe , profitable wayes of secretion , and excretion , still advancing the principal Agent , then for that end to give vent indiscreetly to what comes next without any election , p. 124. How much blood doth he account to be a great Quantity ? I do not know of any Physician that takes away such great Quantities , as to create these dangers . incommodating , if not hazarding the loss of the vital principles . For believe it , whosoever hath any great quantity of blood taken from him , either rues it for the present , or hereafter : Let him that is heterodox prate what he will , alledging examples of those sturdy , lusty bodies , which have hereby received immediate succour ; I can make good by practise ( and challenge any one to come to that ; otherwise let him forbear his Garrulity ) whosoever is cured by a Lancet in this sort , Can you make good by practise , that Phlebotomy is the cause of these subsequent evils . is either prone to relapses , or to live more crazy in his younger or elder years , although for some short time he may not by reason of a robust ingrafted constitution be sensible of these inconveniences . "

As for Phlebotomy in order to Revulsion , p. ●26 . he thus explodes it . " Another pretended way for sangu●●●ission is Revulsion , by which they say a violent sl●●x of morbifick l●qu●r into any noble parts , is intercepted : for this end they use the Lancet in a Pleuri●ie , Perip●eumony , or any inward infl●mmation : 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 stowed in . 'T is 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 for as . 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 't is easily to be remarqued 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 Witchcraft . Hippocrates and Galen having taken notice of 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. aph. 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 , Plato 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 bonas 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 . G. Celsus Medicin . l. 1. c. 1. Ea corpora , quae more corum [ Athletarum ] repleta sunt , celerrime & senescunt & aegr●tant . 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 oppressed , 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 , Ae●i●n . v●r . Histor. l. 9. c. 31. as not to have been much Phlebotomized : 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 . 'T is a most humoursome and 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 Idaea 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 .

Anton. Benivenius Medicinal . observat. c. 69.

" Men commonly attribute much to the Pulse in the discovery of diseases : If that be weak , low and small , they frequently presage death or mortal dangers : if it be full and strong , they give hopes or assurance of recovery . Yet we meet with one Philip , a drunken and corpulent fellow , who lying sick in his bed , I found his Pulse so weak , that it was scarce perceivable , and I should have thought him near death , had not the high colour of his face , the fulness of his veins , and his eyes ready to start out , together with the setting of his teeth , all proceeding from redundance of blood , hindered me from passing such a Prognostick . Upon due examination of circumstances , I concluded the whole distemper to arise from a Plenitude and that there was no such effectual remedy for him as speedy Phlebotomy : His friends were much against it , apprehending that the weakness of his condition was such , that it would rather hasten his death , than cure him : but at last they did assent thereunto , and I caused him to be let blood . " And immediately he recovered , the decay of his strength " and malady not being more sudden , then was his recovery . "

This observation of Bonivenius 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 quodammodo strangulari videretur , etiam mutus factus fuit . Huic vero & sanguis largiter detractus e communi dextri brachii vena , mox loquelam & sanitatem restituit . "

It were endless to transcribe cases of this nature : nor do I believe that there is any understanding Practitioner who will deny that 't is 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 Plethoricael , 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 : Galen . adv. Erasistratum c. 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 , Asclepiades was he that first professed to cure cito . tu●o , jucinde . C. Cels. l. 3. c. 4. and instead of one Medicament do substitute another . But what Asclepiades or Erasistratus might do in their dayes ( when fastings , bathings , oylings , and the like were the so 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 see Miracles , the events of diseases being such , that Nature oftentimes transcends our Art , Fere , quos ratio non restituit , temeritas adjuvat . C. Celsus Med. c. l 3. c. 9. and Imagination : And sundry unexpected Medicaments ( undoubtedly rash ) do effect Cures that the most rational and Methodical procedures have failed in . Nothwithstanding all this , I do not 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 , 't is 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 commit●ed by him , into an Hectick or putrid Feaver : Non est tamen negligenda haec febris Ephemera quamvis velocis & bonae terminationis sit , Forrest . obs. l. 1. obs 3. in Scholio . cum soleat propagines malas gignere , & in alias febres transmutari : & licet cito terminetur , non tamen inter morbos acutos reponenda : quia caret malis accidentibus . Si error contingat in cura●ione vel per medicum imperitum , vel aegrotum periculum est ne in Hecticam transeat , si biliosae fuerit temperaturae , qui egrotat : In aliis vero in putridam . 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 , Forrest . obs. l. 1. obs. 12 , 13. and Experience demonstrates . As for diseases accompanied by , or occasioned from a particular 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●rtics ; which every body cannot endure , Si omnia membra vehementer resoluta sunt ( in apoplexia ) sanguinis detractio vel occidit , vel liberat . Aliud curationis genus vix unquam sanitatem resiituit ; saepe mortem tantum differt . C. Celsu● 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 ●ubest copia , sed quia ea quae subest , tunc est inutilis & noxia . Valler . Method , med. l. 2 c 3. For if the Feaver be such as is accompanied with a particular des●uxion 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 't is not to be conceived how so acute a disease should admit of a lingring cure . The residue doth not need any answer : for to say that whosoever looseth 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 impossible but that a Patient may be so debilitated with his malady , and the means used for his recovery , that he continue 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 , quod junctum aliis maxime movet . C. Celsu● 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 : 'T is 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 ,

The quantity of Blood in Humane bodies .

The several Qualities of the afore●aid 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 , in rot. adv. Gassend . 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. Massaria de febr . c. 29. Io. Riolah 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 . Maebius fund , med. c. 12. sect. 18. Moebius doth allow of twenty four pounds to be the usual quantity : Homo staturae decentis ad libras xxiv . sanguinis in corpore habet . Riolan . de circulat sang ▪ ( in Antropograph . ) c. 15. p. 585. Riolanus imagines there may be in such a person fifteen or sixteen pound , at most but twenty in a French-man , 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. Slegelius de sangu . motu . c. 13. p. 104 ▪ 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 .

