affected with the Green-sickness Cachexy and that sort of Dropsie called Leucophlegmatia who all have a difficulty of breathing by reason of dregs of the ill-mixt Blood that are left there Wherefore the use of the Lungs seems to be this That the Blood through the lesser Vessels as so many rivulets may as to all its parts lie open to and meet with the nitrous Particles of the Air and be by them enlivened and accended The Pneumonic Artery as also the Aorta and Wind-pipe hath a muscular Coat furnished with two ranks of Fibres namely straight and circular which doubtless when they are contracted do make the Pneumonic Arteries to beat and the Blood to be urged and driven still more and more forward A great many Glandules with a Net of Vessels lie on this musculous Coat The frame and branching of the Pnenmonic Artery in some one Lobe of the Lungs are expressed in the second Table All the Coats of this Vessel are drawn distinct and apart from one another in the sixth Table and first Figure and also in the fourth Table and second Figure The Pneumonic Vein having its rise in the left Ventricle of the Heart The description and use of the Pneumonic Vein and being divided and variously subdivided first into greater branches and then according to the greater and lesser Lobes of the Lungs into lesser and lastly into the least of all is carried above the Weazand and as it goes on does exactly answer to the branching both of the Pneumonic Artery and the Weazand and goes every where with them as it were cheek by joll and where the Weazand ends into the little Bladders the Veins being twisted with the Arteries as was said before do make as it were a little Net wherein those little Bladders are encompassed The Anatome of the Pneumonic Vein differs little or nothing from that of the Vena cava and its branches All the Vessels of this kind have four Coats distinct from one another 1. The outmost of these Coats consists of Fibres that seem to be nervous which perhaps are after a sort muscular and are extended straight long-wise though in no very regular order This Coat of the pulmonary Vein is very laxe and loose from the rest of the Vessel insomuch that it may all of it be blown up and very much extended as if it were a distinct Vessel Whence one might suspect that this were a peculiar passage to carry back Lympha or Serum separated from the Blood but it seems to be more probable that this outmost Coat is therefore made so loose that the passages might be much distended and widened for the return of the Blood now hot and boiling 2. 3. Two other Coats common both to a Vein and Artery viz. the vasculous The use of the venous and vasculous Coat and the glandulous lie under this the office of the vasculous is to bring nourishment to the part and of the glandulous to receive and send away the superfluous serosities 4. The fourth and inmost Coat is plainly muscular having Ring sibres The muscular Coat as the like Coat of an Artery hath which certainly being successively contracted after the stream of Blood do cause its return to be hastened and on occasion to be shortned But here arises a doubt wherefore Why there is no Pulse in the Veins seeing the Veins as well as Arteries have contracting muscular Fibres which in the latter are pulfifick and seeing both are alike joined to the Heart that beats continually the Veins as well as the Arteries should not statedly beat according to the constant turns of the Systole's and Diastole's in the Heart It may easily be answered to this first that the Arteries have a great deal more of the moving Fibres than the Veins have and therefore whereas those being strongly contracted successively do force the Blood along as if driven with a wedge for these it sufficeth that whilst they are gently contracted behind the stream of Blood they calmly and equally drive it forward flowing back again of its own accord and as it were down-hill But besides the reason hereof seems to depend somewhat on the unlike or rather inverted conformation of the Vessels for the Blood conveighed by the Arteries is driven still from wider to narrower spaces and therefore going along it every where violently distends them and lifting up the sides of the Vessels raises the Pulfe because whiles that part of the Artery that is behind the Blood is contracted by its muscular Fibres that part which is before it must needs beat being filled with the stream of blood gushing in but on the contrary the blood in the Veins returning to the Heart runs out of less into greater spaces or out of rivulets into a more capacious and deep chanel and therefore glides along silently and without the fluctuating of a Pulse The blood in the pulmonary Veins seems as much The disposition of the blood in the Pneumonic Veins or more than that within the Arteries to be animated or inflamed anew by the air insinuating it self every where from the Pipes or little Bladders of the Trachea because in those Veins 't is first changed from a black-purple to a scarlet the reason whereof is because the blood at the extremities of the Vessels namely as it passes out of the Arteries into the Veins does every where and most of all meet with the particles of the air And for that reason it is that if any liquour be squirted into the Pneumonic Artery it will not so readily and quickly pass through the Lungs and return by the Vein as it will do if you make the same experiment in any member or part of the body besides yea part of the liquor so injected will sweat through into the Pipes of the Trachea or the spaces between the little Lobes and another part being turned into a froth will return very slowly by the Veins which is a certain proof that while it passes through the Lungs it makes a stay in the mouths of the Vessels and is mingled with the airy particles The Circulation of the blood through the Lungs hath something diverse from or rather contrary to that which is made through the rest of the body seeing the Pneumonic Arteries contain a black-purple blood and the Veins a scarlet whereas in all the body besides the branches of the Aorta carry a scarlet blood and those of the Vena cava a black-purple Besides we may observe of the pulmonary Vein that it does every where in its whole length want valves except where 't is fastned to the Heart Which appears by this that when any liquor is injected into its trunk just as it is in the Artery it presently passes through all its branches without lett Which ought to be so to this end that the blood may always because of the violence of the passions freely every way fluctuate and regurgitate in and about the Heart Besides that the left Ventricle
of the Heart might never be overcharged with the blood impetuously rushing into it by the instinct of Nature the Fibres at the root of the Vein being contracted its course might be inverted and flow back The description of the Pneumonic Vein as to its utmost branching is in the fourth Table and third Figure To these three sorts of Vessels The Lymphaeducts added to the aforesaid Vessels wherein the air and the blood are conveighed the Lymphaeducts that carry forth a water are joined A power of these dispersed through the Lungs wait on the Arteries and Veins All the branches tending from the surface of the Lung towards its original unite into some greater trunks which being inserted into the Wind-pipe discharge thereinto the Lympha that is superfluous from the blood and nervous humour Indeed there is need of a great many of this sort of Vessels in the Lungs because seeing the blood is hottest of all here is hastily circulated and yet can exhale nothing to without by transpiration the Veins can hardly receive all the whole mass of blood from the Arteries and the Glandules contain not long what is deposited in them therefore there as need of Lymphaeducts as so many chanels whereby the superfluous humour might continually be sent off If these at any time happen to be obstructed or broken there often follows a Dropsie of the Lungs or Breast and sometimes Coughs and Phthisicks These lymphatick Vessels of the Lungs may very well be seen if in dissecting a live Dog you press the top of the Thoracick duct that nothing may be poured into the subclavian Vein for then the Lymphaeducts of the Lungs because they cannot discharge themselves into the common Receptacle now stopt and filled swell much and are very apparent If such a stoppage be made for some time in a Dog that hath eat and drunk largely a milky liquor will sweat into the Lungs out of the Thoracick duct the Valves being unlocked yea and the same liquor will pass through the Lymphaeducts placed far beneath the Reins and will render them strutted with that homour as if abounding with milk The rough delineation of the Lymphaeducts spreading themselves in the superficies of the lobe of a Lung is represented in the first Table 5. The last kind of Vessels belonging to the Lungs are the Nerves and their branches The nervous slips dispersed throughout the Lungs whereof there are many as we elsewhere intimated dispersed every where through the Lungs Heretofore doubting about the office of these we were induced to think the first force or at least instinct of breathing depended on these Nerves because otherwise we can hardly conceive after what manner the motion of the Lungs in breathing coughing laughing and other their actions should be always so exactly proportioned according to the several exigences of Nature For even as the blood doth more intensly or remisly heat and boil up within the Praecordia and as certain contents of the Trachea provoke the nervous Fibres we breathe either quicker or slower and oft-times though unwillingly we cough But besides there doth occur another and more necessary use of these Nerves for since it is manifest that the Coats of those Veins and of the Trachea are every where endued with muscular or moving Fibres by which they are contracted it is plain that the Pneumonic Nerves do convey as well plenty of spirits as inclinations of contraction to those Fibres And it is very probable from those Nerves convulsively distempered that the Palpitation of the Heart is often excited as also the Asthma and Chin cough We have some time since delivered the Anatomy or description of the Pneumonic Nerves in our Treatise of Nerves viz. pag. 311. so that there is here no need to repeat or inlarge The fivefold Vessels forementioned being mutual and many ways accompanied in their distribution as if divided into secret Groves with small bladders as in Trenches every where interwoven when they are complicated and variously woven together do constitute a fleshy web which is the very structure of the Lungs which moreover appears like a more solid Parenchyma in as much the Arteries and Veins being filled with blood are stufft up and the Vessels of the Trachea and Lymphaeducts being emptied of the air as well as water do fall together and seem to close We shall the less admire the fleshy fabrick of this Lung wove together out of meer Vessels and little Bladders if we consider the frame of the seminal Testicles to be nothing else than a heap composed of hollow filaments or spermatic Pipes woven together The description of the Nerves of the Lung and what relates to the bundle of Fibres whereof it is compact and to the spreading of its branches are described in the fifth Table The web of the Lung as above-said The Coats of the lungs whereof one is smooth and the other rough being weaved together of Vessels and little Bladders and divided according to their greater and lesser branchings into lobes and little lobes a Membrane wraps them about as a common covering Of this there are two Coats viz. one outer and fine which appears like a certain subtle texture or weaving together of nervous filaments as is apparent in most other Bowels the other more inward which is both rough and somewhat thick and consisting almost of meer ends of Vessels and little Bladders and by reason of the hollownesses every where caused from these its inward superficies resembles a Hive of Bees the forms of these are aptly enough described in the eighth Table This Membrane of two Coats blown up hath very many and large Pores insomuch that if Quick-silver be poured into the Trachial branch of one of the lesser lobes almost filling within the whole Membrane it will every where burst out from the Pores Both the arterial blood and the air beating in this Membrane as against a bank are reflected the former is brought back by the Veins into the left Venter of the Heart a certain watry part being sent away through the Lymphaeducts In the mean while the air is returned back by the same passages of the Trachea by which it flowed in For continually fresh air ought to be suckt in that it might supply nitrous Particles to the Blood to make room for which the other old air being now weak and useless must be first breathed out Because therefore both functions are to be performed within the same passages it is to be done by alternate turns first the one then the other While the air is drawn in the Lungs are blown up as if wind were forced into them and whilst the same is breathed out they fall down and are narrowly squeezed together for the benefit of excluding it and so after the manner of Bellows discharge constant changes of the Systole and Diastole Yet by what impulse and Organs it is accomplished is worth our labour here to consider Therefore upon the whole matter it is manifest by common
obnoxious to depravation than this Pneumonic machine of the breast The organs of breathing being hurt the breathing is hurt also through which by sucking in air we preserve the vital flame of the blood with its motion and heat For whereas the vessels of the lungs belong to the function of breathing viz. the Trachea with the Bronchii and little bladders also the heart with arteries and veins besides which there are nerves with fibres as well musculous as nervous Lympheducts and Glandules also the contents of these Vessels viz. Air the old and fresh blood with its Serum the Lympha and the animal Spirits any fault happening in any of these doth oftentimes discompose the whole Pneumonic function Nor less also the moving Organs of the breast viz. the muscles with the Diaphragma and the nerves appointed to their use And likewise sometimes the animal spirits before they enter into those nerves being ill disposed often cause great disorders in breathing When the chief function and uses of the Lungs have been to convey the blood and air through the whole frames of the parts and their inmost recesses The uses and ends of breathing which use to be hurt and every their smallest passages and every where to mingle them namely for that purpose that the venal blood returning from its circuit and diluted with fresh juice and thereby crude and as it were half extinct may as well be more perfectly mix'd and wrought together as more effectually kindled afresh in all its parts by the nitrous air from hence the chief faults about this business or function of the Lungs do most of all consist in these two things First that the blood hath not due passage through the Sinus of the heart and the pneumonic vessels And secondly because the Air is not drawn in and breathed out in a due manner into the Trachea and its passages The defects and failings of the Lung in its office There are two parts of either of these For first as to the passage of the blood sometimes the fault is caus'd within the right Sinus of the heart or the pneumonic Arteries and also sometimes caused within the pulmonary veins or the left Ventricle of the heart Secondly as to the Air the failure is chiefly in inspiring and exspiring although each function offends sometimes equally There are divers accidents of each and many causes and ways of its being done whereof we will here briefly touch upon the chief Therefore first First in respect of the blood when the blood doth not duly pass through the right Ventricle of the Heart and the Pneumonic Arteries either it happens by its own fault or by the fault of those passages and sometimes by the fault of further passages For sometimes the stream of blood stops in the nether region of the Pracordia by reason of obstruction in the other moreover sometimes the defect or fault of the air breathed in stops the free passage of the blood What relates to that fault of the blood The opinion of the famous Sylvius concerning the blood fermenting in the Lungs when it passes not quick enough through the right Sinus of the Heart and Pneumonic Arteries the opinion of the Renowned Sylvius should here be discoursed but that it would be too tedious and from our purpose For he supposes The descending branch of the venal blood moistned with chyme together with the lymphatic humour returning from the whole body hath the nature of an acid-sweet spirit and in the mean time its branch ascending impregnated with choler from the bladder of the gaul mixt into the mass of blood does participate of an oily volatile salt and so by the meeting together of these something contrary to themselves a gentle and friendly contention or boiling is stirred up in the right ventricle of the heart in which and for which the fiery parts lurking and being shut up in each being freed and set at liberty do rarifie the chyle and blood and so change and alter them that they exercise the function of life and heat as well as motion and nourishment through the whole body Which seems not likely to be true There are many reasons why I assent not to this ingenious and neatly-framed Hypothesis For besides that many do far otherwise determine about the origine and dispensation of Choler and so not without strong reasons and experiments are thorowly perswaded by eye-sight that there is not any such boiling up of the blood of a different quality and striving or contending in the right ventricle of the Heart Our opinion hereof Our judgment continues still as it hath been that both streams of blood washed thorowly with the fresh chyme do consist altogether of one kind and for that cause the milky Vessels of the Chest carry about part of the Chyle so long a journey which they pour into the descending trunk of the Vena cava just as the meseraick Veins pour the other part into its ascending trunk also that the lymphatic humor together with the Chyle is poured into the subclavian Vessels so that it may very commodiously be reduced into blood neither truly doth there seem need of other or more passages Moreover we determine that that humor rightly constituted doth agree with and is easily assimilated to the mass of blood as well as the Chyle it self made sweet without any contention raised in the heart But if the lymphatic humor returning from the Brain and nervous kind as well as from the Glandules degenerate from its due temperature and contract a sowreness as it often comes to pass then being re-infused into the venal blood it overcomes it and it precipitates it into serosities and from thence great streamings of urine do ensue Moreover we have shewed elsewhere that the Diabetes is provoked from such a cause But such a flux of the lymphatic humor is so far from exciting a greater boiling up of the blood in the right ventricle of the Heart that rather on the contrary from thence often chilness of the whole or stiffness with a weak Pulse and sometimes swoonings or convulsive fits are provoked accompanied with a plentiful and pale urine The reason whereof without doubt is that then the clear humor flowing from the brain and nervous parts turns the blood into serosities and cools it by too much diluting and for that cause the animal spirits being destitute of their vehicle either faint or run into irregular motions But truly as we altogether deny an Elastic effervescence of the blood in the right Ventricle of the Heart from contention of dissimilar parts The pneumonic circulation of the blood is stopt sometimes by the fault of the heart it self so as often as from thence the blood is not cast out into the Lungs after a due manner we determine it to happen not so much from the proper fault and defect of the blood it self as from the animal faculty For if the spirits actuating the moving Fibres of
cholerick and inclining to the Jaundice to void yellow and sometimes very bitter as if it had been meet choler 3. The blood dissolved also lodges in the Lungs infections that cause corruption Moreover many instances manifestly declare that sometimes the Lungs are tainted by the corruption and putrefaction of the blood For the blood toucht with an infection or a pestilent or venemous contagion begins to be corrupted and withdraw into clotted and corrupted portions from thence the Lungs undergo the chief taint from whence the greatest danger of life is threatned This is too well known in the Measles small Pox Plague and malignant Feavers for me now to undertake to explicate it by which maladies as often as the sick die it seems to come to pass either because the blood clodding in the vessels of the Heart or Lungs obstructs the way of its proper course so that presently its influx into the Brain is hindred or because the corruption of the blood affixt to the sides of the pulmonary passages causes a Phlegmon as it were and therefore provokes a most troublesom cough or difficult breathing and frequently bloody spittle So much for the impediments of the circulation of the blood which happen in the Lungs by reason of the mass of blood too much dissolved The blood is hindred in the Lungs by reason of the too thick consistence of the blood and apt to depart into parts and portions which being there left obstruct their passages There remain other no less prejudices to the Pracordia which proceed from the consistence of the blood too much bound up together and sending nothing from it self by which a burning Feaver Pleurisie or Peripneumony arise In the former distemper the blood being more sulphureous than it ought and therewithal being thick As is perceived in a Feaver is not diluted enough with its Serum and those particles of it contained within it self it puts away with great difficulty wherefore it is more plentifully kindled in the Lungs and when it passes through the passages hereof with more difficulty by reason of its greater boiling and of its thickness the Heart beating quick and most vehemently endeavours its circumpulsion with all its might notwithstanding from its greater flame growing hot within the Pracordia heat and a most troublesom thirst with roughness and as it were a certain parching of the tongue arises In the other kind of distemper In a Pleurisie and Peripneumony viz. a Pleurifie and Peripneumony the blood is alike thick but less sulphureous and inflammable wherefore it doth not participate of such a burning yet by reason of its thickness it doth not so easily and quickly pass through the Chest or Lungs is frequently extravasated and sticking to the interspaces or sides of the passages causes obstructions and soon after an inflammation to which pain often succeeds with bloody or discoloured spittle We may observe in blood-letting in these kinds of distempers that after it hath setled its superficies is covered with a little whitish skin or otherwise discoloured but always with a thick and viscous the reason whereof is that the blood when it doth not send away in the circulation its old particles nor doth admit enough of new it is thickned with a continual boiling and like boiled flesh changed from a bloody colour into a whitish in which state passing with difficulty through the small passages of the vessels it is in danger to be extravasated and easily provokes a Pleurisie or Peripneumony Besides these stoppages of the blood The blood is hindred in the Lungs by the fault of the heart caused by its own fault while it passes through the Praecordium there are also other impediments which happen either by the defect of the Heart or its passages or by the fault of the air inspired By what means and for what cause the Heart offending in its motion forces the blood from its right ventricle through the Lungs into the left irregularly we have clearly shewn in our late Tract of Cardiac Distempers to wit that muscle sometimes labouring for want of spirits doth not vigorously and strongly enough perform its beatings 1. When the spirits thereof are wanting For when in corporal exercise the blood more plentifully than usual is forced from the Vena cava into the ventricle of the Heart if this cannot firmly contract it self labouring according to its strength it causes frequent and weak Pulses moreover to help this as well the Pneumonic Arteries as others in fundry parts of the body which drive about the blood every way do cause frequent and inordinate contraction Thus I have observed in Virgins afflicted with the Green-sickness and in other cachectical bodies from a quick motion of the body not only a palpitation of the Heart but in the neck temples and other places the Arteries to have beaten irregularly Neither is it the want of spirits only 2. Because moved inordinately but their disorder is sometimes the cause that the Praecordium doth with less strength convey the blood for sometimes the spirits the inmates of the Cardiacal nerves being stirred up by an incongruous conjunction and affected convulsively do impress their irregular contractions upon the Heart or Arteries whereby the progress of the blood is several ways perverted or hindred as it often happens in Palpitation of the Heart Trembling intermitting Pulse and other the like passions 3. The pneumonic process of blood is variously stopt 3. The blood is hindred from obstruction of the passages Which are shut up divers ways For divers causes here rehearsed because the passages are not open enough which impediments happen as often as the Pores or those passages are either stopt or broken Of the former there are two reasons viz. sometimes the ways are shut for as much as the passages of the vessels contracted by the carneous fibres are brought nearer one another as we have elsewhere shewed doth sometimes happen in Palpitation of the Heart and a convulsive Asthma The affects of which sort by reason of the stream of blood shut within the Praecordia difficult or hard breathing a small Pulse and chilness of the whole body are wont to accompany Moreover sometimes the course of the blood is shut up because the passages of the vessels are pressed together by a body or by some humor from without wherefore when the little Cells or bronchial Pipes as is usual are filled with a viscous flegm purulent matter or blood extravasated as the free passage of the air is hindred in them so also the passage of blood is stopt in the vessels adjoining On the same account come tumors little swellings worms also stony sandy and curdly concretions and others of another kind are in diverse manners excited the chief whereof we shall touch on hereafter The bronchial Pipes are filled Moreover we sometimes see the canals as well of an Artery as of the pneumonic Vein made very bony in some part and their sides so compressed
that a very small chink remains for the blood to pass Not long since we dissected a young man who died by reason of an ill formation of the pneumonic Vein Sometimes wax hard in whom the trunk of this vessel growing stony near the juncture to the heart did stick so close that the blood did drop into the heart only by drops or by a very little stream 2. That the passages bringing blood are often filled and stopt insomuch that the stream of blood is obstructed or straitned many anatomical instances and observations manifestly declare From thence it appears The vessels are stuffed with concretions resembling the Polypus that grumous or as it were carnous concretions of the blood do frequently so stop the ventricles of the heart and the roots of its larger vessels that the course of the stream of blood is almost entirely stopt Moreover reason perswades and experience concludes this more frequently to happen in the lesser vessels for seeing as we have even now intimated the blood emitted by Phlebotomy in Rheumatisms Peripneumonies and Pleurisies when it is cold is covered all over with a thin skin altogether of the like substance with those concreted Polypus's it plainly appears that it passes with difficulty through the passages of the lesser vessels by reason of those viscous excrements wherefore that it may pass by some means it distends them very much and sometimes breaks quite through them also it frequently unlocks their mouths and opens gaps into the Trachea insomuch that portions of the extravasated blood are by coughing frequently ejected We have known some to have died Asthmatic or short-winded whose Lungs being free from an Ulcer or any more grievous wound have swelled so much that they wanted room for their motion within the cavity of the Chest the reason whereof doubtless was that the thicker and more feculent blood for that cause not easily passing through those vessels every where extended the Arteries and Veins and caused it to stagnate in the lesser Pipes Moreover the feculencies of blood one while salt of different kinds another while sulphureous or earthly being combined with them and thrust into the small passages of the vessels and fixed there do altogether obstruct them insomuch that the pneumonic circulation of the blood is contracted into a shorter space and consequently the function of breathing is straitned in the compressed Pipes or little Cells There are many kinds and sundry ways of such an obstruction which if all or the chief should be enumerated such a Pathology would swell into a too great bulk 3. The pneumonic passage of blood is not only hindred by reason of the passages shut and obstructed but sometimes also being burst asunder For those vessels being small The blood is also hindred because the passages are burst asunder as in spitting blood or tender or very loose in some persons are frequently opened by the force or acrimony of blood so that the blood either bursting into the Trachea is ejected by spitting or heaped up in the interspaces of the passages causes a Peripneumony or falling down into the cavity of the Chest produces an Empyema Of all these we shall treat singly in the Chapter of spitting of blood 3. One impediment of the blood is want or default of air There remains as yet a third impediment of blood in the pneumonic passages which happens for the want or fault of Air. If at any time the Blood is not kindled after a due manner within the passages of the Lungs from air breathed in by the Trachea for that cause as presently its flame is irregular so likewise its motion is variously stopt or perverted for although the blood is forced through the lungs by the meer impulse of the heart notwithstanding the pulse hereof is proportioned according to the tenour of its being kindled by the air wherefore when the flame of blood is diminished or supprest for want or through the fault of the air presently the pulse proves languid or unequal and by reason of the bloods course being troubled or stopt presently a paleness and coldness succeeds wholly intercepted or frustrated because the nitrous particules are wanting presently the pulse ceases and anon life is lost The reason of all which is both because the blood being much impeded in its accension or extinct like Must given over working presently subsides and is unapt for any motion and chiefly because the flame of the blood failing and being substracted from the brain presently the Hypostasis of the animal spirits as it were light streaming from thence immediately fails and together with it the exercise or actions of all faculties do cease But if the blood is too much kindled the Sulphur of the Blood and the Nitre of the Air running together more than it ought for that cause presently that this too much burning may be eventilated enough the pulse of the heart is increased to its utmost We might adde many instances of this kind but truely this consideration of the blood leads us to the second thing proposed of Respiration hurt namely that we may duely weigh what sort of failings or defects do happen about the inspiration as well as expiration of the Nitrous air requisite for the preserving the nitral flame of blood that is to say from what causes they proceed and also what effects they are wont to produce in which search we will first treat of Inspiration hurt SECT I. CHAP. III. Of Inspiration hurt BReathing is accounted hurt Breathing hurt by the vicious qualities or defect of air when its use is frustrated or any ways hindred which most frequently happens by reason of the fault or defect of the Air drawn in As to the former if the Air chance to be depraved it neither duely kindles nor eventilates the blood yea it sometimes overthrows the temperament thereof or infects it as is every where seen in a Constitution of Air very malignant That we may touch on the chief reasons of these distempers The faults of the air we are to observe That as the Nitrous particles of Air are chiefly necessary as is manifest by manifold experiment for the preservation of life so frequently it happens that Nitre of the Air either to sail or be wholly wanting or by particles of another kind to be so much muffled or bound up that they cannot enough exercise their vital power or lastly malignant or fatal Corupscles to be adjoyned thereunto First the nitrous particles of Air are deficient if when it stagnating or growing hot the Nitre is chased thence or not stirr'd into action Wherefore in a low-roost Chamber or too close and in other places crouded with assemblies of men or made hot with the ardor of the Sun we difficultly or weakly breathe The same comes to pass in places of great height on the tops of those mountains exceeding the top of the Atmosphere wherein breath is faintly drawn for want of Nitre neither can we live long there
