Surgery is an Art, which teaches the way by reason, how by the operation of the hand we may cure, prevent, and mitigate diseases, which accidentally happen unto us. Others have thought good to describe it otherwise, as that; it is that part of Physic which undertakes the cure of diseases by the sole industry of the hand; as by cutting, burning, sawing off, uniting fractures, restoring dislocations, and performing other works, of which we shall hereafter treat. Surgery also is thus defined by the Author of the medicinal Definitions; The quick motion of an intrepid hand joined with experience: or an artificial action by the hands used in Physic, for some convenient intent. Yet none must think to attain to any great perfection in this Art, without the help of the other two parts of Physic; I say of Diet and Pharmacy, and the diverse application of proper medicines, respecting the condition of the causes, diseases, symptoms, and the like circumstances, which are comprehended under the names of things natural, not natural, and besides nature (as they are commonly called) we intend to describe in their proper place. But if any reply, that there are many who do the works of surgery, without any knowledge of such like things, who notwithstanding have cured desperate diseases with a happy success; let them take this for an answer, that such things happen rather by chance, than by the industry of the Art, and that they are not provident that commit themselves to such. Because for some one happy chance, a thousand dangerous errors happen afterwards, as Galen (in diverse places of his writings) speaks against the Empirics. Wherefore, seeing we have set down Surgery to be a diligent operation of the hands, strengthened by the assistance of Diet and Pharmacy, we will now show what, and of what nature the operations are.
Five things are proper to the duty of a surgeon: to take away that which is superfluous; to restore to their places such things as are displaced; to separate those things which are joined together; to join those which are separated; and to supply the defects of nature. Thou shalt fare more easily and happily attain to the knowledge of these things by long use and much exercise than by much reading of books or daily hearing of teachers. For speech, however perspicuous and elegant soever it be, cannot so vividly express anything as that which is subjected to the faithful eyes and hands.
We have examples of taking away that which abounds in the amputation or cutting off a finger, if any have six on one hand, or any other monstrous member that may grow out; in the lopping off a putrified part inwardly corrupted; in the extraction of a dead child, the secundine, mole, or such like bodies out of a woman’s womb; in taking down all tumours, as wens, warts, polypus, cancers, and fleshy excrescences of the like nature; in the pulling forth of bullets, of pieces of mail, of darts, arrows, shells, splinters, and of all kinds of weapons in what part of the body soever they be. And he taketh away that which redounds, which plucks away the hairs of the eyelids, which trouble the eye by their turning in towards it; who cuts away the web, possessing all the Adnata and part of the cornea; who letteth forth suppurated matter; who taketh out stones in what part soever of the body they grow; who pulls out a rotten or otherwise hurtful tooth, or cuts a nail that runs into the flesh; who cuts away part of the uvula, or hairs that grow on the eyelids; who taketh off a cataract; who cuts the navel or foreskin of a child newly born, or the skinny caruncles of women’s privities.
Examples of placing those things which are out of their natural site are manifest in restoring dislocated bones; in replacing the guts and kals fallen into the cods, or out of the navel or belly by a wound, or of the falling down of the womb, fundament, or great gut, or the eye hanging out of its circle or proper place.
But we may take examples of disjoining those things which are continued from the fingers growing together, either by some chance, as burning, or by the imbecility of the forming faculty; by the disjunction of the membrane called hymen, or any other troubling the neck of the womb, by the dissection of the ligament of the tongue, which hinders children from sucking and speaking, and of that which hinders the glans from being uncovered by the foreskin; by the division of a varicose vein, or of a half-cut nerve or tendon, causing convulsion; by the division of the membrane stopping the auditory passage, the nose, mouth, or fundament, or the stubborn sticking together of the hairs of the eyelids. Refer to this place all the works done by caustics, the saw, trepan, lancet, cupping glasses, incision knife, leeches, either for evacuation, derivation, or revulsion sake.
The Chirurgian draws together things separated, which heal wounds by stitching them, by bolstering, binding, giving rest to, and sit placing the part; which repairs fractures; restores luxated parts; who by binding the vessel stays the violent effusion of blood; who cicatrizes cloven lips, commonly called hare-lips; who reduces to equality the cavities of ulcers and fistulas.
But he repairs those things which are defective, either from infancy or afterwards by accident, as much as art and nature will suffer; who sets on an ear, an eye, a nose, one or more teeth; who fills the hollowness of the palate eaten by the pox with a thin plate of gold or silver, or such like; who supplies the defect of the tongue in part cut off by some new addition; who fastens to a hand, an arm, or leg with fit ligaments workmanlike; who fits a doublet bombasted, or made with iron plates to make the body straight; who fills a shoe too big with cork, or fastens a stocking or sock to a lame man’s girdle to help his gait. We will treat more fully of all these in our following work. But in performing those things with the hands, we cannot but cause pain: for who can, without pain, cut off an arm or leg, divide and tear asunder the neck of the bladder, restore bones put out of their places, open ulcers, bind up wounds, and apply cauteries, and do such like? notwithstanding, the matter often comes to that pass that unless we use a judicious hand, we must either die or lead the remnant of our lives in perpetual misery. Who therefore can justly abhor a Chirurgian for this, or accuse him of cruelty? or desire they may be served, as in ancient times the Romans served Archagatus, who at first made him free of the city, but presently after, because he did somewhat too cruelly burn, cut, and perform the other works of a good Chirurgian, they drew him from his house into the Campus Martius and there stoned him to death, as we have read it recorded by Sextus Cheroneus, Plutarch’s niece by his daughter. Truly it was an inhumane kind of ingratitude to so cruelly murder a man intent on the works of so necessary an art. But the Senate could not approve the act; wherefore, to expiate the crime as well as then they could, they made his statue in gold, placed it in Aesculapius’s temple, and dedicated it to his perpetual memory. For my part, I very well like that saying of Celsus: A Chirurgian must have a strong, stable, and intrepid hand, and a mind resolute and merciless, so that to heal him he taketh in hand, he be not moved to make more haste than the thing requires; or to cut less than is needful; but which does all things as if he were nothing affected with their cries; not giving heed to the judgment of the vain common people, who speak ill of Chirurgians because of their ignorance.
That the Chirurgeon may rightly and according to Art, perform the fore-said works, he must set before his eyes certain Indications of working: Otherwise, he is like to become an Empiric, whom no Art, no certain reason, but only a blind temerity of fortune moves to boldness and action. These Indications of actions are drawn from things (as they call them) natural, unnatural, and besides nature, and their adjuncts, as it is singularly delivered by the Ancients, being men of an excellent understanding. Wherefore we will prosecute according to that order, all the speculation of this Art of ours. First, therefore, things natural are so termed, because they constitute and contain the nature of man’s body, which wholly depends on the mixture and temperament of the four first bodies, as it is shown by Hippocrates in his Book de Natura humana: wherefore the consideration thereof belongs to that part of Physic which is named Physiology; as the examination of things not natural to Dietetics, or Diet, because by the use of such things it endeavors to retain and keep health: but Therapeutics or the part which cures the diseases, and all the affects besides nature, challenges the contemplation of those things which are not agreeable to nature. But the things which are called natural may be reduced to seven heads: besides which there comes into their fellowship, those which we term annexed.
The seven principal heads of things natural are,
Elements.
Temperaments.
Humors.
Parts or members.
Faculties.
Actions.
Spirits.
To these are annexed and somewhat near,
Age.
Sex.
Color.
Composure.
Time or season.
Region.
Vocation of life.
CHAP. IIII. Of Elements.
An Element (by the definition which is commonly received amongst Physicians) is the least and most simple portion of that thing which it composes: or that my speech may be the more plain: the four first and simple bodies are called Elements; Fire, Air, Water, and Earth; which accommodate and subject themselves as matter to the promiscuous generation of all things which the Heavens engird, whether you understand things perfectly, or imperfectly mixed. Such Elements are only to be conceived in your mind, being it is not granted to any external sense to handle them in their pure and absolute nature. Which was the cause that Hippocrates expressed them not by the names of substances, but of proper qualities; saying, Hot, Cold, Moist, Dry; because some one of these qualities is inherent in every Element, as his proper and essential form, not only according to the excess of latitude, but also of the active faculty; to which is adjoined another simple quality, and by that reason principal, but which notwithstanding attains not to the highest degree of his kind, as you may understand by Galen in his first Book of Elements. So, for example sake, in the Air we observe two qualities, Heat, and Moisture, both principal, and not remitted by the commixture of any contrary quality, for otherwise they were not simple. Therefore thou mayst say, what hinders that the principal effects of heat show not themselves as well in the Air, as in the Fire? because as we said before, although the Air have as great a heat according to his nature, extent and degree, no otherwise than Fire has, yet it is not so great in its active quality. The reason is, because that the calorific force in the Air is hindered, and dulled by society of his companion and adjoined quality, that is, Humidity which abates the force of heat, as on the contrary, dryness quickens it. The Elements therefore are endowed with these qualities.
Names of the substances:
Fire
Air
Water
Earth
is
Hot and dry
Moist and hot
Cold and moist
Cold and dry
Names of the qualities
These four Elements in the composition of natural bodies, retain the qualities they formerly had, but that by their mixture and meeting together of contraries, they are somewhat tempered and abated. But the Elements are so mutually mixed one with another, and all with all, that no simple part may be found; no more than in a mass of the Emplaster Diacalcitheos you can show any Axungia, oil, or litharge by itself; all things are so confused and united by the power of heat, mixing the smallest particles with the smallest, and the whole with the whole, in all parts. You may know and perceive this concretion of the four Elementary substances in one compound body, by the power of mixture, in their dissolution by burning a pile or heap of green wood. For the flame expresses the Fire, the smoke the Air, the moisture that sweats out at the ends, the Water, and the ashes, the Earth: You may easily perceive by this example so familiar and obvious to the senses what dissolution is, which is succeeded by the decay of the compound body; on the contrary, you may know that the coagulation, or uniting and joining into one of the first mixed bodies is such, that there is no part sincere, or without mixture. For if the heat which is predominant in the fire, should remain in the mixture in its perfect vigor, it would consume the rest by its pernicious neighborhood; the like may be said of Coldness, Moisture, and Dryness; although of these qualities, two have the title of Active, that is, Heat, and Coldness, because they are the more powerful; the other two Passive, because they may seem more dull and slow, being compared to the former. The temperaments of all sublunary bodies arise from the commixture of these substances & elementary qualities, which has been the principal cause that moved me to treat of the Elements. But I leave the force and effects of the Elementary qualities to some higher contemplation, content to have noted this, that of these first qualities, (so called, because they are primarily and naturally in the four first bodies) others arise and proceed, which are therefore called the second qualities: as of many of these, Heaviness, Lightness, variously distributed by the four Elements, as the Heat, or Coldness, Moistness or Dryness, have more power over them. For of the Elements, two are called light, because they naturally affect to move upwards: the other two heavy, by reason they are carried downward by their own weight. So we think the fire the lightest, because it holds the highest place of this lower world; the Air which is next to it in site, we account light; for the water which lies next to the Air, we judge heavy; and the earth the center of the rest we judge to be the heaviest of them all. Hereupon it is, that light bodies, and the light parts in bodies, have most of the lighter Elements; as on the contrary heavy bodies have more of the heavier. This is a brief description of the Elements of this fragile world, which are only to be discerned by the understanding, to which I think good to adjoin another description of other Elements, as it were arising or flowing from the commixture of the first; for besides these, there are said to be Elements of generation and Elements of man’s body. Which as they are more corporeal, so also are they more manifest to the sense. By which reason Hippocrates being moved, in his Book de Natura humana, after he had described the nature of Hot, Cold, Moist and Dry, he comes to take notice of these by the order of composition. Wherefore the Elements of our generation, as also of all creatures which have blood, are seed and menstrual blood. But the Elements of our bodies are the solid and similar parts arising from those Elements of generation. Of this kind are bones, membranes, ligaments, veins, arteries, and many others manifest to the eyes, which we will describe at large in our Treatise of Anatomy.
CHAP. V. Of Temperaments.
A Temperament is defined as a proportionable mixture of hot, cold, moist , and dry; or, it is a concord of the first disagreeing faculties. That harmony springs from the mixture of the four first bodies of the world. This Temperament, whether it is considered to be a concord, is given to plants and brute beasts for the beginning of their life, and so consequently for their life and form. But as plants are inferior in order and dignity to beasts, so their life is more base and infirm, for they have only a growing faculty by which they may draw an alimentary juice from the earth, as from their mothers’ breasts, to preserve them and their life, by which they may grow to a certain bigness; and lastly, by which they may bring forth their like for the perpetual continuance of their kind. But the life of beasts has to the three former the gift of sense annexed; by benefit whereof, as by a certain inward knowledge, they shun those things that are hurtful, and follow those which profit them, and by the power of their will, they move themselves whither they please. But the soul of man is far more perfect and noble than the rest, and arises not from that earthly mixture and temper of the Elements, but acknowledges and has a far more divine offspring, as we shall teach hereafter.
They divide a Temperament at the first division into two kinds; as one a temperate, another an untemperate. The untemperate is of two sorts; the one wholly vicious, which has altogether exceeded the bounds of mediocrity: the other which has somewhat strayed from the mediocrity of temper, but notwithstanding is yet contained within the limits of health: as that which brings no such evident harm to the actions, but that it somewhat hinders them, so that they cannot so well and perfectly perform their duties. But the vicious Temperament does three manner of ways corrupt the functions, either by weakening, depraving or abolishing them. For so stupor, or astonishment, diminishes and slows the quickness of motion; convulsion depraves it; the palsy abolisheth it, and taketh it away. The temperate Temperament is also divided into two kinds; which is either to equality of weight, or justice.
It is called a temperature to weight which arises from the equal force of exactly concurring qualities, and as placed in a perfect balance, draws downward neither to this nor that part. They think the example of this Temperament appears in the inner skin of the fingers’ ends of a man tempered to justice. For seeing the most exquisite touch resides there, they ought to be far from all excesses of contrariety; for otherwise, being corrupted by too much heat or cold, moisture or dryness, they could give no certain judgment of the tangible qualities. For which thing nature has excellently provided in the fabric and coagulation of the parts of which the skin consists. For it is composed of hot and moist flesh, and therefore soft, and of a tendon and nerve cold and dry, and therefore hard, which are not only equally fitted and conjoined, but wholly confused and mixed together, by which it comes that, removed from all extremes of opposition, it is placed in the midst, as a rule to judge of all the excesses that happen to the touch.
So it was fit that the eye, which was to be the instrument of sight, should be tinctured with no certain color, that it might be the less deceived in the judgment of colors. So it was convenient that the hearing should not be troubled with any distinct sound, whereby it might more certainly judge of equal and unequal sounds, not distinguished by a ratable proportion; neither was it fit the tongue should have any certain taste, lest the access of that taste should deceive it in knowing and judging of so many different tastes. The Temperature tempered to justice is that, which although it is a little absent from the exact and severe parity of mixed qualities, yet has that equality which does fully and abundantly suffice for to perform all the functions fitly and perfectly which nature does require, wherefore we can judge no otherwise of it than by the integrity of the Actions. For hence it took its name, for as distributive justice equally gives to every one rewards or punishments according to their deserts; so nature, having regard to all the parts of the body, gives them all that temper which may suffice to perform those duties for which they are ordained.
Let us for an example consider a Bone; no man doubts but that, like the other similar parts of the body, it proceeds from the mixture of the four Elements: but nevertheless nature weighing the use of it, and ordaining it to support the rest of the body, would have more of the terrene and dry Element infused into it, that it might be the stronger and firmer to sustain weight. But a Ligament, seeing it was made for other uses, has less of that earthly dryness than the bone, but more than the flesh, altogether fitted to its nature. So it has seemed good to nature to endow all the parts of the body, not only with an equal portion but also proportion of Elements and qualities; we call that a temperament to justice: and we say that it is in Plants, Brute Beasts, and all natural bodies, which enjoy that temper and mediocrity, which may be agreeable to their nature. Hereupon by comparison arise eight kinds of intemperate tempers, as
Four simple
Hot
Cold
Moist
Dry
temperate in
temperate in
Dryness and moisture
Heat and cold.
Four compounds
Hot and Moist
Hot and Dry
Cold and Moist
Cold and Dry
temperate in
temperate in
Dryness and moisture
Heat and cold.
But these temperaments are either of the whole body, or of some part thereof and that either principall, as
And that either
Principal, as
or of the rest of the parts composed of other parts which have no principality in the body.
Again, such temperaments are either healthful, which suffice perfectly to perform their actions; or unhealthful, which manifestly hurt them, the signs whereof may be read described by Galen. And you must observe that when we say the body, or any part of it is hot, we understand more hot than is fit for one of that kind which is tempered to justice; as when we say a man has a hot liver, we mean his liver is hotter than a man justly tempered should have; for all other tempers, whether of the whole body, or any of the parts thereof, are to be referred to this; and in the cure of diseases, we must look upon it as the mark, and labor to preserve it by the use of convenient things, as much as lies in our power.
Wherefore because it is very necessary to know the distinction of temperaments, I have thought good in this place, briefly to handle the temperaments of the parts of the body, ages, seasons of the year, humors, and medicines. Therefore the temperaments of the parts of our body are of this nature, not only by the judgment of the touch of a man’s hand which is justly tempered (who is often deceived by flowing heat, which spreads from the heart into all the body, imparts a certain kind of heat to all the parts,) but also by the rule of their reason, composition and substance, as
– A Bone is the most dry and cold.
– A Gristle less than it.
– A Ligament less than a Gristle.
– A Tendon is so much drier and colder than the membrane, by how much it in the same temper exceeds a Vein and Artery.