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 Phlebotomy . It is recorded by Matth. de Gradi , that he had under his cure a lean , slender and seemingly Phlegmatic Nun , Schenck . 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 loss of blood . Brassavolus relates how he had in cure one Diana a Lady of the House of Este , Art . Muso Brassavolus comment . ad Aphor. ●3 . 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 Gonzaga's ; Marcell . Donatus de variolis . c 23. who was recovered to as perfect health and as good an habit of body , Amat . Lusit . curat . 100. cent. 2. & cur. 60. cent. 7. as he ever enjoyed before . 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 , Schenck . 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 , Schenck . 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 : Almar . Blondelus de venae fectione , 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 fluxes of blood , in men and women , he professeth to have observed many times . Forrest . Obs. Medic. l 1● . Obs. 14. cum Sch●lio . 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 . He also tells of another Gentleman , that having drunk Wine-must , Id. ibid. Obs. 12. 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 ●ebr . 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 . nov● Anat. adv. G●ssendum . p. 108. Imo decem vel duodecim libras per nares , vel haemorroidas , per uterum in mulieribus effundi intr● 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 ●ore considerable , in that I. I. Becherus hath published a great mistake about it : I. I. Be●herus Physic. sub●erran . l. 1. sect 5. c. 1. p. 30● . viz. Siccum sangninem in ignent lardum ●●grare , & absumi , non minori celeritate quam ipsum olium & vini spiritus ; & in hoc quidem balsamino spiritu & igne , totius sanguinis vis & bonitas consistit , quoque 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 't is 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 . " I have seen many ( saith Blondelus ) who being casually hurt in the Eye by a tennis-ball , Almericus Blondelus de venae sectioue . c. 1. p. 8. 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. Siegel . 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 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 out 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 Graef de ge nitol . p 84 , 85. who in perfect 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 Bartholi● . Spiceleg . de 〈◊〉 ▪ Lympe . 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 difficult 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 , that 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 seasonableness ▪ and season of the years . Nor shall I exclude the passionately-angry , or melancholick , or phlegmatick from a latitude , yet doth their blood exceedingly vary in the porrenger , and consequently in the veins . Van der Linden Disp. Physiol . 41. §. 22. I have oftentimes seen ( and so hath Van der-Linden ) 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 is turned topsie-turvey , 't is not the impressions of the Air that restores the decayed colour in the more black blood , but the assent of this Ichorou● bl●●d through the more black and fibrous mass . I have some ground● for this suggestion ; but I never could 〈◊〉 any 〈◊〉 or thin concretion upon the turned blood , and to 〈…〉 fect thereof I have been willing to attribute the ●●●●nomenon , 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 . Simon 〈◊〉 de febr . malign . in the surface of the Blood : 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 : ●urel . Severin●s Epidoch . de aq peric . sect. 8. 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 . " 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 . Barthol Spic . 1. de va●is Lymphat . c. 7 ▪ Ent de circul . s●ng . p 106. & 267. " So Aurelius Severinus : with whom Bartholin agrees . And Doctor Ent sayes it is more dilated than the venovs . Besides this , there is a discrepancy in the venous blood it self : for in the 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 : Willis 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 Bartholin : Sanguinem in cava prope cor puriorem esse illa qui in vena portae continetur , Bartholin . 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 ●ab . 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 Li●den Select . 11 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 fundam 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 the head at the nose hath been of a laudable colour and consistence , Ballonius Epidem , l. 1. p. 68. 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 . Ballon . 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 Castro de febr . puncticulari . p. 90. ●i purus , rubicundus , & inculp●tus educatur , veneno si●atem 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 apparebat , 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 o● 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 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 . Coy●tarus de febr . pu pur . p. 247. Circa morborum Epidemialium principia — sanguis si educatur , ruber & sano similis apparet — quoties iterum & tertio mittitur , 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 Conserved 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 . Blo●d●lus de ven●e 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 j●dicationem , 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 r●tten : Others have had their blood extreamly depraved , in whose vitals no default could be found . B●llon . Epid. 〈…〉 " Plurimis impurissimus sanguis detractus est , imo nunquam fere purus , quibus tamen mortuis & sectis partes omnes satis integrae sunt 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 left 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 dignumest , qui fiat ut multis quibus putrefacta poene viscera sunt reperta , Id. Ibid. l. 1 , p. 100. 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 succus in venis , talis color efflorescat ) tamen florentissimus sanguis detractus fuerit non serosus nimium , non subviridis & virore pallidus , — Mul●os videmus scabie infectos , p. 101. aut simili vitio , quibus certo affirmamus nos impurum sectione venae sanguinem detracturos , & tamen in ista defaedatione cutis , illibatus incorruptusque sanguis est , & opinionem spemque fallit eventus . Nos Elephanticis saepe landabilem 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 de●init 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 corrupted . Almaric . Blondelus de venae sectione . p. 68 , 69. His superaddo sanguinem detractum omnimodas puritatis notas retinuisse , a sero bene repurgatum .

Dr. Willis de sebr . 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 gelantinae similis in emisso sangui●e , plerumque in morbosis condensata conspicitur , & vidi cori instar crassam lentamque ; saepe in febribus acutis hoc anno observatur . Th. Bartholin . de lacteis 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 : sometimes it is (a) (a) It was black , in colour and consistence like to liquid Pitch , in the Woman whose menstru● stopp'd eight moneths , and was cured by Galen with reiterated and large Phl●botomies . 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 (b) (b) Aliquando putrescentia non tam se insinuat colore , quam substantiae modo , ut quum erit raber sed non concrescens . V●lles . de victu in ●cut . p. 45. coagulate , but remains ●luid , like thick Milk ; which is a bad sign , and occurs often in putrid Feavers , and Cachexies . 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 without any crackling . as that the Crassament was laudable for colour and con●istence , 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 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 heat , 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. 217. 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 Serum which I have tasted , I never found any to be bitter , though I extracted some once that seemed so bilious , that being put into a● 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 . C●in● . p. 253. Asclepiadio more . " And Vesalius gives us an account of one Prosper Martellus , a Florentine 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 Oservation 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 dissected 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 floridus color , & in se esse acrior & biliosior : unde quaedam mulier 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 , Ballon . 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 Roots , 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 pale and freckled : such persons ( which are frequent in Barbadoes ) are called Mobby-faces .

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 , 't is 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 , 't is 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 asserts , that all those Humours when they are actually in the blood they become excremen●itious , 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 't is no longer Milk . E●a●●us 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 . Physioleg . 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 .

●●len . l. 2. de elem ▪

Galen . 4. de usu part . c. 4. & de nat. fac . l. 3. c. 13.

V●llerioia loc. commun . l. 1. c. xi .

Mercat . Qu. 65.

Both these Similitudes of Milk and Wine to Blood were first I think introduced by Galen , 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 , 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 vital liquor ; because she never produceth it alone ; or if it be ever seen so , 't is 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 ; obliging themselves to produce each Humour in its imaginary purity , when 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 perspicu●ty 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 some where calls it an Hippocratical demonstration : De re ipsa ●t neque dubi tes , morbi morborumq icurationes docent . Nimirum hoc est maximum argumentum Hippocratis , a●t Massarias . 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. Caleni 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● : quemadmodum caecus alicujus tunicam albam esse af●erit . — Nil scimus . Dicamus ergo . Primarum rer●m , principiorum , aut elementorum cansas 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 Quartane was troubled with obstructions of the Spleen and Liver , effervescences in the Intestines , Asthe●atic p●voxysmes , acute pains in her head , obtuse pains in her limbs , visible beginnings of a Dropsie ; the blood at its issuin● out seemed very black but was pretty laudable in the porringer : it burned well , without any crackling or i●umescence almost : s● did the Serum : Here the salt seems rather defective , than to abound , as it ought by those principles . 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 . "

