affected with the Green-sickness Cachexy and that sort of Dropsie called Leucophlegmatia who all have a difficulty of breathing by reason of dregs of the ill-mixt Blood that are left there Wherefore the use of the Lungs seems to be this That the Blood through the lesser Vessels as so many rivulets may as to all its parts lie open to and meet with the nitrous Particles of the Air and be by them enlivened and accended The Pneumonic Artery as also the Aorta and Wind-pipe hath a muscular Coat furnished with two ranks of Fibres namely straight and circular which doubtless when they are contracted do make the Pneumonic Arteries to beat and the Blood to be urged and driven still more and more forward A great many Glandules with a Net of Vessels lie on this musculous Coat The frame and branching of the Pnenmonic Artery in some one Lobe of the Lungs are expressed in the second Table All the Coats of this Vessel are drawn distinct and apart from one another in the sixth Table and first Figure and also in the fourth Table and second Figure The Pneumonic Vein having its rise in the left Ventricle of the Heart The description and use of the Pneumonic Vein and being divided and variously subdivided first into greater branches and then according to the greater and lesser Lobes of the Lungs into lesser and lastly into the least of all is carried above the Weazand and as it goes on does exactly answer to the branching both of the Pneumonic Artery and the Weazand and goes every where with them as it were cheek by joll and where the Weazand ends into the little Bladders the Veins being twisted with the Arteries as was said before do make as it were a little Net wherein those little Bladders are encompassed The Anatome of the Pneumonic Vein differs little or nothing from that of the Vena cava and its branches All the Vessels of this kind have four Coats distinct from one another 1. The outmost of these Coats consists of Fibres that seem to be nervous which perhaps are after a sort muscular and are extended straight long-wise though in no very regular order This Coat of the pulmonary Vein is very laxe and loose from the rest of the Vessel insomuch that it may all of it be blown up and very much extended as if it were a distinct Vessel Whence one might suspect that this were a peculiar passage to carry back Lympha or Serum separated from the Blood but it seems to be more probable that this outmost Coat is therefore made so loose that the passages might be much distended and widened for the return of the Blood now hot and boiling 2. 3. Two other Coats common both to a Vein and Artery viz. the vasculous The use of the venous and vasculous Coat and the glandulous lie under this the office of the vasculous is to bring nourishment to the part and of the glandulous to receive and send away the superfluous serosities 4. The fourth and inmost Coat is plainly muscular having Ring sibres The muscular Coat as the like Coat of an Artery hath which certainly being successively contracted after the stream of Blood do cause its return to be hastened and on occasion to be shortned But here arises a doubt wherefore Why there is no Pulse in the Veins seeing the Veins as well as Arteries have contracting muscular Fibres which in the latter are pulfifick and seeing both are alike joined to the Heart that beats continually the Veins as well as the Arteries should not statedly beat according to the constant turns of the Systole's and Diastole's in the Heart It may easily be answered to this first that the Arteries have a great deal more of the moving Fibres than the Veins have and therefore whereas those being strongly contracted successively do force the Blood along as if driven with a wedge for these it sufficeth that whilst they are gently contracted behind the stream of Blood they calmly and equally drive it forward flowing back again of its own accord and as it were down-hill But besides the reason hereof seems to depend somewhat on the unlike or rather inverted conformation of the Vessels for the Blood conveighed by the Arteries is driven still from wider to narrower spaces and therefore going along it every where violently distends them and lifting up the sides of the Vessels raises the Pulfe because whiles that part of the Artery that is behind the Blood is contracted by its muscular Fibres that part which is before it must needs beat being filled with the stream of blood gushing in but on the contrary the blood in the Veins returning to the Heart runs out of less into greater spaces or out of rivulets into a more capacious and deep chanel and therefore glides along silently and without the fluctuating of a Pulse The blood in the pulmonary Veins seems as much The disposition of the blood in the Pneumonic Veins or more than that within the Arteries to be animated or inflamed anew by the air insinuating it self every where from the Pipes or little Bladders of the Trachea because in those Veins 't is first changed from a black-purple to a scarlet the reason whereof is because the blood at the extremities of the Vessels namely as it passes out of the Arteries into the Veins does every where and most of all meet with the particles of the air And for that reason it is that if any liquour be squirted into the Pneumonic Artery it will not so readily and quickly pass through the Lungs and return by the Vein as it will do if you make the same experiment in any member or part of the body besides yea part of the liquor so injected will sweat through into the Pipes of the Trachea or the spaces between the little Lobes and another part being turned into a froth will return very slowly by the Veins which is a certain proof that while it passes through the Lungs it makes a stay in the mouths of the Vessels and is mingled with the airy particles The Circulation of the blood through the Lungs hath something diverse from or rather contrary to that which is made through the rest of the body seeing the Pneumonic Arteries contain a black-purple blood and the Veins a scarlet whereas in all the body besides the branches of the Aorta carry a scarlet blood and those of the Vena cava a black-purple Besides we may observe of the pulmonary Vein that it does every where in its whole length want valves except where 't is fastned to the Heart Which appears by this that when any liquor is injected into its trunk just as it is in the Artery it presently passes through all its branches without lett Which ought to be so to this end that the blood may always because of the violence of the passions freely every way fluctuate and regurgitate in and about the Heart Besides that the left Ventricle
obnoxious to depravation than this Pneumonic machine of the breast The organs of breathing being hurt the breathing is hurt also through which by sucking in air we preserve the vital flame of the blood with its motion and heat For whereas the vessels of the lungs belong to the function of breathing viz. the Trachea with the Bronchii and little bladders also the heart with arteries and veins besides which there are nerves with fibres as well musculous as nervous Lympheducts and Glandules also the contents of these Vessels viz. Air the old and fresh blood with its Serum the Lympha and the animal Spirits any fault happening in any of these doth oftentimes discompose the whole Pneumonic function Nor less also the moving Organs of the breast viz. the muscles with the Diaphragma and the nerves appointed to their use And likewise sometimes the animal spirits before they enter into those nerves being ill disposed often cause great disorders in breathing When the chief function and uses of the Lungs have been to convey the blood and air through the whole frames of the parts and their inmost recesses The uses and ends of breathing which use to be hurt and every their smallest passages and every where to mingle them namely for that purpose that the venal blood returning from its circuit and diluted with fresh juice and thereby crude and as it were half extinct may as well be more perfectly mix'd and wrought together as more effectually kindled afresh in all its parts by the nitrous air from hence the chief faults about this business or function of the Lungs do most of all consist in these two things First that the blood hath not due passage through the Sinus of the heart and the pneumonic vessels And secondly because the Air is not drawn in and breathed out in a due manner into the Trachea and its passages The defects and failings of the Lung in its office There are two parts of either of these For first as to the passage of the blood sometimes the fault is caus'd within the right Sinus of the heart or the pneumonic Arteries and also sometimes caused within the pulmonary veins or the left Ventricle of the heart Secondly as to the Air the failure is chiefly in inspiring and exspiring although each function offends sometimes equally There are divers accidents of each and many causes and ways of its being done whereof we will here briefly touch upon the chief Therefore first First in respect of the blood when the blood doth not duly pass through the right Ventricle of the Heart and the Pneumonic Arteries either it happens by its own fault or by the fault of those passages and sometimes by the fault of further passages For sometimes the stream of blood stops in the nether region of the Pracordia by reason of obstruction in the other moreover sometimes the defect or fault of the air breathed in stops the free passage of the blood What relates to that fault of the blood The opinion of the famous Sylvius concerning the blood fermenting in the Lungs when it passes not quick enough through the right Sinus of the Heart and Pneumonic Arteries the opinion of the Renowned Sylvius should here be discoursed but that it would be too tedious and from our purpose For he supposes The descending branch of the venal blood moistned with chyme together with the lymphatic humour returning from the whole body hath the nature of an acid-sweet spirit and in the mean time its branch ascending impregnated with choler from the bladder of the gaul mixt into the mass of blood does participate of an oily volatile salt and so by the meeting together of these something contrary to themselves a gentle and friendly contention or boiling is stirred up in the right ventricle of the heart in which and for which the fiery parts lurking and being shut up in each being freed and set at liberty do rarifie the chyle and blood and so change and alter them that they exercise the function of life and heat as well as motion and nourishment through the whole body Which seems not likely to be true There are many reasons why I assent not to this ingenious and neatly-framed Hypothesis For besides that many do far otherwise determine about the origine and dispensation of Choler and so not without strong reasons and experiments are thorowly perswaded by eye-sight that there is not any such boiling up of the blood of a different quality and striving or contending in the right ventricle of the Heart Our opinion hereof Our judgment continues still as it hath been that both streams of blood washed thorowly with the fresh chyme do consist altogether of one kind and for that cause the milky Vessels of the Chest carry about part of the Chyle so long a journey which they pour into the descending trunk of the Vena cava just as the meseraick Veins pour the other part into its ascending trunk also that the lymphatic humor together with the Chyle is poured into the subclavian Vessels so that it may very commodiously be reduced into blood neither truly doth there seem need of other or more passages Moreover we determine that that humor rightly constituted doth agree with and is easily assimilated to the mass of blood as well as the Chyle it self made sweet without any contention raised in the heart But if the lymphatic humor returning from the Brain and nervous kind as well as from the Glandules degenerate from its due temperature and contract a sowreness as it often comes to pass then being re-infused into the venal blood it overcomes it and it precipitates it into serosities and from thence great streamings of urine do ensue Moreover we have shewed elsewhere that the Diabetes is provoked from such a cause But such a flux of the lymphatic humor is so far from exciting a greater boiling up of the blood in the right ventricle of the Heart that rather on the contrary from thence often chilness of the whole or stiffness with a weak Pulse and sometimes swoonings or convulsive fits are provoked accompanied with a plentiful and pale urine The reason whereof without doubt is that then the clear humor flowing from the brain and nervous parts turns the blood into serosities and cools it by too much diluting and for that cause the animal spirits being destitute of their vehicle either faint or run into irregular motions But truly as we altogether deny an Elastic effervescence of the blood in the right Ventricle of the Heart from contention of dissimilar parts The pneumonic circulation of the blood is stopt sometimes by the fault of the heart it self so as often as from thence the blood is not cast out into the Lungs after a due manner we determine it to happen not so much from the proper fault and defect of the blood it self as from the animal faculty For if the spirits actuating the moving Fibres of
do want Bridles not Spurs But in the Plague Small-pox and Measles broke out and in malignant Feavers sometimes the blood spontaneously flowing out portends for the most part evil therefore in those affects styptic Remedies or things stopping the eruption of blood are more convenient than breathing of a Vein Thirdly 3. Or Art out-done by Nature Notwithstanding on the contrary there are cases of shedding blood by Nature which Physick can no way imitate neither if they chance to fail can be supplyed by Phlebotomy In Feavers about the Crisis of the Disease to wit after the digestion of the matter that is to say the preparation for Excretion spontaneous Haemorrhagies if coming in time do far excell any Phlebotomie which none knows the best season of Moreover the Fluxes of the Terms and Haemorrhoids happening by Natures instinct are more advantageous than the mission of blood provok'd by Art in any of those places Between Phlebotomie and spontaneous Haemorrhagies Phlebotomy and spontaneous Hemorrhagies differ as to the subject and matter there is yet a notable difference although not of great moment in Physical practice viz. both as to the Subject and Matter of either of them for in this the blood being florid and throughly Scarlet doth for the most part only flow out of the Arteries but in the other Evacuation the Blood being of a black purple with a Scarlet Cream is only drawn out of the vein Whence the stream of Blood which is one within all the vessels and throughout continuous acquires such a diverse kind of appearance seeing we have shewed in another place it is not our present purpose to make any surther search into this Aetiologie because it concerns not much to the curing any distemper out of what vessel the blood be let provided it flow out largely But that the ancients do in some cases commend Arteriotomie and prefer it to an incision of a vein the Circulation of Blood not being then known we have elsewhere discoursed how well it may be done Hitherto of Phlebotomie compared with a spontaneous Haemorrhage The use and effects of Phlebotomy now our next business is to describe the use and effects thereof as well good as bad in Physical practice Wherefore we will first shew in general what alteration of the mass of Blood this Evacuation bring then what diseases it more immediately respects either of the whole body or its particular parts About the former How it affects and alters the Blood it is obvious enough that the blood is altered by breathing a vein both as to its quantity and temperament and as to its disposition and motion The first and most common Indication of Phlebotomie is 1. Diminishes its quantity that the plenty of blood be diminished by this Administration And truly this is a vulgar Remedy to remove or provide against a Plethora Any one though of the vulgar sort growing to a full habit of body le ts blood without the advice of a Physitian Moreover Rusticks and Countrey-men for healths sake Emission of the Blood is not to be either too prodigally or too slenderly made once or twice in a year cause blood to be drawn from themselves and their Beasts But although this custom is grown so much in use with some prodigal of their blood that they breathe a Vein on the smallest occasion and sometimes without any manifest cause notwithstanding we may find many others no less obstinate against this custome insomuch that for no cause will they lose any blood unless the greatest necessities be urgent Upon this matter whereas Arguments are alleadged on either part The reasons of the former hinted at that I may in few words determine what seems fit to be ordained in the first place it is requisite we grant that letting blood is convenient against a Plethora either made or beginning for by no other Remedy are the evils of that Affection wont to be better removed or provided against Notwithstanding the necessity of this evacuation ought to be declined as much as may be because from thence as we have intimated elsewhere the blood becomes more sulphureous and less salt and for that reason it most commonly disposes all men to be feaverish and to be fat Moreover the Great Remedy Blood-letting if it be prostituted to every little occasion becomes less efficacious to any grand affections when need requires To which we may adde that according to the vulgar observation by how much the more familiarly any one uses Phlebotomy he will the more frequently stand in need of it for blood being emitted to avoid a Plethora the rest of the mass will the sooner rise to a Plethora far otherwise than is the opinion of some who dread lest the store of blood be consumed by frequent Phlebotomie for that on the contrary by this means the quantity is more encreased although the Crasis be the worser for so the blood having lost much of its balsamick Salt and preservative against putrefaction instead thereof is filled with a pinguifying and more fiery Sulphur Secondly 2. Phlebotomie amends the mixture of the Blood Phlebotomie doth frequently correct the mixture and temperament of the blood in a manifold respect For in the first place if any thing heterogeneous be confounded with its mass which cannot be rightly digested nor easily excerned and sent away a Vein being opened the blood flowing out conveyes frequently much of the portion of that matter forth with it insomuch that the rest may be either subdued or expell'd For the orifice of a vessel being opened presently the blood fermenting gathers together the extraneous particles as much as possible and excludes that portion of it self wherein many of them are heaped up From hence we may observe the blood flowing out first and last to be well enough It restores its temper when that emitted between appears corrupt Also secondly the blood declining from its temperament is frequently restored by Phlebotomie For when the mass thereof by the Sulphur or fixt Salt or both together being exalted shall degenerate into sharp salt or saline-sulphureousness a portion of the blood being withdrawn immediately a new fermentation thereof arises and very often there is a transposition made of all the particles of that sort that afterwards the Spirits may a little emerge with the volatile Salt and recover their dominion the Sulphur and fixt Salt as is fitting being subdued For this reason it is that letting Blood doth not only confer great help in Feavers but also in the Scurvy Jaundies and beginning Consumption for the blood after the vessels are emptyed like the Stomach disburden'd doth better digest and assimilate any humoursingested and the more easily throws off and separates whatever is heterogeneous But if the mixture of Blood begins to be much loosned and become very bad Some distempers of the blood admit not Phlebotomy as in the Plague and malignat Feavers we must altogether abstain from Phlebotomie for the blood
that a very small chink remains for the blood to pass Not long since we dissected a young man who died by reason of an ill formation of the pneumonic Vein Sometimes wax hard in whom the trunk of this vessel growing stony near the juncture to the heart did stick so close that the blood did drop into the heart only by drops or by a very little stream 2. That the passages bringing blood are often filled and stopt insomuch that the stream of blood is obstructed or straitned many anatomical instances and observations manifestly declare From thence it appears The vessels are stuffed with concretions resembling the Polypus that grumous or as it were carnous concretions of the blood do frequently so stop the ventricles of the heart and the roots of its larger vessels that the course of the stream of blood is almost entirely stopt Moreover reason perswades and experience concludes this more frequently to happen in the lesser vessels for seeing as we have even now intimated the blood emitted by Phlebotomy in Rheumatisms Peripneumonies and Pleurisies when it is cold is covered all over with a thin skin altogether of the like substance with those concreted Polypus's it plainly appears that it passes with difficulty through the passages of the lesser vessels by reason of those viscous excrements wherefore that it may pass by some means it distends them very much and sometimes breaks quite through them also it frequently unlocks their mouths and opens gaps into the Trachea insomuch that portions of the extravasated blood are by coughing frequently ejected We have known some to have died Asthmatic or short-winded whose Lungs being free from an Ulcer or any more grievous wound have swelled so much that they wanted room for their motion within the cavity of the Chest the reason whereof doubtless was that the thicker and more feculent blood for that cause not easily passing through those vessels every where extended the Arteries and Veins and caused it to stagnate in the lesser Pipes Moreover the feculencies of blood one while salt of different kinds another while sulphureous or earthly being combined with them and thrust into the small passages of the vessels and fixed there do altogether obstruct them insomuch that the pneumonic circulation of the blood is contracted into a shorter space and consequently the function of breathing is straitned in the compressed Pipes or little Cells There are many kinds and sundry ways of such an obstruction which if all or the chief should be enumerated such a Pathology would swell into a too great bulk 3. The pneumonic passage of blood is not only hindred by reason of the passages shut and obstructed but sometimes also being burst asunder For those vessels being small The blood is also hindred because the passages are burst asunder as in spitting blood or tender or very loose in some persons are frequently opened by the force or acrimony of blood so that the blood either bursting into the Trachea is ejected by spitting or heaped up in the interspaces of the passages causes a Peripneumony or falling down into the cavity of the Chest produces an Empyema Of all these we shall treat singly in the Chapter of spitting of blood 3. One impediment of the blood is want or default of air There remains as yet a third impediment of blood in the pneumonic passages which happens for the want or fault of Air. If at any time the Blood is not kindled after a due manner within the passages of the Lungs from air breathed in by the Trachea for that cause as presently its flame is irregular so likewise its motion is variously stopt or perverted for although the blood is forced through the lungs by the meer impulse of the heart notwithstanding the pulse hereof is proportioned according to the tenour of its being kindled by the air wherefore when the flame of blood is diminished or supprest for want or through the fault of the air presently the pulse proves languid or unequal and by reason of the bloods course being troubled or stopt presently a paleness and coldness succeeds wholly intercepted or frustrated because the nitrous particules are wanting presently the pulse ceases and anon life is lost The reason of all which is both because the blood being much impeded in its accension or extinct like Must given over working presently subsides and is unapt for any motion and chiefly because the flame of the blood failing and being substracted from the brain presently the Hypostasis of the animal spirits as it were light streaming from thence immediately fails and together with it the exercise or actions of all faculties do cease But if the blood is too much kindled the Sulphur of the Blood and the Nitre of the Air running together more than it ought for that cause presently that this too much burning may be eventilated enough the pulse of the heart is increased to its utmost We might adde many instances of this kind but truely this consideration of the blood leads us to the second thing proposed of Respiration hurt namely that we may duely weigh what sort of failings or defects do happen about the inspiration as well as expiration of the Nitrous air requisite for the preserving the nitral flame of blood that is to say from what causes they proceed and also what effects they are wont to produce in which search we will first treat of Inspiration hurt SECT I. CHAP. III. Of Inspiration hurt BReathing is accounted hurt Breathing hurt by the vicious qualities or defect of air when its use is frustrated or any ways hindred which most frequently happens by reason of the fault or defect of the Air drawn in As to the former if the Air chance to be depraved it neither duely kindles nor eventilates the blood yea it sometimes overthrows the temperament thereof or infects it as is every where seen in a Constitution of Air very malignant That we may touch on the chief reasons of these distempers The faults of the air we are to observe That as the Nitrous particles of Air are chiefly necessary as is manifest by manifold experiment for the preservation of life so frequently it happens that Nitre of the Air either to sail or be wholly wanting or by particles of another kind to be so much muffled or bound up that they cannot enough exercise their vital power or lastly malignant or fatal Corupscles to be adjoyned thereunto First the nitrous particles of Air are deficient if when it stagnating or growing hot the Nitre is chased thence or not stirr'd into action Wherefore in a low-roost Chamber or too close and in other places crouded with assemblies of men or made hot with the ardor of the Sun we difficultly or weakly breathe The same comes to pass in places of great height on the tops of those mountains exceeding the top of the Atmosphere wherein breath is faintly drawn for want of Nitre neither can we live long there
the Lungs were free from any Ulcer yet they were set about with little swellings or stones or sandy matter throughout the whole for from thence the blood because it could neither be freely circulated in the Praecordium nor animated enough by the nitrous air and when in the mean time it is perpetually polluted by its proper dregs deposited in the Lungs is frequently vitiated and made incapable of nourishing thereby wherefore a Phthisis is better defined that it is a withering away of the whole body arising from an ill fromation of the Lungs The Ancients following Hippocrates The cause assigned by the Ancients for the most part have assigned only two causes of this disease viz. a Catarrh and the breaking of a Vein to which some have added an Empyema and others exclude a Catarrh from this number for what is vulgarly affirmed that flegm falling from the Head into the Lungs and abiding there putrifies is most commonly the cause of a Phthisis or is often brought by it we have formerly intimated to be altogether erroneous and shall presently shew it more clearly In the mean time to shew what the matter is that generates a Consumption as often as it arises without an Empyema or Haemoptoe going before What the consumptive matter is it must be considered after how may manners and by what ways any thing disagreeable or heterogene can enter into the Lungs which diligent search being made it will easily appear that any thing that is an enemy to the Lungs creeps in and is admitted chiefly either by the Trachea or by the pneumonic Arteries By what ways it enters the Lungs yea and sometimes haply by the Nerves but nothing by the Veins or Lymphaeducts whose function is only to carry back or away the blood or Lympha and to leave there nothing at all As to the Trachea it is manifest it is ordained for this end that by its passages or pipes the air might be conveyed in or presently carried back by a constant recourse from whence it comes Sometimes by the Trachea yet not destilling from the head moreover whether any matter being hurtful or mortal to the Praecordia may be admitted the same way shall be now our present disquisition And that the Lungs frequently incur a pernicious pollution by this entrance is clear from hence because the moist air of some regions repleat with fumes or abounding with malignant vapours doth frequently induce the consumptive inclination nevertheless the affection thereof is wont to be communicated only by aerial minute particles whereby either the temperament of the blood or the conformation of the Lungs or both are prejudiced But whether besides this a serous matter or some humor corrupting the Lungs doth enter them through this passage is not without reason doubted although many do determine a Catarrh or a destillation of the Serum from the Brain into the Lungs by the passages of the Trachea the principal cause of a Phthisis Which opinion being erroneously delivered by the Ancients I admire any either of our modern Physicians or Philosophers have admitted thereof for it is manifest by anatomical observations that nothing from the Brain by the Glandula pituitaria which seems the only passage from thence falls down into the Palate or Breast but that the Serum there deposited is conveyed by appropriate passages to the jugular Veins and is remanded to the blood Moreover it is manifest to sight that whatsoever relique of Serum is laid aside in the Glandules of the Ears Mouth Nose or Face is conveyed from them all by peculiar passages insomuch that no humor whatsoever destils from the Brain or the Palate into the Lungs But although matter exciting a Congh doth not destil from the Head by the Trachea into the Lungs yet sometimes falling down from the sides of the Trachea into their cavities But sweating out of the sides of the Trachea it produces that disease commonly called a Catarrh For the Aspera Arteria like the Arteries beinging blood are endued with a nervous and musculous Coat and so do occasionally enjoy sense and motion having also a glandulous Coat and full of little vessels to sustain the vital heat and nourishment These last Coats make those interspaces and as it were cover the Cartilages Moreover the superfluous serosities proceeding from the blood watering the Trachea are deposited into this glandulous Coat which for the most part presently sweating into the cavities of the Trachea serves chiefly to make them slippery and most but if the mass of blood be poured out too much and precipitated into serosities as it frequently happens a cold being taken or the swallowing down of acid things and on many other occasions for this cause a great plenty of watry matter sweats out of the Glandules of the Trachea and mouths of the little Arteries into its cavities which soon doth cause a most troublesom Cough and often much spittle which afterwards comes to be consumptive But surely this cause of Spittle and as it were a Catarrhal Cough very rarely comes alone The consumptive matter brought into the Lungs rather by the pneumonic Arteries because while the blood watering the Trachea having suffered solution throws in its serosities into the Glandules whence presently they sweat into its cavities and also the remaining blood being in like sort dissolved it insinuates its Serum set apart within the pneumonic arteries partly into the tracheal hollownesses and partly into the Lympheducts by the overflowing whereof the Lungs are as it were overwhelmed and much incited for the most part provok'd to Cough and continual spitting A Cough and spitting of this kind as long as moderate A Cough and spitting sometimes healthful only throwing off the serosities of the blood rather are beneficial than prejudicial because the mass of blood and the very lungs being throughly purged after this sort those symptoms for the most part spontaneously abate and from thence ensues a more perfect health But if they be protracted a long time the serous humour being on both sides laid aside into the tracheal passages and from thence more plentifully daily heapt up at length it will change into corruption because as well the free enjoyment of air is impeded as also the motion of the blood and its temperature wholly perverted from hence a Cough becomes more fierce and breathing more difficult nay rather the whole mass of blood in as much as it is defiled by the foul blood which the Veins receive from the Lungs degenerating by degrees from its benign properties and being depraved it not only continually pours forth the super fluous Serum but also the nutritive Juice which it cannot assimilate out of the pneumonic Arteries into the tracheal passages Yet often being too much is dangerous and so this mass of consumptive matter is daily increased till the Lungs being more and more obstructed and filled and the blood being defiled and rendred unfit to perform any of its functions the Cough
Very many of these being endued with a narrow breast and a neck somewhat long and of a constitution very tender contract a Cough from the least occasion neither can they endure a cold or moist air To some of these a mansion in a City is very prejudicial where the air is breathed in thick and smoaky on the contrary to others prone unto the same disposition it is very friendly the reason whereof we shall diligently inquire hereafter To all of them a North-wind is for the most part an enemy considering that it usually irritates a Cough also a Spitting of blood a Pleuisie or Peripneumony viz. the pneumonic or the thoracical Vessels being thereby stufft and in the mean time the blood being rendred more rurgid and sharp by reason of transpiration hindred and the effluvia's restrained within the mass thereof For an hereditary disposition to a Phthisis doth chiefly consist in these two things In what it consists viz. 1. In regard the Patients being endued with a more sharp and elastic blood do require a more plentiful transpiration which perhaps if it be less granted the matter that was wont to evaporate redounds upon the infirm Lungs 2. If the pneumonic Vessels be too loose and tender they do not duly contain the Serum and other recrements of blood within the dissolved mass thereof but they sometimes suffer both them and a certain portion of the blood it self to break out into the Tracheal passages whose moving Fibres when they are infirm do not presently turn forth what is poured out into the cavities but they suffer it to abide and putrifie in the same place and at length to degenerate into black filthy gore corruptive both of the Lungs and blood 3. What the consumptive diseases of the breast are A Phthisis is sometimes the product or consequent of some other previous distempers of the Breast Those consumptive passions chiefly are Empyema's Pleurisies a Peripneumony and Imposthume of the Lungs and sometimes the small Pox Measles also irregular Feavers ill or slightly judged do cause the same effect The chief of these distempers or at least those which are proper to the Thorax together with the rendring the reason of the causes and how they dispose to a Consumption shall be declared hereafter with the reasons and manner of procedure in the mean time we are to take notice that this kind of fault is common to them all that is to say they dissolve the unity and weaken the tone of the Lungs and pervert the temperature of the blood whence whatsoever incongruous or distempered thing is poured out upon them from its depraved mass they do easily admit thereof and difficultly or not at all drive it back 4. The influence of the air for exciting a Consumption The procatarctic causes of a Phthisis being now explained viz. those which consist as well from the blood as the Lungs there is another common to them both which may be justly added and although altogether extrinsec hath great affinity with them both viz. the condition or temper or the air breathed in For such is the influence hereof to some consumptive persons that the cause of the disease is sometimes wholly ascribed to the incongruity of the air wherein they dwell and for a cure the alteration of air or soil is preferred to all other remedies whatsover Hence many of our Country troubled with a Cough or being in a Consumption flock to the Southern parts of France and others in the mean time who cannot go beyond Sea or will not presently hasten to remove out of the City-smoke into the Country as to a most undoubted refuge wherefore all our Villages near London which injoy a clear and open air are esteemed as so many Spittles for consumptive persons Notwithstanding all do not alike receive help from such a change of places for many either passing to France or to Country Villages do in those places rather find their graves than health And therefore London is not presently to be forsaken by all phthisical persons for I have known may obnoxious to a Cough or Consumption to have enjoyed their health much better in this smoaky air than in the Country So that for cure of the same disease while some avoid this City as Hell others flye to it as to an Asylum The reason of these things do clearly appear out of the Doctrine of Breathing before handled The grosser and City-air to some consumptive persons healthful to others hurtful for we do demonstrate the blood passing through the Lungs both as to its kindling or vitality and as to its motion doth chiefly depend on nitrous air suckt in whence it is a consequence that the tenor of this ought to be so proportioned to the temperament of that that the blood being moderately kindled within the Pracordia may burn out clearly and vigorously The reason whereof is inquired as well without smoak and sootiness as without too intense a flame and that it may pass the pneumonic Vessels freely and without any hindrance or leaving of recrements Wherefore a moist and close air as it is healthful to none so to them that cough it is especially hurtful on the contrary a serene and mild air moderately injoying the Sun and wind as it is healthful to all persons so it is friendly to all consumptive persons As to other conditions of the air some escape a Cough or lose it living in mountainous places exposed to the Sun where the impendent Atmosphere being free from all thick smoaky and feculent vapous whatsoever abounds with nitrous particles for those whose thick and feculent blood abounds with an impure Sulphur to kindle this duly and to waste the dregginess there is need of a very thin and nitrous air If the Lungs be not too tender but firm and strong they endure the more fierce assaults of its particles on the other side they who have a thin and subtil blood easily dissolvable and endued with a more pure but very little Sulphur and having tender and soft lungs very sensible and of a finer texture these persons being impatient of a nitrous and sharper air are most at ease and best in a thick and more sulphureous one Wherefore it conduces to these persons that they breathe the gross and more fat air of a smoaky City which to an impoverished and more thin blood doth afford Sulphur which fails sometimes and also Nitre and doth something thicken and fix its subtile consistence moreover it dulls the substance or texture of a Lung too much sensible and more thin and is a defence against the invasions of a more sharp and improportionate Air. A sulphureous air healthful to some consumptives It is manifest by frequent experience that a thicker Air provided it be sulphureous proves very benign to some phthisical persons that I do not say to all It is a common observation that a Consumption seldom infests those Regions either in England or Holland where fires
are nourished by turffe and do breathe a very sulphureous odour yea rather those places are chiefly wholesom and frequently sanative to persons obnoxious to a Phthisis or labouring under it To which we may add that a suffumigation of Sulphur and Arsenic which is filled with much Sulphur is reputed for the curing of almost incurable Ulcers of the Lungs although the last yet the most efficacious remedy Sulphureous Medicines chiefly agreeing Moreover add to this that pectoral Medicines prepared of Sulphur are far to be preferred to any other so that Sulphur is justly reported by Chymists to be the Balsam of the Lungs By what order and by what means these Medicines do work and so notably help in diseases of the Thorax we shall hereafter make diligent search into in the mean time that sulphureous Air is found helpful to certain phthisical persons the reason consists in these two things viz. in the first place as we now intimated from such an Air suckt in there is help brought to the jejune and depauperated blood and to the tender Lungs Secondly that the sulphureous Particles being suckt in with the nitrous do provide against The reason thereof discoursed or take away the acidities of any of the humours by which their flowings and extravasations into the Lungs do chiefly arife And for this reason it is that sulphureous Medicines being also taken inwardly do confer so excellent a help to them that cough or are phthisical therefore Sulphur as I now hinted hath the report of being the Balsam of the Lungs For as balsamic things applied to an Ulcer or Wound extinguish the acidity of the Ichor there sweating out and corrupting and paining the little Fibres soon ease the pain and afterwards heal the wound so also the sulphureous Particles passed into the Lungs either with the air or with the blood in as much as they provide against or abolish the acidities of all humors i.e. the blood the Serum the Lympha the nervous or nutritive Juice they conduce to the prevention or cure of a Consumption We shall in what follows more at large declare the cause when sulphureous Medicines shall be particularly treated of The conjunct and procatarctic causes of a Phthisis being thus handled it will not be necessary to discourse much touching the evident causes For in what manner a closing of the Pores by cold a surfeit or tipling and other errours of several sorts in the six non-naturals dispose to those distempers and sometimes presently do bring them The three times or distinct states of a Cough is so clear that it needs no explaining Neither is there any reason we should be long delayed about the Semiotical part of this disease nevertheless it is fit we observe the divers states or distinctive signs which certainly belong unto it 1. When it is meerly a Cough 2. When it begins to degenerate into a Phthisis 3. When it is a perfect and almost desperate Phthisis From which things duly designed the Prognostic of the above-mentioned affections will be very apparent 1. And in the first place what belongs to a new Cough and as yet alone When new there is no suspicion of a Consumption this taking its rise from any cause whatsoever in bodies predisposed to a Phthisis will scarce ever be free from the suspicion of danger but in a strong man and one who hath often before endured a Cough Scot-free it will not be immediately to be feared for when being stirred up from a more forcible evident cause without Feaver or indisosition of the whole body it shall not be very troublesom then it meerly passes for a cold being taken and is altogether neglected or in a short time is wont to be finished without many or very considerable Remedies Moreover if a small Feaver with thirst and want of appetite accompany this there is hope that the blood being restored to its due temperament the Cough then will cease of its own accord but if it be protracted longer and not easily yield to vulgar Remedies and produces much spitting and that discoloured it must not be any longer neglected but be provided against by a method of healing and by fit remedies and an exact course of diet For then it may well be suspected that the Lungs being prejudiced in their structure do not circulate the blood entirely but let fall the Serum and Lympha and frequently the nutritive Juice and moreover those humors so laid aside do putrifie and from thence the blood is defiled which by a reciprocal hurt prejudices again the Lungs 2. When it begins to induce a Consumption But if to a Cough growing daily worse and worse with plentiful and thick spittle a languishing and pining of the whole body loss of appetite difficult breathing thirst and fervent heat of the blood be added there is great cause of suspicion that it is come at least to the first limits of a Phthisis if not further Wherefore it will behove us to use all means whereby the Lungs may be freed from the great quantity of matter heaped up together and be defended from its continual assault or invasion and also that the mass of blood may be cleansed from all dregs and restored to its due temperament whereby it may rightly contain its serosities and other humors within it self or transfer them to some other place than to the Lungs 3. When it becomes a confirmed Consumption But if beyond the state of this distemper now described plenty of spittle and that discoloured shall be daily increased and all other things growing worse and worse a dejection of the whole strength and a hectic Feaver with a continual thirst night Sweats an Hippocratical face an utter decay of the flesh almost to the driness of a Skeleton happen upon all these then for the most part no place is left for Medicine but only a dreadful prognostic at least all hope of Cure being waved we must insist upon Anodynes whereby an easie death may be procured What therefore belongs to the cure of a Cough in general The curing method and first against a beginning Cough according to the three above-mentioned states of this disease a threefold method of healing ought to be appointed viz. that bounds as it were being set we may more distinctly prescribe what is to be done for the cure of a Cough whilst being on this side the limits of a Phthisis it passes only for a cold catched 2. What manner of healing to a beginning Phthisis 3. What to a Phthisis consummated or desperate 1. Although against a new Cough for the most part there are used only Remedies Empirical and scarce any of the common people but are furnished with many and divers of this sort which every where without the advice of a Physician very many confidently take and without method and give them to others yet men of a delicate constitution or inclining to a Consumption hereditarily or sometimes formerly
