very weakly others use their arms but with little strength and some the use of their Limbs almost taken away The material and continent cause of these fugitive and vagrant pains is the same or of the same nature with the former Arthritis or Joynt-Gout viz. a tartarous or sharp penetrating serosity that molests these several parts and to confirm that this is a serous or watry humor it makes no Tumor nor suppurates which were it of another kind it would besides the mobility and fluctuating nature thereof argues it to be of that kind and farther à juvantibus we may most rationally conclude so Transpiration and copious emission of Urine and also Purgation that evacuates serous humors gives allay and sedation to these fleeting pains But why this should be so moveable and changing its place the other fixed or constant to a part since one and the same humoral matter is the cause of both the reason hereof may be this from abundance of the humor and for want of vent one way not being sufficient to receive and spend it Nature is necessitated to find out and break through several ways that is by forcing the Anastomoses and opening the terminations of the Veins spewing forth this punging irritating humor into several parts and being an unwelcome guest hostile and troublesom the Archaeus or vital principle defending its Territories quoad posse and unwilling to give it harbour transmits it from place to place This Rheumatism and erratic pains depending upon the same humoral cause with the Gout will require much what the same method and Medicines for Cure as also such Prophylactics that are proper and fit by way of prevention for the other may here be used with the like advantage and therefore it is not needful to point out a particular methodus medendi or peculiar Medicines only the Topical Medicines are not of such use here as in the Joynt Gout And now I have gone through and briefly inquired into the most and most considerable pains incident to several and principal parts of mans Body it remains now as is proposed and promised in the front of this Work that I proceed on to the next Stage viz. Inflammations and there observe what is most remarkable and most profitable to be taken notice of Inflammations internal BY the common order of causation Pain precedes Inflammation follows To illustrate and set forth the nature of Inflammations more evidently and to avoid confusion and intanglement in our Discourse we shall distribute our matter and place it distinctly under these following Heads First What the word imports and congruous signification with the nature thereof Secondly What Parts of the Body Inflammations do usually possess Thirdly The occasional Matter that provokes and sets forward these Inflammations Fourthly How they arise and from what Principle or Efficient they are caused Fifthly The Vse and Practice that ariseth naturally from the preceding Doctrine The word Inflammatio used in the Latine in the Greek is 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 uro to burn or inflame in both Languages signifying some extraordinary and preternatural heat kindled and begun in some part of the Body and in the common acceptation of a Phlegmon or Inflammation is understood thereby a hot Tumor arising from blood But although Inflammations are reckoned among the Tumors and so accounted by most Practisers yet I must take leave to divide Inflammations from Tumors and distinguish them apart as properly so for commonly they are separate although oftentimes conjunct and the denomination was given à calore not à tumore By Inflammation therefore I understand here only a preternatural or extraordinary heat begun in any part as the Etymon of the word imports before a Tumor be raised but by time and continuance Inflammation or great heat does attract matter and forms a Tumor and then Inflammation and Tumor are coupled or complicated together for as we plainly find external parts to burn or feel very hot and to look red you say then the part is inflamed although no Tumor or swelling appear so is it internally the part is fiery hot or inflamed before a fluxion of blood arrive thither to throng the part and raise a Tumor so that there are Inflammations without Tumors and Inflammations conjoyned with Tumors and here I make Inflammation a distinct Classis and to be a gradation or step towards a Tumor which probably may follow if not prevented as sometimes it doth And here it is worth our inquiry to know the reasons why some Inflammations produce Tumors and some go off without forming a Tumor and this is caused from the difference of the parts affected and the copious influx and contumacy of the material cause to be removed from the efficacy of means timely used or the strength of Nature to relieve her self Secondly We are to take notice what parts of the Body are subject to Inflammations and they are the muscular flesh the Membranes the Parenchyma of the Viscera and the Glandula's hence it is that Inflammations as they are seated in divers parts of the Body so are they called by distinguishing names from the part affected as Phrenitis an inflammation of the Meninges or Membranes of the Brain Ophthalmia of the Eye Parotis of the Glandule near the Ear. Peripneumonia of the Lungs Pleuritis of the Pleura Nephritis of the Kidneys Angina of the Muscles of the Throat Now from the part affected you are to observe that any member the more nervous it is by so much the pain is greater and by how much the part is more fleshy by so much the sooner the Inflammation comes to a resolution or collection of matter In the third place we come to remark the conjunct and material causes of Inflammations and they are generated either by obstruction or extravasation Obstruction begets Inflammation when the fluid liquors in the Vessels are denied their free motion and transition and this happens when these Juyces are coagulated gross or thick and thereby become stagnant in the smaller Vessels Or by compression when the Vessels are stopt by some adjacent part tumified or extended beyond its common bounds Or by an influx of blood rushing into some smaller Vessels from whence there is not a ready transmission and passage for the venal and arterial Pipes entring into a member are commonly large but grow smaller as they go deeper in and their ramifications very minute that they may soon be overcharged by a turgid blood more than ordinarily fermenting and flowing in Thus great pain from what cause soever may introduce Inflammation by drawing a flux of humors to a part or member from whence they cannot readily retire or move forwards And here you may see how Contusions Luxations Fractures c. do occasion Inflammations if not prevented by care and skill with exquisite good means By extravasation sometimes Inflammations do arise that is when either by plenitude and fulness or heat and
thinness of blood the terminations or mouths of the Veins are opened and some effusion made which then being out of its proper place does degenerate and corrupt and affords matter for Inflammation Thus by Ruptures Punctures and Wounds extravasated blood is the material cause of Inflammations Fourthly but matter alone cannot produce an Inflammation nor any other disease being inactive and a dead thing of it self except some vital Agent works upon it forms and moves it who or what this Agent is we are to inquire farther Since then Inflammation is not procured by matter alone nor can it exist only by matter there must then be an internal efficient and movent Principle joyned with this matter that fabricates and generates of this matter an Inflammation But understand me rightly I do not mean that this matter takes fire and is kindled as if it were a sulphurous and combustible matter and so cause an Inflammation or scorching heat no such thing but this morbific hostile matter stirs up the vital heat by way of irritation provokes the vital principle to estuate and wax hot for from hence does all heat emanare stream and issue forth whether it be a temperate and natural warmth or a preternatural and inflaming heat both proceed from this fountain So that hereby you must distinguish between the occasional matter of Inflammations and the internal efficient that does excandescere inflammare This inflaming heat ariseth from a principle much different from the materia morbifica occasionalis this great heat does not rise out of the morbific matter inflamed but from the vital Principle incensed A Stone in the Kidneys by raising great pain may cause an Inflammation there and this stone is the occasional and material cause thereof but none can think that this contains fire in it or is capable to be inflamed or to communicate any heat to the containing parts save only what it hath received from the vital heat residing in the body And thus it is in all other cases of Inflammation in any part of the body from what cause soever This vital Principle is seated in every member of the body and does preside as Governor and not only for defence thereof but also to move and act in it so as no vital office or function can be performed without the assistance and power of this internal invisible Agent nor is there any heat but what ariseth from hence And this is that which Hippocrates calls the impetum faciens Helmont the Archaeus which I chuse rather to call the vital Principle When any thing happens out of order in the body a Vessel obstructed or some liquor extravasated or what else that may disturb and interrupt any member in its office soon the vital Principle is affected and concerned therein and if the matter be considerable and contumacious pain ariseth there and this pain is the suffering and anguish of the vital Regent strugling to resist the injury and labouring to remove the impediment hence the Inflammation and preternatural heat arising from this vital power Fifthly and in the last place from the doctrine preceding we are to make some observations that may be useful for guidance in Practice and to remark some pernicious errors that pass undiscerned And first here you must take notice of the affinity between Inflammations and Feavers that most Feavers do arise from Inflammations of some particular part and are the off-spring from thence or springing from that root For the quòd sit Practice does affirm it for rarely you shall meet with any considerable Feaver but some particular part is chiefly complained of and as the grief or pain does abate there the Feaver is remiss and slackens also Secondly you are to note that Feavers are erroneously defined à calore praeter naturam in corde accenso assigning the Heart to be the Focus where febrile heat is first kindled and from whence it is maintained when almost in any other part of the body if an inflammation happen there a Feaver will certainly follow taking its rise from thence not from the Heart so that the Heart then suffers sympathically by consent not idiopathically and originally And whereas I said almost any part intimating thereby that a slight Inflammation may be in the small and capillary Veins of short continuance which may not communicate a Feaver to the whole body and such inflammations we see externally planted sometimes the capillary Veins of the Cutis being affected calore rubore which either spontaneously vanish or soon yield to some outward application only Thirdly From the denominations of Feaver and Inflammation you may observe the parity or near relation they have to each other for from the Etymon of the words they seem to import much what the same thing denoting only an extraordinary heat 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 ignis and in the Latine Febris à ferveo 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 inflammatio from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 uro Fourthly We shall not depend upon Etymologies which are allegorical and often strained but inquire into the nature and extent of each and know what is meant by the one and the other and then what difference between them Feavers are known and defined by preternatural heat and effervescency through the whole body Inflammation is a preternatural heat of a particular part Hence we remark that Feavers are general Inflammations or inflammations dilated Inflammations particular Feavers of a member thus differing in extent and latitude but withal observe the order of causation Inflammation precedes and lays the foundation in this or that part there is the fomes and miner a morbi a Feaver follows upon the whole body caused only by consent from thence and condolency Now if all or most Inflammations cause Feavers and Inflammations so frequent as being the certain consequents of great pain then two things are to be noted first that upon the appearance or discovery of a Feaver you may suspect an Inflammation couched under it from whence as the spring this Feaver does arise Secondly that the Cure of most Feavers ought to be designed and managed so as respecting and aiming chiefly at a particular Inflammation upon which the Feaver does depend sublatâ causâ and when a Feaver ariseth upon this account as for the most part it doth then little regard is to be had to the general Feaver but die stress of Cure lyes upon removing the occasional and material causes of Pain and Inflammation in the particular part the foundation of all the rest which being removed the depending Feaver falls of course Thus all our Discourse tends to make a true discovery of causes that when preternatural heat does arise in the body and beget a Feaver we may know not only what to call it but also what to do by levelling at the right mark But by the way I must tell you also how a Feaver sometimes does arise and not from Inflammation of a pained part and that is when some