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 , who upon washing all the blood from the concrete Mass of blood , M. Malpighi . de viscer . structura . p ▪ 163. edit. Londinens . found the remainder to be a fibrous con●texture 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 fanquin●s ▪ durior est & candicans , subjectus sanguis in pelui sine fibris plane est putridus ; i●o vidi in hujusmodi , ne guttulam coloris rubri . Bart●olin . de lacteis dubia . c. 3. as Rheumatismes and Plurisie● covereth like a pituitous mass the surface of the blood , whilest that remains fluid and blo●kish 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 Hartshorn 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 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 tingeth 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 hilis mixtura sanguinem reperius : Vide Pecque●i Dissertat . Anatomic . de circulat . sanguin . c. xii . flavescens id serum salsumque testatur ; Videtur humor felleus sanguini firmiter adhaerescere ; quod in seri illius parte fundatus sit , nec facile ab illo , intra ulteriorem praeparationem separari possit . Charleton . oeconom . Ani●al . c. 7. sect. 16. nisi forsitan aliquot in suppositis quibus dulcem mitior natura sanguinem concoxit , sicut & 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 infatuated 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 decision 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 anything 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 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 . 'T is an effect of that Soveraign command that every thing hath its being and faculties ; " Quin nil aliud est Natura , Erostus disput. 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. Highmore , Velthusius , Courvee , and Everatius . 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 ●●re are exerted the preludes 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 in dissection , Io. Ioc. Wepfo●us de apopl . p. 92. &c. Bustachius de dentil . c. 20. Th. Kerkring . Obs. Anatom . c. 26. 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 evident 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 the●●●re 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 , Glis●●n Anat. Hepatis c. 35. antequam sanguinis ruborem induit , sese a reliquis ovi partibus ( quibus promiscue commiscetur ) segregare incipit , & in rivulos seu'rdmificationes quasdum excurrere , quae postea venas evadunt . Rivuli isti in unum punctum coleuntes , in eum locum conveniunt , qui postea punctum saliens & cor appellatur . Idque fieri videtur , diu antequam sanguinis aliquod vestigium compareat . " Herewith agree the most exquisite Observations of Doctor Highmore . Dr. Higemore 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 Parenchymas 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 effect to the identity of the cause , Glissen . Anat. Hepatis . c. 35. is allowable . Est enim causarum identitas quae facit ut effectus sit idem : quippe effectus supponitur non esse , donec a causis existentiam suam indeptus fuerit ; & 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 sanguification much , seems apparent from hence : that the blood is seen in them before it is in the heart : Greg : Horstiu● Instit. Medic. disp. 3. Coron. 1. Append . conclu● . 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 . Pifan . 1. part. 6. circ. 7. — ●pe●ta namque in cadavera vena , sanguis prostuit . Ent. de circul . sang . sect. 137. " Manat praeterea aliquid a venis nobis incognitum , quod dumearum ambitu sanguis concipitur , prohibet ejus 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 fluidity but motion of the blood seems to depend much thereon : for if by a ligature the impulse and succession of blood be prevented , yet will the blood in the veins continue its course , and not stagnate . Exempto e corpore corde , motus tamen sanguinis , isque satis celer in sanis videntur . Et si vena ulla , ●●laeus de moru 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 , Pecquet dissertat . 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 fire 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 there 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 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 Macosities ; nay it hath been observed by Riolanus to have been tinged yellow : Riolanus Anthopogr . l. 6. c●lt . p. 411. How much more may be concluded hence in favour of the Galenical alimentary humours supposed to constitute 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 Maebi●● de usu ventriculi fu●do● ▪ Medic. c. x where he resolves it is done by an Animal bear , or Spirit●● vitalis veget● colote praeditus . for even Concoction in the Stomach is not the bare effect of Heat elixating the meat ; nor of acid or saline Ferments dissolving it ; nor of any other kind of imaginary Fermentation : But 't is 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 specifick 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 Helmont saith ) that it is generally rather saline , Vide Maebium ubi supra : & Karger . de ferment sect. 3. c. 2. p. 200 , 201. as are also the recrements of it that remain in the empty stomach : It is true that according 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 , Vesalius 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 sea-sick . From the stomach the Cremor descends into the Intestines ( not all at once , Reusuer●● 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 refracted 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 imbibe 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 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 : 't is insipid ; and as it makes so considerable ● part 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 quantities with the Chyle is undeniable , so 't is not improbable that it gives a fluidity to the Chyle beyond what it acquires in the stomach : thus Painters to make their colours and oyls more fusile , Platerus Quaest. Physiolog . 17. 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 't is manifest that this happens in the descent of the Excrements through the tract of the Intestines : and why not in the venae lacteae ? there are signs of it in the flavidity usually observed in the Arterious blood : and 't is remarqued by Judicious Maebius concerning the blood , that it is not Homogeneous . " Habet enim sua stamina , Maebius fundam . Medic. c. 14. p 339. & nigricantes fibras : habet serum salino principio imbutum ad putredinem eludendam : habet partem subtiliorem splendente rubore excellentem , super●iciem in extravasato cruore ambientem : Et haec in recessu videtur custodire BILEM ALIMENTAREM , flavidine sub insigni rubore abscondita . Quae ex rubro nigricant , flavedini si misceantur , talem splendentem ruborem exhibere , cuivis clarum est . " The bitterness which it hath is produced by the Liver upon its separation there , M●bius ubi supra . p. 338. which is not done by meer percolation , but an accessional of transmutation there . As for Melancholy , how much the Pancreatick 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 Regnerus de Graeff hath most ingeniously written thereof : besides that the more black part of the blood seems as essential thereunto , as the more bright Red. But the Degeneration of the Blood into those Excrementitious Humours , seems to evince as muck as the Galenists pretend unto ; Since every thing is not produced out of every thing , but out of determinate matter : 't is 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 Portuguess Peasant , Fonseca de Ex●rement . c. de Vrin●● , 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 & quartana laborantibus , Vesolius Examin . obs. Pallop . p. 191. & dein suspendio aut capite plexis , in furiis & mania oppressit obsessis , in melancholia morbo effectis , ex variis febrium ( quae continuae fuerunt , & rigorum & sudor●m inordinatos circuitus faciebant ) generibus extinctis , faedo ictero , eoque vario vexatis , malo habitu diu pressis , & dysenteria cruciatis , subinde reperi , modo commemorare : Sive scilicet hic insignem bilis nunc flammae , nunc atramenti quo scribimus in modum atrae , sive albicantis propemo●um colorem ( qui fere conterminas partes inficeat ) sive sluidam , aut luti modo , aut unguenti cujusdam ex farinis & melle & terebinthina apparati ritu consistentis substantiam , sive varias calculorum effigies , sive bili● vesiculae molem instar duorum pugnorum ob contenta tumidam , sive omnis bilis defectum , recenserem . Quae omnia me de hujus vesiculae natura adhuc magis quam antea habent solicitum , Regner . de Graeff de succo pancreatit . §. 65. As to the Pancreatick juyce its variety is no less observable : " So for the Phlegm , and Blood 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 shall from what hath been said erect an Hypothesis concerning Plebotomy which will authenticate the received practise , which is so judiciously and happi●y 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 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 . Seneca de benit . 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 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 Sanguification 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 is there no such strict connexion betwixt the Soul , 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 qnantity is more than can be governed by Nature in sickness ; 't is but the observation 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 her self make men and women apt to bleed at some times , Hippocrat . sect. 3. Aphor. 27.20 . 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 't is represented . 'T would 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 .

H●ving 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 ; 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 ( 't is 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 't is 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 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 : 't is not to be denied but some are cured with fewer Remedies than others are : But yet 't is 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 certum est , 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 . Riolanus de circulat fang . 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 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 which 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 Helmontian : 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 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 ; 't is 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 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 Blood 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 Gont : Van der Heyden Synopsis discurs . disc. 2. de potu frigida . 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 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 't is 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 and frequently the sole remedy ) or advise with any Farrier , 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 , and I have frequently observed that the best Medicaments have been ineffectual till after Phlebotomy , So Blondelus could not with all his Skill cure the Marquess of Cauvre till he did bleed him ) in a chronical terrible dysentery : which he confesseth , though he writes against Phlebotomy in Epidemical dysenteries . Valles . meth. med. l. 4. c. 2. 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 . " 'T was 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 ( 't is certain ) will guide a man rightly to his utmost ends . 'T is a kind of impertinency that swayes this Age ; for 't is not so much a Physicians business to talk ; but to heal . It was most judiciously said long ago , C. Cels●● Medicin . in pref. " Ac nihil istas cogitationes ad Medicinam pertinere , co quoque sensudisci , quod , qui diversa de his senserint , ad eundem tamen sanitatem homines perduxerint . — It a que ingenium & facundiam vincere : morbos autem non eloquentia sed remediis curari . Quae siquis elinguis usu discreta bene norit , 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 ●steemed it very well in Physicians if they could demonstrate by their success the solidity of their judgment , 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 ▪ Hippocrat . de A●te . 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 upon were such as were deduced from that Philosophy which makes Rarity and 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 interlexture 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 streightness in the habit of the body . This Hypothesis ( for the further explication whereof I remit you unto Prosper Alpinus ) having been of great renoxa , and more 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 their Maladies , did merit my regards : 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 : Neither is it convenient in a great Cacochymy to purge before bleeding ; Valles . method . medend . l. 4. c. 2. not so much for fear of irritating the Humours , Gregor. Horstius Instit. Med. di●p . 18. Coron. d●venae sect. qu. xi . 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 qualmes the Patients feel are an effect of Diaphoresis . Lipothymia juvet : quia sudorem & validam perspirationem facit . 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 several 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 ) hereunpon there happens a dangerour Orgasmus or turgency of humours in the sick : which Phlebotomy doth prevent . And 't is 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 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 to 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 Phle●otomy as a great Anodyne : and particularly Cit●sius concerning the Colick in Poict●ers . 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 Br●w-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 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 ferment sect. 1 c. 9. & sect. 2. c 8. as not to be able to ferment ( for freedom of room is necessary to Fermentation ) nor transpire , Williss . de ferment . c. 6 , 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 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 whole bo●y by a natural coherence and dependance , is not only evacuated , 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 Arteries 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 be discovered upon burning ) by their expansion , and contraction adding much thereunto : Thus in Water-engines the narrowness of the ●ipes 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 Phlebotomy . Thus upon Scarification 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 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 , Id. ibid. p. 107 , 108. fluit porro quocunque permittitur , 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 arbitr●ntur . " 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 . ●antundem 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 ●rure . 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 morbifick 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 : 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 Phlebotomise , 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 pulsation 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 Hypothesis , 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 for 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 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 proctise Physick . and makes them irregular ) the great incouragement of Quacksalvers , 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 't is impossible for any man to be excellent in Physick . Vide Meibo●ium 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 Hieroglyphics 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 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 Pleuri●e , 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 parenrs , 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 a man that is a speculative Artist ( how much more those that are neither speculative , nor Empirics ? ) 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 . 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 . Hippocr . de veter medicin . c. 17.