dram to be strewed upon burning coals Take Gum of Ivie Of the more strong Frankincense of each two drams Flower of Brimstone one dram and half Mastich one dram with a dissolution of gum Tragacanth form Troches Take of white Amber Arsenicals Olibanum of each two drams prepared Orpiment half an Ounce Styrax Labdanum of each one dram and half with solution of Gum tragacanth make Troches for fumigation Mountebanks do ordinarily prescribe the smoak of Arsnick to be suckt into the mouth Smoak of Auripigment like Tobacco kindled in a Pipe and sometimes with good success Moreover it is in practice with the Vulgar to burn like Tobacco in a Pipe little bits of cloth stained with Arsenick such as wherewith the walls of Taverns are hung and so suck the smoak into the consumptive Lungs for cure 3. Of a confirm'd Consumption These things being thus unfolded concerning a Cough and a Phthisis beginning both as to what belongs to the Pathologie and cure it remains now lastly to discourse of a more painfull Phthisis confirm'd and almost desperate and to consult what is to be perform'd when the lungs being very much vitiated and affected with one or more filthy ulcers neither the air nor the blood do rightly pass through them but choak or corrupt the mass thereof by continually suggesting filthy corruption insomuch that a hectick feaver and an Atrophie by reason of nourishment being frustrated infest the diseased with the loss of all their faculties and by daily weakening their strength precipitate them to the grave The most certain sign of this disease growing desperate uses to be accounted a pain very troublesome with an inflammation of the throat for this symptom argues a great putrefaction of the lungs from whence the putrid effluvia's exhaling are thrown about in the narrow passage of the throat The formal reason thereof which wound and grievously irritate those tender fibres there In this case the cleansing of the lungs as also the drying up of the Ulcer are in vain designed for all hotter Medicines ordain'd for those purposes and fit enough in the beginning of a Phthisis are not to be endured in a confirmed one inasmuch as augmenting the inflammation of the lungs they procure a hectick feaver thirst wathings and other more painfull symptomes or call them back afresh For truly in such a state of this disease where onely the prolongation of life is proposed with a light toleration and an easie death those remedies help chiefly which bridle the fervour of the blood allay the heat in the Praecordia and restore the sprits and gently cherish them Hence for food Asses Milk also Water-gruel Barly-broths Cream of Barly and for drink Ptisan Emulsions water of milk distilled with Snails and temperate pectoral herbs are usually of greatest success Forms of remedies in a desperate Consumption Syrups and Linctus's which appease the inflammation of the throat and Lungs and facilitate expectoration but chiefly the more mild Hypnoticks whereby moderate rest may be procured may be frequently or daily taken The forms of these are common enough but however according to our method we will annex some of the more select of each kind Take of Barly half an ounce Decoctions candied Eringo roots 6 drams parings of Apples one handfull Raisins stoned two ounces Liquorish three drams boyl them in three pints of spring-water to two make a Ptisan to restrain thirst take it 3 or 4 times a day also in the room of ordinary drink if it agree Take the tayls of twenty Crevises candied Eringo roots one ounce a crust of white-bread Raisins stoned two ounces Liquorish 3 drams boyl them in 3 pints of Spring-water to two strain it and take 3 or 4 ounces three times a day After the same manner is prepared the Decoction of Snails Take of Snails half-boyled and cut three pound Distilled waters ground-Ivy 6 handfulls Nutmegs sliced numb 6. crum of white-bread two pound fresh milk 8 pounds distill it in a Pewter Still The same way is distilled the water of Crevise-tayls The dose 3 or 4 ounces three times a day Hypnoticks sweetned with pearl'd Sugar or Sugar of Roses Take ears of greeen Wheat as many as convenient distill them in a common still drink three or four ounces three times a day sweeten'd with pearl'd Sugar Take syrup de Meconio three ounces water of green Wheat 6 ounces mix them Hypnoticks drink two or three spoonfulls at bed-time every or every other night Take Conserve of Mallow-flowers wild or garden three ounces Lohoch de pino two ounces Eclegma's Syrup of Jujubes two ounces make a Lohoch of which take often a dram and half or two drams What hitherto we have discoursed of concerning a Cough of every kind whether it be solitary and simple or the forerunner and companion of a Phthisis also what is to be prescrib'd in every case touching the method of healing it would be easily illustrated by the history of Cures or by the Anatomical observations on those that have dyed by that disease For instances of this sort and very many examples are every where had and happen daily it pleases us here to annex a few of the more select out of the large choice of these accommodated to the chief kinds of a Cough and Phthisis And first I will endeavour to illustrate the type of a simple Cough by one history or two and which takes its rise of it self and is altogether void of the suspicion of a Phthisis It is now many years since I took care of the health of a certain Student The History of a Cough threatening a Consumption obnoxious to a Cough from his tender years and who was wont frequently to undergo the more painfull affections of it and those of long continuance This person seemed of a melancholick temper of a sharp wit of an indefatigable spirit of a constitution indifferently strong but that his Lungs originally being infirm did suffer when the blood dissolv'd into serosities In Summer as long as he transpired freely he lived healthily enough but in the Spring and Autumn when the blood changing its temperament those serous fluxes came upon him either of their own accord or from any sleight occasion he fell easily into a Cough with abundant and thick spittle notwithstanding this distemper frequently within six or seven dayes as soon as the mass of blood was purged throughly by the Lungs vanished leisurely without any great use of remedies But if to the aforesaid occasions of this disease were added some stronger causes as chiefly the obstruction of the pores and errors touching his diet sometimes a more prodigious and stubborn cough neither presently nor easily yielding to remedies and threatning nothing less than a Phthisis did come upon him then manifestly the patient for the first days suffered light shiverings in his whole body and the sense of a Catarrh in his Larynx afterwards by frequent
Nature as far as is possible to be presently sent out of doors But if the extravasated blood be thrown into the interspaces of the little Lobes or soaking out of the outer Membrane fall into the cavity of the Thorax it doth propagate an Empyema and frequently an Imposthume in that place But for the most part the blood subject to fall from the pulmonary course produces various kinds of bloody spittle Either in the Larynx or in the middle of the Bronchii or in the orbicular little bladders according as it makes its nest either upwards within the cavity of the Larynx or a little beneath about the intermedial passages of the Trachea or lastly further within the orbicular little bladders The first distemper proceeds alone from the mouths of some Artery being opened which covers the trunk of the Trachea the next sometimes perhaps from this cause yet more often from the pneumonic Arteries themselves being open or burst asunder which vessels as they are greater pour out often a dreadful quantity of blood the spitting out whereof proves plentiful and violent in regard that the muscles of the whole breast together with the fibres of the Trachea are much provoked and greatly contracted But if the spring of bloody spittle consists in the lowermost little bladders the blood is thrown out more sparingly but with a profound frequent and very troublesom Cough 3. And from hence which was in the third place purposed the differences of bloody excretion out of the Lungs and the manifold modes and courses of bloody spittle are made known For the blood soaking into the Larynx after a small tickling in the throat without coughing or hawking doth easily and almost insensibly ascend into the mouth and if an extravasation of this kind of blood happens in sleep it presently flows out of the mouth upon wakening they being scarce sensible of it in as much as the moving fibres of the Trachea being contracted while one sleeps have then emptied the blood fresh distilled into the mouth But if from a greater vessel gaping or burst about the middle of the Lungs the blood which is ever frothy does break out abundantly into the Tracheal passages this by an outragious Cough raised thereby is forthwith cast upwards with violence and in great plenty insomuch that the sick seem rather to vomit than cough out blood And finally if the blood breaking out of the foldings of the vessels wherewith the orbicular little bladders are incompassed falls down into those little cells from thence it is discharged by turns in lesser quantity and not unless by a strong and very frequent Cough So much concerning the formal reason The procatarctic and evident causes thereof the conjunct causes and differences of an Haemoptoe as to what belongs to the primary and evident causes either of them are manifold and various In the former number are reckoned first an hereditary indisposition of the Lungs whenas they have originally been weak and soft with a straitness of the breast Moreover their ill temper from a Cough Empyema or Pleurisie going before and especially an obstruction or ill conformation do very much dispose to spitting blood and so much the rather if in such a habit an acrimony or Dyscrasie of the blood shall accrue from an ill course of Diet unwholesom Air or by any other means The suppression of the Menstrua the Haemorrhoids or blood flowing from the Nostrils incline most to a spitting blood Secondly among the evident causes ought to be reckoned primarily the excess either of heat or cold for when the blood grows above measure hot or the transpiration thereof through the Pores of the skin is hindred thereupon swelling after a huge manner it frequently bursts out of the pneumonic Vessels From hence Hippocrates long ago observed and as yet it is a vulgar observation That spitting blood most frequently happens in the winter when the North-wind blows Neither less seldom hath the use of bathing brought this evil upon many before the use whereof they were healthful enough Moreover many contract this from drinking of wine and strong waters from a blow a fall hollowing vomiting coughing or any other violent stirring of the whole body or of the Lungs Also certain poisons and according to Hournius the Lunar beams the reason whereof doth not easily appear neither doth there remain any credit thereto are reported to provoke this distemper The Prognostics of this disease are enough known to the vulgar The Prognistics of this disease whereas there is not any one of them who doth not suspect the spitting of blood as very dangerous Nevertheless whereas the kinds hereof are various one is found more or less dangerous than another The blood soaking out of the vessels of the Trachea is often free from any evil moreover when breaking out from the lowest and lesser pulmonar Vessels it often admits of Cure at least it is much safer than a plentiful spitting of blood happening from the great branches of the Artery being opened into the Trachea But the predisposition of the Patient makes a great difference in the Prognosticks of this disease for if blood-spitting be provoked by reason of a solitary evident cause and shall happen to a body formerly sound and well set there appears far greater hope of help than if the distemper arising of its own accord shall happen to a cachectical phthisical scorbutic or otherwise sickly body However 't is a common observation that this disease is dangerous and always difficult to cure the reason whereof is also clearly manifest for as much as the function of the Lungs consisting in a perpetual motion is altogether contrary to the method of healing a wound whereto primarily ease and rest are required In like manner this happens to be a greater hindrance to its Cure in as much as the frame of the Lungs is not a Parenchyma as was thought but a texture or very subtile web of innumerable vessels the unity whereof if once dissolved it will be altogether impossible for the ends of the disjoined vessels to meet again together or the space to be filled up with flesh or callous as in other parts But there is this only to be hoped that while the ends of the vessels grow together incongruously and always imperforated the circulation of the blood ceasing in the part distempered may be supplied by another neighbouring part which indeed rarely succeeds without hurt or prejudice of the whole Lungs As to what appertains to the Method of healing the Haemoptoe or spitting blood The Cure thereof the curative indications shall be chiefly these two viz. to stay presently and restrain the flux of blood then secondly to heal the dissolution of unity without any relicts of a Consumption in the Lungs I. As to the former these two things are chiefly to be procured 1. Indication viz. first that blood flow not to the part distempered and secondly that in the mean time the opening of the vessel
of a defect of fault in the motive organs or mixt when either parts conspire in the fault which origine every great and inveterate Asthma is wont to have of each of these we will treat in order 1. The ancient Physicians The Ancients allowed the cause of it only from the Bronchia obstructed and for the most part hitherto the Moderns have only acknowledged the first kind of Asthma judging the next cause and almost the only cause of this Disease to be the straitness of the Bronchis viz. inasmuch as the spaces of those passages being either straitned together by obstruction or compression as often as the use of breathing is required do not admit of plenty enough of Aire wherefore for the more free inspiration of aire as shall be needfull the organs of breathing do most difficultly labour with throes most frequently repeated But that some are found obnoxious to fits of an Asthma Or vapours from the Spleen or Womb but erroneously without manifest taint of the Lungs it was wont to be ascribed to vapours from the Spleen Womb Mesentery or some other bowel undeservedly enough but surely that passion without the straitness of the Bronchia or fault of those bowels we have in another place sufficiently evidenced to arise from Cramps of the moving parts and shall be presently clearly made out But in the mean time by what means it may arise also from the passages of the Trachea obstructed or compressed it lyes upon me to declare The straitness of the Bronchia After what manner the straitness of the Bronchis arises inducing the first kind of an Asthma is supposed to come to pass by an obstruction as often as either thick humours and viscous or purulent matter or blood extravasated are forced in upon them or that little swellings or Schirrus's or little Stones stop up their passages or finally that a Catarrh of a serous humour suddenly distills upon them Moreover the same distemper is thought to be raised by compression as often as matter of that kind and of every kind of them shall cleave to the passages of the pneumonic Arterie or vein Surely an asthmatical disposition depends upon these various causes and manners of disturbance but all invasions of the disease or at least the greater fits are usually provoked by reason of some accidents or occasions For while the stream of blood sliding and running down gently can be content with a small breathing it passes through the precordia without great labour either of Lungs or Breast But being boyling and passing through the Lungs more impetuously it requires a more full inspiration of aire for the freer admittance of this through strait passages presently all the breathing organs are alarmed into most frequent throes Whatever causes an effervescence of the blood is the evident cause of an Asthma Whatsoever therefore makes the blood to boyl or raises it into an effervescence as violent motion of the body or minde excess of extern cold or heat the drinking of Wine Venery yea sometimes mere heat of the Bed doth cause asthmatical assaults to such as are predisposed It is usual that those who are obnoxious to this disease oftentimes dare not enter into a Bed only sleep in a Chair or on a bed being covered with garments The reason whereof is Why Asthmatical Persons are worse in bed that the body covered and heated with bed-cloaths the blood being a little raised into a more quick motion and grown hot requires a more plentifull sucking in of air than may be supplyed from the passages of the Trachea being straitned for the more blood passes the Lungs each Systole and Diastole by so much for the enkindling and eventilation thereof the air ought to be more plentifully and quickly brought in and sent forth to which task when by reason of impediments it is not easily dispatched yet in some manner to be performed the ultimate endeavors of all the parts appointed for breathing are made use of with a great contention of the whole breast Moreover the blood being stirr'd is not only an occasion but also in some part a cause in those that are asthmatically predisposed for the vessels bringing blood being thereby more fill'd and distended within the lungs compress the Tracheal passages being already very strait and render them much more close II. A convulsive Asthma which we judged to be the second kind of this disease A convulsive Asthma and to be raised without any great obstruction or compression of the Bronchia from the mere Cramps of the moving fibres is not limited to one place or to any peculiar organ but being of a diffused energy it is extended to almost all the parts employed in breathing whereof one while this another while that or some other is in fault It s Seat manifold and diffused For a convulsive affection inciting an Asthmatical invasion hath regard to the moving fibres of the vessels of the Lungs to the Diaphragma to the muscles of the breast to the Nerves which belong unto the Breast or Lungs nay to the origine of those Nerves planted within the Brain and whilest the morbisic matter dwells in every of these places hindering or perverting the work or breathing it brings on the fits of this Disease as in another Tract we have somewhile since plainly demonstrated For the animal Spirits destin'd to the function of breathing if at any time they are very much molested and constrained into irregular motions enter inordinately into the fibres as well nervous as moving of the organs of breathing and make them for that cause one while to be contracted another while to be distended irregularly as also their solemn and equal turns of Systole and Diastole to be variously disturbed or hindered The morbific cause or matter provlking the Spirits prepared for the pneumonic work as in divers places so chiefly in these three The morbific matter consists in several places is wont to advance its force or power viz. 1. Either in the muscular fibres themselves or 2. In the branches or nervous slips or lastly within the Brain by the origine of the Nerves 1. As to the former 1. In the muscular fibres the heterogene matter being inimical to the Spirits is sometimes shaken off from the Brain into the trunks of the Nerves and from thence by their passages and slips if perhaps it shall be in very little quantity without very great or sensible hurt slides down to their lower ends And when it falls in the nervous fibres and being heaped up daily shall at length sensibly increase unto a great quantity it begins to trouble the inmate Spirits and to provoke them into asthmatical Convulsions which forthwith infest and are encreased by reason of evident causes neither do they utterly cease untill the stock of matter so accumulated be wholly dispers'd and consumed afterwards when it being renewed arises to a fulness the fits of that disease return and are for that cause
by the common consent of most is judged to arise in as much as the yellow choler not at all or not enough received The Jaundies from the ends of vena porta into the passages of the cholerick pore overflows into the mass of blood and pollutes it with its greenness whereby also the very skin is discolour'd That obstruction is wont to happen after many manners and in various places The cause of it For sometimes it happens near the extream ends of either kind of vessels viz. the end of the vena porta and the porus bilarius the interspaces whereof happen frequently to be compressed and stopt by reason of the Parenchyma of the Liver being tumefied or otherwise vitiated wherefore the humour of the gall not being transferred out of the separating vessels of the porta into the other receiving vessels turns back upon the blood Secondly the passage of the humour of the gall is sometimes intercepted in the middle passages of the cholerick pore for that the cavities of these are filled either with a viscous or sandy and sometimes with a stony matter as is plainly discerned in the Livers of beasts in the winter senson while they are fed with hay and straw Thirdly it is also manifest by Anatomical observation sometimes an obstruction in the very bladder or the gall or in the cystic passage is the cause of the Jaundies for if at any time it being filled with stones receive not the choler or being here shut up or grown together it restrains the descent of the choler towards the guts that humour although well separated from the blood is constrained to flow black into the mass thereof and so propagates the Jundies Against this most received opinion by which it is judged The opinion of Sylvius of the cause of the Jaundies that the cause of the Jaundies for the most part consists on this side the vesica fellis or about it towards the Liver the most Renowned Sylvius altogether places it without this viz. in the Cystic or common passage For supposing the choler not to be separated from the blood within the passages of the Liver but in the very bladder of the Gall to be propagated of a humour brought thither by the Arteries He judged the greatest part being carried upwards by the passage of the pori bilarii to be poured into the blood for some notable uses and also another part to descend beneath to the Intestines also for necessary uses wherefore if this latter sluce be shut all the choler is carried upwards into the blood and filling it too much with this humour perverts it from its genuine temper into an Icterical But truly lest the stopping of the passage of the bladder or of the common passage neither of which easily happens or from any light occasion may seem less efficacious to excite any Jaundies therefore whether such an obstruction hath place or no the most Renowned man ingeniously supposes besides The choler while it is generated in the bladder does undergo sometimes a notable change by which it is moved and is born about more plentifully and impetuously towards the blood with which yet it is less mingled than is was wont to be but only confounded together with it and so more easily departs from it and infects and tinges the solid parts with its colour But that the choler in the Jaundies may be rendred unfit a mix with the other humours or to be nearly united he determines it to be done by a spirit too valatile mixed plentifully with it and so making it more spirituous and immiscible with others He confirms this assertion by two instances viz. in as much as the most spirituous poison from the biting of a Viper and the too much use of the more generous drinks viz. Wine and Strong-waters causes sometimes the Jaundies Moreover he endeavours to procure credit to this Hypothesis for that this disease is wont to be cured not only by medicines opening obstructioins but by them which blunt the force of a raging volatile salt of which sort are the decoction of Hemp-seeds also Venice soape with many other things of the same sort It belongs not to this place neither is it to our purpose to descend to end this contention nor dare I now rashly determine it since it hath tired so many Renowned Wits of the Moderns whether really the choler be made in the bladder of the Gall or whether it be only separated from the blood in the Liver the great organ of separation I confess this latter opinion best pleases me The Authors opinion And weighing these things seriously I am induced to think the cause of the Jaundies to consist chiefly in this that the choler being sever'd in the Liver is not by reason of the ways being obstructed at all or not enough conveyed to the bladder of the Gall but that it must of necessity regurgitate into the mass of blood notwithstanding in the mean while we deny not but this affect may sometime arise although more rarely from the Cystic passage or common pipe being obstructed But also we think the fault of the blood to preceed in part and perhaps sometimes wholly for the morbific cause when to wit from its sulphurous and fixt Saline Particles above measure exalted the choler is more plentifully or quicklier generated in the mass of blood than can be separated or discharged forth by the ordinary ways wherefore this separating every where from the blood with the Serum The cause of this disease sometimes in the blood is affixed to the solid parts and impresses its tincture upon them And without doubt it is for this reason that some poisons and chiefly the biting of Vipers and the dayly use of more generous drinks induces the Jaundies in bodies before sound for whose cure sometime Phlebotomie and medicines reducing the blood to a right temper are wont to profit more than those opening obstructions Moreover it seems for this reason that a tertian intermiting Feaver so frequently terminates in the Jaundies for we may not suspect the passages of the Liver can be by any means obstucted since in all fits so great an agitation of the blood and humours by cold and heat and such an-evacuation of them happens either by vomit or sweat and truly even as feaverish fits are caused inasmuch as the sulphurous part of the blood being too much advanced in the first place perverts the nutritious juice into a morbific matter and afterwards being inflam'd consumes and exterminates it so when the fixt salt is at last exalted together with the sulphur in the blood and for that cause meer choler is abundantly engendered the feaversh enkindling of the blood ceases by reason of the restrictive force of the fixt salt and in place thereof the distemper of the Jaundies doth succeed But as the blood being too much advanced to a sulphureo-saline distemperature causes the Jaundies in any though least predispos'd to it so in others
many senses together viz. it is a Tumour of the Abdomen First in respect of blood from a waterish tumour contained within the cavity thereof The water making this tumour sometimes encreases to a huge inundation and scarce credible quantity I have once seen a Tub would hold 15 gallons filled with water taken out of the Abdomen of a woman dead of a Dropsie But whence that humour proceeds also by what manner and from what causes it gathers together in the belly first and afterwards is sensibly augmented and lastly by what passages and by what vertue and operations of Hydragogue Remedies it may again be taken from thence and evacuated seems most difficult to be unfolded As to the former viz. the encrease of water It doth not always proceed from the Liver Spleen some have thought it to descend from the Liver and others from the Spleen distempered into the cavity of the Abdomen and so this bowel or that being vitiated always to be the cause of an Ascites But that this is otherwise Anatomies of many dead of this disease do manifestly declare when after the inundation of the belly the Liver and Spleen and found often without fault And truly these bowels do not seem the Springs of any such illuvies being endowed with no cavityes wherein waters might be accumulated together wherefore the origine of an Ascites as of a standing Pool or Lake is to be derived from a River or at least a glutt or inundation of some Humour The humours that flow within the passages or Vessels as Brooks The humours by which it is produced are are chiefly these three viz. the Blood the milkie Humour and the Lympha The showering or distilling of water may come to pass from the nervous Liquor which sometimes slowly and insensiby sweats out of the fibres and membranes and from vapours condensed within the hollowness or some Cavity of the Body Whether by these wayes an Ascites doth rather and oftener proceed we will now search And in the first place as to what relates to the blood it is without doubt First the Blood the Serum falling from the masse thereof too much dissolved as it doth excite Fluxions and Catarrhs of various kindes so it sometimes stirs up the greater illuvies of waters viz. Dropsical wherefore when an Anasarca proceeds altogether from this cause and when oftentimes an Ascites comes upon that disease not immediately heald we may well enough inferr that either distemper is induced from a watery humour every where poured out from the little mouths of the Arteries Moreover it is not much improbable that the Serum of the dissolved Blood is first and solitarily poured out of some end of the Coeliac and Mesenteric Arterie being open into the Cavity of the Abdomen and so brings on an Ascites without an Anasarca going before and so especially if perhaps it happen that scirrhous Tumours Ganglion's little swellings or preternatural Concretions of another manner are first raised about the Mesentery the Spleen the Liver the Womb or any of the other bowels of the nether belly for because the Circulation of the blood is hindred in those places that the blood being carryed through the arteries may be some way brought back the serous part being thrust out from its company falls into the cavity For truly it is most evidently manifested that it so comes to pass by this Experiment mentioned by us in another place viz. If in a living animal the jugular veins being taken up and bound with a thred the reduction of the blood be stopt the whole Region of the head swells in a short space with a water between the skin and clearly hydropical And truly I have more frequently observed that an Ascites hath followed upon secret tumours gathered and raised in some place in the lower belly which certainly happens for the reason above recited When the course of blood being obstructed the watery part is extravasated in a short space that humour is not meerly serous but besides the nutritious Liquor ordained to nourish all the solid parts is emptyed into the belly wherefore while this Region swells up the members are extenuated and the Lympha taken out from an Ascites with heat thickens and grows white like the white of an Egge It is also very probable 2 3. The milkie and watery humour that the milkie Vessels being burst asunder pour out their humour into the cavity of the abdomen Truly the most renowned Sylvius thought this disease most frequently engendred from such a cause And truly as out of the milkie or watery Vessels viz. one of them or both together being divided or opened we may well suspect the illuvies of water or chyle sometimes to overflow the bowels of the nether belly so the following observation seems to confirm the same thing Of late one that had been long sick of the Jaundies and in the mean time temperate and abstemious of drink to which he was not prompted by thirst contracted an Ascites increased in a short time hugely After that medicines were administred in vain a Paracantesis is attempted according to the manner of Sylvius with a hollow Needle out of the orifice not icterical water but limpid and thin flowed out abundantly from whence we may inferre that hydropic humour flowed not out of the mass of blood for then it had been coloured but distill'd out of the lymphic or milkie vessels into the cavity of the abdomen We have joyn'd together as akin the ways of the milkie and lymphic Vessels in propagating an Ascites because both vessels do convey the chyle or what is analogous to it to the common Receptacle and many branches or leading Pipes of either kind are distributed about the bowels of the nether belly in the mean time it is not improbable but that a solitary fault of either vessel may sometimes produce an Ascites As to the other wamys of generating an Ascites proposed in the beginning I am scarce induced to think such an inundation of the belly can easily arise from the distilling of a nervous humour or by reason of vapours there condensed although perhaps in a Tympany where the cavity of the abdomen is enlarged and transpiration hindred the effluvia that were wont to exhale being forced inwards are changed into Lympha or water wherefore for the most part an Ascites is ever conjoyn'd with that disease The immediate or conjunct causes of an Ascites being design'd after this manner An Ascites often the product of the Jaundies which indeed seem to be either a watery humour poured out of the Vessels bringing Blood or Lympha or Chyle poured out of the proper passages of them both not we must in the next place inquire about the more remote causes of this disease viz. for what occasions and after what manner the vessels affected of either sort deposite their burdens into the cavity of the belly First therefore The kinds of a Dropsie that the watery part of
being administred he was restored to his entire health and even now though five years since lives and continues sound There remain certain other splanchnical Affections The 〈◊〉 of 〈◊〉 〈◊〉 touching the Remedies whereof according to the ensuing method we should here have treated notwithstanding I have performed this task already for the most part under other titles for as is above intimated Remedies which concern the Kidnies we have for the most part unfolded under the rank of Diureticks and those which concern the Stomach and Guts under that of Vomits and Purges what relates to the Spleen we have finished in the Hypochondriac Pathologie and what to the Womb in the Hysterical As to what appertains to the Genital parts and their Diseases and help I reserve for another time and place it behoves me now next of all after treating hitherto of the inward Pharmacie to discourse something of the outward and of the Reason or Aetiologie of the administrations thereof which shall be done inthe next Section beginning with Phlebotomie that great Remedy SECT III. CHAP. I. Of Phlebotomie AMong the universal Documents of Philosophie Phlebotomie a very general and ancient medicine or aids of Physick none either in Theory or Practice hath been more ancient or general than the speculation of the Blood and letting it out by opening a Vein As to the former we have in other places often explicated the nature and constitutive parts of the Blood we have unfolded the Virtures and Energy of the same and have demonstrated that it is in truth enkindled and that from the burning there of the flame of animal life as of a Lamp doth begin and receives continuation But as to what relates to Phlebotomie all Authors of every age have made mention thereof Moreover the same was ever in Medicinal use with all Nations howsoever barbarous or rude Neither is it a wonder for truely Nature it self in the first place hath taught the necessity and way of that part of Chirurgery Even the Divine Law commanding the Rite of Circumcision as a Symbol thereof seems to intimate that the innate impurities of Humane Nature ought to be purged in some manner by letting out the blood That we may methodically discourse of this great Remedie Nature shews it by Haemorrhagies we ought first to consider by what means also for what causes and ends the letting of blood either happens spontaneously to Nature or is indicated by the Physitian then secondly we will annex the chief effects of this Evacuation as well good as bad whether advantageous or disadvantageous and together propound certain Rules and Cautions to be observed about due administration of Phlebotomie As to the former spontaneous Haemorrhagies which suggest the use of Phlebotomy whereas they are manifold and of diverse kinds they are usually reduced to these two heads or ranks to wit they are denominated either critical Nature endeavouring something good and wholsome or symptomatical which for the most part happen she being dejected from her government and being altogether out of order Critical either with or without a feaver The bloody eruptions of the former kind are again distinguished that they are either raised without a Feaver and are either perodical which happen often at set seasons as the Flowers in Women and the Hemorrhoids in some and in others the solemn or otherwise accustomed opening of the Nostrils which very often succeed according to the great changes of the Year or alterations of the Air or they are fleeting and uncertain as when blood doth advantageously break out of those places and of many others one while in this part another while in that part of the body Moreover bloody Crises do sometimes happen in a Feaver and do often put an end to it as Hippocrates long ago observed and is now manifest by very common observation The blood breaks out in all these cases inasmuch as being turgid and above measure rarified within the vessels it desires a larger space wherefore unless some portion thereof give way the whole mass rund the hazard of being constipated and as well the motion thereof to be hindered as the enkindling to be suffocated and the temperature to be perverted For there are two chief Reasons or Causes The causes thereof proceed either wherefore such turgescencies of the Blood do arise inasmuch as its liquor is as well inflammable as fermentative 1. As to the former of these that the Blood may be duely enkindled for the supporiting Life 1. From the kindling of the blood and the due exercise of the functions thereof it behoves that the innate sulphureous particles of it be proportion'd unto the Nitrous adventitious ones from the Air. Therefore as often as the Blood being very boyling and rarified is much opened and loosened in its own consistence so that the Sulphur being dissolved is kindled in greater plenty there is a most frequent and painfull breathing instituted for the drawing in of a more plentifull Nitre Now if the Sulphur abounding in this manner cannot be wasted by burning nor the vital flame regulated the next course immediately to diminish the sulphureous suel is that a certain portion of the rarified Blood have vent From hence not only in Feavers but after drinking Wine Bathings being in the Sun and other accidents by which the Blood grows very turgent either an Haemorrhagia of its own accord succeeds or there is often need to supply the defect of such a spontaneous evacuation by Phlebotomie But that such kind of effusions of Blood whether made by Nature or Chirurgery are commonly reported to bridle its heat or raging really they do this only inasmuch as they diminish the kindling of the blood by withdrawing part of the sulphureous fuel as Oyl from a Lamp 2. But moreover in the second place the Blood 2. From its Fermentation inasmuch as it is a fermentative liquor it is apt also to be extravasated Namely if at any time any heterogeneous thing and not miscible be confounded with its liquor it grows hot very much like Wine in a Vessel and boyls up in the Vessels to exclude that disagreeable thing which if it can neither subdue nor turn off by Sweat Urine or otherwise the Blood it self excludes part of it self as a Vehicle for carrying that matter forth wheresoever a vent is to be found For this reason viz. that any disagreeable or indomitable thing may be turn'd out of the mass of blood divers sorts of Hemorrhagies happen as well in Feavers as without them all which are excited by Nature for an intention of good as also those by which the too much enkindling of the Blood is depressed But that frequently it happens otherwise ought to be imputed to divers accidents and circumstances But for the most part the sailure about the spontaneous Hemorrhagies critically instituted 1. Criticall Hemorrhagies sometimes turn into symptormatical is either in the first place because the blood while it is boyling knows
being withdrawn the store of Spirits whose only part it is to vindicate the mass of blood from putrefaction and corruption is diminished so that immediately all things tend to a deadly dissolution Moreover if the Dyscrasie of the blood shall be of that manner that the more noble Principles to wit the Spirit the volatile Salt and Sulphur being depressed or cnsumed the watery and earthy particles predominate the blood ought not to be sent out but preserved even as the treasure of life for when the abundance of Spirits are so small any loss of them doth cause all the functions to stagger and gives way to the disease wherefore in a Dropsie Cachexia Consumption and other Distempers where the active Principles are greatly depressed the opening a vein is almost the same thing as cutting the mans throat In the before mentioned cases In some eases about Phlebotomy it is very doubtfull where the temperament of blood is respected it is easie to determine whether Phlebotomie be convenient or not but in some others as in a putrid continual feaver when upon this hinge Life and Death are turned there is need of the greatest deliberation and so much the rather because the event of the Disease and the success of all the accidents in its whole course whether good or bad is usually imputed to Blood-letting or its omission and from hence it is that Physitians being solicitous to preserve their own repute do chiesly raise doubts in their consultations of this matter And chiefly in a continual putrid Feaver But truly in this difficult knot that we may not be led by the rumour of the vulgar as it chances to happen one while approving another whise condemning Phlebotomie but with more certain advice we must consider the state of the Blood the tendency of the morbific matter and the strength of Nature First as to the former if in a putrid Feaver the blood very much growing hot shall raise a great heat with thirst watchings and burning of the Jaws and no eruption of abundant sweat nor pushes appear or is suddenly expected opening of a vein is so clearly demonstrated How the doubt is to be determined that it is a wickedness to omit it but on the contrary if in a languid body a slow and remiss Feaver but continual arises with a weak Pulse let Blood-letting be spared and the cleansing thereof be procured by breathing Sweats Urine and blistering Notwithstanding in a middle state of Blood and of a Feaver Phlebotomy almost indifferent in it self is determined by other things Therefore secondly we must weigh the tendency or flux of the morbific matter which if it remain dull in the mass of blood and unfit to be separated and so as it is frequently wont to be instead of a Crisis a translation towards the head be made and threaten the brain and nervous stock the cutting of a vein ought seasonably to be administred whereby these evils may be provided against Notwithstanding if that this matter being soon raised into a rage and either rushing inwardly to the bowels of the nether Belly provokes a huge Vomiting or Dysenterical affections or being driven outwardly seems to be about to bring the Small-pox Measles and other pushes every such force of Nature if good ought not to be disturbed if evil not to be made worse by Phlebotomie for in these cases it is not only dangerous to let blood but also very scandalous Thirdly about Phlebotomy to be administred in a doubtful case we are to take heed to the strength of the Patient for in a healthful Constitution a vigorous Age the commencing of a Disease and the functions both vital and animal being yet in a florid or indifferent estate we may confidently prescribe letting of blood unless something indicates the contrary Notwithstanding when it is otherwise as to those conditions we may not rashly proceed to that Evacuation Thirdly Thirdly Phlebotomy corrects or stays the inordinate motions of the Blood the inordinate motions of the Blood when being very much moved as it were with fury it either rushes impetuously one while into these parts another while into those or transferres the noxious matter are best restrained or reduced by Phlebotomy wherefore in great Cephalalgies in all soporiferous or convulsive invasions for Catarrhs Ophthalmia's and a Cough Asthma fits of the Gout and Stone or Phlegmons Erysipelas's also for many other Distempers raised by the flowings of the Blood or Serum an incision of the vein is commonly prescribed and indeed for the most part as with good success so also upon right Reason for the Vessels being emptyed the blood having obtained a more free space is circulated pleasantly and undisturbedly besides whatever is extravasated of the Blood or Serum is wont to be suckt up again and reduced into its course The Effects as well good as bad being thus shewn What Diseases and of what parts Blood-letting chiefly respects which happen to the blood in the manifold state thereof by Phlebotomie we will next make strict examination what Diseases chiefly either of the whole body or of any private Region that kind of Remedy doth more immediately regard And first as to what relates to general Distempers it is commonly enough known that letting blood is indicated bu a hot and dry temperament and interdicted by a moist and cold It is usually propounded in every Feaver but never in a Dropsie Moreover if we consider particular Diseases there is no region or part of the Body but as they rejoyce in the influence of vital as well as nutritious blood as long as it is well so as often as it is disturbed in any place or reaches out any disagreeable or provocative thing in place of benign Juice it requires avocation and a letting out thereof If I should take notice of every single case of this Indication we should here rehearse almost the whole Pathologie of the humane body An aking Head a Brain oppress'd with blood or overflowed with Serum whence spring a world of evils burning of the eyes inflammation of the face mouth and throat all the diseases of the Breast and Praecordia inasmuch as the disorder of Blood affords a rise or fuel to each of these likewise obstructions or inflammatory affections of the Liver Spleen and other Bowels moreover as a Plethora and Athletick habit of the whole body so also the tumours of each member painful and convulsive passions seem to accuse the blood as Author of all the evil and require its sending out as a certain kind of revenge In these and very many other distempers if at any time Bleeding be clearly indicated After Phlebotomy being indicated these four things following ought to be considered before it be performed four things ought to be considered viz. In what place by what manner and instrument at what season and in what quantity the Blood ought to be taken away First as to the former although according to the Laws of the