SECT I. CHAP. VII Of Spitting Blood HItherto of a Cough and Phthisis as well in its beginning as confirmation which are the most common affects of the Lungs and most especially dangerous Besides which there are many other diseases of those parts that do occur which when they are not at all or not seasonably enough cured for the most part degenerate into a Phthisis These passions or at least the chief of them as we have before hinted are spitting of blood an Imposthume or Ulcer of the Lungs a Peripneumony Empyema a Pleurisie a Tumor of the Lungs and obstructions by reason of things divers ways concreted viz. sometimes little Pustles and Scirrhus's another while gravel and little stones and sometimes other preternatural matter and lastly hitherto belong an Asthma and convulsive distempers of the Breast Of these we shall treat in order and first of Spitting blood The spitting of blood out of the Lungs and the ejection thereof by Cough sometimes less and almost none Spitting blood a distemper very frequent another while more violent is a distemper frequent enough and truly an admiration it is that it happens not more frequently For whereas the vessels bringing blood are divided into twigs and innumerable slips and those very small and whereas the blood even siercely boiling is violently conveyed through them all complicated after divers manners and variously intorted we can hardly conceive how the circulation thereof being so perplexed and intricate and also so impetuous should be performed without some impediment and interruption And truly we conclude it to be very difficult in living bodies because it hardly succeeds by injection in the dead for as much as liquor sent therough the entrance of the pneumonic Artery will not readily and easily return by the Veins but sticking longer in the passage and skipping over the usual passages variously runs out into the little bladders and other canals of the Trachea and into the interspaces and other various gaps of the little Lobes Concerning an Haemoptosis or spitting blood we are to consider Three things to be considered concerning it first out of what vessells and by what distemper the blood bursts out secondly in what places most frequently laid up thirdly by what means it is wont either to be ejected or brought upward that it may be discharged by the mouth As to the first we are to suppose by the Law of Circulation that the blood of it self bursting out doth altogether proceed from the Arteries for the Veins as long as they remain whole do reduce it towards the Heart and not at all pour it out although we deny not that sometimes they being hurt by a wound fall bruise or some violent accident so as to be loosned from their unity do let go the blood out of their cavities Out of what vessels the blood bursts out Nevertheless the blood most commonly causing an Haemoptoe or blood-spitting proceeds from the little mouths of the Arteries being open or torn and then the fault is wont to be either in the ill temperament of the blood or ill framing of the vessels Of either of these there are variousw kinds and differences By what sault both of the vessels and of the blood it happens which also concur after a diverse manner to provoke the spitting of blood For the blood being sometimes more thin and also sharp it unlocks or corrodes the mouths of the little Arteries and sometimes again being more thick and prone to coagulate when it cannot readily enough be received by the Veins it is extravasated By reason of these faults in the blood they who labour with the Scurvy or with a pestilent Feaver as also those who have drunk some sort of poison do srequently fall into a spitting of blood Neither is this distemper less wont to arise from the fault of the vessels in as much as those being too tender or too thin many times are burst by a violent motion as by coughing hollowing leaping or other vehement exercises or for that being too loose and moist their mouths open and suffer the blood to break out of its circulation moreover sometimes for that the Veins being contracted and wrinkled by cold do not readily pass away the blood but the same restagnating distends the little Arteries and bursts out of their mouths As to the Arteries out of which the blood breadks causing a spitting of blood What Arteries chiefly and where placed do void blood it concerns much of what sort they are and where they are placed for besides that there arise notable differences of bloody spittle according as the blood breaks out from a smaller or a greater vessel and if either of them be placed in the top of the Lungs near the Larynx or in the middle region thereof among the greater branches of the vessels or lastly in the lower region among the orbicular little bladders moreover we observe that the Arteries which use to void blood are either of the number of them Both the pneumonic and tracheal are in fault which arising out of the pulmonary Trunk do every where accompany the branches of the Trachea or of those which owning their origine to the Aorts do cover the coat of the Trachea with a thick branching For it is apparent as we have declared before from the mouths of these as also of the Glandules and unctuous humor sweats out to make the inner superficies of the Trachea slippery Spitting blood from the tracheal Arteries moreover in as much as a serous houmor distils abundantly on t of the same into the cavity of the rough Artery a Catarrh arises Wherefore we doubt not at all to affirm that even fro the mouths of these being open meer blood sometimes soaking into the Tracheal passages does propagate a bloody spittle though in quantity very small I have observed many who without a Cough or any indisposition of the Lungs have once or twice a day voided one or two bloody spittles which as often as it came upon them the Patients perceived either in the bottom of the throat or on the top of the breast a kind of distillation whence immediately by the meer contraction of the Tracheal Fibres with a Snail-like motion a little of the fluid blood being mixed throughly with flegm and not at all frothy is voided and when sometimes that distemper had lasted for many months no prejudice ensued from thence which might bring or threaten a Phthisis which would not have come to pass if any of the pneumonic Vessels had been opened 2. So much concerning Vessels voiding blood and of their divers affections 2. In what places the blood is deposited What belongs to the places wherein the extravasated blood is deposited these chiefly and almost only arew the rough Artery and the inward cavity of the parts thereof For into this as into a Jakes all the filth or superfluities of all the rest of the passages are derived by the utmost endeavours of
Circulation of the Blood as oft as the mass should be diminished First the place from whence Blood is to be taken it differs little from what vessel a part thereof be taken provided it be large enough notwithstanding for that besides a general evacuation of the blood sometimes a particular one properly called Derivation as when the blood is to be brought out of a private place where it is accumulated and moreover a Revulsion when it is to be called into this or that part are intended for that reason in a humane Body there are appointed as it were various Boundaries out of which now by this now by that or by another vein the blood may be emitted as occasion is given and for the uses chiefly requisite If therefore at any time an univeral Evacuation of the blood be indicated the median vein of the Arm is best to be opened for this is easily opened being large enough and whereas it equally flows from the whole body to the orifice thereof being open enough by whose more free efflux nt only a Plethora is taken away but the greater vessels being every where emptyed after this manner the blood stagnating in any place is brought into motion and being extravasated is again swallowed up into the veins wherefore in great distempers when the blood being heaped in the Brain In some cases from the Arm. or Praecordia does threaten sudden destruction the best way not only of general Evacuation but of a Revulsion is to send the blood by a full current out of the vein of the Arm being largely open'd But if without any great Plethora the blood ought to be evacuated from the whole and pulled back from the upper part of the body towards the inferiour as in the suppression of the menstrual flux or Hemorrhoids it will be rather fit to bleed in the Foot or sedentary vessels by Leeches In others from the vein of the Forehead Temples or Throat But if after the blood being evacuated from the whole it be also to be derived from any private part where it is accumulated let its drawing off be near the place affected Hence in Cephalick Diseases we open the vein of the Forehead of the Temples or of the Throat To cure Tumours or pains raised in the Joynts we cut a vessel either beneath or near them or draw out the blood by Cupping-glasses or Leeches In like manner in distempers of the Thorax and nether Belly either Cupping-glasses are applyed to the region suffering The Cophalic Vein of the Arm the Liver Vein or the Salvatella erroneoufly so called or Leeches to the sedentary vessels But that some Vessels are reported to bear a peculiar respect to certain Bowels and that they ought to be lanced in their distempers viz. such are the outward brachial vein which is said to respect the head and the inward the Liver also the outer vein of the Hand tending to the Ring-finger which is said to respect th Spleen and for that cause this is called the Salvatella and the former of them the Cephalick and the other the Jecorary all this is meerly a vulgar error which being propt by no reason or Anatomical observation I am ignorant whence it took its origine Therefore as soon as it is agreed on to cut a vein and its place let a large Vessel be chosen and very conspicuous that it may the more easily be opened and being remote from an Arterie Nerve and Tendon may be the more securely lanced wherefore in the Arm the median vein is commonly chosen although the Cephalick being less environed with other Vessels is the more safely opened The Jugular Vein is almost always opened as often as blood is let in Beasts The jugular Veln is most safely opened it is a wonder it hath not obtained the same Custom in Man when the large and eminent Pipe hereof may most easily and safely here be cut because it neither hath an Arterie for its companion and lies a great way from any Nerve Moreover from this vessel as from any other whatsoever opened an universal evacuation of blood is made from the whole body and together the best derivation thereof from the head so that all the stagnations or aggestions of the Blood and Serum are discharged thence Concerning Vessels in the soot or the hand there is no great reason of choice Of Veins in the band or feet but take the vein which chiefly swells it matters little concerning the Place unless that if incision be made above or near the Ankle there is great care to be taken lest a Tendon be hurt which sometimes by unskilful or rash Chirurgeons happens to the damage of the Patient Moreover let care be taken lest a vein be cut near its Anastomosis with an Artery for if this be committed the blood being entirely Scarlet will impetuously skip out and the flux thereof is not easily stayed nor the orifice of the vessel soon stopt The chief places being thus designed of letting forth the blood we ought to consider by what menns or by what instrument the Blood ought to be drawn forth and the choice of the vessels being shewed we ought next to treat of the Manner or Instruments by which blood is drawn out which is used to be done either by a Lancet in cutting the vein or by suction by Leeches or by Cupping-glasses after Scarification But there is no need of discoursing these because each of these parts of Chirurgerie are every where in familiar use by Quacks Barbers and Women and all things relating to them so commonly known as a man his own house wherefore we will speak but one word Helmont of late and still certain followers of him Some of the Ancients as well as Modern have ridiculously exclaimed against letting of Blood Pseudochymists and Fanaticks have ejected Bleeding out of all Physick because they think this evacuation to be a great injury to Nature which being aided either by her own strength or by their Panacea's they will have to overcome every offensive thing of her self Surely this is no less ridiculous a thing than that long since Chrysippus Apaemantes Strato and some others as Galen reports damn'd this remedy because a vein is difficultly known from an Artery Truly it is manifest enough by sad experience that in cutting a vein sometimes an Artery hath been pierced whence either death or loss of the member sometimes ensues the reason whereof is not as is commonly alleadged that the coats of an Artery being more nervous or membranous than the coats of a Vein can scarcely or not at all be healed when in truth that Vessel is endowed with more and thicker fleshy fibres Wherefore in opening a Vein the pricking of an Artery is so dangerous but the cause is that an Artery like the Heart it self ought incessantly to shake and beat the fibres thereof repeating perpetual turns of Systole and Diastole wherefore a little hole being made in its Pipe for
to wit Curatory Vital and Preservatory the two former respect immediately the symptom to be stopt as often as it shall be urgent and the last is busie about removing the Cause of the Disease that so the assaults of the Hemorrnage may be small or not at all Besides an Hemorrhage ought to be handled one way without a Feaver and after a different manner if pressed with a Feaver Therefore whensoever without a feaver much blood shall flow out of the Nose The Curatory Indication suggests three intentions of healing presently as there shall be need of stopping Remedies there will be three chief intentions of Curing all being together assumed into practice viz. Let the turgescency of blood be bridled that it may be less disposed into inordinate tendencies Moreover in like manner let it be endeavoured that as well its fluxion being withdrawn from the Nostrils may be diverted to another place as that the mouths of the Vessels gaping within the Nostrils be shut for which purpose Remedies as well external as internal very many and of diverse kinds are wont to be exhibited of the former we will entreat in order briefly First therefore let the Patient be quiet plac'd with his head upright Outward remedies to stop the flux of blood then let many of the Joints of his Arms and Thighs but not all be bound with strait Ligatures which ought now and then to be loosened and removed to other parts for all being bound together and long by reason of the blood being held in the outward parts 1. Ligatures and too much detained from the heart hath caused most dreadful swoundings but otherwise this Remedy being prudently administred frequently helps For when the blood by this means running into the members by the Arteries is stopt that it presently returns not by the veins it s more impetuous spreading it self into the head is impeded Moreover by the painfull Ligatures of the Joints the muscular Fibres of the Carotides Arteries are preserved from Cramps which oftentimes come upon them Secondly For diverting the tendency of blood from the Nostrils 2. Bleeding it is sometimes expedient to breath a Vein in the Arm or in the Foot For by how much more blood is carryed by the Arteries to the vein cut by so much less will the afflux be towards the Nostrils Yet this administration does not always so help but sometimes a contrary effect thereof happens as we have already observed in spitting blood The reason whereof is that the vessels being suddenly and not sufficiently emptyed suck up again the disagreeable humours formerly ejected and stagnating within the pores whereby the blood incontinently is stirred up into a greater eruptive turgescency Thirdly Cold things applyed to the Forehead and Temples 3. Application of cold things also to the Nape of the Neck where the vertebral Arteries ascend cause the vessels to be bound together and the flux of blood to be somewhat stopt or repelled Notwithstanding it is ill which some advise that cooling Topicks be applyed to the Jugular Veins for so the blood being retarded in its recourse flows the more plentifully out of the Nostrils Moreover what is usual to apply linty Cloaths or a Spunge moistened with Vinegar to the Pubes and Testicles helps by no other means than the ligature of the members to wit inasmuch as the flowing back of the venous Blood is impeded A sudden and unexpected sprinkling of cold water on the face frequently stops an Haemorrhage inasmuch as it gives an impression of terror Fourthly Cupping-glasses applyed upon the Hypochondres Flanches 4. Cupping-glasses inner part of the Thighs and the soles of the feet are accounted a famous remedy as well with the ancient as with modern Physitians for diverting a tendency of the blood from the Nostrils And the reason is plain viz. because a Cupping-glass being put on the impulse of air being prohibited by the space of the orifice and encreased every where about presently the blood and humours yea and vapours and solid parts being call'd from any other tendency are driven towards the empty space of the Glass Fifthly 5. Frictions Rubbing of the extream parts are commended in this distemper by some Practitioners which we judge not always useful nay scarce safe because although they solicit a greater appulse of the blood to the feet or hands yet they so hasten the return thereof that the whole mass of blood being raised into an effervescence it hazards a more violent tendency towards the Nostrils Sixthly Zacutus Lusitanus among his revulsory Remedies 6. Cauteries propounds an actual Cautery to be applyed to the sole of either foot and Crato the bending the little finger of the same side which because done with no trouble we may try but we advise not so of the former unless the way of helping were more certain which might compensate the pain and lameness that would ensue thereon Seventhly Swounding raised by any means presently stops an Haemorrhage 7. Faintings however contumacious it be wherefore when such bleeding persons are taken out of their beds or when they do timorously admit of Phlebotomie though but sparingly or have their members bound for a longer time or are suddenly affrighted with some feigned rumour or by some other occasion fall into a swouning or fainting of the spirits the flux of blood ceases thereon presently The reason whereof is evident enough for that as soon as the motion of the heart fails presently the blood and spirits rush thither and so every outward flux is stopt on a sudden and what was immoderate before doth not again return Eighthly Remedies by Sympathy and Antipathy In the last place for repressing the flux of blood from the Nostrils Remedies ought to be recited which are said to operate after an occult manner by Sympathy or Antipathy 1. Sympathetick powder 2. Young Ashwood of which sort first is the sympathetick powder made of Roman Vitriol calcin'd to a whiteness by the Summer Sun also a piece of wood cut from a young Ash first sprouting about the time the Sun enters Taurus the efficacy of which remedy in the late Civil Wars many worthy of credit attest to have been approved for stopping the Hemorrhages of wounded Souldiers Yea some still with much confidence prescribe it in all eruptions of blood I confess the reasons of effects of this kind are concealed from me if so be they happen often Besides it seems not a less Empirical and irrational Remedy that a silk Bag with a dry Toad in it 3. A dry Toad worn on the pit of the Stomach stops any kind of Hemorrhage and prevents its return unless according to the Aetiology of Helmontius that the application terrifying the Archaus compells the blood being astonish'd either to go back or desist from its inordinate excursion There remain very many famous Medicines whose Operations are wont to be referred to hidden Causes and secret vertue 4. A Blood-stone 5. Mosse as
D. The branches of the Trachea constituting the lesser lobes are whole and shut that the Ring-like Griste may also appear in them E E E E. The like branches being cut open that the holes and straight muscular Fibres may be seen together F F F F. The trunks from which the Tracheal branches being cut off are removed that there may be space afforded to the rest when cut open G G G G. The secondary little lobes hung upon the trunks of the Bronchii as grapes which also may be divided into lesser lobes the more inward passages of all which pass out of the Bronchii into the little bladdery Cells h h h h. The Vessels bringing blood crawling over the superficies of those little lobes The second Figure of the third Table expresses a part of the pulmonary lobe wherein the membranous interspaces being blown up all the little lobes appear in their proper figure and do somewhat represent the leaf of Polypody A A. A part of the Arteria complicated with the other Vessels to which trunk made up of all those the little lobes grow like leaves of a tree b b b b. The little Lobes themselves c c c c. The Vessels bringing blood creeping through them d d d d. The membranous interspaces of the little lobes which also are covered with e e e e the Vessels bringing blood The fourth Table expresses as well the Vessels belonging to the Trachea as those bringing blood separate and distinct one from another constituting one little Lobe as also the peculiar framing of every one of them The first Figure represents the separating into divers parts the Tracheal branch distributed into one little lobe and the branching into Pipes and orbicular little bladders A A The trunk of the Aspera arteria in the superficies whereof the ring-like gristles do appear b b b b The lesser branches going from that trunk wherein also little Rings appear c c c c The passages of those branches into orbicular little bladders which seem like the clusters of Grapes d d The Vessels bringing blood distinct from the Pneumonic which cover the Trachea and serve to nourish it The second and third Figure shews distinctly the equal branchings of the Artery and Pneumonic Veins within the same little Lobe both which being complicated with Tracheal Vessels do for the most part make up the texture of the pulmonary frame The fifth Table sets forth the pulmonary Nerve more accurately described by the aid of a Microscope so that it plainly appears that the Trunk is as it were a bundle of innumerable little Fibres bound together moreover its Trunk while it creeps into the lungs in the likeness of Mother of Time doth spread the various little sprigs every way Fig. 1. resembles a part of the nervous trunk cut away one end whereof being opened and lookt on by a Microscope seems to unfold it self almost into innumerable little fibres A The trunk of the Nerve a a a a The little Fibres divided from one the other about the end cut off and spread abroad The second and third figure do shew some fibres as well of the trunk as of every branch and moreover the slips of the little twigs from divers stemmes often repeated B. The chief trunk b. b. b. b. The little fibres about the extremity cut off explicated c. c. c. c. The little twigs springing from the bundles of the little fibres The sixth Table first sets forth the anatomy of the Artery bringing blood drawn in apt figures which we have described in a late treatise The first and upper figures hereof represent the four distinct Coats of that Vessel viz. the nervous muscular glandulous and the vasculous 1. The first inward nervous coat which perhaps is somewhat musculous consisting of streight or long fibres which being contracted shorten the Pipe of the Artery 2. The coat properly muscular consisting of a heap of small circular fibres which when they are contracted successively under the stream of blood do make its circuit to be shortened It is from the motion of these that the arteries beat 3. The glandulous coat which like that in the guts being placed over the musculous coat is weaved together of very small and most numerous glandules 4. The outward vasculous coat which variously folded together and wreathed of Vessels bringing blood and with slips and nervous fibres seems like a certain little net The second and lower figures of the sixth Table do shew the anatomy of the Vein or its four coats expressed in fit places which Coats do appear entire as successively taken one part from the other beginning outmost I. The outward coat consisting of nervous fibres which perhaps are somewhat muscular and as it were streight or stretch'd out in length although not orderly II. III. The vasculous and glandulous coat which are the same as in an artery IV. The most inward muscular coat consisting also of circular fibres as in an artery which being contracted behind the stream of blood hastens its returning course The seventh Table expresses the distinct Coats of the aspera arteria and separated one from the other The first figure shews the most inward Coat endowed with streight or long muscular fibres The second figure descrbes the glandulous coat and the third figure the vasculous coat which are almost the same as in the vessels bringing blood and also in the Guts 4. The fourth figure expresses the outward coat which is partly cartilaginous and partly muscular The transverse or annular fibres hereof do fill up and weave together the interspaces of the Cartilages The eighth Table shews a part of the outmost pulmonary Coat covering over its whole frame most finely and curiously described by the help of a Microscope The first Figure shews a portion of the above-mentioned coat which partly by reason of the extremities of Vessels of every sort ending in it seems pricked full of holes as it were and partly from the complications of the vessels bringing blood which like the twining sprigs of Vines gird about the orbicular bladders is distinguished into many irregular Area's The second Figure represents a part of the outermost membrane separated from the clusters of vessels pull'd off and without any Area onely markt with little holes as it were with small pricks The third Figure expresses one singular area of the Coat above mentioned augmented in largeness by the help of a Microscope SECT I. CHAP. II. Of the sundry kinds of Breathing hurt and their causes with the accounts of their Symptoms HItherto we have strictly viewed the Lungs and the parts any way serving their motions and consequently the vital function which being many and different and the provision of the Organs as many very accommodate to Breathing so the same are many wayes in hazard to be perverted or vitiated upon sundry occasions Truly a Watch framed with the greatest artifice with a Spring with wheels plain and toothed with chain and ballance is not more prone or easie to be
the Heart either grow weary or are forced into convulsive disorders for that cause the Heart beating in disorder drives out before it the blood either infirmly or irregularly But that the blood issuing out of the Heart doth not always with expedition pass through the Pneumonic Arteries 2. Sometimes by the fault of the blood 3. Sometimes by reason of passages obstructed that sometimes happens from its own proper fault and also sometimes from the passages obstructed and also by reason of other causes The blood it self in a double respect hinders its own passage through the Lungs viz. either offending as to its kindling or as to its temperature There are sundry accidents of either of these For first even as the blood is more or less kindled than is convenient it is hindred or obstructed in the pulmonary circuit if at any time the watry earthy or fixt saline parts are predominant in the blood the spirit and sulphur being consumed or brought low by reason hereof its liquor being not well or less kindled by the nitrous air is not easily rarified in the pulmonary passage and scarce passes through them like a flame of its own accord but it sticks still in its passages heavy and muddy and creates much trouble and labour to the Heart wheresoever it is circulated Hence as often as the blood is a little more plentifully forced into the Pracordia by the quicker motion of the whole body or of its parts the Heart and Lungs labour hard for its driving about and that with the utmost endeavours And in this case it is probable The blood hindred in the Lungs sometimes because not kindled enough that the blood carried more rapidly into the right Ventricle of the Heart doth somewhat stagnate because it cannot presently be carried into the passages obstructed before it Moreover from this cause those grumous or fleshy concretions called the Polypi of the Heart sometimes seem to arise Hence both in the Pica Leucophlegmatie Dropsie and inveterate Scurvy from the quicker motion of the body arises difficult and painful breathing 2. Sometimes the blood is too much kindled and breaking out almost into a flame Sometimes too much and being above measure expanded it can scarce be contained in the pulmonary passages which it very much blows up and extends but endangers them to be inflamed or kindled wherefore lest it should tarry longer in them the Pracordia beat with most frequent and strong endeavours that the blood so over-much kindled might be ventilated and circulated for otherwise it being carried within the Lungs and inflaming them all over would quickly destroy the vital function Besides these things which concern the kindling of the blood It is also stopt through its temperament being vitiated there are other faults as to its temperament or mixture by reason of which it less freely or expeditely is conveyed through the pneumonic passages For when its consistence is either too laxe or too close it will not easily pass through the small passages of the Lungs but oftentimes is in hazard to stick and stagnate in them and also run out and be extravasated The blood being in a diverse manner made loose in its consistence either deposites its Serum or its dregs or its putrefaction in the Lungs which being lodged in the recesses of the Vessels or affixed unto their sides do variously stop or pervert the course of the blood 1. The dissolution of blood which is most commonly injurious to the Lungs When the blood is too much loosened in its consistence although not very dangerously is wont to happen for as much as the serosities being unapt to be contained within the mass thereof and when they are not presently sent away by sweating or urine they separate from the blood within the Lungs and so boiling up and breaking out from their proper vessels do as well disturb and stop the passage of air as that of blood so that for the sake of expelling those serosities and continuation of the circulation of blood the Lungs are provoked into a frequent and very troublesom Cough What the formal reason of this Cough is and the manner of its being brought about we shall declare hereafter Though there are many causes and occasions by which the serous liquor Why it lodges the Serum in the Lungs departing from the loosned consistence of the blood flows out abundantly into the Lungs yet for the most part it happens from one of these three viz. first and most frequently because the Pores outwardly bound up by cold cast back the serosities which were wont to be sent away by perspiration into the mass of blood which compel it presently to boil up and cast off the serous superfluities in the Lungs The various causes and ways of doing it From this kind of cause Catarrhs and Coughs frequently arise insomuch that the beginning of every cough by the vulgar is always imputed to such an occasion to wit catching cold 2. The drinking of sharp and thin liquors as Cider Rhenish Wine white Wine Paris Claret commonly causes to some a Cough or catarrhal distemper the reason whereof is for that the blood weak in temperament is presently dissolved and precipitated into serosities like milk by sowre things cast into it which flow plentifully from the mouths of the inward Arteries I have experimented this upon my self yearly when in the Summer season when the blood abounds with sulphur I have drank Cider and tartish Wines safely yea frequently to advantage the same in winter when the blood is prone to sowreness but moderately tasted of do presently provoke a Cough 3. There is another cause of this serous inundation flowing out upon the Lungs viz. when the Lympha watering the nervous and solid parts doth suddenly suffer a flux and for that cause it streams back into the blood out of the Fibres and Glandules and other passages and receptacles whose liquor it presently dissolves and precipitates into serosities which often infests the Lungs For this reason a sudden and troublesom Cough frequently accompanies convulsive distempers which being commonly called a vaporous Cough is ascribed unto vapours Moreover in great alterations of air especially when the season varies from dry into moist and the volatile and fixed salts do thereby melt the Cough and Catarrhs increase very much Neither doth the serous liquor only but also many other humors or recrements of the blood lodged in the Lungs frequently stuff up their passages so that by obstructing both the passages of air and of blood they cause difficult breathing or a cough This is every where perceived in ill-habited bodies also in Gluttons and Drunkards and others leading an inordinate and slothful life Wherefore Foot-men use a thin and spare diet that they may have their Lungs free from the filth and recrements of the blood I have observed some melancholy persons the adust faces abounding in the pulmonary passages to have voided blackih spittle like ink also others
the Lungs were free from any Ulcer yet they were set about with little swellings or stones or sandy matter throughout the whole for from thence the blood because it could neither be freely circulated in the Praecordium nor animated enough by the nitrous air and when in the mean time it is perpetually polluted by its proper dregs deposited in the Lungs is frequently vitiated and made incapable of nourishing thereby wherefore a Phthisis is better defined that it is a withering away of the whole body arising from an ill fromation of the Lungs The Ancients following Hippocrates The cause assigned by the Ancients for the most part have assigned only two causes of this disease viz. a Catarrh and the breaking of a Vein to which some have added an Empyema and others exclude a Catarrh from this number for what is vulgarly affirmed that flegm falling from the Head into the Lungs and abiding there putrifies is most commonly the cause of a Phthisis or is often brought by it we have formerly intimated to be altogether erroneous and shall presently shew it more clearly In the mean time to shew what the matter is that generates a Consumption as often as it arises without an Empyema or Haemoptoe going before What the consumptive matter is it must be considered after how may manners and by what ways any thing disagreeable or heterogene can enter into the Lungs which diligent search being made it will easily appear that any thing that is an enemy to the Lungs creeps in and is admitted chiefly either by the Trachea or by the pneumonic Arteries By what ways it enters the Lungs yea and sometimes haply by the Nerves but nothing by the Veins or Lymphaeducts whose function is only to carry back or away the blood or Lympha and to leave there nothing at all As to the Trachea it is manifest it is ordained for this end that by its passages or pipes the air might be conveyed in or presently carried back by a constant recourse from whence it comes Sometimes by the Trachea yet not destilling from the head moreover whether any matter being hurtful or mortal to the Praecordia may be admitted the same way shall be now our present disquisition And that the Lungs frequently incur a pernicious pollution by this entrance is clear from hence because the moist air of some regions repleat with fumes or abounding with malignant vapours doth frequently induce the consumptive inclination nevertheless the affection thereof is wont to be communicated only by aerial minute particles whereby either the temperament of the blood or the conformation of the Lungs or both are prejudiced But whether besides this a serous matter or some humor corrupting the Lungs doth enter them through this passage is not without reason doubted although many do determine a Catarrh or a destillation of the Serum from the Brain into the Lungs by the passages of the Trachea the principal cause of a Phthisis Which opinion being erroneously delivered by the Ancients I admire any either of our modern Physicians or Philosophers have admitted thereof for it is manifest by anatomical observations that nothing from the Brain by the Glandula pituitaria which seems the only passage from thence falls down into the Palate or Breast but that the Serum there deposited is conveyed by appropriate passages to the jugular Veins and is remanded to the blood Moreover it is manifest to sight that whatsoever relique of Serum is laid aside in the Glandules of the Ears Mouth Nose or Face is conveyed from them all by peculiar passages insomuch that no humor whatsoever destils from the Brain or the Palate into the Lungs But although matter exciting a Congh doth not destil from the Head by the Trachea into the Lungs yet sometimes falling down from the sides of the Trachea into their cavities But sweating out of the sides of the Trachea it produces that disease commonly called a Catarrh For the Aspera Arteria like the Arteries beinging blood are endued with a nervous and musculous Coat and so do occasionally enjoy sense and motion having also a glandulous Coat and full of little vessels to sustain the vital heat and nourishment These last Coats make those interspaces and as it were cover the Cartilages Moreover the superfluous serosities proceeding from the blood watering the Trachea are deposited into this glandulous Coat which for the most part presently sweating into the cavities of the Trachea serves chiefly to make them slippery and most but if the mass of blood be poured out too much and precipitated into serosities as it frequently happens a cold being taken or the swallowing down of acid things and on many other occasions for this cause a great plenty of watry matter sweats out of the Glandules of the Trachea and mouths of the little Arteries into its cavities which soon doth cause a most troublesom Cough and often much spittle which afterwards comes to be consumptive But surely this cause of Spittle and as it were a Catarrhal Cough very rarely comes alone The consumptive matter brought into the Lungs rather by the pneumonic Arteries because while the blood watering the Trachea having suffered solution throws in its serosities into the Glandules whence presently they sweat into its cavities and also the remaining blood being in like sort dissolved it insinuates its Serum set apart within the pneumonic arteries partly into the tracheal hollownesses and partly into the Lympheducts by the overflowing whereof the Lungs are as it were overwhelmed and much incited for the most part provok'd to Cough and continual spitting A Cough and spitting of this kind as long as moderate A Cough and spitting sometimes healthful only throwing off the serosities of the blood rather are beneficial than prejudicial because the mass of blood and the very lungs being throughly purged after this sort those symptoms for the most part spontaneously abate and from thence ensues a more perfect health But if they be protracted a long time the serous humour being on both sides laid aside into the tracheal passages and from thence more plentifully daily heapt up at length it will change into corruption because as well the free enjoyment of air is impeded as also the motion of the blood and its temperature wholly perverted from hence a Cough becomes more fierce and breathing more difficult nay rather the whole mass of blood in as much as it is defiled by the foul blood which the Veins receive from the Lungs degenerating by degrees from its benign properties and being depraved it not only continually pours forth the super fluous Serum but also the nutritive Juice which it cannot assimilate out of the pneumonic Arteries into the tracheal passages Yet often being too much is dangerous and so this mass of consumptive matter is daily increased till the Lungs being more and more obstructed and filled and the blood being defiled and rendred unfit to perform any of its functions the Cough