Then follow the harder veins, for the softer veins are in a middle temper of dryness and moisture, like as the skin; although all, both soft and hard, are of a cold temper. Wherefore all these parts of their own nature are cold and without blood: although the veins and arteries wax hot, by reason of the heat of the blood they contain, which notwithstanding also borrows that heat from the heart, as a part most hot, and softer than the skin; the liver next follows the heart, in the order of the hotter parts, which is far softer than the skin itself: for if, according to Galen’s opinion, the heart is somewhat less hard than the skin, and that is far harder than the liver, as appears by touching them, it must necessarily follow that the liver much exceeds the skin in softness; I understand the skin simple, and separated from the flesh lying under it, to which it firmly cleaves. The flesh is more moist and hot than the skin, by reason of the blood dispersed in it. The spinal marrow is colder and moister than the skin; but the brain so much exceeds it in moisture, as it is exceeded by the fat. The lungs are not so moist as the fat, and the spleen and kidneys are of the like nature, and nevertheless they are all moister than the skin.
According to the diversities of ages, the temperaments both of the whole body and all its parts undergo great mutations; for the bones are far harder in old men than in children, because our life is, as it were, a certain progress to dryness, which when it comes to the height consequently causes death. Wherefore in this place we must speak of the Temperaments of ages, when first we shall have defined what an age is. Therefore an age is defined as a space of life in which the constitution of the body of itself and of its own accord, undergoes manifest changes; the whole course of life has four such ages. The first is childhood, which extends from the birth to the eighteenth year of age, and has a hot and moist temper, because it is next to the hot and moist beginnings of life, seed, and blood: Youth follows this which is prolonged from the eighteenth to the twenty-fifth year, and is temperate, and in the midst of all excesses; Man’s estate succeeds youth, which they deny to extend beyond the thirty-fifth year of age, and in its proper temper, it is hot and dry: whereby it comes to pass that then the heat is felt more acrid and biting, which in childhood seemed mild; because the progression of the life to dryness has much wasted the native humidity.
Then succeeds old age, ever divided into two parts; the first whereof extends from the thirty-fifth to the forty-ninth year; those of this age are called old men (but we commonly call them middle-aged men). The latter is as it were divided by Galen into three degrees; the first whereof are those, who having their strength sound and firm undergo civil affairs and businesses: which things those in the second degree of old age cannot do, because of the debilitating of their now decaying strength: but those which are in the last degree are afflicted with most extreme weakness and misery, and are as much deprived of their senses and understanding, as of the strength of their bodies; whereof arose this Proverb, Old men twice children. Those old men of the first rank are pleasant, and courteous, and those we say are beginning to grow old, or in their green old age; those of the second sort delight in nothing but the board and bed; but old decrepit men of the last order, think of nothing else than their graves and monuments. Their firm and solid parts are of a cold and dry temperature, by reason of the decay of the radical moisture, which the inbred heat causes in the continuance of so many years. Which thing may happen in a short space, by the vehement flame of the same natural heat, turned by fevers into a fiery heat. But if any, to prove old men moist, will object that they cough up and spit much, I will answer him, as an old Doctor once said; That a pitcher filled with water may pour forth much moisture; yet no man will deny but that such a vessel of its own terrene nature and matter is most dry; so old men may plainly be affirmed to be moist by reason of their defect of heat and abundance of excrements. But this description of ages is not to be taken so strictly, as always to be measured by the spaces and distances of years, for there are many who, by their own misdemeanor, seem elder at forty than others do at fifty.
Lastly, the famous Philosopher Pythagoras divided man’s life into four ages, and by a certain proportion compared the whole course thereof to the four seasons of the year; as childhood to the Spring, in which all things grow and sprout out, by reason of plenty and abundance of moisture. And youth to the Summer, because of the vigor and strength which men enjoy at that age. And man’s estate, or constant age to Autumn, for that then, after all the dangers of the forepassed life, the gifts of discretion and wit acquire a seasonableness, or ripeness, like as the fruits of the earth enjoy at that season. And lastly, he compares old age to the sterile and fruitless Winter, which can ease and comfort its tediousness by no other means than the use of fruits gathered and stored up before, which then are of a cold and troublesome condition. But for extreme old age, which extends to eighty, or a hundred years, it is so cold and dry that those who arrive at that decrepit age are troublesome, harsh, touchy, froward, crabby, and often complaining, until at length deprived of all their senses, tongue, feet, and understanding; they doting, return again to childishness, as from the staff to the start. And thus much of the Temperaments of ages.
But now in like manner, we will explain the temperatures of the seasons of the year, which are four, the Spring, Summer, Autumn, Winter. The Spring continues almost from the twelfth or thirteenth day of March to the midst of May, Hippocrates seems to make it hot and moist; which opinion seems not to have sprung from the thing itself, but from an inveterate error of the ancient Philosophers, who would fit the temperaments of the four seasons of the year, as answering in proportion to the temperatures of the four ages.
For if the matter comes to a just trial, all men will say the Spring is temperate, as that which is in the midst of the excess of heat, cold, moisture, and dryness; not only by comparison because it is hotter than Summer and colder than Winter; but because it has that quality of its own proper nature. Wherefore it is said of Hippocrates: The Spring is most wholesome and least deadly; if so be that it keeps its native temper, from which if it declines, or succeeds a former untemperate season, as Autumn or Winter, it will give occasion to many diseases described by Hippocrates; not that it breeds them, but because it brings them to sight, which before lay hid in the body. Summer is comprehended in the space of almost four months; it is of a hot and dry temper, a breeder of such diseases as proceed from choler, because that humor at this time is heaped up in many bodies by adustion of blood bred in the Spring; but all such diseases do speedily run their course. The beginning of Autumn is from the time the Sun enters into Libra, and endures the like space of time as the Spring. But when it is dry, it has great inequality of heat and cold; for the mornings and evenings being very cold, the noons on the contrary are exceeding hot.
Wherefore many diseases are in Autumn, and then long and deadly, especially if they incline towards winter: because all daily and sudden changes to heat and cold are dangerous. The winter possesses the remnant of the year and is cold and moist; it increases natural heat, stirs up the appetite, and augments Phlegm. It increases heat by Antiperistasis, or contrariety of the encompassing air, which being then cold prohibits the breathing out of heat: whereby it happens that the heat being driven in and hindered from dissipation, is strengthened by uniting its forces. But it augments Phlegm, for that men are more greedy, the Appetite being increased by the strengthened heat: from whence proceeds much crudity and a large store of diseases, especially Chronic or Long which spread and increase rather in this winter season than in any other part of the year. To this discourse of the temper, of the seasons of the years, is to be revoked the variety of tempers which happens every day, which certainly is not to be neglected, that there may be a place of election, especially if nothing urges. For hither belongs that saying of Hippocrates; When in the same day it is one while hot, another cold, Autumnal diseases are to be expected. Therefore an Indication taken from hence is of great consequence to the judgment of diseases; for if it agrees with the disease, the disease is made more contumacious, and difficult to cure. Whereupon the Patient and Physician will have much trouble; but if on the contrary, it reclaims and dissents, the health of the Patient is sooner to be expected. Neither is it a thing of lesser consequence to know the customs and habits of the places and Countries in which we live, as also the inclinations of the Heavens and temperatures of the Air; but let us leave these things to be considered by Natural Philosophers, that we may deliver our judgment of the temperaments of Humors. Blood, as that which answers to the Air in proportion, is of a hot and moist nature, or rather temperate, as Galen testifies; for, he says, it is certain and sure that the blood is neither hot nor moist, but temperate as in its first composure none of the 4 first qualities exceeds another by any manifest excess, as he repeats it upon the 39th sentence. Phlegm, as that which is of a watery nature, is cold and moist; no other-wise than Choler being of a fiery temper, is hot and dry. But Melancholy assimilated to Earth, is cold and dry. This which we have spoken in general of Phlegm and Melancholy, is not always true in every kind of the said humors. For salty Phlegm is of a hot and dry temperature, as also all kinds of Melancholy which have arisen, or sprung by adustion from the native and Alimentary, as we will teach in the following Chapter. Now the Temperaments of Medicines have not the same form of judgment, as those things which we have before spoken of; as, not from the Elementary quality which conquering in the contention and mixture, obtains the dominion; but plainly from the effects which taken or applied they imprint in a temperate body. For so we pronounce those things hot, cold, moist, or dry, which produce the effects of Heat, Coldness, Moisture or Dryness. But we will defer the larger explanation of these things to that place, where we have peculiarly appointed to treat of Medicines; where we will not simply inquire whether they be hot or cold, but what degree of heat and cold, or the like other quality: in which same place we will touch the temperatures and all the Nature of tastes, because the certainest judgment of medicines is drawn from their tastes. Hitherto of Temperaments, now we must speak of Humors whose use in Physical speculation is no less than that of Temperatures.
CHAP. VI. Of Humors.
TO know the nature of Humors is a thing not only necessary for Physicians, but also for Chirurgeons, because there is no disease with matter which arises not from some one, or the mixture of more Humors. Which thing Hippocrates understanding, wrote every Creature to be either sick or well according to the condition of the Humors in the body. And certainly all putrid fevers proceed from the putrefaction of Humors. Neither do any acknowledge any other original or distinction of the differences of Abscesses or Tumors: neither do ulcerated, broken or otherwise wounded members hope for the restoration of continuity, from other than from the sweet falling down of humors to the wounded part. Which is the cause that often in the cure of these effects, the Physicians are necessarily busied in tempering the Blood, that is, bringing to a mediocrity the four humors composing the mass of blood, if they at any time offend in quantity, or quality. For whether anything abound, or digress from the wonted temper in any excess of heat, cold, viscosity, grossness, thinness, or any such like quality, none of the accustomed functions will be well performed. For which cause those chief helps to preserve and restore health have been divinely invented; Phlebotomy, or bloodletting which amends the quantity of too much blood; and purging which corrects and draws away the vicious quality. But now let us begin to speak of the Humors, taking our beginning from the definition.
An Humor (is called by Physicians) what thing so ever is Liquid and flowing in the body of living Creatures endued with Blood, & that is either natural, or against nature.
The natural is so called because it is fit to defend, preserve and sustain the life of a Creature. Quite different is the nature & reason of that which is against nature. Again the former is either Alimentary, or Excrementitious; The Alimentary which is fit to nourish the body, is that Humor which is contained in the veins and arteries of a man which is temperate & perfectly well; & which is understood by the general name of blood which is let out at the opening of a vein. For blood otherwise taken is an Humor of a certain kind, distinguished by heat and warmness from the other Humors comprehended together with it, in the whole mass of the blood. Which thing that it may the better be understood, I have thought good in this place to declare the generation of Blood by the efficient and material causes, All things which we eat or drink, are the materials of blood, which things drawn into the bottom of the ventricle by its attractive force, and there detained, are turned by the force of concoction implanted in it, into a substance similar to Almond Butter. Which thing although it appears one and like itself, yet it consists of parts of a different nature, which not only the variety of meats, but one & the same meat yields of itself. We term this Chylus (when it is perfectly concocted in the stomach). But the Gate-vein receives it driven from thence into the small guts, and sucked in by the Mesenteric veins, and now having gotten a little rudiment of Change in the way, carries it to the Liver, where by the blood-making faculty which is proper and natural to this part, it acquires the absolute and perfect form of blood. But with that blood at one and the same time and action all the humors are made whether Alimentary or excrementitious. Therefore the blood, that it may perform its office, that is, the faculty of nutrition, must necessarily be purged and cleansed from the two excrementitious humors. Of which the bladder of Gall draws one which we call Yellow Choler, and the Spleen the other which we term Melancholy. These two humors are natural, but not Alimentary, or nourishing, but of another use in the body, as afterwards we will show more at large. The blood freed from these two kinds of excrements is sent by the veins and arteries into all parts of the body for their nourishment. Which although then it seems to be of one simple nature, yet notwithstanding it is truly such that four different and unlike substances may be observed in it, as blood properly so named, Phlegm, Choler and Melancholy, not only distinct in color, but also in taste, effects and qualities.
For as Galen notes in his book De Natura Humana, Melancholy is acid or sour, choler bitter, Blood sweet, Phlegm unsavory. But you may know the variety of their effects, both by the different temper of the nourished parts, as also by the various condition of the diseases springing from thence. For therefore, such substances ought to be tempered and mixed amongst themselves in a certain proportion, which remaining, health remains, but violated, diseases follow. For all acknowledge that an Edema is caused by Phlegmatic, a Scirrhous by Melancholic, an Erysipelas by Choleric, and a Phlegmon by pure and laudable blood. Galen teaches by a familiar example of new wine presently taken from the press, that these four substances are contained in that one Mass, and mixture of the blood. In which everyone observes four distinct Essences; for the flower of the wine working up swims at the top, the dregs fall down to the bottom, but the crude and watery moisture mixed together with the sweet and vinous liquor, is everywhere diffused through the body of the wine; the flower of the wine represents Choler, which bubbling up on the surfaces of blood, as it concretes and grows cold, shines with a golden color; the dregs Melancholy, which by reason of its heaviness ever sinks downward, as it were the Mud of the blood; the crude and watery portion Phlegm: for as that crude humor, except it be rebellious in quantity, or stubborn by its quality, there is hope it may be changed into wine, by the natural heat of the wine; so Phlegm which is blood half-cooked, may by the force of native heat be changed into good and laudable blood. Which is the cause that nature decreed, or ordained no peculiar place, as to the other two humours, whereby it might be severed from the blood; But the true and perfect liquor of the wine represents the pure blood, which is the more laudable and perfect portion of both the humours of the confused mass. It may easily appear by the following scheme, of what kind they all are, and also what the distinction of these four humours may be.
| - | NATURE | CONSISTANCE | COLOR | TASTE | USE |
|---|---|---|---|---|---|
|
Blood is |
Of Nature airy,
hot and moist, or rather temperate,
|
Of indifferent consistence, neither too thick nor too thin |
Of colour red, rosy or crimson,
|
Of taste sweet |
Of such use, that it chiefly serves for the nourishment of the fleshy parts, and carried by the vessels imparts heat to the whole body. |
|
Phlegm is |
Of Nature watery, cold and moist, |
Of Consistance liquid, |
Of Colour white |
Of Taste sweet, or rather unsavory, for we commend that water which is unsavory, |
Fit to nourish the brain and all the other cold and moist parts, to temper the heat of the blood, and by its slipperiness to help the motion of the joints. |
|
Choler is |
Of Nature fiery, hot and dry,
|
Of Consistance Thin,
|
Of Colour yellow, or pale,
|
Of Taste bitter,
|
It provokes the expulsive faculty of the guts, attenuates the phlegm cleaving to them, but the alimentary is fit to nourish the parts of like temper with it.
|
|
Melancholy is. |
Of Nature earthly, cold and dry. |
Of Consistance grosse and muddy,
|
Of Colour blackish
|
Of taste acid, sour or biting.
|
Stirs up the appetite, nourishes the spleen, and all the parts of like temper to it, as the bones.
|
Blood hath its nearest matter from the better portion of the Chylus: and being begun to be laboured in the veins, at length gets form and perfection in the liver; but it hath its remote matter from meats of good digestion and quality, seasonably eaten after moderate exercise; but for that, one age is better than another, and one time of the year more convenient than another. For blood is made more copiously in the Spring, because that season of the year comes nearest to the temper of the blood, by reason of which the blood is rather to be thought temperate, than hot and moist, for that Galen makes the Spring temperate, and besides, at that time blood-letting is performed with the best success; youth is an age very fit for the generation of blood; or by Galen’s opinion, rather that part of life, that continues from the 25th to the 35th year of our age. Those in whom this humor hath the dominion, are beautified with a fresh and rosy colour, gentle and well-natured, pleasant, merry, and facetious. The generation of Phlegm is not by the imbecility of heat, as some of the ancients thought; who were persuaded that choler was caused by a raging, blood by a moderate, and phlegm and melancholy, by a remiss heat. But that opinion is full of manifest error: for if it be true that the Chylus is laboured and made into blood in the *1.68 same part, and by the same fire, that is, the liver; from whence in the same moment of time should proceed that strong and weak heat, seeing the whole mass of the blood, different in its four essential parts, is perfected and made at the same time, and by the same equal temper of the same part, action, and blood-making faculty; therefore from whence have we this variety of humors? From hence, for that those meats by which we are nourished, enjoy the like condition that our bodies do, from the four Elements, and the four first qualities; for it is certain, and we may often observe in what kind soever they be united or joined together, they retain a certain hot portion imitating the Fire, another cold, the water; another dry, the earth, and lastly, another moist like to the Air. Neither can you name any kind of nourishment, how cold soever it be, not Lettuce itself, in which there is not some fiery force of heat. Therefore it is no marvel, if one and the same heat working upon the same matter of Chylus, varying with so great dissimilitude of substances, does by its power produce so unlike humors, as from the hot, Choler; from the cold, Phlegm; and of the others, such as their affinity of temper will permit.