the most part remains uncurable by reason of the continual motion of the Vessel and the efflux of blood It is otherwise in a Vein whose opening is immediately stopt of its own accord for but little of contractive work lies in its Coats yea this only that its fibres being lightly opened as occasion serves the blood flowing back of its own accord is gently moved forwards and after Phlebotomy the vessel being empty they are permitted to be quiet so that in the mean time the little hole made by incision is easily glewed together Whenever Physitian or Patient do dread the opening of a vein to be administred drawing of blood by Leeches or Cupping-glasses will aptly enough and with like advantage supply the defect hereof Moreover these administractions to remove the conjunct cause of a disease where there is need rather of partial than general Evacuation or Derivation are frequently preferr'd to Blood-letting it self There is no need to dwell longer on explicating the manner and reafon of the effects of either of these operations commonly enough known but proceeding to other things we will next throughly weigh the Time and Quantity of letting Blood The opportunity of letting blood is often of so great moment Thirdly The Time of letting Blood comes into consideration that whereas this Evacuation succeeds well at one time at another it highly prejudices But there are diverse respects of time to be considered about the due performance of Blood-letting but chiefly these four The Time of the Disease the Age the Year and Day The first concerns chiefly the Cure of the Patient the others the Preservation of him First therefore if blood ought to be let in any Disease 1. In respect of the disease it will be chiefly sesonably about the beginning or encrease thereof but not at all or very cautiously in the state or declination For at that time whilst Nature is busied endeavouring a Crisis so that the Spirits are in great labour and the blood ferments very much that great endeavour of it ought not to be disturbed and in the height of the disease either Nature being Conqueress doth not want such a relief or being subdued will not endure such an Evacuation Secondly If at any time for preservation it be deliberated touching letting blood 2. In respect of age Infants Boys and Old men by the Custon of all Nations obtain an exemption also this evacuation was wont to be interdicted to pregnant Women but now most commonly prescribed Men of a vigorous Constitution and middle Age do well enough endure Phlebotomy and often times want it Notwithstanding the first and second time it ought not to be done without great occasion for that being once begun and afterwards repeated it will soon proceed into an inevitable Custom Thirdly Hence they who used to let blood Spring and Autumn 3. In respect of the Tear and its parts afterwards cannot omit this evacuation without hazard But to whom it will be either profltable or necessary to breath a Vein once or twice a year the chief seasonable times will be in the beginning of Spring and Autumn viz. when the Blood being prone to ferment anew is in danger to change its Crasis Phlebotomy seasonably administred provides lest the Sulphur and Salts being exalted it should contract a feaverish scorbutical or other peccant distemper likewise lest suffering a flux it should pour forth the serous Recrements and other Feculencies upon the Brain the Lungs or Bowels of the nether belly About the Solstices when our bodies are very cold or hot the blood as the juice of all Vegetables consisting in a more fixt state and unapt to sweel up ought not to be let out unless upon some urgent cause But whereas some precisely or rather ridiculously observe about Phlebotomy The Aspect of the Moon and Stars are here of no moment even as the Countrey-men about Gelding Cattle the position of the Heavens and the Aspects of Moon and Stars it appears altogether frivolous and for that chiefly is this Custom condemned inasmuch as counterfeit Astrologers have a Figure in their Almanacks wherein every sign of the Zodiack is allotted to every particular member of our bodies and for that cause under what sign the Moon is conversant they forbid blood to be drawn from the respective part of man They who observe without reason the Heavens do erre as the saying is the whole compass of the Heavens Moreover this vulgar error is not only absurd but frequently malevolent inasmuch as many of the common people will abstain from Phlebotomy whatever indication makes for the same if as they say the Sign be in the place of letting blood Fourthly As to what relates to the time of the Day in acute Disease 4. The time of the day about letting of Blood when a Physitian is sent for and there be indication for Phlebotomy immediately to be performed after the body is prepared he may prescribe that operation any hour in day or night but otherwise if any interval may be allowed then breathing a Vein rather is to be celebrated in a morning when the Stomach is fasting the vessels emptyed by sweat in the night the stream of blood being quietest and appearing free from any â—â—ous filth Yea although necessity urge it may be deferr'd a little untill the new Juice of things eaten be pass'd into the blood for the vessels being emptryed-will not only snatch the crude Chyle into themselves but frequently what is disagreeable or unproportionate unto the blood whence not only its motion is difordered but also the vital flame runs the hazard of being extinct I have known some by Phlebotomy administred presently after plentiful Drinking or pouring in of vinous liquors to have fallen into dreadfull swoundings away which have lasted very long untill the vital spirit being almost overwhelmed recovered it self again Moreover in the fifth place the opening the vein being indicated 5. The Quantity of the Blood to be taken away ought to be considered and its time appointed there remains still no little consideration to be had what Quantity of blood is to be let out in which point there is most commonly a fault committed while some being too audacious and others no less timerous they affix those bounds on this or that side of which for the most part consists the Right For that I may omit those who scarcely or not at all admit of Phlebotomy as I have before hinted so I cannot easily assent to their practice who fear not to draw blood to swounings Too much Phlebotomy to be avoided Besides an error of no light moment is committed within the moderate bounds while in some cases blood is drawn by too sparing a hand and in others with too free In a burning Feaver But a more spare Bleeding often hurts and fixes a feavour Pleurisie Peripneumonia Squinancy Frenzie Apoplexie and other great diseases that have their origine from a turgescency or phlegmonic incursion of
best to referre the other to the hysterical Pathologie Here properly belongs to this place the blood flowing out of the Nostrile being the most general kind of passions of the sort For the present the Cure of the Hemorrhage of the Nostrils is only propounded and common to every Age Sex and Temperament so that from the Diagnostick and Therapeutick of it duely assign'd the uses and efficacies of Medicines stopping blood will best appear for what we proffer for the unfolding the Causes and Cure of this bloody eruption may be accommodated unto all other dreadful Hemorrhagies It is observable enough that the Flux of blood from the Nostrils doth happen to most men from extraordinary occasions for as oft as the blood about to break out through its own turgescency or through laxity of the vessels is apt in some place to make or find its way it is by a certain instinct of Nature very often directed to the Nostrils as to the part most easily opened A description of the Vessels from which Blood flowes The vessels from whence it flows in that place are slips of the arterial Branch going from the Carotides after having pass'd the Cranium it comes to the basis of the Cerebrum for this proceeding near to the mammillary Processes sends very many twigs from it self every where about of which some eminent ones passing the hole of the Sieve-like Bone with the smelling Nerves are distributed through the glandulous membrane investing the windings of the top of the Nose These nasal Arteries departing first from the Trunk of the Carotides within the skull anticipate part of the blood chiefly serous from the brain and lay aside the Serum it self and other watery recrements into the glandules of the Nostrils as into the proper Emunctories of that Region whence they distill into the cavity thereof Wherefore if the mouths of those little Arteries do alwayes gape somewhat by reason of the sweating out of the Serum it is no marvel if the blood it self being made more turgid opening them a little more which often are too loose of themselves bursts forth of dores Indeed this Emissary both of the Serum and of the Blood being apt ordinarily to open or on any occasion prevents or cures great incommodities of the brain or of the Praecordia yea and sometimes of the whole body For in the first place They are the same by which the Serum distills to the Nostrils this way the Serum as I said is derived from the head and when the mouths of those Vessels are vellicated or provoked by any sneezing Medicine put into the Nostrils the Serum is from thence more abundantly drawn out which yet doth not descend from the Brain as is commonly thought but is anticipated by these nasal arteries lest it should go to it from which when it is more plentifully drained and brought forth by the use of Errhines for that cause the Brain becomes more serene and exempt from vapours Then secondly lest the Brain should be overwhelmed at any time by blood more impetuously overflowing a portion hereof passing through these vessels and breaking out easily prevents it But sometimes it happens that an Haemorrhage of this kind The Blood flowing forth in too great plenty from these Vessels is very hurtfull rather becomes a Disease than a Remedy for whensoever the blood flows out more often and more abundantly than is fit from the Nostril if life be not immediately hazarded by reason of too great loss yet the remaining mass of the blood being impoverished thereby and losing its temper acquires a cachectick and frequently an hydropick disposition even as we have clearly intimated before where we also have shewn the Aetiologie of this distemper in common with other too great Hemorrhagies either to consist in the fault of the blood or of the vessels or of both together First The causes of such an immoderate flux the blood bringing an Hemorrhage of it self offends either in Quantity or Quality and therefore while occasionally it boyls up it cannot be contained within the vessels but either opening their mouths by distending them or unlocking them by its acrimony 1. From the fault of the Blood it skips out To which happens that the blood being sometimes dissolved in its consistence and as it were infected becomes unfit to continue the course of Circulation inasmuch as portions thereof separating from one another are partly fixed in the flesh or skin having suffer'd death and partly breaking out stirre up frequently dreadful and sometimes mortal Haemorrhagies as every where is discovered in malignant Feavers and sometimes in the Scurvy Notwithstanding the blood offending by meer Quantity or Acrimony unless the fault of the Vessels happening thereon provoke the flux thereof or too easily permit it seldom breaks out into a great Hemorrhage Therefore secondly 2. From the fault of the Vessels the vessels bringing blood as often as they conspire to produce that affection are usually in the fault either first inasmuch as their small mouths gaping by reason of the fibres being too loose and weak do not readily enough transvasate the blood out of the Arteries into the Veins which fault happens to scorbutick and cachectical persons or secondly inasmuch as by reason of the same moving fibres being affected with the Cramp and Convulsion the blood being snatcht impetuously to and fro and chiefly towards the Head is constrained to break out to continue the thread of circulation even as it will plainly appear in the case of a Patient which shall be shewn below 1. Prognosticks As to the Prognosticks although an immoderate flux of Blood in the Small-Pox Measles malignant Feavers and in the Plague doth ever presage evil and is expedient to be stopt notwithstanding it ought to be restrained not by meer cooling or revulsory things but to be chang'd by temperate Hydroticks into sweating 2. An Haemorrhage of the Nostrils though not great is more dangerous in Cachecticks with a weak Pulse and a cold sweat than a plentifull Hemorrhage in men endued with a Pulse strong enough and blood very fervent 3. They who are obnoxious to this Disease by reason of a Dyscrasie of blood and loosness of the vessels if there come upon both these a convulsive disposition of the fibres of the little Arteries they receive a far more difficult Cure and frequently are reduced to extream languishings by reason of the great losses of blood 4. From those who are feaverish when much blood shall flow out of the Nostrils and does not terminate the disease often-times in the place of a Crisis a delirous or a soporiferous affection succeeds There are many other prognosticks about a Hemorrhage accurately remarkt by Hippocrates which notwithstanding properly belonging to the discourse of a Feaver we omit in this place for truly the Cure in general of this Distemper is here almost only intended About which there will be three primary Indications Three primary Indications of Cure
hath been very necessary to the uses of the Lungs for seeing the air ought only to enter the Lungs for that end The use of the aforesaid frame that it might pour out to the blood nitrous particles for its flame and vitality or life and presently return back and seeing the blood doth pass through the Lungs for that cause that it might meet the air suckt in according to all its parts therefore it behoves that both these viz. the air and the blood be divided into small portions and with these make every where distinct and short meetings The manner of this is most elegantly perceived in the gills of fishes for seeing the Bronchia are as so many greater Lobes every one of these is divided into many rundles furnished with a complication of every kind of Vessels as if it were into so many Lobes in every one of which the blood is drawn out by minute portions as it were little rivulets that it might throughly meet with the nitrous particles and afterwards return into its chanel The Bronchial Pipes lead into the utter cavities The uses of the little bladdery Cells viz. into the numerous little Bladders discovered by Malpighius which truly are certain continued parts of the Aspera Arteria but distinct from the former because the Grisles are wholly wanting to them and which supply the turn of these are distant one from another in larger spaces for all the Bronchial branches send forth lesser slips from themselves every way whose passages although void of Grisles notwithstanding are straitned as it were with certain ligaments at certain intervals and the spaces between these being filled with air suckt in do make partly those small bladdery little Cells In truth those passages may not unaptly be compared to the Gut Colon of a Mouse whose continued hollowness in as much as it is girt about in divers places seems to be divided as it were into many little purses Moreover those bladdery passages being shorter on either side the Sinus or hollowness have as it were particular little Bladders growing thick to them and therefore the heap of all the Cells seems not much unlike to a bunch of Grapes The Figures of these as much as may be are exactly represented in the third Table Those little bladdery Cells that they may put forth their contracting endeavours for breathing have muscular Fibres as is plainly seen by the Microscope For as much as great plenty of air ought to be drawn within the Lungs and reserved in part lest it fail at any time therefore besides those upper passages which are as it were the threshold and dens moreover more inner chambers and capacious are required in which the air may be treasured up and from thence be dispensed upon occasion For it sometimes happens the external is too sharp or otherwise disagreeable to the Lungs so that as it was greatly necessary that it should be suckt in more sparingly and its vehemence presently be attempered and rebated by the air treasured within Moreover it cannot be drawn in or inspired otherwhile in quantity great enough as in running singing or much speaking also in some crazy dispositions and in that case the inward air being rarified supplies in a manner the defect of the outward Therefore seeing those bladdery little Cells receive a greater stock of air than that they can be bound presently to return it all by every turn of expiration Endued only with Muscular Fibres therefore the grisly twigs are wanting to them and their hollownesses are more large of themselves that they may be more largely distended but that they may puff out a greater quantity of air upon occasion or throw out matter to be coughed out being endued with muscular Fibres they contract themselves more narrowly and throw out what is contained within them thoroughly For the ordinary Systole's of the Breast which the relaxation of the Muscles do partly effect cast out perhaps at every turn the whole air from the Trachea and Bronchus but not from the little Bladders for the emptying of these as often as need shall be both the cavity of the whole Breast is very much straitned and the small bladdery Cells themselves are straitned from their proper Fibres being drawn together 2. The description and use of the Pneumonic Artery The next Vessel is the Pneumonic Artery of whose most thick branches extended every where to and fro and with other branches twisted and complicated together the frame of the Lungs consists This Artery issuing from the right Sinus of the Heart and inclining towards the Trachea is parted into a right and left branch which applying themselves to the like parallel branches of the Trachea do accompany them every where or rather are set under them for they are planted beneath and are first carried into the greater lobes of the Lungs and afterwards into all the lesser lobes in every of which the little branch of the Artery stretched out sends out on either side more slips from it self which presently are associated by other bronchial and venal slips and are several ways complicated and where the outmost sprigs of the Aspera Arteria depart into circular little Cells the Arteries being complicated with the Veins as is discovered by the Microscope do girt about those little Bladders with their thick branching and enwrap them like Ivy from whence we may conjecture that it is not for nothing that the Blood-vessels that are any where in the Lungs do curiously wait upon those of the air and every where insinuate and intimately mingle themselves Surely whatsoever hath been supposed by others I shall not easily believe that this is done for the more exact mingling of the Blood and its parts be they never so unlike For to do that what need would there be of so full an access of air which in rightly making other mixtures the more perfect whereof are called Digestions we seek as much as we can to keep out For if the air might freely come and go the Particles that should be mixed would most of them flye away And as to that which is affirmed That the Blood in the Lungs is carried through those small winding and extreme narrow passages only that it may be the better mixed I say that its being so carried is quite contrary to such an intention for the best mixture of any liquor as also of the Blood it self is made by fermentation and the liquour to be so mixed or fermented like Wine in a Hogshead requires a free and spacious room but it s going through these small and narrow passages like so many strainers serves rather for the separation than the mixture of its parts wherefore unless the Blood be exactly mixed in the greater Vessels and be there rightly fermented it does while it passes through the Lungs leave there the dregs and whatsoever parts are not rightly mixt and so does stuff up and very much obstruct their passages as we may see in persons
the Heart either grow weary or are forced into convulsive disorders for that cause the Heart beating in disorder drives out before it the blood either infirmly or irregularly But that the blood issuing out of the Heart doth not always with expedition pass through the Pneumonic Arteries 2. Sometimes by the fault of the blood 3. Sometimes by reason of passages obstructed that sometimes happens from its own proper fault and also sometimes from the passages obstructed and also by reason of other causes The blood it self in a double respect hinders its own passage through the Lungs viz. either offending as to its kindling or as to its temperature There are sundry accidents of either of these For first even as the blood is more or less kindled than is convenient it is hindred or obstructed in the pulmonary circuit if at any time the watry earthy or fixt saline parts are predominant in the blood the spirit and sulphur being consumed or brought low by reason hereof its liquor being not well or less kindled by the nitrous air is not easily rarified in the pulmonary passage and scarce passes through them like a flame of its own accord but it sticks still in its passages heavy and muddy and creates much trouble and labour to the Heart wheresoever it is circulated Hence as often as the blood is a little more plentifully forced into the Pracordia by the quicker motion of the whole body or of its parts the Heart and Lungs labour hard for its driving about and that with the utmost endeavours And in this case it is probable The blood hindred in the Lungs sometimes because not kindled enough that the blood carried more rapidly into the right Ventricle of the Heart doth somewhat stagnate because it cannot presently be carried into the passages obstructed before it Moreover from this cause those grumous or fleshy concretions called the Polypi of the Heart sometimes seem to arise Hence both in the Pica Leucophlegmatie Dropsie and inveterate Scurvy from the quicker motion of the body arises difficult and painful breathing 2. Sometimes the blood is too much kindled and breaking out almost into a flame Sometimes too much and being above measure expanded it can scarce be contained in the pulmonary passages which it very much blows up and extends but endangers them to be inflamed or kindled wherefore lest it should tarry longer in them the Pracordia beat with most frequent and strong endeavours that the blood so over-much kindled might be ventilated and circulated for otherwise it being carried within the Lungs and inflaming them all over would quickly destroy the vital function Besides these things which concern the kindling of the blood It is also stopt through its temperament being vitiated there are other faults as to its temperament or mixture by reason of which it less freely or expeditely is conveyed through the pneumonic passages For when its consistence is either too laxe or too close it will not easily pass through the small passages of the Lungs but oftentimes is in hazard to stick and stagnate in them and also run out and be extravasated The blood being in a diverse manner made loose in its consistence either deposites its Serum or its dregs or its putrefaction in the Lungs which being lodged in the recesses of the Vessels or affixed unto their sides do variously stop or pervert the course of the blood 1. The dissolution of blood which is most commonly injurious to the Lungs When the blood is too much loosened in its consistence although not very dangerously is wont to happen for as much as the serosities being unapt to be contained within the mass thereof and when they are not presently sent away by sweating or urine they separate from the blood within the Lungs and so boiling up and breaking out from their proper vessels do as well disturb and stop the passage of air as that of blood so that for the sake of expelling those serosities and continuation of the circulation of blood the Lungs are provoked into a frequent and very troublesom Cough What the formal reason of this Cough is and the manner of its being brought about we shall declare hereafter Though there are many causes and occasions by which the serous liquor Why it lodges the Serum in the Lungs departing from the loosned consistence of the blood flows out abundantly into the Lungs yet for the most part it happens from one of these three viz. first and most frequently because the Pores outwardly bound up by cold cast back the serosities which were wont to be sent away by perspiration into the mass of blood which compel it presently to boil up and cast off the serous superfluities in the Lungs The various causes and ways of doing it From this kind of cause Catarrhs and Coughs frequently arise insomuch that the beginning of every cough by the vulgar is always imputed to such an occasion to wit catching cold 2. The drinking of sharp and thin liquors as Cider Rhenish Wine white Wine Paris Claret commonly causes to some a Cough or catarrhal distemper the reason whereof is for that the blood weak in temperament is presently dissolved and precipitated into serosities like milk by sowre things cast into it which flow plentifully from the mouths of the inward Arteries I have experimented this upon my self yearly when in the Summer season when the blood abounds with sulphur I have drank Cider and tartish Wines safely yea frequently to advantage the same in winter when the blood is prone to sowreness but moderately tasted of do presently provoke a Cough 3. There is another cause of this serous inundation flowing out upon the Lungs viz. when the Lympha watering the nervous and solid parts doth suddenly suffer a flux and for that cause it streams back into the blood out of the Fibres and Glandules and other passages and receptacles whose liquor it presently dissolves and precipitates into serosities which often infests the Lungs For this reason a sudden and troublesom Cough frequently accompanies convulsive distempers which being commonly called a vaporous Cough is ascribed unto vapours Moreover in great alterations of air especially when the season varies from dry into moist and the volatile and fixed salts do thereby melt the Cough and Catarrhs increase very much Neither doth the serous liquor only but also many other humors or recrements of the blood lodged in the Lungs frequently stuff up their passages so that by obstructing both the passages of air and of blood they cause difficult breathing or a cough This is every where perceived in ill-habited bodies also in Gluttons and Drunkards and others leading an inordinate and slothful life Wherefore Foot-men use a thin and spare diet that they may have their Lungs free from the filth and recrements of the blood I have observed some melancholy persons the adust faces abounding in the pulmonary passages to have voided blackih spittle like ink also others
cholerick and inclining to the Jaundice to void yellow and sometimes very bitter as if it had been meet choler 3. The blood dissolved also lodges in the Lungs infections that cause corruption Moreover many instances manifestly declare that sometimes the Lungs are tainted by the corruption and putrefaction of the blood For the blood toucht with an infection or a pestilent or venemous contagion begins to be corrupted and withdraw into clotted and corrupted portions from thence the Lungs undergo the chief taint from whence the greatest danger of life is threatned This is too well known in the Measles small Pox Plague and malignant Feavers for me now to undertake to explicate it by which maladies as often as the sick die it seems to come to pass either because the blood clodding in the vessels of the Heart or Lungs obstructs the way of its proper course so that presently its influx into the Brain is hindred or because the corruption of the blood affixt to the sides of the pulmonary passages causes a Phlegmon as it were and therefore provokes a most troublesom cough or difficult breathing and frequently bloody spittle So much for the impediments of the circulation of the blood which happen in the Lungs by reason of the mass of blood too much dissolved The blood is hindred in the Lungs by reason of the too thick consistence of the blood and apt to depart into parts and portions which being there left obstruct their passages There remain other no less prejudices to the Pracordia which proceed from the consistence of the blood too much bound up together and sending nothing from it self by which a burning Feaver Pleurisie or Peripneumony arise In the former distemper the blood being more sulphureous than it ought and therewithal being thick As is perceived in a Feaver is not diluted enough with its Serum and those particles of it contained within it self it puts away with great difficulty wherefore it is more plentifully kindled in the Lungs and when it passes through the passages hereof with more difficulty by reason of its greater boiling and of its thickness the Heart beating quick and most vehemently endeavours its circumpulsion with all its might notwithstanding from its greater flame growing hot within the Pracordia heat and a most troublesom thirst with roughness and as it were a certain parching of the tongue arises In the other kind of distemper In a Pleurisie and Peripneumony viz. a Pleurifie and Peripneumony the blood is alike thick but less sulphureous and inflammable wherefore it doth not participate of such a burning yet by reason of its thickness it doth not so easily and quickly pass through the Chest or Lungs is frequently extravasated and sticking to the interspaces or sides of the passages causes obstructions and soon after an inflammation to which pain often succeeds with bloody or discoloured spittle We may observe in blood-letting in these kinds of distempers that after it hath setled its superficies is covered with a little whitish skin or otherwise discoloured but always with a thick and viscous the reason whereof is that the blood when it doth not send away in the circulation its old particles nor doth admit enough of new it is thickned with a continual boiling and like boiled flesh changed from a bloody colour into a whitish in which state passing with difficulty through the small passages of the vessels it is in danger to be extravasated and easily provokes a Pleurisie or Peripneumony Besides these stoppages of the blood The blood is hindred in the Lungs by the fault of the heart caused by its own fault while it passes through the Praecordium there are also other impediments which happen either by the defect of the Heart or its passages or by the fault of the air inspired By what means and for what cause the Heart offending in its motion forces the blood from its right ventricle through the Lungs into the left irregularly we have clearly shewn in our late Tract of Cardiac Distempers to wit that muscle sometimes labouring for want of spirits doth not vigorously and strongly enough perform its beatings 1. When the spirits thereof are wanting For when in corporal exercise the blood more plentifully than usual is forced from the Vena cava into the ventricle of the Heart if this cannot firmly contract it self labouring according to its strength it causes frequent and weak Pulses moreover to help this as well the Pneumonic Arteries as others in fundry parts of the body which drive about the blood every way do cause frequent and inordinate contraction Thus I have observed in Virgins afflicted with the Green-sickness and in other cachectical bodies from a quick motion of the body not only a palpitation of the Heart but in the neck temples and other places the Arteries to have beaten irregularly Neither is it the want of spirits only 2. Because moved inordinately but their disorder is sometimes the cause that the Praecordium doth with less strength convey the blood for sometimes the spirits the inmates of the Cardiacal nerves being stirred up by an incongruous conjunction and affected convulsively do impress their irregular contractions upon the Heart or Arteries whereby the progress of the blood is several ways perverted or hindred as it often happens in Palpitation of the Heart Trembling intermitting Pulse and other the like passions 3. The pneumonic process of blood is variously stopt 3. The blood is hindred from obstruction of the passages Which are shut up divers ways For divers causes here rehearsed because the passages are not open enough which impediments happen as often as the Pores or those passages are either stopt or broken Of the former there are two reasons viz. sometimes the ways are shut for as much as the passages of the vessels contracted by the carneous fibres are brought nearer one another as we have elsewhere shewed doth sometimes happen in Palpitation of the Heart and a convulsive Asthma The affects of which sort by reason of the stream of blood shut within the Praecordia difficult or hard breathing a small Pulse and chilness of the whole body are wont to accompany Moreover sometimes the course of the blood is shut up because the passages of the vessels are pressed together by a body or by some humor from without wherefore when the little Cells or bronchial Pipes as is usual are filled with a viscous flegm purulent matter or blood extravasated as the free passage of the air is hindred in them so also the passage of blood is stopt in the vessels adjoining On the same account come tumors little swellings worms also stony sandy and curdly concretions and others of another kind are in diverse manners excited the chief whereof we shall touch on hereafter The bronchial Pipes are filled Moreover we sometimes see the canals as well of an Artery as of the pneumonic Vein made very bony in some part and their sides so compressed
Secondly the Nitrous particles of Air are wont to be obscured or blunted by other accessories also sometimes they are too much sharpened For as often as the South-wind blows the Air is too moist and thick inasmuch as the Nitrous particles are seiz'd upon by the watry and sulphureous and are much blunted so that while it is drawn in the blood is not vigorously kindled but like green wood put into fire it rather smokes than burns bright wherefore during such a state of Air we become stupid and dull and unapt for motion but on the contrary the North-wind blowing the cooling sharp and most nipping particles are adjoined to the Nitrous and the blood is enough kindled and we breathe freely yet the Vital flame is every where restrain'd by intense frost disproportion'd thereunto and unless refresh'd by motion and heat it is frequently entirely extinguished 2. Besides these faults of the Air whereby breathing is wont to be hurt The defect of air hurting breathing proceeds from the pneumonic Organs moreover this evill sometimes proceeds from its defect inasmuch as it cannot be drawn in in plenty enough Of which effects though there are many and divers causes yet for the most part it happens in respect of the organs of breathing either hindred as to their motion or their passages obstructed 1. The Organs of breathing are either meerly passive viz. which are moved as the Lungs or are Active and move themselves and those together as the muscles of the Chest and Diaphragma In every of these the impediments of the motion by which breathing is hurt happen variously And first what respects the Lungs we mentioned before that they sometimes very much swell by reason of the vessels being much distended and fill'd with blood insomuch as being stiffe and inflexible they obey not the turns of the Systple and Diastole of the Chest Moreover it happens sometimes through a phlegmon little swellings and other concretions of divers forms that a like stiffeness is caused in them Secondly the active organs of breathing or the moving parts viz. the muscles of the Chest and Diaphragma are wont to be perverted or stopt from their moving function by divers causes A solution of continuity made in any part of these either by clotting of blood or by falling down of the Serum and other homors as in the Pleurisie and Scurvy or in those that are wounded or bruised doth every where cause pain in the place affected with impotency of motion and difficult breathing Moreover sometimes without pain or any evident cause those parts being hindned from their motion do produce a most heavy pursiness As is frequently seen in an Asthma Suffocation of the womb and in certain other convulsive or hypochondriac distempers The reason of which passion without doubt consists in this for that the animal spirits appointed to the moving function of those parts are disturbed about their Origine or hindered in the passages of the Nerves and are turned aside from their due influx into the moving fibres Insomuch as many who are sound enough as to their Lungs and only obnoxious to affects of the Brain and Nerves are frequently surprized with horrid fits of an Asthma as we have at large declared in another place 2. The stopping of air hindering breathing whereby it less freely enters the Lungs frequently happens by reason of the Conveyances viz. the passages of the Trachea being shut or not enough open For indeed those passages are wont to be stopt as we have formerly observed touching the Vessels bringing Blood and prohibit the full entrance of air when they are either obstructed or compressed or more narrowly contracted The various ways of Obstructions Though there are many causes and wayes whereby the passages of the Trachea are wont to be obstructed yet chiefly and most often a Catarrhal distillation of the Serum while it departs from the blood and flows out of the vessels bringing blood into these parts which being first thin and sharp produces a troublesome Cough afterwards thickening by digestion and cleaving to the sides of the Trachea exceedinly straitens the ways of inspiration A Catarrb and shortens them by quite stuffing up their extremities In like manner the sweating out of extravasated blood as also of Pus or ichorous matter out of the Lympheducts or Veins into the tracheal little bladders doth frequently produce an Asthma and often a Consumption the reason of which sort of distempers shall be more largely explained hereafter Secondly it is manifest enough by common observation that the Tracheal passages as well the last as the intermedial often-times are straitened or shut The swelling of blood by which the passages are press'd together by compression For after a plentiful meal or abundant drinking of Wine or strong Ale inasmuch as the pneumonic vessels are very much distended by reason of the turgency of blood and the sides of the Trachea being press'd together do not admit of a free and usual entrance of air men otherwise healthful enough do breathe difficultly and painfully Which truely we esteem to happen from the lungs being filled and extended rather than from a cram'd stomach hindering the Systole of the Diaphragma Moreover for this reason even in the very paroxysmes of feavers a frequent and painfull breathing is manifest Neither onely from the turgency of blood but also from the same stagnating or extravasated and also from stony concretions and divers other manners the vessels of the Trachea being pressed together cannotdischarge a free breathing 3. The passages of the Trachea being sometimes more nearly contracted and closed from their fibres convulsively disposed deny a passage to the Air for due breathing The Cramps of the tracheal passages From hence when there is no obstruction or ill conformation in the lungs as also no consumptive disposition yet from those fibres preternaturally convulsed and drawa together dreadful fits of an Asthma frequently arise Whereas we have in another place discoursed of these passions it will not be requisite here again to repeat that discoure Resides these accidents of breathing hurt there are certain others which are stirr'd up by reason of the Air prohibited in its frist entrance viz. in the Nostrils the throat the Larynx from a tumour or ill conformation For the Polypus in the Nose the Quinzy in the Throat or inflammation of the Tonsils do render a difficult breathing in the same manner as a heap of sand about a Haven obstructs the ingress and regress of Ships But truly since the reasons of those passions and their manner of being made are exposed to sense it seems superfluous here to deliver their causes SECT I. CHAP. IV. Of Expiration hurt AS Expiration is much easier The act of expiration is easier than of inspiration and with lesser trouble performed than Inspiraration so it is less endangered to be stopt or perverted as to its function for in truth the contractive endeavours of fewer muscles are required to perform that