and Spittle become worse and worse and presently become dangerous Moreover breathing being hurt the faintness and pining away of the whole body the debility of all the functionx and at length a hectick feaver and a hasty declination to death follows When by the long continuance of a Cough and Spitting leasurely encreasing Why the Consumptive matter affects and by degrees hurts the lungs the humour is more plentifully deposited out of the mass of blood into the lungs it first of all enters into the tracheal little bladders and at length fills them and somewhat distends them from which while every morning by expectoration then more copiously performed it is almost entirely cast out from them thence the Thorax is exempt for a short space from the burden and respiration seems more free yet a little afterwards the blood being stuff'd again with Serum or nutritive juice it pours down new matter into the lungs and from thence again after meat or sleep the little bladders are fill'd and the humours by the afflux daily encreased are more distended and enlarged and at length the sides of two or more of the little bladders being burst many little bladders are here and there framed as it were into one lake within which the consumptive matter being more abundantly collected there it putrifies for it is not entirely prefently cast out and from thence it corrupts the substance of the lungs to which it is joined and imparts a putrid defilement to the blood passing through it This breach thus made in the lungs is daily encreased and frequently more are at the same time formed in divers places and by reason of the great plenty of humours heaped up and putrified in them a heaviness of the breast is felt like a weighty burden upon them the breathing is more hindrd moreover from the tabid blood being more plentifully intermix'd with the mass of blood frequent effervescences of it destruction of the nutritive juice also thirst heat loss of appetite nightly sweats and a pining of the whole body do arise How an Vlcer of the Lungs is made But the blood being polluted from the lungs causes them to be punished with a reciprocal affection that is to say from its peculiar pollution because the blood in the veins receiving this purulent matter in every circuit it immediately delivers it into the arterial from whence whereas it cannot be sent enough away by sweat or by Urine it is brought back by the pneumonic arteries to the lungs where again being separated from the blood it is every where conveyed as well into the little bladders of the Trachea as into the lesser passages insomuch that at length the whole frame of the lungs being filled clefts or ulcers are formed consequently in many places and all the other hollownesses are stufft with frothy quitter But sometimes it happens that there is one Ulcer or hole or happily two formed in the Lungs and the sides grow callous round about so that the matter being there gathered together is not conveyed into the mass of blood but is daily expectorated though in a vast plenty They that are so affected as if they had but an issue in the lungs An ulcer of the lungs covered with a callus less prejudicial although they cast up much Spittle and thick and yellow matter every morning and a little sometimes all day yet otherwise they live well enough in health they breathe eat and sleep well are well in flesh or at least remain in an indifferent habit of body and frequently arrive to old age insomuch that some are said to have been consumptive thirty or forty years and to have prolonged the disease even unto the term of their life for that cause not being shortened And in the mean time others who cough or spit less within a few months fall into a hectick feaver and in a short while are hurried into their grave Hitherto touching the conjunct cause and formal reason of a Phthisis or pulmonary Consumption The evident causes of a consumption what belongs to the other causes that is to say procatarctic and evident ones they truly are various and manifold inasmuch namely as they are more near or more remote inward or outward and lastly connatural or adventitious That I may undertake to design the powers operations and modes of effecting of all these in producing a Phthisis primarily it is requisite that I shew by how many modes and by reason of what occasions the serous humour of as folks commonly say the Catarrhal is laid apart out of the mass of blood into the little bladders of the lungs and into other passages of the Trachea The primary causes of a Consumption some from the blood others in part from the lungs Upon diligent search of this it is obvious to any one to percieve the morbific cause consists of two parts and that the fault is in the ill temper of the blood sending an offending matter to the Thorax and also the weakness or ill tone of the lungs easily receiving it As to the former it is manifest enough by common observation that the mass of blood being stuft with incongruous particles viz. it s proper ones degenerated or with others from other places intermingled The ill temper of the blood disposes to it doth boyl up for the expurging of them and what is to be separated when it is not easily sent away by any other ways it is spread abroad into the lungs if they are of a weaker constitution and cleaves to them There are many dyscracies of the blood and those of divers kinds and affections by by which its liquor being dissolv'd in its consistence and as it were curdled doth not rightly contain the serous and nutritive juice within it self moreover sending away these and other excrementitions humours uncessantly from it self as sometimes it deposits them among other parts so more often into the lungs 1. The blood sometimes like Milk grown sour of it self is depraved by little and little and at length departing from its genuine faculty into a sourness and being dissolv'd in its existence doth cast abroad its serosities too easily prone to separate themselves out of the Pneumonic and also Tracheal Arteries into the tracheal passages Thus to some it is ordinary once or twice in a year without any manifest cause to be afflicted with a grievous and troublesome Cough with copious spitting which in a certain process of time after the blood purged from its dregs and excrements recovers its temperature doth spontaneously abate and after doth succeed a more firm and durable health By reason of such a Cough serving for a purge to the blood I have known some often in a day and especially every morning who were wont to spit out spittle like black Ink with a small endeavour of the Trachea which distemper when for many months they had constantly labour'd under after a greater Cough occasionally contracted with much and yellow spittle they
Greeks by little and little revived Various opinions are recited so that some did dare to make incision on the same side yet always one side judged the others of the opposite perswasion as it were guilty of murder as often as any unlucky event did happen So that while among Physicians about phlebotomy there was no less a contention than among the Jews and Samaritans about the Sacred place of Worship at length the Doctrine of the Circulation of the Blood held out like a new Light by the most renowned Harvey discuss'd all the clouds of this Controversie so that immediately it clearly appeared to be almost the same thing whether incision be made in the Vein on the affected or opposite side of a patient sick of a pleurisie although in our Age Custom hath prevailed first and rather to open the Vein of the affected side Notwithstanding a Vein being opened in either Arm draws nothing at all immediately from the vertebral Arterie or from the pleura they are only the branches of the Azygos or of the vertebral vein that receive the blood out of the place affected but that they may accomplish this they are not unloaded in any other manner but that the quantity of the whole blood be abated by phlebotomie wheresoever made Onely this may be affirmed for opening rather the vein of the affected side that the Basilick vein being unloaded the Arteries of the Arm receive the more ample provision of blood from hence the bloody stream of the vein Aorta runs down more swistly from that side towards the branches of the Arm and perhaps in the interim of its quick passage it infuses less blood into the vertebral Arteries for the nourishment of the disease As to that opinion that the blood is sometimes more plentifully carryed from place to place that from hence the right Lung or Liver being beset with an inflammation or obstruction the right part of the head is in pain and of the face grows more red I say this sometimes is brought to pass because the patients do constantly lie in their bed on the side affected wherefore the Vessels being compress'd the blood stays longer in other parts of the same side while it is circulating But of these things we will make a more diligent search when we shall render the History and Aetiologie of phlebotomy But if phlebotomy by reason of a weak pulse Cupping-glasses with Scarification supply the place of blood-letting and fainting of the animal function neither ought to be at first administred nor repeated though the pain be most urging Cupping-glasses with Scarification do well supply the turn hereof being applyed to the place pained Riverius and Zacutus Lusitanus have cited notable Examples of cures effected by this remedy And surely this practice seems to lean upon a reason strong enough for the blood being drawn away from the side affected that which is lodged in the neighbouring vessels being the conjunct cause of this disease is moved with it and partly drawn away and partly turned to its Circulation Moreover to remove an inflammation of the Pleura besides withdrawing blood by a free Phlebotomy or Scarification also the serous and other excrementitious humours ought to be gently solicited and excerned as well out of the mass thereof as out of the bowels by Stool Urine and Sweat The more strong purgatives are deservedly prohibited because they disquiet the blood and constrain it to be impacted more deep into the places affected And that certain renowned Chymists viz. Angelus Sala Hartman M. Rulandus with many others do audaciously exhibit Vomits of Stybium to any afflicted with a Pleurisie and magnifie it for the best remedy seems to me neither safe nor congruous to reason Whether Purges and Vomits are to be taken in a Pleurisie the only reason of helping as I think and that very uncertain and full of danger may be viz. that the medicine operating more vehemently while the patients suffer exolution of spirits or swoonings all the vigour and turgescence of the blood abates and for that cause the nervous Fibres remit their wrinklings or painfull contractions and the Vessels carrying blood being much emptyed do suck up the morbifick matter In the mean time there is danger lest the humours being violently disturbed rush more impetuously to the part affected at least lest the Spirits being too much dejected and the work of Nature disquieted about the digesting or separation of the morbific mater strength should utterly fail before the disease be cured Yet in the mean time Clysters are of frequent or daily use yea sometimes more benigne solutive purgatives are allowed provided that the Feaver be not very intense Julips and temperating Decoctions and things gently moving Sweat and Urine What other kind of Remedies are convenient in this disease as we have prescribed before for a Peripneumonie are also here convenient but let all hot and sharp things whether aromatick or endowed with a vinous spirit be carefully declined II. The second Indication preservatory The second Indication preservatory designed against the clamminess and boyling up of the blood prescribes Medicines of that sort which consisting of a volatile or alcalizated Salt do destroy the combinations entered into of the acid and fixed or otherwise distempered Salts with the other more thick particles For which intent the eyes or claws of Crabs the tooth of a Boar the Stone of Carps the jaw of a Pike Fish the Bone in the heart of a Stag the Priapus of a Hart Sal Prunella Salt of Coral Salt of Urine or volatile salt of Harts-horn powder of Goats-blood infusion of Horse-dung Spirit of Harts-horn of salt Armoniack Spirit of Tartar the simple mixture mineral Bezoar Diaphoretick Antimony flowers of salt Armoniack are very famous Remedies in a Pleurisie III. The third Indication vital The third Indication vital which provides that the strength and vital heat be preserved during the course of the Disease in due tune and state gives in precept first an apt kind of food and moreover Cardiac and Anodyne remedies and those which seasonably occur to other symptomes if perhaps they arise First in a true Pleurisie a most thin Diet ought to be appointed viz. of meer Oatmeal and Barley and for ordinary drink a Ptisan or Posset-drink rather than Beer alone is convenient although in an outragious thirst this also is to be allowed of in a moderate quantity Moreover for quenching thirst Juleps Apozemes and Emulsions are taken by turns to all which adde Sal Prunella Secondly Cardiacks let only the temperate Cordials be administred which mildly do recreate the animal spirits and not at all intend the kindling of the blood burning out of its due proportion For these intentions the water of Carduus Mariae Carduus Benedictus of Balm Borage Cowslips Black-cherries are usually given with success whereto let the powder of Pearls and Coral be added Thirdly It behoveth to administer Anodynes both inwardly to provoke sleep in
the blood sweats out into the Aqualiculum or belly either the very Blood or Vessels containing it or both together are in fault The Blood is in fault when being depraved in its Crasis it doth not rightly contain within its consistence the constitutive parts but being apt to be dissoved it every where rejects its serosities from the mixture which either it drives out by Urine or Sweat or permitting them to reside within pours them out into the pores of the flesh The Description of an Ascites or the cavity of the bowels The vessels bringing blood grow faulty for a second reason for that their extremities or little mouths either are too much loose or altogether shut up In the former state the clew of Circulation of blood is not entirely and firmly continued but the thinner and more crude part of the blood being apt to depart is suffered to flow out near to the interspaces or inosculations of the Arteries and Veins likewise on the other side when the course of blood is hindred by reason of a tumour or obstruction of some vessels their little mouths being throughly closed to this being so straitned that a passage may be made open by some means that which is thin and watery is extravasated and sent away into the neighbouring places as we have shewed above 2 2. In respect of the Lymphaducts 3. But an Ascites beginning alone doth often arise by reason of the milkie or lymphatic vessels being depraved wherefore seeing we suppose the cause of this kind of disease to be oftentimes conjunct we must enquire by what means and for what occasions these vessels are wont to be so opened or burst asunder that they pour out thei liquor into the cavity of the belly First therefore as to what belongs to the Lymphaducts these vessels may be in fault after a diverse manner but chiefly either that being obstructed or compressed near their origine they do not receive the humour or being burst about the middle or extream parts do pour it out into the belly There are many causes and reasons of effecting of either of these for it may be a viscous matter obstructs their beginnings or glandulous scirrhous and other preternatural Tumours compress them as also a vast inundation of Lympha flowing out moreover vehement motions of the Body or passions of the mind may burst them asunder 2. The milkie Vessels no less than Lymphatick are in danger to be broke 3. In respect of the milkie vessels and so by pouring out their liquor into the cavity of the Belly do excite the Dropsie called Ascites and truly they are wont to be hurt for the like reason in regard their middle passages or their ends either are obstructed by a more viscous chyle brought into them or by Phlegme from the intestines or they are compressed by Tumours bred in the Mesenterie for forthwith the chyle entering into the beginnings of the vessels and not finding a passage first very much distends them and afterwards breaks them There are many causes and occasions for which the thicker and obstructing humours are driven forwards into the milkie Vessels for besides an irregular Diet and for the most part from meats hard to be digested this evil is frequently caused by too much drink or immoderate exercise immediately after Food also from cold drink while the Bowels are very hot for so the passages of the Vessels before gaping are suddenly shut and afterwards more narrowly closed wherefore the chyle sticking within their straitned chanels doth throughly fill and obstruct them in a short space As to what belongs to the differences of this Disease besides them already cited The differences of this disease viz. that it comes after an Anasarca or comes solitary that this also is manifold and after a diverse manner according as the Vessels bringing blood or water or milk are found in the fault Moreover we observe that the Dropsie called Ascites sometimes proceeds from a meer watery humour filling and distending the parts of the nether belly but sometimes there happens to this deluge an extension of the membranes or inflations made by the irregularities of the inmate spirits and so they do encrease the swelling of the Abdomen and in this case a certain Tympanites comes upon an Ascites even as more frequently on the contrary this is the offspring of that Moreover in an Ascites meerly watery sometimes the Lympha only fluctuates within the Cavity of the Abdomen so that in the mean time the bowels being soakt in it continue still entire and little or nothing encreased in their bulk but sometimes besides the inundation of the Lympha in the hollow of the belly the blood being slowly circulated there and almost stagnating it is much diluted with water Moreover the Parenchyma of the bowels and the sides of the Vessels and of the membranes and chiefly the Glandules every where numerous being moisten'd do swell with the flowing water and so the tumour of the belly consisting as it were of many pools of water and moorish Contents rises into a vast bulk The Prognostick of this Disease is always suspected and accounted of an ill omen The Prognostick for none of the vulgar but will pronounce the obstinate tumour of the belly to be very dangerous and difficult to cure If any seem to be affected with a Dropsie or a Consumption with them presently the next question is Who shall be his heir An Ascites beginning after an Anasarca which proceeds commonly from the whole mass of blood being pour'd forth into serosities and sweating them out of the little mouths of the Arteries into the cavity of the Abdomen is accounted of easier cure or at least of more promising hope than that solitary disease coming from tumours about the bowels or from the Lymphatick or lacteal Vessels being burst asunder for as well the conjunct as procatarctick cause of the former Disease oftentimes is used to be removed wholly or in part but in the other case both for the most part exist incurable A reddish Urine lixivial and little in an Ascites is of ill signification for 't is a sign that the mass of blood being repleated with a scorbutick Salt and Sulphur boyled together is too much bound up in its substance insomuch that it doth not well separate the feculencies nor discharge them by fit and convenient Sinks which notwithstanding it doth evilly dispose by constraint into the Cavity of the Belly forasmuch as it is hindred in its Circulation in the very same place For in an Ascites the blood is not always dissolved as in an Anasarca but sometimes appears too much compacted in its temper yet so that the salt Serum being denyed to the pores of the skin and to the Urnary passages by reason of the Obstructions of the bowels is forced to break out within the abdomen If in an Ascites by a Purge taken the waters are evacuated with ease plentefully by stool and from thence
of small Cinnamon-water one ounce Diacodium three ounces Tincture of Saffron two drams Mix them and take one spoonfull at night if sleep be wanting Or Take Syrup of Cowslip-flowers three spoonfuls compound Poeony-water one spoonful Laudanum tartarized one dram take one spoonful if Watchings require it 3. Extinguishers of Thirst in this Disease being very thirsty Things mitigating Thirst ought frequently and in small quantities to be administred that that troublesom symptom may be restrained without much drink which is perpetually pernicious For which purpose Take of Conserve of Wood-sorrel passed through a Sieve three ounces Pulp of Tamarinds two ounces Sal Prunella one dram with a sufficient quantity of Syrup of the juice of Wood sorrel make a Lohoch of which let him lick often SECT II. CHAP. V. Of an Anasarca NOw two kinds of Dropsies viz. Ascites and Tympanie according to common reckoning being finisht although the third to wit an Anasarca for that it is an affection rather of the whole body than of the nether Belly appertains not properly to this place notwithstanding the Pathologie thereof having some affiance with the former we think sit to deliver here also its Cure in short The description of an Anasarca An Anasarca is described after this manner That it is a white soft Tumour of the whole outward Body or of some of its parts yielding to the touch and leaving a dent upon compression proceeding from a watery humour extravasated and accumulated as well within the interspaces of the Muscles as within the pores of the flesh and skin yea of the Glandules and Membranes It differs from an Ascites as to its outward form and appearance How it differs from an Ascites yet not as to its morbific matter which being the same in both distempers as it is heaped within the greater or lesser hollownesses it gains divers Appellations of the Disease The watery humour procuring an Anasarca The Original from the blood doth proceed altogether or for the most part from the blood for it being continually produced within the mass of blood by the fault and defect of sanguification it is poured out in greater abundance from the extremities of the Arteries than can be received or brought back by the Veins or the Lymphaducts or can be discharged by the Reins or pores of the skin and other vents of the serous Juice From these it follows that the material cause of this Disease is a watery humour The material and efficient cause and the efficient is blood which engenders waters and deposits them in the places affected We will exactly weigh the reasons of either of them and the manner of becoming and effecting it and first we will treat of the efficient Cause of an Anasarca 1. The affection of the Blood or rather the Hydropical brood The Blood its efficient cause in a double respect consists in these two things to wit First by reason of a failure or fault of sanguification it doth not rightly assimilate the nutritious Juice perpetually infused into its mass but suffers it to degenerate into a watery humour Then secondly by reason of the too loose mixture thereof it doth not retain that humour so degenerated so long within its consistence untill it might be discharg'd through fit Emunctories or Emissaries but lets it out every where near to the ends of the Arteries into the inter-spaces of the Vessels and there leaves it Either of these vices of the Blood we will consider a little more In the first place as to the former for the most part it is confessed by all First that it doth not rightly sanguifie that the Blood it self and not the Heart or Liver sanguifies by what of late is plainly understood concerning the functions of these parts yet by what means the Blood assimilates Chyle infused to it self and converts it into fresh blood to be bestowed to so many and diverse sorts of uses doth not easily lie manifest to us But what some affirm that it is made only by the exact comminution and commixtion of particles and for that cause the particles of either kinde being confused together they think that within the straiter passages of the Liver and Lungs they are kneaded and wrought together as it were with little pestils seems little probable to me but on the contrary I think these bowels as I have shewed already are constituted the Organs rather of separation than of mixture The reason whereof enquired into but the reason of sanguification altogether consists in this that the active particles of the old blood to wit the saline and sulphureous being placed in vigour with the spirituous immediately act upon the like particles of the infused Chyle as yet existing in an inferiour state and do so stir them up and ferment them that thereupon being extricated from the coverings of the thicker parts they are carryed into a like degree of exaltation or perfection with the former and being at length associated with them and made also homogeneous they put on the same nature of Blood the more thick and heterogeneous particles being removed thence to another place from those which they had deserted and gone away from For truly Sanguification is altogether finisht by Fermentation even as the maturation of the Must into Wine or Ale but the reason of the difference is that Wine being shut up in the Tub still remaining entirely in the same Mass is flowly fermented as to its whole consistence and is not accomplished but in a long space of time but the Blood constituted in a perpetual flux by the loss of some parts and the reparation of others is fermented by the parts still received fresh and is generated anew The old Blood for the most part affords the same thing towards the fresh Chyle The reason and manner of sanguification explained as Ferment from the flower or faeces of old Ale being put into new Ale notwithstanding as it were by a contrary manner because the huge mass of blood being formerly fermented doth suddenly ferment and alter the small portions of the Chyle continually brought in but the fermenting liquor in Ale in a very little quantity is put to the great mass of the other liquor to be fermented which it brings not to maturity under a long space of time After the rudiments of blood are so cast by fermentation the conclusion and perfect assimilation into blood is acquired by accension for surely that it is so enkindled as I think I have formerly shewed by demonstration which arguments chiefly taken from its proper passion although many have cavil'd at none have been yet able to overthrow Wherefore while the whole mass of blood consists of Blood and Chyle confusedly mixt together it is fermented while it is circulating andbeing divided into most minute portions is spread through the whole Lungs that it might be kindled successively according to all its parts by the nitrous air suckt in for by that means both the
do want Bridles not Spurs But in the Plague Small-pox and Measles broke out and in malignant Feavers sometimes the blood spontaneously flowing out portends for the most part evil therefore in those affects styptic Remedies or things stopping the eruption of blood are more convenient than breathing of a Vein Thirdly 3. Or Art out-done by Nature Notwithstanding on the contrary there are cases of shedding blood by Nature which Physick can no way imitate neither if they chance to fail can be supplyed by Phlebotomy In Feavers about the Crisis of the Disease to wit after the digestion of the matter that is to say the preparation for Excretion spontaneous Haemorrhagies if coming in time do far excell any Phlebotomie which none knows the best season of Moreover the Fluxes of the Terms and Haemorrhoids happening by Natures instinct are more advantageous than the mission of blood provok'd by Art in any of those places Between Phlebotomie and spontaneous Haemorrhagies Phlebotomy and spontaneous Hemorrhagies differ as to the subject and matter there is yet a notable difference although not of great moment in Physical practice viz. both as to the Subject and Matter of either of them for in this the blood being florid and throughly Scarlet doth for the most part only flow out of the Arteries but in the other Evacuation the Blood being of a black purple with a Scarlet Cream is only drawn out of the vein Whence the stream of Blood which is one within all the vessels and throughout continuous acquires such a diverse kind of appearance seeing we have shewed in another place it is not our present purpose to make any surther search into this Aetiologie because it concerns not much to the curing any distemper out of what vessel the blood be let provided it flow out largely But that the ancients do in some cases commend Arteriotomie and prefer it to an incision of a vein the Circulation of Blood not being then known we have elsewhere discoursed how well it may be done Hitherto of Phlebotomie compared with a spontaneous Haemorrhage The use and effects of Phlebotomy now our next business is to describe the use and effects thereof as well good as bad in Physical practice Wherefore we will first shew in general what alteration of the mass of Blood this Evacuation bring then what diseases it more immediately respects either of the whole body or its particular parts About the former How it affects and alters the Blood it is obvious enough that the blood is altered by breathing a vein both as to its quantity and temperament and as to its disposition and motion The first and most common Indication of Phlebotomie is 1. Diminishes its quantity that the plenty of blood be diminished by this Administration And truly this is a vulgar Remedy to remove or provide against a Plethora Any one though of the vulgar sort growing to a full habit of body le ts blood without the advice of a Physitian Moreover Rusticks and Countrey-men for healths sake Emission of the Blood is not to be either too prodigally or too slenderly made once or twice in a year cause blood to be drawn from themselves and their Beasts But although this custom is grown so much in use with some prodigal of their blood that they breathe a Vein on the smallest occasion and sometimes without any manifest cause notwithstanding we may find many others no less obstinate against this custome insomuch that for no cause will they lose any blood unless the greatest necessities be urgent Upon this matter whereas Arguments are alleadged on either part The reasons of the former hinted at that I may in few words determine what seems fit to be ordained in the first place it is requisite we grant that letting blood is convenient against a Plethora either made or beginning for by no other Remedy are the evils of that Affection wont to be better removed or provided against Notwithstanding the necessity of this evacuation ought to be declined as much as may be because from thence as we have intimated elsewhere the blood becomes more sulphureous and less salt and for that reason it most commonly disposes all men to be feaverish and to be fat Moreover the Great Remedy Blood-letting if it be prostituted to every little occasion becomes less efficacious to any grand affections when need requires To which we may adde that according to the vulgar observation by how much the more familiarly any one uses Phlebotomy he will the more frequently stand in need of it for blood being emitted to avoid a Plethora the rest of the mass will the sooner rise to a Plethora far otherwise than is the opinion of some who dread lest the store of blood be consumed by frequent Phlebotomie for that on the contrary by this means the quantity is more encreased although the Crasis be the worser for so the blood having lost much of its balsamick Salt and preservative against putrefaction instead thereof is filled with a pinguifying and more fiery Sulphur Secondly 2. Phlebotomie amends the mixture of the Blood Phlebotomie doth frequently correct the mixture and temperament of the blood in a manifold respect For in the first place if any thing heterogeneous be confounded with its mass which cannot be rightly digested nor easily excerned and sent away a Vein being opened the blood flowing out conveyes frequently much of the portion of that matter forth with it insomuch that the rest may be either subdued or expell'd For the orifice of a vessel being opened presently the blood fermenting gathers together the extraneous particles as much as possible and excludes that portion of it self wherein many of them are heaped up From hence we may observe the blood flowing out first and last to be well enough It restores its temper when that emitted between appears corrupt Also secondly the blood declining from its temperament is frequently restored by Phlebotomie For when the mass thereof by the Sulphur or fixt Salt or both together being exalted shall degenerate into sharp salt or saline-sulphureousness a portion of the blood being withdrawn immediately a new fermentation thereof arises and very often there is a transposition made of all the particles of that sort that afterwards the Spirits may a little emerge with the volatile Salt and recover their dominion the Sulphur and fixt Salt as is fitting being subdued For this reason it is that letting Blood doth not only confer great help in Feavers but also in the Scurvy Jaundies and beginning Consumption for the blood after the vessels are emptyed like the Stomach disburden'd doth better digest and assimilate any humoursingested and the more easily throws off and separates whatever is heterogeneous But if the mixture of Blood begins to be much loosned and become very bad Some distempers of the blood admit not Phlebotomy as in the Plague and malignat Feavers we must altogether abstain from Phlebotomie for the blood