There is no cause that any one should think that variety of humors to be caused in us, rather by the diversity of the active heat, than wax and a flint placed at the same time, and in the same situation of climate and soil, this to melt by the heat of the Sun, and that scarse to wax warm. Therefore that diversity of effects is not to be attributed to the force of the efficient cause, that is, of heat, which is one and of one kind in all of us; but rather to the material cause, seeing it is composed of the conflux, or meeting together of various substances, gives the heat leave to work, as it were out of its store, which may make and produce from the hotter part thereof Choler, and of the colder, and more rebellious Phlegm. Yet I will not deny that more Phlegm, or Choler may be bred in one and the same body, according to the quicker, or slower provocation of the heat; yet nevertheless it is not consequent that the origin of Choler should be from a more acrid, and of Phlegm from a more dull heat in the same man. Every one of us naturally has a simple heat, and of one kind, which is the worker of diverse operations, not of itself, seeing it is always the same, and like itself, but by the different fitness, pliableness, or resistance of the matter on which it works. Wherefore Phlegm is generated in the same moment of time, in the fire of the same part, by the efficiency of the same heat, with the rest of the blood, of the more cold, liquid, crude, and watery portion of the Chylus. Whereby it comes to pass, that it shows an express figure of a certain rude or imperfect blood, for which occasion nature hath made it no peculiar receptacle, but would have it to run friendly with the blood in the same passages of the veins, that any necessity happening by famine, or indigency, and in defect of better nourishment, it may by a perfecter elaboration quickly assume the form of blood. Cold & rude nourishment makes this humor to abound, principally in winter, and in those which incline to old age; by reason of the similitude which Phlegm hath with that season and age. It makes a man drowsy, dull, fat, and swollen up, and hastens gray hairs. Choler is as it were a certain heat and fury of humors, which is generated in the liver, together with the blood is carried by the veins and arteries through the whole body. That of it which abounds, is sent, partly into the guts, and partly into the bladder of the gall; or is consumed by transpiration, or sweats; It is somewhat probable that the Arterial blood is made thinner, hot, quick and pallid, than the blood of the veins, by the commixture of this Elementary choler. This humor is chiefly bred and expelled in youth, and acrid and bitter meats give matter to it: but great labors of body and mind give the occasion. It makes a man nimble, quick, ready for all performance, lean, and quick to anger, and also to concoct meats. The Melancholic humor, or Melancholy, being the grosser portion of the blood, is partly sent from the Liver to the Spleen to nourish it, and partly carried by the vessels into the rest of the body, and spent in the nourishment of the parts endued with an earthly dryness; it is made of meats of gross juice, and by the perturbations of the mind, turned to fear and sadness. It is augmented in Autumn, and in the first and crude old age; it makes men sad, harsh, constant, forward, envious and fearful. All men ought to think, that such humors are wont to move at set hours of the day, as by a certain peculiar motion or tide. Therefore the blood flows from the ninth hour of the night, to the third hour of the day; then Choler to the ninth of the day; then Melancholy to the third of the night, the rest of the night that remains, is under the dominion of Phlegm. Manifest examples hereof appear in the French-Pox. From the elaborate and absolute mass of the blood (as we said before) two kinds of humors, as excrements of the second concoction, are commonly and naturally separated, the one more gross, the other more thin. This is called either absolutely choler, or with an adjunct, yellow choler. That is called Melancholy; which drawn by the Spleen in a thinner portion, and elaborated by the heat of the Arteries, which in that part are both many and large, becomes nourishment to the part; the remnant thereof is carried by the venous vessel into the orifice of the ventricle, whereby it may not cause, but whet the appetite, and by its astringency strengthen the actions thereof. But yellow Choler drawn into the bladder of the gall, remains there so long, till being troublesome, either in quantity or quality, it is excluded into the guts, whereby it may cast forth the excrements residing in them; the expulsive faculty being provoked by its acrimony, and by its bitterness kills the worms that are bred there. This same humor is accustomed to dye the urine of a yellow color. There is another serous humor, which truly is not fit to nourish, but profitable for many other things, which is not an excrement of the second, but of the first concoction. Therefore nature would that mixed with the Chylus, it should come to the Liver, and not be voided with the excrements, whereby it might allay the grossness of the blood, and serve it for a vehicle; for otherwise the blood could scarcely pass through the capillary veins of the Liver, and passing the sinuous and gibbous parts thereof, come to the hollow vein. Part of this serous humor separated together with the blood which serves for the nourishment of the Kidneys, and straight carried into the bladder, is turned into that urine which we daily make; the other part therefore carried through all the body together with the blood, performing the like duty of transportation, is excluded by sweats into which it degenerates. Besides the forenamed, the Arabians have mentioned four other humors, which they term Alimentary and secondary, as being the next matter of nourishment, like those four the blood contains, the remote. They have given no name to the first kind, but imagine it to be that humor, which hangs ready to fall like little drops in the utmost orifices of the veins. They call the second kind Dew; being that humor, which entered already into the substance of the part, moistens it. The third they call by a barbarous name Cambium, which already put to the part to be nourished, is there fastened. The fourth named Gluten, or Glu, is only the proper and substance-making humidity of the similar parts, not their substance. The distinction of the degrees of nutrition recited by Galen in his Books of Natural faculties, answers in proportion to this distinction of humors. The first is that the blood flows to the part that requires nourishment; then that being there arrived, it may be agglutinated; then lastly, that having lost its former form of nourishment, it may be assimilated.
Those humors are against nature, which being corrupted, infect the body and the parts in which they are contained by the contagion of their corruption, retaining the names and titles of the humors, from whose perfection and nature they have revolted; they all grow hot by putrefaction, although they were formerly by their own nature cold. And they are corrupted, either in the veins only, or within and without the veins; In the veins Blood and Melancholy; but both without and within the veins, Choler and Phlegm. When blood is corrupted in its thinner portion, it turns into choler, when in its thicker, into Melancholy; for the blood becomes faulty two manner of ways, either by the corruption of its proper substance by putrefaction, or by admixture of another substance by infection. The Melancholy humor which is corrupted in the veins, is of three sorts: the first is of a Melancholy juice putrefying, and by the force of a strange heat, turned as it were into ashes, by which it becomes adust, acrid and biting. The other arises from that Choler which resembles the yolks of eggs, which by adustion becomes leek-coloured, then aeruginous, or of a bluish green, then red, and lastly black, which is the very worst kind of Melancholy, hot, malign, eating and ulcerating, and which is never seen or voided with safety. The third comes from Phlegm putrefying in the veins, which first degenerates into salt Phlegm, but straight by the strength of extraneous heat degenerates into Melancholy.
Phlegm not natural is bred, either
Choler not natural is bred, either
In the veins, as the vitelline (like in consistency to the yolk of a raw egg) which the acrimony of strange heat breeds of yellow choler, which same in diseases altogether deadly, degenerates into green, aeruginous, and lastly into a blue, or color like that which is dried by woad.
Or in the capacity of the upper belly as the ventricle, and this is of five kinds:
The kinds of such choler are often cast forth by vomit in diseases, the strength of the disease being past; being troublesome to the parts through which they are evacuated, by their bitterness, acrimony, and biting. The Signs of a Sanguine Person. I think it manifest, because the matter and generation of flesh is principally from blood, that a man of a fleshy, dense, and solid habit of body, and full of a sweet and vaporous juice, is of a Sanguine complexion. And the same party has a flourishing and rosy colour in his face, tempered as with an equal mixture of white and red; of white, by reason of the skin lying utmost; of red, because of the blood spread underneath the skin; for always such as the humor is, such is the colour in the face. In manners he is courteous, gentle, easy to be spoken to, not altogether estranged from the love of women, of a lovely countenance and smooth forehead, seldom angry, but taking all things in good part; for as the inclination of humors is, so also is the disposition of manners. But blood is thought the mildest of all humors; but the strong heat of the inward parts makes him to eat and drink freely. Their dreams are pleasant, they are troubled with diseases arising from blood, as frequent phlegmons, and many Sanguine pustules breaking through the skin, much bleeding, and menstrual fluxes. Wherefore they can well endure bloodletting, and delight in the moderate use of cold and dry things; and lastly, are offended by hot and moist things. They have a great and strong pulse, and much urine in quantity, but mild of quality, of an indifferent colour and substance.
The Signs of a Choleric Person.
Choleric men are of a pale or yellowish color, of a lean, slender and rough habit of body, with fair veins and large arteries, and a strong and quick Pulse: their skin being touched, feels hot, dry, hard, rough and harsh, with a pricking and acrid exhalation which breathes forth from their whole body. They cast forth much choler by stool, vomit and urine. They are of a quick and nimble wit, stout, hardy and sharp vindicators of received injuries, liberal even to prodigality, and somewhat too desirous of glory. Their sleep is light, and from which they are quickly awakened; their dreams are fiery, burning, quick and full of fury; they are delighted with meats and drinks which are somewhat more cold and moist, and are subject to tertian and burning fevers, phrensy, jaundice, inflammations, and other choleric pustules, the Loose, Bloody flux, and bitterness of the mouth.
The Signs of a Phlegmatic Person.
Those in whom phlegm has the dominion, are of a whitish-colored face, and sometimes livid and swollen, with their body fat, soft and cold to touch.
They are molested with Phlegmatic diseases, as oedematous tumors, the dropsy, quotidian fevers, falling away of the hair, and catarrhs falling down upon the lungs, and the asthma, or wheeze; they are of a slow capacity, dull, slothful, drowsy, they do dream of rains, snows, floods, swimming, and such like, that they often imagine themselves overwhelmed with waters; they vomit up much watery, and Phlegmatic matter, or otherwise spit and evacuate it, and have a soft and moist tongue.
And they are troubled with a dog-like hunger, if it at any time should happen that their insipid phlegm become acid; and they are slow of digestion, by reason of which they have great store of cold and Phlegmatic humors, which if they be carried down into the windings of the colicky gut, they cause murmuring and noise, and sometimes the colic.
For much wind is easily caused of such Phlegmatic excrements wrought upon. by a small and weak heat, such as Phlegmatic persons have, which by its natural lightness is diversely carried through the turnings of the guts, and distends and swells them up, and while it strives for passage out, it causes murmurings and noises in the belly, like wind breaking through narrow passages.
Signs of a Melancholic person.
The face of Melancholic persons is swart, their countenance cloudy and often cruel, their aspect is sad and froward; frequent Schirrhous, or hard swellings, tumors of the spleen, Hemorrhoids, Varices (or swollen veins) Quartan fevers, whether continual or intermitting, Quintain, Sextain, and Septiman fevers; and to conclude, all such wandering fevers or agues set upon them. But when it happens that the Melancholic humor is sharpened, either by adustion or mixture of Choler, then Tetters, the black Morphew, the Cancer simple and ulcerated, the Leprous and filthy scab, sending forth certain scaly and branlike excrescences, (being vulgarly called Saint Mani’s evil) and the Leprosy itself invades them: They have small veins and arteries, because coldness has dominion over them, whose property is to straiten, as the quality of heat is to dilate. But if at any time their veins seem big, that largeness is not by reason of the laudable blood contained in them, but from much windiness; by occasion whereof it is somewhat difficult to let them blood; not only because that when the vein is opened, the blood flows slowly forth, by reason of the cold slowness of the humors; but much the rather, for that the vein does not receive the impression of the Lancet, sliding this way and that way, by reason of the windiness contained in it, and because that the harsh dryness of the upper skin resists the edge of the instrument. Their bodies seem cold and hard to the touch, and they are troubled with terrible dreams, for they are observed to seem to see in the night Devils, Serpents, dark dens and caves, sepulchers, dead corpses, and many other such things full of horror, by reason of a black vapor, diversely moving and disturbing the Brain, which also we see happens to those who fear the water, by reason of the biting of a mad dog. You shall find them froward, fraudulent, parsimonious, and covetous, even to baseness, slow speakers, fearful, sad, complainers, careful, ingenious, lovers of solitariness, man-haters, obstinate maintainers of opinions once conceived, slow to anger, but angered not be pacified. But when Melancholy has exceeded nature’s and its own bounds, then by reason of putrefaction and inflammation all things appear full of extreme fury and madness, so that they often cast themselves headlong down from some high place, or are otherwise guilty of their own death, with fear of which notwithstanding they are terrified.
But we must note that changes of the native temperament do often happen in the course of a man’s life, so that he who a while ago was Sanguine may now be Choleric, Melancholic, or Phlegmatic; not truly by the changing of the blood into such humors, but by the mutation of diet, and the course or vocation of life. For none of a Sanguine complexion but will prove Choleric if he eats hot and dry meats, (as all like things are cherished and preserved by the use of their like, and contraries are destroyed by their contraries) and weary his body by violent exercises and continual labours; and if there be a suppression of Choleric excrements, which before did freely flow, either by nature or art. But whoever feeds upon meats generating gross blood, as Beef, Venison, Hare, old Cheese, and all salt meats, he without all doubt sliding from his nature, will fall into a Melancholic temper; especially if to that manner of diet, he shall have a vocation full of cares, turmoils, miseries, strong and much study, careful thoughts and fears; and also if he sit much, wanting exercise, for so the inward heat as it were defrauded of its nourishment, faints, and grows dull, whereupon gross and drossy humors abound in the body. To this also the cold and dry condition of the place in which we live doth conduce, and the suppression of the Melancholic humor accustomed to be evacuated by the Hemorrhoids, courses, and stools.
But he acquires a Phlegmatic temper whoever useth cold & moist nourishment,
much feeding, who before the former meat is gone out of the belly, shall stuff his paunch with more, who presently after meat runs into violent exercises, who inhabit cold and moist places, who lead their life at ease in all idleness; and lastly, who suffer a suppression of the Phlegmatic humour customarily evacuated by vomit, cough, or blowing the nose, or any other way either by nature or art. Certainly it is very convenient to know these things, that we may discern if any at the present be Phlegmatic, Melancholic or of any other temper, whether he be such by nature, or necessity. Having declared those things which concern the nature of Temperaments, and deferred the description of the parts of the body to our anatomy, we will begin to speak of the faculties governing this our life, when first we shall have shown by a practical demonstration of examples, the use and certainty of the aforesaid rules of Temperaments.
CHAP. VII. Of the Practice of the aforesaid rules of Temperaments.
That we may draw the Theoretical of the Temperaments into practice, it hath seemed good for avoiding of confusion, which might make this our Introduction seem obscure, if we would prosecute the differences of the Tempers of all men of all Nations, to take those Limits which nature hath placed in the world; as South, North, East, and West, and as it were the Center of those bounds, that the described variety of Tempers, in colour, habit, manners, studies, actions, and form of life of men that inhabit those Regions situated so far distant one from another, may be as a sure rule, by which we may certainly judge of every man’s temperature in particular, as he shall appear to be nearer, or further off from this, or that region. Those who inhabit the South, as the Africans, Ethiopians, Arabians, and Egyptians, are for the most part deformed, lean, dusky colored and pale, with black eyes and great lips, curled hair, and a small and shrill voice. Those who inhabit the Northern parts, as the Scythians, Muscovites, Polonians, and Germans, have their faces of color white, mixed with a convenient quantity of blood, their skin soft and delicate, their hair long, hanging down and spreading abroad, and of a yellowish, or reddish color; of stature they are commonly tall, and of a well-proportioned, fat, and compact habit of body, their eyes gray; their voice strong, loud, and big. But those who are situated between these two former, as the Italians and French, have their faces somewhat swarthy, are well favored, nimble, strong, hairy, slender, well in flesh, with their eyes resembling the color of Goat’s eyes, and often hollow-eyed, having a clear, shrill, and pleasing voice.
The Southern people are exceeded so much by the Northern in strength and ability of body, as they surpass them in wit and the faculties of the mind. Hence is it you may read in Histories that the Scythians, Goths, and Vandals vexed Africa and Spain with infinite incursions, and most large and famous Empires have been founded from the North to the South; but few or none from the South to the North. Therefore the Northern people, thinking all right and law to consist in Arms, did by Duel only determine all causes and controversies arising amongst the inhabitants, as we may gather by the ancient laws and customs of the Lombards, English, Burgundians, Danes, and Germans; and we may see in Saxo the Grammarian that such a law was once made by Fronto, king of Denmark. This custom at this day is everywhere in force amongst the Muscovites. But the Southern people have always much abhorred that fashion, and have thought it more agreeable to Beasts than Men. Wherefore we never heard of any such thing used by the Assyrians, Egyptians, Persians, or Jews. But moved by the goodness of their wit, they erected Kingdoms and Empires by the only help of Learning and hidden sciences. For seeing by nature they are Melancholic by reason of the dryness of their temperature, they willingly addict themselves to solitariness and contemplation, being endowed with a singular sharpness of wit. Wherefore the Ethiopians, Egyptians, Africans, Jews, Phoenicians, Persians, Assyrians, and Indians have invented many curious sciences, revealed the Mysteries and secrets of Nature, digested the Mathematics into order, observed the motions of the heavens, and first brought in the worship and religious sacrifices of the gods: Even so far that the Arabians who live only by stealth, and have only a Wagon for their house, do boast that they have many things diligently and accurately observed in Astrology by their Ancestors, which every day made more accurate and copious; they, as by an hereditary right, commend to posterity, as it is recorded by Leo the African. But the Northern people, as the Germans, by reason of the abundance of humors and blood, by which the mind is as it were oppressed, apply themselves to works obvious to the senses, and which may be done by the hand. For their minds oppressed with the earthly mass of their bodies, are easily drawn from heaven and the contemplation of Celestial things, to these inferior things, as to find out Mines by digging, to buy and cast metals, to draw and hammer out works of Iron, steel, and brass. In which things they have proved so excellent that the glory of the Invention of Guns and Printing belongs to them.