the places from whence the humour to be coughed out proceeds For sometimes cleaving to the sides of the Larynx or sweating from them the moving fibres being shaken by a gentle little Cough it is easily and by a short passage cast forth into the mouth sometimes the matter to be excerned being impacted a little deeper in the pipes of the Bronchii is not shook out but by large expirations and often repeated and lastly it sometimes happens that the excrements to be cast out are deposited within the farthest little bladdeers of the Trachea out of which it is not brought forth without a vehement labour of coughing and that frequently repeated and at last driven forth by a long journey through the whole lungs Concerning the Cough of a nutritious humour as also of a bloody and purulent hereafter it shall be discoursed when we treat of a Consumption and its remedy A dry Cough as often as it is the proper passion of the Lungs A dry Cough is excited after many manners and by sundry causes for an obstruction of any of the pneumonic passages whether it be by compression or oppletion or contraction doth necessarily induce this Wherefore an inflammation a tumour a little swelling a stagnation of the blood either through plenty or scarcity also gravelly stony or polypose Concretions worms and many other preternatural things inasmuch as they almost perpetually provoke the nervous fibres do induce a dry vain Cough but troublesome But a dry Cough sometimes is stirr'd up by the instinct of Nature as in place of a Pump to wit that the blood either by reason of its proper ill temperament or by reason of the pneumonic Vessels not being open enough not passing well through the lungs may be promoted by the shaking of these parts and forced into a more rapid motion What belongs unto the other acts of expiration hurt as when in sneezing hiccough laughing crying and in other affects its natural and even function is troubled or perverted seeing the rendrings of the causes of these which also in another place we have in part designed do not properly appertain to our purpose omitting them here we will pass to the thing chiefly designed viz. to the diseases of the breast and their remedies and to the reasons of curing them SECT I. CHAP. V. Of a Phthisis or Consumption in general WHereas we have hitherto viewed the fabrick of the Lungs accurately delineated and the motion thereof together with that of the whole Breast and the ways and passages of the air and of the blood and of other humors through them and have also observed their various impediments their remora's or diversions according to which it happens the act of the pneumonic function is after a diverse manner hurt or perverted in inspiration and expiration now in the next place we are to descend to the Pathology of this region so travelled over and which was our design from the beginning to treat of Medicines belonging to the Thorax or Remedies appropriated to heal the distempers of the Breast and the manner of their operation Of all the diseases of the Breast a Phthisis A Phthisis accounted chief among the diseases of the breast or Consumption by right claims the first place for there is none more frequent or difficult to cure Moreover all the other affects of the Thorax being ill or not at all cured do lead into this as lesser streams into a greater Lake and so ending in Phthisis lose both their natures and ancient names But truly these terms of Phthisis and Tabes in their proper signification denote an Atrophy The various acceptation of Phthisis or a withering away of the solid parts with debility of strength the distempers of which sort frequently proceed from a wound or Ulcer of the Lungs notwithstanding sometimes without any fault of these the extenuation or pining away of the whole body takes its rise from the meer fault of the blood or chiefly from the nervous juice It denotes any Atrophy Therefore before we handle a private pulmonary Phthisis seems to our purpose to explain the general reasons of this sickness and to declare how many ways and from when causes the ill temperaments of the humors are wont to induce a privation of nourishment of the whole body as it were consumptive For truly the Consumption of the Lungs it self doth not next and immediately proceed from an Ulcer or corruption of that bowel but it arises for as much as the blood from them contracting a corruption and highly defiled for that very cause loses altogether its nutritive virtue Moreover as well this as the nervous liquor acquires such an indisposition Of which in general we will now inquire And first what relates to the Blood An Atrophy first depends on the blood made unfit to nourish we may often take notice that some pine away without a Cough or without any apparent fault either in the Lungs or Breast in the mean time as to appetite digestion sleep and almost the oeconomy of the whole natural and animal function do carry themselves indifferent notwithstanding as if nourishment should be poured into a Receptable bored through they are not nourished but pine away sensibly maugre all Dietetical Rules The formal or conjunct reason of which kind of affect frequently consists only in this that the blood being notably depraved cannot assimilate the nourshing juice continually mixt with it wherefore it doth not only forthwith send it away but also takes away some particles of the solid parts which snatching to it self it presently throws out or casts it into some place or other or consumes it by evaporation The depravations or degenerate states of the blood that are wont to induce an Atrophy either consist in its proper distemper or themselves are communicated from some other place and indeed chiefly from the bowels or from the nervous liquor being also degenerate The proper Dyscrasie of the blood it self is twofold according to which it happens The consumptive Dyscrasit of the blood either from it self or communicated from other parts that the saline-acid particles or the sulphureous and most sharp are exalted above measure and predominate over the rest For sometimes the blood withdraws it self from its genuine disposition viz. a sweet and volatile into an acid as is always found in scorbutical melancholy or cachectical persons Wherefore the nutritious juice being ever mingled with the bloody mass seeing it cannot for that reason be assimilated and affixed to the solid parts is released again in a short time and is either forthwith sent away by urine sweat or a Diarrhoea or being pen'd up within the flesh or cavities of the bowels brings a Dropsie of which sort of distempers being led forth into an evil state 1. The kinds of the former are reckoned up the ordinary effect is wont to be that when some parts do swell very much other parts are very much extenuated Here it would
the entire body succeeds Surely when the nervous liquor and animal spirits pass not fully and freely out of the Dorsal Spine into the whole body from thence oftentimes a pining doth arise hence Imposchumes and Ulcers arise about the Loins or the Os sacrum which in as much as they consume or pour forth the nervous liquor too much cause an Atrophy in the whole or at least in the lower parts 2. From the expense of the humour through the genital parts That humour is first either seed a too great expence whereof induces an Atrophy Another kind of Tabes Dorsalis far more frequent is also twofold viz. it either ariseth from the great or too-often loss of the genital humor or from a continual corrupt flux from the genital parts 1. As to the first it is manifest by vulgar observation that the immoderate use of Venery yea involuntary efflux of the seed if it be either great or continual produce a faintness in the whole body and at length a pining away The reason of this as we have intimated in another place is not that the seed according to the opinion of some descends from the Brain through the Nerves into the spermatic bodies and from thence by reason of a great loss thereof first the Brain and then the parts all depending on the influence of the Spirits springing from thence become infirm and pine away But seeing we have sufficiently evinced that the seminal matter is immediately supplied out of the mass of blood into the genital parts and that it is altogether the same with that out of which the animal Spirits instilled into the Brain are proceated it will necessarily follow by now much the greater portion is got to the Testicles for repairing the loss of seed by so much is the Brain defrauded of its due share and therefore at length the sunction in the whole body as well motive as nutritive doth waver and diminish Our furious Whoremongers are sensible of a great debility about their Loins and the parts placed below them to wit the Thighs and Legs do chiefly wither away the reason is because as well the provision of the animal Spirits in its first spring viz. in the Brain failing the outmost chanels viz. the ends of the spinal marrow and the Nerves springing from it do suffer first and chiefly for this defect and moreover because near the Loins the arterious blood gives out to the Testicles more excellent particles and chiefly restaurative being destined to nourish the Back and in the mean time the venous blood being for that cause decayed or consumed is enfeebled and steals from the Loins as much as possibly may be The loss of the seed causing a Consumption is sometimes voluntary The losses whereof are voluntary or involuntary of which sort the salacious and prone to Venery do suffer sometimes involuntary of which affects there are divers kinds For in some it only happens by dreams or obscene phantasms but in others besides those occasions every endeavour of the Back whether through bearing a weight or excretion of Urine or the faeces of the Belly causes the genital humor to be thrust out the cause whereof is both because the seed is watry and thin and at once sharp and provocative also because the parts are weak and not able duly to digest or retain it In the other Tabes Dorsalis above-mentioned not the seed it self 2. Or Ichor flowing into those parts from solution of continuity but an ichor or a certain putrilage is cast out abundantly from the genital parts the efflux whereof if it the great and continual doth frequently impair the strength of the whole body and by withdrawing and prodigally removing the nutritive matter it induces an Atrophy or consumption For near the spermatic Vessels or in passage from them as well in men as women there are certain Emunctories placed whose faculty is to receive the superfluous humour from the seed formed and when it abounds to send it abroad through the genital parts For this cause that those passages in either Sex may be made slippery and moist lest they grow dry The formal reason of a virulent Gonorrhea and become less sensible the Prostates in men and the Glandules about the horns of the womb in women are constituted out of both which always in the act of coition and sometimes without when the spermatic bodies abound with too much moisture a certain serous liquor sweats out and in women whose bodies are more moist and in whom nature hath made these ways for their menstrual excretion this doth oftner and more plentifully happen than to men But if these Emunctories be affected with a great debility or a certain virulency so that they corrupt this liquor sent or do not retain it enough it is not only sent away incessantly and flows out plentifully through the Pudendum but also other superfluous humours or recrements of the whole body flowing together to those weak parts are thrown forth together Also the nutritious Juice destined to the neighbouring parts flows thither and presently goes out together so that at length by reason of the loss of the nutritious Juice which flowing to the same place is corrupted and continually sent away not only pains of the neighbouring parts but of the whole body and a pining doth succeed These things are commonly known in a Gonorrhoea also in fluore muliebri or those affects from an impure bed or immoderate Venery or are caused by a blow a bruise violent exercise or any other hurt inflicted upon the Loins It is not proper to this place to deliver particularly the true rendring of the cause and curatory method of healing of this sort of passions we shall proceed to treat of a Phthisis or Tabes properly so called viz. which arises from the only or chief fault of the Lungs which was the business of our design SECT I. CHAP. VI. Of a Phthisis properly so called or of a Consumption arising by fault of the Lungs A Consumption doth so frequently and usually proceed from the Lungs being depraved that some have termed it the peculiar Disease of this Bowel and that it very often so comes to pass the reason is because as we have shewed before the pining of the body doth for the most part more immediately proceed from the blood depraved and unapt for nourishment it is manifest that as its perfection is acquired in the Lungs so from these being ill-affected the same is most of all vitiated and degenerates into a languishing and corruptible state For in the Lungs rather than in the Heart or Brain the threads of life are spun and there they are oftnest defiled or broken A Phthisis is usually defined to be A pining away of the whole body The definition of a Phthisis taking its rise from an Ulcer in the Lungs But less true because I have opened the dead bodies of many that have died of this disease in whom
and Spittle become worse and worse and presently become dangerous Moreover breathing being hurt the faintness and pining away of the whole body the debility of all the functionx and at length a hectick feaver and a hasty declination to death follows When by the long continuance of a Cough and Spitting leasurely encreasing Why the Consumptive matter affects and by degrees hurts the lungs the humour is more plentifully deposited out of the mass of blood into the lungs it first of all enters into the tracheal little bladders and at length fills them and somewhat distends them from which while every morning by expectoration then more copiously performed it is almost entirely cast out from them thence the Thorax is exempt for a short space from the burden and respiration seems more free yet a little afterwards the blood being stuff'd again with Serum or nutritive juice it pours down new matter into the lungs and from thence again after meat or sleep the little bladders are fill'd and the humours by the afflux daily encreased are more distended and enlarged and at length the sides of two or more of the little bladders being burst many little bladders are here and there framed as it were into one lake within which the consumptive matter being more abundantly collected there it putrifies for it is not entirely prefently cast out and from thence it corrupts the substance of the lungs to which it is joined and imparts a putrid defilement to the blood passing through it This breach thus made in the lungs is daily encreased and frequently more are at the same time formed in divers places and by reason of the great plenty of humours heaped up and putrified in them a heaviness of the breast is felt like a weighty burden upon them the breathing is more hindrd moreover from the tabid blood being more plentifully intermix'd with the mass of blood frequent effervescences of it destruction of the nutritive juice also thirst heat loss of appetite nightly sweats and a pining of the whole body do arise How an Vlcer of the Lungs is made But the blood being polluted from the lungs causes them to be punished with a reciprocal affection that is to say from its peculiar pollution because the blood in the veins receiving this purulent matter in every circuit it immediately delivers it into the arterial from whence whereas it cannot be sent enough away by sweat or by Urine it is brought back by the pneumonic arteries to the lungs where again being separated from the blood it is every where conveyed as well into the little bladders of the Trachea as into the lesser passages insomuch that at length the whole frame of the lungs being filled clefts or ulcers are formed consequently in many places and all the other hollownesses are stufft with frothy quitter But sometimes it happens that there is one Ulcer or hole or happily two formed in the Lungs and the sides grow callous round about so that the matter being there gathered together is not conveyed into the mass of blood but is daily expectorated though in a vast plenty They that are so affected as if they had but an issue in the lungs An ulcer of the lungs covered with a callus less prejudicial although they cast up much Spittle and thick and yellow matter every morning and a little sometimes all day yet otherwise they live well enough in health they breathe eat and sleep well are well in flesh or at least remain in an indifferent habit of body and frequently arrive to old age insomuch that some are said to have been consumptive thirty or forty years and to have prolonged the disease even unto the term of their life for that cause not being shortened And in the mean time others who cough or spit less within a few months fall into a hectick feaver and in a short while are hurried into their grave Hitherto touching the conjunct cause and formal reason of a Phthisis or pulmonary Consumption The evident causes of a consumption what belongs to the other causes that is to say procatarctic and evident ones they truly are various and manifold inasmuch namely as they are more near or more remote inward or outward and lastly connatural or adventitious That I may undertake to design the powers operations and modes of effecting of all these in producing a Phthisis primarily it is requisite that I shew by how many modes and by reason of what occasions the serous humour of as folks commonly say the Catarrhal is laid apart out of the mass of blood into the little bladders of the lungs and into other passages of the Trachea The primary causes of a Consumption some from the blood others in part from the lungs Upon diligent search of this it is obvious to any one to percieve the morbific cause consists of two parts and that the fault is in the ill temper of the blood sending an offending matter to the Thorax and also the weakness or ill tone of the lungs easily receiving it As to the former it is manifest enough by common observation that the mass of blood being stuft with incongruous particles viz. it s proper ones degenerated or with others from other places intermingled The ill temper of the blood disposes to it doth boyl up for the expurging of them and what is to be separated when it is not easily sent away by any other ways it is spread abroad into the lungs if they are of a weaker constitution and cleaves to them There are many dyscracies of the blood and those of divers kinds and affections by by which its liquor being dissolv'd in its consistence and as it were curdled doth not rightly contain the serous and nutritive juice within it self moreover sending away these and other excrementitions humours uncessantly from it self as sometimes it deposits them among other parts so more often into the lungs 1. The blood sometimes like Milk grown sour of it self is depraved by little and little and at length departing from its genuine faculty into a sourness and being dissolv'd in its existence doth cast abroad its serosities too easily prone to separate themselves out of the Pneumonic and also Tracheal Arteries into the tracheal passages Thus to some it is ordinary once or twice in a year without any manifest cause to be afflicted with a grievous and troublesome Cough with copious spitting which in a certain process of time after the blood purged from its dregs and excrements recovers its temperature doth spontaneously abate and after doth succeed a more firm and durable health By reason of such a Cough serving for a purge to the blood I have known some often in a day and especially every morning who were wont to spit out spittle like black Ink with a small endeavour of the Trachea which distemper when for many months they had constantly labour'd under after a greater Cough occasionally contracted with much and yellow spittle they
have afterwards escaped altogether free from that former black spittle the reason whereof it that a heavier Cough abiding with plentiful spitting for several days altogether purges away those melancholy foeculencies from the blood and moreover it alters the temperament of the blood or rather takes away the ill temperament thereof 2. And sometimes it receives a consumptive taint from the nervous juice The nervous juice being frequently degenerated and with an abundant lympha returning back out of the fibres and nervous parts into the blood as it produces ill affects of the bowels and of the reins whereof in another place we have hinted so sometimes it causes a fierce and very troublesome Cough This kind of Cough one while is Catarrhal inasmuch as the Lympha having pass'd through the mass of blood is deposited in the Lungs by the arteries another while it is convulsive inasmuch as the Nerves and fibres constituted to move the breast are possest by that liquor and are provok'd into convulsive motions from either cause either conjunct or separately it comes to pass that more grievous passions of the brain and nervous kind frequently call on a troublesom Cough or are wholly changed into it 3. And sometimes by reason of a fault communicated from the Lympheducts Besides the faults of the blood and nervous juice frequently exciting a Cough it is probable that it sometimes arises from the Lympheducts being obstructed which belong unto the Lungs for whereas very many Vessels of this kind are spread abroad through the Lungs whose function it is to receive whatsoever is superfluous of the Lympha that is carryed through the Arteries into the Praecordia and not immediately brought back by the veins and to convey it to the trunk of the passage of the Thorax if by chance it happens that these passages are stopt or obstructed by viscous matter or compress'd or thickned by cold should not well discharge their duty it must needs be that those watery excrements shut out from their wonted sluces or whirling back into the blood do incite its fierce boyling up or being poured into the passages of the Trachea do stir up a Cough 4. Neither do the humors above-mentioned only The fourth reason is usual evacuations suppressed in as much as they either pervert or hinder the crasis or motion of the blood induce a Cough which frequently is the beginning of a Phthisis but moreover any usual or wonted Evacuations suppressed or let do usually impress a fault upon the Lungs The menstruous flux or the Haemorrhoids obstructed often bleeding at the Nose it by chance it ceases Issues closed up Pustles Scabs and Wheals driven back do frequently affix a taint in the Thorax If a plentiful spitting from the Glandules of the Mouth stops of its own accord or be cured by Medicine afterwards sometimes a consumptive Cough succeeds wherefore the same is vulgarly called a Rheum which had lately fallen from the Head into the Jaws and Throat and thence destilled deeper into the Lungs when indeed it is nothing else but a certain superfluous serosity of blood that being used to be put aside by the cephalic Arteries into the Glandules of the Mouth now being excluded thence is hurried through the preumonic Arteries into the Lungs Besides these private and periodical or extraordinary Evacuations By reason of transpiration hindred whose suppressions incline to a Cough and Phthisis there occurs another general and constant Evacuation viz. insensible transpiration which being either stopt or suppressed is oftner the occasion or parent of that evil than all the rest For the steams that usually evaporate by the Pores of the skin being restrained within ferment the blood and soon pervert it and cause it to be precipated into serosities which with other excrements of the mass of blood being immediately laid aside in the Lungs do stir up a troublesom Cough and often a consumptive one Hence it is a common observatioin that the catching of a cold by which the Pores are stopt whether it be by the blowing of cold air or being wet by rain or leaving off cloaths or by what other means it may come to pass disposes very many to distempers of the Thorax Wherefore in our Idiom the cause being put for the effect a Cough is called Catching of cold These are the chief causes and occasions which occur from the blood any ways depraved Partly from the Lungs and therefore depositing a peccant matter into the Lungs There follow other causes in regard of the Lung it self viz. those which dispose this Bowel more readily to a Cough or a Phthisis of which there are three sorts 1. An ill frame of the Breast From the breast ill formed From the hereditary disposition From foregoing distempers of the breast From incongruity of the air 2. An innate weakness of the Lungs or hereditary disposition to a Consumption 3. Preceding diseases of the Thorax as a Wound a Blow a Pleurisie a Peripneumony Empyema Spitting of blood the small Pox and Measles c. 4. The incongruity of air which is inspired as deserving a place among the procatarctic causes By reason of any one of these causes and sometimes of many together the matter provoking a Cough proving often after consumptive doth easily assault the Lungs and enters them and frequently imprints a deadly hurt On each of these we shall insist a little First therefore as to the frame of the Breast the case stands thus viz. that the Lungs being still whole and sound and free from any phthisical impression may be kept for a long time in their office it will behove that they sitll be exercised with a motion that is vigorous and with stretched our sails as it were to discharge the strong interchanges of the Systole and Diastole to that end that the air being plentifully suckt in The reason of the former exposed may be admitted to their inmost apartments and from thence immediately be cast back for the most part together with all the effluvia and sooty vapours at every change of breath Wherefore since the action of the Lungs doth depend much on the frame of the Thorax as being the moving Engine it must needs be that by reason of its ill fashioning the function of breathing becomes defective in many things There are two special kinds of a Breast ill framed viz. crookedness and shoulders like wings for which reason many are found prone to a Phthisis the reason of which is that in any such figure of the breast being either depressed or made long the Lungs do neither injoy a space so free and ample nor can the moving Muscles be so strongly contracted as in a square breast 2. What an hereditary disposition is The innate debility or hereditary disposition of the Lungs to a Consumption is so frequent and vulgarly known that when any is found inclining to a Consumption he is presently questioned whether his parents were not obnoxious to this distemper
pints of fresh milk let it be distilled in the common Organs i.e. a Pewter-Still The dose 3 ounces twice or thrice in a day by it self or with some other Medicine Every dose let it be sweetned when it is taken with Sugar-candy or with the syrup of the juice of Ground-Ivy In a constitution less hot especially if there be no fervent heat of the blood or Praecordium to six or seven pints of Milk adde one pint or two of Canary wine and in a phlegmatick or old body instead of Milk let the Menstruum be Ale or Brunswick Beer i. e. Mum. Moreover in Winter-season when Snails cannot easily or scarcely be procured at all there may be substituted in their stead Lambs or Sheeps Lungs also sometimes Calves being half-boyl'd and cut small with the forementioned ingredients and a fit Menstruum being added let them be distilled in common Organs or Rose-stills To this form The convulsive Cough of children call'd the Chin-cough treating of a Cough not yet arrived to a Phthisis ought to be referred the convulsive or suffocating Cough of children and in our Idiome called the Chin-cough This assaults chiefly Children and Infants and at certain seasons viz. Spring and Autumn especially is wont to be epidemical The diseased are taken with frequent and very fierce fits of Coughing wherein namely the Organs of breathing do not only labour in pain but also being affected convulsively they do variously suspend or interrupt their actions but for the most part the Diaphragma convulsed by it self or by the impulse of other parts doth so very long obstinately continue the Systole or Diastole that Inspiration or Expiration being suppress'd for a space the vital breath can scarcely be drawn insomuch that coughing as being almost strangled they hoop and by reason of the blood stagnating they contract a blackness in their countenance if perhaps those organs not in such a measure convulsed they are able to breathe any thing freer notwithstanding they are forced always to cough more vehemently and longer untill they wax faint The formal reason or conjunct cause of this disease The reason thereof consists in these two things viz. that there is present a quick and vehement irritation of the lungs whereby they are almost continually incited to throw off something troublesom by Cough and also that the motive parts of the Thorax viz. the Nerves and nervous fibres being predisposed to convulsions as often as they are irritated do excite a Cough not regular but convulsive and such as is opposite or injurious to the usual function of breathing The matter provoking the lungs so frequently into a Cough seems to be the Serum The cause partly a Catarrh uncessantly soaking out of the mass of blood by reason of its frame being too much loosened and troubling the parts belonging to the breast inasmuch as it destills as well through the tracheal arteries into the hollowness of aspera arteria as that it is poured in plentifully through the pneumonic arteries into all the open passages The convulsive disposition of the moving parts A convulsive disposition of the parts of the breast as in other convulsive distempers seems to proceed from a heterogene and elastic matter falling from the brain through the nervous passages together with the nervous liquor into the small moving fibres of the breast wherefore when the spirits that are contained in those little fibres are stirr'd to perform violent motions of breathing out they pass into convulsive motions What relates to the Prognostick of this distemper The prognostick of this disease this Cough although it be seldom very dangerous or mortal yet it remains very difficult of cure and frequently it rather ceases by change of the season than is extinguished by remedies The cause whereof is that here not as in an usual Cough the blood onely ought to be altered and its recrements to be derived out of the Lungs to be conveyed to the habit of the body by sweating but moreover an amendment of the nervous juice ought to be procured About the curing of this disease Cures first Empirical the way of healing used in other kinds of Coughs doth rarely profit here wherefore old women and Empiricks are oftener consulted than Physitians and the rational curatory method being postponed and neglected remedies for the most part onely Empirical are brought into use Among the many remedies of this kind these two following are preferr'd to all others and chiefly wont to be used viz. Cup-moss or Chin-moss or Chin-cups and the various preparations thereof and compositions are taken inwardly and if there shall be need of any further medicine that some Bugbear being presented the Child labouring with it may be cast into a sudden fright But if the wished success be wanting to administrations of this sort Ptisans Syrups Julips or Decoctions and other pectoral helps are rejected and frequently they desist from all other Medicines expecting untill the disease either at length of its own accord determine or be cured by reason of the succeeding change of the year 1. Chin-cups a great remedy Chin-cups or Moss is in most common use in our Countrey against the Coughs of Children and is vulgarly enough known as to its form and manner of growing It is of an astringent nature as far as we gather by its taste and contains in it self particles somewhat sharp and biting and smelling of plenty of volatile Salt from whence we may safely conjecture that its use is to fix the blood and to appease the fluxes of Serum The reason wherof is inquired and moreover by volatilising the nervous juice to take away the convulsive disposition It is usually administred in form of Powder Decoction and Syrup according to the following Receipts Take of Chin-cups in powder one dram Sugar-Candy one scruple mix them divide it into three or four parts take a dose morning and evening with a fit vehicle Take of the same Cup-moss two drams milk of Brimstone two scruples powder of Anniseeds one scruple divide it into six parts to be taken as the former Take of the same Chin-moss or cup-moss one dram boyled in milk for one dose take it morning and evening To those with whom milk doth not agree or to whom it little profits let it be boyled in Spring-water or Hyssop-water or in any other pectoral water and let it be given from two ounces to four twice in a day sweetning it with Sugar or some fit Syrup Take of this Muscus Pyxidatus or chin-moss one ounce boyl it in two pints of some pectoral water to the consumption of half To it strained adde of Sugar-Candy one pound and evaporate it in a gentle bath to the consistence of a syrup 2. The other remedy for the convulsive Cough is wont to be Frights profit in this Cough that they be cast into some sudden fright from hence whenas medicines effect less with the vulgar it is a familiar practice that to fright them
of such kind of particles which being mild and thin may be tamed by the blood and assimilated without any effervescence or heat Wherefore Asses milk also sometimes Cows or Goats milk also Water-gruel Cream of Barley Ptisan Almond-milks and other simple nourishments will better agree and nourish more than Flesh Eggs and Gelly-broaths strong Ale Wine or any other kind of richer fare Secondly 2. That the acidities of the blood and other humours be taken away that the blood retaining its own temperament be not easily dissolved into serosities injurious to the Lungs it behoves that as well the acidities of it self as of other humors mixt therewith and chiefly the nervous and limpid ones be destroyed which intention Medicines prepared with Brimstone will best accomplish which for that cause in this case provided a hectic Feaver be not present may be more frequently and in abundance taken Wherefore the Tincture the Balsam the Syrup the Flowers and Milk of Sulphur in somewhat a large Dose may be exhibited twice or thrice a day For the same reason traumatic or vulnerary Decoctions also Decoctions of the pectoral Herbs commonly so called also of the Woods are to be taken instead of ordinary drink Moreover the Powder of Crabs eyes Hog-lice and other things endued with an Alcali or volatile Salt are often administred with great success 3. That the excrements of the blood be drawn off from the Lungs The third intention of healing respecting the first indication viz. that the superfluous dregs of the depraved blood if they shall be very much predominant being commanded out from the Lungs may be discharged by other Emunctories suggests very many ways to be used for their dispatch For besides Phlebotomy Diuresie and sometimes a gentle Purgation which take place in all Coughs yea in the beginning of a consumptive Cough or Phthisis hither also ought to be referred Baths taking in a more warm air whereby they may more freely transpire also Frictions of the extreme parts Dropaces Issues Blisterings or Depilatories Errhines Gargles and other private or public sluices either of humors or vapors The second indication in the beginning of a Phthisis viz. that the consumptive matter laid aside within the Lungs may be easily and daily evacuated Second indication requires expectorating Medicines is performed by expectorating Medicines These are said to operate after a twofold matter according to which their virtue is conveyed two ways to the Lungs For of those being taken by the mouth some immediately dismiss their active particles into the Trachea which partly by making the way slippery and loosning the matter impacted and partly by provoking the excretory Fibres into Convulsions do procure expectoration in which number are chiefly accounted Linctus's and Fumigations The expectorating Remedies of another kind which deservedly are accounted more available do exercise their energie by the passage of the blood For whereas they consist of such kind of particles which cannot be digested and assimilated by the mass of blood being spread through the blood because they cannot be mixt with it they are presently again exterminated and so penetrate from the pneumonic Arteries into the tracheal passages where lighting on the matter they divide and attenuate and so disturb it that the little fibres being irritated from thence and successively contracted while they cough the contents of the Trachea and of its little bladders are ejected upwards into the mouth Medicines proper for this use besides Sulphur and the preparations of it are artificial Balsams distilled with Oil of Turpentine Tinctures and Syrups of Gum Ammoniac Galbanum Asa foetida Garlick Leeks and such like yielding a strong scent from which also Lohochs and Eclegma's are prepared And these work both ways partly by slipping into the Trachea and partly by entring the Lungs by the circulation of the blood and assault the morbific matter both before and behind and so exclude it with the greater force 3. What belongs to the third indication viz. that the frame of the Lungs being hurt or their constitution vitiated may be either restored or amended Third indication is performed by Balsamicks and vulneraries such things are of use as resisting putrefaction do cleanse heal dry and strengthen to which intent also Remedies prepared of Sulphur Balsamics and Vulneraries do agree Hence some Empirics do not only successfully prescribe the smoak of Sulphur vivum but also of Auripigmentum to be suckt through a Pipe or Funnel into the Lungs Moreover it is for this reason that change of air and soil viz. from Cities to the Country or sulphureous air or the passage from one Region into another that is hotter is of such a signal advantage Hitherto of the Method of Healing which seems to be of use against the more painful Cough or Phthisis beginning now it remains according to all those curatory indications to subjoin certain select forms of Medicines which also according to the way of healing described above in a slight Cough which is short of a Phthisis Forms of remedies for a consumption we shall distinguish into certain ranks viz. which are Mixtures Linctus's Lohochs Tinctures Balsams Troches Lozenges Powders Pills Decoctions and distilled Waters We shall set down some Examples of each of these whereto also may be referred some of the forms of Medicines before described for a beginning Cough and not as yet consumptive 1. Magisterial Medicines and Syrups Take of our Syrup of Sulphur three ounces Mixtures water of Earth-worms an ounce tincture of Saffron two drams mingle them Take one spoonful at night and first in the morning Take of Syrup of the juyce of Ground-Ivy three ounces Snail-water an ounce flour of Brimstone a dram mix them by shaking The Dose one spoonful at night and morning Take of tincture of Sulphur two drams Laudanum tartarizated a dram Syrup of the juice of Ground-ivy two ounces Cinamon-water two drams the dose one spoonful at bed-time and if sleep be wanting towards morning Syrupus Diasulphuris Take of Sulphur prepared after our manner half an ounce Syrups best Canary wine two pints let them be digested 28 hours in a water or sand Bath which being done take of the finest Sugar two pounds dissolved in Elder-flower-water and boil to a height to make tablets afterwards pour to it by little and little Wine coloured with Sulphur and warm let it boil a little on the fire strain it through woolen You will have a most delicate Syrup of a gold colour and for coughs and other distempers of the lungs where a hectic Feaver and heat of the Praecordium is absent most profitable the dose a spoonful morning and evening by it self or with other Pectorals Syrup of Garlick Take ten or twelve cloves of Garlick stript from the little skins and cut into slices Aniseeds bruised half an ounce Elicampane sliced three drams Liquorish two drams let them digest for two or three days in a pint and half of spirit of Wine close and
difficulty ariseth The reasons of the case viz. whereas his Lungs were found altogether free from any Ulcer or notable wound whence that most dire stench of spittle and breath always a forerunner and companion of the bloody spittle the last invasion of this disease only excepted proceeded We have in another place given remarks upon all these things as that Ulcers of the Lungs and the purulent spittle of consumptive persons seldom or never stink but the matter cast out of an Imposthume of the Lungs doth frequently stink but that in the sick Doctor the Lungs being free from either affect breathed out so horrible a breath the reason will best of all appear if we inquire of the manner and cause of a stench in general For we observe this to be excited when the impure Sulphur is dissolved either by a lixivial or an acid Salt and is precipitated by the other Let common Sulphur or Sulphur of Antimony be dissolved by Oil of Tartar or Stygian water afterwards if you pour on this solution a dissolution of fixed Salt and upon that Vinegar a most hideous stench will arise In like manner we may conceive in the case proposed that the sulphureous particles of the blood being very impure were corroded by the fixt Salt with which its juice abounded very much afterwards when the acid humor having endured a flux reflows from the nervous parts into the mass of blood it precipitates the dissolved Sulphur and so causes that stench to be exhaled from the Lungs and whilst it forces the blood into a turgency a little after it compels to a spitting of blood I have known some endued with a breast firm enough and free from all Coughs and consumptive disposition who have for the most part breathed out a most hideous stench which could proceed from no other cause besides what even now we have observed The impure blood abounding with Sulphur dissolved with Salts if perhaps while it is rarified within the Lungs and loosned in its frame it meets with an acid humor it will exhale in breathing putrid and horrid effluvia's It happens by the like reason of the blood otherwise disposed that as the breath of some persons is very stinking so of others very sweet And indeed the breath or air reciprocated through Respiration for that it carries out with it the effluvia's of blood highly rarified within the Pracordia one while disperses a grateful vapor another while a most unpleasant SECT I. CHAP. VIII Of a Peripneumony or Inflammation of the Lungs APeripneumony is usually defined to be The description of a Peripneumony an inflammation of the Lungs with an acute Feaver a Cough and difficult breathing They who labour with this distemper are greatly sensible of a notable inflammation in their breast with a swelling of the Lungs and sometiems a pricking pain they draw a painful and short breath or as Hippocrates affirms a deep breath the Feaver presses with great thirst watching and painful Cough whereto also bloody spittle or streakt with blood succeeds By which Symptoms it clearly appears that this disease arises in as much as the blood boiling feaverishly doth not easily pass through the lesser pneumonic Vessels but sticking in their passages begets first an obstruction afterwards being more heaped and extravasated propagates a Phlegmon or inflammation with heat a Cough and discoloured spittle Moreover in as much as the blood so accumulated and stagnating puffs up these passages of the Lungs and compresses them a difficulty of breathing is caused and in as much as it pulls or distends the nervous Fibres a pain frequently arises But if it be asked After what manner a Phlegmor is bred in the Lungs how a Phlegmon should grow together in the frame of a Lung meerly bladdery and excarnous and after what manner it is distinguished from that distemper which is wont to be stirred up in musculous flesh or the substance of a bowel We must answer although the above-mentioned parts vary as to the texture notwithstanding the reason of the affect is altogether the same in each of them For the small sanguiferous vessels do every where alike embrace bind and variously gird about both all the Tracheal passages in the Lungs and also the fleshy fibres in the Muscles and lastly the little fibres and nervous threds with the thickest foldings like clusters of the Parenchyma But that which produces a Phlegmon is the blood it self which while it grows very hot and is hindred in its passage every where and especially in the Lungs whose vessels branch into very small foldings doth first beget an obstruction and then an inflammation Wherefore the formal reason and conjunct cause of a Peripneumony consists in these two things The conjunct cause of a Peripneumony consists in two things 1. That the blood boils 2. That it sticks in the passages Sometimes this disposition sometimes that is first viz. that the blood boils feaverishly and sticking also within the more narrow passages of the Lungs engenders there an obstruction causing inflammation Unless these two things concur there is an exemption from this disease for in many other Feavers especially in a burning Ague though the blood most intensly heated and inflaming all the Praecordia as also in the longing of women the Green-sickness and the Dropsie of the breast is very clammy yet though sticking very much in the passages of the Lungs it does not stir up a Peripneumony to produce which both distempers must concur and join their strength Nevertheless when there is an indisposition of both these one while this another while that is first in act and after a sort one is the cause or at least the occasion of the other For sometimes the blood irritated into a Feaver causes an obstruction of the Lungs and the blood also sometimes finding a remora in the Lungs receives a feaverish boiling from its proper obstruction Notwithstanding for the constituting the procatarctic cause of this disease the blood ought to be fitted as well for the boiling as for the obstructing the vessels of the Lungs Though it will not be easie to shew what this disposition of the bloody liquor is inclining to a Peripneumony What that is Phlebotomy discovers yet the reason thereof doth something appear by Phlebotomy always made use of in this disease with the best success For the blood being drawn from any labouring with this disease as also from those in a Pleurisie after it grows cold in its superficies instead of a Scarlet cream it hath a little film somewhat white or otherwise discoloured growing on it which also is very tough and viscous whence we may conjecture that the mass of blood being too strait in its frame whilst that in the circulation it doth not discharge its recrements grows too thick and as it were clammy and for that cause becomes too prone as well to boil as to stick within the narrow passages and especially of the Lungs But if farther inquisition be
