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1

OF PHLEBOTOMIE

2
3    The purpos forsoth of þis present besynes yt ys forto tret
4shortly in which maner sekenes flebotomie ys competent and of which
5veynis. Þerfor it is to wyt that some minision is made or done by
6metacentesyn, i.e. , evyn drawyng, some by antepasyn. By metacentesyn
7it ys sayd to be done when þe blode ys drawyn on the same partie in
8which ys the sekenes, Verbi gratia , if pleuresis be in the left
9syde, be the minicion made in the left arme. Methasentesen sowneþ
10as mech as lenial detraccion, drawyng be lyne. It ys made by
11antepasyn when minucion is made, and anthepasyn ys sayd as wer contrare
12pascions. It ys to wyt forsoþ yf the body be plectoryk or replete,
13minucion owth to be done by antepasyn, elles forsoþe by methasentasyn.
14Also yf the sekenes be inveterat, i.e. , old, be metasentesyn. If it is
15to be resent or newe, by anthepasyn. But here resith a dut, if þe
16body be plectoric and the passion old, minucion owth to be by the
17fyrst comandment done by antepasyn, by the last comandment by
18methasentesyn. To þis we say þat plectoric preiudiȝþ, i.e. , demyþ
19afore, wheþir forsoth the passion be newe or old, whilis forsoth the
20body plectoric be minysched be antepasyn. To þe forseyd consederacioun
21ys addyd to that yf the mater furios, i.e. , wode, as in antrace,
22þofe þe bodi be plectoric, it owþ to be done by methisentesyn þat
23the furri ... mater be not drawyn to nobylle membris. Also yf any
24man be prickyd of venemus best as of serpent or of scorpion,
25be hit done by methasentisyn yf hym nedys fleobotomie.
26    Also hit ys to wyt that minucion ys done sumtyme by apofresim,
27i.e. , wiþdrawyng ovþir for multitude of humors or for debylete
28of the pacient. Where forsoþ of autorus þat in sinocha inflative
29& in asmite of sanguyne minucion owth to be done unto sincope,
30i.e. , swonyng, defaylyng of hert. Which forsoþ exschuyng the
31oppenion of þe comun peple doþ þat ys equifolent, or euyn þerto,
32in minushynge by apoferesim as mech as owth to be withdrawn after
33þe consederacion of hem. Ouer þat, yf þe pacient be feble, be

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34þer made minucion by apoferesim in mech quanlite & atwix þe
35withdrawyng be he refreshyd. Yt is to wyt as seyþ Galien in
36Metategni þat if it owth to be done by apoferisim, be þe flebotom
37dippyd in oyle þat the wond of þe flebotomie be leng holdyn oppyn.
38Also sum men of custum when þey are flebotomyd swoneþ; sech, as
39seþ Constantyne, be þey refreshyd with ellectuary comfortatyve
40er þey fleobotomie. If þis ys hit that old men owth to be
41fleobotomyd after mete when they have aboue slepp, yong men
42forsoþ affore mete, for old men are more feble, yong men more
43strong. Also þer is anothyre resone: for yong men sith þey
44abovnd with hote humoris owth to be flubotomid in þe ouyr of
45hote humors - if blode abovnd, afore terce, if colere, atwix terce
46and none. Old men forsoþ sith they abovnd with cold humors and
47melancolie owth to be flubotomid in the ouyr of malencolie, that
48ys after none. Also sum have so thyk blode that the veyne yponyd
49ys vneth yput owte; sech afore fleubotomie are to be bathyd
50and exercisid. Ouer þat, as it is had in Megategni, if any man
51have a stomac defective & owiþ & febele, he owt to eschewe flebotomie,
52& moste (þo) þat are made of veynes þat are in þe plicature or bowynge
53of þe arme wheche are .v. veynes: Fyrst is cephalica, i.e. ,
54capitalis or hedd veyne; 2, mediana or cardiaca, i.e. , veyne of þe
55herte; 3, epatica or bacilica, lyuer veyne; 4 is vena purpurea ,
56purpur veyne or corde of þe arme; 5, titilica or titillaris, þer
57is a veyne aboue þe cubite or elbow whech is seid vena pulmonia ,
58i.e. , veyne of þe lunges. Flebotomie made of þis helpiþ moche in
59cardiaca & asmate, but þis veyne when it is kitte is wont to be
60inflat or bolned.