to discharge and abate blood by the Nose by the Haemorrhoids or Menstrual purgations sometimes by plentiful feeding and too much ease so that evacuation and transpiration is not proportionable in abatement and to balance the imported food Conjunct causes are such as more immediately and nearly concur or conspire actually in forming of these pleuritic pains and they are either acidity or viscidity within the Vessels of the Pleura or a violent fluxion from the larger Vessels too great for the capacity and reception of these exiguous canals 2. Acidity or an acrid serosity does sometimes fabricate and finish this disease by punging and lancinating the Pleura for omne acidum extra stomachum corpori est hostile says Helmont thereby irritating and exciting the vital spirit to estuate and be incensed and from this focus a febrile heat is kindled and communicated to the whole Body and that oftentimes and for the most part it is a sharp serous humor predominant in the blood which caused this disturbance in the Pleura is confirmed by the manner of solution or termination of the disease which most frequently is by a sudorific evacuation or insensible transpiration and therefore Hippoc. in his Predictions says Sudores urinas in Pleuritide probè fieri bonum esse salutare Friendly Sweats and effusion of Urine presageth a good event 2. Viscidity or grumosity of the blood does sometimes cause pleuritic pains for by obstructing those small ductures of the Pleura and stopping the Circulation a Tumor thereby is raised within this double Membrane for the Veins Arteries and Nerves lye between these two Coats of the Pleura And that the blood is thus apt to be stagnant especially in the smaller Vessels by coagulation grossness or congelation is confirmed by Phlebotomy for being let out of the body it is sometimes found destitute of its Serum or Latex that keeps it fluxile thin and transient and also is manifest so to be when it is in the Vessels as in Gangrenes where the blood is fixed and the part almost mortified and when Pleurisies do happen upon this cause of concretion they commonly tend to suppuration as not capable of being discussed or put into motion for a discharge of the part Now the Blood becomes thus incrassated gross and viscous from every cause that does too much exhaust and expend the serosity thereof as too great transpiration or sweating or immoderate making of urine and sometimes from a malignant or a venemous Miasm that curdles or congelates the blood 3. Fluxion or ebullient and preternatural Fermentation causeth pleuritic pains and thus it happens when a Pleurisie is the consequent or appendent to a Feaver preceding for sometimes a Pleurisie does precede and is the cause of a Feaver as when the dart is felt to strike the Pleura before any febrile distemper appears sometimes a Pleurisie does supervene and follow a Feaver as an effect from that general ebullition the hot spumous blood rushing into the Pleura Having established these causes in their due Series presenting them in the method and order of their causation and action we shall not trouble our selves with Choler Flegm and Melancholy the supposed materials of every disease nor shall I controvert the insufficiency of that doctrine here For Indications of Cure prompting what is to be done which way and with what they are various as the case presents 1. Plethory indicates Phlebotomy and requires a depletion or abatement of the redundance of blood that there may be room for the peccant matter to retire and for a revulsion and derivation thereof as also to avert the current and flux tending towards the pained part 2. Purgation by sedate and amicable Cathartics if you can procure such else by Clysters the best substitutes in that defect is necessary to absterse and cleanse the whole Body thereby subducting fuel from the fire and for rendring the Patient not so liable to effervescency and turgid estuation and for a retraction from the part affected 3. Topical Discussives are available and contribute to the remove of the morbific cause both as defensatives giving robor to the grieved part for resistance of the humors flowing in and also for a transmission and discharge of the conjunct matter residing 4. Diaphoretics to rarifie dissipate and set open the Pores for a free transpiration and exsudation are not only safe but exceeding necessary thereby to avert the antecedent cause resorting to the pained place and to disperse and scatter the morbific conjunct cause from the part affected if possible to prevent suppuration which is very dangerous and commonly mortal 5. Anacathartics or proper and truly expectorating Medicines are auxiliary and profitable in promoting expectoration by digesting the peccant matter and rendring it more apt and easie to be brought up and of these some are attenuating others incrassating to be used pro re nata suitable to the offending cause which if it yields soon and freely and Nature throws it up by cough and spitting it portends good promising shortness of the disease and a prosperous event which Hippoc. 1. Aphor. 12. confirms 6. Anodynes elected by a discerning Judgment and cautiously used may be of good advantage in some cases and at some times else may prove very pernicious Having dispatched these pleuritic pains we are next to take notice what other pains are incident to the Thorax or Breast And here we find pain to arise from Inflammations of the Lungs of the Mediastinum and of the Diaphragma whereof an account will be given in their proper places hereafter when we treat of Inflammations But the Lungs do suffer pain also from other causes as from Tumors not inflamed sometimes from adhesion or sticking of the Lungs to the sides of the Breast sometimes from stones and worms that have bred there observed and found upon Dissections and sometimes by Erosions and Vlcers of which in their due place following Back-pains of the Thorax are either upon the Spine between the shoulders or upon the Scapulae the shoulder blades And these pains do arise from some impressions of cold lately taken or from defluxion of a serous humor from the Head or sometimes from a maligne Miasm Venereal or Scorbutic that infests those parts Pain sometimes is seated at the bottom of the Sternum between the short Ribs under the Cartilage mucronata vulgarly called the Pit of the Stomach but improperly This Cartilage hangs down being as it were a defensative to the subjacent parts namely the Stomach and Liver yet is flexible to give way to the extensions of the stomach without compression This place is very tender at all times insomuch that a blow here is ready to make a strong man faint the part being thus sensible pain therefore here must be very troublesom Now this place is of acute sense or feeling in regard the upper Orifice of the Stomach being very nervous and almost subjacent to this Cartilage and the Heart adjacent hence it is that a blow or
Dysentery sending forth blood and corrupt matter Sometimes a bloody Flux continues a while without Vlceration and afterwards ulcerates the guts and makes a Dysentery that is when this extravasated blood lodging in the guts degenerates and putrifies it does thereby erode and plant an Vlcer which compleats a Dysentery Now this kind of Dysentery ariseth from an impurity or corruption of the blood which causeth a preternatural fermentation or effervescence in the whole mass but Nature not being able to depurate and separate from this degenerate admixture either by Transpiration or Vrine is forced upon this emission by the Intestines without a secretion and throws out both the good and bad together In the prosecution of Cure as these causes are rightly adjudged and Medicines adapted thereto depends the success and therefore that course and Method which is advantageous and proper to one may be injurious and altogether disagreeing to another And here you must take notice that Dysenteries are sometimes malignant as commonly when Epidemical and then Alexipharmacal Medicines are not to be omitted Now concerning the degrees of Dysenteries as to a better and worse curable or deplorable state and the signals declaring them as also several Queries that might be raised and satisfaction given to each the conciseness of this Work will not admit to inlarge thereon In the next place and of great affinity with Dysenteries is a Tenesmus agreeing in the causes and Symptoms but differing in the part affected a Tenesmus being seated at the lower end of the right Gut or Fundament The Etymologie of the word imports something of the nature of the disease being a frequent desire and straining downwards to the stool but instead of excrements blood and mucous matter is brought forth and with great pain This ariseth from an Ulceration of the last Intestine procured from the same causes as Dysenteries which we need not repeat This disease is most dangerous to women with child for that it causeth abortion but to all persons it is very troublesom and painful and if it continues long the Vlcer becomes fistulous and difficult to be cured And now I remember the Cure of an old Vlcer in this part notwithstanding the contumacy and difficulty thereof In the year 1653. when I was but a young Practiser yet by the blessing of God upon my endeavors I cured a Gentlewoman afflicted with an Ulcer in ano for seven years who could not in all that time receive help though she had tryed many Physicians and Chirurgions having a plentiful Fortune to allow it She was aged between fifty and sixty an Aldermans Wife of Maxfilde in Cheshire where I happened to stay in that Town for some time whereby this Gentlewoman beyond her expectation received a perfect Cure To finish our Discourse of Pains belonging to the Intestines we shall conclude with the Haemorrhoids A disease frequent and sometimes of great complaint The word Haemorrhois signifies a Flux of Blood in general but custom hath restrained it and amongst Physicians it is used and understood only that effusion of blood by the Haemorrhoid Veins which Veins terminate at the lower end of the last Intestine and about the Fundament These Haemorrhoid Veins are internal and external although most of the Ancients and some modern Authors acknowledge only the internal but erroneously The internal and external Haemorrhoid Veins do differ much As first in their rise or descent for the external do proceed from the Hypogastric branch of the Vena cava and the internal from the Vena portae and commonly from the splenical branch thereof Secondly in number the internal being but one though orbicularly multiplied and divided about the Anus The external are threefold Thirdly in their insertions the internal being inserted into the membranous substance of the right Gut the external into the musculous substance of the Anus or Fundament Fourthly they differ in their contents the internal carrying a gross and blacker blood the external more thin and ruddy Fifthly in their office and use the internal evacuates the Vena porta and splenical Arteries thereby advantageous in some diseases of the Spleen and Cacochymies The external do empty the Vena cava and correct such diseases that depend upon Plethory or redundance Sixthly they differ in evacuation the internal not so copious the external commonly large in the profusion and sometimes very injurious and to some mortal Seventhly in pain the internal for the most part painful the external not in evacuation Lastly they differ in association the internal descending without Arteries the external are adjoyned with Arteries to the Anus The Haemorrhoid Veins are liable to contrary affects and the diseased do suffer in a different way sometimes these Veins abound with blood and swell for want of apertion and a discharge and this is called the blind Haemorrhoids è contrà sometimes the mouths of these Veins do open and pour out too plentifully either suddenly or by too long continuance and this is called the open Haemorrhoids Both these extremes are grievous to suffer The swelling of the Haemorrhoid Veins and pains from thence have the same causes as provoke and continue the Haemorrhoidal Flux viz. blood offending in quantity or quality which if it find not vent by the terminations or mouths of the Veins they are extended and swell big and sometimes inflame which if it continue is dangerous lest it become cancerous and gangrene On the other side an immoderate Flux is very pernicious and induceth Dropsies Consumptions Cachexies c. by exhausting the treasury of life These Haemorrhoidal Fluxes continuing unduly and injuriously argue the blood to be hot and sharp or too thin abounding with an acrid serosity which provokes the expulsive faculty and opens the mouths of the Veins But the blind swelling Haemorrhoids denote the blood to be gross and thick or the coats that cover the extreme ends or mouths of those Veins to be dense and impenetrable not permitting an exsudation Here it may be queried how it comes to pass that these Haemorrhoid Veins should be more troubled with blood and more frequently suffer an apertion since many other places of the body receive the extremities or terminations of the Veins and so equally capable of effusion In answer hereunto you must understand that although Nature hath formed the like and planted them in divers parts of the body which sometimes though more rarely do issue and send forth blood yet these Haemorrhoids are placed more commodiously for voiding of superfluous and feculent blood being near the common vent and outlet for excrements to pass away and their situation being downwards together with the straining upon occasions at the stool the extremities of these Veins are filled and sometimes forced to evacuate more frequently than others Now concerning the blind Haemorrhoids you may take notice and know that there is this difference sometimes the Tumor or extension is in the trunk or cavity of the Veins and then there is no apertion and sometimes the