I have already spoken concerning Phlebotomy in the Plague : In a Pleurisie 't is no less evident that Physicians are divided in their judgments . To begin 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 'T is 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 divate 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-duaeg ; but is himself Author and Witness : Thus he bristles most Porcupine like . Se jaculo , sese pharetra , sese utitur arcu .

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 't is 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 to think that some upon large and repeated Phlebotomies may 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 disharged by urine : See Schenckius obs. l. 2. de pleurit . Prosper Alpin . Medic. meth. l. 7. c. xi . 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 ; 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 Pleuritics 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 .

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 . Redivicus ● . 3. p. 10● :

Baptist. Cadronch . 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 , Castellus de abusu 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 , Gobelchoveru● centur. 2. cur 92 in Scholio Hollerius apud facetium in Coac . l. 7. sect. 2. sect. 18. vide etium Iaco● 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 inutilis est , aut certe non necessaria . Aliis enim levioribus anxiliis curari potest , quomodo is a Galeno percuratus , qui in levi pleuritide sanguinem exp●ebat ;

Galen●● comment . 3 in l. 6. Epidem .

But Riolanus doth blame Galen as violating his own Rules hereby ▪ De circula● sang , c. xx .

& plurimi visi sunt a nobis & aliis medicis citra ejusmodi a●xilium 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 praenuntiauerint , Holler . de morb intern . l. 1. c. 26. De pleuritide . cris●● tempore , quae fere fit ad septimum , aut alium diemcriticum , vehementer Pleuritis exacerbatur , symptomata omnia increscunt , tum nibil 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 't is 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 :

Alexius Pedemont . de secr. l. 1. p. 51 , 49. River . cent. 4. obs. 88.

Quercetan . Rediviv●● ● . 3. p. 103.

as he in Alexius Pedemontius with the pectoral drink , 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 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 non encurbitulis adhibitis , Fr. Volleriole obs. Medic. l. 4 , obs. 1. ullave purgatione , duobus tantum illi praescriptis Clysteribus emollientibus , sputo eodem die 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 . sebr . 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 adolescente praedivite , qui tempestiva 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 this way of his condemned by Vallesius , whose words are these . Valles in Hippocrat . de victa in morb . acut . l. 4. p. 197 " Haec [ apud Hippocratem ibi ▪ ] ratio curandi plouriticos , 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 aegruti , desperant servari posse , ad nullam aliam ●ranse●ntes curatione● . Scio tamen quendam , ●ui homo quidam vulgaris nescio quid hujusmadi in potu dedit , copiosissimo sudore excitato , servatamesse brevi , & thoracem laxatum , & sputum redditum facile , cum septima jam dies esset , & nihil cae●isset excre●re , & pene jam strangulari prae respirandi difficultate periclitaretur . Idiotae etiam qui Emperice curatione● 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 expectorate , ( and perhaps a pectoral liniment , or fomentatio● ) 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 , 〈◊〉 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 , 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 Asarabacea-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 P●eurisies 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 .

Ludovicus Paniza , Mantuanus ▪ in Apologia Commentarii de parc● evacuatione in gra●in● morborum principiis a materia multa & mala & non furiosa pedetentim facienda . cap. 6. fol. 59. col. 1.

" Praeterea quid sensui respondebimus ? quod anno 1554. mea conjuge pleuritide correpta , ea suum annum 72. agente , imbecillis naturae , melancholicae temperaturae , sanguine & carne exuta , dolore ad spatulam ascendente . E●● secundo mobi die , non cum Phlebotomia , sed cum Pharmaco purgavimus , quod summa cu●● tranquillitate subduxit , deinde subtili cum diaeta , & coquentibus , & sputum facilitantibus ( ut par est in hujusmodi morbis ) usque ad septimam sic procedentes , qua tra●sacta , de Phlebotomia memores , sanguinis & carnis privatione , aetate , & aegra reluctante , eam dimissimus , atque ad id faelicissimum purgatorium Medicamentum rursus devenimus , a quo post xiv . diem salvata fuit , "

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.

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 Vallesit . Hippocrat . Epidem §. 3. l. 3. p. 309 , 310 , 311 , 312. cum notis Vallesi● . and De morbis , besides what he hath set down occasionally in his other Works : It is an Acute Feaver , finishing its course in seven , 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 matter . Hippocr . Coac . Praenot . l. 5. sect. 2. sect 27. cum notis Iacotii . Ballonius Epidem . l. 1. p. 20. Besides , it is a very faellatious disease , and frequently after hopes of a recovery by a benign Anacatharsis , after that the stitches have abared , 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 . Coac . 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. Librand . ● 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 flatulent ones ? Is it not moreover known , that Vinegar dissolves congealed Blood , and is therefore given in bruises : As also Oxymel and syrup of Vinegar in Pleurisies ? But 't is 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 noti● Vollesit . 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 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 partite , and , after some intermission , repeated phlebotomies : and in order to the Anacatharsis or expurgation by spittle , we do give them all befitting 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 , were Rixa de lana caprina . Vesal . exam. obs. Fallopii . p. 129. yet this is evident , that Nature delights to evacuate 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 't is wisdome for us to imagine , that 't is not indifferent what side we 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 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. 33. 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 once case of his .

Tulpius Obs. l. 2. c. 2.

" Vxori Cusparis Walendalii , insurrexit , octavo a partu die , acerbissimus lateris dolor : repetens identidem , tot insultibus , ut necesse fuerit , ter pedis , & quinquies brachii exoluere venas : antequam comprimeretur , sanguis , a suppressis menstruis sursum raptus . Sed ea fuit ipsi virium constantia : ut praeter sanguinem toties detractum , sustinuerit insuper ingens alvi profluvium , antequam integre , evicerit hunc morbum . "