best to referre the other to the hysterical Pathologie Here properly belongs to this place the blood flowing out of the Nostrile being the most general kind of passions of the sort For the present the Cure of the Hemorrhage of the Nostrils is only propounded and common to every Age Sex and Temperament so that from the Diagnostick and Therapeutick of it duely assign'd the uses and efficacies of Medicines stopping blood will best appear for what we proffer for the unfolding the Causes and Cure of this bloody eruption may be accommodated unto all other dreadful Hemorrhagies It is observable enough that the Flux of blood from the Nostrils doth happen to most men from extraordinary occasions for as oft as the blood about to break out through its own turgescency or through laxity of the vessels is apt in some place to make or find its way it is by a certain instinct of Nature very often directed to the Nostrils as to the part most easily opened A description of the Vessels from which Blood flowes The vessels from whence it flows in that place are slips of the arterial Branch going from the Carotides after having pass'd the Cranium it comes to the basis of the Cerebrum for this proceeding near to the mammillary Processes sends very many twigs from it self every where about of which some eminent ones passing the hole of the Sieve-like Bone with the smelling Nerves are distributed through the glandulous membrane investing the windings of the top of the Nose These nasal Arteries departing first from the Trunk of the Carotides within the skull anticipate part of the blood chiefly serous from the brain and lay aside the Serum it self and other watery recrements into the glandules of the Nostrils as into the proper Emunctories of that Region whence they distill into the cavity thereof Wherefore if the mouths of those little Arteries do alwayes gape somewhat by reason of the sweating out of the Serum it is no marvel if the blood it self being made more turgid opening them a little more which often are too loose of themselves bursts forth of dores Indeed this Emissary both of the Serum and of the Blood being apt ordinarily to open or on any occasion prevents or cures great incommodities of the brain or of the Praecordia yea and sometimes of the whole body For in the first place They are the same by which the Serum distills to the Nostrils this way the Serum as I said is derived from the head and when the mouths of those Vessels are vellicated or provoked by any sneezing Medicine put into the Nostrils the Serum is from thence more abundantly drawn out which yet doth not descend from the Brain as is commonly thought but is anticipated by these nasal arteries lest it should go to it from which when it is more plentifully drained and brought forth by the use of Errhines for that cause the Brain becomes more serene and exempt from vapours Then secondly lest the Brain should be overwhelmed at any time by blood more impetuously overflowing a portion hereof passing through these vessels and breaking out easily prevents it But sometimes it happens that an Haemorrhage of this kind The Blood flowing forth in too great plenty from these Vessels is very hurtfull rather becomes a Disease than a Remedy for whensoever the blood flows out more often and more abundantly than is fit from the Nostril if life be not immediately hazarded by reason of too great loss yet the remaining mass of the blood being impoverished thereby and losing its temper acquires a cachectick and frequently an hydropick disposition even as we have clearly intimated before where we also have shewn the Aetiologie of this distemper in common with other too great Hemorrhagies either to consist in the fault of the blood or of the vessels or of both together First The causes of such an immoderate flux the blood bringing an Hemorrhage of it self offends either in Quantity or Quality and therefore while occasionally it boyls up it cannot be contained within the vessels but either opening their mouths by distending them or unlocking them by its acrimony 1. From the fault of the Blood it skips out To which happens that the blood being sometimes dissolved in its consistence and as it were infected becomes unfit to continue the course of Circulation inasmuch as portions thereof separating from one another are partly fixed in the flesh or skin having suffer'd death and partly breaking out stirre up frequently dreadful and sometimes mortal Haemorrhagies as every where is discovered in malignant Feavers and sometimes in the Scurvy Notwithstanding the blood offending by meer Quantity or Acrimony unless the fault of the Vessels happening thereon provoke the flux thereof or too easily permit it seldom breaks out into a great Hemorrhage Therefore secondly 2. From the fault of the Vessels the vessels bringing blood as often as they conspire to produce that affection are usually in the fault either first inasmuch as their small mouths gaping by reason of the fibres being too loose and weak do not readily enough transvasate the blood out of the Arteries into the Veins which fault happens to scorbutick and cachectical persons or secondly inasmuch as by reason of the same moving fibres being affected with the Cramp and Convulsion the blood being snatcht impetuously to and fro and chiefly towards the Head is constrained to break out to continue the thread of circulation even as it will plainly appear in the case of a Patient which shall be shewn below 1. Prognosticks As to the Prognosticks although an immoderate flux of Blood in the Small-Pox Measles malignant Feavers and in the Plague doth ever presage evil and is expedient to be stopt notwithstanding it ought to be restrained not by meer cooling or revulsory things but to be chang'd by temperate Hydroticks into sweating 2. An Haemorrhage of the Nostrils though not great is more dangerous in Cachecticks with a weak Pulse and a cold sweat than a plentifull Hemorrhage in men endued with a Pulse strong enough and blood very fervent 3. They who are obnoxious to this Disease by reason of a Dyscrasie of blood and loosness of the vessels if there come upon both these a convulsive disposition of the fibres of the little Arteries they receive a far more difficult Cure and frequently are reduced to extream languishings by reason of the great losses of blood 4. From those who are feaverish when much blood shall flow out of the Nostrils and does not terminate the disease often-times in the place of a Crisis a delirous or a soporiferous affection succeeds There are many other prognosticks about a Hemorrhage accurately remarkt by Hippocrates which notwithstanding properly belonging to the discourse of a Feaver we omit in this place for truly the Cure in general of this Distemper is here almost only intended About which there will be three primary Indications Three primary Indications of Cure
a few days so cruelly encreased that it could hardly be impeded by any Remedies from degenerating into a Gangrene Wherefore when the blood being extravasated through the solution of the Union and wanting the afflux of the Serum whereby it may be diluted and brought back proceeds into an Inflammation What Remedies there is need of Fomentations and Cataplasms of Emollients being outwardly administred do often-times bring help inasmuch as the moist and sost particles falling from these go under the blood stagnating and dllute it and so pleasingly moving it together cause it to return the more easily into the Vessels hence it is that the moist applications of this king being administred outwardly do supply the defect of the intern Serum requisite to dilute the blood For this end oftentimes pureing and bleeding are required notwithstanding that the blood being so diluted and irritated into motion might be rendered fit for its Circulation there is also need that the Vessels which should receive it should be enough emptyed for which purpose Phlebotomy and Purgation are frequently of necessary use besides a slender Diet. And indeed according to usual custom we purge Cacochymicks or Plethoricks a little before or after the Issue is made and frequently breathe a vein in those Patients Neither are these Remedies ony fit in an Issue new made to provide against or discharge an Inflammation but also they are advantageous as often as that distemper ensues upon an old Orifice of the skin For as often as the blood being very impure and together growing feaverishly hot An Inflammation sometimes happens to old Issues doth enter into a separating turgescence it frequently hppens that it discharges its recrements and feculencles otherwise unapt to be purged out about the Fontinel and there being impeded in its Circuit by them accumulated together it is extravasated and for that cause brings on a fierce Phlogosis Such an affection not long since happening in a renowned ancient person and being neglected from its commencing within a short space of time degenerated into a Gangrene notwithstanding from which by the help of appropriated remedies carefully exhibited as well inward as outward he escaped not without great danger of life At some other time hereafter perhaps when treating of Cutaneous diseases we will speak more largely of the Aetiologies and Remedies of an Inflammation and of an Abscesse or Impostumation and Spachela At the present we will consider the other Symptomes of Fontinels 2. An Issue pouring out too much and stinking Ichor requires remedy 2. Whenever an Issue throws out too much Ichor which for the most part is thin and very stinking and sometimes discoloured so that the so vast loss of humour and that stinking not to be endured do require a Remedy in such a case there will be two chief Therapeutick Intentions viz. First that the mixture of blood be strengthened lest its consistence should be too prone to dissolution and serous efflux Of which there are two Intentions Secondly That the tone of the place ulcerated by the Fontinel be preserved and rendred exempt from any putredinal ferment so that no taint being there lodged in secret do impart any pollution on the blood passing through in Circulation whereby it being infected might presently goe into parts and the Serum be constrained there to discharge it self more abundantly This former scope of Curing enjoyns scarce any thing but moderate purging by intermission First that the Temperament of the blood be restored and a regular Course of Diet viz. that the Patient be restrained from all surfeit and excess as to the plenty of Nourishment the quality and seasons of receiving it likewise more especially from small Wines Cider and other acid liquors whereby the blood is wont to be dissolved into effluxes For indeed those that are so affected do smartly pay for any error or irregularity in Diet pain being immediately irritated about the Issue For due preservation of the tone of the place where the Issue is made Secondly to preserve the tone of the part ulcerated and exempting it from putrefaction let sedulous care be endeavoured that all nastiness be declined that both the solid things put into the orifice as also the Coverings whether Plaisters or Leaves of Ivy or Oyl cloaths be changed twice every day for in some persons any of these will quickly contract a stench and presently cause the Ulcer of the Issue to putrifie But if this tends to putrefaction immediately in place of a Pease or wooden Pill let a Pill of Virgins Wax be put in incorporated with red Sanders and Verdigrease Moreover let a Fomentation withall Morning and Evening with the Decoction of St. John's Wort Yarrow Centaury c. be made use of 3. Thirdly a dry and troublesome Issue requires help Sometimes a Fontinel like a dry Fountain pours out little or no humour the reason whereof is usually either for that orisice being not deep enough doth not penetrate the whole skin which is cured by piercing it deeper or the Ulcer though hollow and large enough yet remains always dry because the Serum doth not easily nor in plenty separate from the mass of blood by reason of its consistence being too much bound up and then the only remedy is to wear solid things within the Orifice which may more proyoke or twitch the mouths of the Vessels for which purpose Pease made of Ivy-wood or Box or of the roots of Gentian or Hermodactyls are often used with success 4. An Issue sometimes will heal up notwithstanding all endeavours to the contrary It often happens that the Orifice of an Issue being too mallow and sparingly sweating out lchor is grown over with a thin skin with the Pease included therein and the deep hole is healed up quite for which fault there is scarce an apt remedy to be administred Wherefore it is better to close that Issue rather than alsays in vain to fret the skin or transfer it to some other place 5. Sometimes it hath spongy flesh growing about the lips The sore of an Issue tending to healing and being forbidden often procures a spongious flesh about the edges and sometimes in the hollowness it self the reason whereof is because the nutritious liquor being conveyed to the ends of the Arteries and nervous fibres and being not immediately washt away by the serous Ichor fixes there and beginning to be assimilated stretches out both these vessels to fill the cavity with flesh and into these rudiments of flesh both the blood and Animal spirits flow most copiously and the blood in t he mean time being conveyed thither forms sprigs of veins within that bulk for its return Not with standing this flesh as yet rude and without shape being excluded for the most part from the hole grows up over the edge and when in this manner it rises higher than that it may possibly be covered and cloathed with skin and Cuticula it remains always naked and spongious
Cap. 1. Tab VIII part 2. ist Fig 1. Fig 2. Fig 3. THE SECOND PART OF PHARMACEVTICE RATIONALIS OR OF THE OPERATIONS OF MEDICINES IN HUMANE BODIES SECT I. Of the Medicines of the Thorax CHAP. I. Of the Organs of Breathing and their Vse IN the former Treatise having essayed to explain the reasons of every Medicine for the most part we have toucht only upon general Medicines namely which excite some Evacuation or recreate and restore the fainting Spirits or calm those which are too much raging and unquiet The Authors purpose in the present work But moreover there are many other Remedies and those of several sorts which are supposed to have respect to some peculiar part of the Body or some particular Disease and to be appropriated to those ends by a certain kind of specific virtue or operation Now as concerning both the 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 of these at least the chief of them viz. whether it be really so and for what reason it comes to pass to be so it seems now worthy to be inquired into And first of all we will treat of the Medicines of the Thorax viz. those that are wont to be prescribed against the Cough Phthisic Catarrh Asthma Dyspnoea and other Diseases of the Breast But since the reasons as well of these Diseases as of medicinal Operations in healing them seem very abstruse and most difficult to declare The parts of the Thorax therefore before I enter upon this task something ought to be premised about the parts themselves as well touching their uses and ordinary actions as their sicknesses or preternatural affects As to the first the parts of the Thorax are either principal as the Heart and Lungs with the Vessels appendent unto them or subservient as the Membranes and Muscles with the Diaphragma as likewise the Ribs with the Vertebra's the Pneumonic Vessels with the nervous Fibres and Glandules The consideration of the Heart and its Vessels doth not properly belong to this place because not so much the sicknesses of the Breast alone as the general sicknesses of the whole body are usually reckoned amongst its passions Whereas therefore the remedies appointed to cure the diseases of that region have special respect to the Lungs and to the other Organs of breathing serving them therefore first we will describe the fabrick and use of these parts then their diseases afterwards together with the method of cure and remedies and lastly endeavour to add the reasons of all these The substance of the Lungs was always accounted by the Ancients and mostly hitherto by modern Authors for flesh and a Parenchyma like the frame of the other bowels which notwithstanding was accounted lighter and spongeous for as much as it was apt to be distended much by air pufft in The substance of the Lungs altogether membranous and to float upon waters Moreover whereas the Lungs taken out of an Embryo look red and sink in water and the Lungs of some grown persons being boiled appear compact enough and more solid almost no man doubted but they consisted really of flesh until lately the renowned Malpighius a most diligent Searcher of Nature found those parts to be altogether excarneous and meerly membranous and therefore he judges the bulk of the Lungs if the Nerves and certain Vessels be separated with the branches of the Trachea to be a certain heap of little Bladders and those small Bladders every where stretched out and sinuous to obtain such position and knitting together that an entrance lies open into them from the Aspera Arteria and so from one into another until at length they all end in the Membrane inclosing the Lungs And truly that it is so he makes clear to sense by an Experiment For let a Lung be taken out hot and let water be so often cast by a Syringe into the Pneumatic Artery as till the whole frame appear somewhat white and almost transparent the blood being clean washed out afterward this water being squeezed out by pressing and the air let in by the Wind-pipe and pen'd in let the Lung so filled be dryed and it does not only whilst exposed to the light outwardly shew transparent little Bladders but being inwardly cut it presents a white heap of little Bladders to the eyes Besides having viewed it with a Microscope he discovered a certain wonderful Net binding and knitting together every one of those little Bladders which Net consists of the minute productions and branchings of the Artery and Vein which Vessels circulate the blood by the small and crooked passages and by the many turnings of the Pipes The most renowned man hath found out beside these little Bladders for the most part constituting the frame of the Lungs a new and more admirable furniture of this Bowel Consisting of almost infinite Lobes viz. he shews plainly the bulk of the Lungs to be blown up by almost infinite lobes girt about with their proper Membrane which being endued with common Vessels grow to the small twigs of the Aspera Arteria the insertion and situation of which kind of little Lobes are manifold as being sometimes affixt to the Basis of the Trachea sometimes to the Ribs or to its Cone also according as they end in the outward and plain superficies or in the corners of the Lungs and according as they ought to have a due position knitting and inter-spaces among themselves rightly to fill up the frame of the Lungs The little lobes out of which each lobe of the Lungs is made up in the third Table are accurately and to the life expressed Certain inter-spaces distinguish these little lobes which manifestly appear in a larger Lung or in any other half boiled which as the renowned Person hath observed are not bare cavities or empty spaces Their little branchings but they have many Membranes spreading from the little lobes some parallel some angular and are also covered with many Vessels so as these inter-spaces are certain membranous little bladders yet transparent and most thin If you lightly open in one single lobe of the Lung one of these inter-spaces with the point of a knife and shall blow into it by a small hole through a Pipe presently that whole lobe will be very much extended every interspace being pufft up and then if you bring this frame to the light the inter-spaces being made transparent do sever by great intervals every lobe very conspicuous and so every rank of the lobes will appear like a Polypody-leaf and under the same figures as Malpighius hath described and are represented in Fig. 2. of our third Table But when the little lobes are filled and extended by liquor easily congealing cast into the passages of the Trachea the appearance thereof is somewhat diverse and seems in the form of Grapes as is expressed in Fig. 1. of the same Table The Veins and Arteries every where accompany this production of the Aspera Arteria and extend themselves
and motion either in the whole or at least in some parts And truly it is manifest even to common observation that its more inward passage doth excel with a most acute sense for as much as it is so much provoked by the smallest prejudice that presently it is wonderfully forced into a convulsive motion viz. a Cough but as a sense of annoyance and from thence very often an instinct of motion arises from this Vessel so we think that its Fibres do after a sort move of themselves both in breathing and coughing Surely in respect of this it is not to be doubted because in this inner Membrance we find two orders of muscular Fibres in that fashion disposed as in the Aorta and Intestines to wit there is one upper order of straight Fibres which while they are contracted make all the circular Cartilages to be drawn together nearer to one another and for that cause to abbreviate the Trunk of this Vessel according to all its parts successively Under this lies another order of circular Fibres which while they are pufft up being contracted the hollowness of the Wind-pipe is much narrowed Therefore when the moving Fibres of either kind make the passage to be straitned according to all its dimensions it is obvious enough that they conduce to the discharge of the function of breathing and more or less to be active as there is endeavour to breathe quicker or slower more intensly or more remiss These Fibres being more vehemently contracted in a Cough in hawking in blowing out and certain other more strong exercises of expiration do force the breath and other contents of the Aspera Arteria to be violently expelled Moreover from this action sometimes either depraved or hindred it shall be declared hereafter how an Asthma a Dyspnoea and some other diseases about breathing do arise This inner musculous Coat hath also two others The glandulous and vasculous Coats as if growing thereunto to wit one glandulous and that full of vessels For as in another place we have remarked about the Anatomy of the sanguiferous Artery one may also here take notice that the inward Pipe of the Wezand is covered with a most thick weaving of Vessels of every kind and especially of those carrying blood in fashion of a Net The Arteries not springing from the Pneumonic Vessels but from the Bronchial branch which the most renowned Mr. Ruisch discovered to have its rise from the Aorta are inserted into this same which the veiny slips do accompany owing their origine to the Vena cava The nervous sprigs meeting these two are variously folded and so of all weaved together is framed as it were a little Net covering the whole back of the Weazand under which folding of Vessels very small and whitish Glandules are every where strewed or rather cleave to them just in the like manner as we have in another place shewn to be in most other greater Vessels and in all membranous Bowels on all which the Lymphaeducts adjoyned do wait As to the use of these without doubt the Arteries and Veins wash through the Pipe of the Weazand with bloody stream for its nourishment and the Nerves carry plenty of Spirits and the faculty of performing motions to the muscular Fibres Afterwards whatsoever of superfluous moisture be left by the Arteries that the Veins cannot bring back the Glandules do receive and retain until it may be sent back to the mass of blood through the Lymphaeducts When they are too much filled by reason of the Lympha more plentifully left a humour distilling from the Glandules as well as from the Arteries into the hollowness of the Wind-pipe brings a Catarrh All the Coats of the Aspera Arteria distinct and separated from each other are expressed in the seventh Table The second part of the Wind-pipe commonly called Bronchos Of the Bronchia begins from the entrance of the Lungs for near the fourth Vertebra of the Chest that great Pipe descending is divided into two Trunks one whereof goes towards the right side of the Lungs the other the left afterwards both haveing entred the Lungs and being subdivided for the greater Lobes distribute very many sprigs as for the most part in the gills of fishes to the Lobes or lesser Lobes through the whole frame of the Lungs The passages of all these are furnished even as in the Larynx with Cartilages but framed something in a differing manner for in the Bronchia these are not Ring-like but resembling a Coat of Male so that when there is need to contract those passages the inferiour Cartilage goes under the hollowness of the upper almost in the same manner as it is in the joynts of the shelly Coat of a Lobster Provision is so made by the work of God that when the Lungs are dilated the Bronchia are stretcht out into the greatest length and when they are contracted the Bronchia are abbreviated one part being drawn into another The Coats of the Bronchia as also of the Larynx Their Systole and Diastole have muscular Fibres of both kinds together with the Glandules and the Net-like twisting of Vessels from whence we may also conclude that all the lesser Pipes of the Aspera Arteria have their constant turns of Systole and Diastole viz. all the Pipes are contracted while we breathe out and relaxed while we suck in air moreover from the same Glandules and little Net of Vessels every where continued almost within every inward recess of the Lungs doth distil the Catarrh humour A certain Bronchial branch of the Trachea belonging to each Lobe of the Lungs is described in the second Table H. H. And the branched Bronchia of both sides not only constitute two or more greater Lobes but as Malpighius hath observed The Lobes of the Bronchia many lesser or little lobes distinct among themselves for each Bronchial branch sends forth to and fro many little branches or twigs every of which twigs being joyned with alike twigs of the Pneumonic Artery and Vein from thence are parted into innumerable lesser sprigs all which being every where fellowed and complicated among themselves and having got Nerves and peculiar Lymphaeducts and ending in the outward superficies of the Lungs represent as it were a certain private Grove and so the whole structure of the Lungs consists of many little branches of the aforesaid Vessels complicated as it were of so many several Groves The branches whereof and outmost sides of which Their little branchings disjoyned from one the other although they may seem mutually to touch themselves and cleave together yet they are disjoyned one from the other and are every one bounded within their proper limits far otherwise than the productions and communications of Vessels are in the Brain where the Arteries and Veins rising up in its several corners extend on every side and creeping through its whole space and mutually inosculating do all communicate among themselves That former fashioning of the Vessels
Secondly the Nitrous particles of Air are wont to be obscured or blunted by other accessories also sometimes they are too much sharpened For as often as the South-wind blows the Air is too moist and thick inasmuch as the Nitrous particles are seiz'd upon by the watry and sulphureous and are much blunted so that while it is drawn in the blood is not vigorously kindled but like green wood put into fire it rather smokes than burns bright wherefore during such a state of Air we become stupid and dull and unapt for motion but on the contrary the North-wind blowing the cooling sharp and most nipping particles are adjoined to the Nitrous and the blood is enough kindled and we breathe freely yet the Vital flame is every where restrain'd by intense frost disproportion'd thereunto and unless refresh'd by motion and heat it is frequently entirely extinguished 2. Besides these faults of the Air whereby breathing is wont to be hurt The defect of air hurting breathing proceeds from the pneumonic Organs moreover this evill sometimes proceeds from its defect inasmuch as it cannot be drawn in in plenty enough Of which effects though there are many and divers causes yet for the most part it happens in respect of the organs of breathing either hindred as to their motion or their passages obstructed 1. The Organs of breathing are either meerly passive viz. which are moved as the Lungs or are Active and move themselves and those together as the muscles of the Chest and Diaphragma In every of these the impediments of the motion by which breathing is hurt happen variously And first what respects the Lungs we mentioned before that they sometimes very much swell by reason of the vessels being much distended and fill'd with blood insomuch as being stiffe and inflexible they obey not the turns of the Systple and Diastole of the Chest Moreover it happens sometimes through a phlegmon little swellings and other concretions of divers forms that a like stiffeness is caused in them Secondly the active organs of breathing or the moving parts viz. the muscles of the Chest and Diaphragma are wont to be perverted or stopt from their moving function by divers causes A solution of continuity made in any part of these either by clotting of blood or by falling down of the Serum and other homors as in the Pleurisie and Scurvy or in those that are wounded or bruised doth every where cause pain in the place affected with impotency of motion and difficult breathing Moreover sometimes without pain or any evident cause those parts being hindned from their motion do produce a most heavy pursiness As is frequently seen in an Asthma Suffocation of the womb and in certain other convulsive or hypochondriac distempers The reason of which passion without doubt consists in this for that the animal spirits appointed to the moving function of those parts are disturbed about their Origine or hindered in the passages of the Nerves and are turned aside from their due influx into the moving fibres Insomuch as many who are sound enough as to their Lungs and only obnoxious to affects of the Brain and Nerves are frequently surprized with horrid fits of an Asthma as we have at large declared in another place 2. The stopping of air hindering breathing whereby it less freely enters the Lungs frequently happens by reason of the Conveyances viz. the passages of the Trachea being shut or not enough open For indeed those passages are wont to be stopt as we have formerly observed touching the Vessels bringing Blood and prohibit the full entrance of air when they are either obstructed or compressed or more narrowly contracted The various ways of Obstructions Though there are many causes and wayes whereby the passages of the Trachea are wont to be obstructed yet chiefly and most often a Catarrhal distillation of the Serum while it departs from the blood and flows out of the vessels bringing blood into these parts which being first thin and sharp produces a troublesome Cough afterwards thickening by digestion and cleaving to the sides of the Trachea exceedinly straitens the ways of inspiration A Catarrb and shortens them by quite stuffing up their extremities In like manner the sweating out of extravasated blood as also of Pus or ichorous matter out of the Lympheducts or Veins into the tracheal little bladders doth frequently produce an Asthma and often a Consumption the reason of which sort of distempers shall be more largely explained hereafter Secondly it is manifest enough by common observation that the Tracheal passages as well the last as the intermedial often-times are straitened or shut The swelling of blood by which the passages are press'd together by compression For after a plentiful meal or abundant drinking of Wine or strong Ale inasmuch as the pneumonic vessels are very much distended by reason of the turgency of blood and the sides of the Trachea being press'd together do not admit of a free and usual entrance of air men otherwise healthful enough do breathe difficultly and painfully Which truely we esteem to happen from the lungs being filled and extended rather than from a cram'd stomach hindering the Systole of the Diaphragma Moreover for this reason even in the very paroxysmes of feavers a frequent and painfull breathing is manifest Neither onely from the turgency of blood but also from the same stagnating or extravasated and also from stony concretions and divers other manners the vessels of the Trachea being pressed together cannotdischarge a free breathing 3. The passages of the Trachea being sometimes more nearly contracted and closed from their fibres convulsively disposed deny a passage to the Air for due breathing The Cramps of the tracheal passages From hence when there is no obstruction or ill conformation in the lungs as also no consumptive disposition yet from those fibres preternaturally convulsed and drawa together dreadful fits of an Asthma frequently arise Whereas we have in another place discoursed of these passions it will not be requisite here again to repeat that discoure Resides these accidents of breathing hurt there are certain others which are stirr'd up by reason of the Air prohibited in its frist entrance viz. in the Nostrils the throat the Larynx from a tumour or ill conformation For the Polypus in the Nose the Quinzy in the Throat or inflammation of the Tonsils do render a difficult breathing in the same manner as a heap of sand about a Haven obstructs the ingress and regress of Ships But truly since the reasons of those passions and their manner of being made are exposed to sense it seems superfluous here to deliver their causes SECT I. CHAP. IV. Of Expiration hurt AS Expiration is much easier The act of expiration is easier than of inspiration and with lesser trouble performed than Inspiraration so it is less endangered to be stopt or perverted as to its function for in truth the contractive endeavours of fewer muscles are required to perform that
Nature as far as is possible to be presently sent out of doors But if the extravasated blood be thrown into the interspaces of the little Lobes or soaking out of the outer Membrane fall into the cavity of the Thorax it doth propagate an Empyema and frequently an Imposthume in that place But for the most part the blood subject to fall from the pulmonary course produces various kinds of bloody spittle Either in the Larynx or in the middle of the Bronchii or in the orbicular little bladders according as it makes its nest either upwards within the cavity of the Larynx or a little beneath about the intermedial passages of the Trachea or lastly further within the orbicular little bladders The first distemper proceeds alone from the mouths of some Artery being opened which covers the trunk of the Trachea the next sometimes perhaps from this cause yet more often from the pneumonic Arteries themselves being open or burst asunder which vessels as they are greater pour out often a dreadful quantity of blood the spitting out whereof proves plentiful and violent in regard that the muscles of the whole breast together with the fibres of the Trachea are much provoked and greatly contracted But if the spring of bloody spittle consists in the lowermost little bladders the blood is thrown out more sparingly but with a profound frequent and very troublesom Cough 3. And from hence which was in the third place purposed the differences of bloody excretion out of the Lungs and the manifold modes and courses of bloody spittle are made known For the blood soaking into the Larynx after a small tickling in the throat without coughing or hawking doth easily and almost insensibly ascend into the mouth and if an extravasation of this kind of blood happens in sleep it presently flows out of the mouth upon wakening they being scarce sensible of it in as much as the moving fibres of the Trachea being contracted while one sleeps have then emptied the blood fresh distilled into the mouth But if from a greater vessel gaping or burst about the middle of the Lungs the blood which is ever frothy does break out abundantly into the Tracheal passages this by an outragious Cough raised thereby is forthwith cast upwards with violence and in great plenty insomuch that the sick seem rather to vomit than cough out blood And finally if the blood breaking out of the foldings of the vessels wherewith the orbicular little bladders are incompassed falls down into those little cells from thence it is discharged by turns in lesser quantity and not unless by a strong and very frequent Cough So much concerning the formal reason The procatarctic and evident causes thereof the conjunct causes and differences of an Haemoptoe as to what belongs to the primary and evident causes either of them are manifold and various In the former number are reckoned first an hereditary indisposition of the Lungs whenas they have originally been weak and soft with a straitness of the breast Moreover their ill temper from a Cough Empyema or Pleurisie going before and especially an obstruction or ill conformation do very much dispose to spitting blood and so much the rather if in such a habit an acrimony or Dyscrasie of the blood shall accrue from an ill course of Diet unwholesom Air or by any other means The suppression of the Menstrua the Haemorrhoids or blood flowing from the Nostrils incline most to a spitting blood Secondly among the evident causes ought to be reckoned primarily the excess either of heat or cold for when the blood grows above measure hot or the transpiration thereof through the Pores of the skin is hindred thereupon swelling after a huge manner it frequently bursts out of the pneumonic Vessels From hence Hippocrates long ago observed and as yet it is a vulgar observation That spitting blood most frequently happens in the winter when the North-wind blows Neither less seldom hath the use of bathing brought this evil upon many before the use whereof they were healthful enough Moreover many contract this from drinking of wine and strong waters from a blow a fall hollowing vomiting coughing or any other violent stirring of the whole body or of the Lungs Also certain poisons and according to Hournius the Lunar beams the reason whereof doth not easily appear neither doth there remain any credit thereto are reported to provoke this distemper The Prognostics of this disease are enough known to the vulgar The Prognistics of this disease whereas there is not any one of them who doth not suspect the spitting of blood as very dangerous Nevertheless whereas the kinds hereof are various one is found more or less dangerous than another The blood soaking out of the vessels of the Trachea is often free from any evil moreover when breaking out from the lowest and lesser pulmonar Vessels it often admits of Cure at least it is much safer than a plentiful spitting of blood happening from the great branches of the Artery being opened into the Trachea But the predisposition of the Patient makes a great difference in the Prognosticks of this disease for if blood-spitting be provoked by reason of a solitary evident cause and shall happen to a body formerly sound and well set there appears far greater hope of help than if the distemper arising of its own accord shall happen to a cachectical phthisical scorbutic or otherwise sickly body However 't is a common observation that this disease is dangerous and always difficult to cure the reason whereof is also clearly manifest for as much as the function of the Lungs consisting in a perpetual motion is altogether contrary to the method of healing a wound whereto primarily ease and rest are required In like manner this happens to be a greater hindrance to its Cure in as much as the frame of the Lungs is not a Parenchyma as was thought but a texture or very subtile web of innumerable vessels the unity whereof if once dissolved it will be altogether impossible for the ends of the disjoined vessels to meet again together or the space to be filled up with flesh or callous as in other parts But there is this only to be hoped that while the ends of the vessels grow together incongruously and always imperforated the circulation of the blood ceasing in the part distempered may be supplied by another neighbouring part which indeed rarely succeeds without hurt or prejudice of the whole Lungs As to what appertains to the Method of healing the Haemoptoe or spitting blood The Cure thereof the curative indications shall be chiefly these two viz. to stay presently and restrain the flux of blood then secondly to heal the dissolution of unity without any relicts of a Consumption in the Lungs I. As to the former these two things are chiefly to be procured 1. Indication viz. first that blood flow not to the part distempered and secondly that in the mean time the opening of the vessel