made What affection of the blood produces it from whence this disposition of blood proceeds by which it becomes clammy and viscous like ropy wine the general reason hereof is this viz. that the more thick parts of blood are not made thin enough by the more subtile so that all of them being equally mixed and mutually incorporated at length the good humors separate themselves into their appropriate functions and the superfluous are perpetually discharged by their proper Emunctories But on the other side in as much as the sulphureous particles of the blood being combined together with the saline and earthy too much exalted ensnare and entangle all the rest for that cause its liquor containing within it self all its recrements and impurities grows clammy as glue and in that regard contracts an inflammable disposition For it is obvious to every person that the blood that grows clammy in this manner is rendred prone to obstruct the narrow passages of the vessels which surely are very small in the Lungs moreover for the same reason they are disposed to become fearish viz. because retaining obstinately within its own bosom all the feculencies and ecrements from the same presently gathered into a heap it is constrained into a great turgescence or swelling whereby of necessity an inflaming obstruction of the Lungs takes either its origine or augmentation Moreover as to the procatarctic cause of this disease The fault of the Lungs produces it very frequently the faultiness of the Lungs is joined herewith and determines that general intemperament of blood to affect this part in such a sort For as the clammy blood grows hot the more strong and sound Praecordia do frequently discharge the designed mischief from themselves and the taint being fixed to the Pleura or about the habit of the body a Pleurisie or Rheumatism is rather caused than a Peripneumony Nevertheless the tender Lungs being bnoxious to a Cough or formerly prejudiced in their frame either by spitting blood or other distempers of the breast from the blood boiling up while it is too much bound nd clammy in its own consistence they easily engender an obstructing Phlegmon Hitherto of the conjunct and procatarctic causes of a Peripneumony The evident causes of a Peripneumony as for what regards the evident causes whatsoever suddenly perverts the temperament of the blood or restrains its free transpiration ought to be referred hither as chiefly are excesses of heat and cold or the inordinate drinking of Wine or strong Waters any veement exercise and the drinking of some waters and those especially icy Besides sometimes a malignant distemperature of Air doth engender this disease in many and akes it Epidemical Authors in Physick do every where observe and it is also a vulgar observation a Peripneumony frequently succeeds or comes upon a Pleurisie It often succeeds or follows after a Pleurisie but nothing is more usual than in a Pleurisie a bloody and thick spittle and as it were purulent to be voided Hence a regat disquisition arises by what passage or ways the matter by spittle cast out can be conveyed from the Pleura to the Tracheal passages Some think that this being fallen into the cavity of Thorax is sucked into the Lungs as with a Sponge and others suppose that it is transferred thither by the Membranes adhering thereto by which the Lungs often stick unto the Pleura But truly either way seems improbable if not impossible For first that the Lungs do not suck in the contents of the hollowness of the Chest is manifest from hence because in a Dropsie or wound of the breast when they happen the Lungs being unhurt neither water nor blood is at all discharged by coughing though frequently great plenty of this or that humor be there which presently flows out of its own accord from the Thorax incision being made But that Sometimes the Membranes growing from the Lungs knit themselves tot he Pleura is clearly manifest by Anatomical observation yea and by this way of return I have sometimes known the purulent matter translated into the side and there by an Issue made by Art or Nature to have been evacuated with a heathful Crisis nevertheless such Membranes of the Lungs joined to the Pleura do seldom pre-exist and in a Pleurisie which is a very acute disease they cannot like a Mushroom be the issue of one or two days moreover though sometimes those obscure passages may be ready at hand which perhaps by some admirable instinct of Nature discharge something out of the Lungs towards the precincts of the Thorax yet it seems against the Oeconomy of Nature that they can derive any corruption outwardly engendered to this most noble part within which surely is the fountain both of life and heat As to this if it may be lawful to propound our Judgment The reason of this is inquired into I am induced to think that a Peripneumony and Pleurisie are one while singular and separate affects and another while bred together and coexisting from the first and another while are by course one after another or succedaneous For the procuring cause being stirred up into act so that the blood growing clammy and boiling together obstructs in some places the lesser vessels the nest of the disease sometimes is fastned on the Pleura or separately in the Lungs sometimes in each of them together and sometimes first in one and then in t'other but for the most part the Pleura being first healed presently the same morbific cause invades also the pneumonic Vessels Moreover we have known a various shifting of this affect viz. that it has first troubled the right or left side presently that being deserted to have occupied the Lungs and afterwards both being deserted to affect the Brain and frequently to transfer its seat from thence into the above-mentioned places But for the reason aforesaid a Peripneumony not only succeeds a Pleurisie but frequently a Squinancy and sometimes other distempers for while the blood growing clammy and boiling together continues a Feaver in the whole it transfers the obstruction causing a Phlegmon variously hither and thither And from hence the solution of that observation is clearly manifest which has so much puzled Interpreters viz. that a Palsie or dead Palsie of one side doth sometimes succeed a Peripneumony because the blood that being clammy had lately obstructed the pneumonic Vessels afterwards stuffing certain foldings of the vessels of the Carotides prohibits the engendring of animal spirits in this or that part of the head and so restrains their influence into the respective nervous parts The differences of this disease From what hath been said the chief differences of a Peripneumony are made plain namely that it is either a simple distemper or joined together with a Pleurisie Squinancy or some other and then it is either primary or secondary Moreover it is usually distinguished as to the Feaver and state of breathing to wit according as this is more or
after I repeated Phlebotomy and after continuing the same Remedies in four or five dayes he intirely recovered his health The blood we took from him was alwayes in the Superficies viscous and discoloured A certain Gentleman of a sanguine Complexion and a strong habit of body The second History after an immoderate drinking of Wine contracted a Feaver with a most painful Peripneumonie insomuch that thirst and heat mightily pressing him sitting always upright in his bed or Chair and breathing short and very frequent he could scarcely yea almost not at all suck in air enough to sustain the vital flame Because he could not undergoe a large Phlebotomy I drew blood twice or thrice day after day frequent Clysters were administred Moreover Apozemes Juleps also Spirit of Armoniack and powders of Fish-shells were administred by turns Within four or five dayes the Feaver somewhat abated also he began to breathe better and sometimes to take short sleeps yet he did always complain of a notable heaviness of his breast and intolerable oppression of the Lungs wherefore when Phlebotomy was no longer safe I applyed very large Vesicatories to his Arms and Thighs the blisters in his arms dry'd up in a short space but those on his legs did not only remain open but after five or six days did run hugely and afterwards almost for a month daily discharged great plenty of a most sharp ichor in the mean time his lungs sensibly amended and at length were delivered from all their burden lastly the little sores raised by the Vesicatories very painfully and not without frequent Medicines could be cured SECT I. CHAP. IX Of a Pleurisie HOw great affinity there is between a Pleurisie and Peripneumonie The diseases of a Pleurisie and Peripneumonie are akin we have hinted before viz. although either distemper is sometimes solitary and exists separately from the other yet they often happen together or one while this another while that come one upon the other or succeeds it The foregoing cause is the same of both viz. a disposition of the blood to be clammy and boyl up withall also the conjunct cause is the same viz. an obstructing Phlegmon in some part of the lesser Vessels by reason of such a disposition of blood Moreover the same method of Cure is prescribed by most modern Physicians for either disease The chief reason of the difference whereby they are distinguished one from the other is taken from the places affected which their Names denote How they differ betwixt themselves For the blood predisposed to the enkindling in some place an enflaming obstruction therefore often plants the nest of the disease in the breast because here it burns out more hideously by reason of the Hearth of vital fire and also is not freed from the vaporous Effluviums and other Recrements which hinder Circulation To all which there ensues that in this Region the mass of blood being shut up and not able to pass through the more strait Conveyances is not as in the bowels of the lower Belly opened with any ferment or new washt with any watery juice wherefore if perhaps the blood carried through the vertebral Arteries into the membrane encompassing the ribs shall stick in its passage about the narrowness of the Vessels or inter-spaces the Distemper of which we now treat succeeds In like manner if an obstruction happen within the passages of the Lungs a Peripneumonie will ensue as we have declared before Wherefore according to the Pathologie of this disease before delivered those things which belong to the Theory of a Pleurisie as well as the Curatory method may with small labour be designed Both the sense of pain The seat of a Pleurisie as well as Anatomical Observations taken from the Patients dead of a Pleurisie do plainly attest the feat of this Disease as often as it exists primarily and solitarily consists in the Pleura or Membrane environing the inside of the ribs And a true and singular Pleurisie is an inflammation of the Pleura it self from the abundant flowing in of inflamed blood growing clammy withall taking its motion through the vertebral Arteries with a continual and acute Feaver a pricking pain of the side a Cough and difficulty of breathing The next Cause is the blood obstructed by reason of its clamminess in the lesser vessels and interspaces of that membrane in like manner as it is in a Peripneumonie or being extravasated being heaped in the same place more plentifully The next cause of it by reason of the swelling up for that cause exciting an inflammation An acute pain ariseth upon this by a wound in a part highly sensible also there ariseth a Cough by reason of a provocation giving impression to the intercostal muscles moreover a difficult breathing by reason of the muscular fibres being hurt as to their action which because they cannot perform long and strong contractions they are constrained to undergoe weak although more frequent Contractions otherwise than in a Peripneumonie in which that symptome ariseth from a Lung too much fill'd and stuffed The Feaver is caus'd from effervescence of blood and is for the most part rather the associate than the effect of a Pleurisie For the blood from what cause soever driven into a feaverish turgescency if it be bound up together in its mass will be apt to grow clammy which together with the Feaver most often induces a Pleurisie or a Peripneumonie or both of them From hence we may observe this disease doth frequently vary its kind and change its place viz. from a Pleurisie into a Peripneumonie and on the contrary afterwards it passes from both or either into a Frenzy or a Squinancy for that the blood while it is boyling throws off its viscous recrements one while in this part another while in that another while in more together and lastly it reassumes them again and variously transferrs them The more remote causes of a Pleurisie are the same as of a Peripneumonie viz. whatsoever stirs up the blood The more remote causes of this Disease predisposed to grow clammy and also to boyl up and provokes a feaverish turgescency Hither appertains excess of heat and cold a sudden constipation of the pores surfeit drinking of Wines or Strong-waters immoderate exercise sometimes the malignant constitution of the Air brings this disease almost on every body and renders it Epidemical whereto may be added that this disease is very familiar to some from their constitution or custome so that a distemperature of blood induced almost by any occasion immediately passes into a Pleurisie From what we have already said the signs of this disease do appear manifest enough by which it is well known as to its Essence and is distinguished from other diseases and especially from a Bastard Pleurisie and a Peripneumonie But it is to be observed that a pain in the side arises sometimes very troublesome which while it counterfeits a Pleurisie is sometimes taken for it although falsly For in
some persons obnoxious to the Scurvy and the affects of the nervous kinde sometimes it happens that a sharp humour and very painful descends into the Pleura or intercostal Muscles and being fixt there produces most fierce tortures which distemper is yet discriminated from the Pleurisie inasmuch as it is void both of Feaver and Thirst the Pulse always abides moderate and laudable frequently the appetite and strength endure moreover the pain is not long fixed or limited to one place but sensibly creeps hither and thither into the neighbouring parts as the matter slides down through the passages of the fibres out of one place into another We meet not with many differences of this disease The differences of it notwithstanding it is used to be distinguished viz. to be either true and exquisite even as we have now described or spurious which having its seat in the intercostal muscles or their interspaces proceeds from winde or a serous and sharp humour heaped up in the same place and raises a pain less sharp without so much as an inflammation or feaver And whereas the grief is planted externally the Patient for the most part lyes better on the opposite side otherwise than in a true Pleurisie Secondly a Pleurisie is either single or complicated with a Peripneumonie or some other distemper and so it is either primary or secondary or join'd with some other affection As to the Prognosticks of this disease The Prognosticks Hippocrates hath observed many certain tokens whereby a good or evil event is signified to patients sick of the Pleurisie To run through each of these and to unfold them with Commentaries added to them we have neither leisure nor doth it seem worth our endeavours The chief thing of all in a Pleurisie is that the disease be presently dispatch'd partly with a free and frequent bleeding and partly by a Critical Sweat arising about the fourth day or before the eighth or these things not duely succeeding it will be prolonged and then most frequently a Peripneumonie or Empyema or a collection of corrupt matter between the Breast and Lungs or both distempers do arise upon this disease from which there follows a solution of the disease but slow and incertain and most frequently full of dangerous chances A Peripneumonie coming upon a Pleurisie not presently cured as it is often wont to be all our hope is placed in digesting maturely the Spittle and quick Expectoration thereof for if this be laudable and plentiful and easily and hastily thrown off it doth often finish both diseases intirely Notwithstanding it is not therefore a consequent that the matter of a Pleurisie is derived from the side into the Lungs by I know not what blinde passages or that the same being sweat out of the Pleura into the cavity of the breast is imbibed by the Lungs and at length drawn upwards through the passages and excern'd forth But when a Peripneumonie arises on a Pleurisie and the matter impacted in the Lungs begins to be evacuated by Spittle so that the affected places of the Lungs are continually emptyed the blood resumes the other matter fixed in the Pleura and carryes it to the Lungs where the places of conveyance are open to be ejected by Spitting But if the Pleurisie be cured neither by it self nor associating with a Peripneumonie then at length either by an Imposthume made in the Pleura or in the Lungs an Empyema or corruption between the Breast and Lungs succeeds or all the matter being brought into the Lungs and there putrified loosning the unity of the Viscera it propagates a mortal or scarce curable Consumption As to the cure of a Pleurisie forasmuch as the state of this Disease The Cure thereof the Crisis and tendencies are manifold divers curatory Indications offer themselves according to their various regards and as occasion serves according to the advice of a prudent Physician they ought to be appointed in the beginning and sometimes altered or continued For surely one Method is convenient for a solitary and simple Pleurisie and another if it be complicated with a Peripneumonie Besides it behoveth to ordain another and another if perhaps a Crisis be expected by Spitting or matters growing worse the disease is either passing into an Empyema or tends to a Consumption As to the three later cases that is to say when a Pleurisie commencing passes into a Peripneumonie or Empyema or lastly into a consumptive disposition there is designed an appropriate way of curing in the pathologies of each of these diseases particularly delivered But as to what appertains to our present purpose three Indications offer themselves for a primary and simple Pleurisie and they are curatory preservatory and vital I. The first Indication takes care that the Inflammation or obstruction of blood in the Lungs by all manner of means with all expedition be removed The first Indication for which intent phlebotomie in every Age by all physicians excepting some Fanatick or false Chymists is wont to be prescribed as a principal remedie Phlebotomie necessary almost in all Pleurisies The reason of which is altogether the same as in a Peripneumonie and many other distempers caused by reason of a stop of blood in some place and so an accumulation Because that the vessels bringing blood being much emptyed do not only rescind the nourishment of the disease but drink up the matter which is the conjunct cause thereof and convey it to another place Wherefore blood is to be freely drawn away in a Pleurisie if the strength endure it and the Pulse be strong And surely it is far better that the first time and every time after as often as there is need to repeat it blood be more largely emitted than to do it more often and more sparingly For very many portions of the blood growing clammy and degenerating into viscousness are heaped up about the place affected which unless they are call'd away from thence by emptying the Vessels through large phlebotomie and in a great part let forth the letting of blood will be frustrated of its desired effect Wherefore that Physicians prescribe blood in a Pleurisie to be drawn out even to swooning seems not incongruous to reason although that practice is not rashly to be attempted for that every evacuation ought to be proportioned to the tenour and tolerance of the strength which rule such a phlebotomy doth exceed But though there is almost a general consent of all Physicians to breath a vein in a Pleurisie notwithstanding there was ever an earnest contention about the place What Vein is to be opened in a Pleurisie what Vein ought to be opened Hippocrates and Galen opened a Vein on the same side of the patient afterwards the Arabians and their followers the Italians and French did either open the Saphene or the Basilica of the opposite side damning the phlebotomy of the same side by Bell Book and Candle Yet in the later generation the practice of the Ancient
Greeks by little and little revived Various opinions are recited so that some did dare to make incision on the same side yet always one side judged the others of the opposite perswasion as it were guilty of murder as often as any unlucky event did happen So that while among Physicians about phlebotomy there was no less a contention than among the Jews and Samaritans about the Sacred place of Worship at length the Doctrine of the Circulation of the Blood held out like a new Light by the most renowned Harvey discuss'd all the clouds of this Controversie so that immediately it clearly appeared to be almost the same thing whether incision be made in the Vein on the affected or opposite side of a patient sick of a pleurisie although in our Age Custom hath prevailed first and rather to open the Vein of the affected side Notwithstanding a Vein being opened in either Arm draws nothing at all immediately from the vertebral Arterie or from the pleura they are only the branches of the Azygos or of the vertebral vein that receive the blood out of the place affected but that they may accomplish this they are not unloaded in any other manner but that the quantity of the whole blood be abated by phlebotomie wheresoever made Onely this may be affirmed for opening rather the vein of the affected side that the Basilick vein being unloaded the Arteries of the Arm receive the more ample provision of blood from hence the bloody stream of the vein Aorta runs down more swistly from that side towards the branches of the Arm and perhaps in the interim of its quick passage it infuses less blood into the vertebral Arteries for the nourishment of the disease As to that opinion that the blood is sometimes more plentifully carryed from place to place that from hence the right Lung or Liver being beset with an inflammation or obstruction the right part of the head is in pain and of the face grows more red I say this sometimes is brought to pass because the patients do constantly lie in their bed on the side affected wherefore the Vessels being compress'd the blood stays longer in other parts of the same side while it is circulating But of these things we will make a more diligent search when we shall render the History and Aetiologie of phlebotomy But if phlebotomy by reason of a weak pulse Cupping-glasses with Scarification supply the place of blood-letting and fainting of the animal function neither ought to be at first administred nor repeated though the pain be most urging Cupping-glasses with Scarification do well supply the turn hereof being applyed to the place pained Riverius and Zacutus Lusitanus have cited notable Examples of cures effected by this remedy And surely this practice seems to lean upon a reason strong enough for the blood being drawn away from the side affected that which is lodged in the neighbouring vessels being the conjunct cause of this disease is moved with it and partly drawn away and partly turned to its Circulation Moreover to remove an inflammation of the Pleura besides withdrawing blood by a free Phlebotomy or Scarification also the serous and other excrementitious humours ought to be gently solicited and excerned as well out of the mass thereof as out of the bowels by Stool Urine and Sweat The more strong purgatives are deservedly prohibited because they disquiet the blood and constrain it to be impacted more deep into the places affected And that certain renowned Chymists viz. Angelus Sala Hartman M. Rulandus with many others do audaciously exhibit Vomits of Stybium to any afflicted with a Pleurisie and magnifie it for the best remedy seems to me neither safe nor congruous to reason Whether Purges and Vomits are to be taken in a Pleurisie the only reason of helping as I think and that very uncertain and full of danger may be viz. that the medicine operating more vehemently while the patients suffer exolution of spirits or swoonings all the vigour and turgescence of the blood abates and for that cause the nervous Fibres remit their wrinklings or painfull contractions and the Vessels carrying blood being much emptyed do suck up the morbifick matter In the mean time there is danger lest the humours being violently disturbed rush more impetuously to the part affected at least lest the Spirits being too much dejected and the work of Nature disquieted about the digesting or separation of the morbific mater strength should utterly fail before the disease be cured Yet in the mean time Clysters are of frequent or daily use yea sometimes more benigne solutive purgatives are allowed provided that the Feaver be not very intense Julips and temperating Decoctions and things gently moving Sweat and Urine What other kind of Remedies are convenient in this disease as we have prescribed before for a Peripneumonie are also here convenient but let all hot and sharp things whether aromatick or endowed with a vinous spirit be carefully declined II. The second Indication preservatory The second Indication preservatory designed against the clamminess and boyling up of the blood prescribes Medicines of that sort which consisting of a volatile or alcalizated Salt do destroy the combinations entered into of the acid and fixed or otherwise distempered Salts with the other more thick particles For which intent the eyes or claws of Crabs the tooth of a Boar the Stone of Carps the jaw of a Pike Fish the Bone in the heart of a Stag the Priapus of a Hart Sal Prunella Salt of Coral Salt of Urine or volatile salt of Harts-horn powder of Goats-blood infusion of Horse-dung Spirit of Harts-horn of salt Armoniack Spirit of Tartar the simple mixture mineral Bezoar Diaphoretick Antimony flowers of salt Armoniack are very famous Remedies in a Pleurisie III. The third Indication vital The third Indication vital which provides that the strength and vital heat be preserved during the course of the Disease in due tune and state gives in precept first an apt kind of food and moreover Cardiac and Anodyne remedies and those which seasonably occur to other symptomes if perhaps they arise First in a true Pleurisie a most thin Diet ought to be appointed viz. of meer Oatmeal and Barley and for ordinary drink a Ptisan or Posset-drink rather than Beer alone is convenient although in an outragious thirst this also is to be allowed of in a moderate quantity Moreover for quenching thirst Juleps Apozemes and Emulsions are taken by turns to all which adde Sal Prunella Secondly Cardiacks let only the temperate Cordials be administred which mildly do recreate the animal spirits and not at all intend the kindling of the blood burning out of its due proportion For these intentions the water of Carduus Mariae Carduus Benedictus of Balm Borage Cowslips Black-cherries are usually given with success whereto let the powder of Pearls and Coral be added Thirdly It behoveth to administer Anodynes both inwardly to provoke sleep in
lymphaducts relating to the left side of the lungs being first obstructed near their insertions into the passage bringing the chyle did swell up to a great bulk and afterwards being broken distill'd their humour into the cavity of the Thorax When now an Inundation of the Precordia and so of the vital Fort was imminent The reason thereof this Gentleman at length thinking it time to provide for himself entered into a course of Physick and carryed certain Medicines into the Countrey for his cure yet without any signal success Afterwards coming to London he first consulted the worthy Dr. Lower being of his former acquaintance He proposing the opening of the Thorax for his only remedy took care that the worthy Dr. Micklethwait and my self should be sent for to the consultation The Cure by a Paracentesis of the breast Immediately an incision was appointed by the consent of us all wherefore after provision for the whole being made a Chirurgeon applyed a Cautery between the sixth and seventh Vertebra and the next day he put his Pipe into the Orifice cut into the cavity of his Breast which being done immediately a thick liquor whitish like Chyle and as it were milkie flowed out There was about six ounces only taken from him the first time and the next day as much more The third day when a little greater quantity was suffered to come out being affected immediately with great fainting and afterwards being feaverish he was ill for a day or two Wherefore it seemed good to stop the issue of that matter till he recovered his temperament and strength but afterwards a sparing evacuation of the same matter being daily made the cavity of his breast was wholly emptyed but as yet he wears a pipe in the orifice with a tap which being opened once in a day and a nights space a very little of the humour flows out in the mean while being well in stomach visage and strength he walks abroad rides and performs all exercises he was formerly accustomed to vigorously enough He used not neither was there need of much medicine only after the Incision we advised temperate Cordials viz. powder of Pearles Juleps and sometimes Hypnoticks and afterwards a vulnerary decoction to be taken twice a day By this method and these forms of Medicines sometimes continued this worthy person seemed to recover his temper and his strength and the habit of his body and his breast exempt from the Dropsie Notwithstanding he still wore a silver Pipe in the orifice of his side out of which ichor daily flowed and when after some months this being withdrawn the Issue was shut up a gathering of the same humour was made within the hollow of his breast perceivable by the sound and fluctuation thereof but when that the disease returning the same medicine was to be used and incision of his side appointed Nature by chance discharging the function of a Chirurgeon the matter being prone to burst out and flowing to the place made its own way He is now necessitated for preventing the illuvies of his Breast to keep that orifice constantly open like a sink From these things I think it manifest enough that an Ascites of the Breast sometimes arises from the lymphatick vessels burst asunder within the Lungs neither doubt I less but that the same affection may be caused from the chyliferous passages being broke within the Thorax notwithstanding this chance so rarely happens that as yet I have not known it by my own observation or others relation Moreover it little avails to make inquisition into the Aetiologie of such a disease because it is not only apparently incurable but in a short time mortal because the Precordia are incontinently overflown by the inundation of the chyle and also the blood and the animal spirits being defrauded of their wonted supply of nutritious Juice are immediately dissolved From the various causes of this Disease even now set down The differences of this disease it will be easie to collect its differences For first a Dropsie of the Breast is either simple and primary peculiar to this Region or secondary coming upon a general Dropsie as it is wont often to be in cachectic presons Secondly this Disease is distinguished as to the places affected viz. forasmuch as water is either collected in the whole breast or only in one side thereof Thirdly as to the matter accumulated in a pectoral Ascites which one while is limpid and plainly waterish another while more thick whitish and as it were milkie such as we have described in the foregoing History The diagnostick signs do manifestly enough discover this disease The Diagnostick signs viz. the fluctuation of water is perceived by handling and by feeling at every bending of the body and the sound is clearly heard Moreover they are affected much with a dry and empty Cough as also with a Dyspnoea almost continual and painful especially while they ascend steep places Besides they have a thirst with a little feaver and in the night after the first sleep great disquiet and tossing of the body proceeding from the vapours being elevated by the heat being more intense Sometimes there comes upon these a Palpitation of the heart an intermitting or disturbed Pulse and frequent faintings of the spirit As to the prognostick this disease is always difficult to cure and among the vulgar accounted incurable And surely if it come upon an Ascites of the Abdomen or an Anasarca throughout the whole body it is judged not without cause desperate But if the affection be primary and happen to a body otherwise sound we are not altogether to despair of Cure What relates to the curatory part of this Disease The Cure the chief Indications will be three Curative Preservative and Vital according to the common method of curing in most other Distempers The first has regard that the water heaped up in the cavity of the Breast by any means be evacuated The Second provides that afterwards a new illuvies be not gathered in the same place The Third procures the restoration of strength and the symptoms impairing it to be removed with expedition To satisfie the first Indication What Intentions of healing the first Indication suggests and that an Ascites of the Breast may be emptyed there are but two ways or means of evacuation to be met with whereby this collection of waters may be drayn'd viz. Either that the vessels of the Breast and the passages of the humours being emptyed might suck up that Lympha being rarified and afterwards by the passages of the blood or air convey them forth or secondly that by an incision of the side those waters may be drained forth plentifully in their own Species That former manner although more seldom yet sometimes succeeds The first Intention which I can attest out of my own observation For the consistence of the Lungs being spongy within and externally very porous while by every turn of the Diastole they are drenched
from 15 drops to 20. with the distilled water prescribed above In this Class of Medicines by which the icterical distempers of the blood are to be corrected Steel remedies of several kinds steel'd remedies do also challenge their place by right for these afford notable help not so much by unlocking the obstructions of the bowels as by depressing the rage of the Sulphur and fixt Salt and by volatilizing the blood in the Jaundies no less than in other cachectical distempers Wherefore to the Decoction or Tincture or Infusion above prescribed is properly added the filings of Iron or the prepared powder thereof its mineral consistence being some wayes opened or the vitriolic Salt extracted from hence it is that Medicinal waters heal even to a miracle those sick of the Jaundies that had been despaired of although these drunk in a very large quantity inasmuch as they pass through all the vessels do also open the passages of the Liver however shut up Therefore also even Preparations of Steel are added to the Electuary Pills and Powders above recited one while this another while that in due proportion Moreover the Syrup thereof given twice a day to one spoonfull in three ounces of Apozeme or water against the Jaundies also tincture of Steel to twelve or fifteen drops may be administred in the same manner In the last place we may annex to this classis of altering Medicines those things which not taken inwardly Outward and Sympathetick remedies against the Jaundies but outwardly applyed and by contact used to the very urine of the Patient are held to cure this disease As to the former a remedy often tryed by the vulgar is a living Tench-fish whose Scales and outer superficies do resemble a yellow colour applyed to the right Hypochondria or Stomach according to some to the soles of the feet according to others whence a sudden flight of this disease is expected hence although many promise themselves a sure cure it hath often deceived me Another cure of the Jaundies at a distance is said to be done by I know not what sympathy or secret manner of working Take the fresh Vrine of the Patient made at one time of the ashes of the Ash-tree searced as much as suffices to reduce it into Paste which may be formed into three equal balls to be placed in a place shut near the hearth or Stove as these dry and harden the Jaundies will vanish after this course I have known this inveter ate disease happily cured although resisting many other remedies the practice thereof is very familiar with the Vulgar If of a certain it could be made manifest that this effect doth for the most part happen The reasons of some of them and the reason of it be inquired into in the first place we ought to suppose a consent or sympathy of the spirits and other particles in the animated blood with other symbols inmates of the fresh urine and that they immediately are affected in the like manner with these Notwithstanding it is evident enough that a lixivial Salt mingled with urine doth presently set free the volatile salt formerly subdued or enwrapt in other particles as is plainly seen in distillation of Urine which if you urge by it self with a sand-heat nothing but phlegm will arise but adde the calx of Tartar or Ashes immediately the Spirit and volatile Salt will come forth wherefore that Empirical administration being administred at the same time both in the Icterical urine and also in the blood of the Patient the volatile Salt escapes out of the power of the fixt Salt and the Sulphur and for that cause the icterical distemper of the Blood is put to flight Also upon the same reason is built another sympathetical cure of the Jaundies whereof Phil. Grulingius and Felix Platerus do make mention viz. the sick party pissing upon Horse-dung while it is hot hath cured many of the Jaundies inasmuch as the fixt Salt of the Urine and thereby the fixt Salt of the icterical blood of the patient is altered by the volatile Salt of the fresh dung and reduced into its due temperature 3. The third Curatory indication vital institutes a convenient course of Diet The Third Indication vital and moreover Cordials and Anodynes of both which there is frequent need As to what relates to the former Food in this disease more than in any other ought to be medicinal For Vegetables and their parts styled commonly Hepatick remedies are boyled in the broths of these Patients And these also are wont to be made instead of other flesh of Worms or Snails which are accounted Antidotes against the Jaundies Moreover Ale and other ordinary drinks are impregnated with infusion of Medicaments Take of the roots of stinging Nettles of Strawberries of each an ounce and half Eriygo-roots candied one ounce Ivory and Harts-horn of each two drams Earthworms cleansed twenty a Crust of White-bread Mace two drams boyled in two pound of water to one pound strain it through Hippocrates sleeve to which adde Diasantalon half a dram make broath whereof take from four ounces to six twice in a day for ordinary drink fill a Tub of four Gallons with Beer after it hath wrought put in the following Bag. Take the tops of Roman Wormwood white Horehound dryed of each two handfuls the roots of sharp pointed Docks six ounces of the Bark of Ash of Barberries of each 3 ounces the outer Rinds of eight Oranges and of four Limons being sliced and bruised let them be prepared according to Art Since many sick of the Jaundies are usually affected with a great languishing Forms of Cordials and frequent faintings of the Spirits they have also need of cordial Remedies Take of small Aqua Mirabilis eight ounces water of Earth-worms four ounces Syrup of Orange-peels two ounces mingle them the dose two or three ounces Moreover they who are troubled with this disease do very much suffer with pain sometimes very troublesome in the night and are often obnoxious to waking wherefore also Anodynes come into use for administration Take of Aqua Mirabilis water of Earth-worms of each one ounce Diacodium six drams Tincture of Saffron half an ounce the dose one or two spoonfuls late at night if sleep be wanting Take of Laudanum tartarizated two drams Aqua Mirabilis two ounces Syrup of Clove-gilly-flowers one ounce mix them the dose is one spoonfull after the same manner SECT II. CHAP. II. Of other Hepatick Remedies THe Liver is seldom or never found obnoxious to an Atrophie or extenuation since truly it performs the office of a strainer and according to some of a mingling bowel but on the contrary by reason of many causes and occasions it runs the hazard of being encreased as to its bulk and to be stufft and swell'd with divers things gathered therein and with concretions Hence no small account of health consists in this that the Liver having right conformation may freely convey the blood every
the swelling of the belly is somewhat diminished we are not to despair of the Cure but if Purgers bring out little or nothing of the Serum or Lympha and thence by reason of the Nervous fibres being irritated and driven into extensions or inflations of the bowels and membranes as it uses frequently to be the belly swells the more and grows like a Drum we may expect only a fatal event of the Disease About the curing of the Dropsie called Ascites it behoves us chiefly to consider by what ways the waters heaped within the abdomen The Cure of an Ascites may be thence brought out and evacuated for such an evacuation ought to be attempted only by possible ways And here presently is to be observ'd that the remedies used for Hydragogues according to the ordinary practice of Medicine intend to accomplish that end by purging by Urine By what and how many remedies the eduction of the water is to be endeavoured by Sweating and by insensible transpiration In some cases of the Sick you ought to proceed by this way and in other cases rather by that way or another and if none of these seem feasible or succeed well let mature consultation be had for a Paracentesis It will be worth our labour to weigh every of these kinds of Medicines and the reasons of every one and the manner of their operations and with how much vertue Hydragogues are endowed First First by purging therefore as to what relates to purging we have in another place shewed that from the irritation of the Physick made in the belly and guts as well the Contents and winde of these bowels as moreover the humours driven into their Coats and Glandules and which are heaped up in the Vessels and Pipes of the neighbouring parts are disquieted and partly streined into the passages of the guts and partly returned into the mass of blood insomuch that the tumour of the abdomen arising from the stoppage and as it were a waterish affection of those kind of Parts is often abated by Purgatives seasonably administred and sometimes wholly removed but it doth not so succeed when it proceeds from a Lympha fluctuating within the cavity of the abdomen or from an inflammation of the membranes or from a tympanitic extension because Hydragogues do little or nothing bring out those waters and if they be of the stronger sot they encrease this passion and exasperate it by inflaming the part Catharticks used for Hydragogues Catharticks are either Vomits or Purges are either Vomits or Purges they exert their power in the stomace and these rather in the Intestines insomuch that they powerfully provoke and twitch the Nervous fibres and together pour forth the blood and nervous liquor by a certain septick force and do cause the serous humours wherever impacted to be stirr'd and do cause them plentifully to be sent away by the passage granted Either are reckon'd of a various kinde viz. either simple or compound gentle or strong by the Ancients as well as by the Moderns some of which that are most chielfy noted we will here briefly observe 1. Emetick Hydragogues chiefly famous are Gambugia Esula Spurge and their several Preparations as also the Hercules of Bovim and the Pilulae Lunares 2. The chief medicines of either kinde Purgers are Elder and Dwarf-Elder Soldanella Gratiola or Hedge-hyssop the Juice of Orris and Elaterium We will briefly prescribe some methods either of preparing or compounding or administring each of these 1. 1. Gummi guttae Gambugia first an Indian Medicine being from thence brought by our Countrey-men from the Painters Shops coming to the Apothecaryes began to be in use and is much magnified for purging out serous humours But sorasmuch as taken by it slef it vehemently disturbs the Stomach and often weakens it therefore that its outragious and violent vomiting force may be somewhat abated there are divers ways of its Preparation invented but truly it is best corrected with an acid Spirit or with an alcalizate Salt or by throughly mixing and correcting it with aromaticks Adrian à Mynsicht It s various Preparations extolls the magistery thereof which is made by a dissolution in Spirit of Wine and after drawing it off and precipitating it with Spring-water also dissolving it with Spirit of Wine vitriolated and with Tincture of Roses and red Sanders and after by evaporating it others prepare it with the fume of Sulphur after the manner of Scammonie sulphurated others grinde it on a Marble moistening it with Oyl of Cinnamon or Cloves or other chymical Aromaticks I use most the Solution thereof made with a tincture of Salt of Tartar the dose from 15 drops to 20 or 30. Take of Gum-gutta gr 6. Mercurius dulcis gr xv Conserve of Violets The forms of Hydragogues prepared thereof a dram and a half make a Bolus Take of Gambugia twelve grains Salt of Wormwood fifteen grains Oyl of Mace one drop Conserve of Damask Roses one dram make a Bolus and it is wont to be given with Tartar vitriolate or Cream of Tartar and powder of Rhubarb Take of Gum-gutta sulphurated or vitriolated fifteen grains Cream of Tartar half a scruple Extract of Rhubarb one scruple Oyl of Cinnamon gut 2. make 4 Pills Lately a woman afflicted with a most painfull Ascites and most desperate as it seemed to me the ensuing Medicine being taken for 6 days successively she began to be much better and in a short time afterwards recovered her health entirely Take of powder of Gum-gutta twelve grains Oyl of Cinnamon one drop with syrup of Buck-thorn make a Bolus the dose daily to be augmented ascending from twelve grains to twenty Take of our Tincture of Gum-gutta one scruple water of Earth worms one ounce Syrup of Rhubarb half an ounce mix them and let it be taken with government 2. Whereas there are several species of Spurge or Tithymalus 2. Spurge The Preparations thereof and all of them work more violently either by Vomit or Stool by reason of the notable provocation they make in the bowels and for that cause do abundantly bring out serous humours yet by reason of the too outragious force of many of them the lesser Spurge for the most part only is now in use and the preparations thereof most of all magnified are the powder of the bark of the Roots and the Extract and we think fit to adde the tincture inferiour to none of the rest Take of Spurge with the Roots cleansed four handfuls Lignum-Aloes and Cloves of each one dram bruise them and boyl them in four pound of Spring-water to half the strained Liquor clarifie by separation or settling in a long glass afterwards evaporate the clear liquor in a Bath heat to the consistence of an Extract the dose one scruple Take of this Extract half an ounce Forms pour upon it into a matrass of the Tincture of Salt of Tartar 6 ounces digest them in a Sand-hath to the Extraction