61    It is to wete þat in flebotomie 4 þyngis are principalli
62attendid: sc. , custome, tyme, age, & vertue. In moste hoote tyme
63forsoþ it owiþ not to be donne ne ful cold tyme ne in recent or newe
64mone. Þe reson or skelis is redi spede: in somere & moste aboute
65þe caniculere dayes mannys bodi ouer mersure is disoluyd; by
66dissoluyng it is moche inaynyte or anentisiþ. Þerfor if by
67flebotomie it be more inanyssched it is to eschewe or bewaer þat

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68þe pacient falle not into sum sekenesse of inanicioun. Anoþer
69reson þer is for in so hoot tyme þer is more trubblynge of humorys
70& by flebotomie it scholde be made more, þat perauenture þer
71schold folowe som oþer noynge. In ful colde tyme not to be donne,
72for þe humours are compatte & vnable to be brouȝte ouȝte, & þanne
73good are raþer browȝte þanne euel. Also in newe mone it owyþ not to
74be don, for þann bodiis are inanisched or voide of humours & be
75flebotomie þer schold be more inanisched. Also coustome is to be
76attendid. If an holde man forsoþe þat is not wont to be flebotomied,
77fale or renne in ony sekenesse askynge flebotomie whe drede for
78to flebotomie hym for vncustome & debilite or febilnesse. Also age
79is to be atendid, for wiþinne þe 12 ȝere owiþ non to be flebotomyed,
80ne holde men sett in holde age, for þanne þei abunde wiþ colde humours.
81Nerþeles þis is not generale. Þere are forsoþe sum olde men þat
82hare carnose & of sanguyne complexioun, haboundynge wiþ hoote humurus
83& are moche vigrose or strong, & siche are flebotomyed. Vertu is
84moste to be attendid; strong men forsoþe owt to be minuschid, not
85feble forsoþe. Wite þu þat vertu & age are more to be attendid in
86flebotomie þanne tyme & custome boþe.
87    Tho seie in wiche sekenesse flebotomie helpid; begynne at
88febres & first at efimera. Laborande in a febre efimera, sc. , of
89hotnesse, if vertu and age suffre, mynusche he of cephalica of
90þe riȝt arme in somere, in wynter of þe lifte. After þe mynuschyng
91take he zuccar ros. wiþ water colde, or wiþ water of ros. if he be
92ricche, & he shal be þe bettere. Laboryng wiþ effimera of etynge
93of hoot þynge þe stomac inanissched, minusche he hym of cephalica
94of þe ryȝt arme in somer, of þe lift in wyntir. Aftir take electuary
95frigidam & confortatyue of þe lyuere as zuccar ros., triasandalis,
96diarodoun abbatis sine musco. Laborynge wiþ efimera of fastynge
97or excerie or of coldenes of þe aire, eschewyng or war hym of
98mynuschynge. Laborynge of efimera weche we sei synocham inflativam,
99mynusche hem of mediana of þe ryȝte arm in somer, in wyntir of þe
100lifte; & þat be apoforesyn. Olde men minusched þe pacient be
101sinocham (vnto) sincope, for double cause: for þe multidude of
102matere or þerfore þat in syncope is defaute; of mowyng of þe hert
103or defaylyng scuwiþ in frigidacat or coldyng of al þe bodi.

