An Introduction, or Compendious Way to Surgery.

By Ambrose Parey, Father of Surgery, 1510-1590

XVII. Of Repletion, and Imanition, or Emptiness.

There are, to bee short, two sorts of Repletion, or of all excesse; one is of a simple qualitie, without any defluxion, or societie of any humor, as appeares in distempers without matter: the other is of quantitie and masse, the body being distended with too much meate, or too great quantitie of humors; from whence proceed an infinite number of diseases. They call the Repletion of meates, satietie or fulnesse, and it is of two kinds; the one which is called  Repletion or fulnesse to the vessels; the other Repletion to the strength.

We judge of satietie to the vessels, by the distention and swelling of the veines and intrailes, as the stomacke. We call satietie to the strength, when the body is loaded with more meates, than it can well beare. But also there is a double repletion of humors. For either it is of some one humor, or of all the humors; they call this by a peculiar name Plethora. For Galen defines Plethora an equal excesse of all the humors. For if at any time he define a Plethora to be an excesse of bloud only, then verily by the name of bloud, he understands an equall comprehension of the four humors; as it is taught in physicke schooles.

The repletion which is caused by some one humor, is termed by Galen in the place before mentioned, Cacochymia, that is, an evil juice, whether the repletion proceed of a cholericke, melancholicke, phlegmaticke, or serous humor.

Now Inanition, or evacuation is no other thing than the expulsion, or effusion, of humors which are troublesome, either in quantitie, or qualitie. Of evacuations, some are universal, which expell superfluous humors from the whole body, such as purging, vomiting, transpiration, sweats, phlebotomie. Some particular which are performed only to evacuate some part, as the braine by the nose, palate, eyes, ears; the lungs by the weazon; the stomacke by vomite and stoole, the guts by stoole, the liver and the spleene by urine and ordure. These evacuations are sometimes performed by nature, freeing itself of that which is troublesome to it; otherwiles by the art of the physition in imitation of nature.

And again, one of these is good and requisite, when only the humor which is hurtful, either in quantitie or qualitie, is evacuated. The other not requisite, or immoderate, when the profitable humors together with the unprofitable, are expelled.

But what evacuations soever these be, they are performed and done, either by the scratching and rubbing of the skinne, as when a cholericke, salt, or serous humor, or some windinesse lying betweene the skinne and the flesh, cause itching. For by scratching the skinne, it gets passage out, which is manifest by the effluxe of a serous matter burning, or causing scabbs and ulcers, if the humor be somewhat grosse, but insensible and not so manifest, if it be windinesse, the skinne by that rubbing being rarefied, and the grosse flatulency attenuated. Wherefore they doe ill who hinder their patients from scratching, unless they scratch so cruelly and hard, that there bee danger, by reason of the great heat and pain thereby caused, of some defluxion or falling down of humors into the part.

Or these evacuations are performed by much matter evacuated from an opened bile, or running ulcer, a fistula, or such like sores. Or by sweats which are very good and healthful, especially in sharpe diseases, if they proceede from the whole body, and happen on the criticall dayes. By vomit, which often violently drawes these humors from the whole body, even from the utmost joints, which purging medicins could not evacuate, as wee may see in the palsie, and sciatica, or hipgoute. By spitting, as in all who are suppurated either in the sides or lungs. By salivation, or a flegmaticke fluxe by the mouth, as in those who are troubled with the french pockes. By sneezing and blowing the nose; for by these the braine opprest  with moisture, disburdeneth itself, whether it be done without, or with the helpe of sternutatories and errhines; wherefore children, and such as have somewhat moist braines purge themselves often this way. By hicket and belching; for by these the windinesse contained in the stomacke, is often expelled. By urine, for by this not onely feavers, but which is more to bee admired, the french-pockes hath often beene terminated and cured.

For there have been some troubled with the pockes, in whom a fluxe of the vicious and venenate humor could not by unctions of quicksilver be procured, either from the mouth, or belly; yet have beene wonderfully freed by aboundance of urine, both from danger of death and their disease. By bleeding; for nature hath often found a way for grievous diseases, especially in young bodies, by bleeding at the nose, and by their courses in women. By a fluxe, or laske, purgation, sweats, insensible evacuation and transpiration; for so tumors, the matter being brought to suppuration, doe sometimes vanish away and are dissolved, both of their owne accord, as also by dissolving, or discussing medicins. We doe the same by exercise, diet, hot-houses, long sleepe, waking, and shedding of teares. By sucking, as with cupping glasses and horse-leaches in wounds made by venemous bitings.

In all such kinds of evacuations, wee must consider three things, the quantity, quality, and manner of evacuation. As for an example, when an Empyema is opened, the matter, which was contained in the capacity of the breasts; otherwise, unlesse all the matter bee emptied, there may happen a relapse; the matter should be white, soft, equall, and nothing stinking: Lastly, you must let it forth not altogether, and at one time, but by little and little, and at severall times, otherwise not a little quantitie of the spirits and heate doth flow out together, with the unprofitable matter, and so consequently a dissolution of all the powers.