THE Frequent but unsuspected PROGRESS OF Pains Inflammations Tumors Apostems Ulcers Cancers Gangrenes and Mortifications internal THEREIN Shewing the secret Causes and Course of many lingering and acute mortal Diseases rarely discerned Initia Morborum quamvìs levia serpunt WITH A TRACT OF Fontanels or Issues and Setons By Everard Maynwaringe M. D. LONDON Printed by J. M. for Henry Bonwicke at the Red Lion in St. Pauls Church-yard 1679. EMMANUEL Collegium Emmanuelis Cantabrigiae LICENSED Roger L'Estrange Septemb. 16. 1678. THE DESIGNMENT AND NECESSARY USE OF THIS WORK FEW there are that think themselves concerned in this train of dangerous diseases because they judge themselves clear at present and do suppose these rarely to happen for that they seldom hear of any to dye upon these accounts and therefore do not imagine that such ill Fate should befal them but Feavers Scurvy Dropsies Consumption or such like common diseases they expect to be their lot but when you come to understand as by the discovery following you will plainly perceive that few sicknesses or infirmities you can fall into if they be not radicated in or grounded upon some of these latent or lurking destroyers yet there is a tendency towards them for a complication therewith and their terminations therein as the last Scene especially if the disease or sickness be contumacious and of long continuance or acute dangerous and mortal so that upon a true information you will find such probability to be ingaged here when any infirm or sickly state shall alter your present healthful condition of body And for such as have already some warnings by pain and a valetudinary state may seasonably inquire and consult some sagacious and solid Judgment from whence it does arise whither it tends what progress probably it will make if not prevented a resolve upon the question very likely will fix here if the case be throughly examined and duly searcht into Considering that pain most frequently either ariseth from some of these already begun to act their parts or that some of them will most likely follow thereupon although veiled under the covering of a more known and familiar Disease as fully declared in the subsequent Discourse for whether the manifest Disease afflicting be the Scurvy Consumption Dropsie Ague Spleen Pox or other chronic Disease very often it falls out though seldom taken notice of that some of this train is complicated and joyned therewith if good Medicines or great Providence stop not the progress And if the sickness be acute malign pestilential or other as small Pox spotted Feavers Plague or any general Phlogosis and febrile scorching distemper they come on commonly by Inflammation in some particular part and proceed on to tumifie apostemate and gangrene when such a disease is not checkt but grows desperate and becomes fatal to the sick and thus Pleurisies Angina's Peripneumonia's Inflammations of the Brain Ventricle Liver Spleen Mesentery c. they go on in this road by these stages and transitions from Inflammation to Tumor and so forward finishing the course with a Gangrene and Mortification if good means take not good effect to prevent and stop the progress Observing therefore in constant Practice the frequency latency and danger of this association and confederate train disguised and couched under some more appearing and known disease I thought it a Work necessary and grateful to unmask and lay open such secret destroyers that in the designments and methods of Cure they may strictly be sought after and aimed at thereby preventing the danger threatned and securing the Patient Novemb. 15th 1678. Wine-Office Court in Fleet-street The principal Occurrences and chief Heads treated of PAins Inflammations c. their order connexion commutation and transition The frequency and latency of this train in most Sicknesses or Diseases The disguised Progress thereof The danger and frequent Mortality from not discerning them Feavers mistaken and the common courses for Cure erroneous Pains in general their different nature causes and tendency to farther mischief Pains of the Head the causes and various parts affected Pains in the Breast and the several causes thereof Pains of the Dugs of the intercostal Muscles of the Pleura or Pleurisies pains of the Lungs of the Heart Mediastinum Diaphragma and Cartilago mucronata Pains in the Abdomen or Belly and various causes thereof Pains of the Stomach of the Guts Colic-pains Dysenteric and Haemorrhoidal pains of the Spleen an eminent Cure and how performed pains of the Liver pains of the Reins and Bladder Gout-pains and Rheumatism their causes and indications of Cure Inflammations internal what they are how they arise what parts they possess the material and efficient causes thereof directions for Cure Tumors internal the occasional causes thereof the modus generandi how to know them their way of resolution fixation and translation their different state and condition scirrhous apostemate and cancerous cautions in Cure Vlcers internal the essential differences their manner of generation the continent causes the manifesting signs Gangrenes and Mortification what they are the difference between them the external and primitive causes of Gangrenes the internal and conjunct causes the Characters declaring a Gangrene their state of curability and incurability many thousands dye gangrened not taken notice of instructions before curing amputation when and where to be made The Result of the whole matter Fontanels and Setons what they are how made where to be placed for whom beneficial the due ordering them in several conditions the time when to heal them safely THE ORDER AND DEPENDENCE OF Pains Inflammations Tumors c. internal cautioning their proceeding and complication THE natural oeconomy and government of humane Bodies may well be compared to a body Politick subjected to State-discipline Order and Conformity the former hath a regular course instituted and implanted by Nature the latter hath Laws imposed and injoyned by humane Authority to be observed In both these Governments so long as Order and Laws are obeyed and kept the whole is preserved sound safe and in quietness but when the subjected parts of either do mutiny rebel and shake off the Government refusing to act in their stations and subserviency the whole then is put into disorder the union of Community is broken and the publick safety endangered thereby If a part of the body decline its office and performance of duty acts perversly and inordinately the mischief stops not there but other parts also are perverted thereby and drawn into consent likewise if one Member of State be sick of tranquillity and peace be disturbed at the Government and begins to be dissenting disobedient or mutinous ten to one but this infection begets another of the same mind and faction and the second makes a third and thus the malignity spreads When any part of the body begins to fail and be out of order it seldom stops at its first degree of declension but makes a progress from bad to worse if not remedied and prevented So a Member of State
this so in all other cases where separation of unity does happen from an internal cause arising in the body that it is the consequent of pain and not as those learned men would have it the approximate cause of pain To illustrate this truth a little farther and that you may the better understand and have a clearer satisfaction herein practice depending upon it I mean the allay or remove of pains consider and know that the sense of Feeling being spread through the whole body is as the last or inmost covering that does inwrap or infold the life and is as it were the watch or guard upon the confines thereof Now any thing that does stir up Feeling that thus nearly and intimately approaches the life if it exceed the bounds of moderation and is violent if it be any way unnatural or injurious it raiseth a disturbance in the vital principle of that part which is pain so that the assault is first made upon the life which governs and preserves unity and continuity of parts but that vital principle being fretted distracted and put by its placid regular oeconomy and government the Organ perisheth as the life of the part decays or is out of course being then unable to protect and preserve it From hence I am perswaded to believe and must assert That the approximate cause of pain is every thing that does intimately and approximately affect and disgust the vital principle in every part pained which pain is the estuation anguish and fury of the life or vital principle which does dolere being exasperated and provoked by those causes and if solution of continuity does happen upon this disturbance it is wrought and caused by the exorbitance and enormity of the vital principle deserting or being put by the charge and due management of the part Moreover pain sometimes continues long by intervals and remissions to molest a part and no separation of unity to be caused thereby although it is an interruption and breach of Harmony so that this ira sive dolor this pain of the vital principle does not always arise to the height of producing discontinuity and is so far from being the approximate cause of all pain that many times it never happens either before or after pain to be a cause or an effect Now what this vital principle is residing in and governing every part in their several functions of vitality whether it be Anima or Archaeus according to Helmonts doctrine or spiritus impetum faciens according to Hippocrates I shall not enter into the controversie because it will require a large discourse or rather a peculiar Tract to determine this Problem and clear up the truth of our novel opinion disintangling it from the objections and prejudice of ancient received doctrine which will disjoyn and delay our matter chiefly intended therefore I forbear the digression and proceed Pains are various or do affect the sense in a different manner and this either from the nature of the part grieved or from the variety of causes or both Now the nature and condition of parts are different and various these ten several ways or may be reduced to these heads Ducture Figure Situation Composition Beginning Progress Substance Temperature Number and Office And as parts are varied by these differences so pains thereby are made various and not only pains but also all other Symptoms and diseases have a specification from hence Pain sometimes is obtuse or heavy as if a weight were pressing upon the part pained as when the Parenchyma of the Liver spleen Lungs or Kidneys is grieved and this by reason they hang or depend on Ligaments and Membranes Pain sometimes is acute sharp and punging as if the part were perforated or pricked with a Needle as in a Pleurisie and this is caused from a thin acrid or acrimonious humor penetrating the Pleura for nothing but what is subtile and acute can procure this or the like punctures and invade the dense substance of a Membrane Pain sometimes is with pulsation that is a beating pain like to the motion of the Pulse and this pain happens commonly upon an Inflammation and also where an Artery is seated in the part for where there is no Artery there is no pulsation it being the office of this Vessel only to make a pulse From hence Galen 2. de loc affect 3. took notice that upon an Inflammation of the Lungs or the Pleura there was no pulsation or beating pain because there were no Arteries in the parts Pain sometimes is mordacious or biting from sharp humors vellicating the sensible parts Pain sometimes is frangitive as if grinding or bruising and this is proper only to the bones or rather the Periosteum that covers the bone by which Membrane the bone is made sensible and the pain lyes deep Pain sometimes is tensive or stretching and this happens from a repletion or fulness of some humor wind or vapor filling and extending the part if this stretching pain be cum gravitate pondere with heaviness or weight then you may conclude it is humoral or something of more solid substance but if the extensive pain be without weight then it signifies wind or vapor as very often such are Colic pains from a collection of wind between the tunicles of the guts Pain sometimes is convulsive and this is proper to the Nerves and Tendons because the nervous filaments are so united that they cannot be torn but are contracted to their original Pain sometimes is lacerating or tearing and this is proper to the flesh because the flesh hath Fibres and small Nerves not so united as the Membranes and therefore à causa solvente continuum are easily lacerated And thus much for the various kinds or different sort of pain next the situation or extension and the duration is to be regarded Pain is either universal affecting the whole body from some general cause as in Feavers Agues c. Or else pain is seated in some particular region or part of the body as the Head Breast Stomach Belly c. Pain sometimes is more outward ot external upon the superficies of the body whose seat is more easily discovered and known laying hand upon the place by the Patients direction Sometimes pain is internal and deep with difficulty to be certainly determined which part is grieved and requires good anatomical judgment to assign the part or member From hence pains some may be said to be manifest others abstruse as also from their causes evident and latent Pains some are constant as to place or fixed others erratic or shifting from one place to another Pains some are constant as to time or continual others intermitting and by intervals having cessation for a time and returning again In all pains there ought to be considered these four things the Greatness the Kind the Property the Place Greatness and vehemency of pain does arise from the greatness of the offending cause and the sensibility called tenderness of the part All pain
commonly called Stitches Pains are incident to these Muscles from external injuries as contusions and impressions of cold or else internal causes and these are either by defluxion of humors that may flow in as most frequently from an abounding serosity being thin sharp and extravasated falls in amongst these Muscles or else by congestion matter is accumulated which Nature not being able to discharge lyes there as a burden impeding the muscular motions and causeth pain Sometimes from flatulency and wind getting into the Interstitia of the Muscles thereby causing intercurrent and fleeting pains And for remedy in such cases Fomentations and hot Bags applied are advantageous Evacuations being premitted according to the condition of the Body requiring We come now to consider of Pleurisies or pains in the Pleura that inward Membrane that does invest or line the Breast a disease very eminent and frequently occurring that both Hippoc. and Galen often mention it by way of example These pains are acute and sharp like punctures and have no constant place but in some persons they seize the right side in others the left in some the pain is higher in others lower towards the Hypochonders sometimes more backward and sometimes forward and although chiefly and more manifestly the pain be here or there to be pointed at yet the whole Membrane by reason of continuity is thereby affected and the parts adjacent do suffer by consent from whence various Symptoms as concomitants and attendants do inseparably accompany and consort with this pleuritic pain Hence it is that difficult and short breathing is constantly annexed to it and this because the parts for respiration are hereby impeded and have not their due motions and liberty of extension but are restrained and curbed which is done in favour to avoid compressing the grieved part otherwise would exasperate and increase the pain and therefore the sick fetch their breath short and quick because they cannot take it fully and largely and do repeat it the oftner by way of recompence To this and by consent of parts is adioyned a short and dry Cough which irritates and provokes the pain by moving and straining those parts and therefore is very troublesom and grievous to the Patient Here also a continual acute Feaver does necessarily follow as inseparable for the Archaeus or vital Principle being invaded in those parts by something hostile does therefore insurge becomes inraged grows hot and fiery raising a burning distemper throughout the body To these we may add another constant Character namely a hard swift but small Pulse And these are the pathognomonical signals that are always attending upon and do distinguish Pleurisies from other diseases of adjacency or affinity and likeness with them for when pains fall in amongst the intercostal Muscles although there may be some punctures or prickings because of the Membranes there yet not so great the Feaver not so high nor the breath so short nor the Cough so troublesom if any If the Lungs be inflamed only the pain is but little not punging but obtuse not in the circumference or sides but in the cavity or middle of the Breast yet the difficulty of breathing is greater here than in Pleurisies from angustness that seizeth the parts of respiration Pleurisies differ from Inflammations of the Diaphragma because in this there is no pain in the sides but only at the end of the short Ribs and the upper part of the Belly is extended and with it a Delirium Pleurisies also are distinguished from Inflammations of the Liver in the seat or place of pain which always is in the right side under the short Ribs the pain not punging but heavy and obtuse the Cough less difficulty of breathing less but the Urine higher-coloured or tinged red And now I see the reason though very weak why some Authors have distinguished Pleurisies or differenced them into legitimate and spurious which indeed is a division of Pleurisies into Pleurisies and no Pleurisies for I account no disease to challenge that denomination but such as have their foundation in the Pleura else by the same reason all diseases may admit of the same distinction of legitimate and spurious for as much as every disease hath some Symptom which is common to other diseases that may give them some resemblance or affinity with each other or be affected by consent from another but I pass it over and come to examine the causes from whence pleuritic pains do arise These causes are external and internal External causes are such as remotely prepare and dispose the body to a likely capacity of reception or aptness to this disease laying the foundation for internal causes and they do arise out of or from the irregular unfit or improper use of the Diaetetics which leads to a morbific or unsound state For example violent exercise or otherwise raising great heat in the Body and opening the Pores by neglect upon it as not to preserve that warmth for some time and suffering it gradually to abate and go off by keeping on cloaths and forbearing cool drinks this may introduce a Pleurisie So likewise in the heat of Summer to throw off cloaths and be exposed to the wind at a Casement or the cool Air in the evening To over-heat the Body with strong Liquors and suddenly endeavor to cool it again with small Beer may effect the like Cold North-winds after Southerly and hot weather does alter the texture of the blood and is previous to pleuritic or similar pains But here you must take notice and know that quicquid recipitur recipitur per modum recipientis all Bodies are not alike nor equally disposed for reception for in some these causes produce Pleurisies in others Angina's in some Dysenteries in others Arthritic pains c. According to the aptitude and disposition of Bodies in fabrication or organization and peculiar properties have the same general external causes various and divers effects being determined and specificated by different states of Body more liable and apt to this or that disease rather than another Hence it is that external causes as Diaetetic errors have heterogeneous effects and procure dissimilar diseases according to various constitutions purity and impurity stability or debility concurring with or resisting their influence which consideration brings me directly to the next stage being the latter part of the preceding division Internal causes are antecedent or conjunct Antecedent as plethory being fulness of blood or Cacochymy a depraved or degenerate blood both which are previous states or conditions of Body disposing or rendring more liable to this disease for the great Vessels being full and distended upon any Effervescence and Superfermentation of the blood this impetuously like a torrent is impelled into the smaller Pipes as those of the Pleura where not having a free passage it does cause pain by distension and Inflammation Now this plenitude is brought on or aggravated and increased sometimes by a suppression of some accustomed Evacuation as those that are wont
stomach and disgustful to irritate and provoke the expulsive faculty but a Singultus by inanition is a vellication of of the retentive faculty and is the effect of exhaustion and large evacuations and accounted more dangerous than the former Therefore Hickops after great vomiting or purging Hectick Feavers and long-wasting sicknesses are very bad signs There is also a pain belonging to the mouth of the stomach which although it be a real pain and properly so called according to the definition of dolor yet Physicians have given it another denomination and that is Nauseousness or a nauseating sick pain at the Orifice of the stomach The causes of this nauseating pain are various as whatever is disgustful there whether it be meat or drink offending in quantity or quality or indigested depraved matter the relicts after former digestions floating upon the stomach or only imbecillity and weakness of the stomach being not able to close with and digest although good food be sent in and thus it is when the Tone of the stomach is altered by intemperance and ill usage by great or long sickness or decayed and worn out by age Sometimes the cause is organical as when a Tumor or Apostem is forming there And not only thus idiopathically but also sometimes the stomach complains and nauseates sympathically by consent from other parts by reason of vicinity or communication and thus a Tumor of an adjacent part may molest and afflict the stomach and other remote parts discharging and emptying themselves into the stomach by Vessels of intercourse Veins Arteries and Nerves In the cavity of the stomach there is sometimes a pain of oppression or heaviness being over-charged or loaded and grieved with something difficult to be digested and sent off or a pain of distension and inflation from wind and phlegmatic turgid humors or a punging and pricking pain in this or that part of the Ventricle from some acetous sharp humor or an eroding and gnawing pain from worms or a mordicant fretting bilious matter Pain of the stomach ariseth sometimes from Inflammation accompanied with very severe Symptoms but of this in its proper place hereafter where we treat of Inflammations Pain also afflicts the stomach from Apostems and Vlcers of which in their due place also Pains of the Intestines or Guts HAving gone through those Pains belonging to the Stomach or Ventricle in the next place and in order we come to treat of pains incident to the Intestines or Guts being derived from the Ventricle and are one continued body and passage from the Pylorus to the Anus notwithstanding for distinction sake and because this long cavity is different in several parts thereof as to magnitude substance figure place and office therefore it is divided into parts having several names for a more distinct knowledge both in relation to the different formation thereof as also to point particularly where a disease is in any part thereof The division is made into small and great Guts the small or thin are three Duodenum jejunum and Ileon the great or thick are three also caecum Colon and rectum and in this order they lye from the Ventricle to the Fundament The three first are circumvolved about the Vmbilicus or Navel and take up the centre of the Abdomen the other are subjacent and circumferential Pains do frequently molest the small Guts but chiefly the Ileon which when they arise to extremity the disease is called Iliaca passio from that Gut most affected The seat of these pains are above the Navel chiefly extending to the Hypochonders These pains differ in their causes and therefore some are weak and transient arising from wind and acidities which cause some punctures gripes or distensions and continue not but sometimes these pains are more grievous depending upon causes greater and more contumacious and therefore attended with other Symptoms in great rigor as constipation of the Belly violent heat fainting vomiting and casting up whatever is received nothing passing downwards but moves upwards that sometimes the excrements are voided by the mouth About the causes of these violent pains Physicians do not concur The general opinion taken from Galen will have these pains to arise from an Inflammation of the Guts others modern Authors from a peristaltic motion or the motion of the Guts inverted for whereas in the course of Nature the expulsive faculty moves downward by a contraction of Fibres from the Ventricle to the Anus è contrà in this case the Fibres contract below and drive upwards But this difference may be reconciled and neither opinion to be faulted being rightly underftood for Inflammation may begin and cause the motion of the Intestines which naturally tends or moves downwards to be changed upwards by a different contraction of Fibres So that Inflammation causeth mediately peristaltic motion immediately and sets forth the order of causation the one superior the other subordinate Quod est causa causae est etiam causa causati All the Guts are capable of Inflammation but the small Guts more usually as being most liable for having more Veins and Arteries than the rest These Iliac pains from Inflammation are very dangerous if they arise to a great height because the Inflammation is apt to make a mortal transition into a Gangrene and indeed all Inflammations of the Guts are difficult and doubtful because they easily gangrene and mortifie And not only Inflammation inverts the motion of the Guts but also other causes may beget this Iliac passion or joyn with it as partial causes as an Apostem or other sort of Tumor a Rupture an Exulceration indurated Excrements causing great obstruction also whatever by compression or constriction of the Guts constipation or coalescence may cause contortion and turn the natural course and motion thereof and of these frequent examples in practice do manifest and confirm Pains of affinity and adjacency to the Ileon and which are often complicated therewith are Colic pains so called from the Gut Colon the part wholly or chiefly affected This Intestine is last but one and more capacious than any of the rest furnished with many little cells or private receptacles to receive the excrements and retain them else they would pass away too frequently and inconveniently This Gut is seated almost round the Abdomen or Belly so that Colic pains are not easily distinguished by the place being sometimes here and sometimes there left side right side or under the Ventricle hence it is that Colic pains do counterfeit sometimes the stone or pain in the Kidneys left and right and sometimes they are supposed to be pains of the spleen but most frequently these pains are towards the left side near the flank where the Colon is more angust tortuous and circumflected and therefore when the excrements are hardned in the superior and more capacious part of the Colon and are then forced down by wind or otherwise into the narrower great pain must needs arise thereupon But concerning the causes of Colic-pains