heterogeneous discordant matter or some malign and venenate Miasm is mingled or got into the blood Nature which is the vital Principle raiseth a preternatural fermentation and febrile effervescency in the mass of blood for a purification and separation of this exotic mixture and admits of no sedation and rest until that work be finished Fifthly and from hence you are to be warned of the dangerous and common Practice in Feavers by Juleps Barley-water and other such like cooling Medicines used to allay the heat from a great mistake of the rise of Feavers and from whence this heat does assurge for whether the Feaver does depend upon a particular inflamed part or a general fermentation of the blood for purification in both cases of Feavers such cooling Medicines are pernicious and have killed thousands for by insisting so much upon them and aiming to suppress the Feaver by Coolers which is not possible to be done thus trifling the time away the opportunity of curing is lost and the disease prevails The errour of these cooling Medicines is apparent from the insuccess thereof for never was the thirst of a sick person satisfied by a Julep but a draught of good drink such as the Patients stomach calls for that is acceptable and refreshing so that I say Juleps are but cold comfort to a feaverish sick man for these cold Medicines imposed upon the sick are so far from assisting Nature to perform the work she is strugling about that they nauseate and flat the stomach which should invigorate the other faculties damp the power of Nature contending and leave her languishing for refreshment coveted in her natural common drink What advantage can there be in a Julep to take off or any way contribute to the removal of any matter that is the cause of Inflammation in the Liver Spleen Kidneys Mesentery Pleura c. any part of the body truly none but that is not all for besides the doing no good it does much mischief in suppressing the fortitude of Nature and cheating the poor Patient of that desired common assistance by drink that would be comfortable But no more of this because I have enlarged upon this point pag. 27 28 29 30. yet it falls in here necessarily to be taken notice of because Inflammations always introduce Feavers which Feaver being most obvious and apparent ingrosseth all endeavours for allaying that general and expanded heat but they go the wrong way to work even preposterously beginning at the wrong end But now to inform what is necessary to be done when a pained inflamed part requires help take these directions in general which will be advantageous in most if not all particular cases First Examine and consider the nature of the part inflamed being the part primarily affected the foundation of this disturbance from whose peculiar structure and fabrication as also from its office you will find what are the usual impediments that molest and disturb such a part and how it becomes liable thereto Secondly You are to consider what way this matter is to be carried off if it be humoral and by what means adapting such Remedies suitable to the condition of the part affected and proper for the removal of such a morbific cause Thirdly The Feaver that ariseth from and depends upon this Inflammation is not to biass you or take you off from any thing necessary to be done in order to reduce the part primarily affected but prosecute directly there and regard not the Feaver for as you get advantage in relieving the part grieved you will find the Feaver to decrease and totally vanish when that is restored And to tell you plainly I know nothing you can do advantagious for the part inflamed that may be injurious upon account of the Feaver if the Feaver were independent and had no relation to the other Fourthly If blood be the primary cause or otherwise aggravating through plenitude make a depletion thereby the Circulation will be more free turgency abated and fluxion prevented at least retracted for if the cause be in the Veins or Arteries most necessary it is to be done for commonly then a plethory grossness or coagulation gave the occasion of this grief but if it an acrid serosity that lanceth and irritates the tender part Phlehotomy may draw off and make a diversion for a time until other good means can be administred to eradicate or blunt the sharpness of its acidity Fifthly Set open the vents and outlets which Nature hath framed and make evacuation to abate fulness and remove foulness in the whole body thereby you will prevent or allay the turgency of ill humors that are apt to ferment and move upon this disorder and cut off a supply of morbific matter that may resort to the part pained of raise a new disturbance in other parts of the body Here you must procure and prosecute this intention with Balsamic Abstersives the true Cathartics not venenous Laxatives the common reputed Purgatives and cleanse the lower region of the body whereby also you will subduct and draw away from the parts affected The grosser matter being thus removed and carried off sufficiently the remainder discharge by Transpiration making an apertion of the Pores and setting open those imperceptible vents by the use of effectual and choice Diaphoretics thereby to attenuate rarifie and scatter For outward Inflammations Topical Medicines are applied to the part Fomentations Cataplasms Vnguents c to appease and allay but our internal cases do not admit of such applications therefore we are to design otherwise and adapt such internal Medicines and by such operations as may reach the morbous matter to remove and transmit it yet when an Inflammation is seated near the superficies or extern parts of the body as the Pleura the gibbous part of the Liver and such like especially if a Tumor conjoyned do appear also or any visible extension then local Medicines may be of good use and contribute towards a Cure But here by way of caution take notice That no refrigerating or repercussing application be made to repel and drive back from the part pained for this may prove of dangerous consequence as the imprudent adventures of some in this manner have left sad memento's to forbid the like practice But some may say How shall we know when any internal part is inflamed because neither the eye nor the hand can reach there to discover the disease Yes very well for great pain and anguish continuing in any secret internal part and raising a febrile heat in the whole body does as certainly declare that part to be inflamed in the sense before expressed as any outward signs can manifest where seeing and handling does or can adjudge the case Sixthly and in the last place because Inflammations do arise from and depend much upon the continuance of pain therefore Anodynes or allayers of pain may be profitable at some times and in some cases but warily to be used and the times nicely to be distinguished and
commonly called Stitches Pains are incident to these Muscles from external injuries as contusions and impressions of cold or else internal causes and these are either by defluxion of humors that may flow in as most frequently from an abounding serosity being thin sharp and extravasated falls in amongst these Muscles or else by congestion matter is accumulated which Nature not being able to discharge lyes there as a burden impeding the muscular motions and causeth pain Sometimes from flatulency and wind getting into the Interstitia of the Muscles thereby causing intercurrent and fleeting pains And for remedy in such cases Fomentations and hot Bags applied are advantageous Evacuations being premitted according to the condition of the Body requiring We come now to consider of Pleurisies or pains in the Pleura that inward Membrane that does invest or line the Breast a disease very eminent and frequently occurring that both Hippoc. and Galen often mention it by way of example These pains are acute and sharp like punctures and have no constant place but in some persons they seize the right side in others the left in some the pain is higher in others lower towards the Hypochonders sometimes more backward and sometimes forward and although chiefly and more manifestly the pain be here or there to be pointed at yet the whole Membrane by reason of continuity is thereby affected and the parts adjacent do suffer by consent from whence various Symptoms as concomitants and attendants do inseparably accompany and consort with this pleuritic pain Hence it is that difficult and short breathing is constantly annexed to it and this because the parts for respiration are hereby impeded and have not their due motions and liberty of extension but are restrained and curbed which is done in favour to avoid compressing the grieved part otherwise would exasperate and increase the pain and therefore the sick fetch their breath short and quick because they cannot take it fully and largely and do repeat it the oftner by way of recompence To this and by consent of parts is adioyned a short and dry Cough which irritates and provokes the pain by moving and straining those parts and therefore is very troublesom and grievous to the Patient Here also a continual acute Feaver does necessarily follow as inseparable for the Archaeus or vital Principle being invaded in those parts by something hostile does therefore insurge becomes inraged grows hot and fiery raising a burning distemper throughout the body To these we may add another constant Character namely a hard swift but small Pulse And these are the pathognomonical signals that are always attending upon and do distinguish Pleurisies from other diseases of adjacency or affinity and likeness with them for when pains fall in amongst the intercostal Muscles although there may be some punctures or prickings because of the Membranes there yet not so great the Feaver not so high nor the breath so short nor the Cough so troublesom if any If the Lungs be inflamed only the pain is but little not punging but obtuse not in the circumference or sides but in the cavity or middle of the Breast yet the difficulty of breathing is greater here than in Pleurisies from angustness that seizeth the parts of respiration Pleurisies differ from Inflammations of the Diaphragma because in this there is no pain in the sides but only at the end of the short Ribs and the upper part of the Belly is extended and with it a Delirium Pleurisies also are distinguished from Inflammations of the Liver in the seat or place of pain which always is in the right side under the short Ribs the pain not punging but heavy and obtuse the Cough less difficulty of breathing less but the Urine higher-coloured or tinged red And now I see the reason though very weak why some Authors have distinguished Pleurisies or differenced them into legitimate and spurious which indeed is a division of Pleurisies into Pleurisies and no Pleurisies for I account no disease to challenge that denomination but such as have their foundation in the Pleura else by the same reason all diseases may admit of the same distinction of legitimate and spurious for as much as every disease hath some Symptom which is common to other diseases that may give them some resemblance or affinity with each other or be affected by consent from