The people who inhabit the middle regions between these, are neither naturally fit for the more abstruse sciences, as the Southern people are, nor for Mechanical works, as the Northern, but intermeddle with civil affairs, commerce and Merchandising. But are endowed with such strength of body as may suffice to avoid and delude the crafts and arts of the Southern inhabitants; and with such wisdom as may be sufficient to restrain the fury and violence of the Northern. How true this is, anyone may understand by the example of the Carthaginians and Africans, who when they had held Italy for some years by their subtle counsels, crafty sleights, and devices, yet could not escape but at the length their Arts being deluded, and they spoiled of all their fortunes, were brought into subjection to the Romans. The Goths, Huns, and other Northern people have spoiled & overrun the Roman Empire by many incursions and inroads, but destitute of counsel & providence, they could not keep those things which they had gotten by Arms and valour. Therefore the opinion of all Historians is agreeing in this, that good laws, the form of governing a Commonwealth, all political ordinances, the Arts of disputing and speaking, have had their beginning from the Greeks, Romans, and French. And from hence in times past and at this day a greater number of writers, lawyers, and counselors of State have sprung up, than in all the world besides. Therefore that we may attribute their gifts to each Region, we affirm that, The Southern people are born and fit for the studies of learning; the Northern for wars, and those which be between them both for Empire and rule. The Italian is naturally wise, the Spaniard grave and constant; the French quick and diligent, for you would say he runs when he goes, being compared to the slow and womanly pace of the Spaniard, which is the cause that Spaniards are delighted with French servants for their quick agility in dispatching business. The Eastern people are specially endowed with a good, firm and well-tempered wit, not keeping their counsels secret and hidden. For the haste is of the nature of the Sun, and that part of the day which is next to the rising of the Sun is counted the right-side and stronger; and verily in all living things the right side is always the more strong and vigorous. But the Western people are more tender and effeminate, and more close in their carriage and mind, not easily making any one a partaker of their secrets. For the West is, as it were subject to the Moon, because at the change it always inclines to the West, whereby it happens that it is reputed as nocturnal, sinister and opposite to the East; and the West is less temperate and wholesome. Therefore of the winds none is more wholesome than the East wind which blows from the west with a most fresh and healthful gale, yet it seldom blows, and but only at sunset.
The Northern people are good eaters, but much better drinkers, witty when they are a little moistened with wine, and talkers of things both to be spoken and concealed, not very constant in their promises and agreements, but principal keepers and preservers of shamefastness and chastity, far different from the inhabitants of the South, who are wonderful sparing, sober, secret and subtle, and much addicted to all sorts of wicked lust. Aristotle in his Problems saith that those nations are barbarous and cruel, both which are burnt with immoderate heat, and which are oppressed with excessive cold, because a soft temper of the heavens softens the manners and the mind. Wherefore both, as well the Northern, as Scythians and Germans; and the Southern, as Africans are cruel; but these have this of a certain natural stoutness, and soldier-like boldness, and rather of anger than a wilful desire of revenge; because they cannot restrain by the power of reason the first violent motions of their anger by reason of the heat of their blood. But those of a certain inbred and inhumane pravity of manners, wilfully and willingly premeditating, they perform the works of cruelty, because they are of a sad and melancholy nature. You may have an example of the Northern cruelty from the Transylvanians against their seditious Captain George, whom they gave to be torn in pieces alive and devoured by his soldiers, (being kept fasting for three days before for that purpose) who was then unbowelled, and roasted, and so by them eaten up. The cruelty of Hannibal the Captain of the Carthaginians may suffice for an instance of the Southern cruelty. He left the Roman captives wearied with burdens and the length of the way, with the soles of their feet cut off; but those he brought into his tents, joining brethren and kinsmen together, he caused to fight, neither was satisfied with blood before he brought all the victors to one man. Also, we may see the cruel nature of the Southern Americans, who dip their children in the blood of their slain enemies, then suck their blood, and banquet with their broken and squeezed limbs.
And as the inhabitants of the South are free from diverse plethoric diseases, which are caused by abundance of blood, to which the Northern people are subject, as fevers, defluxions, tumors, madness with laughter which causeth those who have it to leap and dance (the people commonly term it S. Vitus’ Evil) which admits of no remedy but music: so they are often molested with the frenzy invading with madness and fury; by the heat whereof they are often so ravished and carried beyond themselves that they foretell things to come; they are terrified with horrible dreams, and in their fits they speak in strange and foreign tongues, but they are so subject to the scurf and all kinds of scabs and to the leprosy as their home-bred disease, that no houses are so frequently met with by such as travel through either of the Mauritanias, as hospitals provided for the lodging of lepers.
Those who inhabit rough and mountainous places are more brutish, tough & able to endure labor: but such as dwell in plains, especially if they be moorish or fen-like are of a tender body, and sweat much with a little labor; the truth of which is confirmed by the Hollanders and Frisians. But if the plain be such as is scorched by the heat of the sun, and blown upon by much contrariety of winds, it breeds men who are turbulent, not to be tamed, desirous of sedition and novelty, stubborn, impatient of servitude, as may be perceived by the sole example of the inhabitants of Narbon, a province of France.
Those who dwell in poor and barren places are commonly more witty and diligent and most patient of labor; the truth of which the famous wits of the Athenians, Ligurians, and Romans, and the plain country of the Boeotians in Greece, of the Campanians in Italy, and of the rest of the inhabitants adjoining to the Ligurian Sea, approve.
CHAP. VIII. Of the Faculties.
A Faculty is a certain power, and efficient cause, proceeding from the temperament of the part, and the performer of some actions of the body. There are three principal faculties governing man’s body as long as it enjoys its integrity; the animal, vital, and natural. The animal is seated in the proper temperament of the brain, from whence it is distributed by the nerves into all parts of the body which have sense and motion. This is of three kinds, for one is moving, another sensitive; the third principal. The sensitive consists in the five external senses, sight, hearing, taste, smell, and touch. The moving principally remains in the muscles and nerves, as the fit instruments of voluntary motion. The principal comprehends the reasoning faculty, the memory, and fantasy. Galen would have the common or inward sense to be comprehended within the compass of the fantasy, although Aristotle distinguishes between them.
The vital abides in the heart, from whence heat and life are distributed by the arteries to the whole body: this is principally hindered in the diseases of the chest; as the principal is when any disease assails the brain; the prime action of the vital faculty is pulsation, and that continued agitation of the heart and arteries, which is of threefold use to the body: for by the dilatation of the heart and arteries the vital spirit is cherished by the benefit of the air which is drawn in; by the contraction thereof the vapors of it are purged and sent forth, and the native heat of the whole body is tempered by them both.
The last is the natural faculty which has chosen its principal seat in the liver; it spreads or carries the nourishment over the whole body; but it is distinguished into three other faculties: the Generative which serves for the generation and forming of the issue in the womb; the Growing or increasing faculty which flourishes from the time the issue is formed, until the perfect growth of the solid parts into their full dimensions of length, height, and breadth. The nourishing faculty, which as a servant to both the other repairs and repays the continual efflux and waste of the three-fold substance; for Nutrition is nothing else but a replenishing, or repairing whatsoever is wasted or emptied. This nourishing faculty endures from that time the infant is formed in the womb until the end of life. It is a matter of great consequence in physick to know the four other faculties, which as servants attend upon the nourishing faculty; which are the Attractive, Retentive, Digestive, and Expulsive faculties. The Attractive draws that juice which is fit to nourish the body, that I say, which by application may be assimilated to the part. This is that faculty which in such as are hungry draws down the meat scarcely chewed, and the drink scarcely tasted, into the gnawing and empty stomach. The Retentive faculty is that which retains the nourishment once attracted until it be fully labored and perfectly concocted; and by that means it yields no small assistance to the Digestive faculty. For the natural heat cannot perform the office of concoction, unless the meat be embraced by the part, and make some stay therein. For otherwise the meat carried into the stomach never acquires the form of chylus, unless it stays detained in the wrinkles thereof, as in a rough passage, until the full time of chylification. The Digestive faculty assimilates the nourishment, being attracted and detained, into the substance of that part whose faculty it is, by the force of the inbred heat and proper disposition or temper of the part. So the stomach plainly changes all things which are eaten and drunk into chylus, and the liver turns the chylus into blood. But the bones and nerves convert the red and liquid blood which is brought down to them by the capillary or small veins, into a white and solid substance. Such concoction is far more laborious in a bone and nerve than in the muscular flesh. For the blood being not much different from its nature, by a light change and concretion turns into flesh. But this concoction will never satisfy the desire of nature and the parts, unless the nourishment purged from its excrements, put away the filth and dross, which must never enter into the substance of the part. Wherefore there do not only two sorts of excrements remain of the first and second concoction, the one thick, the other thin, as we have said before; but also from the third concoction which is performed in every part. The one of which we conceive only by reason, being that which vanishes into air by insensible transpiration. The other is known sometimes by sweats, sometimes by a thick fatty substance staining the shirt; sometimes by the generation of hair and nails, whose matter is from fuliginous and earthly excrements of the third coction. Wherefore the fourth faculty was necessary which might yield no small help to nourishment; it is called the expulsive, appointed to expel those superfluous excrements which by no action of heat can obtain the form of the part. Such faculties serving for nutrition are in some parts twofold; as some common, the benefit of which redounds to the whole body, as in the ventricle, liver, and veins; others only attending the service of those parts in which they remain, and in some parts all these four, as well common as proper, are abiding and resident, as in those parts we now mentioned: some with the four proper have only two common, as the gall, spleen, kidneys, and bladder. Others are content only with the proper, as the similar and muscular parts, who if they want any of these four faculties, their health is decayed either by want of nourishment, an ulcer, or otherwise. The like unnatural effects happen by the deficiency of just and laudable nourishment. But if it happens those faculties do rightly perform their duty, the nourishment is changed into the proper substance of the part, and is truly assimilated, as by these degrees. First it must flow to the part, then be joined to it, then agglutinated, and lastly, as we have said, assimilated. Now we must speak of the actions which arise from the faculties.
CHAP. IX. Of the Actions.
AN Action or Function is an active motion proceeding from a faculty; for as the faculty depends on the temperament, so the Action on the faculty, and the Act or work depends upon the Action by a certain order of consequence. But although that the words Actions and Act or work are often confounded, yet there is this difference between them, as that the Action signifies the motion used in the performance of anything; but the Act or work, the thing already done and performed: for example, Nutrition and the Generating of flesh are natural Actions; but the parts nourished, and a hollow ulcer filled with flesh are the works of that motion, or action. Wherefore the Act arises from the Action, as the Action arises from the faculty, the integrity or perfection of the instruments concurring in both. For as, if the faculty be either defective, or hurt, no Action will be well performed: so unless the Instruments keep their native and due conformity (which is their perfect health, the operator of the Action proper to the instrument) none of those things, which ought to be, will be well performed. Therefore for the performance of blameless and perfect actions, it is fit a due conformity of the Instrument concurr with the faculty. But Actions are two-fold; for they are either Natural, or Voluntary. They are termed Natural, because they are performed not by our will, but by their own accord and against our will: as are that continual motion of the Heart, the beating of the Arteries, the expulsion of the excrements, and such other like which are done in us by the Law of Nature whether we will, or not. These Actions flow either from the Liver and veins, or from the Heart and Arteries. Wherefore we may comprehend them under the names of Natural and Vital Actions. For we must attribute this Action to each faculty, lest we may seem to constitute an idle faculty, and no way profitable for use. The involuntary vital actions are the dilation and contraction of the Heart and Arteries, which we comprehend under the sole name of the Pulse: by that they draw in, and by this, they expel, or drive forth.
The involuntary vital actions are,
Generation
Growth and
Nutrition
which proceed from the
Generative, Growing, and Nourishing faculty
Generation is nothing else than a certain producing, or acquiring of matter, and an introducing of a substantial form into that matter; this is performed by the assistance of two faculties: of the Altering which does diversely prepare and dispose the seed and menstruous blood to put on the form of a bone, nerve, spleen, flesh, and such like; of the Forming faculty which adorns with figure, site, and composition, the matter ordered by so various a preparation.
Growth is an enlarging of the solid parts into all the dimensions, the pristine and ancient form remaining safe and sound in figure and solidity. For the perfection of every growth is judged only by the solid parts; for if the body swell into a mass of flesh, or fat, it shall not therefore be said to be grown: but then only when the solid parts do in like manner increase, especially the bones, because the growth of the whole body follows their increase, even although at the same time it waxes lean and pine away.
Nutrition is a perfect assimilation of that nourishment which is digested, into the nature of the part which digests. It is performed by the assistance of four subsidiary or helping actions: Attractive, Retentive, Digestive, and Expulsive.
The voluntary actions which we willingly perform are so called because we can at our pleasure hinder, stir up, slow, or quicken them. They are three in general: the sensitive, moving, and principal Action. The sensitive Soul comprehends all things in fine senses, in sight, hearing, smell, taste, and touch. Three things must necessarily concur to the performance of them: the organ, the medium or means, and the object. The principal organ, or instrument, is the animal spirit diffused by the nerves into each several part of the body, by which such actions are performed. Wherefore for the present we will use the parts themselves for their organs. The means is a body which carries the object to the instrument. The object is a certain external quality, which has power by a fit medium or means to stir up and alter the organ. This will be more manifest by relating the particular functions of the senses by the necessary concurrence of these three.
Sight is an action of the seeing faculty, which is done by the eye fitly composed of its coats and humors, and so consequently the organic body of this action. The object is a visible quality brought to the eye. But such an object is two-fold; for either it is absolutely visible of its self, and by its own nature, as the sun, the fire, the moon, and stars: or desires, as it were, the help of another that it may be actually such; for so, by the coming of light, the colors, which were visible in power only, being brought to the eye do seem and appear such as they actually are. But such objects cannot arrive at the eye, but through a clear and luminous medium, as the air, water, glass, and all sorts of crystal.
The Hearing hath for its organ the ear and auditory passage, which goes to the stony bone furnished with a membrane investing it, an auditory nerve, and a certain inward spirit there contained. The Object is every sound arising from the smitten or broken air, and the collision of two bodies meeting together. The Medium is the encompassing air which carries the sound to the ear.
Smelling (according to Galen’s opinion) is performed in the mamillary processes produced from the proper substance of the brain, and seated in the upper part of the nose: although others had rather smelling should be made in the very foremost ventricles of the brain. This Action is weak in man in comparison of other creatures: the Object thereof is every smell, or fumid exhalation breathing out of bodies. The Medium by which the Object is carried to the noses of men, beasts, and birds is the air, but to fishes, the water itself. The Action of taste is performed by the tongue being tempered well and according to nature, and furnished with a nerve spread over its upper part from the third and fourth conjugations of the brain. The Object is taste, of whose nature and kinds we will treat more at large in our Antidotary. The Medium by which the Object is so carried to the organ that it may affect it is either external or internal: The external is that spittle which doth as it were anoint and supple the tongue; the internal is the spongy flesh of the tongue itself, which affected with the quality of the Object doth presently so possess the nerve that is implanted in it, that the kind and quality thereof by the force of the spirit may be carried into the common sense. All parts endowed with a nerve enjoy the sense of touching, which is chiefly done, when a tractable quality doth penetrate even to the true and nervous skin, which lies under the cuticle, or scarf-skin; we have formerly noted that it is most exquisite in the skin which invests the ends of the fingers. The Object is every tractable quality, whether it be of the first rank of qualities, as heat, cold, moisture, dryness, or of the second, as roughness, smoothness, heaviness, lightness, hardness, softness, rarity, density, friability, unctuosity, grossness, thinness. The Medium by whose procurement the instrument is affected is either the skin or the flesh interwoven with many nerves.
The next Action, is that Motion, which by a peculiar name we call voluntary; this is performed and accomplished by a muscle, being the proper instrument of voluntary Motion. Furthermore, every motion of a member possessing a muscle is made either by bending and contraction, or by extension. Although generally there be so many differences of voluntary motion, as there are kinds of sites in place; therefore Motion is said to be made upward, downward, to the right hand, to the left, forward and backward; hither are referred the many kinds of motions, which the infinite variety of muscles produce in the body. Into this rank of Voluntary Actions, comes Respiration, or breathing because it is done by the help of the muscles; although it be chiefly to temper the heat of the Heart. For we can make it more quick or slow as we please, which are the conditions of a voluntary Motion.
Lastly, that we may have somewhat in which we may safely rest and defend ourselves against the many questions which are commonly raised concerning this thing, we must hold, that Respiration is undergone and performed by the animal faculty, but chiefly instituted for the vital.
The principal Action and prime amongst the Voluntary actions is absolutely divided in three, Imagination, Reasoning, and Memory.
Imagination is a certain expressing, and apprehension which discerns and distinguishes between the forms and shapes of things sensible, or which are known by the senses.
Reasoning is a certain judicial estimation of conceived or apprehended forms or figures, by a mutual collating or comparing them together.
Memory is the sure storer of all things, and as it were the treasury which the mind often unfolds and opens, the other faculties of the mind being idle and not employed. But because all the forementioned Actions whether they be natural or animal and voluntary, are done and performed by the help and assistance of the Spirits; therefore now we must speak of the Spirits.
CHAP. X. Of the Spirits.
The spirit is a subtle and airy substance, raised from the purer blood that it might be a vehicle for the faculties (by whose power the whole body is governed) to all the parts, and the prime instrument for the performance of their office. For they being destitute of its sweet approach do presently cease from action, and as dead do rest from their accustomed labors. From hence it is that making a variety of spirits according to the number of the faculties, they have divided them into three; as one Animal, another Vital, another Natural.
The Animal hath taken his seat in the brain; for there it is prepared and made, that from thence conveyed by the nerves it may impart the power of sensation and motion to all the rest of the members. An argument hereof is, that in the great cold of winter, whether by the interception of them in their way, or by the concretion, or as it were freezing of those spirits, the joints grow stiff, the hands numb, and all the other parts are dull, destitute of their accustomed agility of motion, and quickness of sense. It is called Animal not because it is the life, but the chief and prime instrument thereof; wherefore it hath a most subtle and airy substance: and enjoys divers names according to the various conditions of the sensors or seats of the senses into which it enters; for that which causeth the sight, is named the Visive: you may see this by night, rubbing your eyes, as sparkling like fire. That which is conveyed to the Auditory passage, is called the Auditive or Hearing; that which is carried to the instruments of Touch, is termed the Tactile; and so of the rest.