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104Þerfor, for in sinocha was moste distemperanse of heete, it owiþ
105to be minisched to sincop, þat be þe coldenesse ybred
106in of þe sincop so mych feruour brennyng or heete go away or at
107þe laste be mynusched or lesned. We forsoþe dredynge þe
108opynyoun of þe leude comoun peple, wiþdrawiþ as myche tymes as
109þei dide at ones, and of þe veyne mediana, for þis skel: it
110draweþ or avoydeþ (as wel) as doþ þe lauere parties as þe
111hupermore parties - it is made forsoþe of þe branche of basilica
112& of þe branche of sephalica. Laboryng of efimera folwynde
113apostum of þe brayne, as frenesi, if vertu & age sufre, mynusche
114of cephalice on þe riȝt arme in somer, on þe lefte in wynter
115& þat to þe 4 day. But it is to wete þat somme laboryng of acut,
116i.e. , agew, þe frensi comyþ aboue aftir þe 4 day. Neþereles we
117mynusche not þise of ony of þe arme veynes; neþerles we do þat is
118equifolent or euen to. We opene þe hededes of þe veynes beynge
119in þe nostrillis wiþ bristlis of a sweyn or wiþ a stikke, þat þe
120blod renne out a gret quantite. Laboryng wiþ sinocha or efimera
121folwyng apostum of þe heed, ater þe mynuschynge, take he electuary
122frigidaurum & confortative as zuccar ros. wiþ siripum ros. or of
123violette. Laborynge wit efimera folwynge litargie, if vertu & age
124sufre, mynusche hym of þe veyne beynge atuix þe þombe & þe schewyng
125of þe lifte arme; aftir take þe zuccar ros. Laboryng efimera
126folwyng apostum of þe splen, if vertu & age sufre, mynusche of þe
127veyne salvatilla weche is atwene þe leche fyngre & þe litil fyngre
128of þe lifte hande & take electuary. Laborynge efimera folwyng
129squinancie, mynusche of cephalica of boþe armes; aftir take diamoron,
130which if it be not hadde, gargarise he mel ros. wiþ (decoccioun)
131stiptik þynge, as beþ ros., balistic, & c. Laboryng of efimera
132folwynge apostum of þe liuere, mynusche he hym of basilica of þe riȝte
133arme; aftir he take electuary frigidum & confortative as triasandle wiþ
134som siryp of ros, or of violet. Labrynge of efimera folwynge of
135aposteme of þe stomac, mynusche hym of þe veyne comynge to þe litil
136fyngere on þe riȝt hannd; aftir, take electuary confortative of þe
137stomac as succar ros. or sirypus ros. or violet. Laboryng of efimera

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138folowyng aposteme of þe bleddre or of þe reynes, mynusche he hym of
139sophena, weche strechid to þe ancle of þe foot or ellis þat þat
140strecchiþ to þe þomble too of þe fotte: after do he as we seide.
141Laborynge of efimera folowyng of sidis of þe ribbis, mynusche hym
142of cardiaca, i.e. , mediana of þe riȝte arme. Forsoþe þat is
143funden in Viatico , þat þe labryng of pluresis owe to be don of
144basilica; þis is þe skal & reson: þe autur considerid þe spiritual
145to be febled in þe pluresis; & if þer schold be don mynyscoun of
146þe cardiaca, þere scholde be mad mor febelynge. Laborynge of
147efimera folwyng peripulmonie, mynusche he hym of þe veyne beyinge
148aboute þe cubit in þe neþirmore partie. Laborynge of pluresie or of
149peripulmonie, take after mynusch electuary frigidum & moistynge of
150þe wombe as diadragagantun, svme wiþ deccocioun of þe colde
151sedis & citrulle, melonis, cucurbites, & cucumeres wiþ sum anulo
152lenetive or softyng as dragagant.