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 Baconical Ignoramus's cannot do that . I find that Forrestus seldome , if ever bled his 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 venae sectione curantur , & ex decem unus vel duo emoriuntur , & 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 't is 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 Botallus did the wonders he speaks of , but as there were left-handed Catoes heretofore , so there is many a left-handed Eotallus , 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 . 'T is 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 . " Siquidem antiqui , primam ultimamque aetatem sustinere non posse hoc auxilii genus judicabant ; C. Celsus Medic . l , 2. c. 10. persuaserantque sibi , mulierem gravidam quae ita 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 aetas sit , neque quid in corpore intus geratur , sed quae vires sint . Ergo si juvenis imbecillus est ; aut si mulier , quae gravida non est , parum valet , male sanguis mittitur , emoritur enim vis , siqua supererat , hoc modo erepta . At firmus puer , & robustus senex , & gravida mulier valens , ●uto sic curantur . " I have seen some of all Ages phlebotomised , and have preserved the lives of some small Children by that means ; I have seen Ladies with child to be let blood , when they were continually swooning , and fainting , and extream weak : and that judicio●sly : for they having large veins , and otherwise a firm and imperspirable habit of body , we did not regard the Animal Imbecillity , nor the irregularity of a pulse 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 Timaeus : He did not scruple to let a gravid woman blood , but she was so far gone , as that he trembled : " Tandem non tantum adstantibus mulierculis , sed & ipsa aegra venae-sectionem vehementer urgente , exemplo Petri Salii Diversi , qui ultimo mense , & instante partus tempore feliciter venum aperuit , Baldass . Timaeus respons. Medic. 58. jeci aleam , Petrus Salius Diversus de affect . particular . c. xxii . & secta mediana sanguinem ad uncias circiter sex detraxi , & sic optato successu & matrem & 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 , or not , If be 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 , 't is 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 looseness , 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 adivce 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 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 beneficial to the Patient . Larvi sanguinis fluxus ex naribus multa solvunt , Hippocr . Epid. l. 2. sect. 3. p. 102. cum notis Volles●i . Prosp. Alpinus de praesag . vita & morte . l 7. c. 2. ut Heragorae . Non agnoseebant Medici . Though it happen symptomatically , yet is it frequently advantageous , even in Pleurisies : nay 't is an accident we may commonly expect in them : Quibus febricitantibus rubores in facie , & capitis vehemens dolor , venarumque pulsus , Coac . praenot . l. 4. v. 30 , Prosp. Alpinus de praesag . l. 7. c. 16. iis ut plurimum fluor fit sanguinis : and in a Pleurisie , 't is alwayes the most mild and safe , if the Patient begin his Anacatharsi● 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 morbis , p. 170. Holler . apud Iacot . in Coac , l. 5. sect. 2. sect. 59. which if it be small doth portend evil ; but if it be large , is beneficial . Pleuritis larg● haemorrhagia enaribus judicare potest , stillatione non potest . And this good fortune did recover Demosthenes out of an incurable Pleurisie , as he relates it himself . Demosth. adv. Canon . cit●nt● Beverovicio 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 mihi doloribus afflicto , & jam desperata purgatio sanguinis ultro copiosa supervenisset , me saniosum ( 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 ) factum fuisse periturum : nunc is sanguis recessu mihi suo saluti suit . " 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. 80. 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 't is 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 : 't is 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 Dedicaments so safe , so authenticate according to the Rules of Art and practical Observations ( which we preserve ) that 't is 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 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 auferamus , quo sanguis , variolarum fermento inquinatus , & coagulari aptus , adhuc motum aequabilem in corde & vasis stagnatione retineat , ac effervescens portiones cum veneno gelatus for as 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 for as 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 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 Measil● 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 .

Ballonii , ad D ▪ D. Francisc● Vautier Archiatrorum Comitem .

— 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 , 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 , quercea corona dignus habitus est , Tu certe qui Regem Christianissimum ab hoste tam infenso liberasti , auream , qualis est ab Atheniensibus Hippocrati concessa , meruisti . Nec dubito quin si vixisses priscis illis temporibus , quibus inter Heroas 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 acknowledgments 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 disease . I did at first doubt , Whether I ought to reckon them as Distinct Authors , because they so for 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 .

Doctor T. Whitaker of the Cure of the Small Pox , p. 22.

" In the Regimen of this Disease , the whole work consists in moderation of Air and Diet , without any other mixtures of violence , or bland impediments , which may altogether pervert , or in or by a less force retard Nature in its motion , the motion of Nature in this case being from the beginning of the disease to the eruption of the pustules Critical , and in Critical motions the least application of any Medicament is so dangerous , that no expert Physician will admit of it . " — The Diet is to be Alimentum medicamento sum , such as is Milk with Saffron and Marigold flowers .

" Doctor Sydenham doth suppose that it is natural for the Blood of all persons at least once in their lives to undergo a great change , and as it were a new form : and that there is no peculiar venome or malignity infecting the Blood , but all is the result of this inclination in it to exchange its state ; and in order thereunto some parts are to be expelled ; and in order thereunto must first be separated : He observes that this Feaverish , or great ebullition is not constant to the Smoll Pox , but that the separation and expulsion is frequently performed without any great sense thereof , the Patient never confining himself to the chamber . This is done by a Feaverish Ebullition in the mass of blood , whereby those parts are separated from the residue , and discharged into fleshy parts of the Body , which Nature looks as requisite in order to the change she is going to make : All this is usually done in four dayes , and the Blood is recomposed and becomes as calm in its motion , as it was before . The expelled matter is to be elevated into pustulary abscesses , and there maturated and dryed up . For the carrying on of all this work , it is his judgment that the Physician ought to do nothing : " But the Patient is to be kept in a moderate heat , and temperate diet , taking nothing that is cold ; " and not so much as being confined to his bed beyond his ordinary use , except necessity require it , and then he is to use no more clothes , nor warmth than he accustomed himself unto in health , not so much as being obliged to keep his armes in Bed . On the fourth day he gives them one very gentle Cordial to promote their eruption , and abandons them to Saffron and Milk , to be given twice a day , and ordains that he be kept in a constant moderate warmth , such as is natural , and usual to the Patient . "

This is the sum of his Method , except I add , that " when they are upon maturation , he gives a mild Cordial twice each day , morning and evening : And in case that during the time of the decumbiture of the Patient by any accident a new Feaver arise , then is the Patient to be kept still in such a proportionate heat as is usual to him in health , if the season be temperate , he is not to have a fire ; to be dieted with small Beer and Water-gruel , stewed Apples , or the like , but to have no Cordial , not so much as Harts-horn posset-drink . "

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 r●ason 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 out .

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 , Forrest . 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 , Prosper . Alpin . de prae●ag . vit. & morte . lib. 6. c. xi . so as that oftentimes they bring a momentany alleviation ; 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-w●rd , 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 its due time ) we must consider whether it be only a Motion , or whether 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 Fox 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 ) 't is 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 : 't is 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 quendant statum , & diathesin immutet , hominemque etiam cui sanguis purus & 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 adipiscigestit , qualem ejusmodi aer aut victus postulaverint : minime vero quod particularum vitiosarum in sanguine stabulantium irritatio , febrim procreet . " — 'T is 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 't is 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 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 , 't is certain 't is 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 . Sal●●as . de annis Climacter . p. 726 , 727. It may be imagined to have come from Aegypt by contagion , and might have been called 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 , 'T is Epidemical to Aegipt at this day . 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 alterations , that they have ever been preceeded and accompanied with many petty changes in other things : and if ever I have so much vacant time as to make political reflexions upon the rise of Mahomet , I may declare much to this purpose . This is that invidious subject about which Ecebolius Glanvill makes so much noise : as if , to avow that Mahomet were a Gentleman of noble extraction , married to one who for birth , riches and beauty might have been a Princess ; and accomplished with that sober Vertue , Wit , Eloquence , and Education , by much travel ( for he travelled all over Aegypt , Africk , and Spain ) as to render 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 that time , that most of the Fables in the Alcoran were accommodated to the honour of the times , more than to truth ( and 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 ! B●t 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 & Ranchin . de morb . puer . sect. 2. c. 1. p. 258. 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 fecissevisi sint , ea certe exigua est , & dubia , ut certum sit , vix illis temporibus fuisse talem morbum : negligentissimi certe habendi essent , Hofman . Animadu . in Monton . c 7. sect. 15. & Instit. l. 3. c. 109. sect 1. & Nardicis noct. genial . 7 p. 456.457 . 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 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 ●ebribus , c. 6. de vatiolis . " 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. but compares the Blood to Must , Senner● . de ●ebr . l. 4. c. xii . 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 only : Hor. Augen . de febr . l. 9. c. xx . Steph. Castren . Quae ex quibus , l. 3. c. 16. Th. Bartholin . Cista Medica , p. 594. so that if the Eyes , Lungs , Stomach , Guts , Pancreas , or Membranous parts be affected , 't is 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 .