Dysentery sending forth blood and corrupt matter Sometimes a bloody Flux continues a while without Vlceration and afterwards ulcerates the guts and makes a Dysentery that is when this extravasated blood lodging in the guts degenerates and putrifies it does thereby erode and plant an Vlcer which compleats a Dysentery Now this kind of Dysentery ariseth from an impurity or corruption of the blood which causeth a preternatural fermentation or effervescence in the whole mass but Nature not being able to depurate and separate from this degenerate admixture either by Transpiration or Vrine is forced upon this emission by the Intestines without a secretion and throws out both the good and bad together In the prosecution of Cure as these causes are rightly adjudged and Medicines adapted thereto depends the success and therefore that course and Method which is advantageous and proper to one may be injurious and altogether disagreeing to another And here you must take notice that Dysenteries are sometimes malignant as commonly when Epidemical and then Alexipharmacal Medicines are not to be omitted Now concerning the degrees of Dysenteries as to a better and worse curable or deplorable state and the signals declaring them as also several Queries that might be raised and satisfaction given to each the conciseness of this Work will not admit to inlarge thereon In the next place and of great affinity with Dysenteries is a Tenesmus agreeing in the causes and Symptoms but differing in the part affected a Tenesmus being seated at the lower end of the right Gut or Fundament The Etymologie of the word imports something of the nature of the disease being a frequent desire and straining downwards to the stool but instead of excrements blood and mucous matter is brought forth and with great pain This ariseth from an Ulceration of the last Intestine procured from the same causes as Dysenteries which we need not repeat This disease is most dangerous to women with child for that it causeth abortion but to all persons it is very troublesom and painful and if it continues long the Vlcer becomes fistulous and difficult to be cured And now I remember the Cure of an old Vlcer in this part notwithstanding the contumacy and difficulty thereof In the year 1653. when I was but a young Practiser yet by the blessing of God upon my endeavors I cured a Gentlewoman afflicted with an Ulcer in ano for seven years who could not in all that time receive help though she had tryed many Physicians and Chirurgions having a plentiful Fortune to allow it She was aged between fifty and sixty an Aldermans Wife of Maxfilde in Cheshire where I happened to stay in that Town for some time whereby this Gentlewoman beyond her expectation received a perfect Cure To finish our Discourse of Pains belonging to the Intestines we shall conclude with the Haemorrhoids A disease frequent and sometimes of great complaint The word Haemorrhois signifies a Flux of Blood in general but custom hath restrained it and amongst Physicians it is used and understood only that effusion of blood by the Haemorrhoid Veins which Veins terminate at the lower end of the last Intestine and about the Fundament These Haemorrhoid Veins are internal and external although most of the Ancients and some modern Authors acknowledge only the internal but erroneously The internal and external Haemorrhoid Veins do differ much As first in their rise or descent for the external do proceed from the Hypogastric branch of the Vena cava and the internal from the Vena portae and commonly from the splenical branch thereof Secondly in number the internal being but one though orbicularly multiplied and divided about the Anus The external are threefold Thirdly in their insertions the internal being inserted into the membranous substance of the right Gut the external into the musculous substance of the Anus or Fundament Fourthly they differ in their contents the internal carrying a gross and blacker blood the external more thin and ruddy Fifthly in their office and use the internal evacuates the Vena porta and splenical Arteries thereby advantageous in some diseases of the Spleen and Cacochymies The external do empty the Vena cava and correct such diseases that depend upon Plethory or redundance Sixthly they differ in evacuation the internal not so copious the external commonly large in the profusion and sometimes very injurious and to some mortal Seventhly in pain the internal for the most part painful the external not in evacuation Lastly they differ in association the internal descending without Arteries the external are adjoyned with Arteries to the Anus The Haemorrhoid Veins are liable to contrary affects and the diseased do suffer in a different way sometimes these Veins abound with blood and swell for want of apertion and a discharge and this is called the blind Haemorrhoids è contrà sometimes the mouths of these Veins do open and pour out too plentifully either suddenly or by too long continuance and this is called the open Haemorrhoids Both these extremes are grievous to suffer The swelling of the Haemorrhoid Veins and pains from thence have the same causes as provoke and continue the Haemorrhoidal Flux viz. blood offending in quantity or quality which if it find not vent by the terminations or mouths of the Veins they are extended and swell big and sometimes inflame which if it continue is dangerous lest it become cancerous and gangrene On the other side an immoderate Flux is very pernicious and induceth Dropsies Consumptions Cachexies c. by exhausting the treasury of life These Haemorrhoidal Fluxes continuing unduly and injuriously argue the blood to be hot and sharp or too thin abounding with an acrid serosity which provokes the expulsive faculty and opens the mouths of the Veins But the blind swelling Haemorrhoids denote the blood to be gross and thick or the coats that cover the extreme ends or mouths of those Veins to be dense and impenetrable not permitting an exsudation Here it may be queried how it comes to pass that these Haemorrhoid Veins should be more troubled with blood and more frequently suffer an apertion since many other places of the body receive the extremities or terminations of the Veins and so equally capable of effusion In answer hereunto you must understand that although Nature hath formed the like and planted them in divers parts of the body which sometimes though more rarely do issue and send forth blood yet these Haemorrhoids are placed more commodiously for voiding of superfluous and feculent blood being near the common vent and outlet for excrements to pass away and their situation being downwards together with the straining upon occasions at the stool the extremities of these Veins are filled and sometimes forced to evacuate more frequently than others Now concerning the blind Haemorrhoids you may take notice and know that there is this difference sometimes the Tumor or extension is in the trunk or cavity of the Veins and then there is no apertion and sometimes the
praep â„¥ ii vin alb lib. iv Diger sâ—…a in balneo Mariae per dies iv colat duleoret syr byzantin simp The aperitive Pills were these following R. Gum. ammonias acet scillit solut Ê’ ii myrrhae rub tart chalybeat anaÊ’ ss croci ℈ j. ol foenic. dulc chym gut viii succi cochlear q. s Fiat massa During which time from the beginning she was anointed with a Liniment all over her belly morning and evening The Liniment was this R. Ol. cappar unguent è succis aperit ana â„¥ j. Misce After this a Cataplasm was applied to the region of the Spleen every day for a week The Cataplasm was made thus R. Panis alb farin sem lini ana â„¥ iv farin hord â„¥ jss lactis vaccin lib. jss Coq ad exsiccationem adde mucilag rad althaeae foenugr ana â„¥ j. ol chamaem cappar ana â„¥ j. gum ammoniac acet scillit solut Ê’ iii. galban bdellii styracis liquid anaÊ’ ii crociÊ’ ss Misce f. Cataplasma After this the pain was gone and the Spleen began to be soft and yielding Then I appointed the former Apozem to be repeated which being taken the swelling of her belly was much gone down After this I caused a Fomentation to be applied morning and evening for some days and then ordered the Chalybeat Wine to be repeated The Fomentation was this R. Rad. bryon ireos nostr ana â„¥ iv rad cyclamin cucum agrest filicis mar ana â„¥ ii fol. lauri abrotan absinth menthae salviae hyssop ana M.ii. sem cymin foenugr ana â„¥ j. flor chamaemel melilot ana M.j. Coq in aq fabror lib. x. acet vin alb sub finem addit lib. ii ad tertiae partis consumpt pro Fotu After which one purging Potion was given and an Emplaster applied to the Spleen and then both the Spleen and Abdomen the whole belly as flat and soft as ever she was and perfectly cured and returned home All which was performed in the space of about seven weeks and two months after she conceived with child as I was informed by her relations and she stood firm in health long after Notwithstanding the success was very good and the Medicines well designed as such preparations will afford yet in the like cases I do not use the same now This in short and I could not rehearse the particulars so exactly being twenty years since but that I have the whole story with the several Medicines in writing now by me and this I have related to confirm what I asserted here before that a diseased Spleen may lay the foundation for and introduce a Dropsie and now I proceed on to set forth the causes of a pained Spleen which being rightly stated applications may more successfully be made in that complaint The most frequent and apparent Symptom that afflicts the Spleen is Pain and this doth arise and depend upon some of these several diseases Obstruction Tumor Inflammation Apostemation Compression Vlceration Obstruction in some of the Vessels of the Spleen is a frequent cause that produceth pain and this obstruction is procured from a feculency and grossness of blood which ariseth either from a natural debility of the Spleen not able to perform its office duly or occasioned by a melancholy disposition a studious sedentary inactive or a careful and afflicted life to which or singly an evil bad diet and irregular diaetetic customs may contribute or effect as more fully you may be informed in a late Tract of mine entituled The Preservation of Health and Prolongation of Life All which impedes the due fermentation and volatization of the blood in the Spleen from whence it becomes thick and foul and begets a stoppage or too slow a motion and fulness in those Vessels And whereas the office of the Spleen as before determined is to ferment anew spiritalize exalt and rarifie the thick indigested and melancholy blood sent thither for a farther elaboration and depuration it is most rational that this not being performed from some of the impediments aforesaid obstruction and stagnation there will be the consequent and the Patient from hence will feel a pain and heaviness about those parts But for a more promptness or aptness to these obstructions angustness and straitness of the Vessels so formed by Nature does render some persons more prone than others to obstruction and these splenetic pains And farther this obstruction does arise not always from the causes aforesaid but sometimes from a compression of other parts adjacent that may incommode and offend the Spleen or by contusion from a blow or fall or by an injurious dress and too strait lacing or girding as frequently amongst the female Sex These obstructions when continuing and contumacious are so aggravated and increased with additional influx that they form a Tumor this distension being perceptible by sight sometimes but always by seeling is to be adjudged and distinguished whether soft and flatuous or hard and scirrhous the former sooner yielding to means but the latter more difficult of cure Inflammation though rarely yet sometimes does affect the Spleen and this inflammation does arise from obstruction for the blood being stopt in its current and passage and upon some extraordinary causes being more hot and fiery does make a sudden ebullition and inflame causing great pain heat and extension and this pain is distinguished by pulsation and beating of the part having many Arteries This Inflammation not rightly applied unto by diligent and good means does make transition and passeth into Apostemation and sometimes terminates in a scirrhous Tumor but these two dangerous commutations are to be prevented with great care and industry therefore before the disease arrives to this height and when only pain or heaviness gives warning and tells you of a distempered Spleen it is then most seasonable and opportune to apply the means and then a little may prevent that which afterwards perhaps a great deal cannot cure And first the procuring causes if any there be apparent are to be avoided as a sedentary slothful life intemperance and gross feeding or unseasonable eating as late suppers immoderate study melancholy grief or care which introduce sometimes but always contribute to aggravate splenetic distempers and although a natural debility and infirm constitution of the Spleen may procure the effects aforesaid without other provocations yet most frequently they are so caused at least much heightned thereby and therefore for prevention as also for cure those injurious habits are to be abandoned and such a diaetetic course of life observed as may check this disposition of body as at large you may be directed in the fore-mentioned Book The preservation of Health and prolongation of Life c. For Pharmaceutic Remedies that are made publick I shall commend the aperitive Tincture of Mars Pil. Antihypochondriac Swelferi chalybeated Tartar Sal volatil Succini Spir. Veneris rightly prepared which prudently used pro re nata as the several cases require may prove advantageous Pains of the
them do gangrene by concreting and condensing the blood stopping the canals and suffocating the life as the Venom of a Scorpion and Asp others by putrifying and corrupting the blood or some other part where they chiefly discharge their venom Internal and conjunct causes of Gangrenes are Inflammation corrupt venenous or malignant matter that preys upon and destroys the vital Principle stagnation of the blood or what else may intercept commerce and supply from the fountain of life The Characters or signs declaring a Gangrene are these the sense of feeling decays the colour changeth and inclines to be livid or blackish the flesh grows flaccid and frigid but when the Gangrene proceeds on to a Sphacelus or perfect mortification these Symptoms then are aggravated and appear more eminent sense is quite abolished and the part becomes fetid and cadaverous Gangrenes are very seldom mentioned in Practice and you shall rarely hear of any person to dye of a Gangrene yet I must believe and not without good grounds that many thousands dye by an internal Gangrene not taken notice of for if the major part at least a great part do dye with a high Feaver or Phlogosis we may rationally then conclude that a Gangrene is frequently conjoyned as the last Actor in the Tragedy and immediate cause of death for Gangrenes do commonly supervene Inflammations where they are mortal and thus also Inflammations from fractures and dislocations often bring on a Gangrene And in malignant high Feavers there are sometimes such vibices marks of mortified blood and black mouths which do strongly suggest a Gangrene within the body And for those that perish by the Plague in so short a time whose venemous matter shews it self by Spots Vesicles Buboes and Carbuncles most of these dye gangrened And many of those that expire by the small Pox have a Gangrene in some part the putrid matter being lodged there Nature not able to protrude and bring it forth and it is very reasonable to assert this for if a Gangrene will arise out of a very small portion of matter extravasated defluxed or congested in a part then where the whole body abounds with malign putrefaction and overflows with it any part thereof remaining within the body may and does very often corrupt and gangrene that part That our Opinions are not so extravagant and excentric from the Judgment of all Learned men as some perhaps inconsiderately may censure take notice what Arnisaeus an eminent Physician in Germany Professor in the University of Julia writing to Gregor Horstius about a Person of Quality that dyed of the small Pox queried or rather concluded that the Liver was gangrened and farther saith Verisimile est multis idem accidere qui ex variolis moriuntur To which Horstius answers by Letter and consents with his determination in these words Cùm autem necessariò febris sanguinea cum putredine majori concurrunt in tali casu facillimè fieri poterit ut praevalente calore febrili 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 in viscere sanguificationis prae caeteris corrumpatur inprimis cùm propter cutem undique pustulis exulceratam incrustatam transpiratio eventilatio difficilior fit Si enim inflammationes internae ipsiusque jecoris juxta communem nostrum amicum Guil Fabr. non rarò desinunt in gangraenam non video cur non idipsum saepiùs etiam fieri possit tunc temporis ubi variolis undique satìs quidem expulsis gravissima symptomata partium internarum inflammatarum nihilominus perdurant eo usque donec aegrum penitùs jugulent Horst Institut Med. Disp 3. coron 1. additament And in many other acute malign Diseases either the morbific matter is not discussed and discharged from the seat of the disease or else is expulsed thence into some other perhaps a remote part where it corrupts the member and extinguisheth the vital Principle called by some the innate Spirit Now concerning the curability and incurability of Gangrenes take these instructions before the disease be undertaken or left for desperate and hopeless First Consider the duration or time of the disease the age and strength of the Patient for a Gangrene in the beginning is more easie and hopeful than after continuance because it proceeds on commonly and draws nearer to a Sphacelus which is incurable also young persons vegete and vigorous in spirit are more hopeful than others aged or worn out by long or enervated by acute sickness Secondly Examine into the essence nature and rise of the disease which will lay open much of the difficulty thereof for Gangrenes from a primitive cause as Contusion Fracture Section Vstion Caustic or other erosion c. are more curable and less dangerous than those that arise and depend upon antecedent internal causes for Gangrenes of this sort do declare a cachectic depraved habit of body and that some of the internal Viscera are damnified and vitiated from whence a supply of ill matter and therefore in Hydropic Scorbatic and Hectic febrile bodies also in malign and contagious diseases small Pox Venereal Lues Plague c. Gangrenes are more desperate Thirdly The part affected or seat of the disease is to be noted for if a principal part be gangrened recovery is very rare also in the Guts a Gangrene is mortal by reason of continual moisture there and imbecillity of these also in the Vagina Vteri and Glandules of the body a Cure is seldom performed Now as touching the Cure of Gangrenes there is not any one Method or particular Medicine for Gangrenes but they require such variation of Cure according to the difference of their causes from whence they do arise with respect to the part affected And therefore we cannot point out any general course that may be applicable to this great disease but indications of particular and special cases must vary and will make exceptions against it So that the rational Physician perpending and duly considering the nature of the disease and variations thereof as aforesaid with the Symptoms and circumstances attending must design such a Method and adapt such Medicines pro re nata as may best suit with the urgency of this dangerous and threatning Malady The means required and useful in these emergencies are taken some from Pharmacy and some from Chirurgery Pharmaceutic Remedies are both internal and external Internal are select and choice Purgatives Diaphoretics and Cardiacs elaborated and prepared according to latter inventions and the best Rules of Art Topical and external are Fomentations Liniments and Cataplasms specificated and appropriated to these purposes Chirurgical helps are Phlebotomy Cupping Scarification Canteries c. and therefore an expert Chirurgeon must here be assisting to perform these operations Now all these various means are not to be used to every person gangrened but each case will require some of these more or less as the Judgment of a skilful Physician in this disease shall determine and appoint But if the Gangrene by continuance and neglect or from acuteness by great
liberty for the use of various means a deliberate way of Cure and gradual spending of the morbific matter Issues do contribute assistance herein but in acute diseases that require speedy help they are not a proper Remedy But although these Fontanels are of good use in the cases aforesaid yet they are not to be relied on as curative Remedies that is they do not eradicate a disease because they do not apply to the spring where it does arise but they give vent and turn the current of a humor this way or that way that it shall not overflow to do hurt other ways They minorate and lessen the morbific matter and abate the extravagant productions and growth of a luxuriant humor and are but remedia à posteriori So that these Issues do not hinder must not justle out the use of good Medicines that must take away the antecedent cause and radically cure by applying to the fountain and rise of a disease the part primarily affected and deficient in office that is the original cause of any producted noxious matter For the right placing of Issues that they may prove advantageous for the purposes intended you are to consider whether the case requires a general evacuation only or revulsion and evacuation or derivation and evacuation If only a general evacuation answers your intention then set your Fontanel in the left Arm but if for revulsion of a humor it must be remote from the part affected or complaning but if derivation be most convenient then the Issue must be near the part affected Sometimes an Issue is placed in the part affected to empty and evacuate a morbific humor lodged there Secondly Having thus determined the part or member you are then to chuse a fit place for the Issue observing diligently the position and motion of the Muscles else your Issue will not be so beneficial nor lye easie for if it be set upon or too near a Tendon or in the body of the Muscle the motion and attrition of the Muscle will molest and disturb it with pain and the evacuation will be but little therefore you must place them in interstitiis Musculorum in the place or distances between the Muscles where the extravasated humors are most frequent in their motions and perambulations and therefore this operation is not rashly to be attempted but considerately to be performed by good advice and a skilful hand in Anatomy Fontanels being thus appointed for several purposes and cases will require a different situation some in one part of the body and some in another For diseases that are seated in the Head Fontanels or Setons may be placed in the hind-part of the Neck but because they appear more in sight there and also are troublesom Issues may with the like benefit be set inter Scapulas between the shoulders one of each side the Spine or else in the Arm between the two Muscles Deltoides and the Biceps about four or five fingers breadth below the shoulder-joynt and this is the most frequent place because the Patient may dress this Issue without help But Fontanels in the Back do not only contribute help to infirmities of the Head but also they are beneficial for Arthritic or Gout-pains by intercepting and evacuating the morbific humor that tends towards the Joynts also Fontanels thus placed do divert and turn off a defluxion or current of humors that invade the Lungs and therefore such as are troubled with Coughs from a destillation of Rheum into the Breast and are inclining to be consumptive will find benefit thereby In the Groin Issues may be set for diseases of the Liver or Spleen observing the rectitude of parts the right side for the Liver the left side for the Spleen this place also is convenient for derivation of the morbific humor that causeth Sciatica-pains and pains of the Back towards the lower end of the Spine and about the Loins The Glandules in the Groin are appointed to receive superfluous and excrementitious humors which being readily discharged again by Issues the current of morbific matter will then more freely resort thither and exonerate such parts adjacent as are infested and oppressed therewith The Thigh and Leg also are places for Fontanels to make a revulsion of humors that molest and injure the superior parts and also may serve for a general evacuation In the Thigh an Issue is usually placed a little above the Knee as being most fit there for a binding to keep on as also in the Leg a little below the Knee the inside of the gartering place The Issue being made whether by Caustic or Section the orifice must be kept open with some pellet for which commonly the largest sort of Pease is made use of and so continued except some occasion by alteration or condition of the Fontanel causeth variation and then sometimes little balls are made of Ivy-wood Gentian-root Orris or Hermodactyls c. as the case may require The first dressings of the Issue for two or three days a digesting Plaster is to be laid on afterwards an Ivy-leaf may be used which attracts a serous humor and provokes the Issue to run and over this is laid a thin paper but for a constant wearing and common use a piece of varnish or oil'd cloth such as the coverings or riding Hat-cases are made of is very commodious and easie to provide very necessary for journies or voyages where the other is not to be had and this you need to change but once in a week or more wiping and turning it every dressing For the due ordering and keeping of Issues you are to observe the times of dressing such as run sparingly or but little once in 24 hours is sufficient but those that send forth matter more freely and plentifully dress them morning and night that is to take out the Pease wipe the place and put in another If the Issue fills up at the bottom and makes the Pease to start then lay a Groat upon the place next under the binding which will keep in the Pease and continue the Fontanel deep If the brim or edge of the Issue rise high with proud flesh sprinkle a little powder of burnt Alum upon it for one or two dressings which will bring it down even with the Cuticula When your Fontanel abounds and runs much with a sharp or stinking ichorous humor that excoriates round about the Orifice and causeth pain to abate and take off the antecedent cause you must purge sometimes with a proper and good Medicine avoid also intemperate or often drinking between meals be sparing in your diet especially at nights and keep seasonable hours for bed-time When you desire and the case requires an Issue to evacuate more inlarge the Orifice and Cavity thereof by putting in pellets bigger than pease as Horse-beans and if that be not sufficient you may put in two An Issue sometimes at the first making will not run well the morbific matter being accustomed to frequent other places and having