This Animal spirit is made and labored in the windings and foldings of the veins and arteries of the brain, of an exquisite subtle portion of the vital brought thither by the carotid arteries, or sleepy arteries, and sometimes also of the pure air, or sweet vapor drawn in by the nose in breathing. Hence it is that with ligatures we stop the passage of this spirit from the parts we intend to cut off. An humor which obstructs or stops its passage, does the like in apoplexies and palsies, whereby it happens that the members situated under that place do languish and seem dead, sometimes destitute of motion, sometimes wanting both sense and motion.
The Vital spirit is next to it in dignity and excellence, which hath its chief mansion in the left ventricle of the heart, from whence through the channels of the arteries it flows into the whole body to nourish the heat which resides fixed in the substance of each part, which would perish in a short time unless it should be refreshed by heat flowing thither together with the spirit. And because it is the most subtle next to the Animal, Nature (lest it should vanish away) would have it contained in the nervous coat of an artery, which is five times more thick than the coat of the veins, as Galen, out of Herophilus, hath recorded.
It is furnished with matter from the subtle exhalation of the blood, and that air which we draw in breathing. Wherefore it does easily and quickly perish by immoderate dissipations of the spirituous substance and great evacuations; so it is easily corrupted by the putrefaction of humors, or breathing in of pestilent air and filthy vapors, which thing is the cause of the so sudden death of those which are infected with the plague. This spirit is often hindered from entering into some part by reason of obstruction, fulness, or great inflammations, whereby it follows that in a short space, by reason of the decay of the fixed and inbred heat, the parts do easily fall into a gangrene and become mortified.
The Natural spirit (if such there be any) hath its station in the liver and veins. It is more gross and dull than the other, and inferior to them in the dignity of the action and the excellence of the use. The use thereof is to help the concoction both of the whole body, as also of each several part, and to carry blood and heat to them.
Besides those already mentioned, there are other spirits fixed and implanted in the simular and prime parts of the body, which also are natural, and natives of the same place in which they are seated and placed. And because they are also of an airy and fiery nature, they are so joined or rather united to the native heat, that they can no more be separated from it than flame from heat; wherefore they, with these that flow to them, are the principal instruments of the actions which are performed in each several part; and these fixed spirits have their nourishment and maintenance from the radical and first-bred moisture, which is of an airy and oily substance and is as it were the foundation of these spirits and the inbred heat. Therefore, without this moisture, no man can live a moment. But also the chief instruments of life are these spirits together with the native heat. Wherefore this radical moisture being dissipated and wasted (which is the seat, fodder, and nourishment of the spirits and heat) how can they any longer subsist and remain? Therefore the consumption of the natural heat followeth the decay of this sweet and substance-making moisture, and consequently death, which happens by the dissipating and resolving of natural heat.
But since then these kinds of spirits with the natural heat are contained in the substance of each simular part of our body (for otherwise it could not persist) it must necessarily follow that there be as many kinds of fixed spirits as of simular parts. For because each part has its proper temper and increase, it has also its proper spirit and also its own proper fixed and implanted heat, which here has its abode, as well as its original. Wherefore the spirit and heat which is seated in the bone is different from that which is impacted into the substance of a nerve, vein, or such other simular part; because the temper of these parts is different, as also the mixture of the elements from which they first arose and sprang up. Neither is this contemplation of spirits of small account, for in these consist all the force and efficacy of our nature.
These being by any chance dissipated or wasted, we languish, neither is any health to be hoped for, the flower of life withering and decaying by little and little. Which thing ought to make us more diligent to defend them against the continual efflux of the threefold substance. For if they be decayed, there is left no proper indication of curing the disease, so that we are often constrained, all other care laid aside, to betake ourselves to the restoring and repairing the decayed powers. Which is done by meats of good juice, easy to be concocted and distributed, good wines, and fragrant smells.
But sometimes these spirits are not dissipated, but driven in and returned to their fountains, and so both oppress and are oppressed; whereupon it happens we are often forced to dilate and spread them abroad by binding and rubbing the parts. Hitherto we have spoken of these things which are called natural, because we naturally consist of them; it remains that we now say somewhat of their adjuncts and associates by familiarity of condition.
The adjuncts and associates to things natural are
CHAP. XI. Of the Adjuncts of things Natural.
Sex is no other thing than the distinction of Male and Female, in which this is most observable, that for the parts of the body, and the fire of these parts, there is little difference between them; but the Female is colder than the Male. Wherefore their spermatic parts are more cold, soft, and moist, and all their natural actions less vigorous, and more depraved.
The Nature of Eunuchs is to be referred to that of women, as who may seem to have degenerated into a womanish nature, by deficiency of heat; their smooth body and soft and shrill voice do very much assimilate women. Notwithstanding, you must consider that there are some manly women, which their manly voice and chin covered with a little hairiness do argue; and on the contrary, there are some womanizing or womanish men, which therefore we term dainty and effeminate.
The Hermaphrodite, as of a doubtful nature and in the middle of both sexes, seems to participate of both Male and Female.
The color which is predominant in the habitat and superficies of the body and * 1.160 lies next under the skin, shows the temperament of what kind soever it be; for as Galen notes in Comment. ad Aphor., 2. sect. 1. Such a color appears in us, as the contained humor has. Wherefore, if a rosy hue colors the cheeks, it is a sign the body abounds with blood, and that it is carried abroad by the plenty of spirits. But if the skin be dyed with a yellow color, it argues choler is predominant; if with a whitish and pale hue, phlegm; with a sable and dusky, melancholy. So the color of the excrements which are according to Nature is not of the least consideration. For thus, if an ulcer being broken sends forth white matter, it argues the soundness of the part from whence it flows; but if sanguineous or bloody, green, blackish, or of diverse colors, it shows the weakness of the solid part, which could not assimilate by concoction the color of the excrementitious humor. The like reason is of unnatural tumors; For, as the color, so the dominion of the humor causing or accompanying the swelling commonly is.
The Conformity, and integrity of the Organical parts is considered by their figure, greatness, number, situation, and mutual connexion. We consider the figure, when we say almost all the external parts of the body are naturally round, not only for show, but for necessity, that being smooth, and no way cornered, they should be less obnoxious to external injuries; we speak of greatness, when we say, some are large and thick, some lank and lean. But we consider their number, when we observe some parts to abound, some to want, or nothing to be defective or wanting. We insinuate site and connexion when we search, whether everything be in its proper place, and whether they be decently fitted, and well joined together.
We have handled the varieties of the four seasons of the year, when we treated of Temperaments. But the consideration of Region (because it has the same judgment that the Air) shall be referred to that disquisition, or inquiry which we intend to make of the Air, amongst the Things not natural.
The manner of life and order of diet are to be diligently observed by us, because they have great power either to alter, or preserve the Temperament. But because they are of almost infinite variety, therefore they scarcely seem possible to fall into Art, which may prosecute all the differences of diet and vocations of life. Wherefore if the Calling of life be laborious, as that of husbandmen, mariners, and other such trades, it strengthens and dries the parts of the body. Although those which labor much about Waters are most commonly troubled with cold and moist diseases, although they almost kill themselves with labor.
Again, those which deal with Metals, as all sorts of Smiths, and those which cast and work brass, are more troubled with hot diseases, as fevers. But if their Calling be such as they sit much, and work all the day long sitting at home, as shoemakers; it makes the body tender, the flesh effeminate and causes great quantity of excrements. A life as well idle and negligent in body, as quiet in mind, in all riotousness and excesses of Diet, does the same. For from hence the body is made subject to the stone, gravel, and gout.
That calling of life which is performed with moderate labor, clothing and diet, seems very fit and convenient to preserve the natural temper of the body. The ingenious surgeon may frame more of himself that may more particularly conduce to the examination of these things. Therefore, the things natural, and those which are near or neighboring to them being thus briefly declared, the order seems to require that we make inquiry of things not natural.
CHAP. XII. Of things not natural.
The things which we must now treat of, have by the latter physicians been termed, Not natural; because they are not of the number of those which enter into the constitution, or composure of man’s body; as the Elements, Humors, and all such things which we formerly comprehended under the name of Natural: Although they be such as are necessary to preserve and defend the body already made and composed. Wherefore they were called by Galen Preservers, because by the due use of them the body is preserved in health. Also they may be called doubtful; and Neuters, for that rightly and fitly used they keep the body healthful; but inconsiderately, they cause diseases. Whereby it comes to pass that they may be thought to pertain to that part of Physick which is of preserving health, not because some of these things should be absolutely and of their own nature wholesome, and others unwholesome, but only by this, that they are, or prove so by their convenient, or preposterous use. Therefore we consider the use of such like things from 4 conditions, quantity, quality, occasion, and manner of using; if thou shalt observe these, thou shalt attain and effect this, that those things which of themselves are as it were, doubtful, shall bring certain and undoubted health. For these 4 Circumstances do so far extend, that in them as in the perfection of Art, the Rules which may be prescribed to preserve health are contained. But Galen in another place has in 4 words comprehended these things not Natural; as things Taken, Applied, Expelled, and to be Done. Things Taken are those which are put into the body, either by the mouth or any other way, as the Air, meat, and drink. Things Applied are these which must touch the body, as the Air now mentioned, affecting the body with a diverse touch of its qualities of heat, cold, moisture or dryness. Expelled are, what things soever being unprofitable are generated in the body and require to be expelled. To be Done are labor, rest, sleep, watching, and the like. We may more distinctly and by expression of proper names revoke all these things to six; which are
CHAP. XIII. Of the Air.
Air is so necessary to life that we cannot live a moment without it, if so be that breathing, and much more transpiration, be not to be separated from life. Wherefore it much conduces to know what air is wholesome, what unwholesome, and which by contrariety of qualities fights for the patient against the disease; or on the contrary by a similarity of qualities shall nourish the disease, that if it may seem to burden the patient by increasing or adding to the disease, we may correct it by art. So in curing the wounds of the head, especially in winter, we labour by all the means we may to make the air warm. For cold is hurtful to the brain, bones, and the wounds of these parts; and heat is comfortable and friendly. But also the air being drawn into the body by breathing when it is hotter than ordinary, does with a new warmth overheat the heart, lungs, and spirits, and weaken the strength by the dissipation of the spirits too much attenuated; so being too cold, in like manner the strength of the faculties faints and grows dull, either by suppression of the vapors, or by the inspissation, or thickening of the spirits.
Therefore, to conclude, that air is to be esteemed healthful, which is clear, subtle, and pure, free and open on every side, and which is far removed from all carrion-like smells of dead carcasses, or the stench of any putrefying thing whatsoever: the which is far distant from standing pools, and fens and caves, sending forth strong and ill vapors; neither too cloudy nor moist by the nearness of some river.
Such an air, I say, if it have a vernal temper, is good against all diseases. That air which is contrary to this is altogether unhealthful, as that which is putrid, shut up, and pressed, by the tightness of neighboring mountains, infected with some noxious vapor. And because I cannot prosecute all the conditions of airs, fit for the expelling of all diseases, as which are almost infinite, it shall suffice here to have set down what we must understand by this word air.
Physicians commonly use to understand three things by the name of air; the present state of the air; the region in which we live; and the season of the year. We spoke of this last when we treated of temperaments. Wherefore we will now speak of the two former. The present state of the air, one while for some small time, is like the spring, that is temperate; other times like the summer, that is hot and dry; other times like the winter, that is cold and moist; and sometimes like the autumn, which is unequal; and this last constitution of the air is the cause of many diseases. When upon the same day, it is one while hot, another cold, we must expect autumnal diseases. These tempers and varieties of constitutions of the air are chiefly and principally stirred up by the winds; as which being diffused over all the air, show no small force by their sudden change. Wherefore we will briefly touch their natures: that which blows from the east is called the east wind, and is of a hot and dry nature, and therefore healthful. But the western wind is cold and moist, and therefore sickly. The south wind is hot and moist, the author of putrefaction and putrid diseases. The north wind is cold and dry, therefore healthy: wherefore it is thought, if it happen to blow in the dog days, that it makes the whole year healthful, and purges and takes away the seeds of putrefaction, if any chance to be in the air. But this description of the four winds is then only thought to be true if we consider the winds in their own proper nature, which they borrow from these regions, from which they first proceed. For otherwise they affect the air quite contrary, according to the disposition of the places over which they came, as snowy places, seas, lakes, rivers, woods, or sandy plains, from whence they may borrow new qualities, with which they may afterwards possess the air, and so consequently our bodies.
Hence it is we have noted the Western wind unwholesome, and breeding diseases, by reason of the proper condition of the region from whence it came; and such, that is cold and moist; the Gasconies find it, truly to their great harm, that it seldom blows with them, but it brings some manifest and great harm, either to their bodies, or fruits of the earth. And yet the Greeks and Latins are wont to commend it for healthfulness, more than the rest. But also the rising and setting of some more eminent stars do often cause such cold winds that the whole air is cooled or infected with some other malignant quality. For vapors and exhalations are often raised by the force of the stars, from whence winds, clouds, storms, whirlwinds, lightnings, thunder, hail, snow, rain, earthquakes, inundations, and violent raging of the sea have their origin. The exact contemplation of which things, although it be proper to astronomers, cosmographers, and geographers, yet Hippocrates could not omit it, but that he must speak something in his book De aëre & aquis, where he touches by the way, the description of the neighboring regions, and such as he knew.
From this force of the air, either hurtful or helping in diseases, came that famous observation of Gnido of Caulias, that wounds of the head are more difficult to cure at Paris than at Avignon, and the plain contrary of wounds of the legs; for the air of Paris compared to that of Avignon is cold and moist, wherefore hurtful and offensive to the wounds of the head. On the contrary, the same air, because it obscures the spirits, incrassates the blood, condenses the humors, and makes them less fit for defluxions, makes the wounds of the legs more easy to be healed, by reason it hinders the course of the humors, by whose defluxion the cure is hindered. But it is manifest that hot and dry places make a greater dissipation of the natural heat, from whence the weakness of the powers; by which same reason the inhabitants of such places do not so well endure bloodletting; but more easily suffer purges, though vehement, by reason of the contumacy of the humor caused by dryness. To conclude, the air changes the constitutions of our bodies either by its qualities, as if it be hotter, colder, moister, or drier; or by its matter, as if it be grosser or more subtle than is fit, or corrupted by exhalations from the earth; or by a sudden and unaccustomed alteration, which any man may prove, who makes a sudden change out of a quiet air into a stormy and troubled with many winds. But because, next to the air, nothing is so necessary to nourish man’s body as meat and drink, I will now begin to speak of them both.
CHAP. XIV. Of Meat and Drink.
That this our Treatise of meat and drink may be more brief and plain, I have thought good to part it into these heads, as to consider the goodness and illness of both of them, their quantity, quality, custom, delight, order, time, and to accommodate them all to the ages and seasons of the year. We judge of the goodness and pravity of meats and drinks, from the condition of the good or vicious humors, or juice which they beget in us. For evil juice causeth many diseases. As on the contrary, good juice drives away all diseases from the body, except the fault happen from some other occasion, as from quantity, or too much excess. Wherefore it is principally necessary, that those who will preserve their present health, and hinder the access of diseases, feed upon things of good nourishment and digestion, as are good wine, the yolks of eggs, good milk, wheaten bread well baked, the flesh of Capon, Partridge, Thrushes, Larks, Veal, Mutton, Kid, and such like others, which you may find mentioned in the Books which Galen wrote de Alimentorum facultatibus; where also he examines those which are of evil juice by their manifest qualities, as acrimony, bitterness, saltiness, acidity, harshness, and such like.
But unless we use a convenient quantity and measure in our meats, howsoever laudable they be, we shall never reap these fruits of health we hoped for. For they yield matter of diseases, by the only excess of their quantity; but we may by this know the force of quantity on both parts, because often the poisonous quality of meats of ill nourishment does not hurt, by reason they were not taken into the body in a great quantity. That measure of quantity is chiefly to be regarded in diseases: for as Hippocrates says, if any give meat to one sick of a fever, he gives strength to the well, and increases the disease to the sick, especially if he does not use a means. Wherefore it is a thing of no small consequence, to know what diseases require a slender and what a large diet; of which thing there is large relation made in the Section of the Aphorisms of Hippocrates; where he teaches, the sick must feed more largely in the beginning of long diseases, whereby they may be enabled to endure the length of the disease, and last to the state thereof. But in sharp and violent diseases, which presently come to their height, we must use a slender diet; but most slender, when the disease is in the height; and besides, all our consultations in this kind must be referred to the strength of the patients. But those who enjoy their perfect health must use a quantity of meat, agreeable to their evacuation and transpiration; for men by reason of the strength of their heat, and the more copious dissipation of the triple substance, have greater appetite than women; altogether by the same reason that young people, and such as grow, need more frequent and plentiful nourishment than old men; and also amongst young men of the like age, some do rightly require more copious nourishment than others, that is, according to the quantity of their evacuations and customs. Certainly for gluttony, it is such as may be extended to all; but we all should take so much meat and drink that our powers may be refreshed and not oppressed: for by the decree of Hippocrates, these be the two compendiary ways of preserving health; not to be over-filled with meat, and to be quick to work; and thus much of the quantity of meats. Neither must those who are either sound or sick have less regard to the qualities of their meats; and those are either the first, as heating, cooling, moistening, drying; or the second, attenuating, incrassating, obstructing, opening, or some other like, working according to the condition of their nature. The manner of our diet is not only to be framed according to these, but also to be varied; for the present state of those who are in health requires to be preserved by the use of like things. As hot and moist nourishment is to be prescribed to children, as to those which are hot and moist: and cold, and dry, to old men, as to those who are cold and dry; if so be that vulgar saying be true, that Health delights in the use of like things. Yet because old age, how green and new begun howsoever it be, is of itself as it were, a disease, it seems to be more convenient, both to truth and for health, that old people should eat meats contrary to their nature, that is, hot and moist, that so we may defer as much as we can, the causes of death, cold and dryness, which hasten the destruction of that age. For we must resist diseases by the use of their contraries, as those things which are contrary to nature. For otherwise, as much meat as you give to the sick, you add so much strength to the disease. And the same is the cause why Hippocrates said that a moist diet is convenient for all such as are sick of fevers, because a fever is a dry distemperature. Therefore we must diligently pry into the nature of the disease, that knowing it, we may endeavor to abate its fury by the use of contraries.