Fernel . patho . l. 4 c. 18. & de abdit . rerum causis , lib. 2. c xii . I might proceed to demonstrate that there is not any thing new 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 : Collado obs. in Holler . meth. c. 92. And the rest hath been inculcated by an hundred Writers : provided the Small Pox were gentle : Io. Dan. Horstius obs. Anatom . 9. yet , as much as they have been for the keeping of them moderately cool as to Air , or Diet , before the eruption 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. Sydenham , p. 138. Mihi quidem rationi consentaneum videtur , ut quo diutius Natura separationem molitur , ac perficit , dum modo ebullitio non omnino torpeat , eo certius atque universalius eadem separatio absolvitur . For our best Writers , In genere melius est variolos & morbillos icto , quam tarde crumpere . Sennert . de febr . l. 4. c. xii . 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 furtherr , 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 ( at least is not ) to his Chamber , and any strictness of Rules : Coyttarus de purpur ▪ febr . 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 erumpunt . 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 Sydenham . 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 , profusion 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 happens that the Patient dyes , no errour intervening : whereupon Ioseph de Medicis exclaims after forty years of practise . Ioseph de Medic● 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 est mutatio quaedam subita ad salutem , Hor. Augen . de febr . 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 vomitum , 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 extimam & intimam simul , utque sic per abscessus parvos , quos pustulas nuncupavimus , ubique procreatos . Nunquam alvi ftuore , nunquam vomitu sanantur ; imo si forte adveniant , pessimum signum est . " But if we take Crisis and Critical evacuations in this sense , 't is 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 , Avicenno 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 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. causia lib. 2. c. xii . " Hoc & morbor●m 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 quatuor e 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 , 't is 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 consid●ration 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 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 ? Joh. 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 having more than is requisite for the commodious discharge of that Disease : for if the body be either way Plethoric , there is apparent danger least the Patient be strangled , or that the turgent 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. 6. cbs. 44. since that adds much to the mildness or perilousness 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 ought also to weigh well the first Symptomes , Ho● . 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. Thlebotomy , 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 momentany Looseness ( and 't is 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 : 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 vena●● fecuim●s , & medicamentum purgans dedimus , quibus die sequenti , aut postridie apparerent variolae , & melius multo habuerunt , quam quibus non a●si 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 't is as vain a surmise to think that an intelligent Practitioner will do any thing rashly ; as 't is 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 folid 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 . Men● comment . in lib. de sangemiss . 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 and all●viated 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 Langius , 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 Physician● 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 : De diaeta , l. 1. c. 5 it being the dictate of Hippocrates , 〈◊〉〈◊〉〈◊〉〈◊〉〈◊〉 . And Aristotle long ago censured those who out of a preconceived opinion of the event of a thing did form their judgment ; Frederic . Bonaventura de partu ●ctomestri . 1.5 . 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 thereof , 't is 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 W●itaker 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 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 may 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 't is 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 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 . l x. c. iv . " Omnes , qui de variolis scripserunt , unanimi consensu , principium curationis , illarum fieri debere a vacuatione sanguinis contendunt , ide●que venam incidendam esse , aut scarificationes administrand●s , 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 't is 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 iunc ut administretur phlebotomia , nisi inveniatur vehementia repletionis , & dominium materiei : tunc enim phlebotometur quantitate quae alleviet , seu minoret . Et convenientius quidem , quod in hac 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 Medicu apud Greg. Horst . ● . 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 ●urcharge of morbific humours , then he alloweth only a minute letting of blood , and not what is too copious : and adds , that in this disease 't is 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 transpire 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 circumference , 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 : Rhases ( inter Scriptores de sebribus ) 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 〈◊〉 concurring 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 , Rhases 18. Cont. 8. citante 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 fuerit , non veritur vacuare usque ad animi deliquium : si mediocris , mediocriter educit : si parva fuerit , paulum sanguinem 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 , Botallu 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 febr . 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. Claudinus 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 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 , Gordonius : lilium Medicinae . part. 1. c. 12. de variolis . aut si sanguis dominatur , aut virtus est sortis , 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 morbisick 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 , one of our best Writers upon the Small Pox , ( and who protests he writes n●thing in order to its Cure , but what six and forty 〈◊〉 Experience had convinced him of to be good ) doth allow , ●d . ibid. c. 3. 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 Lusitanus de venae sectione . c. xi . Artic. 1. p. 145. 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 ; Epiphanius Ferdinandus cas. Medic. 78. Aemil. Campol . de variolis , c 413. so that I shall cite no more of that Nation .

In Spain 't is approved of by Christophorus a Vega , whose words are these . C●risto a Vega de arte med. l. 2. sect. 7. c. 1. " Si vero lactae fuerint variolae , & ab humore fiant crassiore , ab initio sanguinem mittere , si febris adfuerit ; sine ipsa vero minime . " And the best of Writers , Ludovicus Mercatus is thus peremptory in his Resolution . Lud. Mercatus de puer . morb l. 2. c. 22 Vide etiam Ludo. Mercat . de febr . l. 7. c 3 & de recto Medicinal . praesid . usu . l. 1. c. 4. & Anton. Ponce Sanctacruz de impediment . magn . auxil . l. 3 c. 18. " De sanguinis detractione 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 sanguinis 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 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 Jacch●● , de febr . c. 54. & Cons. Medic. l. ● . cons. 4● . 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 , Felix Platerus t. 2. de cur . variolar . inter opera , p. 200. " Sanguinis detractio per venae sectionem in brachio facta ab initio , si Synochi hae sunt febres , cu juscunque generis , ad sanguinis accensi , vel simul putridi , vel maligni etiam portionem educendam , causamque sic minuendam , in adultis plurimnm competet . Quae & infantibus majoribus , cum in minoribus natu non liceat , non inutiliter administraretur . Quae tamen , si jam maculae & pustulae eruperint , ne naturae motus impediatur , omittenda erit . " i. e. Bleeding in the Arm , 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 . ● . 2. l. 6. in append . de variolis ▪ & ibid. de febr . l. 1. Que ult. I. Dan. Horstius epist. x. Sennert . de febr . l. 4 , c. xii . and justifies 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 cons●uxit , vena aperienda , ut natura oneris parte levata , quodreliquuum est facilius vincere possit . Post quartum autem diem , & ubi maculae 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 back which was hastening unto and fixed in the habit of the body . Baldasser Timaeus ●os . medicin . l. 8. c. 29. To these may be added Baldasser Timaeus , 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. as also the younger Sebizius , now Professour at Iena ; and I. Christianus Frommanus , a Physician in Saxony : D. Sebizius disp. de variolis ult. qu. 4. I. Christ . ●ramman . discurs . medic . sect. 97.103 . 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 , Fr. Ioel pract. l. 9. sect. 5. § 2 Th. Bartholin . ●isla Medica , p. 60. Also Hoeserus Hercul . medic . l. 7. c. 6. and S. Hefenreffer de morb . cut . l. 2. c. 4. and sayes many have been happily recovered by these means . And so much for Germany .