of a Tincture the dose from 20 drops to 30 in a convenient vehicle Take of the Powder of Spurge from seven grains to ten Cinamon half a scruple Salt of Tartar eight grains mix them together in a glass mortar give it by it self or mixed with a fit Conserve or Syrup make a Bolus or Pills 2. Precipitate of Mercury with Gold The Hercules of Bovius or the Hercules of Bovius which is much extolled by the Author for curing Dropsies it is described in a former Treatise in the Chapter of Vomits and the manner of preparing and the working thereof and the Reasons are there delivered This Medicine inasmuch as it twitches the stomachical fibres by its acrimony and pours out the blood by reason of the mercurial and salt particles causes or stirs up a fierce Vomit and thereby causes the serous humours violently strained into the Cavities of the bowels to be ejected 3. The Pills called Lunares produce the same effect in like manner Pilulae Lunares by reason of the vitriolate particles of Silver sharpened with other saline menstruums viz. by wrinkling of the fibres of the Bowels very much they force the serous humours to be strongly strained into their passages and so to be evacuated A Solation of Silver made in Stygian water and well cleansed and by a little evaporation is reduced into pleasant Crystals which by themselves or with an addition of Salt Nitre to abate the fierceness of the Lunar Vitriol are made into Pills with crums of bread the dose is one Pill sometimes two or three respecting the ability of strength and working Medicines of this kinde are exhibited sometimes with success in a strong constitution and bowels strong and a good habit but they are scarce ever conveniently or rarely without prejudice taken by tender and cachectical persons Hydragogues meerly or chiefly purging are either of a more mild sort as Elder Purging Hydragogues Dwarf-Elder Soldanella and juice of English Orris which seldom being administred by themselves do want the stirring up of sharper Medicines and on the other side they blunt their too much fierceness or they are of a stronger sort as Gratiola or Hedge hyssop Jallap and Elaterium The seeds or grains of Elder and Dwarf-Elder being dryed Elder and Dwars-Elder are reduced into a powder which being taken to the weight of one dram doth gently bring forth serous humours by siege Water and Spirits are distill'd of the juice of either sorts of Berries fermented also Robs and Syrups are made of them which with many other Preparations of those Vegetables are much magnified for all hydropical Distempers Soldanella and Gratiola Soldanella are rarely used by themselves in our age neither are any neat and very efficacious Medicines prepared out of those Simples they are frequently mixt with certain other Hydragogues and chiefly are ingredients in compounding Apozems The Juice of English Orris is a very profitable Medicine The juice of Orris and because to be easily provured for the poor is the more to be esteemed It is given grom six drams to an ounce and a half or two ounces either by it self in a fit vehicle or with other things appropriated thereunto Jalap is a most known Medicine against every Dropsie and common enough Any one of the common people suffering under that disease presently takes of the powder of the root of Jalap a Pennyworth mixt with Ginger and White-wine and the desired effect doth frequently follow this remedy used with intermission Elaterium is rightly esteemed the most powerful Hydragogue Elaterium for that it most painfully provoking the splanchnick fibres and together melting the blood and humours by a certain corrosive force compells whatsoever serosities the Coats of the Bowels Membranes Vessels also the Glandules and flesh do contain in themselves to be poured out into the cavities of the Stomach and guts by which Medicine happily working the asswaging of the Abdomen doth sometimes succeed Truly this is the chief weapon of the Empirical Magazine against any Ascites which they notwithstanding using in all cases do oftener administer to the hurt than benefit of the Patient the dose is from three grains to ten or fifteen taken either by it self only with correcting spices added or it is given with other hydragogues in form of a Powder Pills or Electuary The tincture and essence of it are extracted with Spirit of Wine or with tincture of Salt of Tartar These are the chief simple Hydragogues The forms of Hydragogues from which being prepared with the addition of others many compounded ones as well Magistral as common in Shops are made adn are every where in use moreover very many more might be prescribed extemporarily as occasion serves Of these we will here annex a few more select forms and chiefly those that are taken in the form of Potions Powders Electuary and Pills Take of Dwarf-Elder A Tincture English Orris of each an ounce and half leaves of Soldanella and Gratiola i.e. Hedge-hyssop of each one handful Asarum and Asse Cucumber-roots of each two ounces roots of lesser Galangal six drams choice Jalap half an ounce Elaterium three drams Cubebs two drams shred and bruise them and pour upon them three pound of small Spirit of Wine tartarizated digest it stopt close in Sand for two days strain it clear and depurate it by settling The dose from two spoon-fuls to three in a convenient vehicle Take of Elaterium Powders Soldanella Ginger of each one scruple Galangal Cloves Cinamon of each half a scruple Salt of Tartar fifteen grains make a powder for two doses Take powder of Jalap one dram Ginger one scruple Cream of Tarar 15 gr make a powder to be given in a draught of White-wine Take of Rhubarb one scruple Pills Elaterium 5 grains Tartar vitriolated half a scruple Spicknard three grains with Syrup of Buckthorn make four Pills Take of pill Aloephanginae half a dram Elaterium half a scruple Oyl of Cloves gut 3. make four Pills Bontius hydropick Pills are given from half a scruple to half a dram prepared thus Take of Aloes two drams and a half the preparation of Gum-gutta one dram and a half Diagridium corrected one dram Gum Ammoniacum dissolved one dram and a half Tartar vitriolated half a dram make a mass and form it into Pills Certain hydragogue Electuaries re now every where in use and celebrated by practisers Electuaries Of which sort are 1. One described by the renowned Sylvius and the other by Zwelfer This following pleases us Take of Resine of Jalap two drams Tartar Vitriolate one dram Extract of Rhubarb two drams of Spurge a dram and a half lesser Galangal one dram beat them in a mortar and lastly adde of Conserve of the flower of English Orris four ounces and with Syrup of Peach-flowers make an Electuary the dose from half a dram to a dram and a half or two drams I might here set down or describe many other
frequently so raised even the belly also doth from thenc swell the more forasmuch as the Blood being agitated and poured out deposits in that place more largely the Serum and for that cause the mouths of the Vessels are more loosened and opened so that they may more readily let fall water prone to depart from the mass of blood But the Remedies which are chiefly wont to be administred with success near the places affected when a Cure is intended without a Paracentesis are Clysters and Plaisters The former draw the Serum out of the Vessels and Glandules of the Guts and Mesentery without fusion of the whole mass of blood Glysters and Plaisters which the stronger purging Medicines do excite which being so emptyed do imbibe a little the extravasated Lympha For this purpose the ensuing Clyster wont to be prescribed by us in this case is most fit in regard it contracts the intestinal fibres together and draws the Serum imbibed by the blood or contained formerly therein towards the Reins Take a pint of Vrine of a sound man that drinks Wine Forms thereof Venice Turpentine dissolved with the Yolk of an Egge an ounce and a half Sal Prunella one dram and a half make a Clyster which repeat daily Sometimes Plaisters yield help in an Ascites yet let them be such as by a certain restringent and comfortable virtue strengthen the bowels and bind together the moughs of the Vessels lest they too much spue out their serosities for this purpose I use to apply the Plaister Diasaponis with successe Or Take of the Plaister of Minium Paracelsus Plaister of each what suffices make a Plaister to be applyed to the Abdomen If this disease is accompanyed with a Tympanie Epithemes of another manner are fit as we shall hereafter declare The great and most present remedy of an Ascites is that the waters may be drawn out by a Paracentesis being made which administration however doth not oftner cure the disease than kill the Patient wherefore there is need of exact caution to whom and at what time of the disease it ought to be administred to persons of an ill habit who have been long ill in whom the conformation and temper of the bowels is wholly depraved it will be in vain to have the Lympha drawn out by the Paunch being pierced for thereupon immediately the Spirits faint and the strength is dissoved and after a while a new illuvies of the morbific humour succeeds When and to whom a Paracentesis is convenient in an Ascites But those who being formerly of sound bowels and healthful enough as to other parts when they fell into an Ascites from some great and evident cause as we are not at first presently to make a Paracentesis so neither if it be needfull ought we to deferre it too long for an incorrigible depravity of the Bowels is contracted by a longer delay while they remain a long while drowned and as it were boyled in water It is beside our purpose to describe here the administration of a Paracentesis whether it be done after the ordinary manner or by a hollow Needle according to Sylvius this part of Chirurgery as dangerous when Physitians seldom prescribe yet Quacks and Empiricks rashly and unluckily essay it Artists not being consulted we will relate here for conclusion the History of a true and huge Ascites lately cured without and Paracentesis A young Woman wise to a Merchant being slender and proper A history of a cure while she gave suck to her Child to encrease her milk day and night did immoderately guzzle one while plain Ale another while Posset-drink After having used this kind of dyet for a fortnight she contracted a vast Ascites in a short time the beginning whereof she was not in the least sensible of for her Abdomen being great with water fluctuating within did much swell up and its bulk when she turned from one side to the other fell without the Ileon and borders of the rest of the body when in the mean while the flesh of all her Members was very much consumed that she seemed no less in a consumption than a Dropsie The Child being weaned and a better course of Diet being appointed she betook her self to Medicines and took in the first place the more mild Hydragogues as well purgative as diuretical but without any advantage also she was worse after every purge but being committed to our care and almost desperate I handled her after the ensuing method I prescribed these Medicines for the most part forbidding Ale and any potulent liquor medicined excepted Take of the leaves of Plantane Brooklime Clivers of each 4 handfuls bruised and pour upon them of water of Earth-worms and Rhadish compound of each three ounces press them take it twice a day viz. at Eight in the Morning and at Five in the Afternoon She continued long in the use of this Medicine but did sometimes vary the Composition sometimes changing the herbs sometimes the Liquor poured on them Take of the reddest Tincture of Salt of Tartar an ounce and a half she took 20 drops at night and early in the morning in two spoonfuls of the following Julep drinking seven spoonfuls after it Take water of Elder-flowers Saxifrage of each six ounces water of Snails Earth-worms and Rhadish-compound of each two ounces She wore a Plaister of Minium and Oxycroceum upon her Belly The following Clyster was given first daily afterwards every two or three days Take Vrine of a healthy man one pound Turpentine dissolved with the Yolk of an Egg an ounce and a half Sugar an ounce Sal Prunella one dram make a Clyster By the constant use of these things her Belly asswaged within a fortnight but her flesh daily wasting a Consumption was threatned Wherefore going into the Countrey to avoid this she drank Asses milk by the benefit of which Nutriment and of purer Air continually taking the above-mentioned Medicines she recovered her entire health within three or four weeks and lives yet in health SECT II. CHAP. IV. Of a Tympanie ATypany vulgarly A Tympany not properly a kind of Dropsie although not properly is esteemed a kind of Dropsie from which rank Prosper Martianus alleading the testimony of Hippocrates rejects as well this Disease as an Anasarca But the former infessting the region of the Abdomen and raising it up into a bulk now comes under consideration next after an Ascites to which it is something a-kin where first of all it is obvious that this Disease as it is most difficult to cure so also to be known for although its outward form viz. a somewhat hard swelling of the belly very stiffe and yielding a sound like a Drum upon touching it is evidently perceived by many senses together notwithstanding what may be the morbifick matter inducing that Tumour or after what manner it is generated in the belly or from what place it comes thither is altogether unknown therefore those who have a Tympanie as though
composing himself for sleep he began to sleep soundly he was surprized with such a difficulty of breathing that the frequency of it threatned the danger of choaking at which time also he perceived a certain palpitation about the Hypochondria as if some living Animal were underneath the midriff this distemper afterwards ended in a Tumour of the Abdomen by which he dyed In this and other cases now cited the same reason holds viz. that the animal spirits being used to make irregular excursions into the nervous Fibres of the lower belly at length do not only more often and abundantly enter into them but being impacted and hindered they abide in them and so at length induce tympanitic inflations of the bowels Truly this morbific beginning happens sooner of later The evident causes of this disease if thereupon do come the evident causes which disturb the Spirits in the bottom of the belly and compel them to frequent disorders and also do either stop the motion or pervert the temperature of the nervous Juice flowing within those Fibres in which rank are accounted irregularities in the six Non-naturals immoderate Passions and chiefly of grief and usual evacuations suppress'd drinking of cold water after some great heat or any sudden cold induced on the belly either from air or water As to the Prognosticks The Prognosticks thereof this disease is always accounted of so bad an omen that commonly the name is abhorr'd insomuch that frequently when there is no suspicion of ill from the tumour of the belly if perhaps that swelling be call'd by the Physitian a Tympanie forthwith it is concluded desperate Notwithstanding this Disease rarely kills of it self but being protracted a long space of time that it may at length more certainly kill it gains to it self an Ascites as a Harbinger of Death That we may search into the reason thereof it will be obvious enough to conceive while all the bowels are distended in the lower belly and are held as it were stiffe the passages of the blood and nervous and lymphatic humours being too much extended or compressed are much straitened and for that cause cannot freely and readily transmit its Juice from whence it follows that every humour being straitned in the passage that at length it may pass by some means it shakes off a certain serosity from its masse wherever way is given and those droppings of the humours falling into the hollow of the Abdomen excite an Ascitick Dropsie What relates to the Curatory part of this Disease The Cure the whole scope of healing is commonly bent against wind viz. Indications inculcated by practical Authors suggest the matter to be evacuated from whence the winds are raised and to remove the cause that lifts them up and the winds to be discuss'd and dissipated which do already distend the belly For these ends Purgers appointed against the humour chiefly suspected are wont to be prescribed with great confidence although with small or ill success that is to say Phlegmagogues so called another while those that purge Melancholy another while those that purge Choler whereto also are joyn'd purgers of water as weapons intended against every enemy For this disease as is manifest by our observation is wont for the most part to be exasperated with strong Purgers and seldom alleviated the reason whereof is evident enough because the nervous fibres being provok't by a sharp Medicine the animal Spirits renew their irregular excursions Remedies designed against Wind profit not and do every where more and more stretch them out rather than give any remission to them wherefore although frequent and abundant watery and flatulent stools are procured notwithstanding the Belly swells the more Moreover to dispell discusse and bridle the winde there is a more than Aeolian power prescribed Medicines commonly call'd Carminatives almost of every kind or form are sedulously administred within and without above and beneath and upon the part affected notwithstanding this disease for the most part is untamed by all these whence we may suspect that the true cause of the disease lyes as yet conceal'd because Medicines profit not that are administred indicated or suggested according to the ordinary Aetiologie or reason of it Although I cannot challenge a better successe in curing this disease or a more certain method of healing attested from experience notwithstanding in the mean while we will here proffer another way of curing accommodated to our Hypothesis and established by reasons strong enough Wherefore in a Tympany as in most other affections 3. Curatory Indications there will be three chief indications Whereof the first and chiefly insisted on is the Curatory that by recalling the animal Spirits from their convulsive affection and reducing them into order endeavours the removal of the swelling of the Belly The second Preservatory which restrains those or other Spirits from their irregular excursions into the lower Belly and together corrects the faults of the nervous liquor watering it both as to its temper or motion The third Vital by removing the Symptoms urging doth succour and sustain all the functions oppressed or weakened as much as possible may be I. The first Indication is of greatest moment The first Indication hardest on which the hinge of the whole Cure turns but it is most difficultly performed for it doth not easily appear by what remedies or wayes of administration it ought to be attempted when most weapons or medicines do little or nothing prevail against this inviolable enemy What and what sort of Medicines are good or hurtful in this Disease Phlebotomie assumes no place here but is declined for the most part as prejudicial also Catharticks insomuch as they provoke the affected fibres and disturb the Spirits and hurry them more impetuously do increase rather than diminish or cure the Tumour of the Belly in like manner Diaphoreticks impell the Spirits and the morbific particles deeper into them whereas they ought to be allured and call'd out of the Fibres The chief order of healing seems to be placed in Diureticks and the use of Clysters and also great things are expected from topical Applications because they are more immediately exhibited to the disease and as it were by contact and because they do best discusse Tumours in other places Yet not all Dissolvents are here fitting nor those which profit most in other Tumours for the more hot being given for discussing whether they are applyed by fomentation Liniments or in the form of a Cataplasm or Plaister oftner afford hurt than succour in a Tympanie for the both open and dilate the passages of the fibres that from thence they may lye more open to the incursion of the Spirits and also rarifie the particles impacted so that while they occupy a larger space an inflation and intumescency of the Belly is augmented Lastly what appertains to Alteratives which succour against other affections of the nervous kinde only a certain few are fit in a Tympanie for where
boyled Salt Alum and Sulphur and after applyed Cow-dung for a Cataplasm I use to prescribe these ensuing Take of flowers of Sal Armoniack one ounce Crystal mineral two ounces A somentation Spirit Wine small and imbued with much Phlegme two pound mixe and dissolve them in a glass Let a woollen Cloth dipt into this warm be applyed upon the whole Abdomen and then let it be changed wetting it again let it be done for the space of half an hour twice a day afterwards let there be applyed a Cataplasm of Cow-dung with the powder of Dogs turd or the following Plaister Take Empl. Diasaponis that is de Minio with Venice Soap A Plaister let it be spread thin upon limber Leather and applyed to the whole Belly to be renewed once in ten or twelve dayes II. The second Indication requires mostly alterative Remedies to wit The second Indication those which stop the fermentations of the humours in the bowels of the nether Belly and the Orgasms and irregular excursions of the Spirits also those which procure equal mixtions and due motions of the Chyle and nervous Juice Of Chalybeate Medicines for which end Chalybeates are chiefly in use And truly it is wont not only in this but in many other splanchnical Diseases to have resort to the Medicines of Iron as if from thence to fetch the sharpest weapons whenas many Empiricks and Quacks who prescribe these things confidently and dogmatically observe not by what way such a Medicine doth operate or what alterations for the better may be lawfully expected from thence wherefore while Iron changed into Medicine although the Sword of Goliah is snatcht and brandisht by a blind man it is no marvel if it prove in vain or if in the stead of the disease which is an Enemy Nature it self is sometimes hurt and truly frequently it happens so when Chalybeats of which there is great variety and diversity of operations are administred without any choice or difference either of the temperament or constitution in the Patient and respect to the state of the Disease Of Medicines prepared of Iron or Steel and of their vertues and manner of working What preparations of Iron are not convenient we have in another place treated and there is no need here to repeat the same things For this disease if any of them not all of them are fit for those in which the frame of the mixture being opened the Sulphur remains still and being loosened predominates over the rest they are altogether to be excluded from this number for they do much ferment the Juices of the bowels with their notable fermentation and do so exagitate the Blood and Spirits that the whole Region of the nether Belly is lifted up into a greater bulk as if by a certain Spirit thronging violently into it Neither here are they fit from which the sulphureous particles together with the saline are chased away as in Crocus Martis prepared by long and strong Calcination For this Medicine as it is conducing to stop all fluxes rather fixes any impaction of Humours and Spirits and renders them more obstinate But there remains a Martial Remedy of a middle kind What sort may be admitted wherein the Sulphur being wholly or for the most part expell'd a vitriolic Salt remains and predominates as indeed it is in the solution of the filings of Iron or in a simple Infusion or in Mineral water in the Salt or Vitriol of Mars in our preparation of Steel with many others out of which medicines being prepared or compounded we find by often Experience that in some cases they contribute notable help For these destroy the exotick ferments of the bowels and restore the native ferments they open their obstructions they fix the blood and restrain its consistence from too much dissolution wherefore Chalybeate remedies after the same manner as certain other alteratives do perhaps something profit against the procatarctick and more remote causes of a Tympany but as to the conjunct cause they contribute little or no succour Take of our Steel finely prepared two drams Forms of Chalybeates the distilled water above prescribed two pound Syrup of the five Roots two ounces mix it in a glass let it clarifie by settling the dose three or four ounces in the morning and at five afternoon Take of the Powder of Aron-roots Crabs-eyes of each three drams Crystal Mineral two drams Vitriol of Mars a dram and a half Sugar of Rosemary-flowers two drams mix them the dose half a dram twice in a day with a convenient vehicle Hartman doth wonderfully magnifie the liquor of the flowers of Tapsus Barbatus or Mullein A liquor of the flowers of Tapsus Barbatus as a specifick remedy in this disease by putting the fresh flowers into a Vessel being strongly press'd and put into an Oven with bread being close stopt afterwards the Liquor being strained let it be distill'd in Balneo the dose one Scruple in the Decoction of Fennel-seeds and Roots Surely this Medicine if it doth effect any thing ought to be given in a larger dose Johannes Anglus commends an Electuary of Rosata Novella with Diatrion Santalon and Egges of Ants which remedy seems to promise something probable enough In imitation of this I here propound this ensuing Take Conserve of Chichory flowers An Electuary of Indian Cresses of each three drams powder of Aron-roots Lignum Aloes yellow Sanders of each one dram Crabs-eyes one dram and a half Salt of Wormwood one ounce Ants Egges one ounce the liquor of Tapsus Barbatus half a dram with a sufficient quantity of Syrup of Citron-rinds make an Electuary the dose two drams twice in a day drinking after it of the former distilled water or of the following Julep three ounces Take the water of the leaves of Aron A Julep of the Juice of Elder-berries of the water of Juniper and Elder-flowers of each six ounces the magistral water of Snails and of Earth worms of each two ounces Syrup of the Juice of Elder-berries two ounces mix and make a Julep III. Third Indication The third Indication Vital prescribes Remedies against fainting of Spirits and difficult breathing and against Watching and Thirst We will briefly annex certain forms of either kind 1. Cardiacks Take of the water of Napha Cordials Marygolds Camomile of each three ounces of Dr. Stephan's water two ounces Tincture of Saffron two drams Sugar one ounce Pearls one dram make a Julep the dose four or five spoonfuls three times a day or oftner in faintings Take Conserve of Marygolds two ounces Confection of Alchermes and de Hyacintho of each two drams prepared Pearl one ounce Syrup of the juice of Citrons enough to make a Confection take the quantity of a Nutmeg evening and morning drinking after it a draught of the Julep 2. Hypnoticks Take of Aqua Hysterica six drams Hypnoticks Syrup de Meconio half an ounce mix them and take late at night Or Take
of small Cinnamon-water one ounce Diacodium three ounces Tincture of Saffron two drams Mix them and take one spoonfull at night if sleep be wanting Or Take Syrup of Cowslip-flowers three spoonfuls compound Poeony-water one spoonful Laudanum tartarized one dram take one spoonful if Watchings require it 3. Extinguishers of Thirst in this Disease being very thirsty Things mitigating Thirst ought frequently and in small quantities to be administred that that troublesom symptom may be restrained without much drink which is perpetually pernicious For which purpose Take of Conserve of Wood-sorrel passed through a Sieve three ounces Pulp of Tamarinds two ounces Sal Prunella one dram with a sufficient quantity of Syrup of the juice of Wood sorrel make a Lohoch of which let him lick often SECT II. CHAP. V. Of an Anasarca NOw two kinds of Dropsies viz. Ascites and Tympanie according to common reckoning being finisht although the third to wit an Anasarca for that it is an affection rather of the whole body than of the nether Belly appertains not properly to this place notwithstanding the Pathologie thereof having some affiance with the former we think sit to deliver here also its Cure in short The description of an Anasarca An Anasarca is described after this manner That it is a white soft Tumour of the whole outward Body or of some of its parts yielding to the touch and leaving a dent upon compression proceeding from a watery humour extravasated and accumulated as well within the interspaces of the Muscles as within the pores of the flesh and skin yea of the Glandules and Membranes It differs from an Ascites as to its outward form and appearance How it differs from an Ascites yet not as to its morbific matter which being the same in both distempers as it is heaped within the greater or lesser hollownesses it gains divers Appellations of the Disease The watery humour procuring an Anasarca The Original from the blood doth proceed altogether or for the most part from the blood for it being continually produced within the mass of blood by the fault and defect of sanguification it is poured out in greater abundance from the extremities of the Arteries than can be received or brought back by the Veins or the Lymphaducts or can be discharged by the Reins or pores of the skin and other vents of the serous Juice From these it follows that the material cause of this Disease is a watery humour The material and efficient cause and the efficient is blood which engenders waters and deposits them in the places affected We will exactly weigh the reasons of either of them and the manner of becoming and effecting it and first we will treat of the efficient Cause of an Anasarca 1. The affection of the Blood or rather the Hydropical brood The Blood its efficient cause in a double respect consists in these two things to wit First by reason of a failure or fault of sanguification it doth not rightly assimilate the nutritious Juice perpetually infused into its mass but suffers it to degenerate into a watery humour Then secondly by reason of the too loose mixture thereof it doth not retain that humour so degenerated so long within its consistence untill it might be discharg'd through fit Emunctories or Emissaries but lets it out every where near to the ends of the Arteries into the inter-spaces of the Vessels and there leaves it Either of these vices of the Blood we will consider a little more In the first place as to the former for the most part it is confessed by all First that it doth not rightly sanguifie that the Blood it self and not the Heart or Liver sanguifies by what of late is plainly understood concerning the functions of these parts yet by what means the Blood assimilates Chyle infused to it self and converts it into fresh blood to be bestowed to so many and diverse sorts of uses doth not easily lie manifest to us But what some affirm that it is made only by the exact comminution and commixtion of particles and for that cause the particles of either kinde being confused together they think that within the straiter passages of the Liver and Lungs they are kneaded and wrought together as it were with little pestils seems little probable to me but on the contrary I think these bowels as I have shewed already are constituted the Organs rather of separation than of mixture The reason whereof enquired into but the reason of sanguification altogether consists in this that the active particles of the old blood to wit the saline and sulphureous being placed in vigour with the spirituous immediately act upon the like particles of the infused Chyle as yet existing in an inferiour state and do so stir them up and ferment them that thereupon being extricated from the coverings of the thicker parts they are carryed into a like degree of exaltation or perfection with the former and being at length associated with them and made also homogeneous they put on the same nature of Blood the more thick and heterogeneous particles being removed thence to another place from those which they had deserted and gone away from For truly Sanguification is altogether finisht by Fermentation even as the maturation of the Must into Wine or Ale but the reason of the difference is that Wine being shut up in the Tub still remaining entirely in the same Mass is flowly fermented as to its whole consistence and is not accomplished but in a long space of time but the Blood constituted in a perpetual flux by the loss of some parts and the reparation of others is fermented by the parts still received fresh and is generated anew The old Blood for the most part affords the same thing towards the fresh Chyle The reason and manner of sanguification explained as Ferment from the flower or faeces of old Ale being put into new Ale notwithstanding as it were by a contrary manner because the huge mass of blood being formerly fermented doth suddenly ferment and alter the small portions of the Chyle continually brought in but the fermenting liquor in Ale in a very little quantity is put to the great mass of the other liquor to be fermented which it brings not to maturity under a long space of time After the rudiments of blood are so cast by fermentation the conclusion and perfect assimilation into blood is acquired by accension for surely that it is so enkindled as I think I have formerly shewed by demonstration which arguments chiefly taken from its proper passion although many have cavil'd at none have been yet able to overthrow Wherefore while the whole mass of blood consists of Blood and Chyle confusedly mixt together it is fermented while it is circulating andbeing divided into most minute portions is spread through the whole Lungs that it might be kindled successively according to all its parts by the nitrous air suckt in for by that means both the
vital flame is continued and all the particles of Blood having as it were passed the fire become more purified and more agreeable among themselves moreover they are so disposed of whilest they are kindling that while some go into Nourishment of the Spirits of the Nervous Juice and the folid parts and others less useful depart into the ferments or recrements of the bowels mean while others being more fixt abide longer in the mass of blood and sustain its consistence and by fermenting the Nutritious Juice still engender new Blood untill themselves being impoverished are at length discarded and give place to others that are fresh and Iustie Having shewed after this manner by what course Sanguification ought to be finished An Hydropick temper of the blood springs from a double respect as well by fermentation as accension of the Blood it will be easie to conceive wherein the fault confists producing an Hydropick dispdsition To wit this usually assumes its rise whensoever either or both those Conditions requisite to Sanguification ether fail or are perverted First therefore this bappens more frequently and rather Viz. First from the desect or fault of its Fermentation for that the blood being depraved in its temperature doth not rightly ferment the Nutritious Juice poured into it that so it might be changed into laudable blood For when the watery particles predominate with the earthy in the mass of Blood the Salt and Sulphur being depressed with the Spirit as all the functions both Vital and Animal from thence languish and waver so especially Sanguification it self fails and is perverted For the Juice of the Chyle commixt with the Blood when it cannot be dissolved and fermented with the particles thereof after the fashion of other liquors as often as being mixt they want ferment it degenerates perhaps into a watery acid or ropy or otherwise faulty humour which being afterwards daily encreased and at length rising to its fulness lyes heavy on the blood and oft-times almost stifles its heat from whence there is a necessity that it be forthwith discharged by some means and wheresoever it can get vent but afterwards for that the offices of separation fail in their sunctions the stock of the animal Spirits Languishng by reason of the diminished provision from the influxe of Blood the abounding Serum is deposited every where into the pores and next vacuities whether greater or lesser out of the little moughts of the Arteries from whose daily and great encrease after all the pores are filled arises that as it were fenny habit call'd Anasarca of the whole body outwardly or of some of its members Secondly not only the defect or fault of Fermentation Secondly from defect of Accension but also of the accension of the Blood induces sometimes an Hydropical disposition on the mass thereof which is clearly discern'd inasmuch as some persons inhabiting Maritime or moorish places fall into the Dropsie without any other cause or occasion than that they draw a thicker air endowed with heterogeneous vapours by which the Nitre is either driven away or obscured Therefore the blood becoming degenerate and vitiated as to its temperature because it is not duely kindled nor perfected by efflagration within the precordia doth not rightly dissolve and assimilate the Juice of the Chyle but suffers it to be perverted into a watery liquor But although in the first place the blood being depraved for this reason sometimes loses its fermenting vertue and therefore the rather and more immediately procures a Dropsie notwithstanding it is manifest the first fault thereof assumes its origine from unwholsom air suckt in and not duely enkindling the Blood because such Hydropicks removing their residence into Sunny and Mountainous places recover their health without any other Medicines Hitherto of the nearest Causes of an Anasarca and which are conjoyned to the Disease it self which namely are the depravation or defect of the mass of blood chiefly as to its fermentation and in some measure as to the enkindling thereof which latter is scarce wont to be effective but when if follows the former But what remains as to the more remote and procuring causes of this Disease to wit from which the defermentative affection arises that I may say no more of the defect or depravation of its enkindling I say that these appear so diverse and many that I judge it hardly possible to recite them all particularly notwithstanding very many or at least the chief may be reduced to these three heads to wit Reduced to three heads For that the watery distemperament of the blood doth arise inasmuch as its active Principles viz. Spirit Salt and Sulphur are not invested with their fermenting and sanguifying force or vertue I account this to come to pass either First because those particles are too much wasted by their great expences or Secondly because they are not repaired by convenient and proportionate Refections or Thirdly for that they are overwhelmed or obscured by some other duller or heterogeneous Particles being too much accumulated in the mass of Blood We will a little weigh the Reasons and ways of each of these their coming to passe In the first place the former of these is evidently discerned in frequent and inordinate Haemorrhages whereby many men although strong and formerly healthy First because the active particles of the blood are too much consumed are immediately enclined to a Dropsie more than from any other accident or occasion the reason whereof is that the blood is so impoverished through its more noble Particles issuing out in great abundance that afterwards it can neither duely ferment nor enkindle the Juice of the Chyle brought into it Moreover sometimes the same effect fucceeds although in a more slow degree from Feavers and other long maladies and languishings to wit inasmuch as the blood suffering under a long depression is so extenuated and robb'd that at length it becomes watery and defermentative Secondly the Blood sometimes deferting its genuine disposition Secondly because they are not enough repaired declines into an Hydropical one for that the nourishment being more slender than it was wont or ought to be bestowed upon it its active and sanguifying Particles are not enough repaired within its masse for so we have observed that some who have used themselves to Wine and stronger Drink after they have been reduced to homely Diet and smaller drink of water of small beer suddenly have become Hydropick It is a common observation and frequently true although of ill omen that Drunkards and darly drinkers if that wild Custom be left at length becoming sober and abstemious are much in hazard lest by reason of the usual fermentation of the blood being denressed they become obnoxious unto that Disease I knew a notable Drunkard who declared that a Priest very learned and Pious was guilty of his death because he gave him admonition to Temperance and to leave his Drunkenness Thirdly because they are buryed in duller
particles and he complying therewith incontinently fell into a mortal Dropsie But the third cause or occasion disposing to that Disease the most common and notable consists in this that the active Particles of the Blood being involved with other more dull or heterogeneous ones or being dissipated from one the other lose their fermentative power or cannot enough exercise it But such an affection of them as it is wont to be raised from various causes and accidents so chiefly from these three Whereof there are three causes one while solitary another while united together to wit First from the Non-naturals immoderately received Secondly from the Naturals unduely retain'd or Thirdly from the Preternaturals corruptly generated in the body The errors of Diet deservedly may be referred to the first rank of these whereby the stock of that Disease is always most abundant For it is a common Prognostick and in every bodies mouth First from Non-naturals immoderately ingested that Gluttons and great Drunkards dye at length of a Dropsie to which moreover not only Surfeits and immoderate and daily Tiplings incline but also frequent and unseasonable Treats and moreover the continual pouring in of absurd and hard to be digested Nourishment For from the evil course of Diet of each kind used any while whenas the Juice of the Chyle oftentimes crude incongruous and above measure plentiful is poured into the masse of blood it of necessity follows that it is first burdened and afterwards its Consistence being loosened the more noble Particles being forced asunder it is so involved or abated by the other heterogeneous ones that being hindred it desists from its fermentative or sanguisying virtue insomuch that the bowels being in a short time hurt by its assaults a Cachexia and then a Dropsie sollowes whereof that is alwayes a forerunner Secondly Secondly From Naturals unduely retained in this place are put all ordinary accustomed and solemn Evacuations suppressed It is observable enough that a Cachexie and often a Dropsie doth arise from a menstruous or Hemorrhoidal flux dimmished or stopt no less than from a too immoderate one by reason of the fermentation of blood impeded by the heterogeneity of Particles Moreover the same is often wont to be effected from Issues suddenly stopt or eruptions of the Skin suddenly repercuss'd Lastly suppression of Urine and sweating much hindred do render the blood more watery by an immediate and necessary affection and incline to the Dropsie Also it is an observation frequent enough fo healthful Persons who being compelled for some time to abstain from going to Bed that their feet have swoln Thirdly Thirdly From Preternaturals generated in the Body Preternatural things generated within the Body but especially Tumours and Humours do hinder the motion of the blood or pervert its temper and so induce an Hydropical disposition Tumours stirred up in some place about the Bowels inasmuch as they hinder or straiten the circuit of the Blood do cause its Serum to be there extravasated and poured out by the accumulation whereof within some cavity in the first place an Ascites as we have shewn above and at length an Anasarca a consequent of that doth frequently ensue Different manners hereof are reckoned Moreover Humours of divers sorts being engendred in divers places within and transferred into the blood do first pollute the masse thereof and defile it with heterogeneous Particles whereby at length it is so depraved in its temperament that it perverts the Juice of the Chyle brought in when it cannot further ferment and assimilate it into an hydropical liquor For this reason nothing is more usual than that Consumptive persons and those that are affected with strumous and cancrous Ulcers nay of any sort within the Reins Mesentery Guts or other Bowels of the lower Belly after they have been long consuming dye at length hydropical Hitherto concerning the next efficient cause of this Disease The material cause of an Anasarca is partly the Serum of the Blood and partly the nutritious Juice also of the chief remote ones as well procuring as evident But as to what appertains to the material cause it is obvious unto the Sense that it is a meer Lympha accumulated within the pores of the Skin and of the other outward parts which being deposited there by the blood the liquor thereof being partly serous and partly chylous Juice but failing in Sanguification and Nourishment of the body to which it was destinated it is cast off like recrements into the vacuous spaces of every vessel And though the matter of the Dropsie proceed from the Blood and Chyle yet it is no wonder if it appear neither like blood nor milkie but only limpid because the Urine even of healthful people after more plentiful drinking is rendred crude as well as watery and therefore it is manifest it is nothing changed by the blood but leaves in that place whatsoever of colour or thicker consistence it brings to its masse And although a reason may be given in either case that the Urine inasmuch as it is streined through the Kidneys and the hydropic matter thorough the pores of the solid parts even so become limpid and watery notwithstanding it is evident by observation that the watery part of the Chyle even while it is confounded with the blood is not intimately mixt with it but being deprived of its colour and consistency it remains under the form of Lympha within the pores of the blood the sure sign of which is that the blood taken from any Animal by Phlebotomy after being cold it is divided into parts Why the hydropick humour is limpid and not milkis nor bloody exhibits a watery liquor which consists of Serum and Nutritious Juice plainly limpid and separate from the other blood It will be from our present purpose to enquire any further into the reasons hereof and manner of being so and wherefore blood which being poured into water doth presently tinge the same and bloodies all solid bodies whensoever it is sprinkled thereon yet dyes the Serum of no colour with which it is intimately confounded and a long time circulated From the AEtiologie of this disease now delivered The Differences of the Disease the differences of it may easily be collected to wit first it is either universal when the whole habit of the body and all the members swell up or it is particular wherein for the most part the inferiour members only suffer in the mean time the rest of the body pining away for want of Nourishment which kind of distemper and not a Tympanie Prosper Martianus will have Hippocrates style the dry Dropsie in which what is reported of the Syren the dry is joyned to the watery Secondly an Anasarca whether universal or particular is either simple of conplicated with an Ascites and then either an Anasarca ensnes an Ascites or this disease follows that Moreover an Anasarca may be distinguished many ways in respect as well of the procatarctick as