another but I pass it over and come to examine the causes from whence pleuritic pains do arise These causes are external and internal External causes are such as remotely prepare and dispose the body to a likely capacity of reception or aptness to this disease laying the foundation for internal causes and they do arise out of or from the irregular unfit or improper use of the Diaetetics which leads to a morbific or unsound state For example violent exercise or otherwise raising great heat in the Body and opening the Pores by neglect upon it as not to preserve that warmth for some time and suffering it gradually to abate and go off by keeping on cloaths and forbearing cool drinks this may introduce a Pleurisie So likewise in the heat of Summer to throw off cloaths and be exposed to the wind at a Casement or the cool Air in the evening To over-heat the Body with strong Liquors and suddenly endeavor to cool it again with small Beer may effect the like Cold North-winds after Southerly and hot weather does alter the texture of the blood and is previous to pleuritic or similar pains But here you must take notice and know that quicquid recipitur recipitur per modum recipientis all Bodies are not alike nor equally disposed for reception for in some these causes produce Pleurisies in others Angina's in some Dysenteries in others Arthritic pains c. According to the aptitude and disposition of Bodies in fabrication or organization and peculiar properties have the same general external causes various and divers effects being determined and specificated by different states of Body more liable and apt to this or that disease rather than another Hence it is that external causes as Diaetetic errors have heterogeneous effects and procure dissimilar diseases according to various constitutions purity and impurity stability or debility concurring with or resisting their influence which consideration brings me directly to the next stage being the latter part of the preceding division Internal causes are antecedent or conjunct Antecedent as plethory being fulness of blood or Cacochymy a depraved or degenerate blood both which are previous states or conditions of Body disposing or rendring more liable to this disease for the great Vessels being full and distended upon any Effervescence and Superfermentation of the blood this impetuously like a torrent is impelled into the smaller Pipes as those of the Pleura where not having a free passage it does cause pain by distension and Inflammation Now this plenitude is brought on or aggravated and increased sometimes by a suppression of some accustomed Evacuation as those that are wont
constriction obstruction inflammation or intemperate heat Imposthumation by erosion by exotic generation 1. The Heart is pained by extension from a sudden ebullition and turgid fermentation of the blood raised by passion or otherwise whereby the Vessels are suddenly forced upon distension to receive and transmit the inundation and swelling current of the blood and from hence pain and trouble ariseth at the Heart 2. By constriction the Heart is pained and that from external and internal cause externally from the Pericardium compressing whereby the Heart is denied the full liberty of its Diastole or expansion and this may arise upon a double account either from the Pericardium being too replete and full or too much exhausted and empty You must understand therefore that this Pericardium or Capsula cordis is a Membrane designed by Nature to involve and inclose the Heart for its defence as also being a moist Bath to irrigate and keep it souple containing a Serum or water and this Membrane should extend and be enlarged according to the motions of the Heart being greater or less now when this water does abound filling the cavity of this inclosure the Heart thereby is prohibited its full expansion and è contrà when this water is too much wasted and dryed up the Pericardium cleaves to the Heart and impedes its pulsific motion thus either plenitude or vacuity begets anxiety and trouble at the Heart Internal cause of constriction is when the Heart it self is seized with a Tabes or vehement exsiccation and the fibres so contracted that it hath no capacity or less for dilatation and permission of the transient blood 3. Obstruction causeth pain and trouble at Heart when the free current of the blood is impeded from within due Vessels and this is procured sometimes from a perturbation of the movent spirits and sometimes from an indisposition of the impulsed blood First from a sudden and violent recurrence of Spirits from other parts and tumultuous confluence at the Heart whereby the circulation is checkt and the blood stopt in the Ventricles causing a suffocation for a time and this happens upon vehement passions and consternations of the mind Secondly From an inhability and incapacity of the blood being gross concreted or grumous that it hardly or with difficulty passeth through this Organ causing thereby an obtuse pain oppression or heaviness at the region of the Heart and sometimes a Lipothymy or Syncope fainting or swooning 4. By Inflammation or intemperate heat the Heart is pained as in most Feavers where intensness of heat is accompanied and this heat continuing does exsiccate and contract the heart and brings a Tabes or Consumption upon the whole Body 5. By Imposthumation the Heart is pained sometimes as also by other Tumors there bred Which by dissection hath appeared after death 6. By Erosion or Vlceration sometimes the Heart is pained and suffers by continual palpitation 7. By exotic Generations and strange productions the Heart sometimes is pained as when worms stones or bony substance is bred in the Parenchyma of ' the Heart which hath been found there upon dissection after death and to these diseases and such as most of the forementioned the Symptom of Palpitation does necessarily belong shewing the continual molestation and trouble the Heart lyes under who endeavors to acquit and extricate it self by laborious lofty and strong pulsations Pains in the Abdomen or lower Region of the Body NOW we have done with those pains incident to the middle Cavity namely the Thorax or Breast I come in the next place and by the order proposed to the lower Region called the Abdomen or Belly containing the Stomach Liver Spleen Kidneys c. And here first as the principal member we shall inquire into pains belonging to the Stomach or Ventricle being the great Office and Laboratory to prepare Aliment to supply and maintain the whole Body therefore if this part be pained and out of order all the rest must needs fare the worse for it every part having a concern from hence Pains of the Stomach are various both in respect of their causes and also from the different parts of the Ventricle where they do infest and those are three the upper Orifice called Os Ventriculi the lower Orifice called Pylorus and the whole cavity of the Stomach The upper Orifice or mouth of the Stomach is subject to great pain as being very tender and sensible in regard it is very nervous and this pain is the more eminent and remarkable for that commonly two principal parts are hereby affected and drawn into consent the Brain and the Heart the former by the Nerves of the sixth conjugation derived from the Brain whose ramifications are wreathing or twining about this Orifice and therefore from hence Head-aches Vertigoes and Epilepsies do often arise The Heart also is affected both in respect of vicinity as near adjoyning to this Orifice and also for that the same pair of Nerves doth serve both the Heart and Stomach whereby of necessity there must be a communication of pain and therefore it is that this pain in extremity causeth Fainting and Swooning and hence it is that this pain by a peculiar distinguishing title is called Cardialgia and also for that the ancient Greeks called the mouth of the stomach 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 As for the causes of this Cardialgia or stomach-pain sometimes they are sharp acrid and hot biting humors fluctuating and rising up to the Orifice of the stomach where they cause an eroding or gnawing pain and sometimes a scalding or heat there and this vulgarly is called the Heart burning Sometimes flatulency and wind causeth this pain by way of distension and a swelling fulness and the Orifice is constringed and shut up so as denying vent in this case the Patient labours and strains to belch but cannot unlock or loosen the Orifice of the stomach but so soon as the Orifice does slacken and give way the wind breaks forth and ease followeth Sometimes Worms do cause this pain having gotten up to the mouth of the Ventricle where they gnaw and bite Sometimes churlish and deleterious or ill prepared Physick or discordant food having such properties as may irritate and provoke this tender part or food received in too great a quantity above what the stomach is able to master and digest then it riseth up to the mouth of the stomach causing oppression and pain there until it be discharged upwards or downwards by the strength of Nature or the assistance of Art Besides this Cardialgia there is also another sort of pain that afflicts the mouth of the stomach and that is Singultus a Hicket or Hickop and although the whole Ventricle be molested therewith yet the chief pain or trouble is at the Orifice or mouth of the stomach This Hickop is a convulsive motion of the stomach thereby causing pain The general causes assigned by Hippocrates are two repletion and inanition under repletion is comprehended whatever humor or vapor is in the
praep â„¥ ii vin alb lib. iv Diger sâ—…a in balneo Mariae per dies iv colat duleoret syr byzantin simp The aperitive Pills were these following R. Gum. ammonias acet scillit solut Ê’ ii myrrhae rub tart chalybeat anaÊ’ ss croci ℈ j. ol foenic. dulc chym gut viii succi cochlear q. s Fiat massa During which time from the beginning she was anointed with a Liniment all over her belly morning and evening The Liniment was this R. Ol. cappar unguent è succis aperit ana â„¥ j. Misce After this a Cataplasm was applied to the region of the Spleen every day for a week The Cataplasm was made thus R. Panis alb farin sem lini ana â„¥ iv farin hord â„¥ jss lactis vaccin lib. jss Coq ad exsiccationem adde mucilag rad althaeae foenugr ana â„¥ j. ol chamaem cappar ana â„¥ j. gum ammoniac acet scillit solut Ê’ iii. galban bdellii styracis liquid anaÊ’ ii crociÊ’ ss Misce f. Cataplasma After this the pain was gone and the Spleen began to be soft and yielding Then I appointed the former Apozem to be repeated which being taken the swelling of her belly was much gone down After this I caused a Fomentation to be applied morning and evening for some days and then ordered the Chalybeat Wine to be repeated The Fomentation was this R. Rad. bryon ireos nostr ana â„¥ iv rad cyclamin cucum agrest filicis mar ana â„¥ ii fol. lauri abrotan absinth menthae salviae hyssop ana M.ii. sem cymin foenugr ana â„¥ j. flor chamaemel melilot ana M.j. Coq in aq fabror lib. x. acet vin alb sub finem addit lib. ii ad tertiae partis consumpt pro Fotu After which one purging Potion was given and an Emplaster applied to the Spleen and then both the Spleen and Abdomen the whole belly as flat and soft as ever she was and perfectly cured and returned home All which was performed in the space of about seven weeks and two months after she conceived with child as I was informed by her relations and she stood firm in health long after Notwithstanding the success was very good and the Medicines well designed as such preparations will afford yet in the like cases I do not use the same now This in short and I could not rehearse the particulars so exactly being twenty years since but that I have the whole story with the several Medicines in writing now by me and this I have related to confirm what I asserted here before that a diseased Spleen may lay the foundation for and introduce a Dropsie and now I proceed on to set forth the causes of a pained Spleen which being rightly stated applications may more successfully be made in that complaint The most frequent and apparent Symptom that afflicts the Spleen is Pain and this doth arise and depend upon some of these several diseases Obstruction Tumor Inflammation Apostemation Compression Vlceration Obstruction in some of the Vessels of the Spleen is a frequent cause that produceth pain and this obstruction is procured from a feculency and grossness of blood which ariseth either from a natural debility of the Spleen not able to perform its office duly or occasioned by a melancholy disposition a studious sedentary inactive or a careful and afflicted life to which or singly an evil bad diet and irregular diaetetic customs may contribute or effect as more fully you may be informed in a late Tract of mine entituled The Preservation of Health and Prolongation of Life All which impedes the due fermentation and volatization of the