SUBSECT. II.—Bloodletting.
Phlebotomy is promiscuously used before and after physic, commonly before, and upon occasion is often reiterated, if there be any need at least of it. For Galen, and many others, make a doubt of bleeding at all in this kind of head-melancholy. If the malady, saith Piso, cap. 23. and Altomarus, cap. 7. Fuchsius, cap. 33. [4246]“shall proceed primarily from the misaffected brain, the patient in such case shall not need at all to bleed, except the blood otherwise abound, the veins be full, inflamed blood, and the party ready to run mad.” In immaterial melancholy, which especially comes from a cold distemperature of spirits, Hercules de Saxonia, cap. 17. will not admit of phlebotomy; Laurentius, cap. 9, approves it out of the authority of the Arabians; but as Mesue, Rhasis, Alexander appoint, [4247]“especially in the head,” to open the veins of the forehead, nose and ears is good. They commonly set cupping-glasses on the party's shoulders, having first scarified the place, they apply horseleeches on the head, and in all melancholy diseases, whether essential or accidental, they cause the haemorrhoids to be opened, having the eleventh aphorism of the sixth book of Hippocrates for their ground and warrant, which saith, “That in melancholy and mad men, the varicose tumour or haemorrhoids appearing doth heal the same.” Valescus prescribes bloodletting in all three kinds, whom Sallust. Salvian follows. [4248]“If the blood abound, which is discerned by the fullness of the veins, his precedent diet, the party's laughter, age, &c., begin with the median or middle vein of the arm; if the blood be ruddy and clear, stop it, but if black in the spring time, or a good season, or thick, let it run, according to the party's strength: and some eight or twelve days after, open the head vein, and the veins in the forehead, or provoke it out of the nostrils, or cupping-glasses,” &c. Trallianus allows of this, [4249]“If there have been any suppression or stopping of blood at nose, or haemorrhoids, or women's months, then to open a vein in the head or about the ankles.” Yet he doth hardly approve of this course, if melancholy be situated in the head alone, or in any other dotage, [4250]“except it primarily proceed from blood, or that the malady be increased by it; for bloodletting refrigerates and dries up, except the body be very full of blood, and a kind of ruddiness in the face.” Therefore I conclude with Areteus, [4251]“before you let blood, deliberate of it,” and well consider all circumstances belonging to it.
SUBSECT. III.—Preparatives and Purgers.
After bloodletting we must proceed to other medicines; first prepare, and then purge, Augeae stabulum purgare, make the body clean before we hope to do any good. Walter Bruel would have a practitioner begin first with a clyster of his, which he prescribes before bloodletting: the common sort, as Mercurialis, Montaltus cap. 30. &c. proceed from lenitives to preparatives, and so to purgers. Lenitives are well known, electuarium lenitivum, diaphenicum diacatholicon, &c. Preparatives are usually syrups of borage, bugloss, apples, fumitory, thyme and epithyme, with double as much of the same decoction or distilled water, or of the waters of bugloss, balm, hops, endive, scolopendry, fumitory, &c. or these sodden in whey, which must be reiterated and used for many days together. Purges come last, “which must not be used at all, if the malady may be otherwise helped,” because they weaken nature and dry so much, and in giving of them, [4252] “we must begin with the gentlest first.” Some forbid all hot medicines, as Alexander, and Salvianus, &c. Ne insaniores inde fiant, hot medicines increase the disease [4253]“by drying too much.” Purge downward rather than upward, use potions rather than pills, and when you begin physic, persevere and continue in a course; for as one observes, [4254]movere et non educere in omnibus malum est; to stir up the humour (as one purge commonly doth) and not to prosecute, doth more harm than good. They must continue in a course of physic, yet not so that they tire and oppress nature, danda quies naturae, they must now and then remit, and let nature have some rest. The most gentle purges to begin with, are [4255]senna, cassia, epithyme, myrabolanea, catholicon: if these prevail not, we may proceed to stronger, as the confection of hamech, pil. Indae, fumitoriae, de assaieret, of lapis armenus and lazuli, diasena. Or if pills be too dry; [4256]some prescribe both hellebores in the last place, amongst the rest Aretus, [4257]“because this disease will resist a gentle medicine.” Laurentius and Hercules de Saxonia would have antimony tried last, “if the [4258]party be strong, and it warily given.” [4259]Trincavelius prefers hierologodium, to whom Francis Alexander in his Apol. rad. 5. subscribes, a very good medicine they account it. But Crato in a counsel of his, for the duke of Bavaria's chancellor, wholly rejects it.
I find a vast chaos of medicines, a confusion of receipts and magistrals, amongst writers, appropriated to this disease; some of the chiefest I will rehearse. [4260]To be seasick first is very good at seasonable times. Helleborismus Matthioli, with which he vaunts and boasts he did so many several cures, [4261]“I never gave it” (saith he), “but after once or twice, by the help of God, they were happily cured.” The manner of making it he sets down at large in his third book of Epist. to George Hankshius a physician. Walter Bruel, and Heurnius, make mention of it with great approbation; so doth Sckenkius in his memorable cures, and experimental medicines, cen. 6. obser. 37. That famous Helleborisme of Montanus, which he so often repeats in his consultations and counsels, as 28. pro. melan. sacerdote, et consil. 148. pro hypochondriaco, and cracks, [4262] “to be a most sovereign remedy for all melancholy persons, which he hath often given without offence, and found by long experience and observations to be such.”
Quercetan prefers a syrup of hellebore in his Spagirica Pharmac. and Hellebore's extract cap. 5. of his invention likewise (“a most safe medicine and not unfit to be given children”) before all remedies whatsoever. [4263]
Paracelsus, in his book of black hellebore, admits this medicine, but as it is prepared by him. [4264]“It is most certain” (saith he) “that the virtue of this herb is great, and admirable in effect, and little differing from balm itself; and he that knows well how to make use of it, hath more art than all their books contain, or all the doctors in Germany can show.”
Aelianus Montaltus in his exquisite work de morb. capitis, cap. 31. de mel. sets a special receipt of his own, which, in his practice [4265]“he fortunately used; because it is but short I will set it down.”
℞. Syrupe de pomis ℥ij, aquae borag. ℥iiij. Ellebori nigri per noctem infusi in ligatura 6 vel 8 gr. mane facta collatura exhibe.
℞. Epithymi semunc. lapidis lazuli, agarici ana ℥ij. Scammnonii. ℨj, Chariophillorum numero, 20 pulverisentur Omnia, et ipsius pulveris scrup. 4. singulis septimanis assumat.