errour and folly of the rest for by insisting so much upon this heat the supposed obstacle of Cure or the thing to be cured the opportunity perhaps may be lost but the Patient certainly injured by the vain use of Medicines levelled at this mark Few diseases there are amongst the Chronic or slow of motion but some febrile or preternatural heat more than the ordinary and natural temper does attend them especially at such times if the disease have any manifest intentions of degrees or Paroxysms of pain and scarce any among the acute or swift but a brisk and high Feaver does always accompany for in all cases where pain is continuing especially if severe a Feaver is adjoyned and they become fratres in malo or rather a branch from that stock and the order of causation runs thus First there is the morbific cause planted in this or that part or transient which is either some degenerate or peccant humor there infesting or corruptive seminary the fundamental matter of Pains Tumors c. or some extraordinary production as stones worms c. These preternatural causes do seldom lye dormant but raise pain by obstruction by oppression or compression by convulsion distention corrosion putrefaction c. The parts being thus affected and grieved the vital principle residing as governor there is hereby excited and irritated to remove expel and cast off the offending cause this strugling and irritation of the life is the very pain and anguish that is felt in the part for the Organ is not capable of pain of it self but the life inhabiting and inabling the part to perform vital offices that does dolere and aestuare Now a Feaver which is pain diffused ariseth from particular pains thus As the members or parts of the body being many do consent with one another some more immediately and peculiarly than with the rest by vessels of communication partnership in office or vicinity yet the life being one entity or common being extended and expanded throughout the whole fabrick of the body cannot suffer here or there but the whole is injured disturbed and drawn into consent more or less manifestly or secretly and the Spirits upon great occasisions are raised up in commotion throughout the body as instruments to vindicate the publick from an enemy invading And farther take notice that particular pains beget the general a Feaver greater or less sooner or flower upon a double account 1. From the Nature and Quality of the Part in formation and office 2. From the greatness or inconsider ableness fierceness or mildness of the morbific cause For example Sickness which is pain at the Heart or Stomach raiseth a Feaver great and soon and this by reason of the excellency and necessity of their offices whereby the whole body consents forthwith that what afflicts these is a general complaint more immediately but other parts in a lower station subservient and ministerial whose function being not so general but of particular and private use do not communicate their diseases so soon nor the whole body so highly resenting their ill affects because the publick can spare their offices and be without their exquisite or compleat assistance for a time without great complaint or manifest want Secondly the cause or morbific matted being greater or less in any part does thereby affect more or less sooner or later and therefore sand or small gravel in the Kidneys do not afflict the part nor raise so great a disturbance in the body as a stone there that obstructs the ducture and stops the current of the Urine and is much more difficult to be removed And sickness or pain at the Stomach by little over-drinking of good liquor Wine or Beer c. is not so lasting nor molesting nor preading in the effects over the whole body â—s a surfeit of meat fruit or an over-charge of bad liquors these shall produce not only sickness or pain in the stomach but sickness or a hot pain in the whole body which is called a Feaver and this sickness may be dangerous as sometimes it proves mortal Pain is fixed in one part but the Feaver is universal spread throughout the body for from this pain of a particular part the whole life estuates is incensed and disquieted as if a cord be tyed or fastned at both ends of great length and strait strike it hard in one place and it jarrs the whole length but at the place struck the vibration is greater and more manifest So where the disease is seated the pain is more apparent and that part most sensible where the wound is given where the oppression lyes where the obstruction is where the humor is corroding putrifying c. there pain is eminenter limited or bounded and to be pointed at particularly here and not there eminently but from hence ariseth the Feaver which is pain diffused in a remiss degree and seemingly of another nature or quality a different thing supposed by some therefore denominated a Feaver This Feaver although it be a pain yet it is not so felt by the Patient nor so understood by others because of the greater particular pain that drowned it and because of its expansion and latitude all parts bearing their proportion and share so that where a Feaver stands alone without a particular pain in this or that part yet the Feaver the general pain is not so manifest to the sense of the Patient because every part hath its portion and therefore is not so discernable and uneasie for a Feaver is pain expatiated through the body and you are not so sensible of it as when pain is contracted into a narrow compass the rest being free and at ease That all Feavers are pains greater or less examine but the definitions of Febris and that of Dolor Feaver and pain you will be fully informed how they agree a Feaver being comprised under pain as a Species of that Genus being a hot pain or the pain of heat Dolor est tristis sensatio in tactu Gal. Febris est calor contra naturam in corde accensus ex eo in totum corpus diffusus which is Hippocratic and Galenic Doctrine Now where there is heat higher or exceeding that which is natural it must affect the sense of feeling and cause pain and although I do not like the definition of Febris yet it will serve my turn here being right in the opinion of those Galenists with whom I now contend From hence we must understand and be untaught again that Dolor and Febris do differ as genus and species a Feaver being contained under and is one sort of pain viz. a hot scorching pain and sometimes a Feaver is a cold pain as the rigor of intermitting Feavers called Agues do testifie And since that all Feavers we pains little or great we shall not need to institute a Method of Cure different upon the notion of a Feaver but only having respect unto the cause that raiseth this feaverish or hot pain and therefore
will receive some ease and benefit by that which is good soon after it is received into the Stomach long before it can make a progress the common way out of the stomach And this consent likewise is between the Oesophagus the mouth of the Stomach and the Heart and thus it is between the Bladder and the Intestinum rectum the last Gut and from hence pains of the Bladder are mitigated and eased by Clysters through insensible passages and not by any manifest ducture or Vessel of communication From hence we may learn by such Examples that Sympathy and consent of parts is strictly to be marked else it is not possible to know where the root of a Disease is and from whence pain or other Symptoms do arise for one part may be pained and the disease lye in another and if this be not rightly distinguished there cannot be a true adaptation of Medicines nor due application made where it ought to be which renders all endeavors frustraneous But to descend from generals and to make our Discourse more profitable and satisfactory to the particular cases of the Reader inquiring after his own peculiar concern and present complaint we will take notice of some pains incident to particular and principal parts of the Body remarkable and frequently occurring examining their causes Pains of the Head THat the Head akes every one can tell that suffers under it but the causes and the parts affected distinctly are known only to the Physician and he by questioning and examining the Patient draws his conclusions by collating the several answers and makes Judgment thereupon All which depends upon a due observance of these four Particulars rightly to determine the case First Inquiry is to be made of the Patient concerning his course of life for some time before whether regular or irregular in labour exercise or ease if thereby any thing hath been done to procure or introduce the present complaint and of his former state of Health and Sickness Secondly Of his state and condition of Body as it now is Thirdly The place or seat of pain the compass and extent of it Fourthly The quality or condition of the pain vehement or moderate continual or intermitting acute or obtuse c. Having made disquisition by these Topicks and traced the Patient through these grand inquiries you will then understand something of the rise and progress of the pain sought after giving you then occasion to take a farther prospect and consideration of the various differences of pains in the Head wherein your present case will be found and exhibited to your view as followeth Head-aches are either more general and dilated affecting the whole or else one side of the Head or some particular part as Forehead Temples c. 2. Head-pains are either internal or external 3. Idiopathical or Sympathical 4. Recent and of late standing or inveterate and of long continuance Pain of the whole Head or major part does denote the cause to be more general and of large extent as in Feavers and plethoric persons wherein the whole body is distempered and from thence the whole Head or most part therewith affected Pain in particular places as of the right or left side fore-part or hind-part the top or the crown signifies the cause to be or act there only and does arise from some defect or trouble in the part it self by some peccant humor there bred or by transmission of morbific matter from or by consent with some other part diseased adjacent or remote As more particularly hereafter Now you must understand that although every person seems to be equally disposed alike and liable to these pains yet it is much otherwise for some are often complaining of Head-ach some rarely or never and this by reason of the different fabrication and formation of parts as well within as without the man and also by reason of the soundness and strength of parts that some have above another by which they endure long and free from pain or other infirmities Internal pain is seated within the Cranium or Skull and signifies the Brain it self or Membranes investing the Brain or some Vessel Vein Artery or Nerve to be affected if the Brain akes the pain is obtuse and heavy the Patient is much inclining to sleep or drowsiness so likewise when the Veins are molested the pain is remiss but if the Membranes or Nerves be the complaining parts the pain is more acute and punging and then it reacheth commonly to the roots of the Eyes because these Membranes do cover the Optick Nerves which lead to the Eyes and it may be known what Nerve is affected by the part consenting which that Nerve does supply and serve and thus sometimes the Ear or Tongue sometimes the Shoulders or Breast complains by that Nerve inserted into them for their use but if an Artery be the place then the pain is beating Pulse-like External pain is superficial and without the Skull shewing that the Pericranium or Membrane covering the Skull is the part grieved and sometimes the Cutis or outward skin only and then the pain is more remiss but both are known and aggravated by compressing the part or place and if the pain be in the fore-part of the Head and extend to the Eye-brow the Periosteum is affected Pains of the Head per essentiam or Idiopathical are when the cause of pain is seated in the part pained by reason of debility or dyscrasie and infirm state thereof from whence ill matter is congested and accumulated causing a disturbance or distemper and sometimes pains fixed from extraordinary productions there ingendred and bred as worms stones c. as hath been noted by Authors of repute and credit Hollerius Schenkius Kentman and others Pains of the Head sympathical are when the cause lyes remote and the part pained suffers by Sympathy transmission or consent from other members and not by any proper defect or disability of its own And thus the Head is very apt compati to suffer and condole with most parts of the Body by reason the Nerves are branched forth and dispersed in all parts of the Body from the Brain and spinal Marrow which being of exquisite sense does affect their original and fountain by this communication and intercourse with other parts and not only by the Nerves coming from the Head is this consent maintained but also by the Veins and Arteries going from other parts up to the Head conveying good or ill Hence it is that very frequently the Head is pained from distempers of the Stomach sometimes from the Spleen Womb Intestines c. Having given you the various differences of Head-pains as to the quality or condition of them and also pointed at the several parts affected per se per consensum I come now to set forth the causes or rise of these pains from whence they spring whether generated in the Head or communicated to it from other parts Causes of Head-achs or pains are external and internal External
Causes may be such as these as when the Head is exposed to heat or cold a strong scent sweet or stinking Fumes or smoke a blow or fall c. occasioning disturbance of the Spirits Obstructions in the Pores and Vessels Inflammations Tumors or Imposthumes Internal Causes are sometimes plenitude or fulness of blood which then upon small occasions is ready to estuate and ferment causing extension of the Vessels and Membranes or else depravation and foulness of the blood which may offend the Brain or other parts of the Head by its noxious properties Now the degeneration of the blood from its due and laudable state to an evil and bad condition is various and does manifest it self by divers Symptoms in several parts of the Body and also when it is let out of the body by colour sapor consistence heat c. Either the blood is impoverished and deficient in vital Spirits and heat slow in motion feculent gross or grumous and thereby apt to be stagnant or obstruct or else too hot and fiery causing inquietude of the Spirits and irregular motions of that vital stream disturbing the Head with pain and watchfulness Secondly The blood degenerates sometimes from its Balsamic qualities into an acrid sharp or acrimonious condition and then most commonly there is an abounding serosity or a superfluous latex or water which state of the blood as very remarkable causing many diseases I shall set forth in another Work Deo volente to be made publick Thirdly The blood may be contaminated with a contagious malignant or virulent Miasm and taint as in the Plague small Pox highly graduate Scorbute Venereal Lues as more fully appears in my Tracts of the Scurvy and that of the Venereal Lues In all which cases the Head frequently is offended and suffers pain And here also we must account amongst the internal causes Impotency and weakness of some Organical parts of the Head not performing their office Obstructions of some ducture or porosity by constriction compression or coagulation Congested matter infesting any part of the Head raiseth pain Wind or flatulent Spirits roving here and there may produce the like Watching unseasonably which tires the Spirits causeth disturbance in the Head Immoderate study or cogitation weakens the Brain and renders it liable to pain Violent motion agitating the Spirits furiously and driving the humoral currents out of their natural placid course discomposeth the Head and may cause pain Immoderate Venus or long forbearance the first by too great exhaustion and draining the Nerves the latter by plenitude over-charging the Genital Vessels reverberating back or by consent affects the Head And now briefly I shall shew here what parts chiefly and frequently the Head consents with from whence internal causes of pain are communicated and as these parts are well or ill by intervals so the Head is better or worse thereby The Stomach in the first place as being the general and grand office of preparation to supply the whole body with nutriment so is it the part that most frequently afflicts the Head by communication through Vessels of intercourse conveying to each other The Head complains from the Stomach either before meat when supposed to be empty or after meat when replete and filled If the Head complains before eating it argues the Stomach to have some remainders or relicts from former digestions not wrought off that does disturb the Stomach and from thence the Head if after meat the Head akes it does declare the Stomachs indisposition to digest and imbecillity to overcome what is received and labouring under the burden the Head suffers also Now to know that the Stomach is not in good order or ability for the true performance of its office in digestion is manifest by these signs Vomiting or nauseating pain oppression or heaviness eructation or belching want of appetite or thirstiness But here by way of caution in this consent between the Stomach and the Head you must rightly distinguish lest it happen as sometimes it doth that the Stomach suffers from the Head and not the Head from the Stomach and since the consent is reciprocal and mutual you must nicely observe which is the part primarily affected and which the part by consent else endeavors of relief will be frustrate if you begin not with the part primariò diseased to free and set that right for then the other spontaneously and of course will be reduced The Spleen being ill-affected draws the Head into consent sometimes and participates of its evil and this is to be known by examining the Spleen whether any Symptom of disorder or distemper is manifest there or from thence Now the signs of a diseased Spleen are these pain hardness tumor or extension flatulent motions in the left Hypochonder or side under the short Ribs And most commonly the Head is affected or pained on the same side or else the forepart If the Liver occasions the disturbance or pain in the Head for the most part the pain is seatted on the right side and then some Symptoms of a distempered Liver will appear as heaviness or fulness in the right side hardness pain or heat affecting also the Stomach and causing thirst also driness or heat in the palms of the hands and soles of the feet and as these signs have their intention or remission so the Head is better or worse If the Womb be in fault and cause pain of the Head as frequently it doth by the great communication and consent between these parts then either there is a suppression of the menstrual purgation or irregular and out of due course not keeping the due times or insufficient in quantity or abounding or too long retension of semen or too great a profusion and wasting Some of these causes are sufficient not only to disturb the Head but also divers other parts of the body and these pains of the Head arising by consent from the Womb do most commonly affect the top or hind-part of the Head If from the Intestines pains of the Head do proceed then either worms are bred there or the Guts are troubled with sharp or corrupt humors or else there is costiveness and siccity of the Bowels whereby the Excrements are baked and hardned causing too long retention and from hence by Vessels of communication the Head complains also If from the Kidneys the Head is grieved then inquire into the condition of the Kidneys and you will find some signals of a Disease there either stone or gravel or a sharp Serum an Inflammation or preternatural heat an Vlcer or Excoriation Now as concerning the Cure of Head-achs and likewise of all pains that arise by consent from other parts take this general Rule That in the first place application be made to the part primarily affected to reduce that into a state of integrity then consider the part that suffered by communication and participation if by continuance or length of time any impressions remain there or debility that may require help although
to discharge and abate blood by the Nose by the Haemorrhoids or Menstrual purgations sometimes by plentiful feeding and too much ease so that evacuation and transpiration is not proportionable in abatement and to balance the imported food Conjunct causes are such as more immediately and nearly concur or conspire actually in forming of these pleuritic pains and they are either acidity or viscidity within the Vessels of the Pleura or a violent fluxion from the larger Vessels too great for the capacity and reception of these exiguous canals 2. Acidity or an acrid serosity does sometimes fabricate and finish this disease by punging and lancinating the Pleura for omne acidum extra stomachum corpori est hostile says Helmont thereby irritating and exciting the vital spirit to estuate and be incensed and from this focus a febrile heat is kindled and communicated to the whole Body and that oftentimes and for the most part it is a sharp serous humor predominant in the blood which caused this disturbance in the Pleura is confirmed by the manner of solution or termination of the disease which most frequently is by a sudorific evacuation or insensible transpiration and therefore Hippoc. in his Predictions says Sudores urinas in Pleuritide probè fieri bonum esse salutare Friendly Sweats and effusion of Urine presageth a good event 2. Viscidity or grumosity of the blood does sometimes cause pleuritic pains for by obstructing those small ductures of the Pleura and stopping the Circulation a Tumor thereby is raised within this double Membrane for the Veins Arteries and Nerves lye between these two Coats of the Pleura And that the blood is thus apt to be stagnant especially in the smaller Vessels by coagulation grossness or congelation is confirmed by Phlebotomy for being let out of the body it is sometimes found destitute of its Serum or Latex that keeps it fluxile thin and transient and also is manifest so to be when it is in the Vessels as in Gangrenes where the blood is fixed and the part almost mortified and when Pleurisies do happen upon this cause of concretion they commonly tend to suppuration as not capable of being discussed or put into motion for a discharge of the part Now the Blood becomes thus incrassated gross and viscous from every cause that does too much exhaust and expend the serosity thereof as too great transpiration or sweating or immoderate making of urine and sometimes from a malignant or a venemous Miasm that curdles or congelates the blood 3. Fluxion or ebullient and preternatural Fermentation causeth pleuritic pains and thus it happens when a Pleurisie is the consequent or appendent to a Feaver preceding for sometimes a Pleurisie does precede and is the cause of a Feaver as when the dart is felt to strike the Pleura before any febrile distemper appears sometimes a Pleurisie does supervene and follow a Feaver as an effect from that general ebullition the hot spumous blood rushing into the Pleura Having established these causes in their due Series presenting them in the method and order of their causation and action we shall not trouble our selves with Choler Flegm and Melancholy the supposed materials of every disease nor shall I controvert the insufficiency of that doctrine here For Indications of Cure prompting what is to be done which way and with what they are various as the case presents 1. Plethory indicates Phlebotomy and requires a depletion or abatement of the redundance of blood that there may be room for the peccant matter to retire and for a revulsion and derivation thereof as also to avert the current and flux tending towards the pained part 2. Purgation by sedate and amicable Cathartics if you can procure such else by Clysters the best substitutes in that defect is necessary to absterse and cleanse the whole Body thereby subducting fuel from the fire and for rendring the Patient not so liable to effervescency and turgid estuation and for a retraction from the part affected 3. Topical Discussives are available and contribute to the remove of the morbific cause both as defensatives giving robor to the grieved part for resistance of the humors flowing in and also for a transmission and discharge of the conjunct matter residing 4. Diaphoretics to rarifie dissipate and set open the Pores for a free transpiration and exsudation are not only safe but exceeding necessary thereby to avert the antecedent cause resorting to the pained place and to disperse and scatter the morbific conjunct cause from the part affected if possible to prevent suppuration which is very dangerous and commonly mortal 5. Anacathartics or proper and truly expectorating Medicines are auxiliary and profitable in promoting expectoration by digesting the peccant matter and rendring it more apt and easie to be brought up and of these some are attenuating others incrassating to be used pro re nata suitable to the offending cause which if it yields soon and freely and Nature throws it up by cough and spitting it portends good promising shortness of the disease and a prosperous event which Hippoc. 1. Aphor. 12. confirms 6. Anodynes elected by a discerning Judgment and cautiously used may be of good advantage in some cases and at some times else may prove very pernicious Having dispatched these pleuritic pains we are next to take notice what other pains are incident to the Thorax or Breast And here we find pain to arise from Inflammations of the Lungs of the Mediastinum and of the Diaphragma whereof an account will be given in their proper places hereafter when we treat of Inflammations But the Lungs do suffer pain also from other causes as from Tumors not inflamed sometimes from adhesion or sticking of the Lungs to the sides of the Breast sometimes from stones and worms that have bred there observed and found upon Dissections and sometimes by Erosions and Vlcers of which in their due place following Back-pains of the Thorax are either upon the Spine between the shoulders or upon the Scapulae the shoulder blades And these pains do arise from some impressions of cold lately taken or from defluxion of a serous humor from the Head or sometimes from a maligne Miasm Venereal or Scorbutic that infests those parts Pain sometimes is seated at the bottom of the Sternum between the short Ribs under the Cartilage mucronata vulgarly called the Pit of the Stomach but improperly This Cartilage hangs down being as it were a defensative to the subjacent parts namely the Stomach and Liver yet is flexible to give way to the extensions of the stomach without compression This place is very tender at all times insomuch that a blow here is ready to make a strong man faint the part being thus sensible pain therefore here must be very troublesom Now this place is of acute sense or feeling in regard the upper Orifice of the Stomach being very nervous and almost subjacent to this Cartilage and the Heart adjacent hence it is that a blow or
moderate and gentle making a profitable secretion without gripes or pains but for the most part with these more or less which by continuance and shaving the guts so thin at last do come to the quick and cause excoriations and this difference ariseth from the nature and quality of the humors or stimulating cause which sometimes is so extreme sharp introducing a Dysentery or bloody Flux These Fluxes sometimes produce good effects when the peccant matter of any disease or an exuberant humor is timely and moderately discharged and sent off but otherwise not and therefore saith Hippoc. In turbationibus alvi vomitibus sponte contingentibus siquidem qualia purgari oportet purgentur confert leniter serunt sin minùs vice versâ In respect of place or parts mandant from whence these Fluxes take their rise and the terminus à quo they proceed sometimes from morbific matter congregated and concentred issuing from the whole body and of this take the example of Hippoc. giving a Prognostic in this case 7. Aphor. 29. Si Leucophlegmatiâ detento fortis Diarrhoea supervenerit malum solvit Which is to be understood in the beginning of the disease strength firm and the Viscera sound else it is commonly mortal But sometimes also these Diarrhoea's do emerge from particular parts as the Ventricle Brain Spleen Liver Mesentery c. and therefore in the Cure of these Fluxes regard must be had to the part principally affected from whence as the original and fountain these Diarrhoea's do assurge And therefore examination is to be made by the Diagnostic signs of every principal part discovering thereby which performs their offices in integrity and which of them decline their functions and are depraved as being the Authors of this disturbance The third sort of Flux is a Dysentery or bloody Flux which is a dolorous and frequent excretion of blood from an Exulceration of the Guts There are several voidings of blood by stool that are to be distinguished and know from Dysenteries Galen mentions four others add two more The first is a profusion of blood arising from plenitude or fulness of good blood Nature over-burdened dischargeth her self this way by the Guts The second is an evacuation of crude and watry blood not having its full tincture The third is of a feculent and foul blood The fourth of an acrid and salt blood The fifth is of a tabefied blood in acute diseases The sixth which is Galens fourth is a Dysentery distinguished from the rest by Ulceration and great pain To examine this division in the several parts thereof and to set forth what truth and errour it contains therein is not our business at this time I shall only discourse upon the last viz. a Dysentery being painful and grievous to bear which kind of bloody Flux ariseth from and is accompanied with an Exulceration and commonly is the consequent of long or severe Diarrhoea's for those Fluxes not being checkt do sometimes make their transition and terminate in Dysenteries This word Dysentery taking its name from the part affected imports only a difficulty of the Intestines but may as properly be used for other diseases and pains there but Authors having fixed it to bloody Fluxes from Exulceration its general signification is restrained and custom amongst Physicians hath fastned it here as the character of this disease only The parts affected are the Guts either the small or the great and sometimes both but pains of the small are more grievous than those of the great the small Guts being of more exquisite sense The external and procatarctic causes that predispose and introduce a dysenterical disposition or promote and set forwards an inclination already begun are First the constitution of the Air. Secondly a bad Diet conspiring therewith or some unwonted kind of Meats or Drinks and therefore it is that many people upon the change of Climate and a new sort of Food do fall into bloody Fluxes hence it is also that these Fluxes are sometimes epidemical and malignant infesting many together in a City or Country as of late years in London and some other parts of England this disease was raging These epidemical Dysenteries arise sometimes to to the height of pestiléntial and are very contagious that it is not safe to converse with or be near the diseased but especially such as attend upon the sick are in most danger from the Excrements that send forth a pernicious and infectious vapor For the time of the year Autumn is most ready and does more frequently produce these Fluxes partly from the change of the season and partly from the effects of Summer fruits to which many are intemperately given the consequents whereof are commonly Diarrhoea's and Dysenteries Now the reason why these Fluxes do break out more frequently at this time of the year is because the external ambient Air and cool blasts condensing and incrassating the Juyces of the body as also occluding and shutting up the Pores denying and hindring the former Transpiration which in the Summer and hot weather did spend and evaporate that way much superfluous matter which vents being stopt humors accumulate ferment and grow turgid and forceth a discharge inwards by the Guts And not only this change of Air from hot to cold or Summer fruits are procuring causes but also some astral and inimical influences drawn in with our breath may deprave and alter the Crasis of the blood and nervous juyce as to effect this disease and make it popular in like manner as other Epidemical diseases are sometimes procured Also some sorts of Meats in quantity or quality offending and disagreeing and for want of good digestion may corruption and dispose to these Fluxes To these we may add as procurers some ill prepared Medicines and medicinal Drugs not well corrected that have and will produce a Dysentery But concerning the proximate cause and manner of generation of this disease we must farther declare And whereas before we mentioned several sorts of bloody excretions or fluxes not dolorous nor depending upon or conjoyned with exulceration of the Intestines and therefore not denominated nor to be understood as Dysenteries in the strict and present sense therefore I must wave the mentioning of their causes and only give an account of Dysenteries in the usual acceptation of the word In the forming or generating of this Dysentery you must understand that sometimes the Vlceration is planted first and hath the priority and a Flux of blood follows as the consequent but sometimes the voiding of blood precedes and an Vlcer or Vlcers is procured thereby as the effect and this consideration is not of small moment in the designment and intentions of curing for both the former and the latter happen in several persons Sometimes Vlceration is made by sharp corrosive humors as in Diarrhoea's which ulcerate the guts first then a Dysentery of blood follows Or Sometimes from an Inflammation of the Intestines or other Tumor coming to suppuration which breaks and makes a