blood in the Spleen from whence it becomes thick and foul and begets a stoppage or too slow a motion and fulness in those Vessels And whereas the office of the Spleen as before determined is to ferment anew spiritalize exalt and rarifie the thick indigested and melancholy blood sent thither for a farther elaboration and depuration it is most rational that this not being performed from some of the impediments aforesaid obstruction and stagnation there will be the consequent and the Patient from hence will feel a pain and heaviness about those parts But for a more promptness or aptness to these obstructions angustness and straitness of the Vessels so formed by Nature does render some persons more prone than others to obstruction and these splenetic pains And farther this obstruction does arise not always from the causes aforesaid but sometimes from a compression of other parts adjacent that may incommode and offend the Spleen or by contusion from a blow or fall or by an injurious dress and too strait lacing or girding as frequently amongst the female Sex These obstructions when continuing and contumacious are so aggravated and increased with additional influx that they form a Tumor this distension being perceptible by sight sometimes but always by seeling is to be adjudged and distinguished whether soft and flatuous or hard and scirrhous the former sooner yielding to means but the latter more difficult of cure Inflammation though rarely yet sometimes does affect the Spleen and this inflammation does arise from obstruction for the blood being stopt in its current and passage and upon some extraordinary causes being more hot and fiery does make a sudden ebullition and inflame causing great pain heat and extension and this pain is distinguished by pulsation and beating of the part having many Arteries This Inflammation not rightly applied unto by diligent and good means does make transition and passeth into Apostemation and sometimes terminates in a scirrhous Tumor but these two dangerous commutations are to be prevented with great care and industry therefore before the disease arrives to this height and when only pain or heaviness gives warning and tells you of a distempered Spleen it is then most seasonable and opportune to apply the means and then a little may prevent that which afterwards perhaps a great deal cannot cure And first the procuring causes if any there be apparent are to be avoided as a sedentary slothful life intemperance and gross feeding or unseasonable eating as late suppers immoderate study melancholy grief or care which introduce sometimes but always contribute to aggravate splenetic distempers and although a natural debility and infirm constitution of the Spleen may procure the effects aforesaid without other provocations yet most frequently they are so caused at least much heightned thereby and therefore for prevention as also for cure those injurious habits are to be abandoned and such a diaetetic course of life observed as may check this disposition of body as at large you may be directed in the fore-mentioned Book The preservation of Health and prolongation of Life c. For Pharmaceutic Remedies that are made publick I shall commend the aperitive Tincture of Mars Pil. Antihypochondriac Swelferi chalybeated Tartar Sal volatil Succini Spir. Veneris rightly prepared which prudently used pro re nata as the several cases require may prove advantageous Pains of the
of Urine This disease is always accompanied with an acute Feaver great Thirst astriction of the Belly heat of Vrine and great pain about the Loins and if the Arteries be affected the pain will be with pulsation Sometimes a Delirium attends with long watching and if the Inflammation be in the Membrane the Patient is scarce able to sit upright because the pain thereby is exasperated If the right Kidney be affected pain extends upwards to the Liver and short Ribs and downwards to the Genitals also a stupor seizeth the right Thigh by consent the Nerve being compressed that passeth thence down to the Thigh But if the left Kidney be the part affected that side is most grieved and in like manner but if both the Kidneys be attacked then the Symptoms on both sides are equal The termination of these Inflammations are either by an Apostem or Abscess by induration and a scirrhous hardness or by Transpiration and resolution which last is the only safe and secure way and this the Physician ought to design for and aim at in his administrations But if contrary to his endeavors the Inflammation apostemates suppurates and breaks evacuating the purulent matter by the Vreters into the Bladder there is good hopes of safety but if it be discharged inwards by the emulgent Veins the case is desperate Scirrhous Tumors in the next place come to be viewed and these are hard Tumors very difficult to be removed being the relict of an Inflammation or other Tumor preceding and not well cured or formed by gross matter congested and accumulated there causing contumacious obstructions for humoral matter flowing thither and being obstructed in the transition the heat of the part does exsiccate and harden it by time more and more and then by accumulation and addition forms a Tumor This causeth heaviness about the Loins but little pain the Urine is but little also and that pale and watry in regard the office of the Kidneys is debilitated and by reason of the angustness of the passages letting pass the thinner but retaining the thicker part of the Urine The longer this Tumor continues the more difficult and incurable it becomes and withal it brings on hydropic Cachexies for the superfluous serosity not being drained away regurgitates back into the body The Cure is to be set upon with internal and external Medicines Aperitives Resolvents Discussives and Emollients Apertion of the Vessels contrary to Nature somtimes does threaten danger by the appearance of blood staining the Vrine and this proceeds from a weakness of the Vessels being relaxed in their retentive faculty or by a plenitude and fulness of blood or because the blood is thin and sharp which causeth the mouths of the Vessels to open On the contrary Angustness or straitness sometimes does incommode the Vessels appertaining to the Reins which hinders the free ransmission of the Vrine Now this angustness of the Vessels does arise either by compression from some Tumor or distended part that presseth upon the Vessels and straitens them from without Or by contraction or constriction of the Vessels that are shrunk as by great heat in long Feavers or a Tabes that seizeth the Kidneys Or lastly by obstruction within from some viscous matter grumous or clotted blood sand gravel stone c. The Sign declaring these obstructions is a suppression of Vrine with pain or an abatement of the usual quantity not answerable to the drink received The place or part affected whether in the Kidneys or Vreters is known by the seat of pain The causes that obstruct are known by their proper signals and by examining into the preceding state of the Patient The place or part grieved with these obstructions whether in the Kidneys or Vreters pain discovers and the dislodging or shifting thereof Of all the obstructions that infest the Kidneys the most frequent and saddest complaint is from the Stone this being the most contumacious obstruction the most painful being a hard solid body and the most uncertain Remedies for relief Concerning the generation of these Stones there have been various Opinions amongst Learned men in short the difference and contest hereupon may be reduced to these two Heads what the material cause of the Stone is and what the efficient For the material cause or matter whereof the Stone is bred Galen and most of his Disciples will have it to be a phlegmatic gross or viscous humor apt for condensation and induration and the efficient to be heat exsiccating this matter and bringing it to a stony hardness but others of them will have this to proceed from cold by way of congelation But this Doctrine cannot hold as rational nor does it answer experience as for the matter we cannot allow it to be such for as much as many that abound with a viscous tough Phlegm and slimy matter as most ancient people do yet many of them are never trouble with stone or gravel And for a concurrence of both the causes material and efficient we have examples of the Aged who are most cold and phlegmatic and for abounding heat with the like matter we may produce Feavers yet no stony concretion or signs thereof to be found from such sicknesses So that we are now to seek for other causes both material and efficient whereon to ground our endeavors for the relief of such as are afflicted with this disease The matter therefore and substance of the Stone is from a tartarous and saline succus with the addition of a terrestrial feculency concreted or petrified by a lapidifactory Spirit or disposition of the Reins which is the efficient and seminal being of that production The concurrence of both these causes does much produce the Stone and afflict the Patient in a high degree but one of them is sufficient viz. this petrifying power of the Reins to coagulate any laudable good matter imported there into a stony substance To confirm this Fernelius relates upon his own knowledge of one that for three or four months together above a dozen small stones came from him every day all which time notwithstanding he eat nothing but Broths and Panadoes being confined to his Bed by weakness and pain But allowing this to be true from the credit of the Author yet we must owne and acknowledge that besides this principal cause of a petrifying Spirit in the Reins there are also antecedent and procatarctic causes adjuvant and promoting as some sorts of meats and drinks and other errours in the Diaetetics that increase and set forward this disease which otherwise might be much slower in generation nor yet arrive to so high a degree of torture also the Stomach Spleen or Liver not performing their functions rightly may contribute matter to the promotion hereof For relief of the diseased in this case there are two grand intentions to be prosecuted and aimed at a dissolution of the body of the stone already generated and secondly the taking away of the petrifying disposition of the Reins and abolition of
that coagulating ferment and for these purposes were Paracelsus his Ludus and Aroph also the Alkahest cannot fail herein But such as have not acquired the great Arcana's and cannot procure a dissolvent for the Stone that is to make an Analysis or resolution of it into a liquid juyce and reduce it back again to its humoral flowing state capable of abstersion and cleansing out must endeavor to facilitate the exclusion of this hard body by the best and most hopeful means for that purpose by lubrifying relaxing and dilating the passages and asswaging the Spasm and contraction of the Vreters that the stone may slide away much sooner and with less pain hence by way of caution observe That Diuretics and provokers to expulsion are not to be given before this preparation be made else you precipitate the Patient into danger and increase his torment dislodging and forcing the stone through angust and very tender cavities not provided to give passage without detriment to this unwelcome stranger And thus much briefly concerning petrifaction or the production of Stones in the Kidneys I proceed on to the next a most difficu't and painful disease belonging to this Member namely Vlcers Vlcers of the Kidneys are introduced several ways or take their rise from several causes 1. Acrimony and sharpness of humor passing this way and continuing long does excoriate which not timely observed and remedied because pains at first are but small does corrode farther eat into the flesh and plants an Vlcer 2. The Kidneys are ulceratedsometimes from an Inflammation or other Apostem there coming to suppuration and breaking which dischargeth the matter by Urine or otherwise but leaves a putrid Vlcer behind 3. Sometimes from a clot of blood extravasated or out of its place putrifying does infect the part tabifie and ulcerate and not to be neglected lest this be the consequent 4. Sometimes a Stone being rough angular or sharp frets or grates upon the parts and makes a solution of continuity which at first sends forth a bloody Urine afterwards purulent and begets an Vlcer and this last is the most frequent cause that generates Vlcers in the Kidneys These Vlcers are discovered by pain about the Loins a purulent Vrine and sometimes Caruncles or small fleshy rags or strings of concreted blood is brought forth with the Urine accompanied commonly with heat in the Back and sometimes faint Sweats which continuing bring on a Consumption and Hectic Feaver Of these Vlcers some are more sordid foul and stinking as the Urine does declare others not ill scented the Pus white not viscous but cloudy and light The difficulty of these Cures lyes here for