153    It is left behynde to sei of febris putrid, and fyrste of
154interpolates. Þerfore it is to wete þat it semyþ ageynyst resoun
155to be flebothomyed in interpolates; flebotomye forsoþe al only
156bryngiþ out humeros wiþin þe vestelis; febris forsoþe interpolates
157al only ben made of humerous putrefacte wiþoute forþe, to brynge
158out of wech flebotomye semyþ not compotent or acordynge. To weche
159we sei it is compotent for 2 causes: for or humours contenyd in þe
160vessel, i.e. , veynes & brouȝt out be flebotomye is not mynystrid
161materie to þe place putride, or for þat be flebotomye þe veynes ar voide
162and by cause of voidenesse ar drawe humourus wiþ outforþ contened.
163And so oft tymes ceceþ þe febire interpolates or þe fervour
164or brynnynge hete is lessid, as is sene of þe 3^ne, wiche ofte tymes
165is curid be flebotomye. Also it is to wete þat in þe day of accesse
166& in þe houre of þe acsesse ouwiþ mynuscioun to be don if þe pacient
167be stronge þat þe materie of þe sekenesse ymoved be more liȝtli
168brouȝt out, þof al þat olde men seme to wille or wesche. Þay
169commande forsoþe in þat day of accesse, i.e. , interpolacoun,
170to be mynuschid, & also a medicyne laxatif to be ȝeffen þan.

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171Consederyng þe pacyent to be myche febled in þe day of accesse &
172for to be ouertrobleid be þe disese or hevynesse of þe febre, and
173if he ware þane flebomyed or acatarthies, i.e. , laxatif ygefen,
174he scholde be more feblid & more perturbacoun or troblyng schulde
175be made in hym; and moste for þe bodiis beynge in more hoot regiouns
176was more feble þan bodies being in colde regions. Whe forsoþe
177cosederynge þe body stronge, we fleubotomye hym þe accesse
178bygynynge & we gif medicyne.
179    Laboryng of codidian interpolate of flewme naturale, if þe
180bodi be plectorik, mynusche he of mediana of þe riȝthe arme or of
181þe lifte after þe forseid consederacoun. Labrynge of a cotidiane
182of dulce flewme or salse fleume, munusch of mediana or basilica of
183þe riȝth arme or þe lefte; after mynuschynge take electuary frigidum
184& confortativum. Forsoþe it befalliþ þe labrande of salse fleume
185for to have icchynge in þe neþer partie; to wech be more
186scarifyinge in þe legge a palme, sc. , bout þe hele. Laborynge
187of a cotidian of fleume acetose if þe bodi be plectoric, mynusche hym
188of salvatilla of þe lifte hande weche atuxe þe litil fyngir & þe
189leche; after be don as we seide. Laborynge of a cotidiane of
190fleume vitre no manere mynusche, but if þe bodi be riȝt moch
191plectorice. Laborynge of a tercyane of colera naturale, mynusche
192hym of basilica of þe riȝt or lift arme after þe consederacoun
193yseide; take he electuary frigidum & humiditative of þe breste,
194for a tercianare is wont to have þe spirituales idryed. Laborynge
195of a terciane of colere citrine or vitelline if he have putride
196humerous in þe veynes, do he as in terciana vera. It is to wete
197þat of collere prassine & eruginose is not wont febre to be
198brouȝt inne; þay dwelle litil forsoþe in þe bodi, for þe nature
199puttynge hem oute to þe outwarde parties for hastynes of is
200meuyngis. Neþeles if þei habunde in þe stomac, mynusch he as is seid
201in 3ana vera; take electuary frigidum & confortative of þe stomac, as
202succar ros. & triasandalis. Laborynge of a quartayne of melancolie
203naturale, after þe 7th accese mynusche he hym of salvatilla of þe
204lift hand, weche propirli draweþ out or avoideþ melancolious humourus.

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205Laboryng of a quarteyne of melancoliie not naturale, mynusche hym
206of basilica of þe riȝt or of þe left arme as in þe terciane.
207Laborynge of a double terciane or quartayne, mynusche him as is
208seide in þe symple tercyane or quartane.