Liver BEfore I inquire into the nature and causes of these pains it will be necessary to let you know the office and use of this member its situation figure and vessels for hereby the disease upon which pains depend will be more manifest and apparent as also such parts as suffer by vicinity connexion and consent from hence To enumerate the various Opinions that have been held by Learned men in all Ages concerning the office of this member would be too tedious therefore I shall only mention what latter discoveries have proved most rational from the motion of the Chyle and Blood which is this That the Liver primarily is appointed to receive the blood coming from the Heart to give it a farther digestion and depuration by separating the bilious matter and secondarily by embracing the Ventricle to cherish and promote the stomachs digestion or chylification for which purposes this member is fitly seated formed and furnished with vessels to import and export The Liver is placed in the right Hypochonder under the Diaphragma covered in part by the short Ribs and covering the upper and forepart of the Ventricle and for firmness of situation it is fastned by three Ligaments to the Abdomen to the Cartilage ensiformis and to the Diaphragma The figure of this member upon the superior part is convex or round the better to give way to the motion of the Diaphragma but the under side is concave or hollow fitly to apply to the extension of the Ventricle As for magnitude it is various in divers persons greater and less and also different in the same persons in health and sickness this member sometimes being wasted and shrunk and sometimes swelled or increased wonderfully big This Organ hath vessels appertaining to it as Veins Arteries and Nerves the two eminent great Veins of mans Body Vena cava and Vena portae having their roots variously dispersed here through the Parenchyma or body of the Liver the trunk of the former rising out of the superior gibbous part the latter from the concave and under-side The Liver being designed for the use aforesaid seated and accommodated after this manner we shall inquire into the impediments and preternatural conditions from whence pain and trouble ariseth for many complain of pain and heaviness in their right side about the short Ribs sometimes more forward sometimes backward sometimes inward and sometimes more outward To what parts these pains belong and the causes from whence they arise is worth our labour to be resolved for sometimes pains of the Liver have erroneously been taken for Pleurisies because the pain hath extended upwards and affected the Thorax by reason of vicinity and sometimes the muscular pains of the Abdomen in the right Hypochonder have been adjudged to be hepatic not rightly discerning the diagnostic signs Diseases which the Liver is most subject to and procuring pain are these Obstruction Adhesion Inflammation Inflation scirrhous Tumors Apostems Vlcers From hence we may understand that as these pains are various in their causes so are they dissimilar and unlike in the sense of feeling and differently seated Obstructions that impede and injure the office of the Liver and producing pain are frequent and these are either in the outmost gibbous part and do belong to the trunk of the Vena cava or else in the hollow inferior part and the Vena portae is concerned herein or else the obstructions are fixed in the body of the Liver and then the small ramifications of either or both Veins are affected Hence it is that this member is most frequently infested with obstructions because it is stored with so many vessels as none more But besides these obstructions of the Vessels there are also obstructions in the Parenchyma or substance of this Organ that is when the small Meatus or Pores are shut up that ventilation and transpiration is denied hence it is that this member sometimes is preternaturally extended and increased in magnitude through all its dimensions for having a continual supply of additional matter and not duly expended the part of necessity must be augmented and inlarged And it is observed by some that those have the greatest Livers that are of a colder temperature and such as are great eaters of this Cornelius Gemma gives an example of an Old woman that could not forbear eating and drinking scarce a moment but with great trouble and anguish and being opened after her death her Liver was found to be wonderfully big Signals declaring the Liver to be obstructed are a heaviness fulness or an obtuse pain in the right Hypochonder and chiefly after meat or exercise and upon more than ordinary motion the face is apt to be high-coloured the hands to look red and the breath to be short and they are apt to be feaverish upon small occasions but upon rest and ease commonly they are inclined to be pale Causes from whence these obstructions arise and do depend are first such as remotely dispose as a plentiful and bad Diet or a gross feeding upon such meats as are difficult to be digested and distributed what those are you will find in the Preservation of Health c. also a thick unwholesom Air to be without exercise and to indulge sleep too much which over-clogs the body makes a Plethory and fulness whereby the circulation is retarded laying the foundation and an aptness for obstructions in general Secondly and more immediately from a viscidity and grossness of the blood rendring it influid slow of motion and apt to stop in the vessels and this is generated in the Liver from its distemper debility and decay of the faculty or is transmitted from other parts and brought in from the antecedent causes aforesaid to which we may add angustness of the vessels in some persons disposing to this inconvenience Obstructions of the Liver are carefully to be lookt after and removed because they introduce many other diseases as Jaundice Dropsies Feavers Inflammations scirrhous Tumors c. Adhesion or Coalescence sometimes is the cause of pain in the right Hypochonder as when the Liver sticketh to or groweth together with the Peritonaeum And this may happen from too much and constant lying on the right side or by the magnitude of the Liver extending to the Peritonaeum whether tumified preternaturally or increased by a natural nutrition and growth Now pain ariseth hence the Membrane that invests and covers the Liver being very sensible as all Membranes are that cleaving to the Peritonaeum is disturbed and strained by motion or shaking of the body or by lying on the contrary side the weight of the Liver endeavouring a separation Inflammation sometimes seizeth the Liver and causeth great pain and this commonly proceeds from or is the consequent of obstructions for the blood being stopt in its current and overflowing especially being more hot and fiery is then apt to inflame the part and this is manifest to sense by heat and tension of the right Hypochonder Inflammation is known from
very weakly others use their arms but with little strength and some the use of their Limbs almost taken away The material and continent cause of these fugitive and vagrant pains is the same or of the same nature with the former Arthritis or Joynt-Gout viz. a tartarous or sharp penetrating serosity that molests these several parts and to confirm that this is a serous or watry humor it makes no Tumor nor suppurates which were it of another kind it would besides the mobility and fluctuating nature thereof argues it to be of that kind and farther à juvantibus we may most rationally conclude so Transpiration and copious emission of Urine and also Purgation that evacuates serous humors gives allay and sedation to these fleeting pains But why this should be so moveable and changing its place the other fixed or constant to a part since one and the same humoral matter is the cause of both the reason hereof may be this from abundance of the humor and for want of vent one way not being sufficient to receive and spend it Nature is necessitated to find out and break through several ways that is by forcing the Anastomoses and opening the terminations of the Veins spewing forth this punging irritating humor into several parts and being an unwelcome guest hostile and troublesom the Archaeus or vital principle defending its Territories quoad posse and unwilling to give it harbour transmits it from place to place This Rheumatism and erratic pains depending upon the same humoral cause with the Gout will require much what the same method and Medicines for Cure as also such Prophylactics that are proper and fit by way of prevention for the other may here be used with the like advantage and therefore it is not needful to point out a particular methodus medendi or peculiar Medicines only the Topical Medicines are not of such use here as in the Joynt Gout And now I have gone through and briefly inquired into the most and most considerable pains incident to several and principal parts of mans Body it remains now as is proposed and promised in the front of this Work that I proceed on to the next Stage viz. Inflammations and there observe what is most remarkable and most profitable to be taken notice of Inflammations internal BY the common order of causation Pain precedes Inflammation follows To illustrate and set forth the nature of Inflammations more evidently and to avoid confusion and intanglement in our Discourse we shall distribute our matter and place it distinctly under these following Heads First What the word imports and congruous signification with the nature thereof Secondly What Parts of the Body Inflammations do usually possess Thirdly The occasional Matter that provokes and sets forward these Inflammations Fourthly How they arise and from what Principle or Efficient they are caused Fifthly The Vse and Practice that ariseth naturally from the preceding Doctrine The word Inflammatio used in the Latine in the Greek is 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 uro to burn or inflame in both Languages signifying some extraordinary and preternatural heat kindled and begun in some part of the Body and in the common acceptation of a Phlegmon or Inflammation is understood thereby a hot Tumor arising from blood But although Inflammations are reckoned among the Tumors and so accounted by most Practisers yet I must take leave to divide Inflammations from Tumors and distinguish them apart as properly so for commonly they are separate although oftentimes conjunct and the denomination was given à calore not à tumore By Inflammation therefore I understand here only a preternatural or extraordinary heat begun in any part as the Etymon of the word imports before a Tumor be raised but by time and continuance Inflammation or great heat does attract matter and forms a Tumor and then Inflammation and Tumor are coupled or complicated together for as we plainly find external parts to burn or feel very hot and to look red you say then the part is inflamed although no Tumor or swelling appear so is it internally the part is fiery hot or inflamed before a fluxion of blood arrive thither to throng the part and raise a Tumor so that there are Inflammations without Tumors and Inflammations conjoyned with Tumors and here I make Inflammation a distinct Classis and to be a gradation or step towards a Tumor which probably may follow if not prevented as sometimes it doth And here it is worth our inquiry to know the reasons why some Inflammations produce Tumors and some go off without forming a Tumor and this is caused from the difference of the parts affected and the copious influx and contumacy of the material cause to be removed from the efficacy of means timely used or the strength of Nature to relieve her self Secondly We are to take notice what parts of the Body are subject to Inflammations and they are the muscular flesh the Membranes the Parenchyma of the Viscera and the Glandula's hence it is that Inflammations as they are seated in divers parts of the Body so are they called by distinguishing names from the part affected as Phrenitis an inflammation of the Meninges or Membranes of the Brain Ophthalmia of the Eye Parotis of the Glandule near the Ear. Peripneumonia of the Lungs Pleuritis of the Pleura Nephritis of the Kidneys Angina of the Muscles of the Throat Now from the part affected you are to observe that any member the more nervous it is by so much the pain is greater and by how much the part is more fleshy by so much the sooner the Inflammation comes to a resolution or collection of matter In the third place we come to remark the conjunct and material causes of Inflammations and they are generated either by obstruction or extravasation Obstruction begets Inflammation when the fluid liquors in the Vessels are denied their free motion and transition and this happens when these Juyces are coagulated gross or thick and thereby become stagnant in the smaller Vessels Or by compression when the Vessels are stopt by some adjacent part tumified or extended beyond its common bounds Or by an influx of blood rushing into some smaller Vessels from whence there is not a ready transmission and passage for the venal and arterial Pipes entring into a member are commonly large but grow smaller as they go deeper in and their ramifications very minute that they may soon be overcharged by a turgid blood more than ordinarily fermenting and flowing in Thus great pain from what cause soever may introduce Inflammation by drawing a flux of humors to a part or member from whence they cannot readily retire or move forwards And here you may see how Contusions Luxations Fractures c. do occasion Inflammations if not prevented by care and skill with exquisite good means By extravasation sometimes Inflammations do arise that is when either by plenitude and fulness or heat and
heterogeneous discordant matter or some malign and venenate Miasm is mingled or got into the blood Nature which is the vital Principle raiseth a preternatural fermentation and febrile effervescency in the mass of blood for a purification and separation of this exotic mixture and admits of no sedation and rest until that work be finished Fifthly and from hence you are to be warned of the dangerous and common Practice in Feavers by Juleps Barley-water and other such like cooling Medicines used to allay the heat from a great mistake of the rise of Feavers and from whence this heat does assurge for whether the Feaver does depend upon a particular inflamed part or a general fermentation of the blood for purification in both cases of Feavers such cooling Medicines are pernicious and have killed thousands for by insisting so much upon them and aiming to suppress the Feaver by Coolers which is not possible to be done thus trifling the time away the opportunity of curing is lost and the disease prevails The errour of these cooling Medicines is apparent from the insuccess thereof for never was the thirst of a sick person satisfied by a Julep but a draught of good drink such as the Patients stomach calls for that is acceptable and refreshing so that I say Juleps are but cold comfort to a feaverish sick man for these cold Medicines imposed upon the sick are so far from assisting Nature to perform the work she is strugling about that they nauseate and flat the stomach which should invigorate the other faculties damp the power of Nature contending and leave her languishing for refreshment coveted in her natural common drink What advantage can there be in a Julep to take off or any way contribute to the removal of any matter that is the cause of Inflammation in the Liver Spleen Kidneys Mesentery Pleura c. any part of the body truly none but that is not all for besides the doing no good it does much mischief in suppressing the fortitude of Nature and cheating the poor Patient of that desired common assistance by drink that would be comfortable But no more of this because I have enlarged upon this point pag. 27 28 29 30. yet it falls in here necessarily to be taken notice of because Inflammations always introduce Feavers which Feaver being most obvious and apparent ingrosseth all endeavours for allaying that general and expanded heat but they go the wrong way to work even preposterously beginning at the wrong end But now to inform what is necessary to be done when a pained inflamed part requires help take these directions in general which will be advantageous in most if not all particular cases First Examine and consider the nature of the part inflamed being the part primarily affected the foundation of this disturbance from whose peculiar structure and fabrication as also from its office you will find what are the usual impediments that molest and disturb such a part and how it becomes liable thereto Secondly You are to consider what way this matter is to be carried off if it be humoral and by what means adapting such Remedies suitable to the condition of the part affected and proper for the removal of such a morbific cause Thirdly The Feaver that ariseth from and depends upon this Inflammation is not to biass you or take you off from any thing necessary to be done in order to reduce the part primarily affected but prosecute directly there and regard not the Feaver for as you get advantage in relieving the part grieved you will find the Feaver to decrease and totally vanish when that is restored And to tell you plainly I know nothing you can do advantagious for the part inflamed that may be injurious upon account of the Feaver if the Feaver were independent and had no relation to the other Fourthly If blood be the primary cause or otherwise aggravating through plenitude make a depletion thereby the Circulation will be more free turgency abated and fluxion prevented at least retracted for if the cause be in the Veins or Arteries most necessary it is to be done for commonly then a plethory grossness or coagulation gave the occasion of this grief but if it an acrid serosity that lanceth and irritates the tender part Phlehotomy may draw off and make a diversion for a time until other good means can be administred to eradicate or blunt the sharpness of its acidity Fifthly Set open the vents and outlets which Nature hath framed and make evacuation to abate fulness and remove foulness in the whole body thereby you will prevent or allay the turgency of ill humors that are apt to ferment and move upon this disorder and cut off a supply of morbific matter that may resort to the part pained of raise a new disturbance in other parts of the body Here you must procure and prosecute this intention with Balsamic Abstersives the true Cathartics not venenous Laxatives the common reputed Purgatives and cleanse the lower region of the body whereby also you will subduct and draw away from the parts affected The grosser matter being thus removed and carried off sufficiently the remainder discharge by Transpiration making an apertion of the Pores and setting open those imperceptible vents by the use of effectual and choice Diaphoretics thereby to attenuate rarifie and scatter For outward Inflammations Topical Medicines are applied to the part Fomentations Cataplasms Vnguents c to appease and allay but our internal cases do not admit of such applications therefore we are to design otherwise and adapt such internal Medicines and by such operations as may reach the morbous matter to remove and transmit it yet when an Inflammation is seated near the superficies or extern parts of the body as the Pleura the gibbous part of the Liver and such like especially if a Tumor conjoyned do appear also or any visible extension then local Medicines may be of good use and contribute towards a Cure But here by way of caution take notice That no refrigerating or repercussing application be made to repel and drive back from the part pained for this may prove of dangerous consequence as the imprudent adventures of some in this manner have left sad memento's to forbid the like practice But some may say How shall we know when any internal part is inflamed because neither the eye nor the hand can reach there to discover the disease Yes very well for great pain and anguish continuing in any secret internal part and raising a febrile heat in the whole body does as certainly declare that part to be inflamed in the sense before expressed as any outward signs can manifest where seeing and handling does or can adjudge the case Sixthly and in the last place because Inflammations do arise from and depend much upon the continuance of pain therefore Anodynes or allayers of pain may be profitable at some times and in some cases but warily to be used and the times nicely to be distinguished and
chosen as not to displace or put by a curing Medicine for no Opiate or Anodyne is curative but palliative and for allaying the extremity of pain and to give rest only for pain keeping the sick from natural and wonted rest does bring great weakness and lassitude of spirits Since pain therefore and long watching enervates and debilitates Nature greatly on the contrary sleep refresheth and restores much that the enfeebled Patient then may gain respite from pain and refreshment by rest when the sick is in danger as being tyred out for want of ease and sleep then the case calls for Anodynes and ought to be made use of But because Opiates and Anodynes do not remove the morbific cause therefore they are not to be insisted upon or relyed on as curing means but they are to be used in cases of extremity for mitigation and ease and at such due times as not to hinder the operation of any curative Remedy Tumors Internal Scirrhous Apostemate and Cancerous TVmors may fitly be placed next to Inflammations because Inflammations are the foundation or occasion of many Tumors though Tumors sometimes arise not procured or cause by Inflammation preceding but most frequently Tumors grow up and take their rise from pain and where pain is Inflammation in our sense follows of course and there is much reason for it because pain and heat does arise from one and the same principle as already set forth and when this painful inflaming heat continues you may rationally expect a Tumor by fluxion to follow if not prevented by good means to pluck out the spina morbifica the thorn in the flesh or Nature so powerful and prevalent to free her felf Tumors have their denomination à tumeo to swell and the Greek word 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 fignifies protuberance or expansion so that by Tumor you may understand a part enlarged and increased in bigness preternaturally for natural extensions are not to he called Tumors as the dugs or belly of a woman with child though they be extended bigger than ordinary yet it is natural or by the course of Nature You are not to expect here a Chirurgical Treatise of Tumors as if tire Cures hereof were to be performed by manual operation but I shall shew you some differences of external Tumors that require such management only that you may the better apprehend and judge of internal for as external Tumors do arise from internal matter and present outwards so hidden internal Tumors are formed of the like matter and from such occasions much what as the external save only some outward injuries that may affect the superficial and hot the interior parts as Contusion Scalding Cupping Vesicatories c. Galen in his Book de Tumoribus reckoning up all sorts of Tumors as he supposed gives in the account to be sixty one but Ingrassias in his Survey of Tumors afterwards adds art hundred sixty five more to them and gives particular names but examining the reason hereof we find the advance of number not any way to promote their Cures but makes confusion and perplexity in Practice for this variety is not from any real difference in their nature but from some accidental difference between them in appearance as magnitude figure situation c. so that the same in kind is repeated by another name therefore this vast number will admit of a great abatement and the designment of their Cures much easier and better managed when all are reduced under a few general heads respecting their continent matter and many joyned together under one name by the union and similitude of their nature The difference therefore of Tumors arising from the variety their material causes and the modus generandi are chiefly to be lookt it for from thence is the designment of Cures more especially bottomed but with some respect to the seat or part affected The general division of Tumors from their material causes in the common received Practice is sixfold First from Blood which makes a Phlegmon Second from Choler which generates an Erysipelas Third from Phlegm which begets an Oedema Fourth from Melancholy which makes a Scirrbus Fifth from serous or watry humor which generates watry Tumors as Hydrocephalus Sixth from Flatulency and this Tumor is called Emphysema Inflatio Tumor flatulentus Under these six general Heads are comprised alfo several other subdivisions as first such as arise from the degenerate and depraved condition of these simple and single humors secondly such as spring from the composition and mixture of the simple humors one with another How far I can comply with this specious Doctrine whether it be not more notional than practical and my exceptions against it I shall not declare now in regard time and the intended conciseness of this Work will not give me leave to establish my own opinion and judgment dissenting in this matter nor is it necessary to lay open the intricacy of out design in hand by debating and controverting this Doctrine which relates chiefly to external Tumors and Chirurgical Practice And although internal Tumors are generated of the same matter as external yet all these differences supposed to be true cannot so nicely and certainly be adjudged and determined but indications from thence must be more general and at large for dislodging cleansing and carrying off any such material cause that infests and tumifies a member or part Since therefore internal Tumors do not present themselves to the eye for a more certain and exact knowledge we are to make judgment of them and determine from the fabrication and office of the part affected and complaining which gives some intimation thereof what Succus or depraved and preternatural matter may reside there as also from the general constitution and disposition of the body antecedently disposing thereto for that Cacochymy which is predominant in the body is most likely to be the cause or matter of the hidden Tumor except some other circumstances and probabilities do mainly suggest another morbous matter From the nature and condition of the part affected you may sometimes conclude the Tumor there to be of such a kind as when the left Hypochonder is preternaturally extended you may rationally judge flatulency and melancholy feculency to be the matter and cause thereof From the signals of a serous Cacochymy or abounding serosity in the body you may conclude if swelled legs or feet do happen hereupon the Tumor is hydropic For the modus generandi and the occasional causes of internal Tumors they may be reduced to these five 1. Attraction 2. Transmission 3. Congestion 4. Obstruction 5. Extravasation First By Attraction humors are brought to any part and there accumulated and thus pain increasing heat preternaturally like a Ventose or a Vesicatory does attract from the adjacent parts and procures a confluence of humors to the part pained and thereby forms a Tumor Now if pain be so apt to beget a conflux and consequently a Tumor then you ought to beware and often suspect