that the Urine which is acrid flowing always by the Vlcer hinders the consolidation of the part besides the situation being remote the virtue of a Medicine is much altered before it arrive to the part but in the designment and managing of these Cures the body must be well cleansed not with the common deleterious Purgers but balsamic Detersives and so kept with a proper Diaetetic regimen as no impurity or sharp humors disturb or abate the power or Medicines which must be truly balsamic and healing The experience of these Ulcers I have had several times both many years since and lately I remember in the year 1652. I cured an Ulcer of the Kidneys in a man about thirty years of age living near Sheffield in York-shire who came to me four miles twice a week during his Cure I being then for a while at Norton upon the edge of Darby-shire His Urine was hot sharp and stinking with a great purulent sediment a great pain in his Back with scorching heat and often flushing faint Sweats all over his Body Indeed I have wondered since how I did perform such a difficult Cure then having so little practical knowledge I being but a Tyro in this Art it being in the first year of my Practice and newly graduated Batchellor in Physick but Providence had appointed me the instrument to free this poor man out of his pain and languishing condition Since I have been acquainted with several of the like cases and may with better assurance promise a Cure from tryed Medicines acquired by experience beyond what Book-practice does communicate and this last year here in London I cured a Gentlewoman of an Ulcer in the Kidneys In the next place we are to take notice of Pains belonging to the Bladder The Bladder is the last receptacle for the Urine and performs the office of a Cistern to the Body for keeping and discharging the Urine at convenient times and therefore is capable of distension and contraction being a membranous bag furnished with right transverse and oblique Fibres for that purpose and hath two Muscles at the neck of it to let go or retain the Urine This part is liable to great grievances and painful infirmities as Distension Obstructions Inflammation Excrescences Vlcers scirrhous hardness From hence come suppressions of Urine imminution or small quantity ardor or heat of Urine Strangury or dolorous emission and dropping incontinency of Urine or difficulty of retaining it Distension of the Bladder happens from too long retaining of the Urine whether it be voluntary or involuntary so that afterwards the Fibres do not recover again the power of contracting the Bladder and this may prove of dangerous consequence and to some it hath proved mortal Obstructions of the Bladder causing a suppression of Urine or diminution dolorous or difficult excretion does arise from many causes as a stone in the Bladder or gravel coagulated blood worms a viscous humor or purulent matter a Caruncle or Tumor in the neck of the Bladder or by compression from a tumified part adjacent as the Womb or right Intestine Inflammation sometimes happens from extremity of pain by the Stone Vlcer or other torturing cause and these Inflammations are commonly mortal Vlcers do possess the Bladder sometimes and most commonly in the neck thereof caused by a stone or gravel excoriating and wounding the part or by an eroding purulent matter coming from other parts and lodged there or by a continued Acrimony and sharpness of Urine corroding sometimes from an Inflammation or Abscess more rarely but it hath happened sometimes from a Gonorrhoea ill cured and I may say very ill indeed for the Ulcer thus procured is of far greater difficulty and danger than the Gonorrhoea Not long since an Ulcer of the Bladder was committed to my care being the relict of a Gonorrhoea ill managed by a Chirurgeon using Restringents unseasonably Ulcers in the meatus Penis as also in the Prostates are more frequently offered to our help as lately another person applying to me having an Ulcer procured in the Prostates from the like improper and pernicious course and although Gonorrhoea's are frequently cured and may with much certainty and safety in skilful hands yet there are many that patch up a seeming Cure for the present but future consequents are sad memento's of their Undertakers folly And at this
such a product for as much as pains are very frequent in most diseases as before proved Then also remember upon a cessation of pain there ought to be care taken by proper means for the recession and dissipation of confluxed matter and not imagine upon a presumption that when the pain is gone all is gone and the Patient secure Secondly Transmission procures a Tumor when the expulsive faculty of some parts is vigorous and strong to send off any excrementitious matter and deposite it upon a weaker which being not able to expel it lodgeth there and generates a Tumor Thus the principal and more noble parts have a natural robor and fortitude to send off their superfluous and noxious matter and transmit it to the inferior and ignoble Now there are some parts that are weak by Nature and some by Accident By Nature those are weak that are designed ministerial and subservient and therefore liable to transmited matter from their superiors thus the Glandules are all weak parts lax and spongious apt to receive and imbibe hence it is that the Heart transimts to the Glandules in the Arm-pits the Brain behind the Ears the Liver to the Groins and the Glandules of the Mesentery are very apt to tumifie and are the latent causes of some difficult abstruse diseases The Skin also is a weak part and general Emunctory for the whole body and therefore many Eruptions and Tumors are there visible By Accident some parts are weak as when by a disease inordinate living or casual injury some particular part though strong by nature and original formation may be vitiated debilitated and made feeble Thirdly By Congestion Tumors are sometimes bred as when a part or member does not transmute the alimentary supply into its own substance but suffers it to degenerate there and accumulate into a Tumor or else the expulsive faculty may be weak and not able to send off the excrementitious part which remaining there may produce the like or sometimes the fault may be in the nutritious supply not being capable of a good transmutation as in cacochymical and foul bodies Sometimes the relicts of an acute sickness not well cured by congestion in this of that part does afford matter to beget internal Tumors and therefore after the small Pox Agues Feavers c. purgation and cleansing ought well to be performed else chronic diseases commonly do succeed them from peccant matter lodged here or there and therefore upon such neglects or insufficient performance thereof we find commonly big and hard Bellies or swell'd Legs some part or other pained tumified or hard And these are the effects of imperfect Cures when the morbific matter is only abated and the storm laid but the remainder accumulates by collection and congestion to produce a dissease of another nature Fourthly By Obstruction Tumors or extensions are begotten for when the current is stopt in any Vessel and by the Law of Circulation the continent Succus or humor is still moving forwards to this place obstructed the Vessel or containing part must needs tumifie and swell as not able to receive and contain the additional flowing matter in its former dimensions And this is apparent to the eye in external parts which must needs prove the internal for a strait Ligature upon the Arm or Leg does cause the part below the binding to swell and for this reason because the Vessels are obstructed by compression that the blood cannot circulate and move on And the case is the like in effect when obstruction of a Vessel is made from coagulation incrassation or grossness or any concreted matter within the ducture or cavity to obstruct and stop the stream Now obstructions are generally acknowledged to be the frequent causes of many or most-diseases and few cases do present in Practice but obstruction bears a part and sometimes the solitary cause or else obstruction is very much wronged for nothing more frequent in Physicians mouths than obstructions and yet nothing more seldom mentioned than an internal Tumor from whence we may well conclude it is rarely thought on or not at all suspected But obstructions are so familiar and frequent in discourse that they are little accounted of at least not thought to be of any dangerous consequence not considering that this obstruction may and does often being contumacious beget a Tumor and this Tumor may cause a long and difficult or dangerous acute sickness if not mortal for the progress may go on still from Tumor to Apostem or suppuration and then plant an Vlcer there or this Tumor may become scirrhous and hard then perhaps cancerous gangrened and then you know what follows next mortification From hence it is very reasonable to judge of the series and course of many chronic or long lingering diseases as also or the acute mortal sicknesses most of which do make their progress by these stages have these commutations and transition at last their fatal termination because this latent train of diseases was not suspected But all this while the Feaver was the disease feared and vainly endeavoured against and the Patient is said to dye of a Feaver because a Feaver did attend the life did estuate and was disquieted in the whole course and every transition of the sickness even to death Fifthly By Extravasation a Tumor is sometimes generated as when the Vessels are replete and full causing tension by thinness heat and sharpness of blood or a preternatural and turgid fermentation distending the Vessels the mouths of the Veins are hereby opened sometimes and a stillicidium or effusion of the contained liquor procured which being lodged out of its proper place does corrupt inflame and produce a Tumor Now concerning the signs of an internal Tumor they are not only extension and increase of magnitude which is apparent when it makes a protuberance upon the superficies but also a fixed heaviness or hardness or pain upon pressure with the hand does give great suspicion and probable conjecture of a latent internal Tumor lying deep and obscure especially and by way of confirmation when the preceding causes apt to generate Tumors do concur to strengthen the probability But before we conclude this Discourse of Tumors something more is to be said and that touching a Scirrhus and Apostem which are comprehended under Tumors and do signifie only the distict and special condition thereof and here we have occasion to take notice of the different state of Tumors and their way of resolution fixation or translation Tumors do either wear away and spend by discussion and transpiration or they recede by a translation of matter into another part or they apostemate and come to suppuration or they indurate and become scirrhous or they tabefie and corrupt the part where they are seated Discussion of a Tumor is the best that can be expected and this ought chiefly to be aimed at in Practice the next to be hoped for and endeavoured is dislodging of it and removal from a noble to an