But if custom (as they say) be another nature, the physician must have a great care of it, both in sound and sick. For this sometimes by little and little and insensibly changes our natural temperament, and instead thereof gives us a borrowed temper. Wherefore if any would presently or suddenly change a custom which is sometimes ill, into a better, truly he will bring more harm, than good; because all sudden changes (according to the opinion of Hippocrates) are dangerous. Wherefore if necessity require, that we should withdraw any thing from our custom, we must do it by little and little, that so nature may by degrees be accustomed to contraries without violence, or the disturbance of its usual government. For that meat and drink which is somewhat worse, but more pleasant and familiar by custom, is to be preferred (in Hippocrates’ opinion) before better, but less pleasant and accustomed. Hence is it, that countrymen do very well digest beef and bacon, which commonly they use; but will turn into nidorous vapours, partridge, capon, and other meat of good nourishment, sooner than change them into good and laudable chylus. The cause of which thing is not only to be attributed to the property of their stronger, and as it were burning heat, but much more to custom, which by a certain kind of familiarity, causes that meats of hard digestion are easily turned into laudable blood. For the force of custom is so great, that accustomed meats are more acceptable; whereby it comes to pass, that while the stomach delights in them, it more strictly embraces them, and happily digests them, without any trouble of loathing, vomiting, or heaviness. All the contrary meets and happen in the use of meats which are unpleasant to the taste and stomach. For the ventricle abhorring those things, makes manifest how it is troubled by its acid and nidorous belchings, loathing, nauseousness, vomit, heaviness, pain of the head, and trouble of the whole body. Wherefore we must diligently enquire what meats the patient chiefly delighted in, that by offering them, his appetite languishing by reason of some great evacuation, vomit, or the like, may be stirred up. For it will be better and more readily restored by things acceptable, though they be somewhat worse, as we noted a little before out of Hippocrates. By which words he plainly taught, that it is the part of a good and prudent physician to subscribe to, and please the palate of his patient.
But seeing that order is most beautiful in all things, it is truly very necessary in eating our meat: for how laudable soever the meats be in their quantity and quality, howsoever familiar by use, and grateful by custom, yet unless they be eaten in due order, they will either trouble or molest the stomach, or be ill, or slowly and difficultly concocted; wherefore we must diligently observe what meats must be eaten at the first, and what at the second course; for those meats which be hard to concoct, are not to be eaten before those which are easy of digestion; neither dry and astringent things, before moistening and loosening.
But on the contrary, all slippery, fat, and liquid things, and which are quickly changed ought to go before, that so the belly may be moistened; and then astringent things must follow, that the stomach, by their help, being shut, and drawn together, may more strictly comprehend the meat on every side, and better perform the chylification by its proper heat united and joined together.
For this cause Hippocrates Lib. de victu in acutis, commands those things to be always eaten in the morning, which are fit to loosen the belly, and in the evenings such as nourish the body. Yet notwithstanding drink ought not to precede, or go before meat, but on the contrary meat must precede drink, by the order prescribed by him.
Whether ought we in our eating to have less care of the time, than we have of the order: for the time of eating of such as are healthful, ought to be certain and fixed; for at the accustomed hour, and when hunger presses, any sound man, and who is at his own disposal, may eat, but exercise and accustomed labors ought to go before; for it is fit, according to the precept of Hippocrates, that labour precede meat, whereby the excrements of the third concoction may be evacuated, the native heat increased, and the solid parts confirmed and strengthened, which are three commodities of exercise very necessary to the convenient taking of meat. But in sick persons we can scarcely attend, and give heed to these circumstances of time, and accustomed hour of feeding; for that indication of giving meat to the sick is the best of all, which is drawn from the motion of the disease, and the declining of the fit: for if you give meat in fevers, especially the fit then taking the patient, you nourish not him, but the disease. For the meat then eaten is corrupted in the stomach, and yields fit matter for the disease. For meat (as we noted before out of Hippocrates) is strength to the sound, and a disease to the sick, unless it be eaten at a convenient time, and diligent care be had of the strength of the patient, and greatness of the disease.
But neither is it convenient that the meat should be simple, and of one kind, but of many sorts, and of diverse dishes dressed after different forms, lest nature by the continual and hateful feeding upon the same meat may at length loathe it, and so neither strictly contain it, nor well digest it; or the stomach accustomed to one meat, taking any loathing thereat, may abhor all other: and as there is no desire of that we do not know, so the dejected appetite cannot be delighted and stirred up, with the pleasure of any meat which can be offered. For we must not credit those superstitious, or too nice physicians, who think the digestion is hindered by the much variety of meats.
The matter is far otherwise, for by the pleasure of what things soever the stomach allured does require, it embraces them more straightly, and concocts them more perfectly. And our nature is desirous of variety. Moreover, seeing our body is composed of a solid, moist, and airy substance, and it may happen that by so many labors, which we are compelled to undergo, and sustain in this life, one of these may suffer a greater dissipation and loss than another; therefore the stomach is necessarily compelled to seek more variety, lest anything should be wanting to repair that which is wasted. But also the age and season of the year yield indications of feeding, for some things are convenient for a young man, some for an old man, some in summer, some in winter. Wherefore we ought to know what befits each age and season. Children need hot, moist, and much nourishment, which may not only suffice to nourish, but increase the body. Wherefore they worst endure fasting, and of them, especially those who are the most lively and spirited. With old men, it is otherwise, for because their heat is small, they need little nourishment, and are extinguished by much. Wherefore old men easily endure to fast; they ought to be nourished with hot and moist meats, by which their solid parts, now growing cold and dry, may be heated and moistened, as by the sweet nourishment of such like meats. Middle-aged men delight in the moderate use of contraries to temper the excess of their too acrid heat. Young people, as temperate, are to be preserved by the use of like things.
The manner of diet in winter must be hot and inclining to driness. Wherefore then we may more plentifully use roast-meats, strong wines, and spices; because in the winter season we are troubled with the cold and moist air, and at the same time, have much heat inwardly; for the inner parts, according to Hippocrates, are naturally most hot in the winter and the spring, but feverish in summer; so the heat of summer is to be tempered by the use of cold and moist things, and much drink. In the temperate spring all things must be moderate; but in autumn, by little and little, we must pass from our summer to our winter diet.
CHAP. XV. Of Motion and Rest.
HEre Physicians admonish us, that by the name of Motion, we must understand all sorts of exercises, as walking, leaping, running, riding, playing at tennis, carrying a burden, and the like. Friction or rubbing is of this kind, which in times past was in great use and esteem, neither at this day is it altogether neglected by Physicians. They mention many kinds of it, but they may be all reduced to three, as one gentle, another hard, a third indifferent; and that of the whole body, or only of some part thereof. The friction is called hard, which is made by the rough, or strong pressure of the hands, sponges, or a coarse and new linen cloth: it draws together, condenses, binds and hardens the flesh, yet if it be often and long used, at length it rarefies, dissolves, attenuates and diminishes the flesh, and any other substance of the body; and also it causes revulsion, and draws the defluxion of humors from one part to another. The gentle friction which is performed by the light rubbing of the hand, and such like, does the contrary, as softens, relaxes, and makes the skin smooth and unwrinkled, yet unless it be long continued it does none of these, worthy to be spoken of. The indifferent kinds consisting in the mean between the other two, increases the flesh, swells or puffs up the habit of the body, because it retains the blood and spirits which it draws and suffers them not to be dissipated.
The benefit of exercise is great, for it increases natural heat, whereby better digestion follows, and by that means nourishment, and the expulsion of the excrements, and lastly, a quicker motion of the spirits, to perform their offices in the body, all the ways and passages being cleansed. Besides, it strengthens the respiration, and the other actions of the body, confirms the habit, and all the limbs of the body, by the mutual attrition of the one with the other; whereby it comes to pass they are not so quickly wearied with labour. Hence we see that country people are not to be tired with labour.
If any will reap these benefits by exercise, it is necessary that he take opportunity to begin his exercise, and that he seasonably desist from it, not exercising himself violently and without discretion; but at certain times according to reason.
Wherefore the best time for exercise will be before meat (that the appetite may be increased by augmenting the natural heat) all the excrements being evacuated, lest nature being hungry and empty, does draw and infuse the ill humors contained in the guts, and other parts of the body, into the whole habit, the liver, and other noble parts. Neither is it fit to presently, after meat, to run into exercise, lest the crude humors and meats not well concocted be carried into the veins. The measure and bounds of exercise must be, when the body appears more full, the face looks red, sweat begins to break forth, we breathe more strongly and quickly, and begin to grow weary; if any continue exercise longer, stiffness, and weariness assails his joints, and the body flowing with sweat suffers a loss of the spirituous and humid substance which is not easily repaired; by which it becomes more cold, and lean even to deformity.
The quality of exercise which we require, is in the midst of exercise, so that the exercise must be neither too slow and idle, nor too strong, nor too weak, nor too hasty, nor remiss, but which may move all the members alike. Such exercise is very fit for sound bodies. But if they be distempered, that sort of exercise is to be made choice of, which by the quality of its excess, may correct the distemper of the body, and reduce it to a certain mediocrity. Wherefore such men as are stuffed with cold, gross, and viscous humors, shall hold that kind of exercise most fit for them, which is more laborious, vehement, strong, and longer continued. Yet so, that they do not enter into it before the first and second concoction, which they may know by the yellowness of their urine. But let such as abound with thin and choleric humors choose gentle exercises, and such as are free from contention, not expecting the finishing of the second concoction, for the more acrid heat of the solid parts delights in such half concocted juices, which otherwise it would so burn up, all the glutinous substance thereof being wasted, that they could not be adjoined, or fastened to the parts. For the repeating, or renewing of exercise, the body should be so often exercised, as there is a desire to eat. For exercise stirs up and revives the heat which lies buried and hidden in the body: For digestion cannot be well performed by a sluggish heat; neither have we any benefit by the meat we eat, unless we use exercise before.
The last part of exercise begun and performed according to reason, is named the ordering of the body, which is performed by an indifferent rubbing, and drying of the members; that so the sweat breaking forth, the filth of the body, and such excrements lying under the skin, may be allured and drawn out; and also that the members may be freed from stiffness and weariness. At this time it is commonly used by such as play at tennis.
But, as many and great commodities arise from exercise conveniently begun and performed, so great harm proceeds from idleness; for gross and vicious juices heaped up in the body commonly produce crudities, obstructions, stones both in the kidneys and bladder, the gout, apoplexy, and a thousand other diseases.
CHAP. XVI. Of Sleep and Watching.
That this our speech of Sleep and Watching, which we now intend to may be more plain, we will briefly declare, what commodity or discommodity they bring, what time and what hour is convenient for both, what the manner of lying must be, and the choice thereof; what the dreams in sleeping, and what pains or heaviness and cheerfulness after sleep may portend.
Sleep is nothing else than the rest of the whole body, and the cessation of the animal faculty from sense and motion. Sleep is caused, when the substance of the brain is possessed, and after some sort overcome and dulled by a certain vaporous, sweet and delightsome humidity; or when the spirits almost exhausted by performance of some labor, cannot any longer sustain the weight of the body, but cause rest by a necessary consequence, by which means nature may produce other from the meat by concoction turned into blood.
Sleep fitly taken much helps the digestion of the parts, because in the time of rest, the heat, being the worker of all concoction, is carried back to them, together with the spirits. Neither does sleep only give ease to the weary members, but also lessens our cares and makes us to forget our labors.
The night is a fit time to sleep and to take our rest in, as inviting sleep by its moisture, silence and darkness. For the heat and spirits in the thick obscurity of night, are driven in and retained in the center of the body; as on the contrary by the daily and as it were friendly and familiar light of the Sun, they are allured and drawn forth into the superficies, and outward part of the body; from whence they leave sleeping and begin to wake. Besides, which makes not a little, to that opportunity and benefit which we look for from sleep, the night season suffices for the work of just and perfect concoction. Which is one reason amongst many that sleep in the daytime may be harmful. For we are wakened from our sleep by the heat and spirits called forth to the skin either by the light, or noise during the daytime, before that the concoction which was begun is finished. But that sleep cannot but be light which comes without necessity of sleeping. Wherefore the concoction being attempted, but not perfected, the stomach is filled with crudities, distended with acid or sour belching, and the brain troubled with gross vapors and excrementitious humidities. From whence proceeds pain and heaviness of the head, and a store of cold diseases. But although sleep during the nighttime be wholesome, yet it is fit, that it be restrained within the limits of an indifferent time. For that which exceeds hinders the evacuation of excrements both upwards and downwards: but in the mean time the heat which is never idle, draws from them some portion or vapor into the veins, principal parts and habitat of the body, to become matter for some disease. We must measure this time, not by the space of hours, but by the finishing of the work of concoction, which is performed in some, sooner than in others. Yet that which is longest is perfected and done in seven, or eight hours. The ventricle subsiding and falling into its self and its proper coats, and the urine tinctured yellow, gives perfect judgment thereof. For on the contrary the extension of the stomach, acid belching, pain of the head, and heaviness of the whole body, show that the concoction is imperfect.
In sleeping we must have special care of our lying down, for first we must lie on our right side, that so the meat may fall into the bottom of our stomach, which being fleshy and less membranous, is the hotter, and more powerful to assimilate. Then a little after we must turn upon our left side, that so the liver with its lobes, as with hands, may on every side embrace the ventricle, and as fire put under a kettle, hasten the concoction. Lastly, towards morning it will not be unprofitable to turn again upon our right side, that by this situation the mouth of the stomach being opened, the vapors which arise from the elixation of the chylus may have freer passage. Lying upon the back is wholly to be avoided; for from hence the kidneys are inflamed, the stone is bred, palsy, convulsion, and all diseases which have their origins from the defluxion into the spinal marrow, and to the nerves taking beginning from thence. To lie upon the belly is not unprofitable for such as have used to lie so, if they be not troubled with defluxions into the eyes; for so the humor will more easily flow into the part affected. But thus the work of concoction is not a little furthered, because by that form of lying, not only the inward heat is contained and gathered together about the ventricle, but the encompassing warmth of the soft feathers of the bed, aids and assists it. Neither are the dreams which we have in our sleep to be neglected, for by the diligent consideration of these, the affections and superfluous humors which have chief power in the body are marvelously known. For those who have raging choler running up and down their bodies while they sleep, all things to them appear bright, shining, fiery, burning, full of noise and contention. Those who abound with phlegm dream of floods, snows, showers and inundations and falling from high places. Those who are melancholic dream of gaping and gulfs in the earth, thick and obscure darkness, smoke, caves, and all black and dismal things. But those whose bodies abound in blood dream of marriages, dances, embracings of women, feasts, jests, laughter, of orchards and gardens; and to conclude, of all things pleasant and splendid.
Also we must observe how the patient doth after sleep, whether more lively and cheerful, or more heavy, for by the opinion of Hippocrates,
Cum labor à somno est, laethalem collige morbum:
Sinprosit somnus, nihil hinc laethale timendum est.
Pained sleep ensuing, an ill disease doth show:
But if sleep profit bring, no harm from thence will flow.
And as sleep, so watching, if it exceed measure, is hurtful; for it hurts the temperature of the brain, weakens the senses, wastes the spirits, breeds crudities, heaviness of the head, falling away of the flesh, and leanness over all the body, and to conclude, it makes ulcers more dry, and so consequently rebellious, difficult to heal, and malignant. There are many other things that may be spoken of sleep and watching, but these may suffice a surgeon.
CHAP. XVII. Of Repletion and Inanition, or Emptiness.
There are, to be short, two sorts of Repletion, or of all excess; one is of a simple quality, without any defluxion or society of any humor, as appears in distempers without matter: the other is of quantity and mass, the body being distended with too much meat, or too great quantity of humors; from whence proceed an infinite number of diseases. They call the Repletion of meats, satiety or fullness, and it is of two kinds; the one which is called Repletion or Fullness to the vessels; the other Repletion to the strength.
We judge of satiety to the vessels, by the distention and swelling of the veins and entrails, as the stomach. We call satiety to the strength, when the body is loaded with more meats than it can well bear. 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 excess of all the humors. For if at any time he defines a Plethora to be an excess of blood only, then verily by the name of blood, he understands an equal comprehension of the four humors; as it is taught in physic schools.
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 proceeds of a Choleric, Melancholic, Phlegmatic, or serous humor.
Now Inanition, or evacuation is no other thing than the expulsion, or effusion of humors which are troublesome, either in quantity or quality. Of evacuations, some are universal, which expel superfluous humors from the whole body; such are purging, vomiting, transpiration, sweats, phlebotomy. Some particular which are performed only to evacuate some part, as the brain by the nose, palate, eyes, ears; the lungs by the wheeze; the stomach by vomit and stool, the guts by stool, the liver and the spleen by urine and excrement. These evacuations are sometimes performed by nature, freeing itself of that which is troublesome to it; other times by the art of the physician in imitation of nature.