such a product for as much as pains are very frequent in most diseases as before proved Then also remember upon a cessation of pain there ought to be care taken by proper means for the recession and dissipation of confluxed matter and not imagine upon a presumption that when the pain is gone all is gone and the Patient secure Secondly Transmission procures a Tumor when the expulsive faculty of some parts is vigorous and strong to send off any excrementitious matter and deposite it upon a weaker which being not able to expel it lodgeth there and generates a Tumor Thus the principal and more noble parts have a natural robor and fortitude to send off their superfluous and noxious matter and transmit it to the inferior and ignoble Now there are some parts that are weak by Nature and some by Accident By Nature those are weak that are designed ministerial and subservient and therefore liable to transmited matter from their superiors thus the Glandules are all weak parts lax and spongious apt to receive and imbibe hence it is that the Heart transimts to the Glandules in the Arm-pits the Brain behind the Ears the Liver to the Groins and the Glandules of the Mesentery are very apt to tumifie and are the latent causes of some difficult abstruse diseases The Skin also is a weak part and general Emunctory for the whole body and therefore many Eruptions and Tumors are there visible By Accident some parts are weak as when by a disease inordinate living or casual injury some particular part though strong by nature and original formation may be vitiated debilitated and made feeble Thirdly By Congestion Tumors are sometimes bred as when a part or member does not transmute the alimentary supply into its own substance but suffers it to degenerate there and accumulate into a Tumor or else the expulsive faculty may be weak and not able to send off the excrementitious part which remaining there may produce the like or sometimes the fault may be in the nutritious supply not being capable of a good transmutation as in cacochymical and foul bodies Sometimes the relicts of an acute sickness not well cured by congestion in this of that part does afford matter to beget internal Tumors and therefore after the small Pox Agues Feavers c. purgation and cleansing ought well to be performed else chronic diseases commonly do succeed them from peccant matter lodged here or there and therefore upon such neglects or insufficient performance thereof we find commonly big and hard Bellies or swell'd Legs some part or other pained tumified or hard And these are the effects of imperfect Cures when the morbific matter is only abated and the storm laid but the remainder accumulates by collection and congestion to produce a dissease of another nature Fourthly By Obstruction Tumors or extensions are begotten for when the current is stopt in any Vessel and by the Law of Circulation the continent Succus or humor is still moving forwards to this place obstructed the Vessel or containing part must needs tumifie and swell as not able to receive and contain the additional flowing matter in its former dimensions And this is apparent to the eye in external parts which must needs prove the internal for a strait Ligature upon the Arm or Leg does cause the part below the binding to swell and for this reason because the Vessels are obstructed by compression that the blood cannot circulate and move on And the case is the like in effect when obstruction of a Vessel is made from coagulation incrassation or grossness or any concreted matter within the ducture or cavity to obstruct and stop the stream Now obstructions are generally acknowledged to be the frequent causes of many or most-most-diseases and few cases do present in Practice but obstruction bears a part and sometimes the solitary cause or else obstruction is very much wronged for nothing more frequent in Physicians mouths than obstructions and yet nothing more seldom mentioned than an internal Tumor from whence we may well conclude it is rarely thought on or not at all suspected But obstructions are so familiar and frequent in discourse that they are little accounted of at least not thought to be of any dangerous consequence not considering that this obstruction may and does often being contumacious beget a Tumor and this Tumor may cause a long and difficult or dangerous acute sickness if not mortal for the progress may go on still from Tumor to Apostem or suppuration and then plant an Vlcer there or this Tumor may become scirrhous and hard then perhaps cancerous gangrened and then you know what follows next mortification From hence it is very reasonable to judge of the series and course of many chronic or long lingering diseases as also or the acute mortal sicknesses most of which do make their progress by these stages have these commutations and transition at last their fatal termination because this latent train of diseases was not suspected But all this while the Feaver was the disease feared and vainly endeavoured against and the Patient is said to dye of a Feaver because a Feaver did attend the life did estuate and was disquieted in the whole course and every transition of the sickness even to death Fifthly By Extravasation a Tumor is sometimes generated as when the Vessels are replete and full causing tension by thinness heat and sharpness of blood or a preternatural and turgid fermentation distending the Vessels the mouths of the Veins are hereby opened sometimes and a stillicidium or effusion of the contained liquor procured which being lodged out of its proper place does corrupt inflame and produce a Tumor Now concerning the signs of an internal Tumor they are not only extension and increase of magnitude which is apparent when it makes a protuberance upon the superficies but also a fixed heaviness or hardness or pain upon pressure with the hand does give great suspicion and probable conjecture of a latent internal Tumor lying deep and obscure especially and by way of confirmation when the preceding causes apt to generate Tumors do concur to strengthen the probability But before we conclude this Discourse of Tumors something more is to be said and that touching a Scirrhus and Apostem which are comprehended under Tumors and do signifie only the distict and special condition thereof and here we have occasion to take notice of the different state of Tumors and their way of resolution fixation or translation Tumors do either wear away and spend by discussion and transpiration or they recede by a translation of matter into another part or they apostemate and come to suppuration or they indurate and become scirrhous or they tabefie and corrupt the part where they are seated Discussion of a Tumor is the best that can be expected and this ought chiefly to be aimed at in Practice the next to be hoped for and endeavoured is dislodging of it and removal from a noble to an
ignoble part or to such place where means can better be used and more apt for recession or egression of the continent material cause but if the Tumor apostemates the danger is greater or less according to the nature and condition of the member or part if it indurates the danger is delayed but if it corrupts the part the danger is greater and more speedy in execution Apostem is that degree or state of a Tumor when it is maturated or ripe which is called Suppuration the material or humoral cause being then converted into a Pus or purulent matter and while this is in fieri doing all Symptoms are aggravated pain heat pulsation tension are greater but being perfected they all decrease again and the Patient finds ease but not out of danger in these internal Apostems for if it be so seated where there is no convenient vent or Emunctory to discharge it the case is desperate As the humoral matter that formed the Tumor was more benign and good as pure blood so the converted Pus or purulent matter from thence does commonly answer it in goodness for of good blood and in sound bodies the maturation is more kindly the Pus white mild and not endangering to corrupt the part but in foul depraved bodies and malignant diseases apostemated matter is more putrid stinking and venenous and does threaten a Gangrene or mortification of the part and therefore such internal collections of matter in pestilential and malignant Feavers Venereal Pox small Pox and such like are commonly mortal Scirrhous Tumors are such as when the continent matter does not maturate and become soft fit to break and discharge but grows hard and fined in the part not apt to be discharged or removed by discussion or suppuration And this the word Scirrhus imports from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 induro Tumors in some parts of the body are apt to suppurate as in the carnous or fleshy in other parts as the Joynts Tendons and Ligaments more inclined to indurate and become scirrhous and the reason may be this that those parts which take their origine from blood are more prompt and ready to suppurate as the flesh but those which take their rise from seminal matter as the Tendons Ligaments Nerves c they are more inclinable to scirrhosity or hardness But besides this disposition of the parts affected there is also and chiefly a propension in the congested or influxed matter of these Tumors for by the different nature of humoral matter some is more fluxible and thin participating much of serosity and apt to transpire or be discussed other more yielding to a preternatural digestion and suppuration as the blood that is pure and good other inclining to be viscous coagulated and consequently to indurate as a feculent grumous or gross blood deprived of its serosity And farther besides the disposition of parts and that of the material cause inclining to this scirrhosity there may also come in and be joyned with these a third promoter which in some cases may be the chief cause and that is an ill method and injurious Medicines so endeavouring to remove may thereby fix and fasten the matter for thus a Tumor which might probably be dispersed may be changed from its own capacity and tendency and become scirrhous and indurate as when constant or great Coolers are administred to abate the symptomatical or concomitant Feaver the matter of the Tumor is thereby fixed and impacted which otherwise might have surrendred unto proper and powerful Medicines duly used And e contrà by too great Dryers and Heaters the thinner part is evaporated and the grosser remains therefore medio tutissimus ibis good resolutive transpiring Medicines taking their turns with the use of proper Cathartics is the safe and bed way These scirrhous Tumors although they are not so dangerous for the present except they be very great or cancerous yet they are the foundation of some chronic or lingering diseases which proves very contumacious and sometimes incurable especially if the Tumor be latent and concealed and Hectic Feaver sometimes takes its rise from hence which if you think to cure by Emulsions Restauratives and cooling Drinks you will be much mistaken in your purpose and endeavours These scirrhous Tumors some are with pain some without those that have pain are more hopeful except they be cancerous but those which are insensible upon pressure are more difficult or incurable Now according to the nature and degree of depravedness in the continent matter and from the part affected so are these Tumors better or worse to be dealt with And because these Tumors are internal and hid from the eye therefore judgment is to be given of them from their situation and from the constitution with other circumstances of the Patients body But although these scirrhous Tumors are thus difficult to be undertaken and managed yet these are not the worst and they may arrive farther and to a more dangerous state as when Tumors in their variation and degeneration do turn cancerous and this is apt to be in such bodies as abound with a black feculent blood or a thick blood adust by intemperate heat and by how much the blood thus exceeds in this preternatural condition by so much the Cancer is compleated confirmed and the worse and this supervenes a Scirrhus commonly as being an apt previous disposition but may happen also without a Scirrhus preceding from other Tumors degenerating into Cancers and therefore in the Cure of scirrhous Tumors great circumspection and diligence is to be used lest by their delay add continuance or improper usage of Medicines these Tumors do not become cancerous and desperate as sometimes it falls out so Now a Tumor is said to be cancerous when it turns into a dark reddish or livid and blackish colour declaring this transmutation and degenerate state The beginning of these Cancers are very small in compass as those that present outwards do manifest their gradual inlargement but by time they increase and grow big with tumified Veins round about These cancerous Tumors may happen to any part of the body but chiefly and molt frequently in the upper parts about the Face as Nose Lips c. or the Dugs and other glandulous parts also the Womb is thus affected sometimes from Tumor there bred venereal or other degenerating cancerous These Tumors sometimes are occasioned from the menstrual suppression in women and Heamorrhoidal in men and when it happens so those causes are to be removed with speed Great skill and circumspection is to be used in Tumors of this nature lest provoking the continent matter it grow more fierce eating and ulcerating and from a cancerous Tumor it become a cancerous presiding Vlcer which is worse now the signs of this Tumor inclining to break and ulcerate are great heat and pulsation in the part The difficulty or incurability of Cancers lye here for that the cancerous matter will not yield to digestion or discussion and this because the
remove the disease or retard its course To set forth and make evident the truth of our first Position you must know that Pain is commonly the first Symptom of most diseases and if it does not appear as a leader yet very frequently it comes in early or soon after the disease hath discovered it self and few that complain of sickness but complain of some pain that attends it and this our Practice must owne and confirm and taking a survey of the Catalogue of Diseases belonging to mans Body you will find no Symptom so frequently adjoyned and appertaining to them as that of pain and the reason hereof in part may be this That all the Symptoms of diseases are the objects of sense that is they do come under or are discernable by some of the senses which being compared amongst themselves are of greater and lesser latitude now pain belongs to and is adjudged by the sense of feeling only which sense is of the largest capacity of all the rest being extended throughout the body even through the Organs of all the other senses whereas the rest are confined to particular parts the Eye the Ear c. and have no larger extent or place of residence as hereafter we shall have further occasion to discourse For instance seeing may discover what is amiss upon the external parts or superficies of the body and discern what comes forth that it may be adjudged but feeling takes cognisance of inside and outside and what we cannot see we feel and are sensible of by pain even amongst the most secret and hidden parts of the body so that pain is known to be and does manifest it self whether it be within or without Hence it is that pain is the most usual and most frequent Symptom amongst diseases Pain therefore belonging to this capacious sense and being an appertainer thereto and having admission into all its quarters and confines no wonder then if pain so frequently occurs and is the most usual attendant or most troublesom intruder upon the sick Having thus proved and might farther confirm it if needful that pain is the most general and frequent complaint of the diseased we shall proceed and inquire farther how Tumors Inflammations c. do follow thereupon and how pain introduceth and ushers in the rest of its fellows and how pain is introduced sometimes by them and how they appear very often with their consorts having relation to and dependence upon each other by way of causation that some of them and sometimes all are principal Actors in the Tragedy of most mortal diseases though seldom discerned Mortal diseases I said because where diseases are stopt in their progress and have not their full course but are taken off by effectual means or great Providence the links of this chain is broken and then perhaps pain may exercise its power singly and alone for a time and by intervals or pain may contract or associate a Tumor and sometimes an Inflammation and yet all end well these may go off or be sent off by Medicine and proceed no farther and the Patient recover or return to a good and sound state of Health but too often it proves otherwise either by neglect and delay by improper methods and erroneous proceeding or for want of exquisite means the progress goes on gradually to the last and ends with Death In this train of Diseases pain for the most part is a leader and sometimes a follower but seldom misseth to be the discoverer Pain begins and gives the Alarm discovering a disorder or disease in this or that internal and hidden part of the body gives warning betimes and implores aid but none coming at least not sufficient and effectual the pain continues as the cause is yet remaining if the help of Art be wanting yet Nature is not wanting to her self but summoneth all her power and endeavors to dislodge and expel this morbific cause and raiseth all her Spirits though in a febrile disturbance and confusion against this common enemy to the part grieved these Spirits resort plentifully and with them the blood is conveyed which flowing in and remaining there a Tumor is generated and by this concourse of Spirits the part grows fiery and an Inflammation is planted here and superadded The case remaining thus for a while and this confluence not dispersed discussed or drawn off the Tumor perhaps grows cancerous afterwards gangrenes and mortifies then death immediately ensues and concludes all But sometimes the Tumor suppurates or apostemates and then the contained purulent matter breaks forth and begets an Vlcer if the Patient survive and hold it out and with this the diseased may continue a longer or shorter time according to the nature of the Vlcer and as it is more or less dangerously seated for if it be a principal part or adjacent or this ulcerous matter issuing falls into some inconvenient cavity where it is lodged again and finds no Emunctory or passage out or erodes and rots some choice vessel of great use the case is deplorable and scarce remediable Now to comment a little upon this series and progress consider that where there is pain and it continues especially in a high degree you may rationally expect a Tumor or flux of Humors congregated to be the consequent if not prevented which is brought to pass and effected after this manner or upon a threefold account First Because Nature in a time of exigence and need does endeavor to help her self and exerts her power to the utmost and therefore when pain afflicts a member the Spirits resort thither and with them the blood also to relieve it Secondly The part pained by reason of this plenitude of blood and confluence of Spirits does wax hot and this heat begets an attraction and draws more humors to the part Thirdly Pain debilitates and disables the part whereby it is become uncapable to defend it self but lyes obnoxious to this flux of humors which being out of their proper place and remaining in a distempered part they degenerate variously Now upon a survey of the whole matter although Nature intends well in this hurry and bustle being rouzed up and pricked by pain and success sometimes happens upon it or no damage yet commonly it falls out otherwise and there is an oppression and over-charge brought upon the part The confluence of Spirits together with the innate tumultuate and inflame the grieved member which being thus discomposed and out of order cannot moderate and check the flux and attraction of humors but is over-loaded crowded therewith and distended And unless the help of Physick directed by a prudent hand steps in to appease and allay this disturbance by casting out the morbific seminary or matter and reduce this disorder it goes on from bad to worse frequently and from thence to extremity and perhaps to an irrecoverable state in manner and by such gradations as before related And besides what pain does thus effect as a leader Tumors sometimes do take their
his right aims at the morbific cause Hence ariseth all the inventions of cooling and so frequently used in most cases repeated Phlebotomies Ptisans Juleps Emulsions cooling Apozems Embrocations Liniments c. which make the great clutter of Pots and Glasses about the sick and nothing more advantageous to the Apothecary than trifling away the time thus with a number of these hazardous but many times and too often pernicious Medicines This mode of Practice and these devices for cooling feaverish bodies I suppose are taken up in imitation of Galen a famous Master of this Art who appoints exhaustion of blood by Phlebotomy ad animi deliquium until the Patient faints and large draughts of cold water until the Patient turns pale shakes or quivers and the whole body cooled And an Author of our time in his Writings de Febribus appoints the casements to be set open to cool the sick upon what design I know not except to fan the house lest the heat of the Feaver should fire the chamber And a late Author of great Fame in his Works de Febribus supposing Feavers to arise à sulphure accenso exaltato from a sulphurous deflagration of the blood prosecutes upon the indication of refrigerating and quenching this fire by cooling Liquors and for incouragement herein gives an example I suppose his own Patient of a young man about twenty years old that by immoderate drinking of Wine fell into a Feaver with thirst and insignal burning about the Heart who after Phlebotomy and plentiful drinking of water aquae fontanae ingentem quantitatem ebibit the Authors words he recovered The success was good and I may say wonderful but whether from the means or Providence judge you but I shall not imitate the Practice lest ten dye for one that lives but this learned Doctor hath highly deserved in some other parts of his Writings and therefore I tread softly Now to consider all this in gross for brevity sake and apply it to our purpose in hand these ways truly are very probable not rational to cool a feaverish hot sick man and to make him in a short time stone-cold and the probability thereof upon good ground does appear thus First Upon the account of this latent Series and progress Inflammations Tumors c. ushered in by pain more frequently than discerned as already proved this refrigerating course the insisting upon or intermixing these cooling Medicines now and then to quench a preternatural heat is destructive at best a great delay and impediment in the Cure and this is the common way of Practice which needs no farther confirmation but a review Secondly In all other cases and from what cause soever a Feaver doth arise this juleping and cooling mode of Practice is dangerous more or less as the case is in it self but in no wise advantageous making acute diseases to commute and terminate in chronic and chronic or lingering diseases to hold on their course and become more contumacious To prove the first we shall compare that series and commutation of diseases with the designment and nature of these cooling Medicines and by that you shall see what probability and season there is to expect from thence any good effect but rather the contrary promoting of mischief begun and setting forward those diseases Whatever causeth pain whether it be obstruction in the part or oppression by indigested or degenerate incongruous matter by wind and flatulency by any exotic generation as worms stones c. any Tumor or Apostem breeding Inflammation or Vlcer planted c. these cooling and cold inventions touch not the disease except to do mischief and exasperate and remove no morbific cause for the nature of these causes and diseases requires Aperitives Abstersives Catharticks Discussives Diaphoreticks Dissolvents Sarcoticks c. pro re nata each case requiring some or more Medicaments of these Operations But these Coolers è contrà stand in opposition and act repugnant to these properties and consequently to the Cures of those infirmities by obstructing of Ductures and Pores incrassating what should be attenuated coagulating what should be kept fluid condensing what ought to be rarified and discussed fixing and retaining what should be moved and sent off impeding transpiration but promoting putrefaction generally they check and damp the power of Nature endeavouring to extricate and quit her self from those incumbrances and growing evils that assault and beset her To make good the second part that in what other case soever a Feaver or vehement heat shall arise with ebullition of the blood and preternatural fermentation cooling Medicines are very prejudicial in many cases mortal for whether it be a pestilential or other maligne Miasm seminary or taint or other impurity and feculency of the blood that Nature intends by this febrile disturbance and irritation to throw off and separate which Nature sometimes without help does perform and makes a good Crisis but these Coolers act counter to and prevent Natures good work checking the fermentation and thereby hindering the separation of any degenerated or noxious admixture And the reason of these ill consequents from Coolers does mainly lye here for as the stomach doth preside over and hath great influence upon the other faculties and subsequent digestions whose briskness and vigorous performance depend much thereon so likewise whatever subverts the tone of the Stomach and flats the acuteness of this principal part and prime office of digestion injures allays and abates the energy of the rest impedes the fermentation of the blood for depuration in such cases as also for conservation and. supply in the constant daily work And although the Patient escapes this Feaver and comes off with life yet by this male Practice they fall into Dropsies Scurvies Jaundies and cachectic foul habits of body an obstructed or tumified Spleen Liver Mesentery c. Or it breaks out upon the Skin and some eruption or cutany defedation will appear in time or it settles in some Limb and disables the part And it is but reasonable to expect that Patients thus cured should soon be Patients again upon the old account the relicts of the former sickness for that morbific matter and cause of Feaver being retained by checking and cooling the febrile fermentation and not observing Hippoc. advice Quò natura vergit this morbous impurity and foulness must precipitate and settle somewhere and then you may well imagine it will make some appearance or alteration in time upon some part or other and then an after-game is to be played for not having its due fermentation secretion and pass-port formerly when it did turgere and was upon the flight only wanted the Physician 's direction and guidance hinted by Hippoc. 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Aphor. 21. Sect. 1. Now a hole in the skin perhaps is thought on an Issue for a tedious and troublesom vent to discharge the matter which a good laudable course in due time might have prevented And thus or by this means the Patient comes into the Physicians