ignoble part or to such place where means can better be used and more apt for recession or egression of the continent material cause but if the Tumor apostemates the danger is greater or less according to the nature and condition of the member or part if it indurates the danger is delayed but if it corrupts the part the danger is greater and more speedy in execution Apostem is that degree or state of a Tumor when it is maturated or ripe which is called Suppuration the material or humoral cause being then converted into a Pus or purulent matter and while this is in fieri doing all Symptoms are aggravated pain heat pulsation tension are greater but being perfected they all decrease again and the Patient finds ease but not out of danger in these internal Apostems for if it be so seated where there is no convenient vent or Emunctory to discharge it the case is desperate As the humoral matter that formed the Tumor was more benign and good as pure blood so the converted Pus or purulent matter from thence does commonly answer it in goodness for of good blood and in sound bodies the maturation is more kindly the Pus white mild and not endangering to corrupt the part but in foul depraved bodies and malignant diseases apostemated matter is more putrid stinking and venenous and does threaten a Gangrene or mortification of the part and therefore such internal collections of matter in pestilential and malignant Feavers Venereal Pox small Pox and such like are commonly mortal Scirrhous Tumors are such as when the continent matter does not maturate and become soft fit to break and discharge but grows hard and fined in the part not apt to be discharged or removed by discussion or suppuration And this the word Scirrhus imports from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 induro Tumors in some parts of the body are apt to suppurate as in the carnous or fleshy in other parts as the Joynts Tendons and Ligaments more inclined to indurate and become scirrhous and the reason may be this that those parts which take their origine from blood are more prompt and ready to suppurate as the flesh but those which take their rise from seminal matter as the Tendons Ligaments Nerves c they are more inclinable to scirrhosity or hardness But besides this disposition of the parts affected there is also and chiefly a propension in the congested or influxed matter of these Tumors for by the different nature of humoral matter some is more fluxible and thin participating much of serosity and apt to transpire or be discussed other more yielding to a preternatural digestion and suppuration as the blood that is pure and good other inclining to be viscous coagulated and consequently to indurate as a feculent grumous or gross blood deprived of its serosity And farther besides the disposition of parts and that of the material cause inclining to this scirrhosity there may also come in and be joyned with these a third promoter which in some cases may be the chief cause and that is an ill method and injurious Medicines so endeavouring to remove may thereby fix and fasten the matter for thus a Tumor which might probably be dispersed may be changed from its own capacity and tendency and become scirrhous and indurate as when constant or great Coolers are administred to abate the symptomatical or concomitant Feaver the matter of the Tumor is thereby fixed and impacted which otherwise might have surrendred unto proper and powerful Medicines duly used And e contrà by too great Dryers and Heaters the thinner part is evaporated and the grosser remains therefore medio tutissimus ibis good resolutive transpiring Medicines taking their turns with the use of proper Cathartics is the safe and bed way These scirrhous Tumors although they are not so dangerous for the present except they be very great or cancerous yet they are the foundation of some chronic or lingering diseases which proves very contumacious and sometimes incurable especially if the Tumor be latent and concealed and Hectic Feaver sometimes takes its rise from hence which if you think to cure by Emulsions Restauratives and cooling Drinks you will be much mistaken in your purpose and endeavours These scirrhous Tumors some are with pain some without those that have pain are more hopeful except they be cancerous but those which are insensible upon pressure are more difficult or incurable Now according to the nature and degree of depravedness in the continent matter and from the part affected so are these Tumors better or worse to be dealt with And because these Tumors are internal and hid from the eye therefore judgment is to be given of them from their situation and from the constitution with other circumstances of the Patients body But although these scirrhous Tumors are thus difficult to be undertaken and managed yet these are not the worst and they may arrive farther and to a more dangerous state as when Tumors in their variation and degeneration do turn cancerous and this is apt to be in such bodies as abound with a black feculent blood or a thick blood adust by intemperate heat and by how much the blood thus exceeds in this preternatural condition by so much the Cancer is compleated confirmed and the worse and this supervenes a Scirrhus commonly as being an apt previous disposition but may happen also without a Scirrhus preceding from other Tumors degenerating into Cancers and therefore in the Cure of scirrhous Tumors great circumspection and diligence is to be used lest by their delay add continuance or improper usage of Medicines these Tumors do not become cancerous and desperate as sometimes it falls out so Now a Tumor is said to be cancerous when it turns into a dark reddish or livid and blackish colour declaring this transmutation and degenerate state The beginning of these Cancers are very small in compass as those that present outwards do manifest their gradual inlargement but by time they increase and grow big with tumified Veins round about These cancerous Tumors may happen to any part of the body but chiefly and molt frequently in the upper parts about the Face as Nose Lips c. or the Dugs and other glandulous parts also the Womb is thus affected sometimes from Tumor there bred venereal or other degenerating cancerous These Tumors sometimes are occasioned from the menstrual suppression in women and Heamorrhoidal in men and when it happens so those causes are to be removed with speed Great skill and circumspection is to be used in Tumors of this nature lest provoking the continent matter it grow more fierce eating and ulcerating and from a cancerous Tumor it become a cancerous presiding Vlcer which is worse now the signs of this Tumor inclining to break and ulcerate are great heat and pulsation in the part The difficulty or incurability of Cancers lye here for that the cancerous matter will not yield to digestion or discussion and this because the
part affected is debilitated and overcome by this depraved malign matter that it cannot exercise its transmutative and digestive power nor will this cancerous matter obey Discussives by reason of the viscidity and grossness thereof wherefore Hippocrates gave sentence That such are not cured but by section or ustion and yet this is not to be done except the Cancer be small and in such a part as will admit of amputation If Cancers external are thus difficult to be managed although they appear to the eye and are subject to manual operation and tractation the internal must be greater and more hazardous where they cannot be applied unto after this manner with convenient Topical Medicines therefore prevention in time is mainly to be endeavoured when a Tumor is generated lest it change into this dangerous condition for I find by the design of Practisers in the Remedies appointed that palliation is sought for the Cure not hoped for The grand intention to be prosecuted for Cure is to change the condition of the blood which does feed and supply this Cancer so that the antecedent cause being taken away the continent will then more likely abate and until that be done this cannot be expected The means indicated for Cure of these cancerous Tumors are branched into three parts Dieatetic Pharmaceutic and Chirurgical but I shall not enlarge upon the Indications for Cure for that these cases are so nice and difficult as not to be handled with generals but from a collation of all the circumstances attending the Patient which varies every particular case And so I pass from Tumors to remark their usual commutation and transition into Vlcers the next considerable in order to be treated of Ulcers internal THE Latine word Vlcus is derived of 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 signifying a disjunction of parts or solution of continuity but to distinguish this from other solutions of continuity an Ulcer does yield a Sanies or purulent matter so that a Wound coming to digestion and affording pus may then be called an Vlcer and any part that is gauled raw and tender the covering Membrane being fretted and eaten away by some sharp humor or other cause it stiled Excoriation only until it produce corrupt matter and then it is properly called an Vlcer thus internal parts are sometimes excoriated raw and painful but cicatrized or skinned again before it arrive to the degree of an Vlcer And thus it is most frequently in the urinary ductures or passages and sometimes in the Guts but such Excoriations are not to be slighted or neglected lest they beget Vlceration as sometimes it falls out so By external or outward Vlcers which are manifest to the eye you may conceive of internal Vlcers for they arise from the same causes and have the same accidents but I shall not inlarge upon all the accidental differences that attend upon and distinguish external Ulcers as not so pertinent and necessary to our subject in hand The essential and most considerable difference of Vlcers does arise from their causes and from the part affected which bears the great sway in curing and from whence the chief indications are taken for although in external Vlcers other accidental differences may be observed and noted yet in internal Vlcers such differences cannot be regarded as being obscured or hid so that whether they be broad or narrow deep or shallow fistulous or otherwise is hot positively to be said and if it were known institution or method of Cure could not be so varied as external are capable of by reason these are subject to manual tractation The continent causes of Vlers are such matter as emane and flow from thence and that is of three sorts Ichor Pus and Sordes The first is an ichorous or sanious matter being thin indigested and watry or diluted bloody The second is a Pus or purulent matter of a betted consistence and concocted thicker The third is a sordid foul matter more thick and glutinous The ichorous thin matter usually issues in the beginning of Vlcers and denotes indigestion and also at any time afterwards does declare the same that the Vlcer is not in a good healing condition The Pus or purulent matter signifies the Vlcer to be in a better state of healing and if it be white and sweet these are good signs The sordid gross matter does intimate a preternatural heat of the parts strongly exsiccating but not healing for as much as this matter is foul and stinking Vlcers for their manner of generation and rise may be caused these four ways by Erosion by Frication Apostemation and Contagion 1. By Erosion Ulcers are begotten in any part of the body when a sharp corrosive humor does excoriate and eat into the substance of any part and being thus injured is thereby perverted in its office and self-preservation converting that nutritious Succus which comes for its supply into an ulcerous degenerate matter no way useful but to be excreted and voided And thus a Phthisis an Vlcer of the Lungs is sometimes generated from a sharp Serum invading that tender part and thus a Dysentery is sometimes begotten being an ulceration of the Guts from sharp excoriating humors and thus an ulceration in the Meatus Penis is bred from a sharp eroding Gonorrhaea and an Ulcer in the neck of the Bladder may be planted there by a sharp gauling Urine 2. By Frication or attrition as when any hard bony or stony substance does fret raze and excoriate a part and thus a stone begets an Vlcer in the Kidneys or Bladder and sometimes in other parts of the body 3. By Apostemation as when any Apostem breaketh and dischargeth its matter an Vlcer is left behind though the Apostem be gone and thus are Vlcers generated sometimes in the Ear from a preceding Apostem in the aspera Arteria after an Angina or Squinance in the Breast after a Pleurisie in the Lungs from a Tumor suppurated there also in the Liver Spleen Womb or other parts apostemated 4. By Contagion or infection and thus women whole Privities are infected do communicate this virulency or venom and seize the Genitals of their Partner from whence venereal Vlcers do arise and thus men whole Seed is tainted do infect sound women and cause virulent Vlcers in their Privities which malignity not being well managed and mastered by skill and efficacious Medicines it spreads breaks forth and begets Vlcers in many other parts of the body as at large I have set forth in another Tract entituled The Mystery of the Venereal Lues Internal Vlcers though they disappear yet are known to be by these signs First Pain which is more or less according to the nature and sensibility of the part Secondly From preceding causes as Inflammation or Tumor preceding whose Symptoms being allayed and ceased yet pain remains Thirdly and manifestly From excretion of ulcerous matter where there is any ducture or outlet for discharge by the Intestines by the Privities the Nose Ears or Mouth but where there