may be some-how shut 1. That the blood may not flow to the part distempered 1. It stops the flux of blood there are many intentions of healing in use viz. it will be requisite to diminish the abundance of blood to restrain the boiling thereof to alter the intemperament and depress its motion or divert it another way for which purposes Phlebotomy Ligatures and Frictions are often convenient also Juleps Decoctions Emulsious and succulent Expressions of Herbs ought to be drunk Likewise moderate Hypnotics and in the first place Diacodiates are exhibited with success for these by restraining the motion of the Heart do force the blood to cool 2. That the opening of the vessel may be shut 2. It shuts the opening of the Vessels astringent and agglutinating remedies are in the first place convenient The chief of these are used to be exhibited in the form of a Linctus so that while one swallows certain particles gliding into the rough Artery may more immediately communicate their power to the part diseased But the reason of this operation seems not to be of any great moment because the efficacy of the Medicines themselves chiefly and almost only by the conduct of blood reaches to the seat of the disease Wherefore not only Lohochs but also Decoctions Powders and Pills of vulnerary and balsamic Ingredients are prescribed with success The forms hereof we shall annex beneath II. The second indication which is also preservatory II. The second preservatory indication respecting the healing of the dissolution of unity without any remaining hurt of the Lungs ought to provide against two sorts of evils viz. lest the spitting blood whereunto the distempered are afterwards always prone begin again and lest a Phthisis succeed which threatens every body subject to the Haemoptosis For these ends for the prevention of this disease daily care and constant course of healing ought to be ministred to the blood and Lungs 1. As to the blood the mass thereof ought to be contained ever in a due quantity 1. It respects the blood which is to be kept in a right Crasia and a right temperament with a mild and equal motion Hence lest it superabound or distempered with a Dycrasie enter into turgescencies or lodge its impure feculencies in the breast it is requisite sometimes to use Phlebotomy and a gentle Purgation An exact course of Diet is always necessary Moreover for the depurating and sweetning the blood drinking of Asses milk or of Medicinal waters sometimes does greatly help But Decoctions distilled Waters Juices of Herbs which carry away the ill temperaments of blood and derive the Serum and other impurities from the Lungs and bring them forth either by Sweat or Urine are to be carefully drunk Besides for this purpose Issues do chiefly conduce 2. Neither ought there to be less care of the Lungs themselves 2. A 〈◊〉 frame of the Lungs to be procured namely that the whole frame thereof and chiefly the place affected be preserved in due frame and right tone Hence every violent motion whereby its unity is more dissolved or the restitution thereof hindred should be industriously declined Let the party live in a clear and open air but not too fierce or sharp let him abstain from grosser foods from Noon-sleeps from plentiful Suppers and other errors in diet which induce either repletion or obstruction upon the Praecordia But let remedies be admitted in daily use which by a peculiar property or certain specifick vertue are reported to heal the Lungs The method of healing requisite for spitting of blood being shadowed after this manner there yet remains as to all the therapeutic indications and according to the various intentions of healing which belong to them for us to subjoyn some more choice forms of Remedies whose Van those deservedly lead which meeting with the symptom most urging do suddenly restrain the flux of blood cast out by coughing or otherwise out of the Lungs In the first rank of these Medicines those are reckon'd which hinder the blood from flowing to the part affected and together are impregnate with a certain astrictive and agglutinative power whereby the opening of the vessel may be shut The forms of Medicines and after the Belly being cleared with a Clyster and Phlebotomie unless a weak pulse and defect of heat withstand it made use of there is wont to be given somewhat in form of a Julep Decoction Emulsion juicy Expression Powder Pills or Lohochs We will annex certain more elegant and more efficacious Receipts of all of these as likewise of Narcoticks which notwithstanding ought not every where and indifferently to be used but methodically and seasonably according to advice of a discreet Physician according to the various constitution of the patient and condition of the disease 1. Juleps and Distilled Waters Take of Purslain and Poppy-water of each 6 ounces Juleps Dragons-blood in most fine powder half a dram syrup of red Poppies two ounces spirit of Vitriol of Mars ℈ ss mix them the dose ℥ iij. repeated once in 5 or 6 hours Take of Plantane-water lb j. Gum Tragacanth and Arabick powder'd of each ʒss mingle and dissolve them after adding syrup of dryed Roses ℥ j ss make a Julep the Dose ℥ iij. or ℥ iiij every third or fourth hour Take of the water of Oak-buds red Roses Water-lillies of each ℥ iiij of Blood-stone finely ground Bole-Armenick powder'd of each ʒss syrup of Water-lillies ℥ ij mix them the dose ℥ iij. or ℥ iiij three or four times a day Take of the Dew or almost insipid Phlegm of Vitriol lb j. Syr. of Myrtles ℥ ij mix them Distilled Waters the dose ℥ ij or ℥ iij. often in the day or in the night Take of Cypress-tops M. viij of the leaves or flowers of Willow M. vj. the greater Comfry-roots Water-lillies of each lbss Pomegranate flowers M. ij All being cut small together pour on them lb viij of new Milk let it be distill'd in common Organs the dose ℥ iij. or iiij often in a day Take of this distill'd Water and of Plantane-water of each lbss Gumm Tragacanth and Arabick of each ʒ ij dissolve them the dose is ℥ iij. every third hour The following Mixture is prescribed by Dr. Frederick Decker to be taken a spoonfull at a time in spitting blood and seems a very beneficial one Take of Plantane-water ℥ ij Cinnamon-water ʒ ij conf of Hyacinth ʒ iss distill'd Vinegar ℥ ss of red Coral prepar'd ʒss Balaustins Dragons-blood of each ℈ ss Laudanum Opiate gr iij. Syr. of Myrtles ℥ j. mingle them Take of Plantane red Rose and Purslain-water of each ℥ iiij of Blood-stone and Dragons blood reduced into fine-powder A Julep of each half a dram Sugar-Candy ʒ vj. make a Julep A Solution of common Vitriol or of Vitriol of Mars made in Spring-water and applyed with a rag to a wound wonderfully stops bleeding but is scarcely convenient to be given inwardly 2. Decoctions Tinctures and
afterwards he used the pectoral Decoction three months and a very slender Diet viz. without any flesh only of Herbs Barley c. and Milk-meats in a short time he recovered his former health and now lives in that state so triumphing over that cruel disease that many Haemoptotic persons consult him as their Oracle and for a Cure do propound a method of this kind of living to be followed before the Physicians advice What is most wonderful in this case is The reason of the case that after so many breaches so often happening in the Lungs this famous Person was not in the intervals affected with a Cough neither fell afterwards into a Consumption whereas most after any of the smallest vessels being open in the Pracordia for some time after labour with a Cough with plentiful and thick spittle and at length frequently become consumptive And that it happened otherwise to our Patient I chiefly attribute to the balsamic constitution of his blood viz. in the mass whereof the serous recrements are either less collected or so strictly mingled that they cannot be easily separated thence wherefore after the vessels were broken or their unity dissolved a plentiful I chor or sharp humor being wont to generate a Cough and Spittle did not sweat out as in many others Moreover what he himself observed contrary to many others that his spitting blood happened never in winter but in Summer came also so to pass by the same reason because when the blood did less abound with vaporous recrements the opening or obstruction of the Pores were neither an advantage nor prejudice to it nevertheless the blood growing hotter than it ought to be seeing it exhaled not there was a necessity it should break out of the vessels and when again diminished in quantity sending away little or no serous Ichor out of the orifices of the Vessels the spitting of blood ceased without a remaining Cough The same reason holds of many that spit blood wherefore some are found much inclinable others not prone to a Consumption This Gentleman ever found the use of the pectoral Decoction advantageous to him wherefore when he often varied other Medicines he always retained the same Decoction moreover he hath commended it to many others spitting blood with success The form of the Prescription was this Take of all the Sanders of each six drams A Drink infuse them for twelve hours in seven pints of Spring-water then hoil them to a confumjption of a third part after add leaves of Colis-foot Maidenhair Mouse-ear Speedwel flowers of St. Johns-wort each two handfuls sweet Fennel-seeds six drams Liquorish half an ounce Raisins stoned half a pound boil them to four pints afterward strain it and keep it for ordinary drink Moreover the spitting blood threatning and pressing upon him he took thrice or oftener a day the quantity of a Nutmeg of the following Electuary drinking after it seven spoonfuls of a Julep Take conserve of red Roses three ounces The Electuary conserve of Hips Comfry each an ounce and half Dragons blood a dram species of Hyacinth two scruples red Coral a dram with a sufficient quantity of syrup of red Poppies mix them and make a soft Electuary let him take hereof evening and morning a dram and half drinking after a draught of the following Julep At other times let him lick it with a Liquorish-stick Take Plantane and Spawn-Frog water each six drams The Julep syrup of Coral dried Roses each an ounce Dragons blood two scruples mix them and make a Julep Among the examples of them that spit blood the case of that Reverend person Dr. Berwick S.T.P. and lately Dean of St. Pauls Church ought not to be omitted which some while since I learned partly from the Patient himself and partly was communicated to me from his Brother that most skilful Physician Dr. Berwick my most dear Friend That most renowned Divine fifteen years before he died laboured with a most obstinate Cough The second History and sometimes with a bloody and falt spittle with a grievous breath stinking like Heel by which being made lean by a pining away of the body he wanted but little of being almost extinguished by a Consumption As often as his spitting blood intermitted the rankness of breath and spittle ceased also afterwards the return hereof declared constantly that other affect to be presently attendant In this languishing condition when this Renowned man was discovered to favour the Kings Party at that time oppressed with a grievous Tyranny and being cast into a strait Prison did drink meer water instead of ordinary drink he recovered his health beyond the hope and expectation of all persons and so remained indifferently healthful for above ten years space Nevertheless afterwards I know not by what occasion unless by the hardship of a cold winter not only the aforesaid evils viz. a Cough with bloody and salt stinking spittle did become fierce upon him but also over and above a debility of stomach want of appetite and a nightly Feaver did accrue But not long after these Symptoms a little remitting fair weather again seemed to shine out until on a certain day the air being suddenly changed into an intense cold towards night he was assaulted with great straitness of breast and difficult breathing with a quick and weak pulse and fainting of all his spirits as if he had been expiring Nevertheless from his danger he suddenly escaped by the interposition of a Crisis viz. by a plentiful spitting of blood and after by a breathing Sweat but from that time his spittle remitted much of the usual stench and something of its saltness and when in a short time afterwards the last and most painful invasion of spitting blood threatned him that usual presage from stench of breath was wanting but the subsequent spitting of blood being very plentiful did so dcebilitate his strength that from that time declining sensibly he expired within a month and when a little before his decease by reason of a sharp pain in his side a Vein was breathed his blood seemed to fail so that almost none streamed out Moreover in his body dissected after death very little quantity of blood was found nor could they find any footsteps of the other most notable Symptoms viz. spitting of blood and of the stinking breath and spittle for there was no collection of any filth or stinking and putrid matter nor any cavity in the Lungs made by an Ulcer or Wound but only one lobe of this bowel or rather the whole left side was so hardned from a scirrhous Tumor that the blood could not easily or but very little pass through the frame being so obstructed and as it were stony wherefore it is no marvel if the blood that should have passed most swiftly through the Lungs did now and then burst out in some place from the vessels which were joined together or suffered not a circulation by reason of the Schirrosity Notwithstanding here a greater
less prejudiced and as it shall be more intense or remiss this disease also is denominated either more or less acute As to the Prognostics of this disease Prognostics common experience doth attest that it is a very dangerous disease because many Patients either die of it or very difficultly recover health No less may we conclude this from the reason or Etiology of it for a wound with much extravasation of blood or a stagnation caused in the Lungs is most difficultly cured and the affected place is never restored unto its former conformation The prognostic signs which are of greatest note are taken from the appearance of Symptoms and nature of things thrown out and the state of strength 1. 1. From the appearance of Symptoms A Peripneumony coming upon a Pleurisie or Quinzy for the most part is worse than arising of it self or succeeding either of them but if upon this disease after what manner soever begun an acute Feaver follows with great thirst watchings and not breathing unless set upright it is ill and yet much worse if upon it a Delirium a Fenzy convulsive motions or a Palsie on one side ensue Moreover the Patient is not in less danger if he be very pursie if troubled with vomiting or frequent swounding away a weak Pulse and a cold Sweat For while these Symptoms are instant upon him the obstruction of the blood in the Lungs is not removed nothing is digested or ejected by spittle but the circulation of the blood being more and more hindred and its kindling by breathing stopt the animal spirits are throughly disordered and at length faint until together with a prostration of the whole strength the vital flame is extinguished 2. 2. From what is excreted As to Prognostics from things excerned we observe a Peripneumony to be dangerous wherein nothing is thrown out by spittle next to this then the spittle is thin and crude mixed with blood it is far better when the spitting is yellow and thick streaked with a little blood The Urine being yellow from the beginning and of a good consistency with a cloud in the midst shews that almost all the recrements of the blood are lodged in the place affected when from that state it is changed into a thick and turbid Urine it shews the morbific matter to be swallowed up again from that part into the blood but if such kind of Urine be suddenly changed into a thin one then a Delirium or death it self is impendent Much Sweat and plenty of Urine a Diarrhoea bleeding at Nose flowing of the Menstrua's or the Haemorrhoids do frequently promise good in this distemper yea any of these Evacuations happening seasonably doth frequently discharge the disease 3. 3. From the state of strength The condition of strength is ever of great moment in forming a due Prognostic in this disease for oftentimes when horrid Symptoms as an intense Feaver a Breathing very painful with a Cough watchings and other ominous signs shall be pressing if the Pulse be as yet strong and the animal spirits persist in their vigor there is better hope of the Patient than if these things being more quiet there were a weak Pulse and the Spirits should become drowsie and oppressed The first indication about the curatory Method in a Peripneumony is The Cure hath two chief indications that the blood being impacted in the pneumonic Vessels and causing a phlegmonous obstruction may be from thence discussed and restored to its pristine circulation Which if not to be procured the second indication will be that that matter be duly digested or brought to suppuration and with all expedition voided by spittle While the former indication prevails the intentions of healing will be these ensuing The first indication suggests four intentions of curing First that the more plentiful afflux of blood to the part affected be prevented or pro hibited by some means Secondly we must endeavour that the matter stagnated or extravasated in the Lungs be swallowed again by the Veins into the rest of the mass and caused to circulate Which that it may be the better procured thirdly the hoold ought to be freed from its clammy viscousness whereby its fluidity is impeded Fourthly that we apply to the Symptoms most urgent viz. a Feaver cough Watchings and difficult Breathing fit Remedies But if notwithstanding all these another indication shall come into use it will be requisite to prescribe maturating and expectorating Medicines vulgarly so called together with these 1. That we may satisfie the first and second intention together 1. The first intention that the afflux of blood may be cut off 2. That the extravasated be reduced to oirculation Phlebotomy is for the most part requisite in every Peripneumony yea sometimes it ought to be more frequontly repeated for the vessels being emptied of blood do not only withdraw the nourishment of the disease but do also sup up the matter impacted in the place affected Wherefore if strength remain and the Pulse be strong enough a more free breathing of a Vein is convenient at the very beginning but otherwise let it be used in a little quantity which however may be repeated as occasion offers it self We intimated above that blood drawn in a Peripneumony and also in a Pleurisie after it is cold contains in its superficies a small viscous and discoloured film moreover we may observe one while the blood entirely another while only a portion thereof is subject to this change For when the blood is received into three or four dishes sometimes in all but oftener in the second and third dish it is apparently bad and in the first and last laudable enough wherefore they commonly give it in precept that blood is always so long to be emitted till that which is so depraved begins to come forth and if strength remain the bleeding should continue till the good blood flows out again Truly as common experience doth approve of this practice even so doth reason it self for in this disease Rules concerning Phlebotomy because the whole mass of blood doth not presently acquire that clamminess the depraved portions are chiefly accumulated about the place of obstruction and adhere on every side in the lesser vessels Wherefore the blood first issuing by Phlebotomy is often void of any fault afterwards the vessels being emptied receive the other morbific matter at first stagnated and restore it to its circulation and when the portions thereof being placed near are carried as it were in a joint troop they flow out together at the orifice of the opened Vein and after that entire mass of bad blood hath flowed out the residue being more pure doth succeed Wherefore in this case ever let incision be made with a large orifice and let the blood be drawn out not only with a more plentiful spouting but also with a continued for otherwise if in the midst of Phlebotomy the bad blood issuing out the orifice as the manner of some
after I repeated Phlebotomy and after continuing the same Remedies in four or five dayes he intirely recovered his health The blood we took from him was alwayes in the Superficies viscous and discoloured A certain Gentleman of a sanguine Complexion and a strong habit of body The second History after an immoderate drinking of Wine contracted a Feaver with a most painful Peripneumonie insomuch that thirst and heat mightily pressing him sitting always upright in his bed or Chair and breathing short and very frequent he could scarcely yea almost not at all suck in air enough to sustain the vital flame Because he could not undergoe a large Phlebotomy I drew blood twice or thrice day after day frequent Clysters were administred Moreover Apozemes Juleps also Spirit of Armoniack and powders of Fish-shells were administred by turns Within four or five dayes the Feaver somewhat abated also he began to breathe better and sometimes to take short sleeps yet he did always complain of a notable heaviness of his breast and intolerable oppression of the Lungs wherefore when Phlebotomy was no longer safe I applyed very large Vesicatories to his Arms and Thighs the blisters in his arms dry'd up in a short space but those on his legs did not only remain open but after five or six days did run hugely and afterwards almost for a month daily discharged great plenty of a most sharp ichor in the mean time his lungs sensibly amended and at length were delivered from all their burden lastly the little sores raised by the Vesicatories very painfully and not without frequent Medicines could be cured SECT I. CHAP. IX Of a Pleurisie HOw great affinity there is between a Pleurisie and Peripneumonie The diseases of a Pleurisie and Peripneumonie are akin we have hinted before viz. although either distemper is sometimes solitary and exists separately from the other yet they often happen together or one while this another while that come one upon the other or succeeds it The foregoing cause is the same of both viz. a disposition of the blood to be clammy and boyl up withall also the conjunct cause is the same viz. an obstructing Phlegmon in some part of the lesser Vessels by reason of such a disposition of blood Moreover the same method of Cure is prescribed by most modern Physicians for either disease The chief reason of the difference whereby they are distinguished one from the other is taken from the places affected which their Names denote How they differ betwixt themselves For the blood predisposed to the enkindling in some place an enflaming obstruction therefore often plants the nest of the disease in the breast because here it burns out more hideously by reason of the Hearth of vital fire and also is not freed from the vaporous Effluviums and other Recrements which hinder Circulation To all which there ensues that in this Region the mass of blood being shut up and not able to pass through the more strait Conveyances is not as in the bowels of the lower Belly opened with any ferment or new washt with any watery juice wherefore if perhaps the blood carried through the vertebral Arteries into the membrane encompassing the ribs shall stick in its passage about the narrowness of the Vessels or inter-spaces the Distemper of which we now treat succeeds In like manner if an obstruction happen within the passages of the Lungs a Peripneumonie will ensue as we have declared before Wherefore according to the Pathologie of this disease before delivered those things which belong to the Theory of a Pleurisie as well as the Curatory method may with small labour be designed Both the sense of pain The seat of a Pleurisie as well as Anatomical Observations taken from the Patients dead of a Pleurisie do plainly attest the feat of this Disease as often as it exists primarily and solitarily consists in the Pleura or Membrane environing the inside of the ribs And a true and singular Pleurisie is an inflammation of the Pleura it self from the abundant flowing in of inflamed blood growing clammy withall taking its motion through the vertebral Arteries with a continual and acute Feaver a pricking pain of the side a Cough and difficulty of breathing The next Cause is the blood obstructed by reason of its clamminess in the lesser vessels and interspaces of that membrane in like manner as it is in a Peripneumonie or being extravasated being heaped in the same place more plentifully The next cause of it by reason of the swelling up for that cause exciting an inflammation An acute pain ariseth upon this by a wound in a part highly sensible also there ariseth a Cough by reason of a provocation giving impression to the intercostal muscles moreover a difficult breathing by reason of the muscular fibres being hurt as to their action which because they cannot perform long and strong contractions they are constrained to undergoe weak although more frequent Contractions otherwise than in a Peripneumonie in which that symptome ariseth from a Lung too much fill'd and stuffed The Feaver is caus'd from effervescence of blood and is for the most part rather the associate than the effect of a Pleurisie For the blood from what cause soever driven into a feaverish turgescency if it be bound up together in its mass will be apt to grow clammy which together with the Feaver most often induces a Pleurisie or a Peripneumonie or both of them From hence we may observe this disease doth frequently vary its kind and change its place viz. from a Pleurisie into a Peripneumonie and on the contrary afterwards it passes from both or either into a Frenzy or a Squinancy for that the blood while it is boyling throws off its viscous recrements one while in this part another while in that another while in more together and lastly it reassumes them again and variously transferrs them The more remote causes of a Pleurisie are the same as of a Peripneumonie viz. whatsoever stirs up the blood The more remote causes of this Disease predisposed to grow clammy and also to boyl up and provokes a feaverish turgescency Hither appertains excess of heat and cold a sudden constipation of the pores surfeit drinking of Wines or Strong-waters immoderate exercise sometimes the malignant constitution of the Air brings this disease almost on every body and renders it Epidemical whereto may be added that this disease is very familiar to some from their constitution or custome so that a distemperature of blood induced almost by any occasion immediately passes into a Pleurisie From what we have already said the signs of this disease do appear manifest enough by which it is well known as to its Essence and is distinguished from other diseases and especially from a Bastard Pleurisie and a Peripneumonie But it is to be observed that a pain in the side arises sometimes very troublesome which while it counterfeits a Pleurisie is sometimes taken for it although falsly For in
of a defect of fault in the motive organs or mixt when either parts conspire in the fault which origine every great and inveterate Asthma is wont to have of each of these we will treat in order 1. The ancient Physicians The Ancients allowed the cause of it only from the Bronchia obstructed and for the most part hitherto the Moderns have only acknowledged the first kind of Asthma judging the next cause and almost the only cause of this Disease to be the straitness of the Bronchis viz. inasmuch as the spaces of those passages being either straitned together by obstruction or compression as often as the use of breathing is required do not admit of plenty enough of Aire wherefore for the more free inspiration of aire as shall be needfull the organs of breathing do most difficultly labour with throes most frequently repeated But that some are found obnoxious to fits of an Asthma Or vapours from the Spleen or Womb but erroneously without manifest taint of the Lungs it was wont to be ascribed to vapours from the Spleen Womb Mesentery or some other bowel undeservedly enough but surely that passion without the straitness of the Bronchia or fault of those bowels we have in another place sufficiently evidenced to arise from Cramps of the moving parts and shall be presently clearly made out But in the mean time by what means it may arise also from the passages of the Trachea obstructed or compressed it lyes upon me to declare The straitness of the Bronchia After what manner the straitness of the Bronchis arises inducing the first kind of an Asthma is supposed to come to pass by an obstruction as often as either thick humours and viscous or purulent matter or blood extravasated are forced in upon them or that little swellings or Schirrus's or little Stones stop up their passages or finally that a Catarrh of a serous humour suddenly distills upon them Moreover the same distemper is thought to be raised by compression as often as matter of that kind and of every kind of them shall cleave to the passages of the pneumonic Arterie or vein Surely an asthmatical disposition depends upon these various causes and manners of disturbance but all invasions of the disease or at least the greater fits are usually provoked by reason of some accidents or occasions For while the stream of blood sliding and running down gently can be content with a small breathing it passes through the precordia without great labour either of Lungs or Breast But being boyling and passing through the Lungs more impetuously it requires a more full inspiration of aire for the freer admittance of this through strait passages presently all the breathing organs are alarmed into most frequent throes Whatever causes an effervescence of the blood is the evident cause of an Asthma Whatsoever therefore makes the blood to boyl or raises it into an effervescence as violent motion of the body or minde excess of extern cold or heat the drinking of Wine Venery yea sometimes mere heat of the Bed doth cause asthmatical assaults to such as are predisposed It is usual that those who are obnoxious to this disease oftentimes dare not enter into a Bed only sleep in a Chair or on a bed being covered with garments The reason whereof is Why Asthmatical Persons are worse in bed that the body covered and heated with bed-cloaths the blood being a little raised into a more quick motion and grown hot requires a more plentifull sucking in of air than may be supplyed from the passages of the Trachea being straitned for the more blood passes the Lungs each Systole and Diastole by so much for the enkindling and eventilation thereof the air ought to be more plentifully and quickly brought in and sent forth to which task when by reason of impediments it is not easily dispatched yet in some manner to be performed the ultimate endeavors of all the parts appointed for breathing are made use of with a great contention of the whole breast Moreover the blood being stirr'd is not only an occasion but also in some part a cause in those that are asthmatically predisposed for the vessels bringing blood being thereby more fill'd and distended within the lungs compress the Tracheal passages being already very strait and render them much more close II. A convulsive Asthma which we judged to be the second kind of this disease A convulsive Asthma and to be raised without any great obstruction or compression of the Bronchia from the mere Cramps of the moving fibres is not limited to one place or to any peculiar organ but being of a diffused energy it is extended to almost all the parts employed in breathing whereof one while this another while that or some other is in fault It s Seat manifold and diffused For a convulsive affection inciting an Asthmatical invasion hath regard to the moving fibres of the vessels of the Lungs to the Diaphragma to the muscles of the breast to the Nerves which belong unto the Breast or Lungs nay to the origine of those Nerves planted within the Brain and whilest the morbisic matter dwells in every of these places hindering or perverting the work or breathing it brings on the fits of this Disease as in another Tract we have somewhile since plainly demonstrated For the animal Spirits destin'd to the function of breathing if at any time they are very much molested and constrained into irregular motions enter inordinately into the fibres as well nervous as moving of the organs of breathing and make them for that cause one while to be contracted another while to be distended irregularly as also their solemn and equal turns of Systole and Diastole to be variously disturbed or hindered The morbific cause or matter provlking the Spirits prepared for the pneumonic work as in divers places so chiefly in these three The morbific matter consists in several places is wont to advance its force or power viz. 1. Either in the muscular fibres themselves or 2. In the branches or nervous slips or lastly within the Brain by the origine of the Nerves 1. As to the former 1. In the muscular fibres the heterogene matter being inimical to the Spirits is sometimes shaken off from the Brain into the trunks of the Nerves and from thence by their passages and slips if perhaps it shall be in very little quantity without very great or sensible hurt slides down to their lower ends And when it falls in the nervous fibres and being heaped up daily shall at length sensibly increase unto a great quantity it begins to trouble the inmate Spirits and to provoke them into asthmatical Convulsions which forthwith infest and are encreased by reason of evident causes neither do they utterly cease untill the stock of matter so accumulated be wholly dispers'd and consumed afterwards when it being renewed arises to a fulness the fits of that disease return and are for that cause