And again, one of these is good and requisite, when only the humor which is hurtful, either in quantity or quality, 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 skin, as when a choleric, salt, or serous humor, or some windiness lying between the skin and the flesh, cause itching. For by scratching the skin, it gets passage out, which is manifest by the efflux of a serous matter burning, or causing scabs and ulcers, if the humor be somewhat gross, but insensible and not so manifest, if it be windiness, the skin by that rubbing being rarefied, and the gross flatulency attenuated. Wherefore they do ill who hinder their patients from scratching, unless they scratch so cruelly and hard, that there may be 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 sharp diseases, if they proceed from the whole body, and happen on the critical days. By vomit, which often violently draws these humors from the whole body, even from the utmost joints, which purging medicines could not evacuate, as we may see in the palsy, and sciatica, or hip gout. By spitting, as in all who are suppurated either in the sides or lungs. By salivation, or a phlegmatic flux by the mouth, as in those who are troubled with the French pox. By sneezing and blowing the nose; for by these the brain oppressed with moisture, disburdeneth itself, whether it be done without, or with the help of sternutatories and errhines; wherefore children, and such as have somewhat moist brains purge themselves often this way. By hiccup and belching; for by these the windiness contained in the stomach is often expelled. By urine, for by this not only fevers, but which is more to be admired, the French pox has often been terminated and cured.
For there have been some troubled with the pox, in whom a flux of the vicious and venomous humor could not by unctions of quicksilver be procured, either from the mouth or belly; yet have been wonderfully freed by abundance of urine, both from danger of death and their disease. By bleeding; for nature has often found a way for grievous diseases, especially in young bodies, by bleeding at the nose, and by their courses in women. By a flux, or laxative, purgation, sweats, insensible evacuation and transpiration; for so tumors, the matter being brought to suppuration, do sometimes vanish away and are dissolved, both of their own accord, as also by dissolving, or discussing medicines. We do the same by exercise, diet, hot-houses, long sleep, waking, and shedding of tears. By sucking, as with cupping glasses and horse leeches in wounds made by venomous bites.
In all such kinds of evacuations, we must consider three things: the quantity, quality, and manner of evacuation. As for an example, when an empyema is opened, the matter which runs out, ought to be answerable in proportion to the purulent matter, which was contained in the capacity of the breasts; otherwise, unless all the matter be emptied, there may happen a reflux; the matter should be white, soft, equal, and nothing stinking: Lastly, you must let it forth not altogether, and at one time, but by little and little, and at several times, otherwise not a little quantity of the spirits and heat does flow out together with the unprofitable matter, and so consequently a dissolution of all the powers.
CHAP. XVIII. Of the Perturbations, or Passions of the mind.
The perturbations are commonly called the accidents of the mind; because, as bodily accidents come from the body, so may these be present and absent from the mind, without the corruption of the subject. The knowledge of these must not be lightly passed over by the chirurgeon; for they stir up great troubles in the body, and yield occasion of many and great diseases; of which things, joy, hope, and love may give an apparent testimony. For by these motions the heat and spirits are sometimes gently, sometimes violently diffused over all the body, for the enjoying of the present, or hoped-for good. For then the heart is dilated, as to embrace the thing beloved, and the face is dyed with a rosy and lively colour. For it is likely that the faculty itself is stirred by the object, by whose power the heart itself is moved.
For it is first necessary, before we be moved by any passions, that the senses in their proper seats, in which they are seldom deceived, apprehend the objects, and straight as messengers carry them to the common sense, which sends their conceived forms to all the faculties. And then, that each faculty, as a judge, may afresh examine the whole matter, how it is, and conceive in the presented objects some show of good, or ill, to be desired, or shunned. For what man that was well in his wits did ever fall into laughter, unless he formerly knew, or saw somewhat said or done, which might yield occasion of laughter? Therefore joy proceeds from the heart, for the thing causing mirth or joy, being conceived, the faculty moves the heart, which, shaken and moved by the faculty which hath dominion over it, is dilated and opened, as ready to embrace the exhilarating object. But in the meantime, by the force of that dilatation, it sends forth much heat and spirits together with the blood into all the body. A great part of which coming to the face, dilates it; the forehead is smooth and plain, the eyes look bright, the cheeks become red, as dyed with vermilion, the lips and mouth are drawn together, and made plain and smooth; some have their cheeks dented with two little pits (which from the effects are called laughing cheeks) because of the contraction or curling, which the muscles suffer by reason of their fullness of blood and spirits, all which to be brief is nothing but to laugh.
Joy recreates and quickens all the faculties, stirs up the spirits, helps concoction, makes the body to be better looking, and fattens it, the heat, blood, and spirits flowing thither, and the nourishing dew or moisture, watering and refreshing all the members; from whence it is that of all the passions of the mind, this only is profitable, so that it exceed not measure; for immoderate and unaccustomed joy carries so violently the blood and spirits from the heart into the habit of the body, that sudden and unlooked-for death ensues, by a speedy decay of the strength, the lasting fountain of the vital humour being exhausted. Which thing principally happens to those who are less hearty, as women and old men.
Anger causes the same effusion of heat in us, but far speedier than joy; therefore the spirits and humors are so inflamed by it, that it often causes putrid fevers, especially if the body abounds with any ill humor.
Sorrow, or grief dries the body by a way quite contrary to that of anger, because by this the heart is so straitened, the heat being almost extinct, that the accustomed generation of spirits cannot be performed; and if any be generated, they cannot freely pass into the members with the blood; wherefore the vital faculty is weakened, the lively colour of the face withers and decays, and the body wastes away with a lingering consumption.
Fear in like sort draws in and calls back the spirits, and not by little and little as in sorrow, but suddenly and violently; hereupon the face grows suddenly pale, the extreme parts cold, all the body trembles or shakes, the belly in some is loosed, the voice as it were stays in the jaws, the heart beats with a violent pulsation, because it is almost oppressed by the heat, strangled by the plenty of blood, and spirits abundantly rushing thither; the hair also stands upright, because the heat and blood are retired to the inner parts, and the utmost parts are more cold and dry than stone; by reason whereof the utmost skin and the pores, in which the roots of the hair are fastened, are drawn together.
Shame is a certain affection mixed, as it were, of Anger and Fear; therefore if, in that conflict of, as it were, contending passions, Fear prevails over Anger, the face waxes pale, (the blood flying back to the heart;) and these or these symptoms rise, according to the vehemency of the contracted and abated heat. But if on the contrary, Anger gets the dominion over Fear, the blood runs violently to the face, the eyes look red, and sometimes they even foam at the mouth.
There is another kind of shame, which the Latins call Verecundia (we Shamefastness) in which there is a certain flux, and reflux of the heat, and blood first recoiling to the heart, then presently rebounding from thence again. But that motion is so gentle, that the heart thereby suffers no oppression, nor defect of spirits; wherefore no accidents worthy to be spoken of arise from hence: this affect is familiar to young maids and boys; who if they blush for a fault committed unawares, or through carelessness, it is thought an argument of a virtuous and good disposition.
But an agony, which is a mixed passion of a strong fear, and vehement anger, involves the heart in the danger of both motions; wherefore by this passion, the vital faculty is brought into very great danger. To these six Passions of the mind, all others may be revoked, as Hatred and Discord to Anger; Mirth and Boasting, to Joy; Terrors, Frights and Fainting, to Fear; Envy, Despair and Mourning, to Sorrow.
By these it is evident how much the passions of the mind can prevail to alter and overthrow the state of the body; and that by no other means, than that by the compression and dilatation of the heart, they diffuse and contract the spirits, blood, and heat; from whence happens the dissipation, or oppression of these spirits.
The signs of these symptoms quickly show themselves in the face; the heart, by reason of the thinness of the skin in that part, as it were painting forth the notes of its affections. And certainly the face is a part so fit to disclose all the affections of the inward parts, that by it you may manifestly know an old man from a young one, a woman from a man, a temperate person from an untemperate one, an Ethiopian from an Indian, a Frenchman from a Spaniard, a sad man from a merry one, a sound person from a sick one, a living person from a dead one. Wherefore many affirm that the manners, and those things which we keep secret and hidden in our hearts, may be understood by the face and countenance.
Now we have declared what commodity and discommodity may redound to man from these aforementioned passions, and have shown that anger is profitable to none, unless by chance to some dull person by reason of idleness, or oppressed with some cold, clammy, and phlegmatic humor; and fear convenient for none, unless peradventure for such as are brought into manifest and extreme danger of their life by some extraordinary sweat, immoderate bleeding, or the like unbridled evacuation. Wherefore it behoves a wise surgeon to have a care, lest he inconsiderately put any patient committed to his charge into any of these passions, unless there be some necessity thereof, by reason of any of the aforementioned occasions.
CHAP. XIX. Of things against Nature, and first of the Cause of a Disease.
Having intreated of things natural and not natural, now it remains we speak of things (which are called) against nature, because they are such as are apt to weaken and corrupt the state of our body. And they are three in number; The cause of a disease, a disease, and a symptom. The cause of a disease is an effect against nature, which causes the disease. Which is divided into internal and external. The external, original or primitive, comes from some other place, and outwardly enters the body; such are meats of ill nourishment, and such weapons that hostilely wound the body.
The internal have their essence and seat in the body, and are subdivided into antecedent and conjunct. That is called an antecedent cause, which as yet does not actually make a disease, but comes near to cause one; so humors copiously flowing, or ready to flow into any part, are the antecedent causes of diseases; The conjunct cause is that which actually causes the disease, and is so immediately joined in affinity to the disease, that the disease being present, it is present, and being absent, it is absent.
Again, of all such causes, some are born together with us, as the over-great quantity, and malignant quality of both the seeds, and the menstruous blood, from diseased parents are causes of many diseases, and especially of those which are called hereditary.
Others happen to us after we are born, by our diet and manner of life, a stroke, fall, or such other like. Those which are bred with us, cannot be wholly avoided or amended; but some of the other may be avoided, as a stroke and fall; some not, as those which necessarily enter into our body, as air, meat, drink, and the like.
But if any will reckon up amongst the internal, inherent, and inevitable causes, the daily, nay hourly dissipation of the radical moisture, which the natural heat continually preys upon; I do not gain say it, no more than that division of causes celebrated and received by philosophers, divided into material, formal, efficient, and final; for such a curious contemplation belongs not to a surgeon, whom I only intend plainly to instruct. Wherefore that we have written may suffice him.
CHAP. XX. Of a Disease.
A disease is an affect against nature, principally and by itself, hurting and depraving the action of the part in which it resides. The division of a disease is threefold; distemperature, ill conformation, and the solution of continuity.
Distemperature is a disease of the similar parts dissenting, and changed from their proper and native temper. That digression from the native temper happens two ways; either by a simple distemperature from the excess of one quality; and this is fourfold; hot, cold, moist, and dry; or by a compound distemperature, by the excess of two qualities, which also is fourfold, hot and moist; hot and dry, cold and moist; cold and dry. Again, every distemperature is the fault of one simple and single quality, as an inflammation; or has some vicious humors joined with it, as a phlegmon; again, a distemperature is either equal, as in a sphacele; or unequal, as in a phlegmon, beginning, or increasing.
Ill conformation is a fault of the organic parts, whose composure is thereby depraved. This has four kinds; the first is when the figure of the part is faulty, either by nature or accident, or some cavity abolished, as if a part, which nature would have hollow for some certain use, does grow or close up; or lastly, if they be rough, or smooth otherwise than they should be, as if that part which should be rough, is smooth, or the contrary. Another is in the magnitude of the part increased, or diminished contrary to nature. The third is in the number of the parts, increased, or diminished; as if a hand has but four or else six fingers. The fourth is in the site and mutual connection of the parts, as if the parts which should be naturally united and continued be pulled asunder, as happens in luxations; or the contrary. The third general kind of disease, is the solution of continuity, a disease common, both to the similar and organic parts, acquiring diversity of names, according to the variety of the parts in which it resides.
CHAP. XXI. Of a Symptom.
WE do not in this place take the word Symptom in the most general acceptation, for every change or accident which happens to man besides his own nature; but more reservedly and specifically, only for that change which the disease brings, and which follows the disease, as a shadow does the body.
There are three kinds of a Symptom properly taken. The first is when the action is hurt; I say hurt because it is either abolished, weakened, or depraved; so blindness is a deprivation, or abolishing of the action of seeing; dulness of sight is a diminution, or weakening thereof; and a suffusion, such as happens at the beginning of a cataract, when they think flies, hairs, and such like bodies fly to and fro before their eyes, is a depravation of the sight.
The second is a simple affect of the body, and a full fault of the habits thereof being changed, happening by the mutation of some qualities; such is the changing of the native colour into a red by a phlegmon, and into a livid and black by a gangrene; such is the filthy stench the nose affected with a polypus sends forth; the bitter taste, in such as have the jaundice; and the rough and rugged skin in them who are leprous.
The third is the fault of the excessive retention of excrements which should be expelled, and expulsion of such as should be retained; for the evacuation of a humor profitable both in quantity and quality is against nature, as bleeding in a body not full of ill humors, nor plethoric; and also the retention of things harmful in substance, quantity, and quality, as the courses in women, the urine, and the stone in the bladder.
CHAP. XXII. Of Indications.
The knowledge and exercise of Indications befit that surgeon, whom no blind rashness of fortune, but reason; no chance, but counsel directs in the undertaking and performing the works of his art. For an Indication is a certain safe and short way, which leads the physician, as by the hand, to the attainment of his purposed end, of preserving the sound, or curing the sick.
For Galen defines an Indication to be a certain insinuation of what is to be done, or a quick and judicious apprehension of that which may profit or hurt. And as falconers, mariners, plowmen, soldiers, and all manner of artisans, have their peculiar terms and words, which are neither known, nor used by the vulgar; so this word Indication is proper and peculiar to physicians and surgeons, as a term of art not vulgar; by consideration of which, as by some sign, or secret token, they are admonished what is to be done to restore health, or repel an imminent danger.
There are three prime and principal kinds of Indications, each of which is subdivided into many others. The first is from things natural. The second from these things which are termed not natural. The third from those things which are contrary to nature. Things natural show they must be preserved by their like, and in the compass of these are contained all the Indications which are drawn from the nature of the patient, that is, from his strength, temper, age, sex, habit, custom, diet.
Things not natural may be doubted as uncertain, for one while they indicate the same things with things natural, that is, they coindicate with the strength, temper, and the rest; other times they consent with things against nature, that is, they coindicate with the disease. Wherefore Galen when he says that Indications are drawn from three things; The disease; The nature of the Patient, and the encompassing air, by proposing the familiar example of the air, he would have us to understand the other things not natural; because we may shun, or embrace them more or less as we will ourselves, but we must, whether we will or no, endure the present state of the air. Therefore the air indicates something to us, or rather coindicates; for if it nourishes the disease, as conspiring with it, it will indicate the same that the disease, that is, that it must be preserved in the same state.
Things contrary to nature indicate they must be taken away by their contraries; Therefore that we may more accurately and fully handle all the Indications drawn from things natural, we must note, that some of these are concerning the strength of the Patient, by care to preserve which, we are often compelled for a time to forsake the cure of the proper disease: for so a great shaking happening at the beginning of an ague or fever, we are often forced to give sustenance to the Patient, to strengthen the powers shaken by the vehemence of the shaking, which thing, notwithstanding, lengthens both the general and particular fits of the ague. Other pertain to the temper, other respect the habit, if the Patient be slender, if fat, if well fleshed, if of a rare, or dense constitution of body. Other respect the condition of the part affected in substance, consistency, softness, hardness, quick or dull sense, form, figure, magnitude, site, connection, principality, service, function, and use. From all these, as from notes, the skillful surgeon will draw Indications according to the time and part affected: for the same things are not fit for sore eyes, which were convenient for the ears, neither does a phlegmon in the jaws and throat admit the same form of cure, as it does in other parts of the body. For none can there outwardly apply repercusives, without present danger of suffocation. So there is no use of repercussives in defluxions of those parts which in site are near the principal. Neither must thou cure a wounded nerve and muscle, after one manner. The temperature of a part, as moisture, always indicates its preservation, although the disease be moist and give Indication of drying, as an ulcer. The principality of a part always insinuates an Indication of astringent things, although the disease require dissolving, as an obstruction of the Liver; for otherwise unless you mix astringent things with dissolving, you will so dissolve the strength of the part, that hereafter it cannot suffice for sanguification. If the texture of a part be rare, it shows it is less apt, or prone to obstruction; if dense, it is more anxious to that disease; hence it is that the Liver is more obstructed than the spleen. If the part be situated more deeply, or remote, it indicates the medicines must be more vigorous and liquid, that they may send their force so far. The sensibility, or quick-sense of the part, gives indication of milder medicines, than perhaps the signs, or notes of a great disease require. For the physician which applies things equally sharp to the horny tunic of the eye being ulcerated, and to the leg, must needs be accounted either cruel, or ignorant. Each sex and age has its Indications, for some diseases are curable in youth, which we must not hope to cure in old age; for hoarseness and great distillations in very old men, admit no digestion, as Hippocrates says;
Nunquam decrepitus Branchum coquit, atque Coryzam.
The feeble sire, for age that hardly goes,
Ne’er well digests, the hurtful rheum or pose.