is no passage or vent it corrupts the containing part and is mortal except a passage can be made by section Vlcers from their causes their aptness and inaptness for healing some are benign mild and tractable others are malign very difficult or incurable The benign and mild are such as arise in sanguine sound bodies and the younger people having no ill Symptoms or adjuncts of impediment the matter of such Vlcers is a laudable Pus or otherwise apt for digestion more yielding and readily commanded by Medicines Malign Ulcers and contumacious difficult or intractable are such as are sordid fetid ichorous unctious dolorous corroding and depascent of long continuance virulent cancerous fistulous cavernous the products or effect of malignant diseases as venereal Lues Leprosie Pestilence c. in cachectic habits of body hydropic hectic aged consumptive and decayed persons in principal and difficult parts of the body as the Brain Lungs Liver Spleen c. the Spondyls of the Back and great Junctures Since Vlcers are thus various in their nature from the several conditions of bodies and diseases that they arise from or depend on and the difference of parts wherein they are seated a general Method of healing and course of Medicines cannot be instituted and appointed but every case hath its peculiar complication of circumstances as directory indications to be remarked from whence a designment method and adaptation of Medicines is formed suitable to the particularity and different case of every individual Patient and therefore I have not proceeded to the Rules and Medicines for Curation Only thus much I shall note to you as a grand observable in the Cure of these Vlcers That such as arise from some remarkable disease as Dropsie Scorbute Venereal Lues or other malign and Cacochymical habits of body that these Vlcers are not to be cured until the disease and evil state of the body on which they do depend be reduced to a good condition or mediocrity of constitution for the antecedent cause which first produced the Vlcer must be removed before the Vlcer is capable of healing because of the continual supply of peccant matter brought to the ulcerated part and therefore application is first to be made there else all endeavours will be frustrate And further the designment of these Cures are not to be paralleled with nor levelled by the methods and intentions that the common Rules in Chirurgery have laid down for as much as many of them are erroneously grounded and deserve great correction and amendment which hereafter will be pointed out and discussed for we have not room here nor time now to ingage in that Cantroversie and must refer it to the next opportunity Gangrenes and Mortification THE last and worst transition of this dangerous train of Diseases and the ne plus ultrà in vitality is a Gangrene being a borderer upon or next adjoyning unto Mortification or the beginning thereof And although Gangrenes are thus ranked next to Vlcers and it falls out so sometimes in the preternatural course of Nature if I may so speak yet it is not always so but a part may and does gangrene sometimes before it be ulcerated for Inflammations and Tumors do gangrene as oft as Ulcers but Gangrenes are placed in this order after Vlcers as being the worst and last morbous state that can come and beyond this there is no disease for although Mortification be set down after Gangrene yet this is no disease vita extincta non est morbus for diseases are seated in the life corpus vivens est domicilium morborum and where no life is there is no disease but Mortification is posited here as the center to which diseases move and as bounds to stop all farther disquisition A Gangrene is a corruption and change of a part or member into such a degree or state as beginning to mortifie or is mortifying But Sphacelus with the Greeks Syderatio in the Latine which we call Mortification in English is when a part is perfectly mortified and dead and therefore a Gangrene is capable of Cure but a Sphacelus not because the part is dead A privatione ad habitum non datur regressus The external and primitive causes of Gangrenes are Contusion Vulneration Congelation Combustion Constriction Poyson Contusion sometimes introduceth a Gangrene by coagulating and fixing the blood so firmly in the part contused that thereby the life is supprest and overcome for communication and intercourse with other parts of the body which is requisite being thus denied the life extinguisheth besides the coagulated bruised blood remaining long undiscussed does putrifie and gangrene Vulneration or section sometimes procures a Gangrene when the vital Principle is so debilitated or enormous by the wound that instead of a good suppuration and vigorous transmutation a depraved matter is generated which corrupts and gangrenes the part and thus a small cut of a finger or Toe hath gangrened and killed the person but in greater Wounds the danger is greater as more frequently to happen Congelation by extremity of cold hindring Transpiration and condensing the blood rendring it stagnant in the Vessels suffocates the life and gangrenes the member thus in extreme cold Countries people by casualties exposed have their Limbs mortified sometimes and thus a Gangrene is brought upon an Inflammation or Erysipelas sometimes by incautelous and pernicious application of great refrigerating or cooling Medicines thereby incrassating the blood and prohibiting transpiration And this is very hazardous though advised and practised frequently by some Chirurgeons in these cases using cold astringent emplastic Cataplasms ex farin hord bolo armen album ovor aceto c when an Inflammation appears Combustion sometimes begets a Gangrene and destroys the life of the part when by neglect thereupon or improper means used relief is not duly afforded and thus by Cauteries and Caustics sometimes a member becomes mortified Now Vstion or great hurt by burning causeth Gangrenes by corrugating shrinking and searing up the Vessels that they cannot bring supply of vital Spirits and nutriment to the part Constriction or compression procures a Gangrene by intercepting of vital communication so that the member thereby is as it were separated and cut off from the body and fountain of life for the parts are maintained by influxed rays and streams of vital heat and moisture to the remotest parts of the body but being deprived thereof they dye thus a Ligature drawn strait about the Arm or Leg and continuing too long may gangrene and mortifie the part by excommunicating it from commerce with and participation of the general life And thus sometimes internal scirrhous Tumors do compress the Vessels and obstruct them of this Fabricius Hildanus gives an example of one that a Gangrene seized both his legs of which he dyed the cause was latent until by dissection he found a scirrhous Tumor about the Vena cava descending between the Reins where this great Vein divides into two parts to supply both legs Poysons some of
them do gangrene by concreting and condensing the blood stopping the canals and suffocating the life as the Venom of a Scorpion and Asp others by putrifying and corrupting the blood or some other part where they chiefly discharge their venom Internal and conjunct causes of Gangrenes are Inflammation corrupt venenous or malignant matter that preys upon and destroys the vital Principle stagnation of the blood or what else may intercept commerce and supply from the fountain of life The Characters or signs declaring a Gangrene are these the sense of feeling decays the colour changeth and inclines to be livid or blackish the flesh grows flaccid and frigid but when the Gangrene proceeds on to a Sphacelus or perfect mortification these Symptoms then are aggravated and appear more eminent sense is quite abolished and the part becomes fetid and cadaverous Gangrenes are very seldom mentioned in Practice and you shall rarely hear of any person to dye of a Gangrene yet I must believe and not without good grounds that many thousands dye by an internal Gangrene not taken notice of for if the major part at least a great part do dye with a high Feaver or Phlogosis we may rationally then conclude that a Gangrene is frequently conjoyned as the last Actor in the Tragedy and immediate cause of death for Gangrenes do commonly supervene Inflammations where they are mortal and thus also Inflammations from fractures and dislocations often bring on a Gangrene And in malignant high Feavers there are sometimes such vibices marks of mortified blood and black mouths which do strongly suggest a Gangrene within the body And for those that perish by the Plague in so short a time whose venemous matter shews it self by Spots Vesicles Buboes and Carbuncles most of these dye gangrened And many of those that expire by the small Pox have a Gangrene in some part the putrid matter being lodged there Nature not able to protrude and bring it forth and it is very reasonable to assert this for if a Gangrene will arise out of a very small portion of matter extravasated defluxed or congested in a part then where the whole body abounds with malign putrefaction and overflows with it any part thereof remaining within the body may and does very often corrupt and gangrene that part That our Opinions are not so extravagant and excentric from the Judgment of all Learned men as some perhaps inconsiderately may censure take notice what Arnisaeus an eminent Physician in Germany Professor in the University of Julia writing to Gregor Horstius about a Person of Quality that dyed of the small Pox queried or rather concluded that the Liver was gangrened and farther saith Verisimile est multis idem accidere qui ex variolis moriuntur To which Horstius answers by Letter and consents with his determination in these words Cùm autem necessariò febris sanguinea cum putredine majori concurrunt in tali casu facillimè fieri poterit ut praevalente calore febrili 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 in viscere sanguificationis prae caeteris corrumpatur inprimis cùm propter cutem undique pustulis exulceratam incrustatam transpiratio eventilatio difficilior fit Si enim inflammationes internae ipsiusque jecoris juxta communem nostrum amicum Guil Fabr. non rarò desinunt in gangraenam non video cur non idipsum saepiùs etiam fieri possit tunc temporis ubi variolis undique satìs quidem expulsis gravissima symptomata partium internarum inflammatarum nihilominus perdurant eo usque donec aegrum penitùs jugulent Horst Institut Med. Disp 3. coron 1. additament And in many other acute malign Diseases either the morbific matter is not discussed and discharged from the seat of the disease or else is expulsed thence into some other perhaps a remote part where it corrupts the member and extinguisheth the vital Principle called by some the innate Spirit Now concerning the curability and incurability of Gangrenes take these instructions before the disease be undertaken or left for desperate and hopeless First Consider the duration or time of the disease the age and strength of the Patient for a Gangrene in the beginning is more easie and hopeful than after continuance because it proceeds on commonly and draws nearer to a Sphacelus which is incurable also young persons vegete and vigorous in spirit are more hopeful than others aged or worn out by long or enervated by acute sickness Secondly Examine into the essence nature and rise of the disease which will lay open much of the difficulty thereof for Gangrenes from a primitive cause as Contusion Fracture Section Vstion Caustic or other erosion c. are more curable and less dangerous than those that arise and depend upon antecedent internal causes for Gangrenes of this sort do declare a cachectic depraved habit of body and that some of the internal Viscera are damnified and vitiated from whence a supply of ill matter and therefore in Hydropic Scorbatic and Hectic febrile bodies also in malign and contagious diseases small Pox Venereal Lues Plague c. Gangrenes are more desperate Thirdly The part affected or seat of the disease is to be noted for if a principal part be gangrened recovery is very rare also in the Guts a Gangrene is mortal by reason of continual moisture there and imbecillity of these also in the Vagina Vteri and Glandules of the body a Cure is seldom performed Now as touching the Cure of Gangrenes there is not any one Method or particular Medicine for Gangrenes but they require such variation of Cure according to the difference of their causes from whence they do arise with respect to the part affected And therefore we cannot point out any general course that may be applicable to this great disease but indications of particular and special cases must vary and will make exceptions against it So that the rational Physician perpending and duly considering the nature of the disease and variations thereof as aforesaid with the Symptoms and circumstances attending must design such a Method and adapt such Medicines pro re nata as may best suit with the urgency of this dangerous and threatning Malady The means required and useful in these emergencies are taken some from Pharmacy and some from Chirurgery Pharmaceutic Remedies are both internal and external Internal are select and choice Purgatives Diaphoretics and Cardiacs elaborated and prepared according to latter inventions and the best Rules of Art Topical and external are Fomentations Liniments and Cataplasms specificated and appropriated to these purposes Chirurgical helps are Phlebotomy Cupping Scarification Canteries c. and therefore an expert Chirurgeon must here be assisting to perform these operations Now all these various means are not to be used to every person gangrened but each case will require some of these more or less as the Judgment of a skilful Physician in this disease shall determine and appoint But if the Gangrene by continuance and neglect or from acuteness by great