by the common consent of most is judged to arise in as much as the yellow choler not at all or not enough received The Jaundies from the ends of vena porta into the passages of the cholerick pore overflows into the mass of blood and pollutes it with its greenness whereby also the very skin is discolour'd That obstruction is wont to happen after many manners and in various places The cause of it For sometimes it happens near the extream ends of either kind of vessels viz. the end of the vena porta and the porus bilarius the interspaces whereof happen frequently to be compressed and stopt by reason of the Parenchyma of the Liver being tumefied or otherwise vitiated wherefore the humour of the gall not being transferred out of the separating vessels of the porta into the other receiving vessels turns back upon the blood Secondly the passage of the humour of the gall is sometimes intercepted in the middle passages of the cholerick pore for that the cavities of these are filled either with a viscous or sandy and sometimes with a stony matter as is plainly discerned in the Livers of beasts in the winter senson while they are fed with hay and straw Thirdly it is also manifest by Anatomical observation sometimes an obstruction in the very bladder or the gall or in the cystic passage is the cause of the Jaundies for if at any time it being filled with stones receive not the choler or being here shut up or grown together it restrains the descent of the choler towards the guts that humour although well separated from the blood is constrained to flow black into the mass thereof and so propagates the Jundies Against this most received opinion by which it is judged The opinion of Sylvius of the cause of the Jaundies that the cause of the Jaundies for the most part consists on this side the vesica fellis or about it towards the Liver the most Renowned Sylvius altogether places it without this viz. in the Cystic or common passage For supposing the choler not to be separated from the blood within the passages of the Liver but in the very bladder of the Gall to be propagated of a humour brought thither by the Arteries He judged the greatest part being carried upwards by the passage of the pori bilarii to be poured into the blood for some notable uses and also another part to descend beneath to the Intestines also for necessary uses wherefore if this latter sluce be shut all the choler is carried upwards into the blood and filling it too much with this humour perverts it from its genuine temper into an Icterical But truly lest the stopping of the passage of the bladder or of the common passage neither of which easily happens or from any light occasion may seem less efficacious to excite any Jaundies therefore whether such an obstruction hath place or no the most Renowned man ingeniously supposes besides The choler while it is generated in the bladder does undergo sometimes a notable change by which it is moved and is born about more plentifully and impetuously towards the blood with which yet it is less mingled than is was wont to be but only confounded together with it and so more easily departs from it and infects and tinges the solid parts with its colour But that the choler in the Jaundies may be rendred unfit a mix with the other humours or to be nearly united he determines it to be done by a spirit too valatile mixed plentifully with it and so making it more spirituous and immiscible with others He confirms this assertion by two instances viz. in as much as the most spirituous poison from the biting of a Viper and the too much use of the more generous drinks viz. Wine and Strong-waters causes sometimes the Jaundies Moreover he endeavours to procure credit to this Hypothesis for that this disease is wont to be cured not only by medicines opening obstructioins but by them which blunt the force of a raging volatile salt of which sort are the decoction of Hemp-seeds also Venice soape with many other things of the same sort It belongs not to this place neither is it to our purpose to descend to end this contention nor dare I now rashly determine it since it hath tired so many Renowned Wits of the Moderns whether really the choler be made in the bladder of the Gall or whether it be only separated from the blood in the Liver the great organ of separation I confess this latter opinion best pleases me The Authors opinion And weighing these things seriously I am induced to think the cause of the Jaundies to consist chiefly in this that the choler being sever'd in the Liver is not by reason of the ways being obstructed at all or not enough conveyed to the bladder of the Gall but that it must of necessity regurgitate into the mass of blood notwithstanding in the mean while we deny not but this affect may sometime arise although more rarely from the Cystic passage or common pipe being obstructed But also we think the fault of the blood to preceed in part and perhaps sometimes wholly for the morbific cause when to wit from its sulphurous and fixt Saline Particles above measure exalted the choler is more plentifully or quicklier generated in the mass of blood than can be separated or discharged forth by the ordinary ways wherefore this separating every where from the blood with the Serum The cause of this disease sometimes in the blood is affixed to the solid parts and impresses its tincture upon them And without doubt it is for this reason that some poisons and chiefly the biting of Vipers and the dayly use of more generous drinks induces the Jaundies in bodies before sound for whose cure sometime Phlebotomie and medicines reducing the blood to a right temper are wont to profit more than those opening obstructions Moreover it seems for this reason that a tertian intermiting Feaver so frequently terminates in the Jaundies for we may not suspect the passages of the Liver can be by any means obstucted since in all fits so great an agitation of the blood and humours by cold and heat and such an-evacuation of them happens either by vomit or sweat and truly even as feaverish fits are caused inasmuch as the sulphurous part of the blood being too much advanced in the first place perverts the nutritious juice into a morbific matter and afterwards being inflam'd consumes and exterminates it so when the fixt salt is at last exalted together with the sulphur in the blood and for that cause meer choler is abundantly engendered the feaversh enkindling of the blood ceases by reason of the restrictive force of the fixt salt and in place thereof the distemper of the Jaundies doth succeed But as the blood being too much advanced to a sulphureo-saline distemperature causes the Jaundies in any though least predispos'd to it so in others
many senses together viz. it is a Tumour of the Abdomen First in respect of blood from a waterish tumour contained within the cavity thereof The water making this tumour sometimes encreases to a huge inundation and scarce credible quantity I have once seen a Tub would hold 15 gallons filled with water taken out of the Abdomen of a woman dead of a Dropsie But whence that humour proceeds also by what manner and from what causes it gathers together in the belly first and afterwards is sensibly augmented and lastly by what passages and by what vertue and operations of Hydragogue Remedies it may again be taken from thence and evacuated seems most difficult to be unfolded As to the former viz. the encrease of water It doth not always proceed from the Liver Spleen some have thought it to descend from the Liver and others from the Spleen distempered into the cavity of the Abdomen and so this bowel or that being vitiated always to be the cause of an Ascites But that this is otherwise Anatomies of many dead of this disease do manifestly declare when after the inundation of the belly the Liver and Spleen and found often without fault And truly these bowels do not seem the Springs of any such illuvies being endowed with no cavityes wherein waters might be accumulated together wherefore the origine of an Ascites as of a standing Pool or Lake is to be derived from a River or at least a glutt or inundation of some Humour The humours that flow within the passages or Vessels as Brooks The humours by which it is produced are are chiefly these three viz. the Blood the milkie Humour and the Lympha The showering or distilling of water may come to pass from the nervous Liquor which sometimes slowly and insensiby sweats out of the fibres and membranes and from vapours condensed within the hollowness or some Cavity of the Body Whether by these wayes an Ascites doth rather and oftener proceed we will now search And in the first place as to what relates to the blood it is without doubt First the Blood the Serum falling from the masse thereof too much dissolved as it doth excite Fluxions and Catarrhs of various kindes so it sometimes stirs up the greater illuvies of waters viz. Dropsical wherefore when an Anasarca proceeds altogether from this cause and when oftentimes an Ascites comes upon that disease not immediately heald we may well enough inferr that either distemper is induced from a watery humour every where poured out from the little mouths of the Arteries Moreover it is not much improbable that the Serum of the dissolved Blood is first and solitarily poured out of some end of the Coeliac and Mesenteric Arterie being open into the Cavity of the Abdomen and so brings on an Ascites without an Anasarca going before and so especially if perhaps it happen that scirrhous Tumours Ganglion's little swellings or preternatural Concretions of another manner are first raised about the Mesentery the Spleen the Liver the Womb or any of the other bowels of the nether belly for because the Circulation of the blood is hindred in those places that the blood being carryed through the arteries may be some way brought back the serous part being thrust out from its company falls into the cavity For truly it is most evidently manifested that it so comes to pass by this Experiment mentioned by us in another place viz. If in a living animal the jugular veins being taken up and bound with a thred the reduction of the blood be stopt the whole Region of the head swells in a short space with a water between the skin and clearly hydropical And truly I have more frequently observed that an Ascites hath followed upon secret tumours gathered and raised in some place in the lower belly which certainly happens for the reason above recited When the course of blood being obstructed the watery part is extravasated in a short space that humour is not meerly serous but besides the nutritious Liquor ordained to nourish all the solid parts is emptyed into the belly wherefore while this Region swells up the members are extenuated and the Lympha taken out from an Ascites with heat thickens and grows white like the white of an Egge It is also very probable 2 3. The milkie and watery humour that the milkie Vessels being burst asunder pour out their humour into the cavity of the abdomen Truly the most renowned Sylvius thought this disease most frequently engendred from such a cause And truly as out of the milkie or watery Vessels viz. one of them or both together being divided or opened we may well suspect the illuvies of water or chyle sometimes to overflow the bowels of the nether belly so the following observation seems to confirm the same thing Of late one that had been long sick of the Jaundies and in the mean time temperate and abstemious of drink to which he was not prompted by thirst contracted an Ascites increased in a short time hugely After that medicines were administred in vain a Paracantesis is attempted according to the manner of Sylvius with a hollow Needle out of the orifice not icterical water but limpid and thin flowed out abundantly from whence we may inferre that hydropic humour flowed not out of the mass of blood for then it had been coloured but distill'd out of the lymphic or milkie vessels into the cavity of the abdomen We have joyn'd together as akin the ways of the milkie and lymphic Vessels in propagating an Ascites because both vessels do convey the chyle or what is analogous to it to the common Receptacle and many branches or leading Pipes of either kind are distributed about the bowels of the nether belly in the mean time it is not improbable but that a solitary fault of either vessel may sometimes produce an Ascites As to the other wamys of generating an Ascites proposed in the beginning I am scarce induced to think such an inundation of the belly can easily arise from the distilling of a nervous humour or by reason of vapours there condensed although perhaps in a Tympany where the cavity of the abdomen is enlarged and transpiration hindred the effluvia that were wont to exhale being forced inwards are changed into Lympha or water wherefore for the most part an Ascites is ever conjoyn'd with that disease The immediate or conjunct causes of an Ascites being design'd after this manner An Ascites often the product of the Jaundies which indeed seem to be either a watery humour poured out of the Vessels bringing Blood or Lympha or Chyle poured out of the proper passages of them both not we must in the next place inquire about the more remote causes of this disease viz. for what occasions and after what manner the vessels affected of either sort deposite their burdens into the cavity of the belly First therefore The kinds of a Dropsie that the watery part of
purging Hydragogues 2. Diuretick Hydragogues but Catharticks do not always cure an Ascites yea often-times exasperate it and if they be long continued render it incurable hence it is necessary to have recourse to other Remedyes for the Cure of this disease Wherefore let us next enquire whether Diureticks do here profit or not And truly any one may easily think that Remedies moving Urine conduce very much for draining waters out of every place or cavity of the body In truth it is manifest by frequent experience these do often cure an Anasarca before any other Remedy let us see what they may effect for the emptying the Cavity of the Abdomen As to this it first appears What Profit they bring in an Ascites that there is no passage immediately open from an Ascitick pool to the Reins although contiguous but that whatsoever waters are transferred from hence thither must of necessity first be drunk up into the mass of blood and from thence be poured out of its bosom into the sink of Urine and truly it is but a little which the gaping little mouths of the veins about the superficies of the bowels can receive if perhaps they are open at all and Diureticks can but effect this one thing that by pouring forth the blood and forcing its serosities more plentifully to the Kidnies they cause the waters fluctuating in the belly to be allured to it being so emptyed in the mean time there is no less danger lest Diureticks being unseasonably administred while they dissolve the blood too much they constrain the serum to depart into the seat of the Ascites more than into the Reins and so rather augment than remove the inundation of the belly For that it sometimes so happens I have often found by experience wherefore when Diureticks are prescurbed to cure an Ascites we must chielfy provide against such a contrary effect For this reason indeed Astringents and Corroboratives are always mixt in Remedies for the Dropsie founded on experience and the Authority and Practice of the Ancients not that such as is commonly said do confirm the Tone of the Liver but conserve the temperature and mixture of the blood lest it be wholly dissolved by too great a fusion Wherefore in an Ascites which chiefly or in part happens by reason of the frame of the bowels and vessels and chiefly the Coats Glandules and their little strings and their interspaces being stuffed by a serous humour and therefore very much swell'd up as Catharticks so also Diureticks profit and are frequently taken with success forasmuch as by the use of these the masse of blood being emptyed the serum being more plentifully derived to the kidneys doth easily reveive unto it self those waters every where stagnating about their little mouths and conveys it towards the urinary sink but on the contrary in a meer Ascites where the heap of waters do overflow the Cavity of the Belly the Textures of the bowels being free from the serous stuffing Diureticks are given in vain or incommodiously inasmuch as they express nothing from this Lake of the belly and most frequently by dissolving the blood more impetuously drive together the waters apt to be instill'd there Not all Diureticks of every kinde are equally convenient in an Ascites With what choice and difference they ought to be administred neither ought they indifferently to be administred for we must observe the affected in this disease for the most part make a little reddish Urine and as it were lixivial which truly is an indication that the temperature of he blood is too much bound in them by reason of the fixt and sulphureous Salt exalted and combined together and therefore that the Serum is not duely separated within the reins which notwithstanding is shook off about the windings of the obstructed bowels and so is depisited in the Cavity of the Belly Wherefore in this Case it will be convenient to drink only those things to excite Urine which so restore and amend the Constitution of the blood that the enormities of the fixed Salt and Sulphur being taken away the serous part might be separated within the reins and more plentifully discharged for which purpose not acid or lixivial things but those endowed with a volatile Salt are appointed For I have often observed in Patients of that kind when the Spirit of Salt and other acid drops of Minerals and when the dissolutions and Deliquiums of Salt of Tartar Broom and other things have done more hurt than good that the Juice of Plantane Brooklime and other Herbs abounding with a volatile Salt have much helped as also the expressions of Millepedes for the same reason Salt of Nitre throughly purified or Crystal Mineral doth often profit Forms of Medicines more accommodate for this use are extant in our former Treatise where viz. examples of Diureticks are described in which both volatile and nitrous Salts are the Basis Moreover hither ought to be referred the notable experiment by which Joannes Anglus affirms himself often to have cured the Ascites from a hot cause John English his Empyrical remedy which Medicine also that expert Physitian Dr. Theodore Mayern was wont to magnifie and prescribe in the like case Take of the juice of Plantane and Liverwort and fill an Earthen pot to the top which being stopt close put in a hot Oven after the Bread is drawn and make a little fire on the sides of the pot to continue the heat of the Oven after it is so boyl'd strain it and being sweetened with Sugar drink of it Morning and Evening and it cures In imitation of this I have often with success prescribed as followeth Take of green Plantane-leaves four handfuls Liverwort Brooklime of each two handfuls bruise them together and pour upon them half a pound of small compound Radish-water or other appropriate Aagistral express it strongly the dose three ounces three times in a day Although Diaphoreticks are most efficacious in an Anasarca How beneficial Diaphoreticks are in an Ascites yet in an Ascites they are rarely or not at all used for being unseasonably offered they impress oft-times great hurt on the Patient without any avail forasmuch indeed as by heating the blood they cause the fluctuating waters to grow hot and as it were to boyl in the hollowness of the belly so that the spirits and humours are disturbed by vapours raised from thence and so a disorder of all the functions follows and the very bowels being as it were boyled are much prejuciced Moreover from sweating unadvisedly instituted the blood being forced into a fusion and precipitation of the Serum throws it off the more into the nest of the Ascites Wherefore when some prescribe fomentations and liniments adn bathing to be applyed to the swelling Paunch of the Belly for the most part it turns to the worse in such Patients for besides a little Feaver a Vertigoe fainting of the spirits and other ill symptomes of the brain and heart being most
evident causes as we have before intimated and such differences thereof are found to be frequently fo great moment about duely instituting the Prognostick and Cure Wherefore what relates to the prognostick part this disease while it is simple The Prognosticks of it proves least dangerous among all the kinds of Diopsies and a particular one seising only the inferiour members so that the belly doth not together swell with them in much safer than an universal one An Anasarca bringing on an Ascites wherein for the most part the Urine is plentiful enough and the thirst not very intense is far more safe than an Anasarca brought in by an Ascites wherein the diseased do very much thirst and make little red and thick and for the most part a lixivial Urine In like manner it is or worse when an Anasarca comes upon a Tympanie or a Phthisis as sometimes 't is wont Lastly no slight Prognostick of this disease is taken from the complyance or the obstinateness of the Patient about Diet and Medicine For whatsoever the condition of the disease may be if the hydropick person refusing medicine will indulge his fancy we may not hope any good from thence About the Curatory part to be designed in order The Cure of it Two Indications two chief Scopes of Healing do occurre viz. First that the water between the skin be consumed by some means Secondly then provision must be made lest it be continually generated and accumulated afresh for which purpose a Physitian is to employ his labour both that the bowels of Concoction being emptyed of their Superfluities and free from obstructions may always procure laudable Chyle and supply the masse of blood in due plenty as also that the blood the principles thereof being restored to its sermentative power may orderly ferment the Juice of the Chyle continually poured into it and assimilate it into Blood The vital Indication seems not at all necessary in this disease as in many others for that very rarely in this appear swoonings of the Spirits or Watchings for which Cordials and Hypnoticks are required and there is little need of restoring Diets because Fasting and Abstinence rather help and oft-times make up the greatest part of the Cure the reason whereof is that the Vessels being emptyed through want do swallow up the waters between the skin or stagnating in other places and do discharge them forth partly by the Kidnies by the pores of the skin and other Emunctories and partly do adyantageously employ them being yet turgid with alimentary Juice to the nourishing of the body First That the first Indication being Curatory The first intends the evacuation fo the morbific matter intending an Evacuation of th morbific matter may be performed there ought to be exhibited all Hydragogue medicins as well simple as compound and also the froms of medicines recounted and prescribed in the former Chapter of an Ascites Moreover hereto belong not only Catharticks and Diureticks but also Diaphoreticks which though in other sorts of Dropsies they are very much forbidden often take place in curing of an Anasarca In a simple Anasarca we may lawfully administer strong Purgers By Purgers and frequently they much profit And truly this Disease being cured sometimes by means of a Cathartick Empiricks do much glory of their Cures and certain of their medicines become much cryed up for curing hydropical persons for if at any time it happens that they have healed one or two labouring with an Anasarca by their specifick Hydragogues and Elateriums it is enough wherewith they may always magnifie themselves and their Art although by the same medicine they have murdered a hundred Ascitical persons Strong Purgers are couvenient but not to all Wherefore although Preparations of Spurge or Elaterium Pilulae Lunares Hercules Bovii and other Hydragogues have sometimes profited in some cases notwithstanding if they be indifferently exhibited to all Hydropicks or at all to any endowed with a weak Constitution and Bowels of a brittle tone or of evil conformation they oftener cause death than remedy wherefore let it always be committed to the judgment of a prudent Physitian the time when how long and what sort of Catharticks are to be used We have before described froms of Hydragogue Purgers of every sort to wit those that exercise their power upwards and downwards and as well mild as stronger workers so that they may be referred hither and accommodated to the method of healing now proposed But if the reason be enquired The manner of their working after what manner Purgers do operate in this disease and why they more happily and much more efficaciously bring out waters than in any other sorts of Dropsie I say in an Anasarca the morbific matter which is the Lympha subsists partly in the mass of blood partly in the habit of the body within the pores and vacuities between the ends of the vessels wherefore a strong Cathartick being administred presently troubles and dissolves the mass of blood and stirres it up to the excretion of any superfluous or heterogeneous thing and irritates also the little mouths of the Arteries gaping towards the Cavities of the Intestines that the humour ejected from the blood may easier find vent through these Emunctories From hence in the first place the waters fluctuating within the blood are abundantly drained out afterwards the vessels being emptyed do presently swallow up again the waters between the skin and presently discharge them forth partly by siege and partly by Urine or Sweat in the mean time there is no fear lest as in an Ascites the morbific matter being driven and poured from the blood by the Medicine should be further forced into the places affected whence not easily flowing back again it should be more largely encreased nor lest as in a Tympany by reason of the Fibres of the Stomach and Guts being too much irritated by the Physick those bowels might be provok'd into convulsive swellings For as long as the bowels are firm and well constituted the particles fo the Medicine inflict them with no hurt but presently being brought into the blood they do not only allure waters out of it but by exagitating the mass thereof they raise the active particles formerly overwhelmed and dispose them towards their fermentative power Secondly Secondly By Diureticks Hydragogues working by Urine as well simple as the compound as also forms of Medicines prepared from either of them and the manner of their administration we have also described above which also may be transferr'd hither to save repetition And chiefly Lixivials But because not all Remedies of this kind do help alike in all the Distempers it is here observable that for curing an Anasarca Lixivials as has been frequently manifest by our observation do far excell other Diureticks For indeed now it is a common and thredbare Remedy for any one having swell'd members after a previous Purge to take twice or thrice in the day from six
being administred he was restored to his entire health and even now though five years since lives and continues sound There remain certain other splanchnical Affections The 〈◊〉 of 〈◊〉 〈◊〉 touching the Remedies whereof according to the ensuing method we should here have treated notwithstanding I have performed this task already for the most part under other titles for as is above intimated Remedies which concern the Kidnies we have for the most part unfolded under the rank of Diureticks and those which concern the Stomach and Guts under that of Vomits and Purges what relates to the Spleen we have finished in the Hypochondriac Pathologie and what to the Womb in the Hysterical As to what appertains to the Genital parts and their Diseases and help I reserve for another time and place it behoves me now next of all after treating hitherto of the inward Pharmacie to discourse something of the outward and of the Reason or Aetiologie of the administrations thereof which shall be done inthe next Section beginning with Phlebotomie that great Remedy SECT III. CHAP. I. Of Phlebotomie AMong the universal Documents of Philosophie Phlebotomie a very general and ancient medicine or aids of Physick none either in Theory or Practice hath been more ancient or general than the speculation of the Blood and letting it out by opening a Vein As to the former we have in other places often explicated the nature and constitutive parts of the Blood we have unfolded the Virtures and Energy of the same and have demonstrated that it is in truth enkindled and that from the burning there of the flame of animal life as of a Lamp doth begin and receives continuation But as to what relates to Phlebotomie all Authors of every age have made mention thereof Moreover the same was ever in Medicinal use with all Nations howsoever barbarous or rude Neither is it a wonder for truely Nature it self in the first place hath taught the necessity and way of that part of Chirurgery Even the Divine Law commanding the Rite of Circumcision as a Symbol thereof seems to intimate that the innate impurities of Humane Nature ought to be purged in some manner by letting out the blood That we may methodically discourse of this great Remedie Nature shews it by Haemorrhagies we ought first to consider by what means also for what causes and ends the letting of blood either happens spontaneously to Nature or is indicated by the Physitian then secondly we will annex the chief effects of this Evacuation as well good as bad whether advantageous or disadvantageous and together propound certain Rules and Cautions to be observed about due administration of Phlebotomie As to the former spontaneous Haemorrhagies which suggest the use of Phlebotomy whereas they are manifold and of diverse kinds they are usually reduced to these two heads or ranks to wit they are denominated either critical Nature endeavouring something good and wholsome or symptomatical which for the most part happen she being dejected from her government and being altogether out of order Critical either with or without a feaver The bloody eruptions of the former kind are again distinguished that they are either raised without a Feaver and are either perodical which happen often at set seasons as the Flowers in Women and the Hemorrhoids in some and in others the solemn or otherwise accustomed opening of the Nostrils which very often succeed according to the great changes of the Year or alterations of the Air or they are fleeting and uncertain as when blood doth advantageously break out of those places and of many others one while in this part another while in that part of the body Moreover bloody Crises do sometimes happen in a Feaver and do often put an end to it as Hippocrates long ago observed and is now manifest by very common observation The blood breaks out in all these cases inasmuch as being turgid and above measure rarified within the vessels it desires a larger space wherefore unless some portion thereof give way the whole mass rund the hazard of being constipated and as well the motion thereof to be hindered as the enkindling to be suffocated and the temperature to be perverted For there are two chief Reasons or Causes The causes thereof proceed either wherefore such turgescencies of the Blood do arise inasmuch as its liquor is as well inflammable as fermentative 1. As to the former of these that the Blood may be duely enkindled for the supporiting Life 1. From the kindling of the blood and the due exercise of the functions thereof it behoves that the innate sulphureous particles of it be proportion'd unto the Nitrous adventitious ones from the Air. Therefore as often as the Blood being very boyling and rarified is much opened and loosened in its own consistence so that the Sulphur being dissolved is kindled in greater plenty there is a most frequent and painfull breathing instituted for the drawing in of a more plentifull Nitre Now if the Sulphur abounding in this manner cannot be wasted by burning nor the vital flame regulated the next course immediately to diminish the sulphureous suel is that a certain portion of the rarified Blood have vent From hence not only in Feavers but after drinking Wine Bathings being in the Sun and other accidents by which the Blood grows very turgent either an Haemorrhagia of its own accord succeeds or there is often need to supply the defect of such a spontaneous evacuation by Phlebotomie But that such kind of effusions of Blood whether made by Nature or Chirurgery are commonly reported to bridle its heat or raging really they do this only inasmuch as they diminish the kindling of the blood by withdrawing part of the sulphureous fuel as Oyl from a Lamp 2. But moreover in the second place the Blood 2. From its Fermentation inasmuch as it is a fermentative liquor it is apt also to be extravasated Namely if at any time any heterogeneous thing and not miscible be confounded with its liquor it grows hot very much like Wine in a Vessel and boyls up in the Vessels to exclude that disagreeable thing which if it can neither subdue nor turn off by Sweat Urine or otherwise the Blood it self excludes part of it self as a Vehicle for carrying that matter forth wheresoever a vent is to be found For this reason viz. that any disagreeable or indomitable thing may be turn'd out of the mass of blood divers sorts of Hemorrhagies happen as well in Feavers as without them all which are excited by Nature for an intention of good as also those by which the too much enkindling of the Blood is depressed But that frequently it happens otherwise ought to be imputed to divers accidents and circumstances But for the most part the sailure about the spontaneous Hemorrhagies critically instituted 1. Criticall Hemorrhagies sometimes turn into symptormatical is either in the first place because the blood while it is boyling knows