Moreover, according to his decree, the diseases of the Renes, and whatsoever pains molest the bladder, are difficult to heal in old men; and also reason persuades that a Quartan admits no cure in Winter, and scarcely a Quotidian, and ulcers in like manner are more hard to heal in Winter; that hence we may understand certain Indications to be drawn from time; and to increase the credit of the variety and certainty of Indications, some certain time and seasons in those times command us to make choice of Medicines; for as Hippocrates testifies;
Ad Canis ardorem facilis purgatio non est.
In Dogdays heat it is not good,
By purging to cleanse the blood.
Neither shalt thou so well prescribe a slender diet in Winter as in the Spring, for the air hath its Indications. For experience teaches us that wounds of the head are far more difficulty and hardly cured at Rome, Naples, and Rochelle in Xantoigne. But the times of diseases yield the principal Indications, for some Medicines are only to be used at the beginning and end of diseases, others at the increase and vigor of the disease. We must not contemn those Indications which are drawn from the vocation of life and manner of Diet; for you must otherwise deal with the painful Husbandman (when he is your Patient), who leads his life sparingly and hardly, than with the Citizen who lives daintily and idly. To this manner of life and Diet may be referred a certain secret and occult property, by which many are not only ready to vomit at eating some meats, but tremble over all their bodies when they hear them but spoken of. I knew a prime Nobleman of the French Nobility, who was so perplexed at the serving in of an Eel to the Table, at the midst of dinner and amongst his friends, that he fell into a swoon, all his powers failing him. Galen in his book De Consuetudine tells that Arius the Peripatetic died suddenly, because compelled by the advice of those physicians he used, he drank a great draught of cold water in the intolerable heat of a fever. For no other reason, says Galen, than that, because he, knowing he had naturally a cold stomach from his childhood, perpetually abstained from cold water.
For as much as belongs to Indications taken from things against nature; the length and depth of a wound or ulcer indicates one way; the figure cornered, round, equal, and smooth, unequal and rough, with a hollowness straight or winding, indicate otherwise; the site right, left, upper, lower in another manner, and otherwise the force and violence of antecedent and conjunct causes. For oftentimes the condition of the cause indicates contrary to the disease, as when abundance of cold and gross humors cause and nourish a fever. So also a symptom often indicates contrary to the disease, in which contradiction, that Indication must be most esteemed, which does most urge; as for example’s sake, if swooning happen in a fever, the feaverish burning shall not hinder us from giving wine to the Patient.
Wherefore these Indications are the principal and most noble which lead us, as by the hand, to do these things which pertain to the cure, prevention, and mitigation of diseases. But if any object that so curious a search of so many Indications is to no purpose, because there are many surgeons which setting only one before their eyes, which is drawn from the Essence of the disease, have the report and fame of skillful surgeons in the opinion of the vulgar; but let him know that it does not therefore follow that this indication is sufficient for the cure of all diseases; for we do not always follow that which the Essence of the disease does indicate to be done. But chiefly then, where none of the fore-recited Indications do resist or gainsay; you may understand this by the example of a Plethora, which by the Indication drawn from the Essence of the thing requires Phlebotomy; yet who is it that will draw blood from a child of three months old? Besides, such an Indication is not artificial but common to the surgeon with the common people. For who is it that is ignorant that contraries are the remedies of contraries? and that broken bones must be united by joining them together? but how it must be performed and done, this is of Art and peculiar to a surgeon, and not known to the vulgar. Which the Indications drawn from those fountains we pointed at before, abundantly teach, which, as by certain limits of circumstances, encompass the Indication which is taken from the Essence of the disease, lest any should think, we must trust to that only. For there is some great and principal matter in it, but not all. For so the meanest of the common people is not ignorant that the solution of continuity is to be cured by repairing that which is lost. But in what parts we may hope for restitution of the lost substance, and in which not, is the part of a skillful surgeon to know and pronounce. Wherefore he will not vainly bestow his labor to cure the Nervous part of the Diaphragm, or Midriff being wounded, or the Heart, small Guts, Lungs, Liver, Stomach, brain, or bladder; and that, I may speak in a word, Empirics are not much more skillful than the common people, although they do so much extol themselves above others by the name of experience. For although experience be another instrument to find out things with reason, yet without reason, it will never teach what the substance of the part in which the disease lies may be; or what the action, use, site, connection, from whence special and proper Indications are drawn; With which the surgeon being provided and instructed shall not only know by what means to find out a remedy, but also, lest he may seem to mock any with vain promises, he shall discern what diseases are incurable, and therefore not to be meddled with.
But implicit, or intricate diseases require each to be cured in their several order, except some one of them be desperate, or so urge and press that the physician think it necessary after a preposterous order, to begin with it, although often he be forced to make some one of these diseases incurable, or give occasion of causing some new one, into which straits we are necessarily compelled to fall, when, (for example) we determine to pull, or take away some extraneous body; for the performance whereof we are compelled to enlarge the wound. So we are forced by necessity to open the neck of the bladder, (that so we may draw forth the stone therein contained) with a wound which often degenerates into an incurable fistula. For that disease which threatens danger of present death is of such moment that to shun that, it may be counted a small matter and commodious for the sick to bring in other diseases, though incurable. For if a convulsion happen by pricking a nerve which we cannot heal by any remedies, then by cutting the nerve asunder we end the convulsion, but deprive the part into which that nerve did go of the use of some voluntary motion. So if in any great joint there happen a luxation with a wound, because there is danger of convulsion by trying to restore and set right the luxated part, we are forced for shunning thereof, to attend the wound only, and in the meantime to let alone the luxation. Otherwise in implicit diseases if there be nothing which may urge, or call us from the ordinary cure, we must observe this order, that beginning with that affect which hinders the cure of the principal disease, we prosecute the rest in the same and their proper order, until all the diseases being overcome we shall restore the part affected to its integrity. Therefore let us take for an example, an ulcer in the leg, a varix (or big swollen vein) and a phlegmonous tumor round about it; and lastly, a body wholly plethoric and filled with ill humors; order and reason require this, that using the advice of some learned physician we prescribe a convenient diet, and by what means we may, bring him to an equilibrium by purging and blood-letting, and then we will scarify in diverse places the part where it is most swollen, then presently apply leeches that so we may free it from the burden of the conjunct matter; then use cauteries to help the corruption of the bone, and in the meantime change the circular figure of the ulcer into an oval, or triangular; then at length we will undertake the cutting of the varix, and cure the ulcer which remains according to art, and so at length cicatrize it. In all this whole time the patient shall neither walk, nor stand, nor sit, but lie quietly, having his leg orderly and decently rolled up. But if (as it often happens) the temper of the hurt part be different from the temper of the whole body, the manner of curing must be so tempered, that we increase the dose of hot or cold medicines, according to the ratable proportion of the indications requiring this, or that. Therefore imagine the part ulcerated to be such, as that it is two degrees drier than the just temper; but the whole body to exceed the same temper in one degree of humidity: reason and art will require that the medicine applied to the ulcer be dryer by one degree than that which the part would otherwise require if it were temperate; but on the contrary let us suppose thus. The whole body to be one degree more moist than the temper requires, and the ulcerated part to be one degree drier; truly in this case the medicine that is applied to the ulcer by reason of the part itself, shall not be increased in dryness, but wholly composed and tempered to the indication of the ulcer, because the force of the moisture exceeding in the like degree does counterpoise the superfluous degree of dryness. But it is easier by an artificial conjecture to determine of all such things than by any rules or precepts.
To these so many and various indications, I think it good to add two other; the one from similitude; the other of a certain crafty device, and as the latter physicians term it, of a certain subtle stratagem. We draw indication from similitude, in diseases which newly spring up and arise, as which cannot be cured by indications drawn from their contraries, as long as their essence is unknown and hidden; wherefore they think it necessary to cure them by a way and art like those diseases, with which they seem to have an agreeing similitude of symptoms and accidents; Our ancestors did the same in curing the French pox, at the first beginning thereof, as long as they assimilated the cure to that of the leprosy, by reason of that affinity, which both the diseases seem to have. But we follow crafty devices and subtle counsels, when the essence of the disease we meet with is wholly secret and hidden, either because it is altogether of a hidden and secret nature, and which cannot be unfolded by manifest qualities, or else resides in a subject which is not sufficiently known to us, nor of a physical contemplation, as the mind. For then we being destitute of indications taken from the nature of the thing, are compelled to turn our cogitations to impostures and crafty counsels; and they say this art and craft is of chief use in melancholy affects and fictions, which are often more monstrous and deformed than the Chimera so much mentioned in the fables of the ancients; to which purpose, I will not think much to recite two examples. A certain man troubled with a melancholic disease, I know not by what error of opinion, had strongly persuaded himself that he was without a head; the physicians omitted nothing, by which they might hope to take this mad opinion out of his mind. But when they had in vain tried all medicines, at length they devised this crafty, but profitable device, they fastened and put upon his head a most heavy helmet, that so by the pain and trouble of his head nodding and drawn down by that weight, he might be admonished of his error. It is reported, another molested by the obscurity and darkness of the same disease, did verily believe that he had horns upon his head; neither could he be drawn or diverted from that absurd and monstrous opinion, until that binding up his eyes, they miserable bruised and scratched his forehead with the bony roughness of the lower parts of an ox’s horns, that so he began to believe by the painful drawing of the blood that ran down his face, that those bloody horns were forcibly plucked from him. Ingenious surgeons in imitation of these examples may in like cases do the same. For that case requires a man of a quick apprehension and advice, who may give manifest proof of his diligence and skill by medicinal stratagems, as one who forthwith can politically devise stratagems of diverse sorts. But, now coming to the end of this our tract of indications, we must chiefly and principally observe; that of indications some are indicative; which absolutely and of themselves command this to be done; other coindicative, which indicate the same with the indicative, and jointly show it to be done, but in some sort secondarily and not primitively; some are repugnant, which of themselves and their own nature persuade quite contrary to that the indicative primitively did; or which dissuade us from doing that, to perform which the indicative did persuade us; other descriptionPage 47 correpugnant, which give their voice after the same form and manner with the repugnant against the indicative, as the coindicative consent to and maintain them. Let this serve for an example of them all. A plethora, or plenitude of humors of its own nature, requires and indicates blood-letting, the springtime persuades and coindicates the same, but to this counsel is quite opposite and repugnant, a weak faculty, and childhood is correpugnant. Wherefore these four must be diligently weighed and considered when we deliberate what is to be done, and we must rather follow that which the indicative, or repugnant show and declare, as what the disease and strength of the patient require, than that which the coindicative, or correpugnant shall persuade, because they have a weaker and but secondary power of indicating, and not essentially and primitive. But because the kinds of indications are so many and diverse, therefore that the knowledge of them may be more perspicuous and less confused, I have thought good to describe and distinguish them by this following scheme.
An indication is a certain plain and compendious way which leads the surgeon to a certain, determinate and proposed end for the cure of the present disease; of which there are 3 kinds:
The first is drawn from things natural which indicate their preservation by their like; of this kind are many other which are drawn, either:
The second is drawne from things not naturall, which one while indicate their preservation by their like, another while their change by their contraries; for so
The third from things contrary to nature which show they must be taken away by the use of their contraries, as
CHAP. XXIII. Of certain wonderful and extravagant ways of curing diseases.
AS Monsters sometimes happen in nature, so also in diseases, and in the events and cures of diseases. I understand by monsters certain marvelous successes in diseases, or certain ways of curing them, which swerve from art, and happen besides reason, nature, and common use.
Alexander ab Alexandro, and Peter Gilius tell that in Apulia, a part of Italy, they have a certain kind of spider very frequent; the natives call it Tarentula, Petrus Rhodius calls it Phalangium. The inhabitants find these spiders in the first heat of summer so venomous and deadly that whosoever they touch with their virulent bite falls down presently, without he has speedy remedy, deprived of all sense and motion, or certainly if he escapes the danger of death, he leads the remnant of his life in madness. Experience hath found a remedy by music for this so speedy and deadly a disease; wherefore, as soon as they can, they fetch fiddlers and pipers of divers kinds, who by playing and piping may make music, at the hearing of which, he who was fallen down by reason of the venomous bite rises cheerfully and dances so long to their measures and tunes until by the painful and continued shaking and agitation of the whole body, all the malignity is dissipated by transpiration and sweat.
Alexander adds that it happened once in his sight that the musicians’ wind and hands failing them ceased playing, and then the dancer presently fell down as if he had been dead; but by and by, the music beginning anew, he rises up again and continued his dancing till the perfect dissipation of the venom. And that it hath happened besides that one not so perfectly healed, certain relics of the disease yet remaining, when a long time after he heard by chance a noise of musicians, he presently fell to leaping and dancing, neither could he be made to leave before he was perfectly cured.
Some affirm according to the opinion of Asclepiades that such as are frantic are much helped with a sweet and musical harmony. Theophrastus and Aulus Gellius say that the pain of the gout and sciatica are taken away by music. And the Sacred Scripture testifies that David was wont by the sweet sound of the harp to refresh and ease King Saul when he was miserably tormented by his evil spirit. Herodotus in Clio tells that Croesus, the King of Lydia, had a son who for a long time could not speak, and when he came to man’s estate was accounted dumb: but when an enemy with his drawn sword invaded his father (overcome in a great fight, and the city being taken in which he was), not knowing that he was the King, the young man opened his mouth, endeavoring to cry out, and with that striving and forcing of the spirit, he broke the bonds and hindrances of his tongue and spoke plainly and articulately, crying out to the enemy that he should not kill King Croesus. So both the enemy withheld his sword, and the King had his life, and his son had his speech always after. Plutarch in his book, Of the Benefit to be Received from Our Enemies, tells that a Thessalian called Proteus had a certain inveterate and incurable ulcer in a certain part of his body, which could not be healed before he received a wound in a conflict in the same place, and by that means the cure being begun afresh, the wound and ulcer were both healed.
Quintus Fabius Maximus, as Livy writes, was long and very sick of a quartan ague, neither could he have wished success from medicines administered according to art, until skirmishing with the Allobroges he shook off his old feverish heat, by a new heat and ardent desire of fighting. It was credibly reported to me of late by a gentleman of the Lord of Lansack’s Chamber that there was a French gentleman in Poland who was grievously tormented with a quartan fever, who one time walking upon the bank of the River Wixell to take away the irksomeness of his fit, was thrust in jest into the River by a friend of his that met him by chance, by which (although he could swim, as he also knew who thrust him in) he conceived so great fear that the quartan never troubled him after. King Henry the Second commanded me to go from the camp at Amiens to the City Dorlens, that I might cure those that were hurt in the conflict with the Spaniards. The Captain S. Arbin, although at that time he had a fit of a quartan ague, yet would he be present at the fight, in which being shot through the side of his neck with a bullet, he was struck with such a terror of death that the heat of the fever was assuaged by the cold fear, and he afterwards lived freed from his ague.
Franciscus Valleriola, the famous physician of Arles, tells that John Berlam, his fellow citizen, troubled with a palsy of one side of his body for many years, his house taking fire, and the flame coming near the bed in which he lay, he struck with a great fear, suddenly raised himself with all the force he had, and presently recovering the strength of his body, leaped out at the window from the top of the house, and was presently cured of his disease, sense and motion being restored to the part, so that afterward he went upright without any sense of pain, who lay immovable for many years before. He tells the like in the same place of his cousin John Sobiratius; he was a long time lame at Avignon, by reason that the nerves of his hams were shrunken and drawn up so that he could not go; being moved with a vehement and sudden passion of anger against one of his servants whom he endeavored to beat, he stirred his body so that forthwith the nerves of his hams being distended, and his knees made pliant, he began to go and stand upright without any sense of pain, when he had been crooked for the space of six years before, and all his life after he remained sound.
Galen tells he was once fetched to stanch the bleeding for one who had an artery cut near his ankle, and that by his means he was cured without any danger of an aneurysm (i) a relaxation of a venous vessel; and besides, by that accidental wound he was freed from the most grievous pain of his hip, with which he was tormented for four years before: but although this easing of the pain of the sciatica happened according to reason by the evacuation of the conjunct matter, by the artery of the ankle of the same side being opened; yet because it was not cut for this purpose, but happened only by chance, I judged it was not much dissenting from this argument.
Pliny writes that there was one named Phalereus, who, casting up blood at his mouth, and at length, medicines being nothing avail, being weary of his life, went unarmed in the front of the battle against the enemy, and there receiving a wound in his breast, shed a great quantity of blood, which gave an end to his spitting of blood, the wound being healed, and the vein which could not contain the blood being condensed.
At Paris in Anno 1572, in July, a certain gentleman, being of a modest and courteous carriage, fell into a continual fever, and by that means became frantic, moved with the violence of which he cast himself headlong out of a window two stories high, and fell first upon the shoulder of Valterra, the Duke of Alençon’s physician, and then upon the pavement; with which fall he cruelly bruised his ribs and hip, but was restored to his former judgment and reason. There were present with the patient besides Valterra, witnesses of this accident: these physicians, Alexis, Magnus, Duretus, and Martinus. The same happened in the same disease, and by the same chance to a certain Gascoyne lying at the house of Agrippa in the Pavedostreet.
Othomannus, Doctor of Physic of Mompelier and the King’s professor, told me that a certain carpenter at Broquer, a village in Switzerland, being frantic, cast himself headlong out of a high window into a river, and being taken out of the water was presently restored to his understanding.
But if we may convert casualties into counsel and art, I would not cast the patient headlong out of a window. But would rather cast them suddenly and thinking of no such thing into a great cistern filled with cold water, with their heads foremost, neither would I take them out until they had drunk a good quantity of water, that by that sudden fall and strong fear, the matter causing the frenzy might be carried from above downwards, from the noble parts to the ignoble; the possibility of which is manifest by the aforesaid examples, as also by the example of such as bitten by a mad dog, fearing the water are often ducked into it to cure them.