In England the paucity of our Writers upon this subject gives me no opportunity to defend Doctor Willis by the citation of any Book : 't is 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 : 't is 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 't was 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 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 , 't is 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 , & variola 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 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 . " Hoc primum sciat & consideret , Lud. Mercatu● de puer morbis , l. 2. c. 22. 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 : talis 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. Amicus tr . de variolis , c. 8. inquit Avicenna , plerumque ex angina suffocati pereunt , orta minimum inflammatione in gutture . " Sometimes the matter taketh a wrong course , so as that a Flux ensues , which sometimes becometh bloody : and this befals the Patient either before they come out , or a little after they have appeared : or in the declination : in all which cases , 't is a bad sign : but in the last , commonly mortal . " Si debet hujusmodires experientiae judicio terminari , Hor. Augen . de febr . l. x. c. 8. haec fidem saciet , fluore in declinatione adveniente , etiamsi non sit exulceratious , majorem aegrotorum partem mor. " Sometimes the matter is so acrimonious , that it corrodes the bones , as Paraeus testifies upon his knowledge . Ambr. Paraeus Chirurg. l. 9. c. 1. " Quineliam animadvertere licet in plerisque hujus morbi malignitate mortuis & dissectis , eum in principibus partibus invehi corruptionis impressionem , quae hydropis , phthiseos , rauvicitatis , asthmatis , dysenteriae ulceratis intestinis , ac tandem mortis consecutionem attulerit : prout pustulae pari rabie debacc●a●ae sunt , qu● per corporis superficiem furere ce●nuntur : non enim externas modo partes deturpant , pustularum & ulcerum altius sese in carnem desigentium impressionibus & cicatricibus relictis , sed & saepe movendi facultatem adimunt , arrosis & labefactatis cubiti , carpi , genu & p●dum 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 beat more vigourous than in others : It is also true , that they do hold that sometimes the Small Pox are so mild , that there is little or nothing to be done by the Physician : But 't is 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 . Hor. Augenius de febr . l. 9. c. 4 , 6 , Horatius Augenius and others aver , 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 of 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 Sydenham 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 ; few , 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 .

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 exasperate 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 ●ollunt . 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 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 evacuatiion 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 recrementition 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 .

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 ; 't is necessary that we consider the 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 , Peripnenmonies , Pleurisies , the Small Pox , &c. " Comitatae febres continuae sunt , F. Platerus prax . t. 2. p. 13 de febr . generibus . 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. 29. 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 , and upon due pondering of all circumstances● ) administer a vomit : for , it is neither repugnant but congruous to any of those primary Feavers ; nor contraindicated 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 . exercit . 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. 78. 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 ; 't is 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 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 ! 't is not the time of their separation or motion that way ! ) or impede their eruption , Angel . Sola ternar . Bezoart . c. viii . Forrestus lib. 6 obs. 49. eu● Scholio . 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 ) 't is 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 , 't is indubitably requisite to bleed : and our case here is like to those cases which possess the Brewers , Greg. Horstius 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 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 facile 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 ventilaturi & nullo modo transpiratio prohibetur , Ioseph de Medicis apud Gr. Horst . t. 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 , whether the Feaver be a simple Synochus , or one that is putrid and malignant : and 't is 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 . " Sunt aliae ita malignae , ut non solum carnosum genus adoriantur , Epiphan. Ferdinand . cas. medic. 78. 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 . Epiph. 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 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 family ( adult persons ) that bled of themselves eighteen or twenty ounces , with greater benefit : whilest I durst not be allowed to take away eight . Epiphan. 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 exi●ret , 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 fluore 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 facta 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. c●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 : 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 de . dic . Ma●sil . C●gnati 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 flesh 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 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. coron. de venae sect. qu. 7. 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 . Joseph de Medicis apud Gr. Horst . t. 2. p. 52.53 . 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 Pleurisis , Collado obs. in Hollerii meth. c. 93. and Inflammations of the Liver , and Lungs ? Is this the effect of that Revulsion , Botallus de venae sect. c. 5. sect. 6. that the Humors should slow 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. and Minadous upon an infinity of Patients ) and of the Parotudes ( of which Riverius bo●steth ) 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 ex-anthematibus , interdum ad Phlebotomian venimus . Ita nobilissimae comitissae hymondanae Franciscoe , Admiralii filiae , venam pertundi jussi , cum exanthematu non satis prodirent , idque felici successis . " 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 whensoever it happens otherwise , 't is by accident only ? Doth not Collado argue judiciously against the generality of that Assertion ? Collado obs. in Holler . method . c 9● . 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.

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 ●onet that old Rule in Logick : Syllogizari non est ex particulari .

Pag. 140. edit. 2. As for Doctor Sydenham , he grants that 't is 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 't is 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 ( eoque fortasse melius , quod evacuationes jam dictae praecesserant ) paulo post ex improviso quasi repercussae detumescunt , 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● Such is the Treatise of his , Ep. dedic . ad cl. R. B. Quae etiamsi neque mole ampla , neque spoliis Authorum ( quorum cineres per me molliter cubent ) sit sufferta , tamen non erit , uti spero , eo nomine tibi minus grata , quippe qui inter magna quid inters●● & 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 ●eb . 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 , & geminas qu●e 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 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 ( 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 fanguine florido rubenti , libenter nonnihil fanguinis fubtraxissem prius qu●m eruptio fieret : sed incerti eventus me●u retractus optimum consilium intermis● , quod prosicuum videbam : In mittendo enim sanguine non tam annos Medicus numerat , quam vires aegrotantis aestimat , Celso praeeunte . Negligentiam tamen meam vel metum supplevit Natura optato successu & selici variolarum eruptione . Quippe quotquot ex meis decubuerunt , plerisque delirantibus , eruptionem variolarum , haemorrhagia narium praecessit , qua sublevata Natura promptius expulit variolas 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 consequ●nces 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 't is 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 . 'T is 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. ● . as Vrgency , or a Cura coacta did not absolve the Practitioner from its obligation at sometimes ? And that is the present case . We do univer●ally 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 accidens 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 ●ox , 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 Phlebotomile : 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 appeared . Zacut. Lu●itan . 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 . Diemedes Amicus de variolis , c. 6. " Diomedes Amicus faith 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 . 'T is 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 't is 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 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 apparent 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.

Vollesius 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 . Lu●i●an . de venae sect. c. xi . Art. 1. p. 145. Ioseph de Medicis apud Greg. Horst . t. 2 Hoeferus l. 7. p. 366.

Bartholin . cist . ●edic . p. 101.

that there is still occasion for it . Multa in praecipiti periculo recte fiunt , alias omittendu ▪ I have already alledged the Authority of Avicenna and P●hases , and Bayrus , and the practise of Heurnius upon the Countess of Egmond : I add here , that 't is approved of by Vallesius , Mercatus , Paschalius , Fonseca , and the Physicians of Spain : by Horatius Hugenius , Caesar Claudinus , Ephiphanus Ferdinandus , Dilectus Lusitanus , and the vulgar practise of Italy : By Ioseph de Medicis , Hoeferus , Bartholinus , and many other Physicians in high and low Germany : and the happy practise thereof frequently in this Nation , 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 justifie any prudent Man in the doing thereof ; Let us now examine with what success it hath been done . 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 detract a humorum portione , reliqua facilius superentur . Certe si imperfecte prodeant exanthemata , naturae laboranti succurrendum , partim parca venae apertione , si copia sanguinis oneret , q●od multorum felix eventus comprobavit , partim sudoriferis , quae , ubi malignitatis suspicio , tutius ad extrema corporis clinimant ic●ores . " And Dilectus Lusitanus professeth the neglect of it to be an errour : " Qua in parte aliquorum Italorum Doctorum error & timor calumniandus venit , Dilect . Lu●itan . 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 tali● evacuatio fuit repugnata , & ante suppurationem pueros suffocari , & in multa illarum quantitate etiam suppurata . Non enim potest natura tanta regere & vincere ulcuscula , & ideo suffocatur , indeque multotier pulmonia & alia superveniunt accidentia . " 'T is 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 : Hippocr . sect. 2● aph. 29. but in the state to supersede : Cum morbi incipiunt , 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 turgent and crude humours , 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 , 't will 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 ; 't is 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 , 't is 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 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 , 't is 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 , or death . Prosper Alpin . de praesag . vita & morte . l. 1. c. ult. 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 is hazardous ; but 't is 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 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 labuniur 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 , of 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 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 . 'T is 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. 173. de medic . Aegypt . l. 4. c. 15. 'T is 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 , Melichius Armament . medic . dist. 9 in Scholio super Pilulis de nitro . 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 Physician hath more reason than 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 ; yet 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 't was 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 mortifie 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 esflux of blood at the Nose . It is here as it is in a Synochus putrida , ( for commonly 't is 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 . 'T is meer folly here to object , that albeit that Phlebotomy be omitted , yet ought we to presume well of the Patient , because the Small Pox do come forth : as when sweat appears in a Synochus : for there is a great disparity 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 here , than upon the eruption of sweat : Moreover the sweat consists of a more subtle and Ichorous substance , 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 , 't is prudence to submit thereunto rather than to incurre greater .