209    It is to sei of acutes, i.e. , agues. Laboryng of watsomeuer
210day acute, mynusche hym to þe 4th day, not ouer þat, for þanne is
211wonte to be mad agment; in augment forsoþe or in þe state ouwiþ not
212to be mynusched. Neþeles it is to wete þat in febris peracutes,
213i.e. , stronge brenyng agues, þe begynnyge last not sumtyme ouer a
214day & þanne in þe firste day owiþ mynuschynge to be don, & not
215aftirwarde wes, for seyþ y ypocras: in riȝt moche peracute if it
216spede do it þe same day; for to deferre forþsoþ or delay in siche
217it is euel. Labarynge of cotidiane contynuel or a tercian
218contynuel or of synocha or of causon, if vertu & age suffre, mynusch
219of basilica or of cephalica þe lift or þe riȝt arme aftir þe
220consideracoun yseide; aftir take electuary frigidum & confortative,
221as succar ros. & triasandalis wiþ sirupe of ros. or of violett.
222It is to weten þat auturs tretyn of causon commaundeþ not
223mynuschynge to be don, as it schewiþ in Viatica & in Liber febris
224Constantyny , & þat be suche reson. In causon is moste heete is in
225drynesse ioned þerto weche is weston & file: Þanne if þer were
226made mynuschyng þe heet scholde be more scharped for þe habundance
227of blod ymynusched, weche haþ to represse þe efecte of drynes &
228to scharpe het is þat þat is moste dred in causon. Men forsoþe
229þat beþ now beddiþ to be mynusched in causon in a litil quantite,
230þat þere be made a ventosynge alone & infrigidacoun, i.e. ,
231coldnes; after take electuary frigidum as succar ros. or violeut
232or gommes of sourre bredd þres iwasche in g. colde watir.
233Laborynge of þe etic, if vertu & (age) asuffre, mynusche he
234hym of mediana or basilica of þe ryȝt or left arme, aftir þe
235consideracoun yseide, & þat in litil quantite. Laborynge in þe
236febre ethic ethicethic & also in euery longe sekenesse is wont litil to be
237corupt, wherefore it ouwiþ to be wiþ drawen þat be is conrupcoun

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238he hourte not rahþer þanne helpe; aftir take he electuary frigitatum
239& restauratif of humidite, as diadragagantum frigidum or sed or
240infusum or som electuary to restore humydite or moystenes.
241    Laborynge of whatsoeuere spise of þe dropesi, if vertu & age
242suffre, mynusch of basilica of þe ryȝt arme, moste in tympanite and
243ashite. Alexandire forsoþe commandiþ a pacient leucoflamcie to be
244fleubotomyed; euel humourus forsoþe if þey be in veynes ar
245competenly brouȝt out be flebotomye. Aftir, electuary frigidum
246confortatiue of þe lyuere; þe lyuere forsoþe it is moche wonte to
247be febled. Laboryng of ictercian citrina, i.e. , gelow iaundeyes,
248& also of agriacape gasiliontes, i.e. , grene jawnes, mynusche of
249bacilica of þe ryȝt arme. Laboryng of malanchiroun, blac jawnes,
250mynusch of salvatilla of þe lifte hand, weche draweþ melancoliuus
251humourus. Laboryng of manya, i.e. , melancolia, mynusche of þe
252veyne beyng atuixe þe þombe & þe schewyng fyngre of þe lifte
253hand, weche after sume men is seide matrix, after oþer men forsoþe
254vena mediana is seid matrix. Aftir þis, if it be ned, mynusche
255he of þe veyne þat is in þe mydis of front, weche veyne is reseptacle
256or resceyvynge of melancolie, & be þat veyne moste kutt if þe
257sekenesse be in þe hyndere selle, i.e. , partie of þe hedd; wherfor
258seiþ ipocras: þe hyndere partie of þe heed akynge, þe ryȝt streyȝte
259veyne þat is in þe myddis of þe fronte ikutt, helpeþ. Laboryng of