no measure of flowing out and therefore being stirr'd into violence it flows out too much or secondly because the mouths of the vessels once opened do not presently close again nor are able to be shut or Thirdly because Nature endeavouring an excretion of blood doth it by places more open but often inconvenient as when an Hemorrhage happens through the Lungs the Kidneys Guts or other Bowels which therefore pass from a Critical into a Symptomical and often into a malignant Haemorrhage Neither only by these means but by many other failings of Nature or impediments 2. Symptomatical Hemorrhagies arise either do Symptomatical Haemorrhagies happen in all which either the Blood it self or the Vessels containing it or both of them together are wont to be chiefly in fault 1. In the first place the Blood besides the reasons above mentioned First by the fault of the blood to wit forasmuch as it becomes inflammable or fermentable above measure is apt also to be extravasated because either its liquor being empoisoned or otherwise corrupted cannot retain its due mixture but being apt to coagulate or putrifie divides it self into parts and whilst some of them being here and there planted sending forth spots wheals and other brands of Malignity do discolour the Flesh and the Skin and obstruct the proper passages others otherwise running out an breaking forth wheresoever there is a vent found do produce bloody Excretions in divers places as is commonly discerned in the Plague Small-pox Measles and malignant Feavers yea perhaps this in some measure is the reason why in scorbutick Distempers as spots and marks so also Haemorrhagies are so familiar 2. Secondly The vessels bringing Blood being faulty many and divers ways Secondly The fault of the Vessels for that they are ill formed but chiefly in these three do appear the cause of a symptomatical Haemorrhage viz. In the first place if perhaps any where some of them are obstructed as often as the blood assumes a more rapid motion either in the same place or in the contiguous parts and also sometimes in remote parts it is constrained to burst out Frequently from such a cause an Haemoptoe proceeds moreover Spitting of blood and the Haemorrhage of the Nostrils do often follow the suppression of the Terms and Hemorrhoids Secondly the little mouths of the vessels by reason of the fleshy Fibres being loosened or resolved by which they are clos'd sometimes are ill formed so that when the ends of the Arteries do gape too much the little mouths of the veips do close By reason of this affection Scorbutical and Cachectical persons are found obnoxious to Haemorrhagies as we have remarkt in another place But Thirdly Thirdly Forasmuch as they are convulsively affected it frequently comes to pass that the Vessels being so evilly formed are also convulsively affected and so the morbific cause being as it were doubled this evil is much encreased insomuch that the muscular fibres of the Vessels being inordinately contracted cause sudden and violent fluxes of the blood one while towards the upper parts anotehr while to wards the lower and so their little mouths being open in the mean time they provoke prodigious Haemorrhagies For I have observed in some persons when the current of blood was small enough with a small and weak pulse the Convulsions of the Vessels generated in some place and propagated under the likeness of wind running to and fro in the body to drive more impetuously the blood however slow of it self and to constrain it into violent eruptions and in cases of this sort when Phlebotomies and Medicines refrigerating and tempering the blood have not at all profited the greatest relief hath been found from Narcoticks Antispasmodicks and Ligatures 3. 3. From the blood and vessels being both in sault Thirdly If perhaps it shall happen that these faults of the Blood and Vessels are complicated and put forth their mischiefs joyntly at once from thence it will be of necessity that this evil will be more intense and more frequent and prodigious Haemorrhagies will be raised the reasons of which as they appear plain enough by what goes before it will be neither necessary nor seasonable here longer to dwell upon explicating of them but rather whereas we have designed hitherto the acts of Nature about spontaneous effusion of Blood and its courses both rightly instituted and also wrongfully and evilly constrained now it behoves us next to declare how far Art for the most part the Ape of Nature and sometimes Mistris or Moderatrix thereof can act likewise well or better about letting of blood and how sometimes it is wont to succeed worse We advertise of these things in general Emission of the Blood procured by art that a Physitian imitates Nature in some cases of letting blood exceeds her in other cases and frequently regulates and reduces her when acting amiss Moreover ther are some cases wherein Nature excells far the efficacy or Art concerning bloody excretions briefly of each of these Therefore in the first place 1. It either imitates Nature in whatever affects spontaneous Haemorrhagies are wont to bring help when these are wanting Physick the Handmaid of Nature rightly substitutes Phlebotomie Therefore if perchance the Blood be immoderately kindled by reason of its Sulphur being too much loosened and advanc'd by breathing a vein what is superfluous of that inflammable fuel will flow out as also the immoderate turgescency of Blood by reason of somewhat untamable being mixed with it will be allay'd by this course Wherefore letting of blood is advantageously administred as well against continual Feavers which proceed from the former cause as intermittent Feavers whose fits proceed from the latter cause Also in like manner as often as an accustomed evacuation being suppressed or a humour driven back from the ourward parts or a sudden stoppage of the pores or if a Surfeit drinking of Wine or other accidents of this nature cause a turgescency of blood inasmuch as they dash heterogeneous particles against it Phlebotomie is usually the most ready Remedy Secondly 2. Or excells and regulates it Physick in Blood-letting not only imitates Nature but often excells it and also succours her being weakened and reduces her often erring For if at any time the blood struck with violence rushes in a heap against any part and either presently breaks out in the same place or abundantly gathered together engenders an Inflammation a vein being pierced in a remote place stops that preternatural tendency of the blood and frequently carryes away the bleeding or inflammation Wherefore in a Pleurise a Squinancy a Peripneumonia in spitting or vomiting of blood when Nature is vanquished or being outragious seems to cast violent hands upon her self Chirurgery recalling the blood to another part and sending it out restores the matter that was almost desperate Moreover Physick frequently restrains or reduces Nature when too prodigal or prevaricating in pouring out of the blood for in truth all immoderate Haemorrhagies
the blood a sparing Phlebotomy doth always more prejudice than advantage For besides that it doth not remove the antecedent cause of the disease to wit the Plethora it further causes the conjunct cause viz. the inflammation and bursting out of the blood to be angmented For truly it is a constant observation that upon blood too sparingly drawn the whole mass doth boyl up more notably and doth acquire a new flux into the part affected the reason of which is that in a great Plethora many portions both of the Blood and Serum being thrust forward into recesses and strait places are there constrained to abide which after the Vessels being a very little emptyed The Reason of which is declared do impetuously regurgitate into the mass of blood and do much disturb it and force it more impetuously to and fro Wherefore also in this respect the vessels ought to be very much empted viz. that besides freeing the former Juice from straitness also space may be given to the Juice reduced from exile which otherwise being not congruous coming upon the blood troubles it and provokes it into effervescencies and eruptions From hence we may observe that almost all men grow more hot presently after Phlebotomy and yet the blood being sufficiently evacuated a little after they enjoy a more temperate condition But as a slender withdrawing of blood in some cases is only vain but is performed with prejudice so in other cases too much effusion is rarely committed scot-free and sometimes brings notable detriment of health For when either strength languishes or the body labours under a notorious Cachexia we must spare Blood-letting and its taking away is either prohibited or being indicated by some accident is allowed but in a small quantity Wherefore in men endowed with a weak tender and cold Constitution and in consumptive persons those affected with a long or malignant Feaver In some eases the mission of Blood must be altogether avoided also in Hydropicks or Cacochymicks a vein is not rashly to be breathed at least if it be much blood is not suffered to be taken away It will be an impossible thing to prescribe general Rules according to the particular cases of every individual person whereby the quentity of letting Blood may be exactly proportion'd according to the strength of the Disease and the ability of the Patient but let this be left to the judgment of the prudent Physitian present and let his Commands be ever exacutly observed And let not as it every where is such leave be given to Quacks Empiricks and Barbers to play with humane life who every where rashly and wickedly use Phlebotomy and if the blood spring more sreely and appear discolour'd therefore bragging of the vessel being well pierc'd they say it must be let out more plentifully because it appears bad when oftentimes on the contrary it ought to be spared As soon as the Quantity of Blood to be taken away is determined Phlebotomy ought ever to be done with a large orifice our next care ought to be that a more large orifice being made the blood equally mixt may flow out as soon as may be for otherwise if it go out from a small hole or drop by drop or with a little stream the mass of blood fermenting will separate into parts and what is more subtile and spirituous will burst out the thicker and feculent remaining behind Hence it is to be observed that the blood being let out of a large orifice with a more full stream if it be a little stopt with the finger clapt on it and a little after suffered to flow out the blood going out the second time becomes much purer and brighter than the former because in the interval of flowing the more subtile particles being unfolded from the thicker and accumulated together have prepared themselves to fly away Wherefore if Hippocrates's Precept shall be observed ' viz. to let it run to the change of its Colour it behoves us to procure that it spring out quickly with a full a not interrupted stream Besides all this as to what appertains to the alteration of the blood let out and cold and to the inspection and the judgment thereof for that we have often discoursed it in other places we now pass it by hastening to other things and now the thread of Method leads us to entreat of Remedies opposite to Blood-letting to wit Ischaemones that is those which are convenient to stop immoderate Haemorrhagies whether engenderd by Nature or by accident SECT III. CHAP. II. Of Remedies restraining or stopping of Blood EVen as Art imitates Nature in letting forth the blood by Phlebotomy offending in plenty or temperament or in its motion Every Hemorrhage is not to be stopt so it succours her being diseased or working wrong by stopping the flux of blood whensoever it is immoderate or hurtfull Whereas there are various and many species of an Hemorrhage there is no need of Physick for them all If perhaps a great effusion of blood happens by a solution of unity excited by an outward accident as a wound or stroke Chirurgery suggests the manner of Administrations whereby it should be restrained Moreover an Hemorrhage as long as it shall be Critical ought to be disturbed by no Medicine but left to the meer government of Nature as long as she does aright use her power and as to the Symptomatic whilest it is little or not much troublesome there is required no Physick notwithstanding there is great need of it if at any time the Flux of blood be either immoderate or flow out by unapt places Eruptions of blood of this last kind chiefly challenge a Cure But only the immoderate and inconvenient if perhaps the blood be cast upward by Coughing or Vomit or downwards by seige or thrown off through the Ureters For in these cases though the quantity of the Blood excreted be not much to be dreaded notwithstanding because often a dangerous or mortal Ulcer ensues the solution of the Unity so made in the Lungs or in the Stomach Guts or in a Vein therefore we must industriously rancounter those Hemorrhagies from their first appearance Therefore among the Diseases of those parts The chief Cases of the latter are reckoned such bloody excretions are accounted but we have already in another place delivered the Theories of Spitting Blood and of the affection Dysenterical and the reasons of healing them so that there is no need to repeat them here neither also to propound here a remedy for bloody Urine for that it belongs to the Nephritic Pathology wherefore we will pass to those Passions for which by reason of an immoderate efflux of blood there is great need of restraining Medicines The kinds of these Affections are chiefly three viz. Haemorrhage of the Nostrils And also of the former of the Flowers and the immoderate Flux of the Hemorrhoids The Cure of which last doth belong more to Chirurgery than Physick and I think it
to wit Curatory Vital and Preservatory the two former respect immediately the symptom to be stopt as often as it shall be urgent and the last is busie about removing the Cause of the Disease that so the assaults of the Hemorrnage may be small or not at all Besides an Hemorrhage ought to be handled one way without a Feaver and after a different manner if pressed with a Feaver Therefore whensoever without a feaver much blood shall flow out of the Nose The Curatory Indication suggests three intentions of healing presently as there shall be need of stopping Remedies there will be three chief intentions of Curing all being together assumed into practice viz. Let the turgescency of blood be bridled that it may be less disposed into inordinate tendencies Moreover in like manner let it be endeavoured that as well its fluxion being withdrawn from the Nostrils may be diverted to another place as that the mouths of the Vessels gaping within the Nostrils be shut for which purpose Remedies as well external as internal very many and of diverse kinds are wont to be exhibited of the former we will entreat in order briefly First therefore let the Patient be quiet plac'd with his head upright Outward remedies to stop the flux of blood then let many of the Joints of his Arms and Thighs but not all be bound with strait Ligatures which ought now and then to be loosened and removed to other parts for all being bound together and long by reason of the blood being held in the outward parts 1. Ligatures and too much detained from the heart hath caused most dreadful swoundings but otherwise this Remedy being prudently administred frequently helps For when the blood by this means running into the members by the Arteries is stopt that it presently returns not by the veins it s more impetuous spreading it self into the head is impeded Moreover by the painfull Ligatures of the Joints the muscular Fibres of the Carotides Arteries are preserved from Cramps which oftentimes come upon them Secondly For diverting the tendency of blood from the Nostrils 2. Bleeding it is sometimes expedient to breath a Vein in the Arm or in the Foot For by how much more blood is carryed by the Arteries to the vein cut by so much less will the afflux be towards the Nostrils Yet this administration does not always so help but sometimes a contrary effect thereof happens as we have already observed in spitting blood The reason whereof is that the vessels being suddenly and not sufficiently emptyed suck up again the disagreeable humours formerly ejected and stagnating within the pores whereby the blood incontinently is stirred up into a greater eruptive turgescency Thirdly Cold things applyed to the Forehead and Temples 3. Application of cold things also to the Nape of the Neck where the vertebral Arteries ascend cause the vessels to be bound together and the flux of blood to be somewhat stopt or repelled Notwithstanding it is ill which some advise that cooling Topicks be applyed to the Jugular Veins for so the blood being retarded in its recourse flows the more plentifully out of the Nostrils Moreover what is usual to apply linty Cloaths or a Spunge moistened with Vinegar to the Pubes and Testicles helps by no other means than the ligature of the members to wit inasmuch as the flowing back of the venous Blood is impeded A sudden and unexpected sprinkling of cold water on the face frequently stops an Haemorrhage inasmuch as it gives an impression of terror Fourthly Cupping-glasses applyed upon the Hypochondres Flanches 4. Cupping-glasses inner part of the Thighs and the soles of the feet are accounted a famous remedy as well with the ancient as with modern Physitians for diverting a tendency of the blood from the Nostrils And the reason is plain viz. because a Cupping-glass being put on the impulse of air being prohibited by the space of the orifice and encreased every where about presently the blood and humours yea and vapours and solid parts being call'd from any other tendency are driven towards the empty space of the Glass Fifthly 5. Frictions Rubbing of the extream parts are commended in this distemper by some Practitioners which we judge not always useful nay scarce safe because although they solicit a greater appulse of the blood to the feet or hands yet they so hasten the return thereof that the whole mass of blood being raised into an effervescence it hazards a more violent tendency towards the Nostrils Sixthly Zacutus Lusitanus among his revulsory Remedies 6. Cauteries propounds an actual Cautery to be applyed to the sole of either foot and Crato the bending the little finger of the same side which because done with no trouble we may try but we advise not so of the former unless the way of helping were more certain which might compensate the pain and lameness that would ensue thereon Seventhly Swounding raised by any means presently stops an Haemorrhage 7. Faintings however contumacious it be wherefore when such bleeding persons are taken out of their beds or when they do timorously admit of Phlebotomie though but sparingly or have their members bound for a longer time or are suddenly affrighted with some feigned rumour or by some other occasion fall into a swouning or fainting of the spirits the flux of blood ceases thereon presently The reason whereof is evident enough for that as soon as the motion of the heart fails presently the blood and spirits rush thither and so every outward flux is stopt on a sudden and what was immoderate before doth not again return Eighthly Remedies by Sympathy and Antipathy In the last place for repressing the flux of blood from the Nostrils Remedies ought to be recited which are said to operate after an occult manner by Sympathy or Antipathy 1. Sympathetick powder 2. Young Ashwood of which sort first is the sympathetick powder made of Roman Vitriol calcin'd to a whiteness by the Summer Sun also a piece of wood cut from a young Ash first sprouting about the time the Sun enters Taurus the efficacy of which remedy in the late Civil Wars many worthy of credit attest to have been approved for stopping the Hemorrhages of wounded Souldiers Yea some still with much confidence prescribe it in all eruptions of blood I confess the reasons of effects of this kind are concealed from me if so be they happen often Besides it seems not a less Empirical and irrational Remedy that a silk Bag with a dry Toad in it 3. A dry Toad worn on the pit of the Stomach stops any kind of Hemorrhage and prevents its return unless according to the Aetiology of Helmontius that the application terrifying the Archaus compells the blood being astonish'd either to go back or desist from its inordinate excursion There remain very many famous Medicines whose Operations are wont to be referred to hidden Causes and secret vertue 4. A Blood-stone 5. Mosse as
being raised the flux of Blood often ceases if it be not very dangerous Take water of Meadow sweet Tormentil of each four ounces Remedies Saxons cool Cordial two ounces Treacle water an ounce and a half Acetum Bozoardicum three drams Syrup of Croal an ounce and a half Confection of Hyacinths two drams make a Julep the dose six spoonfuls every third hour Take of the Powder of Toads prepared half a dram Camphire two grains take it every sixth hour with the forementioned Julep Or Take Powder of Scarlet-cloth from half a dram to two Scruples as before Take Consection of Hyacinths three drams Powder of Scarlet-cloth on edram Syrup of Corals enough to make a Confection the dose the quantity of a Nutmeg every other hour Take of Bistort and Tormentil-roots of each one ounce the leaves of Meadowsweet Pimpernel Wood-sorrel of each one handful burnt Harts-horn two drams Shavings of Ivory and Hart horn of each two drams boyl them in Spring-water from three pound to two adding about the end Conserve of red Roses three ounces the dose three ounces being strained often in a day 2. Second Indication vital Hitherto of the first Indication Curatory together with the scopes of healing and forms of Remedies appointed for a Haemorrhage of the Nose happening with or without a feaver The second Indication Vital only prescribes a slender Diet temperate Cordial The Position of the Sick and a fit handling of the Patient The Provision of the first is so small and easie that there seems no need to appoint a Measure and Rules for it particularly About the latter the chief question is whether we ought to retain them within or out of their beds Without doubt the languishing and those obnoxious to often swounings are not to be roused up unless as we have already hinted it be for a Curatory attempt as to others less weak it seems so to be determijned Those whose Blood does not easily transpire by reason of the constipation of the pores Sometimes in bed and sometimes out and is incited into a greater turgescence from the heat of the bed and proner to break out it will be expedient they not only remain out of bed while bleeding but also sometimes through extern applications to be cooled in the whole habit of their body or at least in most of their members Wherefore Fabritius Hildanus relates he suddenly cured one of a great Hemorrhage of the Nostrils after many things tryed in vain by putting him into a vessel of cold water Also with like success Riverius cured another affected in like manner being taken out of his bed and laid on a woollen Matte on the Pavement he bathed his whole body with Linnen dipt in Oxycrate Yet this method is not alike convenient for all persons or at all seasons but on the contrary those whose blood is halituous and enjoying more open pores doth evaporate easily mnad being wont to be dissolved by a more moderate heat encompassing them into sweat and from thence find themselves more quiet it is more convenient that they remain within the bed not only while the blood breaks out but as long as there is danger of its return For this reason it is that many obnoxious to dreadful Hemorrhagies during the Summer when they transpire more freely live exempt from that disease but the Winter cold pressing them by reason of their pores being bound up they suffer under more frequent and dreadful Invasions 3. Third Indication Preservatory hath two intentions of healing The third Indication Preservatory which regarding the removing the Cause of that disease either stops the eruptions of blood or renders the same more rare or less and suggests these two Intentions of healing viz. 1. That the blood being restored to its due temperament and mixture may quietly circulate within the vessels without turgescency and breaking out 2. That the Vessels carrying Blood as to the structure of their little mouths and the tenours of the muscular fibres may be contained in their due state so that they neither cause those inordinate tendencies of blood towards the Head nor suffer effluxes out of the nose For both these ends too great plenty and impurity of the Blood are carefully to be provided against by Phlebotomy and Purgation seasonably used afterwards for procuring and conserving its good temperature the following Alteratives may be given at fit seasons of healing Take of Conserve of red Roses Forms of Remedies of Hipps an three ounce powder of all the Sanders an half a dram Coral prepared one dram of the reddest Crocus Martis two drams Sal Prunella four Scruples with Syrup of Coral make an Electuary take the quantity of a Chesnut early in the morning and at night by it self or drinking after it three ounces of the following water Take the tops of Cypresse Tamaris an eight handfuls St. Johns-wort Tamarisk Horsetail an four handfuls of all the Sanders bruised an one ounce of the Crum of Whitebread two pound slice them small and pour on them of new milk eight pound distill in a cold Still sweeten each dose when taken with Syrup of the juice of Plantane Take leaves of Plantane Brooklime stinging Nettles of each four handfuls to them bruised pour half a pound of the foregoing water of small Cinnamon-water two ounces press them strong the dose three ounces to four at Nine in the Morning and at Five in the Afternoon Madicines of this sort are taken in Spring and Autumn for twenty or thirty dayes with sometimes a gently Purge coming between In Summer let them drink Mineral Steel-waters for a Month than which in this case there is not a better Remedy Out of many Examples of persons labouring with an Hemorrhage we only propose this one singular case I was lately consulted at a distance for a certain Gentleman that had suffered frequent and great eruptions of blood one while at the Nostrils An Example of a rare Hemorrhage anotehr while at the Hemorrhoid Vessels He had frequently used Phlebotomy by perswasion of his friends without benefit yea frequently falling into cold Sweats and Swounings after breathing a vein and notwithstanding obnoxious to eruptions of blood he was wont to be much worse I prescribed Juleps having not yet seen him and cooling Decoctions and Anodyhnes also the juicy expressions of herbs and other things cooling the blood but even from these as if all still far enough from the scope he was nothing the better At length being sent for into the Countrey to visit him I found the affection under which he suffered to be meerly or chiefly convulsive for whereas he daily bled his Pulse was weak the extreme parts cold and all his Vessels as being too much emptyed fell flat It s Aetiologie also the patient was affected with a continual Vertigo and trembling of heart and by and by with a swouning or fear of it Really the blood was so far from breaking out by reason of turgescentce that
administer both a Dropace and Vesicatory Also by applying still the same Plaister the Scarf-skin being blister'd and taken off and the place being red and ulcerated and only wiping it once or twice in a day and putting it on again they cause the little Ulcer raised by the Vesicatory to flow at pleasure yea sometimes above a month and to throw off a plentiful Ichor Others inclose Cantharides bruised and sprinkled with Vinegar in Silk and apply to the place Some Empiricks use in the room of Cantharides a mass of the leaves of Crow-foot or flamula Jovis bruised on the place by which the Scarf-skin being blistered or rather eaten the skin it self as if toucht with an actual fire is much inflam'd and deeply ulcerated whence not only a profusion of Ichor but an inflammation of the whole member and a feaverish disposition sometimes follow wherefore these things are not to be used rashly 2. 2. How they operate If it be enquired of the manner and reason how these and other Vesicatories operate in the first place we ought to shew by what manner actual Fires and things endued with particles proceeding from Fire do raise a blister then by an easie Analogy the force and manner of working of those sorts of remedies will be known which are reported to be endowed with a potential fire Wherefore we observe of the former that the fiery particles not being too vehemently applyed penetrating the Scarf-skin without dissolution of unity enter under the skin it self Shewed by the example of Fire where the extremities of the vessels bringing blood of the Nerves and of the nervons Fibres are terminated and there do variously twist together these altering them from their position and pervert the structure of the whole texture of the skin insomuch that from all the vessels being made angry in a high degree the watery humour being imbued with igneous particles and therefore rejected as well by the blood as by the nervous Juice is spued out in great abundance This Lympha because it cannot pass through the Scarf-skin separates it from the skin and raises it into a bladdery bulk from which at length being broke of its own accord or occasionally it flows out Moreover as long as the igneous particles adhere to the skin and the mouths of the Vessels being covered with an Eschar are not closed up these being continually twitched by them do continue to spue out the Ichor This kind of ichorous flux will the sooner cease if immediately upon the hurt inflicted the fiery particles be drawn out by the application of some proper Antipyretick as Fire it self Nitre Soap Onions and the like Moreover it runs the longer if omitting an Antipyretick medicines hindering the generation of a Cicatrice or of the outer-skin and unlocking the mouths of the vessels be worn upon the place affected By these it is easie to understand by what manner Vesicatories perform their operation How Cantharides excite Blisters and draw forth water viz. Cantharides as likewise any other of the same vertue being outwardly applyed and being heated by Effluvia's of the parts subjected and so being provok'd to exert their power do plentifully dispatch sharp and as it were fiery particles from themselves which penetrating the Scarf-skin without any tearing it they are dashed against the Cutis or other skin where first they act upon the Spirits and then by the affecting these upon the Humours and solid parts They very much provoke the Spirits and drive them into painful Convulsions of the fibres dissolve the Humours and constrain them to separate into parts so that the watery part being very much embued with those sharp and as it were venemous particles is rejected every where by the other Juice and when in the mean time the ends of the Vessels and Fibres are either eaten by the burning or opened by twitching and as it were drained that Ichor conveying the hurtful particles is plentifully spued out of their little mouths which then separateds the impervious Cuticula or the Scarf-skin from the other skin or Cutis is self and raises it into a little bladder and after this being beoken and taken away it is for some time poured out by the ulcerated shin as we shewed it to come to pass by reason of the particles of fire But this is not only done because the serous Juice imbibing the sharp parts of the Medicine and conveying them out doth not always bear them all back the same way by which they entred but sometimes this being endued with these stings regurgitates into the mass of Bloodl and afterwards being circulated with it and ejected with its infestous burden through other Emunctories Why they bring a fervent Dysurie offends some weak or tenderer Channels in its passage or going forth from whence very many contract a Strangury from great or many Vesicatories by reason of the urinary passages being affected for that cause with Acrimony or Erosion which in some becomes most sharp and intolerable Also that application sometimes brings bloody Urines to others afflicted with the Stone hence a suspicion also arises that those who have tender Lungs or who are subject to a Consumption are much endagered by this Medicine outwardly applyed which notwithstanding I have not known happen to any but can reather attest by frequent experience on the other side that it redounds to advantage rather than hurt For the more sharp particles of Cantharides if they be long applyed being sometimes imbibed more plentifully by the blood infect its whole Serum which Juice so sharpened as long as it is confounded with the Balsamick blood hurts no part but being separated from it by the Kidneys it sometimes brings hurt to them and frequently not only twitches the neck of the Bladder by its Acrimony but sometimes corroding it causes filth and little skins nay and blood to come away but in the mass of blood the same more sharp saline-volatile particles do often most notably help inasmuch as they destroy the fixt or acid Salts in it and unlock the consistence of the blood too much bound up and so do cause the serous and other morbific recrements before wrapt up with it to be separated from it and to be more easily dispatched by Urine and Sweat Vesicatories move Sweat and Vrine hence Vesicatories being applyed long in Feavers do call forth plentifull Urine and a more easie Sweat Also they open the obstructed wayes and move together the portions of Blood or Serum stagnating or being extravasated in any place and restore them to their Circulation Wherefore they are not used only to help in serous maladies but also in those of the blood yea in a Pleurisie Peripneumonia and in any other Feavers Having hitherto shewed after what manner Vesicatories operate first on the Spirits and then on the Humours and solid parts it is now our business in the next place to shew both the good and evil effectgs of them as also the manners of
every one without consulting a Physician will prescribe to themselves Cantharides for Revulsion I confess when I have often been surprized with a great Cough with abundant and thick Spittle whereot I am originally obnoxious I have received relief from no other Remedies more than from Vesicatories wherefore I am wont while that distemper doth urge to apply Medicines drawing blisters first upon the Vertebra's of the Neck then those little Ulcers being hcaled beneath the Ears and afterwards if need require it upon the Scapula's for so the serous filth loosened from the consistence of the blood sweating forth is derived from the Lungs and also the mixture of the blood sonner recovers its temper inasinuch as after this manner its enormous salts are destroyed Thirdly 3. Also in all Distempers of the Brain and of the nervous Stock In respect of the Humour Epispasticks as they are of most common use so they are wont to confer great help in soporiferous convulsive and painful distempers for deriving and evacuating it out of the nervous stock and the brain it self Was ever any surprized with a Lethargy Apoplexie or Epilepsie but that immediately Friends and Attendants however unexpert have tormented his Hide with the application of Cantharides In stupendious convulsie motions ascribed usually to nothing less than Witchcraft I have applyed Vesicatories with great benefit in many parts of the body at once and I have continued them above a Month presently renewing them in fresh places And also pains that are fixt and most fiercely tormenting in the membranous parts are seldom cured without this administration For sometimes morbific humours and Particles which being deeply radicated yield nothing at all to Purgers or sweating Medicines or Diureticks yet have seemed to have been pulled up by the roots by Vesicatories as it were remedies laying violent hands on the disease But this Remedy although most general is not used to operate so easily and happily in some Diseases and Constitutions For what Distases Vesicatories are intended wherefore we may not rashly or indifferently use it towards all persons For those who are Nephritick and obnoxious to a frequent and painfull Strangury scarce ever endure the application scot-free wherefore on those that are so affected we must not use Vesicatories unless in malignant Feavers or acute Cephalick Disea2es for avoiding the greater Evil. As to what relates to the various Temperaments and Constitutions of men in respect of which Vesicatories are used to be more or less convenient or advantageous In what Constitutions they agree best Concerning these this threefold notable difference occurs In the first place some persons for the most part endure well the use of this Medicine and the little Ulcers raised thereby in the skin sweat out an Ichor sufficiently plentfull witout any Dysurie or great Inflammation of the place blistered and then heal of their own accord which effect succeeds only in blood of a good temperament where to wit the Salt and Sulphur being moderately and rightly constituted there is present an abundant plenty of Serum whose Juice easily and more largely separating from the rest of the blood carryes away the sharper particles of the Medicine imbibed with it self and partly sweats them out through the placd blister'd and partly conveys them out without prejudice by the Urinary passages therefore also the advantagious effects now recited are produced in the mass of blood 2. Also in whom not But secondly this remedy with some doth nither well agree nor operate profitably because it rubifies the place very much to which it is applyed or rather excoriates it with most fierce pain and great inflammation notwithstanding the little ulcers made in the ssme place although they do for some time torment the patient yet pour out very small or scarce any Ichor Also to these always blister'd with torment for the most part a violent Strangury happens The use of these Vesicatories being troublesome and unsuccessefull doth frequently to men of a cholerick and hotter temperament In men of a more hot temperament they torment the part and do not draw forth the water whose blood is endowed with a plentiful Salt and Sulphur and a small quantity of Serum being more throughly concocted with the rest Wherefore when the Juice that ought to carry away the more sharp particles of the Medicine doth neither easily nor plentifully pass from the rest of the blood that it may speedily wash them out those particles sticking still in the skin do as it were infect and impoyson the blood it self passing through and for that cause beingimpeded from its circuit they cause it to stagnate and to be gathered together about the extremities of the Vessels whence they are inflamed Moreover the serous Juice being separated by the Kidneys when of it self it is little and sharp and besides becomes stinging from the particles of the Medicine it irritated the Neck of the Bladder and frequently corrodes it by its acrimony In others inasmuch as they draw forth too much Ichor they are not profitable 3. There remains a third Case although more rare relating to blistering to wit in whom little Ulcers beling raised in the skin presently pour out the serous humour in so great abundance that in a little time it will be necessary to give repelling Medicines and that shut the mouths of the Vessels otherwise from too much flowing out of waters a dissolution of strength and a fainting of the Spirits are in danger to ensu This I have known so constantly happen to some Patients that afterwards I was fain to restrain their use of Cantharides although there was need of them the reason whereof seems to be that the blood being endowed with a salt Serum and more sharp than it ought to be hath a consistence too easily dissolved wherefore that serous juice being sharp and fretting of it self as soon as it is provok'd by the particles of the Medicine loosening the consistence of the Blood too easily dissolved immediately breaking out with violence from the mass of blood wheresoever there is a passage afforded it flows out with a full torrent through the mouths of the vessels gaping in the blistered place Besides this too much flowing out of the Serum The Vlcers of Vesicatories do sometimes plentifully flow in Feavers and give Judgment of the Disease raised from the first application of the Vesicatory sometimes happening late in malignant Feavers and in others ill or not at all judged and remaining a good while wholly consumes the morbific matter and delivers the Patient from the jaws of Death In such a Case after the little Ulcers for the first days have poured out little or a very small quantity of Ichor at length Nature attempting a Crisis by this way a vast Illuvies of Serum flows out from the same and so sometimes for many dayes nay weeks continues to flow out untill the Patient before accounted desperate recovers his entire Health Little Ulcers so abundantly flowing