their inconvenient and disturbing objects as the Philosopher says Excellens sensibile laedit sen sum as the light of the Sun or flame is troublesom to the Eyes and great noise as of a Bell or Gun if near especially sudden and unexpected does offend the Ears and a strong or stinking scent is offensive to the Nose and an ungrateful taste as too salt too sowre or bitter is unpleasant to the Palate but pain affects the sense of feeling Parts therefore that are capable of pain are endowed with the sense of feeling and those parts are membranous that is they are invested with or lined with some Membrane by which the sense of feeling is communicated and hence the Bones are capable of pain by the Periosteum that Membrane which covers them And this sense as it is more general extending through all parts and more useful than the rest of the senses so the disturbance arising thence is more insufferable and grievous to be endured and better it is to want any other sense than this yea all for where feeling is departed the life is ceased in that part This sense therefore being supreme the defections and disturbances thereof must be of greater importance and concernment than the rest The other Senses are confined to and exercise their functions in one Organ or part of the Body the Eye the Ear c. but feeling is not restrained to so narrow a compass but is seated in all parts of the Body even in the Organs of those other senses The great Prerogative of this sense above the rest having no limits but reaching through the whole Body and exercising its power among the other senses and an inseparable consort with the life were worth inquiring into the reasons thereof if time would give leave for that diversion What pain is scarce any one but can tell and some by woful Experience whereby they will consent with the definition thereof dolor est tristis sensatio in tactu pain is a trouble arising in the sense of feeling but that which is so plainly felt is not very easie to be understood from whence it does arise The Causes of pain are as various as the Objects of the sense of Feeling for whatever objects assault that sense violently or extremely as too hot cold hard sharp heavy c. are offensive to the Organ of Feeling and do raise pain Concerning the approximate cause of Pain there are several opinions I wave the more extravagant and improbable and shall recite those in which the most Philosophers and eminent Physicians do consent and pitch upon as most agreeable to reason One Party asserts That a sudden and violent mutation of the active qualities or the tactil qualities suddenly and violently acting upon the sense of feeling are the approximate cause of pain The other Party determines That solutio continui a solution or disjunction of continuity is the immediate cause of all pain The third Opinion joyns these two together and will have pain to arise from them both according to the definition of Plato Est itaque dolor tristis in sensu tactûs affectio à membri intemperie continuitatis divortio subitò facta And Hippoc. before him taught the same doctrine Quae naturam inquit mutant ac corrumpunt dolores excitant To which Galen does subscribe Now to comment a little upon these different Judgments I cannot but observe and do owne that there is something of probability and reason in these several sentiments but not a full satisfaction to the matter queried nor the whole truth rightly stated and for this reason I am the more nice and strict in this inquiry because from hence the nature of Anodynes or asswagers of pain are discovered and this is the ground-work upon which they are formed and rightly adapted I allow that unity is the perfection of Bodies and is necessary to perfect sanity disjunction or separation dissolves the harmony and leads or is the progress to destruction for whatever tends to disjoyn or make a separation of parts does threaten to ruine the whole And true it is that the active qualities or tactil objects do cause pain as they do make their impulsions violently upon the Organ of Feeling which when they do it moderately placidly and amicably they cause pleasure or no pain But whether the impetuous and vehement acts of those Agents raising pain do always cause a solution of continuity approximately and immediately is much to be doubted I yield that the vehemency of these tactil objects may procure a solution of continuity sometimes as we see from pain that Imposthumes Vlcers Gangrenes and Mortifications do follow but these are not inseparable and necessary consequents for they happen but sometimes pain may continue for a time cease again and no breach of continuity remain a◠an effect thereof To which our Adversaries have this evasion by way of Reply That pain is caused à continui solutione non à soluta unitate which as I conceive the meaning is as much as to say solution of continuity in fieri is sufficient though it be not in facto esse But to pass over this Sophistry as not worth the expence of time to lay it open and if we make appear that the whole matter or controversie is bottomed upon this error mistaking the cause for the effect and the effect for the cause Cujus contrarium then the pleadings of our Antagonists will be put to silence as absurd the doctrine laid aside and practice grounded upon better principles They affirm solution of continuity to be the approximate cause of pain the contrary whereof we will set forth and prove that pain is the cause of solution of continuity And here we must first distinguish between violent external Agents as sword staff bullet fire c. causing wounds contusions fractures combustions c. and internal causes gradually arising in the Body as products of a degenerate state In the first cases solution of continuity causeth pain as when the wound is given pain follows as an effect so likewise upon a sudden fracture or rupture in the latter pain precedes as the approximate cause solution of continuity comes after as the product or consequent For example some indigested or degenerate matter lodgeth or fixeth in this or that part of the Body Nature not able to subdue or transmit it away this like a thorn irritates and provokes the vital principle to a disquietness and disturbance which is pain this pain draws a confluence of humors to the part grieved and increaseth the first offending matter causing Inflammation and Tumors this apostemates and then breaks forth into an Vlcer Observe the Series first here is peccant matter as the occasional cause raising pain this pain attracts humors from other parts which being transplanted out of their proper place they degenerate corrupt and then produce an Imposthume and Vlcer Thus you see pain goes before solution of continuity follows after and therefore it is plain as in
spends or wears and abates the strength of Nature but violent and vehement pain requires sudden relief lest the sick faint or expire Upon the first assault Nature does insurge and raiseth all her strength to bear resist and overcome the offending cause and cooperates vigorously with the means for relief and ease but help not coming strength abates grows weaker and weaker as not able to hold it out long and this is perceived and known by the Pulse which at the first access of great pain beats high strong and quick but afterwards falls off grows weak small slow or swift labouring and languishing Secondly The Kind and nature of the pain is to be observed and noted whether tensive heavy acute biting c. that accordingly fit Remedies may be adapted to such variations Thirdly The Property is to be regarded whether pain be moveable or fixed continual or constant or returning by intervals whereby the fallacy or certainty of the Cause may be adjudged Fourthly The Place of pain is to be distinguished for that which will be a good remedy and proper to one part or member may prove of little advantage or injurious to another because some parts have Antipathy or disgust and dislike to some remedies which ratione morbi in respect of the Disease may be proper and requisite but the part will not admit it as Oyl generally is anodyne and asswaging but hot in pains of the Eyes for there it is injurious to the part and a puncture of the flesh and a puncture of a Nerve will require different remedies And upon this account Galen 4. Meth. 5. would not allow of Suppuratives to every wound and chiefly in the Tendons and Nerves and condemns those Chirurgions that make not that distinction And here you must diligently search and examine whether the pain be idiopathical or sympathical that is whether the part pained does suffer per se from a cause residing in that part or whether the cause lyes in another part and the part pained does complain per sympathiam seu consensum only by consent from some other diseased or distempered part And this distinction ought strictly to be observed without which no Cure can succeed for if the peccant matter or cause offending lye in one part and the remedy be applied to another you cannot in reason hope for a good effect thereon This therefore is to be received as a fundamental Truth That all parts of the Body may fail in their office and true performance of their duties vel vitio proprio vel alieno either by a deficiency of their own or depravation and injury from other parts and this not being duly taken notice of by some Practisers no wonder if Patients languish so long under their hands waiting in vain for their relief and Cure for finding the Patient to complain of pain in this or that part they think of nothing but applying to the part pained concluding with the common saying Vbi est dolor ibi est morbus which is oftentimes a great mistake For example the Head akes and complains many times not from any defect of its own being firm and sound but either from the Stomach being foul or otherwise diseased whose ill affects also are communicated to the Head by the Nerves of the sixth conjugation sometimes from the Spleen sometimes from the Womb and sometimes from other parts by reason of the Nerves propagated into all parts of the Body having their original from the Brain and spinal Marrow derived from thence and of the same nature from whence the Head does consent with all those parts And the Arm may complain wanting its power of due motion or strength although the Arm be sound and well yet if the Nerves that supply those Muscles of the Arm with Spirits be hurt the Muscles are deprived of their use or act deficiently and depravedly As by a blow upon the Back or by other causes there not so manifest the Arm may fail in its due motion the Nerves being injured in vain then it is to apply Topical Medicines to the Arm but application must be made to the Vertebrae of the Back from whence the Nerves are derived and implanted into those Muscles And since the several parts of the Body do complain sometimes by their own fault or decay in themselves and sometimes only by injury transferred or received from other parts we will conside how many ways there are for parts of the Body to be ill-affeced and receive prejudice one from the other The Sympathy or consent of parts whereby one suffers from another may arise upon a treble account 1. Per Sympathiam generis 2. Ob Familiaritatem operis 3. Propter Vicinitatem First Per Sympathiam generis by which we understand that consent and affect that is communicated by continuity of parts of the same kind as when the Neck being hurt the Hand consents and complains because the Nerve serving and coming down to the Hand is derived from the Neck and this way of consent may also be effected not only by the long Nerves but also by the long Muscles and the Veins in other parts as sometimes it happens that the Leg is stiff and wants its flexibility and bending inwards by reason of some disease not in the Leg but in the Hip where the original of the Muscle is that serves for this motion and therefore erroneously some have applied Fomentations Vnguents and Plasters to the Leg upon this supposition Quò ubi est symptoma ibi sit morbus not considering that the Tibia does suffer by consent and the root of the disease lyes in Coxendice where the Muscle does arise And thus it falls out very often that the Disease is far distant from the Symptoms and therefore the original and progress of the Muscles ought diligently to be observed in such cases as these that the part primarily affected and the part affected by consent may be distinguished else the designment of Cure will fail and be insuccessful Secondly Consent of Parts is procured ob Familiaritatem seu per consortium operis and this consent is common to all those parts that are ordained by Nature to concur together in some common office and thus it is between the Womb and the Dugs Thirdly Consent of Parts is frequent propter Vicinitatem by reason of vicinity adjacency when parts are situate near to each other they are mutually affected either by some sensible passages or insensible for totum corpus est perspirabile the whole body is perspirable by Pores latent arid invisible by which there is conveyance to and reception from each other and do thereby sympathize with the good or ill of one another although the ways of communication are not manifest and thus it is between the Stomach and the Lungs and is easily perceived by fuch as are Asthmatical Phthisical or have Coughs that by eating or drinking this or that those infirmities will be exasperated and made worse almost presently and è contrà they
the foundation or first cause of complaint be removed else you begin at the wrong end for in vain it is to endeavor amendment in the part consenting until the other be in its rectitude sublatâ causâ tollitur effectus For example if the Head complain from the Stomach let the Cure be designed upon the Stomach and that being performed the work is done Thus you see plainly that the Cure of Head-pains by consent is as various and different as the parts of the Body are different in organization situation and office whereby they become liable and are seized with various diseases requiring a different manner or methods of curing which are to be treated of in their proper places Touching the Cure of Head-pains that are the products or consequents of essential or idiopathical Diseases seated in the Head the removing or taking away those pains depends upon the Cure of those Diseases whereof they are the effects and concomitants and do require their due and regular course of means suitable to the nature of the disease but in cases of extremity and for mitigation of pain and the inconveniencies arising thence as long watching or want of rest and prostration of strength there are such good Remedies as Anodynes prudently to be used for allay and giving ease or respite until the causes can be eradicated and a perfect Cure wrought Pains in the Thorax or Breast AMongst the several divisions of mans Body into parts we may observe three insignal Cavities each containing principal Members of the Body the first and supreme is the Head and all contained therein the middle cavity is the Breast which contains the Lungs and Heart the lower region called the Abdomen or Belly comprehends the Stomach Liver Spleen Guts Kidneys c. And having taken cognizance of those pains incident to the Head we now come to remark what pains happen to the containing and contained parts of the Breast Hence we may note that these pains from their situation and place may be distinguished into external and internal External pains we may call such as are outward amongst the musculous and fleshy parts as the Paps Dugs and intercostal Muscles Internal pains are such as seize the Heart Lungs Mediastinum c. parts contained The Breast is circumscribed thus the upper part is from the two Canal-bones called Claviculae about the bottom of the Neck the lower part is bounded by the Diaphragma or Midriff spread just above the Stomach and Liver from side to side the fore-part is the Sternon or Breast-bone seated in the middle which joins and fastens the Ribs on the back-part is the Vertebrae or Spine consisting of many bones knit together where also the Ribs have their articulation the sides are compassed with Ribs swelling outwards and they reach from the Spine to the Sternon And this is the extent or limits of the Breast Pain may fall into the Paps or Dugs of both Sexes but most commonly it happens so to women except from external causes blows or falls and thus it is upon a sixfold account First Because those parts are more capacious and swelling outwards in Women which being glandulous spongy soft and porous are thereby apt to imbibe or receive any vagrant humor coming to this part Secondly More liable to the impressions of cold from its tender soft nature and being by them more frequently exposed to the air which may occasion and lay a foundation for pain and other Symptoms to follow Thirdly In Women these parts being furnished with more Vessels of use for lactation or suckling are thereby more liable and obnoxious to disorder Fourthly From the communication and intercourse between this part and the Womb whose diseases and distempers may affect the other by consent Fifthly From the attraction of suckling ill humors may be drawn and gathered there which otherwise would not resort to that part Sixthly Pain seizeth this part in Women from the various conditions of their milk Now the variations of milk causing this effect arise upon a double account redundance or plenitude and Cacochymy or alienation Sometimes by plenitude for milk abounding and distending the Vessels causeth pain and trouble in the part Sometimes by alienation of milk from its natural good condition to a degenerate state and this proceedeth from a cachectic or vicious habit of body for as the blood is good or bad so likewise the milk which is sanguis dealbatus blood changed white by another digestion This milky substance being balsamic dulcid and pure in its integrity yet is very subject to alterations and change from distempers and various dispositions of the Body as sometimes from thence being not so sweet but saltish bitter acrid and punging sometimes curdling and coagulating thereby not flowing freely in the Vessels but causing obstructions in those small ductures hence arise pains inflammations hardness tumors c. if not prevented by a due course with good means And such inconveniencies as these are frequent to Women after the birth of children when milk flows plentifully into those parts and this many times or for the most part does proceed from the imprudent custom of managing Women in child-bed especially some Nurses who would be thought more careful kind and diligent to their Mistresses do feed them too plentifully giving them Caudle at every 〈◊〉 or after every short sleep night and day telling them they are empty and must fill up again and make up their loss which after this manner being done too hastily and the body changing from a large evacuation to a sudden â—epletion the Stomach thereby fails and is clogâ—â—… the blood ferments into disorder causing â—â—…e and dangerous Feavers of which the milk â—â—…ticipates and thereby degenerates endangerâ—â—g both the Mother and the infant But indeed by experience I have found and reason urgeth the same that nothing is more safe than a spare diet which preserves the Stomach quick and sharp and keeps the whole body in a moderate temper and a regular condition not occasioning such overflowings of milk or otherwise flouding and this I have cautioned and made some Nurses sensible of who by observance thereof afterwards found their offices more successful and have given me thanks for my advice as being the safest and best way to discharge the trust and care reposed in them In the next place we are to take notice of pains that are seated in the musculous parts namely the intercostal Muscles in number 44 so called from Costae the Ribs which these Musc les do cover and also are inserted filling up the spaces between each Rib. In these parts pains sometimes do fix and settle and are most perceived upon drawing in of the breath when the Muscles are upon extension and swelling outward These pains are called by some Bastard Pleurisies though improperly and by mistake for pains of the Pleura are different Sometimes these pains are not of continuance as to time nor constant as to place but move here and there and these are
pressure here raiseth a fainting pain the Cartilage yielding and giving way to any force But sometimes a pain is planted here not always by any external manifest cause but from internal and preternatural state of the parts and this pain is rarely taken notice of by Physicians and mentioned but by a few practical Authors Now to examine into the cause of pain you must know that this Cartilage is flexible and yielding in its natural condition being of a middle nature between a Bone and a Ligament and therefore may be curvated and bent inward upon a threefold account By Laxation Exsiccation and external depression 1. By Laxation as when too much moisture resides here mollifying and loosning the part from any small occasion the Cartilage may be inflexed and turned inward changing its due position and rectitude and from the like cause Ligaments are sometimes relaxed which renders Junctures ready and apt for dislocation and disjuncture and upon this score the Vertebrae of the Spine have been displaced also the Hip and Ancles 2. By Exsiccation this Cartilage may be distorted and wrested from its posture as sometimes that which was straight green and pliable by drying and shrinking becomes crooked bent and drawn aside So this Cartilage that was a Grisle tender and pliable sometimes becomes dry hard and bony and fixed upon distortion or writhing as not returning to its rectitude or straightness and distance from the subjacent parts over which and for whose guard it is placed 3. By external Depression as from a blow or fall any thing too much or too long pressing upon that part may pervert and alter the situation and due posture and those whose business or imploy keeps them bending or pressing forward too much and constant renders them liable to this inconvenience and therefore Students and Clerks that write much pressing upon this part are injured thereby and find it upon age though youth bears it off for a time Now since this Cartilage is thus exposed to depression and bending inward and thereby the tender parts subjacent to be pressed upon and molested the cause of pain and manner how is made evident and which most commonly is felt after eating and upon a full stomach when the parts are dilated and swelling up to this Cartilage And farther as all parts of the Body in several persons do vary and differ much in figure position magnitude and distance so thereby some are more liable and apt for this pain than others although subject to the same external procuring or internal antecedent causes And so I dismiss this particular pain and pressure and must take cognizance briefly of that which is more general upon the whole Breast The Thorax or Breast suffers by compression or constriction whereby a general obtuse pain of angustness is perceived and that chiefly upon inspiration and drawing in of the breath and why now more than at another time is because the inspired air fills and distends the Breast which makes opposition to or resists the compressing causes Now the cause of angustness or coarctation is from the Genus nervosum that gives motion to the Muscles and other parts of the Breast which Nerves sometimes are impedited and contracted that their functions are not freely executed and therefore to this Symptom of compression is commonly adjoyned shortness or difficulty of breathing upon the same score and sometimes spasms or convulsive motions And this complaint of straitness or contraction of the Breast does frequently happen to scorbutic persons whose nervous juyce being degenerate and tainted their Organ or Vessels perform not their office duly as they ought in giving the full motion and extension or every part for this nervous liquor being fed and supplied from the mass of blood which is scorbutic feculent and depauperated in spirit that also which is extracted thence must be answerable and of a degenerate nature so then this nervous juyce which should be vegete noble and spirituous for putting the motive faculties into action with vigor and briskness is become dispirited flat and depraved and the Organs acted thereby move heavily and irregularly so that upon inspiration or filling the Breast with Air the parts do not readily give way by expansion to let in hence the Patient feels himself girt or strait-laced It remains now in the last place that we finish this second division in examining and searching into the nature and causes of those pains that more peculiarly and eminently afflict the Heart The Heart being a noble or the noblest and principal part is as the Sun of the Microcosm whose irradiating lustre and beams of vital heat enlivens and refresheth all the regions and parts thereof the Eclipses storms and clouds then that happen as the consequents of its distempers and sufferings must needs be eminent and remarkable This supreme Organ that bears the government of vitality is so generally concerned in all diseases and discomposures of the Body that few there are but the Heart is made sensible thereby and gives notice thereof by variation of the Pulse as a sigrial from thence And not only distempers of the Body or the defect and decay of some particular member or faculty does affect the Heart but also the disorders and passions of the Mind have influence thereon that from thence the Heart akes beats or suffers pain and restless disturbance hence it is that grief anger fear desire c. Changeth the regular motion of the Heart and the Pulse alters as a token and manifest character of its sufferings Now the Heart is made thus sensible of the Bodies infirmities and preternatural mutations from the vital government that is planted here having commerce and communication with every member from the circulating afflux and reflux of the crimson vital stream continually transmitted through this Organ which thereby is affected well or ill as the blood is better or worse in the current and quality thereof And the Heart is also affected from the mind for as much as the Soul exerciseth her power more eminently here and if a particular part may bee assigned this may be said to be the seat or Throne of Regality The Heart being of a solid fibrous flesh the pain thereof is obtuse not so accurately perceptible so acute and sharp as those of the nervous parts notwithstanding the effects and consequents thereof are impressed upon the whole Body and each member is impaired in its vivacity and vigor and although this Heart pain by the nature and substance of the Organ is not so great commonly and perceptible as that of some other parts yet when this pain does arise to some degree a Syncope seizeth the Patient a deprivation or cessation of life for a time that what it wants as to sense is doubled in the consequents as threatning and endangering the life so that extremity of pain is not perceived here because sense decays as the cause of pain increaseth The Heart is molested and suffers pain these several ways by extension