Hitherto I have treated of Phlebotomy as 't is 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 Therax : or that the Small Pox very much affect the Stomach , and Entrails , or occasion a Diarrhaea , or Dysentery : For in these cases , 't is most probable that the Patient either will not live to the state of the disease , or dye then . 'T is a received tradition from Avicenna downwards , Diomedes Amicus de variolis , c. 8. that in case the Patient in the Small Pox do breath freely , and suffer no defect in his voice , there is little , 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 appear 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 , 't is 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 Pleurisie , and particularly by affecting the membranes of the Stomach , they have created Vomittings 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 to sleep , and 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 .

Instances of the happy success of Phlebotomy in the Augment of the Small Pox , after they were come forth . § . 7. The illustrious Lord of Poyrin , Botollus de venae secticne , c. 5. a strong young man , was seised with a violent putrid Feaver ; on the third day he was taken with a looseness , which resembled what Physicians call a Diarrhaea : on the day following the Feaver and Flux continued with the same violence , and a multitude of red spots appeared all over his body , with a little protuberancy : on the fifth day , all symptomes persisted in the same violence , or rather encreased , whereupon I being present caused him to bleed eighteen ounces ; after which operation all those perillous symptomes did so abate , that within two dayes there was not any thereof remained . § . 8. On the same day that the aforesaid Lord was let blood , and in the same house , there was a Servant of Mr. Barrussa , who was sick of the same distemper ; but he had no Flux : he had been sick four dayes , and two dayes were passed since the Small Pox appeared : He was of the Age of eighteen years . I took from him a pound of blood ; whereupon all his distemper left him , and he went about his business , attending on his Master , on the day following , which was the fifth day of his sickness . § . 9. Such Phlebotomy did also recover Mr. Clermont from a Feaver , and the Small Pox : as also — Villard , one of the Queens Pages ; and another Page of the Duke of Alencon's , and many others were cured by me in that manner . Also that learned Physician Pietreus told me , that he practised this course with good success upon his own Son .

I come now to the third Question : Whether in the State of the Small Pox Phlebotomy may by 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 matted : 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 . 'T is 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. except it be I. Frommannus , who finds some cases in which he justifieth it in the State of the Measils . 'T is also true , that the common Precept amongst us is , not to disturbe Nature in the State , Hippocr . Aph. 29. sect. 2. 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 and 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 : 't is 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 will not cure as , when other remedies have ill operated ; and cast our selves 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 . Galen . de sang . missione , c. 20. " Quocunque etenim die mittendi sanguinis scopos in aegrotante inveneris , in eo praesidium hoc adhibeto , etiamsi vigesimus ab initio morbi dies fuerit . Quinam vero suerunt hiscopi . Magnus morbus , virium robur , excepta aetate puerili , & ambiente nos aer● admodum calido . " In another place he sayes , Galen . meth. l. 9. c. 5. There is not any time of a disease in which you may not bleed ; but the sooner it is done , the better . Another sayes , Vbi magnitudo morbi postulet , & vires permittunt , Hier. Rubeus in C. Cels l 2. c. 10. p. 94. non solum octavo die , ut Hippocrates Anaxioni , sed & decimo , ac vigesimo , felici successu `venam secammus . This point is excellently prosecuted and illustrated by Botallus , B●tallus de venae sect. c. 22. Concerning bleeding in the Augment , State , and Declination of a putrid Feaver , see Caspar Bravo 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 disease I have 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 distemper or Squinancy , sometimes a Pleurisie ; sometimes a Diarrhaea or Dysentery : sometimes an immoderate Flux of the Menstrua : In all these cases 't were great indiscretion , if not ignorance , to omit Phlebotomy : If any of them can be disputed , 't is that of a Diarrhaea and Dysentery : and yet that is so vindicated by Botallus , Botallus c. 5. Prosper Alpinus de med. Aegypt . l. 2. c. 7 and Prosper Alpinus , ( not to mention others ) and attested unto by a successful Experience , that 't is 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 an 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 evacuation by blood-letting : and he is unacquainted with his profession , who hath not seen prodigious effects 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 , 't 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 Books informed themselves of the history of Physick , as it relates to particular cases , and by a diligent attendance on their practise observed the truth 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 t is 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 , 't is 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 .

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. Augen . de febr . l. 9. c. 8. Caspar Bravo resolut . med. part. 2. disp 3. resol . 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 . Hippocr . aph. 27. sect. 2. " Iis quae non secundum rationem sublevant , non oportet fidere : neque ●erreri 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 . 'T is observed that a Flux in the declination of the Small Pox is generally mortal , Hor. Augen . de febr . 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 befalleth 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 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 be more radicated and setled 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 't is 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 , 't is possible that Phlebotomy 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 attentively that disease ,

Forrestus l. 20. obs. xi . xii , Claudinus Emperic . ration . I. 3. sect. 3. tract. 4. c. 5. Ioel pract. l. 2. sect. 5 §. 4. R Dodonaeus obs. med c 33. Eugalen . de scorbuto , p 150.151 .

B. Brunerus ( sub finem Eugaleni ) & H. Brucaeus ibid. Baldassar Timaeus cas. medic . l. 3. cas. 39.

Platerus prax . ● . 3. p. 431. Bennertus de scorbuto , c. 7. B. Ronsseus de scorb . c. 8. Wierus in curat . scorbuti . S ▪ Albert. de scorb . § 240 , &c. M. Martinus , sect. 145. &c. Gregor. Horstius de scorbuto exercit . 2. sect. xi .

Mollenbroccius de varis c. 8. & 13.

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 : and the Colledge of Physicians at Coppenhagen ( in their advice for the Scurvey , Bartholin . cist . medic . p. 506. published by Bartholinus ) I might add others to this Catalogue , but that 't were needless . 'T is true , that in the Scurvey many do not bear well large Phlebotomy ; but that is not the Question : 't is 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 , 't is 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 notorius that no Nations do bleed more largely , nor more frequently that they : I will not insist on what they do in their natural or artificial Bathes , with Cupping-glasses and Scarifications , Th. Iordan . delue ●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 .

As to Phlebotomy , in Denmark nothing is more common than whensoever the Almanack recommends bleeding , for every man almost to step 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 puerile fear in the Patient , or ignorance in the Physician , hinder them . " Adultiores alii in venarum apertione nimis sunt profusi vel audaces , Th. Bartholin , medic . Dan. dissert. 9. p. 431 , 432. quippe visa fascia rubente ante aedes Chirurgorum appensa , ex Calendariorum signis dependentium , statim sine alia corporum praeparatione in sella officinae considentes brachium sine delectu pertundendum offerunt ; & peracta 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 , 't were 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 , Wepserus de apoplex a histor. 3. p. 12. & quolibet vice duas , quandoque tres , non raro quatuor venas pertundendas curant ; emittunt soepe binas sangninis libras : Nulla cura est vel temperamenti , vel sexus , vel aetatis : Vindentur quandoque gravidae , quae his 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 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 , 't is 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 . Rol●ine . method . medic . special . l. 4. sect. 2. cap. 5. " Reverenda canitie , & septuaginta annorum decursu venerabili praesuli 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 't is evident , that whatsoever the German practise be in Diseases , 't is not their Reason , but superstition and imaginary fear that makes them 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 professeth 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 , Io. Dan. Horstius obs. & epist. ep. x p. 54 , in opposition to him : " Experientia testatur quod non solum in Febribus his , sed & in variolis & morbillis , 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 pleased to consider the shortness of the time allotted unto me , the great distractiin with which I 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

Your most humble and devoted Servant Henry Stubbe . Warwick April 3 1671