Sciatica For surely the glandulous Emunctories settled in that place do imbibe very many recrements of the blood and nervous Juice which if they be throughly and continually discharg'd from them by a fit vent it will much conduce to exempt the contiguous parts from any morbifick Mine The Thigh being a member soft and large in bulk In the Thigh seems apt enough for enduring many and great Issues to wit those which may purge away plentiful humours from the whole body Yet it doth not succeed so with many patients partly because of its figure too much declining like a Cone invers'd the Ligature containing the Pease in the orifice is not easily kept on and partly because a solution of the Unity being made among the concourse of so many Tendons it frequently becomes inflamed and painfull insomuch that fometimes it hath been necessary that it should immediately be stopt up to withdraw the trouble of pain and of lameness Notwithstanding it succeeds better in some Patients for that an inflammation doth not always ensue upon the place where the incision was made and that the Ligature has remained immovable to those that tye their hose above the knee Moreover A fit place in the member to be chosen that it may be made far from Vessels and Tendons as concerning Issues it is requisite to choose a convenient place not only in the body but also in the very member where incision is made which chiefly calls for the judgement of an expert Physician or Chirurgeon for carefull provision must be made lest a Cautery or incision be made upon or too near the Tendons or greater Vessels but let the Fontinel be made not in the very body of the muscle but in the interspace or distance between the muscles where the orifice as John Heurnius learnedly observes ought to pass through the whole skin so far untill the little membrane of the muscle underneath be penetrated Wherefore this part of Chirurgery is not rashly to be allowed to Quacks and others ignorant of Anatomy for that from this being ill done not only a frustration of the benefit but from thence frequently great mischief happens and sometimes to the hazard of life It is not needfull to describe the figure and use of the cutting Instrument Symptoms accidental to Issues how to be cured together with the manner of preparing and compounding Causticks for making Issues inasmuch as it is notorious to the common people yet it behoves us to handle in what manner the symptomes which happen to these Emissaries after they are made may be cured and it will not be besides the matter to discourse what do either impede or pervert their powers Whereas many and several distempers happen to Issues help is not required for them all but only for such as are of greatest moment Wherefore there will be need of help 1. Wheresoever an inflammation ensues upon the part or place where it is What chiefly require help 2. If the Orifice vent more or less Ichor than it ought 3. If the Ulcer shall be apt spontaneously to be dryed up and cover'd over with a skin or if it be prone to abound with spongious flesh growing about the sides As to lesser faults as when the Ulcer shall break forth into frequent Haemorrhagies or change its place creeping into another less convenient with many other ways by which it prevaricates it will not be worth our labour to discourse here 1. 1. Inflammation An inflammation frequently happens to an issue and that so painfull sometimes that it threatens a Sphacela yea and sometimes causes one But such an affection ensues either upon the orifice new made or happens after wards by reason of the blood and humours occasionally agitated and rushing frequently and in heaps to that part When a Fontinel is made Which happens to a new Issue the Reason of it and Cure proposed immediately by reason of solution of the Unity and consequently by reason of the circuit of blood somewhat hindred in that place a certain inflammation and ulcerous pain happens to some patients but in some endued with a fervent blood and whose Serum is less diluted this ensues much fiercer For the blood being brought thither by the Arteries the ends of the Vessels being cut off and obstructed it can neither go out nor be returned immediately by the Veins but sticking there in the passage it is accumulated more and more and being at length extravasated and filling and stopping all the pores of the contiguous skin and flesh it raises a tumour with redness and heat most intense which coming to pass either the blood so heaped up and extravasated An Inflammation hath three manner of Crisis's in a snort space of time becomes immovable by reason of constipation and for that cause being as it were divided from the rest of the mass it is extinguished and suffering death produces a Sphacela upon the part or secondly the blood so stagnating is after a sort agitated as to its particles and enjoying alwayes a vital flame and made more intense by the same it is as it were boyled throughly and so is changed into a Pus to be evacuated by an abscesse Or thirdly which happens more frequently and ought always to be procured in our case the blood provoking an inflammation is reduced into the Vessels and restored to Circulation by other passages whereinto it is constrained But that it may be reduced these two things will be necessarily requisite First The ordinary and best these is that the extravasated blood may be reduced That it be much diluted with the Serum flowing thither abundantly or rather thrust forward into the part Then secondly that the Vessels behind the Tumour being emptyed may swallow up the blood diluted and driven back by the Serum for the blood being forced towards the Tumour whenas it cannot advance forward yet its bulk being diminished that it may be able to return back it dischages the Serum plentifully from it self and drives it for wards into the places obstructed which entring under the stagnating blood dilutes it and succeeding into its places forces it back into the passages of the Vessels and in the mean while that Serum tending for ward exhales by the pores insomuch that the blood which was extravasated being diluted and forced back by the Serum and the Serum it self evaporated How it is done the swelling with the Inflammation vanishes leisurely away But if as in more hot temperaments it comes often to pass the blood being extravasated and impacted in the pores be not diluted by the Serum brought to it in great plenty it will not only stick there pertinaciously but it will irritate a fiercer Phlogosie with a Feaver and sometimes other dreadful symptomes So not long agoe when a renowned Divine endowed with a thicker and hot blood had an Issue cut in the inside of his Leg although the skin only was cut an inflammation followed presently which within
furrow the skin Neither only the humour being too much exhausted out of the pores but also retained in the same either unduely or above measure From the sudden shutting up of the pores doth render the skin rough and unequal The hairy pores which though they are not the only yet are much the passages of Sweat do constantly send out more plentiful Effluvia's for the sake of transpiration wherefore they ever seem greater and more open but if it shall happen that these are suddenly obstructed by any outward cold the Vapours being restrained within In the larger pores are the roots of the hairs they do every where swell up the skin about the places where they break out and lift it up into little heaps from hence of at any time our bodies are exposed naked to the Northern wind or are plunged in a River the exterior Superficies before smooth and soft will become rough and rugge like the skin of a a Goose new pull'd Without doubt those greater pores being according to the furrows of the skin planted parallel and as it were in a rank after the manner of a Quincunx or exact Square are made as so many pitts for the planting of hairs as it were trees for so they appear in four-footed Beasts and in some hairy parts of men These things being thus briefly declared concerning the Cuticula and Skin as touching their frame and uses there is way enough made to search and unfold the Diseases of the same parts and the reasons of healing them Wherefore first scarce any Diseases properly belong to the Cuticula No Diseases of the Scars-skin it being devoid of life and sense This sometimes being too thick hinders Transpiration and also sometimes by reason of accidents in some places it grows too thick and callous but it self being clearly unsensible it is never sick notwithstanding this is a cause that some distempers which might be blown off by Transpiration do cleave to the superficies of the skin inasmuch as the dregs of the blood and humours and recrements being thrust forward outwards The cause of some having passed through the whole skin when they cannot evaporate wholly by reason of the thickness of the Scarf-skin being fastened in the outed skin produce various discolourations and stains thereof of which fort are those spots called Heat spots Freckles or Ephelides as also scorbutical and malignant spots also Pimples and whatsoever other stains without any swellings or roughness do seem to besprinkle the skin or outward Scarf-skin with marks or some little disfigurings The Cutaneous distempers reckoned up But truly as to what belongs to the distempers of the Skin it self in general since they are various and manifold they are wont to be distinguished under a various respect and chiefly that they are either with or without a Tumour we have but now taken notice of these latter ones Distempers of the Skin with a Tumour Distempers in the skin with or without a tumour are either universal dispersed throughout the whole body or are particular being raised in these or those members dispersed or as it were by chance The former either happen upon a Feaver as chiefly the Small-pox Measles or other malignant wheals whereto also may be added the fleeting pushes of Infants or happening without a feaver as the Itch Tetters and leprous distempers The outward particular Tumours or dispersed ones for the most part do not seize upon the skin only but also upon the parts subjected viz. now the carneous another while the tendinous or membranous or glandulous and for that cause do exist of a sundry disposition and of a diverse form To discourse particularly concerning all these and to assign the reasons of their Causes and Cure of every one would be a matter not only of an entire Tract but of a great Volume Wherefore for the present we will only briefly speak of the Distempers merely or for the most part Cutaneous of which sort are all spots and Pimples as also the Scab or Itch Tetters or leprous Maladies perhaps an opportunity may happen when I may treat more specially of Tumours of every kind First then that we may begin with Spots as Affections of lesser moment those offer themselves called Ephelides because they are chiefly caused from the Suns heat 1. Spots call'd Ephelides for that cause frequent in the Spring and increase most in Summer again in Winter they soon vanish Moreover whereas they happen in the more beautifull persons The description of the Ephelides and of a thinner skin they break out chiefly in those places where the Cuticula is most thick and is exposed to the Sun and Air viz. the face and hands of a colour yellowish or brown in magnitude of a Flea-bite but they exist unequal and irregular as to their Figure These differ little or nothing from those brownish or yellowish spots which some call Lentigines or Freckles which consisting of the bigness of a Lentil mark the parts of the face as it were with many drops The matter of these seems to be a more thin portion of the cholerick humour The matter and cause thereof allured outwards by the force of the Sun attenuating it and opening the pores of the skin which beginning to be evaporated is fixt to the inside of the outmost skin or Cuticula which it cannot pass through Surely it is a sign these spots proceed from Choler or other yellow scums of the blood because they are chiefly familiar to them whose hair is yellow Moreover the reason is manifest enough because they arise more often in a fair Complexion and in those parts exposed to the Sun and Air for their more thin skin transmits the humour rarified by the solar heat so far untill it is retained by the thicker Scarf-skin near the places of issuing out This affection presages or indicates no evil as to the state of health and although in appearance it represents something of deformity notwithstanding that is made good again insomuch that it signisies them so spotted to be endued with a more pure Constitution Besides these small freckly spots there are others much larger Lenticular Spots above a hands breadth in magnitude which deform the skin in divers places especially about the breast and back one while with brown another while with pale or blackish spots These at certain times as I have observed in many being wont to arise in certain parts and vanish again are commonly called Liver-spots Liver Spots falsly so called and those most markt with them are thought to have a Liver less sound or at least not well sanguifying which not withstanding is not true on this account but only inasmuch as the cholerick humours when they are not enough separated from the mass of blood within the Liver being thrust for ward to the skin do so discolour it which fault also is imputed to the Spleen for truly this deformity arises because that the feculencies and
excrements of the blood when not enough received by the Vessels of separation are together dlluted with the Serum with which they are conveyed to the skin and in the same place being cast off by the blood and deserted by the serous Juice while it is evaporating they are fastened about the outer little holes or pores even as a mossie down cleaving to the strait places of a River These spots chiefly appear in Summer and most upon the Breast and Back The Description and Cause of them viz. at which time and in those places men are most apt to sweat for that serous Juice which brought out those dregs from the mass of blood into the strait places of the skin leaves them there altogether unable to evaporate This indisposition hath nothing of evil joyned to it nor is it a symptom of any present disease nor doth it prefage any suddenly approaching Moreover when for the most part it happens to places that are covered and brings no deformity or trouble there seems little or no need of Cure but because an opinion is frequent with the Vulgar that the Liver is eminently endangered by these spots and necessarily requires Medicine for this cause to satisfie the importunate craving Medicines we are wont to prescribe besides extern Cosmeticks even inward hepatical Remedies whose use although not very necessary yet because from thence the depuration of blood and opening obstructions of the bowels are dispatcht they are not altogether in vain The inward Medicines profitable to this design are described before among the hepatical Remedies The Topical or outward are altogether the same in these as in any other kind of spots some select forms of which we will annex Concerning Pestilential Pestilential and scorbutick spots as also Scorbutical spots of which we have purposely in another place spoken there is no need here to repeat the same especially because for these another method is required than for those but now described inasmuch that in one kind of spots Medicines for the most part outward are wont to be administred without Splanchnic or Cordial medicines but in the other kinds only inward medicines without any that have reference to the Skin Wherefore The Cure of the Spots as to the spots called Freckles Lentigines and those commonly called Hepatical they properly belong to the Art of Beautifying and for the taking away these Deformities of the Skin only Cosmetick Remedies are prescribed without any method of healing There is every where a plentiful harvest of these with curious Ladies and others that are solicitous of cleansing their skins yet all these forasmuch as they only respect two Intentions of healing may be reduced to these two heads viz. either by opening the pores of the skin and Scarf-skin and sometimes by excoriating this they do endeavour to have the humour drawn outward and also to be evaporated or on the other side and not with less success those things are administred that may drive back the spotty matter and force it inwards We will annex here in order some usual Forms of the Topicks of either sort being rationally found out and frequently made use of happily enough because it is not lawful without offence of the Great Ones to detect the more secret mysteries of the Cosmetick Art Forms of Cosmeticks and to profane it among the Vulgar First therefore for cleansing the skin 1. Which cleanse the skin and drawing forth the matter of Spots Take of a small ly of Salt of Tartar four ounces Oyl of bitter Almonds made by expression as much as suffices in such a proportion let it be mingled that the liquor turn presently white and so remain with this mixture let the parts be anointed morning and evening and gently chased Take of Aron-roots Bryony Solomons-Seal of each one ounce Powder of Fenugreek seeds one dram of Camphir half a dram these being beat together pour on them three ounces of Oyl of Tartar per deliquium let it be pressed and applyed with a rag twice a day Take of quick Brimstone in powder one ounce black Soap two ounces tye them in a rag and hang them in a pinte of Vinegar for nine dayes after let it be used by washing the part twice a day and chafing it Secondly 2. Which repell the spotty matter For the other intention of discussing the spots from the skin and repelling their matter inwards Lac Virginis was a renowned Remedy among the Ancients and is as yet commended and made use of by many The Preparations are well enough known Viz. A Solution of Litharge made in distilled Vinegar by pouring of Oyl of Tartar per deliquium Lac Virginis it is precipitated into a white liquor like milk with which let the face and hands be washed twice a day and gently chaf'd A remedy like this or of the same vertue is prepared out of the solution of red Lead or Ceruse made in the same Menstruum and precipitated with Alum Water or a Solution of Sal Gem. Or Take of Camphir sliced two drams bruised in a glass Mortar pour thereon leisurely the juice of one Lemmon then adde one pint of White-wine strain it and let the remaining Camphir tyed in a rag be hung in the Glass Take Verdigriese four Ounces pour thereon two pints of White-wine Vinegar being put into a Cucurbite-glass let them be distilled in Sand let the Phlegme be kept for use with which let the face be anointed twice a day For this purpose also the Phlegme of Vitriol doth notably conduce It suffices some to use the distilled simple water of Bean-flowers or of Fumitory or the liquor of a Vine distilling from the Boughs cut in the Spring-time Notwithstanding the more nice and those who chiefly boast to understand this Art are scarce content with any Remedies but Mercurial wherefore the following water is commended and sold by Empiricks at a great rate against all foulness of the face whatsoever Take of Mercury sublimate one ounce powdered A Mercurial Cosmetick water put it in a Tin Vessel with three pints of Spring-water let them stand twenty four hours space ever and anon stirring it with a wooden Spatula untill the whole liquor grows black which notwithstanding being philter'd through brown Paper becomes clear with a rag or a feather dipt in this let the face be gently done over once or twice in a day This Remedy doth most notably help against all cutaneous Deformities It s Vertue viz. inasmuch as it drives away the humours within the little pores and those impacted within the little holes howsoever small dissolves the inveterate and stubborn combination of Salts or Sulphurs and restores the whole skin where it is applyed though evilly framed as to its pores and makes it well coloured Wherefore it is usefull not only to cleanse the spots of the face but also to take away wheals and its redness as also the Disease of the Erisypelas Moreover sometimes it happens that many parts of
the face especially the Nose and Forehead are markt with most thick Specks looking black as if burnt by Gunpowder which proceeds from hence because the sudatory pores are sometimes fill'd with a more thick black humour another while with little worms with black heads which little Insects being squeezed out of the pores and exposed to the Sun are easily seen to live and to move themselves and in such a malady of the skin no Lotion or Oyntments are wont to profit but what are Mercurial notwithstanding to this Hony there is a Thorn at hand more than enough malignant It s familiar use is not safe For the particles of the Mercury together with its Salts by which they are divided and sharpened into small bits being applyed to the face do shake off the peccant and uncleanly matter out of the Pores and expell it thence but having driven it back they pursue it in and readily insinuate with the Blood and nervous Liquor whose temperaments they prejudice Yea by meeting with these they imprint very often on the Brain and sometimes on the Praecordia and other parts their virulency that can never be wiped out From hence it is frequently observed that women or men that have long used Mercurial Cosmeticks are troubled with a Vertigo and convulsive Distempers or are obnoxious to paralytical and their Teeth grow black and sometimes fall out SECT III. CHAP. VI. Of the Mange or Scab with the Itch. AFter the more simple maladies of the skin viz. those which happen without any Tumour and Ulceration and only deform it with spotted appearances Psora a disease properly cutaneous we will now in order treat of the more grievous Affections and those which dissolve the Unity and especially of the Psora or Scab which in sundry and srequent places of the whole Body doth much infest the skin with a painful Itch and with small Pustles and breakings out being sometimes dry and often scaly and another while moist and disposed to ulceration and a malady of this sort is most properly the Disease of that part considering it frequently begins in the very skin by reason of some outward Contagion and often receives Cure by certain Remedies applyed to the skin only at least the reason of both holds so far that it is seldom otherwise undertook or perfectly cured The Psora or Scab is vulgarly described to be a breaking out of Pustules and wheals throughout the whole body here and there It s description procured from a sharp and salt humour heaped up in the Pores of the skin and that it may be discussed from thence induces a notable Itch and a necessity of scratching That we may search duly into the causes of this Disease and the reason of the symptoms we will more deeply enquire concerning the matter effecting and the conjunct cause thereof that it may certainly be known of what sort that humour is which is heaped up within the skin by what means it is either generated there or comes from some other parts afterwards in what pores or little places it is contained and how endeavouring to break out it doth create so troublesom an Itch. Wherefore about the origine of this Disease What humour its matter is of that we may not impute the fault with the Ancients to the Liver or Spleen the matter thereof is not any particular humour of the four commonly supposed ones not Phlegme nor yellow Choler nor black Not any of the four common humours neither also the blood apt of it self to be extravasated moreover neither doth it seem to consist of two or more of these humours mixt together For though such humours be granted notwithstanding if this Disease always consist of them it would not so easily be catch'd by a meer and light contagion But a humour plac'd in the Glandules of the skin or receive Cure by an Oyntment alone Wherefore it is rather to be supposed that the morbific matter is the humour of the Lympha constantly resting in the glandules of the skin notwithstanding degenerating from its genuine disposition that is to say its volatile-salt into an acid or otherwise offending disposition For when the continual Supplements from the blood come to this so depraved and uncessantly evaporating these Juices new and old do not easily agree or are united but boyling together after the mutual custom of dissimilar Salts they are coagulated into a recrementitious matter which filling and distending the pores of the skin every where raises it into Tumours Moreover it something hinders the Blood in its passage and constrains it to be extravasated From hence thick Pustules are raised and because that matter passing into an Ichor is compelled by the Serum and Blood pursuing it still forward they rise up into little heaps afterwards the Animal Spirits entring inordinately into the nervous Fibres that they may promote the throwing off that ichor do cause the sense of that troublesome itch Indeed an inspection with a Microscope doth most clearly discover that there is a lymphous humour in the glandules of the skin which lye under all the sweating pores treasured up for some uses The description of that Juice or Humour so that according to the plenty and diverse stay thereof these Glandules exist more or less turgid This Juice is laid aside by the Blood through the Arteries in these Glandules that this little burthen being cast off it might return more easily through the veins in the mean time being reposed there it hath its uses viz. In the first place continually moistening the miliarie Teats which lying under the nervous little Fibres are the proper Sensory of Touching it preserves them from dryness which would hinder the Sense also it imbues the adust effluvia's passing uncessantly from the blood being kindled in their passage near the skin with a certain moisture and renders them fit to be voided by the pores and whilest part of this humour doth so continually evaporate with the Effluviums of the blood those expenses are repaired by the Lympha continually fresh being deposited by the Arterial blood as is abovesaid Notwithstanding this occonomy of the Region of the skin is not always so regularly kept How it degenerates but that the glandulous humour falling from its own disposition and function not only will provoke in the skin but sometimes in the whole body preternatural affections of divers sorts This growing clammy and cleaving more obstinately in the little Cells obstructs transpiration and immoderate sweating proceeds from its too plentifully flowing out and from the same restagnating inwards a more than usual Diuresis This is done three ways Moreover as to what belongs to the Scab and pustulous eruptions that humour as it is wont to be depraved many ways so chiefly these three and is wont to enter into a coagulative disposition with the Serum being fresh poured out from the blood 1. By reason of impure Blood viz. First the Blood it self being very
impure and also dissolved it leaves its corruptions and superfluous dross in the cutaneous Glandules which in the same place putting on the nature of more corrupted ferment they boyl up with other adventitious Juices or passing by these and are diversly thickened and so they beget not only pustulous affections but also leprous of divers kinds From hence the daily and often eating of Shell-fish and also of others and of salted meats that have been hung in the Sun or Smoak also the taking disagreeing Drinks and venemous Medicines do cause cutaneous and frequently dreadful eruptions Secondly 2. By mere stagnation The humour being heaped within the cutaneous Glandules sometimes doth not only become pustulous by a mere stagnation but also frequently Lousie Wherefore not only they that have been long in prison but also those who being of a sedentary life are used to nastiness and sluttishness do live obnoxious to the above-mentioned maladies inasmuch as the cutaneous humour being not at all eventilated is corrupted by mere standing after the manner of putrefying water and so it puts on the disposition of a corrupting ferment 3. By Contagion received from without to which moreover Supplements of putrefraction come from the blood in the like manner depraved Thirdly If perhaps these Canses are wanting that the glandulous humour of the skin neither contracts any stain from fault of the blood nor its own proper stagnation notwithstanding virulent steams communicated from without render it no less prolific as to those diseases This is manifest by common observation especially forasmuch as they that have health most and are endowed with the best Constitutions scarce ever escape free from the same if they lye in the same Bed either with a scabby person or where he hath lately lain and not only so but moreover the Linnen of the Scabby oftentimes washed with other Linnen have bestowed the contagion upon others Surely the taint of no disease the Plague only excepted is more easily or certainly propagated than this of the Mange If the reason of this be enquired into The reason of its most sudden contagion is unfolded we presently say that the liquour susceptive of the scabby taint is mightily exposed and most easily disposed unto it and indeed much more ready to either than the Blood or Nervous Juice For the glandulous humour of the skin abounding in the outer superficies of the body first imbibes every atome let in by holes and pores every where open and anticipates them from the blood Moreover that this is so soon infected with a scabby Contagion both the activity of the ferment communicated causes it and also the proneness of the glandulous liquor to degenerate For indeed the effluvia's falling from the breaking out of the scabby skin are aptly enough compared to the Yest of Ale remaining on the top as it were its outmost Coat of which if the least portion be taken from thence and mixed with other new Ale unfermented presently it ferments the whole mass how great soever and changes it into the disposition of the liquor from whence it was taken Certainly there is a very considerable energy which the particles however so small and little carryed to the highest activity are able to perform but especially if they fall into a liquor of which sort is the cutaneous made up together of subtile particles of several sorts as well partaking of the blood as of the nervous Juice and for that cause most readily apt to be fermented The Contagion when any where received presently spreads over the whole skin Wheresoever therefore these effluvia's of the Contagion abovesaid hit against any outward part of a healthful body first they will infect the cutaneous humour only planted in that place but then the particles of this so corrupted being received by the venous blood and presently delivered to the Arteries are diffused through the entire habit of the body and in a short time defile the whole mass of this Humour and make it scabby From these Causes of a Psora as well adjunct as procuring being unfolded Of the Itch. the reason of the first symptoms or breaking out in Pustules is manifest enough but as to the other viz. the Itch as it is troublesome to Sense that the formal reason thereof may be known we ought to consider to what Sensory or organ of sense it properly belongs and of what sort its passion or affection should be Concerning these things first it is sure it belongs to the sense of touching It belongs to the Sense of Feeling and that the first Instruments hereof are Teats fashioned like a Millet and their little Fibres dispersed through the whole skin as we have before declared Moreover with this sense all the nervous fibres are endowed being diffused throughout the whole body Notwithstanding whereas there are two supream passions of Touching Of what sort its Affection is and as it were generical viz. Pain and Pleasure it is deservedly doubted to which of these Itching ought to be related For the solution of which we ought to shew by what means the Animal Spirits being inmates to the organ of Touch are affected in Pain and also after what manner in Pleasure then their demeanour also as to the Itching being design'd it will easily be manifest of what Province this Passion is The chies Affections of feeling are Pain and Pleasure and in what things the nature of it and the manner of its acting do consist Let the Reader pardon me if I should by way of digression expound this more at large and even to tediousness because this Aetiology seems very necessary both to the understanding and curing of most outward distempers Pain being distinct from Sadness and belonging to the Touch is used to be defined Atroublesome feeling proceeding from the dissolution of Vnity And indeed it takes its origine as often The formal reason of Pain and in as much as any sensible thing disagreeable or improportionate being applyed to that organ of fense divides and separates the fibres one from the other and for that cause repelling the animal spirits inhabiting in them from their wonted and quiet emanation distracts them from one another and as it were puts them to flight then presently forasmuch as that outward repulse of the spirits is communicated by a continued order of other spirits to the first organ of Sense it stirres up the Spirits dwelling there into the like confusions so a perception is caused of grief or pain inflicted outwardly In truth the whole series of animal spirits which are affected with pain as it were some singular member of the sensitive Soul conceiving trouble as it were from the impression of the object is forced to be wrinkled with pain and to contract in self into a lesser dimension When a dissolution of Unity is said to be the cause of pain we must not understand it so as if this affection only were caused from a wound
not always round or of a regular Figure but diversly formed Moreover there is no stop in this condition but the distemper unless it be restrained with Medicine breaking out still in more places and creeping on every where in broadness at length not only covers over the whole member but also the whole body with a leprous dry scurf and this kind of Impetigo the Ancients call'd by reason of its outrage 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and for the most part accounted it incurable From hence the chief differences of this disease are made known The differences of this disease and in the first place as it is less or more malignant according to the fashion thereof it is distingushed as it comes nearer the nature of the Scab or Leprosie or as it is in a middle condition between both We are also to note this distemper sometimes infests some particular members as the Arms or Thighs the rest of the body being untoucht but sometimes it begins together in all parts and every where excites scatrteringly little Pimples or Clusters thereof Also eruptions of this kind are in some for a season or periodical and for the most part infest these persons during Winter only vanishing away about Summer likewise on the contrary in others they abhorre Winter and are wont to observe the season of the Swallow going and coming but in most others the Disease being continual grants no truce yea it hat neither remission nor mediocrity Moreover How it differs from the Psora and Leprosit we must distinguish an Impetigo from other Diseases a-kin to it and first from the Scab and the Leprosie It differs from the former as to the form of the Pustules for every where in the Psora they are single and remote from one another although by small spaces here most of them break out in Clusters concurrently and as it were disjoyned by branches with great interspaces But between these distempers a notable difference yet arises in that the Scab is wont easily or scarce otherwise to be propagated or arise but by Contagion but the infection of an Impetigo is so seldom or never that the Miasma from the Husband doth not pass to the wise or from her to him though they lye together Also this Disease differs from the Leprosie as well in respect of the form of its eruption as of its contagion which is likewise active in this as in the Psora and the breaking out is much larger and more horrid viz. it is every where shelly and scaly without intermission and diffused through the whole body From hence it is manifest that the material cause of an Impetigo The material cause not a humour of the skin is not merely a cutaneous humour by reason of effluvia's or a taint received from without or depraved by reason of other accidents and degenerated from its temperament because it is not easily communicated to others by Contagion as in the Psora neither is it immediately dispersed throughout the whole body But tartarous Concretions begot in the blood But indeed little Pustules breaking out first about the initiations of the Disease seem therefore to proceed for that certain acid salt Concretions happen to be in the mass of Blood like Tartar in Wine which when they can neither be concocted or again dissolved are here thrust out into the skin as there into the sides of the Vessel As long as these Concretions are small and few they are conveyed into the skin in this or that member and by one or two branches of an Artery then as Nature is wont to continue the same manner of excretion as it began the matter being carryed every where by the same vessels to the same nests near the first wheals it causes heaps of others round about therm but afterwards when the dyscrasie of the blood is daily augmented and that Tartarous matter is generated more plentifully in the mass thereof more portions are conveyed by other Arteries and still by more to the outward places and for that cause also more pimples break out both in the same and in other members which a new matter coming continually by the same Arteries and being placed close to the former enlarges them every day and every where dilates them by the addition of other pustules and at length if this sort of Tartar of the blood augment hugely being carryed out by more or all the Arteries together it is fastened in the skin and in process of time covers over all the superficies thereof with a scaly or downright leprous shell And then that cutaneous humour being wholly corrupted promotes the disease it self for it causes the stock of the morbific matter to be encreased by polluting more or rather poysoning the blood and humours whilest they pass in Circulation moreover dismissing the corruptive steams from it self it renders the Contagion of the same disease unto others Wherefore both the procuring and conjunct causes of this Disease consist in this The next cause of it for that without any fault of the skin it happens that the blood is filled with salt Particles of a various disposition and condition into the preceding cause of which disposition we will anon inquire and where those fixt and acid Salts are especially predominant as the manner is they mutually embrace one another and so grow together into Tartarous Concretions which being thrust forth into the blood cause eruptions of wheals as it were nests of the Disease then they being daily and leisurely encreased both in number and largeness according to the supply of matter they produce the beginning augmentation and state of this disease As to what relates to the antecedent and evident causes The evident Causes there are two chief kinds of occasions from which this distemper for the most part derives its origine to wit an evil manner of Diet or a taint of the Scurvy or Pox or other Diseases left in the body being ill or not at all cured We will weigh a little the reasons of each of these As to the former besides the common irregularities in Diet Irregularities in Diet. wherein some being too much addicted to eating of flesh salted and afterwards dryed in the Sun or Smoak and the drinking of acid Wines do easily contract this malady Also it is a vulgar observation The daily eating of Pork or Fish that very many are disposed thereunto by the too frequent or daily feeding on Pork and Fish and especially Shell-fish There is a notable instance of the former which is that that food was chiefly forbidden the Jews for prevention of this disease Also there is an example of the other that in time past the Inhabitants of Cornwal for the most part dwelling on the Sea-coast inasmuch as the poorer sort were fed with Fish became very obnoxious to Leprous Distempers The reason thereof inquired into insomuch that for their relief many Hospitals were erected in that Countrey That I may hint in a few
physical hours and also constantly instead of ordinary drink Take the Shavings of Willow half a pound of Sarsaperilla eight ounces whits Sanders Lignum Lentiscinum of each two ounces Shavings of Ivory and Harts-horn of each six drams Filings of Tin crude Antimony of each four ounces tyed in a rag of Liquorish one ounce infuse them in sixteen pound of Spring-water and boyl them to half keep it strained for use Fifthly Medicines of Steel 5. Medicines of Steel in that they are every where accounted among the more excellent Remedies are wont seldom to be omitted in this Disease although not frequently given with success for most Preparations of Steel wherein the Sulphureous Particles predominate inasmuch as they ferment the blood and irritate it into Critical Effervescences do cause these impetiginous eruptions to augment rather than diminish notwithstanding the Salt Syrup Tinctures and infusions of Vitriol inasmuch as they fix the Blood and something restrain the raging of the Salts do fitly enough agree with the intention of Cure now proposed but being weak in efficacy they do not prevail against so Herculean a Disease Wherefore Sixthly these and many other Remedies nothing availing 6. Sallvation many commend Salivation as the stoutest Wrestler and only match for such an Enemy Yet the event doth not always answer this great expectation for I have experimented this remedy without success in four Patients labouring under a painful Impetigo which had resisted other Medicines Some of these were provok'd to abundant Spitting by Unction with Quick-silver others by doses of Solar Precipitate which they have endured for the space of twenty dayes which time being elapsed all the scaly eruptions and clusters of wheals have vanished notwithstanding to confirm the Cure a Diet-drink of the Decoction of Sarsa was appointed and frequent sweating under a Cradle and due purgation between was continued for a month Notwithstanding this Course being finished Salivation does not alwayes cure this Disease when no footsteps of the distemper seemed to be left within another month a new stock of the same Disease beginning to break out it encreased quickly to its usual maturity Moreover when one of them would repeat this course and another after two relapses would experiment it the third time both of them at length after great sufferings of Pain despaired of Cure Whence it is manifest that the Venereal Distemper although highly malignant and raising most filthy Ulcers consuming the flesh and bones is more easily and certainly cured than the Impetigo The reason whereof if we enquire Why the Impetigo is more difficult of Cure than the Pox. may plainly be conceived for that the cause of the latter Disease consists in a malignant and altogether heterogeneous pollution infecting and poysoning the blood and nervous Liquor for a certain time but not altogether overthrowing or for ever depraving its temperament wherefore the Cure is performed by Salivation or a sudorifick Diet eradicating all that venom and then the natural disposition of the blood and humours remains entire But in a more difficult Impetigo the Elemental particles and first Constitutives of the blood are corrupted insomuch that unless the natural disposition and constitution of these are restored all Evacuations and Expurgations of any venemous malignant and heterogeneous matter however plentiful and eradicative do little or nothing prevail Wherefore many famous Physicians not undeservedly judg'd this Disease being confirmed and raised to the borders of a Leprosie to be hardly or never cured Secondly Impetigo succeeding a Scurvy how to be cured No better event attends this malady ensuing upon an inveterate Scurvy perhaps hence the intentions of healing are a little more certain when this Distemper is placed as the Basis or root of that to wit that the chief curing Indication being taken from thence we must chiefly insist upon Antiscorbutical remedies but the more sharp and hot of this kind as the Garden Scurvy-grass Water-cresses the Horse-rhadish Hot antiscorbuticks do not agree Pepperwort and others too much irritating the blood inasmuch as they dissolve the temperament thereof more and drive out more plentifully the Tartarous Coagulum to the skin are always discovered to be more prejudicial than advantagious and for this reason the use of Baths Nor Baths or bathing in hot waters which namely evacuate the humours of the whole body by an abundant Evaporation and cleanse the pores of the skin and seem very available in this malady often-times are so far from helping that those Eruptions are wont to be exasperated from thence and very much encreased for I have known many not extreamly Impetiginous to have gone to our Baths to bathe in the hot waters that have returned altogether Leprous But only the more temperate Remedies endued with a nitrous vitriolick or volatile Salt Wherefore when the Symptoms of this distemper arise from a scorbutick evil all elastick things are to be avoided and only the more temperate endued with a Nitrous Vitriolic or volatile Salt are to be administred We will lay down some Models of each sort As first Crystal Mineral Juices of some Herbs and Decoctions Salt and Mineral purging Waters are most predominant with a Nitrous Salt Take of Crystal Mineral Forms of Nitrous Medicines or Nitre purified one ounce Flowers of Sal Armoniack one dram bruise them in a glass Mortar give one dram three or four times in twenty four hours Take of the leaves of Housleek the greater two handfuls bruise it and boyl it in two pound and a half of new Milk till it turn to Curds and Whey strain it and take a pint of the clear liquor twice in a day Take of the leaves of Dandelyon six handfuls Water of Sow-thistles bruise them and put them into a glazed earthen pot with a cover which put in an Oven after the bread is drawn out let it stand six or seven hours then pour it through a Strainer the dose is four ounces to six of the clear liquor thrice or oftner in a day Cucumbers being endowed with a Nitrous quality are advantagious by experience against this disease Cucumbers wherefore in lieu of a Sallad let them be plentifully and often eaten moreover three of four of them cut into slices let them be infused and stopt close in three pints of Spring-water all night to the clear liquor poured out adde Sal Prunella two or three drams the dose is half a pint thrice or oftener in a day For the same purpose Decoctions of the leaves in running water together with the fruit do profit 1. Purging Mineral Waters Certain mineral purging waters of which sort are chiefly those of North-hall an Analysis being made by Evaporation manifestly shew a Nitrous Salt with which they are imbued and I have sometimes found the daily drinking about four pintes for many dayes to help against a gentle Impetigo 2. Vitriolick acidule waters But as I have before hinted those Mineral waters endued with a