constriction obstruction inflammation or intemperate heat Imposthumation by erosion by exotic generation 1. The Heart is pained by extension from a sudden ebullition and turgid fermentation of the blood raised by passion or otherwise whereby the Vessels are suddenly forced upon distension to receive and transmit the inundation and swelling current of the blood and from hence pain and trouble ariseth at the Heart 2. By constriction the Heart is pained and that from external and internal cause externally from the Pericardium compressing whereby the Heart is denied the full liberty of its Diastole or expansion and this may arise upon a double account either from the Pericardium being too replete and full or too much exhausted and empty You must understand therefore that this Pericardium or Capsula cordis is a Membrane designed by Nature to involve and inclose the Heart for its defence as also being a moist Bath to irrigate and keep it souple containing a Serum or water and this Membrane should extend and be enlarged according to the motions of the Heart being greater or less now when this water does abound filling the cavity of this inclosure the Heart thereby is prohibited its full expansion and è contrà when this water is too much wasted and dryed up the Pericardium cleaves to the Heart and impedes its pulsific motion thus either plenitude or vacuity begets anxiety and trouble at the Heart Internal cause of constriction is when the Heart it self is seized with a Tabes or vehement exsiccation and the fibres so contracted that it hath no capacity or less for dilatation and permission of the transient blood 3. Obstruction causeth pain and trouble at Heart when the free current of the blood is impeded from within due Vessels and this is procured sometimes from a perturbation of the movent spirits and sometimes from an indisposition of the impulsed blood First from a sudden and violent recurrence of Spirits from other parts and tumultuous confluence at the Heart whereby the circulation is checkt and the blood stopt in the Ventricles causing a suffocation for a time and this happens upon vehement passions and consternations of the mind Secondly From an inhability and incapacity of the blood being gross concreted or grumous that it hardly or with difficulty passeth through this Organ causing thereby an obtuse pain oppression or heaviness at the region of the Heart and sometimes a Lipothymy or Syncope fainting or swooning 4. By Inflammation or intemperate heat the Heart is pained as in most Feavers where intensness of heat is accompanied and this heat continuing does exsiccate and contract the heart and brings a Tabes or Consumption upon the whole Body 5. By Imposthumation the Heart is pained sometimes as also by other Tumors there bred Which by dissection hath appeared after death 6. By Erosion or Vlceration sometimes the Heart is pained and suffers by continual palpitation 7. By exotic Generations and strange productions the Heart sometimes is pained as when worms stones or bony substance is bred in the Parenchyma of ' the Heart which hath been found there upon dissection after death and to these diseases and such as most of the forementioned the Symptom of Palpitation does necessarily belong shewing the continual molestation and trouble the Heart lyes under who endeavors to acquit and extricate it self by laborious lofty and strong pulsations Pains in the Abdomen or lower Region of the Body NOW we have done with those pains incident to the middle Cavity namely the Thorax or Breast I come in the next place and by the order proposed to the lower Region called the Abdomen or Belly containing the Stomach Liver Spleen Kidneys c. And here first as the principal member we shall inquire into pains belonging to the Stomach or Ventricle being the great Office and Laboratory to prepare Aliment to supply and maintain the whole Body therefore if this part be pained and out of order all the rest must needs fare the worse for it every part having a concern from hence Pains of the Stomach are various both in respect of their causes and also from the different parts of the Ventricle where they do infest and those are three the upper Orifice called Os Ventriculi the lower Orifice called Pylorus and the whole cavity of the Stomach The upper Orifice or mouth of the Stomach is subject to great pain as being very tender and sensible in regard it is very nervous and this pain is the more eminent and remarkable for that commonly two principal parts are hereby affected and drawn into consent the Brain and the Heart the former by the Nerves of the sixth conjugation derived from the Brain whose ramifications are wreathing or twining about this Orifice and therefore from hence Head-aches Vertigoes and Epilepsies do often arise The Heart also is affected both in respect of vicinity as near adjoyning to this Orifice and also for that the same pair of Nerves doth serve both the Heart and Stomach whereby of necessity there must be a communication of pain and therefore it is that this pain in extremity causeth Fainting and Swooning and hence it is that this pain by a peculiar distinguishing title is called Cardialgia and also for that the ancient Greeks called the mouth of the stomach 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 As for the causes of this Cardialgia or stomach-pain sometimes they are sharp acrid and hot biting humors fluctuating and rising up to the Orifice of the stomach where they cause an eroding or gnawing pain and sometimes a scalding or heat there and this vulgarly is called the Heart burning Sometimes flatulency and wind causeth this pain by way of distension and a swelling fulness and the Orifice is constringed and shut up so as denying vent in this case the Patient labours and strains to belch but cannot unlock or loosen the Orifice of the stomach but so soon as the Orifice does slacken and give way the wind breaks forth and ease followeth Sometimes Worms do cause this pain having gotten up to the mouth of the Ventricle where they gnaw and bite Sometimes churlish and deleterious or ill prepared Physick or discordant food having such properties as may irritate and provoke this tender part or food received in too great a quantity above what the stomach is able to master and digest then it riseth up to the mouth of the stomach causing oppression and pain there until it be discharged upwards or downwards by the strength of Nature or the assistance of Art Besides this Cardialgia there is also another sort of pain that afflicts the mouth of the stomach and that is Singultus a Hicket or Hickop and although the whole Ventricle be molested therewith yet the chief pain or trouble is at the Orifice or mouth of the stomach This Hickop is a convulsive motion of the stomach thereby causing pain The general causes assigned by Hippocrates are two repletion and inanition under repletion is comprehended whatever humor or vapor is in the
they are various and may be ranked under these Heads 1. Obstruction of the Meatus felleus 2. Wind and flatulent Vapors 3. Acrid punging and sharp Humors 4. Indurated Excrements 5. Stones generated in the Colon. 6. Worms 7. Compression 8. Inflammation 9. Venenous and malignant Matter 10. Apostems and other Tumors By the first it appears that Obstruction in the Guts which produceth Colic pains does sometimes arise from an antecedent obstruction in another part as when the Meatus cysticus the passage of the Gall into the jejunum is stopt it causeth also a stoppage in the Guts for the Gall being naturally discharged into the Guts does stimulate them to expulsion and moves the excrements downwards but for want of this exciting and provoking matter the Guts fill up are obstructed and distended thereby raising pain Wind and flatulency begets Colic-pains sometimes and these are not fixed but roving here and there and commonly attended with a rumbling and noise in the belly and this is an effect of crudities and weak digestion rising from a natural debility or occasioned by intemperance and a bad diet And this flatus is either in the cavity of the Colon involved in a viscous tough flegm inclosed as in a Bladder or sometimes shut up within the Tunicles of the Intestine where forcing its way out does cause great pain in the part Sharpness of an humor indigested or degenerate does sometimes cause Colic pains and this is either a mordant biting Choler or an acid serosity Driness and hardness of Excrements do cause Colic-pains sometimes for as much as they stop the passage and extend the Intestines denying vent to any sudden fermenting humor wind c. that should freely pase away This costiveness and constipation is acquired by ill diet in the use of hot dry astrictives by watching or sleeping too much immoderate Venus by heating the body and sweating much through exercise labour intemperate Air c. These are great dryers and take off the lubricity of the Guts that they perform not their office as they ought thus excrements not being transmitted and sent away duly they accumulate fill up distend and obstruct the Intestines and give great occasion to Colic-pains Stones sometimes are generated in the Colon and do cause Colic-pains also a clot of worms gathered and twisted together obstructing the Guts have raised Colic pains Compression and contraction by Inflammations and Tumors in the Guts or parts adjacent do sometimes cause Colic pains Also malignant and venenate matter hath procured the like as Paulus Aegineta relates of a pestilential Colic that arose in Italy and afflicted many of the Roman Provinces Fluxes of the Belly HAving spoken something concerning pains of the Guts Iliac and Colic attended with astriction of the Belly and costiveness I shall briefly set forth those pains that are accompanied with a Flux or loosness There are three sorts of Fluxes of the Belly distinguished by several names Lientery Diarrhoea and Dysentery The first is a Flux of indigested or semidigested food passing away before its due time from an imbecillity of the digestive faculty But this not being dolorous or painful we shall pass it by as not our subjevt in hand The Diarrhoea is a flux of humors depraved and injurious which stimulates Nature to expulsion and is for the most part painful and irksom to bear 1. This kind of Flux is various in the matter of 2. Different in the efficient cause as some are of opinion 3. Unlike in the manner and circumstances 4. Various in respest of place as issuing from several parts of the body Touching the diversity of matter in this flux physicians have distinguished it into phlegmatic choleric melancholic and serous or watry which distinction is not simply manifest but a complication and mixture of many sorts whereof one may abound and be predominant yet the denomination and character of the whole is hard to be given The variety of depraved matter that happens in mans body is not to be reduced to four Heads nor three times so many for this stimulating matter thus sent forth by a Flux is the manifold different material cause of hundreds of diseases which preternatural variation of humors or juyces are not to be comprised within so narrow a compass nor reducible to four Cardinal points for admit there were four natural constituent humors in mans body as common doctrine teacheth yet these in their sundry variations and complicate degenerations would be so variously changed as not to retain any relict or smack of their original descent that a denomination from thence if possible to be distinctly given would no way answer in the similitude or nature thereof and consequently of no use in practice In respect of the efficient cause Authors have distinguished these Fluxes into critical and symptomatical by critical they understand when Nature in due time and with good success throws off and expels any peccant matter and finds relief by it in any case A symptomatical Flux they mean when Nature irritated untimely or immoderately is not benefited thereby but rather injured and endangered The 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 of this is true and it often falls out thus but the distinction of critical and symptomatical relating to the efficient cause and the reason thereof I do not assent to nor comply with since every Flux is symptomatical whether it produce good or evil for that which they call Critical and is seasonable and duly performed with good effects attending is but symptoma morbi the Symptom of some disease as well as the other so that the difference is in the nature of the disease afflicting the matter excreted or voided the fortitude of Nature the time where the way by which it ought or ought not to pass which does distinguish these Fluxes in their effects to be good or ill but shews no diversity in efficient causes which is one and the same for Nature is efficient whether irritated unseasonably and frustrated of her end or performing these endeavors in due time and to good purpose But although the efficient cause of Diarrhoea's be simple and single yet the occasional causes are many for these Fluxes are occasioned sometimes by change of air or place and variation of the seasons by some kind of meats or drinks taking cold or other casualties and accidents which puts Nature upon some disorderly fermentation and excretion and this commotion occasions and stirs up any morbific matter and noxious humors which before perhaps lay dormant and still now to grow turgid and active contributing to advance and promote the Flux begun but this managed by a discreet hand may not prove injurious but some advantage gained which if neglected and Nature not governed and guided in this prodigal expence much detriment may come thereby an exhaustion of nutritious Juyce with great debility and weakness As this Flux Diarrhoea is various in the matter discharged so likewise in the manner and circumstances as greater and more violent or
other diseases of the Liver by the vehemency of the Symptoms that attend this more than in other cases for the pain is greater the Feaver higher and other Symptoms more fierce and sharp If the Inflammation be upon the superior gibbous part of the Liver it counterfeits a Pleurisie and affects the breast much by short breath and a dry Cough the Tumor then extending to the Diaphragma the Vitals are most affected and pain reacheth up to the Jugulum sometimes but if it be in the cavous inferior parts then the Stomach is most sensible thereof by great thirst nauseating or vomiting But lest you be mistaken between an Inflammation of the gibbous part of the Liver and that of the Muscles you must observe the difference by sight and feeling that the former hath its extension circular according to the figure of the Liver but the latter not besides the former may be perceived to lye deeper the other a more superficial distension If the Inflammation be in the body or flesh of the Liver the pain is obtuse and heavy but if the Membrane investing be the seat of the Inflammation the pain is more sharp and punging Inflammations are better or worse as the blood is good or bad for according to the degrees of pravity and goodness the Inflammation varies and therefore a Phlegmon is not so vehement as an Erysipelas Inflammations are very cautiously to be dealt with both in regard of the present danger as also for future consequents for if a right course be not observed in the Cure although the Patient may escape the acute sickness and recover yet he may fall into a Dropsie or Consumption and that perhaps incurable the Liver being so decayed and tabefied as not to be reduced to soundness hence it is that after Inflammation Apostemation so frequently follows or a scirrhous Tumor If the Inflammation terminate in or leave an Apostem behind it if it be deep in the Parenchyma of the Liver it is more desperate but if the Apostem or Abscess lyes between the flesh and the covering Coat of the Liver their case is more hopeful because the matter may be better discharged and the Liver not in so much danger Concerning the termination of this Phlegmon or Inflammation either it spends it self and goes off by resolution or it arrives to maturation or it ends in a scirrhous hard Tumor The first is only desired and that which all Practisers should aim at in the administration and application of Medicines the two latter are doubtful and dangerous In the beginning therefore Discussives and Diaphoretic resolvers are the chief means to oppose this disease not neglecting to abate Plethory and to make evacuation thereby to retract and withdraw fuel from the fire But if the Apostem cannot be discussed then the best way is to bring it to suppuration as soon as may be left the part gangrene and if the faculty of the Liver be strong to digest and beget a laudable white Pus or matter then there may be hopes of the Patients recovery but if it be sordid and stinking the case is desperate This matter is evacuated sometimes by stool and sometimes by Urine but if it fall into the Abdomen section must be made to let it out if Nature cannot discharge it other ways Natura in statu praeternaturali ab interitu se liberatura saepe mirabiles quaerit vias ac meatus Moebius The Apostem being thus generated and arriving to suppuration it breaks and then the Scene is changed for now it becomes an Vlcer and challengeth that denomination But an Vlcer is generated sometimes without Inflammation by sharp eroding humors which is not so dangerous as the other because it comes on gradually the Symptoms milder and gives more time for the use of means An Apostem likewise is gathering in the Liver sometimes without Inflammation is not then so painful nor comes to its height so soon Apostems do not always come to suppuration but sometimes they grow hard and scirrhous and such Tumors the Liver and also the Spleen are subject to These scirrhous Tumors do depend upon impacted matter that will not be discussed and are the consequents of Inflammations or inveterate obstrictions procured sometimes by an ill management of their intended Cures drawing away the thinner matter and leaving the grosser behind as by the use of too great dryers and heaters or by refrigerating and constringing Medicines do so incrassate the humors as not to be resolved This Scirrhus of the Liver is painful in the beginning before it come to be exquisite and confirmed but afterwards not and that which is with pain is more hopeful the other desperate because it is in the way to gangrene Those that are thus affected lye more easie on their right side than on the left in regard the weight of the Liver presseth upon the Ventricle when they are upon the left You are to take notice that pains of this Scirrhus and also from other Tumors of the Liver or obstructions do not always possess the right side but pain is felt sometimes forward upon the region of the Stomach for as much as one part of the Liver lyes forward upon the Ventricle hence it is that many are mistaken sometimes in judging all pains about the region of the Stomach to be pains of the Stomach when indeed they are seated in the left part of the Liver There is also an Inflation of the Liver which is a Tumor or extension thereof from wind and flatulent humors sometimes in the vessels and sometimes lodged between the investing Membrane and the Parenchyma This Tumor is not hard but yields to pressure the pain from hence is mutable shifting its place greater and less sometimes ceasing but returning by intervals There are also other causes that have and may produce pains of the Liver as stones and worms which have been found upon dissection but being more rare and scarce to be discovered but after death I wave the prosecution thereof and pass on to the next considerable part Pains of the Reins and Bladder FOR the better understanding of Pains in these parts and their Causes we shall first shew you the formation of the Kidneys and their use afterwards we shall discover the impediments and morbous affects that produce pain The Reins or Kidneys are two placed one of either side the Spine or Back-bone about the lower short Ribs the one under some part of the Liver the other under the Spleen In the structure of the Kidneys the most observable for our purpose are the Cavities and Ductures in the Parenchyma or body of them and the Vessels leading to and from The substance of the is much like to that of the Heart There are two Cavities in the Kidneys being larger than the rest into which the smaller Pipes do convey and empty themselves as containing Cisterns and out of these again there are other small conveyances to transmit and send it forth there are also certain
of Urine This disease is always accompanied with an acute Feaver great Thirst astriction of the Belly heat of Vrine and great pain about the Loins and if the Arteries be affected the pain will be with pulsation Sometimes a Delirium attends with long watching and if the Inflammation be in the Membrane the Patient is scarce able to sit upright because the pain thereby is exasperated If the right Kidney be affected pain extends upwards to the Liver and short Ribs and downwards to the Genitals also a stupor seizeth the right Thigh by consent the Nerve being compressed that passeth thence down to the Thigh But if the left Kidney be the part affected that side is most grieved and in like manner but if both the Kidneys be attacked then the Symptoms on both sides are equal The termination of these Inflammations are either by an Apostem or Abscess by induration and a scirrhous hardness or by Transpiration and resolution which last is the only safe and secure way and this the Physician ought to design for and aim at in his administrations But if contrary to his endeavors the Inflammation apostemates suppurates and breaks evacuating the purulent matter by the Vreters into the Bladder there is good hopes of safety but if it be discharged inwards by the emulgent Veins the case is desperate Scirrhous Tumors in the next place come to be viewed and these are hard Tumors very difficult to be removed being the relict of an Inflammation or other Tumor preceding and not well cured or formed by gross matter congested and accumulated there causing contumacious obstructions for humoral matter flowing thither and being obstructed in the transition the heat of the part does exsiccate and harden it by time more and more and then by accumulation and addition forms a Tumor This causeth heaviness about the Loins but little pain the Urine is but little also and that pale and watry in regard the office of the Kidneys is debilitated and by reason of the angustness of the passages letting pass the thinner but retaining the thicker part of the Urine The longer this Tumor continues the more difficult and incurable it becomes and withal it brings on hydropic Cachexies for the superfluous serosity not being drained away regurgitates back into the body The Cure is to be set upon with internal and external Medicines Aperitives Resolvents Discussives and Emollients Apertion of the Vessels contrary to Nature somtimes does threaten danger by the appearance of blood staining the Vrine and this proceeds from a weakness of the Vessels being relaxed in their retentive faculty or by a plenitude and fulness of blood or because the blood is thin and sharp which causeth the mouths of the Vessels to open On the contrary Angustness or straitness sometimes does incommode the Vessels appertaining to the Reins which hinders the free ransmission of the Vrine Now this angustness of the Vessels does arise either by compression from some Tumor or distended part that presseth upon the Vessels and straitens them from without Or by contraction or constriction of the Vessels that are shrunk as by great heat in long Feavers or a Tabes that seizeth the Kidneys Or lastly by obstruction within from some viscous matter grumous or clotted blood sand gravel stone c. The Sign declaring these obstructions is a suppression of Vrine with pain or an abatement of the usual quantity not answerable to the drink received The place or part affected whether in the Kidneys or Vreters is known by the seat of pain The causes that obstruct are known by their proper signals and by examining into the preceding state of the Patient The place or part grieved with these obstructions whether in the Kidneys or Vreters pain discovers and the dislodging or shifting thereof Of all the obstructions that infest the Kidneys the most frequent and saddest complaint is from the Stone this being the most contumacious obstruction the most painful being a hard solid body and the most uncertain Remedies for relief Concerning the generation of these Stones there have been various Opinions amongst Learned men in short the difference and contest hereupon may be reduced to these two Heads what the material cause of the Stone is and what the efficient For the material cause or matter whereof the Stone is bred Galen and most of his Disciples will have it to be a phlegmatic gross or viscous humor apt for condensation and induration and the efficient to be heat exsiccating this matter and bringing it to a stony hardness but others of them will have this to proceed from cold by way of congelation But this Doctrine cannot hold as rational nor does it answer experience as for the matter we cannot allow it to be such for as much as many that abound with a viscous tough Phlegm and slimy matter as most ancient people do yet many of them are never trouble with stone or gravel And for a concurrence of both the causes material and efficient we have examples of the Aged who are most cold and phlegmatic and for abounding heat with the like matter we may produce Feavers yet no stony concretion or signs thereof to be found from such sicknesses So that we are now to seek for other causes both material and efficient whereon to ground our endeavors for the relief of such as are afflicted with this disease The matter therefore and substance of the Stone is from a tartarous and saline succus with the addition of a terrestrial feculency concreted or petrified by a lapidifactory Spirit or disposition of the Reins which is the efficient and seminal being of that production The concurrence of both these causes does much produce the Stone and afflict the Patient in a high degree but one of them is sufficient viz. this petrifying power of the Reins to coagulate any laudable good matter imported there into a stony substance To confirm this Fernelius relates upon his own knowledge of one that for three or four months together above a dozen small stones came from him every day all which time notwithstanding he eat nothing but Broths and Panadoes being confined to his Bed by weakness and pain But allowing this to be true from the credit of the Author yet we must owne and acknowledge that besides this principal cause of a petrifying Spirit in the Reins there are also antecedent and procatarctic causes adjuvant and promoting as some sorts of meats and drinks and other errours in the Diaetetics that increase and set forward this disease which otherwise might be much slower in generation nor yet arrive to so high a degree of torture also the Stomach Spleen or Liver not performing their functions rightly may contribute matter to the promotion hereof For relief of the diseased in this case there are two grand intentions to be prosecuted and aimed at a dissolution of the body of the stone already generated and secondly the taking away of the petrifying disposition of the Reins and abolition of
that coagulating ferment and for these purposes were Paracelsus his Ludus and Aroph also the Alkahest cannot fail herein But such as have not acquired the great Arcana's and cannot procure a dissolvent for the Stone that is to make an Analysis or resolution of it into a liquid juyce and reduce it back again to its humoral flowing state capable of abstersion and cleansing out must endeavor to facilitate the exclusion of this hard body by the best and most hopeful means for that purpose by lubrifying relaxing and dilating the passages and asswaging the Spasm and contraction of the Vreters that the stone may slide away much sooner and with less pain hence by way of caution observe That Diuretics and provokers to expulsion are not to be given before this preparation be made else you precipitate the Patient into danger and increase his torment dislodging and forcing the stone through angust and very tender cavities not provided to give passage without detriment to this unwelcome stranger And thus much briefly concerning petrifaction or the production of Stones in the Kidneys I proceed on to the next a most difficu't and painful disease belonging to this Member namely Vlcers Vlcers of the Kidneys are introduced several ways or take their rise from several causes 1. Acrimony and sharpness of humor passing this way and continuing long does excoriate which not timely observed and remedied because pains at first are but small does corrode farther eat into the flesh and plants an Vlcer 2. The Kidneys are ulceratedsometimes from an Inflammation or other Apostem there coming to suppuration and breaking which dischargeth the matter by Urine or otherwise but leaves a putrid Vlcer behind 3. Sometimes from a clot of blood extravasated or out of its place putrifying does infect the part tabifie and ulcerate and not to be neglected lest this be the consequent 4. Sometimes a Stone being rough angular or sharp frets or grates upon the parts and makes a solution of continuity which at first sends forth a bloody Urine afterwards purulent and begets an Vlcer and this last is the most frequent cause that generates Vlcers in the Kidneys These Vlcers are discovered by pain about the Loins a purulent Vrine and sometimes Caruncles or small fleshy rags or strings of concreted blood is brought forth with the Urine accompanied commonly with heat in the Back and sometimes faint Sweats which continuing bring on a Consumption and Hectic Feaver Of these Vlcers some are more sordid foul and stinking as the Urine does declare others not ill scented the Pus white not viscous but cloudy and light The difficulty of these Cures lyes here for that the Urine which is acrid flowing always by the Vlcer hinders the consolidation of the part besides the situation being remote the virtue of a Medicine is much altered before it arrive to the part but in the designment and managing of these Cures the body must be well cleansed not with the common deleterious Purgers but balsamic Detersives and so kept with a proper Diaetetic regimen as no impurity or sharp humors disturb or abate the power or Medicines which must be truly balsamic and healing The experience of these Ulcers I have had several times both many years since and lately I remember in the year 1652. I cured an Ulcer of the Kidneys in a man about thirty years of age living near Sheffield in York-shire who came to me four miles twice a week during his Cure I being then for a while at Norton upon the edge of Darby-shire His Urine was hot sharp and stinking with a great purulent sediment a great pain in his Back with scorching heat and often flushing faint Sweats all over his Body Indeed I have wondered since how I did perform such a difficult Cure then having so little practical knowledge I being but a Tyro in this Art it being in the first year of my Practice and newly graduated Batchellor in Physick but Providence had appointed me the instrument to free this poor man out of his pain and languishing condition Since I have been acquainted with several of the like cases and may with better assurance promise a Cure from tryed Medicines acquired by experience beyond what Book-practice does communicate and this last year here in London I cured a Gentlewoman of an Ulcer in the Kidneys In the next place we are to take notice of Pains belonging to the Bladder The Bladder is the last receptacle for the Urine and performs the office of a Cistern to the Body for keeping and discharging the Urine at convenient times and therefore is capable of distension and contraction being a membranous bag furnished with right transverse and oblique Fibres for that purpose and hath two Muscles at the neck of it to let go or retain the Urine This part is liable to great grievances and painful infirmities as Distension Obstructions Inflammation Excrescences Vlcers scirrhous hardness From hence come suppressions of Urine imminution or small quantity ardor or heat of Urine Strangury or dolorous emission and dropping incontinency of Urine or difficulty of retaining it Distension of the Bladder happens from too long retaining of the Urine whether it be voluntary or involuntary so that afterwards the Fibres do not recover again the power of contracting the Bladder and this may prove of dangerous consequence and to some it hath proved mortal Obstructions of the Bladder causing a suppression of Urine or diminution dolorous or difficult excretion does arise from many causes as a stone in the Bladder or gravel coagulated blood worms a viscous humor or purulent matter a Caruncle or Tumor in the neck of the Bladder or by compression from a tumified part adjacent as the Womb or right Intestine Inflammation sometimes happens from extremity of pain by the Stone Vlcer or other torturing cause and these Inflammations are commonly mortal Vlcers do possess the Bladder sometimes and most commonly in the neck thereof caused by a stone or gravel excoriating and wounding the part or by an eroding purulent matter coming from other parts and lodged there or by a continued Acrimony and sharpness of Urine corroding sometimes from an Inflammation or Abscess more rarely but it hath happened sometimes from a Gonorrhoea ill cured and I may say very ill indeed for the Ulcer thus procured is of far greater difficulty and danger than the Gonorrhoea Not long since an Ulcer of the Bladder was committed to my care being the relict of a Gonorrhoea ill managed by a Chirurgeon using Restringents unseasonably Ulcers in the meatus Penis as also in the Prostates are more frequently offered to our help as lately another person applying to me having an Ulcer procured in the Prostates from the like improper and pernicious course and although Gonorrhoea's are frequently cured and may with much certainty and safety in skilful hands yet there are many that patch up a seeming Cure for the present but future consequents are sad memento's of their Undertakers folly And at this