no measure of flowing out and therefore being stirr'd into violence it flows out too much or secondly because the mouths of the vessels once opened do not presently close again nor are able to be shut or Thirdly because Nature endeavouring an excretion of blood doth it by places more open but often inconvenient as when an Hemorrhage happens through the Lungs the Kidneys Guts or other Bowels which therefore pass from a Critical into a Symptomical and often into a malignant Haemorrhage Neither only by these means but by many other failings of Nature or impediments 2. Symptomatical Hemorrhagies arise either do Symptomatical Haemorrhagies happen in all which either the Blood it self or the Vessels containing it or both of them together are wont to be chiefly in fault 1. In the first place the Blood besides the reasons above mentioned First by the fault of the blood to wit forasmuch as it becomes inflammable or fermentable above measure is apt also to be extravasated because either its liquor being empoisoned or otherwise corrupted cannot retain its due mixture but being apt to coagulate or putrifie divides it self into parts and whilst some of them being here and there planted sending forth spots wheals and other brands of Malignity do discolour the Flesh and the Skin and obstruct the proper passages others otherwise running out an breaking forth wheresoever there is a vent found do produce bloody Excretions in divers places as is commonly discerned in the Plague Small-pox Measles and malignant Feavers yea perhaps this in some measure is the reason why in scorbutick Distempers as spots and marks so also Haemorrhagies are so familiar 2. Secondly The vessels bringing Blood being faulty many and divers ways Secondly The fault of the Vessels for that they are ill formed but chiefly in these three do appear the cause of a symptomatical Haemorrhage viz. In the first place if perhaps any where some of them are obstructed as often as the blood assumes a more rapid motion either in the same place or in the contiguous parts and also sometimes in remote parts it is constrained to burst out Frequently from such a cause an Haemoptoe proceeds moreover Spitting of blood and the Haemorrhage of the Nostrils do often follow the suppression of the Terms and Hemorrhoids Secondly the little mouths of the vessels by reason of the fleshy Fibres being loosened or resolved by which they are clos'd sometimes are ill formed so that when the ends of the Arteries do gape too much the little mouths of the veips do close By reason of this affection Scorbutical and Cachectical persons are found obnoxious to Haemorrhagies as we have remarkt in another place But Thirdly Thirdly Forasmuch as they are convulsively affected it frequently comes to pass that the Vessels being so evilly formed are also convulsively affected and so the morbific cause being as it were doubled this evil is much encreased insomuch that the muscular fibres of the Vessels being inordinately contracted cause sudden and violent fluxes of the blood one while towards the upper parts anotehr while to wards the lower and so their little mouths being open in the mean time they provoke prodigious Haemorrhagies For I have observed in some persons when the current of blood was small enough with a small and weak pulse the Convulsions of the Vessels generated in some place and propagated under the likeness of wind running to and fro in the body to drive more impetuously the blood however slow of it self and to constrain it into violent eruptions and in cases of this sort when Phlebotomies and Medicines refrigerating and tempering the blood have not at all profited the greatest relief hath been found from Narcoticks Antispasmodicks and Ligatures 3. 3. From the blood and vessels being both in sault Thirdly If perhaps it shall happen that these faults of the Blood and Vessels are complicated and put forth their mischiefs joyntly at once from thence it will be of necessity that this evil will be more intense and more frequent and prodigious Haemorrhagies will be raised the reasons of which as they appear plain enough by what goes before it will be neither necessary nor seasonable here longer to dwell upon explicating of them but rather whereas we have designed hitherto the acts of Nature about spontaneous effusion of Blood and its courses both rightly instituted and also wrongfully and evilly constrained now it behoves us next to declare how far Art for the most part the Ape of Nature and sometimes Mistris or Moderatrix thereof can act likewise well or better about letting of blood and how sometimes it is wont to succeed worse We advertise of these things in general Emission of the Blood procured by art that a Physitian imitates Nature in some cases of letting blood exceeds her in other cases and frequently regulates and reduces her when acting amiss Moreover ther are some cases wherein Nature excells far the efficacy or Art concerning bloody excretions briefly of each of these Therefore in the first place 1. It either imitates Nature in whatever affects spontaneous Haemorrhagies are wont to bring help when these are wanting Physick the Handmaid of Nature rightly substitutes Phlebotomie Therefore if perchance the Blood be immoderately kindled by reason of its Sulphur being too much loosened and advanc'd by breathing a vein what is superfluous of that inflammable fuel will flow out as also the immoderate turgescency of Blood by reason of somewhat untamable being mixed with it will be allay'd by this course Wherefore letting of blood is advantageously administred as well against continual Feavers which proceed from the former cause as intermittent Feavers whose fits proceed from the latter cause Also in like manner as often as an accustomed evacuation being suppressed or a humour driven back from the ourward parts or a sudden stoppage of the pores or if a Surfeit drinking of Wine or other accidents of this nature cause a turgescency of blood inasmuch as they dash heterogeneous particles against it Phlebotomie is usually the most ready Remedy Secondly 2. Or excells and regulates it Physick in Blood-letting not only imitates Nature but often excells it and also succours her being weakened and reduces her often erring For if at any time the blood struck with violence rushes in a heap against any part and either presently breaks out in the same place or abundantly gathered together engenders an Inflammation a vein being pierced in a remote place stops that preternatural tendency of the blood and frequently carryes away the bleeding or inflammation Wherefore in a Pleurise a Squinancy a Peripneumonia in spitting or vomiting of blood when Nature is vanquished or being outragious seems to cast violent hands upon her self Chirurgery recalling the blood to another part and sending it out restores the matter that was almost desperate Moreover Physick frequently restrains or reduces Nature when too prodigal or prevaricating in pouring out of the blood for in truth all immoderate Haemorrhagies
being withdrawn the store of Spirits whose only part it is to vindicate the mass of blood from putrefaction and corruption is diminished so that immediately all things tend to a deadly dissolution Moreover if the Dyscrasie of the blood shall be of that manner that the more noble Principles to wit the Spirit the volatile Salt and Sulphur being depressed or cnsumed the watery and earthy particles predominate the blood ought not to be sent out but preserved even as the treasure of life for when the abundance of Spirits are so small any loss of them doth cause all the functions to stagger and gives way to the disease wherefore in a Dropsie Cachexia Consumption and other Distempers where the active Principles are greatly depressed the opening a vein is almost the same thing as cutting the mans throat In the before mentioned cases In some eases about Phlebotomy it is very doubtfull where the temperament of blood is respected it is easie to determine whether Phlebotomie be convenient or not but in some others as in a putrid continual feaver when upon this hinge Life and Death are turned there is need of the greatest deliberation and so much the rather because the event of the Disease and the success of all the accidents in its whole course whether good or bad is usually imputed to Blood-letting or its omission and from hence it is that Physitians being solicitous to preserve their own repute do chiesly raise doubts in their consultations of this matter And chiefly in a continual putrid Feaver But truly in this difficult knot that we may not be led by the rumour of the vulgar as it chances to happen one while approving another whise condemning Phlebotomie but with more certain advice we must consider the state of the Blood the tendency of the morbific matter and the strength of Nature First as to the former if in a putrid Feaver the blood very much growing hot shall raise a great heat with thirst watchings and burning of the Jaws and no eruption of abundant sweat nor pushes appear or is suddenly expected opening of a vein is so clearly demonstrated How the doubt is to be determined that it is a wickedness to omit it but on the contrary if in a languid body a slow and remiss Feaver but continual arises with a weak Pulse let Blood-letting be spared and the cleansing thereof be procured by breathing Sweats Urine and blistering Notwithstanding in a middle state of Blood and of a Feaver Phlebotomy almost indifferent in it self is determined by other things Therefore secondly we must weigh the tendency or flux of the morbific matter which if it remain dull in the mass of blood and unfit to be separated and so as it is frequently wont to be instead of a Crisis a translation towards the head be made and threaten the brain and nervous stock the cutting of a vein ought seasonably to be administred whereby these evils may be provided against Notwithstanding if that this matter being soon raised into a rage and either rushing inwardly to the bowels of the nether Belly provokes a huge Vomiting or Dysenterical affections or being driven outwardly seems to be about to bring the Small-pox Measles and other pushes every such force of Nature if good ought not to be disturbed if evil not to be made worse by Phlebotomie for in these cases it is not only dangerous to let blood but also very scandalous Thirdly about Phlebotomy to be administred in a doubtful case we are to take heed to the strength of the Patient for in a healthful Constitution a vigorous Age the commencing of a Disease and the functions both vital and animal being yet in a florid or indifferent estate we may confidently prescribe letting of blood unless something indicates the contrary Notwithstanding when it is otherwise as to those conditions we may not rashly proceed to that Evacuation Thirdly Thirdly Phlebotomy corrects or stays the inordinate motions of the Blood the inordinate motions of the Blood when being very much moved as it were with fury it either rushes impetuously one while into these parts another while into those or transferres the noxious matter are best restrained or reduced by Phlebotomy wherefore in great Cephalalgies in all soporiferous or convulsive invasions for Catarrhs Ophthalmia's and a Cough Asthma fits of the Gout and Stone or Phlegmons Erysipelas's also for many other Distempers raised by the flowings of the Blood or Serum an incision of the vein is commonly prescribed and indeed for the most part as with good success so also upon right Reason for the Vessels being emptyed the blood having obtained a more free space is circulated pleasantly and undisturbedly besides whatever is extravasated of the Blood or Serum is wont to be suckt up again and reduced into its course The Effects as well good as bad being thus shewn What Diseases and of what parts Blood-letting chiefly respects which happen to the blood in the manifold state thereof by Phlebotomie we will next make strict examination what Diseases chiefly either of the whole body or of any private Region that kind of Remedy doth more immediately regard And first as to what relates to general Distempers it is commonly enough known that letting blood is indicated bu a hot and dry temperament and interdicted by a moist and cold It is usually propounded in every Feaver but never in a Dropsie Moreover if we consider particular Diseases there is no region or part of the Body but as they rejoyce in the influence of vital as well as nutritious blood as long as it is well so as often as it is disturbed in any place or reaches out any disagreeable or provocative thing in place of benign Juice it requires avocation and a letting out thereof If I should take notice of every single case of this Indication we should here rehearse almost the whole Pathologie of the humane body An aking Head a Brain oppress'd with blood or overflowed with Serum whence spring a world of evils burning of the eyes inflammation of the face mouth and throat all the diseases of the Breast and Praecordia inasmuch as the disorder of Blood affords a rise or fuel to each of these likewise obstructions or inflammatory affections of the Liver Spleen and other Bowels moreover as a Plethora and Athletick habit of the whole body so also the tumours of each member painful and convulsive passions seem to accuse the blood as Author of all the evil and require its sending out as a certain kind of revenge In these and very many other distempers if at any time Bleeding be clearly indicated After Phlebotomy being indicated these four things following ought to be considered before it be performed four things ought to be considered viz. In what place by what manner and instrument at what season and in what quantity the Blood ought to be taken away First as to the former although according to the Laws of the
the most part remains uncurable by reason of the continual motion of the Vessel and the efflux of blood It is otherwise in a Vein whose opening is immediately stopt of its own accord for but little of contractive work lies in its Coats yea this only that its fibres being lightly opened as occasion serves the blood flowing back of its own accord is gently moved forwards and after Phlebotomy the vessel being empty they are permitted to be quiet so that in the mean time the little hole made by incision is easily glewed together Whenever Physitian or Patient do dread the opening of a vein to be administred drawing of blood by Leeches or Cupping-glasses will aptly enough and with like advantage supply the defect hereof Moreover these administractions to remove the conjunct cause of a disease where there is need rather of partial than general Evacuation or Derivation are frequently preferr'd to Blood-letting it self There is no need to dwell longer on explicating the manner and reafon of the effects of either of these operations commonly enough known but proceeding to other things we will next throughly weigh the Time and Quantity of letting Blood The opportunity of letting blood is often of so great moment Thirdly The Time of letting Blood comes into consideration that whereas this Evacuation succeeds well at one time at another it highly prejudices But there are diverse respects of time to be considered about the due performance of Blood-letting but chiefly these four The Time of the Disease the Age the Year and Day The first concerns chiefly the Cure of the Patient the others the Preservation of him First therefore if blood ought to be let in any Disease 1. In respect of the disease it will be chiefly sesonably about the beginning or encrease thereof but not at all or very cautiously in the state or declination For at that time whilst Nature is busied endeavouring a Crisis so that the Spirits are in great labour and the blood ferments very much that great endeavour of it ought not to be disturbed and in the height of the disease either Nature being Conqueress doth not want such a relief or being subdued will not endure such an Evacuation Secondly If at any time for preservation it be deliberated touching letting blood 2. In respect of age Infants Boys and Old men by the Custon of all Nations obtain an exemption also this evacuation was wont to be interdicted to pregnant Women but now most commonly prescribed Men of a vigorous Constitution and middle Age do well enough endure Phlebotomy and often times want it Notwithstanding the first and second time it ought not to be done without great occasion for that being once begun and afterwards repeated it will soon proceed into an inevitable Custom Thirdly Hence they who used to let blood Spring and Autumn 3. In respect of the Tear and its parts afterwards cannot omit this evacuation without hazard But to whom it will be either profltable or necessary to breath a Vein once or twice a year the chief seasonable times will be in the beginning of Spring and Autumn viz. when the Blood being prone to ferment anew is in danger to change its Crasis Phlebotomy seasonably administred provides lest the Sulphur and Salts being exalted it should contract a feaverish scorbutical or other peccant distemper likewise lest suffering a flux it should pour forth the serous Recrements and other Feculencies upon the Brain the Lungs or Bowels of the nether belly About the Solstices when our bodies are very cold or hot the blood as the juice of all Vegetables consisting in a more fixt state and unapt to sweel up ought not to be let out unless upon some urgent cause But whereas some precisely or rather ridiculously observe about Phlebotomy The Aspect of the Moon and Stars are here of no moment even as the Countrey-men about Gelding Cattle the position of the Heavens and the Aspects of Moon and Stars it appears altogether frivolous and for that chiefly is this Custom condemned inasmuch as counterfeit Astrologers have a Figure in their Almanacks wherein every sign of the Zodiack is allotted to every particular member of our bodies and for that cause under what sign the Moon is conversant they forbid blood to be drawn from the respective part of man They who observe without reason the Heavens do erre as the saying is the whole compass of the Heavens Moreover this vulgar error is not only absurd but frequently malevolent inasmuch as many of the common people will abstain from Phlebotomy whatever indication makes for the same if as they say the Sign be in the place of letting blood Fourthly As to what relates to the time of the Day in acute Disease 4. The time of the day about letting of Blood when a Physitian is sent for and there be indication for Phlebotomy immediately to be performed after the body is prepared he may prescribe that operation any hour in day or night but otherwise if any interval may be allowed then breathing a Vein rather is to be celebrated in a morning when the Stomach is fasting the vessels emptyed by sweat in the night the stream of blood being quietest and appearing free from any â—â—ous filth Yea although necessity urge it may be deferr'd a little untill the new Juice of things eaten be pass'd into the blood for the vessels being emptryed-will not only snatch the crude Chyle into themselves but frequently what is disagreeable or unproportionate unto the blood whence not only its motion is difordered but also the vital flame runs the hazard of being extinct I have known some by Phlebotomy administred presently after plentiful Drinking or pouring in of vinous liquors to have fallen into dreadfull swoundings away which have lasted very long untill the vital spirit being almost overwhelmed recovered it self again Moreover in the fifth place the opening the vein being indicated 5. The Quantity of the Blood to be taken away ought to be considered and its time appointed there remains still no little consideration to be had what Quantity of blood is to be let out in which point there is most commonly a fault committed while some being too audacious and others no less timerous they affix those bounds on this or that side of which for the most part consists the Right For that I may omit those who scarcely or not at all admit of Phlebotomy as I have before hinted so I cannot easily assent to their practice who fear not to draw blood to swounings Too much Phlebotomy to be avoided Besides an error of no light moment is committed within the moderate bounds while in some cases blood is drawn by too sparing a hand and in others with too free In a burning Feaver But a more spare Bleeding often hurts and fixes a feavour Pleurisie Peripneumonia Squinancy Frenzie Apoplexie and other great diseases that have their origine from a turgescency or phlegmonic incursion of
the blood a sparing Phlebotomy doth always more prejudice than advantage For besides that it doth not remove the antecedent cause of the disease to wit the Plethora it further causes the conjunct cause viz. the inflammation and bursting out of the blood to be angmented For truly it is a constant observation that upon blood too sparingly drawn the whole mass doth boyl up more notably and doth acquire a new flux into the part affected the reason of which is that in a great Plethora many portions both of the Blood and Serum being thrust forward into recesses and strait places are there constrained to abide which after the Vessels being a very little emptyed The Reason of which is declared do impetuously regurgitate into the mass of blood and do much disturb it and force it more impetuously to and fro Wherefore also in this respect the vessels ought to be very much empted viz. that besides freeing the former Juice from straitness also space may be given to the Juice reduced from exile which otherwise being not congruous coming upon the blood troubles it and provokes it into effervescencies and eruptions From hence we may observe that almost all men grow more hot presently after Phlebotomy and yet the blood being sufficiently evacuated a little after they enjoy a more temperate condition But as a slender withdrawing of blood in some cases is only vain but is performed with prejudice so in other cases too much effusion is rarely committed scot-free and sometimes brings notable detriment of health For when either strength languishes or the body labours under a notorious Cachexia we must spare Blood-letting and its taking away is either prohibited or being indicated by some accident is allowed but in a small quantity Wherefore in men endowed with a weak tender and cold Constitution and in consumptive persons those affected with a long or malignant Feaver In some eases the mission of Blood must be altogether avoided also in Hydropicks or Cacochymicks a vein is not rashly to be breathed at least if it be much blood is not suffered to be taken away It will be an impossible thing to prescribe general Rules according to the particular cases of every individual person whereby the quentity of letting Blood may be exactly proportion'd according to the strength of the Disease and the ability of the Patient but let this be left to the judgment of the prudent Physitian present and let his Commands be ever exacutly observed And let not as it every where is such leave be given to Quacks Empiricks and Barbers to play with humane life who every where rashly and wickedly use Phlebotomy and if the blood spring more sreely and appear discolour'd therefore bragging of the vessel being well pierc'd they say it must be let out more plentifully because it appears bad when oftentimes on the contrary it ought to be spared As soon as the Quantity of Blood to be taken away is determined Phlebotomy ought ever to be done with a large orifice our next care ought to be that a more large orifice being made the blood equally mixt may flow out as soon as may be for otherwise if it go out from a small hole or drop by drop or with a little stream the mass of blood fermenting will separate into parts and what is more subtile and spirituous will burst out the thicker and feculent remaining behind Hence it is to be observed that the blood being let out of a large orifice with a more full stream if it be a little stopt with the finger clapt on it and a little after suffered to flow out the blood going out the second time becomes much purer and brighter than the former because in the interval of flowing the more subtile particles being unfolded from the thicker and accumulated together have prepared themselves to fly away Wherefore if Hippocrates's Precept shall be observed ' viz. to let it run to the change of its Colour it behoves us to procure that it spring out quickly with a full a not interrupted stream Besides all this as to what appertains to the alteration of the blood let out and cold and to the inspection and the judgment thereof for that we have often discoursed it in other places we now pass it by hastening to other things and now the thread of Method leads us to entreat of Remedies opposite to Blood-letting to wit Ischaemones that is those which are convenient to stop immoderate Haemorrhagies whether engenderd by Nature or by accident SECT III. CHAP. II. Of Remedies restraining or stopping of Blood EVen as Art imitates Nature in letting forth the blood by Phlebotomy offending in plenty or temperament or in its motion Every Hemorrhage is not to be stopt so it succours her being diseased or working wrong by stopping the flux of blood whensoever it is immoderate or hurtfull Whereas there are various and many species of an Hemorrhage there is no need of Physick for them all If perhaps a great effusion of blood happens by a solution of unity excited by an outward accident as a wound or stroke Chirurgery suggests the manner of Administrations whereby it should be restrained Moreover an Hemorrhage as long as it shall be Critical ought to be disturbed by no Medicine but left to the meer government of Nature as long as she does aright use her power and as to the Symptomatic whilest it is little or not much troublesome there is required no Physick notwithstanding there is great need of it if at any time the Flux of blood be either immoderate or flow out by unapt places Eruptions of blood of this last kind chiefly challenge a Cure But only the immoderate and inconvenient if perhaps the blood be cast upward by Coughing or Vomit or downwards by seige or thrown off through the Ureters For in these cases though the quantity of the Blood excreted be not much to be dreaded notwithstanding because often a dangerous or mortal Ulcer ensues the solution of the Unity so made in the Lungs or in the Stomach Guts or in a Vein therefore we must industriously rancounter those Hemorrhagies from their first appearance Therefore among the Diseases of those parts The chief Cases of the latter are reckoned such bloody excretions are accounted but we have already in another place delivered the Theories of Spitting Blood and of the affection Dysenterical and the reasons of healing them so that there is no need to repeat them here neither also to propound here a remedy for bloody Urine for that it belongs to the Nephritic Pathology wherefore we will pass to those Passions for which by reason of an immoderate efflux of blood there is great need of restraining Medicines The kinds of these Affections are chiefly three viz. Haemorrhage of the Nostrils And also of the former of the Flowers and the immoderate Flux of the Hemorrhoids The Cure of which last doth belong more to Chirurgery than Physick and I think it
are Necklaces of Blood-stone hung about the Neck also the moss of a humane Skull carryed in the hand Epithemes of the leaves of Nettles bruised and applyed to the soles of the feet and the Palms of the hands the Empirical administrations of which kind when they may be administred without trouble or cost we make no refusal of since in a dangerous case every thing is to be attempted and applications of that sort do help sometimes in respect that they fortifie the imagination of the patient While such like outward Administrations are used Topicks closing the mouths of the Vessels for repressing or calling aside the flux of blood out of the Nostrils also other Topicks are put up into the Nostrils which may shut the gaping mouths of the vessels for which use the injections of liquid things Pledgets Powders to be blown in and Fumes are wont to be prescribed which not helping in the last place we descend to Escharoticks Ninthly 6. Escharoticks The injection of Vitriol water Among Liquids not only first but as good as all others is esteemed the solution of Vitriol in Fountain-water Some boast this for a great secret and a most certain Remedy Indeed the same being applyed to a fresh wound forasmuch as it shuts the ends of the cut vessels by wrinkling them up it restrains and presently stops the flux of blood But that application in Hemorrhages of the Nostrils where the blood being brought to the gaping mouths of the little Arteries ought to be received by the Veins in regard it shuts them as well or rather than those it succeeds little and sometimes not at all as I have known it frequently experimented This Medicine is prepared of Green Vitriol viz. of Hungary or of our Countrey also of the fictitious Vitriol of Mars dissolved in a sufficient quantity of Spring-water I know some commend the solution of Roman Vitriol which they not only apply by injection but also to a linnen cloath dipt in the blood are wont to administer it sympathetically Moreover the water of the infusion of white Vitriol prepared with Bole and Camphire I have known to be used successefully as well in wounds as often in other Hemorrhagies Tenthly 10. Pledgets Since water cast into the Nostrils doth not adhere enough to the mouths of the Vessels but is washed away by the breaking out of the blood before it can exert its Virtue it is therefore more expedient either that a Styptick powder be blown in or that a Pledget dipt in the water of Vitriol either by it self or strewed with an astringent powder be thrust into the upper part of the Nostril For this purpose many and several kinds of styptick powders have been prescribed I have frequently used either Crocus Martis calcin'd to the highest redness or the powder of Camphorated Vitriol or the vitriolic Soot scrap't from the bottom of an old Brass Pot the powder whereof I have often used with success in this case In obstinate Hemorrhagies not yielding to other remedies let Pledgets whose tops are dipt in Caustick Colcothar be put up deep into the Nostrils that the mouths of the Vessels being burnt and covered with an Eschar all flux of blood may be presently stopt Many other Errhines to stop bleeding are accounted famous with Practitioners Hogs-dung as Hogs-dung thrust into the Nostrils which by the meer ill savour is thought to repell the blood also the smoak of Blood dropping on hot Iron Burnt Blood repercuss'd into the Nose the Powder being burnt is also taken inwardly The moss of a humane Skull unburied put into the Nostrils is commended by many for this effect but these latter applications ought to be referred to the sympathetick Aetiologie if they avail any thing These things concerning outward Remedies stopping blood the vertue and efficacy of which ought at the same time to be promoted by intern Remedies seasonably exhibited and cooperating Therefore a slender Diet being instituted Inward Remedyes whereof are two intentions and the Patient ordered to keep himself in an upright posture or not much supine while the aforesaid Administrations are orderly administred medicines appropriated to the same end are also prescribed to be taken inwardly There will be two scopes of Remedies of this sort viz. 1. That the effervescency of Blood whether incentive or fermentative being suppressed the liquor thereof being restrained within the vessels may pleasingly circulate 2. That the more impetuous motion of the heart driving about the blood too rapidly may be dedpressed by apt Sufflamina's 1. 1. Things appeasing the effervescency of the blood The first Intention requires Medicines that suppress the too much kindling of the blood and appease the undue fermentation thereof for which intents I usually prescribe the ensuing Remedies Take of the water of Plantane red Poppy Purslain and frog-Spawn Juleps of each four ounces Syrup of water-Lillies two ounces Sal Prunella one dram mix them for a Julep the dose three ounces three or four times a day Take Barly-water two pound Red-rose leaves one handfull Tinctures Spirit of Vitriol what suffices to make it gratefull or about half a dram make an Infusion warm for extracting the Tincture adde Syrup of St. John ' s-wort two ounces the dose three or four ounces as oft as they please day or night Take leaves of stinging Nettles of Plantane of each three handfuls pour upon them being bruised Plantane-water 6 ounces press them strongly let the strained liquor be taken 2. For the second Intention to wit 2. Intention to cool the motion of the Heart for the cooling of the heart too vehemently beating Hypnoticks and Opiates are convenient Take water of red Poppies three ounces Is done by Hypnoticks Syrup of Diacodium half an ounce make a draught to take at night Or Take Conserve of red Roses an ounce and a half Powder of Henbane and white Poppy-seeds of each two drams Syrup of Poppyes enough to make an Opiate The dose the quantity of a Nutmeg every six or eight hours Take of Laudanum Cydoniatum one dram the dose fifteen drops twice a day in a convenient Vehicle These things touching an immoderate Hemorrhage and the Remedies thereof Of a Hemorrhage in a malignant Feaver when it happens without a Feaver but that which coming in a feaver ought to be stopt in regard of the too great loss of Blood is either Critical making an immoderate excursion by reason of some accident for which the Method and Medicines even now prescribed with caution and respect had to the Feaver may be accommodated or meerly Symptomatical which being excited in a malignant and Spotted Feaver Small-pox Measles or the Plague neither scarcely can nor ought to be stopt with the Remedies above recited For letting of blood is not convenient repelling Topicks also cooling Juleps or Decoctions and Narcoticks have no place here The chief intention of Healing will be to change the Hemorrhage into Sweating for a gentle Sweat
being raised the flux of Blood often ceases if it be not very dangerous Take water of Meadow sweet Tormentil of each four ounces Remedies Saxons cool Cordial two ounces Treacle water an ounce and a half Acetum Bozoardicum three drams Syrup of Croal an ounce and a half Confection of Hyacinths two drams make a Julep the dose six spoonfuls every third hour Take of the Powder of Toads prepared half a dram Camphire two grains take it every sixth hour with the forementioned Julep Or Take Powder of Scarlet-cloth from half a dram to two Scruples as before Take Consection of Hyacinths three drams Powder of Scarlet-cloth on edram Syrup of Corals enough to make a Confection the dose the quantity of a Nutmeg every other hour Take of Bistort and Tormentil-roots of each one ounce the leaves of Meadowsweet Pimpernel Wood-sorrel of each one handful burnt Harts-horn two drams Shavings of Ivory and Hart horn of each two drams boyl them in Spring-water from three pound to two adding about the end Conserve of red Roses three ounces the dose three ounces being strained often in a day 2. Second Indication vital Hitherto of the first Indication Curatory together with the scopes of healing and forms of Remedies appointed for a Haemorrhage of the Nose happening with or without a feaver The second Indication Vital only prescribes a slender Diet temperate Cordial The Position of the Sick and a fit handling of the Patient The Provision of the first is so small and easie that there seems no need to appoint a Measure and Rules for it particularly About the latter the chief question is whether we ought to retain them within or out of their beds Without doubt the languishing and those obnoxious to often swounings are not to be roused up unless as we have already hinted it be for a Curatory attempt as to others less weak it seems so to be determijned Those whose Blood does not easily transpire by reason of the constipation of the pores Sometimes in bed and sometimes out and is incited into a greater turgescence from the heat of the bed and proner to break out it will be expedient they not only remain out of bed while bleeding but also sometimes through extern applications to be cooled in the whole habit of their body or at least in most of their members Wherefore Fabritius Hildanus relates he suddenly cured one of a great Hemorrhage of the Nostrils after many things tryed in vain by putting him into a vessel of cold water Also with like success Riverius cured another affected in like manner being taken out of his bed and laid on a woollen Matte on the Pavement he bathed his whole body with Linnen dipt in Oxycrate Yet this method is not alike convenient for all persons or at all seasons but on the contrary those whose blood is halituous and enjoying more open pores doth evaporate easily mnad being wont to be dissolved by a more moderate heat encompassing them into sweat and from thence find themselves more quiet it is more convenient that they remain within the bed not only while the blood breaks out but as long as there is danger of its return For this reason it is that many obnoxious to dreadful Hemorrhagies during the Summer when they transpire more freely live exempt from that disease but the Winter cold pressing them by reason of their pores being bound up they suffer under more frequent and dreadful Invasions 3. Third Indication Preservatory hath two intentions of healing The third Indication Preservatory which regarding the removing the Cause of that disease either stops the eruptions of blood or renders the same more rare or less and suggests these two Intentions of healing viz. 1. That the blood being restored to its due temperament and mixture may quietly circulate within the vessels without turgescency and breaking out 2. That the Vessels carrying Blood as to the structure of their little mouths and the tenours of the muscular fibres may be contained in their due state so that they neither cause those inordinate tendencies of blood towards the Head nor suffer effluxes out of the nose For both these ends too great plenty and impurity of the Blood are carefully to be provided against by Phlebotomy and Purgation seasonably used afterwards for procuring and conserving its good temperature the following Alteratives may be given at fit seasons of healing Take of Conserve of red Roses Forms of Remedies of Hipps an three ounce powder of all the Sanders an half a dram Coral prepared one dram of the reddest Crocus Martis two drams Sal Prunella four Scruples with Syrup of Coral make an Electuary take the quantity of a Chesnut early in the morning and at night by it self or drinking after it three ounces of the following water Take the tops of Cypresse Tamaris an eight handfuls St. Johns-wort Tamarisk Horsetail an four handfuls of all the Sanders bruised an one ounce of the Crum of Whitebread two pound slice them small and pour on them of new milk eight pound distill in a cold Still sweeten each dose when taken with Syrup of the juice of Plantane Take leaves of Plantane Brooklime stinging Nettles of each four handfuls to them bruised pour half a pound of the foregoing water of small Cinnamon-water two ounces press them strong the dose three ounces to four at Nine in the Morning and at Five in the Afternoon Madicines of this sort are taken in Spring and Autumn for twenty or thirty dayes with sometimes a gently Purge coming between In Summer let them drink Mineral Steel-waters for a Month than which in this case there is not a better Remedy Out of many Examples of persons labouring with an Hemorrhage we only propose this one singular case I was lately consulted at a distance for a certain Gentleman that had suffered frequent and great eruptions of blood one while at the Nostrils An Example of a rare Hemorrhage anotehr while at the Hemorrhoid Vessels He had frequently used Phlebotomy by perswasion of his friends without benefit yea frequently falling into cold Sweats and Swounings after breathing a vein and notwithstanding obnoxious to eruptions of blood he was wont to be much worse I prescribed Juleps having not yet seen him and cooling Decoctions and Anodyhnes also the juicy expressions of herbs and other things cooling the blood but even from these as if all still far enough from the scope he was nothing the better At length being sent for into the Countrey to visit him I found the affection under which he suffered to be meerly or chiefly convulsive for whereas he daily bled his Pulse was weak the extreme parts cold and all his Vessels as being too much emptyed fell flat It s Aetiologie also the patient was affected with a continual Vertigo and trembling of heart and by and by with a swouning or fear of it Really the blood was so far from breaking out by reason of turgescentce that