260epymate or emoytoysi, if vertu & age sufre, mynusch he of þe veyne
261beyng aboute þe cubite, whech specialy we kytte agayne þe vice or
262trespace of þe lounges. Laboryng of chafyng of þe lyuere, mynusche
263of basilica of þe ryȝt arme. Laborynge of þe vice of þe splen,
264mynusche of salvatilla of þe lifte arme. Laborynge of vice of þe
265stomac, mynusche of salvatilla of ryȝt arme, & most if colre be in
266þe cause. Laborynge of vise of þe reynes, of þe vesice, or of
267þe matrix, of colico, or yliaco, or of apostem, & it be sene þat
268flebotomye helpe, mynusche of sophena wiþin forþe. Þat not ifonde,
269be þat kutt þat is dressid to þe þombe too of þe foot. Laborynge
270of mormale beyng in þe louere partie, mynusch he firste of basilica
271of þe lifte or ryȝt arme. Aftir if it be ned, of sophena; & at þe

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272laste he be scarefied in þe leggis. Laborynge of þe potagre,
273mynusch firste of basilica, after of sophena. Laboryng of sciatica
274& moost of hoot cause, mynusche hym of sophena wiþout forþ - weche
275of constantyn is seide sciatica - for it avayleþ agayne sciatice
276pascoun. Latin text ends; English text continues. It is to wete
277aftir some men þat it is not to mynusch in tercianes interpolat but
278after þe 4th or 5th accesse, & on þe same wise in oþer febris
279interpolat. Also wete þat is warli to be don in mynuschyng for þer
280comyþ oft tymes moche pereiles: for som tyme men felyn prickynge of
281som euel materie aboute þe skyn & þe spondiles & gret gernouses,
282& of þis þus it is perceyued þat þe materies wiþoute þe veynes be,
283but þat materie þat is wiþout veynes as oftetymes is venymouse as
284it schewit in carbounkelis & carancres & antrax is sike like, weche
285ileide to wiþinne veynes, it sleþe. Wherefor som vnwise men
286after þe consayle of oþer onwise men will þann mynusche hem, & of
287þat folwiþ a werse errore þann þe firste. For þe materie þat was
288witoute þe weynes be flebotomye is drawen to wiþinne þe veynes;
289þann falliþ & continewe febre & so oftyn time deþ. Also som men
290when þei have a febre interpolat where þe materie is wiþout þe
291veynes, makiþ hem to be mynusch & falliþ into continell febre;
292for whi: as afore, þe materie þat was firste wiþouten vestellis
293is brouȝt be fleubotomye to wiþinne þe verccelis & so deþ.
294    Also it is to wete þat unwarf man or onavisid mynuscheris or
295blodlateris oftymes erryn in flebotomynge. For after þat Avicenna,
296Walter, & Galien, & oþer auturis also will þat as ofte tymes or as
297euer undir every veyne of þe bodi whech is to be mynusched is an
298arterie undir. Wherefor somtyme it befaliþ þat þe unware mynuschere
299fro þe veyne smytiþ þe arterie & al þe arme is bolnyd. Also som tyme
300þey ar so royde or boystus þat in smytynge wiþ þe fyngere or sum
301like þynge, þe perce þe veyne vnto þe arterie be þe mydde; & þan
302sometyme rennyþ þe blod inwarde as outward & it standiþ þere, is
303putrified & is made as ware, made venym; & þann also þe arme bolnyþ &
304more now for 2 causes: on, for þe blod rennyþ inwade; anoþer for þe
305arterrie is kut be þe mydde of þe veyne & so falliþ moste pereile,
306for as ofte tyme deþ. Wherefore sekirnesse is more for to slit þe
307veynes aftir lengþe wiþ an instrument as warkyfe as haþ French men &
308oþire also, & namely þo þat han streyte veynes. And of fleubotomye
309þese þynges sufisyn; after Maister Henricus Wyntonyensis. Amen.