thinness of blood the terminations or mouths of the Veins are opened and some effusion made which then being out of its proper place does degenerate and corrupt and affords matter for Inflammation Thus by Ruptures Punctures and Wounds extravasated blood is the material cause of Inflammations Fourthly but matter alone cannot produce an Inflammation nor any other disease being inactive and a dead thing of it self except some vital Agent works upon it forms and moves it who or what this Agent is we are to inquire farther Since then Inflammation is not procured by matter alone nor can it exist only by matter there must then be an internal efficient and movent Principle joyned with this matter that fabricates and generates of this matter an Inflammation But understand me rightly I do not mean that this matter takes fire and is kindled as if it were a sulphurous and combustible matter and so cause an Inflammation or scorching heat no such thing but this morbific hostile matter stirs up the vital heat by way of irritation provokes the vital principle to estuate and wax hot for from hence does all heat emanare stream and issue forth whether it be a temperate and natural warmth or a preternatural and inflaming heat both proceed from this fountain So that hereby you must distinguish between the occasional matter of Inflammations and the internal efficient that does excandescere inflammare This inflaming heat ariseth from a principle much different from the materia morbifica occasionalis this great heat does not rise out of the morbific matter inflamed but from the vital Principle incensed A Stone in the Kidneys by raising great pain may cause an Inflammation there and this stone is the occasional and material cause thereof but none can think that this contains fire in it or is capable to be inflamed or to communicate any heat to the containing parts save only what it hath received from the vital heat residing in the body And thus it is in all other cases of Inflammation in any part of the body from what cause soever This vital Principle is seated in every member of the body and does preside as Governor and not only for defence thereof but also to move and act in it so as no vital office or function can be performed without the assistance and power of this internal invisible Agent nor is there any heat but what ariseth from hence And this is that which Hippocrates calls the impetum faciens Helmont the Archaeus which I chuse rather to call the vital Principle When any thing happens out of order in the body a Vessel obstructed or some liquor extravasated or what else that may disturb and interrupt any member in its office soon the vital Principle is affected and concerned therein and if the matter be considerable and contumacious pain ariseth there and this pain is the suffering and anguish of the vital Regent strugling to resist the injury and labouring to remove the impediment hence the Inflammation and preternatural heat arising from this vital power Fifthly and in the last place from the doctrine preceding we are to make some observations that may be useful for guidance in Practice and to remark some pernicious errors that pass undiscerned And first here you must take notice of the affinity between Inflammations and Feavers that most Feavers do arise from Inflammations of some particular part and are the off-spring from thence or springing from that root For the quòd sit Practice does affirm it for rarely you shall meet with any considerable Feaver but some particular part is chiefly complained of and as the grief or pain does abate there the Feaver is remiss and slackens also Secondly you are to note that Feavers are erroneously defined à calore praeter naturam in corde accenso assigning the Heart to be the Focus where febrile heat is first kindled and from whence it is maintained when almost in any other part of the body if an inflammation happen there a Feaver will certainly follow taking its rise from thence not from the Heart so that the Heart then suffers sympathically by consent not idiopathically and originally And whereas I said almost any part intimating thereby that a slight Inflammation may be in the small and capillary Veins of short continuance which may not communicate a Feaver to the whole body and such inflammations we see externally planted sometimes the capillary Veins of the Cutis being affected calore rubore which either spontaneously vanish or soon yield to some outward application only Thirdly From the denominations of Feaver and Inflammation you may observe the parity or near relation they have to each other for from the Etymon of the words they seem to import much what the same thing denoting only an extraordinary heat 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 ignis and in the Latine Febris à ferveo 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 inflammatio from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 uro Fourthly We shall not depend upon Etymologies which are allegorical and often strained but inquire into the nature and extent of each and know what is meant by the one and the other and then what difference between them Feavers are known and defined by preternatural heat and effervescency through the whole body Inflammation is a preternatural heat of a particular part Hence we remark that Feavers are general Inflammations or inflammations dilated Inflammations particular Feavers of a member thus differing in extent and latitude but withal observe the order of causation Inflammation precedes and lays the foundation in this or that part there is the fomes and miner a morbi a Feaver follows upon the whole body caused only by consent from thence and condolency Now if all or most Inflammations cause Feavers and Inflammations so frequent as being the certain consequents of great pain then two things are to be noted first that upon the appearance or discovery of a Feaver you may suspect an Inflammation couched under it from whence as the spring this Feaver does arise Secondly that the Cure of most Feavers ought to be designed and managed so as respecting and aiming chiefly at a particular Inflammation upon which the Feaver does depend sublatâ causâ and when a Feaver ariseth upon this account as for the most part it doth then little regard is to be had to the general Feaver but die stress of Cure lyes upon removing the occasional and material causes of Pain and Inflammation in the particular part the foundation of all the rest which being removed the depending Feaver falls of course Thus all our Discourse tends to make a true discovery of causes that when preternatural heat does arise in the body and beget a Feaver we may know not only what to call it but also what to do by levelling at the right mark But by the way I must tell you also how a Feaver sometimes does arise and not from Inflammation of a pained part and that is when some
part affected is debilitated and overcome by this depraved malign matter that it cannot exercise its transmutative and digestive power nor will this cancerous matter obey Discussives by reason of the viscidity and grossness thereof wherefore Hippocrates gave sentence That such are not cured but by section or ustion and yet this is not to be done except the Cancer be small and in such a part as will admit of amputation If Cancers external are thus difficult to be managed although they appear to the eye and are subject to manual operation and tractation the internal must be greater and more hazardous where they cannot be applied unto after this manner with convenient Topical Medicines therefore prevention in time is mainly to be endeavoured when a Tumor is generated lest it change into this dangerous condition for I find by the design of Practisers in the Remedies appointed that palliation is sought for the Cure not hoped for The grand intention to be prosecuted for Cure is to change the condition of the blood which does feed and supply this Cancer so that the antecedent cause being taken away the continent will then more likely abate and until that be done this cannot be expected The means indicated for Cure of these cancerous Tumors are branched into three parts Dieatetic Pharmaceutic and Chirurgical but I shall not enlarge upon the Indications for Cure for that these cases are so nice and difficult as not to be handled with generals but from a collation of all the circumstances attending the Patient which varies every particular case And so I pass from Tumors to remark their usual commutation and transition into Vlcers the next considerable in order to be treated of Ulcers internal THE Latine word Vlcus is derived of 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 signifying a disjunction of parts or solution of continuity but to distinguish this from other solutions of continuity an Ulcer does yield a Sanies or purulent matter so that a Wound coming to digestion and affording pus may then be called an Vlcer and any part that is gauled raw and tender the covering Membrane being fretted and eaten away by some sharp humor or other cause it stiled Excoriation only until it produce corrupt matter and then it is properly called an Vlcer thus internal parts are sometimes excoriated raw and painful but cicatrized or skinned again before it arrive to the degree of an Vlcer And thus it is most frequently in the urinary ductures or passages and sometimes in the Guts but such Excoriations are not to be slighted or neglected lest they beget Vlceration as sometimes it falls out so By external or outward Vlcers which are manifest to the eye you may conceive of internal Vlcers for they arise from the same causes and have the same accidents but I shall not inlarge upon all the accidental differences that attend upon and distinguish external Ulcers as not so pertinent and necessary to our subject in hand The essential and most considerable difference of Vlcers does arise from their causes and from the part affected which bears the great sway in curing and from whence the chief indications are taken for although in external Vlcers other accidental differences may be observed and noted yet in internal Vlcers such differences cannot be regarded as being obscured or hid so that whether they be broad or narrow deep or shallow fistulous or otherwise is hot positively to be said and if it were known institution or method of Cure could not be so varied as external are capable of by reason these are subject to manual tractation The continent causes of Vlers are such matter as emane and flow from thence and that is of three sorts Ichor Pus and Sordes The first is an ichorous or sanious matter being thin indigested and watry or diluted bloody The second is a Pus or purulent matter of a betted consistence and concocted thicker The third is a sordid foul matter more thick and glutinous The ichorous thin matter usually issues in the beginning of Vlcers and denotes indigestion and also at any time afterwards does declare the same that the Vlcer is not in a good healing condition The Pus or purulent matter signifies the Vlcer to be in a better state of healing and if it be white and sweet these are good signs The sordid gross matter does intimate a preternatural heat of the parts strongly exsiccating but not healing for as much as this matter is foul and stinking Vlcers for their manner of generation and rise may be caused these four ways by Erosion by Frication Apostemation and Contagion 1. By Erosion Ulcers are begotten in any part of the body when a sharp corrosive humor does excoriate and eat into the substance of any part and being thus injured is thereby perverted in its office and self-preservation converting that nutritious Succus which comes for its supply into an ulcerous degenerate matter no way useful but to be excreted and voided And thus a Phthisis an Vlcer of the Lungs is sometimes generated from a sharp Serum invading that tender part and thus a Dysentery is sometimes begotten being an ulceration of the Guts from sharp excoriating humors and thus an ulceration in the Meatus Penis is bred from a sharp eroding Gonorrhaea and an Ulcer in the neck of the Bladder may be planted there by a sharp gauling Urine 2. By Frication or attrition as when any hard bony or stony substance does fret raze and excoriate a part and thus a stone begets an Vlcer in the Kidneys or Bladder and sometimes in other parts of the body 3. By Apostemation as when any Apostem breaketh and dischargeth its matter an Vlcer is left behind though the Apostem be gone and thus are Vlcers generated sometimes in the Ear from a preceding Apostem in the aspera Arteria after an Angina or Squinance in the Breast after a Pleurisie in the Lungs from a Tumor suppurated there also in the Liver Spleen Womb or other parts apostemated 4. By Contagion or infection and thus women whole Privities are infected do communicate this virulency or venom and seize the Genitals of their Partner from whence venereal Vlcers do arise and thus men whole Seed is tainted do infect sound women and cause virulent Vlcers in their Privities which malignity not being well managed and mastered by skill and efficacious Medicines it spreads breaks forth and begets Vlcers in many other parts of the body as at large I have set forth in another Tract entituled The Mystery of the Venereal Lues Internal Vlcers though they disappear yet are known to be by these signs First Pain which is more or less according to the nature and sensibility of the part Secondly From preceding causes as Inflammation or Tumor preceding whose Symptoms being allayed and ceased yet pain remains Thirdly and manifestly From excretion of ulcerous matter where there is any ducture or outlet for discharge by the Intestines by the Privities the Nose Ears or Mouth but where there
is no passage or vent it corrupts the containing part and is mortal except a passage can be made by section Vlcers from their causes their aptness and inaptness for healing some are benign mild and tractable others are malign very difficult or incurable The benign and mild are such as arise in sanguine sound bodies and the younger people having no ill Symptoms or adjuncts of impediment the matter of such Vlcers is a laudable Pus or otherwise apt for digestion more yielding and readily commanded by Medicines Malign Ulcers and contumacious difficult or intractable are such as are sordid fetid ichorous unctious dolorous corroding and depascent of long continuance virulent cancerous fistulous cavernous the products or effect of malignant diseases as venereal Lues Leprosie Pestilence c. in cachectic habits of body hydropic hectic aged consumptive and decayed persons in principal and difficult parts of the body as the Brain Lungs Liver Spleen c. the Spondyls of the Back and great Junctures Since Vlcers are thus various in their nature from the several conditions of bodies and diseases that they arise from or depend on and the difference of parts wherein they are seated a general Method of healing and course of Medicines cannot be instituted and appointed but every case hath its peculiar complication of circumstances as directory indications to be remarked from whence a designment method and adaptation of Medicines is formed suitable to the particularity and different case of every individual Patient and therefore I have not proceeded to the Rules and Medicines for Curation Only thus much I shall note to you as a grand observable in the Cure of these Vlcers That such as arise from some remarkable disease as Dropsie Scorbute Venereal Lues or other malign and Cacochymical habits of body that these Vlcers are not to be cured until the disease and evil state of the body on which they do depend be reduced to a good condition or mediocrity of constitution for the antecedent cause which first produced the Vlcer must be removed before the Vlcer is capable of healing because of the continual supply of peccant matter brought to the ulcerated part and therefore application is first to be made there else all endeavours will be frustrate And further the designment of these Cures are not to be paralleled with nor levelled by the methods and intentions that the common Rules in Chirurgery have laid down for as much as many of them are erroneously grounded and deserve great correction and amendment which hereafter will be pointed out and discussed for we have not room here nor time now to ingage in that Cantroversie and must refer it to the next opportunity Gangrenes and Mortification THE last and worst transition of this dangerous train of Diseases and the ne plus ultrà in vitality is a Gangrene being a borderer upon or next adjoyning unto Mortification or the beginning thereof And although Gangrenes are thus ranked next to Vlcers and it falls out so sometimes in the preternatural course of Nature if I may so speak yet it is not always so but a part may and does gangrene sometimes before it be ulcerated for Inflammations and Tumors do gangrene as oft as Ulcers but Gangrenes are placed in this order after Vlcers as being the worst and last morbous state that can come and beyond this there is no disease for although Mortification be set down after Gangrene yet this is no disease vita extincta non est morbus for diseases are seated in the life corpus vivens est domicilium morborum and where no life is there is no disease but Mortification is posited here as the center to which diseases move and as bounds to stop all farther disquisition A Gangrene is a corruption and change of a part or member into such a degree or state as beginning to mortifie or is mortifying But Sphacelus with the Greeks Syderatio in the Latine which we call Mortification in English is when a part is perfectly mortified and dead and therefore a Gangrene is capable of Cure but a Sphacelus not because the part is dead A privatione ad habitum non datur regressus The external and primitive causes of Gangrenes are Contusion Vulneration Congelation Combustion Constriction Poyson Contusion sometimes introduceth a Gangrene by coagulating and fixing the blood so firmly in the part contused that thereby the life is supprest and overcome for communication and intercourse with other parts of the body which is requisite being thus denied the life extinguisheth besides the coagulated bruised blood remaining long undiscussed does putrifie and gangrene Vulneration or section sometimes procures a Gangrene when the vital Principle is so debilitated or enormous by the wound that instead of a good suppuration and vigorous transmutation a depraved matter is generated which corrupts and gangrenes the part and thus a small cut of a finger or Toe hath gangrened and killed the person but in greater Wounds the danger is greater as more frequently to happen Congelation by extremity of cold hindring Transpiration and condensing the blood rendring it stagnant in the Vessels suffocates the life and gangrenes the member thus in extreme cold Countries people by casualties exposed have their Limbs mortified sometimes and thus a Gangrene is brought upon an Inflammation or Erysipelas sometimes by incautelous and pernicious application of great refrigerating or cooling Medicines thereby incrassating the blood and prohibiting transpiration And this is very hazardous though advised and practised frequently by some Chirurgeons in these cases using cold astringent emplastic Cataplasms ex farin hord bolo armen album ovor aceto c when an Inflammation appears Combustion sometimes begets a Gangrene and destroys the life of the part when by neglect thereupon or improper means used relief is not duly afforded and thus by Cauteries and Caustics sometimes a member becomes mortified Now Vstion or great hurt by burning causeth Gangrenes by corrugating shrinking and searing up the Vessels that they cannot bring supply of vital Spirits and nutriment to the part Constriction or compression procures a Gangrene by intercepting of vital communication so that the member thereby is as it were separated and cut off from the body and fountain of life for the parts are maintained by influxed rays and streams of vital heat and moisture to the remotest parts of the body but being deprived thereof they dye thus a Ligature drawn strait about the Arm or Leg and continuing too long may gangrene and mortifie the part by excommunicating it from commerce with and participation of the general life And thus sometimes internal scirrhous Tumors do compress the Vessels and obstruct them of this Fabricius Hildanus gives an example of one that a Gangrene seized both his legs of which he dyed the cause was latent until by dissection he found a scirrhous Tumor about the Vena cava descending between the Reins where this great Vein divides into two parts to supply both legs Poysons some of
a few years since now dead being often and much afflicted with the Gout his Physicians told him that the Gout kept him alive and if he were cured thereof he would dye soon after To obviate these objections I answer and part hereof I grant that some have dyed by their endeavours for Cure and this not so strange for the like may be said in all other diseases that some have dyed by their Physicians or such as they intrusted as Physicians and not solely or chiefly by their disease Examples we have had in the most if not all diseases the most curable and facile to be dealt with so that by unskilful men improper courses or designments and by bad Medicines or casualties happening by the Patients folly or their Tenders many have dyed in the prime and strength of their age by endeavoring for Cure in Diseases not mortal nor of sudden danger in their own Nature and amongst those the Gout may be reckoned So that if you will plead for no Physick no tampering as you call it with the Gout by the same argument you may abandon Physick in all other sicknesses for the adventure is equal and the security depends only upon the judgment and ability of the Physician and no more hazard in this disease than in another I say therefore in case of the Gout as also in all other diseases if you will securely proceed take a knowing man well grounded in the Theory and through paced in the Practice of this Art Having a frequent experience in the progress and Cure of Diseases and a critical Observator of the Gout in particular this man you may as freely trust and safely yield obedience to in managing a Cure for the Gout as you can do to other Physicians in all cases whatsoever Now as for those Physicians if there be any such so ignorant or fallacious that alledge the Gout to be any way a Preservative of Life and pretend not to cure it for that cause I must tell them plainly first that this is only a pretence to palliate their inability and a crafty evasion to shift off the censure that may fall upon them for not curing what they ought and would willingly do if they could Secondly To shew the pretence is erroneous and void of truth we will search the Gout and see if there be any thing in it or appertaining to it that is a Preservative of mans life or conducing to his health and a sound state of being In the Gout there is no pleasure nor recreation either of Mind or Body both which are promoters of Health and consequently prolongers of Life but on the contrary the Gout is attended with a sedentary inactive confinement melancholy pain watching and unseasonable sleep the consequents and effects of which are debility ot all the faculties and enervation of strength which as these continue longer or more violent and return more frequently and often by so much more is the Patient damnified both for the present and the future and rendred more infirm and liable to the decays of Nature But perhaps you will say this serosity and sharp punging humor falling into an ignoble part and far off from the Vitals is much better and safer there than to wander up and down the body which as it hath happened sometimes may invade a principal part and there threaten or cause death therefore so long as this humor hath a recourse to the Joynts and is not turned off from that current the Patient is not in such great danger as otherwise To this I reply That true it is if there were a necessity that this Tartarous gouty humor must invade one part or other better it is that it passeth a safer way and lodgeth in an ignoble and remote part and better it is that the Physician does nothing than do hurt or run a hazardous course If he cannot eradicate this morbific matter stop the spring and fountain from whence it does arise and where it is generated or this being too hard and difficult a work if he cannot derive the stream and issue thereof to the vents and outlets that Nature hath appointed and framed for a discharge of superfluous and degenerate humors but lets them have their course because not mortal to the constant trouble and damage of this or that part in particular and consequently makes the whole to suffer sympathically and by consent such a Physician either hath not a true notion of this disease the Gout or else he wants commanding Medicines elaborated by his own hands exquisite and effectual to answer the indications that this disease and causes thereof will put him upon for relief of the Patient but to pretend that this disease must not be cured because it spends or employs the humor in a safe way so called is much what alike but very unlike a good Physician as to suffer a man to continue languishing in a Loosness or Vomiting because it dischargeth some peccant stimulating matter but in this case as also in that of the Gout the extravagancy and irritation of noxious humors are to be checkt collected and sent forth by good Medicines in a placid gentle way through convenient ductures and outlets and not let to continue in a detrimental extravagant course Now concerning the curability and incurability of the Gout I do owne that some are much more capable of Cure than others by the nature and condition of their bodies and some are not curable as age and other cirumstances have reduced them to an incurable state yet I say in the worst of cases there are mitigations and helps that check and tame the fierceness of the disease render it more tolerable and easie and such Prophylactics or Preventives there are with a due Regimen of life that will keep off the frequency and retard the returns of this painful Malady Thus much concerning the Gout fixed or constant to a part it remains that I deliver my thoughts and experience touching the Rheumatism or running Gout so called because it shifts from part to part invading not only the Joynts but also the membranosum Genus the Membranes both of the Muscles Viscera and Bones Hence it is that sometimes these pains are external in the Muscles and habit of the Body sometimes internal when the Viscera are assaulted as the Lungs Liver Intestines Spleen c. sometimes these pains affect the Bones by pricking the Periosteum that Membrane which covers and enwraps the bone Some complain of their Arms others of their Shoulder-blades some the Bach others or at other times the Breast sometimes the Thighs and sometimes the Legs the humor shifting and moving from one place to another and this upon changes of the weather turning of the wind and seasons of the year these pains do go and come afflicting more or less and yet no swelling Inflammation or outward appearance upon the part grieved These pains continuing or frequently infesting do debilitate and disable the parts affected insomuch that some go