using them But that they in the first place operate on the Spirits is manifest from hence that they exert no power on the deceased and it is an ill Omen in those that are languishing when Vesicatories have no operation because it is an Indication that the Animal Spirits are much dejected or abundantly diminished Thereofre The effects of Vesicatories it behoves to consider about the due unfolding the energy force or virtue of this remedy what humours it either immediately or mediately evacuates or alters and afterwards in what Diseases and bodies how disposed it either profits or hurts First 1. As to humours of the Skin As to the former the humours that are immediately sent out by a Vesicatory drop forth partly from the pores and glandules of the Skin and partly out of the mouths of the little Arteries and partly out of the extremities of the Nervous fibres perhaps some little of the Juice newly received out of the mouths of the veins though not much seems to be carryed back The humours mediately drawn out by a Vesicatory are those which the aforesaid parts being emptyed receive elsewhere and derive them forth 1. The Skin is a thick Memgbrane consisting of a double Coat very porous also thick set about with most numerous galndules with fat as also the ends of the Vessels and fibres being terminated therein and thickly woven one within another Wherefore while a portion of it is made bare the Scars-skin being taken off with a Vesicatory and the nervous sibres being twitched do bind together and wreath the glandules and pores the serous humour contained in both is most plentifully squeezed out And whereas some pores are pervious into others the Serum doth not only flow out of the place blister'd but sometimes into the little holes first so emptyed a portion of the Serum coming from the neighbouring pores succeeds and thence by and by sweats out wherefore in Patients affected with an Anasarca the little ulcers raised by a Vesicatory exhaust the waters every where in great plenty and draw them out of the neighbourhood yea and sometimes at a great distance 2. 2. In respect of the blood The little mouths of the Arteries being uncovered and twitched about the blistered place do not only vomit out a portion of the Serum brought to them by ordinary custom but the serous liquor being imbued with the Stimula of the medicine in the whole mass of blood immediately is separated more plentifully from the blood and at every turn of Circulation a greater plenty thereof is thrown out by the same mouths of the Arteries continually irritated Which they purge and alter Moreover together with the Serum as it were so stagnating and therefore removed from the whole blood into the little ulcers of the skin other recrements and sometimes the morbific matter it self depart in plenty and are dispatched forth by the same Emissaries and for this reason in malignant feavers yea in some putrid that are difficult to be judged of when the recrements and corruptions of the blood unapt to be thrown off do threaten the Praecordia or Brain Vesicatories continually and leisurely draining it do frequently yield notable relief whereunto we may adde that they do also alter and restore as we before mentined the blood degenerate or depraved as to its Salts and also by opening or subtiliing its consistence dispose it towards an Eucrasie wherefore not only in a seaverish state of Blood but also in a state otherwise peccant or of ill Juice this kind of remedy is often extreamly convenient 3. 3. In respect of the Nerves and of the humours abounding in them and in the nervous parts Both reason and experience have enough proved that Vesicatories evacuate a certain humour from the Nerves and nervous Fibres and for that cause profit very much in convulsive distempers For surely we have in another place clearly enouth demonstrated that the watery liquor of the Brain and Nervous sytem doth sometimes abound with heterogeneous Particles Also it is manifest by frequent and familiar observation that the impurities and recrements of that liquor together with the watery Juice do spontaneously sweat out from the Nerves and nervous Fibres when the fluor is raised and either restagnating within the mass of blood are carryed off by Urine or by Sweats or being deposited within the Cavities of the bowels are dispatched by Vomit or Stool Wherefore when a Vesicatory is applyed the extremities of the Nerves and nervous Fibres being made bare and very much angred immediately a humour abounding near their ends is voided and also the whole Juice planted within their passages by a long succession is chafed and delivered from stagnation and the heterogeneous particles mixt with that nervous Juice being every where agitated and derived from the Brain slide towards their newly opened Emissary by degrees and at length are removed wholly forth From these things we may collect For the curing of what Diseases Vesicatories are convenient for the Cure of what Diseases this kind of remedy doth chiefly conduce for by reason of its evacuation out of the pores and glandules of the skin as often as any serous salt sharp or otherwise hurtful humour is collected in those parts or their neighbourhood and being excluded from the Circulation of blood shall obstinately stick in that place surely there is no more ready or easie way afforded for drawintg it forth than by applying a Vesicatory 1. In all cutaneous Distempers upon or below the place affected Wherefore it is not only indicated by an Anasarca or by any foulness or eruptions of the Skin but moreover a Vesicatory is required for pains either arthritical or scorbutical fixt any where in the extern habit of the body or in any certain member Secondly In respect of the Blood Vesictatories are always used in malignant Feavers 2. They take away the impurities and ill temperament of the blood as well to purge out leisurely any heterogeneous or morbific matter as to change it from a disposition either too acid or salt or otherwise peccant into a right temperament yea they are of most excellent use in all putrid feavers of ill habit and hard to be judged of Also for that cause in the Scurvy Leucophlegmatia This Remedy is profitable in those Diseases which the blood produces in other parts Pica Virginum or Green Sickness also in any other ill habit of body this kind of remedy affords frequently notable help Moreover not only for the sake of correcting the blood it self but besides as often as it being depraved spreads its corruption on other parts and so doth first beget diseases in the Head the Chest the nether Belly or Members and then excites their Fits Vesicatories are usually exhibited with success Wherefore it is a common remedy in Head-aches a Vertigo and soporiferous affections no less than in a Catarrh or any defluxion either into the Eyes Nose Palate or Lungs in which
as it is not easie They are not to be cured so it is not safe to stop them before the whole Mine of theDisease be consumed Not long since a famous Doctor of Physick in London An Example is shewn searcely recovering from a malignant Feaver did copioufly sweat out lchor daily from places blistered in several parts of his body after some time they being troublesome and tedious he did apply stronger Repercussives to them all and immediately restanined their flux Those sluces were scarce two days stopt but his disease revived and on the sudden he was affected with sainting of Spirits and often swooning a cold Sweat and a low weak Pulfe and whereas he could not be relieved by any Remedies however cordial they were hd dyed within three days the cause of which seems to be that the malignant matter being suddenly repercussed fell into the Cardiac Nerves whose action being hindred the vital function quickly failed SECT III. CHAP. IV. Of Fontinels or Issues BEsides Vesicatories which being as it were the extemporary Emissaries of the Serum and other humours externally to be brought forth are only raised upon some occasions and then after their efficacy a little shewed are permitted to be dryed up there are others esteemed as it were continual Foutains Issues rather a preservatory than curatory Remedy therefore named Fonticuli or Issues out of which the Ichor or ferous houmour flows with a constant Sping Those former as they are requisite for the most part for Cure-sake in acute or other Diseases whose morbifick matter requires a quick dispatch in the first place respect the conjunct cause of the Disease to be removed and therefore being more broad are made only superficial that such little Ulcers being large may evacuate much and then easily be healed but on the other side Issues being chiefly indicated for preservation are ordained to remove or vanquish the procatarctick cause of the Disease wherefore they consist of a more narrow orifice but made more deep through the thickness of the whole skin to the end that while they send out the morbifick matter in lesser quantity they may derive it further and continue longer to purge it out There are three chiefheads of disquisitions concerning Issues viz. First About these three things are to be enquired into what humours these Emissaries chiefly evacuate and whence they bring them Secondly in what Diseases or Constitutins they better or worse agree Afterwards Thirdly in what places in what from and with what instruments they ought to bre made 1. As to the former Issues like Blisters 1. What humours they evacuate purge out all humours fixt within the skin although in a less compass or brought through it as well by the sanguiferous as nervous Vessels not only as they provoke or as it were suck the outer superficies of the skin but by piercing through the whole hide or skin they convey out whatsoever flows from the sides of the orifice through the broken Vessels also whatsoever slides down elsewhere beneath the orifice Wherefore not only humours accumulated within the pores of the skin or glandules or brought thither by the Arteries or Nerves have conflux to Issues but moreover the serous recrements under the skin that are wont to be tranferr'd or creep between the interspaces of the muscles and membranes from place to place tend every where unto them and find passage Moreover an Issue appointed in the way anticipates morbifick humours which were formerly wont to be conveyed to other weak and long afflicted parts and by such means exempts one while this part another while that from their invasion Hence either a Gouty or Nephritick or Colick matter and sometimes a Paralytical or otherways scorbutical are frequently intercepted by Fontinels in their passage from their Source to their nests or places of residence and so are conveyed forth and the usual assaults of a disease declined Neither doth this Emissary less purge from thence by degrees the humours impacted in any part or region of the body and there causing prejudice than water-furrows made for derivation of moisture and so prevent or cure a sickly disposition 2. 2. In what diseases they chlefly prevail From these several accounts of assistance whereby Issues in general are wont to help it is easily collected for what distempers they are chiefly required for although there is scarce any disease happens wherein this remedy is either hurtfull or unprofitable notwithstanding it seems rather more necessary in some cases than in others It is commonly prescribed for almost every disease of the head whether outward or in ward Every one of the ordinary people procures an Issue as equal to all other Remedies for the Convulsions of Infants or Youths for Sore-Eyes Kings-Evil as also for Head-ache in persons adult or ancient for drousie vertiginous or Cramp like distempers Neither is it less celebrated against diseases of the Breast As who is obnoxious to a Cough bloody or consumptive Spitting or an Asthma that long enjoys his skin whole In like manner Issues are commended in affects of the lower Belly scarce any Hypochondriacal person or Hysterical woman in like manner no Gouty or Cachectical person but hath his skin pierc'd in many places like a Lamprey It would be a vast work to recount here particularly all the Distempers for which Fontinels are helpfull 3. 3. In what Bodyes they agree not But really this remedy nt however advantagious and benign of it self doth not agree with all persons nor is it indifferently to be prescribed to every one For there are two sorts of men which though sick are to be excused from Issues inasmuch as this Emissary evacuates too much in some and too little in others or less than is convenient and in the mean while remains very painful and intolerable Sometimes a Fontinel is not convenient Viz. First where they evacuate too much because it too much evacuates or consumes the humour or Spirits For I have observed in some that an Issue made in any part of the body pours out an immoderate quantity of Ichor and peccant in quality for out of it by often turns if not continually a watery thin and fetid Juice oftentimes discolouring the Pea and Coverings with blackness flows out in great abundance and so the strength and flesh is impaired by too great an Efflux thereof The reason whereof seems to be this Why they often pour out the humour too much that in some persons end ued with an ill dispositon of blood and humours a wound being made and hindred from healing up degenerates straightways into a silthy and malignant Ulcer the sides whereof put on the nature of an acid corruptive ferment whereby the portions of blood continually forced thither are so tainted and dissolved that the Serum thereof imbued with the dissolved Sulphur and other Corruptions being refused by the Veins flows out there copiously Moreover this putrifying pollution of an Issue being communicated to the
Sciatica For surely the glandulous Emunctories settled in that place do imbibe very many recrements of the blood and nervous Juice which if they be throughly and continually discharg'd from them by a fit vent it will much conduce to exempt the contiguous parts from any morbifick Mine The Thigh being a member soft and large in bulk In the Thigh seems apt enough for enduring many and great Issues to wit those which may purge away plentiful humours from the whole body Yet it doth not succeed so with many patients partly because of its figure too much declining like a Cone invers'd the Ligature containing the Pease in the orifice is not easily kept on and partly because a solution of the Unity being made among the concourse of so many Tendons it frequently becomes inflamed and painfull insomuch that fometimes it hath been necessary that it should immediately be stopt up to withdraw the trouble of pain and of lameness Notwithstanding it succeeds better in some Patients for that an inflammation doth not always ensue upon the place where the incision was made and that the Ligature has remained immovable to those that tye their hose above the knee Moreover A fit place in the member to be chosen that it may be made far from Vessels and Tendons as concerning Issues it is requisite to choose a convenient place not only in the body but also in the very member where incision is made which chiefly calls for the judgement of an expert Physician or Chirurgeon for carefull provision must be made lest a Cautery or incision be made upon or too near the Tendons or greater Vessels but let the Fontinel be made not in the very body of the muscle but in the interspace or distance between the muscles where the orifice as John Heurnius learnedly observes ought to pass through the whole skin so far untill the little membrane of the muscle underneath be penetrated Wherefore this part of Chirurgery is not rashly to be allowed to Quacks and others ignorant of Anatomy for that from this being ill done not only a frustration of the benefit but from thence frequently great mischief happens and sometimes to the hazard of life It is not needfull to describe the figure and use of the cutting Instrument Symptoms accidental to Issues how to be cured together with the manner of preparing and compounding Causticks for making Issues inasmuch as it is notorious to the common people yet it behoves us to handle in what manner the symptomes which happen to these Emissaries after they are made may be cured and it will not be besides the matter to discourse what do either impede or pervert their powers Whereas many and several distempers happen to Issues help is not required for them all but only for such as are of greatest moment Wherefore there will be need of help 1. Wheresoever an inflammation ensues upon the part or place where it is What chiefly require help 2. If the Orifice vent more or less Ichor than it ought 3. If the Ulcer shall be apt spontaneously to be dryed up and cover'd over with a skin or if it be prone to abound with spongious flesh growing about the sides As to lesser faults as when the Ulcer shall break forth into frequent Haemorrhagies or change its place creeping into another less convenient with many other ways by which it prevaricates it will not be worth our labour to discourse here 1. 1. Inflammation An inflammation frequently happens to an issue and that so painfull sometimes that it threatens a Sphacela yea and sometimes causes one But such an affection ensues either upon the orifice new made or happens after wards by reason of the blood and humours occasionally agitated and rushing frequently and in heaps to that part When a Fontinel is made Which happens to a new Issue the Reason of it and Cure proposed immediately by reason of solution of the Unity and consequently by reason of the circuit of blood somewhat hindred in that place a certain inflammation and ulcerous pain happens to some patients but in some endued with a fervent blood and whose Serum is less diluted this ensues much fiercer For the blood being brought thither by the Arteries the ends of the Vessels being cut off and obstructed it can neither go out nor be returned immediately by the Veins but sticking there in the passage it is accumulated more and more and being at length extravasated and filling and stopping all the pores of the contiguous skin and flesh it raises a tumour with redness and heat most intense which coming to pass either the blood so heaped up and extravasated An Inflammation hath three manner of Crisis's in a snort space of time becomes immovable by reason of constipation and for that cause being as it were divided from the rest of the mass it is extinguished and suffering death produces a Sphacela upon the part or secondly the blood so stagnating is after a sort agitated as to its particles and enjoying alwayes a vital flame and made more intense by the same it is as it were boyled throughly and so is changed into a Pus to be evacuated by an abscesse Or thirdly which happens more frequently and ought always to be procured in our case the blood provoking an inflammation is reduced into the Vessels and restored to Circulation by other passages whereinto it is constrained But that it may be reduced these two things will be necessarily requisite First The ordinary and best these is that the extravasated blood may be reduced That it be much diluted with the Serum flowing thither abundantly or rather thrust forward into the part Then secondly that the Vessels behind the Tumour being emptyed may swallow up the blood diluted and driven back by the Serum for the blood being forced towards the Tumour whenas it cannot advance forward yet its bulk being diminished that it may be able to return back it dischages the Serum plentifully from it self and drives it for wards into the places obstructed which entring under the stagnating blood dilutes it and succeeding into its places forces it back into the passages of the Vessels and in the mean while that Serum tending for ward exhales by the pores insomuch that the blood which was extravasated being diluted and forced back by the Serum and the Serum it self evaporated How it is done the swelling with the Inflammation vanishes leisurely away But if as in more hot temperaments it comes often to pass the blood being extravasated and impacted in the pores be not diluted by the Serum brought to it in great plenty it will not only stick there pertinaciously but it will irritate a fiercer Phlogosie with a Feaver and sometimes other dreadful symptomes So not long agoe when a renowned Divine endowed with a thicker and hot blood had an Issue cut in the inside of his Leg although the skin only was cut an inflammation followed presently which within
the face especially the Nose and Forehead are markt with most thick Specks looking black as if burnt by Gunpowder which proceeds from hence because the sudatory pores are sometimes fill'd with a more thick black humour another while with little worms with black heads which little Insects being squeezed out of the pores and exposed to the Sun are easily seen to live and to move themselves and in such a malady of the skin no Lotion or Oyntments are wont to profit but what are Mercurial notwithstanding to this Hony there is a Thorn at hand more than enough malignant It s familiar use is not safe For the particles of the Mercury together with its Salts by which they are divided and sharpened into small bits being applyed to the face do shake off the peccant and uncleanly matter out of the Pores and expell it thence but having driven it back they pursue it in and readily insinuate with the Blood and nervous Liquor whose temperaments they prejudice Yea by meeting with these they imprint very often on the Brain and sometimes on the Praecordia and other parts their virulency that can never be wiped out From hence it is frequently observed that women or men that have long used Mercurial Cosmeticks are troubled with a Vertigo and convulsive Distempers or are obnoxious to paralytical and their Teeth grow black and sometimes fall out SECT III. CHAP. VI. Of the Mange or Scab with the Itch. AFter the more simple maladies of the skin viz. those which happen without any Tumour and Ulceration and only deform it with spotted appearances Psora a disease properly cutaneous we will now in order treat of the more grievous Affections and those which dissolve the Unity and especially of the Psora or Scab which in sundry and srequent places of the whole Body doth much infest the skin with a painful Itch and with small Pustles and breakings out being sometimes dry and often scaly and another while moist and disposed to ulceration and a malady of this sort is most properly the Disease of that part considering it frequently begins in the very skin by reason of some outward Contagion and often receives Cure by certain Remedies applyed to the skin only at least the reason of both holds so far that it is seldom otherwise undertook or perfectly cured The Psora or Scab is vulgarly described to be a breaking out of Pustules and wheals throughout the whole body here and there It s description procured from a sharp and salt humour heaped up in the Pores of the skin and that it may be discussed from thence induces a notable Itch and a necessity of scratching That we may search duly into the causes of this Disease and the reason of the symptoms we will more deeply enquire concerning the matter effecting and the conjunct cause thereof that it may certainly be known of what sort that humour is which is heaped up within the skin by what means it is either generated there or comes from some other parts afterwards in what pores or little places it is contained and how endeavouring to break out it doth create so troublesom an Itch. Wherefore about the origine of this Disease What humour its matter is of that we may not impute the fault with the Ancients to the Liver or Spleen the matter thereof is not any particular humour of the four commonly supposed ones not Phlegme nor yellow Choler nor black Not any of the four common humours neither also the blood apt of it self to be extravasated moreover neither doth it seem to consist of two or more of these humours mixt together For though such humours be granted notwithstanding if this Disease always consist of them it would not so easily be catch'd by a meer and light contagion But a humour plac'd in the Glandules of the skin or receive Cure by an Oyntment alone Wherefore it is rather to be supposed that the morbific matter is the humour of the Lympha constantly resting in the glandules of the skin notwithstanding degenerating from its genuine disposition that is to say its volatile-salt into an acid or otherwise offending disposition For when the continual Supplements from the blood come to this so depraved and uncessantly evaporating these Juices new and old do not easily agree or are united but boyling together after the mutual custom of dissimilar Salts they are coagulated into a recrementitious matter which filling and distending the pores of the skin every where raises it into Tumours Moreover it something hinders the Blood in its passage and constrains it to be extravasated From hence thick Pustules are raised and because that matter passing into an Ichor is compelled by the Serum and Blood pursuing it still forward they rise up into little heaps afterwards the Animal Spirits entring inordinately into the nervous Fibres that they may promote the throwing off that ichor do cause the sense of that troublesome itch Indeed an inspection with a Microscope doth most clearly discover that there is a lymphous humour in the glandules of the skin which lye under all the sweating pores treasured up for some uses The description of that Juice or Humour so that according to the plenty and diverse stay thereof these Glandules exist more or less turgid This Juice is laid aside by the Blood through the Arteries in these Glandules that this little burthen being cast off it might return more easily through the veins in the mean time being reposed there it hath its uses viz. In the first place continually moistening the miliarie Teats which lying under the nervous little Fibres are the proper Sensory of Touching it preserves them from dryness which would hinder the Sense also it imbues the adust effluvia's passing uncessantly from the blood being kindled in their passage near the skin with a certain moisture and renders them fit to be voided by the pores and whilest part of this humour doth so continually evaporate with the Effluviums of the blood those expenses are repaired by the Lympha continually fresh being deposited by the Arterial blood as is abovesaid Notwithstanding this occonomy of the Region of the skin is not always so regularly kept How it degenerates but that the glandulous humour falling from its own disposition and function not only will provoke in the skin but sometimes in the whole body preternatural affections of divers sorts This growing clammy and cleaving more obstinately in the little Cells obstructs transpiration and immoderate sweating proceeds from its too plentifully flowing out and from the same restagnating inwards a more than usual Diuresis This is done three ways Moreover as to what belongs to the Scab and pustulous eruptions that humour as it is wont to be depraved many ways so chiefly these three and is wont to enter into a coagulative disposition with the Serum being fresh poured out from the blood 1. By reason of impure Blood viz. First the Blood it self being very
not always round or of a regular Figure but diversly formed Moreover there is no stop in this condition but the distemper unless it be restrained with Medicine breaking out still in more places and creeping on every where in broadness at length not only covers over the whole member but also the whole body with a leprous dry scurf and this kind of Impetigo the Ancients call'd by reason of its outrage 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and for the most part accounted it incurable From hence the chief differences of this disease are made known The differences of this disease and in the first place as it is less or more malignant according to the fashion thereof it is distingushed as it comes nearer the nature of the Scab or Leprosie or as it is in a middle condition between both We are also to note this distemper sometimes infests some particular members as the Arms or Thighs the rest of the body being untoucht but sometimes it begins together in all parts and every where excites scatrteringly little Pimples or Clusters thereof Also eruptions of this kind are in some for a season or periodical and for the most part infest these persons during Winter only vanishing away about Summer likewise on the contrary in others they abhorre Winter and are wont to observe the season of the Swallow going and coming but in most others the Disease being continual grants no truce yea it hat neither remission nor mediocrity Moreover How it differs from the Psora and Leprosit we must distinguish an Impetigo from other Diseases a-kin to it and first from the Scab and the Leprosie It differs from the former as to the form of the Pustules for every where in the Psora they are single and remote from one another although by small spaces here most of them break out in Clusters concurrently and as it were disjoyned by branches with great interspaces But between these distempers a notable difference yet arises in that the Scab is wont easily or scarce otherwise to be propagated or arise but by Contagion but the infection of an Impetigo is so seldom or never that the Miasma from the Husband doth not pass to the wise or from her to him though they lye together Also this Disease differs from the Leprosie as well in respect of the form of its eruption as of its contagion which is likewise active in this as in the Psora and the breaking out is much larger and more horrid viz. it is every where shelly and scaly without intermission and diffused through the whole body From hence it is manifest that the material cause of an Impetigo The material cause not a humour of the skin is not merely a cutaneous humour by reason of effluvia's or a taint received from without or depraved by reason of other accidents and degenerated from its temperament because it is not easily communicated to others by Contagion as in the Psora neither is it immediately dispersed throughout the whole body But tartarous Concretions begot in the blood But indeed little Pustules breaking out first about the initiations of the Disease seem therefore to proceed for that certain acid salt Concretions happen to be in the mass of Blood like Tartar in Wine which when they can neither be concocted or again dissolved are here thrust out into the skin as there into the sides of the Vessel As long as these Concretions are small and few they are conveyed into the skin in this or that member and by one or two branches of an Artery then as Nature is wont to continue the same manner of excretion as it began the matter being carryed every where by the same vessels to the same nests near the first wheals it causes heaps of others round about therm but afterwards when the dyscrasie of the blood is daily augmented and that Tartarous matter is generated more plentifully in the mass thereof more portions are conveyed by other Arteries and still by more to the outward places and for that cause also more pimples break out both in the same and in other members which a new matter coming continually by the same Arteries and being placed close to the former enlarges them every day and every where dilates them by the addition of other pustules and at length if this sort of Tartar of the blood augment hugely being carryed out by more or all the Arteries together it is fastened in the skin and in process of time covers over all the superficies thereof with a scaly or downright leprous shell And then that cutaneous humour being wholly corrupted promotes the disease it self for it causes the stock of the morbific matter to be encreased by polluting more or rather poysoning the blood and humours whilest they pass in Circulation moreover dismissing the corruptive steams from it self it renders the Contagion of the same disease unto others Wherefore both the procuring and conjunct causes of this Disease consist in this The next cause of it for that without any fault of the skin it happens that the blood is filled with salt Particles of a various disposition and condition into the preceding cause of which disposition we will anon inquire and where those fixt and acid Salts are especially predominant as the manner is they mutually embrace one another and so grow together into Tartarous Concretions which being thrust forth into the blood cause eruptions of wheals as it were nests of the Disease then they being daily and leisurely encreased both in number and largeness according to the supply of matter they produce the beginning augmentation and state of this disease As to what relates to the antecedent and evident causes The evident Causes there are two chief kinds of occasions from which this distemper for the most part derives its origine to wit an evil manner of Diet or a taint of the Scurvy or Pox or other Diseases left in the body being ill or not at all cured We will weigh a little the reasons of each of these As to the former besides the common irregularities in Diet Irregularities in Diet. wherein some being too much addicted to eating of flesh salted and afterwards dryed in the Sun or Smoak and the drinking of acid Wines do easily contract this malady Also it is a vulgar observation The daily eating of Pork or Fish that very many are disposed thereunto by the too frequent or daily feeding on Pork and Fish and especially Shell-fish There is a notable instance of the former which is that that food was chiefly forbidden the Jews for prevention of this disease Also there is an example of the other that in time past the Inhabitants of Cornwal for the most part dwelling on the Sea-coast inasmuch as the poorer sort were fed with Fish became very obnoxious to Leprous Distempers The reason thereof inquired into insomuch that for their relief many Hospitals were erected in that Countrey That I may hint in a few